la médecine n’échappera pas aux changements disruptifs que nous observons dans la société !...

Prof. Dr. Philippe A. Coucke, Chef de Service, ULg-CHU / Service Universitaire de Radiothérapie

Mardi 23 février

La médecine n’échappera pas aux changements disruptifs que nous observons dans la société !

Liege Creative, en partenariat avec :

L’innovation de ruptureou innovation radicale ?Un coup d’œil sur la santé.

Philippe A. COUCKEpcoucke@chu.ulg.ac.be

Définition de l’innovation de rupture

Perception client: FORTE

Perception client FAIBLE

Innovation FORTE Innovation

RADICALEInnovation de production

Innovation FAIBLE Innovation de

RUPTURERenouvellement

Condition de l’innovation radicale

Innovation incrémentale versus radicaleInnovation Components SystemIncremental Improved No changeModular New No changeArchitectural Improved New configuration

New architectureRadical New New configuration

New architecture

New component – New design – New architecture

Radical innovation Technology Impact on societyPersonal computer Microprocessor New administrative

system / internet services

Définir « Innovation radicale » en 6 mots• Invent future, like there’s no past• Positive game changer using tech creatively• Humankind resists disruption, until it’s necessary• Disruption is wiping out dinosaurs with a comet

Le déterminisme technologique est donc constitué autour de deux grandes idées :1. La société n'influence pas la technique, qui tire son évolution d'elle-même

ou de la science.2. La technique influence la société.

Innovation radicale sociétaldans 6 domaines distincts

• Agriculture• Construction• Transport • Manufacture• Logistique• Service

• AgricultureAeroFarms Inc. Raises $20 Million for Aeroponic Vertical Farms December 2015

Aeroponic vertical farms use a staggering 95% less water than conventional field farms. Now, backed by $20 million that was raised by AeroFarms Inc., the company is set to begin funding to build more of the high-tech indoor farms

Genetically Modified Tomatoes Could Be Used to Fight DiseasesOctober 2015

Scientist created genetically modified tomatoes that can produce natural disease-fighting compounds resveratrol and genistein at an industrial scale. Resveratrol is an antioxidant found in grapes that is also present in red wine. It has been reported in studies to increase the lifespan of animals. The scientists were able to modify the fruit so that it produces the resveratrol equivalent of 50 bottles of red wine per tomato.

• ConstructionContour Crafting’s 3D-Printing Tech Can Build Homes On-Site in Under 24 HoursNovember 2015

Robotic construction system Contour Crafting (CC) has debuted their newest 3D-printing technology that can print entire homes on-site in less than 24 hours.

Paris Smart City 2050 by Vincent CallebautJanuary 2016

• TransportElon Musk Says Fully Autonomous Driving Will be Possible In Just 2 YearsJanuary 11th 2016

Driverless buses hit the streets of SionDecember 17th 2015

Le design de l'Hyperloop, le train du futur, dévoilé par Elon MuskPar Direct Matin, publié le 5 Février 2016 à 13:27

• Manufacture

Chercher l’intrus!

This $7000 3D Printer Can Print 10 Materials SimultaneouslyAugust 25th, 2015The MiltiFab has high resolution, meaning the layers of material are extremely thin, creating a relatively smooth surface. The machine prints with "at least" 40 microns resolution or .04 millimeters.

• LogistiqueHitachi’s Warehouse Robot Zips Around on WheelsAugust 26th 2015

Singapore has successfully tested drone deliveryOctober 2015

Startup bets its wheeled robots, not airborne drones, will deliver your groceriesTwo Skype co-founders form a new company, Starship Technologies, to try to lower the cost of package delivery with six-wheeled robots.November 2, 2015 - 9:58 AM PST

• ServiceCrowne® Plaza Hotels & Resorts tests Delivery Robot at its Hotel in the Heart of Silicon Valley

Robot Butler Rolls Into California HotelAugust 14, 2014

Nothing Wrong With Your Patients Having Sex With RobotsArthur L. Caplan, PhD, November 18, 2015

Artificial Intelligence Algorithm Now Capable of Identifying HumorJanuary 19th 2016

The team has trained a machine-learning algorithm to recognize humorous scenes and even create them itself, allowing it to accurately predict when a scene is funny and identify when it is not—despite not having any social context or grasping the subtleties of a human’s diverse social and cultural heritage.

A new algorithm can allegedly identify humor now, thanks to researchspearheaded by Arjun Chandrasekaran from Virginia Tech.

Innovation radicale en médecine:les moteurs du changement

• L’inefficience actuelle• La charge financière• La transparence par les réseaux sociaux

L’inefficience en quatre chiffres:

50 / 35 /10 / 5

P4S vs P4Q

Les honoraires médicaux sous la loupe de Questions à la uneQUESTIONS A LA UNE | jeudi 11 février 2016 à 16h11

Avez-vous déjà payé un supplément pour être soigné plus vite? Ou un médecin vous a-t-il forcé la main pour prendre une chambre particulière sinon il ne vous opère pas? Autant de situations dans lesquelles se retrouvent de nombreux clients, plutôt patients. Images à l'appui! Le journaliste Frédéric Deborsu vous emmène dans l'univers médical où parfois l'argent prime sur les soins.

La démographie sociétale vs médicaleEn 2060, plus de 10 % de la population aura plus de 80 ans en Europe

26/05/15

La réduction de l’offre:1. Vieillissement des médecins.2. Baisse du nombre des médecins.3. Evolution des modes de vie:

• Féminisation du métier.• Horaires flexibles.

L’augmentation de la demande:1. Vieillissement de la population.2. Augmentation de la population.3. Emergence de nouveaux besoins.

Augmentation d’un tiers des besoins !

Perte d’un tiers du potentiel médical !

Impact de la démographie

Impact de la démographie

• Poly pathologies à l’entrée en institution de soins.

• Pathologies intriquées:– Pas mortelle à elle seule– Risque de cascade de

décompensations.

• Insuffisances organiques.• Maladies neuro-dégénératives:

– Troubles de la relation/ communication.

• Cancer.• Maladies (cérébro)vasculaires.

Les stratégies d’innovation radicalepour sortir de la crise:

– Humanistes• Améliorent la vie réelle• Progressistes• Valorisantes

– Ecologiques/durables– Accessibles– Technologiques

Elles répondent aux 3A’s:

AccessibleAffordableAvailable

Quelle pourrait être la vision ?

The future is already here, it is just unevenly distributed…

William Gibson

• Coûts• Démographie• Accessibilité• Variabilité des pratiques• Information inefficiente• Soins fractionnés• Duplication et approche

défensive• Adoption tardive de

l’innovation

• P = Prédictive• P = Préventive• P = Personalisé• P = Participative

Médicine Prédictive

Médecine Prédictive:

Analyse sanguineEmpreintes moléculaires

Déterminer la susceptibilité

Schumpetering Laboratory Medicine

2013

New HIV Test: This Smartphone Accessory Can Take Blood Tests And Diagnose You With HIV In 15 MinutesFeb 5, 2015 02:07

Biomedical engineering at Columbia University School of Engineering and Applied Science

Genetic Sequencing Is Now Available for Just $280January 2016

Full Genomes Corporation is a company that makes next-generation sequencing available to the direct-to-consumer market. Genetic sequencing can now be done for less than $1000.

Nanopore MinION: A Novel DNA Sequencing Device for Diagnosis and Treatment Guidance of Urinary Tract InfectionsSeptember 21st, 2015

Standard bacterial culturing requires two days to grow the bacteria and test their antibiotic susceptibility.

MinION enables rapid point-of-care bacterial characterization from urine samples four times faster than conventional laboratory culturing methods, as well as detection of antibiotic resistance.

MinION Data from Human Gene Sequencing Released. January 2015

University of Toronto scientists have released data on the first reported use of Oxford Nanopore’s MinION to sequence human DNA.

Grail to detect cancer in healthy people: FlatleyDenise Garcia | @denisejaegMonday, 11 Jan 2016

The company, it will start detecting cancer before it's symptomatic. Illumiina started finding cancer in healthy patients while conducting non-invasive prenatal tests in the search for down syndrome, Jay Flatley, Illumina's CEO, told CNBC's "Closing Bell."

Grail has already raised more than $100 million from Illumina as well as Bill Gates, Jeff Bezos’s venture fund (Bezos Expeditions), and Arch Venture Partners.

Bonnes nouvelles!Pour ceux qui ont la phobie de l’aiguille

Prototype Device Allows for Real-Time White Cell Counts Through the Skin, Personalized ChemotherapyOctober 2nd, 2015

Team Leuko, an international groupcollaborating between theMassachusetts Institute ofTechnology (MIT) and a handful ofcenters, hospitals, and foundationsprimarily located in Madrid, Spain, hasdeveloped a device that countspatients’ white blood cells in real-time through the skin (i.e., withoutdrawing blood).

The new technology relies on a special silica glass that has ions throughout that fluoresce in infrared in response to laser light. The length of the fluorescence is proportional to the level of glucose present near the surface of the skin when the glass slide is pressed to a finger.

New Technology for Blood-Free Glucose SensingJuly 17th, 2015

The University of Leeds may have solved one of the biggest holy grails in medicine, the ability to measure blood glucose levels without penetrating the skin.

Medgadget @ CES 2016: Cercacor’s Ember Non-Invasive Hemoglobin SensorJanuary 8th 2016

This past week at CES, Irvine, California based Cercacor Laboratories announced the launch of a device that can measure hemoglobin and pulse rate in 90 seconds with a fingertip sensor. Known as “Ember,” the device works similar to a common pulse oximeter. However, unlike a typical pulse ox, Ember contains eight LEDs to allow for the extreme sensitivity necessary to accurately and precisely measure hemoglobin.

Médecine Préventive:

Déplacer l’accent d’une médecine centrée sur la maladie vers une médecine centrée

sur le maintien de la santé!

The Best Quit Smoking iPhone and Android Apps of the YearAugust 4th 2015

Smoke Free is based on the theory that what really helps people quit is being able to see and measure their progress. The app will tell you how long you’ve been smoke free, how much money you’ve saved, how many cigarettes you’ve avoided, and how your health is improving. You then get badges for progress and success can be shared with friends.

Quitting smoking isn’t an easy process, but it’s necessary to improve your health. Kwit makes it bearable — and even fun — by using gaming techniques. The app has different levels you can reach until you become the “Ultimate Kwitter.”

Quitting smoking is a major change to make in your life, and it’s not always easy to do it alone. Cessation Nation recognizes this fact, and provides you with a virtual village of support to help.

L’Oreal Unveils Wearable Tech That Monitors UV ExposureJanuary 11th 2016

L'Oreal has unveiled "My UV Patch," wearable technology that monitors UV exposure and works with your smartphone.

Using a smartphone, users can take a photo of the patch and upload it to a mobile app that will analyze the dye squares. The results will show how much UV exposure the wearer has received.

Médecine Préventive:

Déplacer l’accent d’une médecine centrée sur la maladie vers une médecine centrée

sur le maintien de la santé!

Mesure de paramètres ponctuellement

Scanadu Scout medical

scanner review

Is your body tuned up or

running rough? This puck

reads your vital signs in

seconds. April 16th 2015

L’examen clinique

Who’s my doctor?

ChemPro 100eNose

Ac 99%Se 100%Sp 97,8%

Ac 97%Se 98,6%Sp 95,9%

Liu

Zoey

The dog has a quality response! Able to distinguish low from high risk ca.Medscape Medical News 2014

Médecine Préventive:

Déplacer l’accent d’une médecine centrée sur la maladie vers une médecine centrée

sur le maintien de la santé!

Mesure de paramètres en continu

Could pregnancy-monitoring clothes be the future of wearables?Diane Shipley January 26, 2015

A closer look at Ralph Lauren's smart shirt for athletesDana Wollman | @danawollman | August 25th 2014 at 2:15 pm

Mouth guard monitors health markers, transmits information wirelessly to smart phone

San Diego, Calif., August 31, 2015 -- Engineers at the University of California, San Diego, have developed a mouth guard that can monitor health markers, such as lactate, cortisol and uric acid, in saliva and transmit the information wirelessly to a smart phone, laptop or tablet.

Researchers Develop New Way to Produce Flexible Electronic Skin PatchesOctober 2nd, 2015

At the University of Texas at Austin investigators have come up with a technique for building flexible electronic skin patches for body monitoring of various electrophysiological signals, as well as skin temperature, hydration, and respiratory rate. The time to produce such devices has been cut from days to approximately twenty minutes.

“I had said it would take about five years to see a product on the market,” Jimenez told the paper. “The calendar is on track and we are already developing a technological lens prototype (that) should be tested on humans in 2016.”

The Google contact lens will be in humans next year, Novartis chief saysSep 6, 2015

Breast Self : le soutien-gorge qui détecte le cancer du sein14 juillet 2014

First Warning Systems leur répond par des chiffres : Breast Self a déjà subi trois essais cliniques, a été testé par 650 « cobayes », et a détecté les tumeurs mammaires avec 90% de réussite. De plus, ce soutien-gorge permettrait de détecter les risques six ans plus tôt qu’une mammographie.

Vitals set includes:Blood pressureElectrocardiography (heart rate)Body temperatureRespiratory rateOxygen saturation

Disease set includes:AnemiaUrinary tract infection, lowerDiabetes, type 2Atrial fibrillationStrokeSleep apnea, obstructiveChronic obstructive pulmonary disease (COPD)Otitis ("ear infection")LeukocytosisHepatitis AAbsence of conditionsMononucleosisStrep throatPneumoniaHIV screenTuberculosis

Health Care 2.0Wearable technology

Health care 3.0Forgettable technology

Researchers at EPFL have developed the world’s first implantable chip capable of continuously monitoring the concentration of a variety of molecules, including glucose and cholesterol, as well as pH levels and body temperature. May 29, 2015

Implantable Wireless Chip Measures Molecules Such as Glucose, Cholesterol, Drugs Taken

Medgadget @ CES 2016: Profusa Unveils Long-Term Implantable BiosensorJanuary 12th, 2016

Profusa showed off an upcoming injectable sensor that can be used to continuously monitor oxygen levels in tissue.

An optical reader placed on the skin measures the fluorescence and relays the data to a smartphone. The biosensor can last as long as two years

La “disruption” est en route !PMI aux US• 215.106 USD in 2016.• 1.106 volontaires.

• Séquençage du génome.• Senseurs multiples + portables smart

pour suivre paramètres physiologiques et environnementaux.

• Pour un sous-groupe de patients:– Micro biome de l’intestin.– Protéines and métabolites.

Initiative au Royaume Uni:• Démarrage en 2015 (100’000

maladies rares et cancers communs).

Annual Accenture Technology Vision 2015• Ownership of wearable is expected to double

next year!• 85% of 1000 surveyed executives, estimate that

– “More intelligent hardware, sensors, and other connected devices would help life sciences transition from selling products to selling outcomes”

• There is a tremendous opportunity for cost savings:– For each type 2 diabetes patients, at least $697 per

year could be saved by using digitally accessed intermediaries and remote monitoring of diagnosis and treatment”

Médecine Préventive:

Déplacer l’accent d’une médecine centrée sur la maladie vers une médecine centrée

sur le maintien de la santé!

Développement de médicaments = chimio-prévention.

La chimio-prévention

• En faisant miroiter la promesse d'une « pilule miracle », la chimio-prévention menace cette stratégie éprouvée qui consiste à cerner et à éliminer les causes de la maladie.

• L'introduction des médicaments préventifs représente, du reste, une nouvelle menace pour la santé, menace liée à l'apparition de maladies et de décès iatrogènes (dont les causes sont médicales).

Chimio-prévention • Le médicament devrait être relativement sûr et ne présenter aucun effet secondaire mettant la vie en danger.

• Les sujets devraient être recrutés au sein d'une population manifestement exposée au risque de la maladie, et non pas être choisis en fonction de conditions démographiques superficielles, comme par exemple être une femme âgée de 61 ans.

• Les facteurs de risque de la maladie devraient être connus, de manière à éviter que le médicament ne fasse plus de tort au grand nombre que de bien à une minorité.

• Le médicament devrait être testé pour son action centrale.

Médecine Personnalisée :

Adapter les traitements à l’individu(pharmaco-génomique)Monitoring /Compliance

One size does not fit all !

List of personal genomics companieshttp://isogg.org/wiki/List_of_personal_genomics_companies

Pharmaco-genomics

Personal genomics

169 Euros

Pharmaco génomique

• Chaque nouvelle substance requiert une étude pharmaco génomique dans le processus de son développement afin de permettre d’identifier les variations génomiques pour définir quels patients ont:

– Un bénéfice particulier.– Des effets secondaires majeurs.

• Tout ce qui est d’application pour les médicaments, l’est aussi pour les vaccins et moyens technologiques !

– Défibrillateurs (10% sont activés au décours d’une vie ).– Provenge® (Dendreon), prostate cancer vaccine

• Coût USD 93’000 per patient • Bénéfice en survie 4 mois

Les nouveaux essais cliniques

• Hypertension:– Adducine gene variants and anti-hypertension treatment– Monitoring through wireless sensor over an extended period of time;

• Diabetes:– Genomic and molecular biologic analysis of DM/TII in the individual patient (Key gene

TCF7L2).– Testing drugs in this particular context– Monitor with wireless sensors for continuous tracking (to replace HbA1C: overall view

over several weeks)• Cancer

– BRAF V600E mutation in melanoma patients– Vemurafenib (FDA approved in 2011), developed by crystallography approach.– Implantable chip to detect CTC’s.

3D Drug printing3D Printing Could Revolutionize Drugs Downloadable, DIY drugs could soon make the idea of "controlled substances" a thing of the past.

When, exactly? “Maybe 10 to 15 years? Who knows?” says Cronin. “Maybe five to 10.”

The 'chemputer' that could print out any drugWhen Lee Cronin learned about the concept of 3D printers, he had a brilliant idea: why not turn such a device into a universal chemistry set that could make its own drugs?

21July 2012

This Device Lets You Brew Your Own Drugs At HomeDecember 22nd 2015

A machine prototype called Farma can let you manufacture your daily prescription of drugs right in your own home. Designed by MIT Media Lab graduate Will Patrick, the concept tech features a green cylinder and uses blue-green algae that’s genetically engineered to produce pharmaceutical drugs.

Currently, opiates can already be can be brewed in a lab and Artemisinin is made using genetically engineered yeast, which makes the possibility of using synthetic biology as a way to create other drugs feasible.

Smart pill bottlesMonitoring adherence (compliance)

Proteus Swallowable Smart Pills FDA Approved to Measure Medication AdherenceJuly 6th, 2015

The patch then uses its built-in Bluetooth antenna to share when every pill was swallowed with the matching smartphone app, which in turn passes the readings to family, caretakers, and the patient’s physician.

The underlying technology has been approved by the FDA since 2012, but the ability to accurately record when every pill was swallowed has only now been FDA-sanctioned to be used to measure medication adherence.

Médecine Participative :

Réseaux sociaux par et pour les patients.Cloud Computing / Crowd sourcing.Changements radicaux formation

DémocratisationSoins adéquats pour tous

Un nouvel équilibre dans l’écosystême

• Au niveau de la relation soigné – soignant• En matière de médecine « hospitalière »

Soigné - SoignantUn nouvel équilibre

‘Dr. Abscess’ and Why Surgeon Scorecard MattersCritics claim our analysis of surgical complications is flawed. We disagree. For the first time, patients can see a surgeon’s record – and use it to help make their best choice. ProPublica, July 28, 2015, 12:18 p.m.

Smart PatientsUne communauté en ligne où soignés et soignants apprennent l’un de l’autre.

Apprendre entre soignés, partager et acquérir des connaissances & expériences. Acquérir

Rechercher de l’information sur les traitements innovants et la médecine personnalisée (avantages et inconvénients).

Partager son histoire afin de donner de l’inspiration et de l’espoir.

Rechercher des essais cliniques pour lesquels vous dseriez susceptibles de participer

Our paths may not be identical, but you will never walk alone. We are stronger and smarter together.

www.smartpatients.com

Who needs beds? New ambulatory centers offer everything except inpatient careBy David Royse | September 12, 2015

The Children's Hospital of MichiganSpecialty Center, which opens in February, will have a 24-hour pediatric emergency room, operating rooms for a range of pediatric surgeries and outpatient care in several specialties… without inpatients beds

Similarly, Montefiore Medical Center in New York opened a “bedless hospital” last year in the Bronx. The $152 million, 12-floor, 280,000-square-foot tower features 12 operating rooms, exam rooms, a headache clinic, imaging facilities and, eventually, a full-service pharmacy—but no inpatient beds.

Hôtel HospitalierL’Agence Régionale de Santé Ile de France a à cœur d’accompagner les transformations nécessaires du système de santé afin notamment de préparer l’hôpital de demain qui devra être plus ambulatoire et recentré sur ses missions d’expertise et techniques. Ceci, à terme, doit permettre d’améliorer la prise en charge des patients, de dégager des marges de manœuvre pour les établissements tout en générant des économies pour l’Assurance Maladie.

Le développement des hôtels hospitaliers est présenté comme une manifestation de cette tendance. En effet, il permettrait d’amorcer le changement de paradigme nécessaire en visant, à terme, à découpler l’activité de soins des problématiques d’hébergement.

Soins à domicileavec un patient connecté

UK NHS to spend nearly 6 billion$ to go digital including remote care & health appsFebruary 12th 2016

One of the NHS’ goals is to have 25% of chronic conditions like hypertension and diabetes monitoring their health remotely by 2020

A New Smartphone is Launching—And It’s Only $4February 17th 2016

The device is called Freedom 251 and was just very recently unveiled. Specs aside, the most impressive thing about the Freedom 251 is, by far, its price. The pricing strategy and development of the technology was anchored on Narendra Modi’s intent to ‘empower India to the last person

Conclusions:La médecine est en pleine

mutation

Big data en médecine

Big data en médecine

Exemples de « Big Data »

• Génome humain• Données stockées dans les

systèmes informatiques hospitaliers.

• Registres divers (exemple cancer)

• Etudes cliniques• Données provenant de

diverses applications (portables).

• Imagerie médicale• Littérature médicale

Roundup: More than a dozen IBM Watson health-related partnershipsBy Aditi PaiFebruary 09, 2016

Memorial Sloan-Kettering Cancer CenterWelltok. Apple, Johnson and Johnson, and Medtronic, American Heart Association (AHA)

Under ArmourNutrinoNovo NordiskManipal HospitalsBoston Children’s HospitalTriax Technologies Spare5Teva PharmaceuticalsMayo ClinicEpicVarious US cancer instituteshc1.comTalkspaceLifeLearn (veterinary medicine)

University of North Carolina, Ann & Robert H Lurie Children's Hospital of Chicago, BC Cancer Agency, City of Hope, Cleveland Clinic, Duke Cancer Institute, Fred & Pamela Buffett Cancer Center in Omaha, Nebraska, McDonnell Genome Institute at Washington University in St. Louis, New York Genome Center, Sanford Health, University of Kansas Cancer Center, University of Southern California Center for Applied Molecular Medicine, University of Washington Medical Center, and Yale Cancer Center.

Smart Machines Can Diagnose Medical Conditions Better Than Human DoctorsROSS CRAWFORD, ANJALI JAIPRAKASH AND JONATHAN ROBERTS 18 JANUARY 2016

Dr Saxon Smith, president of the Australian Medical Association NSW branch, said in a report late last year that the most common concerns he hears from doctors-in-training and medical students are, “what is the future of medicine?” and “will I have a job?”.

It’s not if, but whenThese changes will not happen overnight, but they are inevitable. Though many doctors will see these changes as a threat, the chance for global good is unprecedented.

Artificial intelligence in healthcare to replace jobsBy Sibahle Malinga, ITWeb's portals journalist.Johannesburg, 24 Nov 2015

In the next five years, radiographers around the world will be unemployable because they will be replaced by this cognitive computing system. Such technological innovations not only reinforce change but they also transform the future of industries, whether we like it or not," he explains.

This is according to Anton Musgrave, entrepreneur, business strategist and futurist at FutureWorld International, referring to the benefits and disadvantages of artificial intelligence (AI) systems in the medical fraternity.

He gave an example of IBM Watson's supercomputer, which combines artificial intelligence and sophisticated analytical software to give a 94.6% accurate medical diagnosis in only 12 seconds.

Kaiser plans to take care model to the source: physician trainingBy Adam Rubenfire | December 17, 2015

Kaiser Permanente is preparing to instill its integrated model for high-quality care at sustainable costs in the minds of future physicians. The Oakland, Calif-based system plans to open an independent medical school in Southern California, with its first class expected to enroll in fall 2019.

HMO giant Kaiser Permanente plans to open a medical school in Southern California

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