This article was taken from the February 2013 issue of Wired magazine. Be the first to read Wired's articles in print before they're posted online, and get your hands on loads of additional content by <span class="s1">subscribing online.
In 1967, Star Trek featured a fictional medical device, the Tricorder, which could diagnose a multitude of ailments non-invasively. Now a $10 million (£6.4 million)
X Prize is fuelling a race to make the Tricorder a reality.
Could Walter De Brouwer's Scanadu SCOUT, one of the contenders, be the diagnostic tool that will transform how we manage our future healthcare?
In 2005, Walter De Brouwer carried his five-year-old son, Nelson, into an emergency room in Brussels. The boy was unconscious, and the left side of his head was caved in. In medical parlance he was class three on the Glasgow Coma Scale, a designation that carried the implication of permanent brain damage. Nelson had fallen from a window ten metres up. If he had not been operated on, the blood from his wound would have exerted so much pressure that his brain might have exploded.
Medical procedures for head injuries differ around the world, but some physicians consider operating on Glasgow-3 patients to be pointless. The Belgian doctors agreed to operate, but with the caveat that if Nelson survived there was a good chance that he would be vegetative. They said his "content" might be gone.
The idea of total content loss was significant to De Brouwer: he was a digital entrepreneur who viewed information as the most important currency in the modern world. In his youth, as the publisher of the Belgian cyberpunk magazine WAVE, De Brouwer had been an anarchist; this was when proclaiming "information must be free" sounded like dissent. By the time he founded the deep-future research firm Starlab in 1996, the net was blossoming and disruption had become the norm. Starlab employed the physicist Serguei Krasnikov to research portals for time travel, and the AI expert Hugo de Garis to develop an artificial brain. When Starlab closed its doors in 2001, after losing some key investors, De Brouwer took a job in finance; he was finished with big ideas.
The downside of being an information scientist is that you see everything in terms of data. After Nelson's surgery, De Brouwer sat with his son in the intensive care unit (ICU) beside a series of machines that offered information to the doctors. Then Nelson was moved to the general wards, where, instead of machines, there were just nurses. De Brouwer became consumed by the idea of all the data stuck inside Nelson. "When the doctor comes in it's, like, 'Open your mouth...'" De Brouwer says today. "Our grandchildren will laugh about this, the comedy capers of medicine."
There was a moment -- it would not come for a few more years, after 13 more operations for Nelson -- when De Brouwer wanted to share this knowledge with the world. He wrote to Starlab's former investors: "I propose doing one last big idea. If we succeed, everything else will be a footnote. Our last legacy: to disrupt healthcare. To destroy the hospital and clinical system and give the tools and knowledge to the people."
De Brouwer's big idea? To build a machine to read the information in Nelson's brain.
Singularity University is an experiment in futurist education situated at Nasa Ames Research Center, in the heart of Silicon Valley. Dr Peter Diamandis, the chairman and CEO of X Prize Foundation, cofounded Singularity with Ray Kurzweil in 2009, and he continues to use the institution as a testing ground for bold ideas. In the summer of 2011, when De Brouwer was launching his healthcare project, Scanadu, Singularity hosted a seminar called FutureMed, which aimed to explore how exponential technologies can disrupt healthcare. De Brouwer arrived at FutureMed eager to reveal a secret: Scanadu wanted to manufacture a medical Tricorder -- a piece of hand-held technology from the TV show Star Trek that is capable of scanning, analysing and recording a wide array of data, including physiological. What he didn't realise was that Diamandis wanted to create an X Prize to encourage development of exactly such a device.
The X Prize is renowned for targeting the cusp of what is humanly possible, and the Tricorder certainly qualified. Placed near a patient's body on Star Trek, it offered a complete, non-invasive diagnosis. Like many technologies unveiled on Star Trek, the Tricorder seeped into popular culture, a tribute both to how well the show's creator, Gene Roddenberry, limned the scientific expectations of his day, and to how the Tricorder addressed a latent desire about data extraction: mining the self.
As the global healthcare industry has evolved into a morass of expenditures and conflicting interests, the impulse of self-diagnosis evoked by the Tricorder has come to represent the ultimate goal for medical innovation.
In early 2012, Diamandis went public with the Qualcomm Tricorder X Prize. Sponsored by the Qualcomm Foundation, the philanthropic arm of the telecommunications equipment giant, the prize offers $10 million (£6 million) to the successful designer of a handheld device that integrates the latest in sensor and imaging technologies with non-invasive laboratory tests and an artificial-intelligence data engine, a device capable of diagnosing 15 different diseases in three days. About 250 companies or individuals have pre-registered. By mid-2014 this list will be winnowed down to the ten most technologically and medically proficient concepts. A year later, the finalists will be announced, based on the results of diagnostic testing, a "consumer experience evaluation" and "proof of adequate high-frequency data logging". "In my BMW and plane I have 50 to 100 microprocessors watching what's going on, generating data about all the critical parameters," Diamandis says. "On the human, I have nothing. I have a few bits of data I get on my annual physical. You should have gigabytes of data, to identify well in advance of cancer and heart attacks when something's off. This is where the future is going, there's no question."
The list of the Tricorder X Prize applicants supports this.
Stephen Johnston, from the Biodesign Institute at Arizona State University, has developed a finger-prick blood test that takes an "antibody signature" to provide a wellness report and detect diseases early. Michael Barnathan, the CTO of an AI startup called Living Discoveries, plans to build a device that integrates passive data on everything from mammography to movement. Russian researcher Igor Grakov has developed a cognitive test to determine altered perception of colour -- imbalance is indicative of changes to the autonomic nervous system and molecular biology: this test is being utilised by UK firm Montague Healthcare. Another startup, Lifecom Products, intends to combine individualised sensors with advanced "decision support" to create an intermediate agent that saves physicians from drowning in data. Like other competitors, Lifecom CEO Steve Datena accepts that the intelligence of his product may not matter unless he finds someone to partner with. The breadth of the X Prize's goals appears designed to encourage collaboration, so it's hard to gauge an early front-runner.
Eugene Chan has as good a chance as anybody of winning. In the 90s, he dropped out of Harvard Medical School to pursue an idea for the fastest and cheapest personal genome decoder the world had ever seen. Using a fluorescence-based sequencing technique, he believed he had found a way to decode the variations in all three billion base pairs of DNA in the human genome in 40 minutes. Chan raised $20m to start a company, US Genomics; luminaries such as Craig Venter marvelled at the possibilities and helped him raise a further $30m. However, it changed its business model and scientific focus several times, finally settling on pathogen detection.
Unhappy with the company's new direction, Chan returned to medical school. One night, during a shift at Brigham and Women's Hospital in Boston, Massachusetts, Chan saw a dying patient wait two hours for test results. How could it be that in the 21st century one couldn't get instant lab results? Thus began his journey into medical diagnostics -- he wanted to change the way blood was drawn. He applied to Nasa for funding and set up shop in Cambridge, Massachusetts.
His Universal Blood Sensor (left) looks like an early mobile phone and ejects a small blood-collector. The blood sample travels through a tiny piece of plastic -- a "lab on a chip". Because the sensor can conduct unlimited assays, Nasa commissioned a prototype for the next generation of astronauts, who, if they make it to Mars, will need to perform their own medical diagnosis.
The genome is unchanging; its information is primarily useful as a predictive tool. But the information in blood is ever-changing or, in medical parlance, "actionable". In clinical medicine, actionable information beats static information every time. It could be that Chan's epiphany at the hospital could have enormous impact on medicine.
Diamandis's first X Prize, the Ansari, was awarded to the first privately developed spacecraft to go into outer space -- Scaled Composites' SpaceShipOne -- just eight years after the competition was announced. Since then the X Prize Foundation has launched competitions to sequence the genomes of centenarians, clean up oil spills, put a robot on the Moon -- and create a Star Trek-style Tricorder.
Before the idea for the Tricorder X Prize came about, Diamandis sought advice from experts across disciplines. He talked to Larry Brilliant, the doctor and technologist who worked with the World Health Organisation to eradicate smallpox; and to David Ferrucci, the IBM employee who built Watson, its AI natural-language processor. But the most interesting conversation Diamandis had was with a marketing executive in Qualcomm's Health amd Life Sciences group named Don Jones.
Diamandis approached Jones about an earlier idea for a medical X Prize that he thought Qualcomm might want to sponsor. The idea was to combine AI with smartphone technology to create an "AI Physician" that could make a diagnosis by combing through a patient's medical history and asking questions. "It's projected that, by the year 2020, the US will be short of 91,000 doctors,"
Diamandis tells Wired. "But that shortage is good compared to the rest of world. Take Africa. It has 25 per cent of the world's disease burden but has only 1.3 per cent of the world's healthcare workers." Diamandis's goal was to provide a doctor for every human being on Earth.
Jones told Diamandis that Qualcomm might be interested, but, "Would be much more interested in a solution incorporating more data points than could be provided by software and queries," Jones recalls. Wireless sensors, imaging technology and medical equipment were advancing fast, and Qualcomm saw in them huge opportunities for advancing global health. In thousands of laboratories across the world, scientists were creating a new generation of medical tests so minimally invasive that they could soon be partnered with wireless technology. Generating an infinite stream of real-time information about every cellular function imaginable, our bodies would become living, breathing data centres. "There's a good working example of this," Jones says. "Diabetes.
Forty years ago if you were diagnosed with diabetes you had to go to the doctor's office and get your glucose measured and your insulin dosage adjusted." But with the advent of glucometers, patients can do these things themselves. Self-testing revealed new details about how diet, exercise and stress affected glucose levels. Fifty years after the invention of the glucometer, diabetics remain a rare patient group that can manage their health in real-time. The rest of us rely on metrics such as our body temperatures.
Jones believed that even healthy people should be able to have access to the sort of data available to diabetics. He told Diamandis that Qualcomm would be interested in sponsoring an X Prize that incorporated AI and remote sensoring and diagnostics, a prize that offered not only the possibility of self-diagnosis, but of data management and analysis. Following further development of the concept, the Qualcomm Foundation formally became sponsor of the Qualcomm Tricorder X Prize.
But convincing people that they not only have the right to the information within their bodies, but the knowledge to manage it, is challenging. "There's a great danger in saying healthcare information should be the same as [online] banking. There are so many variables," says Leslie Beard, the manager for the Centre for Innovation in Complex Care, a division of the University of Toronto Faculty of Medicine. Even Harvard chemist George Whitesides, whose work miniaturising diagnostic tests on to squares of paper is being used by the company Diagnostics for All to proliferate cheap medicine throughout the developing world, admits the notion of healthcare's intrinsic "differentness" has merit. "You have something called a 'patient', who you need to get something physical from," he says. "A drop of blood. Urine. You have to think about privacy. You have to think about discomfort."
When Diamandis announced the Ansari X Prize back in 1996, not only was it was illegal in the US to send a commercial rocket into space, there was no regulatory authority for such an idea.
Diamandis had to ask Nasa and the Federal Aviation Authority to create one. The Qualcomm Tricorder X Prize faces similar challenges.
There are also regulatory hurdles confronting the Tricorder X Prize. In the US, the Food and Drug Administration (FDA) plays a czar-like role in dictating which medical technologies enter the marketplace. When Jones and Diamandis finalised the Tricorder concept, they made sure to contact the FDA. "There's never been a device this complex," Jones says. "But the actual prize doesn't require a commercialised, FDA-approved product. Just one that works."
Do you really want unmitigated, real-time access to your body's data? Might it create a population of unfathomably detail-orientated hypochondriacs? Could information be a gift or a curse? Will doctors become mere intermediaries between our bodies and machines? Instead of six years of training, will they require six months?
De Brouwer thinks a lot about such questions. He views Scanadu as part of the digital era's three-pronged information revolution.
This first goal is to create citizen doctors. Then, perhaps, he'll turn his attention to government and then education. A concern, however, is whether Scanadu might become another Starlab. The company was started with an initial $2m in seed funding, and has continued to attract investors. By the end of 2013, it aims to have taken three products to market. However, some VCs find Scanadu challenging due to its plan for a multi-pronged product line:
Tricorders for the medical establishment, for consumers, paediatrics and parents. Scanadu's business model has evolved to target "spit and polish" Tricorders that aim to execute existing ideas better, such as measuring physiological traits (Scanadu SCOUT), testing for upper respiratory infections (Project ScanaFlu) and checking urine for diabetes, kidney failure and pregnancy (Project ScanaFlo).
But whereas Starlab was a patent farm, Scanadu is manufacturing products; whereas Starlab believed anything was possible, Scanadu has a discerning attitude towards new technologies; whereas Starlab was headquartered in a former embassy building on the outskirts of Brussels, Scanadu rents space in a former naval barracks on the campus of Nasa Ames Research Center, down the street from Singularity University. And whereas Starlab was the creation of unbridled optimism, Scanadu was set up by a man who seems to have learned from his mistakes. De Brouwer knows Scanadu is a tough sell. Investors love to throw money at single-purpose technologies that come out of storied institutions and can do one large market test reliably. But Scanadu is, as yet, unproven in the market.
On the day Wired was supposed to meet him last summer, De Brouwer had a heart scare, prompting Scanadu's medical consultant, Jamison Feramisco, to run an ECG with a prototype of the Scanadu SCOUT. De Brouwer caught a flight back to Belgium for a proper check-up, as he has no US health insurance. When he returned to the US, Wired met him at his house in Los Altos, California. He was alone, sitting on a sofa in front of an enormous flat-screen TV that took up an entire wall. There was no other furniture. He was unshaven, and he was wearing black sunglasses.
In Belgium, the doctor had given De Brouwer an ultrasound and a cardiac stress test. If a middle-age heart scare typically instills the fear of advancing age, for De Brouwer it only affirmed what he already believed: that the advice dispensed by doctors, otherwise known as a "diagnosis", was not nearly as valuable as most people think. "He puts me on the machine, puts on the gel, takes the ultrasound," De Brouwer says mockingly. "And all he says is, 'Yep, yep, OK, yep...'"
These days, his son Nelson has problems with syntax and universal knowledge, and the right side of his body is paralysed.
When De Brouwer was in the ICU, he made a discovery that deepened his conviction about why medicine will undergo radical change.
There were other children in the ICU, and De Brouwer realised that the only way he could be useful -- either to Nelson or himself -- was to indulge a kind of therapeutic energy by trying to help the parents. The strangers traded tips and tricks about the significance of the machines' oxygenation readouts, about what to do in case of a blood clot. They created a network. "I forgot my own situation," he says. "Helping is therapeutic, it helps you forget your own misery. "Diagnosis is a 20th-century word, it's obsolete," he says. "A carbon-based unit with a degree and residency duty has pronounced a verdict protected by a community of brethren about a number of government-audited procedures that have been documented by the pharmaceutical industry. The new word is 'recommendation'. If my child is sick, I want to compare him to other children with the same illness. And then I will talk to a doctor, if necessary."
Like many X Prize competitors, Scanadu is building on existing technology, while developing proprietary tech (with a claimed 38 patents at time of press), diagnostic algorithms and techniques such as hyperspectral imaging in diagnosis. Can all this bring us a step closer to a Star Trek future, where data is the doctor? We can't be sure, but someone has to boldly go there.
Other contenders for the X Prize:
Micah Atkin
Chief scientist, MycroLab
The Australian startup has developed a "lab on a chip", a handheld device based on the "microfluidics" principle. It can conduct a variety of lab tests including DNA sequencing and diabetes diagnosis within an hour. Its simplicity means that it can be used in the field with very little training needed.
Stephen Johnston
Codirector, Biodesign Institute Johnston's finger-prick blood test takes an "antibody signature": a sample of the antibodies in your blood that can indicate exposure to diseases. The test would provide a wellness report on one's immune system. The US Department of Defense has awarded Johnston $30 million to deploy the device.
Graham Ewing
CEO, Montague Healthcare
Virtual Scanning technology detects changes in the type of light reflected by the eye -- colour imbalances signal the presence of specific proteins, such as glycated proteins associated with diabetes. The cognitive colour-perception test may also determine other pathologies.
Anita Goel
CEO, Nanobiosym The company has built Gene-RADAR, a handheld device that can read unique genetic fingerprints. This means it can instantly detect a range of diseases based on their DNA or RNA signatures, from samples as small as a drop of blood or saliva, with no need for a lab. Each Gene-RADAR test costs $10 (£6).
Michael Barnathan
CTO, Living Discoveries Living Discoveries' device will integrate passive data from photos, videos and sensors -- so it can detect symptoms such as an abnormal gait, a key indicator of Parkinson's disease. Its AI can analyse and integrate this data to produce a customised health report and even send real-time alerts to doctors.
Earlier X Prizes
The Ansari
X Prize The original X Prize, launched in May 1996, aimed to create a private space-flight vehicle. The prize was won, on October 4, 2004, by the Scaled Composites' Tier One project using the SpaceShipOne craft, designed by American Burt Rutan. His team was awarded $10 million. Over $100 million was invested in new technologies in pursuit of the prize.
Google Lunar
X Prize The prize will go to the first team to land a robot on the Moon, have it travel 500m over the Moon's surface and successfully send video, images and data to Earth. It was announced at the 2007 US Wired NextFest and offers $30 million in prizes. Twenty-five teams are taking part. The prize expires when the money's won, or at the end of 2015 (whichever's first).
The Progressive Insurance
Automotive X Prize
The engineering competition was launched in 2007, to create a fuel-efficient "clean" car that gets 2.35l-per-100km efficiency, produces under 140g per km CO2 emissions, and could be mass marketed. There were several winners, announced on September 16, 2010, including Edison2, which won the $5 million Mainstream Class prize for its Very Light Car.
The Archon Genomics
X Prize This challenges teams to sequence 100 whole human genomes of 100 centenarians within 30 days, with an accuracy rate of at least 98 percent, and at a cost of no more than $1,000 per genome. The "100 Over 100" target aims to identify genes that protect against disease, while giving researchers clues to health and longevity.
Prize announced in October 2013.
Jesse Sunenblick is a writer based in Mexico. He's working on a book about the limits of human knowledge in the information age
This article was originally published by WIRED UK
