TEDMED Blog

Making Social Determinants a True Vital Sign: Last Week’s Hangout Participants Address Unanswered Questions

Last week, a multidisciplinary group of experts joined us for a Great Challenges live online event to discuss how we can work towards making social determinants of health a true vital sign. Moderated by Philadelphia NPR Senior Health Reporter Taunya English, these experts discussed ways to incorporate social determinants of health, such as housing and education, into everyday clinical encounters.

If you were unable to join us, please check out the recast below.

We had so many questions from our audience that our hour-long broadcast was not time enough to address them all (once again, thank you for sending your questions our way!). We asked Pedro “Joe” Greer, Professor and Chair of the Department of Humanities, Health, and Society Associate Dean for Community Engagement at the Florida International University, and Marc Nivet, Chief Diversity Officer of the Association of American Medical Colleges, to weigh in on a few additional questions. Read on to see their responses.

What does the typical medical school include in its social determinants training?

Marc: More than 90 percent of our medical schools include topics related to social determinants. Through the accreditation process, we know that most medical school curricula include didactic and experiential learning programs in community health, health disparities, population health management, and prevention and health maintenance. Medical schools are often starting earlier by integrating this content in premedical programs, like the Summer Medical and Dental Education Program, which includes lectures and community activities to expose aspiring medical students to these issues while in college.

Has it been tough to make room on the syllabus – and convince school administrators that social determinants training is important for future health care providers?

Marc: Through the NIH-National Institute on Minority Health and Health Disparities-funded national learning collaborative Urban Universities for HEALTH, we have learned that leadership involvement is key to transformational change within institutions that leads to measurable improvement in communities. Our project leadership includes presidents of universities as well as deans of several health professional schools including medicine. Because leaders are engaged, strategic plans include a strong focus on training providers that understand the social determinants of health. This has led to significant changes, which include the development of pipeline programs, incorporation of holistic admission practices, and curricula innovations that include training about social determinants.

Does a patient’s socioeconomic status ultimately influence physicians’ decision-making regarding management of patients?

Joe: Unfortunately it does, but by dealing with the social factors perhaps we can make determinations based on medical need, and not a patient’s income.

How do we measure social determinants outside of asking questions?

Joe: We are currently developing a new methodology with the RAND Corporation that is embedded in our electronic health records and Social Portal.

How can we improve health of patients when mental health services are often cut in public system?

Joe: Behavioral health should be intimately tied to physical health. At Florida International University, we are currently trying that model and have hired a psychiatrist to be on our family medicine faculty. We are also working with our social work school and their mental health therapist – as well as the nursing school.

What role does cultural competence play in the provision of care? Is maintaining cultural competence a responsibility of the provider?

Marc: Cultural competence training equips health care providers with a set of knowledge and skills to become responsive to the needs of all patients, not solely racial and ethnic minorities. Cultural competence training helps the provider critically consider how a multitude of factors may influence health and health behaviors including but not limited to their own biases, the patient’s culture, the health care system, and larger societal issues. Once licensed, physicians must participate in continuing medical education to stay current in their field, and this also includes cultural competence training. Hospitals and clinics also provide health care providers with on-site training.

Joe: Cultural sensitivity is vital to improving the health of our patients, from the culture of economics, regions of the USA, country of origin, generations in this country, education, sexual preference, religious beliefs, and on and on.

How might health literacy factor into the issue of social determinants as a vital sign? To what extent is it the physician’s role to educate patients?

Marc: An individual’s educational experiences, socioeconomic background, experience with the health care system and history of access to quality care influence health literacy. Physicians play a critical role in health literacy by working with the patient to assess their ability to understand and follow through on health-related information. Ultimately, it is the responsibility of the health care team and the hospital and clinic leadership to ensure that health information is easy to understand and useful to support the patient’s health.

Paging Dr. Salsa: Q&A with Gerardo Contino

Gerardo Contino, “El Abogado de la Salsa,” and former lead singer of the Cuban mega-group NG La Banda, invigorated the TEDMED 2014 audience with timba — a progressive, raucous style of salsa, with his band, Los Habañeros. We caught up with him to learn about his vision and impressions of TEDMED 2014 speakers.

Gerado Contino TEDMED 2014
Gerardo Contino y Los Habañeros on the TEDMED 2014 stage. Photo: Robert Benson for TEDMED.

What motivated you to perform at TEDMED?

I’ve understood the power of music to heal ever since I was nine years old and sitting at the bedside of my sister, who was diagnosed with an aggressive cancer at the age of 14. I’d sing to her and we’d play her favorite music tapes while she was recovering from surgery or chemotherapy. Music was the one thing that could make her smile during that time. After moving to the United States from Cuba, I began volunteering with a non-profit organization, Musicians On Call, where I sang at the bedside of sick children in order to provide them with some relief and variety. I wanted to share this power of music to heal with the TEDMED community.

What are the top three TEDMED 2014 talks or performances that left an impression with you?

Elizabeth Holmes (CEO, Theranos): Loved this talk because I really felt that they are revolutionizing science and the ways in which all of us as patients, can have access to our health information. It also made me think how useful this technology would have been for my sister when she was undergoing chemotherapy, as the doctors had difficulties finding her veins after a while.

Diana Nyad: This talk stood out to me and was so inspiring. She demonstrated that anything is possible at any age and this was very inspiring to me as an artist. She really demonstrated the saying, you can achieve whatever you set your mind to. And to top it all off, she was a great storyteller and really funny.

Tig Notaro: Tig’s talk really moved me. The fact that when she was at the height of her career, she was diagnosed with cancer and also underwent the personal dramas of losing her mother and breaking up with her partner, all in the span of a few months — that would take the life out of anyone. But instead, she turned it around and opened up to her audiences about what she was going through and used that as a form of not only coping with what was going on in her life, but also strengthening herself.

What is the legacy you want to leave?

A stronger community of Latino artists who are of Afro-Latin and indigenous backgrounds.

What’s next for you?

I’m releasing a new album in 2015 that includes a wider fusion of music, especially dedicated to mixing South American and Caribbean beats. I’m also developing a new project that will include an album and documentary about the various Afro roots of Latino music from African diaspora communities throughout the Americas. The album will feature fifteen songs from fifteen different communities throughout North, Central, and South America.

Discovering Beauty in Science: Q&A with Zachary Copfer

At TEDMED 2014, microbiologist and artist Zachary Copfer tells delightful stories about how bacteria became his artistic medium of choice.  We recently caught up with Zachary to hear more about him, his TEDMED experience, and what lies ahead.

Ultimately, I hope people see my work or watch my talk and say "Wow science is awesome, give me a lab coat because I want in on this!" - Zachary Copfer. (Photo by Jerrod Harris, for TEDMED).

Ultimately, I hope people see my work or watch my talk and say “Wow science is awesome, give me a lab coat because I want in on this!” – Zachary Copfer. (Photo by Jerrod Harris, for TEDMED).

Why does this talk matter now? What impact do you hope the talk will have?

I hope the talk will have the same impact that I strive for my artwork to have on viewers: to get people excited about science. Science is amazing, fun and beautiful! In my artwork, I have found a way to play with science to inspire in others the overwhelming sense of awe I feel when I step back and think of how complex and amazing the universe is.

Please list the top 3 TEDMED2014 talks or performances that left an impression with you, and why.

Naming the top three is almost impossible; I couldn’t even keep track of the number of talks that made me think “oh wow” or gave me goosebumps. Two speakers who instantly come to mind are Diana Nyad and Kitra Cahana. As amazing and awe-inspiring as I feel science to be, nothing can match the power of hearing stories about the human spirit. These talks both gave me goosebumps and had me tearing up a bit. Peggy Battin’s talk was another that left me thinking as I walked out of the auditorium. The issues she explored were issues that a lot of people don’t like to think about, let alone discuss. That makes it all the more important to have people like Peggy discussing them publicly so that others may start to feel more comfortable with them.

What is the legacy you want to leave?

The simplest way to put it would be to say that I want my legacy to be a smile. A shared smile evokes in other people an almost indescribable sensation. A genuine smile is a selfless act that makes other people feel welcome, connected and cared for in a way that few other expressions can communicate. A smile also says that life is fun and is meant to be enjoyed at every moment. To live a life that makes people feel the same way they feel when they receive a genuine smile would be the greatest legacy I believe one could leave behind.

What’s next for you?

To keep playing with science. To explore the aesthetic possibilities of scientific theories and to find ways to share them with others.

Sink or Swim, Do or Die: Q&A with Diana Nyad

Marathon swimmer Diana Nyad returned to the TEDMED stage in 2014 to share lessons of her world record-setting solo 110-mile swim from Cuba to Miami at age 64. We caught up with the open water swim champion about her TEDMED experience and what’s up next for her in 2015.

When you achieve your dreams, it’s not so much what you get, it’s who you become.” Diana Nyad on the TEDMED 2014 stage. Photo: Sandy Huffaker for TEDMED

What motivated you to speak at TEDMED 2014?

TEDMED 2010 was my first TED experience. The range and brilliance of the speakers blew my mind. These dedicated innovators are quite literally solving the medical mysteries of our time, and so I was both humbled and honored to appear on stage in their midst. It was a no-brainer to accept the 2014 invitation and to again mix in with our leading health and medical minds.

What kind of meaningful or surprising connections did you make at TEDMED 2014?

I found Marc Koska and his world-changing work with one-time-use syringes deeply moving. This is a classic tale of a man with a social conscience, determined to literally save millions of lives with plain determination. Thirty years ago, Marc was casually reading a magazine and it shocked him to his very core to learn how many millions of people worldwide either die of or are infected with horrific diseases, due to the use of contaminated syringes. He was shot down everywhere he went but eventually implemented the one-time-use needle that cannot be picked up and used to prick the skin a second time. Marc Koska is a shining example of both the work that TEDMED spotlights and those human beings who refuse to let humanity suffer when there are other choices.

How can we learn more about your upcoming book and one-woman show?

Knopf will publish my “Memoir of Inspiration” sometime in 2015. The world premiere of my one-woman show, “ONWARD!” will be on February 19022, 2015 at Studios Theater in Key West, FL and then we move to a bigger theater in Ft. Lauderdale the following weekend. We hope to develop the show for Broadway next!

At TEDMED, Play Matters

square sleddersIn today’s fast-paced world, we often find ourselves caught up in the go-go-go, operating at breakneck speed and seldom taking a moment to simply stop and appreciate what’s around us. While we know life is busy, this holiday season we encourage you and yours to make time to truly take a break and get out and play.  It is in that spirit that we share this  – our final blog post for 2014. May you enjoy all of the benefits that play offers – from unleashing your inner creativity, to enhancing personal relationships, to nurturing physical health.

Why play? Our 2014 speaker Jill Vialet says it best: “Greatness demands imagination and imagination demands play. Your nine-year-old self knew it, and it’s time to remember: play matters.”

Which is exactly what the TEDMED team will be doing for the next couple of weeks. All work and no play makes TEDMED a dull organization, so we’re at it again. What’s “it,” you ask? It’s our annual break from our daily work life and an opportunity to enjoy the holidays with family and friends, and recharge our batteries – all while taking advantage of the many mental, social, and physical health benefits of hitting “pause” and allowing time for play.

We know well the benefits of taking time off, but beyond these, the need to focus that time on play is key.  For adults, the mental benefits of play are countless – play researcher Stuart Brown even claims it is as fundamental to human life as sleeping. In his TED talk, Brown explains that play fires up the part of the brain responsible for motor control, attention, and language, sends signals to the brain’s reward center, and helps with the development of contextual memory. There is also evidence that, in resetting the brain, playing makes us better at our jobs and fuels creativity. While kids need play for cognitive and social development, adults need play to stay sharp.

shutterstock_23141968That feeling you get when you’re laughing while playing with your loved ones? That’s the science of happiness in action. Research shows that a main reason adults play is to enhance social well-being – in fact, one study found that we are at our happiest when we are at play. The reasons here are twofold: 1) playing is how we make connections with other people, and as humans, connecting with others improves our happiness and 2) play allows us to be our most authentic selves, which translates to “optimal psychological functioning” (read: happiness).

Last but certainly not least, there is no question that play is good for our physical health. Play often involves exercise and fresh air – and if it’s fun, we’re more likely to maintain that healthy behavior. Beyond that, play is also the ultimate stress reliever, reducing the hormones in the bloodstream that cause us to feel tense.  So why not join us this holiday season and get out and play? Your body will thank you.

With that said, we wish you a wonderful, playful holiday. Be on the lookout for our official TEDMED 2015 dates and venue in the New Year – and register before January 1st to take advantage of our special ticket price. In the meantime, we’ll be sharing our staff picks of inspirational talks over the next two weeks. Enjoy!

How Can We Rightsize Treatment Costs? Last Week’s Hangout Participants Address Unanswered Questions

Last week, a diverse panel of experts joined us for a Great Challenges live online event to discuss how we can work towards rightsizing the business of healthcare to achieve the delicate balance between treatment innovation, accessibility, and affordability. Moderated by New York Times Senior Writer Elisabeth Rosenthal, the group explored what it takes to innovate in drug development, how we evaluate long-term treatments versus cures, and what new approaches can make novel treatments more accessible to patients while reducing healthcare system costs. If you were unable to join us, check out the recast below.

We had a so many questions come in via social media (thank you!), that we were not able to get through all of them during our one-hour event. So, we gathered the unanswered questions and  invited James Chambers, Vineet Arora, and Josh Fangmeier to weigh in and continue the conversation. Here’s what they had to say:

How does the insurance industry weigh long-term treatment versus a one-time cure? What other elements besides cost need to be taken into account?

Josh: Due to the fragmentation of the American healthcare financing system, insurers do not always have aligned incentives when it comes to paying for certain services. For example, private insurers could pay for a cost-effective therapy that reduces long-term costs for a medical condition, but Medicare, not private insurers, may capture the savings from this therapy as the patient ages. This has also been an issue for patients enrolled in both Medicare and Medicaid (dual eligible), where interventions by one program lead to savings captured by the other.

James: This is certainly a timely question given the introduction of Sovaldi. It asks questions not just of cost-effectiveness (i.e., value for the money) but also of affordability. As a cure is taken only once (or over a relatively short period of time) there is an incentive for the manufacture to charge a high premium. Even if over the life of the patient the drug represents good value for money, the high upfront cost may prove prohibitive to many patients and providers. We may have to move to alternative payment models in which the cost of a cure is spread over the period that the patient experiences the clinical benefit, i.e., to amortize payment of the drug. However, this is complex and raises many questions, e.g., who pays for the drug, and what happens if the patient shifts between plans?

Is flooding the market with more practitioners an economic strategy to lower healthcare costs?

Vineet: If practitioners means doctors, it takes over ten years to train a doctor, so its hard to “flood the market” with them, especially given the projected doctor shortage. If it means others such as nurse practitioners, there’s also a shortage there so feasibility would be hard. I don’t know how that would impact drug costs per se. Flooding the market also assumes that there is price transparency at the level of patients, and they can choose to go to the best value care – which we know does not exist. So as of yet, in my opinion this strategy would not work without these other things.

Do pharmaceutical companies have any ethical obligation to provide treatment to those who cannot afford it? Why or why not?

James: This is a very difficult question! I believe that if a patient who would benefit from a treatment does not receive it because of its cost, then as a society we have not maximized the benefit of available technology. I believe the healthcare system has the responsibility to offer a “base” level of care to everyone.

Vineet: I believe they do. We have created a healthcare system where anyone can get emergency care regardless of their ability to pay. So, as long as that exists, it means that we will be in a cycle of emergency care for chronic diseases that could be treated with medications unless we can figure out a way to cover the cost of the drugs to keep people healthy. The issue often is who is going to benefit.

How can we accurately and consistently evaluate the right approach to treatment based on the cost of a saved life or improved quality of life?

James: Other countries have national agencies/institutes that evaluate the costs and benefits of new technologies. This provides information to the healthcare system of the value of medical technology and helps prioritize the use of scarce healthcare resources. While PCORI is tasked with evaluating the comparative effectiveness of treatments (although to date it has performed very few head-to-head studies), it does not consider cost in its research. Only if we have information of the costs and benefits of alternative treatments can we use our technology most efficiently. Ironically, many of the leading methodologists on the economic evaluation of medical technology reside in the U.S., but the U.S. is somewhat unique to the limited extent that it uses these techniques.

How much stock can we put in cost-effectiveness studies? Is there a better way we could measure this?

James: There are many different types of analysis to evaluate medical technology, e.g., budget impact analysis to examine the financial impact on introducing a technology to a plan, or comparative effectiveness research to evaluate which of two treatments is most effective. Cost-effectiveness analysis is, however, the only approach that quantifies the VALUE of a technology, i.e., is the additional costs of a treatment worth its additional benefits. While some may argue that cost-effectiveness should not be the sole determinant in drug coverage policy, I believe that decision-makers should have access to this information if they are expected to make value and cost conscious decisions. Without this information, they have a hugely difficult (and maybe an impossible) task.

Might a system in which unused medicines can be returned to pharmacy (and reimbursed) help contain costs?

James: Absolutely.  A huge source of waste!  A very difficult policy to implement, though.

How much is affordable and are caps on out-of-pocket spend in ACA too high?

Josh: Increasing cost-sharing through co-pays, deductibles, and other forms of out-of-pocket spending has been a concern, especially for low-income populations. However, this has been a trend that pre-dated the passage of the Affordable Care Act (ACA). According to the Commonwealth Fund, from 2003-2011, single worker deductibles rose by 117 percent.

The ACA includes minimum value and out-of-pocket spending caps that limit the sale of insurance plans that provide little financial protection. For 2015, the out-of-pocket caps are $6,600 for an individual and $13,200. Although this is a considerable amount for many families, the ACA provides financial assistance, in the form of cost-sharing reductions, to those who enroll in marketplace plans. Cost-sharing reductions increase the value of a silver plan. For example, a Detroit resident making $20,000 would see the out-of-pocket maximum for the cheapest silver plan fall from $6,350 to $1,450, due to cost-sharing reductions.

What can we learn about drug pricing or drug coverage from looking at systems outside of the American one?

James: We can learn from other countries’ systematic approaches to evaluating medical technology. While each country takes a unique approach (some focus on comparative effectiveness, others cost-effectiveness), each formally evaluates new technology before it is introduced to the health care system. This provides information that can be used to implement value-based coverage of medical technology, and in some cases negotiate a price that is commensurate with the health benefits offered by the drug.

We can also learn that cost and cost-effectiveness can be accounted for, but not be the sole determinant in decision-making. France and Germany were previously hugely resistant to accounting for drug cost in national policy but now consider economics (while decisions are primarily driven by comparative effectiveness) in their assessment.

What new approaches can make novel treatments more accessible to patients while reducing healthcare system costs? Do we need to change our drug development models or is there change to be made elsewhere?

James: In theory, using cost-effectiveness evidence to guide coverage of medical technology will result in more efficient use of scarce resources and allow more patients access to effective technology.  However, such an approach is unlikely to be soon embraced in U.S. healthcare.

Maybe the most promising approach is value-based insurance design (VBID).  This approach aligns co-pays in a manner consistent with a drug’s value, i.e., a lower (or no) copay for cost-effective drug, and a higher copay for a cost-ineffective drug.  This approach provides an incentive for the patient to use more cost-effective care . This approach is arguably the most palatable for U.S. healthcare, as cost-effectiveness is not being used to deny or ration care, rather to encourage the use of high-value care.

Placing Science in Context for our Future Health Leaders: Action Inspired by the Great Challenges Program

We’re on a mission to better understand the impact that the Great Challenges Program and the TEDMED community are making in creating a healthier world. For the past 18 months, we’ve convened experts via Google Hangout for unbiased and broadly inclusive discussions on 20 of the thorniest issues in health and medicine today. Diverse subject matter experts share their perspectives and help the TEDMED community dive deeper into key barriers to success for each Challenge. TEDMED believes that when the world achieves a broad-based understanding of any given Challenge, it will then be in a better position to take truly effective action.

After a year and a half, we wanted to know: what impact has our Great Challenges Program had on you? How have these discussions prompted truly effective action from you or within your community? What is your Great Challenges story? We asked – and you answered.

As we read inspiring stories shared by the community, we also want to share them with you. This blog post is the first of a series of Great Challenge successes, so if you have not shared your story – now is the time.

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One of the most inspiring stories we heard was from Jodie Deinhammer, an Anatomy and Physiology high-school teacher at Coppell Independent School District, right outside of Dallas, Texas. Jodie teaches 150 juniors and seniors, and just last year, was Region 10 Secondary Teacher of the Year. From what we heard of Jodie’s story, the TEDMED team certainly wishes we had a teacher like her when we were in high school.

That’s because the Great Challenges Program has helped Jodie innovate in the classroom in ways that inspire her students to place health issues in context – the students don’t just learn about body parts; they focus on the global health system and ways in which we can all work together to shape a healthier world. And, the Program and the positive response from her students have even prompted Jodie to expand the reach of her classroom: two of her courses are available on the iTunes U app, where they have soared into the Top 10 rankings.

Last year, Jodie saw a tweet about one of our Great Challenges online events that focused on reducing childhood obesity. As a class her students watched that session and actively participated online. The students were so energized by the direct access to the expert participants who answered their questions, that they’ve become some of our most active community members. Of particular interest are the obesity and prevention challenges, which relate most closely to their classroom studies. Jodie reports that, “The big picture that we’re creating through the course is directly related to what they’ve watched and learned through the Great Challenges Program.”

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This year, in the first semester, the students have been looking at prevention and obesity, and based on what they’ve learned from the Great Challenges program and in class, have come up with one potential solution to address these large-scale issues: they built a six-week online class to help adults improve their overall health. As part of this online class, the students have come up one challenge per week: during the first week, the online class focuses on giving up a bad habit; during the second, it encourages users to get moving…you get the idea. The students will soon begin using it as part of a health challenge for the school’s teachers.

Next, the students move on to focus on another Great Challenge for the upcoming semester. They’ll tackle “the impact of poverty on health,” working on a program to provide technologies to developing countries in partnership with several global organizations.

This story is an incredible example of the ways in which the Great Challenges Program can empower participants to actively engage in improving their health and that of the world at large. We’re thrilled to see the Program putting science in a real-life context and helping to train the health movers and shakers of the future. And kudos to Jodie for her innovation in the classroom!

Now, it’s your turn – what’s your Great Challenges story? How has our program impacted your work or the way you live your life? Shoot us a note at challenges@tedmed.com. We can’t wait to hear from you.

A terrifying tale about over-prescribing: Q&A with Elizabeth Kenny

Actor and playwright Elizabeth Kenny performs an excerpt from her play dramatizing a horrifying journey through the American medical system during which she was over-prescribed psychiatric medications. We asked her a few questions to learn more about her experience and work.

A terrifying tale about over-prescribing: A performance by Elizabeth Kenny
Actor & playwright Elizabeth Kenny performs at TEDMED 2014. [Photo: Jerod Harris for TEDMED.]

Why does this talk matter now and what impact do you hope it will have?

In 2014, the top selling drug in America was an anti-psychotic called Abilify. Are there really that many people in need of anti-psychotics? I want an answer to this question. The pressure of marketing and the lack of time and true collaboration between patients and doctors are leading to a crisis of over-prescribing and medicalizing suffering of all kinds. I hear people talk about how great it is that more people have access to mental health care now more than ever before – how wonderful it is we have these “silver bullet” medications for debilitating states like depression. I want to be happy, too… but I’m scared. It seems to me that the help being offered is not always helpful. I’m afraid that if we don’t start a more rigorous and nuanced conversation about the health of our mental health system, in the long run, many more people will be harmed than helped. I hope this talk can be a starting place for some to enter the conversation. I think a great place to start would be with simple transparency about what we truly know and don’t know about the brain, and about how psychotropic medications work on it.

Is there anything else you wish you could have included in your talk?

My original play, Sick, was 70 minutes long, and editing it down to a 12 minute talk was an enormous intellectual and artistic challenge. Early on, I realized I would have to leave out the entire second half of the play which was all about withdrawal from the medications – a grueling process, and one that I almost didn’t survive. We were operating under a controversial hypothesis (that the medications I was taking might be making me sick) and we found tremendous resistance from inside the psychiatric community. Coming off psych meds is a deeply personal decision and not one that should be entered into lightly. Tapering very slowly made it possible for me. I suffered tremendously during the protracted eight months in which I tapered off of all my medications. I was very lucky to have my family’s support – physically, emotionally and financially. Getting off my meds became my full-time job; helping me became my mother’s full-time job.

What motivated you to speak at TEDMED?

I had been performing and touring with my play Sick for a couple years when I received the invitation to speak at TEDMED; the experience of making and taking the play on tour was so surprising. While I was living through the story, I was certain that what was happening to me was extreme, that I was one in a million, and that nobody else could possibly be going through the same thing. Once I started to perform and engage with audiences I was shocked by how many people wanted to talk after the show to share their stories. I have lost count of how many times I heard, “I think this is happening to my sister,” or mother, or aunt, or boyfriend. It has become clear to me that what I, my family, and my doctors thought was a rare occurrence may be far more common than any of us can fathom. I feel an obligation as both a writer/performer, and as a person who came through an iatrogenic mental illness, to raise questions. How many more people like me are there? How are people’s lives being subtly or not so subtly diminished by their treatment? Are we really operating within a system that allows for informed consent if all our drug information is coming from those who stand to profit from its sale? My role in transforming the mental health system is to ask questions and tell stories, and the TEDMED stage seemed like a perfect fit.

Check out the archive of our lively Facebook chat with Elizabeth where we dove deeper into her story and reflected on audience members’ similar experiences. 

Beautifying Darkness: Q&A with Zsolt Bognár

Critically acclaimed concert pianist Zsolt Bognár, frequently featured on NPR, performed two pieces by Schubert and shared his story about how a special connection to Schubert brought him healing solace in part by beautifying darkness. For the TEDMED blog, Zsolt gave us insight into his process, his time at TEDMED and what’s next for him.

Beautifying Darkness - Concert Pianist Zsolt Bognar

Concert pianist Zsolt Bognár on the TEDMED 2014 stage. Photo: Jerod Harris for TEDMED.

What motivated you to perform at TEDMED?  

The TEDMED team contacted me and showed me instantly that this event would be about a gathering of many brilliant and inspiring minds, sharing many stories of innovation and courage. I wanted to share a story through my life and music that was very personal to me.

Why does performance/talk matter now? What impact do you hope the talk will have?

Lots of awareness is being raised these days about the importance of addressing mental health issues, including depression. My story concerns the way that I proactively dealt with my own depression through the inspirational story of Franz Shubert’s final year before his death at the age of 31.

What top three TEDMED 2014 talks or performances that left an impression with you, and why?

Kitra Cahana moved me to tears. She told a story of courage and finding freedom in the face of incredible adversity, and shared her story through images of striking beauty. My other favorite was Tiffany Shlain. Her multimedia presentation capturing the interaction of people and minds was stunning. Elizabeth Kenny‘s performance was dynamic and gripping.

What kind of meaningful or surprising connections did you make at TEDMED?

People from all around the world came to me telling me their love of music had been reignited, and that some even plan to restart piano lessons.

What is the legacy you want to leave?

My life has been enriched by being open about the challenges I have faced, and connecting with others about how I overcame them was a personal liberation. I hope that with my music, I can encourage others to find hope by doing the same.

What’s next for you?

I’m in Europe giving recitals around the holidays. In February, 2015, I will give a performance in Cleveland with the Verb Ballet in a set of pieces composed for the occasion by a local composer friend of mine, Philip Cucchiara. I have always loved to combine art forms. My tours in the upcoming year will take me several times to Europe. I will also continue creating episodes for my film series Living the Classical Life with many famous classical musicians from around the world. It’s a very beautiful experience and a wonderful privilege to share music.

Virtual Reality: Immerse yourself in health – Q&A with Howard Rose

In his TEDMED 2014 talk, game designer Howard Rose describes the extraordinary power of play in virtual worlds, and shares how virtual reality can harness the innate human power to recover from and prevent illness. We caught up with Howard to learn more about his TEDMED experience and what inspires his work.

Gaming, health, virtual reality, Howard Rose.

“The doctor-centered paradigm of healthcare underutilizes our innate human power to recover on our own, or to prevent illness in the first place.” Howard Rose, TEDMED2014. Photo: Sandy Huffaker for TEDMED.

What drives you to innovate?

For me, virtual reality (VR) is the ultimate creative medium. As a designer, I enjoy the challenge of transforming complex ideas into meaningful experiences that bring people insight and joy. Virtual worlds can range from being very realistic to a realm of total imagination. Because VR is so unconstrained, the design process invariably evokes challenging questions about the mind, body and senses that spark the creative conflict which drives innovation.

I’ve devoted my career to exploring the boundless possibilities of technology to solve real world problems, particularly problems in health. We are just beginning to discover how to apply VR to some of our toughest challenges to control pain, treat mental illness and improve rehabilitation.

Why does this talk matter now?

Virtual Reality is poised to revolutionize the way we maintain our health and deliver treatment. It will be targeted like a drug and deliver sustained benefits. But better than drugs, VR can be personalized to individuals’ needs on a moment-by-moment basis. VR will make us more resilient, able to perform at our highest capacity. This revolution will be driven by consumer demand.

Today we are at the edge of a wave of new virtual reality technology that costs a fraction of the systems I used 20 years ago. The VR revolution is amplified by advances in neuroscience and the expanding array of biosensors we wear and carry in our mobile devices. All the elements are finally here to deliver intelligent, compelling virtual experiences that know our strengths and weaknesses and respond to our needs. These technologies are going to help people stay healthier on a daily basis, and lead to new treatments for many conditions that today we suppress or control with pills – like pain, anxiety, depression, or post-traumatic stress.

What legacy do you want to leave?

I want to give people the tools to unlock their own potential to be happier, healthier and more productive. My goal is to make the virtual reality health games industry bigger than the entertainment game industry. I’ve been working toward that goal for 18 years at Firsthand Technology, laying the groundwork  with basic research and development.

I’m now part of a new venture, DeepStream VR, to focus on virtual reality games for pain relief, rehabilitation and resilience. DeepStream VR’s mission is to reduce the need for opioids in clinical practice, and provide new alternatives for people at home to relieve pain.