Balancing Medical & Musical Worlds: Q&A with Suzie Brown

In her TEDMED 2015 performance, cardiologist and singer-songwriter Suzie Brown and her husband, Scot Sax, give a vulnerable, evocative performance that tugs at our heartstrings. We caught up with Suzie to learn more about the delicate balance between pursuing her musical passions and practicing cardiology.

Credit: Zoey Sless Kitain

Credit: Zoey Sless Kitain

TEDMED: Can you tell us more about the fine line between exposing your outside life to your patients, being vulnerable with them, and maintaining the level of expertise, stoicism, competence, and objectivity that is expected when playing the role of a doctor?

SUZIE: It IS a fine line. When I am at the hospital, I am 100% dedicated to my patients and I would never want there to be any question about that. For that reason, I generally do not volunteer that I’m a musician, or even that I work part time. Once I have established a more long term relationship, and my commitment to them and competence as their physician has come across, I find it easier to talk about (but I still don’t bring it up). I hope that they feel it on some level though, in that I am more vulnerable and empathetic than I would be otherwise.

TEDMED: How do you balance the medical professional side and musical sides of your life?

SUZIE: It’s not easy. And it’s become even more complicated now that I have kids. My schedule currently alternates between 2 weeks working as a doctor and two weeks “off” from medicine, which is my time for music. After my two doctor weeks, I’m usually exhausted, and I’m always missing my family like crazy. I need to physically and mentally recharge before I’m able to be creative, which takes time. I can’t wait to spend time with my husband and daughters after being away so much at work. In between family and recharging time, I squeeze in my creative time. These days that mostly consists of songwriting with other artists in Nashville, though I still play shows and make albums. Inevitably, the two weeks “off” goes by in a flash. I often wish I had more music time, though I’m SO grateful for the time that I do have.

TEDMED: Do you think the fact that you’re a musician makes you a better doctor?

SUZIE: Definitely. Having time for music allows me to recharge, to replete my emotional reserve, so I have more to give to my patients. It also allows me to access my feelings and maintain a healthy amount of vulnerability – without time away, it’s easy to shut down emotionally, just to get by.


Download the song from Suzie’s TEDMED 2015 performance, “Sometimes Your Dreams Find You,” for free here!

Found in Translation – Kyoto style

By guest contributor and TEDMED 2015 Speaker Daria Mochly-Rosen, PhD and Rosanne Spector

This week I’m visiting Kyoto University to spark something similar to SPARK, the program at Stanford University that translates fundamental academic research into drugs and treatments to benefit patients.

I founded SPARK 10 years ago when I realized how hard it was for me, a professor at Stanford’s medical school, to get the world of drug developers interested in a discovery from my lab that I felt sure could improve patients’ lives. In my TEDMED talk last year, I talked about SPARK’s successes at promoting translational research. Among them: More than two dozen of the Stanford projects have launched start-ups or been licensed to existing companies. Meanwhile, other institutions inside and outside the United States are using SPARK as a template for programs of their own — which brings me to this week in Japan.

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Photo courtesy of http://kodo-kan.com/

After a very productive day with several professors at Kyoto University, my host, associate professor Tomoyoshi Koyanagi, PhD, took me to a very old tea house for a tea ceremony, hosted by Makoto Sarata. Sarata-san is an assistant manager in the Entrepreneur Nurturing Support Department of the Advanced Science and Technology Management Research Institute of Kyoto (a mouthful and yet incomplete title).

As I entered the beautiful tea house, surrounded by a manicured moss garden, I met Sarata-san, a strongly built man who had a huge smile and boundless energy. We sat on the tatami floor mat, drank the green foamy tea in large ceramic bowls, and talked. As you’ll see, the tea house turned out to be the perfect place to talk about translational research.

Sarata-san talked about design thinking and “smile value,” which are his tools to encourage entrepreneurship. Using these tools, he triggers participants to think creatively and positively by first identifying and choosing a problem and only then working on solutions and sorting through many of them to find the one to focus on. I contrasted these tools with our approach in SPARK, which has to include building on years of research that identified a lead (a beginning) for a solution. We talked about SPARK’s challenge, as the process depends on so many diverse types of expertise (medicine, chemistry, material science, pharmacology, etc) and how that generates language barriers.

As we continued, I also heard more about the ancient and beautiful tea tradition. Sarata-san told us that after finishing the tea, it’s the custom for guests to carefully inspect the bowl and admire it from all sides, as each bowl is unique. I immediately picked up my empty bowl from the tatami and held it high to show my appreciation. What a cultural faux pas! After a belly laugh, Sarata-san explained the mistake: The bowl was over 200 years old and I showed disrespect. The proper way is to bend down close to the tatami and elevate the bowl only slightly, so not to risk breaking it. Lost in translation?

As we were putting on our shoes, preparing to leave this ancient tea house, Sarata-sun, called out the tea house chairperson, Dr. Kanako Hamasaki. Hamasaki-san, a beautiful young woman, has a PhD in Kodo, the “way of fragrance.” I am not sure if I understood her explanation of her expertise on the effect of incense on the body. But the discussion was cut short when she exclaimed: “I have the same boots as yours!” We were just two women, sharing the same language – women’s love for shoes.


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Dr. Daria Mochly-Rosen is a professor of Chemical and Systems Biology at Stanford University and is the founder and director of Stanford’s SPARK program. In her TEDMED talk, Daria highlights the value of connecting academia and industry to enhance translational research. 

How Should We Train Medical Students for a Digital Future?

By guest contributor and TEDMED 2015 speaker Robert M. Wachter, MD

When I was a medical student about 30 years ago, I knew what a computer was, but the machines didn’t have any relevance to my professional life. When I started on the wards, all of my clinical notes were handwritten on pieces of paper stored in three-ring binders. We read paper journals, photocopied and handed out articles to our colleagues, and clipped out summaries of “keepers,” filing them in little recipe boxes for later review. To look at our x-rays, we trekked to the radiology department, since that was where the only copy of the film was stored. All of our laboratory results came back on flimsy carbon copy sheets of paper that were filed, in rough alphabetical order, on a rickety poker table outside the clinical laboratory.

In retrospect, it’s amazing that we didn’t kill more of our patients.

In the past five years, fueled by about $30 billion in federal incentive payments, medicine has finally become a digital industry. More than 90% of American hospitals now have electronic health records, as do the vast majority of physician offices. Decades after most other information-intensive industries switched from paper to silicon, in medicine, the x-rays, the three-ring binders, and the card tables have finally left the building.

Clearly, the world of today’s physicians will be vastly different from the world I entered in the early 1980s. Just as clearly, the training of future physicians must evolve for their work in a digital healthcare system. But how should it change?

Digital MedicineIn order to understand this, it’s important to make clear how digitization changes the nature of medical practice. The first issue is how one accesses medical knowledge. Online resources are now a click away, and more sophisticated electronic health records build in decision-support, which can do everything from reminding you that a patient is allergic to a certain antibiotic to guiding you to a well-vetted, evidence-based protocol for the management of a patient with a stroke.

On top of that, there’s the exploding field of analytics. The same technology that allows Amazon and Netflix to say, “Customers like you also liked…” will soon be applied to medical knowledge. Although your average physician won’t be performing big data analytics in the course of her workday, she will need to understand the results of such analytics, and be skilled at asking the big data experts (or the computers themselves, as the tools become more user-friendly) questions that can be answered effectively by existing data.

The role of patients will be transformed. As we’ve seen in other industries, computerization is The Great Democratizer. Patients will be far better informed through online resources, and will no longer be entirely dependent on the physician for expert knowledge. In certain cases, patients will also have access to apps and other tools that allow them to self-manage problems that used to require a physician visit. When they do need to see the doctor, many, perhaps most, of their visits will occur through telemedicine.

What does this mean for the training of future doctors? First, not all physicians will need to be experts in HTML. Clearly, some clinicians will want careers that blend informatics and medicine, and they should be encouraged to pursue this important work. And all students will need to understand the basics of how computers work in a medical context, but that is not the core issue.

Rather, the key change is that students will need to be trained to be leaders in improving systems of care, in working effectively in teams, in partnering with patients in new ways, and in using digital capabilities to enhance all of this work. While they will have less need than in the past to memorize everything in the textbook, it will be a mistake to say that they don’t really need to know very much since all the answers are a web search away. In many cases, it is the deep foundational knowledge that allows you to know when you need to learn more, or when the computer is giving you an answer that is inappropriate for a given patient’s situation. The physician of the future will still need to know quite a lot.

Probably the most important challenge will be one that gets even harder as the information technology gets better: balancing the technology with the humanity of medicine. We must train our future doctors – who will not know anything other than a digital environment – to concentrate on the real patient, not the digital incarnation of the patient, which Abraham Verghese calls the “iPatient”. With all of the data in the computer, this is easy to forget. But, as I wrote in The Digital Doctor, even when that wonderful day arrives when we have finally coaxed the machines into doing all the things we want them to do and none of the things we don’t, we will still be left with one human being seeking help at a time of great need and overwhelming anxiety. The relationship between a doctor and a patient does not feel transactional now, and I don’t think it will then. Rather, it will remain vital, scary, ethically charged, and deeply human.

It will take great discipline and all the professionalism we can muster to remember, in a healthcare world now bathed in digital data, that we are taking care of human beings. The iPatient can be useful as a way of representing a set of facts and problems, and big data can help us analyze them and better appreciate our choices. But ultimately, only the real patient counts, and only the real patient is worthy of our full attention.

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Bob Wachter, digital medicine expertIn his TEDMED 2015 talk, renowned UCSF internist, author and patient advocate Robert M. Wachter shares his struggle to balance patient empowerment with patient safety in our digital age.

The Importance of Replication Studies

 

By guest contributor and TEDMED 2015 Speaker Elizabeth Iorns, PhD

Every year, billions of dollars are spent funding biomedical research, resulting in more than one million new publications presenting promising new results. This research is the foundation upon which new therapies will be developed to enhance health, lengthen life, and reduce the burdens of illness and disability.

In order to build upon this foundational research, these results must be reproducible. Simply put, this means that when an experiment is repeated, similar results are observed. Over the last five years, multiple groups have raised concerns over the reproducibility of biomedical studies, with some estimates indicating only ~20% of published results may be reproducible (Scott et al. 2008, Gordon et al. 2007, Prinz et al. 2011, Steward et al. 2012, Begley and Ellis 2012). The National Institutes of Health (NIH), the largest public funder of biomedical research, has stated, “There remains a troubling frequency of published reports that claim a significant result, but fail to be reproducible. As a funding agency, the NIH is deeply concerned about this problem”.

shutterstock_261331172Despite the growing concern over lack of reproducibility, funding for replication studies, the only way to determine reproducibility, is still absent. With no funding systematically allocated to such studies, scientists almost never conduct replication studies. It would be interesting to obtain the exact numbers, but it appears that last year the NIH allocated $0 to funding replication studies, out of a $30B+ budget. In the absence of replication studies, scientists end up wasting precious time and resources trying to build on a vast, unreliable body of knowledge.

It is easy to see why funders might shy away from funding replication studies. Funders want to demonstrate their “impact,” and it is tempting for them to solely focus on funding novel exploratory findings that can more easily be published in high profile journals. This is a mistake. Funders should instead focus on how to truly achieve their stated goals of enhancing health, lengthening life, and reducing the burdens of illness and disability. Although allocating a portion of funding towards replication studies would divert funds from new discoveries, it would enable scientists to efficiently determine which discoveries were robust and reproducible and which were not. This would allow more rapid advancements by allowing scientists to build upon the most promising findings and avoid wasting their time and funding pursuing non-robust results.

Some researchers find the idea of replicating previous studies unnecessary or even offensive. However, it is the responsibility of the scientific community, including funders, to work as quickly and cost effectively as possible to make progress. Introducing replication studies as part of the process provides an effective way to enable this.

If you would like to see funding specifically allocated for replication studies, please register your support here. We will share this information with funders in the hope that it will encourage them to establish funding programs specifically for replication studies to improve the speed and efficiency of progress in biomedical research.


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In her TEDMED talk, cancer biology scholar and CEO of Science Exchange highlights the importance of funding reproducibility studies to advance scientific progress while maintaining its integrity.

The art of healing across cultures: Q&A with Laurie Rubin

Laurie Rubin works to promote healing across cultures.

Laurie Rubin

Performance artist and TEDMED 2015 speaker Laurie Rubin and her wife Jenny Taira founded Ohana Arts in 2014, a non-profit whose mission is to promote peace and world friendship through the universal language of the arts. They recently performed at a special ceremony in Hawai’i in memory of the recent 70th anniversary of the tragic Hiroshima nuclear bomb calamity. We caught up with Laurie to learn more about her and Jenny’s work to promote cross-cultural understanding and healing.

TEDMED: How did you first become interested in focusing on cross-cultural healing in your work?

LAURIE: From the time I was seven years old, I was in Hebrew School learning about the Holocaust, and the devastating loss of six million Jewish people that happened less than half a century before I sat in the classroom. The Holocaust made several appearances in my history classes throughout my elementary, middle, and high school education. I learned then what war and hate could do to human beings, and how mutual understanding and the necessity to heal was part of the universal human experience. Therefore when my wife Jenny, who is Japanese American, told me the effect the Hiroshima Peace Memorial Museum had on her, as well as Sadako Sasaki’s story, I had many mixed emotions. I first thought, “Why have I never heard about Sadako and her international peace movement?” My second thought was about the message that was consistent throughout my Hebrew School education, “Never again!” It was of the utmost importance to hear from Holocaust survivors about the kinds of things human beings are capable of doing to other human beings so that future generations don’t repeat the same behaviors and make the same grave mistakes. Yet, the only unit I remember doing on Hiroshima was in the 8th grade, and it was just luck that I had that particular teacher put John Hersey’s book, “Hiroshima” in his syllabus at our progressive school where teachers had leeway to create their own curricula. I realized that as a Jewish artist, it is my responsibility to keep enforcing the message of “Never again” by telling more stories beyond those of my people. “Peace On Your Wings,” is a musical Jenny and I wrote about Sadako Sasaki, a 12 year old girl who died of Leukemia resulting from radiation caused by the atomic bomb dropped on Hiroshima, and who became famous for starting an international peace movement through her thousand origami cranes. It is an example of how one’s universal story can help to heal others who suffer from the atrocities caused by war, and an educational step toward preventing history from repeating itself. I realized that if you educate the world about one piece of history, it would simply get placed into a box that people would take less and less seriously over the decades. However, if you make people realize that human cruelty has happened to many people and nations, it drives the point home that it could happen again, and to us. Jenny and I have been trained as classical musicians, and have realized over time that we could use art, music, and theater to make a difference. It is our life’s work and mission to make sure we accomplish this in our unique way by telling as many poignant stories as possible and providing a sounding board for underrepresented voices.

TEDMED: Could you share any experiences you’ve had that have shaped your drive to play an active role in cross-cultural healing?

LAURIE: As a blind student mainstreamed in regular schools, I received a great education, but often felt isolated, and at times bullied. My braille books and adaptive equipment often made me feel like the alien that had unceremoniously waltzed into the lives of sighted children, disrupting their sense of normalcy. It wasn’t until high school when I joined summer programs for advanced musical study that I started making the kinds of friendships I felt deprived of in my school setting. Music was the level playing field for all of us in spite of our differences. Jenny had also gone to similar summer programs. Music brought us closer to youth from other countries, economic, and ethnic backgrounds. When we moved to Hawaii, where Jenny was born and raised, we decided to start Ohana Arts to provide a similar kind of formative experience for the youth here, and the rewards we see are so incredible. We see ourselves through the eyes of the students we work with. We see how the performing arts fosters acceptance, self expression, and a safe haven for those who have felt “different.”

How To Live Free By Breaking Through Perfectionism

By guest contributor and TEDMED 2015 Speaker Seun Adebiyi

I’m training to represent Nigeria – whose tropical climate has never seen a flake of snow – as its first ever Winter Olympic athlete.

That's me loading cargo onto an MD-88 (small jet) at Atlanta International Airport. I decided to work for Delta as a seasonal/summer employee so I can get free or reduced flights to skeleton competitions. I don't have any sponsors, so every penny saved on travel is a penny that can go towards my training.

That’s me loading cargo onto an MD-88 (small jet) at Atlanta International Airport. I decided to work for Delta as a seasonal/summer employee so I can get free or reduced flights to skeleton competitions. I don’t have any sponsors, so every penny saved on travel is a penny that can go towards my training.

Without any sponsors, I work as an airline baggage handler to cover my training expenses. The guy with a Yale Law degree on his knees in the belly of a Boeing 737 stacking suitcases? Yeah, that’s me. It might sound crazy, but as a first-generation immigrant who grew up beneath the poverty line with a single black mom in rural Alabama, I’m no stranger to humble work. We were so poor that even the kids from the projects made fun of my clothing and haircuts (courtesy of my mom and a pair of scissors). I eventually learned to compensate for my inferiority complex by winning…at all costs.
By the time I was 14, I was ranked 4th in the United States for my age group in swimming. I had broken the Nigerian record in the 200 meter freestyle and was on track to compete in the 2000 Olympic Games. Three months before the opening ceremonies, I became paralyzed from the waist down in a training accident. Without the validation of athletic success to prop up my self-esteem, I went into a vicious tailspin that took me down a dark alley of drugs, alcohol and attempted suicide. I didn’t snap out of it until my college roommate blew his head off with a shotgun.
Searching for a reason to live, I began training for the 2004 Olympics with the club team at the University of Pittsburgh. I dropped 75 pounds in nine months, only to miss the Olympic “B” qualifying time by one tenth of a second. In my third year at Yale Law School, I decided to give the Olympics another shot, this time in a high-speed, high-risk winter sport called the skeleton: like the luge, but headfirst. Nigeria had never been to the Winter Olympics in any sport, and I’d never tried the skeleton before.
SkeletonSound like long odds? That’s not even the half of it. One week after my 26th birthday – and eight months out from the 2010 Winter Olympics – I was diagnosed with acute lymphoblastic leukemia and myeloproliferative disorder. Only a bone marrow transplant could save my life, but as an African-American, my odds of finding a compatible donor were less than 17%. Suddenly the improbable seemed impossible.
With only months to live, I partnered with the world’s largest non-profit bone marrow donor organization, Delete Blood Cancer (DKMS), to recruit over 10,000 new donors and hold the first-ever bone marrow donor drive in Nigeria. I chose Nigeria for two reasons. First, my odds of finding a match were highest in my own ethnic group. Second, blacks are underrepresented in the international donor pool, a key hurdle that keeps thousands of minority patients from finding a genetically compatible donor. Nigeria is the most populous and genetically diverse country in Africa, so their donors could potentially help millions around the world. It made sense for me, and it made sense for others.
However, as luck would have it, on the day of my flight to Lagos, I found a match in the U.S. It was literally the biggest lottery win of my life! But there was a catch: doing the transplant would mean postponing my trip to Nigeria. I had to decide which was more important: saving my own life or holding a drive that would one day save the lives of others?
This was the moment of truth. I knew my decision in that moment would shape my character forever. That was when I finally broke free of the inferiority complex that had shackled me to the mindset of “winning at all costs.” For perhaps the first time in my life, I saw with clarity that success is not measured by wealth, prestige, and accolades, but by one’s impact on the lives of others. Against doctor’s orders, I boarded the plane to Lagos, signing up over 300 donors in a single afternoon. Then I had my transplant and have been cancer free for six years.
Everything changed after that. I left my prestigious job on Wall Street to launch the first Bone Marrow Donors Registry in Nigeria (BMRN) in 2012. Two years later, I partnered with the American Cancer Society to develop the Global Scholars Program, which mentors and financially supports young professionals from developing countries to become effective cancer advocates in their communities.
My next goal is to build a pan-African bone marrow donor registry and cord blood bank, so that patients just like me can have a second chance at life. I also still dream of carrying the Nigerian flag in the opening ceremonies of the Winter Olympics one day. We all have a choice to pursue our dreams. It’s never too late to start, and it’s always worth it. Break through, and live free!
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Seun Adebiyi, on breaking through from perectionismIn his TEDMED talk, cancer survivor and Olympic hopeful Seun Adebiyi astounds us with stories from his quest to conquer the impossible – and what he has learned about himself along the way.

Four Thought Leaders Shaping the Future of Health Care

By guest contributor and TEDMED 2015 speaker Thomas H. Lee, MD

For years now, experts have said health care should move “from volume to value,” and the good news is that it’s finally happening. Even within the past few months, the pace of change has accelerated. More and more payments to providers are tied to quality and efficiency, and increasing amounts of data on their performance are being published online.
Empathy suffering health careIn my TEDMED talk, I spoke about how the reduction of suffering was becoming the focus for health care. Today, many health care providers are starting to compete on how well they meet patients’ needs.
As this competition increases, health care providers can look to four key thought leaders whose work influences my own every day: Michael Porter, Leemore Dafny, Ronald Burt, and Nicholas Christakis. Individually and collectively, their contributions provide clarity on what we need to do in health care, why we need to do it, and how to get it done.
Over the last few decades, Michael Porter of Harvard Business School has defined the meaning of strategy for business in general. His work on health care clarifies why an overarching strategic goal is important for every organization, and why that goal should be to create value for patients. He and his colleagues have described how multidisciplinary teams should look, and what kind of information and incentives those teams need to drive improvement.
If Porter’s work describes the “recipe” for what we need to serve in health care, Leemore Dafny helps us understand the heat that is necessary to start things cooking. She is the Harvard economist who has studied payer and provider consolidation and shown how it leads to weaker competition and higher prices. I have long been leery of thinking about health care as a marketplace, concerned about unintended consequences if patients have to act like consumers and make tradeoffs in quality and price. But Dafny and her colleagues are persuasive when they argue that competition in a value-driven market has greater potential to drive improvements in quality and efficiency than the alternatives – and that providers like me should embrace competition and learn to trust market forces.
Porter and Dafny’s work tell us what we have to do, and why we have to do it. But how do we get that work done? Part of the answer is to strive for the creation of social capital.
For the last several years, I have given a book to virtually every new close colleague: Brokerage and Closure: An Introduction to Social Capital by University of Chicago sociologist Ronald Burt. We all know about financial capital (the funds that enable organizations to do things they otherwise could not do), and about human capital (hiring good people). Social capital is about how those people work together. If they are reliable in their coordination, the organization can make leaps in quality and efficiency. Burt provides a clear and useful structure for learning (increasing variation in what is done by brokering ideas) and then converging on best practices (closure).
Then there is the challenge of how do we make collaboration and compassion the norm in health care. Financial incentives cannot get the job done. That is why I think so often of Nicholas Christakis, the Yale social network scientist who has shown how epidemics of values and emotions can spread from person to person. While the work of Porter, Dafny, and Burt define the big picture, Christakis characterizes the nature of the work that needs to be done on the ground.
There are, of course, many more colleagues whose work I respect and learn from, but these four constitute a “package” that I think can accelerate the transition to a new and better health care system.
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TEDMED Speaker Tom Lee, on addressing patient suffering in health careIn his TEDMED talk, quality care pioneer and Chief Medical Officer of Press Ganey, Tom Lee reveals his passionate quest to define empathy as a business asset and patient suffering as an outcome.

Being Wrong Can Help Get It Right

By guest contributor and TEDMED 2015 speaker Anthony S. Fauci, MD

One of the best things I have done in my career is admit that I was wrong.

In the early days of AIDS – before we had the first effective treatments – I was a complete believer in the tried-and-true research-to-pharmaceutical pipeline. This rigorous process, based on the gold standard scientific and regulatory approach to clinical trials, usually required many years to run its course. However, for people living with HIV infection in the 1980s, that was time they did not have.

In the late 1980s, the frustration of those affected by HIV/AIDS was reaching a breaking point. Their anger about the pace of research to develop HIV treatments was often directed at me, as I oversaw much of the government’s HIV/AIDS research as director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. I supported what I knew to be an effective research process. However, it was not until I listened to the activists and began to appreciate their concerns by imagining myself in their place, and by inviting them into my office when they demonstrated in protest on the NIH campus that it became clear that something had to change. At that moment, that something had to be me. I ended up working with the activists to develop an unconventional “parallel track” for drug development, one that provided access to experimental drugs for patients in need at the same time that rigorous clinical trials were still ongoing.

A healthy human T cell uninfected by HIV/AIDS.

A healthy human T cell uninfected by HIV/AIDS.

Change, especially the type of change that asks us to question the systems on which we have built our careers, can be difficult. It requires us to at least question and sometimes change our beliefs and habits, and step into unfamiliar territory. Embracing flexibility is sometimes more difficult than maintaining the status quo; however, having this mindset can generate novel solutions. In the case of HIV, by changing the research paradigm and engaging HIV activists as partners in the research endeavor, we were able to develop effective HIV drugs faster, ultimately saving millions of lives.

As the HIV/AIDS pandemic has evolved over the last 35 years, being open-minded remains crucial to defeating this disease. We must continually step back, reassess, look at the larger picture, and identify solutions to seemingly intractable challenges.

Today, science has presented a clear opportunity to end the HIV/AIDS pandemic. We now know that everyone infected with HIV should be offered antiretroviral drugs as soon as the diagnosis is made, for their health and to prevent further transmission of the virus. Last year, NIH-funded research provided strong evidence of the advantage of beginning treatment soon after diagnosis rather than waiting until immune system damage occurs. Clinical trials also have demonstrated that HIV treatment benefits not only the infected individual, but also his or her sexual partners, as lowering the level of virus in the body reduces substantially the risk of transmitting it to others.

Together, HIV treatment and other proven prevention interventions – such as pre-exposure prophylaxis, or PrEP, a single daily pill containing two anti-HIV drugs – provide a powerful toolbox for ending the HIV/AIDS pandemic. If the tools we already have for HIV treatment and prevention were widely implemented, and all HIV-infected individuals were identified and placed in stable, effective medical care, and uninfected individuals in high risk situations were provided prevention tools including PrEP where appropriate, more than 90 percent of new HIV infections worldwide could be prevented each year.

Sadly, the rate of new adult HIV infections has held steady at about 2 million per year since 2008, indicating that despite innovation and advances, we are still far short of our goal of ending AIDS as a major global health problem. Although we have the tools and knowledge to accomplish this goal, substantial barriers still stand in our way. Economics, race, gender, stigma and discrimination all play a role in preventing people from accessing prevention tools, getting tested, connecting to care and accessing treatment.

Hard-won scientific advances collide with these barriers, impeding the progress that research can bring. Just as we did in the early days of the AIDS epidemic, we must now step back and reassess. We must ask ourselves how we can think differently about bringing about an end to this pandemic by more effectively scaling up the powerful tools of treatment and prevention that we know can bring HIV/AIDS to heel. As I have learned, questioning and sometimes changing how we do things can be the first step toward getting things right.
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Anthony Fauci: Learning from the AIDS epidemicIn his TEDMED 2015 talkNIAID Director Anthony S. Fauci, M.D., shares his deeply personal account of how he had to bend certain overly rigid rules of science to fit with the emergent needs of HIV/AIDS patients and activists.

Getting Out of Diabetes Denial

By guest contributor and TEDMED 2015 speaker Laura Schmidt, PhD

As a society, we are confronting some tough facts about the way we eat and what it’s doing to our health. We live in an environment that bombards us with hyper-palatable foods and sugary drinks on a 24/7 basis—products carefully engineered by scientists to be impossibly tempting and habit-forming. It’s not surprising that many of us find it difficult to summon the willpower to avoid heavy use of these products.

But we can’t ignore the warning signs that our food environment isn’t just making us fat, it’s also making us sick. One is the appearance of adult diseases in children. In my parent’s generation, they called it “adult onset diabetes” because only adults got it. Today, one in four American children will acquire Type 2 diabetes within their lifetimes and an alarming half of our children of color.

shutterstock_293590097When problems get this big and overwhelming, there’s a strong impulse to ignore the problem—to fall into “diabetes denial” just like some people deny the reality of climate change. And at its crux, the junk food problem isn’t all that different from carbon emissions. It’s driven by globalizing industries that reap the economic rewards of free trade as governments struggle—and often fail—to establish regulations that protect human and planetary health.

What’s remarkable is how much progress we have made in the short time that I’ve been involved in food policy, particularly regarding sugar. I was an addiction researcher for years before I wandered into food policy research and got stuck. I got stuck by the sheer enormity of the problem and because I could see that time-tested regulatory solutions for alcohol and tobacco could help us clean up our food environment.

What it takes to fix wicked problems is a “virtuous cycle” of public health policymaking. This is no better illustrated than by the war on tobacco—the single greatest public health victory of the 20th century. Here’s how it works:

It starts with courageous public officials telling people the cold hard facts, thus moving the society out of denial. What follows are policies to tax the most harmful products, which generate funds for public health programs, such as public education campaigns and school-based programs. As momentum picks up, policymakers feel emboldened to pass new regulations, such as product warning labels, as well as measures that directly clean up the environment.

In the short time I’ve been working on food policy, I’ve seen the virtuous cycle take off with regards to some of the most harmful products, namely sugary drinks. Here are just a few highlights:

Courageous public officials speak out: Thomas Frieden, Director of the US Centers for Disease Control and Prevention states that “Taxing sugary drinks at 1 cent per ounce could be the single most effective measure to reverse the obesity epidemic.”

Taxes generate funding for public health: First sugary beverage taxes passed within US borders: the Navajo Nation (2015), Berkeley, CA (2015), Philadelphia, PA (2016)

Policymakers are emboldened: First sugary beverage warning label legislation passed (San Francisco, CA, 2015); first US Dietary Guideline setting an national limit on added sugars (2015); first Food and Drug Administration nutrition label to warn consumers of added sugars (2016)

Direct measures to clean up food environments: First state sales ban of sugary beverages in schools (California, 2009); first city to ban sale on all city properties (New York City, 2012); hospitals begin to ban sales (2011)

The first step in recovering from addiction is to stop denying the problem. It is so gratifying to see our society move from denial to action on sugar in just a few years. May we see many more virtuous cycles that promote human and planetary health to come.


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In her TEDMED 2015 Talk, UCSF researcher and sugar policy expert Laura Schmidt questions whether consumers truly have freedom of choice over the foods they purchase and eat in our sugar saturated society. 

Creating sustainable, delicious meat alternatives

By guest contributor and TEDMED 2015 Speaker Patrick O. Brown, MD, PhD of TEDMED Hive Organization, Impossible Foods

The horse was a brilliant transportation technology until we developed the automobile. The typewriter was a wonder in its time until we invented the personal computer. The carrier pigeon was the state-of-the art in mobile communication, until radio communication was invented. Now it’s the cow’s turn to be replaced by better technology.

Cows, and the other animals we cultivate for food, have, for millennia, been our state-of-the-art technology for turning plants into meat. But we need to do better, and we can.

Cattle Farm - An inefficient source of meatAccording to a recent estimate by the International Livestock Research Institute, 45% of Earth’s dry land — a land area greater than North and South America, Australia and Europe combined — is currently being used to support livestock production. According to the UN Food and Agriculture Organization, animal farming uses and pollutes more water than any other industry and generates as much greenhouse gas emissions as the entire global transportation system. And it is the major driver of deforestation and an unprecedented collapse of wildlife populations around the world.

The world is on a headlong quest to produce ever-greater quantities of meat in the belief that we need a growing supply to feed the world. We don’t. The plant crops harvested in 2015 contained more than enough of every essential nutrient to meet the nutritional needs not only of our current population but the 9 billion people who will share the planet in 2050.

Yet people love, and demand, meat; it is both unfair and unrealistic to ask people to change the diets they love. Fortunately, the problem isn’t that people love meat – it’s how we produce it. And that’s a solvable problem.

We simply need to replace the inefficient, unsustainable animal-based technology we’ve used for thousands of years with a better, more efficient and more sustainable way to transform plants into the meat and dairy foods the world loves.

Five years ago, I founded Impossible Foods, assembling a mission-driven and supremely talented research & development team to take on this challenge. They’ve been developing the know-how and inventing technology for transforming simple nutrients from plants into uncompromisingly delicious, nutritious, affordable and sustainable meats and dairy foods. Our first product, the Impossible Burger, will be available to consumers this summer.

A lifecycle analysis shows that producing an Impossible Burger requires less than 1/12th the land and 1/9th the water and emits only a quarter of the greenhouse gasses, compared to producing the same meat from a cow.

The cow is not getting any better at turning plants into meat and it never will. But with an entirely new approach, we are getting better at it every day, and we’ll keep getting better. And we won’t stop until we’ve made all the foods we currently get from animals — chicken, fish, milk, eggs — directly from plants.

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Pat Brown of Impossible FoodsIn his TEDMED 2015 talk, renowned geneticist and founder of Impossible Foods Pat Brown explains how he uses biochemistry to trick plants into producing the same protein as meat – all while tasting just as delicious – in his quest to eliminate the need for animal harvesting.