The Gift of Giving – 2015’s “Thrilling Three”

December 18, 2015

Another remarkable year enabled by the remarkable. Moments captured, built upon, tested and iterated. Futures built by those who leaped beyond barriers to bring forward the possible. From those who imagine and then stay focused to grind out the stuff of our tomorrows. From those that have “the gift (and grit) of giving.”

Each year, I build and curate a list of the most remarkable advances encountered, then boil it down to what I call my “thrilling three” – the three most thought-provoking ideas, products or trends of the year. Though diverse, each has caused me to pause and say, “Really? Wow, that’s impactful.”

 

 

In 2014, we highlighted the transformative potential of virtual reality displays, and less than a year later, these have grown from what was thought to be the coolest new gadget in the gaming industry to a platform on which even The New York Times uses to tell-and-sell stunning news content. Last year we also highlighted the potency of normative comparisons in driving personal energy consumption behavior. One year later, the COP21 climate deal just inked in Paris is centrally focused on precisely the same – in this case, setting standards and tools to compare not across neighborhoods but between whole countries, big to little and rich to poor. Because when we don’t measure and compare, across the world, we cannot hope to inspire nor hope to improve. Lastly in 2014, we talked about the un-talked about – the tabooed healthcare discussion, the simple truth that all of our lives will, sooner or later, end. When those days near, how do we wish to experience it – an uncomfortable planning oversight that costs our world billions in ineffective and unwanted medical expense? A year later, a subtle but transformative billing change by CMS is bringing light into the sunset of our lives; more on that below.

For 2015, here they are:

1) Squeeze Bio. The applications for cell-based therapies are exploding. In oncology, ophthalmology, regenerative medicine and many more, we are seeing how potent it can be to treat conditions by putting modified cells back into the body. The history of this goes way back – blood transfusions and organ donations are all examples of putting cells from one person into another. But now we are upgrading them first – using engineered cells that allow us to avoid the need to immunosuppress recipients. And we are enabling these engineer cells, all by themselves, to accomplish complex medical procedures. They could be designed to seek out and destroy cancer cells, or to take residence and rebuild a set of lost functions such as sight, cardiac capacity, mobility or more. But to engineer cells one has to go inside and into the nucleus to change some things. To do this, we have historically relied on viruses. Into these viruses we would have built the genes we seek to deliver and with their unique abilities to get inside cells, they deliver our intended genetic cargo. The problem is that viruses can be tricky to work with, and in some cases, bring more to the engineering story than we had hoped. Enter Squeeze Bio, who have discovered a way to engineer cells without the need to infect them with recombinant viruses. The trick is a simple one. By flowing the cells of interest through a constriction, the cells “are squeezed” and become transiently willing to take up our DNA payloads –same outcome but no virus and none of the surprises that viruses can produce. Squeeze Bio is poised to make a long list of cellular therapies possible and hopefully, even more affordable.

2) CPT codes 99497 and 99498. Making decisions about our lives plays off the harmony of two selves. Our first self is derived from the memories gathered across our lives. Though we live in the present, most of our decisions are derived from how past experiences (i.e., tiny recordings) help us predict the way a given decision will turn out. This part of us has been called our “remembering self.” But we live in the present and our present self or so-called “experiencing self” is quite distinct from the other. In no setting are these two manifestations of ourselves more divergent than when we need to make urgent end-of-life decisions. When the pressure is on, our remembering self is compromised. In 2014, I highlighted the importance of advanced care planning discussions, presented innovative dinner formats to socialize these with family members, and new, predictive analytics in palliative care setting.

In 2015, the inspiring innovator in this space is good ole Uncle Sam. In the U.S., medical practice is led by the nose with what are called CPT® codes. No code, no money, no incentive. But if a CPT code exists then a healthcare professional can be reimbursed for his or her time in a care giving setting. Effective January 1st, 2016, the Centers for Medicare & Medicaid Services (CMS) will begin reimbursing physicians for advanced care planning conversations with patients. This is a huge step forward and an important wedge between our “remembering and experiencing” selves. The vast majority of the money spent on healthcare during our lives is spent at the very end, and still only a very small fraction of individuals die in away similar to their wishes. With a head start on this most important life conversation and incentives to support it, only good things can come.

3) Microbiome. We inhabit a world preceded by other life forms, and into these niches we have slowly evolved. From the work of Pasteur’s germ theory, to Koch’s postulate, to Lister’s antiseptic surgeries, our relationship with this ancient microbial world has been shaped on the basis of fear. We were taught that these invisible life forms are the source of suffering, infection, spoilage and decay. Yet, on them we deeply depend.  Outnumbering us both in genetic complexity and presence, our microbial community is perhaps one of the most important components of our innate defense system, and as we are beginning to understand, it plays a central role in our metabolism.

After now nearly a century of antibiotic assault we are beginning to realize just how important and vulnerable our microbial co-pilots are. In 2015, we began to see the potency of treatments that restore our depleted microorganisms. From fecal-microbial-transplants (FMT) to more defined products in which distinct missing organisms are restored, more and more intriguing medical correlations are begin reported.  Manifestations as diverse as metabolic disorders, mental health disorders and even some cancers may all have etiologies that connect back to our microbiome. In 2016 and beyond, our microbial status may in fact become a new vital sign.

Next up, 2016 and the annual ritual otherwise called the J.P. Morgan Healthcare Conference. Here we go again.