Kraft talks about the future of health and medicine—and where technology can take us
Tell Me More is a Tufts University podcast featuring brief conversations with the thinkers, artists, makers, and shapers of our world. Listen and learn something new every episode. Subscribe on Apple Podcasts, Google Play Music, Stitcher, and SoundCloud.
Daniel Kraft is a physician-scientist, inventor, entrepreneur, and innovator. With more than twenty-five years of experience in clinical practice, biomedical research, and health-care innovation, Kraft envisions the reinvention of medical education, revolutions in dentistry, must-have technologies for parents—and the apps that could help change the lives of patients. He came to Tufts to celebrate the 150th anniversary of the School of Dental Medicine.
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Recommended Links:
Daniel Kraft website
Biography of Daniel Kraft
Twitter: @daniel_kraft
TRANSCRIPT
HOST: Welcome to Tell Me More, a podcast series featuring distinguished visitors to Tufts University who share their ideas, discuss their work, and shed light on important topics of the day. Subscribe on Apple Podcasts and SoundCloud.
In this episode, Dr. Daniel Kraft, a physician-scientist, inventor, entrepreneur, and innovator envisions for Tufts University’s Katie McLeod Strollo the reinvention of medical education, crowdsourcing medical data from around the world, revolutions in dentistry, must-have technologies for parents, and the apps and other forms of technology that could help change the lives of patients.
KATIE STROLLO: Welcome Dr. Daniel Kraft. Thank you so much for taking the time to speak with us today. We would love to hear from you a little bit about what you do. How would you describe your work?
DANIEL KRAFT: Well, I trained as a traditional physician-scientist—internal medicine, pediatrics, hematology, oncology—and while doing my traditional medical training, always loved crossing fields from space and aviation—since I’m a pilot—to medical devices, to digital health. And about ten years ago, in 2008, I helped be in on the ground floor of a new institution called Singularity University, where we look at the advancement of technologies from AI, robotics, 3D printing, biology, etc., and how those are going to impact—and how we can leverage exponential technologies to impact—the future. So, part of my academic hat is chairing medicine for Singularity University, which is based in the heart of Silicon Valley and also has built and spun off a program called Exponential Medicine, where we look at how do all these new tools and technologies? What are their implications for the future of health, from health and prevention to diagnostics to therapy to global health? So, part of what I do is help people see the future early and to catalyze new thinking and ideas to address medical and health-related problems.
STROLLO: We want to talk a lot with you about the future, but we would love to first start by taking a quick look back. As compared with, say, ten years ago, what are some of the key advancements between then and now?
KRAFT: Well, there’s a lot that’s happened in the last decade, particularly that we experience as consumers. We’re only basically ten years into the smartphone, into the app store, the fact that I’m wearing a new Apple watch that can do an EKG, that 5G is coming—the fact that we can stream 1,000 movies. Lots has happened in just the last decade. We barely had Twitter and Facebook ten or eleven years ago. So, those are just small examples of advancements, let alone the quick, advancing pace of things like self-driving cars or artificial intelligence being embedded into our environments or things like Amazon Alexa and our home voice assistants that have only been out for about three years. So, a lot’s happening quickly and things are accelerating and it’s kind of that lens . . . I like to share with people when they think, what could the next ten years look like in terms of health and medicine?
STROLLO: How would you describe things that are on your radar that may be coming out in, say, the next five years, ten years? Is our future bright?
KRAFT: Well, we need to sort of rethink and reimagine elements of health and medicine, particularly in the U.S. We’re already . . . 18 percent of our GDP, we have the highest spend per capita, but we’re 14th in terms of outcome, so there’s lots of room to improve. And part of that is potentially reframing the way we really practice and how we practice health care, which, in reality, is more sick care. It’s sort of based on intermittent data, you know, the occasional blood pressure check, EKG, lab, etc., that we get a fraction of the time we might be in the clinic, so that leads to a reactive sick care model. We wait for disease to happen: heart attacks, strokes, a late-stage cancer. And part of what I see of the advent of the new of age of health and medicine is that we’re going to be more continuous with our wearable devices, our Internet of things connected homes, our mattresses can track our physiology when we sleep, the microphone on your phone can pick up changes in even mental health or risk for other diseases.
So, we’ll start to pick up these digital bread crumbs as well as have low-cost genomics—you know, $100 genome, our microbiome data, and use that to smartly, personally, proactively pick up your risk for disease and when you do have an issue, whether it’s high blood pressure, diabetes, high cholesterol, to manage it in a much more precise, data-driven, and feedback-looped manner. So, part of the future is no one technology. It’s more how we put these things together. How do we connect the dots? How do we empower each of us as consumers or patients to use our data, not just from our FitBit or wearable, but to connect that to our health-care team, to crowdsource that so we can take that from big data to actual information and then hopefully to align the incentive to use some of these new tools, data, and technologies to move the curve and not just be treating—you know, spending 80 percent of our health-care dollar on the 20 percent of the population that already have advanced chronic disease?
STROLLO: So, what about the world of dental?
KRAFT: I think there’s a lot of interesting potential in the dental world: everything from new ways to do smarter, easier prevention. There’s obviously connected toothbrushes today and you can gamify it and get your kids or yourself to compete and stay on top of your brushing. I invented a little 3D-printed mouth-washing machine so maybe you could brush your whole mouth and floss with a little automated robot. We can think about ways to look at the microbiome of the mouth and predict who is going to end up with worse periodontal disease and maybe even replace the microbiome in the mouth and the gut. In terms of dental education and therapy, a lot of folks don’t go to the dentist because they’re afraid of the pain or the environment. We can use tools like virtual reality that are used for video gaming—that you can now put your smartphone in a VR headset. Maybe while you’re in the dental chair, use that to relax as a patient. Or for a dental student or surgeon to train for a surgical procedure and practice it ahead of time. So, instead of . . . most of us clinicians train as “see one, do one, teach one.” It’s going to be “see one, sim one, sim one, sim one,” until you get it right.
And then other realms of dentistry could cross over with the advancements in 3D printing. It’s already changed the way we do orthodontics—you know, scan your mouth and 3D-print braces, all the way to 3D printing whole-mouth replacements or even using stem-cell biology to regrow teeth. So, lots of things, I think, can impact dentistry from the proactive preventative side to medical education to engagement, all the way to regenerative medicine.
STROLLO: With it being the 150th anniversary of Tufts University School of Dental Medicine, I’m curious, what do you think the future of dental medicine looks like 150 years from now?
KRAFT: We’re not going to have teeth anymore. We’re just going to be eating some IV infusion of our personalized nutrients. Bad joke. 150 years is probably a hard window, just because things are accelerating. The change we’ve seen in the last twenty years probably dwarfs the one hundred years before that. I hope we still don’t have the model of calling up on the phone, waiting for your appointment, sitting in the waiting room, filling out with a number two pencil the clipboard for the same questions, using a fax machine to communicate.
I would hope the future of dentistry and medicine, in general, will be one where you start to do proactive practice habits—whether it’s easier ways to brush or floss—but that your dentist, when they see you, they’ll see you potentially much more virtually and there already obviously a slew of dental-related apps, but ways that you could do tele-dentistry, virtual care. Maybe you have a home medical kit? A home dental kit, which will enable you to take care of issues, whether it’s dental caries, all the way to a form of something more significant. So, I think we’ll change the practice of our touchpoints. We’ll change the way we use all the data, so it’s blending artificial intelligence for just-in-time information and care. So, I think there’s a variety of ways we’re going to blend into the future. None of it will happen just at once.
And for those who are listening, don’t wait for the future. I think we can all go out there and create it. If you see a challenge area in your clinical practice or your own health issue, go out there and find some solutions that might exist already and help connect those to your primary-care physician or your dentist to help solve them.
STROLLO: So, what would you say to people who might worry about becoming overwhelmed with so much access to information on the Internet and within apps? What’s your advice for consumers?
KRAFT: Well, it is a challenge, being overwhelmed. We can wear all sorts of wearables and have dozens of apps. I think the future is going to be to sort of synthesize these, you know? The next generation of wearables have many more sensors and they don’t just track steps and sleep. They can track my heart rate or if I have a heart arrhythmia. They might give me insights into my sleep in interesting ways that might be indicative of sleep apnea or other problems. And we don’t want to be looking at a raw step and sleep data. We want to see a sort of a synthesized score and different people want to see that information in different ways. Some want to see the actual raw detail; they’re a data geek or they’re an engineer.
Others just want—like a FICO score for your financial health—a FICO score for your overall health and use that to guide prevention and therapy. And if you’re communicating to a millennial versus a baby boomer, you need a different form factor. The user interface is how we design the clinical and preventative experience. So, part of it is letting people meet their data—and, hopefully, information—in ways that match them and their personality and to use that smartly to incentivize good behaviors or to manage a disease and adherence to a therapy when we need to as well, in an engaging way. You know, the engaged, empowered patient is the new drug without being overwhelming and just full of data—not actual information.
STROLLO: How about privacy concerns? Where do you see consumers five, ten years from now, thinking about their privacy as to where it is now?
KRAFT: Social norms change around privacy. The younger kids today are very happy sharing almost everything on social media. Some have different privacy norms, but I think data—and particularly shared data—is really the oil of health and medicine, and dental care as well. How do we crowdsource our genomic information to be doing a smarter job at picking up predictive elements or picking the right therapy for a cancer? How do we share our digital exhaust and understand what it means? But be able to opt in to share that data so that we’re able to build a better map of health care. Just like with our driving today—you know, ten, twelve years ago we still used paper maps? Remember paper maps? Now we all drive using Google Maps or WAZE, which is this convergence of crowdsourced driving data and that’s your speed and location, which is pretty private information.
If I think we have that same mindset that we can share data, but get something back to build our own health-care journeys and health-care maps and guide us around the traffic jam or around the drug that won’t work for us, or to a therapy or a solution that matches our needs. I think that will empower people to share data. At the same time, there’s always going to be dark sides. You can 3D-print a tooth, you can 3D-print maybe an organ and can also 3D-print a gun. Data can be stolen or used in positive or negative ways, so I think we need to look at other technologies. Blockchain is being explored in many ways to store and share medical data; enable clinical trials, and those who are running health-care institutions and records systems need to be on top of these technologies as well, to prevent hacking your hospital or hacking your genome.
STROLLO: Let’s talk a little bit about health-care apps. What has been developed in the last few years—and what’s still coming?
KRAFT: Well, we’re only—in 2018—ten years into the app store and billions of dollars of apps have been sold and there’s tens of thousands of actually health- and medical-related apps. Some of them are actually becoming FDA approved, so the idea of prescribing an app to help manage mental health—your phone could be a signal to someone that is bipolar. Are they sitting on the couch and not moving or are they manic and texting and has their voice changed? That could be an important measure. There are some mental health-related apps out there, some of which are, again, going through regulatory processes.
We’re seeing apps that can combine with wearables and social networks. They can be a game-changer for, let’s say, type 2 diabetes. We can identify individuals who are pre-diabetic, before or they’re on the cusp of becoming diabetic, which adds expense and medical issues and morbidity, mortality, and put them in a social network, give them a wearable, put them with a virtual coach and they can dramatically turn folks around. There’s an app platform from Omada Health, which is now also getting reimbursed. So there’s lots of potential great digiceuticals, apps, devices. Unless they get through the regulatory process and can get reimbursed, sometimes it is a bit of a “So what?”
So, in general, there’s lots of small little apps. Some could be super-simple and effective, like tracking your medications. That’s such an issue, because many folks don’t take their meds. We can see apps that will connect caregivers. We’re doing more patient-centered, more collaborative care and unfragmented care. I think the future of the app, in some cases, they may, in a sense, disappear. Voice is becoming common. You can talk to your Amazon Alexa or Google Home and they’re going to be guiding you through your health regimen or your therapy. “Hey, Daniel, did you remember to do your physical therapy today?” Or “Hey, Alexa, help! I’ve fallen and I can’t get up.” So, voice can be a sort of window for certain folks.
And I think, what will hopefully happen is we’ll have this convergence, kind of like the check engine light in your car that can guide you if you have a problem or can be a smart GPS to guide you to your destination. These apps will become integrated to our phones, our homes, our watches and there won’t be a separate app you have to open for health. And the design of those will match you and your personality and age—and carrots and sticks.
STROLLO: Given we’re here at Tufts University, what about for students? What technology, apps, devices—just amazing for students?
KRAFT: I think we’re at a really golden age of reinventing education, not just in health and medical and dental, but in all fields and my favorite technology there is augmented reality, virtual reality, and extended reality. So, today, you can start to buy off the shelf technologies like HoloLens and it’s being used in medical education to train nursing, medical, dental students, to learn anatomy, for example, in a collaborative way, or to overlay clinical information when you’re doing a procedure on top of a patient to do a better and smarter element. So, you can both learn anatomy through these types of platforms, put on a VR headset—even a cheap one that’s made out of cardboard, where you slot your phone in—will let you go through the heart or go through the anatomy system, in a virtual way, or a collaborative way. So, it’s going to really transform for some people who are very visual learners—like I am—to see something in three dimensions, to go inside a cell and rejigger DNA.
All those ways you can potentially learn using VR and AR and then potentially on the simulation side of the equation, you can potentially put teams together, practice procedure, make mistakes—just like in the flying world, in aviation. I’m a pilot. Flying safety’s gotten dramatically better because we put every airline pilot and others through simulators. It already is starting to change the way we train individual procedures and whole teams, how you respond to a code in an emergency room or how even a whole medical practice can be simulated and optimized. In the fighter pilot world, which I come from as a flight surgeon, we would pre-brief the mission, then fly the mission, and then debrief and looks at the tapes from the dogfights, so that can come to medical education as well and move from our era of see one, do one, teach one, to see one, sim one, sim one, sim one until you kind of get it right before you actually practice on the patient.
STROLLO: And what about parents? What is out there for parents that they just can’t miss, that could just help them better care for their children?
KRAFT: Well, there’s lots of tools now and technologies just to track your kids from the cameras that can watch them in their crib, to even cameras that are being embedded with AI technology so the camera can actually look at the child sleeping and pick up their heart rate, their respiratory rate, interpret their cry—maybe even pick up developmental delay early. It can certainly be a virtual leash if your two-year-old likes to run off in the store, you can find them. I’ve got a two- and a four-year-old. You have to be careful with screen time, I think, a little bit, but there’s ways to get them doing some incredibly creative work and self-paced learning using some smart apps in limited manners. I think, for the parent, you can also get some virtual support and maybe learn some skills and tele-presence in with your pediatrician. You don’t always need to bring your child in for an exam of a rash. You could send them the photo or there’s virtual AI-driven apps that can start to analyze a rash and tell you whether it’s something concerning.
So, lots of tools for the busy, overwhelmed parent that can impact the child’s health from very early on. Everything from wearables for babies, too, to track their vital signs, their steps, how much milk they’re drinking or to match a particular medical or developmental issue.
STROLLO: Let’s talk about crowdsourcing. We have the ability to gather so much information and data from people around the world by way of the Internet. So, what are the possibilities with data as we look into the future?
KRAFT: Data is a bit of the new oil for health care and we have exponential exploding amounts of data, but they’re still often quite siloed. You know, does Tufts talk to partners, talk to Stanford, talk to Royal London Hospital? I mean, some of this data, if we shared it in empowering ways and aligned incentives, could really help speed up discovery, how we manage patients, build those sort of Google Maps for health and biomedicine. So I think data’s important. Sometimes it doesn’t need to be perfect data, you know. Does it need to be an FDA-approved wearable and get your steps exactly right? If it’s a glucometer and it’s connected to your insulin pump, probably yes.
And as we can get more data in the real world as opposed to just folks who are in the hospital or the clinic, we’ll learn how to better predict disease based on, maybe, your mattress sensor picks up that your heart rate has gone up from 55 to 75 and that might be indicative of a pulmonary issue. It might be that people are self-reporting flu in your neighborhood and your doctor knows that information and can prescribe you Tamiflu without bringing you into the office and infecting everybody else. So, it’s how we connect the dots. It’s how we take all this mass of overwhelming data, make it information, and integrate it into the workflow of, let’s say, the overwhelmed clinician. Whether you’re a dentist, a doc, a surgeon, a nurse, a parent—no one wants more apps and check boxes and elements to do. We need to smartly think about the workflow elements so the data becomes useful and not overwhelming.
STROLLO: Let’s talk a little bit about Boston. What’s being developed here right now in Boston that’s particularly intriguing or exciting?
KRAFT: Boston’s such an amazing hotbed. I was lucky to do my medical training here in Boston for four years. You’ve got the convergence of all these great educational centers from Tufts to Harvard to MIT and a rich environment of creativity. So, what I love about Boston is this overlap. Some of the things that are being developed here—certainly a lot on the genome side through many institutions, learning to take our basic genetic information and start to stratify risk for disease. So, imagine when you go to your primary care doctor, they don’t just know your family history, but they know your genetic history and can really start to guide your prevention and management. Not everyone needs to wait for age fifty for a colonoscopy—maybe it’s age sixty. Not everyone needs a mammogram at age forty—some may be earlier or later, just a small example based on your risks. How might we start to modify our microbiomes? That was pioneered in hospitals here—doing fecal transplants to treat patients who might have died in an intensive care unit from C. diff. infections, a form of overgrowth of bacteria in the gut.
There’s a lot of interesting work at this sort of convergence point. Some of it out of the Media Lab, where you’re blending robotics and human interaction. Even wearable exoskeletons or smart prosthetics enable someone who might be missing a leg or two legs to run faster, have more capability than someone who is normally able. So, I think Boston is such an amazing melting pot. Plus, you’ve got the big pharma here, you’ve got an investment community, you’ve got the perfect catalytic environment to take something from the lab and the benchtop to the clinic or to take a student in a dorm now to collaborate and 3D-print a prototype and get it funded and into a medical device or to a hospital system like Tufts.
STROLLO: Now in all of your travels, where in the world is inspiring to you right now? Is there a country or region where technology is exploding, that’s simply extraordinary?
KRAFT: Well, innovation: I live in Silicon Valley and people think, “Oh, it’s the home of all innovation.” I think we’re democratizing innovation and invention. It’s not all coming out of California or Boston. I’ll be in Israel later this month and there’s a lot happening there. They’re certainly an innovation nation. One of the powers of Israel is not just a great educational system, but they have, in the health side, a sort of integrated data form, just like in the United Kingdom. NHS has a lot of their data under one system so you can potentially do discovery and innovation faster. There’s not a big market in Israel, but a lot of that’s distributed to many places from medical device, to apps, to a company that can now take your voice from your smartphone and analyze your emotional states, is one example. Another one in Israel is making a trainable called the “Upright” that you put on your back. It’s like your digital mother tracks your posture and gives you feedback to improve your posture with just a week of wearing it. Those are just a couple of small examples.
So, that’s one place, but I would argue now with the power of the Internet, with programs like Biodesign that I went through at Stanford, you can start to teach innovation. If you’ve got a pain point—if you have a pain point as a parent, as a pediatrician, as a dentist, as a patient, how can I solve this differently with some new technologies that are here today, whether it’s a new app or some 3D-printed solution or some convergence? It’s a real new era when you don’t need to be in a million-dollar lab or a biotech company. You can instruct, innovate, and collaborate and catalyze solutions anywhere.
STROLLO: We’ve talked about crowdsourcing and different regions of the world and apps. How connected can the world get? Could a health-care patient consumer in one region of the world be able to tap into another area quickly, easily, accurately? Where are we going?
KRAFT: Well, when we traditionally practice medicine, if I’m seeing you in the clinic and you have a certain problem and I’m not quite sure what to do, I would go to the literature and I would look for a double-blind, placebo-controlled trial of a patient—hopefully, some like you. In reality, though, most drugs and solutions are sort of to the average, and very few patients are actually the average patient. Part of the potential of connecting the dots around the world, we have now, in the last decade, we’ve gone from about 20 percent to 90-plus percent electronic medical records, but a lot of those records are still klugey, the user interfaces are terrible, doctors don’t like them. But if we can start to learn to connect the dots between the data, someone who’s taking care of someone in Mumbai in India could tap into the Tufts database because there’s patients similar, for some reason, genetically or otherwise, and we can have that as real-time information.
And using AI machine learning to start to sift through some of that, really then give the clinician—let’s say, don’t tell them what to do, but here’s a suggestion. Here’s the basis of these studies and this crowdsourced information from multiple medical centers, this looks like to be the best route of care. If we can start to integrate these data pipes amongst, again, institutions—both hospitals, EMRs, pharma—to the whole world, we can build that sort of smart Internet of health-care things and health-care data that can give us real-time intelligence in real-time proactive health care on a global level at lower cost with better outcomes.
STROLLO: So, bring it back to Boston here. You had a residency at Massachusetts General Hospital and Boston Children’s Hospital. So, we’re wondering, what’s your favorite thing about Boston?
KRAFT: I’m supposed to say the Red Sox, right? But one of my favorite things is I was really lucky to live right on Beacon Street and just the Boston Common and it’s a commons—it’s a true commons—that people would come through there from Bostonians to all over the world and you’ve got the Charles River and the rich mix of people. I just loved the sort of energy of Boston and the diversity, but also sort of the Boston feel and that you’ve got some great traditions and great institutions like Tufts and the fact that everyone kind of plays together well, but also mixes it up and so much has come out of here from the Revolution to revolutions in health and medicine and here at Tufts Dental School on your 150th anniversary, you’re in a great sweet spot of your own history but, also, the milieu around you is going to help you create a lot of great things for the next 150 years.
STROLLO: Thank you, Dr. Kraft. We greatly appreciate your time today.
KRAFT: Thanks for having me.
HOST: Thanks for listening to this episode of Tell Me More. Be sure to subscribe to listen to more episodes of the podcast, and please take a minute to rate and review us wherever you get your podcasts. We’d also welcome your thoughts on the series. You can reach us at tellmemore@tufts.edu. That’s Tufts—T-U-F-T-S dot E-D-U. Tell Me More is produced by Katie McLeod Strollo, Steffan Hacker, and Dave Nuscher. Anna Miller recorded Dr. Kraft’s interview. Web production and editing support provided by Momo Shinzawa and Taylor McNeil. Production support provided by 5 to 9 Media. Special thanks to the Tufts University School of Dental Medicine. Our theme music is sourced from De Wolfe Music. And my name is Patrick Collins. Until next time—be well.
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