At TEDMED, Play Matters

square sleddersIn today’s fast-paced world, we often find ourselves caught up in the go-go-go, operating at breakneck speed and seldom taking a moment to simply stop and appreciate what’s around us. While we know life is busy, this holiday season we encourage you and yours to make time to truly take a break and get out and play.  It is in that spirit that we share this  – our final blog post for 2014. May you enjoy all of the benefits that play offers – from unleashing your inner creativity, to enhancing personal relationships, to nurturing physical health.

Why play? Our 2014 speaker Jill Vialet says it best: “Greatness demands imagination and imagination demands play. Your nine-year-old self knew it, and it’s time to remember: play matters.”

Which is exactly what the TEDMED team will be doing for the next couple of weeks. All work and no play makes TEDMED a dull organization, so we’re at it again. What’s “it,” you ask? It’s our annual break from our daily work life and an opportunity to enjoy the holidays with family and friends, and recharge our batteries – all while taking advantage of the many mental, social, and physical health benefits of hitting “pause” and allowing time for play.

We know well the benefits of taking time off, but beyond these, the need to focus that time on play is key.  For adults, the mental benefits of play are countless – play researcher Stuart Brown even claims it is as fundamental to human life as sleeping. In his TED talk, Brown explains that play fires up the part of the brain responsible for motor control, attention, and language, sends signals to the brain’s reward center, and helps with the development of contextual memory. There is also evidence that, in resetting the brain, playing makes us better at our jobs and fuels creativity. While kids need play for cognitive and social development, adults need play to stay sharp.

shutterstock_23141968That feeling you get when you’re laughing while playing with your loved ones? That’s the science of happiness in action. Research shows that a main reason adults play is to enhance social well-being – in fact, one study found that we are at our happiest when we are at play. The reasons here are twofold: 1) playing is how we make connections with other people, and as humans, connecting with others improves our happiness and 2) play allows us to be our most authentic selves, which translates to “optimal psychological functioning” (read: happiness).

Last but certainly not least, there is no question that play is good for our physical health. Play often involves exercise and fresh air – and if it’s fun, we’re more likely to maintain that healthy behavior. Beyond that, play is also the ultimate stress reliever, reducing the hormones in the bloodstream that cause us to feel tense.  So why not join us this holiday season and get out and play? Your body will thank you.

With that said, we wish you a wonderful, playful holiday. Be on the lookout for our official TEDMED 2015 dates and venue in the New Year – and register before January 1st to take advantage of our special ticket price. In the meantime, we’ll be sharing our staff picks of inspirational talks over the next two weeks. Enjoy!

How Can We Rightsize Treatment Costs? Last Week’s Hangout Participants Address Unanswered Questions

Last week, a diverse panel of experts joined us for a Great Challenges live online event to discuss how we can work towards rightsizing the business of healthcare to achieve the delicate balance between treatment innovation, accessibility, and affordability. Moderated by New York Times Senior Writer Elisabeth Rosenthal, the group explored what it takes to innovate in drug development, how we evaluate long-term treatments versus cures, and what new approaches can make novel treatments more accessible to patients while reducing healthcare system costs. If you were unable to join us, check out the recast below.

We had a so many questions come in via social media (thank you!), that we were not able to get through all of them during our one-hour event. So, we gathered the unanswered questions and  invited James Chambers, Vineet Arora, and Josh Fangmeier to weigh in and continue the conversation. Here’s what they had to say:

How does the insurance industry weigh long-term treatment versus a one-time cure? What other elements besides cost need to be taken into account?

Josh: Due to the fragmentation of the American healthcare financing system, insurers do not always have aligned incentives when it comes to paying for certain services. For example, private insurers could pay for a cost-effective therapy that reduces long-term costs for a medical condition, but Medicare, not private insurers, may capture the savings from this therapy as the patient ages. This has also been an issue for patients enrolled in both Medicare and Medicaid (dual eligible), where interventions by one program lead to savings captured by the other.

James: This is certainly a timely question given the introduction of Sovaldi. It asks questions not just of cost-effectiveness (i.e., value for the money) but also of affordability. As a cure is taken only once (or over a relatively short period of time) there is an incentive for the manufacture to charge a high premium. Even if over the life of the patient the drug represents good value for money, the high upfront cost may prove prohibitive to many patients and providers. We may have to move to alternative payment models in which the cost of a cure is spread over the period that the patient experiences the clinical benefit, i.e., to amortize payment of the drug. However, this is complex and raises many questions, e.g., who pays for the drug, and what happens if the patient shifts between plans?

Is flooding the market with more practitioners an economic strategy to lower healthcare costs?

Vineet: If practitioners means doctors, it takes over ten years to train a doctor, so its hard to “flood the market” with them, especially given the projected doctor shortage. If it means others such as nurse practitioners, there’s also a shortage there so feasibility would be hard. I don’t know how that would impact drug costs per se. Flooding the market also assumes that there is price transparency at the level of patients, and they can choose to go to the best value care – which we know does not exist. So as of yet, in my opinion this strategy would not work without these other things.

Do pharmaceutical companies have any ethical obligation to provide treatment to those who cannot afford it? Why or why not?

James: This is a very difficult question! I believe that if a patient who would benefit from a treatment does not receive it because of its cost, then as a society we have not maximized the benefit of available technology. I believe the healthcare system has the responsibility to offer a “base” level of care to everyone.

Vineet: I believe they do. We have created a healthcare system where anyone can get emergency care regardless of their ability to pay. So, as long as that exists, it means that we will be in a cycle of emergency care for chronic diseases that could be treated with medications unless we can figure out a way to cover the cost of the drugs to keep people healthy. The issue often is who is going to benefit.

How can we accurately and consistently evaluate the right approach to treatment based on the cost of a saved life or improved quality of life?

James: Other countries have national agencies/institutes that evaluate the costs and benefits of new technologies. This provides information to the healthcare system of the value of medical technology and helps prioritize the use of scarce healthcare resources. While PCORI is tasked with evaluating the comparative effectiveness of treatments (although to date it has performed very few head-to-head studies), it does not consider cost in its research. Only if we have information of the costs and benefits of alternative treatments can we use our technology most efficiently. Ironically, many of the leading methodologists on the economic evaluation of medical technology reside in the U.S., but the U.S. is somewhat unique to the limited extent that it uses these techniques.

How much stock can we put in cost-effectiveness studies? Is there a better way we could measure this?

James: There are many different types of analysis to evaluate medical technology, e.g., budget impact analysis to examine the financial impact on introducing a technology to a plan, or comparative effectiveness research to evaluate which of two treatments is most effective. Cost-effectiveness analysis is, however, the only approach that quantifies the VALUE of a technology, i.e., is the additional costs of a treatment worth its additional benefits. While some may argue that cost-effectiveness should not be the sole determinant in drug coverage policy, I believe that decision-makers should have access to this information if they are expected to make value and cost conscious decisions. Without this information, they have a hugely difficult (and maybe an impossible) task.

Might a system in which unused medicines can be returned to pharmacy (and reimbursed) help contain costs?

James: Absolutely.  A huge source of waste!  A very difficult policy to implement, though.

How much is affordable and are caps on out-of-pocket spend in ACA too high?

Josh: Increasing cost-sharing through co-pays, deductibles, and other forms of out-of-pocket spending has been a concern, especially for low-income populations. However, this has been a trend that pre-dated the passage of the Affordable Care Act (ACA). According to the Commonwealth Fund, from 2003-2011, single worker deductibles rose by 117 percent.

The ACA includes minimum value and out-of-pocket spending caps that limit the sale of insurance plans that provide little financial protection. For 2015, the out-of-pocket caps are $6,600 for an individual and $13,200. Although this is a considerable amount for many families, the ACA provides financial assistance, in the form of cost-sharing reductions, to those who enroll in marketplace plans. Cost-sharing reductions increase the value of a silver plan. For example, a Detroit resident making $20,000 would see the out-of-pocket maximum for the cheapest silver plan fall from $6,350 to $1,450, due to cost-sharing reductions.

What can we learn about drug pricing or drug coverage from looking at systems outside of the American one?

James: We can learn from other countries’ systematic approaches to evaluating medical technology. While each country takes a unique approach (some focus on comparative effectiveness, others cost-effectiveness), each formally evaluates new technology before it is introduced to the health care system. This provides information that can be used to implement value-based coverage of medical technology, and in some cases negotiate a price that is commensurate with the health benefits offered by the drug.

We can also learn that cost and cost-effectiveness can be accounted for, but not be the sole determinant in decision-making. France and Germany were previously hugely resistant to accounting for drug cost in national policy but now consider economics (while decisions are primarily driven by comparative effectiveness) in their assessment.

What new approaches can make novel treatments more accessible to patients while reducing healthcare system costs? Do we need to change our drug development models or is there change to be made elsewhere?

James: In theory, using cost-effectiveness evidence to guide coverage of medical technology will result in more efficient use of scarce resources and allow more patients access to effective technology.  However, such an approach is unlikely to be soon embraced in U.S. healthcare.

Maybe the most promising approach is value-based insurance design (VBID).  This approach aligns co-pays in a manner consistent with a drug’s value, i.e., a lower (or no) copay for cost-effective drug, and a higher copay for a cost-ineffective drug.  This approach provides an incentive for the patient to use more cost-effective care . This approach is arguably the most palatable for U.S. healthcare, as cost-effectiveness is not being used to deny or ration care, rather to encourage the use of high-value care.

Placing Science in Context for our Future Health Leaders: Action Inspired by the Great Challenges Program

We’re on a mission to better understand the impact that the Great Challenges Program and the TEDMED community are making in creating a healthier world. For the past 18 months, we’ve convened experts via Google Hangout for unbiased and broadly inclusive discussions on 20 of the thorniest issues in health and medicine today. Diverse subject matter experts share their perspectives and help the TEDMED community dive deeper into key barriers to success for each Challenge. TEDMED believes that when the world achieves a broad-based understanding of any given Challenge, it will then be in a better position to take truly effective action.

After a year and a half, we wanted to know: what impact has our Great Challenges Program had on you? How have these discussions prompted truly effective action from you or within your community? What is your Great Challenges story? We asked – and you answered.

As we read inspiring stories shared by the community, we also want to share them with you. This blog post is the first of a series of Great Challenge successes, so if you have not shared your story – now is the time.

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One of the most inspiring stories we heard was from Jodie Deinhammer, an Anatomy and Physiology high-school teacher at Coppell Independent School District, right outside of Dallas, Texas. Jodie teaches 150 juniors and seniors, and just last year, was Region 10 Secondary Teacher of the Year. From what we heard of Jodie’s story, the TEDMED team certainly wishes we had a teacher like her when we were in high school.

That’s because the Great Challenges Program has helped Jodie innovate in the classroom in ways that inspire her students to place health issues in context – the students don’t just learn about body parts; they focus on the global health system and ways in which we can all work together to shape a healthier world. And, the Program and the positive response from her students have even prompted Jodie to expand the reach of her classroom: two of her courses are available on the iTunes U app, where they have soared into the Top 10 rankings.

Last year, Jodie saw a tweet about one of our Great Challenges online events that focused on reducing childhood obesity. As a class her students watched that session and actively participated online. The students were so energized by the direct access to the expert participants who answered their questions, that they’ve become some of our most active community members. Of particular interest are the obesity and prevention challenges, which relate most closely to their classroom studies. Jodie reports that, “The big picture that we’re creating through the course is directly related to what they’ve watched and learned through the Great Challenges Program.”

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This year, in the first semester, the students have been looking at prevention and obesity, and based on what they’ve learned from the Great Challenges program and in class, have come up with one potential solution to address these large-scale issues: they built a six-week online class to help adults improve their overall health. As part of this online class, the students have come up one challenge per week: during the first week, the online class focuses on giving up a bad habit; during the second, it encourages users to get moving…you get the idea. The students will soon begin using it as part of a health challenge for the school’s teachers.

Next, the students move on to focus on another Great Challenge for the upcoming semester. They’ll tackle “the impact of poverty on health,” working on a program to provide technologies to developing countries in partnership with several global organizations.

This story is an incredible example of the ways in which the Great Challenges Program can empower participants to actively engage in improving their health and that of the world at large. We’re thrilled to see the Program putting science in a real-life context and helping to train the health movers and shakers of the future. And kudos to Jodie for her innovation in the classroom!

Now, it’s your turn – what’s your Great Challenges story? How has our program impacted your work or the way you live your life? Shoot us a note at challenges@tedmed.com. We can’t wait to hear from you.

Virtual Reality: Immerse yourself in health – Q&A with Howard Rose

In his TEDMED 2014 talk, game designer Howard Rose describes the extraordinary power of play in virtual worlds, and shares how virtual reality can harness the innate human power to recover from and prevent illness. We caught up with Howard to learn more about his TEDMED experience and what inspires his work.

Gaming, health, virtual reality, Howard Rose.

“The doctor-centered paradigm of healthcare underutilizes our innate human power to recover on our own, or to prevent illness in the first place.” Howard Rose, TEDMED2014. Photo: Sandy Huffaker for TEDMED.

What drives you to innovate?

For me, virtual reality (VR) is the ultimate creative medium. As a designer, I enjoy the challenge of transforming complex ideas into meaningful experiences that bring people insight and joy. Virtual worlds can range from being very realistic to a realm of total imagination. Because VR is so unconstrained, the design process invariably evokes challenging questions about the mind, body and senses that spark the creative conflict which drives innovation.

I’ve devoted my career to exploring the boundless possibilities of technology to solve real world problems, particularly problems in health. We are just beginning to discover how to apply VR to some of our toughest challenges to control pain, treat mental illness and improve rehabilitation.

Why does this talk matter now?

Virtual Reality is poised to revolutionize the way we maintain our health and deliver treatment. It will be targeted like a drug and deliver sustained benefits. But better than drugs, VR can be personalized to individuals’ needs on a moment-by-moment basis. VR will make us more resilient, able to perform at our highest capacity. This revolution will be driven by consumer demand.

Today we are at the edge of a wave of new virtual reality technology that costs a fraction of the systems I used 20 years ago. The VR revolution is amplified by advances in neuroscience and the expanding array of biosensors we wear and carry in our mobile devices. All the elements are finally here to deliver intelligent, compelling virtual experiences that know our strengths and weaknesses and respond to our needs. These technologies are going to help people stay healthier on a daily basis, and lead to new treatments for many conditions that today we suppress or control with pills – like pain, anxiety, depression, or post-traumatic stress.

What legacy do you want to leave?

I want to give people the tools to unlock their own potential to be happier, healthier and more productive. My goal is to make the virtual reality health games industry bigger than the entertainment game industry. I’ve been working toward that goal for 18 years at Firsthand Technology, laying the groundwork  with basic research and development.

I’m now part of a new venture, DeepStream VR, to focus on virtual reality games for pain relief, rehabilitation and resilience. DeepStream VR’s mission is to reduce the need for opioids in clinical practice, and provide new alternatives for people at home to relieve pain.

Collaborating for Innovation

Conflict of interest. Does it have to dominate the agenda when public-private partnerships address healthcare? And, how can such partnerships lead to more and better innovation?

These were two key questions explored during TEDMED’s latest in-depth discussion of the Great Challenges of health and medicine. Our diverse group of experts provided some insightful and thought-provoking answers. The participants, who ranged from game theorist to pediatric ethicist, discussed obstacles they’ve found as collaborators in public-private partnerships and potential solutions to make these relationships more effective. Dan Munro, a Forbes contributor, moderated the event.

One of the biggest issues identified throughout the discussion was the lack of clarity and “game rules” when it comes to public-private partnerships. Myra Christopher, the Kathleen M. Foley Chair in Pain and Palliative Care at the Center for Practical Bioethics, explained that there are at least 53 different definitions of public-private partnerships. Myra noted, “there is a real cry-out for better and common understanding about the current game rules.”

Another issue that came to the forefront during the discussion was conflict of interest. With so many players in public-private partnerships, it’s hard to avoid conflicts of interest. However, John Tyler, the General Counsel and Corporate Secretary for the Ewing Marion Kauffman Foundation, noted that, “conflicts of interest should not be an impediment. They should not be a barrier, but they should be understood and efforts should be made to try to manage them.” From John’s perspective, one way to make public-private partnerships more effective is to see the opportunity instead of the conflict, which can most likely be mitigated.

David McAdams, a game theorist and Professor of Economics in the Fuqua School of Business and Department of Economics at Duke University, also encouraged looking for the potential opportunities in challenging situations. When asked what the great challenges facing public-private partnerships in the next 20 years are in the context of shrinking resources, David responded that this might not necessarily be a bad thing. With fewer resources “you’re forced to try more creative innovation,” David noted.

With regards to the medical community, Skip Nelson, the Deputy Director and Senior Pediatric Ethicist in the Office of Pediatric Therapeutics, Office of the Commissioner at the U.S. Food and Drug Administration, brought up the issue of incentives. As grant funding is shrinking, “we need to find new ways of valuing what people are doing and promote them appropriately within those institutions.”

Polina Hanin, Academy Director at StartUp Health, brought up the idea of adopting an entrepreneur as a potential method of using public-private partnerships to foster innovation. Doing so would “allow [the entrepreneur] to see the intricacies and work flows that are really going to allow them to create a solution that’s going to work for the community… the organizations, and the patients that these startups are actually trying to help in the long-run.”

The participants agreed that at the core of any public-private partnership there must be trust and transparency. Once we “quit being such skeptics,” as Myra put it, there’s the potential for public and private entities to begin effectively collaborating for innovation.

If you missed the live event, catch the recast here: http://tedmed.com/greatchallenges/liveevent/497919, and stay tuned for our next Great Challenges hangout on Addressing Healthcare Costs next Thursday, December 11 at 12PM EST.

Why be normal? Q&A with Rosie King

Rosie King diagnosed herself with a high functioning form of autism (Asperger’s Syndrome) at age nine and has become a spokesperson for autism in the United Kingdom, including hosting an Emmy award winning BBC documentary on the subject. Shortly after her 16th birthday, she spoke on the TEDMED 2014 stage about her journey.

We asked Rosie a few questions to learn more about her remarkable story.

Why does this talk matter now?

I think the ideas I share in my talk have always mattered.  Society is at a stage where it is beginning to understand equality– I want this to move on from addressing racism and sexism, to addressing discrimination in all areas.  This is the only way to have a civilized society.

Gratefully not normal: "I wouldn't trade in my autism and my imagination for the world." Rosie King, TEDMED 2014.

“I wouldn’t trade in my autism and my imagination for the world.” Rosie King, TEDMED 2014. Photo, Sandy Huffaker for TEDMED.

What legacy would you like to leave?

I want everyone in the world to know that it is important to be themselves.  I come from a family where everyone is different.  We could be a sad family but we have always been encouraged to be proud of ourselves and celebrate our talents.  If the whole world was like my family then it would be a joyful world.  I want to take a little bit of my family’s attitude out there.  It could be like flicking a switch, and I hope that my talk will be that switch.  To ask someone to be anything other than who they really are is cruel, like killing their real self.  Also, that genuine self that could bring so much color to the world!

What did you learn at TEDMED?

Denise [TEDMED speaker coach] taught me about body language and how to speak to a big audience–  that was useful.  I also listened to a very interesting talk [Rebecca Adamson] about how Native American people were treated.  This made me very upset but also glad that it was being brought to light.

For all inquiries regarding speaking engagements or to learn more about her current work, please contact Joanna Jones.

Keep up with Rosie and her family on their blog, My Perfectly Imperfect Family, and check out the books Rosie has illustrated authored by her mother, Sharon.

Live Online Event: Innovation through Collaboration

light bulb 3Please join us as we continue our Great Challenges Google+ Live Online Event Series, this time with a discussion focused on “Achieving Medical Innovation.” We’ll be discussing the various interpretations of public-private partnerships in healthcare, and whether and how these partnerships deter or support innovation.

Moderated by Forbes contributor Dan Munro, our diverse group of participants will explore the various facets of these creative relationships, sharing insights into what it means to have a unified “best-practice” execution of public-private partnerships in the healthcare space.

 

The healthcare world is an ever-evolving area with countless stakeholders, all working towards improving the health of the population. But with different priorities and different ways of working, how can diverse stakeholders work together most effectively? Public-private partnerships can bring together different viewpoints for a greater impact – they can increase resources, extend message reach, and expand collective knowledge and understanding. Many also believe such partnerships can speed up innovation – but what are the legal and ethical implications and challenges of innovating through public-private alliances? How can we think about more sophisticated ways of assessing and managing potential conflicts of interest? Can the medical community develop new models for public-private partnership that drive medical innovation while benefiting all involved parties?

Join us for a live online event on Thursday, November 20 at 12 noon to discuss these issues and more with experts on the topic. Get started today by tweeting your questions and comments and tagging them #GreatChallenges, and we’ll address as many as we can on air.

To learn more about the Great Challenges program, click here.

Get Smart About Antibiotics: Join us for a Twitter Chat with Ramanan Laxminarayan

Join TEDMED Speaker Ramanan Laxminarayan for a Twitter Chat about antibiotic resistance this Wednesday, 11/19 from 3-4pm ET.

Ramanan educates us about antibiotic resistance on the TEDMED stage.

Ramanan educates us about antibiotic resistance on the TEDMED stage.

Curious to learn more about the research behind Ramanan Laxminarayan’s TEDMED talk, “The Coming Crisis in Antibiotics”?

As part of the CDC’s Annual Get Smart About Antibiotics Week, TEDMED is hosting a Twitter Chat with Ramanan and the Center for Disease Dynamics, Economics & Policy (CDDEP) from 3-4pm (ET) this Wednesday, 11/19.

Delve a little deeper into Ramanan’s talk and learn more from him and the CDDEP about the rising challenge of antibiotic resistance and what you can do to combat it.  We’ll be framing our discussion around these three topics:

- Topic 1 (T1): Getting smart about antibiotics from the patient’s perspective
- Topic 2 (T2): Policy recommendations for strengthening antibiotics surveillance domestically and globally
- Topic 3 (T3): Strategies for conserving antibiotics as a natural resource

Tweet your questions our way using the #TEDMED hashtag, and remember to reference the topic! For background reading, be sure to check out the joint CDC/CDDEP study of antibiotic overuse in hospitals, which was just released in the Lancet earlier this week.

We’re looking forward to an insightful, collaborative discussion and hope you will join us then!

Protecting Antibiotics: Q&A with Ramanan Laxminarayan

Antibiotics have relegated life-threatening bacterial infections to our medical history books, or so think the vast majority of us. However, inappropriate antibiotic usage – for viral infections, in animal feed, in over-the-counter availability in some countries, and even over-treatment of some bacterial conditions – has also fueled the development of antibiotic resistance. This decrease in antibiotic efficacy coupled with the pharmaceutical companies’ slow development of new antibiotics are threatening our future fight against bacterial adversaries.

In his TEDMED 2014 talk, Ramanan Laxminarayan discusses how protecting antibiotics is a global issue and a worldwide responsibility, not one limited to a specific area of the world. He recently took the time from his busy schedule preparing for the CDC’s Get Smart About Antibiotics Week to answer a few follow-up questions:

What motivated you to speak at TEDMED?

I’ve been thinking about antibiotic resistance for nearly 20 years now, and have spoken about this problem and possible solutions to audiences ranging from clinicians, epidemiologists, hospital administrators, policymakers, economists, and even physicists.  But, the opportunity to reach a much wider audience through a format like TEDMED is rare and is probably better than even writing a book in terms of getting a message across.

Ramanan Laxminarayan on the TEDMED stage.  - Sandy Huffaker

Ramanan Laxminarayan on the TEDMED stage. – Sandy Huffaker

Why does this talk matter now? What impact do you hope the talk will have?

Like many others, I believe that we bear the responsibility of leaving the natural state of the planet in at least as good condition as it was in when we were first given responsibility for it.  I come to the problem of resistance from that perspective.  If we have fundamentally altered the microbial ecology of the planet, that is not very different from what we have done to the chemical composition of its air and water.  Antibiotics are amongst the most valuable natural resources we have been endowed with, and we have not recognized them as such.

What is the legacy that you want to leave?

Hopefully, my work has awakened, in a few people’s consciousness, the idea that we need a huge change in how we approach antibiotics.  If we are successful, then maybe in a few years, asking for an unnecessary course of antibiotics from your doctor will be the same as asking for a last drink for the road, or for a cigarette from a fellow passenger on an airplane.

Please share anything else you wish you could have included in your talk.

I would have loved to talk about my other passion: what it takes to deliver pediatric vaccines to 27 million children each year in India.  Fortunately, I had a chance to give a TEDx talk about this topic earlier this month. I’d also perhaps like to talk about the information structure of epidemics, if the TEDMED team ever makes the mistake of inviting me back.

How risky is it, anyway?

These days, science can tell us in incredible detail the ways our decisions are impacting our health – it’s easier than ever to discover what is going on in our bodies. We know that a poor diet or lack of exercise can have negative impacts on our heart health. We know that too much sun exposure can lead to skin cancer. We even know how diseases spread – and how they don’t. But, in the face of all of this information, we still continue to make decisions that may not be the best for our health.

In other words, many medical professionals are dismayed by the large gap between risk as perceived by scientists, and risk as perceived by the population as a whole.

As an example of this gap, some doctors and scientists point to the country’s reaction to Ebola. Though the average American is more at risk for flu, a car accident, obesity, diabetes, or heart disease than Ebola, the entry of the disease into the U.S. has brought a high level of fear. This prompts the question: How can the medical community accurately and responsibly communicate risk in a way that encourages healthy choices?

Last week, as part of the Great Challenges program, we convened a group of experts on the topic. They discussed the psychology behind risk perception and talked about strategies and tools that the medical community can use to ensure that patients receive an accurate understanding of their risks and are encouraged to act accordingly. The event was moderated by James Maskell, CEO and Founder of Revive Primary Care.

The participants all agreed that our reactions to risk are often driven by feelings before facts – and that the low level of health literacy in this country doesn’t help. Brian Zikmund-Fisher, PhD, an Associate Professor of Health Behavior & Health Education at the University of Michigan School of Public Health, noted that other elements of human risk perception include our experience (or those of others), our knowledge, our level of control, and our level of dread. He stressed the importance of understanding risk as a population-level construct.

Glyn Elwyn, MBBCH, MSC, FRCGP, PhD, a physician-researcher, Professor and Senior Scientist at the Dartmouth Health Care Delivery Science Center and the Dartmouth Institute for Health Policy and Clinical Practice, posed a key question: “How do we frame information so that it’s easy to understand?” The group agreed that risk perception is largely about context; they stressed the importance of using language and tools to create this context – which is not always statistics. Brian shared his thoughts on the subject: “how can we give people the tools so that they can understand under what circumstances they would be at risk, and when they’re not at risk? We need to use stories to represent examples and also provide quantitative information.”

Thomas Workman, PhD, MA, the Principal Communication Researcher and Evaluator for the Health and Social Development Program at the American Institutes for Research (AIR), had one suggestion: asking patients to think about how they would feel if the health condition for which the patient is at risk occurred. He called for patient involvement in the development of these tools, asking, “How can we incorporate patients into the development of some of these tools and technologies?”

Participants emphasized the importance of the clinical encounter in creating this context. At the same time, the short time for each office visit was a concern. Thomas noted that “The conversation with the physician is just as important as the conversation with the community.” He suggested that risk and prevention discussions can take place with organizations within the community – or even within small family units. David Bell, MD, MPH, an Assistant Professor of Population and Family Health at the Columbia University Medical Center, echoed this sentiment. He stressed the need for risk information to come from a trusted source.

The participants also recognized that the media plays an important role in framing the public’s risk perception. We live in a world where we are confronted with sensationalized news daily. Glyn pointed to the low trust in public information plus dread as a “toxic mix that the media are ventilating,” while Thomas asked: “How can we create more balanced messages?” Brian noted that while individual stories may make interesting news stories, they “will never be representative of the broader range of what could possibly occur.”

On the whole, the participants concurred that, as David put it, “Every step of the way patients get different messages about their risk and we all need to be on the same page.” A tall order, of course, but one which may lead to more realistic understandings of risk – and consequently, it is hoped, the adoption of healthier behaviors.

If you missed the live event, catch the recast here: www.tedmed.com/greatchallenges/liveevent/494673, and stay tuned for our next Great Challenges hangout on Achieving Medical Innovation later this month!