Canadian technology is bridging the gap between science fiction and clinical reality
When imagined in a fictional world advances in science and medicine can produce both terrifying and spectacular outcomes. The imaginations of our greatest artists have an uncanny tendency to predict the course of human development and have inspired a world of technology that was once thought impossible. From Star Trek's hand-held communicators to the incredible prophecies of Aldous Huxley, the imaginative quality of our literature and film has determined the course of innovation.
With a storied past as a home for medical research, Canada has given the world some of the most inspired technology in the pursuit of saving lives and bridging the gap between science fiction and clinical reality. Today, the country’s top scientists and entrepreneurs have found themselves in an groundbreaking corridor where business and technology have met to shape the future of medicine as artful and fantastic as any story before it.
Healthcare, Not ‘Sickcare’
Along that intersection of business and healthcare are the companies bringing the focus of Canada’s public system to the individual. Newtopia is one of its leaders. The Toronto company is an innovative personal health platform that combines genetic testing and behavioural science to inspire people to take control of their own health and lifestyle before they become patients.
Its founder and CEO, Jeff Ruby, was inspired to move into the world of preventative medicine and personal healthcare when his father was diagnosed with abdominal cancer at the age of 54. Jeff had already been well acquainted with the world of business; having built a career as a corporate lawyer. He had the know-how to launch Newtopia as a business, but had never ventured into the world of medicine.
His father’s experience with the healthcare system taught him two valuable lessons which have driven the past sixteen years of his life as an innovator in the healthcare industry. The first of those lessons is that the highly lauded public system is effective but out of focus.
“I — like many Canadians — believed that we had the best system in the world simply because that’s what we’re told,” he says, having since realized that Canada is lacking a fundamental element of healthcare that happens outside of the hospital. Jeff quickly learned that prevention and maintenance of personal health is just as important as treatment.
“I think what we have in place is a functioning sick care system that kicks in when there is something wrong with us,” Jeff says. “It’s quite a magnificent system that kicks in, but there is no system for keeping us out of it. It’s left up to each of us to figure out and — by and large — we are all guessing wildly at what to do.”
This guessing game was first brought to his attention in the doctor's office and taught Jeff his second lesson.
Among the many answers he and his father sought from specialists was the basic question of, "how did I get here?” They were told that it all came down to genetics, lifestyle choices, and a little bit of bad luck, but this response made it clear to Jeff that the current system lacked a personal touch.
“I think what scared me the most was here I was sitting next to my father sharing some of those genes and having no idea what healthy lifestyle choices meant for me.”
But that fear served as an inspiration to fill that gap and provide what he calls, “real healthcare, not the sick care that we generally come to think of as healthcare.”
The platform, which places preventative healthcare in the hands of the patient, is app-based and distributed largely through partnerships with employers.
Its most recent collaboration with health insurance provider Aetna has produced encouraging results which were published in the Journal of Occupational and Environmental Medicine with a nearly 80% success rate.
By encouraging their employees to take part in the program companies could effectively be investing into the productivity of their workforce. But the ultimate idea is to reach as many at-risk individuals as possible on a personal level in order to reshape the way each employee thinks about their health at work and in the home.
“I think the entire movement of precision medicine and precision health is certainly the next generation of both healthcare and sick care,” Jeff says.
Newtopia is specifically designed for the nearly 60 percent of Canadians who are at risk for obesity, diabetes, heart disease and stroke. It monitors five basic areas which can identify an individual’s risk of Metabolic Syndrome. Those areas are: weight, blood pressure, blood glucose, cholesterol and triglycerides. According to Ruby, once three of those are out of range an individual is considered at risk of developing health problems.
The process begins with a voluntary biometric blood test and a screening questionnaire. When an individual has been identified as at risk the program is personalized based on the users biology, determined by a simple genetic test to develop the ideal program.
Offering personalized prescriptions for exercise and diet, the overall goal is to achieve a five to seven percent body weight reduction within the first year. But Newtopia is far more than a weightloss program. It also connects users to other individuals as well as a personal coach who is assigned based on personality. The system encourages interaction and support from a community of users.
Bringing Healthcare Home
Bringing the personalized healthcare revolution into the home with Star Trek-inspired technology, Cloud DX is streamlining the healthcare system while providing diagnostic equipment that was once the realm of imagination.
“There are some that are fearful of that change because they are married to the current system Says Dr. Sonny Kohli, Chief Medical Officer of Cloud DX, “I welcome it.”
Cloud DX began as a team of researchers at the $10 million X Prize competition. Bringing over 300 international teams together, the X Prize challenges its participants to transform the tech of our dreams into real life solutions because, as the organizations founder Peter Diamandis told the Smithsonian, “The day before something is truly a breakthrough, it’s a crazy idea.”
The current challenge is best described as Dr. McCoy’s tricorder from Star Trek. The device is meant to be a portable diagnostic tool, able to identify several conditions outside of the clinic. Cloud DX’s version of the device is called VITALITI and the team are one of six — and the only Canadians – left in the competition.
VITALITI is comprised of two wearable pieces. One is placed on the chest to monitor the heart, and the other in the ear in order to track body temperature, breathing rate and vital signs that can be detected from the posterior auricular artery. The device is meant to be able to diagnose up to 19 different conditions including: urinary tract infection, type two diabetes, pneumonia, tuberculosis and the flu, among others.
While the team’s version of the tricorder has shown some promising results and a successful demonstration at TED Toronto, Sonny says that Cloud DX has evolved as a company and is only beginning to realize their larger vision for the future of healthcare.
As an internal medicine specialist in charge of the intensive care unit at Oakville Trafalgar Memorial Hospital, Dr. Kohli has seen the healthcare system from both sides and agrees that it could be greatly improved.
“The wait times in Canada are just egregious, from waiting on the phone to get an appointment to waiting to get time off work, waiting in traffic and sitting in the waiting room.”
A study conducted by the Fraser Institute measured wait times across the country and found a 97% increase since 1993. With an average of nearly $4000 per capita costs, an aging population and a series of other challenges, the price of accessible healthcare is quickly outweighing its benefits.
“It’s become such a common theme in our system,” Sonny says, “and it’s ripe for disruption.”
Alberta Health Services has recently tried to manage wait times with an app that allows patients to see the ER’s most accessible hours. But even Dr. Paul Parks who helped to set up the program has told the CBC that this method is a, "blunt instrument". The problem with wait time apps is that the app only monitors the problem without addressing the nuances that underpin the backlog.
The real issue, according to opponents of the app system, are the resources that are available and the manpower to manage those resources. For Dr. Kohli, the solution is to, “bring healthcare to the home." He says, enthusiastically, "Let’s prove it can be done.”
“It’s happened with other institutions like banking. We went from conducting transactions from behind bulletproof glass to doing everything from home. I think we can have a similar transition for some of the minor stuff, the preventative stuff in healthcare that we don’t do a good job of in the clinic anyway.”
With the use of cloud servers and mobile devices, something as simple as giving the patient access to their own health records could lighten the load on medical staff that could be using their time to treat patients rather than chase down documents. In combination with their diagnostic equipment, Cloud DX’s technology has the power to democratize medicine and streamline the system by allowing all the preliminary work to be done before they are checked into the hospital.
“A lot of the heavy lifting can be done at home,” says Sonny. “By decentralizing it we really take a load off the system, we empower people who want the knowledge…but they don’t have the reliable medical grade technology at home to say ‘I can manage some of this stuff from home.’”
In the future Sonny hopes to expand the platform and to involve video conferencing and cough analysis to achieve more accurate diagnostic results. Cloud DX’s ultimate vision is a home healthcare system that goes beyond the search engine to provide a more professional experience at home and save us all from the terrifying conclusions we draw when we use technology to guess at our symptoms. In essence, Sonny and his team are redefining the house call.
Getting Personal at the Cellular Level
As the home of pioneers in lung transplant, stem cell technology and cancer research Canada has given the world the potential to save lives through some of the most incredible technologies. Building on that legacy are companies like XOR labs and ExcellThera who have shown a drive to push the limits of what is possible in medicine.
It is estimated that nearly 700,000 patients worldwide are in need of a lung transplant, but of those in dire need, less than one percent will actually receive the organ they need, while 20 percent will die waiting.
The reason behind these disheartening statistics is that hospitals cannot accept every organ they receive. Depending on the lifestyle of the donor, the compatibility of the organ with the patient, and the cause of death organs can be considered unfit for transplant. As a result, only two out of every 10 organs donated will end up saving a patient’s life.
Toronto based company XOR Labs aims to repair these unusable lungs with a technology developed by the current Director of University Health Network’s (UHN) Toronto Lung Transplant Program, Dr. Shaf Keshavjee. The system is called Toronto Ex Vivo Lung Perfusion (Toronto EVLP) and is both a diagnostic and repairative process which places the lungs in a chamber allowing them to breathe for themselves under ideal conditions. In allowing the lungs to breath outside of the body doctors can observe the organ and provide it with the proper nutrition which can work to repair the organ and make it eligible for transplant.
Over 200 patients within UHN have been treated using this system which has doubled the rate of available lungs and is now moving toward a 60 percent increase.
These results have left Jon Rogers, COO of XOR Labs, in an enthusiastic state as his company is looking to take this clinically proven technology to scale with its overwhelming demand.
“We have an opportunity to totally change the world of organ management and provide personalized medicine for the organ,” Rogers says, looking forward to their 2017 launch for a standardized version of the EVLP mechanism.
Looking further into the future, XOR Labs is reaching beyond what is already possible to treat diseased organs within the body and have launched human trials for metastasized lung cancers — an area which has long been the wheelhouse of another technology discovered in Canada: stem cell therapy.
Dr. Peter Zandstra, professor at the University of Toronto and Chief Technology Officer of Montreal-based biotech company ExCellThera, believes that decades of research has shown stem cell therapy to be a potentially curative treatment for many cases of leukemia and some types of autoimmune diseases.
ExcellThera’s work makes use of multipotent stem cells, a cell with the ability to adapt to multiple cell strains, found in Umbilical Cord Blood (UBC). The current system focuses on leukemia and makes use of UCB that is collected from a part of the body that is normally discarded when a baby is born. This particular cell is collected because of its high hematopoietic stem cells or HSC content, which are effectively early stage blood cells that are integral to the immune system.
“One of the dogmas about biotech is that it takes forever to develop these things and I think that’s changing now that we have many of the pieces of the puzzle all in the same place.” Says Dr. Zandstra, acknowledging that Canada’s head start in the industry has given them the years of research needed to bring this technology from the lab to the hospital. “This doesn’t happen overnight. We are building on a legacy and this legacy is [one] both of discovery and research.”
In the early 1960s, Canadian Doctors James E. Till and Ernest McCulloch, stumbled upon an amazing discovery while researching the effects of radiation on cancer cells. Their experiments involved injecting lab mice with irradiated bone marrow cells, which yielded an unexpected result. The marrow began to sprout what the scientists called “spleen colonies” resulting in the discovery that these growths could be used as stems to produce other cells.
ExcellThera is taking the years of research that Till and McCulloch launched to design stem cells with specific therapeutic properties by editing their genomes. What has previously caused barriers is the ability to produce stem cells that will adapt seamlessly to the patient, but with recent advancements made in clinical trials by companies like ExcellThera, doctors can now personalize the system to a patient’s body and reduce the possibility of rejection.
The work is something Dr. Zandstra believes is next generation research. “Now that we can start to grow these cells a little bit better, we can take samples that are much more closely matched to the patient’s immune system.”
With the use of computational biology, a relatively novel method, to identify the connection between cells with the use of mathematical models, doctors will be able to engineer solutions that were not previously possible.
If their work continues to show that cells produced outside of the body can function in the same way that regular cells do, Dr. Zandstra believes that there is a potential to apply this treatment to other parts of the body. But he also emphasizes the importance of rigorous testing before definitive claims are made. “We’re talking about patients that are facing devastating diseases,” he says, pointing to the dangers of claiming a cure where none has been found. “One of the challenges is separating the real science and opportunities from the hype.”
Moving from the lab to clinical trials in less than a decade, the results have kept Dr. Zandstra optimistic for the future. In the coming years the real challenge will be a focus on how the technology can be scaled to meet patient’s needs in an area that is open for entrepreneurs and innovators to bring lifesaving technology from the lab to hospitals around the world.
Silicon Valley North
Where Tommy Douglas aimed to think big and unite the country through a public system, private industry and innovative research is bringing a personal touch to address healthcare challenges with technologies that were once unimaginable. Though the field’s leading visionaries represent diverse sectors of the business and medical communities, there is a common and palpable sense that Canada has offered the ideal environment for innovation.
“Southern Ontario has the opportunity here to be the global leader in personalized organ treatment,” says Ruby, and Toronto in particular is well positioned to become a hub of this new sector. Jeff is most grateful to the health community as an integral part of XOR and its future success. Having provided the technology and research, UHN has not only helped XOR succeed but has established a precedent for further innovation in the region.
“[Toronto has] reached a critical mass of people involved in all steps of the pipeline.” Dr. Zandstra agrees, “The best way to think about it is we have a great university that is doing discovery research. We have hospitals that are innovative in treating disease, business schools that are involved in new business models for translating technologies in complicated areas of healthcare delivery and we’re all kind of within five hundred meters of each other.”
This close proximity has bred both inspiration and the ideal condition for a crossroads between healthcare and business which Dr. Kohli believes could make the region a global beacon for health technology and reverse the brain drain of Canada’s health industry.
“We have this beautiful sector where all the variables are aligned,” He says, “the cost of living is lower than Silicon Valley, we have all these innovative startups that are setting up shop, we’ve got the financial infrastructure, and we’ve got the people. There is nothing we don’t have. We just have to really devote ourselves as a country to turning this corridor into Silicon Valley North.”
Illustration by Deshi Deng