On the 21st of March 2023, PMM volunteers Abirami Prabhakaran, Rithika Ganesh, and Clotilde Vazquez attended the WIRED Health conference at Kings Place, London, United Kingdom.

 

 

The WIRED Health Conference 2023 focused on academic breakthroughs and innovations that have the potential to improve and transform both access to, and delivery of healthcare. The conference featured insightful sessions held by experts in the field who gave presentations and conducted fireside chats and Q&A panels. The conference also included The WIRED Health EY start-up showcase, which featured eight exciting health start-ups and highlighted how the health industry is evolving. It was an excellent space for innovators to network with influencers, entrepreneurs, and medical professionals. This blog will summarize some of the most fascinating sessions that were held at the WIRED Health conference 2023.

21/03/2023 11:10 – 11:30 | THE EVER-CHANGING BRAIN

Written by Rithika Ganesh

Joining online, Professor Sophie Scott, led a session that discussed the complexity of growth and addressed some learnings derived from new knowledge about the brain. The cells that make up our body are continuously replaced in a cycle of life and death over years, meaning that the cells that we are composed of are completely different from those that made up our bodies when we were younger. This powerful statement was highlighted by the speaker who showed us a childhood photo. However, Professor Scott also mentioned some examples of cell types that do not regenerate, and which can last a lifetime. These include oocytes, the cells that make up the lens of the eye, hair cells within the ear, and importantly neurons in the brain.

In addition to their longevity, neurons are unusual due to their structure. They have fine projections called dendrites that allow for communication and connection between neurons. New connections, rather than new dendrites, are formed as the brain grows and develops into a complex biological computational structure that is made up of approximately 86 billion neurons in total.

Myelination is a process by which cells form a myelin sheath that surrounds the neuron’s axon to promote faster conduction, increasing the efficiency of neurons. Myelination continues from childhood until a more adult brain profile is seen in after teenage years. As myelination is essential for rapid connections and high-level cognitive functions, incomplete myelination has been suggested as the reason for the stereotypically poor decision making seen in teenagers. This extends to adults as experiences also change and develop the brain. In truth, the brain is never a finished product, but is always a work in progress. We are able to visualize individual neurons to track their productivity using neurotransmitters. Imaging studies have shown that the prefrontal cortex quadruples in size from birth to the age of six, with continued growth from this age onwards.

Professor Scott highlighted a few key strategies to support brain health. Firstly, brain health is improved by exercise. The brain regularly uses 20% of the body’s total oxygen consumption despite being only one percent of total body weight. Therefore, cardiovascular health is a vital contributor to overall brain health. Secondly, frequent social interaction is immensely beneficial to the physical and mental health of the brain. This fact can be translated clinically in the sense that hearing loss is a risk factor to dementia. Hearing loss affects communication and interaction with the world and therefore, when hearing loss patients do not use hearing aids, their mental and physical health tends to deteriorate. Owing to this, hearing loss is seen as a risk factor for dementia.  

Professor Scott calls for humility when thinking about the brain. The strengths and weaknesses of different brains translate to their characteristics. For example, the elephant brain is particularly skilled in memory and special awareness. This is reflected in an elephant’s incredible ability to remember and locate sources of water. Another example is primate intelligence which is driven by social and environmental interaction, demonstrated by their manual dexterity. The first animal to have its entire neural system genetically mapped is the roundworm. Its 302 neurons are mainly located in the head portion of the worm. Even with so few neurons, roundworms are able to learn from experience and be trained. In comparison, the human has around 86 billion neurons. A specific strength of the human brain is the ability to learn languages. However, the human brain is not as good at judging the scale and magnitude of numbers in comparison to its ability to learn languages. Many people find it difficult to appreciate the difference between 302 neurons in a worm and the 86 billion neurons in a human. This is because humans are able to make sense of a length of time significantly better than they are able to understand magnitude. However, analogies can sometimes be used to aid our understanding. For example, if we think of 302 neurons as being about five minutes, then 86 billion neurons would be around 2727 years. This demonstrates the value of understanding limitations of our brain to create strategies to overcome them.

21/03/2023 11:30-11:50 | MAKING SENSE OF CANCER

Written by Rithika Ganesh

The session by mathematician Hannah Fry, began with a video clip of herself finding out that she had been diagnosed with cervical cancer. Hannah proceeded to discuss the difference between her perception of a cancer diagnosis as a mathematician looking at statistics and probabilities compared to her perception of a cancer diagnosis as a  patient newly diagnosed with cancer.

A year prior to her diagnosis, Hannah sat in a consultation for one of her external projects. There, a patient learned of their treatment options following a diagnosis of breast cancer. The clinician explained to the patient that although the lump has been removed, it could not be said with certainty that there was no residual cancerous tissue and therefore, the cancer was essentially incurable. The patient now had two options. The first option was to receive no further treatment. Considering the fact that the patient is in their mid-sixties, the chances of survival were around 84% with no other intervention. The second option was a demanding treatment regimen involving chemotherapy and radiotherapy, which was estimated to increase the chances of survival to 88%. In perspective, these statistics meant only a four percent improvement in survival chances. Outside of the consultation room, Hannah had the chance to speak to the patient about their thoughts. The patient said that clearly, she had to opt for treatment because otherwise she “was going to die.”

As a mathematician, Hannah felt uncomfortable as she knew that this was a misinterpretation of the numbers. Therefore, she spoke to the clinician about it. However, the clinician explained that she was more concerned about the four percent that are not cured as a result of choosing no extra treatment intervention. The question of informed consent rose from the two sides of this conversation. Was the patient making a choice based on accurate understanding of the statistics? If not, is this considered as informed consent? At the same time, the clinician is likely to be concerned that correcting any misunderstanding could withhold the patient from treatment that could save their life.

Following her diagnosis, Hannah realised how different the numbers can be perceived as a patient. In her own case, her chances of survival seemed to be deteriorating quickly as the cancer seemed to be spreading. With no metastasis of the cancer, her survival rate was greater than 90%. If one lymph node was affected, her survival rate would drop to 60%. With two lymph nodes affected, her chances of survival would drop to below 50%. At one point, it looked as though Hannah’s cancer had spread to four lymph nodes. Luckily, there was no metastasis and a surgical procedure that she underwent, meant that Hannah entered a relatively stable remission. A side effect of the surgery was lymphoedema and although this was presented to her as being a side effect of the surgery, to Hannah, it seemed to be a choice between having terminal cancer or having a side effect and so it seemed obvious to her that she would have to have the surgery.

These two stories demonstrate that the majority of patients come to the same conclusion, which is that if they do not opt for treatment following surgery, they will die. A concerning, but important understanding emerges from both cases. This is that the possibility of death affects clearly decision making, regardless of whether or not the patient understands the statistics they are presented with.

In this, the clinician’s role is crucial. A 2001 study asked terminally ill cancer patients whether they would undergo an intense treatment process that would only increase their chances of survival by 0.1%. Over a third of patients said that they would take the treatment. The same question was posed to clinicians and they refused the treatment unless there was at least a 25% chance of survival. Clinicians differ greatly from patients of the general population in their education and experiences. However, this does not justify the clear gap in translational medicine, where clinicians refuse the same treatments that they are offering to their patients. Statistics play a very important part in this, but need to be communicated in a way that patients can understand and make use of for in their decision-making.

Overall, clinicians should take responsibility to accurately transfer their knowledge to their patients. It must be appreciated that this is not easy to achieve in an average eight-minute consultation. However, it is clear that a more patient-centred approach is needed. The patient should be in charge of their journey and be able to make an informed decision based on what is important to them. The session ended with a key message which is that life is not a problem to be solved, but an experience to have. Similarly, a consultation should be a conversation, and not a maths lesson.

 

21/03/2023 13:30-13:55 | PANEL: THE FUTURE OF THE NHS

Written by Abirami Prabhakaran

Hiba Sher Khan, a Doctor and clinical advisor, with Tara Donnelly, the founder of Digital Care, and Yinka Makinde, the director of digital workforce at NHS England, constituted the panel that discussed the value of digital care platforms in delivering patient care. Virtual wards were established as a platform to enable remote monitoring through the use of healthcare apps and wearables. Tara Donnelly described the breakthroughs in digital home care in the past three years, with the 100,000th person who had been cared for via a virtual ward, and around 4,000 people who had received hospital-level care from their own bed. Virtual wards allow patient care to be delivered from the comfort and convenience of a patient’s home and can help to reduce the number of patients who present at a physical healthcare setting. Importantly, Tara Donnelly emphasized the need for the development of medical innovations that provide evidence-based value and that are cost-effective for the NHS. Currently, there are very low barriers to entry for developing healthcare apps. However obtaining evidence to support the use of the app is very expensive. Therefore, rather than creating an app, Tara Donnelly suggested partnering with similar products in the market and interacting with professionals to deal with any potential issues. Apps that are backed by evidence are much more likely to succeed. For start-ups, conversations with a local Academic Health Science Network (AHSN) could assist innovators and signpost them to relevant organizations.

Doctor Hiba Sher Khan described the current developments in health care and in particular, the integration of electronic primary care and secondary care records. These establish a seamless approach to sharing patient records across different healthcare providers.  From a patient perspective, this can increase patient access to test results, resulting in a more patient-initiated pathway to healthcare, allowing patients to be more proactive about their health. From a clinician’s perspective, this type of sharing can improve workflow, accessibility, and efficiency. Some of the challenges to this integration of records include how to prevent discrepancies in the system and how to ensure that patient and clinician experience is consistent across different trusts.

Yinka Makinde discussed the government’s levelling up agenda to improve healthcare and talked about the digital healthcare hub that supports innovators in getting their products to a level that complies with the digital standards of the NHS. The structure of the integrated care system makes it a great platform for partnering with local healthcare communities where innovations can be utilized to help solve problems, at a localized level. This could help innovators understand how their technology could be utilized. For example, they could be applied in a clinical pathway, to improve workforce efficiency, or to to reduce risk. These findings could assist in obtaining evidence for the products being developed and assist in the scaling up of innovations.  The government´s levelling-up agenda includes the acquisition of Electronic Patient Record (EPR) coverage and interoperability by March, 2025. This ensures that all innovative solutions are at the same level and allows for further solutions to be integrated in the future. However, until consistency is established, it will be difficult to establish interoperability across multiple locations. Therefore, obtaining EPR coverage is crucial for levelling up. Practices in local regions could be provided with the autonomy to choose their desired systems as long as they are compliant with the digital standards of the NHS. However, barriers to levelling up in this way include how money is prioritized in different regions, the digital maturity of the population, the leadership needed to invest in the correct providers, and ensuring correct cultures are associated with the integration of the technology. On the other hand, Tara Donnelly described digital homecare as being more consistent and referred to the integrated care system as an established long-term care management approach that could provide a level of hospital-based care from home. Overall, the integration of digital care into existing healthcare systems could be transformative for enhancing patient care and increasing workflow efficiency.

21/03/2023 13:45-14:05 |BIO WEARABLES A WINDOW TO OUR BODIES LIKE NEVER BEFORE

Written by Clotilde Vazquez

Marc Taub presented an insightful session on the application of biowearables. Biowearables are a type of technology that is designed to be in contact with the skin in order to measure the levels of biomarkers such as ketones, glucose, or lactate. In short, biowearables give us an idea of how well our bodies are functioning.

Traditionally, the main focus of biowearables has been on diabetes. Biowearables that measure glucose levels are essential for  for many patients. FreeStyle Libre was one of Abbott’s first bio wearables. In one study conducting using this device, patients were provided with the device, but were not given access to the data that it generated. They spent an average of 196 minutes per day in hypoglycaemia. Two weeks after providing them with the bio wearable, they were given access to the data and followed for the next 3-6 months. The date demonstrated that amount of time that patients were hypoglycaemic reduced to around 122 minutes per day. This demonstrated access to data-induced changes in the behaviour of patients. Ultimately, Biowearables give patients the autonomy to make real-time decisions. The company is currently developing a new bio wearable that has a dual monitoring system for glucose and ketones.

However, the applications of biowearable technology can be expanded beyond diabetes. Libre Sense is a biowearable that was developed to measure glucose metabolism in athletes. It helps athletes to track glucose levels during training, races, and recovery periods. This can help them to understand the impact of nutritional intake and timing on their physical performance. This device has been used by Eliud Kipchoge, the world record-holder marathon runner.

Lingo is a consumer product that is currently being developed. It measures glucose, ketones, and lactate. By measuring lactate, consumers can receive data that helps them to keep track of their health and to make changes and adjustments to their diets and exercise.

Who has not heard of the famous keto diet? The keto diet involves ingesting a very low amount of carbohydrates and utilizes body fat. The aim of this diet is to get energy from ketones, produced in the liver from stored fat, basically obtaining energy from burning fat instead of from sugars. This process of producing ketone bodies is known as ketosis. Although it is a controversial diet, having a biowearable that measures ketones would inform of when ketosis is achieved, thereby making weight loss less frustrating, and who knows, it could be applied to many other situations.

In a future perspective, biowearables could potentially help doctors to make diagnosis easier, as we would have constant measures, that allow patterns and changes in different markers to be monitored easily. Diagnostics now are time-dependent, as most tests provide a snapshot of what is happening in the body at the time of the test, although that can vary over time. Having a biowearable that measures multiple markers at the same time could accelerate diagnosis and help to make diagnosis more accurate. It could also help us to move towards a more patient-tailored personalized care and encourage consumers be more proactive about their lifestyle.

21/03/2023 13:55-14:50 | THE WIRED HEALTH EY STARTUP SHOWCASE

Written by Abirami Prabhakaran

The WIRED Health Start-up Showcase presented a variety of start-ups involved in delivering personalized patient care in a range of different fields of healthcare.

    • Ariadna Masó, founder & CEO of Sanno described their personalized platform for patients with gastrointestinal issues, which allows patients to receive guidance based on their symptoms, and can connect them with specialists. Sanno’s mission involves accelerating clinical research into areas such as chronic gut conditions. These conditions are suffered by 47% of the population and current treatments are primarily based on trial and error.

    • Jules Goldberg, founder & CEO of Sleepwave, presented his startup which has developed a motion-sensing smart alarm that sounds when you are naturally waking up. This is based on the team’s discovery of a new technology known as silent sonar technology that senses movements within two meters of an individual’s phone. Sleepwave powers contactless sleep tracking and estimates wakefulness, breathing rate, and sleep depth.

    • Kate Ryder, founder and CEO of Maven, talked about Maven´s comprehensive platform which provides support for women and families in the areas of fertility, pregnancy, adoption, parenting, and pediatrics.

    • Astrid Gyllenkrok, CEO and Co-Founder of LEIA, a Swedish FemTech startup is developing the world’s first postpartum tracker, an app that assists women that are in their fourth trimester of preganancy. The mobile app asks the users questions and invites them to acknowledge their physical and mental wellbeing. Based on the information shared, women could receive personalized evidence-based, data-driven insights into their health.

    • Alice Pelton, founder of The Lowdown, talked about their platform which provides crowd-sourced information about various brands and methods of contraception. The Lowdown has a contraception subscription service that is designed to help women to access a wider range of contraceptives that may not be available locally, and has established a contraceptive recommendation tool and calculator to support individuals who may have missed a pill.

    • Kimi Doan, chief growth officer, Earable Neuroscience has developed the world’s first AI-powered brain band which enhances sleep by stimulating precise neurofeedback signals. By monitoring brain wave signals, the brain band enables focus to be optimized and offers curated content to alleviate stress and anxiety. Detailed sleep and focus reports could be accessed through their mobile app.

The WIRED Health Start up Showcase winner was Alice Pelton, founder of The Lowdown.

 

21/03/2023 15:30-15:50| THE FUTURE OF GENOMIC HEALTHCARE

Written by Abirami Prabhakaran

A discussion of the future of genomic healthcare was led by Baroness Nicola Blackwood, who is the Chair of Genomics England. Our genome is the entire set of DNA instructions that is found within our cells and is essential for the development and functioning of an individual. The vast majority of the human genome, approximately 99.2%, is shared among all individuals. However, there are variations that account for approximately 0.2% of the genome. These variations are crucial for the genetic diversity observed among individuals. However, some of these variations can be disease-causing. Therefore, understanding the variations within the human genome could facilitate the development of genomic medicine and personalized medicine.

Baroness Nicola Blackwood highlighted the value of genomic healthcare by describing the impact of the 100,000 genome project on a patient known as Jessica. Jessica had a form of epilepsy that was not responding to treatment and the 100,000 genome project discovered 6.4 million variants within her genome, in comparison to the reference genome. Within those variants, 700,000 variants were distinguished as being rare and 3000 variants were predicted to result in some form of change in the protein encoded by a gene. When compared to Jessica’s parents´genomes, 67 variants were found to differ from those of her parents. These were checked against a panel app (an open-sourced resource for understanding genomic research worldwide). This led to the discovery of a variant called SLC2A1 which linked Jessica’s symptoms with similar epileptic symptoms encountered amongst patients worldwide. Genomic research successfully outlined the cause of Jessica’s form of epilepsy and based on this discovery, clinicians recommended changes to Jessica’s diet. These changes resulted in an improvement to her symptoms and reduced her dependency on drugs. Jessica was one of the first patients to be diagnosed as part of the 100,000 genome project. Overall, the 100,000 genome project led to the diagnosis of 25% of rare diseases for the first time and 50% of cancer patients had been referred to therapeutics, which may not have been discovered otherwise. Approximately 3.5 million people suffer from rare diseases in the UK and around one in every 200 people suffer from rare diseases worldwide. Therefore, the application of genomics can be very useful for the development of treatments against rare diseases.

Furthermore, Genomics England has supported developments in the research and diagnosis of rare diseases by funding the newborn screening programme. This could have a fundamental impact, as around 70% of rare disease patients are children and most children with rare diseases die before the age of five. Participation in the newborn screening programme is optional and only actionable results would be passed onto the mother of the baby. Baroness Nicola Blackwood explained how genomics data could facilitate developments in cancer care. Genomics England has funded the cancer 2.0 programme which utilizes next-generation technologies. This includes Long-Read Sequencing Technologies combined with Illumina, which could provide ongoing diagnostics throughout cancer care. Holistic clinical insights in research and therapeutics are acquired by the combination of genomics data and other data such as imaging data or data from projects such as the 100,000 genome project. It is evident that the future of genomic healthcare will facilitate significant advancements in the diagnosis and treatment of rare diseases, as well as improvements in cancer diagnostics.

21/03/2023 15:50- 16:10| LIFETIME: THE NEW SCIENCE OF THE BODY CLOCK

Written by Clotilde Vazquez

Sleep, melatonin, circadian rhythms, blue light… these are all much-debated terms. When it comes to sleep, there are many common myths. In recent decades, not sleeping much was seen as something heroic, a synonym for productivity. However, nowadays we know just how detrimental lack of sleep is to our health and well-being, and so much so, that sleeping has for many, turned into an anxious activity, where one is more worried about not getting the right number of hours than about actually taking some time to rest, recharge, and repair the brain and the body.

Professor Russell Foster, from Oxford University, author of the book, Life Time, gave an enlightening presentation about sleep, circadian rhythms, and the biology of the body clock. We live on a planet that revolves every 24 hours, creating cycles of light and darkness. Sleep and consciousness cycles are an adaptive response to physical activity and inactivity. The body clock, or circadian system is in charge of adjusting the body’s physiology to the demands of a 24-hour day. If we observe the physiological changes that occur in the body within a 24-hour period, we see changes and fluctuations of a number of different parameters. For example, blood pressure drops at night when the need to deliver oxygen and nutrients to the body is lower due to reduced metabolism. In contrast there is a sharp rise in blood pressure just before we wake up and interestingly, this phase is associated with a 50% increased chance of having a stroke or a heart attack.

Other interesting physiological changes that occur throughout the night or during sleep in humans are an increase in growth hormone, which is required for tissue repair in adults, and a drop in temperature which is associated not only with reduced metabolic rate, but also with sleep induction. Cortisol levels, heart rate, glucose, and metabolite activity all rise at the beginning of the day and even cognitive ability shows a circadian evolution, peaking at around noon.

Although much has been said about melatonin, the truth is that melatonin is a hormonal marker of darkness. It is secreted in the absence of light with levels peaking at around 4 a.m. Melatonin secretion is inhibited by light. With regards to cognitive ability, adults show a marked sharp rise in their cognitive ability from around 11 a.m. to 12 p.m. From that time, the ability to process information starts declining. Interestingly, teenagers show a delayed peak in cognitive ability, for about two hours. And it has been seen that when exams are pushed to early afternoon periods, exam success went up.

Another study in Australia revealed that five a.m. was the time where the ability to process information was lowest, in line with the statistic that shows it is the time when more fatal traffic accidents occur. Upon comparing cognitive decline due to alcohol consumption or sleep deprivation, it was observed that at 5 a.m., cognitive decline due to lack of sleep, is greater than cognitive decline induced by the legal limit for considering a person to be drunk.

However, this is not the only aspect impacted by sleep. Sleep and circadian rhythms impact other areas of care such as cancer. Much work has been done regarding the circadian clock and cancer treatment. In a study with chemotherapy patients, delivering the same dose at different time points (morning and evening) impacted survival after five years. For one group survival was 45% and for the other 10%.

But this is not only applicable to cancer, it is seen in drug development. The main animal model used preclinically to develop drugs are mice, which are nocturnal. Taking this into account when translating results is key. An experiment with a drug for treating heart failure delivered at the beginning of the sleep period in mice (morning) showed great promise in mice. However, in both mice and in humans it was ineffective when delivered in the morning, at the beginning of the wake period. When given to patients in the evening, the beginning of our sleep period, it showed promise. This highlights the importance of taking the timing of drug administration into account.

Sleep and circadian rhythm disruption (SCRD) are related to shift work, long working days, anxiety, stress, pain, or poor health. There are several detrimental consequences of SCRD in emotion regulation, cognition, and physiological health. SCRD is related to increased mood fluctuations, anxiety, risk-taking behaviour, poor cognitive and motor performance, and increased cardiovascular disease or reduced immunity.  Interestingly, shift work has been related and is now considered by WHO as a carcinogenic.

Professor Russel’s group in Oxford is now developing a new drug that targets the system that regulates the internal body clock, as blind people or patients with neurodevelopmental and neurodegenerative disorders experience major disruption of their sleep cycles and, as we have seen this has major impacts overall health. With this drug, they saw that it regulated the sleep/wake cycles in mice, which, if kept under total darkness, because their natural cycles last less than 24 hours, begin being shifted. This suggests that the drug is effective in regulating the body clock, providing hope and potential for the treatment of sleep dysregulation.