TEDMED Blog

Live Online Event: Innovation through Collaboration

light bulb 3Please join us as we continue our Great Challenges Google+ Live Online Event Series, this time with a discussion focused on “Achieving Medical Innovation.” We’ll be discussing the various interpretations of public-private partnerships in healthcare, and whether and how these partnerships deter or support innovation.

Moderated by Forbes contributor Dan Munro, our diverse group of participants will explore the various facets of these creative relationships, sharing insights into what it means to have a unified “best-practice” execution of public-private partnerships in the healthcare space.

 

The healthcare world is an ever-evolving area with countless stakeholders, all working towards improving the health of the population. But with different priorities and different ways of working, how can diverse stakeholders work together most effectively? Public-private partnerships can bring together different viewpoints for a greater impact – they can increase resources, extend message reach, and expand collective knowledge and understanding. Many also believe such partnerships can speed up innovation – but what are the legal and ethical implications and challenges of innovating through public-private alliances? How can we think about more sophisticated ways of assessing and managing potential conflicts of interest? Can the medical community develop new models for public-private partnership that drive medical innovation while benefiting all involved parties?

Join us for a live online event on Thursday, November 20 at 12 noon to discuss these issues and more with experts on the topic. Get started today by tweeting your questions and comments and tagging them #GreatChallenges, and we’ll address as many as we can on air.

To learn more about the Great Challenges program, click here.

Get Smart About Antibiotics: Join us for a Twitter Chat with Ramanan Laxminarayan

Join TEDMED Speaker Ramanan Laxminarayan for a Twitter Chat about antibiotic resistance this Wednesday, 11/19 from 3-4pm ET.

Ramanan educates us about antibiotic resistance on the TEDMED stage.

Ramanan educates us about antibiotic resistance on the TEDMED stage.

Curious to learn more about the research behind Ramanan Laxminarayan’s TEDMED talk, “The Coming Crisis in Antibiotics”?

As part of the CDC’s Annual Get Smart About Antibiotics Week, TEDMED is hosting a Twitter Chat with Ramanan and the Center for Disease Dynamics, Economics & Policy (CDDEP) from 3-4pm (ET) this Wednesday, 11/19.

Delve a little deeper into Ramanan’s talk and learn more from him and the CDDEP about the rising challenge of antibiotic resistance and what you can do to combat it.  We’ll be framing our discussion around these three topics:

- Topic 1 (T1): Getting smart about antibiotics from the patient’s perspective
- Topic 2 (T2): Policy recommendations for strengthening antibiotics surveillance domestically and globally
- Topic 3 (T3): Strategies for conserving antibiotics as a natural resource

Tweet your questions our way using the #TEDMED hashtag, and remember to reference the topic! For background reading, be sure to check out the joint CDC/CDDEP study of antibiotic overuse in hospitals, which was just released in the Lancet earlier this week.

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

What happens when doctors move towards transparency? Q&A with Leana Wen

Physician and public health advocate Leana Wen discussed a highly controversial approach to transparency in the clinical encounter. We caught up with Leana to learn more about her ideas and actions in public health advocacy.

What happens when doctors move toward transparency?

“I want doctors and patients to come together to end the sickness of fear.” Leana Wen, TEDMED 2014. Photo: Sandy Huffaker for TEDMED

What motivated you to speak at TEDMED? I wanted to share a message to doctors, patients, innovators, and all those who are committed to transforming the future of medicine. There is no place better to do that than at TEDMED, in front of people want to learn paradigm-changing ideas and who are already motivated to take action!

Why does this talk matter now? What impact do you hope the talk will have? It’s harder for people now than ever to establish a long-term, trusting relationship with their doctor. There is a growing disconnect between what patients need and what doctors do. I explain in this talk how radical transparency will empower both patients and doctors (and other providers). I hope doctors watching the talk will choose radical transparency and voluntarily disclose both financial conflicts and personal views to their patients. I also hope patients—people—watching the talk will prioritize transparency and choose their doctors accordingly.

What were the top TEDMED2014 talks that made an impression on you? Sonia Shah flipped my conception of cause and effect, and how we may need to change the focus of public health and medical interventions. Eleanor Bimla Schwarz stopped me in my tracks to appreciate how our bodies are made, and how our efforts to interfere with normal body processes can have downstream adverse consequences. Gail Reed and Sigrid Fry-Revere challenged me away from U.S.-centric thinking to consider there is much to learn from how other countries serve patients.

What is the legacy you want to leave? I want doctors and patients to come together to end the sickness of fear. Doctors can take the first step, and let patients into our world. We can ensure patients and their families take part in all bedside rounds. We can embrace open medical records and open disclosure of medical errors. We can show vulnerability and humility with our patients. These are all steps to change the paradigm of medicine from one of secrecy and hierarchy to one that is fully open and engaged. I would love to live in a world where doctors and patients (and all healthcare providers) come together to be equal partners in medical care, without barriers or secrets or fears.

Please share anything else you wish you could have included in your talk. I wish I had more time to talk about how transparency may seem scary, but that research shows openness helps doctors as well as patients. There are studies that show collaborative medical records and open disclosure of medical errors increase patient trust, improve health outcomes, and even decrease malpractice. This will be particularly important as doctors are being measured on quality metrics like diabetes and blood pressure control. Lifestyle changes require trust, and trust requires transparency.

Protecting Antibiotics: Q&A with Ramanan Laxminarayan

Antibiotics have relegated life-threatening bacterial infections to our medical history books, or so think the vast majority of us. However, inappropriate antibiotic usage – for viral infections, in animal feed, in over-the-counter availability in some countries, and even over-treatment of some bacterial conditions – has also fueled the development of antibiotic resistance. This decrease in antibiotic efficacy coupled with the pharmaceutical companies’ slow development of new antibiotics are threatening our future fight against bacterial adversaries.

In his TEDMED 2014 talk, Ramanan Laxminarayan discusses how protecting antibiotics is a global issue and a worldwide responsibility, not one limited to a specific area of the world. He recently took the time from his busy schedule preparing for the CDC’s Get Smart About Antibiotics Week to answer a few follow-up questions:

What motivated you to speak at TEDMED?

I’ve been thinking about antibiotic resistance for nearly 20 years now, and have spoken about this problem and possible solutions to audiences ranging from clinicians, epidemiologists, hospital administrators, policymakers, economists, and even physicists.  But, the opportunity to reach a much wider audience through a format like TEDMED is rare and is probably better than even writing a book in terms of getting a message across.

Ramanan Laxminarayan on the TEDMED stage.  - Sandy Huffaker

Ramanan Laxminarayan on the TEDMED stage. – Sandy Huffaker

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

Like many others, I believe that we bear the responsibility of leaving the natural state of the planet in at least as good condition as it was in when we were first given responsibility for it.  I come to the problem of resistance from that perspective.  If we have fundamentally altered the microbial ecology of the planet, that is not very different from what we have done to the chemical composition of its air and water.  Antibiotics are amongst the most valuable natural resources we have been endowed with, and we have not recognized them as such.

What is the legacy that you want to leave?

Hopefully, my work has awakened, in a few people’s consciousness, the idea that we need a huge change in how we approach antibiotics.  If we are successful, then maybe in a few years, asking for an unnecessary course of antibiotics from your doctor will be the same as asking for a last drink for the road, or for a cigarette from a fellow passenger on an airplane.

Please share anything else you wish you could have included in your talk.

I would have loved to talk about my other passion: what it takes to deliver pediatric vaccines to 27 million children each year in India.  Fortunately, I had a chance to give a TEDx talk about this topic earlier this month. I’d also perhaps like to talk about the information structure of epidemics, if the TEDMED team ever makes the mistake of inviting me back.

Lab Testing Reinvented: Q&A with Elizabeth Holmes of Theranos

The United States spends more on healthcare than any other Western nation – more than two and a half times the amount spent by most developed countries. Even so, most Americans do not have access to quality, timely care. Patients seeking care face unpredictable costs for even the most routine diagnostic procedures, like blood testing.

These hurdles are so prohibitive that seeking out healthcare is often viewed as a last resort – an option to be considered only when symptoms appear. In some cases, this can be too late. Elizabeth Holmes reminds us that access to affordable, preventive care is a human right. It is this right – the right to be as healthy as possible – that is at the root of her mission to make actionable health information accessible to everyone at the time it matters.

At TEDMED 2014, Elizabeth talked about this right and the importance of enabling early detection and empowering individuals to make educated decisions about their healthcare.

Elizabeth Holmes, TEDMED2014. Photo, Jerod Harris, TEDMED.

Elizabeth Holmes, TEDMED2014. Photo, Jerod Harris, TEDMED.

We reached out to her with a couple of follow up questions about her work and her company, Theranos.

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

We believe the right to protect the health and wellbeing of every person – of those we love – is a basic human right. Yet, in the United States today, healthcare is the leading cause of bankruptcy. Similarly, lack of healthcare is the leading cause of the suffering associated with finding out too late in the disease progression process that someone you love is really, really sick. We believe that every individual has a right to accurate, affordable, real-time health information before people become so sick that it is too late to change outcomes.

What is the legacy you want to leave?

Our mission at Theranos is to make actionable information accessible to everyone at the time it matters most. Theranos is a new paradigm of diagnosis, in which every person will be able to see the onset of disease in time for therapy to be effective. Through it, we see a world in which no one ever has to say “goodbye” too soon, and people are able to leverage engagement with their health to live their best lives.

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” -The Universal Declaration of Human Rights, Article 25, Point 1.

How risky is it, anyway?

These days, science can tell us in incredible detail the ways our decisions are impacting our health – it’s easier than ever to discover what is going on in our bodies. We know that a poor diet or lack of exercise can have negative impacts on our heart health. We know that too much sun exposure can lead to skin cancer. We even know how diseases spread – and how they don’t. But, in the face of all of this information, we still continue to make decisions that may not be the best for our health.

In other words, many medical professionals are dismayed by the large gap between risk as perceived by scientists, and risk as perceived by the population as a whole.

As an example of this gap, some doctors and scientists point to the country’s reaction to Ebola. Though the average American is more at risk for flu, a car accident, obesity, diabetes, or heart disease than Ebola, the entry of the disease into the U.S. has brought a high level of fear. This prompts the question: How can the medical community accurately and responsibly communicate risk in a way that encourages healthy choices?

Last week, as part of the Great Challenges program, we convened a group of experts on the topic. They discussed the psychology behind risk perception and talked about strategies and tools that the medical community can use to ensure that patients receive an accurate understanding of their risks and are encouraged to act accordingly. The event was moderated by James Maskell, CEO and Founder of Revive Primary Care.

The participants all agreed that our reactions to risk are often driven by feelings before facts – and that the low level of health literacy in this country doesn’t help. Brian Zikmund-Fisher, PhD, an Associate Professor of Health Behavior & Health Education at the University of Michigan School of Public Health, noted that other elements of human risk perception include our experience (or those of others), our knowledge, our level of control, and our level of dread. He stressed the importance of understanding risk as a population-level construct.

Glyn Elwyn, MBBCH, MSC, FRCGP, PhD, a physician-researcher, Professor and Senior Scientist at the Dartmouth Health Care Delivery Science Center and the Dartmouth Institute for Health Policy and Clinical Practice, posed a key question: “How do we frame information so that it’s easy to understand?” The group agreed that risk perception is largely about context; they stressed the importance of using language and tools to create this context – which is not always statistics. Brian shared his thoughts on the subject: “how can we give people the tools so that they can understand under what circumstances they would be at risk, and when they’re not at risk? We need to use stories to represent examples and also provide quantitative information.”

Thomas Workman, PhD, MA, the Principal Communication Researcher and Evaluator for the Health and Social Development Program at the American Institutes for Research (AIR), had one suggestion: asking patients to think about how they would feel if the health condition for which the patient is at risk occurred. He called for patient involvement in the development of these tools, asking, “How can we incorporate patients into the development of some of these tools and technologies?”

Participants emphasized the importance of the clinical encounter in creating this context. At the same time, the short time for each office visit was a concern. Thomas noted that “The conversation with the physician is just as important as the conversation with the community.” He suggested that risk and prevention discussions can take place with organizations within the community – or even within small family units. David Bell, MD, MPH, an Assistant Professor of Population and Family Health at the Columbia University Medical Center, echoed this sentiment. He stressed the need for risk information to come from a trusted source.

The participants also recognized that the media plays an important role in framing the public’s risk perception. We live in a world where we are confronted with sensationalized news daily. Glyn pointed to the low trust in public information plus dread as a “toxic mix that the media are ventilating,” while Thomas asked: “How can we create more balanced messages?” Brian noted that while individual stories may make interesting news stories, they “will never be representative of the broader range of what could possibly occur.”

On the whole, the participants concurred that, as David put it, “Every step of the way patients get different messages about their risk and we all need to be on the same page.” A tall order, of course, but one which may lead to more realistic understandings of risk – and consequently, it is hoped, the adoption of healthier behaviors.

If you missed the live event, catch the recast here: www.tedmed.com/greatchallenges/liveevent/494673, and stay tuned for our next Great Challenges hangout on Achieving Medical Innovation later this month!

How ultrasound became a disruptive innovation

Resa Lewiss, Director of Point-of-Care Ultrasound and Associate Professor of Emergency Medicine and Radiology at the University of Colorado School of Medicine, unlocked imaginations about ultrasound applications in her talk at TEDMED2014. She explained why and how ultrasound at the bedside has become a game changer for clinical care.

She recently took a moment from her duties in Denver to share more about her work and impressions of TEDMED.

Resa Lewiss: How Ultrasound Has Become a Disruptive Innovation

Reas Lewiss at TEDMED2014. Photo by Sandy Huffaker for TEDMED

What motivated you to speak at TEDMED?

I attended TEDMED2013 in Washington DC. I was inspired by the people, the space and the vision of TEDMED. I believe that the arts inspire creativity and innovation. And innovation begets innovation. I live the aphorism mens sana in corpore sano, [a sound mind in a sound body]. TEDMED does too.

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

This talk will hopefully deconstruct healthcare silos. Point-of-care in partnership with ultrasound can be a concept that is difficult to comprehend. I hope to have connected the dots between the technology and the resultant improvement in patient care- for health care providers, people in tech and people in the world. The safety profile, time efficiency and cost effectiveness are self-evident.

Tell us about the top 3 TEDMED2014 talks or performances that left an impression with you.

Jill Vialet: Sobering reminder for ourselves and loved ones. Play is healthy.

Barbara Natterson-Horowitz: Back to basics, obvious and inherent and yet never quite articulated in this way before.

Bob Carey: Honest and emotional. Much respect for his willingness to show his vulnerability; a sobering performance.

Robin Guenther: She hit it on the head. Who is looking out for the healing and healers? Thank goodness she is. Mens sana in corpore sano.

What is the legacy you want to leave?

One of quality, integrity, justice, honesty, excellence, and mindfulness.

Contact Resa to learn more about how to encourage point-of-care ultrasound curricula integration at all medical schools and for all providers.

Resa Lewiss at TEDMED2014. Photo by Sandy Huffaker for TEDMED.

“Think Big”: Q&A with Eric Chen

At TEDMED 2014, Eric Chen urged us to think big and never stop asking questions. Halfway through a very exciting first semester at Harvard, Eric Chen checked in with TEDMED to answer a few questions we had about his talk.

What motivated you to tell your story on the TEDMED stage?

I see huge untapped potential in kids and nonscientists all over the world, especially in this day and age when the Internet has given all of us so many resources unavailable in the past. However, so many people seem to be intimidated by scientists and the idea of research—they don’t believe they can do something so seemingly complex or sophisticated. I saw the TEDMED stage as a platform from which I could share my story and let them know about their own potential.

Eric Chen takes the stage at TEDMED 2014. - Jerod Harris

Eric Chen takes the stage at TEDMED 2014. – Jerod Harris

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

In today’s age, we will need more and more scientists and innovators to tackle the challenges on the horizon—from pollution to overpopulation. To solve these daunting problems, we will need bold, daring thinkers not afraid to ask the unasked question. It is important that everyone knows they can contribute, regardless of their background or situation, and that a groundbreaking discovery can be just a question away.

What is the legacy you want to leave?

I hope that my message can encourage more youth and nonscientists to think big, and to participate in science, research, and medicine. I would like to help spread the democratization of knowledge, science, and medicine.

Taking Eric’s advice, we didn’t stop asking questions there.  In the spirit of curiosity, we tacked on a few fun questions for your enjoyment:

If you could meet your 10-year-old self, what would you tell him?

I would tell him that I now know how to time travel, and then go collect my Nobel Prize.

If you were immortal for a day, what would you do?

I would completely wreck the world record for most time with breath held underwater.

If you could meet anyone, living or dead, who would you meet?

I would meet Richard Feynman. I’ve always admired not only his scientific ability but also his curiosity and sense of humor.

A right-to-die ethicist faces her hardest choice

Peggy Battin spent most of her academic work exploring a contentious topic that many of us shy away from: decision making at the end of life. Peggy’s field of study took an almost unbearably personal turn when it became time for her husband, Brooke, to decide how to die following a near-debilitating cycling accident.

We reached out to Peggy, asking her to tell us more about what she thinks makes her TEDMED 2014 talk an especially timely one that can help us better understand the current debate over physician aid-in-dying. Here is her response:

Think about the competing tensions over how we die—on the one hand, the desire to be self-determining as much as possible, even at the very end of life, and on the other, the worry that giving people control over their own dying will leave them open to pressures, expectations, and abuse.

I want to be able to die when I want, where I want, with the people I love around me; but I don’t want to be pushed or cajoled or forced into it—not by family members or friends, not by overworked doctors, not by profit-motivated insurers.

Peggy Battin speaks at TEDMED 2014.  Photo: Jerod Harris, TEDMED.

Peggy Battin speaks at TEDMED 2014. Photo: Jerod Harris, TEDMED.

These tensions are fanned by activist groups on both sides. On the one side are the various right-to-die groups, like Compassion and Choices, the Final Exit Network, and many others; physician aid-in-dying, usually called Death With Dignity, has already become legal in four (and a half) U.S. states: Oregon, Washington, Montana, Vermont, and parts of New Mexico. Physician-assisted suicide and active voluntary euthanasia are also legal in the Netherlands, Belgium, Luxembourg, and Switzerland. There are active court cases and/or legislative measures in the United Kingdom, Canada, Australia, France, and much of the developed world.

Why must I be kept alive at such expense when, if I am dying, I would rather die in an earlier, easier, gentler way? That should be my basic right.

On the other side, opposing these measures on the grounds of both moral concern and fears of abuse, are a variety of groups implacably opposed to euthanasia in any form, from the disability-rights group Not Dead Yet to the Catholic Church.

But, you see, if there are such cost savings to be had, don’t you think you might be pressured into it? That’s what “death panels” are all about.

These tensions are further stoked by changes in background epidemiology and concerns over health care costs. The vast majority of people in the developed world now die slow deaths, deaths of heart disease, cancer, various forms of organ failure, the dementias, all of which have characteristically long downhill tail-off slopes, patterns of decreasing function that can also involve pain and suffering, and that also may involve substantial demands on family members and health care. As the populations of the developed countries become increasingly “gray,” this problem intensifies.

Against these tensions, this talk portrays one man’s life and the death that he chooses, a death that is on the border between these two camps: Because it involves the withdrawal of treatment, it legally and morally counts as a “natural” death, but because it involves this man’s own choice of time, place, and the people around him, including medical staff, it looks very much like an assisted death.

Notably Ig Nobel: Science humor

Author and newspaper columnist Marc Abrahams is the editor of the science humor magazine Annals of Improbable Research. At TEDMED 2014 he shared laughter- and thought-provoking stories behind some of the winners of the Ig Nobel Prize Ceremony, which he founded and hosts. Almost all humor aside, Marc snuck away from his duties for a few moments to answer questions for us.

Marc Abrahams at TEDMED 2014: Science Humor

Marc Abrahams at TEDMED 2014. Photo: Sandy Huffaker for TEDMED

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

People are sometimes given very serious advice about their health by Very Important People who know little and assume much. Look at the crazy advice that some politicians and some journalists are giving us — “Don’t vaccinate your kids!”, “Ebola was created by evil people who want to attack the American public!”. If someone — no matter who it is — tells you something that seems absurd, the best thing you can do is laugh, if it strikes you as funny… and then go find out the facts, and think about them. And THEN decide what you think about their advice.

What kind of meaningful or surprising connections did you make at TEDMED?

Three people each told me about scarily good candidates for future Ig Nobel Prizes. I probably would never have heard of any of those nominees if I hadn’t gone to TEDMED. (Sorry — I am not permitted to tell you anything about those nominees. We have rules, y’know.)

What is the legacy you want to leave?

I hope I helped at least a few people decide that it’s okay to make their own decisions — rather than simply accept what some authoritative person told them — about what’s good and what’s bad, and what’s important and what’s not.  

Anything else you wish you could have included in your talk?

Well, of course I wanted to tell the story of homosexual necrophilia in the mallard duck. But there wasn’t time. And anyway, Kees Moeliker, the scientist who made that discovery, is the best person to tell that story, which he did in an obscure biology journal, and then at the 2003 Ig Nobel Prize ceremony, and then again years later in a TED talk.

Can you share some highlights from the 2014 Ig Nobel Prize ceremony?

The on-stage demonstration of the technique that won this year’s Ig Nobel Prize for medicine. It was awarded to a team from the U.S. and India for treating “uncontrollable” nosebleeds using the method of nasal packing with strips of cured pork. Before that night, I had never in my life met anyone who had disguised himself as a polar bear to frighten a reindeer. I am very pleased with the premiere performance — as part of the ceremony  — of “What’s Eating You”, the mini-opera about a couple who decided to stop eating regular food, and instead get all their nutrients from pills. The lead singers were magnificent, and so was the chorus of their intestinal microbes.

What was your favorite winner from the 2014 Ig Nobel prize ceremony?

I am entranced by the Nutrition Prize winners — Raquel Rubio, Anna Jofré, Belén Martín, Teresa Aymerich, and Margarita Garriga, who published a study titled “Characterization of Lactic Acid Bacteria Isolated from Infant Faeces as Potential Probiotic Starter Cultures for Fermented Sausages.” They could not travel to the ceremony, so instead sent us a mesmerizing half-minute-long video in which they explain what they did and why, and then eat some of the sausage. MA2