Medical Innovations Summit at the Royal Society of Medicine April 5 2014

The RSM held another of its innovation summits last Saturday. In addition to the 13 stimulating presentations, the morning was excellently hosted by past RSM President Robin Williamson whose stand-up comedy skills are surely a close match for his well-known surgical expertise.

The first presentation, from Big White Wall, an online provider of personalised mental health services, was begun by founder Jen Hyatt. She quoted hugely impressive statistics of how 95% of users report feeling better, 80% feel able to take control of their lives and 73% share their feelings for the first time when using the wall. She described how they use a ‘social media scraper’ and algorithms to assess people’s state of mind and suggest treatment plans. Dr Simon Wilson, Clinical director, said there was good evidence that online mental health therapy is as effective as face:face.  He went on to explain in more detail how the service was provided and what steps were taken when people posted genuinely concerning material. This is a superb innovation.

This was followed by Dr Farid Khan, CEO of PharmaKure, a company that looks for new uses for existing drugs. Clearly there are many benefits from re-using drugs where safety testing and other regulatory activities have already been completed. He told a great story about finding a drug that hopefully will offer relief to Alzheimer’s patients.

The advent of truly personalised medicine must be furthered significantly by Saudi Arabia’s decision to sequence the genomes of 100,000 citizens. Dr Sultan Al-Sedairy & Shazia Subhani explained how this was being done and what the benefits will be over the coming years.

Dr John Frater & Dr Sarah Fidler then presented on a potential cure for HIV that relies on ‘waking up’ a virus from its hiding place within cells so it can be targeted by a combination of drugs. The important distinction was drawn between so-called ‘sterilising’ cures where infection is completely eliminated & ‘functional’ cure where infection may remain, inactive.

Pat Christen followed this with a most impressive presentation on Hopelab‘s use of video gaming to encourage positive health behaviour in young people with cancer. She stressed the importance of encouraging a sense of ‘purpose’, of developing ‘connection’, and of being in ‘control’ for optimal cancer survival. She ended with a video clip that left few dry eyes in the auditorium of an athlete insisting on completing an Olympic sprint in spite of pulling a hamstring. From this she drew the lesson “if you don’t give up, you cannot fail”. Stirring stuff.

Next, Prof June Andrews gave a delightfully humorous talk about the University of Stirling’s Dementia Services Development Centre Ideas Lab which has so successfully cut through the noise in this area to provide sound advice on how best to manage dementia sufferers. She explained that whilst dementia progress is a downhill journey, carefully planning – such as keeping people in familiar surroundings (eg not putting them into hospital), regular exercise and good environmental design – all help to  postpone the steep slope to the very end of life. Even making it easy to find the WC at night can make an important difference.

Esther Rantzen completed the morning’s presentations by explaining why she set up Silver Line to help older people who were feeling isolated. She read out many heart-rending quotes from people describing why they had called the service.

The afternoon began with a fairly amazing story by Tal Golesworthy, a textile engineer, who suffers from Marfan Syndrome which results in a widened aorta that can stretch and burst. With his background, he designed a Personalised External Aortic Root Support (“PEARS”) to prevent the widening of his own aorta. This has now been used in over 40 patients, with new applications for the technique being considered.

Sarah Bateup spoke about Psychology Online, a service using secure messaging to deliver personalised cognitive behavioural therapy by a therapist (as distinct from a computer programme such as Beat The Blues).  Therapists never meet or talk to patients; there is no waiting list. Depending on condition, they achieve 60-70% recovery vs an average of less than 50% for the rest of the NHS, and on average use 40% fewer sessions than face:face. Patients particularly like having a written transcript of their consultations, which most refer to frequently after the consultations, helping consolidate the improvements; it also gives a different learning experience to speech. This presentation, together with the earlier one by Big White wall confirm my belief that telehealth offers much more for mental health than it does physical health problems, because the medium itself can deliver the diagnosis, the monitoring and the treatment.

Dr Ross Hunter and Dr Mark Carlson spoke about the Nanostim leadless pacemaker which can be implanted without a chest incision. They explained that the 15 month mortality for conventional pacemaker is 36% because of all the potential risks, most of which the Nanostim leadless pacemaker avoids.  Its size, at little bigger in length than a £1 coin, was particularly impressive; the battery is quoted as lasting ten years. A standard pacemaker relies on an accelerometer to change heart rate; the Nanostim works on tiny temperature changes as a patient exercises. Pacemakers with leads can still stimulate both chambers, so there are Nanostim plans to produce leadless pacemakers for both chambers that work with each other to deliver synchronised stimulation.

Dr Ian Hampson, from St Mary’s hospital, Manchester, described the practical challenges to reusing an HIV drug, lopinvar, to attack the strain of human papilloma virus that causes nearly all cases of cervical cancer. Initial results, from a trial in Africa, are extremely impressive. With the challenges they had had to overcome, Dr Hampson, and his wife Lynne (unable to participate in the presentation due to laryngitis) came over as reinforcing proof that by never giving up, you eventually succeed! A truly great achievement.

This was followed by Zoltan Takats, the inventor of the iKnife that can tell the difference between cancerous and non-cancerous tissue using mass chromatography to analyse the gasses from cauterisation. Currently under trial this is hoped to avoid surgeons leaving behind cancerous tissue that can regrow. The presentation included a brilliant visualisation of the gas analysis process. He is now exploring the use of the iKnife concept with bipolar tweezers to identify individual bacteria, and in an iEndoscope to analyse gut microbiota in situ. Amazing stuff.

The final presentation of the day was from Brittany Wenger who taught her computer how to diagnose leukaemia using a cloud-based artificial neural network. Previously she had developed the Cloud4Cancer service to improve breast cancer detection, currently claiming 99.11% sensitivity to malignancy from 7.6 million trials. There was an interesting comparison between this and a previous presentation by an equally-talented young American, Jack Andraka, at an earlier RSM Innovations Summit and who identified a way of detecting pancreatic cancer. His technique relies on biochemistry, for which there are all sorts of rules and regulations in place, plus trials have to be run in real time. Developing appropriate computer algorithms, as Brittany has, currently has much less red tape around it, plus of course past test results can be rerun to test the effectiveness of those algorithms really fast.

Overall, a brilliant 13 presentations that kept us all on the edge of our seats. Congratulations to Paul Summerfield and colleagues at the RSM for a great day. To me these events justify RSM membership all on their own, though perhaps I’m biased.

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