A Culture of Health Includes Everyone

This guest post is by Sam Vaughn, TEDMED 2015 speaker and Neighborhood Change Agent in the City of Richmond, California. You can watch Sam’s TEDMED talk here.

Sam Vaughn 2A person can have a healthy heart and diseased lungs, or a healthy brain and kidney failure. Would you consider that person healthy? Society is quite similar. Until we create a culture of health that is inclusive of all citizens, we cannot consider ourselves a healthy society. Thus, we cannot create a healthy society until we deal with issues of personal security, like crime and gun violence.

As I mention in my TEDMED talk, at the Office of Neighborhood Safety, we identify individuals who are most likely to be perpetrators or victims of gun violence. We work with them through a program called the Operation Peacemaker Fellowship, a seven-step process to help them become self- and socially-aware of their roles in society, and to affirm their God-given and Constitutional rights to happy, safe and successful lives. Perhaps most importantly, we meet and accept them where they are, with no judgement, and recognize the social, structural and strategic injustices that they have faced most of their lives. We challenge them to accept that, despite those injustices, they still have a responsibility to themselves, to their families, and to their communities to do better.

The first step of the Fellowship, and one that is vital to our success, is for us to build a relationship with these individuals. Most young people don’t care what you know until they know that you care. Once trust is established, we create a LifeMAP with them, helping them see that a different future is possible by showing the changes that others have made. We help them envision a future as bright and fulfilling as they can possibly imagine, and we connect them to resources and service providers that can help make that dream become a reality. We connect them to mentors and coaches, a group we call Elders, who are older successful men of color who have successfully made changes in their own lives, and are now reaching back to help others.

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Sam Vaughn, Devone Boggan, and Fellows on a retreat at the Teotihuacan Pyramid of the Sun, Mexico City.

Additionally, in a step riddled with great risk but even greater reward, we take the Fellows on trips around the globe, to help them see how good life can possibly be and get them addicted to living. The catch to this amazing travel opportunity is that they must travel with someone from what would be considered a “rival community.” As they begin to see themselves, and the world they live in, in a different light, they start to see each other differently as well.

Because we believe hard work should be rewarded, we provide a stipend to our Fellows, a practice that is seen as controversial by some. Critics frequently disparage this, claiming that we are paying criminals not to commit crime. Let me counter that by saying that, when I was young, my parents would give me $5 for every “A” I got on my report card. Were they paying me to go to school? Absolutely not– they were rewarding me for working so hard. We aren’t paying these young men for what they aren’t doing. We are rewarding them for what they are doing.

Our final step is to introduce our Fellows to mainstream society and the workforce through subsidized employment. In this stage, they develop a strong work ethic, effective workplace communication and the skills of being a team player. Eventually, they become employable by their own means, without subsidy.

Frankly, our goal is to provide these individuals with what every young person in this country receives when they grow up in a healthy, nurturing community. We’ve been successful. Of those who have participated in our Fellowship, 94% are alive, 84% haven’t been injured by a firearm, and 79% have not been suspects in new firearm-related crimes. During the period of our interventions with these youth, the city of Richmond, California has experienced a 66% reduction in firearm assaults and a 55% reduction in firearm related homicides between 2007 and 2015. By attending to these young men who are and have been traditionally underserved and abandoned by the mainstream services platform, the City of Richmond is creating a culture of health in a once dangerous city that is today a much more desirable place to live, learn, work and play.  

Taking a new look at psychedelics: Q&A with Roland Griffiths

At TEDMED 2015, psychopharmacology researcher Roland Griffiths shared intriguing research findings about psilocybin, a naturally occurring psychedelic substance that has been used for hundreds of years within some cultures for medical, healing, and religious purposes. We reached out to Roland with some questions about his current research.

We’re especially curious about your research into the connections between psilocybin, spirituality, and consciousness. Can you tell us more? Are there any updates?

_JHU9762 RRG office copy_FotorIn ongoing studies, we’re examining the effects of psilocybin in long-term meditators and in religious leaders from the major faith traditions. We’re also conducting two anonymous internet surveys. One is asking about experiences that some people report of an encounter with God, or the God of their understanding. Another is examining anomalous experiences, such as Near Death Experiences, that produce enduring changes in people’s attitudes and beliefs about death and dying. In both surveys, we want to compare spontaneously occurring experiences with psychedelically occasioned ones. Our hope is that these surveys will allow us to better understand such experiences and how they may differ across faith traditions and occasioning events (e.g. prayer, meditation, spontaneously-occurring, nature experiences, drug-occasioned, etc.).

Our research has shown that a single experience with psilocybin can produce personally meaningful experiences accompanied by enduring positive changes in attitudes, mood and behavior. We’ve recently completed a study suggesting that psilocybin decreases depression and anxiety associated with a life-threatening cancer diagnosis. We’re also following up on a pilot study that suggested the psilocybin may be helpful in treating drug addictions — in this case, cigarette smoking. Finally, we’re initiating a study to explore the efficacy of psilocybin for treatment-resistant depression. In several of our studies we are using fMRI brain imaging methods to examine the acute and persisting changes in brain function that occur after receiving psilocybin.

You’ve opened our eyes to the potential therapeutic benefits of psilocybin – but do they come with risks?

_JHU9895 cancer pamphlet copy_FotorAlthough most participants in our laboratory studies have positive psilocybin experiences, about 30% experience significant fear or anxiety sometime during the session. Even for that 30%, given our careful screening and support, persisting adverse outcomes are virtually non-existent. It can be a different story for haphazard use in the general population. We recently conducted an internet survey of almost 2000 people who described their single most challenging experiences after taking psilocybin. Almost 40% of respondents rated the experience to be among the five most challenging experiences of their lives (yet, curiously, often among the most meaningful of their lives). Notably, about 10 percent said they had put themselves or others at risk of physical harm during the challenging experience, most likely in response to fear or panic, and about 10% reported enduring adverse psychological symptoms lasting a year or more. The contrast between the survey results and the excellent safety track record of the laboratory studies underscores the need for careful screening, preparation, and support.

Why study mystical experiences? What does this work mean to you?

Many of the challenges facing the world today, such as the environmental crisis and hostilities within and between cultures, stem from a lack of appreciation for the profound interconnectedness of all people and all things. This sense of interconnectedness or unity is a core feature of the world’s ethical and moral systems. Our interconnectedness is also a core feature of the mystical or transcendent experiences that occur with high probability after the ingestion of psilocybin under appropriate conditions. Ultimately, systematic prospective study of mystical experiences and their consequences may be critical to the survival of our species and the healing of our planet.

Is there a thought or mantra that you repeat to yourself most often?

I try continually to cultivate deep gratitude for the astonishing mystery of consciousness — that we are aware that we are aware — giving rise in me to uplifting and sacred feelings of wonder about all that we do not and quite possibly can never know.

Watch Roland’s TEDMED 2015 talk, “The science of psilocybin and its use to relieve suffering,” here. 

 

Improving the script for caregiving

K&M PhotoboothIn this conversation between two improv actors, Mondy Carter steps into Karen Stobbe’s world and asks for her perspectives on what she thinks living with Alzheimer’s disease is like, and how we can harness the rules of improv to improve our caregiving.  Learn more about Karen and Mondy and watch their TEDMED 2015 talk here.

Mondy: Why do you think being in the moment with someone living with Alzheimer’s is important? I know what I think, but I am interested in how you see it.

Karen: People living with Alzheimer’s are experiencing short term memory loss. When you’re struggling to remember and trying to make sense of the world around you, life becomes very immediate – very  much in the now.  If we stay in the moment with them, it slows us down and brings us more into their world so we can see things from their perspective.

Mondy: That’s how I see your Mom’s experience with Alzheimer’s. You and I walk around with the context of our recent memories, and so the world makes sense to us. But her recent experiences don’t stay with her at all, and that void of information is filled with immediate sensations colored with the only memories that she does have – ones from long ago. Even though we can share the present, I have to be open to her particular present to be in the moment with her.

Karen: Exactly. When you are truly in the moment, you make yourself available to be present for any moment that arrives.

One of the hardest guidelines to follow in improv and Alzheimer’s is listening fully. To really understand a person with Alzheimer’s, I think you have to pretend the other person is the only one in the world as you listen to them. Like I do with you….

Mondy: You do? I must have missed that.

Karen: Perhaps if you listened more fully?

Mondy: Hmmm…sorry, I just got a text!

Karen: Ha. Seriously, though, think about how courageous it is to even try to communicate when you’re struggling to remember, fighting to follow a conversation, or piecing together fragments of memories to make sense of the world. If they are trying that hard, maybe we can try to be more present in our listening. There was actually a study done in nursing homes that showed 92% of the talking was done by those who work there, and only 8% by those who live there. Not a lot of conversations with the residents or listening by the staff is taking place.

Mondy: When I began improv, it was really difficult for me to stop working out my responses while the other players were talking. It’s hard to believe that just letting go of our own ideas allows us to come up with the best ideas. But, when you listen fully and have the other person foremost in your mind, the human brain is perfectly able to come up with what is needed immediately. Wouldn’t you say that listening is the bedrock of improvisation?

Karen: Yes. And isn’t listening something you have to actively practice?

Mondy: I had to, again and again. The “good” thing about doing improv on stage is that, when you don’t follow the guidelines, you fall on your face. There is a tremendous ego incentive to let go of your ego. If you don’t let go and listen, you crash and burn.

Karen: Which is basically what can happen in a caregiving situation.  If you don’t let go and listen, you won’t understand what the person with Alzheimer’s is trying to say. Misinterpreting their intentions or projecting our ideas can lead to frustration on both sides.

Mondy: Is that why so many people think aggression and anger are always a part of Alzheimer’s?

Karen: That’s a common misperception. People think everyone with Alzheimer’s gets to an “aggressive stage” or all “get angry.” That is not true. Most of those so-called behaviors are either their way of trying to communicate, or reactions to our poor behavior. Most of the time, their actions are really very normal for their perceived situation. We just don’t see it that way.

Mondy: Can you give me an example of that situation?

Karen: Imagine that it’s 6:00am and you’re comfortably lying in bed, in your home when… boom! A complete stranger walks in, opens your drapes and says, “Mr. Carter it’s time to get up!” How would you react?

Mondy: I would freak out and throw something at them. Do I have a taser in this hypothetical case?

Karen: Sure, there is a taser…

Mondy: Then I would tase them.

Karen: We do that to people living with Alzheimer’s all the time.

Mondy: We tase them?!

Karen: Ha! Stop it. No, we don’t bother asking them if they even have any desire to get up. We forget to re-introduce ourselves if we’ve been out of the room for a bit. We tell them they are in their room, but then we burst right in and order them around. In that situation, just about anyone would get upset or angry.

Mondy: I see. So that’s why stepping into their world, instead of forcing them to live in ours, is so important.

Karen: Yes – there’s so much we could learn from the basic rules of improv. Stepping into their world, being in the moment, and listening fully – these rules are the foundation of compassionate care for people living with Alzheimer’s.

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Healthy risk-taking for “at-risk” individuals

By Kayt Sukel, science journalist, TEDMED 2014 speaker and guest blog contributor

How can we encourage individuals from “at-risk” populations to take healthy  risks, when we can’t even agree on what risk actually is?

To start, I think we need to make sure that individuals, public health systems, and educational systems are using the same vocabulary when they discuss these kinds of issues. The word “risk” is used in so many different ways—and we tend to talk about it in rather contradictory extremes. “Risk is bad. It will lead to poverty, danger, and death.” Or, “Risk is good. It’s the key ingredient for happiness and success.” The truth, as is often the case, resides somewhere in the middle. As I learned while researching The Art of Risk: The New Science of Courage, Caution & Chance, work in neuroscience shows, more and more, that risk is a key component to learning and skill building. Yet, people still tend to talk around risk. There has recently been a more conscious effort, in the psychological and epidemiological communities, to try to use the term “risk” less—especially when the parties mean “impulsivity,” “sensation seeking,” or some other manner of negative behavior.

We also need to acknowledge that there is risk in every decision one makes, every single day. While the science shows that risk is necessary for learning and growth, that doesn’t mean it’s comfortable or easy. Saying yes to everything is exhausting. Being judged for the risks you take, especially when it somehow gets linked back to the color of your skin, your socioeconomic background, or your gender, is infuriating. Educators and other stakeholders need to understand that, for at-risk populations, putting yourself out there can come at a significant cost. Sure, in the long term, it may not be as great a cost as not pursuing an important professional or personal goal. But we should acknowledge that risk, especially one that makes you vulnerable to criticism and ridicule, is a scary proposition. And, if there isn’t some sort of scaffolding there (in the form of good mentorship, for example) it can be hard for at-risk individuals to see what the long term benefit of risk-taking could be. It’s important that we collaborate, as a community, to make sure that scaffolding is there–for everyone–so we do have room to encourage healthy risks.

The good news is that already have the tools in our arsenal to encourage healthy risk-taking in all populations. We’ve had them for a long time. It’s as simple as providing safe arenas in the arts, sports, and sciences where students even as young as elementary age can learn how to question, to innovate, to fail, to engage, and to move forward.

I know, it may seem like I’m contradicting myself. Risky behavior in safe arenas? What does that even mean? To me, it’s a matter of giving individuals, all individuals, opportunities to test themselves in new ways. Giving them places to do it where the cost of failure is not too great to bear. Time and time again, we’ve seen that music, art, theatre, science clubs, sports, and other extracurricular activities all provide opportunities for individuals to try new things and really work at the edge of their performance ability. This teaches those students key lessons in emotional regulation, problem solving, teamwork, personal responsibility, and perseverance. If we can make these arenas more inclusive, it’s there that we can empower females (both cis and trans) and LGBTQ populations—as well as other at-risk populations—to better understand their own strengths and weaknesses and, ultimately, develop really healthy risk-taking skills. The kind of skills that transcend the school and playground—and help them become more successful in everyday life, no matter what kind of goals they decide to pursue.

Unfortunately, these are exactly the kinds of programs that we keep cutting, both inside and outside schools. If we continue along that vein, it will not only be to the detriment to at-risk populations, but to society as a whole.

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kaytJournalist and science writer Kayt Sukel shared insights into the neuroscience of risk-taking and how play during childhood and adulthood impacts the way we make decisions as adults in her 2014 TEDMED talk, Eliminating Penalties for Playing Out of Bounds. Check out her new book, The Art of Risk: The New Science of Courage, Caution and Chance.

Imagining a culture of healthier childhood

TEDMED speaker and pediatric endocrinologist Louise Greenspan has been a co-investigator in a uniquely comprehensive longitudinal North American study following young girls through puberty. We asked her to design a fantasy health intervention with unlimited resources. Here’s her vision:

Image courtesy of Shutterstock

We all know the expression, ”It takes a village to raise a child.” My fantasy intervention is based on that concept, however it expands on what the village is and what it provides. Today’s industrialized societies have fractured the extended family, resulting in most parents not having support from their own elders in raising their children. Many young parents don’t have the basic knowledge they need to support their growing families in healthy ways. While concepts about child rearing naturally change between generations, there is still a lot to be learned from those who have gone before us.

I’d love to support an intervention that provides education and assistance to families beginning from the moment they find out they are pregnant. The idea would be to start with pregnant mothers, by providing nutritional education and enhanced psychological and educational support, regardless of socioeconomic status. This education would take place in classes with members of the neighborhood who are also pregnant, thus building community.

After delivery, new parents would be encouraged to breastfeed and learn how to nurture their babies by visiting health workers who could come into the home. As the children grow, these home health workers would provide assistance and education to parents on how to feed their children, how to support their developing brains, and also how to discipline them. This way, parents could learn the facts they need to know, as well as start to develop a healthy authoritative approach to setting limits with their children. These trained workers would be available for parents to turn to for advice, to supplement the way some of us were once able to turn to our mothers and grandmothers for advice (but with the latest in knowledge and skills). The health workers would also set up support groups for families who live near each other or hold groups and classes as well.

At age 3, all children would be offered high quality preschool with a healthy lunch provided for all, and the parental support and education could continue, informed by these community schools. Parents would learn how to deal effectively with the challenges presented by their ‘threenagers’ and other toddler challenges. At entry to elementary school, the support and education would be augmented so that it would also be provided directly to the children themselves while also continuing with their families. All kids would have weekly lessons in cooking and healthy eating, and be active participants in growing and preparing healthy food at their school as part of the curriculum. Parents and guardians would participate in sessions about how to feed their children healthfully, assist their children educationally, as well as continue to be given tools about how to effectively parent their children.

Health Education would be taught to the children directly, starting in kindergarten with practical life skills, including cooking. In the early grades, the education might focus on the importance of eating a healthy balanced diet and on getting enough physical activity and sleep. As the children age, lessons would include classes on their body and health, with puberty education starting in third grade, separate from sex education, which could start in sixth grade. In third and fourth grade, children would learn about puberty and the body changes that will start and happen to everyone over the next few years. In middle school, kids would continue to discuss puberty, but would now have discussions about sex and sexuality. In high school, these topics would be discussed in more depth. The lessons learned about cooking, healthy eating, and exercise would continue throughout these years. There would also be age-appropriate mindfulness-based stress-reduction education through all of the grades, with an emphasis on this in high school. Parenting assistance and education throughout these years would reinforce these concepts and would perhaps also focus on how to enforce healthy sleep habits and limitations on screen time. The outcomes examined in this intervention would include rates of childhood obesity, early puberty, and psychological and educational diagnoses issues across the socioeconomic spectrum.

Could an intervention like this help reduce childhood health care disparities? Could it reduce parental stress and anxiety? Might it lead to more teens heading to college, thus reducing educational disparities? It is my dream to be able to study the effects of such a holistic, longitudinal, health education intervention. My hunch is that it could be game-changing.

Louise Greenspan is co-author of the The New Puberty: How to Navigate Early Development in Today’s Girls. Learn more by watching her TEDMED talk, “Weighing the causes of early puberty.”

Crazy about CRISPR

This guest blog post is by Sam Sternberg, a TEDMED 2015 speaker. You can watch Sam’s TEDMED talk, “What if we could rewrite the human genome?”, here. 

This thing called CRISPR seems to be all over the news these days, whether as a miracle treatment to cure genetic disease, an eradication strategy to rid the Earth of mosquitoes (together with Zika virus and the malaria parasite), a weapon of mass destruction alongside North Korean nukes and Syrian chemical weapons, or the reproductive technology that will usher in an era of so-called designer babies. CRISPR was even featured in the recent comeback season of the X-files, in conjunction with aliens and a global pandemic. What could possibly unite all these divergent topics?

The common thread is DNA, and more specifically, an amazing new tool that makes editing DNA virtually as easy as the “find and replace” function in word processing software (check out this neat video for an animated explanation). Of course, scientists have had the ability to modify DNA in the laboratory for decades – even to synthesize entire microbial chromosomes from scratch. But using the CRISPR technology, it’s now possible to rewrite DNA inside living cells with the same kind of control and accuracy, and to tweak billion-letter genomes in almost every way imaginable: deleting genes, adding genes, inverting genes, repairing genes, even turning genes on or off. After three short years of research and development, scientists have been hard-pressed to find things that CRISPR can’t do.

shutterstock_353873630So what is CRISPR, anyway? Although the acronym alone won’t tell you much – CRISPR stands for clustered regularly interspaced short palindromic repeats – the story behind these repeats, and how they came to revolutionize biology, is pretty cool. The short version: after first being detected in E. coli in 1987, CRISPR remained a complete mystery for nearly two decades, until scientists studying yogurt-producing bacteria realized it was a type of antiviral immune system. Subsequent research in flesh-eating bacteria not only revealed how CRISPR naturally worked, but also how it could be redesigned and repurposed for DNA editing in other organisms. (You can read more about some of the breakthrough discoveries here and here.)

After the first reports surfaced in 2013 demonstrating successful editing of the human genome, the CRISPR technology was rapidly applied to a huge number of plants and animals, everything from common model organisms like rice and mice to more exotic species like broccoli and butterflies. Meanwhile, labs all around the world began using CRISPR because of its low cost and easy implementation. Today, even ordinary online shoppers can order do-it-yourself CRISPR kits to edit DNA in the comforts of their own home.

Having spent my PhD years studying CRISPR in Jennifer Doudna’s laboratory, starting well before the technology exploded, I’ve been mesmerized by the myriad ways in which DNA editing is transforming biological research. After all, DNA contains the blueprints for all living things, and we now have total mastery over these blueprints, to alter them in virtually any way that suits our needs or fancies. Yet with this newfound power also comes a responsibility to use it safely, and ethically.

Should CRISPR be used to alter the human genome for generations to come, by editing DNA in fertilized embryos? To create genetically engineered designer pets, such as miniaturized pigs or extra-muscular dogs? Or to spread new traits like malaria resistance or female infertility into wild insect populations? By removing many of the technical barriers that previously limited attempts at DNA manipulation, CRISPR has changed the question facing society from “If we could do it, would we want to?” to, “Now that we can do it, should we?”

Scientists and a wide range of stakeholders have already begun tackling some of the issues raised by CRISPR, and governmental officials are quickly following suit. In the U.S., within the next year or so, we can expect the announcement of an updated system for the regulation of genetically modified products, and a comprehensive study outlining recommendations for the responsible use of gene editing in humans.

There are reasons to proceed cautiously and prudently. But I hope that – even with all the concern surrounding CRISPR – we don’t lose sight of the incredible possibilities. In a medical first, DNA editing saved the life of a one-year-old girl suffering from leukemia last fall, and that may be just the beginning. Whether as a tool to expose the vulnerabilities of cancer, a therapy for patients afflicted with HIV/AIDS, or a cure for muscular dystrophy and sickle cell anemia, CRISPR offers real promise to solve some of the world’s most challenging diseases. Let’s see what a few more years of research can achieve.

Meet Dr. Pamela Wible, physicians’ guardian angel

In this interview, TEDMED’s Dr. Nassim Assefi and founder of the Ideal Medical Care movement Dr. Pamela Wible discuss physician suicide, sexism in medical school, and how to escape “assembly-line medicine.” You can watch Pamela’s TEDMED 2015 talk, “Why doctors kill themselves,” here.

Pamela Wible

Nassim: You’re one of the few physicians I know who’s been outspoken about physician suicide, open about her own history of depression while in medical practice, and proactive in addressing medical student and physician mental health. How did you become such an activist?

Pamela: I’m an activist and community organizer at heart. I was born into a family of physicians, activists, and entertainers. My grandfather started the motion picture workers union in Philadelphia. I’m related to Curly, Moe, and Shemp of the Three Stooges. It’s in my blood to be joyful, comedic, and lighthearted, but also to speak up for the oppressed and victimized. I’m a born healer and problem solver—whether it’s a patient with an ingrown toenail, a doctor with PTSD, or a suicidal health system. I’m curious, relentless, and very vocal about injustice. Yet without action, words fall flat. Action is what excites me most.

Nassim: You’re a somewhat controversial figure in such a conservative profession. You wear glitter, throw Pap parties, and even deliver balloons and homemade soup to your patients during house calls. Is this quirkiness and whimsy an intentional strategy to spread joy and love in your medical practice or just an extension of who you are? Have you ever received pushback from a mistrusting patient or colleague?

Pamela: My personality and my glitter are not strategic. I’m just being me. I find that when I am free to be myself, my patients feel free to be themselves. Authenticity is therapeutic for us all. Authenticity is also sorely lacking in health care, much to the detriment of physicians and patients. Medicine has too many starched white coats and not enough color, soul, and feeling. My patients are relieved and even thrilled to meet a “real” doctor who is a “real person.” Once (in response to an article I wrote for a medical journal) I did receive a letter from a male clinic manager who claimed my appearance was unprofessional. I recited his letter and responded to his concerns in my TEDx talk, “How to get naked with your doctor.”

A surprise birthday party physical at Pamela's clinic.

A surprise birthday party physical at Pamela’s clinic.

Nassim: You’re a pioneer of the Ideal Medical Care movement, have written a book about it, and offer courses and retreats to help doctors escape “assembly-line medicine.” Can you give me the nitty-gritty on ideal medical clinics?   

Pamela: I’m simply practicing medicine the way my dad used to practice as a neighborhood doctor back in the 1950s (though I’m pretty sure he didn’t throw Pap parties for his ladies). Like my dad, I have no staff and I’ve never turned anyone away for lack of money. My dad and I genuinely love people, and I’m sure patients can feel the love.

I see 6 to 8 patients per half day for 30-60 minute visits. I document on an electronic medical record that I created myself on my Apple laptop. I accept insurance and submit claims in 1-2 minutes after each visit through a free online clearinghouse. I roll out the red carpet for every patient, whether millionaire or homeless. It’s VIP without the fee. By cutting out the middlemen, I decreased my overhead from 74% at my favorite assembly-line job to nearly 10%, leaving me with 90% of the revenue I generate. Physicians who practice this way can exceed their previous full-time salaries working a fraction of the hours. However, most doctors enjoy their newfound freedom and autonomy more than money. No amount of money can compensate for a miserable life and most doctors today seem pretty miserable.

Meanwhile, I’m happy. My patients are happy. I feel like I’m on vacation 24/7. I rarely get after-hours calls. Plus, I’ve never sent anyone to collections in 11+ years. This feels like the only viable way to practice medicine.

Best of all, our clinic was designed by my patients. I held town hall meetings and invited my entire community to design their ideal medical clinic. I collected 100 pages of written testimony, adopted 90% of citizen feedback, and we opened one month later with no outside funding.

What Pamela calls the "reverse white coat ceremony" physicians' retreat.

What Pamela calls the “reverse white coat ceremony” physicians’ retreat.

Nassim: Your mother, Dr. Judith Wible, is a psychiatrist and has a scholarship for visionary female medical students in her name. Did she play a role in your activism? 

Pamela: Yes. My mom is an activist and leader in the women’s rights movement. During my childhood she took me in my stroller to women’s liberation marches, bra burnings, and all of that. She and I went to the same medical school too, and what she went through was much worse than what I had to deal with due to out-of-control sexism and harassment.

Nassim: You’ve had some major success lately. A new book, Physician Suicide Letters Answered, that was #1 on Amazon for Medicine for a month after release, a new house bill in Missouri that addresses depression and suicide in medical schools, and you’re being featured in an upcoming documentary, Do No Harm, by an award-winning filmmaker, Robyn Symon. Are you optimistic that all this attention will translate into more compassionate medical education and practice for the students and doctors?

Pamela: I’m a perpetual optimist. All these successes couldn’t have happened without public and professional support and a willingness to finally address medical student and physician suicide. It is a defining moment for us all.

Nassim: So, what’ s next for you?

Pamela: I’ve been sent on some Michael Moore-style missions through hospitals with secret film crews for the documentary. That’s really fun! I’d love to dig deeper into investigative journalism.

Building Healthy Cities

This guest blog post was written by Gil Penalosa, Founder and Chair of the Board of 8 80 Cities and World Urban Parks, as well as former Commissioner for Parks, Sport and Recreation for the City of Bogota, Colombia.

CicLAvia Wilshire 06-2013

CicLAvia, Wilshire Boulevard (2013)

How would your life be different if you lived within a culture of health?

Consider the city. Over 85% of us in the U.S. live in cities. Think about how you go to places, where your children go to school, where your friends live, how you cross the street. This built environment – one that can feel so comforting and routine – is actually damaging to your health.

If you looked down on the average U.S. city from the air, you would find that 15 – 25% of the land is paved with streets. Of the land that is public – as in, not privately owned –  streets occupy between 70 – 90% of space that we all share. In this environment, the automobile has become our community connector. Children used to walk and bike to school, now they are driven. When our children make new friends at those schools, we drive them to their play dates. Parks are few and far between so we drive the kids to soccer practice. As cities spread, we drive for an hour or more to report to work. With all these cars on the road, we advocate for wider streets with more lanes and higher speed limits. In many communities, sidewalks do not even exist.

This method of navigating our built environment is killing us. Studies show that the chances of being killed increase by 75% when hit by a car going 35 mph versus one going 20 mph. Around the world, a person walking is killed by a person driving a car every 2 minutes. Twenty years ago, no state in the US had a population with an obesity rate over 20%. Today, there is not a single state whose obesity rate is less than 20%. Concern over obesity is not aesthetic: it causes heart attacks, respiratory problems, cancer, depression and anxiety.

And the challenges are increasing. Currently in the US there are 42 million people over 65 years old; in just 35 years, this number will double to 85 million. Of all the people who have ever lived to 65, half are alive today. We are living longer – much longer – yet our cities are becoming less friendly to older adults. As wider streets lead to longer crossing times, older people are being killed in crosswalks at 4 times the rate of their proportion of the population. The main issues facing the elderly are isolation and mobility. How are we going to address those if we continue to build communities that quite literally threaten their lives?

How do we change the future? To live a culture of health, citizens can no longer be spectators. We must act. We must each commit to participate.

Call on your governments – elected officials and your city staff in departments of planning, transportation, public health, education, parks and recreation – to commit to working with each other and with other sectors like businesses, media, activists and universities to guide the development of our cities with people in mind, creating healthy communities where all people will live happier.

Reclaim your streets. Walking and bicycle riding are the only individual modes of mobility for all people under the age of 16 and for many adults. Safe and enjoyable walking and cycling should be a right for all people. Support budgets that include money for sidewalks. Advocate for Open Streets, the closing of streets to cars on Sundays so that people can use this public space to walk, bike, be with each other. Make it easy for people be out and about in their communities, to visit other neighborhoods, to meet other people meet as equals.

Support investment in parks, large and small, that thread through your city, in all neighborhoods so that every child has a play area within ¼ mile at any given time. If land is not readily available, public properties can be converted for recreational use. School playgrounds can be used by the school during the weekdays but open to the community in the evenings and weekends.

We must improve the use of all land that is public. It belongs to all people. We must stop building cities as if everyone was 30 years old and athletic and create great cities for all. Any city, of any size, should pay attention to how well they treat its most vulnerable citizens, including children, older adults, disabled and poorer residents.

How is your city doing? You don’t have to be an expert to assess whether a park, street, sidewalk, school, library, actually any public space invites people to walk or ride. Simply use 8 80 Cities’ practice. If evaluating an intersection, think of a child you love, someone around 8 years old. Now think of an 80-year-old that you love. Would you send them across that intersection? Would they feel safe? Can they walk to school or to a park? If your answer is yes, it is good enough. But if it is no, it must be changed. The 8 and the 80 year olds are indicators. If a city promotes a culture of health for them, it will promote a culture of health for everyone, a built environment where everyone can live the healthiest lives possible.

Charting the Next Course: Women Speak from a Mighty River

By Christine McNab, guest contributor. Can Tho, Viet Nam

She’s petite, yet stands tall and steady, strong shoulders and arms steering eight foot-long oars through a swift Mekong current. It’s dawn, and many women do the same, navigating their low wooden boats through a jigsaw of vessels at the Phong Dien floating market. Women here do a brisk trade in produce, exchanging pounds of watermelon, daikon, pineapple, cabbage, morning glory, onion and squash for Vietnamese Dong. The bounty from the Mekong Delta provides much of the food energy for Vietnam’s 90 million people. Women are at the heart of this essential commerce.

“Vietnamese women are often in charge of driving the small boats, and buying and selling at the fruit and vegetable markets,” says Maru, my guide. The work is taxing – a technique combining crossed arms and oars to nudge the boat through narrow spots; a one-legged start of a long motorized rotor for speed, and hours under a searing sun. Our driver, Tay, has been steering boats for more than twenty years. “Women here work very hard,” Maru tells me.

I want to find out a lot more about Tay and Maru, and I will this week as part of my new multimedia project, A River Runs with Her: the Lives of Women and Girls on the Mekong.

Near Can Tho, Viet Nam, March 2016. Photo: Christine McNab

Tay has done the hard work of steering boats on rivers and tributaries of the Mekong Delta for more than 20 years. (Near Can Tho, Viet Nam, March 2016. Photo: Christine McNab)

I’m devoting 2016 to this self-funded project for many reasons. For one, I believe attaining gender equality is at the heart of international development. Many studies, history, and a lot of common sense tell us that we can only make progress when women have the same rights, access to education, health, jobs and justice as men. Women have made great strides in much of the world, but in too many places, women and girls are simply valued less. Equality means equal value, and it also means equal voice.

We don’t hear from women enough. The Economist recently published an excellent essay on the importance of the Mekong River to biodiversity, culture, and Asia’s economy. I admired the reporting, but noticed there wasn’t a single female voice in the piece. Instead, women were in the kitchen making soup or in bars serving beer. I want to hear more from these women.

The newest international Global Goals for Sustainable Development, set by international leaders last September, include important targets for women’s equality, for education, health and participation in governance. The goals are hopeful and ambitious. I wondered what women living in communities along the Mekong think about these goals? What do they need to achieve them?

And then, there’s the mighty Mekong itself, a legendary, 2700-mile artery connecting six countries, many cultures and one of the most bio-diverse areas of the world. Its waters are a lifeblood for millions. As the climate changes, the Mekong, and the traditions and economic lives of millions are changing with it.

Tay doesn’t speak much as she drives her boat down a Mekong Delta tributary. But I want to know what she thinks about all of this. I think it’s her time, and time for all women, to tell the world what they think.

Learn more about A River Runs with Her project in this 1-minute video.

To follow the project, see www.ChristineMcNab.com, add http://www.christinemcnab.com/her-stories/ to your RSS feed, or follow along on Facebook.
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Christine McNab is a global public health worker and communications expert. Her TEDMED talk illuminates the story of how she combined her passions and partnered with the Gates Foundation to create what might be the most artistically crafted vaccine promotion campaign ever.

Promoting Health Equity by Choice

This guest blog post was written by Dr. Mary Travis Bassett, the Commissioner of the New York City Department of Health and Mental Hygiene. Dr. Bassett spoke at TEDMED 2015.

mary-bassettNew York City is one of the most diverse but racially segregated cities in the United States. Neighborhood segregation and structural racism, including poor housing conditions and limited educational opportunities, have led to unacceptable health disparities in our city. In turn, these health disparities have led to many lives – mainly the lives of poor New Yorkers and people of color – being cut short.

On average, New York City residents are expected to live longer than the average person in the United States. However, within the five boroughs, health outcomes can vary substantially from one subway stop to another. Average life expectancy rates can obscure those worrying variations between neighborhoods. In places like the South Bronx and Brownsville, Brooklyn, where I first lived when I was a little girl, people can expect to live lives about 8-10 years shorter than a person living in Manhattan’s Upper East Side or Murray Hill.

The usual explanation for these unhappy odds is that people in these neighborhoods are making a whole series of bad lifestyle choices. They eat too much, don’t exercise, smoke, drink, and so on. I’d like to challenge everyone to think differently.

Instead of thinking that people in Brownsville live shorter lives because they are choosing to eat unhealthy foods and choosing not to exercise enough, let’s think of how a lack of choice can impact a person’s health. For example, people don’t choose to live in a neighborhood where it’s unsafe to walk or exercise outside at night. People don’t choose to rent an apartment in a community that does not have a grocery store nearby. No one chooses to take a job that pays a wage impossible to live on, let alone live healthy on. The problem is not lifestyle choices that are bad for one’s health, but having too few choices that negatively affect a person’s health.

When we think about health, we have to think about restoring choices. For people to live healthier, they need good housing, a more livable wage, a good education, and safe spaces to exercise. All of these help build a neighborhood where people look out for each other. To achieve health equity, we have to confront all of the factors that affect a person’s ability to live a healthy life. That’s why as health commissioner, I will use every opportunity to speak out against injustice and rally support for health equity.

Our new initiative, Take Care New York 2020, seeks to do just that. It is the City’s blueprint for giving everyone the chance to live a healthier life. Its goal is twofold — to improve every community’s health, and to make greater strides in groups with the worst health outcomes, so that our city becomes a more equitable place for everyone. TCNY 2020 looks at traditional health factors as well as social factors, like how many people in a community graduated from high school or go to jail.

Additionally, the City’s investment in Pre-K for All will go a long way toward addressing the inequalities we’ve seen emerge so early in life, which reverberate across the lifespan. Investing in early childhood development is an anti-poverty measure, an anti-crime measure, and it is good for both mental and physical health. For example, the number of words a child knows at age 3 predicts how well he will do on reading tests in third grade, predicts his likelihood of graduating from high school, and so on. Early investment is key to undoing decades of injustice.

I believe that achieving health equity is a shared responsibility, and we can only accomplish real change by working together. This is a big challenge, but I am hopeful. New Yorkers are fortunate to have a Mayor and an administration that is committed to addressing longstanding inequality. Every city needs such committed leadership if we are to see a day where someone’s ZIP code does not determine their health. I hope you will join us on this pursuit of equity.