TEDMED Blog

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.

Watch her recent TEDMED talk and then join us for a Facebook Q&A this Thursday, 12/18 at 1:00 EST as we dive deeper into her experience. 

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.

Games and Health: Q&A with Brian Primack

At TEDMED 2014, Brian Primack, Clinician, Professor, and Assistant Vice Chancellor of Research on Health and Society at the University of Pittsburgh School of Medicine, shed light on how principles learned from video game design can be used to create more effective health behavior change. We caught up with Brian to learn more about his work and his experience at TEDMED 2014.

How healthcare can learn from video games. Jerod Harris, TEDMED2014. Photo: Sandy Huffaker for TEDMED.

The video games industry is really good at getting people to perform certain tasks and to stick with them for the long haul.” Expert design including instant reward, social networks, and intermediate milestones can effectively improve patient outcomes. Photo: Jerod Harris for TEDMED.

Personally, what do you prefer: “old-school” video games, or the most recent technology? Why?

I prefer old-school video games. Part of it may be nostalgia. However, I also think that sometimes, simpler graphics and can translate into a richer imaginative experience. For example, I still sometimes play old Infocom games. Infocom created brilliant text-only interactive fiction games starting in the early 1980s.

Do you encourage your children to play video games?

My kids (ages 7 and 10) play video games, and I often play with them. Some of our favorites are logic, simulation, and/or physics games such as Civiballs, Meeblings, and Bloons Tower Defense. What I encourage even more than playing, however, is creating video games. Both of my kids can do basic programming on MIT’s Scratch platform and have created simple games of their own.

Beyond health and medicine, what other applications or fields do you see gamification having a large impact on?

Gamification may be very valuable in education. I think there is an important balance to be struck, though. I think it’s great to leverage the tools we have now to make learning more engaging. However, we also want to encourage people ultimately to learn for its own sake, not just because they are getting points or incentives. I don’t think these positions are mutually exclusive, but balance is important to think about as we develop new educational tools.

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

I really appreciated the opportunity to reconnect with some past colleagues; it was also invigorating to meet people whose work I had admired from afar. I caught up with Lee Sanders, MD, MPH, Chief of the Division of General Pediatrics at Stanford; he’s well-known for his work on promotion of child and family health via health literacy.

What’s next for you?

Our Center for Research on Media, Technology, and Health continues to research both the positive and negative influences of media and technology on health outcomes. We develop and test interventions to support positive attributes of media and technology while also buffering their potential negative influences.

Zoobiquitous Medicine: Q&A with Barbara Natterson-Horowitz

Barbara Natterson-Horowitz, Professor of Medicine in the Division of Cardiology at UCLA Medical School, offered an unusual perspective on how human patients, including those suffering from mental illnesses, can be helped by applying insights from animal health. We caught up with Barbara to learn more about how her Zoobiquity idea improves understanding of ourselves and the natural world.

Zoobiquitous Medicine. Barbara Natterson-Horowitz at TEDMED2014. Photo: Sandy Huffaker for TEDMED.

“When I see a human patient, I always ask, ‘What do the animal doctors know about this problem that I don’t know?’” Barbara Natterson-Horowitz at TEDMED2014. Photo: Sandy Huffaker for TEDMED.

What motivated you to speak at TEDMED?

After 20 years of practicing cardiology taking care of patients with heart attacks and high cholesterol, I was thrust into the world of veterinary medicine. Seeing my human patients as human-animal patients completely changed how I practice medicine and understand health and disease. Insights from this species-spanning approach to medicine can benefit human and animal practitioners and patients alike. It’s thrilling to introduce this approach to physicians, psychologists, dentists, nurses, etc. and watch their viewpoints transform; the exposure at TEDMED led to a collaboration between a celebrated human breast cancer physician studying a mutation that causes breast cancer in women with a veterinary oncologist working on the same mutation that causes breast cancer in jaguars and other animals!

Why does this talk matter now?

Animals and humans get basically the same diseases. From heart failure, diabetes and brain tumors to anxiety disorders and compulsions, the challenges we face aren’t uniquely human. Discovering why, where, and how non-human animals get sick reveals crucial but hidden clues to human health and illness. For instance:

Breast cancer: When beluga whales began dying of breast and colon cancer in the St. Lawrence estuary, a parallel epidemic of breast cancers in women was discovered in the same region. This species-spanning breast cancer outbreak was ultimately linked to toxins from local aluminum smelting plants.

Obesity: Medical insights into obesity — which challenges physicians and veterinarians alike as animal and human patients are becoming more fat — are generated by a zoobiquitous approach.  Awareness of worsening obesity in domestic and wild animal populations challenges us to consider environmental factors including endocrine disrupting chemicals,  antibiotics, and even climate change as contributors to the “plurality of obesity epidemics.”

Infectious disease: The majority of infections that could create human pandemics come from animal communities. From Ebola to West Nile Virus, SARS to H1N1, some of most worrisome threats to human health and survival are encountered first by veterinarians and animal experts. If we fail to pay attention to these experts and miss out on the opportunity to collaborate, we lose crucial information and increase unnecessary risk for human populations.

How do you see your work fitting into species-survival, wildlife preservation and conservation?

Zoobiquity emphasizes the interconnectedness of animal and human lives and ecosystems. Animals can be sentinels of disease in humans. When horses in Venezuela start to die, it can mean equine encephalitis may threaten local human populations. When cormorants and crows get sick with West Nile virus in Queens and the Bronx, elderly and immunocompromised patients may also be at risk for the virus. On the other hand, humans can be sentinels of disease in animals. Human outbreaks of Brucellosis often lead to identification of sick and suffering animals. The detection of lead poisoning in a child often leads to exposure and disease in local wildlife. Bringing practitioners of animal and human health together encourages the transfer of information from the world of human medicine that is vitally relevant and important to wild animal populations.

What do you hope for the legacy of Zoobiquity? 

Zoobiquity Conferences have now been held across the US and internationally. At these events human health practitioners including physicians, nurses, dentists, psychologists and others come together with animal health practitioners including veterinarians, behaviorists, nutritionists and others to discuss the shared diseases of their different species. I’ve heard some veterinarians joke, “real doctors take care of many species.” Bringing the comparative approach to the human medical community has the power to transform how physicians, nurses, psychotherapists and others understand disease, their patients and the environmental and evolutionary factors that link us all together.  I hope Zoobiquity is successful in bridging the worlds of animal and human health, ecology and evolutionary biology.

Join us next Wednesday, December 10 at 1PM ET for a live Facebook chat with Barbara about species-spanning medicine. Start the conversation today by submitting your questions on Facebook and be sure to like TEDMED for updates!

Collaborating for Innovation

Conflict of interest. Does it have to dominate the agenda when public-private partnerships address healthcare? And, how can such partnerships lead to more and better innovation?

These were two key questions explored during TEDMED’s latest in-depth discussion of the Great Challenges of health and medicine. Our diverse group of experts provided some insightful and thought-provoking answers. The participants, who ranged from game theorist to pediatric ethicist, discussed obstacles they’ve found as collaborators in public-private partnerships and potential solutions to make these relationships more effective. Dan Munro, a Forbes contributor, moderated the event.

One of the biggest issues identified throughout the discussion was the lack of clarity and “game rules” when it comes to public-private partnerships. Myra Christopher, the Kathleen M. Foley Chair in Pain and Palliative Care at the Center for Practical Bioethics, explained that there are at least 53 different definitions of public-private partnerships. Myra noted, “there is a real cry-out for better and common understanding about the current game rules.”

Another issue that came to the forefront during the discussion was conflict of interest. With so many players in public-private partnerships, it’s hard to avoid conflicts of interest. However, John Tyler, the General Counsel and Corporate Secretary for the Ewing Marion Kauffman Foundation, noted that, “conflicts of interest should not be an impediment. They should not be a barrier, but they should be understood and efforts should be made to try to manage them.” From John’s perspective, one way to make public-private partnerships more effective is to see the opportunity instead of the conflict, which can most likely be mitigated.

David McAdams, a game theorist and Professor of Economics in the Fuqua School of Business and Department of Economics at Duke University, also encouraged looking for the potential opportunities in challenging situations. When asked what the great challenges facing public-private partnerships in the next 20 years are in the context of shrinking resources, David responded that this might not necessarily be a bad thing. With fewer resources “you’re forced to try more creative innovation,” David noted.

With regards to the medical community, Skip Nelson, the Deputy Director and Senior Pediatric Ethicist in the Office of Pediatric Therapeutics, Office of the Commissioner at the U.S. Food and Drug Administration, brought up the issue of incentives. As grant funding is shrinking, “we need to find new ways of valuing what people are doing and promote them appropriately within those institutions.”

Polina Hanin, Academy Director at StartUp Health, brought up the idea of adopting an entrepreneur as a potential method of using public-private partnerships to foster innovation. Doing so would “allow [the entrepreneur] to see the intricacies and work flows that are really going to allow them to create a solution that’s going to work for the community… the organizations, and the patients that these startups are actually trying to help in the long-run.”

The participants agreed that at the core of any public-private partnership there must be trust and transparency. Once we “quit being such skeptics,” as Myra put it, there’s the potential for public and private entities to begin effectively collaborating for innovation.

If you missed the live event, catch the recast here: http://tedmed.com/greatchallenges/liveevent/497919, and stay tuned for our next Great Challenges hangout on Addressing Healthcare Costs next Thursday, December 11 at 12PM EST.

What is Culinary Medicine? Q&A with John La Puma

Nutrition specialist, chef, author, and practicing physician John La Puma lives and works on an organic farm in California. He makes his garbanzo guacamole recipe on the TEDMED stage while sharing his philosophy that the food we eat is as important as the pills we take, a key component of preventive health and our well being.  On the TEDMED Blog, John elaborates on culinary medicine and what role patients may have taking charge of their health and even educating their physicians about how to consider nutrition as part of the treatment plan.

John La Puma on culinary medicine

“Food is the most important healthcare intervention we have against chronic disease.” John La Puma, TEDMED 2014. Photo: Jerod Harris for TEDMED.

Why does this talk matter now?

Patients who ask their doctors, “What should I eat for my condition?” really want answers. Meanwhile, clinicians are clamoring for more and better information and training on nutrition. Culinary medicine is a new evidence-based field in medicine that blends the art of food and cooking with the science of medicine to yield high-quality meals and beverages which aim to improve the patient’s condition. It is already being taught in both undergraduate and postgraduate medical education.

What impact do you hope the talk will have?

I hope that the talk will help accelerate the cultural shift in healthcare towards wellness and well-being as primary goals in medicine. People need to know that some physicians care deeply about helping them become well with what they eat.

What is the legacy you want to leave?

Our mission is to inspire health-conscious consumers to look, feel and actually be measurably healthier by what they eat. The opportunity to use culinary medicine to prevent and treat disease is substantial, and culinary medicine should be considered as part of both the medical history and treatment plan in medicine.

How would medicine change if your ideas become reality?

All clinicians should be able to write culinary medicine prescriptions and know how food, like medicine, works in the body. I’d like to see condition-specific food and lifestyle measures become something that clinicians can offer, effectively, before prescription medication for most chronic conditions.

What is your core belief about culinary medicine?

Everyone has a right to clean, healthful, delicious, real food that both satisfies their appetite and makes or keeps them well…before it may be too late to offer more than comfort food.

Please share anything else you wish you could have included in your talk.

70% of heart disease, stroke, diabetes, memory loss, premature wrinkling and impotence are preventable. 80% of cancers and much of asthma and lung disease are preventable, and from environmental causes, like toxin exposure or diet.*  Knowing more about what’s in your food and how it got there can help you take your own health into your own hands, save you money and provide joy and energy for those you love. With culinary medicine, health-conscious people can live life to its youngest.

Ask your doctor, “What do I eat for my condition?”  If he or she doesn’t know, do your own research- here’s my list of resources.

Now it’s time to try John’s Luscious & Rich Garbanzo Guacamole recipe!

1 ripe medium avocado, preferably Haas

1 medium clove of garlic, peeled, diced and creamed with lime zest

1 medium serrano chile pepper, stemmed and diced, but not seeded

1/4 teaspoon minced lime zest, preferably organic

2 tablespoons fresh lime juice (about 1 medium lime)

1 tablespoon extra virgin olive oil, COOC preferred

1/2 cup cooked chickpeas, rinsed and drained

1/2 teaspoon yellow curry powder, such as Madras curry

1/4 teaspoon black pepper

5 sturdy springs cilantro or Italian flat leaf parsley (optional)

Cut the avocado in half long-wise around the pit and separate the halves. Remove the pit.

Use a spoon to scoop around the flesh and remove it in one piece.

Place upside down on a cutting board, dice into large chunks. Scoop up and place in a large stainless steel bowl.

Add the garlic, chile, zest, juice and oil, and mix by hand with a fork or a tablespoon.

Smash the chickpeas with the flat side of a chef’s knife, to break the skin. Sprinkle the curry and black pepper on the garbanzos, add to the bowl, mix again, and top with herb garnish if desired.

Serve with corn tortillas or toasted chips, sliced jicama triangles and sliced cucumber circles. Enjoy!

Nutritional Data Per Serving (3 servings):193 calories, 17 g carbs, 14 g fat, 3 g protein, 125 mg sodium, 7 gram fiber.

Adapted from La Puma J. “ChefMD’s Big Book of Culinary Medicine”, Crown, 2008.

(c) John La Puma, MD, Santa Barbara, CA, 10.2013

*See John’s TEDMED bio page for references and resources that support these claims.