December 26, 2024 • 19 mins
An interview on how the technologies of tomorrow can improve medical care today with noted now-ist Daniel Kraft, MD, a Stanford and Harvard trained physician-scientist, inventor, and entrepreneur focused on accelerating the future of health and biomedicine. He is trained in Internal Medicine & Pediatrics as well as hematology/oncology, stem cell transplantation and in aerospace medicine. He is the founder of NextMed Health & Digital.Health.
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Episode Transcript
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David Klonoff (00:14):
Hello, I'm Dr David Klonoff.
I'm an endocrinologist atSutter Health in UC San
Francisco.
Welcome to Diabetes TechnologyReport.
Today we have a very specialguest.
I've been trying to get him onour show for a long time and
he's here today.
I'm going to introduce ourco-host, dr David Kerr, who will
start the interview.
David Kerr (00:34):
Thanks, david, and welcome everyone.
This is David Kerr.
I'm speaking to you from, asusual, santa Barbara, california
, and you're quite right, wehave a superstar of technology
on the program today, dr DanielKraft.
Daniel, welcome, it's an honorto have you on board.
Actually, we like to beginthese conversations with kind of
(00:56):
finding out what makes you tick.
I mean, you were trained as aphysician, I think internal
medicine, oncology, that sort ofthing but you've ended up being
this superstar looking at thefuture and technology.
How did this transformationcome about?
Daniel Kraft (01:10):
Well, I would say I don't call myself a futurist,
I'm more of a nowist and I justsort of always just follow my
passion for well often lots ofthings.
In medical school I went toStanford.
I liked everything.
I had to pick a specialty.
I liked ER.
I was almost a surgeon.
I ended up I loved kids and Iloved medicine.
So I ended up doing med pedsand then, at Boston Children's
(01:32):
and Mass General, came back anddid hematology, oncology and
bone marrow transplant.
But I think I was lucky,especially while at Stanford, I
had the flexibility to follow myinterests in aviation and space
.
I helped design missions toMars with a bunch of AeroAstro
folks and went to InternationalSpace University.
I started learning digitalhealth and built an early
digital health startup.
I kept abreast of other fieldswhile I was doing stem cell
(01:55):
biology etc.
So I think my passions forcross-connecting and looking at
different fields kept me sort ofinterested in sometimes, you
know, outside the traditionalphysician scientist box.
That's the path I took.
And then, back in 2009, I wasasked to help, you know, the
founding summer of somethingcalled Singularity University,
which was framed aroundunderstanding where technology
(02:17):
is heading, often on theexponential, and so I sort of
came into this role of what'sthe future of health and
medicine as driven by theaccelerations of AI and
wearables and digital health, tolow cost genomics, to 3D
printing, to chatbots, to drones, and that sort of took me on
this sort of unexpected journeyof how do we think about getting
out of our usual silos asclinicians we often get you know
(02:38):
, I'm an oncologist, you're anendocrinologist.
How do we cross, fertilize andlook at our fields and health
and medicine writ large and seewhere technology is today and
where it might be going, and howdo we do things, maybe a bit
differently and morecollaboratively?
David Kerr (02:51):
So let's start with today.
I mean, we are diabetes, welive and breathe diabetes.
If you put your technology guruhat on and said, what do you
see as being the hot topics, thethings that excite you in the
age of diabetes and metabolichealth at the moment, will come
to the future, in the futurewell, this is the moment.
Daniel Kraft (03:13):
The future is coming faster than we think.
I mean even and it's not evenlydistributed a famous quote.
But obviously, as you guys know, we're we're entering this era
of proactive, predictive,preventative care.
Who's going to get diabetes,especially type one?
Maybe optimizing their early,super early diagnosis of stage
zero, preventing it fromhappening.
The ability to start seeing,the ability to over the counter
(03:33):
consumer cgms and all theimplications on the artificial
pancreas.
The ability to maybe evenleverage emerging stem cell
biology and ips cells to curediabetes in some cases.
So that's already the art ofthe possible today and, I think,
big picture.
You know we're so much in a sickcare mode and get paid to treat
disease, especially all thedownstream implications of
(03:54):
diabetes.
I think the exciting elementstoday is to start to be a little
more personalized and proactive, and these new tools are
enabling us to often get lots ofdata.
The challenge is connecting thedots between all this data to
turn it to insights andinformation that you, as an
endocrinologist, can use, thatyour patients and communities
can get more engaged with.
I love the whole.
We are not waiting movement.
The engaged community you'reoften involved with have helped
(04:15):
push the field faster to meetmany of the unmet needs of the
patients and the researchersthat can make a difference
sooner.
David Klonoff (04:23):
Daniel, what do you think of the concept of
precision medicine?
Daniel Kraft (04:28):
I mean more broadly.
I mean we all know that most ofour research is based on the
average patient and no patientis average.
And so we're now in this newera where, you know, through
wearables and digital health, wecan have much more precise data
.
The old model is, you know,intermittent reactive data.
We collect the data in theclinic and the four walls.
I think diabetes is probablythe first area where you start.
(04:48):
We started to get continuous orintermittent seed, you know,
blood sugars et cetera,eventually shared off and on
paper or faxed in to you as a,as a clinician.
And I think big picture I meanespecially with type two
diabetes and never forms thetype one.
It's multiple different diseasesat its omics level which mean
they might be mediateddifferently with exercise, diet,
(05:14):
medications et cetera.
And now the ability to collectthat data in real time and
optimize and have a feedbackloop can make the care not just
always more precise but moretuned and shorten the cycles of
optimization.
So, and I think it's healthcarewrit large, is getting much
more multimodal.
I mean we train as clinicians,we get our chem 20 and 40 in our
basic vitals.
Now we can have your digitomeand look at your food intake
with ai, and use your voice as abiomarker, even to predict
(05:36):
blood sugar, uh and.
And look at our multiplesignals, from you know, from
your microbiome, which certainlyinfects, impacts you know,
metabolic health, to your basegenome, to your digitome, and
start to synthesize that thisidea of the digital twin
interfacing with agentic healthand precision will hopefully
give layers and interfaces, theuser interface that's not just
(05:58):
the same one size fits all appto really engage each of us as
consumers, as patients, asclinicians, to make sense of all
this massive data, to be moreprecise and proactive.
David Klonoff (06:09):
Well as we make sense of all this.
Data treatment will be enteredinto the mix as well.
What do you see as the role forphysicians in the future?
Daniel Kraft (06:18):
That's a great question.
I mean now with.
I mean it's only two years thismonth, essentially, that GPT
was launched to the world andI'm sure we've all been playing
with it and patients are goingto doctor GPT and you could
probably feed in your CGM dataand that would help program your
CNGOS pumps, et cetera.
I think the role of theclinician is going to be
(06:39):
emerging and shifting.
That begs the question of howdo we choose medical students?
How do we train them?
How do we train our fellows?
How do we engage the patientand the clinician in new ways,
particularly when a lot ofhealthcare and some of diabetes
care is arguably somewhatalgorithmic can be much more
continuous and optimized andAI-enabled.
(07:00):
So I think we're going to seenot just obviously physical care
shifting to virtual, but moredigital.
We'll still need thoserelationships.
What the clinician is going todo will hopefully be maybe more
synthesis and more optimizingfor the individual, but using
these new tools, the challenges.
There's lots of tools out there.
I have a platform calleddigitalhealth.
(07:21):
If you search there underendocrinology or diabetes,
there's lots of solutions.
The challenge for, I'm sure,many of your clinicians and
colleagues is how do you plugthat into your workflow?
How do you align the incentivesto do that remote patient
monitoring, to build that sortof digital empathy and feedback
loops and cross connections, andhow do you fit that into the
(07:43):
payment models, the regulatory,the reimbursement and the sort
of workflow of the clinician andthe patient?
David Kerr (07:51):
and their families.
Daniel, I mean, you clearlyhave all of this information and
are enthusiastic and, as yousaid, clinicians the challenge
is closing the gap between whatis out there and what they know
about and what they canimplement.
Just looking back, have youcome across something that you
thought at the time was probablya good idea, but it never got
(08:14):
anywhere?
Maybe it needs an opportunityto be resurrected.
I'm just thinking if you'vecome across an area which could
be potentially hugely valuablein the metabolic health but it's
underexploited at the moment.
Daniel Kraft (08:30):
Well, we all know sort of Moore's law, the power
of technology, which is why wehave a supercomputer on our
wrist or in our aura ring orwhoop, you know.
Another area that's maybebeginning more appreciated is
and it's becoming cheaper andmore available is augmented and
virtual and extended reality.
Right, there's still CluG theApple Vision Pro, expensive,
(08:53):
heavy Oculus Quest as an examplegetting consumerized.
Great for video games, but alsowith lots of applications for
metabolic health, where you canlook at an avatar of yourself
and interact with others in avirtual clinical environment or
show yourself future you ifyou're managing your weight and
your medication and your diet innew ways.
Great for interacting and doingmedical education, simulating
(09:16):
things.
So that's an area maybe that'sstarting to come into the
zeitgeist of both medicaleducation and even therapy.
I've been doing workouts duringthe pandemic, when the gyms
were closed and something calledSupernatural put on the headset
, do amazing workouts infabulous environments, interact
with coaches, and that kept youengaged, gamifying health.
So I think it's not beingresurrected, but we're seeing
some of these consumer typetools, whether it's virtual
(09:38):
reality or even wearables, thatare becoming consumer and
shifting into the true healthand medical angle as well.
David Kerr (09:44):
And just going back to the medical education,
because we have the diabetestechnology interns here today,
and if you had advice for youngpeople who were thinking about a
career in health care, thinkingabout getting into medicine,
are there certain skill setsthat are now must-have, compared
(10:04):
to perhaps when David Klonoffand I went to medical school,
which was when dinosaurs stillruled the earth?
Daniel Kraft (10:11):
Well, I grew up in partly that era.
I mean we had to study for theMCATs and do well in organic
chemistry and physics, and is agood MCAT score and being good
at organic chemistry going tomake you a good clinician of the
future?
What?
Who do we select and whatskills should be?
Sort of maybe part of thepre-med requirements, maybe it's
a little bit of coding.
Sort of maybe part of thepre-med requirements.
Maybe it's a little bit ofcoding.
Maybe it's selecting folks onbetter EQ, emotional
intelligence and can you know,because those skills would be
(10:32):
more important If you're goingto be an interventionalist, are
you good at hand-eyecoordination, video games?
But I would encourage folksgetting into medicine today, and
even those folks who are wellpast our residencies and
trainings, to have thatbeginner's mindset.
You see a problem in the clinicor in the research space and go
how might I solve that?
Not with just the tools andtechnologies of today, but where
(10:53):
are we going to be in two andfive years?
We're already at $100 genome.
Soon we'll be at a $10 genome.
How might you leverage thatinto proactive, early
diabetes-related management?
The next generation wearablesthere's rumors out that the
Apple Watch, let's say, in ayear or two will have relative
real-time blood pressure andreal-time blood sugar.
What is that going to mean?
Maybe not for the full-on type1 diabetic, but for metabolic
(11:15):
health.
Writ large all the impacts ofGLP-1s, et cetera massive things
.
But I would challengeclinicians and medical students
today have that beginner's mind.
See a problem out there, keep alittle note especially when
you're as a medical student orintern or resident and see a
problem and say how could Isolve that in new ways?
Maybe it's an app, maybe it'sconvergence of digital health
and wearables, maybe it'sleveraging AI and agents and
(11:37):
then start building them andprototyping them or trying some
of these emerging solutions youcan find on digitalhealth or at
my NextMed health conference,and start plugging them in early
, before they're always approvedand paid for.
David Klonoff (11:49):
Daniel, you organized a meeting called
NextMed.
Could you talk about that?
Tell us what it is?
Daniel Kraft (11:59):
Yeah, back in 2011 , I was at Singular University
putting together some executiveprograms looking at the future
on AI and robotics, reprinting,nanotech, et cetera.
But everyone and most of themwere not healthcare folks were
interested in health andmedicine, personally or
otherwise, and thought mostmedical meetings I'll go to Ash
and Asko, you go to AmericanDiabetes Association meetings et
(12:20):
cetera are very siloed aroundfields or sometimes technologies
, medical device, pharma, etcetera.
And I thought what happens ifwe bring together physicians,
pharma payers, inventors,technologists, investors?
And that became this platformcalled NextMedHealth, which
we've been running at the HotelDel Coronado every year.
The next one will be March 30thto April 2nd.
Nextmedhealth has all theinformation and what's exciting
is you get people sparked andthey have sometimes no idea
what's already here, right, whata wearable can do that your
(12:42):
camera can pick up your vitalsigns.
That voice is a biomarker forblood sugar.
That, in a chat bot of today,can already do this, and what
might it be doing next and howthat might inform your clinical
practice, your research program,what field you choose to go
into, how you build the nextgeneration startup or academic
program.
So the magic there has beenconnecting the dots between
different fields again lettingpeople see the cutting edge,
(13:05):
like we had moderna there in2015.
We had AliveCore there in 2011.
And that can inform yourmindset and what you do in your
own clinical space and yourresearch space and personally
for your own health and medicine.
So that's NextMedHealth and Ithink it's a pretty unique not
just gathering but community tosort of catalyze the future.
David Klonoff (13:26):
Daniel, I'm a principal investigator on many
clinical trials.
With the new technologies thatare emerging, including remote
visits and real-world evidence,what do you think is the future
of clinical trials for new drugsand new devices?
I think there's.
Daniel Kraft (13:43):
I mean huge implications.
Number one picking the right,let's say new drug.
Ai is enabling new forms ofdrug development.
The Nobel Prize just went fornew ways to discover proteins
and folding, so hopefully findnew drugs with AI to targets and
sometimes multimodal targetsand multimodal therapies.
Patients for your trialsthrough mobile apps, through
(14:09):
social media, and they don'tneed to travel to the ivory
tower as it used to be, and soyou get a much more hopefully
representative population.
Three we can use these newdigitally enabled tools.
You know your wearable devicescan give you digital biomarkers,
not just for your blood sugarbut your activity, your food,
your diet, so we can pull in newforms of information and pick
new primary endpoints andsecondary ones, and then the
ability to crowdsource thatinformation.
(14:30):
I love the.
You know the students on thecall won't remember driving
without Google Maps or Waze, butwe can imagine driving out
without Google Maps or Waze.
Today the future of clinicaltrials is hopefully much more
available than anyone can becomeand often be a data donor in
small ways or large ways, andthen we build those better
health maps, whether it's foryou know, as we've seen with
type one diabetes folkscollating their data and sharing
(14:52):
that and helping tune thealgorithms.
Platforms like MySugar, I think, did that.
It was bought by Roche, Ibelieve.
So I think lots ofopportunities there.
A lot of it means we need tore-educate the clinicians, the
clinical trialists, and alignincentives to make that happen,
including some of the privacylaws and technologies to enable
people to better share theirdata.
David Kerr (15:13):
Daniel, just a kind of philosophical question.
This is all I mean.
So exciting, but if you're theperson with diabetes and you're
listening to this and you'relooking at the future, should
you be apprehensive, saying, myGod, I have a lot to learn.
Learn this is going to consumea lot of time and effort and
dollars on my part.
Or is the future going to beautomate, automate, automate and
(15:34):
reduce the burden?
How do you see this panning out?
Daniel Kraft (15:38):
Well, healthcare and medicine is often still
super confusing.
The interfaces are terrible.
We're still using fax machinesand DVDs to transmit information
, for God's sakes.
But I think what's excitingabout this new AI and sort of
avatar-enabled era is that we'requickly moving into the era of
agentic health, where it's notgenerative AI, it's generative
health and it will know me andthe user interface will be stuck
(16:02):
, you know, will match my age,culture, language, education
level, incentives, and so if I'ma new diabetic or a parent of
one, or a clinician writ large,I can hopefully have these
agents help collect thatinformation and present it to me
in a way that's super usefuland can unfragment things and
simplify elements and then againtune the right selection of a
digital tool or a wearable orthe drug that matches and maybe
(16:25):
again let you opt into aclinical trial.
So it can be super confusing.
But I think we have some newtools to simplify the user
interfaces and make them muchmore highly personalized and
then effective, becauseengagement the engaged,
empowered consumer and patientand clinician is much more
likely to have an impact acrossprevention, diagnostics and
therapy and patient andclinician is much more likely to
have an impact acrossprevention, diagnostics and
(16:49):
therapy.
David Klonoff (16:49):
Daniel, as we get into digital twins and agentic
health, will there be such athing as a doctor visit.
Daniel Kraft (16:51):
What will it be like?
Well, sure, we'll still needsome laying on to the hands.
I think the sort of digital,not just physical or virtual.
But the future of a physical orvirtual exam might not just be
us on a Zoom right, we may beputting our augmented reality
glasses, the meta glasses.
Over the next couple of yearsare going to blend augmented and
virtual and extended reality.
It'll feel like we're in thesame room.
We could all, instead of beingon the flat screen, sort of be
(17:11):
in our virtual environment doingthis podcast recording.
So we'll still need in-personHospitals will probably be much
more higher acuity.
We're moving this hospital tohome movement, where a lot of
folks will be admitted to homefor their maybe not DKA, but
maybe for their pneumonia andantibiotics.
Remote patient monitoring toolsare again still quite
fragmented.
The challenge often isn't thenew technology but connecting
(17:34):
the dots so we don't just createmore data but we have new
insights and knowledge thattranslate to the bedside or,
increasingly, the website muchmore quickly, which back to
medical education.
How do we train physicians andclinicians of all sorts to not
just have good bedside mannerbut good website manner, and how
do their agents start tointervene and have
representations that everyonewould like to interface with.
David Klonoff (17:57):
Well, you've provided several new terms.
I'm going to steal some ofthese, but I will give you
credit.
This is great.
Daniel, I want to thank you forbeing a guest today on Diabetes
Technology Report.
I feel like we're looking 10years into the future here and
we will invite you back.
I hope people listening willattend NextMed if they want to
(18:19):
hear more of this type of topic.
So Diabetes Technology Reportis available on Apple, spotify
and the Diabetes TechnologySociety website.
Daniel, is there anything elseyou want to say before we end
the interview?
Daniel Kraft (18:33):
Yeah, Thanks so much for having me.
I love the endocrinology anddiabetes space because it has
pushed a lot of technologies andinnovation that cross over to
many fields and I would say forall of us, let's not wait for
this 10-year future.
A lot of what I talked about isessentially already here.
If you go to digitalhealth thatplatform I've been building and
search for diabetes orendocrinology or metabolic
health, you'll find a lot ofthings that are already out
there.
You could start plugging theminto your own practice or meet
(18:56):
your unmet need.
It could be a tools that mighthelp your practice or your own
clinical and health pathways.
So I think we're all needingnot to be futurists but to sort
of bring it a bit faster and notwait for folks to deliver it
fully packaged, because it won'twork that way.
So let's all collaborate tobuild that future.
David Klonoff (19:16):
You called yourself a nowist at the
beginning, and this is in linewith us looking into nowism.
So, daniel, thank you.
Uh, on behalf of myself and drdavid kerr, thank you, have a
good day and, uh, we'll see youat our next diabetes technology
report.
Bye-bye, thank you.
Hello, I'm Dr David Klonoff.
I'm an endocrinologist atSutter Health in UC San
Francisco.
Welcome to Diabetes TechnologyReport.
Today we have a very specialguest.
I've been trying to get him onour show for a long time and
he's here today.
I'm going to introduce ourco-host, dr David Kerr, who will
start the interview.
David Kerr (00:34):
Thanks, david, and welcome everyone.
This is David Kerr.
I'm speaking to you from, asusual, santa Barbara, california
, and you're quite right, wehave a superstar of technology
on the program today, dr DanielKraft.
Daniel, welcome, it's an honorto have you on board.
Actually, we like to beginthese conversations with kind of
(00:56):
finding out what makes you tick.
I mean, you were trained as aphysician, I think internal
medicine, oncology, that sort ofthing but you've ended up being
this superstar looking at thefuture and technology.
How did this transformationcome about?
Daniel Kraft (01:10):
Well, I would say I don't call myself a futurist,
I'm more of a nowist and I justsort of always just follow my
passion for well often lots ofthings.
In medical school I went toStanford.
I liked everything.
I had to pick a specialty.
I liked ER.
I was almost a surgeon.
I ended up I loved kids and Iloved medicine.
So I ended up doing med pedsand then, at Boston Children's
(01:32):
and Mass General, came back anddid hematology, oncology and
bone marrow transplant.
But I think I was lucky,especially while at Stanford, I
had the flexibility to follow myinterests in aviation and space
.
I helped design missions toMars with a bunch of AeroAstro
folks and went to InternationalSpace University.
I started learning digitalhealth and built an early
digital health startup.
I kept abreast of other fieldswhile I was doing stem cell
(01:55):
biology etc.
So I think my passions forcross-connecting and looking at
different fields kept me sort ofinterested in sometimes, you
know, outside the traditionalphysician scientist box.
That's the path I took.
And then, back in 2009, I wasasked to help, you know, the
founding summer of somethingcalled Singularity University,
which was framed aroundunderstanding where technology
(02:17):
is heading, often on theexponential, and so I sort of
came into this role of what'sthe future of health and
medicine as driven by theaccelerations of AI and
wearables and digital health, tolow cost genomics, to 3D
printing, to chatbots, to drones, and that sort of took me on
this sort of unexpected journeyof how do we think about getting
out of our usual silos asclinicians we often get you know
(02:38):
, I'm an oncologist, you're anendocrinologist.
How do we cross, fertilize andlook at our fields and health
and medicine writ large and seewhere technology is today and
where it might be going, and howdo we do things, maybe a bit
differently and morecollaboratively?
David Kerr (02:51):
So let's start with today.
I mean, we are diabetes, welive and breathe diabetes.
If you put your technology guruhat on and said, what do you
see as being the hot topics, thethings that excite you in the
age of diabetes and metabolichealth at the moment, will come
to the future, in the futurewell, this is the moment.
Daniel Kraft (03:13):
The future is coming faster than we think.
I mean even and it's not evenlydistributed a famous quote.
But obviously, as you guys know, we're we're entering this era
of proactive, predictive,preventative care.
Who's going to get diabetes,especially type one?
Maybe optimizing their early,super early diagnosis of stage
zero, preventing it fromhappening.
The ability to start seeing,the ability to over the counter
(03:33):
consumer cgms and all theimplications on the artificial
pancreas.
The ability to maybe evenleverage emerging stem cell
biology and ips cells to curediabetes in some cases.
So that's already the art ofthe possible today and, I think,
big picture.
You know we're so much in a sickcare mode and get paid to treat
disease, especially all thedownstream implications of
(03:54):
diabetes.
I think the exciting elementstoday is to start to be a little
more personalized and proactive, and these new tools are
enabling us to often get lots ofdata.
The challenge is connecting thedots between all this data to
turn it to insights andinformation that you, as an
endocrinologist, can use, thatyour patients and communities
can get more engaged with.
I love the whole.
We are not waiting movement.
The engaged community you'reoften involved with have helped
(04:15):
push the field faster to meetmany of the unmet needs of the
patients and the researchersthat can make a difference
sooner.
David Klonoff (04:23):
Daniel, what do you think of the concept of
precision medicine?
Daniel Kraft (04:28):
I mean more broadly.
I mean we all know that most ofour research is based on the
average patient and no patientis average.
And so we're now in this newera where, you know, through
wearables and digital health, wecan have much more precise data
.
The old model is, you know,intermittent reactive data.
We collect the data in theclinic and the four walls.
I think diabetes is probablythe first area where you start.
(04:48):
We started to get continuous orintermittent seed, you know,
blood sugars et cetera,eventually shared off and on
paper or faxed in to you as a,as a clinician.
And I think big picture I meanespecially with type two
diabetes and never forms thetype one.
It's multiple different diseasesat its omics level which mean
they might be mediateddifferently with exercise, diet,
(05:14):
medications et cetera.
And now the ability to collectthat data in real time and
optimize and have a feedbackloop can make the care not just
always more precise but moretuned and shorten the cycles of
optimization.
So, and I think it's healthcarewrit large, is getting much
more multimodal.
I mean we train as clinicians,we get our chem 20 and 40 in our
basic vitals.
Now we can have your digitomeand look at your food intake
with ai, and use your voice as abiomarker, even to predict
(05:36):
blood sugar, uh and.
And look at our multiplesignals, from you know, from
your microbiome, which certainlyinfects, impacts you know,
metabolic health, to your basegenome, to your digitome, and
start to synthesize that thisidea of the digital twin
interfacing with agentic healthand precision will hopefully
give layers and interfaces, theuser interface that's not just
(05:58):
the same one size fits all appto really engage each of us as
consumers, as patients, asclinicians, to make sense of all
this massive data, to be moreprecise and proactive.
David Klonoff (06:09):
Well as we make sense of all this.
Data treatment will be enteredinto the mix as well.
What do you see as the role forphysicians in the future?
Daniel Kraft (06:18):
That's a great question.
I mean now with.
I mean it's only two years thismonth, essentially, that GPT
was launched to the world andI'm sure we've all been playing
with it and patients are goingto doctor GPT and you could
probably feed in your CGM dataand that would help program your
CNGOS pumps, et cetera.
I think the role of theclinician is going to be
(06:39):
emerging and shifting.
That begs the question of howdo we choose medical students?
How do we train them?
How do we train our fellows?
How do we engage the patientand the clinician in new ways,
particularly when a lot ofhealthcare and some of diabetes
care is arguably somewhatalgorithmic can be much more
continuous and optimized andAI-enabled.
(07:00):
So I think we're going to seenot just obviously physical care
shifting to virtual, but moredigital.
We'll still need thoserelationships.
What the clinician is going todo will hopefully be maybe more
synthesis and more optimizingfor the individual, but using
these new tools, the challenges.
There's lots of tools out there.
I have a platform calleddigitalhealth.
(07:21):
If you search there underendocrinology or diabetes,
there's lots of solutions.
The challenge for, I'm sure,many of your clinicians and
colleagues is how do you plugthat into your workflow?
How do you align the incentivesto do that remote patient
monitoring, to build that sortof digital empathy and feedback
loops and cross connections, andhow do you fit that into the
(07:43):
payment models, the regulatory,the reimbursement and the sort
of workflow of the clinician andthe patient?
David Kerr (07:51):
and their families.
Daniel, I mean, you clearlyhave all of this information and
are enthusiastic and, as yousaid, clinicians the challenge
is closing the gap between whatis out there and what they know
about and what they canimplement.
Just looking back, have youcome across something that you
thought at the time was probablya good idea, but it never got
(08:14):
anywhere?
Maybe it needs an opportunityto be resurrected.
I'm just thinking if you'vecome across an area which could
be potentially hugely valuablein the metabolic health but it's
underexploited at the moment.
Daniel Kraft (08:30):
Well, we all know sort of Moore's law, the power
of technology, which is why wehave a supercomputer on our
wrist or in our aura ring orwhoop, you know.
Another area that's maybebeginning more appreciated is
and it's becoming cheaper andmore available is augmented and
virtual and extended reality.
Right, there's still CluG theApple Vision Pro, expensive,
(08:53):
heavy Oculus Quest as an examplegetting consumerized.
Great for video games, but alsowith lots of applications for
metabolic health, where you canlook at an avatar of yourself
and interact with others in avirtual clinical environment or
show yourself future you ifyou're managing your weight and
your medication and your diet innew ways.
Great for interacting and doingmedical education, simulating
(09:16):
things.
So that's an area maybe that'sstarting to come into the
zeitgeist of both medicaleducation and even therapy.
I've been doing workouts duringthe pandemic, when the gyms
were closed and something calledSupernatural put on the headset
, do amazing workouts infabulous environments, interact
with coaches, and that kept youengaged, gamifying health.
So I think it's not beingresurrected, but we're seeing
some of these consumer typetools, whether it's virtual
(09:38):
reality or even wearables, thatare becoming consumer and
shifting into the true healthand medical angle as well.
David Kerr (09:44):
And just going back to the medical education,
because we have the diabetestechnology interns here today,
and if you had advice for youngpeople who were thinking about a
career in health care, thinkingabout getting into medicine,
are there certain skill setsthat are now must-have, compared
(10:04):
to perhaps when David Klonoffand I went to medical school,
which was when dinosaurs stillruled the earth?
Daniel Kraft (10:11):
Well, I grew up in partly that era.
I mean we had to study for theMCATs and do well in organic
chemistry and physics, and is agood MCAT score and being good
at organic chemistry going tomake you a good clinician of the
future?
What?
Who do we select and whatskills should be?
Sort of maybe part of thepre-med requirements, maybe it's
a little bit of coding.
Sort of maybe part of thepre-med requirements.
Maybe it's a little bit ofcoding.
Maybe it's selecting folks onbetter EQ, emotional
intelligence and can you know,because those skills would be
(10:32):
more important If you're goingto be an interventionalist, are
you good at hand-eyecoordination, video games?
But I would encourage folksgetting into medicine today, and
even those folks who are wellpast our residencies and
trainings, to have thatbeginner's mindset.
You see a problem in the clinicor in the research space and go
how might I solve that?
Not with just the tools andtechnologies of today, but where
(10:53):
are we going to be in two andfive years?
We're already at $100 genome.
Soon we'll be at a $10 genome.
How might you leverage thatinto proactive, early
diabetes-related management?
The next generation wearablesthere's rumors out that the
Apple Watch, let's say, in ayear or two will have relative
real-time blood pressure andreal-time blood sugar.
What is that going to mean?
Maybe not for the full-on type1 diabetic, but for metabolic
(11:15):
health.
Writ large all the impacts ofGLP-1s, et cetera massive things
.
But I would challengeclinicians and medical students
today have that beginner's mind.
See a problem out there, keep alittle note especially when
you're as a medical student orintern or resident and see a
problem and say how could Isolve that in new ways?
Maybe it's an app, maybe it'sconvergence of digital health
and wearables, maybe it'sleveraging AI and agents and
(11:37):
then start building them andprototyping them or trying some
of these emerging solutions youcan find on digitalhealth or at
my NextMed health conference,and start plugging them in early
, before they're always approvedand paid for.
David Klonoff (11:49):
Daniel, you organized a meeting called
NextMed.
Could you talk about that?
Tell us what it is?
Daniel Kraft (11:59):
Yeah, back in 2011 , I was at Singular University
putting together some executiveprograms looking at the future
on AI and robotics, reprinting,nanotech, et cetera.
But everyone and most of themwere not healthcare folks were
interested in health andmedicine, personally or
otherwise, and thought mostmedical meetings I'll go to Ash
and Asko, you go to AmericanDiabetes Association meetings et
(12:20):
cetera are very siloed aroundfields or sometimes technologies
, medical device, pharma, etcetera.
And I thought what happens ifwe bring together physicians,
pharma payers, inventors,technologists, investors?
And that became this platformcalled NextMedHealth, which
we've been running at the HotelDel Coronado every year.
The next one will be March 30thto April 2nd.
Nextmedhealth has all theinformation and what's exciting
is you get people sparked andthey have sometimes no idea
what's already here, right, whata wearable can do that your
(12:42):
camera can pick up your vitalsigns.
That voice is a biomarker forblood sugar.
That, in a chat bot of today,can already do this, and what
might it be doing next and howthat might inform your clinical
practice, your research program,what field you choose to go
into, how you build the nextgeneration startup or academic
program.
So the magic there has beenconnecting the dots between
different fields again lettingpeople see the cutting edge,
(13:05):
like we had moderna there in2015.
We had AliveCore there in 2011.
And that can inform yourmindset and what you do in your
own clinical space and yourresearch space and personally
for your own health and medicine.
So that's NextMedHealth and Ithink it's a pretty unique not
just gathering but community tosort of catalyze the future.
David Klonoff (13:26):
Daniel, I'm a principal investigator on many
clinical trials.
With the new technologies thatare emerging, including remote
visits and real-world evidence,what do you think is the future
of clinical trials for new drugsand new devices?
I think there's.
Daniel Kraft (13:43):
I mean huge implications.
Number one picking the right,let's say new drug.
Ai is enabling new forms ofdrug development.
The Nobel Prize just went fornew ways to discover proteins
and folding, so hopefully findnew drugs with AI to targets and
sometimes multimodal targetsand multimodal therapies.
Patients for your trialsthrough mobile apps, through
(14:09):
social media, and they don'tneed to travel to the ivory
tower as it used to be, and soyou get a much more hopefully
representative population.
Three we can use these newdigitally enabled tools.
You know your wearable devicescan give you digital biomarkers,
not just for your blood sugarbut your activity, your food,
your diet, so we can pull in newforms of information and pick
new primary endpoints andsecondary ones, and then the
ability to crowdsource thatinformation.
(14:30):
I love the.
You know the students on thecall won't remember driving
without Google Maps or Waze, butwe can imagine driving out
without Google Maps or Waze.
Today the future of clinicaltrials is hopefully much more
available than anyone can becomeand often be a data donor in
small ways or large ways, andthen we build those better
health maps, whether it's foryou know, as we've seen with
type one diabetes folkscollating their data and sharing
(14:52):
that and helping tune thealgorithms.
Platforms like MySugar, I think, did that.
It was bought by Roche, Ibelieve.
So I think lots ofopportunities there.
A lot of it means we need tore-educate the clinicians, the
clinical trialists, and alignincentives to make that happen,
including some of the privacylaws and technologies to enable
people to better share theirdata.
David Kerr (15:13):
Daniel, just a kind of philosophical question.
This is all I mean.
So exciting, but if you're theperson with diabetes and you're
listening to this and you'relooking at the future, should
you be apprehensive, saying, myGod, I have a lot to learn.
Learn this is going to consumea lot of time and effort and
dollars on my part.
Or is the future going to beautomate, automate, automate and
(15:34):
reduce the burden?
How do you see this panning out?
Daniel Kraft (15:38):
Well, healthcare and medicine is often still
super confusing.
The interfaces are terrible.
We're still using fax machinesand DVDs to transmit information
, for God's sakes.
But I think what's excitingabout this new AI and sort of
avatar-enabled era is that we'requickly moving into the era of
agentic health, where it's notgenerative AI, it's generative
health and it will know me andthe user interface will be stuck
(16:02):
, you know, will match my age,culture, language, education
level, incentives, and so if I'ma new diabetic or a parent of
one, or a clinician writ large,I can hopefully have these
agents help collect thatinformation and present it to me
in a way that's super usefuland can unfragment things and
simplify elements and then againtune the right selection of a
digital tool or a wearable orthe drug that matches and maybe
(16:25):
again let you opt into aclinical trial.
So it can be super confusing.
But I think we have some newtools to simplify the user
interfaces and make them muchmore highly personalized and
then effective, becauseengagement the engaged,
empowered consumer and patientand clinician is much more
likely to have an impact acrossprevention, diagnostics and
therapy and patient andclinician is much more likely to
have an impact acrossprevention, diagnostics and
(16:49):
therapy.
David Klonoff (16:49):
Daniel, as we get into digital twins and agentic
health, will there be such athing as a doctor visit.
Daniel Kraft (16:51):
What will it be like?
Well, sure, we'll still needsome laying on to the hands.
I think the sort of digital,not just physical or virtual.
But the future of a physical orvirtual exam might not just be
us on a Zoom right, we may beputting our augmented reality
glasses, the meta glasses.
Over the next couple of yearsare going to blend augmented and
virtual and extended reality.
It'll feel like we're in thesame room.
We could all, instead of beingon the flat screen, sort of be
(17:11):
in our virtual environment doingthis podcast recording.
So we'll still need in-personHospitals will probably be much
more higher acuity.
We're moving this hospital tohome movement, where a lot of
folks will be admitted to homefor their maybe not DKA, but
maybe for their pneumonia andantibiotics.
Remote patient monitoring toolsare again still quite
fragmented.
The challenge often isn't thenew technology but connecting
(17:34):
the dots so we don't just createmore data but we have new
insights and knowledge thattranslate to the bedside or,
increasingly, the website muchmore quickly, which back to
medical education.
How do we train physicians andclinicians of all sorts to not
just have good bedside mannerbut good website manner, and how
do their agents start tointervene and have
representations that everyonewould like to interface with.
David Klonoff (17:57):
Well, you've provided several new terms.
I'm going to steal some ofthese, but I will give you
credit.
This is great.
Daniel, I want to thank you forbeing a guest today on Diabetes
Technology Report.
I feel like we're looking 10years into the future here and
we will invite you back.
I hope people listening willattend NextMed if they want to
(18:19):
hear more of this type of topic.
So Diabetes Technology Reportis available on Apple, spotify
and the Diabetes TechnologySociety website.
Daniel, is there anything elseyou want to say before we end
the interview?
Daniel Kraft (18:33):
Yeah, Thanks so much for having me.
I love the endocrinology anddiabetes space because it has
pushed a lot of technologies andinnovation that cross over to
many fields and I would say forall of us, let's not wait for
this 10-year future.
A lot of what I talked about isessentially already here.
If you go to digitalhealth thatplatform I've been building and
search for diabetes orendocrinology or metabolic
health, you'll find a lot ofthings that are already out
there.
You could start plugging theminto your own practice or meet
(18:56):
your unmet need.
It could be a tools that mighthelp your practice or your own
clinical and health pathways.
So I think we're all needingnot to be futurists but to sort
of bring it a bit faster and notwait for folks to deliver it
fully packaged, because it won'twork that way.
So let's all collaborate tobuild that future.
David Klonoff (19:16):
You called yourself a nowist at the
beginning, and this is in linewith us looking into nowism.
So, daniel, thank you.
Uh, on behalf of myself and drdavid kerr, thank you, have a
good day and, uh, we'll see youat our next diabetes technology
report.
Bye-bye, thank you.
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