From Hi-tech spectacle to Low-tech revolution: The 12th Medical Innovations Summit

Getting up in the dark at five thirty in the morning for work is never fun,  particularly when I’m working a weekend shift.  However, on Saturday the 16th of April I was awake before the alarm, and I set off with a spring in my step, because on this particular occasion I was heading off to London to attend one of the Royal Social of Medicine’s regular Innovation summits, courtesy of MedTech Campus.

The Royal Society of Medicine was established in 1805, and granted Royal Charter in 1834. Its aims are to:

With a varied year round programme of events, lectures, and workshops, set in a stunning building bang in the centre of London, it’s not the first time I’ve visited this august institution. Its also not the first time I’ve seriously considered joining them as a member, a feeling which was undiminished when I left a few hours later. So, bright eyed and optimally caffeinated, I took my seat.

We started the day talking about sleep, with a polished presentation from Dr Sophie Bostock, Operations Lead at Big Health and a self-professed ‘Sleep Evangelist’. The audience were introduced to Sleepio ( @sleepio), a digital sleep improvement programme. A popular and evidence based Cognitive Behavioural Therapy based approach to the common problem of insomnia and poor sleep, Dr Bostock laid out the harm that comes from sleep disruption, and how through the use of Sleepio users fell asleep 54% faster, woke through the night 62% less, and had a daytime energy and concentration boost of 58%. I can personally attest to the debilitating effects of sleep deprivation and shift working on my performance and concentration; one of the principal concerns I have about the new Junior Doctors’ contract which is currently causing so much anger regarding it’s imposition in England.

Yep - all of these feel *very* familiar
Yep – all of these feel *very* familiar

Insomnia is one of the most common presenting or associated problems I see in my practice, and standard approaches using hypnotic medication are fraught with dangers of addiction, over-sedation and tolerance. I have actually had 2 patients use Sleepio to great effect, and would love to see this adopted at scale in the NHS. Dr Bostock made the familiar call for health commissioners to be more accepting and open minded to digital medicines. Their commitment to establishing an evidence base for this and dialogue with individuals such as myself go a long way to help here.

I’ve always had an affinity for hands-on medicine, hence my love for urgent primary care. Listening to South African doctor William Mapham describe his history of single handedly gassing, cutting and resuscitating during rural caesarian sections, I was struck by how performing medicine in the most difficult of circumstances presents difficult practical problems that require creative solutions, often with a much greater appetite for risk than we might be comfortable with in the ‘developed’ world.  Dr Mapham’s main interest is ophthalmology – 80% of all blindness is preventable or curable, and he has seen first hand the transformative power of simple surgical interventions. He observed that primary healthcare workers often lacked access to appropriate information, skills, and basic diagnostic tools.

The Vula Mobile app can be used to perform clinical eye examination using the smartphone as the tool
The Vula Mobile app can be used to perform clinical eye examination using the smartphone as the tool

The Vula Eye Health mobile app (@vulamobile) was born from this – a clinical case discussion and information tool that allows these workers, often in remote areas with the slimmest of network connections to the world, to access expert information, carry out eye test, discuss cases with specialists, and make referrals. He even managed something harder: a live demonstration. I sought him out in the interval as this app is something that I’ll be able to make use of almost immediately in my own work. It’s a free download on iOS and Android

The summit did not disappoint when it came to the absolute cutting edge of technology. George Frodhsam introduced the audience to Medisieve (@Medisieve), a ground-breaking drug-free malaria treatment that used the principal of magnetism to dialyse and physically separate parasite infected cells from the blood stream of patients, using the naturally occurring paramedic properties of the disease. With the concept proved, it is heading towards human trials by the end of 2016. This was exciting for a number of reasons: it is a novel, drug-free therapy that not only treats a disease that leads to 200 million cases and 600’000 deaths annually,  but also could be developed with engineered magnetic nanoparticles to treat a host of other illness, including other infections and cancers. I was particularly delighted to hear George tell an audience member that their organisation had provided the funds that made the very first trial device possible.

We also had an introduction to genome editing with CRISPR/Cas9TALENs and the intriguingly-titled ‘Zinc Finger’ technologies from Katrine Bosley(@ksbosley), President and CEO of Editas. The tools developed by Editas and other biotechnology companies look set to transform the power of medicine and treat diseases that have up to now been untouchable. Cementing the promise with real world examples, Professors Waseem Qasim and Paul Veys from Great Ormond Street Hospital presented the cases of Layla and Harriet, two children with untreatable relapsed acute lymphoblastic leukaemia that have effectively been cured by gene-edited immune cells. This brief paragraph scarcely does justify to the achievement and incredible possibilities of this maturing therapeutic modality.

And then there were the robots – Professor Guang-Zhong Yang of the Imperial College Hamlyn Centre (@ICLHamlynRobots) have a presentation about the history of robotic surgery, through the current applications, and then a glimpse into the future of the field. As with all exponential fields, the pace of change in the past few years has been staggering. With ever smaller, flexible robotic instruments, in-vivo mass-spectrometry and optical microscopic tools that allow cellular level surgical work, live biopsy, and even augmented reality visual aids and surgical ‘no-go’ zones to assist the surgeons, Professor Yang painted a picture where the surgical robot ‘disappears’, delivering superhuman abilities to the operators alongside Artificial Intelligence assistance.

The Argus II Epiretinal Prosthesis...aka THE BIONIC EYE
The Argus II Epiretinal Prosthesis…aka THE BIONIC EYE

Further surgical demonstrations came from Professor Paulo Stanga(@mvr_lab) & Dr Sallusto. Professor Stanga is a Consultant Ophthalmologist and Vitreoretinal Surgeon at Manchester Royal Eye hospital. He gave a presentation on the Argus II epiretinal prosthesis aka ‘The Bionic Eye’. This has returned functional vision to a number of patients with Retinitis Pigmentosa, a rare condition that has previously been untreatable. He’s moving on to Age Related Macular Degeneration (ARMD), a far more common problem predicted to affect nearly 200 million people globally by 2020

Dr Sallusto talked about another world first – a robotic, transvaginal kidney donation and transplant between two sisters. A technically difficult procedure, this landmark of natural orofice/robotic surgery built on the efforts of many surgeons in the past few years. Incredible stuff, but the video of this and the eye surgery in the post-lunch session was a little hard to take, with audible groans around the lecture theatre as Professor Stanga incised his patient’s eyeball.

Against all of the high technology and promise of digital healthcare and biotechnology, the presentation that most affected me was that of Lauren Braun (@laurenrbraun), founder of the Alma Sana Project. Lauren spoke about her experience as a summer intern working in a vaccine clinic in Cusco, Peru. Here, she found that the poverty and low literacy of mothers led to late or missed vaccinations in their children, which could have devastating consequences. Vaccine-preventable diseases account for 20% of childhood deaths globally, with 18-22 million children vaccinated late. All of this inspired her to develop an innovative, life-saving bracelet which the child wears as a personal, physical vaccination record reminder.

The simplest of ideas making the most profound difference.
The simplest of ideas can sometimes make the most profound difference.

Her talk took us through the challenges of bringing a simple yet powerful idea to practical reality, and hammered the benefit home with first hand accounts of the difference this has made.

I’m sad to say that I couldn’t stay for the whole day, so missed the final quarter and some fascinating sounding talks, but I am assured all will be available online at the Royal Society of Medicine website in the near future.

As I sat on my train home, reviewing my notes and collecting my thoughts, I was struck by the incredible diversity and scope of innovation that was showcased by the RSM team. From the incredibly hi-tech of Professor Yang’s surgical robots and Professor Stanga’s bionic eyes, through the revolutionary use of gene-editing and magnetic medicine to bring hope to those that had previously been beyond assistance, to the realisation of the promise of mHealth with Sleepio and Vula, and finally to the life-changing difference that one intern can make to the children of the world with a simple bracelet.  It may be tough to get up early, but when you do, you are sometimes rewarded with the most incredible sunrise.


 

All of the presentations and content will be available shortly at the Royal Society of Medicine’s website. You can also view their film ‘Doctors of the Future’ from the 18th of April.

 

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