Q&A with Dr. Erik Viirre: Tricorders, Space and the Future of Medicine

Dr. Erik Viirre, MD, PhD

Dr. Erik Viirre, MD, PhD, is a medical neurotologist, a space geek, and a techie. He flew the Zero G aircraft with Stephen Hawking, spent time with Arthur C. Clarke at the author’s home in Sri Lanka, and counts author and XPRIZE founder Dr. Peter Diamandis as a friend. And he is devoted to helping his patients.

Dr. Viirre specializes in neurotology, which is the diagnosis and outpatient treatment of vertigo, balance disorders, and tinnitus. He has been with the UC San Diego Department of Neurosciences since 2006 and the Department of Surgery, Division of Otolaryngology, since 1998. Dr. Viirre is associate director of the Arthur C. Clarke Center for Human Imagination, which integrates the arts, sciences, humanities, engineering and medicine to work on a new theoretical framework for exploring the basis of imagination.

A member of numerous scientific boards, Dr. Viirre is also director of the Applied Cognitive Science Laboratory at the Naval Health Research Center, San Diego. Dr. Viirre received his PhD in Neurophysiology in 1987 at the University of Western Ontario in London, Canada and his MD in 1988.

Dr. Viirre served as the medical and technical director of the Qualcomm Tricorder XPRIZE competition, which concluded in the spring of 2017, and he continues to consult on the Tricorder Device Testing Center at UC San Diego. This center, which kicked off in June, will test second-generation Star Trek-inspired medical devices and is being overseen by UC San Diego Altman Clinical and Translational Research Institute (ACTRI) and the Qualcomm Institute. Dr. Viirre was integral in bringing the Qualcomm Tricorder XPRIZE to UC San Diego, with ACTRI and the Qualcomm Institute facilitating device testing for the competition.

Dr. Viirre sat down recently in his Atkinson Hall office to discuss the Tricorder project, the future of medicine, and his role at UC San Diego, where he dons many hats.

July 9, 2018  | Interview by Patricia Wieser

Tell us how the XPRIZE, Qualcomm and UC San Diego came together?
I have a long history with XPRIZE – pretty much since it was first publicly announced in the 1990s. I helped out Dr. Peter Diamandis, who founded and led the XPRIZE Foundation after the Ansari XPRIZE for Suborbital Spaceflight was successful. He wanted to go beyond space flight and sought sponsors for large incentive prizes. He was always interested in artificial intelligence (AI) and wanted to have an AI medical prize. Once he said the word, “Tricorder,” to Paul Jacobs at Qualcomm, the Qualcomm Tricorder XPRIZE was established. Jacobs was a lifelong Star Trek fan. One of the things engineers and techies love is the Tricorder. It is portable and scientific. The idea was to create an XPRIZE centering on mobile health. We held workshops in San Diego to develop concepts for the competition and our experts were doctors, engineers, patient health advocates and consumers. There were two key elements to the competition: the systems had to be technologically good; and they had to be consumer friendly. The Qualcomm Tricorder XPRIZE was formalized and announced in 2012. That’s when I was engaged by the XPRIZE Foundation to become its medical and technical director of the Tricorder prize.

How did ACTRI become involved?
I helped with all the bits and pieces of putting the program together. One crucial element was where do we hold it? I was routing for UC San Diego and XPRIZE agreed.

I remember a series of knuckle biting meetings. One was with Dr. Gary S. Firestein [director of ACTRI] hoping he would be interested in this Star Trekky kind of far-out medical program. He embraced it and said we have to have this test program here. There were originally 300 letters of intent from teams all over the world expressing interest in competing. Around that time – 2012 – 30 formal applications were submitted from teams of their systems and the work they would do. I helped empanel judges – experts from all over the world – who reviewed these applications and then pitched 10 finalists who would be invited to submit actual technologies. Then it was getting pretty real. We had created the test program. Dr. Firestein recommended that we involve Dr. Gene “Rusty” Kallenberg, who is division chief of family medicine at UC San Diego. I met Dr. Kallenberg outside Whole Foods in La Jolla and pitched to him that we needed his help in tracking down people who had conditions from our list and could be “testers” for the competition.

Another knuckle biting meeting was with the IRB [Institutional Review Board that reviews research studies involving human subjects]. You can imagine, here we are running 10 international sets of technologies across about 25 different diseases testing hundreds of people. So it’s like dozens and dozens of clinical trials. How are we ever going to manage this? I fussed about this for a long time. Then I met with Dr. Michael Caligiuri, who had been director of the UC San Diego Human Research Protections Program, in the lobby of Thornton Hospital. He and I are space geeks. He does amateur astronomy and the transit of Venus was coming up and we yakked about telescopes. Then I asked him about the XPRIZE. I was so nervous. He said, “It’s a competition. It’s not a scientific program. It’s not a clinical trial. So you don’t need an IRB.” He suggested, though, that we take the best practices form from an IRB and hold the competition as though it were a scientific program. Dr. Caligiuri volunteered to head up the IRB task force for the competition. IRB research subjects sign informed consent forms and there is a protocol managed by the IRB. Since we had consumer testers instead of research subjects, the testers would sign a contract instead of a consent form. Dr. Kallenberg formed a physician oversight team; we worked out the diseases that would be part of the competition and how they would be tested; and we decided what would be equivalent to a research protocol and we called it a test program. This became part of the rules of the competition.

The final knuckle biting meeting was with the FDA, but the FDA was super cooperative and helped us design the competition rules. Most importantly, the FDA offered to help the teams so they could get guidance in building these systems that had never been built. The FDA ensured it was feasible to produce these multi-function Tricorder devices for demonstrations and that they were safe.

How did you get UC San Diego physicians on board?
Dr. Kallenberg went to various departments to engage them in helping us find patients for the various conditions, like hepatitis and stroke and bladder infections. He and I went to see the sleep doctors because sleep apnea was one of our conditions. They said, “We already send stuff home for sleep assessments, so what’s so great about Tricorders compared to what we do?” I said, “Well, can they diagnose liver disease?” I got them there. That’s the whole idea – that these things would be demonstrably able to detect all kinds of different conditions.

What about this new initiative called the Tricorder Device Development Project, which kicked off in June, 2018?
We are very fortunate that some of the funds have been brought to UC San Diego and Health for this test program to continue. ACTRI and the Jacobs School of Engineering are creating a sustainable testing center for novel consumer and medical devices that can improve health. The teams know how to best test their own systems, but we know how to test all the systems and have a data cloud to handle the wireless component. The Qualcomm Institute on this campus had a big role in the Qualcomm Tricorder XPRIZE. The data cloud was an essential element that worked beautifully and helped create a data cloud specification. Now we’re working on the next generation of mobile health and how we’re going to enable these systems to talk to our medical records systems at our hospitals and other places. We are working with the Roddenberry Foundation on helping third-world countries; the Foundation is currently funding a program in Mozambique. So it’s really been a fun, collaborative effort characteristic of UC San Diego, bringing together main campus with the medical campus, and all the different departments.

What makes the continuation of the device testing center important? And why is a hand-held/portable health diagnostics system so desirable? What are the potential impacts to humanity?
The original Tricorder prize had two purposes: To make the Tricorder a term of art so that it’s not just for Trekkies; and to demonstrate that mobile technology could do what we said it could do – identify various conditions and be run by consumers without doctors involved. We showed that was true. So the next phase is to go from a demonstration of possibility to making it practical. An example I like is from the Progressive Insurance Automotive XPRIZE, where they developed the formula for MPGe – miles per gallon (gas) equivalent – to measure the energy use of electric cars at an equivalent rate to motor fuel. Our Tricorder test is like that. We’re the nursemaid for these technologies that now have to be commercially successful to reach the world, either through a company or a government. One of the goals of the Tricorder team from India is to create a low-cost system that would be used by tens if not hundreds of millions of people. That for me would be a brilliant success.

The second phase of the testing center is the clinical trials. We have to do the proper documentation, procedures, protocols, consents and regulatory submissions, and these are all very expensive to do. Our test program will help find the most cost-efficient and scientifically rigorous processes so that tests can be done and systems receive the necessary approvals from our country and countries all over the world.

How long will this take?
I’m optimistic that multi-function consumer health devices are just a few years away for us.

How did an medical neurotologist like yourself, one who loves technology, physics and space, come to support this prize and the continuation of the testing center? Are your interests connected? And do the different aspects of your professional life inform one another?
Well, I was very lucky. I met Peter Diamandis in 1988 when I was in the very first class of the International Space University (ISU) that Peter founded. It was at the Massachusetts Institute of Technology (MIT) that year, which was the same year I graduated from medical school. I was an MD/PhD student at the University of Western Ontario. My PhD was in inner ear balance function, which has to do with gravity. That’s how I learned a lot about gravity and had an interest in space flight. I did an internship at NASA’s Ames Research Center. At that time, I read a story in Omni magazine about these guys who founded ISU. I applied for an internship on space medicine. In the spring of my senior year of medical school I had just matched for my internship and a few weeks later received a letter that I had a full scholarship for the space university. Both the internship and summer space program were to start around the same time. Luckily I had matched with my home university. I went to my internship director and showed him the ISU letter and he said, “Well, I guess you better go.” He helped me rearrange my internship schedule so I had enough time for space university and did space medicine for my internship. I worked with NASA’s chief flight surgeon. I designed a space suit for working on the moon, I met all kinds of astronauts, and I worked with Buzz Aldrin. It was kind of incredible.

Many, many people believe in Peter’s ideas and concepts and his real desire to make things better and that’s why he does what he does – forms companies, creates universities, speaks out, creates prizes, and works for the betterment of humanity. Whenever he calls I say “Yes” to whatever it is he asks. I’m super lucky that I’m a friend of his.

Are vertigo and dizziness what initially sparked your interest?
It is a fortuitous coincidence that dizziness is a very important topic in space. I’m an expert on motion sickness and space motion sickness and all these different aerospace medical issues. I helped design the anti-sickness motion medication program.

Tell us more about the Arthur C. Clarke Center for Human Imagination at UC San Diego, of which you are associate director?
I’ve been involved since it was established six years ago. The creation of the Center was a major initiative of the Clarke Foundation after Sir Arthur passed away. Sheldon Brown, the director of the center, asked me to help with the proposal, which was to include the medical center as part of it. Arthur C. Clarke was the Chancellor for ISU, beamed in via satellite for our convocation. I was lucky to meet him in his home, thanks to an email introduction from Peter Diamandis. That meeting was one of the singular events of my life. Our pitch in the proposal was to understand the human brain in diseases like migraines, strokes and depression, some of my specialties. UC San Diego would use our technologies developed for disease to study human imagination.

To me, the pinnacle of humanness is imagination.

I am super lucky to be part of this center and to be able to think about new research in how the brain functions while we imagine.

How do your roles at the Center and as a physician come together to support the development of Tricorders?
From my side of things in Neurosciences, I’m interested in neurological and psychological conditions – headaches, stroke and depression. If we integrate certain blood, cognitive, and physiological tests, we will have the next generation system to demonstrate abnormal neurological conditions. We now have new classes of medicines for migraines, which affect tens of millions of people. If we have new systems for testing migraines, we will be able to see changes in people’s bodies that occur and find out through AI how they describe their symptoms. These systems will give us a better warning for migraines and improve how we implement medicines.

Did you ever get sick on Zero G?
Oh, yes, I’ve been sick on Zero G. I’ve been on five different flights. You see the top of a thundercloud – that’s about 30,000 feet up and that’s where the plane starts. In 30 seconds it is 2 miles down so you come a long way in that little trip. Experiencing weightlessness in that little scrap of gravity field. Lots of fun.

My most memorable flights were with paraplegic kids and with Stephen Hawking.

Was it the closest thing to a Star Trek Mission for you?
What’s a Star Trek mission like? A few minutes of weightlessness is not like a Star Trek mission. It’s much more like walking on the moon or being in earth orbit, which is the intention of those experiences.

I would say that the closest thing to a Star Trek mission is the space university summer program. My first year I was a student and it was like being a cadet. In 1989, the second year, it was held in France and I was a faculty assistant. In fact, one of the summer programs was one I proposed for a gravity research facility using spacecraft rotation to create gravity. In 1996 I was a lecturer at space university, held in Vienna, and my topic was telemedicine, a UC San Diego area of expertise. So for each of those sessions, you had an international crew, you’re on a mission for six or eight weeks, and you have things you go through. It’s the closest thing to a Star Trek mission. We’re talking about space all the time, designing satellites and space suits, and studying the origins of the big bang.

One of the major objectives of ISU was to create an international community that knew one another. I still get emails from my space university friends from all around the world.

Any contact with Tribbles?
Just those on my desk.

If you could be a character in Star Trek, who would it be?
I always wanted to be Captain Kirk. I still do. He had all the fun.

All the doctors, like Dr. McCoy, were kind of grumpy so I didn’t want to be one of them.

If you could choose one mission on the Enterprise, where would you go?
I think that there are two huge scientific questions and the reason I am at the Arthur C. Clarke Center for Human Imagination. What is human consciousness, how does it work and where does it come from? I work on this through the science of consciousness committee. The other is whether there is intelligent life in the universe. The first time we meet intelligence that is not human or is human-created like computers [robots] will be an event bigger than almost anything in human history. It will be like walking on the moon. So the mission I would choose on the Enterprise would be to meet non-human intelligence. It would be amazing.

Why do we build Tricorders? Why are we inspired by Star Trek? It’s fun, but serious at the same time. I love Star Trek because of its message of optimism and equality: Infinite Diversity and Infinite Combination (IDIC). IDIC comes from Spock and that’s Star Trek’s mantra. Because of new advances in medicine and developments like Tricorders, I am more optimistic in my medical career than I have ever been.

Did you ever dream 30 years ago that some of today’s advancements would be possible?
Some, yes. We are making progress, but we still have lots of things we dream about. That’s what I do.

About UC San Diego Altman Clinical and Translational Research Institute:

UC San Diego Altman Clinical and Translational Research Institute (ACTRI) is part of a national Clinical and Translational Science Award consortium, led by the National Institutes of Health National Center for Advancing Translational Science. Established in 2010, ACTRI provides infrastructure and support for basic, translational and clinical research throughout the San Diego region to bring discoveries from the laboratory to the bedside, and facilitates training and education of the next generation of researchers. ACTRI carries out its activities in collaboration with institutional and corporate partners and currently has more than 1,425 members.