Visionaries: Vic Strecher says living with purpose inspires good health

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

Let’s have dinner and talk about death.

How would you like to die?  How would you like to be remembered?  And what’s the best death you’ve ever seen?

It’s difficult thinking about these questions, let alone verbalizing answers. There are consequences, though, for trying to avoid the inevitable.  Some 70 percent of Americans say they would prefer to die at home, yet only 30 percent actually do.  Dying in a hospital, perhaps with unplanned or unwanted treatment, can be hugely expensive for patients’ families and for taxpayers: The Wall Street Journal reports that in 2009, the 1.6 million Medicare patients who died that year accounted for 22.3% of total hospital expenditures.

A new project, Let’s Have Dinner and Talk about Death, aims to give people the opportunity to broach what might be perhaps the toughest subject of all over a table rather than a hospital bed rail.  It’s built around the idea that mealtime discussions offer a convivial forum for participants to talk about, quite simply, how they would like to die.  Hopefully, expressing wishes out loud will lead to having an end-of-life plan in place with family and healthcare providers.

"How would you like to be remembered?"

The concept comes from chef Michael Hebb, a TEDMED 2013 speaker, and Scott Macklin, a Teaching Fellow and Associate Director at the University of Washington’s (UW) Digital Media program.  Hebb says humans have an innate urge to communicate over a meal.  “The table and the fire are where we first concentrated calories by cooking,” he says. “There is a safety and comfort among food and drink, and a sense that issues of gravity can be discussed.”

A web site devoted to the experience, www.deathoverdinner.org, which will be fully operational this summer, will share ideas for hosting dinners devoted to morbidity and will invite users to share their stories in its online community. It’s also the basis of a new UW course. The enterprise is a division of the non-profit Engage With Grace, and two TEDMED partners, Shirley Bergin and Jonathan Ellenthal, are advisors.

Michael Hebb

And what’s the ideal menu for such a dinner?  First, Hebb says, serve something you know how to cook. “Unless you are a culinary wizard, I wouldn’t suggest molecular gastronomy or any new kitchen terrain,” he says. “Make something that makes you happy, both to prepare and to eat.”

For more about the project, visit www.deathoverdinner.org and follow #deathoverdinner.

Call for participants: Be a part of the story at TEDMED Great Challenges Day

Are you obsessed with the future of personalized medicine? Or perhaps its the unfolding advances in technology to improve the management of chronic disease that motivates you each morning? Do you tweet constantly about innovations in health? If you answered yes to any of these questions, then you might be a perfect match for our never-before-done-opportunity.

The TEDMED Great Challenges program is inviting social media users to apply for credentials to attend its first ever Great Challenges Day at George Washington University on April 19th.

A maximum of 20 social media users will be credentialed to attend the event and will be given the same access as news media and bloggers in an effort to align the experience of social media representatives with those of traditional media.

TEDMED social media accreditation for Great Challenges Day opens at Noon EDT Thursday, March 21st and the deadline to apply is 5:00 p.m. EDT Tuesday March 26th. All social media accreditation applications will be considered on a case-by-case basis. Those receiving TEDMED Great Challenges social media credentials will have the opportunity to:

  • Participate in the final morning of TEDMED 2013 at the Kennedy Center in Washington, DC
  • Participate in the first ever TEDMED Great Challenges Day at George Washington University in Washington, DC (Note: Transportation will be available between the Kennedy Center and the campus, and maps are available for walking between the sites)
  • Serve a critical role in sharing the discussions and discoveries from key speakers and breakout room dialogs throughout Great Challenges Day
  • Meet and interact with representatives from TEDMED and the TEDMED community of global thought leaders
  • Meet fellow health and medicine enthusiasts
  • Publish one (1) post, with byline attribution and author feature, on the TEDMED Blog
To Apply: Please make sure to review the details below and then submit your application to be a part of TEDMED Great Challenges Day.

What does it mean to be a part of TEDMED Great Challenges Day?
New to the Great Challenges Program in 2013 is Great Challenges Day, which features the opportunity for you, as an avid social media user, to become a piece of the story. As a member, you will receive access to TEDMED 2013, the Hive, and Great Challenges Day on Friday April 19, 2013 (only). You will receive social media credentials and placement within a Great Challenge delegation for Great Challenges Day.

Social media credentials give users a chance to apply for the same access as journalists in an effort to align the access and experience of social media representatives with those of traditional media. People who actively collect, report, analyze and disseminate news on social networking platforms are encouraged to apply for media credentials. Selection is not random. All social media accreditation applications will be considered on a case-by-case basis. Those chosen must prove through the application and registration process they meet specific engagement criteria.

Great Challenge delegates will meet as a team during Great Challenges Day for a workshop dialog on the pressing issues related to one specific challenge, identifying its untold narrative through a series of activities related to the storytelling of science. Placement within a Great Challenge delegation provides members with the opportunity to share their connection to the Great Challenges program, provide knowledgable reflections on the topics, and facilitate the global community – providing the insights of the social media community within each Great Challenges dialog.

To join us at Great Challenges Day for this opportunity, you must have proven expertise on social media and demonstrate interest in furthering the critical discussions within health and medicine. Participants will share their experience through live tweeting speakers and sharing updates on social media. They will also have the opportunity to work with the editorial team at TEDMED to submit a blog post for blog.tedmed.com, with byline attribution and author spotlight.

How do I register?
Registration opens at Noon EDT on Thursday March 21st and closes at 5:00 p.m. EDT on Tuesday March 26th. The registration link will be shared on TEDMED’s Twitter, Facebook, and Google+ accounts at that time. All social media accreditation applications will be considered on a case-by-case basis.

Do I need to have a social media account to register?
Yes. This event is designed for people who:

  • Actively use multiple social networking platforms (Twitter, Google+, Facebook, others) and tools to disseminate information to a unique audience
  • Demonstrate an advanced, sophisticated awareness of social media engagement
  • Regularly produce new content that features multimedia elements.
  • Have the potential to reach a large number of people using digital platforms.
  • Reach a unique audience, separate and distinctive from traditional news media and/or TEDMED audiences.
  • Must have an established history of posting content on social media platforms.
  • Have previous postings that are highly visible, respected and widely recognized.

Users on all social networks are encouraged to use the hashtag #GreatChallenges. Updates and information about the event will be shared on Twitter via @TEDMED and via posts to Facebook and Google+.

What are the registration requirements?
Registration indicates your intent to travel to the Kennedy Center and George Washington University in Washington, DC and attend the one-day event in person. You are responsible for your own expenses for travel, accommodations, food and other amenities.

TEDMED will provide breakfast and lunch on Friday, April 19th. At both the Kennedy Center and the University, TEDMED Great Challenges will provide a wi-fi login.

Some events and participants scheduled to appear at the event are subject to change without notice. TEDMED and TEDMED Great Challenges are not responsible for loss or damage incurred as a result of attending. TEDMED and TEDMED Great Challenges, moreover, are not responsible for loss or damage incurred if the event is cancelled with limited or no notice. Please plan accordingly.

Those who are selected will need to complete an additional registration step. To be admitted and pick up your credentials, you will need to show a government-issued identification (with a photo) that match the name provided on the registration. Those without proper identification cannot be admitted. All registrants must be at least 18 years old.

Does my registration include a guest?
Because of space limitations, you may not bring a guest. Each registration provides a place for one person only (you) and is non-transferable. Each individual wishing to attend must register separately.

What if I cannot come to Washington, DC?
If you cannot come to Washington, DC to attend in person, or you are unable to attend for the full day on April 19th, you should not register for TEDMED Great Challenges social media credentialing. You can follow the conversation using the #GreatChallenges and #TEDMED hashtags on Twitter.

When will I know if I am selected?
After registrations have been received and processed, an notification email will be sent out to inform you whether or not you have been selected for TEDMED Great Challenges social media accreditation. Those selected will be required to complete an additional step before being accredited. We will send notifications upon approval.

If you do not make the registration list for accreditation, you can still participate in the conversation online by following @TEDMED, #TEDMED, and #GreatChallenges.

Does registration for and/or attendance at this TEDMED Great Challenges with social media accreditation qualify me for media accreditation for future events?
No, your registration and/or attendance, does not qualify you for news media credentials at TEDMED or TEDMED Great Challenges now or in the future.

TEDMED strongly encourages all potential applicants to be familiar with the Great Challenges of Health and Medicine prior to completing their application.

Examined Lives: The tale of the bungled biopsy

By Margaret Brunner*

In December, I went to Starsen Radiology* for my annual mammogram. They called me at the end of the month. They said I needed to come back immediately for another mammogram because they had found a suspicious mass in my right breast. So I went in that day for another mammo. They definitely saw something, and said I needed to get a biopsy done ASAP, and could perform it, f I wanted.

Of course, I panicked.  I called my Ob-Gyn to see what she had to say. The Gyn office said that Starsen* did biopsies all the time, and that it would be okay to schedule it with them. I called and set the appointment for January 7th. I’ll never forget the date.

The big day arrived and I went to Starsen for the biopsy.  I was nervous as heck. I’d never had this done before, so I didn’t know what to expect.  There were two nurses there to help me prep. Then the doctor came in to explain the procedure and had me sign a paper, of course.

The procedure, called stereotactic biopsy, was pretty painful – they said there would be “some discomfort.” They gave me a local anesthetic, but it was never enough.  Boy, was I glad when it was over.  They told me that they would send the tissue sample to the pathology department in a local hospital and that it would take about one to two days to get the results back.

The waiting was the worst part.  You start to think about horrible possibilities.  Starsen never gave me an idea of how many biopsies show a malignancy, though I did find out from another breast center that 80% turn out to be benign. I’ve been relatively healthy all my life.  So, when I got the call that I would need a biopsy, I was very worried. I kept on thinking, “What if do have breast cancer?  How am I going to tell my kids? I haven’t done so many things that I still would like to do.”

This then led me to develop hives, which happens when I’m psychologically stressed.  On day two, I called Starsen to see if they had the pathology report. Nothing yet.  Day three, still nothing.  Day four, nothing.  Day five, nothing.  Imagine my fears growing and my hives getting worse.  Day six: Starsen had finally gotten the pathology report back. It was benign!  Hallelujah!  I was so happy.

Fast forward to a week later. I get a call from Starsen, who tell me that they took a sample of the wrong area.  Are you kidding?? I couldn’t believe it.  When they mentioned risks before the procedure, they mentioned infection. They did say they might not get the right sample, but that it was very unlikely. Not only did I have to endure the pain of the procedure and many days of waiting for the pathology report, I now found out that they got the wrong area. I never found out why, and another radiologist told me the news – not the one who had done the procedure. They tried to make me go to them for another biopsy.  I declined.  I didn’t pay anything for that procedure out of my pocket – I guess insurance picked up the tab.

I wasn’t sure what I should do.  Should I see a surgeon?  I got a few names in my area. Then I talked to someone in my town and found out about a breast surgeon in Manhattan. Apparently, many women in this area have gone to see her and she is well regarded in the field. I wanted to see someone who really knew about breast issues.  I finally got to see her on February 6th.  Because the mass was so far back in the breast, she recommended another stereotactic biopsy, instead of surgically getting a sample of the suspicious mass.  But she said she wanted the radiologists at her location do the biopsy. That was fine with me.  I loved the breast surgeon.  She was a kind doctor.

On February 12th, I went in for my biopsy.  What a different experience.  There were two nurses there for my procedure, but they really “held my hand” to tell me what was going on and what they needed to do during the procedure.  I really liked that aspect.  I also got to meet the two radiologists who were working on my case.  They introduced themselves to me beforehand and told me what to expect during the procedure.  And they gave me their phone number in case I had questions.

After the procedure, the radiologist got another image to make sure they got the right area. The radiologist in New Jersey hadn’t bothered with that.  I loved the radiologist who performed the biopsy.  She kept asking how I was feeling. Although she gave me a lot of lidocaine, I still felt quite a painful tug and pull during the process.

They sent the sample to their pathology group and said to expect the report within 24-48 hours.  After my last experience, I was very skeptical about getting it that soon.  I was ready to wait six days again.  But boy, was I wrong.  The pathology report came back incredibly quickly – 24 hours!  And happily, it was benign!

If I had to do it over again, I would have found a doctor that other women have seen and speak highly of.  I would asked my friends right away to see if they knew of a good doctor.  Telling my friends also helped relieve the stress of worrying about whether I had cancer. My friends are truly one my pillars of strength.

*Names have been changed to protect privacy.

Visit TEDMED’s Great Challenges website to discuss how to eliminate medical errors.

What’s your definition of stress?

This guest post is by Benjamin Miller, PsyD, Director of the Office of Integrated Healthcare Research and Policy at the University of Colorado School of Medicine.

Stress. You’ve experienced it. Chances are, even as you read this blog, you are in the process of experiencing it. No, not that reading blogs is inherently stressful, but rather because we live in a society that is go, go, go. We move at breakneck speed always aware of the next deadline we must meet or the next place we must be. We are a society on the move. What happens when too much “need to” starts to wear on us? What happens when we start to feel a bit overwhelmed like we just can’t take on one more thing? How do we respond?

Well, rest assured, you are not alone. According to the American Psychological Association’s 2012 “Stress in America” survey:

  • Americans report their mean stress level as a 4.9 on a 10-point scale where 1 means “little or no stress” and 10 means “a great deal of stress,” while they define a healthy level of stress as a 3.6 on the same scale. Twenty percent of Americans report stress levels that are extreme (an 8, 9 or 10 on a 10-point scale).
  • The most commonly reported significant sources of stress include money (69 percent), work (65 percent), the economy (61 percent), family responsibilities (57 percent), relationships (56 percent), family health problems (52 percent) and personal health concerns (51 percent).
  • Only 17 percent of those with high stress say that they are doing an excellent or very good job of managing their stress, compared with 59 percent of those with low stress and 37 percent of Americans nationwide.

These data help shine a light on an often dark corner in healthcare – the role of stress. Before we dive any deeper on the topic, let’s define what we are talking about here. According to Merriam-Webster, there are no fewer than six different definitions of stress.

Rather than pick one of these definitions, I would like to propose a more simple definition for us to consider – stress is change. When you read through all the various definitions of stress in the dictionary it becomes quite clear that whether good or bad, stress is something happening to us within our environment.

With this definition in hand, let’s begin to consider how stress plays a role within health and healthcare. Like many things in healthcare, we try to separate out stress; we try to isolate it as its own entity when in reality this could not be further from the truth. You see, stress, whether you identify it or not, is having an impact on your health. For example, over thirty years of research examining the effects stress on cardiovascular health have suggested:

  • Chronic stress related to work and/or one’s personal life is associated with a 40-50% increased likelihood of coronary heart disease.
  • Those already diagnosed with coronary heart disease have poorer prognoses if they have more work-related stress and social isolation.
  • Increased risk of heart disease is now thought to be due to repeated and long-term stress on autonomic and inflammatory processes.
  • This persistent long-term stress in the workplace, in particular, has been found to impact health and has been characterized as both 1) high psychological demands such as multiple responsibilities with high productivity demands, and 2) low personal control and restricted ability to make decisions.

The costs of stress to you, the consumer, and to the healthcare system are exorbitant:

  • Over $300 billion is spent in legal and insurance costs, and reduced productivity, absenteeism and turnover due to job stress.
  • Healthcare spending was 46% higher for workers with high levels of stress.
  • An estimated $2 trillion in annual healthcare costs are due to the management of chronic diseases, which are largely contributed by chronic stress.

Now, consider that we have novel ways to treat stress.

Meditation for stress reduction programs are demonstrating long-term health improvements. In a recent five-year study examining Transcendental Meditation, participants experienced a 48% decreased risk of stroke, heart attack, and death, as well as reductions in blood pressure, stress and anger.

Laughter and learning to take yourself less seriously are approaches that are also receiving more attention for reducing stress and improving health. Humor is known to release endorphins, those feel-good neurochemicals, and reduce circulation of stress hormones. Laughter Yoga Clubs, which combine laughter and yogic breathing, are becoming more popular at companies and colleges worldwide.

More generally, positive thinking is thought to improve immune function and coping with pain, and reduce incidence of depression and overall distress.

“How stressed are you today?”

I remember once working in a primary care practice where every patient was asked the same question: “On a scale of zero to ten, how stressed are you today?”

The answers were always telling, and would in some ways predict how the rest of the visit would go. For example, if a patient said:

“Well, you know I have been feeling a lot of deadlines at work recently. I just haven’t been able to relax as much as I used to. These deadlines have kept me out of the gym, too, which is one way I always fought off my stress. Right now, I would say I am a 7 out of 10.”

With a patient like this, it was fairly obvious that they knew what the stressor was, knew possible solutions on how to manage it, and saw the entire issue pretty clearly. Other patients, on the other hand, were not as insightful.

“On a scale of zero to ten, how stressed are you today?”

The patient, calm, cool, and collective, would look at you straight in the eye and say “zero”. It was during these moments that you knew something was really going on; because, let’s be honest, who has no stress in their life? How do you manage change in your life? How do you identify “stress”?

Follow Ben Miller @miller7, and watch him moderate our Great Challenges live event about  coping with the health effects of stress on Thursday, March 14th at 1pmET.

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

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

 

The dementia tsunami is headed your way

A Guest Post by Amy Goyer

Anyone who has ever encountered someone who has dementia, much less been involved in the intense care for or a loved one with the wretched disease, has three thoughts that permeate his or her mind:

  • First, pleading: “Please, please don’t let it happen to me…and if it does let there be a cure.“
  • Second, reality: “Who will care for me if I do develop dementia?”
  • Third, fear: “How am I going to amass enough money to pay for my care?”

I was first a caregiver for my grandmother who had dementia and now for my Dad, who lives with Alzheimer’s disease, a common form of dementia. I have these thoughts on a daily basis, and I know I’m not alone: 25 million people are projected to develop dementia by the year 2050 unless we find ways to prevent, treat and cure it.

Who will care for these people? What will be the personal, medical and economic impacts of this surge?

Recently, I participated in a TEDMED Google+ hangout chat about the dementia tsunami headed our way. I was encouraged by the robust discussion of these and other key questions by experts, doctors, researchers, service providers and caregivers. Not because there were answers to all of these questions, but simply because the discussion was taking place.

Those of us who work in the field of aging have been riding our virtual horses through the night shouting, “The boomers are coming! The boomers are coming – and they’re bringing dementia!” for many years. Some in the medical community have also been sounding the alarm. In fact, it’s not only the boomers. By 2050, Gen Xers and even Generation Y will be in dementia range.

Now, by shining a light in the darkness on this critical issue, TEDMED is helping to create the only thing that will really change the course of the dementia tsunami: public demand. We must, as a society, reach that “I’m mad as hell and I’m not putting up with it anymore” stage that creates an overwhelming energetic shift. That shift is what it takes to increase research and treatment options for dementia, as well as affordable care for those who have it and support for those of us who take care of them.

Experts in the Google+ hangout shared their perspectives and some key issues in the chat:

  • About 1 in 8 older Americans have Alzheimer’s disease now (one form of dementia).
  • At this time, some medications and treatments can slow certain types of dementia for some people, but nothing stops it. Nothing. There is no cure.
  • The National Institutes of Health spends only about $500 million a year on dementia research – much less than other diseases.
  • Less than 1% of nurses, physicians assistants and pharmacists are trained in geriatrics, yet 26% of their patients are geriatric. There is a dearth of geriatrician physicians (geriatricians) as well. There are simply not enough medical professionals who are trained in dealing with the diseases of old age (including dementia) and the necessary unique treatments and approaches for this population to meet the demand.
  • Family caregivers are bearing the bulk of the burden of care and will do so increasingly in the future – many without connections to resources and supports that are in place. Caregivers for those with dementia have higher rates of depression and other health problems themselves. More funding for training and supporting family caregivers is needed.
  • More people need to participate in dementia research – but caregivers of those who suffer from it are generally so exhausted and overwhelmed we often can’t get it together to register our loved ones or ourselves to participate in research.

Amy Goyer with her parents.

From my perspective as a primary caregiver for both of my parents who live with me, a full-time worker, and an individual who probably has a strong likelihood of developing dementia myself some day, I could feel horrifically hopeless. What keeps me from falling into the abyss of fear? Taking action. I choose to do something about all of this; I do my part in creating that necessary energetic shift.

I do so personally, by making the necessary sacrifices in my life so that I can ensure my parents are getting the best possible care and by taking a relentless approach to doing my homework, asking questions of their health care professionals, leaving no stone unturned when it comes to possible treatment for dementia and their other illnesses. I also honestly share my own personal caregiving experiences in my blog and other forums. Professionally, I take action by raising awareness and helping other caregivers – in particular through my work with AARP and the Ad Council as a spokesperson for their caregiving campaign. We are working hard to connect caregivers with much needed supports through the AARP Caregiving Resource Center. It’s a big job and it will only get bigger.

Whether you are a doctor, researcher, lawyer, nurse, family caregiver or an individual who doesn’t want to get dementia – do something. Keep the discussion going. It’s better than sitting back and waiting for the flood. In the TEDMED chat, expert leaders and participants all agreed on one thing: we must advocate for those with dementia – they can’t advocate for themselves. I might add that, truth be told, when we advocate for prevention, treatment and a cure for dementia, we are actually advocating for ourselves too. The tsunami is coming, and you never know if you will be in its path.

I look forward to more pointed and hopeful discussion about caregiving and dementia at the TEDMED event in Washington, DC coming up April 16-19.

Follow Amy @amygoyer and on Facebook.

 

 

Diverse group of speakers for TEDMED’s 2013 lineup

TEDMED’s mission is to gather multi-disciplinary voices to enlighten, entertain and inspire conversation and new possibilities. Hence the latest additions to our diverse and phenomenal speaker lineup:

One child may be a piano prodigy; another may have Down’s syndrome. Both may equally challenge their families. “Far From the Tree: author Andrew Solomon will share stories about how diversity unites us all.

Hear why internal medicine physician Roni Zeiger left his position as Chief Health Strategist at Google to explore the next generation of social media and health.

Pediatric Critical Care Cardiologist John Kheir will show how patients can ‘breathe easier’ with his life-saving injectable oxygen-filled microbubbles.

Food provocateur Michael Hebb will gather us at his table for a challenging conversation.

Palliative care oncologist, patient advocate, and former NASA programmer Amy Abernethy focuses on the intersection of big data and patient rights.

Visit TEDMED.com for more information and to apply to hear these speakers in person this April at the Kennedy Center.