The active ingredients of placebo effects: Q&A with Ted Kaptchuk

Ted Kaptchuk, Professor of Medicine at Harvard Medical School, directs the Program in Placebo Studies, Healing and Therapeutic Encounter. In his TEDMED talk, he upended many assumptions about what really works in the therapeutic encounter, and what doesn’t, as revealed in placebo research. We caught up with Ted to learn more.

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What motivated you to speak at TEDMED?

My research has implication for the general public.  I want to disseminate the results of my scientific inquiries and encourage patients and the public to demand that health care acknowledge them and their implications for the therapeutic encounter.

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

Health care has become increasingly expensive and dehumanized.  Placebo effects are relatively inexpensive and add humanity (engagement, words and honesty) back into the mix.   I hope my talk will educate the public and encourage people to expect and demand a health care that acknowledges the importance of the human element.  I also hope that health care providers– nurses, physicians, allied health care clinicians, complementary medical practitioners, etc– see that their role as more than using effective interventions, but also a participant involved in a process. Placebo effects tell us, especially for chronic diseases, what the health care provider does actually matters. Symptoms are relieved and the course of illness changes…depending on this interaction. In situations where there are already good drugs and treatments, these interventions become more effective. In situations where there are no good treatments available, the health care provider, by their interactions, can make things better. The placebo effect is about releasing and harnessing powers inherent in the clinical encounter in order to expand what healing is about. Placebo effects are always present. The study of placebo effects encourages patients to expect improvement and encourage clinicians to know that they can always make a difference with engagement, words and honesty. These ideas are too important to disregard. The time is now.

What were your top 3 TEDMED 2014 talks?

Betsy Nabel from the Brigham and Women’s Hospital for discussing humility. Carl Hart for being an inspiration about how to face challenges. Emery Brown for expanding what we know about consciousness.

What kind of meaningful or surprising connections did you make at TEDMED?

I had several discussions with speakers and participants that I am pursuing in relationship to collaborations and dissemination of research. I’ve invited several people to speak at Harvard and have been invited to speak at various institutions.

What is the legacy you want to leave?

I hope that others scientists will see the possibility of pursuing careers investigating the context of healing and its neurobiological underpinning. I hope practitioners will get smarter about what is going on in the therapeutic encounter. I hope patients will set a higher bar in what to expect in health care.

Any advice you have for the TEDMED community?

Demand better health care. Don’t tolerate a clinician with whom you don’t feel bonded (unless it is something like he/she is the only surgeon who can do a particular surgery.) A clinician should make you feel good about visiting them. Don’t accept less.

Global surrogacy: When making babies is no fun. Op-ed by Leslie Morgan Steiner

The content, views and opinions expressed in this blog post are those of the author(s) and do not imply endorsement by TEDMED. By inviting guest bloggers, TEDMED hopes to share a variety of perspectives that provoke and engage our community in discussion and debate.


Leslie Morgan Steiner at TEDMED 2014

Leslie Morgan Steiner at TEDMED 2014: The inconceivable costs of baby-making

As a mother and writer on women’s issues, I believe nothing is more intimate an issue for every woman—actually, every human being—than the desire to have a child.

Now, my children were all conceived and born naturally. They enjoy full robust health. But I discovered that infertility—the myriad variations of disease and biological abnormality that cause specific men and women to be unable to create children together—strikes randomly. Anyone can be infertile. Infertility is surprisingly common; the inability to have children afflicts 10-12% of the human population.

There is no surefire way to prove you are fertile in advance, for example you cannot use a blood test to screen newborns or teenagers for the inability to have children as one might for hemophilia or celiac disease. Part of infertility’s cruelty is the surprise of its assault. You rarely learn you are infertile until you try, and fail, to have a baby.

When I found all of this out, I wondered: what would I have done if I were infertile?

That was when I stumbled upon the seemingly strange new solution of surrogacy—paying another woman to carry a baby for you. Surrogacy has actually always been a solution to the age-old problem of infertility. In fact, surrogacy (via concubine) is mentioned over 20 times in the Old Testament.

Today, the global medical community, funded by generations of desperate infertile women, has figured out exciting—and disturbing—new ways to create babies no matter the obstacles. The medical term is Gestational Surrogacy (GS). A new-and-improved version of an ancient solution to childlessness.

Today, thanks to in vitro fertilization (IVF) and other advances in assisted reproductive technology, babies can be created with sperm from one source, an egg from another, and a uterus from yet another. In England today, women who are carriers of rare mitochondrial disease can actually use their DNA in a healthy donor egg cell to bypass the defective mitochondria, thereby creating an IVF scenario with three biological sources. Surrogates today are not biologically or genetically connected to the babies they gestate. This simplifies many ethical, legal, and parenting issues.

And creates new ones.

Modern surrogacy is transforming humans’ centuries-old definition of motherhood.

Today a newborn can have two mothers or two fathers, or no mother, or no father. A baby can actually have zero legal parents, as in a few isolated cases where a gestational surrogate carried a baby created with donor egg and sperm, and a clinic mix-up blocked authorities from tracking down and proving any legal parent.

Today anyone—a 25-year-old with uterine fibroids, a 40-year-old woman with a cancerous uterus, two married gay men, a nun—can have a baby, their biological baby, via surrogate.

As long as they can afford it, because surrogacy in the U.S. can cost $100,000 or more.

Gestational surrogacy has become better known in recent years due to international celebrities such as musician Elton John, comedian Jimmy Fallon, and actresses Nicole Kidman, Elizabeth Banks and Sarah Jessica Parker who have all had babies via U.S. gestational surrogates.

But the rise of GS is important for normal people too.

Like Gerry and Rhonda Wile, a nurse and firefighter from Arizona, who shared their story with me for my book The Baby Chase.

Gerry and Rhonda met and married in their late 20s. Gerry was already a father, but he’d had a vasectomy, which he didn’t tell Rhonda about for six years (but that’s another story).

As for Rhonda, for her entire life she had an extremely rare, undiagnosed medical condition that allowed her to get pregnant easily—and she did—but the same condition caused her to miscarry 100% of these pregnancies.

Prior to 20th century medical technology, Rhonda would have gotten pregnant and miscarried dozens of times throughout her reproductive years—as often as 3-4 times a year—for decades, without ever understanding what was wrong with her biologically. For too many centuries, infertility was a lifelong, mystifying curse. A perennial loss that often left sufferers, women in particular, feeling rejected by their husbands, families, communities, and even by God.

So what did the Wiles do?

What would you do?

Today there are several options for the world’s infertile. Treatment, adoption, accepting that you will live your life without children. But for the Wiles, there was only one solution. Surrogacy meant the Wiles could create the family they dreamed of using Gerry’s sperm, Rhonda’s eggs (or what turned out to be eggs from a donor), and an unrelated gestational carrier.

Gestational surrogacy is an exciting, awe-inspiring new medical innovation that makes it possible for infertile couples like Gerry and Rhonda, and millions of other people, to have babies and become parents.

Leslie and the Wiles family

Leslie and the Wiles family

Surrogacy today heralds the end of infertility, the death of an affliction that has plagued humans since the beginning of time. However, surrogacy in the United States is financially out of reach to most people. This is why some people, like Gerry and Rhonda Wile, travel to other countries to find affordable, legal surrogates to create their babies.

The final surprise about surrogacy is that it’s personal. It’s human. It’s about you and me and the people we love.

What if you had to travel 8,000 miles to have your baby—and risk not being able to bring her back with you?

Or had to choose between being openly gay and having your own biological offspring?

Or your health insurance said you were too old, or too religious, or not religious enough to qualify for infertility reimbursement?

Or your God said no, you can’t treat your disease…you must live your life without the children you’ve dreamt of having since you were a child yourself.

Imagine the betrayal you would feel if your country, your political leaders, your neighbors, your God, refused you a baby, merely because the treatment for your disease made people uncomfortable.

Would this make you want—or deserve—a baby any less?

In her TEDMED 2014 talk, Leslie Morgan Steiner, journalist and bestselling author, brought the audience along on her journey to learn the truth about a successful gestational surrogacy industry on the far side of the world–and how it could provide a model to help solve several social problems in the US.

 

Stop bypassing the dangers of anorexia – Q&A with Cathy Ladman

“My job is to understand and accept myself, my imperfect self.” - Cathy Ladman, TEDMED 2014 [Photo by Brett Hartman]

“My job is to understand and accept myself, my imperfect self.” – Cathy Ladman, TEDMED 2014 [Photo by Brett Hartman]

 

At TEDMED 2014, Cathy Ladman – a comedian famous for poking fun at her personal neuroses – shared the internal dialogue of someone struggling to cope and understand her eating disorder. Her talk, funny in the “I don’t know if I should be laughing” kind of way, focused on anorexia, which has the highest death rate of any mental illness. We got in touch with Cathy to learn more about her talk and experience at TEDMED.

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

I have thought, for a very long time, that there has to be a real, honest wake-up call in our society regarding the obsession with being thin. There are people dying from anorexia, and our society turns away from these facts because they are inconvenient. These facts get in the way of the, most often, ridiculous female body standard, and that’s what sells magazines, movies, TV shows, etc. I hope that people will see how grave this is, and how we have the power to stop perpetuating it.

After watching this talk, what actions do you want your viewers to take?

Be honest with yourself and others. Find your self-worth in things other than your body and your looks. Speak out when you see TV shows, films or any public media glorifying skinny.

Which TEDMED 2014 talks or performances left the biggest impression on you? Why?

Sigrid Fry-Revere’s “What can Iran teach us about the kidney shortage?” – I never knew of the donor system that exists in Iran. This talk was fascinating, and made a lot of sense to me. I was partly surprised by my response. I would have guessed that I would not be on the side of selling organs, but I see that, handled this way, it’s a sound idea.

Rosie King’s “How autism freed me to be myself”- Rosie was terrific, vibrant, hopeful, brave, completely real, and spoke with no artifice. I loved her!

Abraham Verghese’s “A linguistic prescription for ailing communication”  - Abraham is a gentle, intelligent man, whose love of words echoes my own. The more we know language, the more we create language, the better we can communicate with each other and, hence, understand each other.

Carl Hart’s “Let quit abusing drug users” – This was such a terrific presentation of a perspective that I hadn’t known before, and makes complete sense. His theories could help to change the cycle of drug addiction and poverty.

Acrobaticalist Ninja Theater – Q&A with NANDA

NANDA is a high-energy troupe of comic actors who delight in calculated chaos, kung-faux fighting, and irreverent pop-culture parodies. Their TEDMED 2014 performance literally turned everything upside down (including themselves!) with a mishmash of traditional theater, vaudeville, and circus – all while utilizing dance, juggling and acrobatics. NANDA’s contribution to TEDMED went beyond their performance, as they also led TEDMED speakers through relaxation and voice exercises before their sessions.

NANDA’s performers are Misha Fradin, Chen Pollina, Kiyota Sage, and Tomoki Sage. We got in touch with them to learn more about their time at TEDMED.

Turning it upside down at TEDMED. [Jerod Harris]

Turning it upside down at TEDMED. [Jerod Harris]

 

What motivated NANDA to perform at TEDMED?

We were motivated to connect, share and learn with and from the TEDMED community.  Plus, its always fun to visit San Francisco!

What impact do you want your performance to have?

We hope our performance inspires people to enjoy life to the fullest!

Which TEDMED 2014 talks or performances left the biggest impression on you?

Jeffrey Iliff’s “One more reason to get a good night’s sleep” – Jeffrey inspired me to understand my sleep behavior more, allowing me a better understanding of my self and body. As an acrobat and juggler, my physical and mental health are both very important to me (Misha Fradin).

Kitra Cahana’s “My father, locked in his body but soaring free” – Kitra’s talk was emotional and powerful, there were multiple times I found myself on the edge of my seat as the story was beautifully woven. It inspired my own healing process and compassion around traumatic experiences from my own life (Misha Fradin).

Amy McGuire’s “There is no genome for the human spirit” – Amy’s genetic research made me think about the human race and how we’ll be battling our health problems in the future. I am a huge fan of genome sequencing as I have had family members that may still be alive if there had been affordable tech to do this. The fact that this is becoming a reality is phenomenal, and will drastically change the direction of all medicine (Misha Fradin).

What is the legacy NANDA wants to leave?

We share a vision of living in a global community that values and demonstrates support, imagination, and intercultural collaboration. It is our mission to be an instrument in the success of this vision.

What’s next for the group?

The next step for NANDA is to have as much fun in life as is humanly possible.

Apart from Desire – Q&A with Heather Raffo

Actor, playwright, and librettist Heather Raffo performed a powerful excerpt from her one-woman show, 9 Parts of Desire. We reached out to learn more about her inspirations, aspirations and ambition.

Heather Raffo performs on the TEDMED stage. [Sandy Huffaker]

Heather Raffo performs on the TEDMED stage. [Sandy Huffaker]

 

What motivated you to perform at TEDMED?

As an artist with Iraqi and American heritage, I most wanted to launch a conversation about how we recover from war: how we survive as individuals, families, cultures and countries.

My work grapples with an ever shifting identity of what it means to be Iraqi or American and how trauma changes one’s sense of self.   I was thrilled to have an opportunity to talk and learn from such diverse and profound thinkers and health care professionals about how they relate trauma and loss to survival and healing.

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

A few months ago I had a revelatory conversation with a US Military General. He reminded me that the effects of the wars in Afghanistan and Iraq have only begun to surface for our veterans. For Iraqis, the civilian population has experienced multiple traumas over multiple decades, the sense of belonging that once held that society together is shifting rapidly as it is throughout the Middle East.

The work I do tackles some of the most difficult conversations our nation has yet to have.   It also tackles taboos rarely addressed in Middle Eastern society.  It broadens the lens through which many view the Iraq war, and helps offer a complex understanding of those affected by violence.

What kind of meaningful or surprising connections did you make at TEDMED?  

I connected with so many extraordinary individuals at TEDMED.   But perhaps most moving, were the conversations I had with war veterans who sought me out after my performances. They were thankful that hard truths were used to break open subjects they feel have not been discussed openly. TEDMED was a unique environment to have those difficult conversations about devastating human experiences and the universal will to live.

What is the legacy you want to leave?

I’ve spent the last decades of my life devoted to bridging my Eastern and Western cultures – bringing the worst of war into a sacred artistic experience. The legacy I am working to bring about is a movement that uplifts the feminine experience, that addresses our relationship to violence and that integrates the Middle Eastern voice into the American theatrical canon.

What’s next for you?

I’m working on an adaptation of Ibsen’s A Doll’s House set in a Arab American family.  What is particularly thrilling about this work is that my writing is being done from an embedded position within Middle Eastern American communities.  The first mounted workshop will be at Georgetown’s Davis Performing Arts Center in December 2015.

I’m launching my Places of Pilgrimage monologue series on the web.  Middle Eastern women telling their stories in their own words! It is based on a writing workshop I developed for universities and community centers both in America and internationally.

My opera Fallujah, inspired by the life of US Marine Christian Ellis, will have its world premiere at Long Beach Opera in January of 2016. The opera is composed by Tobin Stokes.

Once these three projects are up and running, links will be available on my website heatherraffo.com.

A new vision for the future of telemedicine: Q&A with Elliot Swart

In his TEDMED talk, Elliot Swart directed our focus to telemedicine and its potential to not only replace but improve upon current diagnostic procedures.  We reached out to learn more about how he is shaping the future of telemedicine.

Elliot Swart takes the TEDMED stage. [Kevosk Djansezian]

Elliot Swart takes the TEDMED stage. [Kevosk Djansezian]

 

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

One piece of advice I took to heart is set out to solve a problem that you truly understand. And even once you have a problem, don’t quit your day job until you have a real idea of how to solve it and why your solution is different. The most unhappy entrepreneurs I know are the ones who decided to be entrepreneurs before they had a problem to solve.

Now, I’m not suggesting you should wait around until lightning strikes. My favorite TED talk of all time is “How to start a movement” by Derek Silvers.  The gift I took away from that talk is that it takes a lot of people to truly accomplish something, and that being the second, third, or even tenth person to join is as important of a role as the person who starts it. There are hundreds of amazing startups and early stage companies solving meaningful problems. Go out and find one!

What has been your main source of inspiration that drives you to innovate?

My company, 3Derm, makes a teledermatology solution to help get melanoma patients seen sooner. In my work I’ve come across a number of people who will tell me about their friends or family who have died from skin cancer. I like cool technology as much as the next guy, but what really drives me is the number of lives we’ll save if we succeed.

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

Telemedicine is still seen as the second best alternative – standard practice only if the patient is extremely remote or has no other options. But, slowly, we’ve seen people start to turn the corner and realize that telemedicine can be used to lower costs and increase convenience in almost any population. By developing telemedicine systems for different specialties, we are essentially distilling the diagnostic process into the necessary information, making medicine more quantitative and easier to standardize.

My company has spent four years creating a telemedicine sense for dermatology. There are many other specialties that will require years of university research and commercialization. I hope my talk can convince people of telemedicine’s potential as a standard of care and the importance of pursuing this research.

Now is the time to face the truth about drug use – Q&A with Carl Hart

In his TEDMED talk, Carl Hart offered a highly provocative but evidence based view of drug addiction and its links with crime. Carl speaks from personal experience; he grew up in a poor neighborhood in Miami, where he himself engaged in petty crime and drug use. Today, Carl is an Associate Professor of Psychiatry and Psychology at Columbia University, and a self-professed advocate for social justice and science.  

"I was unprepared for what I would learn as I went about making my contribution to the study of the neurobiology of addiction." - Carl Hart, TEDMED 2014 [Photo: Kevosk Djansezian]

“I was unprepared for what I would learn as I went about making my contribution to the study of the neurobiology of addiction.” – Carl Hart, TEDMED 2014 [Photo: Kevosk Djansezian]

 

We reached out to Carl to learn more about why his talk is particularly timely today. Here was his response:

Today – May 19 –  would have been Malcolm X’s 90th birthday, had he not been assassinated fifty years ago. Malcolm X’s influence on human rights, social justice activists, and me is increasingly apparent as society becomes more concerned about issues of over-policing in certain communities. My TEDMED talk, “Let’s quit abusing drug users,” is particularly important today because it illustrates the detrimental impact of aggressive selective drug law enforcement on communities of color.

In recent months, the issue of hostile, militarized policing has been pushed to the national forefront in response to the killing of the black, unarmed teenager, Michael Brown, by a white police officer in Ferguson, MO. Similar types of killings have occurred too often under the guise of the war on drugs. Eric Garner, Ramarley Graham, Kathryn Johnston, Trayvon Martin, and Tarika Wilson are just a few examples. In all of these cases, authorities suspected that the deceased individual was either intoxicated from or selling an illicit substance. This talk shows that dangers of drugs have been exaggerated, and that this has helped to created an environment where unjustified police killings are more likely to occur.

The importance of my talk is even further enhanced because too many people misattribute societal ills to drug problems. For example, the majority of people who use drugs – 80-90% – don’t have a drug problem. They are responsible members of our society. They are employed; they pay their taxes; they take care of their families; and in some cases, they even become President of the United States. Our three most recent Presidents all reported using illegal drugs when they were younger. In my talk, I clearly show that the real problems faced by society are not drugs but are poverty, unemployment, ignorance and the dismissal of science that surrounds drugs.

In my TEDMED talk, I also present intriguing results from my own research, during which we brought crack users into the laboratory and offered them $5 cash, or a hit of crack worth more than $5. We repeated this many times with each person over several days in the laboratory.  The drug users chose the drug about half of the time, and the $5 the other half. Even a nominal amount of money was enough to deter them from taking the drug at least half of the time. These findings are inconsistent with the notion that crack users display the insane, “anything for a hit” behavior that I had been previously taught. They also demonstrate how attractive alternatives, such as viable economic opportunities, can go a long way in decreasing societal problems, including drug abuse.

Watch Carl’s TEDMED 2014 talk, “Let’s quit abusing drug users,” here:

 

Op-ed: The primary nature of access to care, by Danielle Ofri

The content, views and opinions expressed in this blog post are those of the author(s) and do not imply endorsement by TEDMED. By inviting guest bloggers, TEDMED hopes to share a variety of perspectives that provoke and engage our community in discussion and debate.

Daniel Ofri speaks on the TEDMED stage. [Photo: Sandy Huffaker]

Daniel Ofri opens up about medical errors on the TEDMED stage. [Photo: Sandy Huffaker]

 

“Doctor, it’s taken so long to get this appointment with you.” This is the opening line of so many medical visits these days, and I find myself constantly apologizing to my patients for the delay. Even though both the patients and I know that it’s a systemic issue, it’s still front and center in our personal interaction. They are frustrated that they can’t get a timely appointment, and I’m aggravated because too many medical issues pile up in the interim, making the visits we do have massively overburdened.

The difficulty with access to medical care has been extensively highlighted at the VA hospital system, but is endemic to our entire medical system, even for patients with good insurance plans. Since the Affordable Care Act, some 10 million more Americans now have health insurance. This is an impressive achievement that should be celebrated, but of course insurance is only the first step in improving overall health. Now, these 10 million Americans must find doctors. A survey of 20,000 doctors from the nonprofit Physicians Foundation reports that fewer than a fifth of American doctors are able to take additional patients. More than 80% of doctors are over-extended or at capacity.

What does this mean for American medicine? One possibility is that the Affordable Care Act has placed us on an unsustainable path, something we hear frequently from those who oppose Obamacare. But this only holds water if the prior status quo—allowing a significant swath of America to remain outside the healthcare system—is considered acceptable. Luckily, we are slowly coming around to the ethical conclusion that the rest of the world has already made, that health care is something that all people deserve. Political realities may have forced awkward contortions in our health-care reform, accommodating multitudes of private insurance plans rather than offering a public option—concrete progress has nevertheless been made. So now the health care system must adapt. It can no longer survive on the expediencies of ignoring 15% of our population—it needs to start thinking about caring for all Americans.

A first step is considering how we allocate our existing clinical resources. The Physicians Foundation survey reported that doctors spend 20% of their time doing non-clinical paperwork. If you visualize that statistic carved out from the total number of doctors, it’s equivalent to about 170,000 doctors whose stethoscopes are sitting idle. This is a mind-boggling waste. To not be able to get an appointment with your doctor because she is spending a fifth of each day doing paperwork would sound ludicrous if it weren’t so dangerous. But patients and their serious medical conditions are getting short shrift as their doctors and nurses drown in metastasizing paperwork. Freeing up doctors’ time to see patients—a true measure of efficiency!—could make a real difference in the access problem. Amputating off even half the paperwork would be the equivalent of 85,000 new doctors available for patients.

A second step is to start planning ahead for healthcare that fits the needs of our patients, now that we are getting serious about taking care of all patients. For that, we need to delve a little more deeply into the access issue. Other countries have access issues also, but their long waiting lists relate primarily to specialties and procedures. What is uniquely American about our access problem is that it is particularly difficult to get primary care. Our inability to provide basic medical care for all Americans is what torpedoes the net efficacy of our medical system. Despite our superior technological advancements, we rank dead last in overall health outcomes compared with other developed countries. There is no secret about how to improve this—it’s tending to the basics. Research shows that the more primary care patients receive, the healthier they are and the longer they live. But the American system is not set up for this. Going forward, the only way to have a significant impact on our nation’s health is by improving access to primary care. Expanding training slots in family medicine, internal medicine, geriatrics, gynecology, and pediatrics is a necessary step, because the sheer growth of the American population means that we will need at least 20,000 more primary care doctors, if not more. But alongside increasing the pipeline of primary care doctors, we have to rethink the way we value and reimburse medical care.

It is an embarrassing truth that in the United States access to medical care relates to how lucrative that care is. It’s much faster and easier to get expensive tests and procedures than to take care of your general health. The fee-for-service system has consistently weighted procedure-based services (surgeries, endoscopies, MRIs) as having more “value” than cognitive-based services (treating diabetes, asthma, or heart failure). This absurd and patently profit-driven assessment means that we end up with more procedures and higher bills but poorer health and ultimately less access to basic medical care. Newer payment systems—bundled payments, pay-for-performance, accountable care—have the potential to jigger the balance somewhat. But our fundamental hierarchy remains completely backwards. Until we reverse this and make primary care, well, primary, getting an appointment with your general doctor in the United States will be the Achilles’ heel of medicine. Unless, of course, that heel needs a botox injection.

Danielle Ofri is an internist at Bellevue Hospital, an associate professor of medicine at NYU, and editor of The Bellevue Literary Review. Her most recent book is What Doctors Feel: How Emotions Affect the Practice of Medicine. In her TEDMED 2014 talk, she makes a powerful against-the-grain case that one of the things medical professionals are most resistant to doing would lead to dramatic improvements in care and undoubtedly save many lives. 

Making a living with biology – Q&A with Nina Tandon

At TEDMED 2014, Nina Tandon invited us into a world of bio-curiosity, urging us to explore the range of possibilities that come alive when we use biology as a tool to innovate.  We got in touch with her to learn more about what inspires her work, and what she hopes to achieve.

"Isn’t it exciting to think that the third industrial revolution could be about life?" - Nina Tandon, TEDMED 2014 [Photo: Jerod Harris]

“Isn’t it exciting to think that the third industrial revolution could be about life?” – Nina Tandon, TEDMED 2014 [Photo: Jerod Harris]

 

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

I hope they learn that life itself is an entrepreneurial journey – it’s not a mystery! I remember, back in 2008, people kept on asking me if I was worried about finding a job.  I told them “I’m not worried about finding a job. I’m worried about the job I’m going to create!”  If you think like an entrepreneur, you are never going to be out of work, because you’re always going to be creating.  We live in an age when we should always be looking for opportunities, rather than simply waiting for them to be handed to us.  Science is evolving.  There isn’t a lack of opportunity – it’s just that they now take a different form.  They can be public/private partnerships, or academic/industrial partnerships.  If you think entrepreneurially, you’ll create your own opportunities.

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

The body is a miracle that many of us take for granted – I am continually inspired by its magic! I think the thing about the body that I am most fascinated by is that it’s so robust.  That robustness is what makes it difficult to study; we’re so busy trying to figure out how to generate data, and we’re looking for linearities within a nonlinear system. Our bodies don’t just have one solution to a problem – there can be tens of them.  That’s why, when biology fails, it fails spectacularly.

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

I hope that people realize that there is huge potential to meet sustainability challenges by viewing biology as a technology partner. We need to take biology off its miraculous pedestal, and ask how it might be possible to utilize it in our work.  That’s a powerful question that so many people are beginning to ask, from the most unexpected fields.  I want people to realize that biology is breathing into their lives.  People should walk around thinking “I might not be a biologist, but I should be because my field is about to be disrupted by it.”

What is the legacy you want your work and/or your talk to leave?

I hope that people will be inspired to care for their own “biological houses” as well as to take action to learn more about science. My hope is that increased appreciation for nature will inspire a new generation of activists and bio-innovators.  I don’t want to leave my stamp on anybody.  I want people to discover their own legacy, their own beauty and potential. I hope people forget all about me – it should be about them, not me.

Check out Nina’s TEDMED 2014 talk, “Borrowing from Nature’s Living Library”:

Illuminating the importance of light design

This is a guest blog post by Mariana Figueiro, Light and Health Program Director at the Lighting Research Center (LRC) and Associate Professor at Rensselaer Polytechnic Institute. Her talk at TEDMED 2014 reveals, surprising facts about the effect of light – its presence, its absence, and its patterns – on human health.

Mariana Figueiro

“We are all swimming in a sea of light” – Mariana Figueiro at TEDMED 2014

All creatures, great and small, are governed by the natural 24-hour, light-dark cycle. Every cell and physiological system in plants and animals exhibits a circadian cycle. In the absence of a regular 24-hour light-dark cycle, a circadian cycle in humans runs with a period close to, but not exactly, 24 hours. Daily exposures to morning light, especially blue light, reset the timing of our biological clock and synchronize our circadian rhythms to the local sunrise and sunset. Disruption of these circadian rhythms resulting from exposure to irregular light-dark patterns or exposure to light at the wrong time of day can compromise health. For example, it has been shown in animal models that circadian disruption is linked to increased risk for diabetes, obesity, cardiovascular disease and even cancer.1-5  Therefore, receiving the right light at the right time can be the key to good sleep, good health and wellbeing. We are swimming in an ocean of light, but like fish that take water for granted, we generally pay little attention to our environmental light. Light is the conductor of our internal symphony, influencing when we sleep and wake, our cognitive abilities, how much we eat, and even how well our medicine works.6-8

Recognizing the impact of light on the individual and on a global scale, the United Nations has proclaimed 2015 as the International Year of Light, citing that light plays a vital role in our daily lives, has revolutionized medicine, and that light-based technologies promote sustainable development and provide solutions to global challenges in energy, education, agriculture and health.

Just last year, the Nobel Prize in Physics was presented to the inventors of the blue LED, Isamu Akasaki, Hiroshi Amano and Shuji Nakamura.

At the Lighting Research Center (LRC) at Rensselaer Polytechnic Institute, we focus on the myriad effects of light on human health at all ages. We are working on developing a lighting system that can be used with premature infant incubators in the NICU to provide cycled lighting, which has been shown to improve health outcomes in premature infants. We are also investigating effective ways to deliver light as a treatment to improve sleep, depression and agitation in Alzheimer patients.

Beyond the long-term health benefits of synchronizing our circadian rhythms to the local time on Earth, light has an acute effect, an alerting boost, like a cup of coffee, which can help give us the energy we need when we wake up in the morning and also help to fight the post-lunch dip. We are trying to figure out how red light impacts alertness and performance during the day and at night. This could benefit shift workers, because red light can increase alertness without affecting melatonin levels. The suppression of melatonin by light at night has been implicated in health problems such as breast cancer in these shift workers.

The newly constructed 24-hour lighting scheme demonstration room at LRC provides cycled electric lighting with cool, high light levels during the day and warm, low levels at night. Construction of the room was made possible through funding and donations from the Light & Health Alliance, led by Dr. Figueiro. Light & Health Alliance members are Acuity Brands, Ketra, OSRAM Sylvania, Philips Lighting, Sharp, and USAI Lighting.

The newly constructed 24-hour lighting scheme demonstration room at LRC provides cycled electric lighting with cool, high light levels during the day and warm, low levels at night. Construction of the room was made possible through funding and donations from the Light & Health Alliance, led by Dr. Figueiro. Light & Health Alliance members are Acuity Brands, Ketra, OSRAM Sylvania, Philips Lighting, Sharp, and USAI Lighting.

Aside from the special light needs of these select populations, there is every reason to believe that introducing a regular 24-hour pattern of light and dark by modifying the amount of electric lighting we are exposed to daily, could improve the health and productivity of everyone. We are currently looking at the impact of artificial light and natural daylight on the health and wellbeing of federal employees working in buildings owned and leased by the U.S. General Services Administration. To further study this question in the home environment, we are also developing a lighting system that could be incorporated into the design of Swedish homes. The availability of daylight in Sweden during winter months is very limited, and so we are designing a “healthy home” using lighting principles that will promote health and wellbeing not only in Swedish homes, but in other places where daylight availability is limited. The system will provide cycled electric lighting with cool, high light levels during the day and warm, low levels at night. This type of cycled lighting is ideal for circadian health, encouraging restful sleep at night and increased alertness and performance during the day – not to mention many other general health benefits, such as improved mood and reduced risk of diabetes, obesity, cardiovascular disease and cancer.1-5, 9 DSC03686

An important component of the healthy home concept is the “Daysimeter” – a personal circadian light measurement device. The Daysimeter measures how much circadian light an individual receives over a 24-hour period, and then via smartphone it automatically adjusts lighting in the home and office to provide the ideal type of light needed to support health and wellbeing.

Imagine wearing this small, unobtrusive device, that would measure a dark, snowy day in January with little or no circadian-effective light, and then adjust the lighting in the morning to provide cool, high light levels to entrain you to the 24-hour solar day and give you an alerting boost of energy. In the afternoon, light levels would be adjusted based on how much light was received during the day, as measured by the Daysimeter. In the evening, the lighting would automatically adjust to provide warm, low levels of soothing light to ensure restful sleep. Thanks to advances in LED technology, the healthy home of the future could realistically happen in the next decade. We have developed the 24-hour lighting scheme and Daysimeter and have completed extensive testing in the lab and in the field, and are now working to study the real-world effects of this lighting scheme with people living their normal, daily lives. Today, many people think of light as just part of a building. In the future, we believe light will become more personalized, customizable, and tailored to the needs of each individual. Perhaps 2015 is the year that we will see the world in a new light.

References 1. Leproult R, Holmback U and Van Cauter E. Circadian misalignment augments markers of insulin resistance and inflammation, independently of sleep loss. Diabetes. 2014; 63: 1860-9. 2. Ye HH, Jeong JU, Jeon MJ and Sakong J. The association between shift work and the metabolic syndrome in female workers. Annals of Occupational and Environmental Medicine. 2013; 25: 33. 3. Young ME and Bray MS. Potential role for peripheral circadian clock dyssynchrony in the pathogenesis of cardiovascular dysfunction. Sleep Medicine. 2007; 8: 656-67. 4. Maemura K, Takeda N and Nagai R. Circadian rhythms in the CNS and peripheral clock disorders: role of the biological clock in cardiovascular diseases. Journal of Pharmacological Sciences. 2007; 103: 134-8. 5. Schernhammer ES, Laden F, Speizer FE, et al. Rotating night shifts and risk of breast cancer in women participating in the Nurses’ Health Study. Journal of the National Cancer Institute. 2001; 93: 1563-8. 6. Hrushesky W. Circadian timing of cancer chemotherapy. Science. 1985; 228: 73-5. 7. Hrushesky W, Wood P, Levi F, et al. A recent illustration of some essentials of circadian chronotherapy study design. Journal of Clinical Oncology. 2004; 22: 2971-2. 8. Zhang R, Lahens NF, Ballance HI, Hughes ME and Hogenesch JB. A circadian gene expression atlas in mammals: Implications for biology and medicine. Proceedings of the National Academy of Sciences. 2014; 111: 16219-24. 9. Figueiro MG, Plitnick B, Lok A, et al. Tailored lighting intervention improves measures of sleep, depression and agitation in persons with Alzheimer’s disease and related dementia living in long-term care facilities. Clinical Interventions in Aging. 2014; 9: 1527-37.


Watch Mariana’s talk from TEDMED 2014