As the world gathers for CES (Consumer Electronics Show), we gathered some of our experts for a podcast discussion of how technologies like biosensing technology, remote cardiac care anywhere and a blood test for mild traumatic brain injury, or concussion, are putting the "real" in the realm of possibility.
The roundtable includes ...
- Marc Taub, Ph.D., DVP Technical Operations, Diabetes Care. As sensing technology advances, it's getting smaller, smarter and more accessible, allowing people to have a window into their body. Continuous glucose monitoring (CGM) for diabetes has shown the future of sensing technology has the potential for broad expansion into sports, wellness and nutrition and, ultimately, to stem the tide of chronic conditions while advancing human performance.
- Phil Adamson, M.D., DVP of Medical Affairs and Chief Medical Officer, Heart Failure. A decade ago, heart disease required a timely visit to the doctor’s office. Today, cardiologists in Florida are remotely caring for people in Brazil with technology that’s only getting smaller, faster and more predictive. Remote heart technology is empowering more people to regain control of how they live their lives.
- Beth McQuiston, M.D., R.D., Medical Director, Diagnostics. We need to treat our brains better — especially when they may have been injured. That's where a blood test for biomarkers of brain injury on a portable instrument fundamentally changes how we can evaluate traumatic brain injuries. This objective analysis for concussion can put an end to the silent suffering of countless TBI survivors.
READ THE TRANSCRIPT:
Beth (00:05): So, you go from impossible to possible, and then you move right into, of course, of course we're going to do this test. So, when people say, it's impossible, we say game on, let's go.
James (00:18): This is CES Tech Talk. I'm James Kotecki. The most influential tech event in the world is back, in Las Vegas, January 5 through 8. And, we are here to preview CES 2022. Today a look at the future of healthcare, the COVID-19 pandemic has made clear to all of us, the paramount importance of health. It also demonstrated the incredible power of health technology, to help us live our lives more fully. And today, health tech is ready to go to remarkable new places, providing not just healthcare or well care, but life care. Abbott, has been a leader through the success of health tech revolutions of the past 130 years, and is poised to help bring better health to more people than ever before in the years ahead. Now, let's explore three parts of that future, with three Abbott innovators: Biosensing technology with Marc Taub; remote heart technology with Phil Adamson: and the blood test for the brain with Beth McQuiston. Welcome everyone.
Beth (01:18): Thank you.
Phil (01:20): Thank you.
Marc (01:20): Hi, James.
James (01:21): Beth, let's start with you. A blood test for the brain. This is an audio medium. Can you help us visualize what that is and how that works?
Beth (01:30): Sure. So, let's start with a blood test for the brain and that's huge. So, I'm a neurologist, and when I was working clinically, you had blood tests for all kinds of different things. Patients would come in through the emergency department, and you could draw their blood for the heart, for the kidneys, for the pancreas, you name it. We could never draw blood tests for the brain, it just didn't exist. Now, with a few drops of blood, you can get from the patient, you can take that, spin it, get the plasma, put it on this portable handheld device, which looks a little bit bigger than a universal remote control. Very small. You wait about 15 minutes, and you get an answer, on two proteins that we can see in the blood. If they are there at a certain level, that means it's a warning bell for further action. If those proteins are not there, a sigh of relief, all is well.
James (02:19): And, when the blood is being drawn, forgive the crudity of the question perhaps, but I think people will be curious, where is the needle going in?
Beth (02:27): Great question. So, right now, what we do is just like every other blood test. You draw it from the vein and you collect that, and you can take this and put it on this device, and wait, and get the answer. You can also use that blood to evaluate other assays as well, or other blood tests, if you need that as well.
James (02:44): But, is it like a, we're talking like a forehead vein? Is it a... Do I have to stick a needle in my head is what I'm asking?
Beth (02:49): Gosh, no. We don't expect you to be like Frankenstein. Let's not go that way. But what you would do is have the nurse withdraw the blood from the vein from your arm — it's called anti-cubital vein — just like you do with most of your blood tests. And then you get a little blood tube. I think we've all been to the doctor before and had our blood drawn. It's exactly like that.
James (03:07): Got it. When I first heard this, I actually did assume — erroneously, it turns out — that the reason that you couldn't do this was because it was hard to kind of stick a needle in a person's head. So, if that wasn't the limiting factor, what was the reason that [crosstalk 00:03:19]...
Beth (03:19): I'm so glad.
James (03:19): ... you weren't able to do this before?
Beth (03:21): I'm so glad you clarified that, James. I'm really glad you clarified that.
James (03:25): I hope I'm not the only one listening to this, but I don't think I'll [crosstalk 00:03:28].
Beth (03:29): I don't think many people would want to sign up for that. The reason is, is that brain proteins are found in extremely low levels in the blood. Which makes sense, right? So, what we're measuring, we're measuring down to the picogram level. And to help you visualize that: One picogram is the amount of weight of DNA in one hummingbird cell. That's super, super low. So, while these brain proteins have existed over the centuries in the blood, we had no ability to measure them — until now — which is extremely exciting.
James (03:59): And, you're measuring these proteins to find specific issues going on with the brain. When you talked about relief or concern, what are people concerned about when they take this test?
Beth (04:08): One of the big concerns is this is an invisible injury. And, what that means is, is when ... Say, for example, you sprain your ankle. You can see that your ankle is big. You can see that it doesn't fit in your shoe, and you can feel that. When people have a concussion or a brain injury, they frequently don't know, right? And, if you think about the brain, your brain, when it's injured, has a hard time realizing that it's injured. You have a … you can tell that you hurt your wrist, you hurt your ankle, when people come into the emergency department, you ask them questions, which is a bit ridiculous ... But, now with an objective test, it takes it to a whole new level. It makes the invisible, visible. Extremely important. It gives you that window into the brain because you can't see your brain like you can see your ankle. And I would argue as a neurologist that your brain is vastly more important than your ankle. So, having that ability to understand whether there's injury, or no injury, is extremely important.
James (05:04): And, so is this just the first step then of other tests that you're hoping to be able to put out into the world to test the brain?
Beth (05:12): We're always coming up with new innovations and our hope, our aim, is that we'll be able to make this test available to anyone that needs it. Whether it's in the hospital setting, whether it's out in the field someplace, it's very important to know whether an injury has occurred. So, this is a first step in our journey, and one that we're extremely excited about.
James (05:31): Great. Please stick with us because we want to get to you again later on the show. But now we're going to move over to Phil Adamson and talk about remote heart technology. Phil, what does that actually mean? And what's possible today when we talk about remote heart technology.
Phil (05:48): Well thank you, James. That's a good question. And it really fits with the post-COVID pandemic concept of how we deliver healthcare in general. If you think about how we visit with doctors, there are certain things that are done, that the doctor does to gain information about how we're doing, what our body's like, what our heart's like. And that information is taken in by the doctor: visibly, tactically with their hands. But now we have sensors that actually have the capability of being permanently implanted that can measure many of the things that we try to get when we’re doctors seeing a patient in the office. If we can now duplicate that information flow — remotely or virtually — we're now able to really duplicate what occurs in a doctor's office, particularly in heart disease. And be able to have high-quality, actionable information, but gain it remotely.
James (06:49): I noticed you said the word “duplicate.” You didn't say “replace.” Is that intentional?
Phil (06:55): Probably. I think that there's always a place for the face-to-face interaction, patient to physician. And maybe that's because I'm a physician and I'm holding on to something that's a thousand years old. But I think that human interaction is important. But on the other hand, high-quality information is also important. And one of the things I think we've learned through the pandemic — and it may be one of the silver linings of a horrible event — is that patients enjoy the ability to see their physician virtually. Not have to drive two hours, go through the traffic, park, cost of all that stuff, then wait in my waiting room for an hour — because I'm always running behind — and then they get their 10 minutes of fame in front of me and then they have another two-hour drive home. I mean, that's, think about that, that's a whole day ...
James (07:43): Right.
Phil (07:43): … that you have to take out. And, if you can't drive, and have to take, have a family member take off work and carry you to the doctor's office, good grief! It becomes, it's just an incredible imposition on the patient to get a very short exposure to what would be a therapeutic sequence. So if we're able to not only gain information from the patient's own home and activities of daily living, I think it will actually be better, honestly, than what we get in the traditional office setting. And it has a potential for replacing many of those events.
James (08:19): So, the experience then for a patient, Phil, is maybe it's something akin to setting up a virtual visit, uploading the data to my doctor. The doctor looks at my data and says, based on this, here's where you are.
Phil (08:31): Exactly. And, quite frankly, the quality of information that we're now able to acquire through multiple sensor-based arrays is probably a superior information stream than what would traditionally be accomplished in the way we traditionally deliver medical care. So, I think we have the opportunity for improving quality, improving the outcomes of the patients — along with improving their quality of life — by just simply not having to take the time out of their lives to come see us.
James (09:03): And, can you just describe physically what these sensors look like, and feel like, to the patient?
Phil (09:08): Sure. We have several. One that's of very significant importance to me, of course, would be the ... a sensor called the CardioMEMS Heart Failure System. It's a micro electromechanical system, which is empowered by external interrogation. So, the device itself is battery-less, wireless, and is encapsulated in essentially a silicon housing that's permanently implanted in one of the blood vessels in the lungs as it comes out of the heart. It's a pressure sensor. And, it turns out, that when people with a particular disease called heart failure — and when they get sick, it's most of the time because there's too much fluid in those blood vessels — and that fluid exerts the pressure so you can see the pressures rise. And we discovered some years ago that those pressures rise three weeks before patients even detect that there's a problem.
James (10:00): Wow.
Phil (10:00): So if we rely on the patient to say, “I'm feeling sick,” they feel sick very late in the process of them and of that program. And, it turns out, that by the time we get involved, it's hard to, it's hard to avert a hospitalization when they get so sick. So when we now have that pressure sensor, that gives us the information. We have this long-term lead time, essentially, to understand what's happening. The sensor itself is permanently implanted from a catheter that comes into the body to deliver the device in the pulmonary artery. And that one then, within 30 days, the artery itself incorporates the sensor into its wall. And it's excluded essentially from the blood flow. So, we have a permanently implanted system that no longer needs to have a battery replaced or lead to break.
Phil (10:50): And the patient essentially lies back on an antenna that then interrogates the device and sends the information to the web for review. So, essentially the antenna pings the device with radio frequency energy. It's passed through a capacitor and then readmitted by the device into the antenna. The radio frequency is changed in direct linear relation to the pressure on the sensor. And so the capacitor senses the pressure, the radio frequency energy is sent back at a different frequency, based on the pressure. And that interrogation essentially allows the device to be operant. Otherwise, the device sits quietly waiting to be pinged.
James (11:34): Well, Phil, this is fascinating. And I want to talk with you more later as well. But let's talk about other sensors for the body with Marc Taub. Marc, give us a overall kind of biosensing snapshot of where we are as a company, as an industry. What are you excited about right now?
Marc (11:51): Thanks, James. I guess we should first start by saying what a biosensor is. So, a biosensor measures an analyte in the body, such as glucose. And then it sends that data to a connected device — it's your smartphone or a reader — and our team at Abbott works to develop the sensing technology. So, at Abbott, we're working on … my focus is on one of those prevalent and expensive and chronic conditions that exist today: Diabetes. And what we're doing is we're letting people with diabetes, we're giving them personalized, biometric information so they get better insights to how they manage their health through our FreeStyle Libre system of products. So, with the FreeStyle Libre sensor, it's a device that's worn on the back of the arm for 14 days and tells you your glucose reading every minute. It tells you your glucose value. It tells you the history of how glucose got there. And it tells you where glucose is going.
Marc (12:38): And this is revolutionary. Before that, for person with diabetes, they would have to — in order to measure their glucose — they'd have to take a lancet, prick their finger, get a drop of blood, put it on a test strip, put it in a meter, wait a couple of seconds, see a result. And, they'd have to do this four, 10, 12 times a day, in order to manage their diabetes. And people didn't like to do it. It's painful. People don't want to test outside of the home often. So they would put their health — their lives! — their health in danger because of the pain of finger sticking. So with a product like FreeStyle Libre they can get this detailed information about their glucose readings. Painlessly. Instantly. Right on their smart phone. And I'm excited about how these devices are getting smaller, and smarter, and more accessible.
Marc (13:19): So, we just launched our new, next-generation FreeStyle Libre 3 system in Europe. And it delivers continuous glucose values once a minute, right to your smartphone. It's the world's smallest, thinnest glucose sensor. It's reduced the size of the on-body device by 70% over generations before it. It's more environmentally sustainable. We've reduced the amount of plastic use in the device — and the amount of packaging waste — by more than 40%. But, really, what I'm most excited about is how people are using the system to get better outcomes.
Marc (13:52): So we know that when people use the FreeStyle Libre system, they're able to spend more of their time in glucose target ranges. They're able to reduce their A1C, which is this measure of your average glucose control over the last three months or so. But, even more than that — we have randomized control trials and we look at real world evidence — and we see that people are able to actually decrease the hospital admission rates when they use a device like FreeStyle Libre. That they have less work absenteeism and sick days related to their diabetes. And that they actually improve their overall quality of life scores by using the device.
James (14:26): And, is it tracking, is it sensing sweat on the skin? What exactly is it picking up?
Marc (14:33): Oh, that's a great question. So, there's actually a little tiny sensor — a filament of material — that's inserted just below the skin surface. And it's measuring glucose in the interstitial fluid. So it's not measuring in the blood. It's measuring it in the fluid that bathes all of your cells, and feeds them, provides them with the glucose that those cells need to survive. So it's measuring the glucose in the interstitial fluid and generating a glucose result right on your smartphone, every minute.
James (14:56): So, if I have this sensor in my arm, and I pick up a piece of cake and I eat it, will I literally see — if I'm watching my smartphone minute by minute — how the glucose is changing in my body?
Marc (15:08): Absolutely. And it's pretty amazing to see that. I don't have diabetes personally. But you can certainly, you get great insights into what meals do, what exercise do, what stress level does to your glucose levels by watching it change, minute by minute. And seeing when you peak. It really is incredibly eye-opening to see what that bagel at breakfast did, or the stress of doing an interview with you, James.
James (15:31): Well, hopefully this is the most relaxing part of your day, Marc. Do you find that people actually do change their behaviors, because they're actually able to get this data in close to real time?
Marc (15:42): We know it. We see it in the results. We see … there's a history of these products in people with diabetes, who are taking insulin, and are making dosing decisions of their insulin levels based upon the glucose readings. But we also see in people who are not titrating their medication, folks earlier in the type 2 disease progression who are on oral medications, or diet and exercise, that they see the results. Their real-time readings of their glucose on the device. And they're able to make better decisions about what meals affect their glucose, what exercise does to their glucose, and they get better outcomes because of it. So it's absolutely, it's the magic of seeing your results in real time. And people intuitively know what to do with those readings when they have access to dense glucose data that really shows them where they're going.
James (16:34): When I was preparing for this interview and talking about biosensing, I was thinking about the movie “Apollo 13” and all the different sensors that the astronauts are wearing when they attempt to go to the moon. And then there's a doctor down at Mission Control who's watching all the feedback that he's getting from all of those sensors. And it strikes me — maybe before now, before this point in history — astronauts may have been the most kind of biocensored individuals that we've had. But now, are we moving into a future where everybody is going to kind of be the equivalent of one of those astronauts? Where not just the glucose monitoring that you're talking about, but all sorts of things will be just kind of standard on everybody, whether they have a health issue, or they just want to keep monitoring their own wellness?
Marc (17:13): I think we're rapidly approaching to that place. We've recently introduced a glucose sensor design specifically for athletes. Based upon the technology that we've developed with our experience with the FreeStyle Libre system for people with diabetes, we introduced Libre Sense. It's the world first biosensor design for athletes. So, it lets athletes understand how their glucose corresponds with their athletic performance. They can understand how to fuel up, avoid fatigue, train better and reach those athletic goals. And we see tremendous opportunity for a platform like the FreeStyle Libre to measure all sorts of analytes to help people manage their health, manage disease progression. Absolutely.
James (17:53): And, I understand the Libre Sense is only available outside the U.S. But look, all of you are bringing such exciting technology into the present, and into the future. And, as we look to the future, we are really excited to see Abbott in a major way at CES 2022. Phil, what's Abbott planning?
Phil (18:12): Well, James, this organization and meeting is so very important for what we've been talking about, about technologic advancements in the delivery of quality healthcare. As a matter of fact, Abbott is the first healthcare company to deliver a keynote address to this program. And, our CEO Robert Ford will do that. We have a booth. We have our technologies available. And I think it's incredibly important that we take advantage of the opportunity to rub elbows with individuals in other areas of technology that may actually impact the way we develop innovation for healthcare.
James (18:53): Beth, CES is a place where a lot of kind of first-ever, never-before-seen, never-before-done technologies begin to take shape and begin to present themselves to the world. What does it mean to kind of be a part of that?
Beth (19:05): I think CES really showcases life changing technology. It's extremely exciting. We are just talking today about three of our really cool life changing healthcare technology innovations we've come up with. We are thrilled to be there. We would invite everyone to stop by our booth. We're going to have a huge presence, and we would love to talk with everyone. So it means everything. We are thrilled.
James (19:27): Beth — and really to all of you — when you are able to achieve something for the first time technologically and do something that other people thought couldn't be done, how does that change your view on what's possible?
Beth (19:41): Well, I tell you, it's a thrill to go from — if this is impossible, can't be done, which is many people have said over the years about our blood tests for the brain — to go from impossible to possible, and then you move right into, of course, of course we're going to do this test. So, when people say it's impossible, we say game on, let's go.
Phil (20:02): And James — I agree, Beth — the other piece of this is that when you overcome sort of the bias — the inherent inertial bias — of how we've always done things, all of a sudden, as Einstein said, all of our hypotheses are really based on what we can measure. And now that you can measure something novel, something new that you've never even seen before, all of a sudden the whole world wakes up. A whole world opens to ask questions you've never been able to ask ever before. And so I think the opening of that door is one of the most refreshing, challenging, and exciting things about innovation.
Marc (20:42): To me, James, it really comes down to how these technological advances really affect the patient. That person with diabetes, how that product that we're bringing to life can improve that person's health, ease the burden of living with their diseases. And that's what motivates us to create these products and to get them into the hands of as many people as possible, to make sure that they're available and accessible.
James (21:06): And, Marc, as you look at other technologies that might be all around you at CES 2022, what are some other things outside your industry that you're watching to kind of say, “OK, one day maybe, if that comes to fruition, then in our industry, we'll be able to do something even better.”
Marc (21:25): That's a great question, James. So, I certainly am very interested in the wearable space. And, understanding where health and wellness come together. I think there's enabling technologies that we always keep a very close eye on, things like wireless technologies, and batteries, and power management. Things like cybersecurity. Those are areas that all of us will continue to walk around the CES exhibits. And it's really coming, seeing those small companies, sometimes on the CES floor, that have a brilliant idea that we grab on and think, “How can we incorporate that into a product?” And make the next version even better.
James (22:00): Beth, as a neurologist, are you interested in how the brain responds to new advanced technologies that simulate external perceptions like AR and VR?
Beth (22:10): When you look at this, and it's life changing technology, or there are stimulus — different kinds of stimuli coming at you — you can see functional differences in a brain MRI. You actually can see brain patterns changing. But I'm also going to add on, I'm also a registered dietician. And I was listening to Marc talk, and I am so excited about this Libre. I wish when I was working as a dietician I had this. Because you're absolutely right, it's life changing. I also used to work in a dialysis center — which one of the biggest causes of people ending up on dialysis is diabetes — so having these devices is absolutely critical in people living their best, healthiest lives. It's just absolutely exciting to talk everybody here today. And, we'll have even more at our booth, when people stop by to talk to us.
James (22:54): As we close out the conversation here, if I talk to the three of you in five years, what do you think we'll be talking about? This is kind of a lightning round, so let's go around starting with you, Marc.
Marc (23:05): I think we'll be talking about how biosensors and continuous glucose monitors are the standard of care for not just people on insulin, but for all people with diabetes. I think we'll be talking more and more people with pre-diabetes, people thinking about how to incorporate them into health and wellness, and weight loss. And, to just, better manage their health overall.
James (23:25): Phil.
Phil (23:26): I really see the future to include bringing this sensor technology together. And exploiting the synergies of understanding things that happen in the interstition from this FreeStyle Libre platform, understanding what's happening in the pulmonary artery from the CardioMEMS sensors pathway. And bringing those data together in an advanced analytic environment, such that we now allow the data to teach us what's happening with the patient.
Phil (23:55): And finally, I think all of that can be, to a large extent, be given into the hands of the patient. Empowering the patient with this data, I think, is going to be what we see in the next five years. That we're not going to have an exponential number of healthcare workers, but we're going to have a lot of patients. And the patients can provide a lot of the work here — and they have a vested interest to make sure that work gets done. So I think the integration of these and the synergies of these sensed information streams are going to be incredibly important.
James (24:27): And Beth, bring us home: Five years on, what are we talking about?
Beth (24:30): Well, now that we have an objective test for the brain — we know who's injured and who's not — what we're going to see is prevention. The best injury is one you don't have. Now that we can discern if people are injured, we can say, “How do we prevent that in the first place?” Safer cars, safer ways of living. And then, along with that, if someone gets injured, how can we treat them the best? Whether that is through exercise, diet, yoga, how do we help folks that have been injured and get them back to their healthiest, best life.
James (25:01): Well, we are so excited to see all of you and live our best lives at CES 2022. Thank you so much Marc Taub, Phil Adamson and Beth McQuiston from Abbott.
Beth (25:12): Thank you.
Phil (25:12): Thank you, James.
Marc (25:13): Thank you, James.
James (25:14): Well, that's our show for now. But there's always more tech to talk about. Subscribe to this podcast. So, you don't miss a minute and get more CES, at ces.tech. That's C-E-S dot T-E-C-H. Our show is produced by Tina Anthony and Kiersten Hizak. Recorded by Andrew Lynn, and edited by Third Spoon. I am James Kotecki, talking tech on CES Tech Talk.