Host Mike Rugnetta: [00:00:01] Will medical innovations be able to keep pace with or even outpace the speed of disease? What will our future bodies be like when we're outfitted with technology that optimizes our health? How does that redefine what it means to be human?

[00:00:16] The boundary between being all natural and part cyborg whether that's a big deal or not. I can see those boundaries rapidly disappearing.

[00:00:24] I think it's just a function of our overall dependence on technology and our wish to live with a greater number of superpowers than nature gave us.

[00:00:34] Welcome to Health Tech on the Horizon presented by Abbott. In the show we explore the future of human health medical innovations and self enhancement. Some of that tech is already here and some of it is yet to come.

[00:00:46] I'm your host Mike Rugnetta and today we're going to be talking about a kind of heart implant technology called Left Ventricular Assist Devices or LVAD which helps those with advanced heart failure stay alive. Joining me are Dr. Andy Fleischli who studied at ETH in Zurich, which is the same university as Einstein. He's the head of the Abbott Mechanical Circulatory Support Office where the full Maglev technology for levitation for the LVAD devices was created. And Dr. Jack Kreindler, a physician physiologist tech entrepreneur and the founder of the Center for Health and Human Performance in London. So thanks both of you for joining us.

Dr. Jack Kreindler: Thank you so much for having us.

Dr. Andy Fleischli: Thank you very much.

Host: So I'm wondering how prevalent this technology is right now because heart disease is the number one cause of death in the U.S. Do you see this as becoming a very prevalent piece of technology? I know the like, the ideal is that as few people need it as humanly possible. But I'm just really curious about both of your takes on the current and potential scale of use of something like this.

Dr. Jack Kreindler: [00:01:58] When I was born, the average life expectancy in the UK was about 71 years old for a man, it's now 79-80. And that's just in 45 years. So things slowly start going wrong after six, seven, eight decades. I'm noticing that after four funnily enough.

[00:02:21] And if we are really going to be living long, longer, and longer lives, we just have to face the fact that our hearts are one of those things with our three billion beats budget that we get. It is one of those things that is just going to fail at some point, however healthily we live. So you know, heart disease being still the number one cause of death, heart failure is a very significant part of that.

[00:02:50] And one thing that a technology like this enables us to see is that there is hope and a bridge towards maybe you know, more lasting solutions. It needs to play its part.

Dr. Andy Fleischli: [00:03:03] I also think you know in the end it also comes back not only extending the life, but also of quality of life with adding devices like an LVAD. This maybe goes one step further than it was before but also other things like a pacemaker or even a let's say if you have a broken bone and you take a piece of metal, you fix it. Even a tooth which is replaced in your mouth and the LVAD also improves your quality of life, probably also extends it if you're not suffering from something else. But in the end I think it all goes back to quality of life. And this is really remarkable.

Host Mike Rugnetta: [00:03:42] And I was just wondering like you know, is the goal in putting together this technology right. Is it always to be increasing lifespan and then hopefully having health span sort of fill up the difference, or what's the sort of ultimate goal?

Dr. Jack Kreindler: [00:03:57] I think we have kind of become accustomed to the notion that it's our right to live as long as humanly possible.

[00:04:08] But I obviously in my work have been principally involved, not in extending human life years, but extending quality years. So you want to call it health extension versus life extension, in line with the principles that Andy was talking about with what he would like his technology to produce and that is to improve quality of life, not necessarily increased length of life. And so if we can help unfortunate people who've ended up in cardiac failure for whom good quality life years are impossible to achieve and turn them back into independence and enjoyment, and the ability to work or be parents and grandparents and spouses and so on. That to me is the highest point that we can achieve with medical technology. But I think in general the dependence on technology is going to become a standard feature of human existence and human health. We are definitely tied together very very closely with the machines that we make and that is I think really fundamentally different to perhaps how we thought about ourselves in the past because those technologies don't exist outside of us, they now exist inside of us. That is bio electronics, that is even the brave new world of genomic engineering, it all really fits under one bonnet which is the fact that we are no longer what nature has carved us into being.

Host Mike Rugnetta: [00:05:42] I think this idea of tech dependency is really interesting and whether or not that contextualizes any of the work that you guys do.

Dr. Jack Kreindler: [00:05:48] It's this concept of becoming comfortable with your dependency on technology that's possibly the biggest thing that we need to start to look at. I would like to also offer a example which is deep brain stimulation for people with Parkinson's disease. The chap called Matt Eagles is diagnosed at the age of seven with Parkinson's disease.

[00:06:10] Fortunately he's got a very slow progressing one but he's been living for well over a decade with wires deep into the middle of his brain.

Host Mike Rugnetta: [00:06:19] I mean it's a lot of the stuff that contextualizes our experience with technology generally. Technology is very ambivalent. You know it is neither, it's not good nor bad. It's kind of both of those things in different measures at different times for different people depending upon what the technology is, I think, you know again, it's really reflective of the social moment. What counts as a cyborg? I think right there's like this idea that humans have been cyborgs since we were wearing clothing or since we, you know, invented shoes or like, Andy to your point, since we've had dental work, since people have been wearing glasses, since you sort of have a vestigial brain in the form of, of a mobile communications device.

Dr. Jack Kreindler: There's not really fundamentally that much difference between relying on something every day and whether it's an implantable or whether it's something that you ingest.

[00:07:11] But I certainly do see the, the difference between something that is sort of not a chemical, not a potion, not something you swallow or infuse, but it is actually an electric mechanical device that is implanted in you. That's my definition really of, of, of cyborg is it's kind of where the fundamental functions of your body are augmented or replaced by electromechanical devices.

Host Mike Rugnetta: [00:07:42] Do you think, Jack, that there is a sort of distinction that you're making that the inherent difference between say a chemical change to the body versus a piece of technology installed in it, that there is something inherent about that difference that will transgress a social moment or a generation and that, that will carry on to this generation of digital natives and their children's children? Do you think it's always gonna be seen as like a fundamentally different kind of thing?

Dr. Jack Kreindler: [00:08:10] Well the boundary between being all natural and part cyborg and whether that's a big deal or not I can see those boundaries rapidly disappearing.

[00:08:23] I think it's just a function of our overall dependence on technology and our wish to not just live, but also live perhaps with a greater number of superpowers than nature gave us. But I think it's, it will eventually start moving into well, how can I just augment my life. I mean for instance if it's possible very, very easily to both implant and remove a something that improves your cardiac function, then is that something that a long distance runner is going to want to have installed in them.

Host Mike Rugnetta: [00:08:59] Andy, I think a lot of people are really familiar with something like a pacemaker, like a device that gets put into your chest, produces electrical signals that help the heartbeat keeps blood pumping throughout the body. I was wondering if you could just sort of walk us through the work that you've done, the technology that you've helped develop, and give us a sense of what it is and how it works and how it maybe differs?

Dr. Andy Fleischli: [00:09:22] Okay so an LVAD is not, it's similar like a pacemaker but it does something significant differently. A pacemaker triggers the heart to beat and then on the other side, the LVAD is really, it's like a pump like the heart is a pump. So if you know a person suffers severe heart failure then it might be that the muscle is not able to, to move all the blood in the heart muscle into the body so you would need really a pump that takes the blood out from the left ventricle, pumps it back into the aorta, back into the body so that all the body has enough blood flow and oxygen with that. In our case, we use Maglev technology which means that the rotor is completely contact free, levitating within the blood without any contact to stay there. So this means you don't have any, any friction or any blood cell damage which is very advantageous for blood handling.

Host Mike Rugnetta: [00:10:27] Is it bad that my main touchstone for Maglev technology is roller coasters? It's amazing to think that, that that's, that that's what goes inside your chest.

Dr. Andy Fleischli: [00:10:36] Yeah I mean the roller coasters are maybe not even that bad of a comparison. It's also a moving part with the stationary part and you have this touchpoint over time you have you have damaged wheels and damaged rails and things like that. Without technology there is no contact at all between the moving parts and the stationary parts and more importantly everything was in between is not squeezed, not stressed. So, so this means the blood in between these two things remains in most optimal shape or condition. There is also no wear out basically and it can last very, very long.

Host Mike Rugnetta: [00:11:16] And can you sort of talk us through what the development process for something like this is. How do you go about designing and testing something that is sort of this high stakes?

Dr. Jack Kreindler: [00:11:29] I personally find it fascinating how you had a vision of the underlying technology and then that moment that you had that kind of breakthrough of sticking a levitating rotor in somebody’s aorta.

[00:11:46] I personally find that utterly fascinating. It is, it is wild. It's a huge leap. What was that sitting in the bath seeing the, the level rise eureka moment that you had? Was it, was it, was it in the bath or the shower? It’s fascinating to me. At the very beginning,

Dr. Andy Fleischli: [00:12:03] At the very beginning we did some, some research on Maglev technologies so magnetic levitation technology that enables this possibility to have this contact free rotor. Back then we didn't really know what, what these technologies should be used for. And then we also came in contact with many, many visitors with energy industry with semiconductor industry but also with the medical device industry and then we, we received some feedback that you know this technology with the rotor that this running contact free. This could be a perfect pump to be used for a blood pump. So that's how we came to that direction and then with some other interactions with some partners, we were able to bring out or to develop this LVAD what we have now in these people to help them.

Dr. Jack Kreindler: [00:12:54] I was just going to say you know, that having practiced medicine for, for now two decades and seeing heart failure many times in people and actually myself once, I was lucky, unlucky enough, I guess lucky from an experience perspective, unlucky enough to feel what heart failure is kind of like because once I, I believe it or not had too much coffee and ended up with an arrhythmia. And it genuinely, genuinely feels like you are dying and it's horrible. The fact that your heart is out of rhythm in this case for me, so this was a effectively a kind of a mini heart failure, temporary mini heart failure as a result of my heart just not beating in synchrony properly and then getting that rhythm back again. It's a little bit like going from being in heart failure than having an something like an LDAV device fitted, going from literally feeling like you were dying, to feeling like the world is on your side again. It really is kind of remarkable and there aren't actually that many things in medicine which really are kind of light switches like that where you go from darkness to light almost instantly. And those are the things that I think are the bits of medicine, medical technology, medical engineering that we should really cherish.

Host Mike Rugnetta: [00:14:20] I wonder Andy if you could sort of take us through what is the distant horizon of this technology. What is it that seems just barely possible at this point?

Dr. Andy Fleischli: [00:14:30] I mean an obvious one is today's LVAD. They still have a cable for the energy transmission from the outside world which has batteries through the skin going to the LVAD which is implanted. So we need to get rid of that. There are people working on that all around the globe. It's not yet really available. So this needs to be changed.

[00:14:53] And so the energy transmit and transmitting can go through. So transcutaneous energy transmission then for sure the device should get smaller, easier to implant.

[00:15:08] Things like that and then add that with you know, what I mentioned, like this smart pump. Adding additional possibilities to gather more data for self diagnosis of both, of the LVAD as well as of the patient and which allows then better treatment for the patient.

Host Mike Rugnetta: [00:15:33] So this is very much from a lay perspective but there is one thing that I'm, I'm very curious about which is how technology like the LVAD shifts the experience of having a body. One thing that you hear a lot about is, is entrainment when you're listening to a piece of music at a certain tempo, your physiology sort of like matches up you know the thing that people talk about the most is you get really excited listening to very fast paced dance music that increases your heart rate. And I think personally I'm just really interested how sort of technology like this relates to the general experiences of excitement or, or calm. You know, I know that those things are whole body experiences but you know like I also know that the heart sort of plays a role. And I was just wondering whether or not when you have something like this, it changes how you feel those things.

Dr. Andy Fleischli: [00:16:31] I mean from, from a technical or engineering point of view, if these feelings are going on or are appearing or whatever then you know, I mean the LVAD doesn't change. So it remains with the speed which is going. But on the other side, I don't think. But it would be an interesting question to ask some people who have one implanted but I don't think that this would change the feeling to something like music or so there's still a native beat of the heart which also can do a little thing. It's just that the, that the native heart is not strong enough to provide the whole blood flow. So I think it would be a very interesting question to, to ask the next person that they will meet who has an LVAD implanted.

Dr. Jack Kreindler: [00:17:21] I would love to see the latest version of your firmware Andy, that had a Spotify plugin that changed its pumping capability according to which nightclub you had decided to go to that Friday. In all seriousness this, this does move into you know the possibility in future that these devices aren't just life restoring, but they're also life enhancing and you know, can maybe provide people with more than just a simple return to normality, but can start to emulate some of those phenomena that you describe Mike. The heart has many neurons in it and is intimately connected to our emotions. And so I think the future of cardiac technology is surely going to get closer to mimicking the natural function of our biology.

Host Mike Rugnetta: [00:18:20] Fabulous. Thank you so much for entertaining, for entertaining my very specific question. Thanks again to Andy Fleischli and Dr. Jack Kreindler. If people want to see more of your guy's work where can they go look?

Dr. Jack Kreindler: [00:18:34] I've got a Twitter, a little Twitter feed. Dr Jack UK and people can find me on LinkedIn. Otherwise, if anyone's around the Marylebone area of London and want a cup of tea and a tour of our little institute, you're more than welcome.

Dr. Andy Fleischli: [00:18:49] I'm located in Zurich in Switzerland. So that's where you can find our site as well as our facility. We do have a coffee machine, we can take a cup of coffee and you can find out also everything on our website like Abbott dot com. So A B B O T T dot com. That's where you can find everything.

Host Mike Rugnetta: [00:19:11] Alright and Jack if you go join Andy for coffee, you have to promise you're not going to have too much.

Dr. Jack Kreindler: [00:19:15] I definitely won't. And if I do I'm very, very sad.

Host Mike Rugnetta: [00:19:20] Well said. And if you are so inclined, you can find me on Twitter at Mike Rugnetta.

[00:19:25] Thank you so much gentlemen. It's been a pleasure. Thank you.