The Unexpected Links Between Your Health and the World Around You

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Type 1 diabetes (T1D) is an autoimmune disease that was traditionally thought to be passed down genetically through families.  But more recent data has shown that most Type 1 diabetics do not have a family member with the disease, and only a small fraction of those with the genetic predisposition for T1D actually develop the disease, suggesting that there must be factors beyond genetics at play.

We know that our environments can interact with our bodies in ways we do not fully understand to either protect us from or propel us towards certain diseases. Environmental factors can be anything from what we eat and drink to the things we touch and the air we breathe.

In the case of Type 1 diabetes, consider one of the most basic ways of interacting with your environment: breathing in the air around you.  Maybe on one not-so-lucky but not completely uncommon day, you breathe in and contract a virus. When you are infected and overcome a viral infection, your immune system normally adapts to become stronger. However, there are some strains of viruses (i.e. enteroviruses), that, when attacking a person with a genetic susceptibility to T1D, can promote inflammation in the insulin-producing part of the pancreas and may instigate the development of Type 1 diabetes (Filippi 2008). The virus’s effect on the body is dependent on the individual, the stage of life when the  infection occurred (i.e. infancy, adolescence, adulthood), the strain of virus and many other factors, creating a cloud of ambiguity around the causal relationship between exposure and disease state.

You may be thinking, “Sure, I can see how environmental factors triggered T1D in that case, but the person in question still had a genetic predisposition to the disease – so doesn’t that make it a genetic illness?” If you are asking this question, you are absolutely right – but you might be surprised to learn how a genetic susceptibility can be created in the first place.

Environmental factors like Vitamin D and ambient air pollution exposure are all suspected of playing a role in the development of T1D. While research has not consistently proven a direct pathway here, we do know that exposure to some of these elements can actually cause epigenetic changes, which represent how your genetics are expressed. For example, maybe your mother had zero family history of Type 1 diabetes and lacked the susceptibility genes to the disease, but she grew up in Los Angeles, where she spent years driving a convertible up and down the busy freeways, increasing her exposure to harmful air pollution. This exposure could have caused methylation to parts of her DNA, leading to an epigenetic change that could be passed on to you, potentially predisposing you to T1D.  So while you are genetically predisposed to the disease, the predisposition itself could have been caused by environmental factors in the first place.

Scientists are uncovering more and more correlations like these between our environments and our health, but the connections remain largely unclear and uncertain. This is partially due to the lack of accurate data streams in the research studies, (i.e. partially due to inaccurate patient self-reporting health outcomes, different experimental methods for testing and different measurement devices, inability to adequately characterize PM composition (is it VOCs? Dust? Microbes? Type of microbes?) etc.). If we could better understand and characterize the environment around us, perhaps we could better understand the cause and effect relationships that lead us to autoimmunity.

 

Nano Takes on TEDxUTAustin

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Against the backdrop of the newest engineering building on the University of Texas at Austin campus was a lively and vibrant atmosphere filled with the tunes of a live jazz band and more than 400 attendees passionately discussing the challenges of the future. A group of people played a slightly tweaked version of Jenga, which involved answering questions written on the blocks, while others signed a huge Canvas X, covering it with their goals and aspirations in gold and silver scribbles.

Bringing TED’s motto of ‘ideas worth sharing’ to life, TEDxUTAustin 2019 was an open and inclusive event, where novel ideas and innovations that transform thinking converged with a diverse body of minds. It was an atmosphere of curious minds ready to create solutions to the world’s biggest challenges and a sanctuary where imagination and neural connections ran wild.

The theme of the conference was “Origins of Tomorrow,” which focused on ideas and initiatives that bridge the gap between where we are today and where we hope to be in the future.

Being one of the only speakers on the future of healthcare, Nano CEO Steve Papermaster took on the responsibility of changing mindsets. By initially energizing the audience about the ways in which technology has changed every aspect of life through the App Store, Google Maps and Amazon, he pushed them to think out of the box and imagine the inconceivable.

“Why hasn’t healthcare adopted a technology platform?” he asked.

Steve discussed how platforms allow people to collaborate on a massive, global scale to solve unsolvable problems. These new technologies serve as a base upon which other applications or processes can be developed. Painting a picture of a future where humans can connect to the invisible and molecular world, where bodies could send real time alerts about an abnormal cell mutation or where specific viruses could be identified and avoided or where cures to illnesses could be downloaded, Steve emphatically drove home the importance of immediate health transformation.

Drawing on his time serving at the White House under former President George W. Bush asa senior advisor on health and technology, Steve explained how the massive undertaking of sequencing the entire human genome at first seemed inconceivable. But through the Human Genome Project, which Steve co-led, the impossible finally became possible.

With every talk in the conference curated to build on the previous talk, Dr. Moriba Jah, an astrophysicist, followed Steve’s talk by discussing the lack of traffic rules in outer space, as countries race to colonize that realm. The juxtaposition of decentralizing healthcare data in our inner space to centralizing traffic rules in outer space allowed the audience members to put together a continuous pattern of interdisciplinary connections.

As humans continue to grow and seek an understanding of the universe around them (Astronomers capture the first image of a black hole), so should we begin to dig deeper to unlock the mysteries of our inner space.

Closing Care Gaps

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An incomplete picture of health

Most healthcare providers only get glimpses into their patients’ daily lives and the wide array of factors that determine their health. A patient with asthma or diabetes may only see their doctor once a quarter, but we know that so much of what impacts health occurs between visits, from activity levels and environmental exposures to protocol adherence.  In general, less information means worse outcomes, lower quality of life and overall higher healthcare costs.

Imagine an asthma patient named Melissa who is experiencing daily coughing and wheezing, even with her prescribed medication. Melissa visits her doctor hoping to address her symptoms, which are interrupting her work and personal life. Her symptoms frequently subside while at her doctor’s office. Despite lengthy troubleshooting and trial and error with numerous medications and care plans, her doctor is not able to adjust her care protocol. Melissa and her doctor are desperate for insights that can help, though without a more comprehensive view into all of the variables that could affect Melissa, there’s not much they can do.

A fuller picture of health for better outcomes

Melissa’s doctor decides the only way to treat her symptoms is to fully understand her lifestyle and routines to get a handle on the root causes of her issues. She wants to understand Melissa’s daily activity levels, genetic information, specific real-time reports of her symptoms, precise medication usage and more.

To start, Melissa’s doctor considers the environmental exposures that she may come in contact with each day. Melissa is well aware of the outdoor environmental factors, such as pollen and pollution, that contribute to her symptoms, but hasn’t considered indoor air quality (IAQ). The average American spends 90% of their time indoors, so IAQ is a critical factor in understanding health. Despite many studies showing that mold or moisture problems in residences were associated with 100% increases in lower respiratory symptoms indicative of asthma, most homes, offices and other facilities do not measure what is in the air indoors. Even small fluctuations in simple conditions like indoor temperature and humidity directly impact the presence and transmission of viruses, bacteria and mold. Cleaning products, paint, furniture, flooring and other indoor materials can also contribute to poor IAQ.

If Melissa’s doctor could measure, track and correlate the indoor air quality she was exposed to at work along with activity data from her Apple Watch, she would have realized that when Melissa gets less than six hours of sleep and arrives at work before 7 a.m., her symptoms flare. Melissa’s office is cleaned every evening with cleaning products that irritate her system. When she’s not well rested and arrives early (not giving the chemicals in the air enough time to dissipate), she becomes ill. When well rested, Melissa is less affected. It turns out that her seemingly random flare-ups are avoidable with the right insight.

This is where Nano is rethinking health. Our vision is to create a full picture of health for every person, encompassing all the important nuances and details from genetics to environmental factors. The Nano platform will enable healthcare providers to better treat their patients while filling in important data and decreasing overall costs.

Learn more about how Nano can help close care gaps for your patients: nanovision.com/solutions.

Nano Night and Our SXSW 2019 Takeaways

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During South by Southwest, Austin’s capacity is stretched to its limits and brings entrepreneurs, thinkers and artists from all around the world to our unlikely tech and music hub. To kick off the festivities this year, we hosted Nano Night, a welcome party at our office for the health and technology crowd coming into SXSW for the conference’s “interactive” week. A big thank you to everyone who came by to mingle and enjoy Austin’s famous Stiles Switch barbecue with us!

 

This year, real-world data and genomics were big themes on the health technology scene at SXSW. Talks and panels suggested that we’re at an inflection point in healthcare where the priority is finding innovative approaches to solving big problems, faster. Whether through unexpected partnerships (JP Morgan, Amazon and Berkshire Hathaway’s Haven Healthcare, for example), wider data sharing or harnessing genomics to pinpoint increasingly precise diagnoses and treatments, the industry feels poised for big breakthroughs.

A highlight for us included the “Real-world Data: How Useful IS It?” panel with Shrujal Baxi (Flatiron Health’s medical director), Patrick Combes (Amazon’s worldwide technical leader), Christoph Koenen (head of cardiovascular development at Bristol-Myers Squibb) and Greg Reh (vice chairman of U.S. and global life sciences at Deloitte). The conversation focused on the need to increase the speed of discovery in health and medicine and the ability of real-world data and technology to provide a full picture of a patient’s health and experience instead of the episodic snapshots that healthcare providers primarily have access to in today’s world.

A favorite quote from BMS’s Koenen:

“Don’t accept that the development and innovation process takes 15 years.
Hold regulators and scientists accountable for it.”

We also loved “Big Data + Genomics = Earlier Disease Detection,” where Jennifer Gardy, deputy director of surveillance, data and epidemiology at the Gates Foundation, showed the Oxford Nanopore’s MinION device, which is a tiny genome sequencer that “looks like a stapler but is so much cooler.” The little sequencer simply plugs into a computer’s USB port and can read DNA in real time from blood samples. As Gardy said, this innovative little device means that we now “have the ability to go out and do genome sequencing of bacterial pathogens, viral pathogens, you name it – anywhere, any time in real time.”  

Overall, SXSW 2019 was an exciting and enlightening year for health and technology. We’re grateful to have returned to our normal traffic patterns, but are already looking forward to next year!

From The App Store to Amazon : The Importance of The Platform Approach

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Steve Papermaster and Arun Kant in Davos

Think about the ways that technology has completely changed your life over the last 15 years. The App Store ignited an entirely new era of possibility and opened the door for people around the world to innovate, solve real problems, and change the lives of billions. Amazon completely changed commerce and cloud computing. Uber transformed transportation. Facebook revolutionized communication. These technology giants all have one very important thing in common: they are all platforms.

A “platform” is a technology that both delivers a new solution and allows others to build on top of it, enabling endless possibilities for improvement, innovation and expansion.

Major platform technologies have impacted almost every area of your life, and yet this kind of completely radical change is still missing from the single most important area of life: your health. Nano is changing this by bringing the first ever platform approach to health, opening the door to innovators everywhere to build and deliver new solutions to health challenges.

Steve Papermaster (Nano’s CEO) and Arun Kant (CEO of Leonie Hill Capital) sat down together during the 2019 World Economic Forum in Davos to discuss the state of healthcare today and the importance of taking a platform approach to effect major change. Listen to their conversation or read the full transcript below.

 

Steve: So, I’m delighted to be joined in this conversation with Arun Kant, who is a very, very well-known investor, and a visionary entrepreneur in his own right with Leonie Hill Capital. He has been involved for decades as a critical partner in, not only multiple industries and multiple companies, but multiple themes of transformation. Delighted to be partnered up with what we’re doing with Nano Vision, and our shared goal to absolutely transform our ability to cure curing, and to cure those ills of lack of advancement relative to where we desire to be.

So, Arun, thanks for joining in the conversation. We’ve had a very dynamic set of exchanges here in Davos over the last several days and it’s a great time to reflect on where and how our opportunity to team up and tackle our vision for Nano and think about how it relates to the themes that we’ve been talking about and that we are now collectively focused on. And so, would love to get your perspective on some of these issues and topics, and on what our opportunity is to build Nano Vision and how that kind of relates, in your mind and your perspective, to some of the other significant areas that you are, and have been involved with, including with companies like SpaceX, and Alibaba, and other really seminal, transformational companies.

Arun: Thank you, Steve. We have to first look at why we have interest in Nano. Because being a disruptive technology, it requires a founder with a vision, and the right team. It is the same way you evaluate technologies, like SpaceX ten years ago, for Tesla 15 years ago, and 18 years ago with Alibaba, and Amazon, or with PayPal.

This is true for all disruptive technologies, and people always have suspicion about whether these companies will ever make it. Because change in our industry is always difficult for normal people to see. It can be only seen by visionaries. That’s why you see there are very few companies which make it big, like Amazon, Facebook, Google, Yahoo, Tesla, SpaceX, Alibaba.

We all know that the medical system is broken. The way we have drugs today for discovery, to bring it to market takes a long cycle. The drugs have many side effects and are very expensive.

So, healthcare, every year, is becoming more and more expensive, and affordability with people is decreasing, but they’re not able to cure. They’re just putting a bandaid. But the reality is, any drugs you take today, from diabetics, to hypertension, they have severe side effects. Then, they take more drugs, and eventually that hits the bottom line for the health industry, and as a human being, you’re not able to cure.

So, with Nano, you become proactive, not reactive. Today we do medicine reactively, but being proactive is the way of the future. So, if you look at any of the technologies you develop through Nano, you basically, are able to find out from the technology this company has if he or she, in the future, will develop some diseases, and can you prevent those by having a combination of, lifestyle changes, and medicines, before it becomes a problem.

So, I think that’s how we should see this company. It’s not a magic cure, It’s not a magic bullet, but eventually you will see many partners with the ecosystem of other major drug companies, and biotech companies, they will all find that the data they were missing all these years were so critical for the drug delivery, and in fact it will shorten the time by half. And when you go to clinical trials, you will actually know well in advance the set of targeted patients you should target for the trials.

Today, the medical system just puts an ad in the newspaper, says, “I will pay $500 a day,” and you take part in the trials, but not much research is done for finding out actually what the patient had gone through, or what is the genetic problem this patient faces in the future.

So, the drugs may be successful for that person X, but may fail for person Y or Z. I think that’s where it’s important that you start somewhere proactively with Nano type of platform.The drugs which Merck, Johnson, and other companies develop have a proper way of a platform where they can actually have the discovery for the drug based on certain targeted diseases and individuals.

Steve: So, you’re touching on several major themes, Arun, that are critical to us with Nano.

First, I would call out the platform approach, and that is something that has been largely non-existent or missing in modern medical development, where each disease state, and each potential targeted, development of a drug, is it’s own little moon shot. There is not even a space platform, if you will.

Each one is developed by it’s own set of researchers and developers in an academic setting, or a small biotech setting, or a very large pharma setting, largely the process of theorizing what could be a possible combination of molecular structures and genetic markers and the ability to design and construct what we call a drug today is an initiative based largely on, even if there’s hundreds of people involved, a handful of instincts of one or two researchers. Then that hypothesis is taken forward in the form of a prototype. A molecular prototype, which has just enough evidence that it might be effective in certain conditions against certain problem areas or certain types of cancer cells, for example.

It then moves through a highly, highly regulated process, well intended to preserve health and safety, and yet so onerous that it has now become a process that extends out over many years to even decades. And so, on average, it takes between nine and 18 years to bring a drug through clinical trials to marketplace, and costs over 1.8 billion dollars per approved drug to move into the marketplace. And yet, we’re talk about those approvals and successes, that’s literally one out of a hundred because we have a nearly 99% failure rate of all drugs that are attempting to move through the clinical trial process, certainly under the U.S. FDA, and its counterparts worldwide, the numbers are really not any different.

So, the odds of coming up with a successful, approved drug have become so minimal, the time frames so long, and the cost so high that we are not only inhibiting innovation, we are placing it in hands of the very, very few companies with the capital, the wherewithal, or the patience and the regulatory capabilities, to actually get these to market.

Going back to the platform approach, and to the very model of how do we even do this is one of the most fundamental issues that we grapple with. So, what we are doing with Nano Vision is, first of all, just acknowledging that, and saying, this process in total, while very well intended, is utterly broken. On an economic, basis, on a time-to-market basis, on an R&D model basis, on an ability to serve customers basis at reasonable cost and on a global basis. Because the result of all of this cumulative development and investment is an output that is so small in total, very, very few new drugs developed brought to marketplace and available to an exceptionally small percentage of people, even those who are actually afflicted with the overall disease state, at costs that are exorbitant, and unaffordable, even in the most wealthy nations on the planet, by the most wealthy people in those nations. And that simply cannot be accepted as the best that we can do.

A platform approach, like we’ve seen in software in developing modern microprocessor technology, like we are seeing in advanced space technology, modern transportation, and in automobiles and, flight, are advancing themselves off of major platform changes.

In transportation, just as an example, if you look at the move towards self-driving cars, if you look at the engineering of the cars themselves, and of their components, and everything it takes to move towards autonomous vehicles, although we’re not yet there, we’re moving forward at, collectively, a tremendous rate of advancement, and society has embraced the collective benefits of at least moving towards that. So, self-driving cars and autonomous vehicles, even ride sharing, ride sharing has transformed what it means to live in at least the top two to three hundred cities in the world, in how you get around, in affordability and availability and access to basic transportation, and it’s been a marvelous advancement.

And that itself has ridden on top of platform changes from mobile computing and smart phones to geolocation services, sharing of data, location-based capabilities, payment structures, a combined integration of multiple innovations into platform approaches.

So, it’s clearly proven that when you’re dealing with tackling enormous societal challenges, that platform models are the only effective solution. And that’s what Nano is all about.

So, Arun, your thoughts on how this compares to some of these other advancements that we’ve enjoyed, and that we are still enjoying in other industries. I think it’s an exciting, powerful prospect, and, more than that, we owe it to ourselves, as society to say, “we shouldn’t accept anything less than this.”

Arun: I agree with you, Steve. When we are going to spend money on buying a smart phone to keep us connected, and talk about food, and everything, but resistant to change for monitoring our health is something I’m not able to believe why it is happening.

So, you know, we want to have a Fitbit to measure how many steps we have taken. That’s okay, but we don’t want to have a monitoring device to say when I’m going to get a stroke, which is potentially going to paralyze me, and I will be in a daycare for a long, long time.

So, I think resistance to change is something. It’ll happen, but it will be overcome in a very short duration. It has happened for generations of technology. From the flip phone, we moved to smart phone, from buying from a shop, we bought from e-commerce, from payment using cash, we are going towards wallets. So, there’s going to be change, and the medical system will have to change.

Nano’s Year in Review

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Nano 2018 | Steve Papermaster

Throughout 2018, from the World Economic Forum in Davos to our TED talk in Zuriberg, Nano traveled the world sharing our vision for the future of health. As 2019 picks up speed, we’re taking a look back at our progress in realizing our mission to eliminate health threats through accelerated development and delivery of care and cures.

Curing our healthcare system – a TED talk by Nano CEO and Chairman, Steve Papermaster

Nano in Davos: Health & The Fourth Industrial Revolution

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This week, Nano traveled to Davos for the 2019 World Economic Forum. One of this year’s discussion themes was the “Fourth Industrial Revolution,” which refers to the increasing overlap between technology and physical human life.

The Fourth Industrial Revolution represents a critical juncture where, as technologies like artificial intelligence and IoT become more prevalent, organizations and governments need to lay the groundwork for governing their use and managing the resulting societal transitions. Throughout the week, there was a lot of discussion about the ethics of intersecting technology and humanity, the future of jobs in an increasingly automated world and the possibilities for large-scale change across a number of industries.

The below video produced by the World Economic Forum is a great primer on the concept of the Fourth Industrial Revolution:

 

As part of this important discussion, Nano’s CEO Steve Papermaster spoke alongside Leonie Hill Capital CEO Arun Kant about how the Fourth Industrial Revolution is poised to be a game-changer for human health.

 

“Cloud computing, coupled with the advent of smart phones and structures like the app store, have lifted the capacity and output of the tech and software industry by several hundred thousand-fold. We will do the same for health.” 

-Steve Papermaster, CEO of Nano at Digital Davos

 

The conversation covered the need to harness emerging technologies for innovation in healthcare as other industries like transportation and communication have done over the last decade – and noted that healthcare is a notoriously slow-moving industry.

“But as I always say, ‘the elephant moves slowly,’” said Arun. “Being a start-up, Nano can move faster.”

We look forward to sharing a full video of the conversation in the coming days.

Nano’s CEO to Speak About the Future of Health in Davos

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Nano’s CEO, Steve Papermaster, will be interviewed alongside Leonie Hill Capital CEO Arun Kant by TechCrunch Editor Mike Butcher during the World Economic Forum in Davos. The two will discuss what could be healthcare’s “Uber moment” amid exciting advancements in technology like IoT and artificial intelligence.

The conversation will take place on Thursday, January 24th at 1 p.m. CET as part of the Davos Digital Forum located at Promenade 69.

News from the G7 Summit You May Have Missed: World Leaders Commit to Fighting Antibiotic Resistance

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Q&A with Maryn McKenna

Last month’s G7 Summit produced headlines covering subjects from political scandal to trade policy. But one critical outcome you may have missed is the G7’s commitment to holistically fighting antibiotic resistance, as outlined in the summit’s full communique. We caught up with Maryn McKenna between book tours, scientific meetings and reporting assignments to get a handle on the importance of this commitment by world leaders and the progress it could represent.

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