Does the Mind Impact Health? A Researcher’s Insights

Alia Crum, PhD, is an assistant professor at Stanford University and is the principle investigator of its Mind & Body Lab. She has won the National Institutes of Health New Innovator Award, a mention in the The New York Times Magazine’s “Year in Ideas,” and was a speaker at TEDMED 2016. Dr. Crum has also worked as a clinical psychologist for the VA healthcare system and as an organizational trainer and consultant. Read more about her work here.

Reprinted with permission from the Robert Wood Johnson Foundation’s Culture of Health Blog.


Three days before my regional gymnastics meet in Arkansas I landed awkwardly on a practice vault, clashing my inner ankle bones. The pain was excruciating – as was the prospect of an injury crushing my dream of competing nationally. I was determined to go on, so I decided to adopt the mindset that I could mentally overcome my physical injury. I diligently iced, taped and tended to it while visualizing myself making it to nationals in spite of the setback.

I competed and placed high enough to qualify, and was elated as well as surprised by how little the pain had affected me. Another surprise: An x-ray the next day showed that my ankle had been broken.

My experience at age 10 shows the power of mindset – the frame of mind through which we perceive, interpret and organize an inherently complex world. The ability to make sense of the world through our mindsets is a natural part of being human. But the mindsets we hold are not inconsequential. In fact they change reality by influencing our attention, affect, motivation, and physiology. I had decided my injury wasn’t going to influence my performance, and almost impossibly, it didn’t.

Experiencing the powerful effects of mindset as an athlete inspired my career as an academic health psychologist. It led me on a journey to find out: just how important are mindsets? Where do they matter most? How can we leverage them to improve health and wellbeing?

The resulting past ten years of research by my colleagues and I has revealed that mindsets are in fact powerful and are often overlooked. Here are some insights from our work.

Your beliefs about stress influence how it affects you.
Stress is a great example of how mindsets can be self-fulfilling. Stressful situations are unavoidable. And yet we’ve found that most people perceive stress as negative – even debilitating. Media or public education campaigns warn us about its harmful effects. However, ample evidence suggests that stress can enhance how our minds and bodies function. It’s how a person thinks about stress that can determine its effects, according to our research.

For example, in one study we told participants – employees in a financial company that was downsizing – that stress can help rather than hurt them. As a result, they reported fewer symptoms of depression and anxiety, higher levels of optimism, and improved work performance versus the control group. In another study we showed that adopting a “stress is enhancing” mindset leads to optimal physiological stress responses, marked by moderate levels of cortisol and high levels of the growth hormone DHEA.

These beliefs about stress tend to be self-reinforcing. So if stress helps you succeed, it reinforces a mindset that stress is helpful. This is particularly important to model for children. Parents can help in explaining that experiencing stress or even failure is a natural part of life that helps us learn and grow stronger.

Mindset magnifies the benefits of exercise.
Another area in which mindsets matter is exercise. In 2007 Ellen Langer and I studied hotel room attendants whose work involved strenuous physical activity. Two-thirds of our study participants had the mindset that they were not exercising enough, that their physical labor was “just work” and not “good exercise.” Once my colleagues and I pointed out that pushing heavy carts, vacuuming, and lifting heavy mattresses qualified as sufficient exercise, they showed improvements in weight, blood pressure, and body fat over the course of four weeks. A control group had no changes. For these room attendants, a small change in mindset measurably impacted their physiological heath. This means that acknowledging the physical nature of our active jobs, or of everyday activities such as housework, grocery shopping, and playing with our kids can help us reap more health benefits from them.

More recently, graduate student Octavia Zahrt and I found that people who perceived themselves as less active than others had up to a 72% higher mortality risk 21 years later than those who perceived themselves as more active, controlling for actual levels of physical activity.

A mindset shift can help you crave healthier foods.
Having trouble sticking to your healthy-eating resolutions? Our research suggests that shifting your mindset can help. On two separate occasions, participants in one of our studies were given a 380-calorie milkshake under the pretense that it was either a 620-calorie “indulgent” shake or a 140-calorie “sensible” shake. When participants drank what they believed was an indulgent shake, they had a significantly steeper decline in ghrelin, a hunger-inducing hormone that regulates metabolism, than when they drank what they thought was a “sensible” shake. Their bodies responded as if they had actually consumed more calories.

Brad Turnwald and I have found that many restaurants describe healthy-menu items using plain language that doesn’t suggest they are exciting and tasty. Yet as we learned in another study, describing vegetables using enticing adjectives traditionally reserved for unhealthy foods – “rich buttery roasted sweet corn,” “slow roasted caramelized zucchini bites” – increased vegetable consumption by 41% compared to the standard approach of touting their health properties.

The moral is that if you want to feel deeply satisfied with healthier foods, eat in a mindset of indulgence! Viewing healthy foods as decadent versus depriving can transform your food choices and your health. Building on these findings, my lab is now designing interventions to help children and adults adopt the mindset that healthy eating is indulgent and fun.

The placebo effect is part of good medicine.
Much of the medical community views the placebo effect as a mysterious, irrelevant, response. Our research instead reveals that it comprises measureable psychological and social components that we can harness to improve health and healthcare: the body’s natural ability to heal, the patient’s mindset, and the physician’s bedside manner.

My lab and others (including the Program in Placebo Studies at Harvard) are studying which mindsets are at play, how they interact with and activate patients’ physiology, and what health care providers can do to shape mindsets that boost the body’s natural healing abilities.

In one study, Lauren Howe, Parker Goyer and I found that when a provider showed competence – such as familiarity with a treatment – and warmth, such as understanding a patient’s needs, values and goals – patients had a stronger response to an inert cream they believed would treat an allergic reaction. This shows that providers can enhance the effect of a drug or treatment with their actions and words. A social context embedded with warmth and competence is especially important in disadvantaged communities where trust in providers may be lacking.

Healthy thinking supports a Culture of Health.
Expanding our definition of health is essential to achieving a Culture of Health. “Health” has traditionally meant an absence of disease. More recently, the definition includes behaviors as well as social demographics and the environment.

Our research adds one more dimension: the critical role of healthy thoughts.

And the role of healthy thoughts is more than just positive thinking. As the studies I described illustrate, mindsets must be specific to have impact: “My work is good exercise.” “Stress helps me thrive.” “This doctor understands me.”

These specific beliefs yield tangible physiological and behavioral consequences. They are further shaped by culture, parenting, healthcare policies and public health messages, and by organizational dynamics, marketing and media.

We can now also see that many current approaches to motivating healthy behavior may, in fact, be counterproductive. For example: constantly warning against the negative effects of stress can reinforce an unhelpful mindset that stress is debilitating. Touting a food’s health properties over its flavor also reinforces the counterproductive mindset that healthy eating is depriving.

I hope these findings will motivate schools, community organizations, health care professionals and others to promote education and awareness of the impact mindsets have on our lives and work to more effectively leverage mindsets to improve health and healthcare.

Mindsets are just one piece in the larger puzzle of factors that influence health. But as I learned at age 10 and continue to learn in my research as an adult, mindsets have a measurable affect on health, and real implications for healing.

A Conversation About Raising Health with Rich Besser

The TEDMED Community is comprised of a powerful network of thinkers, leaders and doers who commit their energy and time towards making the world a better and healthier place. The Community is one of impact and purpose with no shortage of passion from all different points of view, backgrounds and areas of expertise. We rely on our Community to help amplify the voices of those working on the frontlines of health and medicine around the world, whether by collaborating with our Editorial Advisory Board in helping to design the Stage Program, working with our Research Scholars to evaluate potential Speakers, or engaging with Community members in important conversations at TEDMED each year. This passionate group of individuals constantly inspires us.

One of those individuals is Rich Besser, the new CEO and President of the Robert Wood Johnson Foundation. Recognizing Rich’s knack for storytelling and obvious passion for creating a healthier world, we asked him to be TEDMED’s first Session co-curator. The result of this collaboration is the impressive TEDMED 2017 Session called Raising Health. We recently spent some time talking with Rich about his connection to the session and the importance of creating a society that values the health of all children equally.


TEDMED (TM): We are excited to have you as TEDMED’s first Guest Curator of a session! What does this opportunity means to you, and why did you want to focus the session on “Raising Health”?

Rich Besser (Rich): I think this is an incredible opportunity to reach an important audience. The opportunity to be a guest curator gives me the chance to try and change how people think about health in many ways. As a pediatrician and a parent, I know the key role that children play in the health of a community and the health of society. Pediatrics is all about potential and what you can do to make sure that a child has the opportunity to grow up healthy. What I’m hoping here is that with this session people will start to think about all of the things that go into creating the circumstances for a child to be healthy. The speakers that I pulled together for this session look at those circumstances in many different ways that I think will expand the thinking for our audience.

TM: If your session was not limited by time, what are the other topics and themes that you would include?

Rich: I would expand the session to tackle some drivers of health that are a little more challenging to grasp, like housing and transportation and linking those directly to children’s health. I think this session will get people thinking in new ways and expand their ideas as to what it means for us all to embrace the children in our community and give them healthy beginnings.

TM: Given the synergies between your personal commitment to improving health and TEDMED’s commitment to sharing the important work and ideas of those leading the way, is there a recent story that has inspired you as you’ve transitioned into your new role at RWJF?

Rich: I’m really new to the Foundation and it’s been an incredible experience getting to know about the work. I’ve never worked at a place where people have more passion for the mission than they do here at the Foundation, and that’s one of the things that really attracted me here.

During the years that I spent at ABC News, I continued to work as a general pediatrician at a community clinic up in Harlem. Once a week, I would leave the wealthy neighborhood around our offices, get on the number 1 subway train and travel about 15 minutes to clinic where I would care for children, 80% of whom were in foster care. Their stories were just incredible and the experiences that these children, at a very early age, had gone through were incredible. Many had parents who were incarcerated or struggling with issues of addiction. Some children were homeless or physically or emotionally abused. And I know from data that the Foundation and others put out that the future for the children in that community was totally different from the children who lived near our studio around Lincoln Circle. And that’s not acceptable. Geography should not define destiny.

Here at the Foundation, that disparity is not acceptable. So, to be working at a place where the mission is all about ensuring that everyone in America, especially the most vulnerable, has a fair and just opportunity for his or her best health and well-being, to me is an absolute privilege. And to bring that message to TEDMED for me is just a wonderful opportunity.

TM: When you think about your time at TEDMED, are there a couple of things that you hope the community takes away from your session? And when you think about yourself personally, what do you hope to take away from the experience?

Rich: I’m looking for new ideas. I like to talk to people who either haven’t thought about these problems before or are coming at them from a totally different perspective, because I think that’s what challenges us to think about new things and try new potential solutions. What I hope they take away from this session is not just mind expansion, but I hope they come away feeling some ownership of the issues that we’re raising and feeling some inspiration to action. If they walk away asking, “what can I personally do to help my community raise healthy kids, to make sure that every child in my community has the opportunity to live a healthy life?” then I think this session will really be a success.

TM: This year, the TEDMED event theme is “Limitless.” When we think of our theme this year, it’s guided by the idea that–just as your fingerprint is unique impression of you, so is your contribution to shaping a healthier world. As part of the event, we are asking that all of our community respond to this. What would your response be – how are you shaping a healthier world?

Rich: You know, I am trying, through the work that I do and through how I lead my life, to help create a society in which we all value every child as if they were our own and where we are creating the circumstances so that every child has a chance to be their most successful and their healthiest. I remember when I was in college feeling a sense of idealism and wanting to make the world better. People would say that you grow out of it. I haven’t grown out of it and I hope I never do because I think that when you’ve got big goals and you really believe in the power of change, and the power of people coming together, and the goodness of people, that is when we can make a big difference in the world for people now and for future generations.


Learn more about the Raising Health Session and the inspiring Co-host and Speakers who will bring it to life:

Rich Besser, Pediatric Health Reformer
Camila Ventura, Zika Family Caregiver
Chera Kowalksi, First Responder Librarian
Dan Knights, Computational Microbiologist
Heidi Allen, Health Access Investigator
Howard Stevenson, Racial Literacy Leader
Jill Goldstein, Clinical Neuroscientist
Sandy Hassink, Pediatric Obesity Fighter

Working with our body’s defense system

When foreign microbes invade our bodies, our immune system—complex networks of cells, tissues, and organs—spring into action to protect us. But the immune system has been historically tricky to understand: sometimes it attacks itself, such as in the case of autoimmune disease, and in other cases, it can be harnessed as a treatment option to fight certain diseases, such as cancer. This year at TEDMED, Speakers and Innovators will share how they’re each working to create a better understanding of our immune system and how this internal defense system keeps us healthy.

At his lab at the Technion-Israel Institute of Technology, systems immunologist Shai Shen-Orr is committed to understanding the complex immune system from a more integrative—or systems—level. To do this, the lab is pulling together data mined from scientific publications using a software they developed called immuneXpresso, which helps to connect the dots between the interactions of various cell types and regulatory molecules. This information is then combined with genomic-level data in an effort to create a fuller picture of our immune systems, and to enable a better understanding of how its individual parts work together to orchestrate immune responses.

Additionally, Shai is working to identify biomarkers for health and proper immune function. Biomarkers represent an increasingly exciting area of research, not only because they help to advance our understanding of the inner workings of the immune system, but also because changes in biomarkers can indicate responses to a variety of factors such as pathogens, environmental changes, and disease. When we know how and why the different components of our immune system respond to certain triggers, we can translate that knowledge to advance medicine through the development of new and improved treatments and cures. Importantly, we can also harness these insights to help us understand more complex systems in our body more generally.

There is still much to be discovered in terms of how the immune system operates in response to various pathogens and diseases. The immune system becomes even more complex and difficult to understand when it functions abnormally in patients with autoimmune disease, in which it mistakes normal cells as foreign and attempts to protect the body from itself. Dr. Betty Diamond has devoted her career to understanding autoimmune diseases and the various systemic defects that are often present in autoimmune patients as a result. Specifically, her work focuses on the mechanisms of DNA-reactive B cells in patients with lupus, as well as the role of antibodies that breach the blood brain barrier in patients with and without autoimmune disease. Currently, she and her team are researching if these antibodies breaching the blood brain barrier are responsible for some instances of autism and PTSD. With her research, Betty aims to unlock new methods of preventing and treating autoimmune diseases.

For the millions of people worldwide who suffer when their own immune system turns against them, today’s treatment options are limited and inefficient. For instance, many existing treatments such as systemic steroids and immunosuppressants act broadly throughout the body. As a result, the body is forced to absorb the consequences of unnecessary systemic exposure, which may leave the patient with unwanted side effects. Alivio is pioneering a new approach for treating autoimmune and inflammatory diseases based on the concept of targeted immunoregulation. With co-founder Dr. Aleks Radovic-Moreno, the company’s novel hydrogel technology is offering an alternative treatment for autoimmune and inflammatory diseases. By entrapping immunoregulatory drugs and adhering them to inflamed tissues, Alivio’s hydrogel delivers drugs locally based on the level of inflammation. It’s not a one-size-fits all, systems-wide dose—if there’s a flare of increased inflammation present at a particular location, then the patient receives more drugs to that spot.

With autoimmune and inflammatory diseases, protecting the body from its own strong defense system is a complex and difficult challenge. However, the power of the immune system can also be harnessed for good. Oncologist Lennie Sender is exploring the potential of immunotherapy and immunology to treat different types of cancer. At TEDMED, Lennie will share his insights into immunotherapy’s potential to be the latest “breakthrough” in cancer treatment since chemotherapy. Since its advent, there have been numerous conflicting reports about whether immunotherapy (or immuno-oncology) will be a “silver bullet” for different types of cancer, or if such expectations are based on hype or limited evidence. Many of the misconceptions about immunotherapy’s potential are due to our limited understanding of the immune system and how it protects us from disease, and Lennie will shed light on these complicated topics during his Talk.

Comprehending the complexities of the immune system is an ongoing challenge, and these Speakers and Innovators are advancing our understanding of this intricate system each day. From working to understand the immune system and autoimmune diseases from a more holistic perspective, to harnessing the power of the immune system to fight inflammatory diseases and cancer, TEDMED 2017 will feature pioneers who are pushing the limits on what we know and what we can achieve.

Building healthy foundations for life

If we want to build a stronger foundation of health for tomorrow, we need to start with our children today. This year at TEDMED, the program will showcase Speakers who are are dedicated to supporting young people in shaping positive, healthy lifestyles. From helping children living in challenging environments to make healthier choices, to supporting transgender teens and their families with mental and physical health services, to providing young people with new tools to deal with the effects of race issues, these three TEDMED 2017 Speakers are empowering the next generation to navigate today’s complex health challenges and to take charge of their own health.

Physician Sandy Hassink has dedicated her career to helping children achieve a healthy weight. As President of the American Academy of Pediatrics (AAP) and Chair of the AAP Institute for Healthy Childhood Weight Advisory Board and Steering Committee, Sandy aims to ensure every child has access to a healthy and supportive environment, where nourishing food and opportunities for physical activity are readily available. Unfortunately, many Americans don’t live in communities that enable healthy behaviors. For instance, over 23 million Americans (including 6.5 million children) live more than one mile from a supermarket. With this type of statistic in mind, Sandy stresses the importance of understanding that the health decisions people make go beyond willpower or lack of knowledge, and she focuses instead on the ways a person’s neighborhood and physical surroundings ultimately affect their diet and activity choices. Furthermore, Sandy believes influencing healthy behavior is less about telling people what to eat or how to move and more about getting families and children involved in shaping their own healthy lifestyles. Bringing health closer to home has the potential to make long lasting positive impacts—as Sandy puts it, “good nutrition in childhood sets the stage for lifelong healthy eating.”

While childhood obesity is considered one of the nation’s largest health concerns, other important issues related to the health of young people have started receiving more attention in recent years. Gender dysphoria, or the distress that occurs when an individual does not identify with the sex and gender they were assigned at birth, affects an estimated one in 30,000 males and one in 100,000 females in the United States (though data is limited, and studies from other countries suggest this number may be higher). Yet when pediatric endocrinologist Ximena Lopez was first approached by parents looking for medical advice for their child, who was struggling with gender dysphoria, Ximena learned that the only experience her hospital had with transgender youth was in the psychiatric ward. Due to reasons such as discrimination, bullying, isolation, and lack of support, the prevalence of suicide attempts among transgender individuals is 41%—compared to 4.6% of the overall U.S. population. Ximena knew she had to do something to help. In 2014, Ximena founded the Children’s Gender Education and Care Interdisciplinary Support Program, or the GENECIS Program, at Children’s Health in Dallas, Texas, which has grown from five patients to 60. The multidisciplinary team at GENECIS works with patients on everything from medical interventions to mental health support. Ximena stresses that early intervention, treatment, and parental support are key ingredients to a successful outcome. “The parents feel like you’re saving their children,” she says, “and these patients feel like you’re saving them.”

Children and young people confront different types of health stressors every day. Race issues, often a taboo topic and not openly discussed, can be at the root of emotional stress for many young people. Howard C. Stevenson believes it is essential that everyone is given the tools and skills to openly talk about race and to express ourselves in a healthy way when faced with racially stressful situations. To foster these types of important conversations, Howard promotes racial literacy—“the ability to read, recast, and resolve racially stressful encounters”—in schools, families, and communities. At the Racial Empowerment Collaborative, where Howard is Executive Director, programs like EMBRace (Engaging, Managing, and Bonding through Race) are designed to help children and parents reduce and manage racial stress and trauma. Instead of internalizing the emotions connected with racially charged encounters, these programs empower young participants with the tools to successfully navigate difficult conflicts. Through the Collaborative, Howard is helping youth to reduce stress, build confidence, and to stand up for themselves in a productive and healthy way.

The Racial Empowerment Collaborative at Penn GSE.

Kids are the future. Yes, it’s a cliche, but it’s also the truth. These three thought leaders recognize the importance of equipping the next generation with the tools they’ll need to navigate important health decisions and empowering them with the knowledge to live healthy lives now and into adulthood.

Can Learning Social Skills in School Pay Off Beyond the Classroom?

This post was originally published on The Robert Wood Johnson Foundation’s Culture of Health blog.

This is the first of a 5-part blog series, curated by RWJF, a TEDMED Global Partner. This blog series showcases the real and tangible ways that communities around the country are supporting the healthy development of children and young adults. The series helps to set the stage for the important conversations about child health and development that RWJF will host at TEDMED this year.

By Mark Greenberg and Tracy Costigan


Social emotional skills can help students set goals for themselves and build positive relationships with peers. They can also lead to long-term societal benefits that extend far beyond the individual child.

At an elementary school in the Menominee Nation in Wisconsin, the school day starts in an unusual way. Before they do anything else, students sit down at a classroom computer and select the face that best matches how they feel that morning.

If they’re feeling upbeat, they pick a green, smiling face. If they’re upset about something, there’s a red sad face. And if they feel somewhere in the middle there’s a yellow neutral face. This exercise helps these students develop self-awareness and emotional management skills. It also helps teachers recognize which students are having a tough day and where they might need help.

Ryan Coffey, a teacher and counselor at the Wisconsin school, calls this simple check-in an incredible tool that “can change the whole day.”

A 2nd grade Menominee student starts the day with mindfulness meditation.

“It’s about being proactive—before they blow up—instead of reactive. Because [incidents in the community] are hard on them, hard on their classmates and hard on their teacher. It’s traumatic for everyone. When they get older, those negative coping skills lead to the smoking, the drinking, the drug use. If we give them positive skills now … those are life skills they’ll use forever.”

This community has recognized, and put into practice, what research increasingly shows is clear: social emotional development is essential to long-term wellbeing and success.

In fact, building social emotional skills in students as young as kindergartners can have long-term benefits, not just for the students themselves but for society as a whole. Every dollar invested in effective social emotional programs in schools can bring an average of more than $11 in benefits in the long run.

These benefits come in a few different ways. First of all, students with stronger social emotional skills tend to do better in school. One study of eighth grade students found that a measure of self-discipline—one aspect of social emotional development—was a better predictor of grades, school attendance, and admission into a competitive high school program than even IQ.

Secondly, social emotional development can help students graduate from college and land a well-paying job. Children who demonstrate greater social emotional skills as young as kindergarten are more likely to have graduated from college and hold a full-time job 20 years later. Adolescents with these skills earn more as adults.

The long-term benefits of self-control, managing one’s emotions, and building strong relationships extend beyond the educational setting itself. Research shows that children with a stronger social emotional skill set were less likely to experience health problems, struggle with substance abuse, or engage in criminal activity as they got older.

All of these positive long-term outcomes benefit not just the student, but broader society. For instance, when students succeed in school and grow up to become productive adults, they’re ultimately supporting the overall well-being of their neighbors and communities. If, as adolescents grow older, they avoid substance abuse and crime, they’re also preventing associated societal costs.

Now, it’s no secret that investing early, supporting the whole child and student early on, pays off in the long run. Additional research further illustrates how early education programs promote social mobility within and across generations, helps prevent obesity, reduce health care expenditures and leads to overall higher-quality of life.

But what is new and exciting is that more and more schools are putting these social emotional principles and programs into practice the way the Menominee Nation is. Schools have always focused on building the academic skills and knowledge of students, and we’ve always viewed that as a long-term investment in our human capital. A large and growing body of research should make it clear that supporting students’ social, emotional, and physical health is just as strong an investment.


Learn more about research from RWJF and Pennsylvania State University, covering how teachers, parents, schools and others can support the social emotional learning of students.

Talking about our health

Many of us have experienced some level of anxiety at the doctor’s office. There we are, sitting in a chilly room dressed in a paper thin, wearing an open-backed robe, and feeling vulnerable. We find ourselves tempted to exaggerate the amount of time we spend at the gym each week or to downplay the number of cocktails we drink on weekends. We are itching to ask whether our contact lenses can get lost in our eyes, or if that new juice cleanse has any merit—but we don’t. From worrying about looking foolish to fearing that you’ll learn that a weird mole may be much more serious than you thought, there are any number of reasons why we don’t ask our doctors the health questions that plague us. And as a result, there’s a breakdown in communication about one of the most important things we have—our health. At TEDMED this year, we’ll hear from Speakers and Innovators who are actively improving the way we approach conversations about health and the decisions we make about our care.

When communicating with your doctor, it can often feel like you don’t speak the same language. Maybe they use medical terms you don’t understand or offer prescription advice so quickly that you’re not able to absorb the fine details. However, working with your physician and navigating the health care system gets infinitely more difficult when they literally don’t speak the same language as you. That’s where ConsejoSano, founded by Abner Mason, steps in. ConsejoSano is the country’s only patient engagement and care navigation solution for the 54 million Hispanic Americans who prefer to communicate in Spanish. Driven by the goal to meet “people ‘where they are’, linguistically and culturally”, Abner believes that the company’s data analytics, multi-channel messaging, care navigation, and round-the-clock access to native Spanish­-speaking medical advisors will be the formula needed to tackle health disparities and improve outcomes for the underserved Hispanic population.

Even when there’s no language barrier between you and your doctor, having an open and honest conversation with them can sometimes feel awkward. James Hamblin knows it can be uncomfortable to have frank conversations about our health, so he uses humor to answer many of the questions that cross our minds, but that we feel nervous to ask aloud. His columns and videos for The Atlantic acknowledge that healthy choices rarely fall under “all” or “nothing” labels, and that real people fit into those categories even less frequently. James tackles complicated questions like, “if someone chooses to smoke, should they smoke filtered cigarettes?” and fundamental curiosities such as, “how does sunscreen work?” His light-hearted and fact-driven approach makes the conversation about healthy living less intimidating and more accessible.

Like James, Meg Gaines feels strongly that patients need to take a more active role in their own health. As a cancer survivor and attorney in Wisconsin, Meg is committed to improving the physician-patient relationship, which can often be defined by either distrust or implicit trust. Meg says that both can be dangerous. Meg’s philosophy is that by laying a foundation of patient, family, and community participation in health care, we can reframe the idea of health care “delivery” to health care “co-creation.”

Even when we’re able to work closely with our physicians and take control of our own health, many of us are prone to falling back on long-held beliefs and resisting scientific facts. Sara Gorman’s work examines the reasons why it’s so difficult for us to change our minds, even in the face of evidence. For example, why do so many people believe vaccines are harmful, when there is scientific evidence that they are not only safe, but beneficial to our health? Like Meg, Sara advises physicians and health care providers to reconsider their approach with patients. She also offers tips on how providers can help patients understand the health-related options they have and the role providers play in assisting people to make scientifically sound decisions.

Unfortunately, the science isn’t always so black and white. What do we do when trusted news sources treat ongoing scientific investigations as a series of press releases? Massive Science, co-founded by Nadja Oertelt, wants to change the way science is reported. Their mission is to provide accurate, detailed, and clear science stories to the public—directly from researchers and scientists. By working closely with scientists, and helping them to talk about their work in ways that the broader public can understand, Massive is opening up lines of communication between scientists and the science-curious.

Whether it’s making health conversations more accessible, helping people change their minds in light of new evidence, or taking a new approach to sharing scientific data, these Speakers and Innovators see value in improving the way we approach conversations about healthcare and health-related science. By improving lines of communication between patients and physicians—and getting everyone on the same page—we can expect higher patient compliance and better health outcomes.

Patient-artists in medical schools

The trend of including the arts and humanities in the medical education realm is growing rapidly. Studies show immersion in the creative arts improves students’ observation skills, empathic engagement, and even a comfort with ambiguity. Major medical schools around the United States are investing in artists and creating innovative programs, and patient-artists are leading the way.

As Artist-in-Residence at the University of California Los Angeles and now at the University of Southern California, I have been honored to curate gallery shows that have energized the student body and faculty into engaging around topics that bridge the continuum from bench research to patient care.

At the Keck School of Medicine at USC, this curation has produced exhibits that illustrate the patient experience to future medical students, faculty and researchers. The idea is that a painting or work of art can reveal useful information about a patient’s lived experience better than the medical record or a list of lab values can. This is what has led the school to integrate the shows with its core curriculum in the first 2 years and explore the possibilities that have opened up. Interviews with the artists followed by Q&A with the students have led to discussions about the clinical gaze, embodiment of illness, metaphorical language and how visual representations can allow patients and doctors to bridge the communication divide effectively and with compassion.

Image from “Artist & Researcher.” By Qathryn Brehm, Los Angeles, CA

A perfect example of this is Siobhan Hebron, a performance artist with a brain tumor. She describes her experience of living with a serious and life-shortening diagnosis with an unflinching gaze and in this way allows the viewer into an empathic engagement without resorting to a reductive stance. She is much more than her illness, and yet she is also ruled by her illness. Such is the tension that exists in the lives of those who are living with chronic or life-threatening illness. And this is the landscape that the physician of the future will have to become familiar with as technological advancements make living with chronic illness a broader and more common reality.

In the Spring/Summer of 2017, I organized “Artist & Researcher,” a show that paired artists from the community with USC’s medical researchers to create visual and representational art about their research. The thought was that translating the impact and the beauty of the research in this way would inform the lay public, patients and the medical community in general about the work being done on campus. When the show was conceived my assumption was that the flow of information would go in one direction, researcher to artist. The researcher would explain and the artists would create. However, something quite unexpected was noted to happen: the researchers said that their conceptualization of the work was altered by having such in-depth discussions with non-researchers, and that the artist’s depiction of their research gave them a fresh outlook on the subject.

Image from “Pain”, a mail in art show at USC’s Keck School of Medicine. By H.M. Murphy, San Diego, CA.

In the Fall of 2017, the show “Pain 2” explores pain and the different ways that people from different cultures might depict the subject. An international call for mail-in art was sent out earlier in the year, and the gallery received over 300 pieces of mail from 18 countries. Images about subjects as varied as a simple stubbed toe to cancer, suicide, parental detainment during WWII, to life in prison and ever-present back and head pain came in packages and postcards of all sizes and shapes. The results were revelatory. As a patient with a painful illness of my own (Gaucher Disease) I had assumed that the majority of images would be about physical pain, but in fact, almost 40% touched on emotional pain and depression. There was also one image decrying the pain of a parking ticket. A favorite pieces of mine.

Solo artist shows, mail in art show or artist and researcher shows, the response from the medical community and public has been immediate and positive. The level of engagement in the sciences is enhanced by this transmission of ideas in the visual medium, while the creativity and risk-taking inherent to the arts, in turn, informs the research process and brings us closer to the consilience of these two seemingly disparate yet deeply connected realms.

These art exhibits and the patient-artists who make this kind of art serve as a potent resource for the medical educator training the next generation of doctors. The lessons these patient-artists embed into their work are not to be found elsewhere, and do justice to the complexity of illness in a manner not available in any other medium.

Healthcare Accessibility: A Look At The Numbers

At TEDMED this year, we will hear from three Speakers and Innovators who approach health care through the lens of economics. Through their work, we will explore different ways to think about allocating our finite resources in a world of limitless possibilities.

A natural experiment is an observational study that allows for the random—or seemingly random—assignment of study subjects to different groups. These kinds of experiments are rare but important when studying ideas that are impossible or unethical to recreate in the setting of a controlled experiment. Former Emergency Department social worker-turned-Medicaid researcher Heidi Allen seized the opportunity to study one such organic experiment in 2008, when the state of Oregon decided to expand its Medicaid program. There were 90,000 people who signed up for the expanded program, but as a result of limited funding, only 10,000 people were chosen to participate by random lottery. This unique circumstance provided Heidi and her team of researchers a randomized controlled trial with which to study the effects of Medicaid coverage.

The experiment’s results were complicated in terms of their impact on the newly-covered patients. Some outcomes were clearly positive—such as patients experiencing declining rates of clinical depression and financial stress as their medical debts decreased. Other results were less desirable. For instance, data indicated that the newly covered patients’ physical health markers—such as blood pressure, cholesterol, and cardiovascular disease—did not significantly improve. Along with these results, valuable lessons were learned. Heidi’s landmark research helped uncover truths about the role that health insurance plays in the lives of low-income Americans with limited access to coverage.

Even for people with health insurance, trying to understand or predict the costs that will accompany health care can become overwhelming. Often, it’s impossible to ascertain the cost of medical procedures in advance, and it’s not unusual for surprise bills to arrive months after your appointment. Eligible co-founder and CEO Katelyn Gleason wants to take the mystery out of medical billing. By integrating with existing medical systems, Eligible offers patients up-front information on the price of their procedures and co-pays, allowing them to pay at the time of service instead of waiting for months to receive a bill. Eligible not only benefits patients, but also physicians—who are saving valuable time not having to track down patients’ payments, helping them to collect up to 700% more revenue at the time of service.

While Katelyn is helping patients and providers demystify health care billing, health policy expert Amitabh Chandra is focusing on the important role that precision medicine will play in the future of drug pricing. Amitabh encourages us to consider the economic choices necessary to fund the next generation of medicine, in which the creation of targeted therapies that apply to smaller groups of people will change the economics of pharmaceuticals as we know it.

Funding and research in precision medicine are booming and for good reason: this approach hopes to maximize efficiency when treating disease. Currently, the Orphan Drug Act and other FDA regulatory incentives provide economic impetus for pharmaceutical companies to pursue precision medicine research. Yet it’s important to recognize that smaller markets, less competition, high technological manufacturing costs, and increased effectiveness could all result in eventual rising drug prices. Amitabh explores how we can incentivize companies to continue making precision therapeutics that patients can actually afford.

We are excited to hear more from each of these TEDMED Speakers and Innovators about their work investigating ways we can maximize our resources in economically sustainable ways. Join us at TEDMED this year to get to know them and their work better.

What Home Means to Health

As the WHO explains, individual and community health is driven by a variety of factors including the “social and economic environment, the physical environment, and an individual’s behaviors and characteristics”. Only when a person’s social and physical environments are taken into account can we address his or her full health profile from a comprehensive and holistic perspective. This year, we will hear from Speakers and Hive Innovators who are digging into these critical social and environmental factors as a means to improve health.

Miners in Appalachia began the process of mountaintop removal (MTR) coal mining—literally blowing off the tops of mountains—in order to access coal with lower sulfur content. While this type of surface mining holds fewer health risks for miners, the health implications for people living in close proximity to MTR locations had long been unknown. After moving to West Virginia, Professor Michael Hendryx became fascinated by this process of coal extraction and began to study the relationship between mountaintop removal coal mining and the health of people in nearby communities. He discovered an independent correlation between poor health outcomes and proximity to MTR sites, likely due to increased levels of the toxicant crystalline silica (a known contributor to lung cancer that is released from coal). Michael’s findings have been met with strong political resistance, perhaps, in part, because they are based on correlations, rather than causation. As he works to establish direct connections between environmental effects and physical health, mountaintop removal coal mining continues to take place, unleashing salts and trace minerals into the air and nearby mountain streams. Michael is hopeful that his research will encourage policymakers to consider the full picture when assessing the environmental impacts of any energy source.

Like Michael, Sara Vander Zanden of The BLOCK Project recognizes that where someone lives greatly contributes to their health. The BLOCK Project presents a new solution to homelessness, encouraging communities to place a BLOCK Home in the backyard of a single-family home on residentially-zoned blocks in Seattle, Washington. Their artfully designed 125-square-feet homes are off the grid and equipped with a kitchen, bathroom, sleeping area, composting toilet, greywater system, and solar-panels. The BLOCK Project aims to “offer opportunities for healing and advancement to those formerly living on the fringes of society” by fostering connection and community relationships, halting the emotional and physical separation that coincides with the social injustice of homelessness.

A BLOCK Project home, designed by BLOCK Architects.

Surprisingly, our physical environment’s impact on our health starts as early as in our first home—the womb. In her research, neuroscientist Jill Goldstein explores the impact of a fetus’s physical environment on the prenatal development of the brain. Jill’s research has identified that prenatal disruptions (such as a traumatic experience or chronic stress) for a pregnant mother can impact her developing fetus’s brain circuitry. These changes in circuitry can predispose the fetus to certain chronic diseases—such as depression or CVD—years down the line. Stressful external circumstances—such as living in socioeconomically disadvantaged areas—can be physiologically internalized and not only affect an expectant mother’s well being, but also that of her unborn baby.

As these Speakers and Hive Innovators show, addressing the influences of our social and physical surroundings can improve health outcomes beyond the limits of our previous understanding. We’re excited to showcase these individuals and their game-changing work at TEDMED 2017—and we hope that you’ll join us.

Impacting the way we approach family planning

In the United States, 45% of pregnancies are unintended. Just under half of those pregnancies are aborted. Since the conception of birth control pills in the 1960s, the role of preventing unplanned pregnancy has largely been seen as a “women’s issue”. Andrologist John Amory is determined to change that, by enabling men to share greater responsibility for family planning with the development of a better, novel form of male contraception. For over 100 years, there have only been three forms of male contraception – condoms, vasectomy, and abstinence.

Dr. John Amory in his lab at the University of Washington Health Sciences in Seattle, WA.

The development of male contraceptives poses unique physiological challenges. Unlike the female reproductive system which experiences periods of fertility and infertility at regular intervals each month, the male reproductive system is constantly fertile, making 1,000 sperm every day from puberty until death. John is exploring the use of testicular retinoic acid biosynthesis inhibitors to block sperm development as a reversible male contraceptive. Undaunted by the many challenges of his work, John is committed to creating a contraceptive that promotes greater sharing of responsibility between both sexes when making decisions about family planning.

While John is helping parents delay pregnancy until the time is right, for many parents the decision of when – or whether – to have a baby is influenced by biological factors outside of their control. When pregnancy does occur, the fertilized embryo has three genomes: one set of nuclear DNA from dad and one set of nuclear DNA from mom, plus an additional mitochondrial DNA (mtDNA) inherited exclusively from the mother. Mitochondria, or “powerhouses of the cell”, have their own set of DNA which codes for proper energy production and cellular function. Mutations in mtDNA result in a spectrum of incurable diseases, commonly presenting with symptoms like muscle weakness, seizures, developmental delay, or organ failure.

So what if a woman with unhealthy mtDNA wants to become a mother without risking the health of her baby? University of Newcastle professor Mary Herbert provides a solution by transferring a woman’s nuclear DNA and a man’s nuclear DNA into a donor egg containing healthy mtDNA, from which the existing nuclear DNA has been removed. This allows the woman affected by mitochondrial disease to have a child without passing on mutations in mtDNA. The donor egg provides a subset of DNA to the baby, but the genetic characteristics of the baby are completely determined by the nuclear DNA, not by the mitochondrial DNA of the donor. Through this work, Mary is pushing the limits of our understanding of reproduction and looking toward a future where certain mitochondrial diseases can be eliminated from a family for generations to come.

Mary is helping women who carry genes for devastating diseases conceive healthy babies, but what is being done to help women have safe deliveries during childbirth?

Compared to countries of similar wealth, women in the United States have a greater risk of maternal mortality with rates increasing 27% since the year 2000. According to the CDC, 60% of these deaths are preventable, commonly resulting from complications like maternal hemorrhage which can arise without the warning flags of predisposing risk factors, making it difficult to predict. Siddarth Satish, founder of Gauss Surgical, realized that every vital sign is carefully measured in an operating room – except for blood loss. He created Triton OR, an FDA-approved blood loss monitor that provides real time feedback on blood loss, optimizing transfusion decision making and predicting postoperative hemoglobin levels. Siddarth’s innovation helps improve patient outcomes, with the ability to help make childbirth safer – for both the child and the mother.

These 2017 TEDMED Speakers and Hive Innovators are moving beyond what were once thought to be limits when it comes to family planning and childbirth. Join us this November to hear their stories.