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Visionaries: Vic Strecher says living with purpose inspires good health

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Why don’t we always do what’s best for us?

It’s a question that has long preoccupied Vic Strecher, founder and head of the Center for Health Communications Research at University of Michigan and TEDMED 2009 speaker.

After years of teaching health education and helping to create computer-based interactive programs that inspire better personal choices, Strecher is working on a website and a graphic novel based on new thinking in the field and on his own momentous life experience. TEDMED spoke with him about his new projects.

So…why don’t people make more healthful choices? There’s no lack of available health information, and yet lifestyle choices have led many to develop chronic diseases.

VS We know that the choices we make can slowly kill us, like frogs that will stay in water that’s slowly heated until they literally boil to death without jumping out of it. And we’re learning that one reason we resist health messaging is defensiveness. We have this wall around our ego for evolutionary reasons, and ironically our wall has been getting thicker with all the societal messaging we’re getting. With the barrage of junk information and all the choices we face, we’re less able to make competent decisions.

How do you prod people out of that warming water?

VS There’s a relatively new idea being explored called self-affirmation theory. It says that the process of affirming your fundamental beliefs — core values — reduces defensiveness. For example, if you write down or are rating your core values, such as your faith or your commitment to family, and then are exposed to a health message that you may normally process defensively, you’re more likely to accept it.

When you start to put things in writing, you realize, “Hey, my values differ from my behaviors, don’t they?” Research shows that cigarette smokers who affirm their core values are more open to anti-smoking messaging.  People are more likely to participate in diabetes risk assessments if they have just completed their values list.  So how can we get people to start making that kind of connection?

Some of your recent talks have mentioned how empathy can lead to healthier behaviors.  Can you explain? 

VS Jennifer Crocker of Ohio State University, a psychologist who studies self-esteem, wanted to take a look at people’s thoughts while they were affirming their values. And what they were doing was thinking of a connection with loved ones, their friends and family and community, and things bigger than themselves; it drew on something called self-transcendence.

What started you down this path of looking at the bigger picture?

VS Two years ago my daughter passed away; she was 19 years old. I went through a significant grieving process, which included struggling with lethargy, and as a behavioral scientist I was noting my own reactions. I began studying the old philosophers – the Stoics, Existentialists – some like Kierkegaard who were very religious, and some who were atheists.  They all said you have to have a purpose or meaning in your life. Victor Frankl, a Holocast survivor, found out people who were losing their purpose were dying faster in the death camps.

That started me thinking about the epidemiology of this in the medical and health field. People that have a purpose in life are 2.4 times less likely to die from Alzheimer’s Disease, less likely to have a heart attack, and more likely to have good sex. Having a purpose can also help repair our DNA, potentially promoting a longer life. We spend so much time scaring the crap out of people about death and disease, and we should be thinking about teaching them to have purpose in life. We’re so used to telling people, ‘Smoking is bad for you,’ and then ratcheting that fear up. Why not just focus on a totally different direction for this?

You’re working on several new projects with this in mind. Can you share details?

VS I’m self-publishing a graphic novel, “On Purpose,” working with a comic book illustrator and a screenwriter. I decided to put together a story that connects my own personal tale with the related science. It will be about the importance of finding purpose in your life in a nihilistic world, basically. It touches on themes from ancient and modern philosophy, literature, neuroscience, and Egyptology.

I’m also working on a web site. There will be a blog app for people to share their stories. I want to build a community where people can record their purpose and see others’. There will be some kind of filter to group people through their common core values, in a way they might not expect. Some of the real beauty of life is discovering things that you wouldn’t expect to discover or to agree with.

Interviewed by Stacy Lu

Visionaries: Elissa Epel on why toxic stress is public health enemy #1

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Elissa Epel

TEDMED 2011 speaker Elissa Epel, a UCSF psychologist, has studied the health impacts of stress, from its effects on our DNA to its relationship to overeating, for two decades.

Q Some of your research has centered on the way that stress hormones contribute to increasing our drive to eat, particularly high-carbohydrate and high-fat “comfort foods.” To what degree is stress contributing to our national obesity crisis, in your opinion?

EE We can’t quantify exactly how big of a role stress plays. It could be huge. It’s invisible and it’s easy to ignore; it’s pervasive. Most of us have gotten so used to living in a matrix of stress – time pressure, demands, rushed social interactions, rushed eating – that we don’t even notice it. So we might not realize how stressed our body really is. But the effects of stress can still stimulate our appetite, and shift us to choosing more ‘white food’ – what we call “comfort food,” – high-calorie, high-fat food. This promotes metabolic disease because it causes us to store calories in the visceral area and liver. And that stored fat is at the core of many chronic diseases, not just diabetes.

Q I was surprised to see your study showing educational attainment is also related to telomere length. What might the mechanisms for that be?

EE That relationship is multi-layered and needs to be unpacked. One common theme in trying to understand health disparities is testing whether part of it stems from  greater stress exposure or reactivity over a lifetime. For example, the effects of more years of education early in life can be seen decades later, in longer telomere length. Higher education, or maybe it’s the quality of education, can create an infrastructure in the brain for more adaptive coping – it can help with strengthening what we call ‘executive function’ –which helps us think clearly under stress.

Conversely, there are many active ingredients in the milieu of low socioeconomic status that cause wear and tear. Interestingly, though, perception can play a large role here. We have measured this by giving people a picture of a ladder and asking them to place themselves on a rung (the bottom rung being the lowest status).  Rating oneself as low, regardless of actual income or education, relates to poor adaptation to stress.  Specifically, when given the same task to do in the lab, people low on the ladder reacted hotly each time, as if it were new, instead of habituating to it. There is also the built environment of low socioeconomic status, which doesn’t leave opportunities for buying healthy food and places for exercise or safe walking. And the built environment can feed back and affect how people feel.  For example, fewer parks or more liquor stores predict a decreased feeling of neighborhood trust and cooperation.

Q There seems to be a big disconnect between what people know is good for their health, and their actual behaviors. Is mindfulness – focusing on what we’re doing right now, in the present moment – the missing link, do you think?

EE I think that’s right on. We can’t possibly regulate our behavior and feelings, and suppress those pesky but strong impulses and other distractors, if we are not paying attention. In a high-stress environment, our brain activity shifts toward the limbic system and the emotional stress response, and away from the parts of the pre-frontal cortex that house executive control systems, the rational and analytical drivers of our behavior. So we react automatically and impulsively when we are under stress and not paying full attention.

Watch: The Mindful Human Genome

And even if we are focusing a lot of effort on eating better or exercising, but in a really self-critical way, this can sabotage our efforts as well. Very few people meet their exercise, sleep, and nutrition goals each day. So mindful attention includes both an intention and a kind attitude, and these help clear our mind of unhelpful or intrusive thoughts, and improve our ability to carry out our intentions.

Eating is an interesting example of a behavior that is not under our full conscious control, although we have not admitted that yet. Eating is something that we can do without paying attention. Otherwise, if it took focus and effort, that wouldn’t be part of adaptive evolution. Overeating is related to stress but also altered neurobiology of the reward system, the source of our strongest motivational drives. This reward area responds to palatable food. This can drive compulsive behavior that feels out of control, an experience similar to being a drug addict for some people. We have to better understand how powerful certain types of foods can be, and that certain conditions, including stress, make people especially susceptible.

In some of our studies, we are trying to help low-income people who feel very little control over their life, with their weight. We are teaching mindfulness to pregnant women, and it looks like the training might be helping not only them but also their babies. We have to think of ‘stress reduction’ where it matters most – which includes the womb. Prenatal stress exposure can affect a child’s health for a long time, possibly a lifetime. For example, mothers who have experienced major stresses while pregnant have offspring with shorter telomeres.

Dr. Elissa Epel : The Science of Stress

Q One of many intriguing facts you mentioned in your TEDMED 2011 talk was that technology can actually increase stress in various ways. At the same time, we’re seeing a slew of new apps aimed at helping us to calm down.

EE I think mobile apps for stress reduction are a fabulous potential use of technology, if they really work. For example, we could be using our mobile phones to remind us to rejoin with the moment, and to breathe fully, to notice our physical body and become embodied again. We live mired in our thoughts, above the neck, and this is made worse by multitasking.

But technology devices can become part of multitasking, thus adding to the strain on our limited attention, splitting it yet one more way. There are a lot of wellness apps out there, but I also think that we need data. Almost none of them are evaluated so although they seem promising, do people really benefit from them in a way that would lead to meaningful change? This is a powerful way to reach people, and I admit that even I am involved in an effort to test a stress reduction app!

There are so many answerable questions: Can we take people deeper into a meaningful life, or do these technology interventions contribute to fractured attention and more shallow social interactions? Do people stick with them? Do the apps make a dent in chronic stress arousal over time? As a society we desperately need stress reduction. Let’s hope we can use technology to get there.

Q If you had the power to enforce one public health measure based on your research, what would it be?

EE Public policy makers try to use their resources well to help people, but don’t always think about how to make policy motivating to an individual, nor take into account fundamental causes of societal and individual stress. Stress is caused by a perception of lack of control and unpredictability. Policymakers can promote empowerment, helping disadvantaged people gain a sense of control over their daily life.  Social scientists understand which social and structural factors need to change to help individuals change.

A main message of research today, from epigenetics in basic models to epidemiology, is that adult health is shaped early in life, in important ways we can no longer ignore. So resources are best spent early in life, with the goal of promoting good health and habits, and preventing disease. Good quality education is critical, particularly for girls. It directly translates to better health behaviors and eventually health for the next generation. Resources are just much less effective when applied to diseases that are incurable and costly to manage. Our money is spent in an unbalanced and illogical way. We skimp on education — particularly in California — and spend a tremendous amount of money and time trying to cure incurable diseases such as obesity. Instead, we spend big money on bariatric surgery and costly band-aid procedures.

Q Has your research changed any of your own personal or work habits?

EE It has, but only in an incremental way over many years. I have been studying the field of stress for almost 20 years, so I know all too well what we should be doing, and how my behaviors such as curtailing sleep and having too many demands placed on me affects my daily physiology, and cellular stress. Does that mean I get enough sleep, exercise, meditate every day, keep work manageable, and prioritize the things that are most meaningful, versus the most urgent? No. I am closer to that than I used to be, and maybe in another stage of life… I still experience plenty of challenging situations, and have my reactions, but now in a more mindful way, and that is a qualitatively different experience. Like most people, I am a work in progress.

–Interview by Stacy Lu

 

Visionaries: Scott Parazynski practices extreme healthcare in Antarctica

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Scott Parazynski in space gear

Meet the South Pole’s top doc. TEDMED 2010 speaker, Scott Parazynski, is the new medical officer and director of the Center for Polar Medical Operations at the University of Texas Medical Branch (UTMB), where he’ll oversee medical screening and on-ice care of all personnel in the National Science Foundation’s United States Antarctic Program.

Parazynski is also a former NASA astraunaut who flew on five shuttle missions and conducted seven spacewalks, a mountaineer who scaled Everest, a pilot, a competitive luge racer and Olympic luge coach.

Q When will you be leaving for Antarctica? How are you preparing yourself and the staff, medically?

SP I’ll be heading down around Halloween and will spend about a month on the ice at McMurdo [Station]. It’s my first time on the ice. In the spring, I’ll go to the other side of the ice, to the Palmer Station. It’s a strange marriage here in Texas, operating all the medical activities in Antarctica from the most sweltering spot in America.

Winter storm in McMurdo. Photo: NSF

Right now we’re sending hundreds of people down to Antarctica, so it’s the busiest time for us. I used to have a career in the space program, and of course we were scrutinized in incredible detail when we were selected, because it costs a lot to train an astronaut for those incredibly expensive missions. They knew everything about us. It’s quite similar in the Antarctic environment, but we can’t afford to do the same level of medical screening. I also suspect that in general the Antarctic personnel are not as physically fit nor quite as young as the astronaut corps. But we do have medical facilities at all three major stations in Antarctica, so we try and get as many folks on the ice as we can safely.

Q What are the working conditions like?

SP We have the wherewithal to handle the likely medical scenarios. We don’t have CT or MRI scanners, or an operating room and ICU, but we have functional urgent care centers so we can take care of problems for a short time. Occasionally, you have to lift someone off, though it’s a very difficult task in the wintertime to actually get someone off the ice. It’s a very risky rescue operation.

I’ve done a lot of things in remote environments, such as the Himalayas, and I always ask the people I recruit, ‘Have you had to MacGyver medical solutions in your clinical practice? We don’t have the range of equipment and medication that you have in your hospital. Are you capable of thinking on your feet and coming up with real-time solutions?’”

However, UTMB is a world leader in telemedicine, so we can guide people through real-time procedures from our base in Galveston. Healthcare delivery in Antarctica is kind of like medicine on Mars. You have a very austere environment.

Q What are some of the conditions you’re most likely to see?

Standard working gear at McMurdo. Photo: NSF

SP Slips, trips, falls, sore throats and runny noses are the basics. But it’s a unique environment with a higher incidence of orthopedic issues. It certainly does set you up for frostbite, but you get good protection with the heavy uniform. It’s like walking around inside of a marshmallow suit. Snow blindness is a problem. The South Pole station is 11,000 feet above sea level, and people fly there from McMurdo, so you have altitude sickness. We also run dive operations, so there’s the potential for dive injury.

Q Can you talk about ongoing medical research in Antarctica that may have implications for future treatments or interventions?

SP I have to reflect back on my days in NASA as well to answer this. The kind of technologies and solutions that we develop for these extreme environments have great value for general healthcare. For example, the advances in telemedicine that we’re working on for Antarctica may have great potential for family care practice in rural America or remote Africa.

Also, we aim for miniaturization and specificity of medical tools, such as handheld devices for the medical clinics. These will one day be the medical devices for your doc-in-the-box. They’re very expensive at the outset, but with economies of scale they’ll be useful in the general public one day, off the ice.

Another unique element of Antarctica is the isolation component. We send people to these austere environments where it’s dark 24/7 for months at a time, and you’re seeing people day in and day out with no hopes of leaving. So there are longitudinal investigative studies useful for studying seasonal affective disorder.

Q You’ve lived and worked in Africa and the Middle East. Have you taken away healthcare lessons from other cultures that impressed you? Any that might help the U.S. in our current situation?

SP I was going to do a long-duration space flight aboard Mir and I went to Star City, Russia to do my training. I had to go through a bunch of doctors poking and prodding me to see if I was ready for their training program. I’m a pretty fit guy, and I thought it would be a slam dunk.

But a few years prior, I had had a minor ski accident skiing in a whiteout. I hit my shoulder on a snow bank and had to nurse it for several months. In one medical examination, the Russian surgeon noticed a very subtle difference in my [pectoral muscles]. I couldn’t even tell by looking in the mirror, but he knew that I had asymmetry in my muscle group.

We’ve become too focused on technology in America, and there is still an art to medicine that many people in the world practice, certainly in these remote environments and in rural America. Perhaps now with the financial pressures upon us with healthcare reform, we’re going to need to get back to that and look for subtle findings, make better clinical judgments, hone our skills, and MacGyver solutions using the equipment available.

Q You’ve been an astronaut; you’re a diver and a mountaineer. It seems that many of your career choices are driven by the desire to explore limits and to tap the unknown. Is this a conscious choice?

SP Life is an adventure, and the people that inspired me the most when I was growing up were all scientists, engineers and creative, inventive people. But they also had skin in the game. They were also out there doing things, participating in discovery. I like to build new things in challenging new environments. I’m not much of a steady state person.

Q Are you taking anything special with you to the Pole? Any special plans to mark the visit?

SP Yes, you do want to bring some bling with you to these places. For this, I’ve been training myself to do a good handstand. I really want to get the bottom of the world and do a  handstand, and have an Atlas photo.

Q Have you had to conquer fear, and if so, what’s the one thing you always tell yourself?

SP I have been fearful at times that I wouldn’t succeed. I had this spacewalk on my last mission [STS-120 Discovery], and it was very high stakes, and if I hadn’t succeeded there would be huge repercussions for the program, and it was up to me to finish the job.

Scott Parazynski, the first astronaut to summit Mt. Everest

Also, there was summit morning on Everest. The experience is weird — you leave your tent in the middle of the night. And you do think, ‘What’s this day going to be like?’ There are doubts: ‘Am I going to summit? Am I going to make a round trip out of this?’ I’m hoping I’m worthy and strong enough and that I’m going to make the right decision. I had various doubts along the way, but I just focused on the fundamentals: Buckle in carefully, listen to your body and stay hydrated.

Q Countless kids all across the U.S. want to grow up to be just like you. Who were your idols as a kid? Who are they now?

SP For me it was John Glenn, Yuri Gagarin, [Edmund] Hillary, [George] Mallory and [Andrew] Irvine, Lewis and Clark, Jacques Cousteau — folks who were explorers, scientists and who really had skin in the game. Sir Roger Bannister really amazed me, and he was a physician as well. He broke the mile down and said, ‘I need to run at this pace, at this or that piece.’

I still think space is the place. I hope kids still want to grow up and become astronauts. It’s a different environment now. I grew up in the shadows of Apollo, and now kids have computer games with space planes and all kinds of wild stuff. Can they suspend belief and go out and actually do these kinds of things? I’m the chairman of the board of the Challenger Center for Space Science Education. We hope to inspire kids to go out and explore.

I really admire the commercial space flight industry. These are folks that are so passionate that they’re willing to spend their own time and energy to make this happen.

Also, Jim Cameron’s descent in Challenger Deep was an amazing technological feat. Only a couple of guys have been down there, and the last time was decades ago. It was really an audacious accomplishment.

–Interviewed by Stacy Lu

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For more about practicing medicine in extreme environments, watch Scott Parazynski’s TEDMED speech.

This interview has been edited for space and content.

Visionaries: Peter Diamandis says innovation will increase exponentially

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Peter Diamandis: To innovate, we must be fearless dreamers

Peter Diamandis is founder and chairman of the X PRIZE Foundation and co-founder of Singularity University, a TEDMED 2011 speaker, and author of “Abundance: The Future is Better Than You Think.”

What kinds of external conditions lead to innovation on an individual and societal level, and how can we bring those conditions to more people? 

We need to be a society that is full of people who are willing to dream and are willing to take risks. We also need to be a society that also doesn’t pre-judge who can come up with a breakthrough.

The challenge is that right now, we’re unfortunately filled with fear, and that is problematic. If you’re fearful, you become risk averse. You have to view failure as acceptable, because trying something new requires the ability to do that.

If you really want to have a breakthrough, know that the day before it’s a breakthrough it’s a crazy idea, and that you’re going to have multiple failures on the way to success.

In Silicon Valley failure is accepted – two, three failures before success are considered normal. In other parts of the world, failure represents a black mark that you’re going to have a hard time overcoming. It’s mostly old-world Europe, and Asia and Japan. It’s less so in the U.S., which is why we have such a high rate of entrepreneurship.

Was there any era in human history particularly conducive to innovation, in your opinion?

There was a lot of innovation at the turn of the century when people were experimenting, and if you failed and screwed up in a royal fashion you could move someplace else and no one would know and you could start afresh. The ability to have a frontier to move to was very important. Now, if you can screw up anyone can find out on the web. But the web also promotes the rapid exchange of ideas. As populations increasingly move into cities now, too, people are exchanging ideas that drive innovation.

If, per your TED talk, we preferentially pay attention to negative news, what does it take to point people towards the forward-looking optimism that innovation requires?

I think it’s basically to make sure that you are cognizant of the fact that the news media is a drug pusher, and negative news is the drug.

When you hear something negative you need to realize that it’s not probably a full story.  You need to make sure to proactively look at whatever field you’re aware of to find the good news.

Launching the Google Lunar X PRIZE

There are websites and blogs like Singularityhub.com and Kurtzweilai.net that will share with you each day the latest breakthroughs in curing cancer, life extension, imaging molecules, new ways of communicating, and new discoveries on the elements of physics. It makes you realize how fast things are progressing.

We have, and will have more of, access to personal technology. Do people value intangible benefits – better communication, access to knowledge across fields – as part of human abundance?  If not, why not?

When humans get a new capability, they accept this new baseline, and they don’t value it until it’s gone and they lack access to it. It’s like, ‘What has technology done for me lately?’ This stuff didn’t exist two years ago – Google, YouTube.

We get this new stuff this is cool, this is great, it improves our lives – and that becomes the new normal.  You forget that it didn’t exist before.

Plus, I think when we get something new, we expect it to work right away.  We’ve become spoiled to some degree.

Have we become accustomed as well to an ever-greater influx of new innovations?

Yes, and that will continue.  The rate of innovation is a function of the rate at which ideas exchange and mutate. As there are more people connecting online – five billion on the Internet by 2020, up from two billion in 2010 – that’s going to increase the rate of exchange.  Tools of artificial intelligence and cloud computing, and our move to the cities, will also allow us to exchange ideas at greater rates.

Can you speak to some specifics as to what abundance brings to medical advances, such as research data and drug discovery and dissemination?  Do you have case studies to share?

What we’re going to be seeing is an increase in pro-active diagnostic tools.  We have recently announced the Qualcomm Tricorder X PRIZE, a competition that will award $10 million dollars to any team in the world who builds a hand-hand mobile device that can diagnose you better than a board of certified doctors.

We have also launched the Nokia  Sensing X Challenge.  This is about developing a new generation of biometric sensors that will detect the air you breathe, the food you drink, the body’s vital measurements and all of the sensory information that will become part of a Tricorder chip.

When I drive my BMW, it has about 60 to 80 microprocessors monitoring what’s going on in the engine at any time.  When I fly my plane, we’ve got about an equal number of microprocessors. But as a human, I get only a few bytes of data once a year from my doctor.  I should be living in a world where I get a few gigabytes of data daily. This allows me to become the CEO of my own health. I can monitor my own data and know when anything is out of whack. Plus, if you have millions of people being monitored, we start to have knowledge of what’s going on, such as disease breakouts in environmentally dangerous places.

Can you speak further about how inventions like Dean Kamen’s Slingshot will actually help us either create new resources – energy, materials, food – or make better use of what we’ve got?

Technology takes that which is scarce and makes it abundant, and makes more of what we’ve got.  We talk about scarcity of water, but we live on a watery planet.  We talk about energy scarcity, but we live on a planet bathed in energy.  We have vast amounts of mineral deposits.  For planetary resources, we’re looking at mining asteroids.

It seems we already have the technology that would lead to greater abundance for those in dire need of essentials in developing nations.  What kind of capacity-building forces, market or otherwise, need to come to pass to make these innovations commonly available?

I think that is happening automatically. Much of the technologies that are being developed today are frankly going end up in the developing world anyway.

Many of the top technologies in the Tricorder chip, for example, may not end up in the U.S. because of regulatory concerns.   A lot of things may begin in Africa because there are fewer regulations.

–Interviewed by Stacy Lu

Click here to watch Peter’s 2011 TEDMED talk.

Visionaries: Alexandra Drane engages with grace

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Following is Part Three of our email interview with Alexandra Drane, TEDMED 2010 speaker and founder of Eliza Corporation. Here are Part One and Part Two. In this final installment, Drane discusses work she considers critically important both personally and nationally, and what she does to maintain her own good health and considerable vitality.

Engage with Grace, the movement you co-founded to help families be better informed about and to cope with end-of-life decisions, is a force behind National Healthcare Decisions Day on April 16th. Can you talk about which current challenges in health and medicine have made these decisions more critical than ever?

We just don’t do end-of-life well in this country – and that stinks for a lot of reasons.

First, you only die once. Thank you, Atul Gawande, for making that incredibly straightforward point – among others – in this remarkable New Yorker piece about making our last days as pleasant as possible.

Second, since you only die once, die the way you want, and make sure your loved ones get that same honor. It’s a gruesome concept – except it’s not.  Stay here for a minute. We live with such intent, why wouldn’t we want the end of our lives to have that same grace? Why wouldn’t we want to make sure our loved ones are treated with that same dignity?

Third, doing end-of-life well is a gift that keeps on giving, for the person who has a far better experience at the end of a life well lived, but as importantly for those who are left behind. There is no worse hell than second-guessing how you supported a beloved in his or her last days, particularly when what the system often provides – not by willful mal-intent, just by not knowing how to do anything else – is unnecessary and I would even say inhumane.

Fourth, with the demographics shifting the way they are, the magnitude of this problem is quickly going to become unmanageable. It’s bad for us as humans. It’s bad for us as a country.

And this is one of the only places in healthcare where we are all naturally aligned! Most people want less care at the end of life (70% of people want to die at home, yet only 30% do), and less traditional/intensive care usually produces better outcomes and a higher quality of life. Check out stats from the Coalition to Transform Advanced Care. The potential savings are enormous.

In other words, just by designing a system/process where people are informed and get what they want, we get better outcomes, and massive savings.  Here’s the most beautiful thing about it, though. We don’t even have to bring up the cost savings!  While they are relevant to those concerned with the disaster-pointing cost trajectories of our shifting demographics under current care models, just by getting people what they want, the savings will take care of themselves. So don’t focus on the cost; it takes away from the beauty of the story! Instead, focus on this: Just by giving informed people what they want at the end of their lives, we get better outcomes and a better quality of life. Why would we not want that?

When the ‘Death Panel’ fiasco came along, a lot of people, understandably confused by the baloney that was trumpeted about, stood up and articulated that they did not want Death Panels. Based on their understanding, they were right. But they missed the opportunity to stand up for what they did want. And every day that we let the current reality of how end-of-life usually happens continue, we all miss that opportunity.

Let’s agree together to do this better – for ourselves, for our loved ones, for everyone.  Let’s articulate clearly, and loudly, a better reality.  Doctors, we want to know what’s going on with us and with our loved ones in an advanced illness situation. We don’t want false hope, we just want you to be direct, and gentle in how you share with us.  We want to hear our options, all of them, not just the ones that include more and more traditional care delivered in a hospital.  We want you to involve our friends and family in these discussions. Let’s think together based on what options exist in these hard situations.  We want our doctors to be okay with our choices – even if they include intentionally requesting less invasive care in return for a better quality of life.  And most importantly?  Most of us just want to go home.

This discussion matters. We need to have it on a national level, and we need to have it as individuals, as mothers and fathers and children and siblings and cousins and co-workers and friends, and as a population that cares a whole heck of a lot about living a good life, because the end of each of our stories should be just as glorious.

Engage with Grace.

What’s one thing you do every day (or as often as possible) to maintain your own health?

I laugh – all the time – at myself, at the inanity of how many mistakes I make, at how hard this all is, at how beautiful we all are with our extraordinary complexity and yet insane simplicity.

I say inappropriate things, because I can’t help myself, and because they are usually true, and because having real conversations is just fun.  And people are generally more productive when you’re starting from a baseline of authenticity and joy and soul and humor.

I revel in the humility of the great joy that we, at this very moment, are alive. And that in and of itself is a gift. One to be cherished, one to be leveraged, one to be celebrated.  I’m realizing in my old age that being successful is not about being perfect, or sometimes even particularly good at what you do. It’s about being slightly less screwed up than everyone else – at least for this moment – and caring a whole lot in the process.  When you remind yourself that you’re lucky to be alive, that it’s never going to be perfect (for anyone), and then focus on the importance of what you’re trying to achieve, you just feel better.

And finally, I try to sleep more, love my family a lot, and remember to seduce my man on a regular basis.

I guess that’s more than one.

For more from Alexandra Drane, watch her TEDMED 2010 talk.  

Visionaries: Alexandra Drane on crafting seductive health messages

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Alexandra Drane

In Part Two of our email interview with Alexandra Drane of Eliza Corporation, she talks about how most health messaging fails miserably at inspiring change in behavior.

Here’s Part One of the interview.

Your latest new venture, Seduce Health, talks about why so many health messages, both in the private and public sectors, fail miserably to change behavior. What are they missing?  What’s your favorite example of a bad message, in form or content? A good one? 

One of the most gorgeous things about the healthcare space is almost everyone in it is here because they care. They are mission driven to make this world a better place for people – particularly as it relates to health. And that’s a good thing!!  But it’s also our Achilles’ heel. We often project that fanatical level of interest in health and healthy behaviors on the people we are trying to influence, as if they too are spending most of their waking hours thinking about and obsessing over what creates better health-related outcomes. Sadly for all of us, they’re not. In fact, the average person would rather eat worms than read my thoughts on healthcare! They’re out reading about who slept with whom or which team won what or feeling secretly delighted that Facebook’s stock is down because they don’t own any and they don’t work there (at least, that’s what I’m doing).

By virtue of the fact that we sometimes think we’re ‘all that,’ we seek to influence people in ways that don’t resonate because we presume a level of baseline interest or engagement that is just not there. One of my favorite examples is to look at the advertising and marketing efforts of the food, tobacco and beverage companies, and then compare them to most of ours. We send pictures of diseased kidneys; they feature smokin’ hot models with grease from a bacon double cheese burger running down their arms.  Hmmmm – who’s going to win there?  That’s not always true, but you get the point.

My pleasures are fleeting.

The problem (opportunity?) is also compounded when you consider that we as an industry spend 30 cents for every $30 our ‘competition’ (those same food tobacco and beverage companies) have at their disposal. They’re simply spending more money. And with a greater self-awareness about what sells, what resonates, what inspires and seduces and beguiles. And not to pile on, but to be fair – their job is easier! I can sell the pants off how good a donut would taste right now (or Fritos, or a sausage, or …), but convincing you that carrots will hit that same spot?  Slightly more challenging.

So, is the answer to just use beautiful models in all that we do? Of course not. It’s far more complicated than that. But it does require that we inhale more humility about what the average person finds intriguing, what real people are interested in spending time thinking about, and that we design our outreach efforts in a way that fully and unabashedly incorporates that very different perspective.

Bite me! I

How can we do that? By adding joy, soul, humor to our approach…by paying attention to the universal conversations that are happening at the water cooler, at the dinner table, at the bar…. by meeting people in the messy realities of their lives, speaking with them in a way they can understand, one that doesn’t feel condescending or academic, and working to help them solve the problems they care about, which may or may not be the ones on which we are focused.

We work hard to infuse our health messages with a true consumer approach, and we do all we can to avoid tactics like medical terrorism – a favorite go-to of many health organizations – even though the literature (and common sense) shows that terrifying someone into action may work once but has a very short half-life. Many of our favorite examples of what we love, and what we don’t, live at Seducehealth.org. Roll around in them for a bit and share what you think!

It’s not hard to do on paper – the tough part is being brave enough to roll out this kind of approach in the real world.  Luckily, we’ve been able to convince (coerce?) some of our customers into trying fresh approaches, and they work! For example, we reached out to women due for a mammogram with a flirty approach and found that women were 26% more likely to schedule a mammogram after hearing this message versus a straightforward reminder:  “Believe it or not, there’s a mammography machine out there that really misses you. You don’t call, you don’t write. Do you think you’ll visit soon?”

The one thing we know for sure is no one has figured out how to really nail this yet. But we think with time, with more experience, with more data, with more humility, and really with more bravery to try genuinely unorthodox and thrilling approaches to engagement – approaches that DON’T presume people are sitting around waiting to get lectured – we’re going to get there.

–Interviewed by Stacy Lu

Visionaries: Alexandra Drane on why women rock healthcare

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This installment of our Visionaries Series features Alexandra Drane, Founder, Chief Visionary Officer and Chair of the Board of Eliza Corporation, a pioneer in health engagement management via a patented speech recognition technology, rich web and multi-modal delivery platform.

In Part One of our email interview, Drane talks about women in healthcare and how to make it as a startup.

Looking at yourself and other female entrepreneurs in healthcare, and at the growing number of women entering medical school, would you say that women are increasingly having more influence in health and medicine, both in the U.S. and worldwide? What kind of changes might that bring about, both in the business of healthcare and how it is delivered?

There is nothing that makes me happier than diversity of any kind in the healthcare space – why?  Because we humans are kind of a big ole’ mess. We are complicated…and a more collaborative and inclusive perspective on who we (as in the universal ‘We’) are, and how we make choices, is far more likely to succeed when what we’re trying to inspire are healthier behaviors in a day-to-day way, because that’s hard to do.

Alexandra Drane at TEDMED 2010

Also, as it relates to gender specifically, my favorite people in the world usually have a mix of masculine and feminine traits. And in my old age, I’m coming to believe that knowing how to apply traditionally gender-ascribed skill sets dynamically, regardless of your actual gender, is where real impact lives. It’s the balance that has the most value.

The unique relationship between women and the healthcare space is not new. I just think it’s evolving. A few fun stats on this:

  • Women make 80% of the healthcare decisions in their families, and are more likely to be the caregiver when a family member falls ill.
  • Women build stronger relationships and have greater brand affinity for their health plans. Eliza measures engagement using our Eliza Engagement Index, and we find that women are 30% more engaged than men with their health plans.
  • Women are savvy online searchers. 65% of women gather health information online versus 53% of men.
  • Women share what they know. 14% of all American moms are “mommy bloggers.”

So women are engaged – and they’re more ‘experienced,’ so to speak – and in a way I think that makes them more informed and more valuable to the overall process. It’s hard to comment when you have no context. Women historically have more context about what health is, and how it lives/manifests itself, so getting them more influence over the systems being built to impact that makes sense.

Finally – and this is going to get me in trouble – I just find women more willing to point to the blue elephant in the corner. And dagnabbit, there are a lot of blue elephants in the corner in healthcare! I have come to believe that most of us working in the healthcare space have two personalities: The personality we take with us to work where we feel comfortable preaching what people should do and proclaiming edicts to that end (I do this all the time), and then the personality we take home, where we have a third glass of wine and don’t schedule our mammogram and sleep for four hours and have chocolate for breakfast while blowing off the gym for the 7th day that week (story of my life).

Sometimes what we need to remember in our wood-paneled conference rooms is that getting people to live healthy is not as easy as just telling them to do that. Most people get that they are overweight, they get that they are not taking care of themselves. That’s not the problem. The problem is getting them to start, and keep, making different choices on a day-to-day basis; choices, by the way, that are not easy for any of us to make!

I find women are faster to both remember, and bring, this perspective to the work they do, so we can spend more time developing solutions that have a chance of working. Maybe this is because they’ve been more out of control for longer? So their context is more ‘real life’? Maybe it’s because they have tried and failed in their efforts to control the behaviors of their own families, so they carry those scars and that deep rooted respect for just what a challenge this is in all they do? Or, maybe it’s just because I’m a woman, so I’m inclined to think we are superior. :)

You’ve been mentoring companies that back health and medical startups, such as Rock Health and Blueprint Health. What are some of the major goals of startups these days? Are there new and/or recurring themes?

Well, the primary goal of a startup is and should be the same as it’s always been – to survive! It’s bloody hard to get one of these things started, and that’s only more true in healthcare where what we’re selling is just not necessarily what folks – the actual citizens of the U.S. and our end-users, so to speak – want to buy: Less of what they love like meat, cheese, sweets, alcohol, and laziness, and more of what they don’t such as exercise, discipline in food consumption, and taking their medicine, especially for asymptomatic conditions when the medicine has nasty side effects.

And, because of that, there is a universal and never-ending component to what all of us are (and have been) trying to do to make a difference, which is to get people engaged and enable them to make healthier choices. I have been in this space for twenty years now, and what we worked on when I was getting started is the same thing we are talking about now – even after 700 million interactions – getting the right message to the right person at the right time. What’s changed? We’ve added ‘in the right channel,’ to reflect the gorgeous proliferation of technologies that allow us to connect with individuals in real time wherever they are, and increasingly to do that in a way that leverages the far greater (and slowly but surely more relevant) amount of data we have on individuals, like the way they make decisions, for example.

The buzz you’ll hear about are things like mobile, gaming, incentives, provider-centric solutions…and these things are valid components of an overall successful approach. But they do not represent the missing and holy grail that will now ‘save us.’ We, as an industry, have a very ‘run to the light’ mentality: ‘Medical home will save us!’, ‘Texting will save us!’ The reality is no one thing is going to save us. Doctors matter, yes. Mobile phones are a great new channel, yes. Playing a game is better than being lectured, yes.

But living a healthy life is an exhausting and unrelenting day-to-day challenge (opportunity?). We will find success when we finally learn to not only coordinate all these efforts, but coordinate them in a singularly focused outside-in, person-centric way, when we come to realize that there is no one-size-fits-all solution, that there is no one-hit wonder, that we are going to have to try and fail a lot to get to more examples of what works. And we can’t keep throwing out approaches because they don’t deliver the immediate success we seek. Human behavior is messy, it’s complicated, it’s unpredictable – and anyone who questions that need only look at their own health behavior. Few of us are doing all the things we should be doing to be our best selves, and this is our job!

Read Part Two of our interview with Alexandra Drane on Monday, June 11th. To watch her TEDMED 2010 talk, click here.

Visionaries Series: Chuck Pell says “pursuing surprise” is recipe for creativity

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This is Part Two of an interview with engineer Chuck Pell, TEDMED 2011 speaker and co-founder of Physicent, a company applying biomechanics to update surgical instruments.  Click here for Part One.

Q. You’re planning to update more surgical instruments; can you talk about what’s next?

A. There are multiple instruments in development. I should point out that the platform technology making Assuage possible also applies to every other tissue in the body. Let me say that again: All surgeries can benefit from making the instruments biomechanically smart. The old battle between “open” procedures and “minimally invasive” procedures is over. The new world is divided between traditional steel and biomechanically intelligent surgery. All surgical procedures can be smarter and less painful, both open and minimal. It’s not just about rib cages. There is about to be an Oklahoma Land Rush across the entire surgical tray and we are already hell-bent for leather.

Chuck Pell

Q. “Pursue surprise” is something you have mentioned, along with the phrase “beginner’s mind.” How does one cultivate that kind of mindset?

A. Pursue Surprise is the recipe. We are all surprised many times a day, in many settings and in many ways. Comedy and magic depend on it – those take us one way, then surprise us – and we are delighted. But, in the day-to-day world, we’ve trained ourselves to ignore Surprise, in order to Get To The Point. Well, the Point is, there’s a better Point.

Surprise is a gift, a resource, a leg up. The feeling of surprise is the sign that your mental world model has just failed to predict something. Surprise says, “You’re wrong about something.” That’s not a bug; it’s the best feature, ever.  Every surprise is a chance to upgrade your model of the world, to improve your sense of What Is, to get a better sense of How Things Work. The most successful people pay attention to surprises. They take a moment to savor the new insight they’ve just experienced, and then they pursue it to find out where it leads. Pursuing surprise leads to things like human flight, computers, chemistry, medicine, science, penicillin (many people were surprised by the anti-microbial action of Penicillium fungi but failed to pursue it), electricity, rocketry –- stuff like that.

Q. Art, filmmaking, paleontology, biomechanics – you have a varied background, to say the least.  How does it all fit in? How did you get here?

A. To me, its like these are different aspects of a single pursuit. Paleontology and biomechanics tell me about convergent evolution, which tells me about which parts of an organism are evolutionary baggage, and which parts are the essential minimum required to accomplish some task.

A good example: Dolphins, tuna, mako sharks and ichthyosaurs all possess similar design features well-suited to a fast-moving, energy-intensive oceanic lifestyle: highly streamlined torpedo-like bodies, falcate fins, lunate caudal fins, and more, but the clincher is this: each has features the others don’t (the evolutionary baggage) that isn’t part of the essential fast-swimmer minimum design package. That stuff, I can ignore if I want to make, say, a fast biomimetic oceanic robot.

Biomechanics is essential for understanding how tissues behave in the moment, how they work as machines physiologically (e.g., at normal strains and stresses) and how they react to huge distortions – a consequence of almost every type of surgery. Biomechanics is a powerful insight machine, which is why I am stunned that it hasn’t been incorporated into modern medicine more than it has – but that, happily, is changing fast.

Where it made sense, I copied nature in designing these instruments. For example, you look at all these different ways animals grab on to to each other without causing injury. What if we worked for that outcome, versus a design approach like a predator’s talons going in and stabbing someone? As an example, an awful lot of surgical instruments sport serious spikes, which aren’t about patient comfort – they’re about not slipping under load. There are other, nicer ways of preventing slipping without sticking spikes into flesh. We’ve got several.

Before we started delving into the details of surgical instrument design, I had the impression that ‘it was all done,’ that everything will have been worked out to the utmost degree of refinement. So, when I glanced at a surgical tray for the first time, I thought, “Holy crap! Maybe I can contribute something here.” I recognized a number of instruments on the modern trays from art history, namely from Ptolemaic Egyptian tomb carvings (120 BCE). I know humans haven’t changed much in 2,000 years, but our scientific understanding of biomechanics sure has!

Pell onstage at TEDMED 2011

Q. By your own admission, you were a geeky kid, and surely that’s helped make you the creator you are today. I worry about kids today having the focus, inner drive and even enough down time to feed their creativity. What do you think? Will we have more or fewer Chuck Pells in our future?

A. More. We are re-recognizing the value of letting kids make things with bare hands, of savoring being wrong as an insight engine, of getting outside and exploring nature. My parents were strict in some ways, but in others they let me dive deep into projects (that, in retrospect, I’m amazed I survived). Combine kids’ expanding sense of offline learning with Google, Wikipedia, Make magazine, mobile devices, social networking, gamification, worldwide comms, GPS, apps, better AI, a new space industry and the sweeping trend towards cheap, ubiquitous 3D printing, and you’ve got an explosion of inspiration and opportunity. I’m not rare – I’m the vanguard. It’ll be deeply surprising if we’re not stunned daily by the show of enhanced accomplishments of ever-younger kids. I mean, if it’s now a 5th-grade science project to send balloon cameras to the edge of space, what can’t we do? We mustn’t teach the old assumptions to the next generation, because so many of the old assumptions are dead wrong. Imagine a generation of kids growing up pursuing surprise: there will be undergrads on Mars before you know it. I’m betting on it, actually.

Q. How do you stay so productive?

A. I barely sleep. My whole life I’ve gotten about four hours a night. There’s too much to do!  I’ll hate it when I’m dead, because fortune will no doubt have the temerity to wait just that long to reveal fun things like an outbreak of world peace, or alien contact, or cheap anti-gravity, or warp drives, or inter-dimensional travel, or true AI, or the like.

Part of what motivates me is that if any of these things are ever physically possible “in the future,” then they are physically possible right now, this minute. The main thing preventing us from discovering these things is our point of view, which is based on assumptions, most hidden from us. Pursue surprise with enough vigor and the unlikely will become possible, obvious, and even inevitable – and fun. The only thing stopping us is our imagination, and I can imagine quite a bit. I plan to discover as much as possible before I go, and give it to the worlds.

Click here to watch Chuck Pell’s talk at TEDMED 2011, and the audience Q&A following.

Visionaries Series: Entrepreneur Chuck Pell re-imagines the surgical tray

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In this installment of our Visionaries Q&A series, we asked Chuck Pell, TEDMED 2011 speaker, about how he’s biomechanically overhauling surgical instruments — in one case, designing the first update in 75 years — and what that means for patient recovery.

Chuck Pell: Scientist, painter, sculptor, inventor.

Q. The first product your company, Physcient, plans to introduce is called Assuage, a robotic rib spreader for heart and lung surgery that helps prevent common surgical complications like cracked ribs and nerve damage. It’s replacing a hand-cranked design that hasn’t changed since 1936. 1936! What has been keeping us from taking a step back and rethinking those designs? Is surgery some kind of mystical field, some kind of sacred cow?

Physcient's Assauge

A.We’ve left our brilliant surgeons a 1936 design that is amazingly primitive given what we know about biomechanics in 2012. Traditional surgical instruments need to catch up with doctors’ amazing talents and training. As a society, we’ve accepted for 100 years that surgical holes must be profoundly damaging and painful. Physcient respectfully disagrees! In one step, we’ve jumped 75 years into the future – the future of 2012, versus 1936. As an example, our group is the first to ever measure the forces of thoracic retraction, so we’re the first to see those signals, the first to understand them, and the first to capitalize on what they can do for patients.

Current model of a hand-crank rib spreader -- a design unchanged in 75 years.

Our robot senses and responds thousands of times each second, so that it can detect the subtle signs of imminent tissue damage and react many times before a human could detect anything’s amiss. This is what the military calls a force multiplier: It enhances the operator’s capabilities. We change the tool, not the procedure. The instruments should just get better so the surgeon gets to be better, so the patients can hurt less and heal faster.

Q. Have the health/medicine experiences of others in your life shaped the work you’re currently doing, and the innovations you want to see?

A. Yes! My father is gone, probably because he watched my Uncle Earl get cracked open three times. (He’s gone now, too.) Look, everybody is a patient and everybody is pre-operative. And we’re becoming more aware that these surgeries are way more painful than everyone first admits.

The common source of damage appears to be the basic assumptions embodied in the sometimes centuries-old design of the instruments. The results? When patients talk to each other in confidence, they say, “I feel like I’ve been hit by a truck.” Or, “Next time, I’d rather just die.” It doesn’t have to be that way.

When you wake up alive after an operation and the surgeon asks, “How are you doing?” the polite thing to say is, “Thank you for saving my life.” No one says what my Uncle Earl told me, “I feel so bad I want to grab the surgeon with my bare hands.” He was alive, but he was upset at how bad he felt for some time. I was so shocked, that statement stuck with me.

As soon as people find out that major surgery doesn’t have to cause such pain, they won’t sit still for the old way of doing things. They’ll want a better way. I would. So, I design instruments like I’m going to have surgery next week. We’ll shoot for the moon: Surgery should be as pleasant as we can make it, before, during, and after. The fear of waking during painful major surgery should become a thing of the past.

Q. Where are you with Assuage? When will it be clinically available?

A. Assuage should be available within 18 months of closing our current round.

–Interviewed by Stacy Lu

Please stop by tomorrow for part two of our interview with Chuck Pell.  Click here to watch his TEDMED 2011 talk.

 


TEDMED Visionaries: An interview with David Agus

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Today is the inaugural installment of our new blog series, TEDMED Visionaries. We’ll feature in-depth Q&A’s, interviews, podcasts, guest posts and more from our speakers and from leading innovators in the converging worlds of tech, health and medicine.

Our first guest is David Agus, M.D., oncologist and author of the bestselling book, “The End of Illness,” who spoke at TEDMED 2011.

Q: In your book, and in your talk at TEDMED, you mentioned doctors recommending potentially harmful interventions – like smoking, margarine and vitamins – without having data to back up their advice. Why does that still happen, in today’s info-rich age? How could doctors share knowledge better?

Agus: Many times we (the medical community) make recommendations prematurely before prospective data is available. The realization that we are a complex system means that any intervention will change the system, and may do so with a negative health consequence. My hope is that with the digitalization of medical records we will be able to learn from our actions in real time and improve medical care iteratively. Although we like to think that we live in an info-rich, high-tech world, there’s still much about the human body that we just don’t know or understand yet. When a doctor makes a recommendation, it’s with the best intentions, but medicine is still very much an art rather than a science. In the future, that will shift as technology supports the exchange of data-driven wisdom among doctors, which will then inform their decisions.

David Agus

Q.As we head into a future that increasingly uses proteomics and the personal diagnostic tools you envision, how will physician training have to change to accommodate these advances, if at all?

Agus: I think a call for a new way of training physicians is necessary. We need to modernize our medical education system to reflect new understandings and technology. At the same time, we have to be aware of the “human” part of medicine and not lose that important art.

Q. Proteomics and other diagnostic tools may give us a great leap forward in treating some of our most pervasive ills. What, in your opinion, will be the toughest to crack in terms of having a cohesive view of the disease mechanism? Depression? Cancer? Obesity, or Alzheimer’s?

Agus: It’s hard to grade disease complexity, but I think all diseases deserve new thinking and application of technology. As I state plainly in my recent book, it’s quite possible that we already have all the drugs we need to treat the vast majority of diseases — even the ones that entail a breakdown of the system such as cancer or Alzheimer’s disease, and aren’t caused by an invader. We just don’t know how to use this library of drugs (method), how much to use (dosage), and when (schedule). New techniques for collecting health data in the future will hopefully inform this idea.

Q. What is a timeline by when we might see proteomics testing become common? In fact, when will genetic testing become standard as a baseline health metric? It seems that it is no longer prohibitively expensive.

Agus: Proteomics tests exist today—we use them routinely (e.g., prostate specific antigen to detect signs of prostate cancer, pregnancy tests, inflammation tests, etc.). Newer proteomic tests that will benefit from the advances in technology will be introduced in the next several years. In terms of access to these technologies, as well as more widespread use of genetic testing across the general public, I presume that will happen as the technologies become cheaper and we strive to change our healthcare system.

Q. CDC employees carry statins and meat tenderizer to reduce inflammation, should a virus like H5N1 strike, and to neutralize toxins. Do you carry any remedy or health talisman with you at all times, other than wearing comfortable shoes?

Agus: Statins can reduce inflammation, and meat tenderizer can be used to degrade protein-based toxins (if something bites you). I don’t carry anything myself, but I do wear comfortable shoes that don’t hurt my feet (to reduce my levels of inflammation!), I do take a statin and aspirin, and I wear a Nike Fuel Accelerometer on my wrist.

Q. Your book strongly advocates taking personal responsibility for our health. Many of us know what’s good for us, though, and still fail to do it. What’s the missing link?

Agus: I think we need to all better understand the long-term consequences of our actions. I wrote the book to make a difference in this regard. It all comes down to incentives — that’s the missing link. I can tell you that you have a 30 percent chance of becoming obese based on the general population, which is probably meaningless to you. But if I could tell you that your risk of becoming obese in your lifetime is 60 to 80 percent based on your genetics, this would likely mean something, wouldn’t it? That might be enough to inspire you to pay more attention to the lifestyle habits that factor into your weight. That might be enough to motivate you in ways you never thought possible to control your waistline. That’s the power certain technologies such as genetic testing can have on individuals. Another way to look at it: If you knew that your personal risk for having a heart attack in your life was 90 percent, you’d probably do everything you could to treat your heart well. Hearing another umbrella statistic such as “heart disease is the leading killer in our country” has little impact, if any. But learning that your genetic profile puts you in a higher-than-average risk group for suffering from a heart attack speaks much louder than general statistics.

–Interviewed by Stacy Lu