Wearable technology and healthcare – Empatica

As we all wait to see whether the Apple watch catches on, there may be another smartwatch you might want to consider that may tell you more about your health and well-being. Empatica’s Embrace is a slickly-designed smartwatch (USD$199) that slaps around your wrist, has a strap made of Italian leather, and is armed with the latest in sensor gadgetry. Co-founded in 2011 by CEO Matteo Lai and MIT Professor and Director of the Affective Computing Lab, Rosalind Picard, the company operates out of offices in Milan and Boston MA.

Empatica’s products (which also includes a health-monitoring wristband) are equipped with medical standard sensors which monitor heart rate, skin temperature and movement patterns. But most importantly it also measures skin electrical conductance or electrodermal activity (EDA), that spikes in the presence of an oncoming epileptic seizure. The technology was mentioned in a Nature article which also linked to a publication in Neurology  that reported surges in EDA correlated with a measure of brain activity thought to be linked to sudden unexpected death in epilepsy (SUDEP), a common cause of epilepsy-related deaths. Empatica’s patented sensor technology is being used in clinical research in over 135 hospitals, and also by NASA, Stanford, Microsoft, and Intel. Current epilepsy detectors work by monitoring changes in movement that reflect the muscular spasms  and convulsions we often associate with epileptic fits and which take place only during the seizure. However, some forms of epilepsy can take a less visually traumatic form and may just involve someone staring off into blank space for a minute or two. Measuring EDA therefore informs the patient early on if a seizure is oncoming, and works for non-convulsing forms of epilepsy. The company has already garnered some funding from winning the Shark Tank competition, and has recently turned to crowd-funding to generate more funds. They have even committed to a policy of donating one Embrace watch for every watch they sell to a child suffering from epilepsy.

Overall, its a nice product that looks great and is backed by solid scientific research. Some challenges Empatica may face run true with many other forms of wearable technology. Mainly customer uptake (cost may restrict its use to a select population), compliance/long-term adherence, data privacy/ownership, data accuracy, short battery life and the tendency to function only when a phone is nearby. However, wearable tech has already made profound changes to the way things are currently done. Google glasses despite not catching on in the mainstream market, has significantly improved certain procedures like surgery where the surgeon is able to visualize surgery guides or teleconference with an expert based overseas, all done without taking his gloves off. Disneyland has also employed MagicBands that allows people to get on or off rides, pay for food and enter your hotel room, allowing one to travel light. It also lets Disney collect data such as consumer spending habits and human traffic, the latter enabling it to deploy more staff to the relevant areas. Contact lenses are also being designed by Google and Novartis that can monitor blood glucose levels or correct vision by ‘autofocusing’.

Another wearable (if you count phones) tech product or rather software that may play a larger role in healthcare is Apple’s ResearchKit which allows researchers to design apps that can track a person’s health/cognition/motion. Watch the film and you’ll see what I mean. It even goes so far to be able to monitor your gait with the aid of a gyroscope – a cool tool for monitoring Parkinson’s disease patients. This sounds cool but again may be difficult to implement for compliance and data privacy reasons.

There is a low barrier to entry for wearable tech if you are designing something that only tracks “wellness” (e.g. Jawbone/Fitbit) as compared to clinically relevant data. But it is the latter ones such as Empatica’s that would matter the most I imagine.

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What I wish I had done during my PhD

A PhD is a tremendous time investment, but admittedly helps in your scientific career. It’s been about more than 8 months since I finished mine. And looking back on the experience, I definitely would have done certain things different. So this is for those folks who are in the midst of the PhD fervor, or are just starting out (PhD babies!).

Things I should have done or was glad I did during my PhD:

1. Avoid hazy topics and don’t be overly ambitious. I think its probably the secret wish of every PhD student to find a cure for a disease or make a breakthrough discovery during their PhD. This is not a bad thing but a PhD lasts for 4 years (ideally, that’s maximally how long you want it to last) and if you are not already an expert in the field, you are going to take a few months/years groping around to find your bearing. A topic where many questions remain unanswered or controversial with little progression being made by experts in the field over years, is unlikely to yield to your single-handed efforts. So try to keep your research questions simple. Even if it is in a hazy field, tackle a question in a way that nobody has, i.e. find a different approach. Because it is unlikely to yield any novel results if you are just trying what others have already done.

2. Define your project(s) early on. Due to my mistake with point 1 i.e. having an overly ambitious project, I only started on my actual project late in year 2 of my PhD. So that is 2 years of work down the drain, nearly half the PhD! But this is a surprisingly common trend for many PhD students. It’s not always the fault of the supervisor as well, they may also be caught up with the overly ambitious project 1. But one thing is for sure, you have got to know when to quit if the project is going no where. So best way to do this, is to start with a few projects early on, and LET THE DATA GUIDE YOU.

3. Listen but don’t be waiting for instructions. A PhD project is probably the most self-indulgent time of your life. It’s all about you. Which also means you can’t be waiting for your supervisor to tell you what to do. They might try to, but hey its your project. Which is also why you are supposed to have a counsel of Professors on your advisory board. Everyone is there to give you advice, but you choose what to act on. I once even had advice from another PI to plan my figures down to the very blot before I had even begun. Note that this contradicts directly to letting the data guide you. So sure listen to all advice, but don’t get overly carried away by a particular source.

4. Plan your experiments weekly. This is something I did pretty well and was probably what allowed me to graduate on time with just enough data. Time is so precious during your PhD you have no idea. So writing down what you have to do (mostly experiments for me  but you can also set aside time for reading) every week, down to hourly chunks, not only ensures you get things done, it also records what you have already done. I found Outlook calendar to be great for this and it syncs with my phone too.

5. Record, review and secure your data. Your work is defined by your data. You need to make sure you record it in legible format. And you also need to make sure you save it and not lose it when your computer crashes. Occasionally, you ought to look through it carefully to figure out what the heck you’re doing and what more you need to do.

6. Keep up with the literature and read with a focus. Nobody works in a black hole. There are others out there working in your field and you need to know what they are up to. Make it a habit to read at least 2-3 papers a week. When you are reading, know what you are looking for. Usually the objective of the paper, how they did it, and what the results look like (don’t bother with reading through every single word). Don’t read mindlessly, hours can be lost just going from reference to reference. You need to know what you are looking for exactly, if its something you want to learn more about, try recording it/highlighting as you read so you can refer to these highlights after. Get started with your bibliography early, software like Mendeley were real time-savers for me. Also subscribing to email alerts based on search terms relevant to your field is a great way for keeping up to date with current research.

7. Talk, collaborate, go to conferences, meet your friends. I know its hard for scientists. We are a socially awkward bunch. But trust me, do not coop yourself up in the lab. Learning moments are usually when we talk to other people. Even to people in your own lab. I garnered so much advice and ideas just talking to the postdocs in my lab. I also learnt alot from other people in my field and the academic world is actually a pretty friendly place. People give you reagents for free when you ask for it and even the most famous Professors sometimes spend the time to answer an email from a pleading PhD student. Conferences are also great, a lot of intellectual stimulation plus you get to travel. The Society for Neuroscience conferences are amazing, go for one if you have the chance. Talk to your fellow PhD classmates. It helps to learn how other people approach problems and they are a great source of help and advice too. Don’t get freaked out though if their projects are going way better than yours, focus on your own! And finally, try not to work on a Friday night. Release all that scientific frustration in your own way – sport, alcohol, dance, food etc.

A PhD is a great learning experience, but the time is limited, so try to get as much out of it as you can. And don’t forget to find out where you’re going next after the PhD!

Disruptive technology – Theranos?

Disruptive technology is defined as an innovation that creates a new market and value network, eventually disrupting an existing market and value network and displacing existing technology. It is what everyone is on the search for, that business idea that would change how things are currently done. The previous post covered synthetic biology, which I believe will become a disruptive technology though it may take several years.

In current times however, one company that has been on the news for being a disruptive innovator is Theranos started by Elizabeth Holmes at the age of 19. The company is a service provider, providing an array of blood tests at affordable prices using a minute blood sample (25-50 microliters to be exact) obtained by a finger prick. Starting out with the money her parents had saved for her education, Ms Holmes dropped out of Stanford to start the company, initially called Real-time Cures, in Palo Alto. Operating discretely, she has managed to raise over $400 million in funding over 10 years, at times even turning away investors because they were too interested in quick returns. Starting out from the basement of a college house, Theranos now valued at $9 billion, employs about 500 people and has labs at 21 Walgreen departmental stores, making it extremely accessible to the general public. What’s more the cost of her blood tests are often half to a quarter the amount that hospitals and private clinics charge. The right to know the status of your health, is a point Elizabeth consistently drives across in her talks and interviews, relating how deeply affected she was by an uncle’s death from cancer which may have been prevented if only diagnosis tests came earlier and were more affordable.

A co-inventor of 82 US patents and 189 foreign patent applications, 84 of which have been granted so far, Elizabeth is obviously an extraordinarily gifted individual. Though she has received flak for not publishing data from the blood tests in peer-reviewed journals, she has successfully obtained FDA approval for her test system and tests for Herpes Simplex Virus 1. Being recognized by the FDA, the most stringent regulatory board, gives Theranos a boost in terms of establishing itself in the laboratory diagnosis industry. Theranos technology however is based on existing methods, so the basic technology is not disruptive per se. It is more of how it is being implemented which is changing the state of healthcare. Using smaller samples, less material, a smaller carbon footprint, and minimal labspace compared to current standards, allows Theranos to charge less. The results are even sent out using an app, and available much quicker than other test centers such as Quest and Laboratory Corp. of America. This is due to their tests being automated and running through nights and weekends. Furthermore, Theranos is now linking up with insurance providers, which will probably increase their customer uptake.

It is not often that someone so young can drive something to fruition in such a short time. Elizabeth has even garnered support from very famous individuals including former U.S. Secretary of State, Treasury, and Labor George Shultz; former Secretary of Defense Bill Perry; former Secretary of State and National Security Adviser Henry Kissinger; and former U.S. Senators Sam Nunn and Bill Frist, among others. People seem impressed by her conviction, leadership and drive. Perhaps it also helps that she’s blond and beautiful? You can read more about her here and here, and here’s the Ted Talk she gave last year.