Dr. Daniel Kraft is a Stanford and Harvard-trained physician-scientist with more than 25 years of experience in clinical practice, biomedical research and innovation. He is the Founder and Chair for Exponential Medicine, a program which explores convergent, rapidly developing technologies and their potential to reshape the future of health and biomedicine. In 2020 Dr. Kraft became the Chair of the XPRIZE Pandemic Alliance Task Force: made up of 60 leading Universities, Fortune 500 and startups, focused on catalyzing new and existing solutions.
As a speaker and thought leader, Dr. Kraft’s TED and TEDMED talks plus other speeches and interviews online have millions of views, as he offers a compelling fast-paced look at the present, immediate future, and next few years of innovations in healthcare and medicine. Dr. Kraft is passionate about new tools, apps, tests and wearables that by capturing our data combined with AI, are revolutionizing the way we monitor our health and draw a path to wellness – changing the health industry’s focus from reacting and treating sickness to preventing it.
Kraft has conducted extensive research in stem cell biology and regenerative medicine with multiple scientific publications, medical device, immunology and stem cell-related patents through faculty positions with Stanford University School of Medicine and as clinical faculty for the pediatric bone marrow transplantation service at the University of California San Francisco. Kraft is the inventor of the MarrowMiner, an FDA-approved device for the minimally invasive harvest of bone marrow, and he founded RegenMed Systems, a company developing technologies to enable adult stem cell-based regenerative therapies. He is an advisor to the XPRIZE Foundation (where he conceived of the Medical Tricorder XPRIZE and is helping lead a new cancer-focused XPRIZE) and advises several digital health and life science companies.
Kraft is an avid pilot and served for 14 years as an officer and flight surgeon with F-15 and F-16 fighter squadrons in the Air National Guard. He has conducted research on aerospace medicine that was published with NASA, with whom he was a finalist for astronaut selection.
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Dr. Daniel Kraft: Top Healthcare Futurist – Technology Keeping Us Healthier
Joining me now is Dr. Daniel Kraft, a Stanford and Harvard-trained physician-scientist, inventor and entrepreneur with over 25 years of experience in clinical practice, biomedical research and healthcare innovation. He’s board-certified in both internal medicine and pediatrics and has been called one of the 40 smartest people in healthcare. In 2020, he became the Chair of the XPRIZE Pandemic Alliance Task Force. He’s the Founder and Chair of Exponential Medicine, a program that explores convergent, rapidly developing technologies and their potential in biomedicine and healthcare. He’s one of the most in-demand speakers in the world on the future of health, medicine and technology.
Daniel has given five TED and TEDMED Talks, which have millions of views. He has multiple scientific publications, medical device, immunology and stem-cell related patents. He’s also the inventor of the MarrowMiner, an FDA-approved device for the minimally-invasive harvest of bone marrow. Dr. Kraft also served in the Massachusetts and California Air National Guard as an officer and flight surgeon with F-15 and F-16 fighter squadrons. He’s conducted research on aerospace medicine that was published with NASA, with whom he was a finalist for astronaut selection. Please join me now with the incomparable Dr. Daniel Kraft.
Dr. Daniel Kraft, thank you for joining me on the show. How are you doing?
Chris, it’s great to be with you.
How is everything going up there? You’re up north in Northern California, I’m sure.
I’m in sunny Northern California. The skies are blue. We had a lot of smoke and other issues on top of the pandemic. I’m next door to Stanford and the heart of Silicon Valley. It’s like all of us are trying to connect the dots and hopefully do good things in the midst of this pandemic.
You’ve been doing a lot of great things. I know you’re on the XPRIZE Pandemic Alliance Task Force, which I know you’ll talk about in a little bit. I was thinking a lot about you during this pandemic. I’m so excited you’re here. You’re one of those speakers I always recommend to certain organizations who want a speaker who can talk about the future of healthcare, the present of healthcare and medicine, and all of the advancements in technologies that are happening and coming. All the things you’ve been talking about for years are now starting to come into the world such as the technologies, telemedicine, the doctor-patient relationships are improving via technology because of the pandemic.
COVID certainly has had its challenges, but there’s a bit of a silver lining in terms of some of the things that are emerging. Hopefully, it will bring us to a better, brighter future of health and medicine around the planet, including improving health equity and the ways we communicate. Certainly, virtual care has exploded as folks didn’t want to go into the clinic or the ER. It’s been a catalyst for change. There’s a quote from Regina Dugan who was the head of DARPA that, “Sputnik sparked the space age, and COVID is sparking the health age.” We’re all now more involved in appreciating public health and infectious disease and its role in our personal health, friends, family and the economy. One of the upsides of the COVID pandemic is that it’s going to put more attention, focus and energy around building better healthcare systems that will benefit all of us downstream.
I know you’ve been a part of so much of this. You’ve been a proponent of many things that are now out there and starting to happen. I know you did a talk for TEDxMarin that is touching on everything you’ve always talked about, but also where we’re at with this pandemic, where medicine is now and where it’s headed. Talk a little bit about the Pandemic Alliance Task Force, what you guys are doing, but also a little bit about what you’re most excited about that’s starting to occur that you’ve been saying would occur for the last several years as far as those relationships and technologies are working for the patient’s benefit.What we practice today is not healthcare, but sick care. Click To Tweet
If we take a big zoom out of where we are in 2020, which is used to be the future. We’re still using fax machines and paper forms. I even had my own cardiac study done a few months ago that I could only get out on a CD-ROM. I don’t even own a CD-ROM player anymore. It’s like someone gave you a VHS tape to look at your cardiac study. Even where we are now and even in the setting of the pandemic, we don’t practice healthcare. We practice sick care. Sick care is based on how we’ve practiced medicine for eons. I’m a traditionally trained physician-scientist type. The way we tend to practice medicine is based on very intermittent data.
Chris, you’re healthy. Maybe you go and get your checkup once a year. That’s why you get your labs and vitals. Even if you had something like hypertension, you maybe try and fax a PDF of that to your doctor who may not ever want to see the data. That’s the intermittent mode of how we collect data. It’s usually only in the four walls of the clinic, ER or ICU. We’re used to a reactive sick-care state where we wait for the patient to show up with a heart attack or stroke. I’m an oncologist by background with late-stage cancers, for example. We wait for the pandemic to arrive and go, “It’s a bit late and hard to get things back to normal.”
The big picture is we have an opportunity now to leverage a lot of the new technologies we have to be much more connected with our real-time data, whether it’s from a wearable, our genome, or a medical record, to be much more personalized and proactive. Hopefully, it will start to bring care anytime, anywhere at a lower cost with better outcomes. What COVID has done is it unleashed a lot of creativity and innovation to address the whole paradigm from detection, screening, vaccines and PPE. I’ve been involved for more than ten years in the XPRIZE, which is modeled around putting a prize up to address a big, hairy, challenging problem that the market wasn’t addressing.
Through the lens of COVID, we started an XPRIZE Pandemic Alliance made up of 100 different organizations from NGOs and universities to big companies like Microsoft and IBM to small startups with the idea that, “A lot is happening. How do we connect the dots? How do we find the challenges that need to be solved and catalyze those forward?” There are a lot of initiatives we can talk more about. The one that’s probably most on people’s mind is the need for better testing. Even now, several months into the pandemic, it’s still often challenging to get a test, often waiting days to get the results. It’s still often $100 or more per test.
What we need to open up our schools safely, get back to work and travel is a fast, frequent, cheap and easy COVID test. It’s something you could do in ten minutes at home, leveraging your smartphone potentially. We launched the XPRIZE together with OpenCOVIDScreen led by Jeff Huber. $10 million were raised, and 707 teams entered the competition from 70 countries. We’re going to narrow that down to 200 and then to 20 and then 5. The idea is that we’re going to catalyze those winners to market. Hopefully, by early 2021, you’ll be able to get dropped off by Amazon your $5 every-other-day COVID test.
When you do have that test result, how do you communicate that? How do you put and connect that to your passport if you want to travel internationally or walk into Starbucks or school? There are other things emerging. One is called a common pass, a bit of a digital yellow card. There are lots of things coming together. The XPRIZE Pandemic Alliance has been doing a great interface. The task force which I lead has amazing folks from Dean Kamen, who’s probably the Edison of our time, to the former head of NIH Cancer Institute, to champions of industry, to folks who are in the weeds on infectious disease. I’ll stop it there. It’s been an interesting time for me. I live at this interface of technologies to help catalyze solutions that relate to this pandemic but also can help prevent future ones.
You mentioned the wearables. I’ve been hearing about that for years. I know that it’s here. My wife is waiting with the anticipation for her iWatch to show up, which has the phone on it. Tell us a little bit about some of that. A lot of speakers, articles, and people out there are talking about all these great technologies that are coming, that are around the corner or that might be here but only for some people. What is it that we can all take advantage of? I know that a lot of people aren’t even aware. The doctors in the healthcare centers aren’t telling us about all the things that are accessible to us. What can we all do? Are there ways we can call up our doctor and say, “I want to be better connected to you now. Let’s put this in place?” Is that going to start happening? When we start seeing our doctors, are they all going to be recommending some new things for us to do with technologies to improve our lives?
Technology has been accelerating. I’ve been the Chair of Medicine at Singularity University since it started several years ago. I founded and run a program called Exponential Medicine. The theme there is, what are these exponential technologies? How do you put them together to solve challenges across healthcare, from global health to prevention, diagnostics and therapy? One great example of exponential at play is what now fits on your smartwatch. What used to be many years ago would only be in a plugged-in desktop now fits on your smartphone and smartwatch. Soon, it will dissolve probably into your Apple augmented reality glasses.
It’s an incredible time. Most people tend to under-appreciate the pace of exponential change, the Moore’s Law, the power of computing. What fits on my smartphone, which my iPhone 11 is amazing, will feel antique soon. Now, it fits on your watch and into rings. This idea of wearables is essentially mobile computing connected now through the Internet of Things or the Internet of Medical Things. We can do simple, straightforward things now related to COVID or beyond. One of those is the fact that now there are even low-cost wearables. There are versions of the Apple Watch that you can get from China. I have one here. They are $20 but do pretty much everything that my Apple Watch does. They can give you a lens into your own health and health trajectory. Potentially, it can be a bit of a check engine light to see if you have the flu or you have COVID.
Some recent studies from my colleagues at Stanford came out that, “With a smartwatch, you can look at heart rate, heart rate variability, respiratory rates, steps and predict who likely has COVID even when they’re relatively asymptomatic.” The new watches have EKG built in. If you’re sitting down like we are and your heart rate is 180, it might warn you that something is going on with your cardiac state that isn’t normal. We’re going to start to see these wearables give you insights into your overall health and health trends. They can help you become healthier on the wellness side, but also help detect and manage disease as we go forward. It’s the idea of quantified self where you might have all your data on your smartphone to quantified health. It will start to flow to your doctor, nutritionist or physical therapist so that we can use not just the data but the useful, actionable information in a smart way that can help drive insights, diagnostics or therapy.
There’s a new iPhone or iWatch commercial that says, “In the future, there will be a day when you can,” and they were like, “Yes, we have that.” Are there any other things that we should do in a pandemic and also without a pandemic that we should have on our body and in our house that most people don’t have yet because nobody is talking about it and they are not thinking about it enough?
Thinking about the pace of change, it was only a few years ago at the end of 2009 that the first Fitbit launched. Now, I’m wearing four devices. I’ve got my Fitbit and Whoop, which is great for sports and training. I’ve got my Apple Watch. I won’t show you the actual one in my underwear. I have an underwearable. It’s version of the Spire. It’s a little patch. I call it an underwearable that will track respiratory status, heart rate and movement. This started like the Fitbit as a consumer device to track steps and sleep and now are becoming medicalized. If you have a particular condition, let’s say you might have COVID at home, pneumonia or bronchitis, this can track your respiratory status.
You get a pack of ten of these. Put them in your underwear bands. You can even put them in the laundry. The battery lasts for a year. You don’t need to think about it as long as you have your underwear on, which hopefully most of us do most of the time. You can track your physiology. It’s what I call your digital exhaust or digitone. To answer your question, there are all sorts of wearables out there. They’re all much the same in terms of tracking your steps and sleep. Get a simple wearable, one that you like to wear and is fashionable for you. There are lots of different form factors.
Start to get insights. The most important thing to get insight might be your sleep. Sleep is so important to your overall health. A lot of us, particularly in the medical world are sleep deprived or through medical training. Many of us are stressed and don’t get enough sleep. You can get basic insights on your wearable. Many of them can show you, “Chris, how do you compare to others your age and sex in terms of your sleep metrics? How might you improve those?” Coaching is starting to come in there. That might be one simple metric that doesn’t require a doctor or prescription that can dramatically improve and lower your risk of everything from heart disease to diabetes, to depression, to obesity.
Another thing is simply your activity. In the era of COVID, particularly as the lockdown happened, we weren’t going to the gym as much. I watched my activity rate go way down. An example of what you can all do, you can do a workout without anything. There are now YouTube videos, apps and nine-minute workouts. I spent 100 days straight in virtual reality doing workouts. VR is an amazing new platform. These are getting amazing. This used to be a million dollars of technology in a lab at Stanford. Now, you can buy the Oculus and others for $300.
There are now VR-based video games. For exercise, the one I’ve been doing is called supernatural. It’s like Beat Saber on steroids that tracks your heart rate. It’s gamified. You can track your friends and how they’re doing. In 100 days of doing that, my resting heart rate went down eight points, my sleep got better, and my weight went down a couple of pounds. It’s an example of things we can all do. You don’t need fancy, prescribed wearables or other things. It’s just looking at your own data, getting engaged with that and then potentially sharing that with your clinical team, depending on what your issues are. It’s part of now and the future of health and medicine.
Do you have a choice with your doctors to have them monitor the things you’re wearing? Is it up to you to monitor it and let you know that there’s something going on and you need to check out? I’m sure there have got to be some debates going on about who’s watching this information. You said there’s a little bit of a crowdsourcing going on for your community, “Don’t shake hands with Bob today. There’s a 43% chance he’s got COVID.” How does that crowdsourcing work? How does the community look at this data? Can you opt out of it or opt into it?
To see what’s possible now, if you have an Apple phone or even Android, now there’s Apple HealthKit. Now, there’s something called CommonHealth that you can do at Android to start integrating your connected scale, steps, sleep data, smart home information, and maybe even your blood glucose monitor. I’ve got one here. I wore this for the first time, a little patch that is a continuous glucose monitor. All that data can flow into my Apple HealthKit. Normally, only I would see that. It gives me a bit of a dashboard. In the last few years, with many healthcare systems, you can opt in to share that data directly into your own medical record. Theoretically, your doctor could see your wearable data. The challenge is, “How do we make sense of that?”
We haven’t had millions of people with digital exhaust being measured. What’s normal? What’s a normal resting heart rate when you sleep? Part of what you have and you’ve mentioned crowdsourcing, is that now there’s the ability to be a data donor. A Google spinout called Verily has something called the Baseline Trial, 10,000 or more volunteers sharing their digital data, medical records and genomes. The National Institutes of Health has a million patients study called the All of Us trial, which you can still sign up for, where you can donate your medical records, wearable data, blood for your genome and other elements. We’re going to start to crowdsource health and disease.
Many folks out there may have heard of the Framingham trials, a study that’s been going on for 60 years, mostly nurses in Western Massachusetts in Framingham, that have been the basis of who benefits from statin, and what’s happening with cardiovascular disease. What should we do about it? That’s based on a narrow subset of mostly European Caucasians, where now with these sorts of platforms, giving a much more accurate picture across races, socio-economics and locations. Part of the future of health and medicine is what I like to call building the Waze or the Google Maps for health, where we’re all starting to share our data if we want to but we get something back. We get the traffic of our health journey with patients or individuals like us based in our genomes or other elements.There are real, life and death implications of how we share information. Click To Tweet
We’re learning many chronic diseases are very challenging to manage. The clinical trials are usually only on a very narrow subset of patients. Now, there are platforms. One is called StuffThatWorks.health out of Israel that’s built by one of the founders of Waze. If you’ve got migraines, you can learn about what’s working and what’s not working for you, find a whole community of folks with migraine, gain insights in using AI machine learning and get data back. There are lots of new ways to collect data. The challenge is to make sense of that, take that into actual information that you or your clinician, healthcare system or pharma company could use, but still to do that in ways that are honoring privacy and the option to share or not to share. Hopefully, if you are sharing your data, to even get rewarded for that in other ways.
I love that idea of being able to be in a community of people having the same thing, and understand what they’re doing, or having the doctors share their information globally in how they’re treating certain things. I remember a story about Michael Milken. He found out he had stage-four cancer. He went all around the world and talked to all these doctors about how they were treating that type of cancer. He did everything he could to get them to share their information with each other. That wasn’t being done. There’s proof with him in what he did with prostate cancer that when you share data, people get better.
He is a billionaire hedge fund guy who could afford to get all these second opinions and access the crowd of best specialists. Now, in this age of super connectivity and virtual elements, almost any of us should have the ability to have the world’s best information synthesized. The challenge with medicine, as I trained at Mass General Hospital and Stanford, “This is the Mass General way of treating heart attacks or managing disease. Here’s the Stanford way. I saw three patients once three years ago,” but wouldn’t it be great if your clinician or doctor was using the hive mind and had in their hand the right information at the right time? They can’t read all the clinical trials or be up-to-date on everything.
We’re seeing this new blend of AI but I like to call it IA. Not artificial intelligence but IA, Intelligence Augmentation. That’s necessary now if we’re going to up-level everybody to make sense of the data and to synthesize your genome, microbiome, sociogram, where you’ve lived and metabolomics, that could be from your blood sugar. All these things are almost overwhelming amounts of data that needs to become accessible real time. They can continually improve and not take the average seventeen years from discovery and publication to your doctor or specialist knowing what to do with that going forward.
Have you heard and seen that the world is sharing their information with each other? I know there was this huge debate over hydroxychloroquine and Remdesivir. Even Trump himself was talking about HCQ was the way to go. I think he was treated with Remdesivir.
Part of the challenge with the pandemic is we also have an infodemic. Unfortunately, President Trump has been one of the most flagrant instigators of misinformation or promulgating, “Magic cures, hydroxychloroquine,” which very early on, in some basic stuff, had a little bit of promise but never panned out in the gold standard, a double blind randomized placebo-controlled trials. Even the other drug you mentioned, Remdesivir, an antiviral which has been around for a while in more studies. Even though it was published by the World Health Organization, it doesn’t look like it has that much of a benefit. The old drugs like dexamethasone, a steroid, does seem to have the best effect, particularly in sicker patients. Trump did get steroids and Remdesivir and something that’s still in clinical trials. These antibodies that are polyclonal antibodies directed to the virus itself may play a major role going forward but are very expensive and are certainly not ready for prime time quite yet.
In the age of the pandemic, how do we manage information? There’s so much disinformation some good information and where you’re getting your information from. Early in the spring, those who got most of their information from Fox News had a much higher mortality, morbidity rate than those from other sources. There are real implications and life-and-death matters on how we communicate, and also to encourage folks to share their data in smart ways so that we’re all learning faster. Whether it’s for cancer, I trained as a pediatric hematologist/oncologist. Pediatric oncology was the first area to show that we can move the needle. In the 1960s, almost every kid died of even common leukemia. By almost getting every child and their family essentially in a clinical trial, that improved things on the pediatric side that translated to adult oncology.
Even now in most cancer patients, only about 20% or less are involved in a clinical trial. There’s a lot of data information that is being lost and a lot of the incentives are misaligned. Big Pharma companies and academics don’t often want to share that information. One of the good things about COVID is there’s a lot more collaboration happening. We’ve learned how to treat sick patients. The death rate of an intensive care unit intubated patient has gone from 80% to less than 50%. We are making improvements. I think that’s going to help other elements of healthcare going forward.
Hopefully, the other elements of healthcare can learn from what’s going on with COVID. I read that death rates in COVID are going down not just in the young and healthy, and going down by a good margin. That’s great to hear.
There’s a downside. We’ve had probably over 300,000 US deaths contributed by COVID. Some folks were older and had comorbidities. On average, ten years or more of life are lost per COVID death. There are big implications there not just on the human level, but on the economic and others. We’re learning that there’s something called long COVID or long-haulers. What’s the long-term implication? COVID is still a novel Coronavirus. It’s only been around in less than a year. A lot of especially often younger, healthier women are having significant long-term morbidities with neurological issues, pain and cardiac. Even if you had a relatively mild case initially, it doesn’t mean there may not be significant downstream ones, which are going to prevent people from working, having good cognitive function, or shorten their lives. It’s still a long way to go. Even if we are not dying at the same rate, some of the other elements might come back to bite us in a very significant way.
You’re a guy who I would want to talk to at this moment in history more than maybe any other human being I could talk to. I’m going to ask you a question that’s on my mind that a lot of people are also wondering. What is going to happen with this pandemic and this disease? Is 2021 going to see the end of it? Is it looking good to you? Are the numbers looking good? The second surge is not happening in California. I’m living here in California watching the numbers the whole time in LA. I’m sure San Francisco is similar, but California as a whole, the numbers are going way down and continue to go down as far as cases and deaths.
I’m hearing around the rest of the country that there’s this second surge. I talked to somebody from Dubai who said there was a second surge there. Is that going to hit all of us? How bad is it going to be? Are we going to be better prepared for it since we went through it before? Everybody is going to know, “I’ve got to put on the mask. I’ve got to socially distance. I can’t hang out in crowds without masks. Don’t go indoors with people you don’t know.” I hope everybody does that. Tell me your take on the immediate future. Where do you think this is headed?
Health, like politics, is often local and social. Also, we’re in a global world now where we’re super connected. It’s like if you piss in one corner of a swimming pool, that’s going to eventually distribute across the large pool. Sadly, we’re talking in late October of 2020. There is this third wave. Parts of the world like Europe that had done a good job. They are ramping out. The charts now look almost vertical. It’s very scary. That’s because part of it is we’re having pandemic fatigue. People are not always wearing their masks or socially distancing. There is a need to unlock and open up society. There are downsides to overdoing it. How do you safely do that with old-fashioned public health, trace test and isolate? We lost that game super early in the United States. Some parts of the world did a much better job, but it’s rolling back. While California might be a lag, it’s going to creep back here if we’re not on top of things.
Where are things going to go? I tend to be an optimist. I know several of the CEOs of companies who are building out new forms of vaccines like Moderna, which is mRNA-based or those that are DNA-based. It looks like we’ll be on track to have some of what looked like to be safe and effective vaccines by the end of early 2021. That doesn’t mean they’re all distributed. It doesn’t mean that it’s going to work on everybody. If you heard the term herd immunity, you need to have 60% of these vaccines being taken and then a 60% efficacy or more to get that effect where enough folks are vaccinated and immune or have had COVID, that it stops its spread.
I’m hopeful that by next summer, which still feels like a long time away, most of us, at least in Western markets, will have access to a vaccine. We still don’t yet know if we need a booster. How long does that immunity last? Are some vaccine types going to be better for older folks or younger? What happens when 0.01% still have some bad side effects? What’s the plus-minus element? We’ve already heard that some vaccine studies have been put on hold because one patient had an autoimmune or potentially an autoimmune response. There are lots to sort out. That means we need to have that phase four. When you get the vaccine, be part of a global study. Report back if you have other symptoms. That’s how we’re going to learn and improve.
Both of us, we’re talking virtually. It has disrupted many industries. Certainly, the public speaking world has gone and changed. I’ve done many virtual talks. You’ve had many of your amazing speakers do the same. How do we reinvent conferences in the future when we’re back in-person while we still don’t have full-on vaccination and the pandemic is awaited to be safer? I’ve spoken at two in-person events. We all got actual COVID tests. These are 40 people. We’d go into the bubble, “How do we integrate that into the future?” I’m hopeful by next fall, we’ll have a good percentage of the US population vaccinated. That’s going to depend on good communication. People not being red versus blue and saying, “I have the freedom not to wear a mask or not to vaccinate.” We are all in this together. I’m hopeful by the end of 2021, it feels like a long way away, we’ll get back to some level of normalcy. There’s still going to be a lot of downstream implications, challenges and surprises.
Being in California, did you like what our governor said when he said, “We’re not just going to take any vaccines that come into California. We’re going to look at them ourselves first?” Are you going to be part of that task force or group that’s going to look at these vaccines on behalf of California and Gavin?
I know Gavin a bit. I’m not on his exact COVID vaccine panel. The key thing is to have good non-politicized scientists. Even the FDA has done a good job now, pushing back and going, “We’re only going to be releasing vaccines when they’re safe and effective, not based on some political timeline.” We need to look at the data. Because these vaccines will be developed quickly, we don’t yet have the 2 or 3 years of safety data. We’re going to need to keep learning, having our filters out there, and being vigilant but at the same time, moving forward without being too fear-based or waiting ten years for the vaccine to be ready.
What are you telling your friends and your family to do now in our lives? I know you’re going to say washing hands and wearing a mask. What are some of the things you’re taking? This is a little bit more of a personal part. What are some of the supplements, vitamins or food that you believe in?
Number one, for some of us, it’s a good time to get focused back on our health whether it’s doing your workouts, mindfulness and meditation. Paying attention to mental health is a big thing here and trying to optimize your sleep. We can be physically distanced but not socially distanced. In some settings, I’ve had reunions with college classmates and others. We would never have gotten together, at least on Zoom, in the same way. Aside from wearing a mask and washing your hands, there are some things that are potentially protective.The future of medicine is personalized, data-driven, and intelligent. Click To Tweet
One of them is vitamin D supplementation. It seems that many folks who are more susceptible and then have a bad course of COVID have low vitamin D levels. It’s easy to take some vitamin D supplementation, usually after dinner. It’s fat soluble after a meal, not in the morning on an empty stomach. That seems to have some potential protective elements, not a magic bullet. Vitamin C also can seem to play a role in folks who are sicker but might have some protective elements, and little bit of zinc, which seems to play a role in the function around immune system. Not to go crazy on any of these things and don’t overdo it but 4,000 units of vitamin D before bed, just chewy versions.
Is it just regular vitamin D? Aren’t there all these different types of Ds like D3s and all these different variations of D?
There are a few different variations. All of them should do a reasonable job. Getting an addition of 200% of your vitamin D suggested will probably do the trick. Whether other vitamins play a role, still the jury is out. We’re doing trials in these areas. Stick to the basics. There’s no magic bullet. Encourage everyone to get their flu shot. We’re going to have a twindemic as well. In wintertime, people are in closer to quarters. That’s when flu promulgates. You don’t want to get the flu and COVID.
You can’t get COVID from the flu shot?
Absolutely not. You can’t. Sign up at your corner. With our magical technology and your smartphone, you can make your appointment at your local pharmacy to get your flu shot. Make sure they’re in stock and get that done. This is a time also, in terms of what to do, maybe start using some of these quantified self-technologies to get a picture of your health. It’s the scale. It could be the simplest thing. You look at your weight every day. It’s up a pound and a half. You might back off on the extra bread the day after. It’s just the simple measures. You can all now get sequenced. Sequencing have dropped at twice the rate of Moore’s Law. We’re learning that there are some genetic elements to your risk for COVID, your blood type. Type O, which I’m lucky to have, seems to have a bit of lower risk or morbidity rate.
Understanding your genomic risk not just for COVID but more for other diseases. It can mean that part of this cutting-edge in future medicines were going to know your genetic profile. If you have a high risk of Alzheimer’s, breast cancer or diabetes, you can do things earlier when you’re healthier. They’re much more proactive. Maybe getting that mammogram done earlier if you have the genes for a higher risk for breast cancer. Maybe changing your diet earlier in life if you have a risk of obesity. There’s this big potential to take our new forms of data to personalize them and be much more proactive and preventative to bring us a much better healthspan. It’s nice to live to 100, 120 but no one wants to be 120 and feel 120. There is a lot of interest in longevity and technology that could impact that. That means starting with the basics before we go to the magic age reversal pill.
This is all such great information. Thank you so much for sharing all of this with us, being truthful and such an open book. You just said something that reminded me of one of the things you’ve invented. You’re also known as an inventor, scientist and MD. What can you not do? You’ve invented a bone MarrowMiner but you’ve also worked with stem cells, which is interesting. You said the word personalized, which reminded me that you are working on or have already invented some 3D printing of personalized medication. What’s that all about?
We all see challenges in health and medicine. I always say, “Look for that pain point.” When I was a fellow at Stanford, I was part of the first year of the Stanford Biodesign Program. The whole idea is to find a problem that could be a personal one about remembering to take your meds, keeping grandma from having a fall, or replacing fax machines and find a solution. One challenge I’ve seen, I trained both in pediatrics and internal medicine, is when we’ll dose kids based on weight. We’ve got four-year-olds. You don’t give them the same amount of Tylenol you would take. It’s often based on weight. When we get to be adults, everyone gets the same dose of Tylenol, Vicodin, aspirin and statin.
In reality, we should be practicing much more personalized precision medicine based on weight, our pharmacogenomics and blood levels. We have the challenge of a good percentage of the US population is on polypharmacy. They’re taking seven or more pills a day to manage their hypertension, diabetes, mental health, and vitamin D. A few years ago, I thought, “What can happen at this convergence of technology? What if we could 3D print your own personalized polypill?” Here’s a little version of one. The idea of a 3D printed pill is like a Contac Cold pill, where you drop the right number of little suspensions in there to match your dose of aspirin, statin, beta blockers, Synthroid, vitamin D, whatever it might be.
I developed a little printer that would start maybe in your corner pharmacy. Eventually, you might get a little cartridge. You put a little cartridge at home like your coffee machine. It will blend the crisp blend of prevention, multivitamins or therapy that matched you. You might change that every day based on your wearables and other data that would be in your home. That’s the big picture. The future of medicine should be personalized, data-driven and intelligent. The startup I have is called IntelliMedicine. Hopefully, we’re using our new Omix and new data to help pick the right drugs and dose that match you. A lot of folks are still cutting pills in half or thirds or overdosed or under-dosed. Little grandma doesn’t need the same dose of even aspirin as a 200-pound linebacker or 300-pound linebacker.
That’s IntelliMedicine. It’s the idea that we would eventually get to a point where we can 3D print a pill that’s built for you based on you and is modified based on your own data, rather than that broken feedback loop system where you might have something super common like hypertension. High blood pressure is the number one cause of early death and morbidity around the world. Many folks have it or don’t manage it well. Now, you can do fun things like track your blood pressure on your watch. This is a watch with a blood pressure cuff built in. That’s going away soon because now there are cuffless versions like Radar that will track your blood pressure 24/7. They’re going to be built into your watch or a patch. Imagine that data is used instead of once a month getting your blood pressure check to modify your blood pressure medicine that’s printed it out that day.
That’s part of where medicine is going to hopefully go into the future. Ideally, you don’t need medications at all if we should start with prevention and wellness. Many folks have showed like Dr. Dean Ornish that you could even reverse heart disease with diet, meditation, connectedness, love and understanding. I love this quote at my Exponential Medicine conference, which is very tech-focused. We have a morning meditation on the beach. My friend, Swami, who is 70 something years old, had never taken a drug in his life. He said, “The only medication you need is meditation.” There are lots of things we should do before the pill. Realizing that many folks do get diabetes, heart disease and others based on genetics and other issues, even if they are super healthy and run marathons every month, we need to be smarter and integrate that care going forward.
One big point is that technology is only a part of the solution. We need to understand incentives. Many of our healthcare systems are sick care systems. They don’t do better when you don’t show up for that procedure, bypass or surgery. How do we rethink how we incentivize doctors, nurses and each of us to be much more on top of our health and reward that pay for prevention rather than pay for disease? That comes into how our health insurance is set up, fee-based versus value-based care. Part of what we need to do is think about how we re-align the incentives and how we practice health and medicine in a way that’s aligned with better outcomes.
Are you working on all of that?
I try to in different forms. There’s so much out there now. Part of my world is digital health, this idea of mobile connected anytime, anywhere. It’s not just wearables, by the way. Now Wi-Fi can pick up your vital signs, your sensor mattress, or the voice on your smartphone can pick up signs of early neurological disease or the sound of your cough is different for COVID versus the common cold. We have all these new data forms and new apps. There are the apps that connect to your wellness device and help you with your runs and diet. Apps that can help manage hypertension, cancer or mental health issues, or wearables that can be related to those as well. We have now not just wearables. We have insideables, chips underneath the skin. Trainable is one of my favorites. It’s this little sensor. It’s called the upright. You put it on your back. Our postures aren’t great on our smartphones these days. It buzzes your back a little bit when you’re hunched over. That can trigger to improve your posture, which is good in your Zoom calls.
It’s like when you’re driving and your steering wheel buzz because you went over the middle line.
It gives you a little feedback. Our cars are getting smarter. Our wearable technology can start to do that, or the idea of hearables. These devices play music but some of them now can pick up your vital signs. They can give you coaching on your runs. Some of them are going to be that Siri in your ear, that for someone who might have Alzheimer’s, you can say, “Help me find my home. Who am I talking to?” All those things are going to get layered in. There’s so much happening in digital health and medicine, I’ve launched an early version of a website called Digital.health, where you can start to see a bit of what’s available and what’s coming. Hopefully, your clinician can prescribe to you that connected blood pressure cuff and get the data back in a form that’s useful to both of you to help co-manage that disease. The new drug is the empowered you, the empowered patient who’s not waiting to go to Dr. Welby after a problem happens but as part of the whole self-care.
You’re also an expert on VR, AR and XR. Tell everybody about what that is.
I’m not exactly an expert but I’m an enthusiast for this convergence of technology that’s bringing us amazing augmented reality, virtual reality, and what’s called XR, extended reality. I still have over here my antique Google glass that’s magical. Several years ago, they were a great consumer hit. They’ve had a lot of applications particularly in healthcare. There are platforms where physicians will use these to pull up information about their patient to have scribing. There’s someone watching the video and typing their note for them so that can lower the stress of having to type medical records. It has been used for new mothers to learn how to do breastfeeding when they have a coach watching through, or in kids with autism where they can learn to see the emotions of their mother and gamify and improve their emotional intelligence.
Augmented reality is now exploding with things like HoloLens from Microsoft and Magic Leap where now in the operating room, you can pull down the MRI machine information or a CT scan and layer it inside the patient, and use that to guide you through a therapy. That’s augmented reality coming to the operating room. My four-year-old has a shirt where you can put up the iPad and see through their body virtually. It’s a great way to educate them about their anatomy. There’s virtual reality. We talked about the Oculus Quest. It’s great for fun and games and exercise, but VR can be for therapeutics. You can put patients with bad pain from a burn injury. For example, in a cold environment, they’d throw snowballs at penguins. They can use far less or almost no opiates because their brain has been retooled.No one technology will bring about the future of healthcare, but the convergence of everything that we have now holds great promise. Click To Tweet
It can be used for physical therapy. If you have a shoulder surgery, you go into a VR environment and it gamifies doing physical therapy. It gives you points. People are much more tired of their physical therapy. It’s being blended with mental healthcare. It might be a drug or a virtual trip to augment your meditation in VR. It’s being used for training. It’s a game changer. A surgeon now can go into a virtual operating room and practice that orthopedic procedure with the actual virtual instruments they might use on you. That funny fracture or problem might be based exactly on the patient that you’re going to operate on and you can practice. There are lots of applications of AR and VR.
Extended reality is almost that time where we can blend social. I could bring in another doctor and do a consult and be over my shoulder in the operating room. Even on the simple version like in iPad, there’s been work done where a basic medical student in a war zone can be mentored by a trauma surgeon from New York City, watching what they’re doing and even pointing on the iPad, overlapping the patient. It’s a great example of convergent technology. That’s going to be a big game-changer for education and therapy and how we even interact with our own medical element. I’ll give you one fun example. I’m a pilot. I’ve spent time as a flight surgeon in the Air National Guard, taking care of and flying with F-16 and F-15 pilots. We have what’s called the heads-up display. You’re not buried in the cockpit and the round dials. You’re seeing through the cockpit like the heads-up display in a Google Glass.
Imagine our future where you’re getting some guidance either if you’re a doctor that does a procedure, but if you’re in everyday elements, my joke is if you see your breakfast in one way like hash browns, eggs and maybe something not so healthy, and then you show it in another way with the overlap. How many calories is that? How much sugar? Can you be eating that now? There are lots of ways where we’re bringing augmented reality. On the exponential, Apple and others are probably going to likely come out with very consumer, almost invisible augmented reality into our glasses and contact lenses. It’s going to change how we interact with our environments. Conferences and meetings are going to be augmented in VR. I went to Burning Man in 2020 in virtual reality. I ran into somebody I knew, Robert Scoble, who’s a well-known writer and speaker on virtual reality. We were having a normal conversation. We even had a selfie in virtual reality. It’s going to be a game changer. Folks haven’t tried VR now. It’s getting cheap, powerful and lots of fun games but also lots of other ways to use that in your future virtual meetings and conferences.
All of this is so unbelievable. Now, there are conferences where you can go into the lobby and the lounge and hang out with everybody else who’s also sitting at home in this virtual environment. It’s promising. That’s amazing.
Zoom on steroids because I think we all had our fill of Zoom by now. There are ways to make it much more engaging and three-dimensional. Here I am now as my avatar. It follows along here. I can even show up with an overlay. How do you like that? It’s a little scary. The camera is following my voice. I can show up here in this environment and wave or give you the thumbs up. This face looks like me. I tried to modify it a bit but much better looking in the avatar. It gives you an example of what’s possible in our virtual environments.
It’s going to keep getting better and better, more amazing, realistic and accurate as time goes on.
In some cases, we may prefer our avatar virtual self. Pretend you’re paying attention to the meeting and not along. I will show it for you.
I do want to ask you about the stem cell thing too. I know that’s important. I know it’s the future. It’s already here. You’ve invented something around that. You’re a big expert in that field and in that area. Tell us a little bit about the current status of stem cells and what we’re doing with them. What’s exciting that’s going to happen in the next couple of years?
Stem cell therapy or regenerative medicine are broad areas. There is a lot of also politics around, what’s a stem cell? What can it do? My clinical training after internal medicine is pediatric hematology/oncology and bone marrow transplantation. Bone marrow transplantation is a form of stem cell therapy. Probably, it’s the primary one that we’ve been doing for over 50 years. In most cases for a cancer patient, we can hit them with very high doses of chemotherapy and radiation that hopefully kills the leukemia but also knocks out their bone marrow, their blood forming system. We have to do a bone marrow transplant. The blood-forming stem cells either back from themselves if we banked it or from a matched brother, sister or unrelated donor who’s a match. You’ve heard of those bone marrow matching drives. That can repopulate their blood-forming system and even give what’s called graft-versus-tumor effect to help their immune system keep that tumor from ever coming back.
That’s one key form of stem cell therapy that I’ve been doing for years. Now, it’s even being used to cure some genetic disorders like sickle cell or thalassemia. Those blood-forming stem cells are adult stem cells. There are also the forms where you’ve heard of embryonic stem cells, which are pluripotent. They can turn almost every tissue type or induced pluripotent stem cells, where you can turn a skin cell into almost any cell as well. There’s a lot of interest in using those to treat heart attacks, strokes or musculoskeletal issues. Sometimes there’s a lot of hype and hope. People promise, “Fly to The Bahamas and get the stem cell therapy.” It’s not proven. It’s not even stem cells in some cases. The outcomes in some cases are negligible to even very dangerous.
To zoom back again, when I was a bone marrow transplant fellow at Stanford and part of this Biodesign Program, I saw a pain point, which was harvesting bone marrow with a big needle. It’s usually about 100 punctures to pull out a liter of bone marrow. I thought, “There’s got to be a better way.” I invented a device we call the MarrowMiner. It’s a minimally-invasive way to harvest bone marrow. You can watch my TED Talk on that and also my TED Talk about 3D printing pills. The idea is how do you change 100 punctures into just one, and make it from an hour-long procedure into a ten-minute outpatient procedure. We’ve got that device through FDA, clinical trials. We’re at the stage where we’re about to commercialize it. That’s an area where we could use those bone marrow stem cells as the starting point for a bone marrow transplant, orthopedic procedures, or bank and save if you need it later like we can bank cord blood, or to use some of the different cell populations from bone marrow to be used for regenerative medicine to help treat your knee or other challenges. We’ll still learn a lot.
Is that what Kobe Bryant did when he went to Germany? He got some kind of stem cell blood thing for his knee. Do you remember that at all?
I don’t remember his exact case. He probably got something called PRP, Platelet-Rich Plasma, where you can take out some blood and pull out some of the platelets and inject those back in. Not that the platelets do anything but some of the cytokines and molecules that are involved with the platelets. Sometimes with the stem cells, the stem cells may not do anything but they may be making some of these cytokines and chemicals that help in gender regeneration. Ultimately, we want to learn what some amphibians can do. If you cut off their tail, they regrow it. If you cut up the tip of a finger in a little baby, it will regrow. We lose that ability because of our genes. The stem cell has the same genes as all the other cells in our body just activated in new ways. Part of the future of regenerative medicine is to turn those on in our own bodies so we can regrow part of our liver, part of your own heart or manage a stroke. It’s a very exciting era, lots of promise and potential but still, it’s the challenge of understanding what’s real and what’s not, particularly when some snake oil or salmon are out there, like with vitamins and anything else.
Thank you so much. What is it that you’re most excited about in the future, COVID era or not, in you and your peers or just you? It’s something that you’re most excited about. It can be specific or general. I’d love to hear that from you. I know you have access and knowledge. There are many things that we don’t know.
I’m going to disappoint you because there’s no one thing. I wrote a cover article for National Geographic’s whole issue on the future of medicine. They retitled it on me, 12 Innovations That Will Revolutionize the Future of Medicine. The point of my article, the point when I give a keynote or the book I’m writing is that it’s not any one technology. It’s where these exponential technologies or fast-moving technologies are coming together, AI, machine learning, big data, wearables, 3D printing, AR and VR, nanotech, synthetic biology, personal sequencing, and blockchain. It’s when we mash those up in new ways. They’re all getting faster, cheaper, better and more available to the point where a kid in a college dorm can now do some computer data mining, repurpose the drug, get it tested in an animal and disrupt a big pharma company.
We’ve seen how companies like Uber didn’t invent GPS, online maps, and online payments. They connected the dots to solve a pain point. In health and medicine, what I’m most excited about is this convergence of these new tools. Some of it is mobile, what you can fit on your wrist or a smart ring. A lot of it now is how we connect the dots and create smarter learning systems that leverage a lot of these technologies to impact health and wellness, prevention and health span to diagnose these diseases at stage 0, not stage 3 or 4. If you do have a disease, the therapy can be much more precise, personalized and feedback-loop driven. Finally, we can use all these convergences to accelerate global health, whether that’s drones to deliver drugs and vaccines, internet connections from satellites to give someone in a rural village in Rwanda access, or now these pocket AI-driven ultrasounds can be in the pocket of any community health worker.
Finally, to accelerate discovery. We can all get on what we talked about being a data donor. You can all download a clinical trial now. Even if you don’t have the disease and contribute your own data, that can be digitized. It might be with a pill, a digiceutical or an app. That can accelerate learning like we’re doing with COVID. It’s no one technology. It’s how they’re all coming together in magical ways. People from outside of healthcare are all starting to play a role, whether it’s folks from the aviation world taking lessons from flight simulators and checklists. Folks in the financial world where how we do banking can apply to how we do mobile medicine. Folks in the design world who can make great design and that can change education, the infodemic or video gamers. Video games are coming to healthcare. Medical students, surgeons, doctors and nurses are training on video games to do procedures but also to learn in new, engaging ways. There are lots of opportunities, no one technology, no one favorite.
You’re my favorite doctor. The future of medicine, whenever I talk to or read articles that have anything to do with anything we just talked about is very uplifting. The future of healthcare and medicine is in good hands with people like you at the helm. Thanks for doing what you do. Thanks for coming on this show and sharing all of that amazing information with us. Thank you for helping everybody stay well.
Thanks, Chris. Stay healthy. I would encourage everyone reading this to think about what are some simple things you can do? It’s that quote from William Gibson, “The future is already here, just not evenly distributed.” Now, you can get some amazing technology on your wrist and some amazing apps on top of that to utilize. Your challenge is to bring that to your doctor, nurse practitioner or workout coach, and start to integrate that in your own personal care and that of your friends, family and community. It can hopefully lead us to a better, safer and healthier world in the lens of a pandemic, but also to take us to a healthier society in general.
That’s so well said. I can’t tell you how grateful I am that you spent some time with me now. Thanks, Daniel. Have a wonderful rest of your week. I hope 2021 is much better.
You too. See you.
- XPRIZE Pandemic Alliance Task Force
- Exponential Medicine
- 12 Innovations That Will Revolutionize the Future of Medicine – article
- TED Talk – Personalized pills, 3D printed at home – Daniel Kraft
- TED Talk – Future of Health & Longevity – Dr. Daniel Kraft
About Dr. Daniel Kraft
Daniel Kraft is a Stanford and Harvard-trained physician-scientist, inventor, entrepreneur, and innovator and is serving as the Chair of the XPRIZE Pandemic Alliance Task Force. With over 25 years of experience in clinical practice, biomedical research and healthcare innovation, Kraft has chaired the Medicine for Singularity University since its inception in 2008, and is founder and chair of Exponential Medicine, a program that explores convergent, rapidly developing technologies and their potential in biomedicine and healthcare. Following undergraduate degrees from Brown University and medical school at Stanford, Daniel was Board Certified in both Internal Medicine & Pediatrics after completing a Harvard residency at the Massachusetts General Hospital & Boston Children’s Hospital, and fellowships in hematology, oncology and bone marrow transplantation at Stanford.
He is often called upon to speak to the future of health, medicine and technology and has given 5 TED and TEDMED Talks. Daniel wrote the lead article for the January 2019 National Geographic Magazine: A special issue focused on the ‘Future of Medicine’. He has multiple scientific publications and medical device, immunology and stem cell-related patents through faculty positions with Stanford University School of Medicine and as clinical faculty for the pediatric bone marrow transplantation service at the University of California San Francisco.
Daniel is a member of the Kaufman Fellows Society (Class 13) and member of the Inaugural (2015) class of the Aspen Institute Health Innovators Fellowship.
Daniel’s academic research has focused on: stem cell biology and regenerative medicine, stem cell-derived immunotherapies for cancer, bioengineering human T-cell differentiation, and humanized animal models. His research has been published in journals that include Nature and Science. His clinical work has focused on: bone marrow / hematopoietic stem cell transplantation for malignant and non-malignant diseases in adults and children, medical devices to enable stem cell-based regenerative medicine, including marrow-derived stem cell harvesting, processing and delivery. He also implemented the first text-paging system at Stanford Hospital.
He is heavily involved in digital health, founded Digital. Health, and is on the board of Healthy.io and advises several digital health-related startups. Daniel recently founded IntelliMedicine, focused on personalized, data-driven, precision medicine. He is also the inventor of the MarrowMiner, an FDA-approved device for the minimally invasive harvest of bone marrow, and founded RegenMed Systems, a company developing technologies to enable adult stem cell-based regenerative therapies.
Daniel is an avid pilot and has served in the Massachusetts and California Air National Guard as an officer.
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