Dr. Daniel Kraft, Executive Director of FutureMed

Mark Masse ll i: This is Conversations on Health Care . I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, the Super Bowl is behind us. The Baltimore
Ravens are the national champions. And there were some mi ghty fine
commercials to watch.

Margaret Flinter: There were, and it was pretty exciting when that blackout
happened as well, even at the Super Bowl. And I was struck of course Mark, I
think everybody in health care is by the power of the hits these ath letes take and
so pleased to see the NFL is going to try and tackle the rampant problem of head
injury, too many blows to the head and neck.

Mark Masselli: And also President Obama spoke upon that matter before the
Super Bowl so we hope it brings everyon e’s attention to a very serious crisis.

Margaret Flinter: Of course, there is the threat of thousands of former players
filing lawsuits against the NFL for life - altering injury sustained on the field. But
it’s all about prevention and research and I am pleased to see the league is
partnering with GE to research and develop better diagnostic tools.

Mark Masselli: And hopefully, they will find better ways to reduce these injuries
to athletes.

Margaret Flinter: So from the battle on the gridiron to the battle over health care
funding and let’s predict that President Obama may be relenting on the call to
reduce Medicare spending as one strategy to address budget issues.

Mark Masselli: The entitlement discussion is very likely going to dominate the
budge t debate. But I saw something else regarding the health care law that will
likely be the discussion at many state levels. A report out this week looked
across the country, and 39 states have no laws in place protecting consumer
rights pertaining to the A ffordable Care Act.

Margaret Flinter: The Commonwealth Fund issued the report cited this lack of
consumer protection laws for people seeking insurance, especially the provision
that guarantees coverage even if they have preexisting conditions. And I gue ss I
am surprised, I didn’t realize the states had to act on this one.

Mark Masselli: They do. And states like California, Connecticut, Maryland,
Rhode Island, Oregon, not surprisingly, are the states ahead of the curve in
terms of setting up insurance exchanges, which many states are opting not to do.

Margaret Flinter: So it appears once again the federal government will have to
step in with some protective measures for those states that done have these
consumer protection laws on their books.

Mark M asselli: And as we get the health law off the ground, this year I suspect
we will see more states moving towards adoption of the law provisions in the
future.

Margaret Flinter: And speaking of the future Mark, our guest today has a
particular focus on t he future and what health care is likely to look like.

Mark Masselli: Dr. Daniel Kraft is the Executive Director of FutureMed at
Singularity University, analyzing how advances in technology are going to
change the way we consume and deliver health care.

Margaret Flinter: And some of the best innovators in the industry are gathered
this week at FutureMed 2013 so lots of exciting new ideas should emerge from
the gathering.

Mark Masselli: Lori Robertson checks in with FactCheck.org but no matter what
the topic, you can hear all of our shows by Googling CHC Radio.

Margaret Flinter: And as always, if you have comments, email us at
www.chcradio.com or find us on Facebook or Twitter because we love to hear
from you. Now we will get to our interview with Daniel Kraft in just a moment.

Mark Masselli: But first, here is our producer Marianne O'Hare with this week’s
Headline News.

Marianne O'Hare: I am Marianne O'Hare with these Health Care Headlines. The
Obama Admi nistration attempted to quell the ongoing controversy surrounding
the provision of the Affordable Care Act that all women be provided contraception
free of charge by their health plans. With over 50 lawsuits aimed at challenging
the law’s provision, mostl y from religious institutions, the administration offered a
compromise last week. The institutions filing objections due to religious beliefs
would be exempt themselves from funding contraception for employees but even
self - insured institutions like the C atholic church would have to hire a third party
insurer to handle the contraception issue. The offer was meant as an olive
branch to smooth over vociferous objection to that aspect of the health care law
but it’s not being well - received by a number of the parties involved. A lawyer
representing those objecting the ruling say that for - profit family - owned private
companies should also reserve the right to object to that mandate.

As the budget debate looms in Congress, it appears Medicaid will be left
relat ively unscathed. The national health plan that covers one in five Americans
living at or near the poverty line will see their access to Medicaid and CHIP

continue unabated. Medicare had been included in the list of programs up for
discussion in the defic it reduction talks.

And in the progress, not perfection category, kids are making ever so slight
progress in some parts of the nation where obesity is concerned. In cities like
New York and Philadelphia, where aggressive prevention and nutrition programs
are in place, there has been a slight reversal in the numbers of kids determined
to be obese or overweight. And now, snacks sold in US schools will need to be
lower in fat, salt and sugar and include more nutritious items like fruits,
vegetables and whol e grains under new standards proposed by the US
Department of Agriculture. The proposal calls for a limit of 200 calories on items
sold during the school day at vending machines or other venues outside the
school lunch line.

I am Marianne O'Hare with the se Health Care Headlines.

Mark Masselli: We are speaking today with Dr. Daniel Kraft, Chair of the
Medicine track at Singularity University at NASA - Ames in Mountain View,
California in the heart of Silicon Valley. He is the Executive Director and Curato r
for FutureMed, a program which explores convergent, exponentially developing
technologies and their potential in biomedicine and health care. Both an internist
and pediatrician specializing in hematology oncology and stem cell
transplantation, Dr. Kraft is also founder in telemedicine, an organization focusing
on promoting data - driven personalized medicine. Dr. Kraft received his medical
and scientific training at Harvard and Stanford. Dr. Kraft, welcome to
Conversations on Health Care.

Dr. Daniel Kra ft: Great to be here, thanks.

Mark Masselli: I am fascinated with the concept of Singularity University founded
by Ray Kurzweil and some of the world’s top thought leaders in innovation and
disruptive technologies across many disciplines. Your mission is to assemble,
educate and inspire leaders who can facilitate the development of exponentially
advancing technologies and apply these tools to address humanity’s grand
challenges. Give us an idea o f some of the most important disruptive
technologies you are focusing on both in medicine and biotechnology.

Dr. Daniel Kraft : Well, I think one of the aims of Singularity University and the
FutureMed program is to get it out of any one sort of technology bucket and mix
them together . So one of the relatively new things we do here is get folks out of
their usual silo , whether it's in any technology bucket or academic field, and it's
really where these things are coming together and converging whether that’s
(6:38 inaudible) 3D printing which is starting to imp act the world of health care
from printing prosthetics to organs to world of Big Data in IT , and the world of
mobile is exploding and the world of digital health care and mobile health care .
These things coming together across multiple disciplines as you mentioned

where things get exciting and help inspire people to see where the puck is going
and what the potentials are to reinvent major fields , including elements of health
and biomedicine.

Margaret Flinter: Well, let’s talk for a moment , if we can, may be about the
medicine piece or the medical piece because one of the many roles you play at
Singularity is the executive director of the FutureMed program where each year , I
understand, you bring together some of the most forward - thinking minds, the
cutting - edge people we would think in medicine and biotech. Tell us more about
the mission of FutureMed specifically . And can you maybe give us a little bit of
insight into the topics that you expect to dominate this year’s FutureMed 2013?

Dr. Daniel Kraft : S ure. Here at Singularity University , we every quarter or so run
executive program to bring folks from different fields together . And one of the
areas that really turns people on from different arenas is health and medicine
with how technology touches up o n that. So we decided a couple of years ago
given all that interest to create a program called FutureMed , and what’s
interesting there is that instead of the usual medical conferences (7:56 inaudible)
go to hematologist ; I go to the American Society of He matology , or cardiologist , I
will go to the American Society of Cardiology , is we get people mixed together
from different fields and with different perspective s on both the clinical arena,
pharma, data, IT and beyond.

And the mission is really to get peo ple thinking a bit differently and to cross -
fertilize and to recognize how fast certain technologies are moving . See iPad , for
example , now about 70% penetrations from the physicians in the U.S. owning
those , and that ’s changing the way we are doing healt h care. And so at
FutureMed, we bring all these elements together to give people a bit of deep dive
in education into what ’s happening and let them think about how they might
reinvent elements of health and medicine.

So some of the hot topics , for exampl e , thought leaders will bring in will be the
lead physician s from IBM Watson , looking at where Artificial Intelligence can take
health care and where it’s already impacting our ability to leverage all these
masses of information and smart ways for diagnost ics and thera peutic decisions.
We are bringing in well - known investors the Vinod Khosla who co - founded Sun
Microsystems but i s looking at how – and i s funding smaller companies that are
part of this now new set of milieu of startups and devices that when they come
together have the power to really shift the needle in the way that physicians and
patients deal with medical data, how we collect it , how we interpret it.

And one of the hot area s that I mentioned that we have some focus on is the
world of OMAX in personalized medicine. One of the fields that’s changing
exponentially is that of the speed and price sequencing genome, that’s now
about $1,000 and can be done about a day. And that has mass ive implications
to have clinicians and individuals understa nd their own information but also

challenge s about how we bring that into the clinical landscape, how do the
primary care doctor s take your pharmacogenetics , for example , and make that
useful when they prescribe a drug or therapy.

Mark Masselli : And you really walk through that waterfront of changes that are
going on in technology and diagnosis and in health care. (10:00 Inaudible) sort
of the paradigm that the stethoscope which remained relatively unchange d for
over a century, and you say that your st e t h oscope is now digital and you know
that there is an app for that . But it's a paradigm , and it's reflective of the overall
trend in medicine where technology is making everything faster, smaller, cheaper
and better. And while technology is certainly disr upting the status quo , tell us
how you are addressing the problem of really what seems to be intransigence
within the health care community to adapt technology.

Dr. Daniel Kraft : Sure. Well, the medical community in the health care system is
really mult iple systems , and too often, the incentives are sort of misaligned. And
the challenge with some of these new technologies is “ w ho is going to pay for it ,”
whether that’s a digital st e t h oscope or a new app that can help prevent someone
who is pre - diabetic or moving into diabetes by better managing their exercise and
their blood sugars and being socially connected . And we can talk a bit more
about the big changes in health care economics . But today, we spend about
80% of our health care dollar s on those wh o are chronically sick or in the last
couple years of life.

There is a bit of a shift now to rewarding, incentives, and to keep people healthier
and more on top of their early diagnoses or disease days. And that can have a
huge paradigm shift . And when a physician now – let ’ s say a primary physician
is rewarded for keeping their patients with good blood pressure control or good
blood sugars for the diabetics, that change s the needle. It can take devices now
like if you walk into a Best Buy or an Apple S tore, you can see a shelf now of
consumer health care products whether their blood pressure cu ff s that connect to
your smartphone and can transmit blood pressure numbers or glucometer s that
are built into attachments for iPhones or others , or this new (11: 41 inaudible) of
quantified self devices that can help track exercise.

And as those things start to show their value and big payers like Medicare or
some of the big insurers see the value on that , they can get start rewarding
those , and that’s where the s hift starts to happen , and that’s turning to happen as
some of the big payers are even buying app companies and integrating them into
their bigger plans. And some larger associations like Kaiser or the DA where
they are both the payer and the player can s tart to pilot these programs and see
the value of , for example , a connected blood pressure cuff and take things
forward.

Margaret Flinter: It's so interesting because you lay that out so clearly , and we
recognize there is a slew of data gathering devices that are out there ; we have

seen them at the recent consumer electronic s shows that have apps and gadgets
for all kinds of metric gathering . But where we still seem to la g is having a
system that actually collects all that personalized data into a cohesi ve picture of
where we are as patients and what we would call actionable data for their
primary care teams or the specialist teams , what people can actually respond to.
So what’s in your crystal ball in terms of a unified path that might pull all these
te chnological advances and diagnostics together ?

Dr. Daniel Kraft : Well, one of the big challenges in health care is that often the
data collected is not on the same platform or language . And one of the
opportunities we have now with still pretty much con sumer devices that I am
wearing , for example , a Basis watch that measures my motion and activity as
well as my heart rate or there is one s that measure your sleep , t he challenge is
they are creating huge amount s of data , and they are all from different str eams
and different bucket s . The trick , as you mentioned , is to pull all together .

I like to us e the analogy of the modern car which has hundreds or sometimes
thousands of different sensors, one on each tir e , piston , oil, etc. And as the
driver, you don’ t care about the pressure in piston #3 . You care about when you
check , engine l ight comes on , and then hopefully you bring it to mechanic before
the engine blows up or you blow a gas kit. And they can help plug in the
diagnostics and look at all the data from your engine and prevent major
mechanical issue . Or God forbid , if you crash in your car so many systems like
the Un Star system or call 911.

And I think we are starting to see startups and entrepreneurs and bigger system s
start to integrate all thes e data streams that you have your own set of check
engine light for the body, kind of like the Un Star for the body. And as new
players are opening up their APIs so people can share the se data streams, I
think we are going to see this thing integrated , a nd that’s going to , frankly ,
require smart algorithms, learning engines, Artificial Intelligence , which I like to
actually call intelligence augmentation , so that you as an individual or as a
caregiver or as a physician can not leave through a pile of geneti c code, but it
integrate s that for you and says, “Well, this patient has this genotype, has had
this activity . We know they check at the gym two times but McDonald ’s six times ,
and that they haven’t been sleeping as well as normal . May be we need to adjus t
this medicine based on the ir genetics and their activity and their diet. ”

And as we start to crowdsource all that, I think we have a huge amount of
opportunity , and I think we can soon sign up to be data donors , health data
donors . And by pulling these information streams together from hospitals,
individuals, practices, we can get start to have a dashboard for ourselves as well
as our practices and a whole population .

Mark Masselli: We are speaking today with Dr. Daniel Kraft , the Executive
Director o f FutureMed and Chair of the Medical Track at Singularity University in

Mountain View, California, which is committed to leveraging the technology to
improve health care and biomedicine. Dr. Kraft , let’s pull the trigger a little more
on your futuristic v ision of health care , and I am particularly interested in one of
the seminars at FutureMed , and that is how to identify a need , develop the ir
prototype, then go to the marketplace . Currently, standard from bench side to
bedside is around 15 years in the d rug research protocol arena , almost sort of
the wild west of innovation that’s going on now . How do you advi s e today’s
biotech developers to navigate these new orders?

Dr. Daniel Kraft : Well, I think partly it's bringing together different parties. I t hink
we are seeing a new generation of accelerators and incubators . One of them is
Rock Health which I advise up in San Francisco bringing in new thought leaders
and innovators from outside of health care, people from IT and gaming and
people who build Fa cebook platforms and consumer devices. And the challenge
and opportunity is for them to really understand what the unmet need is. I was
fortunate as a fellow at Stanford to go through the Biodesign program , and it was
starting up about a decade ago. And the key thing really is to understand the
unmet need, to spend time in the clinic, understand what drug or therapy is
needed, what that device is going to do.

We used to require a million - dollar lab . It can now be done almost in your
garage , whether tha t ’s with synthetic biology or 3D printers to build early
prototypes . There is the ability to now innovate more quickly and access some of
this big data that’s part of the NIH repositories , and finally to understand where
the puck is moving . It’s like you are building a system that keeps some of these
technologies in mind , if we are going to have a $100 genome in a couple of
years, should your database have a space for that and then finally understanding
the incentives for the physician , for the patient fo r the payer, so that the solution
you are building ends up creating value . It should be built for when we have the
iPad 7 and the low cost genomics and sequencing available to al most all of us.

Margaret Flinter: Daniel, I am still stuck with the image i n my mind of how much
easier health care would be if the check engine li ght came out for all of our
patients . But in all seriousness , I want to talk about the cost s in health care for a
minute . We have just had a report that for the third year in row , th e actual trend
in the rise of health care cost s has been the slowest rise since we start ed
keeping track . So clearly, some thing s are moving in the right direction . What’s
the focus in terms of looking at the impact overall of this advancement of faster ,
smaller , cheaper , better technologies ? Looking at that , wh ere i s the creative
work going on there in understanding the impact on cost ?

Dr. Daniel Kraft : Well, part of it is being leverage d by the digitization of health
care data, Electronic Medical Rec ords which ha ve been very expensive to
implement , unless you have – on our faculty this year , ( 17:31 Inaudible) who is
the head of the UNC who I was the resident with at Mass General, and they are
laying some of the groundwork, some of these expensive tool s to put in

meaningful use , and Electronic Medical Records have some certain costs and
challenges . But as we start to have more connected health care, when we can
have that , what I would like to call, (17:49 inaudible) medicine whe re there is that
check e ngine light helping you pick up cancer diagnosis or signs of heading
towards a stroke or heart attack earlier , you can save massive amounts of dollars
downstream .

So I think we look where again is the puck going with these technologies , where
do they star t to touch each other and enable us to reinvent things . For many of
us, it almost seems ( 18:1 0 inaudible) to go a n d rent a video or a CD from a video
store . Now it's streaming . The way we take photos is dramatically change d in
the last decade. How we r ead , how we get books ha s all dramatically shifted and
disrupted entire field . That’s starting to happen in health care whether that ’s sort
of e - dermatology ; it's starting to happen with telemedicine where visits don’t
require a three - hour wait. Those ar e all ( 18:3 4 inaudible) coming together . And
as the incentives again shift , if you can show to your insurer that you quit
smoking , that you are going to the gym , that you are burning th e s e many
calories , and you are doing 10,000 steps a day , that can ince ntivize lowering
your premium .

If we can start to leverage some of these tools together in smart ways and
integrate them as you mentioned , we have the opportunity to start focusing on
the prevention and not where we spend most of our dollars now in the su per high
tech end where folks have already had the stroke of the heart attack , the late
stage cancer diagnosis. So it’s no one piece ; it's all those together . And what
we hope to do at FutureMed and Singularity University is start to open people’s
eyes t o the p iece of change , the opportunities and challenges and how they can
reinvent some elements of traditional health care.

Margaret Flinter: We have been speaking today with Dr. Daniel K raft , the
Executive Director of FutureMed and Chair of the Medicine Track at Singularity
University at the NASA - Ames Campus in Silicon Valley. You can find out more
about the work they do by going to Singularityu .org or to Futuremed2020 .com.
Dr. Kraft , thank you so much for joining us on Conversations on Health Care
tod ay.

Dr. Daniel Kraft : My pleasure . Thank you.

Mark Masselli: At Conversations on Health Care , we want our audience to be
truly a minnow when it comes to the facts about Healthcare Reform and policy.
Lori Robertson is an award - winning journalist and m anaging editor of
FactCheck.org, a nonpartisan , nonprofit consumer advocate for voters that aim to
reduce the level of deception in U.S. politics. Lori, what have you got for us this
week?

Lori Robertson: Well , Mark and Margaret , we are continuing to se e many claims
being made about gun control , a public health issue . In particular , the 1994
Assault Weapons Ban has taken center stage . Both sides in this debate are
cherry - picking portions of academic reports on that ban. The CEO of the
National Rifle A ssociation Wayne LaPierre told the senate committee that the
band “had no impact on lowering crime .” But the study , as you cited , said it was
too soon to make a definitive assessment of the ban ’ s impact. On the
democratic side , Senator Dianne Feinstein w ho recently introduced new
legislation banning the assault weapons said the old law did reduce crime. Well ,
that’s wrong , too . The study said it could not conclude that the ban was
responsible for a national drop in gun violence.

Both sides are fighting a series of three studies that concluded with the 2004
report on the ban which lasted from 1994 to 2004 and ban ned the manufacture of
many firearms. Any pre - ban assault weapon s were grandfather ed in, meaning
there were still an estimated 1.5 million such weapons in circulation. The studies
said that the ban had mixed results . Crimes involving assault weapon s did
decline, but there was an increase in the use of other guns . The research found
it was simply “premature ” to make definitive assessments of th e ban ’ s impact.

The author of the study recently said th e ban might have modestly reduced
shootings if it had lasted longer , but the impact would be modest . Assault
weapons were used in only 2% of gun crimes before the ban . And that's my
FactCheck for t his week. I am Lori Robertson, Managing Editor of
FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country's major political players and is a project of the Annenberg Public Policy
Center at the University of Penn sylvania. If you have a fact that you would like
checked, email us at Chcradio.com, we will have FactCheck.org's Lori Robertson
check it out for you here on Conversations on Health Care.

Each week , Conversations highlights a bright idea about how to make wellness a
part of our communities and everyday lives. When Piya Sorcar was a graduate
student in public health at Stanford University , a trip to India changed her whole
perspective . In spite of the massive efforts underway to curb the spread of HIV
and AIDS, 2.5 million people are still being infected around the globe every year ,
and she realize d that many of the barriers to properly educating the public were
cultural in nature.

Piya Sorcar : Because of the taboos and because of the stigma , HIV is extr emely
difficult to talk about , let alone , teach about , especially in certain parts of the
world. The knowledge levels still remain pretty low.

Margaret Flinter: And in many parts of India , sex education is banned. That set
Sorcar on a four - year quest t o perfect the training materials being used by

multiple health workers in the field. And she discovered that because of taboos ,
the education videos had to be animated much more simply.

Piya Sorcar : We have explicit images which are extremely clear . Ho wever, a lot
of educators don’t want to use these pictures . Students feel uncomfortable using
these kinds of pictures . But even more importantly , we know that when you are
uncomfortable that that limits learning . And in many parts of the world where sex
education is banned or it's difficult to talk about AIDS education, such pictures
are actually not allowed.

Margaret Flinter: And she also found that translating the copy into different
languages could completely alter the meaning of the words . So they set out to
ensure that translations were fully vetted a n d cross - reference d before being
deployed.

Piya Sorcar : And you find all these problems in your original translation . So then
you go back to the translation , make corrections there and then create yet
another back translation . You do this over and over and over until your final
English translation is very similar to your original English translation.

Margaret Flinter: Sorcar took that four years of research on creating more
effective AIDS trainin g videos and launched TeachAIDS. Her videos have been
translated into 30 languages , are deployed on the ground in 70 countries and are
being utilized by 180 non - governmental organizations on the ground , trying to
stem the spread of AIDS. And each video i s delivered in the vernacular of the
nation where it's being shared.

(Video clip )

Margaret Flinter: She hopes to deploy the free video program to the top 50
nations in the world who have a million or more people living with HIV AIDS. A
simple , well - res earch ed video design ed to be specific to all end - users a n d the
cultures in which they live , now that’s a bright idea.

This is Conversations on Health Care; I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli . Peace and health.

Conversations o n Health Care, broadcast from the campus of WESU at
Wesleyan University , streaming live at Wesufm.org a nd brought to you by the
Community Health Center.