TEDMED 2014 Day Two: Thinking Hard, Playing Hard

The second day of TEDMED tackled some of the toughest topics in health and medicine, including addiction and the growing plague of antibiotic resistance, with musings on the power of transparency and simple play.

What can human doctors learn from veterinarians? Quite a bit, as Barbara Natterson-Horowitz, Professor of Medicine in the Division of Cardiology at UCLA Medical School, revealed. From recognizing and treating issues from postpartum depression to heart disease, physicians would be well served to learn from veterinary medicine for tips on how to treat human animals, she said, adding, “What do you call a veterinarian who can take care of only one species?  A physician.”

Abraham Verghese, professor at Stanford University’s School of Medicine, spoke of the metaphors in medical language, and why illnesses and healing present compelling human stories (perhaps why so many doctors are also wonderful writers).  “Anybody with a curiosity for the human condition, with the willingness to work hard, and with an empathy for fellow humans, can be a great physician,” he said.

Can eating be addictive? Nora Volkow, Director of the National Institute of Drug Abuse, explained a bit of the neurobiology behind why drug addiction is not a moral failure due to a reduction in dopamine receptors – which holds true for those addicted to food as well.

“Addiction and obesity have been stigmatized and dismissed as disorders of poor self-control, self inflicted, personal behavioral choices. I never ever met an addicted person who wanted to be an addict, nor have I ever met an obese person who wanted to be obese. Can you imagine what it must be to want to stop doing something, and not being able to?” Volkow said.

Carl Hart

Carl Hart

Carl Hart, who emerged from a youth of petty crime and drug use to teach psychology and psychiatry at Columbia University, also weighed in on myths of addiction. Up to ninety percent of those who use illegal drugs are not addicts, he said, and drugs don’t necessarily lead to a life of indigency and crime. “We certainly were poor [in my neighborhood] well before drugs entered the picture,” he said, and criminalizing drug possession only contributes to a downward spiral.

In the session appropriately titled, “Don’t You Dare Talk About This,” organ donation advocate Sigrid Fry-Revere spoke of the hurdles of kidney donation, from getting an organ to giving one. Her proposition: Why not help donors financially, as other countries do to good effect, most notably in Iran.

Dr. Leana Wen urged doctors in the audience to declare any financial incentives – including to do more or less treatment – that may influence their decisions in the “Total Transparency Manifesto” movement she founded.

Carla Pugh had a call to medicine as well – to take training beyond pen-and-pencil tests to extended haptic training. A childhood spent fixing things, a life-or-death moment in the ER, and her own research into how often med students miss bodily cues, led to her creating her own patented haptic training tools.

Carla-Pugh_10

Carla Pugh

Science writer and author Kayt Sukel spoke of the neurological benefits of risks — and risky play — even though some choices, particularly those kids make, look silly to the rest of us. There’s a big cognitive payoff in terms of brain growth to new experiences, she said, and an especially big bounce when gambles pay off. It also pays to expect the unexpected; “Every single day is a risky one, because in this life there’s very little that is guaranteed,” she said.

Click here for speaker highlights from Day One of TEDMED 2014.

TEDMED 2014 Session Nine: I Was Just Thinking Too Small

When Robert Hooke looked into a microscope and decided the structures he saw should be named cells, it was an epic moment for scientific probing. It has brought to fruition the longing to see how things really work at their most basic levels, and the ingenuity to devise ways to explore.

Sometimes, however, approaching a mystery or positing a breakthrough means stepping back and applying a wider lens. What if solving a problem means reframing it entirely?

This ninth and final session of TEDMED 2014 is all about taking a look at the bigger picture.

Tomorrow is your last day to register, so don’t miss your chance to join us September 10-12 in Washington, DC and San Francisco, CA.

Screen Shot 2014-09-02 at 3.11.29 PMScreen Shot 2014-09-02 at 3.11.47 PMScreen Shot 2014-09-02 at 3.11.58 PMScreen Shot 2014-09-02 at 3.12.08 PMExplore our full stage program to learn more about all the speakers who will take the TEDMED stage in just over a week, and stay updated by following @TEDMED on Twitter.

TEDMED Stage Program by the Numbers

Numbers2

As we count down the days until TEDMED, we present a numerical look at the speakers for TEDMED 2014.

Some fun facts:

This year, we’re particularly proud that 45 of our speakers – 51 percent – are women.  As we ramp up to an eventual global presence, we’ve invited speakers from 20 nations and five continents.

They also represent a wide variety of interdisciplinary brilliance:  22 MDs, 26 PhDs (10 overachieving MD/PhDs and one hyper-overachieving college dropout), lawyers, architects, economists, journalists, entrepreneurs, an extreme athlete, acrobaticalists, global musicians, comedians, actors, dancers, photographers, and a man who gets a lot of mileage out of his pink tutu.

TEDMED Speakers: Stealing Solutions to Medicine’s Toughest Problems

shutterstock_22354027In four short weeks TEDMED 2014 officially kicks off and we are excited to continue highlighting our sessions with you. Next up, we are pleased to present “Stealing Smart,” a session during which speakers will share inspiring stories and ideas about how we can adapt solutions from other industries, and from other fields both inside and outside of medicine, to solve the most intractable problems in health and medicine. This session is dedicated to the idea that sometimes we need to look outside the realm of health to solve the complex issues within.

There’s still time to join us at TEDMED in Washington, DC or San Francisco, CA to experience how these dynamic thought leaders are accelerating health and medicine by “stealing smart.”

Brian Primack, Associate Professor at the University of Pittsburgh, will shed a provocative new light on the health impacts of existing and possible future relationships between certain popular media products and human behavior.

Barbara Natterson-Horowitz, Professor of Medicine in the Division of Cardiology at UCLA Medical School, will provide a surprising perspective on how human wellbeing, including mental health, can be improved with insights into animal health.

Ramanan Laxminarayan, Director of the Center For Disease Dynamics, Economics, and Policy, will discuss an unusual yet imminently practical approach to conserving antibiotics.

Engineer and entrepreneur Drew Lakatos is the CEO of ActiveProtect, a wearable technology company focused on reducing injury with smart garments that monitor mobility, detect falls, and intervene prior to impact.

Neuroscientist Nora Volkow, director of the National Institute on Drug Abuse at the NIH and a world leader in the neurobiology of diseases of reward and self-control, will apply a lens of addiction to the obesity epidemic.

Dominick Farinacci, trumpeter and protégé of Wynton Marsalis, will perform. He leads the Lincoln Center expansion in Doha and has played music in the lobby of the Cleveland Clinic.

Leslie Morgan Steiner, journalist and author, will bring the audience along on her journey to learn the truth about a successful medical surrogacy industry on the far side of the world – and how it could provide a model to help solve problems in the U.S.

Abraham Verghese, Provostial Professor and Vice Chair for the Theory and Practice of Medicine at Stanford University’s School of Medicine, will share compelling insights into the impact of language on health.

Zachary Copfer, former microbiologist and now an MFA in photography from the University of Cincinnati, will share awe-inspiring images in which the world of medicine is the medium as well as the message.

With the goal of creating “spare parts” for human implantation and disease models, Nina Tandon founded Epibone, the world’s first company to grow living human bones for skeletal reconstruction.

Both a forensic toxicologist and an attorney, Stephen Goldner is the Chairman and CEO of CureLauncher, a free, consumer-friendly resource that connects patients to clinical trials based on their unique goals and conditions.

TEDMED 2014 Session Three: Achieving the Seemingly Impossible

Find a way.” – Diana Nyad

What lies on the other side of self-imposed limitations? Lab tests at your neighborhood pharmacy that use a single drop of blood. A breathtakingly simple way to stop HIV/AIDS in its tracks. A completely counter-intuitive way to address doctor shortages in developing countries. An endurance feat so extreme that it redefines the phrase “will to succeed.”

Speakers for Session Three of TEDMED 2014 will make you rethink the limits of what is possible.

Flat Out Amazing

Elizabeth Holmes, founder and CEO of Theranos, will share the amazing medical insights and technology that have put her on the cutting edge of high-tech diagnostics.

Gail Reed, founder of Medical Education Cooperation with Cuba and editor of MEDICC Review, is a former journalist who will spotlight a completely counterintuitive program to relieve the global shortage of physicians in poor countries.

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Marathon swimmer Diana Nyad will share lessons of her world record-setting solo 110-mile swim from Cuba to Miami at age 64.

Marc Koska, inventor of a life-saving syringe, will share the struggles, setbacks, breakthroughs and ultimate triumphs of this technology’s 30-year odyssey from “great idea” to “globally adopted reality.”

Foteini Agrafioti, a biometric and personal security engineer, will share how your EKG and emissions from your ear may be an alternate kind of fingerprint for you.

Kitra Cahana, one of National Geographic’s youngest photographers, will tell a moving and inspiring story of a medical catastrophe that turned into an unexpected journey into realms of spirituality and imagination.

Click here to register for the event in Washington, DC or in San Francisco, CA.

Killing them softly: Andrew Read’s tactics would stop mosquitoes without resistance

Andrew Read is firing some of science’s latest salvos in the fight against malaria, including a resistance-proof green pesticide

Vector-borne diseases (VBDs)  – deadly viruses and bacteria born by mosquitoes, ticks and fleas – have been gloomy landmarks on the pages of human history, particularly after massive scourges like the fifth-century Plague of Justinian wiped out some 25 to 100 million people in the Eastern Roman Empire and heralded the beginning of the Dark Ages in Europe. And #justonebite from a disease-carrying insect, as the World Health Organization (WHO) Twitter campaign for World Health Day reminds us, is all it takes to contract one.

Mosquito eggs hatching in water. Image: Shutterstock

Mosquito eggs hatching in water. Image: Shutterstock

Malaria kills some 627,000 people each year; in 2012, about 460,000 of them are children who died before their fifth birthday – that’s one child death per minute.  Dengue is otherwise known as “bone-break fever,” due to its wracking effects. Chikungunya, a virus spreading rapidly in the Caribbean, brings headache, joint pain and rashes. No wonder just thinking about these gives us the shivers, a fact Bill Gates drove home when he released a jar of mosquitoes into the room at his TED talk in 2009, saying, “Not only poor people should experience this.”

This unsettling move was prescient; we normally think of these diseases as problems only in poor nations like many in Africa, but thanks to globalization and climate changes they’re getting closer to or diving more deeply into the U.S. Someday, West Nile virus, dengue and perhaps Chikungunya may become facts of life here.

Many of these are killers without a cure, so humans have set our wits to defeating them one way or another.  We’ve tried pesticides; environmental control; shields like clothing and bed nets. TEDMED 2012 speaker Andrew Read, biologist and Director of the Center for Infectious Disease Dynamics at Penn State University, has other ideas: He’s attacking viruses where they live, inside a mosquito’s body.

Read is working with Mathew Thomas, a fellow entomologist, to grow a pathogenic fungus that infiltrates a mosquito’s organs, eventually killing it before the malaria parasite it may harbor matures enough to become contagious, a period of about 12 days. The fungus, which shows no harm to humans, can be sprayed on walls, floors and standing water inside a home.

The fungus aims to be an evolution-proof insecticide. Indoor spraying is still a cornerstone of malaria control, but mosquitoes eventually breed resistance to strains of pesticides if they’re killed immediately, and we don’t have that many new chemical options with which to attack them. Plus, killing all of the world’s mosquitoes could have unforeseen ecological consequences. Instead, Read’s formula kills the bugs more slowly, so that the female has time to lay eggs before expiring.

Read has devoted the majority of his career discovering how infectious diseases evolve, particularly the malaria parasite. As he discussed at TEDMED 2012, there are two ways to combat resistance:  a “drugs-bugs” arms race, in which the bugs are already slowly winning; or evolutionary management, trying to shape the bug populations of the future, which which we’ve done a lousy job so far, he says, in part because many scientists don’t fully understand evolutionary biology.

Andrew Read at TEDMED 2012

“If we’re really serious, we’ve got to start measuring things, like the selective forces happening when we hit these bugs. We need to think if we can retard or even stop the evolution that undermines our marvelous technology.

“When we attack life, life evolves back. We are picking  a fight with natural selection, and natural selection is one of the most powerful forces in the universe. Going into a fight without Darwin is like going to the moon without Newton,” Read said in his talk.

Nevertheless, his solution hasn’t yet gone to trial. Funding for his efforts and similar ones is scarce, Read says, adding, “Killing bugs is just not sexy.” The global research and development budget is small in proportion to the severity of malaria’s harms. Of that, the vast majority goes toward tinkering with chemical solutions to kill the messengers, while only about 4 percent goes toward actual vector control; that may change, Read says, as resistance continues to build, as it is in some areas, including West Africa.

If diseases in Chikungunya do spread into the U.S., and there is political pressure for a greener, non-chemical solution, ideas like his may gain more traction. One sign:  His colleague Matthew Thomas is working on a fungal agent to kill bedbugs — an idea that’s already received much attention as their numbers grow in the U.S.

Stacy Lu

Commentary: On Uber for Health Care

By Ali Khan, M.D., Tasce Bongiovanni, M.D., and Ali Ansary

Let’s get the disclaimer out of the way: We love Uber.

As physicians with roots in the Bay Area, we use Uber all the time. The service is convenient, (usually) swift and consistently pleasant. With a few taps of a smartphone, we know where and when we’ll be picked up — and we can see the Uber driver coming to get us in real time. When the vagaries of San Francisco public transit don’t accommodate our varying schedules, it’s Uber that’s the most reliable form of transportation. (It might be that we like having some immediate gratification.)

So when we caught wind of the news that Uber’s founding architect, Oscar Salazar, has taken on the challenge of applying the “Uber way” to health care delivery, there was quite a bit to immediately like. From our collective vantage point, Uber’s appeal is obvious. When you’re feeling sick, you want convenience and immediacy in your care — two things Uber has perfected.

And who wouldn’t be excited by the idea of keeping patients out of overcrowded emergency rooms and urgent care waiting rooms? The concept of returning those patients to their homes (where they can then be evaluated and receive basic care) seems so simple that it’s brilliant.

Even better, in an era where health care costs are on the minds of many, Uber’s financial structure offers the promise of true price transparency for consumers — a rarity in current American health care. Imagine a system in which, from day one, patients understand how much their care will cost them. That’s the kind of disruptive innovation for which there’s already considerable market demand (as evidenced by the other players in this space); its potential to effect a sea change in health care delivery is even greater.

As physicians deeply immersed in the health policy and innovation arenas, we naturally “get it.” So, then, are we cheering for Uber Health?

Hardly.

Lest you lump us in with Jessica Seinfeld, however, allow us to explain ourselves.

Our concern rests on the potential negative externalities that a disruption like Uber, previously validated in a rational market, can generate when introduced to an irrational one, like health care.

In American medicine these days, many of us are hard at work trying to bend the proverbial cost curve. Considerable research suggests that we can generate significant savings through early, aggressive management of medical problems in the primary care setting — before they lead to the emergency room visits, disease progression, inpatient hospitalizations and subsequent complications that cost billions.

The “Uber way” might tackle part of that challenge, through the avoidance of those expensive ER visits (and, by extension, potential hospitalizations). By encouraging one-off visits from physicians at home, however, that model ignores the longitudinal primary care component that enables the execution of that prevention strategy. In doing so, it fails to capture a critical aspect of the existing value proposition in health care delivery. Most people, after all, wont’ be calling Uber for an elevated cholesterol level or a screening colonoscopy.

For what it’s worth, other actors in the health innovation arena understand the necessity of that longitudinal component. The blossoming concierge medicine industry offers a primary care home with exclusivity. Meanwhile, health care startups such as Iora Health (where one of us works) and One Medical Group promise radically re-envisioned primary care clinics as a critical element of the next social transformation of American medicine. Still others, such as Sherpaa and the health insurance startup Oscar, coordinate services similar to the Uber home visits but within the context of insurance coverage, embedding those visits into a comprehensive model of integrated primary and secondary care.

Technological innovation, at face value, is an incredible tool for social change. Many of the nation’s hottest start-ups often make a moral (or “solutionist“) argument for their work. At times, the products they offer can appear more like innovation for innovation’s sake — technology that is created for no obvious social purpose. But we choose to consider an alternative argument.

We posit that technology has vast potential as a social good — potential that as of yet remains unrealized. The “Uber way,” if considered carefully with a robust medical “home” (be it the patient-centered medical home or otherwise) at its center, could produce positive externalities that impact the lives of millions. Without that core, however, the Uber model runs the risk of becoming yet another example of innovation forged in a vacuum, providing health care on demand — and ignoring the need to contextualize that care within the longitudinal narrative of one’s overall health. We thus offer a path to mitigate that risk for “Uber Health’s” future customers — and that’s a solution for which we’d be willing to wait.

And let’s not even get started on surge pricing during flu season.

Ali Khan, MD, MPP is an internist at Yale-New Haven Hospital and a clinician-innovator at Iora Health. He currently serves as the chair-elect of the American College of Physicians’ National Council of Resident/Fellow Members. Tasce Bongiovanni, MD, MPP is a Robert Wood Johnson Foundation Clinical Scholar at Yale University and a surgical resident at the University of California, San Francisco. Ali Ansary is the founder of SeventyK.org, a TEDMED 2012 speaker and a senior medical student at Rocky Vista University.

Guests posts do not reflect the opinions of TEDMED.

Finding the hidden music in your DNA

In his talk at TEDMED 2013,  Mike Pazin, Ph.D., Program Director for Functional Genomics at the National Human Genome Research Institute (NHGRI), compared different parts of the genome to the lights and switches in a skyscraper. Protein-coding genes are like a building’s lights: they’re easy to spot and determine function, but they’re only 1 percent of the genome.

The rest of the genome is non-coding DNA, which is being mapped by NHGRI’s Encyclopedia of DNA Elements (ENCODE).  How is the group mining data, and what will it uncover about the work of these genes?  How will the results help predict disease risk and point the way toward the most effective therapies?

Dr. Pazin explains:

Mike Pazin: Can collaboration help unlock more DNA secrets?

Join a live online Google+ event this Thursday at 2PM ET to discuss latest advances in human genome research and how they may play out in clinical use.  Click here for more information and to sign up.

TEDMED speaker Lisa Nilsson to show new bodies of art

TEDMED 2012 speaker Lisa Nilsson, who wowed the audience with her fantastic paper sculptures of human anatomy, will show her latest work,  a series called “Connective Tissue” in New York City from October 10 through November 9th at the Pavel Zoubok Gallery.

Nilsson constructs the pieces with tightly curled, 1/4-inch-thick strips of Japanese mulberry paper and the gilded edges of old books, using a centuries-old process called quilling, or paper filigree. This painstaking technique — larger pieces take Nilsson about two months to complete — was popular with nuns and the aristocracy from the 13th through 18th centuries.

Angelico (detail) 2012,  mulberry paper and the gilded edges of old books. Photo: John Polak

Angelico (detail) 2012, mulberry paper and the gilded edges of old books. Photo: John Polak

As she explained in her TEDMED talk,  the “fleshy” quality of the coiled paper drew her mind towards picturing anatomy, and hand-colored illustrations in an ancient French medical book inspired her first piece, a transverse view of female torso.

Nilsson uses a variety of sources for her work, including aged hand-painted French and German anatomy texts, as well as images from the U.S. National Library of Medicine’s Visible Human Project. The male cadaver for that project is that of a 38-year-old Texas murderer who was executed by lethal injection.

“I do notice, especially with that male figure, that his body is very thick and imposing. He’s not a delicate individual, and I wonder if that has something to do with the life he led,” she says.

The resulting pieces are lush yet, upon closer inspection, intricate, delicate and fragile, like the human body.  Nilsson says her work is popular with surgeons – for obvious reasons – but that non-medical folk also appreciate it’s unique and visceral vantage point.

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In an interview with Installation magazine, Nilsson said:

Attention to detail and careful observation are, for me, a means of practicing devotion, a practice common to the scientists and makers of religious art that I admire.  I am inspired, aesthetically, by scientific imagery and objects.  My approach to my work is “play-scientific.”  I use tweezers and scalpels and pretend I’m a surgeon from time to time, but without any of the intense responsibility of the real thing, for which I would be decidedly ill-suited.

For more, visit www.lisanilssonart.com and watch TEDMED Curator Jay Walker’s Q&A with Nilsson.

Rebecca Onie: At last, healthcare considering patients’ social needs

By Rebecca Onie

In April of 2012, I had the opportunity to pose a simple question to the TEDMED community:  What if our healthcare system actually kept us healthy?

This is a simple and universally shared aspiration –the idea that our healthcare system could prevent patients from getting sick in the first place, rather than only treating patients after they have fallen ill. But as is so often the case in healthcare, this can feel intractable. Addressing the root causes of poor health –for example, prescribing antibiotics to a pediatric patient only to find out she has no food at home or is living in a car—can feel overly expansive, complicated, and expensive.

Rebecca Onie at TEDMED 2012

At TEDMED 2012, we sought to present a solution that is instead simple, effective, and cost-effective: in the clinics where Health Leads operates, physicians can prescribe healthy food, heat in the winter, and other basic resources patients need to be healthy, alongside prescriptions for medication. Patients then take those prescriptions to our desk in the clinic waiting room, where our corps of well-trained college student Advocates “fill” those prescriptions by working side-by-side with patients to connect them to the existing landscape of community resources.

The response at TEDMED, as well as the continued demand that Health Leads has experienced since then, has been swift and unequivocal: over the past nine months, we have received expansion requests from more than 700 healthcare institutions that are urgently seeking solutions that will address their patients’ true health needs.

This demand is symbolic of a much larger shift taking place within the healthcare market. The next 12 months, as we all know, will be an unprecedented moment of fluidity and possibility in healthcare. More than twenty million previously uninsured people will introduce complex social needs into the Medicaid system – in the face of a 21,000 physician shortage. Healthcare providers, accountable for delivering health outcomes in this challenging landscape, are compelled to pursue new care delivery models that account for the realities of patients’ lives.

A Health Leads advocate at Hasbro Children's Hospital in Providence, Rhode Island meeting with a patient. Credit: Courtesy of Health Leads

A Health Leads advocate at Johns Hopkins Hospital Children’s Center in Baltimore, Maryland meeting with a patient. Credit: Courtesy of Health Leads

 

These providers – like Health Leads partner Nassau University Medical Center (NUMC)– are leading the way in demonstrating that it is indeed possible to address patients’ basic resource needs in a clinical setting. NUMC has fully integrated Health Leads into its pediatric outpatient operations – empowering doctors, nurses, and social workers there to ask their patients: Are you running out of food at the end of month? Are you worried about paying the electrical bill?

If the answer is yes, those same providers can refer any patients in those clinics to Health Leads, just like any subspecialty referral – and our Advocates can provide real-time updates to the rest of the clinic team about whether or not a patient got the needed resource, yielding better informed clinical decisions.

Furthermore, NUMC is just one of many institutions that are acknowledging the economic value of addressing patients’ social needs – two-thirds of Health Leads’ clinical partners cover all or some of the cost of our services.

Shifting market trends in healthcare are providing increasing financial incentives for healthcare institutions to pay for models like Health Leads: for example, to achieve Patient-Centered Medical Home certification, institutions must show that they 1) maintain a current resource list on five topics of key community service areas of importance to the patient population and 2) track referrals to patients/families.

Health Leads fulfills both of these basic requirements and also gives clinicians a fully built-out patient flow that is aligned with the design principles of a medical home: we are physically based in the clinic, available to patients with a referral from their primary care provider, and are incorporated as part of the greater care coordination team.

The healthcare system is moving.  Clinicians are demanding the ability to address all of the factors that prevent their patients from staying healthy. Patients expect to be able to speak with their doctor about the things that are making them sick in the first place –running out of food at the end of the month, or lack of electricity needed to keep their medicine refrigerated. And hospitals are allocating scarce budget dollars to address these needs.

At long last, the healthcare system is grappling with the realities of patients’ lives. If we together act now to adopt  practical, simple solutions that work, we can move at last from imagination to implementation. And we can create a new kind of healthcare – for patients, for doctors, and for all of us.

Rebecca Onie is Co-Founder and CEO of Health Leads. Join a representative from Health Leads and other organizations for TEDMED’s online discussion about the social determinants of health this Thursday at 2 pm ET. Ask questions via Twitter #greatchallenges – we’ll answer as many as we can on air.