Learning by accident: Q&A with Patricia Horoho

Patricia Horoho, Lieutenant General in the U.S. Army and the first woman and first nurse to serve as the Army’s Surgeon General, revealed how health care can cause harm by sins of commission and omission. We followed up with Patricia to answer a few additional questions about her topic.

Patricia Horoho at TEDMED 2014 [Photo: Sandy Huffaker for TEDMED]

Patricia Horoho at TEDMED 2014 [Photo: Sandy Huffaker for TEDMED]

What motivated you to speak at TEDMED?
TEDMED presented a wonderful opportunity to present a difficult subject in a supportive environment. The other speakers, facilitators, and the audience provided a unique opportunity to participate in a remarkable forum. I also saw TEDMED as an opportunity to clearly demonstrate that Army Medicine isn’t afraid to confront the issues of medical errors and harm.

Why does this talk matter now? What impact do you hope the talk will have?
The facts aren’t new – we’ve known about the tremendous cost in lives and health of medical errors for at least a decade. Many leading healthcare institutions and researchers have addressed the issue, but we still haven’t made significant progress in addressing the underlying root causes. TEDMED allowed me the opportunity to highlight existing research and present the issue from my vantage point as the Army Surgeon General. I have traveled around the globe since TEDMED talking to Army Medical teams about the subject of preventable harm.

What kind of meaningful or surprising connections did you make at TEDMED?
The opportunity to talk with Delegates after my talk was incredibly rewarding. Many shared with me their personal experiences of medical harm or the challenges of getting their organizations to recognize and address the problem. What I heard over and over again was that the fear of litigation or the shame of making a human error kept good people and organizations from openly discussing the issue.

How has the military responded to your talk and your message about preventable harm?
I found that Army Soldiers and their families appreciated our collective willingness to discuss preventable harm on a national stage. Thousands of military health professionals are engaged in the detailed work that is required to turn the dial down on preventable harm.

I think the military medical community received the talk generally the same way the civilian healthcare community did. As you might expect, there were at least two major groups: 1), those who recognize the problem of preventable harm across American medicine and welcome the discussion even though it is uncomfortable and 2), those who don’t believe there is a problem or think that the issue is being blown out of proportion. The latter group often doesn’t appreciate the difference between “harm” and “preventable harm.” In medicine, we talk about “adverse events” which is a sterile euphemism for harm. However not all adverse events are the same. Some, in fact most, occur due to circumstances that are not under the control of healthcare professionals. When we talk about preventable harm, Army Medicine is addressing both the human and system errors that reach the patient and cause unnecessary harm. These human and system errors can be anticipated and we can improve our processes to ensure that they don’t reach our patients.

What’s next for you?
In the next weeks and months, I will continue to travel to Army Medicine facilities around the world speaking face-to-face with the leadership of every Army hospital about how we will eliminate preventable harm. In addition, I have opportunities to share Army Medicine successes and challenges with numerous members of Congress and oversight committees.

Entrancing dance: Q&A with Art of Motion Dance Theatre

Art of Motion Dance Theatre, known for using dance to explore body and mind as creative instruments, performed a piece celebrating the divinity of nature at TEDMED 2014. We reached out to learn more about their art.

Art of Motion Dance Theatre, a modern repertory dance company, at TEDMED 2014. [Robert Benson for TEDMED.]

Art of Motion Dance Theatre, a modern repertory dance company, at TEDMED 2014. [Robert Benson for TEDMED.]

What is the legacy you want to leave? 

We hope to have vicariously reached our audiences and impacted the way they see dance, understand the complexity of the human body, brain, mind and spirit. The AOMDT’s unique movement vocabulary and repertoire seeks to impact communities with its cocktail of motion fusing elements of street dance with eastern and western vocabularies including the formality of classical ballet, the abstraction of modern dance and the discipline of yoga. We rely and thrive on the collaborative process.

Art of Motion Dance Theatre at TEDMED 2014. [Sandy Huffaker for TEDMED.]

Art of Motion Dance Theatre, a modern repertory dance company, at TEDMED 2014. [Sandy Huffaker for TEDMED.]

What is next for Art of Motion Dance Theatre? 

The AOMDT continues to create new work, perform, tour, teach and collaborate with musicians, orchestras, costume and lighting designers. We are working on varied projects from a “Salute to Disney Homage” to an evening of live music to a new, avant garde work with a NYC composer, Richard Carrick. Richard wrote the score for “Prisoner’s Cinema,” and created a film based on research of prisoners in solitary confinement. We are also creating an in-depth evening inspired by the “Secret Life of Plants.”

Learn more about AOMDT’s experience at TEDMED 2014 here or check out their website for upcoming performances.

What gets your heart racing? Q&A with Foteini Agrafioti

At TEDMED 2014, Foteini Agrafioti raised concerns about today’s passwords and IDs, and shared how your body may provide easier, and more accurate, forms of identification. We reached out to her to learn more about what inspires her work.

"The million dollar question is are biometrics secure? James Bond would have you believe so." - Foteini Agrafioti on the TEDMED 2014 Stage [Photo: Kevork Djansezian]

“The million dollar question is are biometrics secure? James Bond would have you believe so.” – Foteini Agrafioti on the TEDMED 2014 Stage [Photo: Kevork Djansezian]

 

What motivated you to speak at TEDMED?

I felt the need to provide a different perspective on biometric security. Our world is evolving so quickly, and biometric authentication has made its way into our lives. I want people to understand the challenges, limitations and implications of this technology.

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

There is no specific source of inspiration. I go by two rules: 1) never get comfortable and 2) surround myself with people who want to disturb the status quo. It all starts with crazy “what ifs…”. We then quickly test those hypotheses and that’s how the innovation journey begins.

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

Obsess! If you are to challenge the status-quo, you had better obsess about it. Protect your vision in the face of abundant skepticism and never give up. You won’t make an impact just by trying – you must go all the way. In the last decade, I can recall many times that people told me that I was set up for failure. Wouldn’t it be a shame if I had believed them?

What’s next for you?

After leaving Nymi, I joined Architech and founded Architech Labs to do research in the area of human computer interaction. My vision is to build technologies that understand the underlying factors of human behaviors and habits. I am now experimenting with affective computing – the engineering field that studies the human emotion. I believe that emotional intelligence is the last barrier to meaningful human-computer interaction and I am thrilled to be working on this.

A chat about guts and brains

Join TEDMED Speaker John Cryan for a Twitter Chat about the gut-brain connection this Thursday, March 19 at 2:30pm.
Do you want to learn more about the research behind John Cryan’s TEDMED talk, “Food for thought: How gut microbes change your mind”?

As part of Society for Neuroscience’s #BrainWeek, TEDMED is hosting a Twitter Chat with John from 2:30-3:30pm (ET) this Thursday, March 19.

Delve a little deeper into John’s talk and learn more from him about the gut-brain connection.

Tweet your questions using the #TEDMED hashtag!

Meanwhile, watch and share John’s talk to learn more and check out his recommended reading + podcasts.

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

 

 

 

Pursuing Mobility: Q&A with Cole Galloway

James “Cole” Galloway, Director of the Pediatric Mobility Lab and Design Studio and Professor at the University of Delaware, revealed an unusual and inspiring way to unlock children’s social, emotional, and cognitive skills. We interviewed Cole to learn more.

Pursuing Mobility. Cole Galloway at TEDMED 2014. [Photo: Sandy Huffaker, for TEDMED]

Cole Galloway at TEDMED 2014. [Photo: Sandy Huffaker, for TEDMED]

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

This talk matters now because every day that kids sit when they could be moving is a day that can never be regained in their emotional, cognitive, and social development. Children’s inability to move and play has alarming implications for their future, and we can’t sit back and wait for data to be collected or companies to assess the economic feasibility of new devices. We started with high-tech custom robot-controlled vehicles, but we quickly realized that we couldn’t meet demand — we had parents begging us for help. That’s why we turned to off-the-shelf ride-on cars that we could adapt in the lab. The greatest impact the talk could have would be for people across the globe to get involved in adapting cars for children in their own communities. Waiting is not an option when it comes to kids.

What is the legacy you want to leave?

The obvious legacy is the development of simple, elegant mobility solutions for people with special needs — solutions that can be implemented by ordinary people who want to make a difference. I hope that people everywhere get the message about how important mobility is — how critical it is to people’s ability to respect themselves and to gain the respect of others.

Beyond that, I hope I’m remembered for not just what I did but how I did it — not only the product but the process — by inviting anyone who could contribute to join me in this effort. I’ve worked with students at all levels (elementary to post doctoral fellows), faculty, clinicians, family members, and business owners. I’ve collaborated with engineers, various types of therapists, food scientists, writers, restaurateurs, fashion designers, marketing professionals, videographers, museum curators, and graphic designers. If you want to accomplish big things, have a big “party” and invite people who have big ideas.

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

Mobility is a human right. Sound overstated? I dare you to: a) look at the definition of a ‘human right’, b) think a bit about how movement and mobility influence your life (not just your ability to get around, but what that ‘getting around’ means to your thinking, planning, happiness, friendships – all the best things in life and then, c) restrict your mobility to some small degree for an hour.  Mobility is a human right.

What’s next for you?

Playgrounds! An experimental playground lab – at Disney!

More than a gut feeling: Q&A with John Cryan

John Cryan, a neuropharmacologist and microbiome expert from the University College Cork, reveals surprising and perhaps strange facts and insights about how our thoughts and emotions are connected to our guts.

Butterflies in the brain? Neuroscientist and microbiome expert at TEDMED 2014 [Photo: Sandy Huffaker for TEDMED].

Butterflies in the brain? Neuroscientist and microbiome expert at TEDMED 2014 [Photo: Sandy Huffaker for TEDMED].

What motivated you to speak at TEDMED?

It is an amazing opportunity to put forward a relatively novel concept, in my case that the microbiome may be a key regulator of brain function. The microbiome is one of the hottest areas in medicine and this opportunity allowed me to bring this within a neuroscience context.

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

The talk summarizes the research on microbe-brain interactions. This is a rapidly evolving field and truly multidisciplinary in nature; I hope my talk reflects this. This research has implications across many aspects of medicine, including psychiatry, gastroenterology, obstetrics, gynecology and pediatrics.

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

Recently, we have been focusing on why, from an evolutionary context, microbe-brain interactions emerged; I wasn’t able to go into this very much during my talk. At TEDMED I talked about how bacteria are required for brain development and social behavior but don’t ask why; in a recent paper we collaborated with the evolutionary microbiologist Seth Bordenstein from Vanderbilt to discuss some of the reasons behind this.

What’s next for you?

Right now we are looking to understand the mechanisms as to how microbes could influence the brain. Moreover, we are investigating the impact of naturalistic disturbances of the microbiota on brain function and behaviours such as Cesarean delivery, antibiotic use and early life stress.

Join us for a live Twitter Chat with John at 2:30pm EST on Thursday, March 19, as part of Brain Awareness Week! Tweet your advance questions #TEDMED and #BrainWeek. Check back on our blog for chat topics!

A better organ-ized kidney solution: Q&A with Sigrid Fry-Revere

Sigrid Fry-Revere, Founder and President of the Center for Ethical Solutions, discusses issues around organ transplantation policy and provides an inspiring and cost-effective living organ donation solution from Iran. We learned more about her work and vision.

Sigrid Fry-Revere discusses living kidney donation solutions at TEDMED 2014 [Photo: Sandy Huffaker for TEDMED]

Sigrid Fry-Revere discusses living kidney donation solutions at TEDMED 2014 [Photo: Sandy Huffaker for TEDMED]

What motivated you to speak at TEDMED?

I was terrified of the thought of speaking before so many people, but I knew my research in Iran and experience as a rejected living organ donor could save lives.

What impact do you hope the talk will have?

We need to rethink conventional paradigms used for donor kidney shortage. Increasing the proportion of cadaveric kidney donation, while helpful, will never be enough. And, as it relates to living donation, it is not simply a question of whether we allow only altruistic (non-compensated) donations or whether we allow a market. Neither a market system nor pure altruism are necessarily the answer, however compensating living organ donors so that they don’t suffer financial consequences for their altruism is certainly a start. Assisting donors with meeting their expenses, or expressing gratitude with gifts or benefits does not diminish their altruism. Unfortunately, policies that limit efforts to to ensure fiscal health of donors makes taking part in the act of helping friends and family who need transplants a privilege only the wealthy can afford.

What’s next for you?

I want to to spur discussion and change, and to this end, I founded two organizations. Stop Organ Trafficking Now! is lobbying Congress to pay more attention to living organ donation and the rights and needs of those living organ donors. Making living organ donation easier means fewer Americans will brave black market organ trafficking channels to try to save themselves or their loved ones. I also co-founded a charity based on my experiences in Iran. The American Living Organ Donor Fund (ALODF) is a living organ donor support organization that provides information, an online donor support group, and financial assistance with non-medical donation related expenses. ALODF exists to support all kinds of living organ donors – kidney, liver, bone marrow and others – but to date only kidney donors have applied. My research has given me a good idea of what needs are alleviated for Iranian living donors in order to to ease the burden of donation. We lack such data for other countries, including our own, so I intend for the ALODF’s efforts to include learning more about the needs of American living organ donors. The American Living Organ Donor Fund has already made more transplants possible for U.S. citizens in its two and a half month existence than some government funded Organ Procurement Organizations (OPOs) average per month. How is this possible? For one, OPOs focus almost entirely on retrieving organs from deceased donors. Cadaveric organ retrieval is expensive and far less productive than live organ transplants. OPOs receive on average $50,000 per kidney retrieval, and as many as 20% of those organs are not viable for transplant. In the last two and a half months, the ALODF has helped 30 Americans receive transplants by helping their living organ donors with out-of-pocket expenses, spending on average $2,500 per donor. If you do the math, that is twenty times less per transplant than what an OPO receives per transplant.

Any corrections to your talk since you gave it?

In both my book and my TEDMED talk I mention that the Fars Province in Iran (an area surrounding the city of Shiraz) doesn’t allow compensating donors beyond the federal government contribution given to all living donors to help cover expenses. Dr. Malek-Hosseini, the head of the transplant program in Shiraz, Iran, notified me in November 2014 that his province no longer allows any unrelated donors. He believes this will  help prevent the illegal payments or black market sales or kidneys that were occurring in his province. Note, no other region in Iran that I know of has banned paying donors or placed such restrictions on relatedness of donors by blood, adoption, or marriage. However it is important to note that throughout Iran, it is illegal for foreigners to either buy organs or sell organs to Iranian citizens.

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.