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Big data, personalized medicine, artificial intelligence. String these three buzzphrases together, and what do you have?
A system that may revolutionize the future of healthcare, by bringing sophisticated health data directly to patients for them to ponder, digest, and act upon—and potentially stop diseases in their tracks.
At Singularity University’s Exponential Medicine conference in San Diego this week, Dr. Ran Balicer, director of the Clalit Research Institute in Israel, painted a futuristic picture of how big data can merge with personalized healthcare into an app-based system in which the patient is in control.
Dr. Ran Balicer at Exponential Medicine
Picture this: instead of going to a physician with your ailments, your doctor calls you with some bad news: “Within six hours, you’re going to have a heart attack. So why don’t you come into the clinic and we can fix that.” Crisis averted.
Following the treatment, you’re at home monitoring your biomarkers, lab test results, and other health information through an app with a clean, beautiful user interface. Within the app, you can observe how various health-influencing life habits—smoking, drinking, insufficient sleep—influence your chance of future cardiovascular disease risks by toggling their levels up or down.
There’s more: you can also set a health goal within the app—for example, stop smoking—which automatically informs your physician. The app will then suggest pharmaceuticals to help you ditch the nicotine and automatically sends the prescription to your local drug store. You’ll also immediately find a list of nearby support groups that can help you reach your health goal.
With this hefty dose of AI, you’re in charge of your health—in fact, probably more so than under current healthcare systems.
Sound fantastical? In fact, this type of preemptive care is already being provided in some countries, including Israel, at a massive scale, said Balicer. By mining datasets with deep learning and other powerful AI tools, we can predict the future—and put it into the hands of patients.
The Israeli Advantage
In order to apply big data approaches to medicine, you first need a giant database.
Israel is ahead of the game in this regard. With decades of electronic health records aggregated within a central warehouse, Israel offers a wealth of health-related data on the scale of millions of people and billions of data points. The data is incredibly multiplex, covering lab tests, drugs, hospital admissions, medical procedures, and more.
One of Balicer’s early successes was an algorithm that predicts diabetes, which allowed the team to notify physicians to target their care. Clalit has also been busy digging into data that predicts winter pneumonia, osteoporosis, and a long list of other preventable diseases.
So far, Balicer’s predictive health system has only been tested on a pilot group of patients, but he is expecting to roll out the platform to all patients in the database in the next few months.
Truly Personalized Medicine
To Balicer, whatever a machine can do better, it should be welcomed to do. AI diagnosticians have already enjoyed plenty of successes—but their collaboration remains mostly with physicians, at a point in time when the patient is already ill.
A particularly powerful use of AI in medicine is to bring insights and trends directly to the patient, such that they can take control over their own health and medical care.
For example, take the problem of tailored drug dosing. Current drug doses are based on average results conducted during clinical trials—the dosing is not tailored for any specific patient’s genetic and health makeup. But what if a doctor had already seen millions of other patients similar to your case, and could generate dosing recommendations more relevant to you based on that particular group of patients?
Such personalized recommendations are beyond the ability of any single human doctor. But with the help of AI, which can quickly process massive datasets to find similarities, doctors may soon be able to prescribe individually-tailored medications.
Tailored treatment doesn’t stop there. Another issue with pharmaceuticals and treatment regimes is that they often come with side effects: potentially health-threatening reactions that may, or may not, happen to you based on your biometrics.
Back in 2017, the New England Journal of Medicine launched the SPRINT Data Analysis Challenge, which urged physicians and data analysts to identify novel clinical findings using shared clinical trial data.
Working with Dr. Noa Dagan at the Clalit Research Institute, Balicer and team developed an algorithm that recommends whether or not a patient receives a particularly intensive treatment regime for hypertension.
Rather than simply looking at one outcome—normalized blood pressure—the algorithm takes into account an individual’s specific characteristics, laying out the treatment’s predicted benefits and harms for a particular patient.
“We built thousands of models for each patient to comprehensively understand the impact of the treatment for the individual; for example, a reduced risk for stroke and cardiovascular-related deaths could be accompanied by an increase in serious renal failure,” said Balicer. “This approach allows a truly personalized balance—allowing patients and their physicians to ultimately decide if the risks of the treatment are worth the benefits.”
This is already personalized medicine at its finest. But Balicer didn’t stop there.
We are not the sum of our biologics and medical stats, he said. A truly personalized approach needs to take a patient’s needs and goals and the sacrifices and tradeoffs they’re willing to make into account, rather than having the physician make decisions for them.
Balicer’s preventative system adds this layer of complexity by giving weights to different outcomes based on patients’ input of their own health goals. Rather than blindly following big data, the system holistically integrates the patient’s opinion to make recommendations.
Balicer’s system is just one example of how AI can truly transform personalized health care. The next big challenge is to work with physicians to further optimize these systems, in a way that doctors can easily integrate them into their workflow and embrace the technology.
“Health systems will not be replaced by algorithms, rest assured,” concluded Balicer, “but health systems that don’t use algorithms will be replaced by those that do.”
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In Goethe’s poem “The Sorcerer’s Apprentice,” made world-famous by its adaptation in Disney’s Fantasia, a lazy apprentice, left to fetch water, uses magic to bewitch a broom into performing his chores for him. Now, new research from Yale has opened up the possibility of being able to animate—and automate—household objects by fitting them with a robotic skin.
Yale’s Soft Robotics lab, the Faboratory, is led by Professor Rebecca Kramer-Bottiglio, and has long investigated the possibilities associated with new kinds of manufacturing. While the typical image of a robot is hard, cold steel and rigid movements, soft robotics aims to create something more flexible and versatile. After all, the human body is made up of soft, flexible surfaces, and the world is designed for us. Soft, deformable robots could change shape to adapt to different tasks.
When designing a robot, key components are the robot’s sensors, which allow it to perceive its environment, and its actuators, the electrical or pneumatic motors that allow the robot to move and interact with its environment.
Consider your hand, which has temperature and pressure sensors, but also muscles as actuators. The omni-skins, as the Science Robotics paper dubs them, combine sensors and actuators, embedding them into an elastic sheet. The robotic skins are moved by pneumatic actuators or memory alloy that can bounce back into shape. If this is then wrapped around a soft, deformable object, moving the skin with the actuators can allow the object to crawl along a surface.
The key to the design here is flexibility: rather than adding chips, sensors, and motors into every household object to turn them into individual automatons, the same skin can be used for many purposes. “We can take the skins and wrap them around one object to perform a task—locomotion, for example—and then take them off and put them on a different object to perform a different task, such as grasping and moving an object,” said Kramer-Bottiglio. “We can then take those same skins off that object and put them on a shirt to make an active wearable device.”
The task is then to dream up applications for the omni-skins. Initially, you might imagine demanding a stuffed toy to fetch the remote control for you, or animating a sponge to wipe down kitchen surfaces—but this is just the beginning. The scientists attached the skins to a soft tube and camera, creating a worm-like robot that could compress itself and crawl into small spaces for rescue missions. The same skins could then be worn by a person to sense their posture. One could easily imagine this being adapted into a soft exoskeleton for medical or industrial purposes: for example, helping with rehabilitation after an accident or injury.
The initial motivating factor for creating the robots was in an environment where space and weight are at a premium, and humans are forced to improvise with whatever’s at hand: outer space. Kramer-Bottoglio originally began the work after NASA called out for soft robotics systems for use by astronauts. Instead of wasting valuable rocket payload by sending up a heavy metal droid like ATLAS to fetch items or perform repairs, soft robotic skins with modular sensors could be adapted for a range of different uses spontaneously.
By reassembling components in the soft robotic skin, a crumpled ball of paper could provide the chassis for a robot that performs repairs on the spaceship, or explores the lunar surface. The dynamic compression provided by the robotic skin could be used for g-suits to protect astronauts when they rapidly accelerate or decelerate.
“One of the main things I considered was the importance of multi-functionality, especially for deep space exploration where the environment is unpredictable. The question is: How do you prepare for the unknown unknowns? … Given the design-on-the-fly nature of this approach, it’s unlikely that a robot created using robotic skins will perform any one task optimally,” Kramer-Bottiglio said. “However, the goal is not optimization, but rather diversity of applications.”
There are still problems to resolve. Many of the videos of the skins indicate that they can rely on an external power supply. Creating new, smaller batteries that can power wearable devices has been a focus of cutting-edge materials science research for some time. Much of the lab’s expertise is in creating flexible, stretchable electronics that can be deformed by the actuators without breaking the circuitry. In the future, the team hopes to work on streamlining the production process; if the components could be 3D printed, then the skins could be created when needed.
In addition, robotic hardware that’s capable of performing an impressive range of precise motions is quite an advanced technology. The software to control those robots, and enable them to perform a variety of tasks, is quite another challenge. With soft robots, it can become even more complex to design that control software, because the body itself can change shape and deform as the robot moves. The same set of programmed motions, then, can produce different results depending on the environment.
“Let’s say I have a soft robot with four legs that crawls along the ground, and I make it walk up a hard slope,” Dr. David Howard, who works on robotics at CSIRO in Australia, explained to ABC.
“If I make that slope out of gravel and I give it the same control commands, the actual body is going to deform in a different way, and I’m not necessarily going to know what that is.”
Despite these and other challenges, research like that at the Faboratory still hopes to redefine how we think of robots and robotics. Instead of a robot that imitates a human and manipulates objects, the objects themselves will become programmable matter, capable of moving autonomously and carrying out a range of tasks. Futurists speculate about a world where most objects are automated to some degree and can assemble and repair themselves, or are even built entirely of tiny robots.
The tale of the Sorcerer’s Apprentice was first written in 1797, at the dawn of the industrial revolution, over a century before the word “robot” was even coined. Yet more and more roboticists aim to prove Arthur C Clarke’s maxim: any sufficiently advanced technology is indistinguishable from magic.
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From how we get around to how we spend our time to how we manage our health, technology is changing our lives—not to mention economies, governments, and cities around the world. Tech has brought good to individuals and societies by, for example, democratizing access to information and lowering the cost of many products and services. But it’s also brought less-desirable effects we can’t ignore, like a rise in mental health problems and greater wealth inequality.
To keep pushing tech in a direction that will benefit humanity as a whole—rather than benefiting a select few—we must encourage open dialogues about these topics among leading figures in business, government, and spirituality.
To that end, SingularityU The Netherlands recently hosted a dialogue about compassion and technology with His Holiness the Dalai Lama. The event was attended by students and tech innovators, ambassadors, members of the Dutch royal family, and other political and business leaders.
The first half of the conversation focused on robotics, telepresence, and artificial intelligence. His Holiness spoke with Tilly Lockey, a British student helping tech companies create bionic limbs, Karen Dolva, CEO of telepresence company No Isolation, and Maarten Steinbuch, faculty chair of robotics at SingularityU the Netherlands and a professor of systems and control at TU Eindhoven.
When asked what big tech companies could be doing to help spread good around the world, His Holiness pointed out that while technology has changed many aspects of life in developed countries, there is still immense suffering in less-developed nations, and tech companies should pay more attention to the poorer communities around the world.
In the second half of the event, focus switched to sickness, aging, and death. Speakers included Liz Parrish, CEO of BioViva Sciences, Kris Verburgh, faculty chair of health and medicine at SingularityU the Netherlands, Jeantine Lunshof, a bio-ethicist at MIT Media Lab, and Selma Boulmalf, a religious studies student at University of Amsterdam. Among other topics, they talked with His Holiness about longevity research and the drawbacks of trying to extend our lifespans or achieve immortality.
Both sessions were moderated by Christa Meindersma, founder and chair of the Himalaya Initiative for Culture and Society. The event served as the ceremonial opening of an exhibition called The Life of the Buddha, Path to the Present, on display in Amsterdam’s 15-century De Nieuwe Kerk church through February 2019.
In the 21st century, His Holiness said, “There is real possibility to create a happier world, peaceful world. So now we need vision. A peaceful world on the basis of a sense of oneness of humanity.”
Technology’s role in that world is being developed and refined every day, and we must maintain an ongoing awareness of its positive and negative repercussions—on everyone.
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