#imaginemed: Thinking Outside the Box (Part 1)

This week, PLOS TGH is handed over to the talented and articulate Alexandra Abel. Combining a passion for medicine, global health and the arts, she reports on the recent #imaginemed event, London.

Sandro

The day before show day, like true scientists, we stood up in the gallery at the Royal Albert Hall contemplating what could possibly go wrong. We recalled the time that over 100 members of the audience decided to join Pete Doherty on stage during his solo performance in 2008, but swiftly noted we did not anticipate the same problem at our event. As exciting as cardiothoracic and maxillofacial surgery are, particularly to us, they don’t generally trigger mass stage invasion. Not during lectures anyway.

A pre-show view from the ImagineMed stage. Photography: Alan Liu

A pre-show view from the stage. Photography: Alan Liu

The following day, while setting up and trying to keep to time, I think we all took at least one unscheduled moment to appreciate just how breathtakingly beautiful the Hall really is. When we worked with Focus Active Learning to make our online game, we learned a lot about the Hall in the process.

For example, there are over 13,000 letter ‘A’s around the Hall to commemorate Prince Albert, over 6 million red bricks make up the Hall’s distinctive exterior, and there are 14 bars (as in drinking ones) in the Hall. But no fun facts compare to standing on the stage looking up at the tiers and the fluted aluminium roof and looming diffuser discs.

 

Meanwhile, over at the Sir Alexander Fleming Building of Imperial College London, an important inaugural event was already underway. Biotech showcase The Cell, in partnership with NeuroPro, sought to showcase a variety of innovative healthcare technologies, and Neuropro showcased their EEG headset, NeuroTrail, which wirelessly monitors real-time EEG. Fifth Sense introduced Scentee, a smartphone attachable olfactory device that can be used to examine users’ sense of smell and indicate anosmia.

Delegates try the Hypnagogic Light at The Cell. Photography: Ellie Pinney

Delegates try the Hypnagogic Light at The Cell. Photography: Ellie Pinney

One of the most lively exhibits was serious games company Focus Active Learning, where delegates tried their hand at several board games including The Nutrition game and Infection Control Game. Among other companies in attendance were socially-minded software company uMotif; Imperial’s MSk Lab; the HELIX Centre, a collaboration between the Royal College of Arts and Imperial looking at design in healthcare; Light Eye Mind, who maintain the UK’s only publicly available Hypnagogic Light; and the revolutionary GoodSAM App for first responders.

The biotech showcase was only our morning activity, and Cell-goers went on to join other attendees as they selected their seats in the Hall. At 2pm, the lovely Dara Ó Briain, who kindly gave up his Easter Monday to host the event, took to the stage to welcome our four thousand strong audience to Imagining the Future of Medicine (ImagineMed)!

Welcome to ImagineMed! Photography: Alan Liu

Welcome to ImagineMed! Photography: Alan Liu

Dara, whose wife is a surgeon, is no stranger to being outnumbered by doctors at social gatherings; and, of course, many attendees were doctors (or medical students), but there was also a number of non-medical, even non-scientific, individuals with an intellectual curiosity, eager to hear about the future of healthcare from the people involved in shaping it.

The first session was called Thinking Outside the Box. Hollywood screenwriter Ira Steven Behr once noted, “…usually when we use that cliché, we think outside the box means a new thought. So we can situate ourselves back in the box, but in a somewhat better position”. Following on from this analysis, and in the spirit of ImagineMed, I like to think ‘outside the box’ represents human imagination. The speakers in this session have certainly all put their imagination to good use, and provided important new perspectives in their areas of expertise.

Francis on stage. Photography: Alan Liu

Francis talks about Looking and Seeing. Photography: Alan Liu

First up was cardiothoracic surgeon Francis Wells, who developed a new way to repair mitral valves after being inspired by the medical drawings of Leonardo da Vinci. Francis noted that in an age where everyone is risk averse, it sets the challenge of ‘how do you make new advances?’ He went on to outline three interconnected principles that have helped him overcome this challenge: 1) Ask the right questions. If we begin with the ‘why’, we can then begin to understand the ‘how’ and the ‘what’. 2) Looking and seeing. We are surrounded by visual data all the time, but turning looking into seeing and perceiving is really important.

“Drawing is a line around a think.” – Francis’ daughter

Francis, a keen artist, explained that drawing and thinking are intimately related, and went on to show some of da Vinci’s astonishingly accurate medical drawings. 3) Form and function in nature. All of us are formed by the forces acting upon us; those forces can be genetic, gravitational, osmotic, or emotional, but everything in nature is a diagram of the forces acting upon it. Francis described how in 1515, da Vinci determined the vortex mechanism by which heart valves close, and five hundred years later, a publication in Nature proved him right. Now with imaging technology, many other vortices have been discovered in the heart leading to a whole new way of looking at how the heart functions as it begins to fail.

Jamil talks about building a brain stethoscope. Photography: Alan Liu

Jamil talks about building a brain stethoscope. Photography: Alan Liu

Second speaker of the day was Jamil El-Imad, Chief Scientist at Swiss-based company NeuroPro. Jamil’s background is in software engineering, but his fascination with neuroscience began when his friend began doctoral research at Imperial College five years ago. He and his friend engaged in an extensive discussion one evening, and came up with their hypothesis: if a healthy brain is rhythmic, then an unhealthy brain must behave in a non-rhythmic fashion. They thought that if they attempted some pattern matching to brain signals, they might learn something new. This approach is very similar to using anti-virus software, which looks for any patterns corresponding to known viruses detected in the past. They wanted to build a brain stethoscope!

They decided to first target epilepsy, a disabling condition that affects 1% of the world’s population. When a seizure strikes, physical injuries result from people losing control and hurting themselves as they fall. Jamil and his friend imagined a portable device, or mobile technology, that can monitor the patient’s EEG readings in real time, and give a prediction or warning before a seizure strikes, allowing the patient to lie down comfortably and safely. Their concept for predicting seizures led to the construction of a headset that can be universally used, to building a mobile lab that can speed up research trials, and some amazing visualisation tools to assist diagnosis.

“Computing has become a utility like electricity and water… opening up a whole new space for us in pursuing opportunities in personalised healthcare.” – Jamil

In his post talk Q&A, Jamil noted that the headset technology can be used for a variety of functions – at the moment, they are using it monitoring coma patients.

Mark talks about Caring Outside the Box. Photography: Alan Liu

Mark talks about Caring Outside the Box. Photography: Alan Liu

Our third speaker of the day was consultant neurosurgeon and prehospital care specialist Mark Wilson. Mark used the stories of his Nan, and a man called Dan, to illustrate how different care is appropriate in different contexts. Nan, one sunny summer’s day, surrounded by family, had ‘keeled over’ in their back garden. Mark’s initial reaction to this situation wasn’t to start CPR. “I thought, wow, what a wonderful way to die,” said Mark, to many chuckles from the audience. Dan is a young man who wrapped his car around a tree a few years ago and suffered a brain injury. Patients like Dan might not look that unwell, but there’s a time-critical emergency going on in their head. Dan had a subdural hematoma (a blood clot on the outside of the brain pushing over the brain).

Mark explained that there is a constant loop between what you can find out from extreme physiology and critical care, and his advice to anyone hoping to find something new is to look off the beaten track. People have extreme physiology immediately following an accident, and it’s an area we don’t do much research on firstly, because we’re often not there; and secondly, when we do get there, it’s often dangerous, or it’s raining – it’s not conducive to research. But it’s an area where Mark believes we can make a massive difference. The best time to minimise secondary brain injury is in the first few minutes following an accident, but patients die because we’re not 100% at managing these secondary injuries. He believes if we can intervene at this early stage, outcomes would be much better.

“If you’re not dead when the emergency services arrive, you shouldn’t die.” – Mark

Nan's fine, she's over there! Photography: Alan Liu

Nan’s fine, she’s over there! Photography: Alan Liu

Fortunately, Dan made a good recovery, and was even sitting in the audience with his girlfriend; but at the ward round Mark did that morning, he had 10 patients very similar to Dan. Trauma is the commonest cause of death worldwide in under 45s, and brain injury is the commonest cause of that trauma. Dan went through a system of care: pre-hospital care, emergency care, intensive care, surgery, and then rehab. Mark believes that care is the most valuable thing doctors do, but it doesn’t appear on any tariff, and therefore, what makes good quality of care is difficult to define. Mark said he feels very privileged to be able to care for people with brain injury because is not like other types of injury – it can change a person profoundly, and he is very passionate about maintaining people as they are.

So what happened to Nan? Luckily, she had only fainted, and was also sitting in the audience.

Talented teenagers from Islington Community Theatre. Photography: Alan Liu

Talented teenagers from Islington Community Theatre. Photography: Alan Liu

Final speaker of the first session, Sarah-Jayne Blakemore, brought 25 teenagers with her to illustrate her interesting research on the teenage brain. But they weren’t just any teenagers; they were very talented members of Islington Community Theatre, who created a unique performance. Sarah-Jayne explained that during adolescence, we develop a very strong sense of self, especially social self. Research shows that teenagers feel worse than adults do after being ‘left out’, suggesting that adolescents are hypersensitive to social exclusion. This might also help to explain why some adolescents are more prone to taking risks, especially when they’re with their friends.

Brain-imaging studies have shown what happens in the brain when we think about other people are thinking and feeling – this is called mentalising. The social brain network is involved in this mentalising, and the social brain undergoes significant change during adolescence. When adults and adolescents do the same mentalising tasks, different brain regions are shown to be active. Sarah-Jayne said these findings show that the adolescent brain is not broken or dysfunctional, it is just activating differently.

 

That’s all for the first session.

Thanks to Cell Coordinator Zinah Sorefan for her information on the activities of The Cell.

Check back for #imaginemed Part 2!

Alex

Alexandra Abel is a graduate from Imperial College London and the Royal College of Music. She has a keen interest in both Global Health and Performing Arts. From September, she will be a medical student at Hull York Medical School.

Join her on twitter @alexandraabel

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#imaginemed: Thinking Outside the Box (Part 1) by Translational Global Health, unless otherwise expressly stated, is licensed under a Creative Commons Attribution 3.0 Unported License.

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