What gets your heart racing? Q&A with Foteini Agrafioti

At TEDMED 2014, Foteini Agrafioti raised concerns about today’s passwords and IDs, and shared how your body may provide easier, and more accurate, forms of identification. We reached out to her to learn more about what inspires her work.

"The million dollar question is are biometrics secure? James Bond would have you believe so." - Foteini Agrafioti on the TEDMED 2014 Stage [Photo: Kevork Djansezian]

“The million dollar question is are biometrics secure? James Bond would have you believe so.” – Foteini Agrafioti on the TEDMED 2014 Stage [Photo: Kevork Djansezian]

 

What motivated you to speak at TEDMED?

I felt the need to provide a different perspective on biometric security. Our world is evolving so quickly, and biometric authentication has made its way into our lives. I want people to understand the challenges, limitations and implications of this technology.

Who or what has been your main source of inspiration that drives you to innovate?

There is no specific source of inspiration. I go by two rules: 1) never get comfortable and 2) surround myself with people who want to disturb the status quo. It all starts with crazy “what ifs…”. We then quickly test those hypotheses and that’s how the innovation journey begins.

What advice would you give to other aspiring innovators and entrepreneurs?

Obsess! If you are to challenge the status-quo, you had better obsess about it. Protect your vision in the face of abundant skepticism and never give up. You won’t make an impact just by trying – you must go all the way. In the last decade, I can recall many times that people told me that I was set up for failure. Wouldn’t it be a shame if I had believed them?

What’s next for you?

After leaving Nymi, I joined Architech and founded Architech Labs to do research in the area of human computer interaction. My vision is to build technologies that understand the underlying factors of human behaviors and habits. I am now experimenting with affective computing – the engineering field that studies the human emotion. I believe that emotional intelligence is the last barrier to meaningful human-computer interaction and I am thrilled to be working on this.

Announcing TEDMED 2015

We’re thrilled to share some exciting news with you: the venue, dates and theme for TEDMED 2015.

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This year’s event will focus on Break<ing>Through the status quo and celebrating the typical, the atypical and the spaces in between as we come together to shape a healthier world.

The mythology of a “breakthrough” tells the story of a lone genius and one magical, “aha” moment. But, let’s not mistake a good story for the truth. In reality, we all have breakthrough potential and the least likely way to unlock that potential is to toil away in social or intellectual solitude. Instead, we break through in new combinations and we collect the building blocks of our future breakthroughs every day, in every new interaction, in every new insight, one improvement at a time.

This year we’ll explore…

  • breaking through the silos that prevent different disciplines from sharing problems and insights;

  • breaking through glass ceilings and closed doors that hold back some women and minorities from entering medical research;

  • breaking through national and cultural boundaries;

And, breaking through old assumptions to explore new science and new visions of what’s possible – in ourselves, in our work and in the world at large.

We invite you to join us and secure your spot at TEDMED 2015 today.

Our home in 2015: Palm Springs, California, November 18-20

The venue this year in sunny Palm Springs, California inspires a new vibe that we hope you are as excited about as we are. A more collaborative setting and design will help speakers, delegates and innovators come together and explore the important topics and themes the stage program brings forward in a more connected way than ever before.

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Of course, our gathering will include the brilliant talks you’ve come to know from some of the most inspiring change-makers both inside and outside of health and medicine, as well as stunning artistic performances and transformative innovators. Our recently formed Editorial Advisory Board – made up of rock star movers and shakers hailing from health and medicine as well as the worlds of business and technology, foundations and academia, philanthropy and design, and journalism and communications – is hard at work helping us shape a diverse and inspiring stage program.

Connecting across the world: TEDMED Live

As always, a vital part of our mission is to ensure that all stage content is accessible to the broadest community possible. Through TEDMED Live our content is free for teaching hospitals, medical schools, non-profits and government agencies around the world, building on last year’s participation of 200,000 remote participants in 140+ countries.

We invite you to join us in Palm Springs this November – visit www.tedmed.com for more information, or click here today.

A week of health and medicine #news from @TEDMED

These are the stories that we shared with the TEDMED community this week – read them again or if you missed them, you’re in luck! Follow us on Twitter to get daily updates.

@TEDMED

Could this gaming platform based on tech from the Gazzaley lab become first FDA-approved video game?

TEDMED 2014 speaker and filmmaker Tiffany Shlain talks about how we can unlock the unique potential of the human brain

TEDMED 2014 speaker Josh Stein uses smart med devices to positively influence patient behavior

New paper on ways to address adverse childhood experiences

More on how TEDMED 2014 speaker Marc Koska is helping save lives around the world w/his single use syringe

#GreatChallenges

Tailored safety-net programs to minimize institutionalizing patients with mental illness

“Basket studies:” a “new breed” of studies are providing a faster way to try drugs on many cancers

“Exploring the supposed contradiction between America’s healthcare costs & and its health outcomes” 

Teens eat better when the motivation is tied to something they’re passionate about 

Idea that kids should eat “bland, sweet food” is an “industrial presumption” 

“12 companies leading the way in digital health”

Bionic reconstruction allows the mind to control a hand after amputation

Wathc the recast of the GreatChallenges G+ Hangout event on patient experience

The CDC says we could cut the HIV transmission rate by more than 90%

Using training and technology to avoid nurse injuries at the VA

Enhancing the role of the patient in the drug review process, with Congress?

“Plain Cigarette Packs May Deter Smokers, Studies Show”

Should generic drug makers update medicine labels when they learn of safety risks?

Add your voice to the Beryl Institute’s global conversation about the state of the patient experience

Mindfulness training on your smartphone

“CHIP reauthorization is…a harbinger of things to come with future ACA battles”

“Federal study: Foster kids struggle to get health screenings”

What could the Supreme Court challenge mean for the Affordable Care Act?

Recast of the discussion from Robert Wood Johnson Foundation on how we can help all kids grow up at a healthy weight

How social media is changing suicide prevention

Reducing air pollution improves children’s lung health during a critical time

Study highlights importance of exercise, even for those w/identical genes & nurturing 

Measuring the Value of Patient-Centered Care: Last Week’s Hangout Participants Address Unanswered Questions

Is it possible to measure the value of patient-centered care? Last week, as part of TEDMED’s Great Challenges Program, a multi-disciplinary group of experts moderated by Boston NPR Health Care Reporter Martha Bebinger, discussed the rise of patient-centered care, explored how we can standardize its measurement to encourage evidence-based policy changes, and touched on what those potential policy changes might look like.

If you weren’t able to join us, check out the recast here:

Thanks again for taking to social media to submit your questions and comments! We had such wonderful questions that an hour left us short on time to address them all. So, we asked a few of our panelists, Steven Horowitz, Alyssa Wostrel and Alex Drane, to offer their perspectives on several remaining questions. Read on for their thoughts:

What are the pros and/or cons of relying on patient or healthcare provider self-reporting of patient-centered care?

Steven: The patient’s assessment of pain and suffering is the gold standard for this measurement. This may be influenced by behavioral problems, addiction or mental illness. How many patients have these problems may vary significantly from community to community, thus survey results may be difficult to compare between geographical regions. In terms of the healthcare provider assessing his or her own performance, I’m reminded of one comedian’s line: “85% of car drivers consider themselves above average.” Many surveys show discordance between what healthcare providers consider important and what patients and families consider important. That does not mean the opinion of the healthcare provider is not helpful. However, the experience of the patient essentially defines the concept of patient-centered care.

If we encourage heavy focus on data (such as survey results), should we be concerned that it may take the attention off of actual patient care? Is there a chance that meeting the specific numbers might not equate to care that is focused on the patient?

Steven: Good question! Surveys and other assessment tools are critically important to generate the data we need for continuous quality improvement. This data keeps us on target for addressing the needs of the patients, however, when these results are blindly tied to pay and promotions there is great potential healthcare providers may inordinately focus on survey results to the exclusion of other important considerations.

Alex: It depends on what you are surveying! Historically, the industry has focused on measuring things that are clinical in nature – these are important indicators of overall health, but may themselves be just markers of other issues. For example, maybe my blood pressure is high because I hate my boss and dealing with him makes my heart race. You can tell me to work on managing my blood pressure or eating better, but if you don’t know why those things are happening, you’re squeezing a water balloon. If, on the other hand, you were asking me about my workplace stress and I told you it was high, then you could provide me with some resources to help, and we could begin to track how well they were working against, let’s say, a goal of a 30% improvement. If workplace stress is what’s making me unhealthy, then reducing my workplace stress by 30% would equate to care that is very much focused on me. We all know the old adage “you can’t manage what you can’t measure” – we need to measure the things that matter so we can manage them. 

If we achieve a standardized measurement system for patient-centered care, do you see a place for rewarding healthcare providers who consistently deliver this type of care? If so, how might that work?

Steven: Healthcare providers, or better, teams of healthcare providers, should be rewarded for consistently outstanding results in patient-centered care. The difficulty remains, however, that high achievers may represent healthcare providers adept at gaming the system or, more hopefully, healthcare providers who have created an outstanding culture of patient-centered care that any assessment would identify. 

What steps can patients take to ensure the care they receive is tailored to them?

Steven: Patients need to ask critical questions, speak to current patients if they are allowed to, review standard healthcare and physician grading systems to identify flaws, and most importantly, avail themselves of the many electronic resources available about how to become a successful and informed patient.

Alex: This is one of the easiest, and hardest, questions in all of health care. The concept of what we can do is enormously straightforward: become empowered, get informed, stand up for what we care about, demand care that is commensurate with our values and beliefs. But oh boy, that can be hard to do. I’m the queen of walking into a doctor’s office ready to demand this and that – only to slouch out, tail between my legs, with none of my original goals shared, acknowledged, let alone addressed. Whose fault is that? On some level, it’s mine. Slowly, with time, with sharing enabled by new technologies, with shifting demographics and new “norms,” we will rise up and demand to be equal participants in our own care – and we will be happier, healthier, and all the more productive (providers, too!). A great low-hanging fruit as we transition from one end of the spectrum to the other is to become an advocate for someone else’s health – bit by bit, if we all commit to do this for each other, we’ll help speed the arrival of a new normal where collaborative, empathetic, holistic care is rarely the exception.

Some argue that medical care is meant to cure – not to cater to patients. What would you say to those who purport that sometimes, the patient isn’t right and needs to be sternly told what to do? 

Steven: In conversations with patients I try to be as supportive and understanding of their concerns as possible, but I’m very clear about my own interpretation of the literature and what I think is in the best interest of the patient. At times I will tell a patient that we are dealing with two separate issues that are interrelated: the healthcare condition that needs treatment and the the underlying fear that may cause denial. It’s at these moments when I express my concern that the emotional component may interfere with the patient choosing the best medical option.

Alyssa: This question suggests a controlling and patronizing role may be successful and necessary in reaching the “cure.” One of the key problems with this approach is that it denies the patient involvement in and accountability for their own health and well-being.

Alex: We’ve all read the literature showing the more collaborative and shared the decision-making is, the better the outcomes. There is also increasing evidence that outcomes in situations where a provider shows empathy trump those where they do not. The days of old-fashioned paternalistic care are coming to an end…all hail the new day!  Look at the extraordinary success of efforts like “Open Notes” at Beth Israel – “Nothing about me without me.” Now – is it true that there might be some souls who, when asked, request an extremely militaristic approach to care delivery? Sure! But then it would be their choice.

What is the best solution for keeping patients engaged and involved? 

Steven: It is important to be respectful and empathic and meet the patient where he or she is now. Encouragement and praise for the patient starting to take responsibility for understanding their condition and becoming proactive is often a turning point in their care.

Alex: If I’m pretty sure my husband is cheating on me and I just got fired…do I really have the capacity to focus on my diabetes? We need to expand the definition of health to include life – because when life goes wrong, health goes wrong. Not only do life challenges sap our capacity to care for ourselves in traditional ways (eating well, taking our meds, exercising, sleeping, taking care of our preventive screenings…) – they actually make us sick as well. Solve the problems real people want solved, redefine “vital signs” to include what is most vital. Meet us in the messy realities of our lives, where we live, work, and play (or pray!) – and not only will we engage, we’ll finally be enabled to make real change to our health. I recently had the great fortune to work with RWJF on their Pioneering Ideas effort, and through that was introduced to the work of Sendhil Mullainathan out of Harvard. Sendhil talks about the difference between something being important and something being urgent. Going to the gym is important – making sure your marriage isn’t collapsing is urgent. Given his additional assertion that time and attention are scarce commodities – how do we incorporate the reality of “attentional real estate” in our attempts to foundationally impact health?  He’s building some super sexy tools to help – so listen here when you get a chance: RWJF’s Pioneering Ideas podcast.

How do we involve patients in crafting policy changes for patient-centered care?

Alyssa: Including patients on hospital and community health center boards and committees to hear their feedback and to involve them in finding and implementing solutions has gotten excellent results.

Dr. Selby observed that measuring patient experience is difficult to do via objective measures (which I think is true). Yet clinicians often show reluctance to embrace subjective assessments. What can be done to change this culture? 

Steven: This is also an excellent question! There are several ways this can change. One is the continued tying together of surveys with critical outcomes. This may include freedom from suffering, duration of illness, complications of treatment and longevity. The ones that I feel strongly about, for which we have barely put a toe in the water, include objective laboratory assessments of inflammatory markers and gene expression. Although “hard” measurements, they may be influenced by “soft” intervention such as meditation, empathy, exercise, diet and sleep.

Unlocking Human Potential: Q&A with Tiffany Shlain

Speaking during TEDMED 2014’s “Human Nature Inside and Out” session, filmmaker Tiffany Shlain captivated her audience with a personal and insightful talk about the unique strengths of the human brain and how we can unlock our potential. We reached out to her for more insights from her talk topic.

Tiffany Shlain on the TEDMED stage [Jerod Harris].

Tiffany Shlain on the TEDMED stage [Photo: Jerod Harris, TEDMED 2014].

 

What motivated you to speak at TEDMED?

I love the mash-up of scientists and artists coming together. Combining art and science is at the root of all of my films, talks, creativity and my upbringing.

Why does your talk matter now?

These days, there is a great deal of conversation about how technology can impact humans. These conversations tend to either be based on fear and anxiety, or are overly idealistic. Meanwhile, there are also conversations taking place about revamping the education system, and focusing on the sciences and engineering. The problem is that I haven’t seen those conversations overlap yet. I want to emphasize what they point to the potential of humanity. Our focus should be on the strengths that are unique to humans, and how we can work in concert with the things we can program machines to do, in order to flourish in the 21st century. This is the conversation we need to be having.

If you had more time on the TEDMED stage, what else would you have talked about?

My talk was the basis of a new film my team is in the process of finishing, called “The Adaptable Mind.” That film will then be the beginning of a longer project we’ll be working on over the next few years. People are ready for this conversation, and I’m excited to dive deeper into it.

Are there any action items you want your viewers to take?

I hope people will practice the human strengths I discuss – metacognition, empathy, creativity, and initiative – and begin working them into their daily lives.

What is the legacy you want to leave?

Through my talks and films, I hope to inspire people to ask questions, laugh, and think deeply about what it means to be human in our ever-changing world.

Introducing the 2015 TEDMED Editorial Advisory Board

We’re excited to share something new to TEDMED!

In preparation for TEDMED 2015 and the selection of 60+ speakers and performers, we’re honored to introduce TEDMED’s Editorial Advisory Board.

Board members will offer their expertise, insights and wisdom to assist in the shaping of our stage program themes, topics, speakers and performers while also advising on TEDMED’s overall editorial strategy. Vetting by the Board will help ensure that TEDMED speakers and stage program topics continue to meet the highest standards of scientific relevance and rigor.

To form this Board, we drew upon our remarkable TEDMED community, gathering 20 highly creative, accomplished, diverse and innovative movers and shakers. Each member embodies a spirit of generosity, depth of knowledge and breadth of experience that will contribute immeasurably to the quality and impact of this year’s stage program.

Inclusiveness is a big part of TEDMED’s DNA. That’s why our Board is made up of representatives from across health and medicine as well as the worlds of business and technology, foundations and academia, philanthropy and design, and journalism and communications. This diversity allows us to approach proposed topics and themes through multiple lenses.

We’re delighted to welcome the members of the TEDMED Editorial Advisory Board and we thank them for their collaboration:

Pam Belluck is a health and science writer for The New York Times. She covers a range of subjects, but tends to focus on the most controversial and complex topics related to the brain, behavior, and reproductive health. An award-winning journalist, Belluck has been the recipient of a Knight fellowship, a Fulbright and the Best American Science Writing.

Carlos Bustamante, PhD, is a Stanford professor, population geneticist and MacArthur “Genius” Fellow who analyzes genome-wide patterns of variation within and between species to address fundamental questions in biology, anthropology and medicine. Bustamante was Stanford’s inaugural co-host at TEDMED 2014 and has also been featured on TEDMED’s Great Challenges Program.

Christopher Elias, MD, MPH, is the President of the Bill and Melinda Gates Foundation’s Global Development Program, where he leads efforts in integrated and innovative delivery, finding creative new ways to ensure that solutions and products get into the hands of people in developing countries who need them most.

Harvey Fineberg, MD, PhD, is the President of the Gordon and Betty Moore Foundation and the Presidential Chair of UCSF. He previously served two consecutive terms as president of the Institute of Medicine. Harvey studies medical decision-making, asking important questions about how new medical technologies are rolled out and how we cope with new illnesses and threats of epidemics. He spoke at TEDMED 2013.

Adam Gazzaley, MD, PhD, is a Professor of Neurology, Physiology and Psychiatry at UCSF and the Founding Director of the Neuroscience Imaging Center. Adam was UCSF’s inaugural co-host at TEDMED 2014.

Carleen Hawn is the Founder and CEO HealthSpottr. Prior to founding Healthspottr, Carleen was an associate editor with Forbes and senior writer and west coast bureau chief for Fast Company magazine.

Peter Hopkins is the Cofounder and President of Big Think, a cutting-edge online knowledge company that makes people and companies faster and smarter through efficient e-learning from world renowned experts. Peter also spearheaded the creation – and currently serves as the Principal – of Floating University, a joint venture with the Jack Parker Corporation that aims to foster content innovation in higher education.

Jeff Karp, PhD, is an Associate Professor at Brigham and Women’s Hospital and Harvard Medical School. His research focuses on stem cell engineering, biomaterials and medical devices inspired by nature. He shared his work at TEDMED 2014.

Mohit Kaushal, MD, MBA, is an Associate Professor at Stanford University and a visiting scholar at the Brookings Institution. He is also a partner at Aberdare, a venture capital firm focused on transformational healthcare opportunities. Mohit has also served on TEDMED’s Hive curatorial board.

Sandeep “Sunny” Kishore, MD, PhD, is an Internal Medicine Resident at Yale University. He’s been a founder of a global health organization, a Delegate to the UN General Assembly, a Fellow at MIT Dalai Lama Center for Ethics & Transformative Values, a Soros Fellow and the first Lancet awardee for community service. Sunny was a TEDMED 2012 speaker and also co-hosted the TEDMED 2014 DC stage.

Rupa Marya, MD, is a hospitalist and an Assistant Professor of Internal Medicine at UCSF. She is also the lead singer, composer and musical director of Rupa & the April Fishes, a band that seeks to celebrate beauty in pluralism and reinvigorate appreciation for living music with their diverse, global sounds. Rupa & the April Fishes performed at TEDMED 2014.

Vivek Murthy, MD, MBA, is the U.S. Surgeon General. Prior to his confirmation, he was a physician at Brigham and Women’s Hospital in Boston, and a Hospitalist Attending Physician and Instructor in Medicine at Harvard Medical School. He is also the President and cofounder of Doctors for America.

Betsy Nabel, MD, is the President of Brigham and Women’s Hospital, a practicing cardiologist, a biomedical researcher, a patient advocate, a Professor of Medicine at Harvard Medical School, and the first Chief Medical Advisor of the NFL. She was previously the Director of the National Heart, Lung, and Blood Institute. She spoke at TEDMED 2014.

Ivan Oransky, MD, is the Vice President and Global Editorial Director of MedPage Today. Previously, Ivan was Executive Editor of Reuters Health, Managing Editor of Scientific American and Deputy Editor of The Scientist. Ivan is Vice President of the Association of Health Care Journalists, and serves on its Board of Directors. Ivan spoke at TEDMED 2012.

Manu Prakash, PhD, is an Assistant Professor of Bioengineering at Stanford University.Manu serves as a core member of graduate program in Biophysics and an affiliate of Woods Institute of the Environment at Stanford University. In 2014, Manu was nominated as MIT Tech Review TR35 and Popular Science Brilliant 10.

Carla Pugh, MD, PhD, is a Surgeon and the Director of the Health Clinical Simulation Program at the University of Wisconsin. Her work focuses on fine-tuning students’ haptic skills as a standardized part of clinical education and daily practice. She spoke at TEDMED 2014.

John Qualter is the co-founder and Chief Creative Officer of BioDigital Systems, where he leads digital content creation and consulting for clients in the device, pharmaceutical and communications industries. John is a pioneer in the field of biomedical visualization, promoting the implementation of high-end 3D media in the healthcare industry. He spoke at TEDMED 2012.

Teeb Al-Samarrai, MD, is a physician, writer and epidemiologist with a diverse background in neuroscience, anthropology, and domestic and international public health. She previously served as a CDC Epidemic Intelligence Service Officer assigned to the New York City Department of Health and Mental Hygiene and currently serves as Deputy Health Officer & Tuberculosis Controller with the Santa Clara County Public Health Department in California, focusing on immigrant and refugee health.

Nina Tandon, PhD, MBA, is the CEO and Co-Founder of EpiBone, the world’s first company to grow living human bones for skeletal reconstruction. She is also an Adjunct Professor of Electrical Engineering at Cooper Union. Named one of the 100 Most Creative People in Business by Fast Company in 2012, Nina was a TEDMED 2014 speaker and is a Senior TED Fellow.

Abraham Verghese, MD, MACP, is a physician,Professor and Vice Chair for the Theory and Practice of Medicine at Stanford University’s School of Medicine and the author of the novel Cutting for Stone. In the modern era of medicine, where patients can seem to be mere data points, Abraham believes in the value and ritual of the physical exam, and in the power of informed observation. He spoke at TEDMED 2014.

It Takes a Village to Combat Childhood Obesity: Last Week’s Hangout Participants Address Unanswered Questions

Last week, a multidisciplinary group of experts joined us for a Great Challenges live online event to discuss whether it truly takes a village to prevent conditions such as childhood obesity. With NPR Correspondent Allison Aubrey moderating, these experts took a close look at community-based prevention initiatives that have led to sustainable health solutions, including reductions in childhood obesity, and discussed how those approaches can be applied elsewhere.

If you weren’t able to join us, check out the recast below.

Thanks again for sending your questions and comments via social media! We had such great questions that an hour did not leave time enough to address them all. So, we asked our panelists, Angela Diaz, Karen Peterson, Belinda Reininger and Risa Wilkerson to offer their thoughts on the remaining questions. Here’s what they had to say:

Conditions such as childhood obesity are more prevalent in lower income areas – these are precisely the ones that may not have the resources to take meaningful action. How can these communities create a program that might have an impact?

Angela: In the absence of additional resources, collaboration becomes even more important. One may build new program opportunities on top of tasks you need to do anyway. For example, a graduate program may need to place students to practice nutrition education or physical education and could be added to the resources available at a local early education center. Or changing the way an organization conducts their regular business may not require additional funding, but instead, a consideration to do things differently. For example, a daycare center offers daily snacks to their kids. An activity that requires no additional resources is setting standards for types of snacks served.

Risa: The Healthy Kids, Healthy Communities initiative supported 49 partnerships to increase children’s access to healthy foods and opportunities for physical activity through changes in policies, systems and environments in those communities at greatest risk for childhood obesity based on race, ethnicity, income and geographic location. The Growing a Movement report provides insights on what is achievable in low-income communities through collaboration among community-based organizations, residents, decision makers and other partners. Much was achieved by these partnerships. I realize that being part of a grant-funded program provides many advantages and yet there are ways communities can replicate some of these efforts, even if on a smaller scale or a longer time frame.

The examples cited (Brownsville, Blue Zones communities) are affiliated with large organizations – they are very special circumstances that many communities cannot replicate. Can a community take steps to better prevent chronic conditions without the backing of a powerful organization?

Angela: When you set the table for collaboration, any individual, small organization, tenant association or civic group can contribute towards health: a scout working on is Eagle project can mark trails in a local park that is used by families during the weekend, thus providing more opportunities for physical activity. A tenant association can organize a “Play Street” during the summer staffed by neighbors and summer youth employment participants from a local multi-service agency.

Belinda: Preventing chronic disease in a community takes more than one large organization – it takes numerous large and small organizations coming together. Large organizations can be helpful when you have grants where costs are reimbursed after the work is done, simply because these organizations tend to be more able to float those costs more easily than smaller organizations. However, smaller organizations are usually able to be more nimble in hiring and purchasing. The strengths of both types of organizations move things forward.

Risa: Any community can take steps toward better conditions even without a large funder behind the scenes. Perhaps there is an existing community coalition or partnership that can help organize efforts. If not, start small to develop one. It is important that coalitions meaningfully engage those residents whom are most affected by the current conditions. A first step can be assessing the situation by looking at health and safety data (most county health departments can help with this) and talking to residents about the barriers they face to eating healthy food and being physically active. From there, choosing small steps toward change to help built trusting relationships and to build energy toward change. This can include collective efforts to invest in improving (even cleaning up) a local park or starting a community garden.

What’s the single most important piece to the puzzle of preventing chronic disease on a community level?

Angela: When neighbors are socially and civically active, they can turn a community around. If neighbors have an opportunity to work together and achieve a small win, like getting a street clean, getting together and watching “Weigh of the Nation” or a similar documentary at a local community center, they may be inspired to take the next step to get more deeply involved with other issues in their neighborhood, like rallying to bring more healthy options to their local grocers.

Risa: There is no single solution. It’s a complex issue and one that requires work at the systems level. What is important is that we don’t rely only on programs, promotion and education to move the needle. We also have to work on changing policies and the social and built environments to support people’s desire to make healthy choices.

In your opinion, is it possible that childhood obesity is not the problem but a symptom of a larger issue at hand? What might that issue be?

Angela: Letting the food industry produce, market and profit from unhealthy, overly processed, high calorie-low nutritional food in the name of corporate freedom, with little regard for health is part of the larger issue. Some subsidies favor the over-production of some crops, for example, corn. Over-diversified crops result in a product flooding the market and then the need for that product to be put to use.

How can lessons learned from Brownsville or the Blue Zones be best applied to other communities? Is it a matter of policy change? Health education? Is it a community-driven process?

Angela: Again, I cannot stress enough that a good place to start is setting the table for people to come together, build relationships and start to talk about what they are doing and where there are opportunities to build on each other’s agenda. This community-driven process can be more powerful than any externally imposed, single lead program or intervention you can think about.

Belinda: Yes – it is all of that. Any community can use the evidence-based Community Wide Campaign approach. It includes media, risk factor screening and health education, policy and environmental changes.

Community leaders in Brownsville and in Blue Zones could be thinking: “Hey, we’ve found a big piece of the puzzle to solve childhood obesity! Now all we have to do is tell the world and everybody will follow our example!” How much has this actually happened? Why isn’t it happening, or happening more?

Angela: We, in public health, are obsessed with replication. There may be some principles that can be used to guide others, but at the end of the day, the relationships and the process are going to be more important and transformative than any specific content we seek to replicate from one place to another.

Based on the success stories we’ve discussed today, what’s the most important step a community looking to improve the health of its population and encourage behavior focused on prevention needs to take?

Angela: Community building is about relationship building. It is relationship, relationship, relationship. One of the most important things for the wellbeing of a community and its members is to feel connected, to be socially and civically engaged, to have common goals and work toward those goals. A good place to start is setting the table for people to come together, build relationships and start to talk about what is important to the community, what are they doing and where there are opportunities to build on each other’s agenda. Another good thing to do is to build shared history – like neighborhood traditions of health related activities that become part of a shared culture. Finally, we must always remember that community-based work is an iterative process: we advance and win some, but sometimes we need to go back to the drawing board as we fine-tune our work in response to input from our community partners.

Karen: Take the long view to developing engaged, sustained community partnerships using the organizations that are active in different community settings. Community success stories often involve not only a focus on “evidence-based behaviors” such as decreasing screen time and sugar-sweetened beverages, but also the use of “evidence-based interventions” (tested with sound evaluation designs) put together to impact all parts of a child’s day – using a community based participatory approach or alternatively, a partnership model. The interface between communities and other “levels of influence” should be considered. In particular, communities are in a position to make sure the organizations most directly responsible for caring for children (schools, childcare, etc.) have the resources they need and that they are active participants in providing their views and expertise in how to solve obesity.

Belinda: Assemble a strong and action-oriented group of partners to establish a plan with short and long-term goals based on needs of the community. Definitely use an evidence-based approach to select strategies. Get started and don’t take no for an answer. You may have to regroup at times, but keep moving forward towards goals as a group.

Giving Sight to Innovation: Q&A with Uzma Samadani

Uzma Samadani is the cofounder of Oculogica, a neurodiagnostic company that, through eye movement tracking, specializes in detecting concussions and other brain injuries otherwise invisible on radiologic scans. She shared her journey of discovery on the TEDMED 2014 stage. We caught up with Uzma and learned more about her vision and methods of discovery.

Uzma Samadani at TEDMED 2014 discusses her eye tracking innovation for diagnosing brain injury.

“I hope people who hear my talk are inspired to work hard and make their own discoveries.” Uzma Samadani at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED]

Who or what has been your main source of inspiration that drives you to innovate?

Necessity was the mother of invention, and serendipity the father. We sought to develop an outcome measure for a clinical trial for severely injured vegetative patients when we developed the eye-tracking algorithm that we subsequently realized could detect concussion. We had expected to use the eye-tracking algorithm to calculate how well people could pay attention and fixate their gaze, but then were surprised to find that it actually showed us what was wrong with the brain. Now that we have discovered this technology, we understand its implications: it enables us to detect previously ‘invisible’ brain injury. We are inspired, driven even, to innovate and make this technology available to everyone who has sustained trauma. We can help people who previously would not have had objective measures indicating brain injury.

Why does your talk matter now? What do you hope people learn from your talk?

My talk is not so much about brain injury directly as it is about a moment of discovery – the rare shock of finding something remarkable and considering its implications, then the doubt, and the concern about artifact. And then, the gradual realization that we have discovered something real and potentially extremely helpful for humankind. I hope people who hear my talk are inspired to work hard and make their own discoveries.

What is the legacy you want your work to leave?

Brain injury is the single greatest cause of death and disability for Americans under the age of 35 years of age. By creating a biomarker and outcome measure for injury, we can test treatments and therapies and also evaluate prophylactics such as helmets. The true measure of our success will be its utility: to other researchers, to clinicians and to the people who sustain injury.

How can we harness the power of imagination to innovate in the pediatric health space?

shutterstock_193115849Innovation in health today occurs incessantly. We see new ideas daily, and the progress we’re making is exciting. But, most of that progress is being made in adult health. While there are 75 million children in the United States today, too often we take the approach of treating children like “little adults,” despite the fact that they have an entirely different set of needs, and those needs change year by year. This lag in pediatric health innovation has inspired TEDMED’s Shirley Bergin to serve as a judge at this year’s inaugural Impact Pediatric Health Pitch Competition at South by Southwest Interactive. (By the way, if you’re innovating in pediatric health, you have a few more days to apply!)

So how can we harness the power of imagination to innovate in the pediatric health space? To gain a better understanding of the barriers facing innovation in pediatric health and how we can move forward, we interviewed a handful of pediatric innovators – including several TEDMED Hive alumni. Read on to hear what they had to say.

What do you think is the biggest problem facing pediatric health today? What can be done to address it?

  • Jessica Eisenberg, VoiceItt: Childhood disabilities are on the rise…Since we are a long ways off for a cure for many of these conditions, we can develop technology to greatly enhance their quality of life. We are living in an exciting period where the development in technology has the potential to break down the gaps between people with disabilities and society, and help them to be fully included in society.

  • Lynn E. Fiellin, play2PREVENT Lab: I think one of the biggest challenges facing pediatric health today, particularly around preventive health, is finding children and teens where they “are.” Healthy kids don’t engage in the health care system beyond “well-child” visits and kids with chronic medical conditions have a number of other issues to address. Beyond vaccination during early childhood, the provision of preventive care…is fairly limited. Innovations in technology focused on preventive care in teens allow us to engage teens and provide them with messages and skill-building to develop behaviors that can lead to lifelong health.

  • Kyle J. Rose, mySugr: One major challenge for parents and healthcare professionals alike is knowing how much independence to give to children regarding the management of their health. How much and at what point?…Educational initiatives…often result in outstanding clinical outcomes, not to mention increased quality of life for both the child and their family.

  • M. Jackson Wilkinson, Kinsights: Misinformation. Parents are in a state of constant information starvation, and as healthcare tightens its belt, they get less face time with healthcare professionals than ever before, and the advice they get from friends, family, and the Internet is usually not vetted. As with so many other fields, pediatrics (and parenting) is in need of a strong dose of information literacy, and it’s innovators who can help develop tools to help patients and parents find the right information for them, rather than playing a dangerous game of telephone.

Why do you think innovation in the pediatric health space often lags behind other areas? 

  • Amy Baxter, Buzzy: In pediatrics, patients aren’t as articulate about what bothers them in healthcare. You don’t have the option of “voting with your feet” when you’re carried to a doctor’s appointment in a car seat. And since children don’t make the financial decisions, they don’t drive the marketplace. Many pediatric products have to come from pediatricians or parents who see a need and have the empathy and time to make them reality.

  • Kyle Rose, mySugr: The pediatric health environment has stricter regulations, for good reason. However, unfortunately in the world of medicine this can add a significant barrier to enter this market. This is true whether it’s a start-up with a new medical device or even a major Pharma company.

  • Roberto Flores, SmileTrain: Children do not have a voice in science, in the government or in a medical office. They need others to speak for them…This is a unique aspect of pediatric care that affects everything from innovation to financial support for children’s health…Innovation in the pediatric space can lay the groundwork for innovation in the adult medical arena and vice versa.

  • M. Jackson Wilkinson, Kinsights: Everything is a little more complicated for a pediatric patient. Parents are often more protective with their child’s health than an adult might be with their own, so it can be difficult to get cooperation for even simple experimental care. Couple that with increasingly complicated privacy regulations, and it’s often just enough to dissuade interested entrepreneurs and researchers.

What can be done to spread the notion that children are not just “little adults” in terms of medical needs?

  • Jessica Eisenberg, VoiceItt: Because it’s more difficult to understand the symptoms and needs of a child, we cannot make a diagnosis and rehabilitation plan in a short office visit. More time and effort must be invested with children to build up their confidence in expressing their needs. The more understanding we have, the more we can spread this notion.

  • Lynn Fiellin, play2PREVENT Lab: The use of innovative methods of reaching kids is much more likely to have greater impact, given that kids now are growing up with innovative technologies and they are “hard-wired” to interact with and respond to them. Demonstrating the successful use of new innovations in pediatric health will help to show stakeholders that innovative health care for kids needs to be designed specifically for them, not only to reach them, but to have a sustainable effect.

  • Kyle J. Rose, mySugr: The healthcare system will need a fundamental shift from short-term to long-term visions, in particular from the payer perspective. Young people do have specific needs. We need to address those needs and also be there to support them as they transition from pediatrics to adults, a time period when they need us most and where patients often fall through the cracks of the healthcare system.

  • Roberto Flores, SmileTrain: A child is different at all phases of development. A person who holds a newborn infant, plays with a child in preschool, plays soccer with a middle schooler and debates with a teenager, will realize that at different ages children’s bodies work differently, heal differently, have different needs, and are often affected by distinct medical problems. As pediatric care involves so many different types of “people” the need for innovation in the pediatric space is that much greater.

How can we better assess pediatric healthcare needs and encourage companies to innovate in them?

  • Jessica Eisenberg, VoiceItt: Bringing together technological companies and associations that have a deep understanding the pediatric population is the key element needed to instigate innovation.

  • Amy Baxter, MMJ Labs: Parents are the best motivators.  Educate them about what is really important for health, and do it transparently…Ignoring parents’ intelligent regard toward their healthcare decisions makes the healthcare providers look suspect, and parents seek other sources of information.

  • Lynn E. Fiellin, play2PREVENT Lab: I believe the best way to assess healthcare needs, in kids, and all individuals, is to review the literature, [and] interview the stakeholders…Once you identify the areas in need, companies need to recognize that looking at new ways of reaching individuals, thinking outside the box, is much more likely to have the desired effect of engaging this population and connecting with them about their most relevant healthcare issues.

  • Kyle J. Rose, mySugr: We believe that the evidence is already there. It is critical to show payers and government systems that if young people are healthy when young that this leads to higher productivity overall. The health economics speak incredibly loudly. Governments could encourage companies via special programs and funding for such outcome-based initiatives.

What inspires you to work in this area?

  • Jessica Eisenberg, VoiceItt: Giving a child back his voice, witnessing an expression of love, a joke or saying he is hungry or cold is one of the most incredible and emotional sights you can witness. Few things are more rewarding than hearing individual stories of connection, love and gratitude on a daily basis.

  • Donna Brezinski, Little Sparrows Technologies: As both a pediatrician and a mother, I am inspired to innovate in the area of pediatric health because in many ways I see children as our role models for innovation. Children have very few predefined expectations of what the world should be, and as such, are boundless in their view of what is possible…As innovators we should emulate their openness to imagine so that we can envision what our world could be rather than be restricted by what it is.  Innovating for children grants us freedom to be hopeful for the future.

  • Lynn E. Fiellin, play2PREVENT Lab: Before I moved into this field, I was doing intervention research with many young adults struggling with the consequences of risk behaviors they had engaged in during adolescence—specifically risky sex and drug and alcohol use. I thought if we could “turn back the clock” and teach them the necessary preventive health skills when they were young teens, we could help them to avoid these serious health consequences.

  • M. Jackson Wilkinson, Kinsights: The families. Parents and families devote so much time, energy, and resources to doing their best to raise a happy, healthy child. When you see how devoted they are, it’s hard not to want to clear aside everything standing in their way. Sometimes it’s something as simple as making sure you don’t ask the same questions over and over, and other times it’s incredibly sophisticated, but there’s a ton of work to do, so I’m happy to pick up my shovel and get to it.

Brain in Progress: Why Teens Can’t Always Resist Temptation

by Nora Volkow, Director of the National Institute on Drug Abuse at the NIH

It’s National Drug Facts Week, when middle and high schools all over the country host events to raise awareness about drugs and addiction, with the help of scientists from the National Institute on Drug Abuse (NIDA). The issues I discussed in my TEDMED talk—the changes in the brain common to obesity and drug addiction—are especially pertinent to the struggles teens face to resist drugs, because adolescence is a crucial period both of susceptibility to the rewards of drugs and of vulnerability to the long-term effects of drug exposure.

“My obsession is to engage the health care system in addiction.” Nora Volkow on Nora Volkow at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED.]

“My obsession is to engage the health care system in addiction.” Nora Volkow at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED.]

Adolescence is a time of major brain development—particularly the maturation of prefrontal cortical regions involved in self-control and the neural circuits linking these areas to the reward regions. The prefrontal cortex, where we make decisions and comparative judgments about the value of different courses of action, is crucial for regulating our behavior in the face of potential rewards like drugs and food. Adolescents are prone to risky behaviors and impulsive actions that provide instant gratification instead of eventual rewards.  In part, this is because their prefrontal cortex is still a work in progress.

The incomplete maturation of the prefrontal cortex is a major factor in why young people are so susceptible to abusing drugs, including alcohol, tobacco, marijuana, and prescription drugs. There are numerous pressures in their lives to try these substances (stress and peers, for example), but inadequate cognitive resources to help them resist. Because their brain architecture is still not fully developed, adolescents’ brains are more susceptible to being radically changed by drug use—often specifically by impeding the development of the very circuits that enable adults to say “later” … or “not at all” … to dangerous or unhealthy options. Thus, when drug abuse begins at a young age, it can become a particularly vicious cycle. Research shows that the earlier a teen first uses drugs, the likelier he or she is to become addicted to them or to become addicted to another substance later in life. It is likely that the same dynamics are at play when it comes to fattening food and the brain’s reaction to it.

Though parents may get frustrated by their teens’ poor decisions at times, they usually forgive them—because on some level adults understand that kids’ internal guidance systems aren’t yet fully functional. People often have a harder time extending that same forgiveness to adults who suffer from addictions or obesity, because we think they should be better able to control their impulses.  But, the fact is that their internal guidance systems, too, are compromised. For such individuals, it is not a question of free choice or just saying no to temptation; in many cases, only externally offered support and treatment can create the conditions in which their guidance systems can be gradually restored to proper working order.

Averting obesity and drug use also requires that, as a society, we take responsibility for the environments we create for young people. Instead of school cafeterias with an array of cheap, tempting foods high in calories and low in nutrients, we must expose young decision makers to food options that strengthen their health and resolve. Instead of stress-filled or empty time that promotes drug use, kids need access to appealing, healthy, and meaningful activities that encourage them to take pride in themselves and their behavior. Arming young people with scientific information about their bodies, brains, and the substances that can affect them is also crucial—which is the goal of National Drug Facts Week.

Obesity and drug abuse are medical issues, not moral failings. It is gratifying to present the converging science clearly showing this in a forum like TEDMED, composed of people who are informed and curious about the latest medical science. My hope is that the general public becomes more compassionate about these issues, supports wider access to treatment, and understands the importance of greater investment in research on the dynamic ways our brain can be changed by our behavior and vice versa.

Neuroscientist Nora Volkow, director of the National Institute on Drug Abuse at the NIH, applied a lens of addiction to the obesity epidemic in her TEDMED 2014 talk. We are excited to share Nora’s original piece on the TEDMED blog.

Check out our archived Facebook chat discussion with Nora about food addiction from studying the brain chemistry of people with drug addictions.