Can we talk about needle pain? Q&A with Amy Baxter

We often ask why parents refuse to vaccinate their children, but there is an important aspect of vaccinations that we rarely openly discuss: needle fear. During TEDMED 2014’s “Don’t You Dare Talk About This” session, entrepreneur and pediatrician Amy Baxter challenged us to change the way we think about needle phobia – an issue that, she says, has important public health implications. We reached out to her with a few questions.

Photo by Bret Hartman, TEDMED 2014.

Amy Baxter on the TEDMED stage. [Bret Hartman, TEDMED 2014]


Why does your talk matter now?

Because vaccines save so many lives, we in healthcare are reluctant to allow any dialogue about whether the number or way we give shots could be damaging. Yet, people feel uncomfortable with the number of injections kids get. The natural unease at watching painful jabs, over and over, is at work when well-meaning parents pick and choose, or refuse vaccination altogether. The lack of communication about the best way to deliver vaccines causes mistrust, and contributes to families feeling that their main source of health information – their family doctor – might not be right about insisting on vaccines. The erosion of doctor/patient trust, and refusal to get vaccinated, will ultimately hurt us all.

By showing the long-term health consequences of too many painful injections at once, my talk presents evidence that we need to have fewer, or less painful, shots. I want people to learn that children’s fear of needles is a natural cause and effect, and is not indicative of a personal weakness. When the next pandemic requires universal vaccination, what happens if and when the 63% of now needle-phobic children refuse?

What do you want your legacy to be?

I want to inspire others who recognize a problem and, no matter what it is, to act. I am proud that I noticed the problem of needle pain; in medicine, we’re trained to ignore pain, or treat it as a necessary evil. Once I realized needle pain does not build character, and can impact children for a lifetime, I used every means I had to conquer the problem.

Once we recognize that our indifference to needle pain can affect compliance, we can change how we vaccinate. If I can help people realize that their shame of needle fear is not a personal failing, more people can receive health care without dread. If nothing else, I hope a doctor will watch this talk and be compassionate and accommodating when a parent says “You know, can we split these shots up into two different visits?”

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

Before devoting a decade of your life to a dream, try the idea out on people who don’t love you. Ask them: Is this something they would buy? Is this what the world has been waiting for? If you had money, would you invest in this idea?

Businesses succeed because someone has a passion and can communicate it to the otherwise indifferent. When you do have a great idea, stick to it and never, ever give up. But before you sacrifice all social currency, work insane hours, and give up time with loved ones (time that you’ll never get back), make sure the idea is worth it.

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

Robert A. Heinlein was a science fiction author who dreamed up worlds that were socially and technologically different from what surrounded him. He invented the water bed, electronically manipulated Waldoes, and inspired Peter Diamandis and Elon Musk (both of whom have been awarded Heinlein Prizes for promoting commercial space flight). While trying to make a buck with his fiction, he also remained true to principles of unwavering integrity, steadfastness, loyalty, and creative self-reliance. Because he changed the world, I have the courage to try to do the same.

Letting bio-inspired solutions evolve: Q&A with Jeff Karp

Jeff Karp, bioengineer and Associate Professor at the Brigham and Women’s Hospital, Harvard Medical School, illuminates the art and science of adapting medical tools, treatments, and technologies from solutions found in nature. We interviewed Jeff to learn more about his views on innovation and bio-inspired work.

“Successful problem definition must precede a successful problem solution.” Jeff Karp at TEDMED 2014.

“Successful problem definition must precede a successful problem solution.” Jeff Karp at TEDMED 2014.

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

Solving medical problems is very challenging; we often encounter barriers that seem insurmountable. Instead of relying on our limited intellect and narrow thinking, there is opportunity for us to turn to nature for inspiration. Every living thing has overcome an enormous number of challenges; in essence, we are surrounded by solutions. My hope is that this talk will help others, through inspiration from nature, overcome challenges they face.

What is the legacy you want to leave?

Innovation is not simply coming up with new ideas. I believe that being innovative means actually doing things that help people. Thus, innovation can only be retrospectively defined. My hope is that when I look back on my career, I can claim that many of the projects that we pursued were innovative.

If you had more time on the TEDMED stage, what else would you have talked about?

There are many projects we are working on that I would love to have shared, such as our new battery coating to prevent injury from accidental ingestion of coin cell batteries by kids. There are 3,000-4,000 accidental ingestions of coin cell batteries each year, mostly in young children, and many result in major injuries including death. We also have a drug delivery system that delivers drugs on demand, which we have shown can be used to prevent transplant rejection, achieve longterm sustained delivery for treatment of inflammatory arthritis, and reduce toxicity and dosing requirements for treatment of inflammatory bowel disease. Additionally we have a technology to administer cells via intravenous infusion and target them in the bloodstream to diseased or damaged tissues — a type of stem cell based GPS system. When I talk about the baby tape innovation, it’s worth pointing out that the nurses and doctors in the neonate units emphasized that it’s okay to leave the glue entirely on the skin, as we can easily detackify it by addition of baby power (so it will not stick to bedding). We also found that by adding baby powder to the remaining glue on the skin, we can place another adhesive directly on top with the same level of adhesion. In addition to the video that I showed where we can seal holes in the heart with our slug inspired glue, we have also shown that the glue can affix a patch inside a beating heart, directly to the septum that separates the chambers of the heart where septal defects are located. We have launched a startup based on this technology, Gecko BioMedical; we hope to have our first products in use soon.

Introducing the 2015 TEDMED Editorial Advisory Board

We’re excited to share something new to TEDMED!

In preparation for TEDMED 2015 and the selection of 60+ speakers and performers, we’re honored to introduce TEDMED’s Editorial Advisory Board.

Board members will offer their expertise, insights and wisdom to assist in the shaping of our stage program themes, topics, speakers and performers while also advising on TEDMED’s overall editorial strategy. Vetting by the Board will help ensure that TEDMED speakers and stage program topics continue to meet the highest standards of scientific relevance and rigor.

To form this Board, we drew upon our remarkable TEDMED community, gathering 20 highly creative, accomplished, diverse and innovative movers and shakers. Each member embodies a spirit of generosity, depth of knowledge and breadth of experience that will contribute immeasurably to the quality and impact of this year’s stage program.

Inclusiveness is a big part of TEDMED’s DNA. That’s why our Board is made up of representatives from across health and medicine as well as the worlds of business and technology, foundations and academia, philanthropy and design, and journalism and communications. This diversity allows us to approach proposed topics and themes through multiple lenses.

We’re delighted to welcome the members of the TEDMED Editorial Advisory Board and we thank them for their collaboration:

Pam Belluck is a health and science writer for The New York Times. She covers a range of subjects, but tends to focus on the most controversial and complex topics related to the brain, behavior, and reproductive health. An award-winning journalist, Belluck has been the recipient of a Knight fellowship, a Fulbright and the Best American Science Writing.

Carlos Bustamante, PhD, is a Stanford professor, population geneticist and MacArthur “Genius” Fellow who analyzes genome-wide patterns of variation within and between species to address fundamental questions in biology, anthropology and medicine. Bustamante was Stanford’s inaugural co-host at TEDMED 2014 and has also been featured on TEDMED’s Great Challenges Program.

Christopher Elias, MD, MPH, is the President of the Bill and Melinda Gates Foundation’s Global Development Program, where he leads efforts in integrated and innovative delivery, finding creative new ways to ensure that solutions and products get into the hands of people in developing countries who need them most.

Harvey Fineberg, MD, PhD, is the President of the Gordon and Betty Moore Foundation and the Presidential Chair of UCSF. He previously served two consecutive terms as president of the Institute of Medicine. Harvey studies medical decision-making, asking important questions about how new medical technologies are rolled out and how we cope with new illnesses and threats of epidemics. He spoke at TEDMED 2013.

Adam Gazzaley, MD, PhD, is a Professor of Neurology, Physiology and Psychiatry at UCSF and the Founding Director of the Neuroscience Imaging Center. Adam was UCSF’s inaugural co-host at TEDMED 2014.

Carleen Hawn is the Founder and CEO HealthSpottr. Prior to founding Healthspottr, Carleen was an associate editor with Forbes and senior writer and west coast bureau chief for Fast Company magazine.

Peter Hopkins is the Cofounder and President of Big Think, a cutting-edge online knowledge company that makes people and companies faster and smarter through efficient e-learning from world renowned experts. Peter also spearheaded the creation – and currently serves as the Principal – of Floating University, a joint venture with the Jack Parker Corporation that aims to foster content innovation in higher education.

Jeff Karp, PhD, is an Associate Professor at Brigham and Women’s Hospital and Harvard Medical School. His research focuses on stem cell engineering, biomaterials and medical devices inspired by nature. He shared his work at TEDMED 2014.

Mohit Kaushal, MD, MBA, is an Associate Professor at Stanford University and a visiting scholar at the Brookings Institution. He is also a partner at Aberdare, a venture capital firm focused on transformational healthcare opportunities. Mohit has also served on TEDMED’s Hive curatorial board.

Sandeep “Sunny” Kishore, MD, PhD, is an Internal Medicine Resident at Yale University. He’s been a founder of a global health organization, a Delegate to the UN General Assembly, a Fellow at MIT Dalai Lama Center for Ethics & Transformative Values, a Soros Fellow and the first Lancet awardee for community service. Sunny was a TEDMED 2012 speaker and also co-hosted the TEDMED 2014 DC stage.

Rupa Marya, MD, is a hospitalist and an Assistant Professor of Internal Medicine at UCSF. She is also the lead singer, composer and musical director of Rupa & the April Fishes, a band that seeks to celebrate beauty in pluralism and reinvigorate appreciation for living music with their diverse, global sounds. Rupa & the April Fishes performed at TEDMED 2014.

Vivek Murthy, MD, MBA, is the U.S. Surgeon General. Prior to his confirmation, he was a physician at Brigham and Women’s Hospital in Boston, and a Hospitalist Attending Physician and Instructor in Medicine at Harvard Medical School. He is also the President and cofounder of Doctors for America.

Betsy Nabel, MD, is the President of Brigham and Women’s Hospital, a practicing cardiologist, a biomedical researcher, a patient advocate, a Professor of Medicine at Harvard Medical School, and the first Chief Medical Advisor of the NFL. She was previously the Director of the National Heart, Lung, and Blood Institute. She spoke at TEDMED 2014.

Ivan Oransky, MD, is the Vice President and Global Editorial Director of MedPage Today. Previously, Ivan was Executive Editor of Reuters Health, Managing Editor of Scientific American and Deputy Editor of The Scientist. Ivan is Vice President of the Association of Health Care Journalists, and serves on its Board of Directors. Ivan spoke at TEDMED 2012.

Manu Prakash, PhD, is an Assistant Professor of Bioengineering at Stanford University.Manu serves as a core member of graduate program in Biophysics and an affiliate of Woods Institute of the Environment at Stanford University. In 2014, Manu was nominated as MIT Tech Review TR35 and Popular Science Brilliant 10.

Carla Pugh, MD, PhD, is a Surgeon and the Director of the Health Clinical Simulation Program at the University of Wisconsin. Her work focuses on fine-tuning students’ haptic skills as a standardized part of clinical education and daily practice. She spoke at TEDMED 2014.

John Qualter is the co-founder and Chief Creative Officer of BioDigital Systems, where he leads digital content creation and consulting for clients in the device, pharmaceutical and communications industries. John is a pioneer in the field of biomedical visualization, promoting the implementation of high-end 3D media in the healthcare industry. He spoke at TEDMED 2012.

Teeb Al-Samarrai, MD, is a physician, writer and epidemiologist with a diverse background in neuroscience, anthropology, and domestic and international public health. She previously served as a CDC Epidemic Intelligence Service Officer assigned to the New York City Department of Health and Mental Hygiene and currently serves as Deputy Health Officer & Tuberculosis Controller with the Santa Clara County Public Health Department in California, focusing on immigrant and refugee health.

Nina Tandon, PhD, MBA, is the CEO and Co-Founder of EpiBone, the world’s first company to grow living human bones for skeletal reconstruction. She is also an Adjunct Professor of Electrical Engineering at Cooper Union. Named one of the 100 Most Creative People in Business by Fast Company in 2012, Nina was a TEDMED 2014 speaker and is a Senior TED Fellow.

Abraham Verghese, MD, MACP, is a physician,Professor and Vice Chair for the Theory and Practice of Medicine at Stanford University’s School of Medicine and the author of the novel Cutting for Stone. In the modern era of medicine, where patients can seem to be mere data points, Abraham believes in the value and ritual of the physical exam, and in the power of informed observation. He spoke at TEDMED 2014.

It Takes a Village to Combat Childhood Obesity: Last Week’s Hangout Participants Address Unanswered Questions

Last week, a multidisciplinary group of experts joined us for a Great Challenges live online event to discuss whether it truly takes a village to prevent conditions such as childhood obesity. With NPR Correspondent Allison Aubrey moderating, these experts took a close look at community-based prevention initiatives that have led to sustainable health solutions, including reductions in childhood obesity, and discussed how those approaches can be applied elsewhere.

If you weren’t able to join us, check out the recast below.

Thanks again for sending your questions and comments via social media! We had such great questions that an hour did not leave time enough to address them all. So, we asked our panelists, Angela Diaz, Karen Peterson, Belinda Reininger and Risa Wilkerson to offer their thoughts on the remaining questions. Here’s what they had to say:

Conditions such as childhood obesity are more prevalent in lower income areas – these are precisely the ones that may not have the resources to take meaningful action. How can these communities create a program that might have an impact?

Angela: In the absence of additional resources, collaboration becomes even more important. One may build new program opportunities on top of tasks you need to do anyway. For example, a graduate program may need to place students to practice nutrition education or physical education and could be added to the resources available at a local early education center. Or changing the way an organization conducts their regular business may not require additional funding, but instead, a consideration to do things differently. For example, a daycare center offers daily snacks to their kids. An activity that requires no additional resources is setting standards for types of snacks served.

Risa: The Healthy Kids, Healthy Communities initiative supported 49 partnerships to increase children’s access to healthy foods and opportunities for physical activity through changes in policies, systems and environments in those communities at greatest risk for childhood obesity based on race, ethnicity, income and geographic location. The Growing a Movement report provides insights on what is achievable in low-income communities through collaboration among community-based organizations, residents, decision makers and other partners. Much was achieved by these partnerships. I realize that being part of a grant-funded program provides many advantages and yet there are ways communities can replicate some of these efforts, even if on a smaller scale or a longer time frame.

The examples cited (Brownsville, Blue Zones communities) are affiliated with large organizations – they are very special circumstances that many communities cannot replicate. Can a community take steps to better prevent chronic conditions without the backing of a powerful organization?

Angela: When you set the table for collaboration, any individual, small organization, tenant association or civic group can contribute towards health: a scout working on is Eagle project can mark trails in a local park that is used by families during the weekend, thus providing more opportunities for physical activity. A tenant association can organize a “Play Street” during the summer staffed by neighbors and summer youth employment participants from a local multi-service agency.

Belinda: Preventing chronic disease in a community takes more than one large organization – it takes numerous large and small organizations coming together. Large organizations can be helpful when you have grants where costs are reimbursed after the work is done, simply because these organizations tend to be more able to float those costs more easily than smaller organizations. However, smaller organizations are usually able to be more nimble in hiring and purchasing. The strengths of both types of organizations move things forward.

Risa: Any community can take steps toward better conditions even without a large funder behind the scenes. Perhaps there is an existing community coalition or partnership that can help organize efforts. If not, start small to develop one. It is important that coalitions meaningfully engage those residents whom are most affected by the current conditions. A first step can be assessing the situation by looking at health and safety data (most county health departments can help with this) and talking to residents about the barriers they face to eating healthy food and being physically active. From there, choosing small steps toward change to help built trusting relationships and to build energy toward change. This can include collective efforts to invest in improving (even cleaning up) a local park or starting a community garden.

What’s the single most important piece to the puzzle of preventing chronic disease on a community level?

Angela: When neighbors are socially and civically active, they can turn a community around. If neighbors have an opportunity to work together and achieve a small win, like getting a street clean, getting together and watching “Weigh of the Nation” or a similar documentary at a local community center, they may be inspired to take the next step to get more deeply involved with other issues in their neighborhood, like rallying to bring more healthy options to their local grocers.

Risa: There is no single solution. It’s a complex issue and one that requires work at the systems level. What is important is that we don’t rely only on programs, promotion and education to move the needle. We also have to work on changing policies and the social and built environments to support people’s desire to make healthy choices.

In your opinion, is it possible that childhood obesity is not the problem but a symptom of a larger issue at hand? What might that issue be?

Angela: Letting the food industry produce, market and profit from unhealthy, overly processed, high calorie-low nutritional food in the name of corporate freedom, with little regard for health is part of the larger issue. Some subsidies favor the over-production of some crops, for example, corn. Over-diversified crops result in a product flooding the market and then the need for that product to be put to use.

How can lessons learned from Brownsville or the Blue Zones be best applied to other communities? Is it a matter of policy change? Health education? Is it a community-driven process?

Angela: Again, I cannot stress enough that a good place to start is setting the table for people to come together, build relationships and start to talk about what they are doing and where there are opportunities to build on each other’s agenda. This community-driven process can be more powerful than any externally imposed, single lead program or intervention you can think about.

Belinda: Yes – it is all of that. Any community can use the evidence-based Community Wide Campaign approach. It includes media, risk factor screening and health education, policy and environmental changes.

Community leaders in Brownsville and in Blue Zones could be thinking: “Hey, we’ve found a big piece of the puzzle to solve childhood obesity! Now all we have to do is tell the world and everybody will follow our example!” How much has this actually happened? Why isn’t it happening, or happening more?

Angela: We, in public health, are obsessed with replication. There may be some principles that can be used to guide others, but at the end of the day, the relationships and the process are going to be more important and transformative than any specific content we seek to replicate from one place to another.

Based on the success stories we’ve discussed today, what’s the most important step a community looking to improve the health of its population and encourage behavior focused on prevention needs to take?

Angela: Community building is about relationship building. It is relationship, relationship, relationship. One of the most important things for the wellbeing of a community and its members is to feel connected, to be socially and civically engaged, to have common goals and work toward those goals. A good place to start is setting the table for people to come together, build relationships and start to talk about what is important to the community, what are they doing and where there are opportunities to build on each other’s agenda. Another good thing to do is to build shared history – like neighborhood traditions of health related activities that become part of a shared culture. Finally, we must always remember that community-based work is an iterative process: we advance and win some, but sometimes we need to go back to the drawing board as we fine-tune our work in response to input from our community partners.

Karen: Take the long view to developing engaged, sustained community partnerships using the organizations that are active in different community settings. Community success stories often involve not only a focus on “evidence-based behaviors” such as decreasing screen time and sugar-sweetened beverages, but also the use of “evidence-based interventions” (tested with sound evaluation designs) put together to impact all parts of a child’s day – using a community based participatory approach or alternatively, a partnership model. The interface between communities and other “levels of influence” should be considered. In particular, communities are in a position to make sure the organizations most directly responsible for caring for children (schools, childcare, etc.) have the resources they need and that they are active participants in providing their views and expertise in how to solve obesity.

Belinda: Assemble a strong and action-oriented group of partners to establish a plan with short and long-term goals based on needs of the community. Definitely use an evidence-based approach to select strategies. Get started and don’t take no for an answer. You may have to regroup at times, but keep moving forward towards goals as a group.

Why You Should Care about the Hidden Threats of Toxic Stress – Q&A with Nadine Burke Harris

In her TEDMED 2014 talk, Nadine Burke Harris revealed a little-understood, yet universal factor in childhood that can profoundly impact adult-onset disease. Eager to learn more, TEDMED reached out to gain further insight into her talk topic.

Photo by Kevork Djansezian, TEDMED 2014.

Photo by Kevork Djansezian, TEDMED 2014.

What motivated you to speak at TEDMED?

I was seeing the health impacts of Adverse Childhood Experiences and toxic stress in my clinic every day, and yet it felt like so few people knew about them. As a doctor, I wanted to sound the alarm about this health crisis. This is something every parent, grandparent, teacher and caregiver should know about.

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

We are spending more and more money on healthcare without getting to the root of some of our biggest health problems. I believe that routine screening and treatment for Adverse Childhood Experiences and toxic stress will lead to better health and quality of life for millions of Americans, not to mention reducing our healthcare costs. I hope to wake people up to this public health crisis and motivate everyone to become part of the solution.

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

We just analyzed the data on Adverse Childhood Experiences for the state of California. Over 60% of California’s population has had at least one experience, and 16.7% have had four or more. Individuals with four or more experiences are at double the lifetime risk of asthma, and over four times the risk of Alzheimer’s disease.

When we think about early adversity, we tend to think of low income communities of color. Our data in California shows that this is a big issue for every neighborhood and every income level. Every doctor should be screening for this.

What is the legacy you want to leave?

Currently, my team and I are working to develop a clinical protocol to effectively treat toxic stress. If we are successful, and I believe that we will be, that will be my legacy.

What’s next for you?

The Center for Youth Wellness is a young organization with a really ambitious agenda. Our goal is to transform the standard of pediatric practice to recognize and treat toxic stress. We have a lot of work to do before the effects of Adverse Childhood Experiences and toxic stress are common knowledge, like lead poisoning or second-hand smoke. Right now, our focus is on developing an effective clinical treatment protocol.

Keeping up with 50+: How can we encourage innovation at the speed at which the 50+ population is growing?

shutterstock_164560796Forty-five percent of the United States population is more than 50 years old, and as science and medicine advance and lives extend, this number will only increase. As this key age group grows, keeping them healthy will be increasingly challenging, but no less crucial. As part of TEDMED’s commitment to fostering innovation in health and medicine – including for the 50+ population, TEDMED’s Shirley Bergin will once again be lending a hand to our partner AARP as an advisor for their Health Innovation@50+ LivePitch. (Applications are being accepted until February 20, so if you’re innovating in 50+ health and medicine – go ahead and throw your hat into the ring!)

To gain a better understanding of the problems facing 50+ health today and what we can do to address the specific needs of this age group, we interviewed three members of our TEDMED 2014 Hive, all of whom are doing great work to enhance health for the 50+ crowd. Read on to hear what they had to say.

What do you think is the biggest problem facing 50+ health today? What can be done to address it? 

Jon Michaeli, MediSafe: One of the biggest problems facing the 50+ demographic is access to affordable, quality care. Aging patients have diminishing access to time- and resource-strained providers who historically have helped to steer their care. As a result, many do not have adequate support to ensure they fill their medications and take them as prescribed. As baby boomers get older, they are diagnosed with more chronic conditions, resulting in an increase in prescriptions. Almost 20% of adults over 65 take ten or more medications and adherence rates drop by 30% in those taking four or more medications daily. Moreover, medication non-adherence accounts for more than 10% of older adult hospital admissions and approximately one-fourth of nursing home admissions. What this patient population needs are interconnected, interactive interventions that uniquely address their challenges, their acceptance of technology, their home environment, and need for caregiver and provider support.

Leon Eisen, Oxitone:Fears dominate the life of many over-50s, preventing them from engaging in adequately healthy behavior. An intensive educational activity accompanied with the 24/7 automated tracking of vitals — and continuous connection to the family members and healthcare professionals — could alleviate the problem.

Courtney Larned, CareSync: For the majority of Americans age 50 and over, the biggest health challenge is getting organized: building a medical team, with a primary physician who really cares and truly believes that older people can still live healthy, full lives, and specialists for any conditions or risk factors. It’s important to know what that patients know what they personally need. When patients…have a current file of [full] medical and family history…then they’re in the best possible position to make the healthiest choices on an ongoing basis and when emergencies happen. Other aspects of getting organized [include] knowing what health insurance covers, what it doesn’t, and what needs to be done in various medical situations to make the most of the insurance that you have; [being aware of drug, vitamin, and food conflicts]; and…putting your medical wishes into writing in a legally-binding advance medical directive…Information is power…the trick is to be as ready as possible.

Where do you see the biggest opportunity for innovation with the 50+ age set?

Jon Michaeli: With 86 million increasingly tech-savvy millennials, there are substantial opportunities for software platforms to help patients keep their care under control from their comfort of their own homes instead of being readmitted to the hospital for care. Non-proprietary cloud-based services are an ideal fit, because they allow multiple parties to participate in the patient’s care, irrespective of their technical capabilities (from landline phone and SMS, to web and mobile apps). Doctors and caregivers can be kept up to date remotely, correlate patients’ adherence to reported symptoms, side effects, biometrics and labs, and generally track progress without actively intervening unless necessary. This improves patient confidence and morale, gives loved ones peace of mind, and offers providers more visibility into patient outcomes.

Leon Eisen:The biggest opportunities will be found in educational, monitoring, self-management and behavior-changing solutions.

Courtney Larned:The generation that’s now stepping into senior citizen status is not used to the idea of being sidelined from anything and is going to want to stay as active as possible, in society, in the workplace, and personally. There’s a lot of room for innovation in government, to fully include all ages in task forces and work groups on policy issues. Practically speaking, there are a lot of ergonomic issues to consider in the workplace and public places – go to any health club and you’ll see the awesome adjustability of most of the machines. Why don’t we see this same adjustability in our office furniture and the medical equipment we are exposed to when we need CT-scans, MRIs, stress tests, radiation therapy and a host of other tests and procedures? So there’s another area crying out for innovation.

How do you think the quick growth of the 50+ population recently has impacted health innovation in this space? Do you see innovation growing in this area as the population increases? Why or why not?

Jon Michaeli: The propensity for chronic illness (and illness in general) increases with age, with chronic patients accounting for 75 – 80% of healthcare costs today. This is a major financial burden and is not sustainable. This in turn is driving innovation, as new technologies can monitor and provide care outside of the hospital. This need/demand is driving a supply of innovative solutions, and the investment appetite to fund it.

Leon Eisen:Innovations are growing exponentially as a result of quick market growth. The increase of population is resulting in more business opportunities.

Courtney Larned:We see and hear about a lot of innovation involving telemedicine, which has a lot to offer as an added tool for wellness, chronic disease, and certain types of easily diagnosed illnesses, but it’s important to remember that the human touch can never be fully removed from the equation. Telemedicine, trackers, smartphone apps, video house calls, and other services yet to be proposed can be a very helpful supplement for ongoing care. They should not be a substitute for an ongoing relationship with doctors or other medical professionals who know you, your situation, your preferences, challenges, and goals.

A Surgeon’s Touch: Q&A with Carla Pugh

Carla Pugh spent her childhood tinkering with appliances and electrical outlets. Quite fittingly, she spoke in TEDMED 2014’s “Play Is Not a Waste of Time” session. Now a surgeon and the Clinical Director of University of Wisconsin’s Health Clinical Simulation Program, Carla shared why haptic skills training matters so much in medicine. Eager to learn more about what she sees for the future of medical education, we reached out to her for a Q&A session.

Carla on the TEDMED 2014 stage. [Photo credit: Jerod Harris, TEDMED].

Carla on the TEDMED 2014 stage. [Photo credit: Jerod Harris, TEDMED].


What impact do you hope your talk will have?

I want to spark a serious conversation about need for elite, high-end, mastery training in the healthcare profession. Healthcare is at a critical juncture where there are huge opportunities for major information exchanges that can empower physicians and patients. Both patients and physicians will benefit from clinical skills performance data. For example, what if we all knew which haptic techniques place physicians at risk of conducting poor clinical examinations?

Outside the measurement of haptic skills, are there other gaps that you believe exist in medical education?

I think the future of medical education is about the global improvement of all skills. The soft skills – like interpersonal communications, and the promotion of tolerance – are definitely the most difficult to achieve. As educators, I think there are gaps in knowing how to be the best teachers we can be, and understanding the limitations of observational learning. When my students walk away from watching a video, I have no idea who’s learned what and who hasn’t. Traditional learning hasn’t fully recognized that, and still hasn’t made strategic efforts to change. Watching videos is helpful because it does give students a certain level of instruction, but at some point it’s important to have that team conversation where you face your colleagues. Also, if you are doing a procedure, at some point you have to pick up an instrument and use it. Videos and observation can only get you so far. Applied learning doesn’t take place until action happens.

Could you paint us a picture of your dream patient simulation lab?

Integration is key. Our whole education system isn’t where it could be; I still dream of something that’s full service. The dream simulation lab would have a central facility, where people come to train and discuss a wide variety of clinical skills. It wouldn’t only be about haptics – it would include communication across professions, and improving patients’ communication with their healthcare providers. Beyond that, it would also be a place where patients could come to learn important techniques – like how to give themselves a shot, take care of a wound, or think of creative ways to remember to take their medication. We would educate using broad, hands-on heuristic techniques.

Standard measurement of a physician’s skill is through the board exam. If you were designing the board exam for surgeons, using all of your haptic technology, what would it be like?

The way that the board exam is administered is highly centralized – we have to go to a board designated location to get tested. Ideally, there would be maintenance of professional certifications, where doctors are given relevant lifelong learning opportunities that are ongoing and well integrated into their daily clinical practice. This is something that the board is working on.

I would like to see decentralized opportunities where doctors are able to practice clinically relevant scenarios.   As doctors, we need to maximize our use of local social capital. For example, I have a few experts working down the hall from me, but I don’t have access to their knowledge, their haptic and communication skills for example. We need more information sharing, and the opportunity for shared practice. I want to compare their performance to my performance, and the ability to choose a training paradigm that directly matches the mastery level that I want to achieve. It’s about mastery, not skills – when we talk about skills, we tend to think of them in terms of “you either have them or you don’t.” Mastery is about constantly improving and working towards better performance. That’s what we should focus on.

Are there any actions items you want your viewers to take?

Make sure to read my research article about using sensor technology to assess clinical skills, which will be published in the New England Journal of Medicine on February 19!

Breastfeeding–what’s in it for mom? Q&A with E. Bimla Schwarz

E. Bimla Schwarz, a women’s health expert and scholar of evidence-based data, sheds new light on breastfeeding’s preventative effects on heart disease and other maladies. While the positive effects of breastfeeding are often noted for infant health, physicians have virtually ignored benefits for the mother. We discussed with Bimla the meaning and impact of her powerful talk.

Breastfeeding advocate and women's health expert E. Bimla Schwarz on the TEDMED 2014 stage.

“On average the waists of moms who don’t breastfeed are six and a half centimeters larger than those who do.” E. Bimla Schwarz at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED]

What motivated you to speak at TEDMED?
I was intrigued by the diversity of TEDMED’s audience. Addressing heart disease in our community and making it easier for moms to breastfeed for as long they want to is going to require lots of new partnerships and creative collaborations.

Why does this talk matter now?
As we become more aware of the lifelong effects of infant feeding practices on maternal and infant health, it becomes imperative to do whatever we can do to make it easier for the moms in our community to recover from pregnancy as nature intended.

What impact do you hope the talk will have?
I hope this talk will inspire more obstetricians and maternity facilities to ensure that the women they care for get the support they need to learn how to breastfeed, and that new moms who are facing the multiple challenges that mothers still commonly face, find the resolve to give breastfeeding a try…and stick with it for a few months.

Is there anything else you really wish you could have included in your talk?
I wish I had woven in the fact that breastfeeding protects moms from breast and ovarian cancer. (See Bimla’s TEDMED page for more resources).

Check out our archived live Facebook Q&A where we’ll dive deeper into these issues with Bimla. 

Giving Sight to Innovation: Q&A with Uzma Samadani

Uzma Samadani is the cofounder of Oculogica, a neurodiagnostic company that, through eye movement tracking, specializes in detecting concussions and other brain injuries otherwise invisible on radiologic scans. She shared her journey of discovery on the TEDMED 2014 stage. We caught up with Uzma and learned more about her vision and methods of discovery.

Uzma Samadani at TEDMED 2014 discusses her eye tracking innovation for diagnosing brain injury.

“I hope people who hear my talk are inspired to work hard and make their own discoveries.” Uzma Samadani at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED]

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

Necessity was the mother of invention, and serendipity the father. We sought to develop an outcome measure for a clinical trial for severely injured vegetative patients when we developed the eye-tracking algorithm that we subsequently realized could detect concussion. We had expected to use the eye-tracking algorithm to calculate how well people could pay attention and fixate their gaze, but then were surprised to find that it actually showed us what was wrong with the brain. Now that we have discovered this technology, we understand its implications: it enables us to detect previously ‘invisible’ brain injury. We are inspired, driven even, to innovate and make this technology available to everyone who has sustained trauma. We can help people who previously would not have had objective measures indicating brain injury.

Why does your talk matter now? What do you hope people learn from your talk?

My talk is not so much about brain injury directly as it is about a moment of discovery – the rare shock of finding something remarkable and considering its implications, then the doubt, and the concern about artifact. And then, the gradual realization that we have discovered something real and potentially extremely helpful for humankind. I hope people who hear my talk are inspired to work hard and make their own discoveries.

What is the legacy you want your work to leave?

Brain injury is the single greatest cause of death and disability for Americans under the age of 35 years of age. By creating a biomarker and outcome measure for injury, we can test treatments and therapies and also evaluate prophylactics such as helmets. The true measure of our success will be its utility: to other researchers, to clinicians and to the people who sustain injury.

How can we harness the power of imagination to innovate in the pediatric health space?

shutterstock_193115849Innovation in health today occurs incessantly. We see new ideas daily, and the progress we’re making is exciting. But, most of that progress is being made in adult health. While there are 75 million children in the United States today, too often we take the approach of treating children like “little adults,” despite the fact that they have an entirely different set of needs, and those needs change year by year. This lag in pediatric health innovation has inspired TEDMED’s Shirley Bergin to serve as a judge at this year’s inaugural Impact Pediatric Health Pitch Competition at South by Southwest Interactive. (By the way, if you’re innovating in pediatric health, you have a few more days to apply!)

So how can we harness the power of imagination to innovate in the pediatric health space? To gain a better understanding of the barriers facing innovation in pediatric health and how we can move forward, we interviewed a handful of pediatric innovators – including several TEDMED Hive alumni. Read on to hear what they had to say.

What do you think is the biggest problem facing pediatric health today? What can be done to address it?

  • Jessica Eisenberg, VoiceItt: Childhood disabilities are on the rise…Since we are a long ways off for a cure for many of these conditions, we can develop technology to greatly enhance their quality of life. We are living in an exciting period where the development in technology has the potential to break down the gaps between people with disabilities and society, and help them to be fully included in society.

  • Lynn E. Fiellin, play2PREVENT Lab: I think one of the biggest challenges facing pediatric health today, particularly around preventive health, is finding children and teens where they “are.” Healthy kids don’t engage in the health care system beyond “well-child” visits and kids with chronic medical conditions have a number of other issues to address. Beyond vaccination during early childhood, the provision of preventive care…is fairly limited. Innovations in technology focused on preventive care in teens allow us to engage teens and provide them with messages and skill-building to develop behaviors that can lead to lifelong health.

  • Kyle J. Rose, mySugr: One major challenge for parents and healthcare professionals alike is knowing how much independence to give to children regarding the management of their health. How much and at what point?…Educational initiatives…often result in outstanding clinical outcomes, not to mention increased quality of life for both the child and their family.

  • M. Jackson Wilkinson, Kinsights: Misinformation. Parents are in a state of constant information starvation, and as healthcare tightens its belt, they get less face time with healthcare professionals than ever before, and the advice they get from friends, family, and the Internet is usually not vetted. As with so many other fields, pediatrics (and parenting) is in need of a strong dose of information literacy, and it’s innovators who can help develop tools to help patients and parents find the right information for them, rather than playing a dangerous game of telephone.

Why do you think innovation in the pediatric health space often lags behind other areas? 

  • Amy Baxter, Buzzy: In pediatrics, patients aren’t as articulate about what bothers them in healthcare. You don’t have the option of “voting with your feet” when you’re carried to a doctor’s appointment in a car seat. And since children don’t make the financial decisions, they don’t drive the marketplace. Many pediatric products have to come from pediatricians or parents who see a need and have the empathy and time to make them reality.

  • Kyle Rose, mySugr: The pediatric health environment has stricter regulations, for good reason. However, unfortunately in the world of medicine this can add a significant barrier to enter this market. This is true whether it’s a start-up with a new medical device or even a major Pharma company.

  • Roberto Flores, SmileTrain: Children do not have a voice in science, in the government or in a medical office. They need others to speak for them…This is a unique aspect of pediatric care that affects everything from innovation to financial support for children’s health…Innovation in the pediatric space can lay the groundwork for innovation in the adult medical arena and vice versa.

  • M. Jackson Wilkinson, Kinsights: Everything is a little more complicated for a pediatric patient. Parents are often more protective with their child’s health than an adult might be with their own, so it can be difficult to get cooperation for even simple experimental care. Couple that with increasingly complicated privacy regulations, and it’s often just enough to dissuade interested entrepreneurs and researchers.

What can be done to spread the notion that children are not just “little adults” in terms of medical needs?

  • Jessica Eisenberg, VoiceItt: Because it’s more difficult to understand the symptoms and needs of a child, we cannot make a diagnosis and rehabilitation plan in a short office visit. More time and effort must be invested with children to build up their confidence in expressing their needs. The more understanding we have, the more we can spread this notion.

  • Lynn Fiellin, play2PREVENT Lab: The use of innovative methods of reaching kids is much more likely to have greater impact, given that kids now are growing up with innovative technologies and they are “hard-wired” to interact with and respond to them. Demonstrating the successful use of new innovations in pediatric health will help to show stakeholders that innovative health care for kids needs to be designed specifically for them, not only to reach them, but to have a sustainable effect.

  • Kyle J. Rose, mySugr: The healthcare system will need a fundamental shift from short-term to long-term visions, in particular from the payer perspective. Young people do have specific needs. We need to address those needs and also be there to support them as they transition from pediatrics to adults, a time period when they need us most and where patients often fall through the cracks of the healthcare system.

  • Roberto Flores, SmileTrain: A child is different at all phases of development. A person who holds a newborn infant, plays with a child in preschool, plays soccer with a middle schooler and debates with a teenager, will realize that at different ages children’s bodies work differently, heal differently, have different needs, and are often affected by distinct medical problems. As pediatric care involves so many different types of “people” the need for innovation in the pediatric space is that much greater.

How can we better assess pediatric healthcare needs and encourage companies to innovate in them?

  • Jessica Eisenberg, VoiceItt: Bringing together technological companies and associations that have a deep understanding the pediatric population is the key element needed to instigate innovation.

  • Amy Baxter, MMJ Labs: Parents are the best motivators.  Educate them about what is really important for health, and do it transparently…Ignoring parents’ intelligent regard toward their healthcare decisions makes the healthcare providers look suspect, and parents seek other sources of information.

  • Lynn E. Fiellin, play2PREVENT Lab: I believe the best way to assess healthcare needs, in kids, and all individuals, is to review the literature, [and] interview the stakeholders…Once you identify the areas in need, companies need to recognize that looking at new ways of reaching individuals, thinking outside the box, is much more likely to have the desired effect of engaging this population and connecting with them about their most relevant healthcare issues.

  • Kyle J. Rose, mySugr: We believe that the evidence is already there. It is critical to show payers and government systems that if young people are healthy when young that this leads to higher productivity overall. The health economics speak incredibly loudly. Governments could encourage companies via special programs and funding for such outcome-based initiatives.

What inspires you to work in this area?

  • Jessica Eisenberg, VoiceItt: Giving a child back his voice, witnessing an expression of love, a joke or saying he is hungry or cold is one of the most incredible and emotional sights you can witness. Few things are more rewarding than hearing individual stories of connection, love and gratitude on a daily basis.

  • Donna Brezinski, Little Sparrows Technologies: As both a pediatrician and a mother, I am inspired to innovate in the area of pediatric health because in many ways I see children as our role models for innovation. Children have very few predefined expectations of what the world should be, and as such, are boundless in their view of what is possible…As innovators we should emulate their openness to imagine so that we can envision what our world could be rather than be restricted by what it is.  Innovating for children grants us freedom to be hopeful for the future.

  • Lynn E. Fiellin, play2PREVENT Lab: Before I moved into this field, I was doing intervention research with many young adults struggling with the consequences of risk behaviors they had engaged in during adolescence—specifically risky sex and drug and alcohol use. I thought if we could “turn back the clock” and teach them the necessary preventive health skills when they were young teens, we could help them to avoid these serious health consequences.

  • M. Jackson Wilkinson, Kinsights: The families. Parents and families devote so much time, energy, and resources to doing their best to raise a happy, healthy child. When you see how devoted they are, it’s hard not to want to clear aside everything standing in their way. Sometimes it’s something as simple as making sure you don’t ask the same questions over and over, and other times it’s incredibly sophisticated, but there’s a ton of work to do, so I’m happy to pick up my shovel and get to it.