Let the games begin!

The Internet-of-Ingestible-Things™ Series

As co-founder of Enteromics and PhD in Cyber-biosecurity, I launch the very first Internet-of-Ingestible-Things™ Hackathon, sponsored by the Dawes Centre for Future Crime, as a series of workshops bringing together experts from cybersecurity with medical device regulatory bodies and makers, to help design security for the new generation “Ingestible-Things”™ or secure smart gut-sensing pills.

The end of the series of talks marks the beginning of the two week sprint for the seven teams competing for a place in the Internet-of-Ingestible-Things™ Hackathon! Only the Top three teams will be selected to help design and build the new generation of secure smart gut sensing pills.

What have we learnt so far?

THE NATURE OF CRIME IS CHANGING.

Prof. Shane Johnson, Director of UCL Dawes Centre for Future Crime, spoke to us about the rapidly changing nature of crime due to technological, environmental and social changes. He discussed the current market asymmetry in devices such as consumer Internet-of-Things (IoT), which vary in security standards. We learnt that when security is overlooked in a product that comes to market it creates what's called a crime harvest. As an example, Shane talked about consumer IoT devices that have increased crime opportunities in burglary and domestic abuse.

Now, if you’ve seen Minority Report you know all about future crime prevention. Shane’s call for action is that we cannot afford to continue to bring new products to market without considering their security implications — especially when these are ingested and will have health implications.

But is there really emerging technology that we will swallow?

WE ARE MORE BACTERIA THAN WE ARE HUMAN.

Dr. Geoff Briggs, technology scout for Walgreens Boots Alliance (WBA), educated us on all the microbiomes or ecosystems of microorganisms we are home to.

Specifically and related to the Ingestible-Things™ is the gut microbiome, or microbes found from gum to bum. At the centre of our health, the gut microbiome is responsible for 70% of our immunity and can be a predictor of how long we live.

Geoff discussed WBA’s main mission of converting an unhealthy state to a healthy one through treating the body, but explored the complexity of answering the question, what is healthy? He explained that what is healthy is specific to the individual, in fact as you age, the ecosystems of microbes too, grow with you and are specific to you — a microbial fingerprint.

As part of the Skincare Innovation team and with the responsibility of discovering, evaluating and developing new technologies in consumer skincare for the past 7 years at WBA, Geoff predicted that the future sees technology that can monitor the gut microbiome and help consumers stay healthy!

To the IoiT hackathon participants, he advised to think low-cost and user-friendly when designing their smart pills.

I thought it was a brilliant presentation — or was that my brain microbiome talking?

Ok now we know that there is emerging swallow-able tech, but who would want to target it?

THERE IS MORE TO WHAT YOU CAN SEE WITH YOUR EYES

Today, biological material, medical devices and health data are increasingly valuable and targeted. Decreasing costs of technologies such as DNA synthesis, also decrease the control of their uses. And in a connected world, this brings challenges to digital biosecurity for smart pills.

Dr. Lauren Richardson, Director of Science and Technology in the Merrick Life Sciences Business Unit, provides technical subject matter advisory support, training, and management for domestic and international work focused on laboratory operational and transition planning, risk and threat management, and health systems strengthening efforts.

Lauren stressed the need for digital biosecurity or Cyber-biosecurity for protecting Valuable Biological Material (i.e. YOU).

She explained that there will be more of the kind of threats targeting individual people with the aim to disrupt an individual’s internal medical environment, but also that there will be a continuation of targeting the Biotechnology market. What are those aspects that are valuable about the devices? Intellectual property, market share, and the raw data that can be aggregated and used for further research market analysis and targeting of new products, to name a few — currently an attack surface wide open to all, at this stage.

As exemplified over the last year, the degree of competition in terms of vaccine development and medical countermeasure developed, can easily be extended to the Ingestible Things™ devices. So what does cyber-biosecurity testing for smart pills look like? A systems approach that removes the assumption of technical expertise, extracts perspectives from multiple end-users and considers accidentally going around mitigation plans because we must remember that Humans are a dynamic environment.

A call for a new species of researchers.

NEXT GENERATION RESEARCHERS

Building medical devices is complex but Dr. Yipeng highlighted that a multidisciplinary team, and a New Generation of researchers can get your work from bench-to-bed!

With his research featured on the IEEE cover of Biomedical Engineering in 2017, Dr. Yipeng Hu, Lecturer at the Department of Medical Physics & Biomedical Engineering at the University College London (UCL), affiliated with the Wellcome Trust and the Centre for Medical Image Computing (CMIC) took us on his three year journey turning his academic research into a certified medical device.

What’s a New Generation researcher? One that is aware of the importance of Human Interactions and designs devices for patients with a “by patient” mentality while responsible for security implications through rigorous testing.

Ok, but what patients are we talking about when thinking of the Ingestible Things™?

GUT FEELING, A NEEDED HEALTH READING.

Carly Medosch, MBA, PMP has been living for over twenty years with multiple chronic illnesses including Crohn’s disease. Crohn’s is a type of Inflammatory Bowel Disease (IBD) that can lead to severe abdominal pain, fatigue, malnutrition and even surgery due to chronic inflammation in the digestive tract.

Since her teens, she spent many years too sick to do much beyond essentials. Currently a Health IT Lead at the Medicare & Medicaid Innovation Center, she is passionate about breaking down silos between patient communities to increase support and advocacy power.

IBD has no cure and even with existing treatments, patients still get unexpected episodes of inflammation — a.k.a “flare ups”. When asked about early warning signs for these episodes, Carly responded with her patient pursuits in self study and data generation. If her symptoms of severe pain persisted for a week then she knew she was experiencing a flare up — a week of severe pain?! And every time a condition worsened, another 2cm to 2 feet of Carly’s digestive tract was removed in surgery — this is a problem.

Current care doesn’t consider the goals of the patient for their own health and their willingness to participate in prevention, monitoring and understanding. There is a clear need for technology and tools that will help patients with chronic illnesses such as Crohn’s monitor their disease progression; rather than depending on a “wait & see”.

Carly’s main asks for Ingestible-Things™ device designers were:

• Clear and accessible instructions on how to use
• Small size, gel-coated and comfortable to swallow pill,
• A fun tracker that localises the pill throughout the gut,
• An option to share data with her doctor
• Data Recommendations on where to click & learn more
• Shared Friends & Family Network to notify when feeling unwell

But wait, there is more..

YOU KNOW WHAT REALLY TAKES GUTS? DIGESTION.

Did you know that Parkinson’s is a gut illness? The number of nerves in your gut are more than those anywhere else in your body, including your brain.

Professor of Neuro-Gastroenterology at University College London, Consultant Gastroenterologist at the University College Hospital and at the National Hospital for Neurology and Neurosurgery, and director of the Gastrointestinal Physiology Unit at University College Hospital, Prof. Anton Emmanuel, MD, FRCP, gave further examples of types of patients that would benefit from such innovations.

Anton has recently been appointed as the interim Head of Workforce Race Equality Standard (WRES), NHS England and NHS Improvement, with the aim to ultimately improving the experience of staff in the NHS to be equitable which can then translate to improved patient outcomes.

From a clinician’s perspective, Anton educated us on how 2/3 of the gut is currently inaccessible, that the gut is not a single organ, and that symptoms are non-specific, all of which contribute to DELAYED DIAGNOSIS to common diseases such as Crohn’s but also niche neurological diseases such as neuroendocrine cancers.

Anton highlighted the need to better understand the gut and the need for novel technology that can access it. His “Clinician’s wish-list” or call-for-action was a smart pill device that can aid clinicians with a better understanding in the science of the gut, implicated in disease and disease severity, and allowing for personalised treatment, earlier intervention, and prevention of unnecessary surgery.

Even more so during the pandemic, where 8 million chronic care patients — in the UK alone — were left untreated, and with 28 million elective surgeries cancelled — including endoscopies, patients were left with worsened conditions.

Remote patient technology and at-home monitoring have tremendous benefits but also their own risks, which is why your end user demands for security.

SECURITY IS A BUSINESS ENABLER.

Without security, there is no business. Security is more than just a compliance check as it is increasingly being demanded by end users. An overlooked role of cybersecurity is in innovation, which Uri Bar-El highlighted. Uri is a veteran Cyber security professional with over 20 years of hands-on experience leading, building and executing cyber security strategies in multinational environments and to executives and board members.

There is no end-user willing to adopt technology that is insecure; and if you can’t sell your technology then you can’t progress your business.

Investing in cybersecurity and Security by Design principles challenges the concept that security always follows and lags behind innovation.

In fact in the last year, the public is increasingly conscious of what security means and demands it. I came across this myself during my own PhD research with participants of my expert panel willing to partake in longer scenario building exercises when interviewed during the covid19 pandemic than participants interviewed before the pandemic. Similarly, our department has conducted research on consumers and their willingness to pay for security in consumer IoT devices to find that after being informed of security implications of the IoT devices, consumers were willing to pay more for the added security.

Uri’s main takeaways were that there is a need to change our mindset from penetration testing to Security-by-Design and to always have potential end-clients in mind as Security ultimately enables innovation.

This begs the question, can the same cybersecurity measures of an old banking system be used for implantables and the Internet-of-Ingestible-Things™ devices?

What does ingestibles’ security look like? Enter, the IoiT hackathon.

With the registration now closed for the IoiT™ hackathon,

the 7 teams are currently putting together their applications and will be attending our exclusive session “WILL IT HACK?”

Invited speaker Ed Chung is Chief Medical Officer for BioBright, a Boston-based digital biosecurity software company. He graduated from the Massachusetts Institute of Technology (MIT) and completed his MD at the Duke University School of Medicine. He works at BioBright at the intersection of the biological sciences and healthcare, collaborating both in the biomanufacturing space and with healthcare equipment manufacturers.

Ed will give the IoiT teams an introduction to a Red Team approach and will walk through how an adversary might attack ingestible devices.

Interested in attending? Sign up here: https://www.eventbrite.com/e/149746007339

The Internet-of-Ingestible-Things™ series and hackathon is led by Mariam Elgabry, Co-founder and Director of Enteromics, a MedTech start-up that builds smart gut-sensing pills that once swallowed connect to a smart phone via an App to deliver AI-powered gut health insights; moving healthcare to the comfort of the home.

Mariam’s background is in deep-tech and bioengineering, holding a MSc in Bioinformatics & Theoretical Systems Biology from Imperial College London, as well as a MRes in Security & Crime Science from the University College London (UCL). Alongside her role at Enteromics, she researches Bio-crime, the Internet-of-Medical-Things (IoMT), and Cyber-biosecurity as part of her PhD research at the Dawes Centre for Future Crime, UCL. Her most recent work discusses the COVID-19 pandemic and its effect on Cyber-biosecurity in the UK and abroad; published by the UK Parliament Joint Committee on National Security.

Mariam’s experience lies at the intersection of industry and research, focusing on tech, health and security. At AstraZeneca, She led an award winning technology for early detection systems in drug testing. Later, as a Lead Microsoft Student Partner, she had the opportunity to help translate technology and innovative tools, from hackathons into start-ups. Alongside her studying, her work as a Sergeant at the London Metropolitan Police exposed her to operations on the field, including risk mitigation — from managing policing activity, to effective deployment of resources to incidents; skills later applied in her work as a Security Design Consultant.

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