How perfectionism became a hidden epidemic among young people

This article, authored by Thomas Curran and Andrew P. Hill, was first published by The Conversation UK.


In our roles as academics, young people knock on our doors almost every day. They are typically ambitious, bright and hard-working. They have a broad network of friends, and most come from supportive families. Yet no matter how well-adjusted they can appear, we are finding that our students are increasingly likely to seek our support for mental health issues, as well as academic ones.

We are not alone in observing this trend. Student mental illness on UK campuses is at record highs. And right across the globe, young people are reporting to clinicians at unprecedented levels with depression, anxiety and suicidal thoughts.

One possible reason for this is that across the US, Canada and the UK, today’s young people are the first generation to grow up in a society based on the principles of neoliberalism championed by the leaders of the late 20th century – Ronald Reagan, Brian Mulroney and Margaret Thatcher respectively. Over the last 50 years, communal interest and civic responsibility have been progressively eroded, replaced by a focus on self-interest and competition in a supposedly free and open market place.

In this new market-based society, young people are evaluated in a host of new ways. Social media, school and university testing and job performance assessments mean young people can be sifted, sorted and ranked by peers, teachers and employers. If young people rank poorly, the logic of our market-based society dictates that they are less deserving – that their inferiority reflects some personal weakness or flaw.

View this post on Instagram

And so exam season begins. #t

A post shared by Charl Cater (@charlcater) on

There is, then, enormous pressure on young people to demonstrate their value and outperform their peers. And there is evidence that they are struggling to cope. In particular, emerging epidemics of serious mental illnesses speak to the negative effects of this market-based society, and a culture which is fundamentally changing the way young people think about themselves and others.

The rise of perfectionism

Leading psychologists, Paul Hewitt and Gordon Flett have suggested that one of the ways in which younger people are acting differently to their older peers is by showing a greater tendency toward perfectionism.

Broadly speaking, perfectionism is an irrational desire for flawlessness, combined with harsh self-criticism. But on a deeper level, what sets a perfectionist apart from someone who is simply diligent or hard-working is a single-minded need to correct their own imperfections.

Perfectionists need to be told that they have achieved the best possible outcomes, whether that’s through scores and metrics, or other peoples’ approval. When this need is not met, they experience psychological turmoil, because they equate mistakes and failure to inner weakness and unworthiness.

We recently published a study in the Psychological Bulletin, which shows that levels of perfectionism have risen significantly among young people since 1989. We think that this may, at least in part, be a symptom of the way that young people are attempting to feel safe, connect with others and find self-worth within market-based, neoliberal societies.

Irrational ideals of the perfect self have become desirable – even necessary – in a world where performance, status and image define a person’s usefulness and value. You don’t need to look far to find examples; corporations and their marketers offer all manner of cosmetic and material solutions for the flawed consumer. Meanwhile, Facebook, Instagram and Snapchat provide platforms to exchange curations of the perfect version of oneself and lifestyle with others.

This is a culture which preys on insecurities and amplifies imperfection, impelling young people to focus on their personal deficiencies. As a result, some young people brood chronically about how they should behave, how they should look, or what they should own. Essentially, agitating to perfect themselves and their lives.

It’s no wonder that there’s substantial evidence indicating that perfectionism is associated with (among other things) depressionanorexia nervosasuicide ideation and early death.

We feel a deep sense of sympathy with our students’ struggles. For the first time on record, young people are expected to be materially less well-off in adulthood than their parents. And it’s not just their material well-being that’s at stake – their mental and physical well-being is threatened by this hidden epidemic of perfectionism.

It’s time for organisations such as schools and universities, as well as the politicians and civil servants who help to shape the way these organisations operate, to take steps to safeguard the welfare of young people. They must resist marketised forms of competition, at the expense of young people’s mental health. They should teach the importance of compassion over competition. If they do not, the rise of perfectionism – and its association with serious mental illness – is likely to continue unabated.


 

Social and personality psychologist Thomas Curran studies the personality characteristic of perfectionism, how it develops, and it’s impact on mental health. He is a member of the Centre for Motivation and Health Behavior Change in Bath, UK, the Motivation, Personality, and Well-being research group in York, UK, and is currently an assistant professor in the Department for Health at the University of Bath. His research rose to prominence following a 2017 publication of the first systems-level cohort study to show that perfectionism is on the rise in American, Canadian, and British college students. Since then, he has written and spoken extensively on how we have created societies perfectly calibrated to promote perfectionism, which is contributing to almost epidemic levels of serious mental illness among young people. He is the author of over 30 published papers and has received numerous awards for his scholarship and research. Thomas spoke on the TEDMED Stage in 2018, and you can watch his Talk here.

Noise is Affecting our Health in More Ways Than We Think

Mathias Basner, MD, PhD, MSc is an Associate Professor in the Department of Psychiatry at the University of Pennsylvania Perelman School of Medicine. His primary research interests concern the effects of sleep loss on neurobehavioral and cognitive functions, population studies on sleep time and waking activities, the effects of traffic noise on sleep and health, and Astronaut behavioral health on long-duration space missions. These research areas overlap widely. Mathias has published 80+ journal articles and reviewed articles for 80+ scientific journals. He is currently on the editorial board of the journals Sleep Health and Frontiers in Physiology. Mathias spoke on the TEDMED Stage in 2018 and you can watch his Talk here.


Noise is a strange animal because it affects our health in many different ways, and we don’t even realize it. Short-term loud noise exposure damages our inner ear and is the reason for noise-induced hearing loss. As mentioned in my TEDMED talk: Whenever you have that ringing in your ear after you leave a concert or a bar, you can be certain that you have done some damage to your hearing, likely permanent. The problem is that we are only paying the price when we are older, in the form of tinnitus and hearing loss. Unfortunately, we are very bad at changing our current behavior based on something that we may experience in the future. Regardless, protecting yourself and your children from high noise levels should be a priority. Always ask yourself: “Is this (concert, fireworks, leaf blower) really worth destroying the hair cells of my inner ear?” As my colleague Daniel Fink recently pointed out, a safe exposure level that does not put our hearing at risk is likely 70 dBA, which is more than 30 times less the sound intensity than the 85 dB typically considered safe for the 8-hour workday.

However, noise affects our health in many different ways beyond hearing. The so-called non-auditory effects of noise include sleep disturbance, increased risk for cardiovascular disease, and disturbed communication. The latter has been shown to affect academic performance of school children, but it can also have catastrophic consequences, e.g. if something is misunderstood in a hospital setting. I believe there are several reasons why environmental noise doesn’t receive the attention it deserves in public health politics. First, humans habituate to their environment. If you are constantly exposed to noise, you may not realize it any more. It can nevertheless very much affect your physiology and psyche. For example, I only realized how loud my every day environment was after I spent some time in a very quiet environment. Second, many of the health effects require long-term exposure to relevant noise levels before they manifest. As mentioned above, humans often have problems making the connection between a present exposure or behavior and future effects. Third, many of the activities that generate noise also generate a societal benefit and/or revenue. For example, an outdoor concert venue can be greatly enjoyable for the patrons, but it can be a torture for those living next to the venue without a realistic opportunity to evade the nightly noise. Likewise, it is very convenient to live close to major transportation infrastructure like a highway or a rail station. However, if you are living too close to rail tracks or roads, this convenience can be offset by the noise and pollution associated with the traffic. Finally, we definitely have a noise equity issue, and those exposed to high noise levels often neither have the means to live somewhere less noisy nor are they influential enough to push the policy envelope.

We always should think of ourselves both as noise recipients and as noise generators. There are things we can do individually to reduce noise levels. For example, we can decide to buy and use products that produce less noise (think of a rake instead of a leaf blower). Or we can postpone activities that generate noise to times considered less sensitive: If you don’t have to, don’t start mowing your lawn a 7 AM on a Saturday morning, your neighbors will thank you. In more general terms: be considerate. However, this will only take us so far. We still need strong noise regulation that is properly enforced to prevent health consequences. And even though the increases in health risks induced by noise may be relatively minor compared to other environmental or behavioral factors, this still constitutes a major public health problem, as noise is so ubiquitous, and so many people are exposed to relevant noise levels. Our research tells regulatory bodies at what noise level certain health effect can be expected, and that helps inform better noise policy.

Further reading:

Basner, M., Babisch, W., Davis, A., Brink, M., Clark, C., Janssen, S., Stansfeld, S.: Auditory and non-auditory effects of noise on health. The Lancet, 383(9925): 1325-1332, 2014.

Basner M.: Much ado about noise: health risks of traffic noise. Dtsch Arztebl Int 2016; 113(24): 405-6; DOI: 10.3238/arztebl.2016.0405

WHO Environmental Noise Guidelines for the European Region, 2018

Q&A with Greg Asbed and Gerardo Reyes Chavez

Greg Asbed is a fierce advocate fighting against forced labor, sexual violence, and other gross human rights violations. He was awarded the 2015 Presidential Award for Extraordinary Efforts in Combating Human Trafficking at the White House on behalf of the Fair Food Program (FFP). As a co-founder, Greg leads the development of innovative market-based enforcement mechanisms, rights standards, and worker education processes. Through this program he coordinates relations among many agriculture stakeholders, including corporate buyers, industry suppliers, and farm workers. He has consulted both nationally and internationally on the adaption of the FFP to other contexts. He is the co-founder of the Worker-driven Social Responsibility (WSR) model, which has been recognized for its unique effectiveness in combating the above-mentioned human rights violations in agriculture. Greg has won numerous awards, including the 2014 Clinton Global Citizen Award and the 2016 James Beard Leadership Award. He was also named a 2017 MacArthur Fellow. He is an advisory board member of the EU’s Horizon 2020 project to end forced labor in supply chains.

Gerardo Reyes Chavez is a key leader of the Coalition of Immokalee Workers’ (CIW), mobilizing communities across the world to advocate for the rights of exploited workers. Through CIW’s Fair Food Program, Gerardo has facilitated unique partnerships among farmers, farmworkers, and retail food companies to ensure humane wages and working conditions for the workers on the participating farms. Gerardo leads workers’ rights education programs, as well as managing the complexities of complaints of abuses in the fields, wage theft claims, and investigating cases of modern-day slavery. He has spoken publicly about the Fair Food Program at events such as Harvard Law School’s Labor and Worklife Program Convening on Farm Labor Challenges and the Interfaith Council on Corporate Responsibility’s Multi-stakeholder Roundtable on Ethical Recruitment. Gerardo is a 2018 Aspen Institute Ricardo Salinas Scholar.


TEDMED: As you two mentioned in your TEDMED Talk, the Fair Food Program (FFP) model is being used in different industries and in different countries. Tell us more about how it’s being used outside of the American agricultural industry.

Greg & Gerardo: The Fair Food Program was the first, fully operational example of the new paradigm for protecting workers fundamental human rights in global supply chains known as Worker-driven Social Responsibility, or WSR. One of the other foundational examples of the new WSR model is the Bangladesh Accord on Fire and Building Safety in the Bangladesh apparel industry. The Accord came together following the horrific Rana Plaza building collapse that led to the deaths of more than 1,100 people in 2013, and it employs the same key mechanisms as the Fair Food Program — binding legal agreements between brands and worker and/or human rights organizations, worker voice throughout the monitoring and enforcement process, and the suspension of sales to participating brands when its standards are violated by suppliers— to ensure that no worker need fear that the building where he or she works will be their tomb due to easily preventable fire and structural hazards. The Accord has been a great success and has saved countless workers lives by preventing the tragic accidents that previously killed workers in the apparel industry by the hundreds every year.

Likewise, workers in many other industries — from the poultry plants of Arkansas to the movie sets of Hollywood — have taken note of the model’s unique power to prevent abuses and are working today to establish enforceable standards in their own workplaces.

TM: The FFP model has successfully interrupted deep-rooted patterns of violence and modern-day slavery in the agricultural industry. What do you think makes the program so effective?

G&G: The Program’s success is due to two key elements: 1) the participation of workers, from start to finish, in the standards-setting, monitoring, and enforcement process and, 2) its ability to harness the purchasing power of the billion dollar brands as both carrot and stick to encourage growers to participate and to enforce Program’s standards when they are violated. Workers not only know exactly how, when and where abuses take place in the fields, they also happen to be there when the vast majority of abuses take place. That makes them ideally suited to both set the standards for the Program and to be the front-line monitors of their own rights. But no matter how strong a set of standards may be, or even how well monitored, if the power to enforce those standards is missing, then it is all for naught. The purchasing power of the multi-billion dollar brands at the top of the food industry — companies like Whole Foods and McDonald’s — is the power that drives compliance in the Fair Food Program. And the incentive their purchases represent to the growers in the Program is so great that it not only fixes violations when they occur, it brings about the gold standard of enforcement — prevention — making a world without victims, the best possible outcome, possible.

TM: Tell us about the upcoming “4 for Fair Food Tour.” Who is involved and what are you hoping to achieve with the program?

G&G: The 4 for Fair Food Tour is a continuation of the CIW’s ongoing national boycott against the fast food giant, Wendy’s. Along with students, people of faith, and community leaders, farmworkers and their families will be traveling across the country to four of the nation’s top public institutions with Wendy’s restaurants on campus – Ohio State University, University of North Carolina Chapel Hill, University of Michigan and University of Florida – to call on the administration at each university to end business relations with Wendy’s.

As the sole major fast food company that has yet to join the Fair Food Program, Wendy’s has been offering stock public relations answers in response to what is a very real, very troubling human rights crisis in agriculture. This tour is about making it clear to Wendy’s that consumers are clear-eyed and deeply committed to real, tangible change for farmworkers, and that Wendy’s refusal to join the most successful supply chain monitoring program in the country has consequences for the company’s brand and business relationships. Because these universities have very clearly stated values and mission statements that support human rights in their suppliers’ operations — for example, in the apparel companies that produce their university logo sportswear — and because the students at these schools clearly support the idea of exploitation-free consumption when possible, we have already seen strong support for the campaign in both the student communities and the cities where the universities are located. We expect that we will see Wendy’s restaurants removed from campus, as were Taco Bell restaurants on 28 campuses around the country during the Taco Bell boycott fifteen years ago, as the students ramp up the pressure on their administrations to live up to the schools’ stated values. That pressure was ultimately successful in prompting Taco Bell to be the first fast-food giant to join the Fair Food Program, and we are confident that it will have the same impact in making Wendy’s the last major fast-food company to join.

TM:  What’s next for CIW?

G&G: As we grow and expand, we will continue to advance every level of our work: We will help convey the lessons and potential of the WSR model to new industries and regions across the globe. We will fortify the gains we’ve made in the current seven states of the Fair Food Program, and expand those protections to more states and crops. We will travel the country and the world to educate public figures, academics, leaders, and everyday consumers about the challenges faced by farmworkers, and the responsibility of consumers to get involved in transforming the food system so that it is more humane and more just. We will win new partnerships with corporate buyers to drive expansion of the Program – Wendy’s, for example, in the not so distant future. And, of course, we will continue to do everything we can to ensure that the people harvesting our food, sewing our clothes, assembling our phones, building our homes, and doing so many more of the crucial jobs at the bottom of global corporate supply chains are empowered to be the frontline monitors of their own human rights.

Designing habitats for humans

Award-winning architect Amanda Sturgeon leads the International Living Future Institute (ILFI), an organization that focuses on the transformation to a world that is socially just, culturally rich, and ecologically restorative. She is also the founder and driving force behind the organization’s Biophilic Design Initiative, which aims to connect people and nature within our built environments and communities. Prior to ILFI, Amanda enjoyed a successful 15-year architectural career working on projects such as Islandwood on Washington’s Bainbridge Island. In 2013, Amanda was elected as a Fellow of the American Institute of Architects for her extensive advocacy and volunteer service to the green building movement, and in 2015, she received the Women in Sustainability Leadership Award, honoring her as one of the top ten most powerful women in sustainability. Amanda is the author of Creating Biophilic Buildings (2017). You can watch her 2018 TEDMED Talk here.


My career has been dedicated to advocating for architecture that connects people and nature, resulting in healthy communities and healthy eco-systems. For example:

A simple window in a hospital room has been proven to reduce hospital stays, and the amount of pain medication a patient needs compared to a room without a view.

Test scores have been shown to increase dramatically when kids have natural light in the classroom.

A study in the City of Portland, Oregon shows that there is a significant reduction in violent crimes in neighborhoods as the tree size and density increases.

Yet, our buildings are not shaped with nature in sight—literally, 45% of global office workers can not see a window from their desk. At TEDMED last November I explored how we got here. From how the incorporation of electricity relegated cooling breezes and natural heat to the backseat of design, to how our buildings became commodities, rather than a shelter that expressed unique cultures and climates. I asked the audience, “Why have we become inside creatures? Why have we passively accepted buildings that have separated us from nature?”

To answer this question—and to create a world full of buildings that are ‘habitats for humans’—I believe we need to turn to a concept of biophilic design, which translates literally to love of life. Biophilic design takes biophilia and applies it to the built environment, while specifically looking at the relationship between people and nature in our buildings and cities. When utilized, biophilic design creates spaces that are healthier and happier for people to be in.

At the International Living Future Institute, where I am privileged to serve as CEO, we decided to make biophilic design a core strategy for our flagship challenge program, the Living Building Challenge. Our work at the Institute is dedicated to creating a world full of living buildings and living communities, understanding that first, we must fundamentally shift the approach that people have toward nature and restore the relationship between the two.

Our buildings can be designed with that in mind. Designed to create spaces inspired by natural forms, spaces where we can feel the textures change under our feet, hear the sounds carried on the wind outside, where we can see the clouds move in the sky and smell the rain.

Watching my TEDMED talk, you will hear case studies of how biophilic design is changing schools, hospitals, and offices around the world, and see how it can re-establish a connection between people and land, with each other and all other living species.

Celebrating the Gift of Community

The following post was written by the TEDMED Team.


Civil rights leader Coretta Scott King once said, “The greatness of a community is most accurately measured by the compassionate actions of its members.”

As we reflect on the past year at TEDMED and the annual gathering that took place this November, King’s words resonate powerfully with us and the way we feel about our own community. From the Partners and Delegates whose thought leadership and creativity inspired us in Palm Springs, to the global audience that engaged in dynamic conversation via TEDMED Live, to the Speakers and Hive Innovators who shared their stories from the Stage, to the Research Scholars and volunteers who supported us with their expertise and enthusiasm, to the Editorial Advisory Board members who helped shape the Stage Program and provided us with guidance throughout the year—we are truly grateful to each and every member of our Community and the unique gifts they have contributed to TEDMED this year.

Clockwise from top left: Delegates in the Theater, an early morning group hike; the TEDMED 2018 Editorial Advisory Board; Stories Under the Stars evening event, hosted by RWJF.

Although this is the season of gift-giving,  TEDMED exchanges a slightly different kind of gift year round. A TEDMED gift is a unique idea or personal perspective connected to health and medicine that, when shared with others, can inspire their thinking and profoundly influence their lives. Each TEDMED Speaker shares a gift from the Stage, for example, at TEDMED this year, Carl June gifted the audience with the story of his journey to pioneering the revolutionary leukemia treatment, CAR-T cell therapy. Rabiaa El Garani helped us to see how hope and love are at the core of her work to help heal survivors of sexual violence. And Queen Dube shared how innovative and inexpensive solutions are saving the lives of thousands of infants every year in Malawi. The list of profound gifts that were shared by this year’s Speakers goes on and on, and we are looking forward to sharing their Talks with you starting in early 2019.

Rabiaa El Garani on stage at TEDMED 2018.

In addition to the gifts that are shared from the Stage, we believe that the greatness of our community is built upon the individual contributions of each member of the TEDMED Community. We’re proud to be a platform where people of all different backgrounds can come together, hold varied points of view, and participate in important conversations that contribute to our shared goal of improving the health of all humanity. This year’s volunteers and Research Scholars are prime examples of how bringing together people with compelling individual gifts to share helps to shape the community at large. For example, volunteer Pratik Chhetri brought his expertise in global health and biomedical research—contributions which have gained him recognition as an individual of ‘Extraordinary Ability’ by the U.S. Citizenship and Immigration Services. Meg Barron, a 2018 Research Scholar and Director of Digital Health Strategy at the AMA, brought her insight into ways we can improve patient and physician satisfaction.

TEDMED 2018 Speaker and Surgeon General Vice Admiral Jerome M. Adams with TEDMED Volunteers.

Taken together, it’s abundantly clear to us that the insight, generosity, and compassion of each individual is what makes the TEDMED Community truly great. We are excited to begin 2019 with a renewed commitment to the importance of fostering community. As you enter the new year, we encourage you to do so with the conviction that the most generous gift you can give is that of yourself.

So, what gift will you share with your community this year? Share your gift with us on social media using #TEDMED.

Exciting New Tech

Mapping human cellular biology. Single-letter gene editing. Bacterial infection diagnosis in mere hours. 3D-printed organs. A mobile ultrasound device that connects to your smartphone. Simple same-day health care. These are some of the bold, cutting-edge ideas from this year’s TEDMED Hive Innovators. In our final Speaker Spotlight of 2018, we’ll be featuring 6 companies that are driving progress in health and medicine. From improving the patient experience to developing new diagnostic tests, these Innovators are pushing the boundaries and thinking outside the box.

With all the advancements we’ve made in health and medicine, it may come as a surprise that we still do not have a map of our human cellular biology. If we did have such a map, computer models of disease progression could be more accurate, which would enable us to discover precision treatment options, faster. Fortunately, Ron Alfa’s team at Recursion is working to create such a map. By using a combination of machine learning and experimental biology, Recursion has set a goal of discovering 100 new drugs by 2025. With one drug currently in an FDA approved Phase 1 trial, and 30 more in the pipeline, the company is well on their way to reaching that impressive goal.

Many genetic diseases are the result of a single-letter misspelling out of billions of bases in the genetic code. However, current methods for gene editing don’t have the precision for making a single-letter correction. Nicole Gaudelli and her team at Beam Therapeutics are working to improve gene editing accuracy, by developing next-generation CRISPR base editing technology to conduct gene correction, gene regulation, gene silencing, and gene reprogramming at the most precise level of gene therapy. Whereas CRISPR is often compared to a pair of scissors, Beam’s base editing “is more like a pencil. When it reaches its target, it finds a letter, erases it and rewrites it as a different letter without disrupting the sequence of other letters around it.” Beam plans to use their gene editing platforms to prevent, modify, or even cure a wide range of diseases that affect people’s lives.

At Prellis Biologics, Melanie Matheu and her team have the ultimate objective of printing an entire vascular system of a complex organ in less than 12 hours. They’re already making important steps toward this goal, having succeeded in creating 3D printed blood vessels—a hurdle that many other companies have yet to overcome. Without a blood supply, cells are only able to survive for a certain length of time; as a result, ultra-high resolution printing is of utmost importance when it comes to developing microvasculature and scaffolding for human tissue. Prellis’s record-speed printing is paving the way for important medical progress and functional organ replacement options.

Day Zero Diagnostics (DZD) is using genomics and machine learning to modernize infectious disease diagnosis and treatment. Current diagnostic tests take 2-5 days to properly diagnose an infection, and this extended wait time is associated with an 8% increase in death per hour. However, Miriam Huntley and the team at DZD have developed a test that rapidly identifies bacteria and their antibiotic resistance profiles, so that patients receive the right antibiotic therapy within ours. By developing a much faster way to accurately diagnose bacterial infections, DZD not only has the potential to reduce hospital costs and the use of broad-spectrum antibiotics, but also to save patients’ lives.

For doctors, having access to an ultrasound machine when it’s needed can be a matter of life and death. However, many hospitals and clinics only have a limited number of ultrasound machines, and some are not able to afford them at all due to the high price tag. The team at Butterfly Network made it their mission to scale down the ultrasound—not only is their handheld probe pocket-sized, but it also costs significantly less than a traditional ultrasound machine. Their technology, called the Butterfly iQ, connects directly to a user’s smartphone and produces clinical-quality full body medical imaging. John Martin, Butterfly Network’s Chief Medical Officer, even used the device to detect a cancerous tumor in his neck on his own. Ultimately, the team at Butterfly Network aims to democratize health care by making medical imaging accessible and affordable—not just for doctors and hospitals, but for patients themselves.

Butterfly iQ

Working on reducing time spent waiting for more common services is Solv, a mobile app that helps people find and book same-day urgent care appointments. According to IBIS World, the Urgent Care Centers industry is growing at an average rate of 5.4% annual and has reached $28 billion in 2018. Heather Fernandez saw a clear opportunity, as well as inefficiencies, in the urgent care system and brought her experience in transparent consumer experiences to the world of urgent care coordination. By creating a seamless, simple, and price transparent interface for a patient to schedule their appointment with a highly-rated convenient care provider, Solv helps patients get the care they need, fast. On the provider’s end, Solv increases online bookings, helps manage appointments, and improves patient satisfaction at clinics and care centers. By easing the coordination of care on both ends, more people are able to get the quality care that they need, when they need it.

There is no question that the future is bright in the world of health and medicine. Each of the Innovators showcased above gives us a taste of what’s on the horizon in healthcare and science. With advances like 3D printed organs, rapid bacterial infection diagnosis, and portable ultrasound imaging, it’s easy to be excited and optimistic about the future of health and medicine. You can check out the full group of 2018 TEDMED Hive Innovators TEDMED.com. If you’re joining us in Palm Springs next week or participating in TEDMED Live, you will see all 16 Innovators speak during the Audacious Session. Be sure to join the conversation surrounding TEDMED 2018, which is taking place November 14-16, using #TEDMED on Twitter, Instagram, and Facebook.

There’s Hope in Our Mortality

Hope is defined as a feeling of expectation and desire for a certain thing to happen. So when we tell you that several TEDMED 2018 Speakers have taught us how to find hope in places such as serious illness and end of life, you might be surprised. Despite the initial discomfort of discussing such difficult topics, there is much to learn from conversations around end of life and cancer diagnoses. Whether it be through sound, support, or a little bit of humor, each of these Speakers has a unique approach to what it means to take on the challenges that life brings us with hope , and their insight can help us learn to become more comfortable and capable of having those difficult, yet critical, conversations about what it means to truly live.  

With a focus on making every moment of our life, down to our last breath, comfortable and full, Steve Pantilat, Chief of the Division of Palliative Medicine at UCSF, works on transforming the healthcare system to improve the quality of life for people living with serious illness and their families. Steve has spent much of his career focusing on how to preserve dignity in some of life’s most vulnerable moments, such as finding better ways to care for people in hospice. As the founding director of the national Palliative Care Quality Network (PCQN), a learning collaborative focused on how to improve palliative care across health care, Steve is creating new ways for doctors and hospitals to collaborate around providing comfort and hope to those living with serious and terminal illnesses. Steve has published over 100 peer-reviewed scientific papers, including one documenting how to set up similar networks to PCQN. While the conversation about death is a critical one to have, Steve’s doing important work to ensure that each person’s wishes are honored during their most vulnerable and difficult times in health care.

While Steve is designing resources for physicians, Yoko K. Sen is designing new hospital experiences for patients. As an ambient electronic musician, Yoko is tuned into sounds in ways that most of us are not. This acute sense was overstimulated when she was admitted to a hospital in 2014 and bombarded with harsh noises from various hospital equipment. This pushed her to ask the question: How do these disturbing sounds impact a patient’s wellbeing and dignity? This question inspired her to found Sen Sound, which not only looks at the impact that alarms and monitors have on the patients in a hospital but also how they affect the hospital staff. Yoko investigated these questions further as the artist-in-residence at Johns Hopkins University’s Sibley Innovation Hub. Turns out, with alarms going off constantly, physicians and patients develop “alarm fatigue” where they stop noticing the alarms altogether. Her effort to redesign the soundscape in hospitals is not merely about eliminating sound but designing the right sound experience for each person. Projects such as My First Sound and My Last Sound think about how to use the hearing sense to provide the best and most positive holistic experience for our most vulnerable populations at the ends of the spectrum of life.

At 34, Kate Bowler was a historian at Duke Divinity School and published author of the “first history of the [American Prosperity Gospel] based on divine promises of health, wealth, and happiness.” A year later, she was diagnosed with Stage IV cancer and confronted with the irony that was being an expert in the idea that good things happen to good people while facing serious illness. Channeling the mixture of emotions that come with such a diagnosis, Kate launched a national conversation about the discomfort we experience while talking about suffering to help not only herself but all of us learn to find hope and comfort in difficult conversations. Often using tongue-in-cheek titles for her articles and books, Kate finds ways to infuse humor into the serious discussions around pain and suffering, helping the reader engage with the difficult content. Aiming to ask the tough but necessary questions such as “What does the suffering person really want?” and “How can you navigate the waters left churning in the wake of tragedy?”, Kate wrote another book, Everything Happens for a Reason (and other lies I’ve loved), and currently hosts a podcast “Everything Happens”. On her show, she interviews guests about topics such as communication, love, and loss when facing illness and death, showing us how to be more comfortable talking about pain.

Whether it be the beginning or end of life, we all wish for our loved ones, and ourselves, to find dignity in the process. Sometimes that means embracing difficult conversations to know what ones’ last wishes are, and other times that means providing support for physicians to provide more options for those suffering. It can include redesigning our sensory experience of a hospital or developing a hospice plan that includes support for all the family members impacted. These Speakers are teaching us how to find hope and beauty in difficult situations and paving the way through what often feels like a dark forest of uncertainty. Be sure to tune into TEDMED 2018 next week, whether in person or online through TEDMED Live, to hear more about their unique perspective on what care can look like in the rawest moments.

A Culture of Health captured in fiction

The Robert Wood Johnson Foundation (RWJF) works with organizations across the United States to build a healthy future where everyone has the opportunity to live their healthiest life possible. RWJF calls that vision: a Culture of Health. Each year, through our partnership with RWJF, TEDMED has been able to share with the TEDMED Community some of the ways in which that Culture of Health vision is building momentum and influencing change.

This year at TEDMED, the Foundation is giving the TEDMED Community a sneak peak of a forthcoming anthology of short stories by some of today’s most thought-provoking futurist and fiction writers. This inventive book, titled Take Us to a Better Place: Stories of Health, Hope, and Healing, offers a creative way for readers to imagine what a healthy future might look like. The stories explore some of the opportunities and risks that reside in that future.  As Michael Painter from RWJF observed, “The invitation to these amazing writers was a broad one, without real requirements. Well, just one: use your imaginations and make us think. Help us imagine what a Culture of Health might be.”

We are excited that the Foundation is sharing a glimpse into this imaginative look at a future Culture of Health. Not only will we learn more about six of the stories, but we will meet five of the short story authors. The five authors will be with us this year to provoke conversation about the topics and themes of their stories. Below, we’re teasing you with just a bit about each of the stories we will share at TEDMED this year – we hope they spark some inspiration about a Culture of Health! If you’re joining us at TEDMED this year, we can’t wait for you to meet the authors, engage in conversation about their work and visions, and read a preview of their story.

Take Us to a Better Place: Stories of Health, Hope, and Healing will be released Spring 2019. Sign up to explore this collection of new, original stories: https://rwjf.ws/2S0STb0

“The Flotilla at Bird Island,” Mike McClelland
“The Flotilla at Bird Island” is set in near-future Atlanta, a city plagued by rising temperatures and large racial and financial divides. The ice caps have melted, leaving Atlanta as the most significant city in the Eastern United States and the capital of the “New Coast.” Every Atlantan carries an inhaler, wears protective jumpsuits and surgical masks, and requires a monthly cocktail of injections to fight the waves of new, aggressive diseases that have appeared as a result of the hotter, wetter world. But, on nearby Bird Island, life of all kinds is thriving, showing what is possible.

“Brief Exercises in Mindfulness,” Calvin Baker
“Brief Exercises in Mindfulness” is the story
of a group of recent college graduates
who have moved to Brooklyn and the
long-term residents they have displaced.
The story revolves around an apartment occupied by Dean, a fledgling technology entrepreneur, consumed by the ambition
to succeed at all costs, including his own
well-being, and his roommate Harry, a
public school teacher torn between the
desire to be of service to the world and his own neuroses.

“Return to Omelas,” Nayomi Munaweera
“Return to Omelas” is Nayomi Munaweera’s response to the questions raised in the legendary writer, Ursula K LeGuin’s famous short story “The Ones Who Walk Away From Omelas.” LeGuin’s story imagines a utopian society in an unspecified country. Every citizen lives free of the slightest sorrow; their lives are without sadness. Yet each of them knows that this perfect happiness is based upon the absolute suffering of one of their own. A child has been locked up in a dark room. The child is meant to suffer, and it is the reason for the city state’s perfect happiness. How long can it continue?

“Paradise,” Hannah Lillith Assadi
“Paradise” is a story about Rita, a
Syrian refugee, who lives in a low-income housing complex in Phoenix, Arizona with
her father and older brother. Before the story begins, Rita’s mother was killed in Aleppo
and Rita is plagued by troubling visions at night. Before going to bed, Rita often tries
to visualize paradise, following from a
proverb her mother often said to her about paradise residing beneath the feet of
mothers, but rather than paradise, Rita sees visions of the war.

“Viral Content,” Madeline Ashby
When Tacoma, Washington’s local high school football star, Tyrone Weathers, dies of an unknown illness, Glory, a young reporter, is determined to identify the cause of his death and inform the community. In her mission to report the story, Glory finds herself competing with special interests – the local sports culture, monopolistic media outlets, and capital – to cover this potentially deadly disease before it spreads any further. Glory persists in her investigation despite the challenges she faces, and she discovers that the source of the illness that took Tyrone’s life is a secret darker than any she could ever imagine.

“The Sweet Spot,” Achy Obejas
As if managing the day-to-day responsibilities of work and two young kids isn’t stressful enough for married couple Isa and Louise, a lover appears on the scene, Esther. Told from Isa’s point of view, “The Sweet Spot” by Achy Obejas traces the erosion of a once strong romantic relationship in a way that mirrors Isa’s gradual loss of hearing.

The Spread of Disease

It’s no secret that we humans are a pattern-seeking species, trying to organize the chaos that is our universe, our planet, and possibly our closets. This powerful ability allows us to make predictive models of all kinds, shapes, and sizes, unlocking the understanding of how things grow, survive, and deteriorate. This week we’ll be focusing on how scientists and innovators have applied these predictive skills when looking at how disease spreads across a species in order to best predict, or prevent it. Whether it’s geo-mapping zoonotic viruses or the fluid dynamics of a sneeze, you are sure to learn a thing or two at TEDMED 2018 about how pattern recognition could be our best shot at preventing the next pandemic.

With the recent outbreak of Ebola in the Democratic Republic of Congo, we are once again reminded just how vulnerable humans are to viral threats. It’s with these types of threats in mind that leaders gathered to form the Global Virome Project (GVP), an innovative partnership to detect the majority of our planet’s unknown viral threats. Partners are working to develop a global atlas of these threats, with a goal of identifying and characterizing 99% of zoonotic viruses within 10 years of its inception in 2016. With an approximate 1.6 million viral species yet to be discovered in mammal and bird populations, there is much work to be done. Patterns will likely emerge as the map gains more detail, and thus the security system of prevention for these potential epidemics will increase in strength. Thanks to the work of Jonna Mazet, Anchor Author of the GVP, and her team, we can look forward to a future that will be focused more on prevention, and require less reactive treatment.

Mapping viruses are tricky for many reasons, one of which is animal populations shifting geographically. With the average global temperature on the rise, a lot of animal populations are disappearing in some locations, or migrating to new homes, and bringing their zoonotic viruses with them. Daniel Streicker, Senior Research Fellow and head of the Streicker Group at the University of Glasgow Institute of Biodiversity, is working to anticipate and prevent infectious disease transmission between species. Daniel is using patterns from the data of longitudinal field studies in wild bats to forecast how a disease like rabies could spread, giving the government the information they need to take preventative actions.

While it takes a bite for a vampire bat to spread rabies to humans, there are many diseases that spread through fluid transmission. Lydia Bourouiba focuses her research on exactly how fluid dynamics impact disease transmission by finding patterns in events like a human sneeze or cough. As the director of the Fluid Dynamics of Disease Transmission Laboratory at MIT, Lydia combines multiple disciplines to analyze pathogen transmission in humans, animals, and plants. Through their research, her team is developing models that improve our understanding of pandemics, and ultimately finding new ways for us to improve prevention and preparedness. By taking a close look at how a splashing droplet radiates its splatter, her team is able to see how much coverage a droplet of pesticide gets on a leaf. Prior to their work, studies of this kind were focused on more steady configurations, like water from a faucet. By looking at unsteady configurations, like sneezes and sprays, Lydia and her team are helping us to better understand the dynamic process of disease transmission.

Playing with fluid dynamics in a different way, Hive Innovator David Hoey and his team at Vaxxas are developing an advanced platform for needle-free vaccine delivery. Based in Australia, Vaxxas has run clinical trials of their Nanopatch™ technology to deliver vaccines, including one for Polio. While the format is revolutionary, using an ultra-high-density array of short projections to deliver the vaccine to the immune cells immediately below the skin’s surface, that’s not the only incredible aspect of this technology. By packaging the vaccine in the Nanopatch™, they have also made the vaccine shelf stable without refrigeration for more than a year at room temperature. This breakthrough solves one of the greatest challenges remote areas face with vaccines: the high cost of refrigerated transport of these life-saving serums. With their outstanding work, the team at Vaxxas is providing hope that we will one day be able to prevent and stop epidemics and pandemics.

Whether it’s by researching fluid dynamics like Lydia, or documenting the geolocation of the world’s zoonotic viruses like Jonna, it is clear that patterns are the key to preventing the spread of disease. Once we find those patterns, like Daniel did with bat migration, we are able to be smarter about vaccination resources and threat awareness. Fueling efforts for smarter preparedness are companies like Vaxxas, who is working to discover new ways to design vaccines in order to provide protection for the world’s most vulnerable populations. We hope you will join us at TEDMED 2018 to learn more about these fascinating Speakers and Innovators and their work to understand and prevent the spread of disease.

Communication Build Up and Break Down

The nervous system is the information highway of our bodies. So, what happens when there’s a traffic jam, or a rogue traveler refusing to go with the flow? This week’s Speaker Spotlight will focus on those who are working to understand how this system works, and what happens when it doesn’t. Communication in the nervous system is dynamic, ranging from electrical signals to the transfer of genetic material, and the communication can come from some unlikely places, like our gut. This communication is critical, and when it breaks down, we see a variety of ailments and illnesses emerge. The question is, how can we stop this communication breakdown?

A good place to start is to establish just how our neural network communicates. Jason Shepherd, an associate professor at the University of Utah, studies how the brain stores information, as well as how these processes can malfunction due to neurological disorders and age-related cognitive decline. Jason and his team at Shepherd Lab have discovered how Arc, a neuronal gene protein that is critical for long-term memory and synaptic plasticity, is able to form viral-like capsids capable of transporting RNA. Jason sees that the larger implications of this discovery could transform genetic engineering and gene therapy, as many gene therapies often use viruses foreign to the human body, and this protein is native to it. As we learn more about how our nervous system transfers information, we remain hopeful that scientists like Jason will be able to find ways to prevent the communication breakdown from occurring.

When blood flow in the brain is disrupted, leaving the neural communication system without oxygen, a communication breakdown occurs. This can have devastating effects on a person’s life, making stroke prevention and treatment critical for our internal information interstate. According to the American Stroke Association, stroke is the fifth-largest cause of death in the United States, killing nearly 130,000 people a year. It is also a leading cause of long-term disability and the leading preventable cause of disability. Inspired by the loss of a patient who would have benefitted from more immediate care, Chris Mansi and his team at Viz.ai got to work developing an artificial intelligence (AI) platform to dramatically reduce the amount of time it takes to detect and triage strokes. Using machine learning software to evaluate brain scans, Viz.ai’s technology is getting critical patients into treatment faster. In February 2018, the FDA granted a de novo clearance for Viz LVO, the first-ever computer-aided triage and notification platform. Most recently, Viz.ai announced its second FDA clearance for Viz CTP through the 510(k) pathway, offering healthcare providers an important tool for automated cerebral image analysis. While the brain is getting choked by a blood clot or bleed, Viz.ai has found a way to improve the communication system outside the body to treat it.

Sarkis Mazmanian, the Luis & Nelly Soux Professor of Microbiology in the Division of Biology and Biological Engineering at the California Institute of Technology, is looking at how unlikely systems are interacting with the nervous system and impacting brain function. With the majority of research for neurodegenerative diseases, like Parkinson’s Disease, focusing on the brain, Sarkis has turned to the gut, looking specifically at the microbiome and how it communicates with the brain. There are a variety of ways in which scientists are studying the relationship between the gut and Parkinson’s, as well as Alzheimer’s disease. Sarkis focuses on how the specific microbes in a person’s gut can impact the brain. In addition to researching how the gut microbiome impacts our nervous system, Sarkis has done extensive research on the relationship between the gut microbiome and the immune system focused on answering the question: why are these bacteria not attacked by our immune system? Sarkis’s team found that the immune response to these bacteria actually benefits both the bacteria and the host. With his most recent published work focused on how the gut microbiome impacts locomotor behavior in fruit flies, Sarkis continues to deepen our understanding of how our microbiome communicates with our bodily systems.

While a good diet and proper sleep are good for everyone, they can be especially impactful for those who may be prone to Alzheimer’s disease. Zooming out of the microbiome and zooming back into the brain, Padideh Kamali-Zare created computational models to understand the role cell structures play in their function during her PhD studies in Sweden, and she has applied this learning to how Alzheimer’s progresses in the brain. At Darmiyan, Padideh and her team are developing software that can detect Alzheimer’s disease up to fifteen years before symptoms of cognitive decline. Using just regular brain MRI scans, Darmiyan produces maps and scores that can detect the progression of the disease. With early detection, they aim to dramatically change lives and therapeutic development, including incorporating the best candidates for clinical trials in new therapies. By alerting individuals earlier about the potential onset of Alzheimer’s disease, Darmiyan’s technology can empower them to take steps to delay cognitive decline.

Today’s healthcare system places a heavy emphasis on healing the body, but often less so on healing the mind, leading to mental health issues that slip past doctors unnoticed and untreated. And where a mental health need is detected, physical care providers are often disconnected from our outnumbered mental health professionals, making care coordination and referral difficult, at best. Quartet Health is focused on bridging this divide, by providing primary care providers with the technology and tools to identify patients who need care. To do so, Quartet connects primary care providers with four key stakeholders: patients, behavioral health clinicians, medical health providers, and payers. Robert Accordino, Chief of Behavioral Health at Quartet, will join us in Palm Springs to share the exciting potential of Quartet’s approach that connects care of the body with the care of the mind.

Yuri Maricich and his team at Pear Therapeutics are taking a radically different approach to treat matters of the mind. By literally reshaping how we think about therapeutics, Pear has found a way to treat substance abuse, mental disorders, and neurodegenerative diseases—wherever and whenever. Based on the premise that software not only has the power to change behavior, but can also change brain function, Pear created their first app, reSET, to help treat patients with substance use disorder. reSET, a Prescription Digital Therapeutics (PDT), is the first of its kind to receive FDA approval, distinguishing it from the 10,000 other apps that may show up when you search the App Store. Through their work, Pear is finding new ways to repair the brain’s communication system while also providing a better communication system between patients and doctors.

While there is still much to learn about how the human brain functions and communicates, it is clear that we are making significant progress. Whether that is identifying Alzheimer’s disease earlier or improving how we provide treatment for mental health conditions, there are many ways that scientists, researchers, and entrepreneurs are improving our understanding of our body’s vast information highway. With improved understanding, we also are able to develop better technologies and treatments for diseases and disorders of the brain. These exciting discoveries in how the brain functions, as well as innovative ways to treat brain diseases, are shining a light toward a healthier future.