TEDMED Blog

Overheard at TEDMED: Let’s Dance

Optimized-MichaelPainterThis guest blog post was written by Michael Painter, senior program officer and senior member of the Robert Wood Johnson Foundation’s Quality/Equality team.

Most have seen Derek Sivers’ 2010 TED talk, “How to start a movement.” In it a horde of dancers danced. That horde didn’t come out of nowhere of course. It started with a single nutty guy’s idea of a dance. Soon another joined, then more and more. Those two eventually became that dancing horde. Change—even big change—is like that dance. It starts small. An idea moves out of a mind into a conversation. Sometimes a small conversation, even over lunch, turns into a bigger one—a much bigger one.

At TEDMED 2015, TEDMED asked its community to dance about health. They asked each of us: what is your role in building a Culture of Health? Sure, we can agree on an ultimate far-off health goal for the country: everyone would have the hope, the means, and lots of opportunities to lead the healthiest lives possible. There are many (many) ways to get to that future. Some of those ideas can be remarkably different—most of them aren’t easy—but together they will help us create our Culture of Health dance.

TEDMED drove that conversation—that dance—with open-ended questions to spark powerful discussions about the role of health in our lives and communities. More than 800 TEDMED Delegates participated on-site, and over 150 contributed their perspectives online in response to thought-provoking questions like:

  • What is masquerading as health?
  • How can business positively impact society’s health?
  • Name one small shift that would make the biggest impact on health?
  • What is the secret to making health a shared value?

Blog post 4A dance floor is only as rich as its many wild dancers. The TEDMED team captured over 1,000 responses that reflected a range of diverse thoughts and insights from health care professionals, government officials, scientific researchers, entrepreneurs, journalists, bloggers, and more.

Blogpost3These TEDMED dancers pointed to barriers and opportunities that will help us all make health a shared value. For example, many questioned whether we have placed too much trust in technology and the latest health apps and gadgets, instead of focusing on building real-life social connections and trusting human relationships. Conversations also highlighted the importance of addressing social determinants (such as housing, discrimination and economic status), and debated whether the government should try to provide incentives for healthy behavior.

TEDMED saw some emerging themes in the Culture of Health dance, summarized in the attached piece. Take a look. See what you think. Help us keep the conversation going in your communities – both online (using the #CultureofHealth and #TEDMED hashtags) and off. We can absolutely build our healthy future—but only if we dance together. Is your toe tapping yet?

Meet Dr. Pamela Wible, physicians’ guardian angel

In this interview, TEDMED’s Dr. Nassim Assefi and founder of the Ideal Medical Care movement Dr. Pamela Wible discuss physician suicide, sexism in medical school, and how to escape “assembly-line medicine.” You can watch Pamela’s TEDMED 2015 talk, “Why doctors kill themselves,” here.

Pamela Wible

Nassim: You’re one of the few physicians I know who’s been outspoken about physician suicide, open about her own history of depression while in medical practice, and proactive in addressing medical student and physician mental health. How did you become such an activist?

Pamela: I’m an activist and community organizer at heart. I was born into a family of physicians, activists, and entertainers. My grandfather started the motion picture workers union in Philadelphia. I’m related to Curly, Moe, and Shemp of the Three Stooges. It’s in my blood to be joyful, comedic, and lighthearted, but also to speak up for the oppressed and victimized. I’m a born healer and problem solver—whether it’s a patient with an ingrown toenail, a doctor with PTSD, or a suicidal health system. I’m curious, relentless, and very vocal about injustice. Yet without action, words fall flat. Action is what excites me most.

Nassim: You’re a somewhat controversial figure in such a conservative profession. You wear glitter, throw Pap parties, and even deliver balloons and homemade soup to your patients during house calls. Is this quirkiness and whimsy an intentional strategy to spread joy and love in your medical practice or just an extension of who you are? Have you ever received pushback from a mistrusting patient or colleague?

Pamela: My personality and my glitter are not strategic. I’m just being me. I find that when I am free to be myself, my patients feel free to be themselves. Authenticity is therapeutic for us all. Authenticity is also sorely lacking in health care, much to the detriment of physicians and patients. Medicine has too many starched white coats and not enough color, soul, and feeling. My patients are relieved and even thrilled to meet a “real” doctor who is a “real person.” Once (in response to an article I wrote for a medical journal) I did receive a letter from a male clinic manager who claimed my appearance was unprofessional. I recited his letter and responded to his concerns in my TEDx talk, “How to get naked with your doctor.”

A surprise birthday party physical at Pamela's clinic.

A surprise birthday party physical at Pamela’s clinic.

Nassim: You’re a pioneer of the Ideal Medical Care movement, have written a book about it, and offer courses and retreats to help doctors escape “assembly-line medicine.” Can you give me the nitty-gritty on ideal medical clinics?   

Pamela: I’m simply practicing medicine the way my dad used to practice as a neighborhood doctor back in the 1950s (though I’m pretty sure he didn’t throw Pap parties for his ladies). Like my dad, I have no staff and I’ve never turned anyone away for lack of money. My dad and I genuinely love people, and I’m sure patients can feel the love.

I see 6 to 8 patients per half day for 30-60 minute visits. I document on an electronic medical record that I created myself on my Apple laptop. I accept insurance and submit claims in 1-2 minutes after each visit through a free online clearinghouse. I roll out the red carpet for every patient, whether millionaire or homeless. It’s VIP without the fee. By cutting out the middlemen, I decreased my overhead from 74% at my favorite assembly-line job to nearly 10%, leaving me with 90% of the revenue I generate. Physicians who practice this way can exceed their previous full-time salaries working a fraction of the hours. However, most doctors enjoy their newfound freedom and autonomy more than money. No amount of money can compensate for a miserable life and most doctors today seem pretty miserable.

Meanwhile, I’m happy. My patients are happy. I feel like I’m on vacation 24/7. I rarely get after-hours calls. Plus, I’ve never sent anyone to collections in 11+ years. This feels like the only viable way to practice medicine.

Best of all, our clinic was designed by my patients. I held town hall meetings and invited my entire community to design their ideal medical clinic. I collected 100 pages of written testimony, adopted 90% of citizen feedback, and we opened one month later with no outside funding.

What Pamela calls the "reverse white coat ceremony" physicians' retreat.

What Pamela calls the “reverse white coat ceremony” physicians’ retreat.

Nassim: Your mother, Dr. Judith Wible, is a psychiatrist and has a scholarship for visionary female medical students in her name. Did she play a role in your activism? 

Pamela: Yes. My mom is an activist and leader in the women’s rights movement. During my childhood she took me in my stroller to women’s liberation marches, bra burnings, and all of that. She and I went to the same medical school too, and what she went through was much worse than what I had to deal with due to out-of-control sexism and harassment.

Nassim: You’ve had some major success lately. A new book, Physician Suicide Letters Answered, that was #1 on Amazon for Medicine for a month after release, a new house bill in Missouri that addresses depression and suicide in medical schools, and you’re being featured in an upcoming documentary, Do No Harm, by an award-winning filmmaker, Robyn Symon. Are you optimistic that all this attention will translate into more compassionate medical education and practice for the students and doctors?

Pamela: I’m a perpetual optimist. All these successes couldn’t have happened without public and professional support and a willingness to finally address medical student and physician suicide. It is a defining moment for us all.

Nassim: So, what’ s next for you?

Pamela: I’ve been sent on some Michael Moore-style missions through hospitals with secret film crews for the documentary. That’s really fun! I’d love to dig deeper into investigative journalism.

Building Healthy Cities

This guest blog post was written by Gil Penalosa, Founder and Chair of the Board of 8 80 Cities and World Urban Parks, as well as former Commissioner for Parks, Sport and Recreation for the City of Bogota, Colombia.

CicLAvia Wilshire 06-2013

CicLAvia, Wilshire Boulevard (2013)

How would your life be different if you lived within a culture of health?

Consider the city. Over 85% of us in the U.S. live in cities. Think about how you go to places, where your children go to school, where your friends live, how you cross the street. This built environment – one that can feel so comforting and routine – is actually damaging to your health.

If you looked down on the average U.S. city from the air, you would find that 15 – 25% of the land is paved with streets. Of the land that is public – as in, not privately owned –  streets occupy between 70 – 90% of space that we all share. In this environment, the automobile has become our community connector. Children used to walk and bike to school, now they are driven. When our children make new friends at those schools, we drive them to their play dates. Parks are few and far between so we drive the kids to soccer practice. As cities spread, we drive for an hour or more to report to work. With all these cars on the road, we advocate for wider streets with more lanes and higher speed limits. In many communities, sidewalks do not even exist.

This method of navigating our built environment is killing us. Studies show that the chances of being killed increase by 75% when hit by a car going 35 mph versus one going 20 mph. Around the world, a person walking is killed by a person driving a car every 2 minutes. Twenty years ago, no state in the US had a population with an obesity rate over 20%. Today, there is not a single state whose obesity rate is less than 20%. Concern over obesity is not aesthetic: it causes heart attacks, respiratory problems, cancer, depression and anxiety.

And the challenges are increasing. Currently in the US there are 42 million people over 65 years old; in just 35 years, this number will double to 85 million. Of all the people who have ever lived to 65, half are alive today. We are living longer – much longer – yet our cities are becoming less friendly to older adults. As wider streets lead to longer crossing times, older people are being killed in crosswalks at 4 times the rate of their proportion of the population. The main issues facing the elderly are isolation and mobility. How are we going to address those if we continue to build communities that quite literally threaten their lives?

How do we change the future? To live a culture of health, citizens can no longer be spectators. We must act. We must each commit to participate.

Call on your governments – elected officials and your city staff in departments of planning, transportation, public health, education, parks and recreation – to commit to working with each other and with other sectors like businesses, media, activists and universities to guide the development of our cities with people in mind, creating healthy communities where all people will live happier.

Reclaim your streets. Walking and bicycle riding are the only individual modes of mobility for all people under the age of 16 and for many adults. Safe and enjoyable walking and cycling should be a right for all people. Support budgets that include money for sidewalks. Advocate for Open Streets, the closing of streets to cars on Sundays so that people can use this public space to walk, bike, be with each other. Make it easy for people be out and about in their communities, to visit other neighborhoods, to meet other people meet as equals.

Support investment in parks, large and small, that thread through your city, in all neighborhoods so that every child has a play area within ¼ mile at any given time. If land is not readily available, public properties can be converted for recreational use. School playgrounds can be used by the school during the weekdays but open to the community in the evenings and weekends.

We must improve the use of all land that is public. It belongs to all people. We must stop building cities as if everyone was 30 years old and athletic and create great cities for all. Any city, of any size, should pay attention to how well they treat its most vulnerable citizens, including children, older adults, disabled and poorer residents.

How is your city doing? You don’t have to be an expert to assess whether a park, street, sidewalk, school, library, actually any public space invites people to walk or ride. Simply use 8 80 Cities’ practice. If evaluating an intersection, think of a child you love, someone around 8 years old. Now think of an 80-year-old that you love. Would you send them across that intersection? Would they feel safe? Can they walk to school or to a park? If your answer is yes, it is good enough. But if it is no, it must be changed. The 8 and the 80 year olds are indicators. If a city promotes a culture of health for them, it will promote a culture of health for everyone, a built environment where everyone can live the healthiest lives possible.

Charting the Next Course: Women Speak from a Mighty River

By Christine McNab, guest contributor. Can Tho, Viet Nam

She’s petite, yet stands tall and steady, strong shoulders and arms steering eight foot-long oars through a swift Mekong current. It’s dawn, and many women do the same, navigating their low wooden boats through a jigsaw of vessels at the Phong Dien floating market. Women here do a brisk trade in produce, exchanging pounds of watermelon, daikon, pineapple, cabbage, morning glory, onion and squash for Vietnamese Dong. The bounty from the Mekong Delta provides much of the food energy for Vietnam’s 90 million people. Women are at the heart of this essential commerce.

“Vietnamese women are often in charge of driving the small boats, and buying and selling at the fruit and vegetable markets,” says Maru, my guide. The work is taxing – a technique combining crossed arms and oars to nudge the boat through narrow spots; a one-legged start of a long motorized rotor for speed, and hours under a searing sun. Our driver, Tay, has been steering boats for more than twenty years. “Women here work very hard,” Maru tells me.

I want to find out a lot more about Tay and Maru, and I will this week as part of my new multimedia project, A River Runs with Her: the Lives of Women and Girls on the Mekong.

Near Can Tho, Viet Nam, March 2016. Photo: Christine McNab

Tay has done the hard work of steering boats on rivers and tributaries of the Mekong Delta for more than 20 years. (Near Can Tho, Viet Nam, March 2016. Photo: Christine McNab)

I’m devoting 2016 to this self-funded project for many reasons. For one, I believe attaining gender equality is at the heart of international development. Many studies, history, and a lot of common sense tell us that we can only make progress when women have the same rights, access to education, health, jobs and justice as men. Women have made great strides in much of the world, but in too many places, women and girls are simply valued less. Equality means equal value, and it also means equal voice.

We don’t hear from women enough. The Economist recently published an excellent essay on the importance of the Mekong River to biodiversity, culture, and Asia’s economy. I admired the reporting, but noticed there wasn’t a single female voice in the piece. Instead, women were in the kitchen making soup or in bars serving beer. I want to hear more from these women.

The newest international Global Goals for Sustainable Development, set by international leaders last September, include important targets for women’s equality, for education, health and participation in governance. The goals are hopeful and ambitious. I wondered what women living in communities along the Mekong think about these goals? What do they need to achieve them?

And then, there’s the mighty Mekong itself, a legendary, 2700-mile artery connecting six countries, many cultures and one of the most bio-diverse areas of the world. Its waters are a lifeblood for millions. As the climate changes, the Mekong, and the traditions and economic lives of millions are changing with it.

Tay doesn’t speak much as she drives her boat down a Mekong Delta tributary. But I want to know what she thinks about all of this. I think it’s her time, and time for all women, to tell the world what they think.

Learn more about A River Runs with Her project in this 1-minute video.

To follow the project, see www.ChristineMcNab.com, add http://www.christinemcnab.com/her-stories/ to your RSS feed, or follow along on Facebook.
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Christine McNab is a global public health worker and communications expert. Her TEDMED talk illuminates the story of how she combined her passions and partnered with the Gates Foundation to create what might be the most artistically crafted vaccine promotion campaign ever.

Design can transform healthcare services and spaces

By Stacey Chang, Executive Director of the Design Institute for Health, a collaboration between the Dell Medical School and the College of Fine Arts at the University of Texas at Austin dedicated to applying design approaches to solving systemic health care challenges as an integrated part of medical education and training. Stacey is also a member of the TEDMED 2016 Editorial Advisory Board.

Stacey ChangRecent developments in medical research have focused significantly on individual health. From personal genome sequencing and microbiome analysis to the influence of a person’s specific environment and behaviors, it’s clear that – as we develop new therapies – there’s tremendous value to be derived from considering what makes each of us biologically unique. Yet, our collective health outcomes as a society inexorably worsen. Although our technological virtuosity shines, we still seem unable to address aspects of health that are broadly universal and shared across the collective of human society.

As we seek new approaches and creative problem solving, “design thinking” should continue to become an increasingly powerful tool for identifying and solving these complex health challenges. Most casual observers view “design” as an aesthetic discipline that gives rise to beautiful things – for instance, we are all familiar with the output of interior designers and graphic designers. Design thinking, however, is not about the output, but rather the perceptive, inspired methodology that leads to that output.

Specifically, design thinking begins with research that reveals the deeper needs of the humans in the system, needs that they are either unaware of or unable to describe. The research, qualitative in nature, is a savvy combination of psychology, sociology, and anthropology. It leads to insights that are the inspirational spark necessary to develop completely new solutions (not just incremental revisions of existing tools or constructs, an unfortunately common response in healthcare). Those solutions are then built and tested, but in quick, low-resolution iterations. The resulting failures are of low consequence, but rich with learning, and the rapid-cycle revision leads to large-scale interventions that have already had the major risks resolved.

Design thinking is a fundamentally different approach to problem solving, and particularly unique in health. After more than a decade practicing design thinking at the design firm IDEO and leading the health side of the business, I founded the Design Institute for Health last year. As a collaboration with the new Dell Medical School and the College of Fine Arts at the University of Texas at Austin, we are positioned to apply design thinking in Central Texas with the goal of developing a model for what the health system of the future looks like.

We’ve already begun to remake services, environments, infrastructure and incentives. For example, through our design research, an underlying insight we identified was that the more you give a patient (a person, really) increased control and ownership over their experience, their anxiety will lower, they’ll be more engaged, and they’ll feel more empowered to develop self-efficacy. Though obvious in hindsight, it turns out that this is applicable across the entirety of people’s experiences in health, and is also consistent across every demographic divide.

The Children's Medical Services, at Broward General Medical Center, in Ft. Lauderdale, Florida. Home Visits with Nurses and Social Workers, June 10, 2011. Inter Professional Nursing.
Home visits with nurses and social workers at the Broward General Medical Center in Ft. Lauderdale, Florida. Image courtesy of the Robert Wood Johnson Foundation.

As a result of this insight, we’re designing outpatient clinics with no waiting rooms (because isn’t waiting just actually a process failure?) where patients and their families are granted their own private room for the duration of their stay. It becomes their personal space, where they can control everything from lighting, to entertainment, to the layout of the space. In this environment, we also ask them to take a more active role in their own care and make decisions, enabling them with information and perspective along the way.

We have also found that care providers (doctors, nurses, and staff) want to be recognized as humans, as well. They hate the system that has turned them into robotic executors of process, instead of providers of human care. In pursuit of efficiency, many nursing functions are parsed into smaller and narrower bundles of tasks. Pre-operative nurses onboard patients, but rarely spend more than ten minutes with a single patient before they’re handed off, and the bed is turned. This assembly line scenario is akin to the automotive assembly line worker who puts the same four screws into the same plastic part over and over again for an entire 8-hour shift. To upend the model, we’re redesigning the roles, so the nurses cover pre-op, intra-op, and post-op; in doing so,the nurses see fewer patients in a day, but develop a meaningful relationship with them throughout the entire stay. While this demands more of them in breadth of skill, it turns out that giving staff more control and ownership over their experience also makes them more engaged and empowered, and delivers a better outcome.

A deeper understanding of human motivation can lead to meaningful impact. In the end, scientific advances are an important and necessary component of the advancement of our society’s health, but it only represents one edge of innovation. To achieve our collective wellbeing, we must ultimately engage everyone in pursuit of better outcomes. We need to redefine health in terms that people can embrace and influence, giving them the agency to act on their own behalf. We might, perhaps, call this a culture of health.

Promoting Health Equity by Choice

This guest blog post was written by Dr. Mary Travis Bassett, the Commissioner of the New York City Department of Health and Mental Hygiene. Dr. Bassett spoke at TEDMED 2015.

mary-bassettNew York City is one of the most diverse but racially segregated cities in the United States. Neighborhood segregation and structural racism, including poor housing conditions and limited educational opportunities, have led to unacceptable health disparities in our city. In turn, these health disparities have led to many lives – mainly the lives of poor New Yorkers and people of color – being cut short.

On average, New York City residents are expected to live longer than the average person in the United States. However, within the five boroughs, health outcomes can vary substantially from one subway stop to another. Average life expectancy rates can obscure those worrying variations between neighborhoods. In places like the South Bronx and Brownsville, Brooklyn, where I first lived when I was a little girl, people can expect to live lives about 8-10 years shorter than a person living in Manhattan’s Upper East Side or Murray Hill.

The usual explanation for these unhappy odds is that people in these neighborhoods are making a whole series of bad lifestyle choices. They eat too much, don’t exercise, smoke, drink, and so on. I’d like to challenge everyone to think differently.

Instead of thinking that people in Brownsville live shorter lives because they are choosing to eat unhealthy foods and choosing not to exercise enough, let’s think of how a lack of choice can impact a person’s health. For example, people don’t choose to live in a neighborhood where it’s unsafe to walk or exercise outside at night. People don’t choose to rent an apartment in a community that does not have a grocery store nearby. No one chooses to take a job that pays a wage impossible to live on, let alone live healthy on. The problem is not lifestyle choices that are bad for one’s health, but having too few choices that negatively affect a person’s health.

When we think about health, we have to think about restoring choices. For people to live healthier, they need good housing, a more livable wage, a good education, and safe spaces to exercise. All of these help build a neighborhood where people look out for each other. To achieve health equity, we have to confront all of the factors that affect a person’s ability to live a healthy life. That’s why as health commissioner, I will use every opportunity to speak out against injustice and rally support for health equity.

Our new initiative, Take Care New York 2020, seeks to do just that. It is the City’s blueprint for giving everyone the chance to live a healthier life. Its goal is twofold — to improve every community’s health, and to make greater strides in groups with the worst health outcomes, so that our city becomes a more equitable place for everyone. TCNY 2020 looks at traditional health factors as well as social factors, like how many people in a community graduated from high school or go to jail.

Additionally, the City’s investment in Pre-K for All will go a long way toward addressing the inequalities we’ve seen emerge so early in life, which reverberate across the lifespan. Investing in early childhood development is an anti-poverty measure, an anti-crime measure, and it is good for both mental and physical health. For example, the number of words a child knows at age 3 predicts how well he will do on reading tests in third grade, predicts his likelihood of graduating from high school, and so on. Early investment is key to undoing decades of injustice.

I believe that achieving health equity is a shared responsibility, and we can only accomplish real change by working together. This is a big challenge, but I am hopeful. New Yorkers are fortunate to have a Mayor and an administration that is committed to addressing longstanding inequality. Every city needs such committed leadership if we are to see a day where someone’s ZIP code does not determine their health. I hope you will join us on this pursuit of equity.

The Barefoot Technologists

by Raj Patel, TEDMED 2015 speaker and guest contributor

Anita carries with Christopher_Fotor

Interviewer: “Have you ever done anything to help your family have enough food or to make food last a long time?”
Child: “Yes.”
Interviewer:“What do you do?”
Child: “I normally don’t eat it that much.” (Source: Fram et al 2011:1117)

It was a hard country. Amid abundant mineral resources and great natural beauty, some of the nation’s poorest women skipped meals so that their children could have enough to eat. The kids were no slouches. They knew what was happening. In a heartbreaking turn, the children skimped on food too. So that there’d be more left for their families. So that they wouldn’t be reduced to begging from their neighbors.

Luckily, I was leaving this country for one filled with entrepreneurs and technologists who’d cracked the problem of hunger.

Luckily, I was leaving the United States for Malawi.

It may seem jaundiced to compare the lot of women in the world’s poorest country with one of the world’s richest. Few would argue that Malawi has ended hunger. Four in ten children there suffer “stunting” – a deprivation of nutrients in the first 1000 days of life that breaks bodies for a lifetime.

Yet it’s true that, when faced with the choice of feeding themselves or their children, mothers around the world skip meals so that their kids don’t go hungry. In the United States, one in seven people struggle with hunger, and in some of those families, mothers skip meals for their kids. It’s true in the United States, and it’s true in Malawi. It’s hard to hear that what we think as third world problems are first world ones too.

The other thing that’s true: people who face hunger can be incredibly smart about solving it. The American child interviewed at the top of this story did what anyone would do for someone they loved. Given their constraints, they shouldered a burden to make it easier for the ones they care about. What I learned from some parents in Malawi is that great technology can, and should, change those constraints.

In Malawi, one of the constraints is that there’s not enough dietary diversity. If breakfast, lunch and dinner is some variation of corn, bodies can break. To solve this, the Soils Food and Healthy Communities Project in Malawi used ideas that are both cutting-edge, and very old: a peer-to-peer network of research and experimentation to find the best crops for human and soil health, the best planting patterns, and the best farming techniques, to get more from the land.

Once they broke through that constraint, they confronted a far deeper one. The new farming practices require more harvest work. Women want to harvest because then they control the crop, and control who it gets sold to. But women also cook, clean, fetch water and firewood – work that is fundamental to rural households in Malawi.

You can watch my TEDMED talk to find out how the farmer research teams broke through this constraint, in spectacular style. What matters more, though, is how they found and addressed the problem. Those of us with access to lab coats can proudly point to years of scientific training, but one of the hardest-won skills – one that my students find hardest to do – is peer review.

Malawian farmers do it better than doctoral students. They run trials, compare findings, confront each other in meeting after meeting and argue, because unlike for academics, this isn’t academic. The results matter. There are plenty of strong personalities at the Soils, Food and Healthy Communities project, but no-one knows who exactly came up with their eventual solution to the problem of hunger. It emerged through a series of meetings, as an exercise in collective technological innovation. Attribution matters less than results, because the stakes are so high.

anita's proteges make sweet potato donuts_Fotor

That’s the great gift of grassroots technologists like those in Malawi. They’ve developed networks of problem-solving skills that have gone on to address other constraints, like limits to grain storage facilities, lack of access to banks, and even climate change. (A women’s collective has emerged to make stoves that use considerably less wood than in an open fire – and the stoves are  called “Climate Change stoves”.) Whether in the US, Malawi, or anywhere else, these ideas can help the world feed itself. Of course, it’s important not to be starry eyed – there are many reasons why things work well here, from an absence of interference by large corporations, to state neglect, a benign village headman and some terrific activism from local leaders.

Yet the lessons remain clear. Too often, experts in white coats won’t believe that people without shoes can develop technology. But if I’ve learned anything from working with farmers in Malawi, it’s that a little humility, ingenuity and a great deal of local science can stop mothers, and children, from ever skipping a meal again.

Precision medicine for understudied populations

by Roxana Daneshjou, guest contributor

Precision medicine, which leverages a patient’s genetics to help make medical decisions, has the potential to revolutionize medicine. Its applications are numerous: from predicting who may have an adverse reaction to a medication, to allowing targeted therapies of cancer with particular mutations. In 2015, President Obama’s State of the Union announced an initiative to further our understanding of precision medicine and to build the infrastructure to implement it. An important part of this initiative is building a large diverse research cohort to help discover disease-gene and drug-gene associations. The key word is diverse – because genetic risk factors can be population-specific. In the past, individuals of African, Hispanic, and Middle Eastern ancestry have been understudied. Only by including individuals from all different ancestral backgrounds can we hope to implement precision medicine in an inclusive way.

In 2011, Russ Altman’s research group was pondering the importance of inclusive precision medicine when it became clear that several studies examining the baseline genetic variation across the globe, 1000 Genomes and the International HapMap Project, had an underrepresentation of Middle Eastern populations. As a scientist of Iranian descent who had undergone direct-to-consumer genotyping with 23andMe, I wondered how to make sense of my data when no baseline genetic study of the Iranian population existed. When scientists Dr. Mostafa Ronaghi and Dr. Pardis Sabeti approached Dr. Altman’s group about the idea of creating such a baseline, I was immediately interested. Through the generous support of the PARSA Foundation, we began our journey to create a genetic baseline of the Iranian population.

Our first roadblock appeared when we spent months exploring the feasibility of collecting samples in Iran. Due to the economic sanctions at that time, it turned out that establishing a collaboration with an Iranian university and collecting samples there would be nearly impossible. In the United States, however, the Iranian diaspora has created a sizeable population generally representing the diversity of sub-ethnic groups in Iran.  We turned to this population to collect our samples and conducted high coverage sequencing of 77 healthy individuals. This data can be used for answering some questions about the population’s history and also as a baseline for scientists interested in studying disease in this population.

Since our aim is to enable other scientists to answer important questions about disease risk and treatment in individuals of Iranian ancestry, we are committed to sharing our data. Our website, irangenes.com, already has summary data of population level genetic variants. We’re currently working on uploading all of our genomic data on a secure server so that scientists can submit proposals to use our raw data.  Since the sanctions on Iran were lifted in January 2016, we have corresponded with scientists in Iran who are using our summary data to help advance precision medicine there. We are also working on uploading all of our genomic data to a secure server as a part of the precision medicine initiative so that scientists can submit proposals to use our raw data.

In addition to the medical applications, we were also interested in learning more about the Iranian population’s history through its genetics. Based on our data, the Iranian population is genetically distinct from other Middle Eastern populations. However, it is important to remember that any two humans share 99.9% of their genome. Moreover, as has been seen in previous studies in other populations, the different Iranian sub-ethnic groups have a lot of genetic overlap. Though capturing the breadth of human genetic diversity is important to inclusive precision medicine, these studies also show us that – at our core – we are a singular human family.

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Roxana Daneshjou is an MD/Ph.D. student at Stanford and is supported by the Paul and Daisy Soros Fellowship for New Americans.

Announcing the TEDMED 2016 Editorial Advisory Board

Artificial intelligence. Climate change. Cybersecurity. Addiction. Pandemics. Global drug development. These are some of the cutting-edge topics intersecting with health and medicine that we’ve been exploring as we design the program for TEDMED 2016. With every event, we strive to inspire new thinking, broaden perspectives, and accelerate progress. Central to this mission is our collaboration with the TEDMED 2016 Editorial Advisory Board (EAB) – a group of leading experts in their fields who each embody a wealth of experience and knowledge. Our board members represent worlds spanning health and medicine, foundations and academia, business and technology, philanthropy and design, and journalism and communications. Their diversity ensures that we approach the curation process from a truly multi-disciplinary perspective.

Image courtesy of Shutterstock.
Image courtesy of Shutterstock.

As we design the TEDMED 2016 program, our EAB members are involved from start to finish. They generously offer their time and insights in crafting the event theme and identifying important and timely innovations and nominations for the stage and Hive.

Fortunately, we didn’t have to go too far to find this year’s board members. Drawing upon our wonderful TEDMED community, we gathered 18 remarkable thought leaders – many of whom are former Delegates, speakers, and co-hosts. A number also served on the 2015 EAB, allowing us to tap into their experience while also taking advantage of fresh perspectives from new members. We are both delighted and honored to be announcing them here:

Abraham Verghese, MD, Physician and Author, Professor at Stanford University

Atul Butte, MD, PhD, Director of the Institute of Computational Health Sciences at the University of California, San Francisco

Bijan Salehizadeh, MD, MBA, Managing Director, NaviMed Capital

Carla Pugh, MD, PhD, Surgeon and Director of the Health Clinical Simulation Program at the University of Wisconsin

Charles “Chuck” Pell, Chief Science Officer and Co-Founder at Physcient

Christopher Elias, MD, MPH, President of the Gates Foundation Global Development Program

Daria Mochly-Rosen, PhD, Professor of Chemical and Systems Biology at Stanford University and Founder and Director of Stanford Universitys SPARK program

Hemai Parthsarathy, PhD, Scientific Director of Breakout Labs and the Thiel Foundation

Jeff Karp, PhD, Associate Professor, Brigham and Womens Hospital and Harvard Medical School

John Qualter, Co-founder of BioDigital Systems

Laura Schmidt, PhD, MSW, MPH, Professor of Health Policy in the School of Medicine at the University of California at San Francisco

Michael Painter, MD, JD, Senior Program Officer at the Robert Wood Johnson Foundation

Michael Penn, MD, PhD, Vice President of Diversity, Outreach, and Mentoring at the Gladstone Institutes

Mohit Kaushal, MD, MBA, Partner at Aberdare Ventures

Stacey Chang, Executive Director of the Design Institute for Health, University of Texas at Austin

Pam Belluck, Health and Science Writer, The New York Times

Roberta Ness, MD, MPH, Vice President of Innovation at University of Texas Health Science Center at Houston

Sandeep “Sunny” Kishore, MD, PhD, Post-doctoral Fellow of the Human Nature Lab at Yale University

New Genetic Spectra Across Earth’s Cities & Far Beyond

by Chris Mason, guest contributor

Since speaking at TEDMED 2015, there have been a number of updates to the science I described in my talk. These areas include: space genomics, beer-omics, extreme microbiomes, global city metagenome sampling, epitranscriptome discoveries in RNA viruses, and DNA as music in microgravity.

Image based on images courtesy of ShutterstockSpace Genomics and Genomic DJs

First, we have completed the first whole-genome sequencing profile of two astronauts’ genomes (the Kelly Twins). Also, in collaboration with our NASA collaborators, (Aaron Burton and Sarah Castro-Wallace) we have been sequencing DNA in microgravity; this will be used for 2016 plans to send an Oxford Nanopore Sequencer onto the International Space Station with astronaut Kate Rubin. We are preparing for the return of astronaut Scott Kelly to Earth next week, and are strategizing how to make genome-guided medicine a part of the standard of care for new astronauts. Our goal is to monitor, protect, and potentially repair astronauts’ biology through an integrated view of the layers of the genome, transcriptome, proteome, all the epi-omes, and the microbiome.

In collaboration with Harvard Medical School’s Consortium on Space Genetics, we’ve formally launched a new research focus for Weill Cornell medical students on the study of space genetics and aerospace medicine. This allows new medical students to learn and train in the methods of space genomics, data analysis, and new technology development for space missions. They’re also trained in synthetic biology, materials science, nanofabrication, microbiome engineering, and gene drives. These skills are taught in our class called “How to Grow Almost Anything (HTGAA) – NYC” that is part of the BioAcademany. Work by Elizabeth Hénaff in the 2015 class also helped with our plan for the Gowanus Canal and extreme microbiomes.

Extreme Microbiomes

Microbiomes can lead to a bounty of discovery for new biology, drugs and molecules. We have been systematically hunting for these microbes around the world as part of the eXtreme Microbiome Project (XMP). Among those sampled sites, we have already found that Brooklyn’s Gowanus Canal, a SuperFund site, holds a suite of unique and potentially protective microbes, and we have been designing artificial sponges to hold these in the canal during the remediation process. This is part of a larger project of urban microbiome monitoring and design, called the Brooklyn Bioreactor, which is a collaboration between our laboratory at Weill Cornell, the landscape architecture firm Nelson Byrd Woltz, the Gowanus Conservancy, and the community laboratory Genspace. Lastly, in collaboration with Shawn Levy at HudsonAlpha, we have started collecting data about beer microbiomes, which show an interesting blend of differences depending on the yeast strain used.

Global Metagenome Collection Day

The Metagenomics and MetaDesign of Subways and Urban Biomes Consortium has now reached 43 cities around the world, and a global City Sampling Day (CSD) event is planned for June 21, 2016, to match the collections of the global Ocean Sampling Day (OSD) group. These seasonal molecular snapshots will begin to expand our search for novel microbiomes, new molecules, will aid us in mapping the distribution of antimicrobial resistance (AMR) markers, and enable a better understanding of urban biology and ecosystems.

Epitranscriptome Discoveries and Sounds of RNA

Last but not least, we have just published the first demonstration of another realm of RNA modifications, collectively called the “epitranscriptome.” Specifically, we show that HIV’s RNA genomes also harbor modified RNA bases, and they impact how infectious the virus may be for a patient. We are now on a search across all RNA viruses to see how common these types of modifications are. We are also working to get direct RNA sequencing in nanopores operational, to enable listening to the “music” of the genome as it moves through the pore, as we demonstrated was possible with single enzymes in 2012. These methods and algorithms can help us discern new and peculiar nucleic acids that might be found not only in our lab, but in far-flung places on Earth and beyond.

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In his TEDMED 2015 talk, geneticist and urban metagenome researcher Chris Mason of Weill Cornell Medicine shares how he’s mapping his expertise into the distant future of outer space in the interest of humanity’s interplanetary survival.