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.

Screen Shot 2013-09-06 at 12.04.39 PM

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.

Visionaries Q&A: Artist Raghava KK on learning to be creative

Raghava KK is an artist, TEDMED/TED speaker and National Geographic Emerging Explorer.

Q. In your talk at TEDMED 2013, you showed us your latest work, in which brain wave technology helps viewers shape your art according to their thoughts and moods. How have people responded so far? 

Contrary to what I anticipated, my talk at TEDMED received an overwhelmingly positive response. I thought the TEDMED audience would predominantly think in fundamentals, and there would be a disconnect. But any science taken to a certain level becomes art. It goes into the ability to transcend to abstract the essence of its thing, and apply it beyond a single application. There’s only a limit to which you can be trained in any one thing.

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From doctors to scientists, there are now a lot of people who are in conversation with me about how we can add value to each other’s methods of inquiry. I’m really excited that I’ve gotten to write the forward to a textbook on cultural sensitivity using perspectives in psychiatry that is being brought out by Massachusetts General, Harvard’s teaching hospital.

Did you learn anything surprising about the brain during this project?

Yes! It shocked me the number of emotions we can go through in one minute.

We like to think about ourselves in absolutes, but we are dynamic and continually changing. Also, I’m surprised by the degree to which you can control brain activity. I can manipulate my art pieces on cue. When some people have that feedback, it can make them feel uncomfortable; with others, it helps neutralize their feelings of fear.

You’re working with an education innovation initiative, NuVu, that stresses creative problem solving skills, and have said, in an interview with Dowser, that education now should be about welcoming instability. Your art encourages dynamic perspectives as well. What is it about the world we live in that makes this so important? Can you point to something in your life or learning that led you to embrace the impermanent?

The one thing we know about the world for sure is that it’s constantly changing.  Evolution is not a ladder that’s built on linear progress. It’s more like a round treadmill, where we’re constantly adapting in relation to a dynamic environment.

So it seems appropriate that we learn in a manner that correlates to the state of the human condition and environment. I’ve reinvented myself many times. I’ve always felt that my education was great; it taught me who I am.

But it’s been my creativity that has constantly told me I can be much more. I could have never planned my whole art career and trajectory. I allowed it to unfold by taking an active role in my life and my future. I think that the incident that really sparked this idea was my decision to quit formal education, and to embrace and learn from impermanence. I haven’t had a formal education since high school, so the world has been my classroom.

A screen for POP-IT, an iPad app designed by Raghava KK. Viewers change the characters by shaking the tablet.

A screen for POP-IT, an iPad app designed by Raghava KK. Viewers change the characters by shaking the tablet.

In that same interview, you said, “Even in my own life, I keep putting myself in uncomfortable situations because of the amount I learn.” Can you give a few examples?

Here are three. First, I recently moved back to India, although I was well settled in New York. I wanted to have my third child here, and expose my children to this impossible democracy, which is an experiment in bringing together multiple, dissimilar perspectives and thus gives us so much to experience and to learn from.

Second, I’m starting a company from scratch and learning about entrepreneurship, because I really want to make an impact with this idea, to transcribe it among audiences. It’s a web-based and mobile educational platform called Flipsicle, and it allows you to actually see multiple visual perspectives on any topic. It’s a man-powered Google for images that uses collaboration and crowdsourcing.

We are producing and consuming more pictures than ever before, but desensitizing us to the fact that pictures are only a single view on an event and truth. Even in our schools, we start out with absolutes and go to abstract at a later stage, like high school, which is far too late. We need to disrupt this teaching and go to abstract thinking at a much earlier stage to really teach perspective.

Third: Once my wife and I accidentally found ourselves in a nudist resort.

This is what happens when an Indian books a holiday without knowing the difference because naturist and nature, because in California “naturist” means “nudist.”  We checked in late in the evening; everyone was wearing clothing, because it was cold.  In the morning I opened the window and saw a guy doing yoga in the buff. Then, my wife and I walked out and we were the only people clothed. So – do we stay here, or we go back home and pretend this never happened? But we thought,  ‘What the hell do we have to lose?’ And it led to an entire series of paintings I did on eros and nudity.  I discovered that it’s the continuum that’s erotic, not the absolute states of nudity. The feeling of the weight of clothing is something you just forget; it’s a change of the clothed state you notice.

"Untitled" by Raghava KK, acrylic on canvas, 2011.

“Untitled” by Raghava KK, acrylic on canvas, 2011.

You mention often that you hope your work will inspire empathy. Can you name a piece of art, or an artist, who inspired that in you, or who/that greatly changed your own perspective?

An artist need not look to art to be inspired, but to life. I see a need for empathy in the world, and that’s what inspired me.

Empathy is fashionable word right now, and it can be easy to misrepresent.

To me, empathy is a tool and it has survival value based on context.  For example, sometimes apathy is important. Extrovertism is overrated. Leadership is overrated; not everyone is a leader. We need to understand these things as continuums that have value based on context. So empathy means contextualizing where I come from, where you come from.

For example, I don’t measure myself by the same metrics by which others do, whether it’s the art world or the commercial world or the entrepreneurial world or the TED world. For someone to understand what I – or anyone — does, they have to have an understanding of how I measure my actions. The need for human dignity comes from these factors. It’s a constant need. And I need to be more than an artist. Life is just a tool. Art is just a tool.

Interviewed by Stacy Lu, @stacylu88

Q: What if we treat violence like an epidemic disease? A: We could put violence into the past!

By Gary Slutkin, M.D.

What if we, as public health professionals, approached violence as a public health problem in a serious way? What if we, as public health professionals, approached violence as a problem that we can treat with health interventions and prevent using science based solutions?

I asked myself those questions when we launched the Cure Violence model of violence reduction 15 years ago. Following more than 10 years of fighting health epidemics in Africa and Asia, I returned to the United States and began to notice parallels between the trajectory of violence plaguing U.S. cities and the trajectory of diseases plaguing the communities in which I previously worked abroad. You see, a cholera outbreak in Somalia shows the same epidemiological curve as the 1994 mass killings in Rwanda; killings in US cities, which appear as a wave sitting on top of a wave, resemble outbreaks of tuberculosis in Europe centuries ago.

Violence has the characteristics of an infectious disease in how it is transmitted from person-to-person and how it is spread neighborhood-to-neighborhood and community-by-community. Thus, we must physically interrupt violence before it takes hold of the minds and bodies of those affected by it, and also change thinking and attitudes to prevent the cycle of violence from repeating itself before the behaviors that trigger violence become cultural norms.

I came to realize that the issue of violence had been fundamentally misdiagnosed –having been seen as a moralistic issue with reduction strategies applied based upon totally outdated thinking. We had simply not taken into account how violence really behaves—as a contagious, or epidemic process, or disease. So, even those of us in the public health community who referred to violence  as a public health problem, had not yet applied specific epidemic control techniques.

Cure Violence now approaches violence in an entirely new way–we approach it like a disease. The Cure Violence model uses the same science-based strategies being used globally to fight other epidemic diseases. We train carefully selected members of the community — disease control workers who are trusted insiders — to anticipate where violence may occur and to intervene before it erupts—just like you might use health workers to find early cases of tuberculosis, SARS, or even bird flu. Other very highly trained health or epidemic control workers take on the specific tasks of behavior change, and changing norms. Transmission is averted and spread limited.

Street outreach workers/violence interrupters in action in Chicago. Photo: Robert Wood Johnson Foundation

Street outreach workers/violence interrupters in action in Chicago. Photo: Robert Wood Johnson Foundation

As it turns out, this approach, the epidemic control model, works. The Cure Violence method, our first application of this thinking, has now been statistically validated to reduce shootings, killings or both by 30 to 70 percent by three independent evaluations directed by the Department of Justice and Centers for Disease Control (CDC) in three major U.S. cities—Chicago, Baltimore and New York. This model is being replicated in more than 50 sites across the US and in 15 cities, and is being applied in seven other countries, with early results also showing great promise.

When we recognize violence as an epidemic disease it empowers us to treat and prevent it with  specific epidemic control methods. Doing this makes it possible for us to be much more effective in reducing the epidemic of violence. Like violence, prior epidemics from leprosy to typhus to plague, were treated moralistically for centuries. However, when their epidemic and contagious nature became identified and the strategies revised to conform to science, we were able to move these diseases into the past.

It is now up to us in the public health fields to do the same with violence.  It is time for health professionals, health departments, and hospitals to step up and work together with this and other epidemic control strategies to put violence into the past.

TEDMED 2013 speaker Dr. Gary Slutkin is an epidemiologist and the Founder/ Executive Director of Cure Violence, formerly known as CeaseFire.

What’s the really big news about pregnancy and birth?

It’s rare that any birth holds so much of the world’s attention as one did this week. Media attention was so frenzied, in fact, that some of its members began to spoof each other: “Woman has baby!” said the cover of one London tabloid. Was this birth really so incredible?

Well, yes, it is. So is any birth, for that matter, from a scientific standpoint. A typical baby has 60,000 miles of blood vessels by the time of birth. How does this intricate development unfold over a course of mere months? How does a woman’s body support this human engineering marvel?

Seeing it happen with the naked eye brings home how marvelous the process really is. TEDMED 2011 speaker Alexander Tsiaras, Founder, CEO and Editor-in-Chief of TheVisualMD.com and a journalist, artist and technologist, has compiled a timeline of conception and pregnancy from scans and computer-generated images. As Tsiaras wrote on The Huffington Post, his own son was in utero as he collected and reviewed scans of fetal development, which added a new dimension of meaning to his work.

““Even though I am a mathematician, I look at [fetal development] with marvel: How do these instruction sets not make mistakes as they build what is us?” he said of the project. See the astonishing images below he presented at TED. (Includes graphic content.)

Alexander Tsiaras: Conception to birth — visualized

The intricate system does break down occasionally, however, with consequences that are devastating. As the World Health Organization reports, some 800 women die every day from preventable causes related to pregnancy and childbirth — 99 percent of them in a developing country. Even in the U.S., one in nine babies is born pre-term, which leads to a higher risk of disability or death.

Michael Rosenblatt told the audience at TEDMED 2011 about the devastating effects of maternal mortality, which can last for generations.

Michael Rosenblatt at TEDMED 2011

There are collaborative efforts at work by governments, international development agencies and non-profits at work, however, that have made progress in reducing maternal deaths by interventions such as improving access to skilled birthing assistance, providing post-natal care for women and newborns and treating infections. Some 30 countries managed to cut their rate of maternal death in half between 1990 and 2010 — a feat also worthy of headlines.

 

 

Why is trust essential to innovation?

By Pritpal S Tamber

Innovation means change. Doing or achieving something in a new, improved way inevitably means changing what was done before. And yet one of the most often-repeated observations in health care is that “doctors are resistant to change”.

In my TEDMED talk I examined what I believe underlies doctors’ behavior and why I think their so-called resistance is a lazy interpretation of a more complex problem.

In essence, doctors are taught to doubt, as this is what helps them make the right decision for their patients. This same behavior also makes them build mechanisms to ensure that the system they work in is safe and effective. I call these mechanisms the “web of trust”.

Innovations disrupt the web of trust, which causes discomfort for doctors. This manifests as resistance. Innovators need to better understand the role of trust in health care (or why doctors doubt) in order to build trust into their innovations. Few, if any, do, which is why I think most current innovations in health care are bound to fail.

Pritpal S Tamber at TEDMED 2013

But health care is about more than doctors. The burden of disease is changing from episodic things that were treated in hospital to chronic things that are part of our daily lives. As a result citizens want more understanding and control of their daily health, which is why we’re seeing more and more innovation outside the traditional boundaries of health care institutions.

It would be a mistake, though, to see the citizen space in isolation. Instead, it’s part of a continuum that extends into primary and then specialist care. This means that whatever tools a consumer uses to manage his or her health needs to be trusted by the clinicians that may ultimately be called upon. Without that trust, care will be fragmented and perhaps ineffectual.

Other industries have learnt how to create these new, distributed forms of trust. In the hotel industry, for instance, AirBnB has enabled ordinary people to rent their spare rooms to strangers. Their website is specifically designed to provide the kind of information people look for when deciding whether to trust someone, either as a host or a guest. Although there is a specific technology that has made all this possible (peer-to-peer platforms, often abbreviated to P2P), it’s about more than just technology. It’s about society embracing opportunity made possible by new forms of trust.

With more and more citizens taking charge of their health, traditional health care needs to understand and embrace a new, distributed form of trust. It’s only with such trust in place will radical innovations that tackle today’s seemingly intractable health challenges be possible. Riffing off P2P, I call this new form of trust, “We2C” – how we, the people, can lead and engage clinicians in a productive manner underpinned by trust.

Follow Pritpal S Tamber at @pstamber where he will be further developing We2C.

Pritpal S Tamber is a TEDMED 2013 speaker, its Clinical Editor, a physician, and the founder of Optimizing Clinical Knowledge, a consultancy based in the UK.

What’s the new way to ask big questions in science?

Parkinson’s Voice Initiative founder and TEDMED 2013 speaker Max Little is an applied mathematician whose goal is to “see connections between subjects, not boundaries…to see how things are related, not how they are different” – which gives him an unusual perspective on how big data could change medicine. We  interviewed him via e-mail to find out more.

You’ve been working to discover the practical value of abstract patterns in various fields, with surprising results in areas as varied as diagnosing Parkinson’s disease over the phone to predicting the weather. Can you explain your approach?

Max Little

Max Little

As an applied mathematician, my training shows me patterns everywhere. Electricity flows like water in pipes, and flocks of birds behave like turbulent fluids. In my projects, I collate mathematical models from across disciplines, ignoring the assumptions of that discipline to a large extent, I put in overly simple models. I use artificial intelligence to throw out inaccurate models. And this approach of exploiting abstract patterns has been surprisingly successful.

For example, during my PhD I stumbled across the rather niche discipline of biomedical voice analysis, originating in 1940′s clinical work. With some new mathematical methods, and combining these with recent mathematics in artificial intelligence, I was able to make accurate medical predictions about voice problems. The clinician’s methods were not accurate. This sparked off research in detecting Parkinson’s disease from voice recordings – the basis of the Parkinson’s Voice Initiative.

But, success like this raises suspicions. So, with collaborators, I tried to make this approach fail. We assembled 30,000 data sets across a wide range of disciplines: exploration geophysics, finance, seismology, hydrology, astrophysics, space science, acoustics, biomedicine, molecular biology, meteorology and others. We wrote software for 9,000 mathematical models from a deep dive into the literature. We exhaustively applied each model to each data set.

When finished, a very revealing, big picture emerged. We found that many problems across the sciences could be accurately solved in this way. In many cases, the best models were not the ones that would be suggested by prevailing, disciplinary wisdom.

Are you doing other research that might have implications for clinical diagnosis?

Here is another example: There is a decades-old problem in biomedical engineering: automatically identifying epileptic seizures from EEG recordings. But, we found over 150 models, some exceedingly simple, each of which, alone, could detect seizures with high accuracy.

Empirical

This challenges quite a few assumptions – but it is not as if we are the first to find this. It happens often when new approaches to address old problems are attempted: for example, in obesity, a new, simple mathematical model revealed some surprising relationships about weight and diet.

You’ve also used fairly simple algorithms to successfully predict weather.

After my PhD, I teamed up with a hydrologist and an economist. We wanted to try weather forecasting using some fairly simple mathematics applied to rainfall data. Now, weather forecasting throws $10m-supercomputers and ranks of atmospheric scientists together, and they crunch the equations of the atmosphere to make predictions. So, competing against this Goliath with only historical data and a laptop would seem foolhardy.

But after two years of hard work, I came up with mathematics that, when fed with rainfall data, could make predictions often as accurate as weather supercomputers. We even discovered that models as simple as calculating the historical average rainfall, and using this as a forecast, were sometimes more accurate than supercomputers. We were all surprised. but this finding seems to line up with results that others have found in climate science: it is actually possible to make forecasts of future global temperatures using simple statistical models that are as accurate as far more complex, general circulation models relied upon by the Intergovernmental Panel on Climate Change.

Is this a new way of doing science?

If we divide science into three branches: experiment, theory and computer simulation, then what I am describing here doesn’t quite fit. These are not just simulations: the results are entirely reproducible with just the data and the mathematics. This approach mixes and matches models and data across disciplines, using recent advances in artificial intelligence.

The three branches of science. What happens when we add computational algorithms to the mix?

The three branches of science. What happens when we add computational algorithms to the mix?

I don’t know what to call this approach, but I’m not the only one doing it. The most enthusiastic proponents are computer scientists, who do something like this regularly in mass-scale video analysis competitions or one-off prizes financed by big pharma for molecular drug discovery as do statisticians working in forecasting.

In your TEDMED talk, you expressed concern that advances in science have stagnated. Can you explain?

Like many scientists, I’m concerned that science is becoming too fragmented. So many scientific papers are published each year that it is impossible to keep track of most new findings. Since most articles are never read, much new research has never been independently tested.

And, unfortunately, scientists are encouraged to ‘hyper-specialize’, working only in their narrow disciplines. It is alien to we applied mathematicians that a scientist who studies animal behavior might never read a scientific paper on fluid mechanics!  In isolation from each other, could they just be duplicating each other’s mistakes?

Max Little at TEDMED 2013

What can we do to create a more unified approach?

First of all, open up the data. There is far too much politics, bureaucracy and lack of vision in sharing data among researchers and the public. Sharing data is the key to eliminating the lack of reproducibility that is becoming a serious issue. Second, don’t pre-judge. We need to have a renewed commitment to radical impartiality. Too often, favoured theories, models, or data persist (sometimes for decades), putting whole disciplines at risk of missing the forest for the trees.

More collaboration would also greatly speed advances. Is first-to-publish attribution of scientific findings really that productive? I think of science as a collaborative journey of discovery, not a competition sport of lone geniuses and their teams.

Scientific theories that can withstand this “challenge” from other disciplines will have passed a very rigorous test. Not only will they be good explanatory theories, they will have practical, predictive power. And this is important because without this mixing of disciplinary knowledge, we will never know if science is really making progress, or merely rediscovering the same findings, time and again.

Follow Max Little @MaxALittle.