PROBLEMS AND PROSPECTS FOR HEALTH EQUALITY
Thomas LaVeist, Ph.D.
Tulane University, USA
INNOVATION IN THE ERA OF VALUE BASED HEALTHCARE
Catherine Mohr, M.D.
In 1985 the US Department of Health and Human Services issued a report entitled, "The Report of the Secretary's Taskforce on Black and Minority Health." While the title lacked in creativity, the contents of the report made up for it by its impact. The report demonstrated that African Americans were in extraordinarily worse health than all other American ethnic groups. The report placed the health of American ethnic minorities on the nation's policy agenda and spurred government action. Congress responded by creating the Office of Minority Health at the National Institutes of Health, which would ultimately become the National Institute on Minority Health and Health Disparities. And the report introduced new terms into the health sciences lexicon - "health disparities" and the aspirational inverse of health disparities - "health equity."
Health disparities refers to differences in health status, access to quality healthcare across different populations. This may include differences in the presence of disease, health outcomes, or access to health care across racial, ethnic, sexual orientation and socioeconomic groups. The disparities in access to adequate healthcare include differences in the quality of care and overall insurance coverage based on race.
In 1999 Congress requested the Institute of Medicine (now, National Academy of Medicine) to compile a report on the state of disparities in the quality of healthcare received by racial minorities. In 2002 IOM released "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care."
But while many in the health sciences community have been mobilized to achieve health equity, 18 years after the publication of the National Academy of Medicine report, there has been little improvement. African Americans comprise 13% of the US population, but 42% of HIV/AIDS cases. African American men are just over 6% of all Americans, but nearly 43% of homicide victims. African American women are nearly 80% more likely to die from a stroke compared with white American women. In 2014, there were 308,960 African American deaths and 61,570 Asian American deaths nationwide. If the death rate for African Americans was equal to the death rate for Asian Americans, there would have been 140,669 African American deaths. Had there been equity in 2014, there would have been 168,291 fewer deaths. 14,025 fewer deaths per month. 3,237 fewer deaths per week. 462 fewer deaths per day. My friend and former classmate, Dr. David R. Williams of the Harvard University, Chan School of Public Health is fond of pointing out that 462 is about the number of seats on a Boeing 747, the most popular commercial airliner. African Americans experience the equivalent of one major plane crash per day.
So why do these disparities exist?
In this lecture I will outline the state of health disparities, discuss the key myths that misinform many about the etiology of health disparities, and summarize the challenging problems that have made progress allusive.
Intuitive Foundation, USA
BEYOND DIGESTION: HOW THE GUT IS THE GATEWAY TO HEALTH AND WHAT CAN WE DO TO HARNESS ITS POTENTIAL
Pankaj Jay Pasricha, M.D.
In a traditional fee for service model for healthcare, new medical technology products were brought into a system that evaluated therapies by themselves in isolation - were they effective enough in the single patient to warrant use of this new device or drug? Even government-funded single-payer systems have traditionally used a population-based average of this same concept of cost effectiveness. The current global move to true value-based healthcare requires an expansion from this traditional narrow focus of evaluating the therapies in isolation. It is a systems-based approach, that must take into account not just individual patient outcomes for the episode of care, but the effects of therapies on the workflow in the hospital, dynamics at a population level, and even has repercussions into how a country trains and credentials its doctors and nurses. This level of complexity presents challenges to both providers of care, and those who would develop tools for those providers to use. In her talk, Dr. Mohr will explore the history of our technological medical interventions, understanding measurements of value with an eye towards developing the next generation of medical devices.
Johns Hopkins University, USA
FUNCTIONAL ULTRASOUND (FUS) IMAGING: A NEW WHOLE BRAIN NEUROIMAGING MODALITY FROM BENCH TO BEDSIDE
Mickael Tanter, Ph.D.
In my presentation I will expound on how the gastrointestinal tract is the "gateway to health" and discuss the opportunities for innovative technologies to modulate this complex system to improve health and provide several examples of my own efforts in this area. There are several functional and anatomical reasons for this. The first and foremost requirement for life is the ability to transduce energy into a form that the organism can use. For higher animals which process complex nutrients, this process (digestion) is very involved and has required the gut to develop its own nervous system (the enteric nervous system or ENS), its own endocrine system (consisting of specialized enteroendocrine cells along its entire length) and specialized signaling channels to the central nervous system, as well as metabolically active or labile organs such as the liver, muscle and adipose tissue. Second, like the skin, the gastrointestinal tract is essentially an external organ with both ends open to the environment and constantly being exposed to toxins, infectious organisms and other threats. When the total surface area of the exposed gut is considered (~32 m2 as compared with 1.5-2 m2 of skin), it is not surprising that it has its own defense mechanisms- from the physical barrier provided by the epithelial lining to highly specialized cells actively engaged in innate and adaptive immunity. Further, the constant threat from the environment along its surface requires the CNS and the autonomic nervous system (ANS) to develop anatomical and humoral mechanisms to monitor and modulate the health of the gastrointestinal tract. Finally, in the last few years it is has become clear that almost every aspect of our health is modulated by the trillions of symbiotic organisms for which arguably the most important niche is the gut, underscoring the importance of this organ.
Physics for Medicine Paris, INSERM, ESPCI Paris, CNRS, PSL University, FRANCE
TINY LEAPS FOR ROBOT-KIND: MICROSYSTEMS-ENABLED ROBOTICS
Sarah Bergbreiter, Ph.D.
In the last twenty years, the progressive introduction of plane or diverging ultrasonic wave transmissions rather than line by line scanning focused beams broke the resolution limits of ultrasound imaging. By using such large field of view transmissions, the frame rate reaches the theoretical limit of physics dictated by the ultrasound speed and an ultrasonic map can be provided typically in tens of micro-seconds (several thousands of frames per second). Interestingly, this leap in frame rate is not only a technological breakthrough but it permits the advent of completely new ultrasound imaging modes, including shear wave elastography1-2, electromechanical wave imaging, ultrafast Doppler, ultrafast contrast imaging, and even functional ultrasound imaging (fUS imaging) of brain activity introducing Ultrasound as an emerging full-fledged neuroimaging modality.
Carnegie Mellon University, USA
USING TECHNOLOGY AND EVERYTHING WE HAVE LEARNED TO ADDRESS THE CLIMATE GRAND CHALLENGE
Leslie Field, Ph.D.
The ability to manufacture micro-scale sensors and actuators has inspired the robotics community for over 30 years. Small robots that can move around in complex environments provide one approach to tackling grand challenges in disaster resilience and improving urban infrastructure. There have been huge success stories; MEMS inertial sensors have enabled an entire market of low-cost, small UAVs. However, the promise of ant-scale robots has not yet seen success. Ants can move at high speeds on surfaces from picnic tables to front lawns, but the few legged microrobots that have walked have typically done so at slow speeds (< 1 body length/sec) on smooth silicon wafers. In addition, the vision of large numbers of microfabricated sensors enabling robots to better interact with complex environments has suffered in part due to the brittle materials used in micro-fabrication.
This talk will present our progress in the design of sensors, mechanisms, and actuators that utilize new microfabrication processes to incorporate materials with widely varying moduli and functionality to achieve more robustness, dynamic range, and complexity in smaller packages. Results include skins of soft tactile or strain sensors with high dynamic range, new models of bio-inspired jumping mechanisms, and magnetically actuated legged microrobots from 1 gram down to 1 milligram that provide insights into simple design and control for high speed locomotion in small-scale mobile robots.
Ice911 Research, SmallTech Consulting, LLC, Stanford University, USA
PRECISION MEDICINE IS ADVANCED BY PRECISION MICROSYSTEMS
Amy E. Herr, Ph.D.
Climate change is upon us, and its impacts have cost the world over one trillion dollars over the past decade. The future looks even grimmer in this regard - rising sea levels, droughts, wildfires, melting ice, and tragic losses of life, wildlife, food, clean water, and infrastructure are already being seen worldwide, and are predicted to become far worse if nothing is done - and soon.
This talk will highlight the need for engineers, inventors, scientists, policy makers, regulators, funders and caring citizens to come to the forefront now to address the largest challenge humanity has ever faced - to restore our climate to ensure a safer and more stable world for ourselves, our children, and future generations.
The worst thing we could possibly do is give up. The grand challenge for us all is to implement known technologies that will improve the climate situation, and to come up with new ideas and new ways to address these urgent problems in a responsible, safe, practical, expeditious and cost-effective way. Everywhere people are banding together to make a difference.
Our own work at Ice911 Research uses remote sensing technologies to monitor test sites treated with reflective materials to slow the ice melt. These monitoring technologies need to measure efficacy, safety and physical parameters of the testing. Small-scale field tests are used to quantify how effectively this approach can slow the melt and the data is used as inputs to expert climate modeling to indicate how and where it would be best to make internationally agreed-upon, sponsored, funded and permitted deployments to start rebuilding ice in the Arctic in order to stabilize the climate, to give the world much-needed time to complete the needed transitions to sustainable energy and fuels.
MEMS sensing and wireless communications are essential to this work. Some climate experts, such as Dr. Jon Koomey, believe that MEMS technology is one of the most important areas that can make a large difference soon in helping to address climate challenges.
This is humanity's time to collaborate and to take on this grandest challenge. Every degree matters. Every degree is worth fighting for.
University of California, Berkeley and Chan Zuckerberg Biohub, USA
MINIATURE ELECTRONICS ENABLING INGESTIBLES FOR ADVANCED MONITORING OF THE GASTRO-INTESTINAL SYSTEM
Nick Van Helleputte, Ph.D.
Recent advances in biomedicine and the biosciences are possible, in important cases, because of technology advances. Microengineered structures and systems have played an out-sized role. For example, in the area of 'wearables', physical MEMS sensors have radically changed how vital signs and activity are monitored and tuned to achieve personal fitness. In a completely different example - genomics (DNA) and transcriptomics (mRNA) - microstructures and microfluidic circuits have literally unlocked information from biology, including through successful commercialization (e.g., Illumina, 10X Genomics, Fluidigm, QuantaLife). Yet, there is a tremendous amount of biological information - and knowledge - locked at the protein level. Radically more physiochemically complex than nucleic acids, proteins are the 'molecular machines' of life. Consequently, proteins offer tremendous potential as biomarkers of disease, with certain key classes existing as nearly 'blind spots' for existing analytical tools. In her talk, Prof. Herr will detail open questions spanning cancer classification to developmental biology that are just starting to benefit from microfluidic systems designed to unlock protein-level information. She will conclude by offering open challenges that microsystems researchers might consider tackling.
Globally metabolic health is dropping at an alarming rate. Metabolic disorders occur when the normal chemical reactions are disrupted, resulting in either too many or too little of critical substances. While some are genetically inherited, others are developed when critical organs, like liver, pancreas or bowel are diseased. But also lifestyle, behavior and nutrition is critical for our metabolic health. For a lot of digestive disorders, the exact pathology and underlying disease mechanism remain not fully understood. Scientist are trying to understand the complex interactions among genetic, environmental, immune, microbial, nutrition and other factors that contribute to digestive diseases. Current practices and methods to investigate the exact workings of our metabolic system and diagnose maladies include offline analysis of stool samples and biopsies, endoscopic inspection and symptom-based diagnostics. While these have their place and merit, they all have their drawbacks and no tools exist that can measure the complex intricacies of the metabolic system in a continuous manner. Advanced ingestible technology could allow unique and unprecedented insight into the human metabolic system. The idea of ingestible devices isn't new. Ingestible camera-pills have been developed and are commercially available aiming to replace invasive and painful endoscopic visual inspection. However, existing ingestible solutions are mostly limited to optical recordings and lack more advanced sensing capabilities and are not suitable to assess nutrition and/or gut health. In order to achieve this, innovative technology is needed for multi-modal electrophysiological and electro-chemical sensing. There is a wide range of interesting parameters to sense along the GI tract ranging from the peristaltic movement and electrophysiology of the enteric nervous system, pH and simple ions and electrolytes, all the way to very complex and challenging molecules including neurotransmitters, hormones and bacteria. While lab analysis of stool samples is able to analyze in great detail complete composition of samples using advanced techniques, it is unlikely that these techniques can be scaled to a form factor of an ingestible. A far more likely scenario is to develop sensors that are specific to the target analytes of interest. To achieve an extremely small form factor and ultra-low power consumption, custom integrated sensor interface circuits co-designed with the actual sensors are needed. Almost all existing ingestible devices are currently battery-powered, and roughly 30%-40% of the volume of existing devices is consumed by these batteries. In order to allow a scale-up in functionality while at the same time a significant reduction in device size, alternative powering methods are needed. Wireless power delivery has been researched extensively, and the methods can be roughly divided into harvesting mechanical energy (vibrations, movement, ...) optical energy (i.e. solar cells or similar optical receptors), RF energy and chemical (i.e. bio-fuel cells). The biggest challenges for the envisaged applications are the size constraints and the tissue depth. There will be innovations needed to push the device size down, while ensuing still reliable operation for a free floating ingestible device. Similarly, ultra-low-power wireless communication with a small footprint and antenna size is required.