Q&A with Sara Gorman, Motive Detective

Sara Gorman is a public health and behavioral science expert who has written extensively about global health, science communication, psychology, and mental health. Her recent work explores the psychology behind irrational health beliefs and decisions, and also provides advice for how the general public can discriminate between valid and invalid science. Sara is co-founder of Critica, a community committed to making rational decisions about health and security. Sara spoke at TEDMED 2017, and you can watch her Talk here.


TEDMED: Your 2017 TEDMED Talk explores the psychology behind irrational health beliefs and why we stubbornly cling to them, even in the face of conflicting scientific evidence. It’s fascinating work—how did you first get interested in this area of study?

Sara Gorman: I became interested in this area of study after learning about increasingly widespread, unfounded beliefs that routine childhood vaccines were causing autism and other adverse health effects in children. These beliefs had developed largely from a fraudulent study that was retracted by the journal it was published in and yet people were still holding onto the belief upwards of a decade later. I came to understand that, despite what a lot of people thought, these erroneous beliefs had nothing to do with a person’s intelligence or even knowledge of and familiarity with science. Rather, there were strong psychological and social factors that were at play here and this is what I set out to study. As I learned more about these psychological and social factors, I realized that the erroneous belief in a link between vaccines and autism was not the only area in health and medicine in which people were insisting on false ideas despite the evidence. The pattern cropped up in unfounded beliefs that HIV is not the cause of AIDS, in beliefs that keeping a gun in the home makes a person safer, and even in practices by healthcare providers that are not evidence-based.

TM: As you say in your Talk, “Science depends on updating constantly with new information, but our brains do everything they can to keep us from changing our minds.” The best scientists must be willing to be proven wrong—going as far as to purposely seek it out. What can we learn from them?

SG: Scientists are trained to be skeptics and to look for things that will disprove their beliefs. When a study is published, the logical next step is for someone to try to replicate it, and in many cases, failure to replicate can come to show that the original findings may have been a fluke. Scientists know that they must constantly question everything they think is true and even ask themselves why they believe something. They must expose the origins of any belief or tenet and understand whether or not they believe the evidence upon which these assumptions are based. All of us could benefit from approaching most questions in life through this lens. It requires a lot of self-awareness about how we form our beliefs and a lot of questioning and re-assessing once we have formed them. We should re-examine beliefs that were formed a long time ago and make sure they are still valid, just as scientists never take old research for granted but constantly try to evaluate whether it is still valid or whether something has changed.

Of course, one of the most important things I emphasize in my book and in my TEDMED Talk is that scientists are just as prone to errors in judgment and belief as the rest of us, so even they must always continue to work on honing these skills of skepticism and constant re-evaluation of their own beliefs.

TM: In your Talk, you tell a funny story about how you were convinced you hated the ballet—and you were very vocal about your feelings—until your boyfriend (and now husband) wanted to take you there. You walked the audience through the process of how you allowed yourself to change your mind regarding this firmly rooted belief about yourself. Could you walk us through the process of how a person can learn to accept something, such as a new scientific finding or a revelation in the news, that goes against their beliefs?

SG: There is not any one formula that will always work for everyone but there are some general guidelines that people can follow. To begin with, it’s important to understand how you formed the belief in the first place. Ask yourself under what circumstances you came to believe what you believe. Were you very emotional or even very distracted at the time? Sometimes that can color our initial evaluation of the evidence and make us decide that we think something is true even if it’s not. Once you’ve gained a better understanding of how you formed the first belief, try to investigate what the enablers of the belief are for you. Does holding this belief help you connect with an important person in your life or hold on to an important part of your identity? You want to be able to understand what values and motivators outside of the evidence itself might be influencing you to believe something. Then, assess what the barriers to changing your mind might be. Would changing your mind on this topic be likely to isolate you from a group or identity that’s very important to you? Finally, expose yourself to the new idea slowly. Don’t just radically change directions on something and announce your new beliefs to the world overnight. That will be too intimidating. If you decide you want to change your mind about something, try living a few hours or even a day in your new belief. Try it on for size and just see how it feels. Then gradually increase your exposure to the new belief until you feel more comfortable. Over time, it will hopefully become more natural and less scary to change your mind.

TM: What was the TEDMED experience like for you?

SG: It was absolutely exhilarating. I felt like a celebrity. When I was in school, I always did a lot of theater and have really missed the stage ever since. Being on the TEDMED stage reminded me of those experiences, which I remember with fondness and nostalgia. The TEDMED community is also incredibly warm and inviting! I am so lucky to have been included in 2017 and look forward to following TEDMED for many years to come.

Speakers for TEDMED 2018

While many of us have personal goals for how to stay healthy, we’re all exposed to health challenges that extend beyond the individual and impact society on a grander scale. At TEDMED, we’ll hear from speakers working to affect positive health changes on a societal level in an effort to empower individuals, build healthier mindsets, and strengthen our communities.

We’ll learn about social movements fighting to protect vulnerable laborers from the predatory conditions that are often common in US agriculture. We’ll also tackle the roots of sweeping epidemics that wreak havoc on our communities in ways that can be quite subtle, and in other ways that are not so subtle. We’ll find out how communities in Puerto Rico are banding together to rebound from the devastation of Hurricane Maria. We’ll confront the uncomfortable inevitability of our own deaths to consider how to get the most from life, especially in the face of serious illness. And we’ll examine the intersection of our physical and digital lives to take a novel look at the human body reclaimed from the virtual world.


Click below to find out more about these speakers and this year’s program.

Don’t miss TEDMED 2018—be there to see these and other talks, live, this November in Palm Springs, CA. Space is limited so register today!

New Speakers Announced for TEDMED 2018

We all want to make healthier decisions and to avoid unhealthy habits, yet for some reason, most of us find it frustratingly difficult to turn these thoughts into action. Ever wonder why? This year at TEDMED, we’ll dive into the reasons why changing behavior can be so difficult and get actionable insights into why humans act the way we do.

For example, we’ll explore the unexpected role that personal relationships play in acts of mass violence, and we’ll assess an uneasy reality that’s having a very intimate impact on adolescent behavior. We’ll be exposed to important perspectives, helping us to see society and healthcare through the eyes of marginalized populations and envision a more inclusive society. We’ll also learn how low-cost, sustainable innovation is changing the future for newborns throughout Africa. And, have you ever wondered what healthier care sounds like? We’ll find out together at TEDMED.


Click below to find out more about these speakers and this year’s program.

This year’s program is one you can’t miss – be there in person this November in Palm Springs, CA. Space is limited so register today!

More Speakers Announced for TEDMED 2018

This week, we’re delighted to introduce you to more of the inspiring pioneers who will take the TEDMED Stage this fall. Together, we’ll explore how ordinary aspects of everyday life can have large impacts on our health – everything from the animals we live near and the spaces we live in; to the invisible sounds that we hear and the air that we breathe. We’ll rethink socially accepted childhood norms, and expose a controversial practice that impacts children around the world. We’ll also analyze the intersection of two rapidly merging fields: technology and biology. How are we programming synthetic organisms to fight human disease? What can we learn from the DNA of our ancestors and what is the correlation between that data and our health today?

Check out the 8 Speakers below and learn how their work is helping to reveal why ordinary aspects of our everyday lives can have big impacts on our health.

Did you miss last week’s Speaker announcement? See all of the Speakers that we’ve announced so far at TEDMED.com. Next week, we’ll continue sharing the Speakers who will be taking the stage at TEDMED 2018, and we’ll soon reveal this year’s session themes. You won’t want to miss this year’s event—register today!

Introducing This Year’s Speakers

Over the next few weeks, we’ll be introducing you to the full lineup of thought-leaders who will take the stage this fall at TEDMED 2018. Our first group, announced below, features speakers who will explore a wide range of issues impacting humanity’s health. You can learn more about the Speakers and their fascinating work at TEDMED.com.

We’ll be sharing much more in the coming weeks, including this year’s session themes, so be sure to stay tuned. You won’t want to miss this year’s event—register today!

Q&A with Camila Ventura, Zika Family Caregiver

Camila Ventura is a Brazilian retina specialist who is dedicated to understanding and fighting Congenital Zika syndrome (CZS). Camila’s work with Zika began during the 2015 outbreak in Brazil, when she first reported the ocular findings of three babies affected by the virus during pregnancy. We caught up with Camila to find out more about her past and current efforts to help babies and families affected by CZS. Camila spoke at TEDMED 2017, and you can watch her Talk here.


TEDMED: There has been considerable improvement in our understanding and treatment of Congenital Zika syndrome since the outbreak, especially thanks to the hard work of teams like yours. What are the biggest challenges communities affected by Zika face today?

Camila Ventura: We have certainly made progress not only in understanding the pathophysiology of this new disease and developing vaccines and tests to diagnose the Zika infection, but also learning how to care for children with Congenital Zika syndrome. As I mention in my Talk, it is impossible to care for a child with CZS without an engaged and interactive multidisciplinary team. We have learned that communication between different professionals is essential to plan interventions and potentialize therapies. We have also learned that CZS has a broad spectrum and that there is not a “one recipe” treatment for these children. In other words, treatment cannot be generalized.

We still face many challenges indeed. Our biggest challenge nowadays is getting these families to reach our rehab center at the Altino Ventura Foundation located in Recife, the capital of Pernambuco state. Most of the children are instructed to come weekly for therapies, but because many live in the countryside, dropouts are one of our biggest challenges.

Another important concern is the late complications that some of the children develop. We had at least 15 children who developed hydrocephaly and required a shunt. Despite the fact that the shunt surgery normalized the brain pressure, some of them progressed with vision loss. We also have children with different levels of dysphagia (some requiring gastrostomy). The biggest concern with regard to dysphagia is the risk of aspirating food into the lungs and developing pneumonia. We had 5 cases that died from pneumonia. The last, but not less important, challenge is the uncontrolled and severe seizures that some children present. Seizures bring a lot of concern not only to doctors, but also to families that many times feel impotent and helpless. However, despite all the complications and challenges we are facing, we are very proud of our work with these kids and their families. We now have three of them walking!

TM: What projects and research have you been involved in since you spoke at TEDMED 2017?

CV: Since TEDMED, we received a National Institutes of Health (NIH) grant and started a collaborative research study with the RTI International, a well-known and respected research non-profit organization. The main goal of this study is to follow 200 children with congenital Zika syndrome and their families for a period of 5 years. By assessing each child, we are trying to understand important outcomes such as neurodevelopment (motor skills and cognition), functional skills (activity of daily living, feeding, and sleeping), social and language skills, temperament, and behavior. Another aim of this study is to understand how families have coped with this new challenge and adapted to disability by assessing stress level, family dynamics, and social support. We hope that this study will enable us to provide an optimized habilitation treatment once we identify specific delays in the child’s development and at the same time, provide caregivers with psychological and social support by understanding their specific needs.

P.S.: I gave an interview at RetinaLink after TEDMED and the NIH Grant.

TM: Your team is composed of a multidisciplinary group of specialists, each skilled at addressing one of the many systems affected in babies with Congenital Zika syndrome. What were some of the challenges in bringing doctors of different backgrounds together? Were there any surprising or unexpected outcomes that came as a result of the collaboration?

CV: To answer your question, I need to explain about our history. The Altino Ventura Foundation is a non-profit organization that started in 1986 as an eye center for the low-income population. In 2004, we opened our Rehabilitation Center that used to be run in a small rented house and we were only accredited to perform visual and motor rehabilitations. However, in 2014, we finally moved to a 3-story building owned by us, and that was when we became fully accredited to rehabilitate patients with multiple disabilities in all four domains (visual, hearing, motor, and intellectual).

By then, we already had the different physicians and therapists working at the same place working for the same goals. Also, at the FAV we have always valued teamwork and interaction between our professionals. However, with the advent of Zika, the interaction was intensified, which brought more unity to our work. Thanks to this strong connection, we have been able to see how it has positively affected our children’s outcomes.

Another important aspect that Zika brought to our institution was the possibility of developing our own protocols for Zika. Since we have the oldest patients with Zika, we did not get to learn from others how to treat our patients. Zika empowered us to develop our own protocols that are used today to treat our children. The visual impairment assessment protocol, for example, was developed by our team and published in the Journal of the American Association of Pediatrics (JAAPOS) in 2016 with the intent of sharing with the world what we have learned so far about the visual aspect of CZS. In addition, the FAV has been a hive for other professionals from other states in Brazil and from the US to visit and to be trained for CZS habilitation treatment.

TM: You work closely with the families of babies affected by Congenital Zika syndrome, and you mention in your Talk that you consider mothers and caregivers to be your best allies in the treatment of their children. When a family is empowered to be involved in treatment, what sorts of positive results do you see?

CV: I truly believe that families make a difference in the child’s outcome not only for children with Zika, but for every child that needs close assistance. In 2016, we realized just how slow the response to our early intervention therapy was—children were coming once every week to the FAV Rehab Center, and we had to think of different strategies since we could not provide as many assessments as we would have liked due to Brazil’s economic and financial situation. We basically had to work with what he had. Despite teaching mothers/caregivers how to stimulate their child at home, we knew they weren’t able to purchase the toys or equipment that were necessary to do so. We then came up with the idea of handcrafting a multi-sensory kit with the mothers/caregivers. They have been using the multi-sensory kit since then and we have filmed a tutorial of how to use the kit and uploaded the series to YouTube so other families can learn and benefit from this idea as well. Here are our tutorials divided into parts 1, 2, and 3. We also provided mothers/caregivers with constant workshops to empower them because we know now that committed parents/caregivers can change a child’s overall outcome.

TM: What was the TEDMED experience like for you?

CV: Absolutely surreal! It was the most thrilling, exciting, scary, nerve-wracking, and challenging experience I ever lived. Having to memorize my 15-minute talk in English and deliver it with emotion with all the tension that was going on inside me was not easy. But after succeeding and looking back at the entire preparation process, I can only thank the amazing professionals I got the chance to work with since day one. I appreciate the sweetness and patience of Lucy Barry, the great suggestions from the straight-to-the-point Marcus Webb, and the amazing support I received from Shirley Bergin. I could not ask for a better team! And if I can add, now that I have stepped in the TEDMED shoes, I value even more each and every speaker that gets on stage to share their personal and/or professional experience – we all have walked an extra mile! Thank you TEDMED for such an amazing experience!

Q&A with Chera Kowalski of the Free Library of Philadelphia

In her 2017 TEDMED Talk, Chera Kowalski shared what it was like to work at the McPherson Square Library, situated in Philadelphia’s “Needle Park,” where she and other staff members played the dual roles of librarian and lifesaver in a community stricken by the opioid crisis. We talked with Chera to learn more about her perspective and her courageous work.


TEDMED: Why did you want to become a librarian? Have those reasons evolved over the years?

Chera Kowalski: In the beginning, I was drawn to the research aspect of librarianship because I was constantly doing research as an undergrad. However, I ended up volunteering with the Free Library because I didn’t want to close myself off from exploring the public librarianship side of the field. As I saw more and more of what a public library is, I wanted to stay because I realized I wanted to work with the public, with the community.

Also, as I have reflected more on my career choice, I realized growing up my mother was always helping people out even when in the midst of her own hardships. She was always connecting people to resources. In the end, I think it was witnessing that which really directed me towards public librarianship. I may not have realized it when I first started on my path to becoming a librarian, but today I definitely do.

TM: Most people wouldn’t think of a public library as being a critical local resource in the opioid epidemic, but Philadelphia’s McPherson Square branch and other libraries across the country are serving as just that. Are there other types of community resources that you think have undiscovered or underused potential in terms of being able to meet the needs of their communities?

CK: Yes, of course there are other types of community resources that have undiscovered or underused potential in meeting needs of their communities. It is important to always explore the landscape of your community because it is more likely than not there are many resources sitting undiscovered or underused. As a public librarian, I am always seeking out resources of all kinds because we can’t offer everything the community needs, but we can connect the community to other resources supporting the particular need. And many public libraries, including the Free Library of Philadelphia, also collaborate and partner with other organizations as well to ensure the needs and wants of the community are being met.

TM: Do you work with other libraries around the country who are facing similar challenges within their communities?

CK: Since the story of our efforts at McPherson Square hit the media, other libraries across the country have reached out to us to ask  how to get their library administration and/or the community to understand the need for overdose reversal training, how to engage the community around the topic of the opioid and overdose epidemic, and so on. I have presented on panels with other public library professionals to educate and engage more people in our field on the issue because the opioid epidemic is affecting communities of all kinds throughout the country and the library needs to be one of the resources communities can turn to for support.

TM: What would you say to critics and skeptics who might say things such as: providing the overdose-reversing drug naloxone at public libraries enables opioid users, or that you shouldn’t administer it in front of children?

CK: I keep saying it is a tool, a skill right up there with CPR. The thing that holds people back from recognizing this, to me, is stigma, misinformation, disinformation. This is why I have made the choice to discuss not just what we do at McPherson Square Library, but also share my personal story. Sometimes it is easier for people to connect to a story than to facts, and the personal story sometimes has the potential to open the doors to those facts and change minds.

At McPherson, the library and the park are always full of kids, and so when people unfortunately overdose in the library or just outside, kids are seeing this, experiencing this trauma, and we did not want kids or anyone to see someone die, especially when there is something available to save lives. The kids and the residents of Kensington witness overdoses constantly because Kensington is the epicenter of Philadelphia’s epidemic. They are experiencing this trauma over and over again, and if naloxone wasn’t available many more deaths would be the result.

TM: What do you think the future of the opioid crisis looks like, and as someone working in the midst of it, do you see an end in sight?

CK: Even though progress is being made, it is not nearly enough, soon enough. The issue is so complex, so complicated, so massive, constantly changing, it’s daunting. We are so behind on what needs to be done and what’s holding us back is, once more, the stigma, the misinformation, the disinformation. There is so much being done on the ground level, the frontlines, but bureaucracy, the concern for profit, the concern for keeping a political seat, just the refusal to educate one’s self are slowing down the critical parts of policy change, of equitable access to treatment, and more. But with all that said, I do have hope because I know there a lot of people willing to put in the effort, the exhaustion, the hard work to change the course of this crisis.

TM: What was the TEDMED experience like for you?

CK: TEDMED was definitely not my usual scene, but I connected to it because everyone there wants to solve problems, challenges, and do so collaboratively. It was such a positive, encouraging experience, I felt reenergized and motivated. The experience also pushed me to reflect on where I want my professional and personal path to lead, which is why I ended up moving into a new position with the Free Library of Philadelphia as the Assistant to the Chief of Staff. It was a heartbreaking, difficult decision, but in the end I had to see the bigger picture. I am still connected to McPherson Square Library and the Kensington community. I visit frequently and I am still finding professional and personal ways to continue to support the library branch and the community.

The limits of scientific certainty and the need for positive change

Michael Hendryx is a pioneering research investigator focused on the impacts of uneven environmental exposures faced by socioeconomically disadvantaged groups. In 2006, Michael started a research program on public health disparities for people in Appalachia who live in proximity to coal mining, with a focus on mountaintop removal. This research has shown that people who live close to mountaintop removal are at increased risk for a wide set of health problems including respiratory illness, cardiovascular disease, birth defects, cancer, and others. Michael spoke at TEDMED 2017, and you can watch his Talk here.


I have committed the last 12 years of my professional life to conducting research on public health conditions in Appalachian coal mining communities. I have focused in particular on a highly destructive form of surface coal mining called Mountaintop Removal. As I described in my TEDMED talk, mountaintop removal involves the heavy use of explosives to reach the buried coal, wholesale destruction of forests and streams, and production of water and air pollution over a large footprint in central Appalachia that is home to over a million people.

MTR site above a town. (Source: Paul Corbit-Brown)

As I write this blog, I am surprised to see these words on the screen: Appalachian coal mining has become a central part of my research career. I am not from Appalachia. I was born in Illinois and have spent most of my life in the Midwest and West. I knew very little about coal mining or its environmental, ecological, economic and public health harms before taking a faculty position at West Virginia University in 2006. But as I learned about the issue, and began to examine it from a public health perspective, I gradually became convinced that this mining practice was truly harmful to the health of nearby community residents.

In retrospect it may seem obvious that this is so, but the work faced two constraints: the impossibility of conducting the “perfect” study to establish definitive cause between mining and public health, and the doubt and resistance, not only from politicians and the industry (predictable) but from research colleagues who were sure (without actually studying the issue) that the health problems must be due to the usual suspects of smoking, obesity and poverty that plague mining-dependent communities. Certainly blowing up mountains over people’s heads couldn’t harm their health! Could it?

As I contemplated my TEDMED talk and considered the message I wanted to offer, I realized that I wanted to raise awareness about mountaintop removal throughout the TEDMED community, but I also wanted to say something to the larger scientific community that was not dependent on a single environmental issue, but that perhaps could aspire to a larger resonance. Initially, I wasn’t sure myself what this would be, but I knew it was something about the tension between science and advocacy, which morphed into a statement about the limits of science in the face of an ethical imperative. From someone like me who prides himself on the power of empirical evidence, this is quite a statement about scientific limits!

It’s a well-known idea in environmental science: the precautionary principle. If there is evidence that health is impaired, and if there is evidence of environmental risk that may reasonably contribute to that impairment, then appropriate action is necessary to reduce the risk even if all causal links are not understood.

Since 2006 I, with many co-authors, have published more than 30 research papers in academic journals that document environmental and public health conditions in mining communities. For me the answer is undeniable, despite the lack of the perfect causal study: mountaintop removal mining is harmful to public health. It should be discontinued to protect human health. I think we have reached the point where further studies are frankly unnecessary, except to keep the issue in the public eye. Additional studies carry the risk of doing a disservice to the people who live in these communities, as we can study the issue to death without ever convincing the politicians and industrialists who are motivated and rewarded by doubt. As I said in my talk, “There can always be doubt, if doubt is what you seek.”

Instead of continuing to document problems, it is past time to move to solutions. It is a fact that the physical reserves of recoverable coal in Appalachia are in sharp decline. It is a fact that the world is moving away from coal to other energy sources. Coal mining as an economic force in Appalachia is subsiding. This has nothing to do with a so-called ‘war on coal.’ It is a consequence of geological and economic reality.

The solutions, in my view, lie in the power, imagination and energy of the people of Appalachia. I have encountered many examples of efforts underway to promote a transition to a strong and sustainable economy for the region as coal approaches its death rattle. I anticipate that these incipient efforts will eventually lead the way to greater opportunity and health for the region. Vested political and economic interests still refuse to acknowledge or support the change, but eventually they will have no choice.

I found a narrative and that narrative became a song

 

Zoë Keating is a cellist and composer who put her music career on hold when her husband Jeff was diagnosed with stage IV non-smokers lung cancer. After Jeff passed away, it took Zoë time to start creating music again, but when she did, it became her lifeline. Zoë spoke about her experiences at TEDMED 2017, and you can watch her Talk, and hear her play the song “Possible,” here.


Four years ago my world exploded and disintegrated: my husband Jeff was diagnosed with terminal cancer, he died 8 months later and I became an only parent.

I spent a long time in a shell-shocked-limbo that I can barely remember (if I was weird to you during that time, I apologize!) and then I feel like I’ve been searching for the blown apart fragments of my life and trying to put them back together with tape but there are huge pieces missing and…what is the shape supposed to be again? I don’t know yet. It’s a process. I’m a process.

For the most part, I’ve been ok with that. But yeah, sometimes there is nagging voice in my head impatient for me to “bounce back”, “be resilient”, “overcome”, etc etc etc. It berates me to “get on with it”—whatever “it” is—so that then I can do the normal things that a successful artist does, like release a new album, something that seemed incredibly daunting in my new life.

So last year the folks at TEDMED invited me to speak. I thought about all the things I wanted to talk about. I could talk about the patient experience of health care. Or maybe I could talk about how I used to suffer from paralyzing stage fright until I discovered live looping—by recording short phrases of the cello and playing on top of them, I made a virtual cello orchestra to keep me company onstage and then I wasn’t afraid. I didn’t want to talk publicly about Jeff’s illness and death and what came after. I didn’t want to be defined by a story that was raw and painful and still bleeding.

I tried to write my talk about something else but as much as I didn’t want to be defined by loss, the biggest thing in my life was the gaping wound where my husband was. It would be insincere for me to give a talk about anything else.

So I started to write. I wrote iteratively in bits and pieces and as I wrote, a clearing appeared, and there was new music in it. As what I wanted to say crystalized into words, so did the music. I ended up making a talk and a song in parallel. In distilling my story, I found a narrative and that narrative became a song.

The act of finishing a single song made it seem possible for me to make another one, which I did after I gave the talk. And then I made another…

Zoë Keating, by Chase Jarvis

One theme running through all my music is the feeling of getting outside of things to get a bigger vista. I’m often looking for the musical equivalent of a bird’s eye view. It has been hard to get that kind of perspective of my life for the last few years. And frankly, it’s hard to imagine making something big, like an album, when you’ve lost your confidence, which I certainly had.

After I gave my talk, I could see that this process of looking at my personal story from afar, having an insight and then iterating on it, was very similar to how I make music. When I combine loops of cello together the resulting sounds and textures hint at new musical patterns to explore. When I wrote about what happened, thought about what I’d written and then refined it, the very process of doing that suggested new ways for me to think about it.

If I was to give another talk today, I might explore an idea I heard about during a subsequent performance that I had with Jad Abumrad, the founder and co-host of “Radiolab”. I was making live music for a talk he gave on the origins of the show in which he mentioned the idea of the “adjacent possible”, a term coined by the theoretical biologist Stuart Kauffman.

Bear with me for a second. Roughly, Kauffman’s theory as I understand it is that biological systems are able to transform into complex systems through incremental changes. Life didn’t start out complicated with something like a flying squirrel. First there were a bunch of carbon atoms, then those atoms combined to make molecules, then proteins, and then proteins made cells possible. Each step along the way created the possibility for the next step to occur, the adjacent possible. Kauffman’s idea has since been applied to social sciences, technology and creativity, describing how new insights can be generated by combining already existing ideas. The adjacent possible are the things made possible by what you are doing right now.

So for me, maybe the act of distilling my story at TEDMED created an adjacent possible for me, one where I’m able to make music again.

Here’s me talking about how music helped me think about life, love and loss, followed by a live performance of a new song called “Possible”. I’ll be releasing the studio version as part of a three-song EP on June 1.

Thank you, TEDMED.

Q&A with Agnes Binagwaho, Rwanda’s Former Minister of Health

In her 2017 TEDMED Talk, Rwanda’s former Minister of Health, Dr. Agnes Binagwaho, shed light on the experience of rebuilding Rwanda’s health system after the devastating 1994 genocide. We talked with Agnes to learn more about her past efforts and to find out what she’s working on today.


TEDMED: Can you describe some of the biggest challenges you faced as you began work to rebuild Rwanda’s health system? How did you overcome them?

Agnes Binagwaho: The biggest challenge I faced was figuring out how to do the most good and save the most lives with the extremely limited resources and infrastructure that existed, and beyond that, figuring out how to contribute to the growth of a system that would deliver the quality care I wanted for all children of Rwanda. Rwanda’s health sector was destroyed and there was a strong need for not just health professionals, but committed health fighters. We overcame these challenges by uniting as a country to determine the best way forward while still remaining true to our vision. We knew that if anyone was going to stand up for us, it was going to have to be us. We took that national commitment and leveraged it into a real transformation, a transformation in which our systems and our laws are mandated to serve the most vulnerable and to leave no one out.

TM: Have you seen Rwanda’s health system successes be leveraged in other countries? Have there been other unexpected outcomes that have emerged as a result of your work?

AB: In many places, similar interventions, policies, and practices are being introduced as the ones we introduced in Rwanda. Particularly around how, as a country, we are able to provide equitable, quality health care to all, and how to use ICT [Information and Communication Technology] in the management of the health system. Our health professionals often advise other national health sectors or organizations on the lessons learned in Rwanda and how they can be applied elsewhere. We are part of a global fight to make a healthier future and we are learning from one another so that we will all reach the SDGs.

TM: You are the Vice Chancellor of the University of Global Health Equity, which is unlike any other university we know. What is global health equity, and how do you teach it?

AB: At the University of Global Health Equity, our vision is a world where every individual – no matter who they are or where they live – can lead a healthy and productive life. We know that this vision is ambitious and that we will face a lot of challenges in its pursuit. We teach the values of accompaniment, compassion, commitment, and integrity to ensure a preferential option for the poor in health care. Our students are trained to connect with the communities most in need and to break down the barriers between academia and medicine and cities and rural or impoverished settings. They are trained to advocate for patients and to look beyond the traditional margins of health care and integrate a holistic view of health into practice and policymaking. At UGHE, we empower global health professionals to be leaders and managers and to use these tools to solve problems for those most in need, and to find lasting and inclusive solutions to the greatest global health challenges today.

Dr. Agnes Binagwaho leads a group discussion during the University of Global Health Equity’s Global Health Delivery Leadership Program, a certificate course conducted in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria. Photo by Zacharias Abubeker for UGHE.

TM: What advice would you give young emerging leaders interested in politics and health reform?

AB: I would tell any young leader interested in this field to join us without hesitation, we need young and energetic thinkers to take up the fight for global health equity and to bring new ideas and innovative solutions to the health challenges of today and tomorrow. I would tell them to follow their dreams and to find what motivates them for public good. We need global health fighters that are passionate and outspoken advocates for those most in need. The field of global health is vast and multidisciplinary, and everyone has a role to play in ensuring access to quality health care for all. There is so much to do.

TM: What was the TEDMED experience like for you?

AB: The experience of the TEDMED talk was great; the scientific content was fantastic and spanned a variety of topics. I loved it; and I learned a lot. It was well organized and I felt really welcome in the community. It was also an occasion for networking with people with diverse experiences, but with the same goals, passions, and vision for a healthier future. I am grateful for the opportunity to come together with such great thinkers and advocates.