Can we talk about needle pain? Q&A with Amy Baxter

We often ask why parents refuse to vaccinate their children, but there is an important aspect of vaccinations that we rarely openly discuss: needle fear. During TEDMED 2014’s “Don’t You Dare Talk About This” session, entrepreneur and pediatrician Amy Baxter challenged us to change the way we think about needle phobia – an issue that, she says, has important public health implications. We reached out to her with a few questions.

Photo by Bret Hartman, TEDMED 2014.

Amy Baxter on the TEDMED stage. [Bret Hartman, TEDMED 2014]


Why does your talk matter now?

Because vaccines save so many lives, we in healthcare are reluctant to allow any dialogue about whether the number or way we give shots could be damaging. Yet, people feel uncomfortable with the number of injections kids get. The natural unease at watching painful jabs, over and over, is at work when well-meaning parents pick and choose, or refuse vaccination altogether. The lack of communication about the best way to deliver vaccines causes mistrust, and contributes to families feeling that their main source of health information – their family doctor – might not be right about insisting on vaccines. The erosion of doctor/patient trust, and refusal to get vaccinated, will ultimately hurt us all.

By showing the long-term health consequences of too many painful injections at once, my talk presents evidence that we need to have fewer, or less painful, shots. I want people to learn that children’s fear of needles is a natural cause and effect, and is not indicative of a personal weakness. When the next pandemic requires universal vaccination, what happens if and when the 63% of now needle-phobic children refuse?

What do you want your legacy to be?

I want to inspire others who recognize a problem and, no matter what it is, to act. I am proud that I noticed the problem of needle pain; in medicine, we’re trained to ignore pain, or treat it as a necessary evil. Once I realized needle pain does not build character, and can impact children for a lifetime, I used every means I had to conquer the problem.

Once we recognize that our indifference to needle pain can affect compliance, we can change how we vaccinate. If I can help people realize that their shame of needle fear is not a personal failing, more people can receive health care without dread. If nothing else, I hope a doctor will watch this talk and be compassionate and accommodating when a parent says “You know, can we split these shots up into two different visits?”

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

Before devoting a decade of your life to a dream, try the idea out on people who don’t love you. Ask them: Is this something they would buy? Is this what the world has been waiting for? If you had money, would you invest in this idea?

Businesses succeed because someone has a passion and can communicate it to the otherwise indifferent. When you do have a great idea, stick to it and never, ever give up. But before you sacrifice all social currency, work insane hours, and give up time with loved ones (time that you’ll never get back), make sure the idea is worth it.

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

Robert A. Heinlein was a science fiction author who dreamed up worlds that were socially and technologically different from what surrounded him. He invented the water bed, electronically manipulated Waldoes, and inspired Peter Diamandis and Elon Musk (both of whom have been awarded Heinlein Prizes for promoting commercial space flight). While trying to make a buck with his fiction, he also remained true to principles of unwavering integrity, steadfastness, loyalty, and creative self-reliance. Because he changed the world, I have the courage to try to do the same.

Letting bio-inspired solutions evolve: Q&A with Jeff Karp

Jeff Karp, bioengineer and Associate Professor at the Brigham and Women’s Hospital, Harvard Medical School, illuminates the art and science of adapting medical tools, treatments, and technologies from solutions found in nature. We interviewed Jeff to learn more about his views on innovation and bio-inspired work.

“Successful problem definition must precede a successful problem solution.” Jeff Karp at TEDMED 2014.

“Successful problem definition must precede a successful problem solution.” Jeff Karp at TEDMED 2014.

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

Solving medical problems is very challenging; we often encounter barriers that seem insurmountable. Instead of relying on our limited intellect and narrow thinking, there is opportunity for us to turn to nature for inspiration. Every living thing has overcome an enormous number of challenges; in essence, we are surrounded by solutions. My hope is that this talk will help others, through inspiration from nature, overcome challenges they face.

What is the legacy you want to leave?

Innovation is not simply coming up with new ideas. I believe that being innovative means actually doing things that help people. Thus, innovation can only be retrospectively defined. My hope is that when I look back on my career, I can claim that many of the projects that we pursued were innovative.

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

There are many projects we are working on that I would love to have shared, such as our new battery coating to prevent injury from accidental ingestion of coin cell batteries by kids. There are 3,000-4,000 accidental ingestions of coin cell batteries each year, mostly in young children, and many result in major injuries including death. We also have a drug delivery system that delivers drugs on demand, which we have shown can be used to prevent transplant rejection, achieve longterm sustained delivery for treatment of inflammatory arthritis, and reduce toxicity and dosing requirements for treatment of inflammatory bowel disease. Additionally we have a technology to administer cells via intravenous infusion and target them in the bloodstream to diseased or damaged tissues — a type of stem cell based GPS system. When I talk about the baby tape innovation, it’s worth pointing out that the nurses and doctors in the neonate units emphasized that it’s okay to leave the glue entirely on the skin, as we can easily detackify it by addition of baby power (so it will not stick to bedding). We also found that by adding baby powder to the remaining glue on the skin, we can place another adhesive directly on top with the same level of adhesion. In addition to the video that I showed where we can seal holes in the heart with our slug inspired glue, we have also shown that the glue can affix a patch inside a beating heart, directly to the septum that separates the chambers of the heart where septal defects are located. We have launched a startup based on this technology, Gecko BioMedical; we hope to have our first products in use soon.

Why You Should Care about the Hidden Threats of Toxic Stress – Q&A with Nadine Burke Harris

In her TEDMED 2014 talk, Nadine Burke Harris revealed a little-understood, yet universal factor in childhood that can profoundly impact adult-onset disease. Eager to learn more, TEDMED reached out to gain further insight into her talk topic.

Photo by Kevork Djansezian, TEDMED 2014.

Photo by Kevork Djansezian, TEDMED 2014.

What motivated you to speak at TEDMED?

I was seeing the health impacts of Adverse Childhood Experiences and toxic stress in my clinic every day, and yet it felt like so few people knew about them. As a doctor, I wanted to sound the alarm about this health crisis. This is something every parent, grandparent, teacher and caregiver should know about.

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

We are spending more and more money on healthcare without getting to the root of some of our biggest health problems. I believe that routine screening and treatment for Adverse Childhood Experiences and toxic stress will lead to better health and quality of life for millions of Americans, not to mention reducing our healthcare costs. I hope to wake people up to this public health crisis and motivate everyone to become part of the solution.

Is there anything you wish you could have included in your talk?

We just analyzed the data on Adverse Childhood Experiences for the state of California. Over 60% of California’s population has had at least one experience, and 16.7% have had four or more. Individuals with four or more experiences are at double the lifetime risk of asthma, and over four times the risk of Alzheimer’s disease.

When we think about early adversity, we tend to think of low income communities of color. Our data in California shows that this is a big issue for every neighborhood and every income level. Every doctor should be screening for this.

What is the legacy you want to leave?

Currently, my team and I are working to develop a clinical protocol to effectively treat toxic stress. If we are successful, and I believe that we will be, that will be my legacy.

What’s next for you?

The Center for Youth Wellness is a young organization with a really ambitious agenda. Our goal is to transform the standard of pediatric practice to recognize and treat toxic stress. We have a lot of work to do before the effects of Adverse Childhood Experiences and toxic stress are common knowledge, like lead poisoning or second-hand smoke. Right now, our focus is on developing an effective clinical treatment protocol.

A Surgeon’s Touch: Q&A with Carla Pugh

Carla Pugh spent her childhood tinkering with appliances and electrical outlets. Quite fittingly, she spoke in TEDMED 2014’s “Play Is Not a Waste of Time” session. Now a surgeon and the Clinical Director of University of Wisconsin’s Health Clinical Simulation Program, Carla shared why haptic skills training matters so much in medicine. Eager to learn more about what she sees for the future of medical education, we reached out to her for a Q&A session.

Carla on the TEDMED 2014 stage. [Photo credit: Jerod Harris, TEDMED].

Carla on the TEDMED 2014 stage. [Photo credit: Jerod Harris, TEDMED].


What impact do you hope your talk will have?

I want to spark a serious conversation about need for elite, high-end, mastery training in the healthcare profession. Healthcare is at a critical juncture where there are huge opportunities for major information exchanges that can empower physicians and patients. Both patients and physicians will benefit from clinical skills performance data. For example, what if we all knew which haptic techniques place physicians at risk of conducting poor clinical examinations?

Outside the measurement of haptic skills, are there other gaps that you believe exist in medical education?

I think the future of medical education is about the global improvement of all skills. The soft skills – like interpersonal communications, and the promotion of tolerance – are definitely the most difficult to achieve. As educators, I think there are gaps in knowing how to be the best teachers we can be, and understanding the limitations of observational learning. When my students walk away from watching a video, I have no idea who’s learned what and who hasn’t. Traditional learning hasn’t fully recognized that, and still hasn’t made strategic efforts to change. Watching videos is helpful because it does give students a certain level of instruction, but at some point it’s important to have that team conversation where you face your colleagues. Also, if you are doing a procedure, at some point you have to pick up an instrument and use it. Videos and observation can only get you so far. Applied learning doesn’t take place until action happens.

Could you paint us a picture of your dream patient simulation lab?

Integration is key. Our whole education system isn’t where it could be; I still dream of something that’s full service. The dream simulation lab would have a central facility, where people come to train and discuss a wide variety of clinical skills. It wouldn’t only be about haptics – it would include communication across professions, and improving patients’ communication with their healthcare providers. Beyond that, it would also be a place where patients could come to learn important techniques – like how to give themselves a shot, take care of a wound, or think of creative ways to remember to take their medication. We would educate using broad, hands-on heuristic techniques.

Standard measurement of a physician’s skill is through the board exam. If you were designing the board exam for surgeons, using all of your haptic technology, what would it be like?

The way that the board exam is administered is highly centralized – we have to go to a board designated location to get tested. Ideally, there would be maintenance of professional certifications, where doctors are given relevant lifelong learning opportunities that are ongoing and well integrated into their daily clinical practice. This is something that the board is working on.

I would like to see decentralized opportunities where doctors are able to practice clinically relevant scenarios.   As doctors, we need to maximize our use of local social capital. For example, I have a few experts working down the hall from me, but I don’t have access to their knowledge, their haptic and communication skills for example. We need more information sharing, and the opportunity for shared practice. I want to compare their performance to my performance, and the ability to choose a training paradigm that directly matches the mastery level that I want to achieve. It’s about mastery, not skills – when we talk about skills, we tend to think of them in terms of “you either have them or you don’t.” Mastery is about constantly improving and working towards better performance. That’s what we should focus on.

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

Make sure to read my research article about using sensor technology to assess clinical skills, which will be published in the New England Journal of Medicine on February 19!

Breastfeeding–what’s in it for mom? Q&A with E. Bimla Schwarz

E. Bimla Schwarz, a women’s health expert and scholar of evidence-based data, sheds new light on breastfeeding’s preventative effects on heart disease and other maladies. While the positive effects of breastfeeding are often noted for infant health, physicians have virtually ignored benefits for the mother. We discussed with Bimla the meaning and impact of her powerful talk.

Breastfeeding advocate and women's health expert E. Bimla Schwarz on the TEDMED 2014 stage.

“On average the waists of moms who don’t breastfeed are six and a half centimeters larger than those who do.” E. Bimla Schwarz at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED]

What motivated you to speak at TEDMED?
I was intrigued by the diversity of TEDMED’s audience. Addressing heart disease in our community and making it easier for moms to breastfeed for as long they want to is going to require lots of new partnerships and creative collaborations.

Why does this talk matter now?
As we become more aware of the lifelong effects of infant feeding practices on maternal and infant health, it becomes imperative to do whatever we can do to make it easier for the moms in our community to recover from pregnancy as nature intended.

What impact do you hope the talk will have?
I hope this talk will inspire more obstetricians and maternity facilities to ensure that the women they care for get the support they need to learn how to breastfeed, and that new moms who are facing the multiple challenges that mothers still commonly face, find the resolve to give breastfeeding a try…and stick with it for a few months.

Is there anything else you really wish you could have included in your talk?
I wish I had woven in the fact that breastfeeding protects moms from breast and ovarian cancer. (See Bimla’s TEDMED page for more resources).

Check out our archived live Facebook Q&A where we’ll dive deeper into these issues with Bimla. 

A conversation with Thomas Goetz: When it comes to healthcare data, it’s all how you look at it

Thomas Goetz is co-founder of IODINE, a new company that uses data information design to inform patient decisions.  He’s been a TEDMED speaker, executive editor of Wired, and wrote “The Decision Tree,” about using technology to help make health decisions.

You’re now Entrepreneur-in-Residence for the Robert Wood Johnson Foundation, working on two projects to improve the patient experience. Can you first talk about Visualizing Health?

We’ve created a library of validated health visualizations. When people talk about communicating health information to individuals, there’s a dearth of validated examples of what the information should look like.  For example, if you’re trying to communicate heart risk information – if you quit smoking, your risk will of cancer will go down from 50% to 30%  — what does that look like in actual practice?

Thomas Goetz

Thomas Goetz

There are the Edward Tufte’s of the world who have an expert [design] sense.  But we wanted to actually validate, though statistical surveys and other testing instruments, what works best for different groups.  We tested pie, bar and spread charts and different visualizations on various audiences and now have a library. We’ll be putting it online, hopefully by early February, for people to use as a reference point under a creative commons license.  Our hope is that these will become templates that people can inspire and adopt in their own patient communications efforts, whether they are commercial or non-profit.


It seems that over the course of human history we’ve been all too willing to give over responsibility for our health, letting the apothecary leach blood or trusting that the medicine man’s dance will cure us. What accounts for this new era of patient engagement?

In many ways it’s a continuum from the 1950s or ‘60s.  We’re now in a place where we can implement things more deliberately. One of my favorite surveys to reference is a 1961 survey that asked oncologists how many of them would tell their patients that they had cancer. And 90 percent of said they would not disclose the diagnosis; that their patients were probably not ready to know. Of course, that seems completely unethical now.

The gradual change in terms of doctors learning to include their patients in diagnosis and care is forced not just by a sense of ethical duty, but also by system structures such as the burden of cost of chronic disease care.  A patient with chronic [illness] may be obligated to do a lot of care on his or her behalf when they can’t have help 24/7.  All of these things are coming to a head, and we’re realizing it’s not just a matter of good practice but one of simply executing what we need to do.  The patient has to be part of the system.

Another of your projects with RWJF is Flip the Clinic, which talks about how to rethink a typically brief doctor’s visit to make it more productive and meaningful.

We’ve been trying to come up with some tools to put in the ecosystem that people can adopt or give feedback on, including ones we’ve gestated internally but also deconstructing things out there that have worked.  We haven’t invented the idea of improving the doctor-patient encounter, but we’ve been amazed to see Flip the Clinic resonate already as a sort of GitHub – the open software collaborating site — around the practice of clinical medicine.  The idea is to help people not reinvent the wheel and [adapt what’s available] to their own needs.

When it debuts, will have two main areas: A hub for content – actual tools and strategies people can bring into their own institutions – and secondly will have a community component where people can exchange what they’ve learned, offer new ideas, connecting, say, people from Seattle to New Jersey and helping them understand what has worked in one place that may help solve a similar quandary in a different city.

What qualifies as real change?

It’s a balancing act – we want to have real innovation but we need to  offer tools that don’t just appeal to the converted; they need to work far and wide.

Late last month, I had a morning where first I talked to a nurse practitioner at a pediatric clinic in Camden, New Jersey, which is in an underserved community.  They’ve having their clinic budget hatcheted every quarter.  Physicians are frustrated.  This is a facility in true need of new approaches and something that re-orients them toward a positive engagement with their population. I went from that call to one with the Mayo Clinic; they were interested in how they might be able to participate. These are institutions on the opposite end of the spectrum, and one of our core objectives is for Flip the Clinic to work in both places.

In initial discussions, it turned out that both providers and patients wanted more control over clinic visits.  What else do they want?

We also earned there was a mutual yearning for some joy and positive emotional experience out of that encounter from both sides, and especially from the physician.  So one of the things we’ve been trying to be careful about is trying to stuff more into this already limited resource of a 15-minute doctor visit.  For everything we add to that visit, we need to take something off their plate. The challenge is to make these things pragmatic and executable in reality and not just say, “Do more.”

Goetz moderated a Great Challenges Google+ Hangout last week about rethinking the clinical visit to maximize value for both providers and patients.  Watch the recap, below.

TEDMED Great Challenges: Meaningful Minutes: Reinventing the Clinical Visit


Regarding your new venture, Iodine, which uses data design to help inform patient decisions: Is good design late to the game with healthcare?  Or it is on the same trajectory as other industries?

I think design is an underexploited tool in healthcare, though it’s ahead of the curve in some ways. Health care and medicine are already based upon a data paradigm; there’s a lot of information flowing through the system. But best practices in design thinking are not well applied, and they’re not oriented towards the patient.  Our goal is to leverage data, to translate it and visualize it, so that ordinary people can act on it and make better decisions about their medications. That’s not an easy problem.

It’s a hard thing to get people out of their routine, especially in a demanding world like healthcare. But that doesn’t mean it’s impossible – and design is essential to that. That’s where the inherent data orientation of healthcare offers some low hanging fruit.  Iodine’s core tenets are data-slash-analytics, behavioral science, and design.  They’re the three legs of the stool for visualizing and presenting information in ways that increase the likelihood that any individual will act to do something better for their health. [Ed. note:  Iodine will formally launch in February.]

While you were at Wired you ran a great piece showing how design could help patients understand their test results. How come doctors haven’t already demanded better design for their own information? It must be hard looking at that gobbledygook all day. 

Unfortunately, this brings us to the horrible world of EHRs. The prevailing industry products are really crappy in this regard; they come from an enterprise software perspective that’s 10 or 20 years old. A physician is almost always not making decisions on technology procurement. Unfortunately, sometime it doesn’t matter what your frontline needs are compared to the cost determinations of your IT department.

The cool thing is that there is another set of savvy tools going straight to the physician that are lightweight and easy to adopt.  There are some companies like Practice Fusion and Pingmd doing innovative things with communications or messaging component. And other companies are working on visualizing lab data, like WellnessFX. That’s a much more interesting strategy and more fun to watch. Sometimes developers use the iPad strategy — taking what physicians are already using and making that your platform, rather than the institutional computer system.

One can’t imagine the current generation of medical students going into the clinic and being satisfied with old-school data design.

That’s precisely where one of these pressures is going to come. The current generation of physicians is being dragged along into the EHR world.  The next generation is going to lead the way, I think. They’re going to demand better tools, both for themselves and for their patients. That’s the world I want to live in; that’s the world I want to in some way help create.

Interview by Stacy Lu

Visionaries Q&A: Artist Raghava KK on learning to be creative

Raghava KK is an artist, TEDMED/TED speaker and National Geographic Emerging Explorer.

Q. In your talk at TEDMED 2013, you showed us your latest work, in which brain wave technology helps viewers shape your art according to their thoughts and moods. How have people responded so far? 

Contrary to what I anticipated, my talk at TEDMED received an overwhelmingly positive response. I thought the TEDMED audience would predominantly think in fundamentals, and there would be a disconnect. But any science taken to a certain level becomes art. It goes into the ability to transcend to abstract the essence of its thing, and apply it beyond a single application. There’s only a limit to which you can be trained in any one thing.


From doctors to scientists, there are now a lot of people who are in conversation with me about how we can add value to each other’s methods of inquiry. I’m really excited that I’ve gotten to write the forward to a textbook on cultural sensitivity using perspectives in psychiatry that is being brought out by Massachusetts General, Harvard’s teaching hospital.

Did you learn anything surprising about the brain during this project?

Yes! It shocked me the number of emotions we can go through in one minute.

We like to think about ourselves in absolutes, but we are dynamic and continually changing. Also, I’m surprised by the degree to which you can control brain activity. I can manipulate my art pieces on cue. When some people have that feedback, it can make them feel uncomfortable; with others, it helps neutralize their feelings of fear.

You’re working with an education innovation initiative, NuVu, that stresses creative problem solving skills, and have said, in an interview with Dowser, that education now should be about welcoming instability. Your art encourages dynamic perspectives as well. What is it about the world we live in that makes this so important? Can you point to something in your life or learning that led you to embrace the impermanent?

The one thing we know about the world for sure is that it’s constantly changing.  Evolution is not a ladder that’s built on linear progress. It’s more like a round treadmill, where we’re constantly adapting in relation to a dynamic environment.

So it seems appropriate that we learn in a manner that correlates to the state of the human condition and environment. I’ve reinvented myself many times. I’ve always felt that my education was great; it taught me who I am.

But it’s been my creativity that has constantly told me I can be much more. I could have never planned my whole art career and trajectory. I allowed it to unfold by taking an active role in my life and my future. I think that the incident that really sparked this idea was my decision to quit formal education, and to embrace and learn from impermanence. I haven’t had a formal education since high school, so the world has been my classroom.

A screen for POP-IT, an iPad app designed by Raghava KK. Viewers change the characters by shaking the tablet.

A screen for POP-IT, an iPad app designed by Raghava KK. Viewers change the characters by shaking the tablet.

In that same interview, you said, “Even in my own life, I keep putting myself in uncomfortable situations because of the amount I learn.” Can you give a few examples?

Here are three. First, I recently moved back to India, although I was well settled in New York. I wanted to have my third child here, and expose my children to this impossible democracy, which is an experiment in bringing together multiple, dissimilar perspectives and thus gives us so much to experience and to learn from.

Second, I’m starting a company from scratch and learning about entrepreneurship, because I really want to make an impact with this idea, to transcribe it among audiences. It’s a web-based and mobile educational platform called Flipsicle, and it allows you to actually see multiple visual perspectives on any topic. It’s a man-powered Google for images that uses collaboration and crowdsourcing.

We are producing and consuming more pictures than ever before, but desensitizing us to the fact that pictures are only a single view on an event and truth. Even in our schools, we start out with absolutes and go to abstract at a later stage, like high school, which is far too late. We need to disrupt this teaching and go to abstract thinking at a much earlier stage to really teach perspective.

Third: Once my wife and I accidentally found ourselves in a nudist resort.

This is what happens when an Indian books a holiday without knowing the difference because naturist and nature, because in California “naturist” means “nudist.”  We checked in late in the evening; everyone was wearing clothing, because it was cold.  In the morning I opened the window and saw a guy doing yoga in the buff. Then, my wife and I walked out and we were the only people clothed. So – do we stay here, or we go back home and pretend this never happened? But we thought,  ‘What the hell do we have to lose?’ And it led to an entire series of paintings I did on eros and nudity.  I discovered that it’s the continuum that’s erotic, not the absolute states of nudity. The feeling of the weight of clothing is something you just forget; it’s a change of the clothed state you notice.

"Untitled" by Raghava KK, acrylic on canvas, 2011.

“Untitled” by Raghava KK, acrylic on canvas, 2011.

You mention often that you hope your work will inspire empathy. Can you name a piece of art, or an artist, who inspired that in you, or who/that greatly changed your own perspective?

An artist need not look to art to be inspired, but to life. I see a need for empathy in the world, and that’s what inspired me.

Empathy is fashionable word right now, and it can be easy to misrepresent.

To me, empathy is a tool and it has survival value based on context.  For example, sometimes apathy is important. Extrovertism is overrated. Leadership is overrated; not everyone is a leader. We need to understand these things as continuums that have value based on context. So empathy means contextualizing where I come from, where you come from.

For example, I don’t measure myself by the same metrics by which others do, whether it’s the art world or the commercial world or the entrepreneurial world or the TED world. For someone to understand what I – or anyone — does, they have to have an understanding of how I measure my actions. The need for human dignity comes from these factors. It’s a constant need. And I need to be more than an artist. Life is just a tool. Art is just a tool.

Interviewed by Stacy Lu, @stacylu88

What’s the new way to ask big questions in science?

Parkinson’s Voice Initiative founder and TEDMED 2013 speaker Max Little is an applied mathematician whose goal is to “see connections between subjects, not boundaries…to see how things are related, not how they are different” – which gives him an unusual perspective on how big data could change medicine. We  interviewed him via e-mail to find out more.

You’ve been working to discover the practical value of abstract patterns in various fields, with surprising results in areas as varied as diagnosing Parkinson’s disease over the phone to predicting the weather. Can you explain your approach?

Max Little

Max Little

As an applied mathematician, my training shows me patterns everywhere. Electricity flows like water in pipes, and flocks of birds behave like turbulent fluids. In my projects, I collate mathematical models from across disciplines, ignoring the assumptions of that discipline to a large extent, I put in overly simple models. I use artificial intelligence to throw out inaccurate models. And this approach of exploiting abstract patterns has been surprisingly successful.

For example, during my PhD I stumbled across the rather niche discipline of biomedical voice analysis, originating in 1940′s clinical work. With some new mathematical methods, and combining these with recent mathematics in artificial intelligence, I was able to make accurate medical predictions about voice problems. The clinician’s methods were not accurate. This sparked off research in detecting Parkinson’s disease from voice recordings – the basis of the Parkinson’s Voice Initiative.

But, success like this raises suspicions. So, with collaborators, I tried to make this approach fail. We assembled 30,000 data sets across a wide range of disciplines: exploration geophysics, finance, seismology, hydrology, astrophysics, space science, acoustics, biomedicine, molecular biology, meteorology and others. We wrote software for 9,000 mathematical models from a deep dive into the literature. We exhaustively applied each model to each data set.

When finished, a very revealing, big picture emerged. We found that many problems across the sciences could be accurately solved in this way. In many cases, the best models were not the ones that would be suggested by prevailing, disciplinary wisdom.

Are you doing other research that might have implications for clinical diagnosis?

Here is another example: There is a decades-old problem in biomedical engineering: automatically identifying epileptic seizures from EEG recordings. But, we found over 150 models, some exceedingly simple, each of which, alone, could detect seizures with high accuracy.


This challenges quite a few assumptions – but it is not as if we are the first to find this. It happens often when new approaches to address old problems are attempted: for example, in obesity, a new, simple mathematical model revealed some surprising relationships about weight and diet.

You’ve also used fairly simple algorithms to successfully predict weather.

After my PhD, I teamed up with a hydrologist and an economist. We wanted to try weather forecasting using some fairly simple mathematics applied to rainfall data. Now, weather forecasting throws $10m-supercomputers and ranks of atmospheric scientists together, and they crunch the equations of the atmosphere to make predictions. So, competing against this Goliath with only historical data and a laptop would seem foolhardy.

But after two years of hard work, I came up with mathematics that, when fed with rainfall data, could make predictions often as accurate as weather supercomputers. We even discovered that models as simple as calculating the historical average rainfall, and using this as a forecast, were sometimes more accurate than supercomputers. We were all surprised. but this finding seems to line up with results that others have found in climate science: it is actually possible to make forecasts of future global temperatures using simple statistical models that are as accurate as far more complex, general circulation models relied upon by the Intergovernmental Panel on Climate Change.

Is this a new way of doing science?

If we divide science into three branches: experiment, theory and computer simulation, then what I am describing here doesn’t quite fit. These are not just simulations: the results are entirely reproducible with just the data and the mathematics. This approach mixes and matches models and data across disciplines, using recent advances in artificial intelligence.

The three branches of science. What happens when we add computational algorithms to the mix?

The three branches of science. What happens when we add computational algorithms to the mix?

I don’t know what to call this approach, but I’m not the only one doing it. The most enthusiastic proponents are computer scientists, who do something like this regularly in mass-scale video analysis competitions or one-off prizes financed by big pharma for molecular drug discovery as do statisticians working in forecasting.

In your TEDMED talk, you expressed concern that advances in science have stagnated. Can you explain?

Like many scientists, I’m concerned that science is becoming too fragmented. So many scientific papers are published each year that it is impossible to keep track of most new findings. Since most articles are never read, much new research has never been independently tested.

And, unfortunately, scientists are encouraged to ‘hyper-specialize’, working only in their narrow disciplines. It is alien to we applied mathematicians that a scientist who studies animal behavior might never read a scientific paper on fluid mechanics!  In isolation from each other, could they just be duplicating each other’s mistakes?

Max Little at TEDMED 2013

What can we do to create a more unified approach?

First of all, open up the data. There is far too much politics, bureaucracy and lack of vision in sharing data among researchers and the public. Sharing data is the key to eliminating the lack of reproducibility that is becoming a serious issue. Second, don’t pre-judge. We need to have a renewed commitment to radical impartiality. Too often, favoured theories, models, or data persist (sometimes for decades), putting whole disciplines at risk of missing the forest for the trees.

More collaboration would also greatly speed advances. Is first-to-publish attribution of scientific findings really that productive? I think of science as a collaborative journey of discovery, not a competition sport of lone geniuses and their teams.

Scientific theories that can withstand this “challenge” from other disciplines will have passed a very rigorous test. Not only will they be good explanatory theories, they will have practical, predictive power. And this is important because without this mixing of disciplinary knowledge, we will never know if science is really making progress, or merely rediscovering the same findings, time and again.

Follow Max Little @MaxALittle.



Visionaries: Vic Strecher says living with purpose inspires good health

Why don’t we always do what’s best for us?

It’s a question that has long preoccupied Vic Strecher, founder and head of the Center for Health Communications Research at University of Michigan and TEDMED 2009 speaker.

After years of teaching health education and helping to create computer-based interactive programs that inspire better personal choices, Strecher is working on a website and a graphic novel based on new thinking in the field and on his own momentous life experience. TEDMED spoke with him about his new projects.

So…why don’t people make more healthful choices? There’s no lack of available health information, and yet lifestyle choices have led many to develop chronic diseases.

VS We know that the choices we make can slowly kill us, like frogs that will stay in water that’s slowly heated until they literally boil to death without jumping out of it. And we’re learning that one reason we resist health messaging is defensiveness. We have this wall around our ego for evolutionary reasons, and ironically our wall has been getting thicker with all the societal messaging we’re getting. With the barrage of junk information and all the choices we face, we’re less able to make competent decisions.

How do you prod people out of that warming water?

VS There’s a relatively new idea being explored called self-affirmation theory. It says that the process of affirming your fundamental beliefs — core values — reduces defensiveness. For example, if you write down or are rating your core values, such as your faith or your commitment to family, and then are exposed to a health message that you may normally process defensively, you’re more likely to accept it.

When you start to put things in writing, you realize, “Hey, my values differ from my behaviors, don’t they?” Research shows that cigarette smokers who affirm their core values are more open to anti-smoking messaging.  People are more likely to participate in diabetes risk assessments if they have just completed their values list.  So how can we get people to start making that kind of connection?

Some of your recent talks have mentioned how empathy can lead to healthier behaviors.  Can you explain? 

VS Jennifer Crocker of Ohio State University, a psychologist who studies self-esteem, wanted to take a look at people’s thoughts while they were affirming their values. And what they were doing was thinking of a connection with loved ones, their friends and family and community, and things bigger than themselves; it drew on something called self-transcendence.

What started you down this path of looking at the bigger picture?

VS Two years ago my daughter passed away; she was 19 years old. I went through a significant grieving process, which included struggling with lethargy, and as a behavioral scientist I was noting my own reactions. I began studying the old philosophers – the Stoics, Existentialists – some like Kierkegaard who were very religious, and some who were atheists.  They all said you have to have a purpose or meaning in your life. Victor Frankl, a Holocast survivor, found out people who were losing their purpose were dying faster in the death camps.

That started me thinking about the epidemiology of this in the medical and health field. People that have a purpose in life are 2.4 times less likely to die from Alzheimer’s Disease, less likely to have a heart attack, and more likely to have good sex. Having a purpose can also help repair our DNA, potentially promoting a longer life. We spend so much time scaring the crap out of people about death and disease, and we should be thinking about teaching them to have purpose in life. We’re so used to telling people, ‘Smoking is bad for you,’ and then ratcheting that fear up. Why not just focus on a totally different direction for this?

You’re working on several new projects with this in mind. Can you share details?

VS I’m self-publishing a graphic novel, “On Purpose,” working with a comic book illustrator and a screenwriter. I decided to put together a story that connects my own personal tale with the related science. It will be about the importance of finding purpose in your life in a nihilistic world, basically. It touches on themes from ancient and modern philosophy, literature, neuroscience, and Egyptology.

I’m also working on a web site. There will be a blog app for people to share their stories. I want to build a community where people can record their purpose and see others’. There will be some kind of filter to group people through their common core values, in a way they might not expect. Some of the real beauty of life is discovering things that you wouldn’t expect to discover or to agree with.

Interviewed by Stacy Lu

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

Elissa Epel

TEDMED 2011 speaker Elissa Epel, a UCSF psychologist, has studied the health impacts of stress, from its effects on our DNA to its relationship to overeating, for two decades.

Q Some of your research has centered on the way that stress hormones contribute to increasing our drive to eat, particularly high-carbohydrate and high-fat “comfort foods.” To what degree is stress contributing to our national obesity crisis, in your opinion?

EE We can’t quantify exactly how big of a role stress plays. It could be huge. It’s invisible and it’s easy to ignore; it’s pervasive. Most of us have gotten so used to living in a matrix of stress – time pressure, demands, rushed social interactions, rushed eating – that we don’t even notice it. So we might not realize how stressed our body really is. But the effects of stress can still stimulate our appetite, and shift us to choosing more ‘white food’ – what we call “comfort food,” – high-calorie, high-fat food. This promotes metabolic disease because it causes us to store calories in the visceral area and liver. And that stored fat is at the core of many chronic diseases, not just diabetes.

Q I was surprised to see your study showing educational attainment is also related to telomere length. What might the mechanisms for that be?

EE That relationship is multi-layered and needs to be unpacked. One common theme in trying to understand health disparities is testing whether part of it stems from  greater stress exposure or reactivity over a lifetime. For example, the effects of more years of education early in life can be seen decades later, in longer telomere length. Higher education, or maybe it’s the quality of education, can create an infrastructure in the brain for more adaptive coping – it can help with strengthening what we call ‘executive function’ –which helps us think clearly under stress.

Conversely, there are many active ingredients in the milieu of low socioeconomic status that cause wear and tear. Interestingly, though, perception can play a large role here. We have measured this by giving people a picture of a ladder and asking them to place themselves on a rung (the bottom rung being the lowest status).  Rating oneself as low, regardless of actual income or education, relates to poor adaptation to stress.  Specifically, when given the same task to do in the lab, people low on the ladder reacted hotly each time, as if it were new, instead of habituating to it. There is also the built environment of low socioeconomic status, which doesn’t leave opportunities for buying healthy food and places for exercise or safe walking. And the built environment can feed back and affect how people feel.  For example, fewer parks or more liquor stores predict a decreased feeling of neighborhood trust and cooperation.

Q There seems to be a big disconnect between what people know is good for their health, and their actual behaviors. Is mindfulness – focusing on what we’re doing right now, in the present moment – the missing link, do you think?

EE I think that’s right on. We can’t possibly regulate our behavior and feelings, and suppress those pesky but strong impulses and other distractors, if we are not paying attention. In a high-stress environment, our brain activity shifts toward the limbic system and the emotional stress response, and away from the parts of the pre-frontal cortex that house executive control systems, the rational and analytical drivers of our behavior. So we react automatically and impulsively when we are under stress and not paying full attention.

Watch: The Mindful Human Genome

And even if we are focusing a lot of effort on eating better or exercising, but in a really self-critical way, this can sabotage our efforts as well. Very few people meet their exercise, sleep, and nutrition goals each day. So mindful attention includes both an intention and a kind attitude, and these help clear our mind of unhelpful or intrusive thoughts, and improve our ability to carry out our intentions.

Eating is an interesting example of a behavior that is not under our full conscious control, although we have not admitted that yet. Eating is something that we can do without paying attention. Otherwise, if it took focus and effort, that wouldn’t be part of adaptive evolution. Overeating is related to stress but also altered neurobiology of the reward system, the source of our strongest motivational drives. This reward area responds to palatable food. This can drive compulsive behavior that feels out of control, an experience similar to being a drug addict for some people. We have to better understand how powerful certain types of foods can be, and that certain conditions, including stress, make people especially susceptible.

In some of our studies, we are trying to help low-income people who feel very little control over their life, with their weight. We are teaching mindfulness to pregnant women, and it looks like the training might be helping not only them but also their babies. We have to think of ‘stress reduction’ where it matters most – which includes the womb. Prenatal stress exposure can affect a child’s health for a long time, possibly a lifetime. For example, mothers who have experienced major stresses while pregnant have offspring with shorter telomeres.

Dr. Elissa Epel : The Science of Stress

Q One of many intriguing facts you mentioned in your TEDMED 2011 talk was that technology can actually increase stress in various ways. At the same time, we’re seeing a slew of new apps aimed at helping us to calm down.

EE I think mobile apps for stress reduction are a fabulous potential use of technology, if they really work. For example, we could be using our mobile phones to remind us to rejoin with the moment, and to breathe fully, to notice our physical body and become embodied again. We live mired in our thoughts, above the neck, and this is made worse by multitasking.

But technology devices can become part of multitasking, thus adding to the strain on our limited attention, splitting it yet one more way. There are a lot of wellness apps out there, but I also think that we need data. Almost none of them are evaluated so although they seem promising, do people really benefit from them in a way that would lead to meaningful change? This is a powerful way to reach people, and I admit that even I am involved in an effort to test a stress reduction app!

There are so many answerable questions: Can we take people deeper into a meaningful life, or do these technology interventions contribute to fractured attention and more shallow social interactions? Do people stick with them? Do the apps make a dent in chronic stress arousal over time? As a society we desperately need stress reduction. Let’s hope we can use technology to get there.

Q If you had the power to enforce one public health measure based on your research, what would it be?

EE Public policy makers try to use their resources well to help people, but don’t always think about how to make policy motivating to an individual, nor take into account fundamental causes of societal and individual stress. Stress is caused by a perception of lack of control and unpredictability. Policymakers can promote empowerment, helping disadvantaged people gain a sense of control over their daily life.  Social scientists understand which social and structural factors need to change to help individuals change.

A main message of research today, from epigenetics in basic models to epidemiology, is that adult health is shaped early in life, in important ways we can no longer ignore. So resources are best spent early in life, with the goal of promoting good health and habits, and preventing disease. Good quality education is critical, particularly for girls. It directly translates to better health behaviors and eventually health for the next generation. Resources are just much less effective when applied to diseases that are incurable and costly to manage. Our money is spent in an unbalanced and illogical way. We skimp on education — particularly in California — and spend a tremendous amount of money and time trying to cure incurable diseases such as obesity. Instead, we spend big money on bariatric surgery and costly band-aid procedures.

Q Has your research changed any of your own personal or work habits?

EE It has, but only in an incremental way over many years. I have been studying the field of stress for almost 20 years, so I know all too well what we should be doing, and how my behaviors such as curtailing sleep and having too many demands placed on me affects my daily physiology, and cellular stress. Does that mean I get enough sleep, exercise, meditate every day, keep work manageable, and prioritize the things that are most meaningful, versus the most urgent? No. I am closer to that than I used to be, and maybe in another stage of life… I still experience plenty of challenging situations, and have my reactions, but now in a more mindful way, and that is a qualitatively different experience. Like most people, I am a work in progress.

–Interview by Stacy Lu