TEDMED Blog

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

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

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

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

What motivated you to speak at TEDMED?

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

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

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

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

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

What’s next for you?

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

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

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

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

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

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

What motivated you to speak at TEDMED?

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

What impact do you hope the talk will have?

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

What’s next for you?

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

Any corrections to your talk since you gave it?

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

Announcing TEDMED 2015

We’re thrilled to share some exciting news with you: the venue, dates and theme for TEDMED 2015.

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This year’s event will focus on Break<ing>Through the status quo and celebrating the typical, the atypical and the spaces in between as we come together to shape a healthier world.

The mythology of a “breakthrough” tells the story of a lone genius and one magical, “aha” moment. But, let’s not mistake a good story for the truth. In reality, we all have breakthrough potential and the least likely way to unlock that potential is to toil away in social or intellectual solitude. Instead, we break through in new combinations and we collect the building blocks of our future breakthroughs every day, in every new interaction, in every new insight, one improvement at a time.

This year we’ll explore…

  • breaking through the silos that prevent different disciplines from sharing problems and insights;

  • breaking through glass ceilings and closed doors that hold back some women and minorities from entering medical research;

  • breaking through national and cultural boundaries;

And, breaking through old assumptions to explore new science and new visions of what’s possible – in ourselves, in our work and in the world at large.

We invite you to join us and secure your spot at TEDMED 2015 today.

Our home in 2015: Palm Springs, California, November 18-20

The venue this year in sunny Palm Springs, California inspires a new vibe that we hope you are as excited about as we are. A more collaborative setting and design will help speakers, delegates and innovators come together and explore the important topics and themes the stage program brings forward in a more connected way than ever before.

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Of course, our gathering will include the brilliant talks you’ve come to know from some of the most inspiring change-makers both inside and outside of health and medicine, as well as stunning artistic performances and transformative innovators. Our recently formed Editorial Advisory Board – made up of rock star movers and shakers hailing from health and medicine as well as the worlds of business and technology, foundations and academia, philanthropy and design, and journalism and communications – is hard at work helping us shape a diverse and inspiring stage program.

Connecting across the world: TEDMED Live

As always, a vital part of our mission is to ensure that all stage content is accessible to the broadest community possible. Through TEDMED Live our content is free for teaching hospitals, medical schools, non-profits and government agencies around the world, building on last year’s participation of 200,000 remote participants in 140+ countries.

We invite you to join us in Palm Springs this November – visit www.tedmed.com for more information, or click here today.

A week of health and medicine #news from @TEDMED

These are the stories that we shared with the TEDMED community this week – read them again or if you missed them, you’re in luck! Follow us on Twitter to get daily updates.

@TEDMED

Could this gaming platform based on tech from the Gazzaley lab become first FDA-approved video game?

TEDMED 2014 speaker and filmmaker Tiffany Shlain talks about how we can unlock the unique potential of the human brain

TEDMED 2014 speaker Josh Stein uses smart med devices to positively influence patient behavior

New paper on ways to address adverse childhood experiences

More on how TEDMED 2014 speaker Marc Koska is helping save lives around the world w/his single use syringe

#GreatChallenges

Tailored safety-net programs to minimize institutionalizing patients with mental illness

“Basket studies:” a “new breed” of studies are providing a faster way to try drugs on many cancers

“Exploring the supposed contradiction between America’s healthcare costs & and its health outcomes” 

Teens eat better when the motivation is tied to something they’re passionate about 

Idea that kids should eat “bland, sweet food” is an “industrial presumption” 

“12 companies leading the way in digital health”

Bionic reconstruction allows the mind to control a hand after amputation

Wathc the recast of the GreatChallenges G+ Hangout event on patient experience

The CDC says we could cut the HIV transmission rate by more than 90%

Using training and technology to avoid nurse injuries at the VA

Enhancing the role of the patient in the drug review process, with Congress?

“Plain Cigarette Packs May Deter Smokers, Studies Show”

Should generic drug makers update medicine labels when they learn of safety risks?

Add your voice to the Beryl Institute’s global conversation about the state of the patient experience

Mindfulness training on your smartphone

“CHIP reauthorization is…a harbinger of things to come with future ACA battles”

“Federal study: Foster kids struggle to get health screenings”

What could the Supreme Court challenge mean for the Affordable Care Act?

Recast of the discussion from Robert Wood Johnson Foundation on how we can help all kids grow up at a healthy weight

How social media is changing suicide prevention

Reducing air pollution improves children’s lung health during a critical time

Study highlights importance of exercise, even for those w/identical genes & nurturing 

Measuring the Value of Patient-Centered Care: Last Week’s Hangout Participants Address Unanswered Questions

Is it possible to measure the value of patient-centered care? Last week, as part of TEDMED’s Great Challenges Program, a multi-disciplinary group of experts moderated by Boston NPR Health Care Reporter Martha Bebinger, discussed the rise of patient-centered care, explored how we can standardize its measurement to encourage evidence-based policy changes, and touched on what those potential policy changes might look like.

If you weren’t able to join us, check out the recast here:

Thanks again for taking to social media to submit your questions and comments! We had such wonderful questions that an hour left us short on time to address them all. So, we asked a few of our panelists, Steven Horowitz, Alyssa Wostrel and Alex Drane, to offer their perspectives on several remaining questions. Read on for their thoughts:

What are the pros and/or cons of relying on patient or healthcare provider self-reporting of patient-centered care?

Steven: The patient’s assessment of pain and suffering is the gold standard for this measurement. This may be influenced by behavioral problems, addiction or mental illness. How many patients have these problems may vary significantly from community to community, thus survey results may be difficult to compare between geographical regions. In terms of the healthcare provider assessing his or her own performance, I’m reminded of one comedian’s line: “85% of car drivers consider themselves above average.” Many surveys show discordance between what healthcare providers consider important and what patients and families consider important. That does not mean the opinion of the healthcare provider is not helpful. However, the experience of the patient essentially defines the concept of patient-centered care.

If we encourage heavy focus on data (such as survey results), should we be concerned that it may take the attention off of actual patient care? Is there a chance that meeting the specific numbers might not equate to care that is focused on the patient?

Steven: Good question! Surveys and other assessment tools are critically important to generate the data we need for continuous quality improvement. This data keeps us on target for addressing the needs of the patients, however, when these results are blindly tied to pay and promotions there is great potential healthcare providers may inordinately focus on survey results to the exclusion of other important considerations.

Alex: It depends on what you are surveying! Historically, the industry has focused on measuring things that are clinical in nature – these are important indicators of overall health, but may themselves be just markers of other issues. For example, maybe my blood pressure is high because I hate my boss and dealing with him makes my heart race. You can tell me to work on managing my blood pressure or eating better, but if you don’t know why those things are happening, you’re squeezing a water balloon. If, on the other hand, you were asking me about my workplace stress and I told you it was high, then you could provide me with some resources to help, and we could begin to track how well they were working against, let’s say, a goal of a 30% improvement. If workplace stress is what’s making me unhealthy, then reducing my workplace stress by 30% would equate to care that is very much focused on me. We all know the old adage “you can’t manage what you can’t measure” – we need to measure the things that matter so we can manage them. 

If we achieve a standardized measurement system for patient-centered care, do you see a place for rewarding healthcare providers who consistently deliver this type of care? If so, how might that work?

Steven: Healthcare providers, or better, teams of healthcare providers, should be rewarded for consistently outstanding results in patient-centered care. The difficulty remains, however, that high achievers may represent healthcare providers adept at gaming the system or, more hopefully, healthcare providers who have created an outstanding culture of patient-centered care that any assessment would identify. 

What steps can patients take to ensure the care they receive is tailored to them?

Steven: Patients need to ask critical questions, speak to current patients if they are allowed to, review standard healthcare and physician grading systems to identify flaws, and most importantly, avail themselves of the many electronic resources available about how to become a successful and informed patient.

Alex: This is one of the easiest, and hardest, questions in all of health care. The concept of what we can do is enormously straightforward: become empowered, get informed, stand up for what we care about, demand care that is commensurate with our values and beliefs. But oh boy, that can be hard to do. I’m the queen of walking into a doctor’s office ready to demand this and that – only to slouch out, tail between my legs, with none of my original goals shared, acknowledged, let alone addressed. Whose fault is that? On some level, it’s mine. Slowly, with time, with sharing enabled by new technologies, with shifting demographics and new “norms,” we will rise up and demand to be equal participants in our own care – and we will be happier, healthier, and all the more productive (providers, too!). A great low-hanging fruit as we transition from one end of the spectrum to the other is to become an advocate for someone else’s health – bit by bit, if we all commit to do this for each other, we’ll help speed the arrival of a new normal where collaborative, empathetic, holistic care is rarely the exception.

Some argue that medical care is meant to cure – not to cater to patients. What would you say to those who purport that sometimes, the patient isn’t right and needs to be sternly told what to do? 

Steven: In conversations with patients I try to be as supportive and understanding of their concerns as possible, but I’m very clear about my own interpretation of the literature and what I think is in the best interest of the patient. At times I will tell a patient that we are dealing with two separate issues that are interrelated: the healthcare condition that needs treatment and the the underlying fear that may cause denial. It’s at these moments when I express my concern that the emotional component may interfere with the patient choosing the best medical option.

Alyssa: This question suggests a controlling and patronizing role may be successful and necessary in reaching the “cure.” One of the key problems with this approach is that it denies the patient involvement in and accountability for their own health and well-being.

Alex: We’ve all read the literature showing the more collaborative and shared the decision-making is, the better the outcomes. There is also increasing evidence that outcomes in situations where a provider shows empathy trump those where they do not. The days of old-fashioned paternalistic care are coming to an end…all hail the new day!  Look at the extraordinary success of efforts like “Open Notes” at Beth Israel – “Nothing about me without me.” Now – is it true that there might be some souls who, when asked, request an extremely militaristic approach to care delivery? Sure! But then it would be their choice.

What is the best solution for keeping patients engaged and involved? 

Steven: It is important to be respectful and empathic and meet the patient where he or she is now. Encouragement and praise for the patient starting to take responsibility for understanding their condition and becoming proactive is often a turning point in their care.

Alex: If I’m pretty sure my husband is cheating on me and I just got fired…do I really have the capacity to focus on my diabetes? We need to expand the definition of health to include life – because when life goes wrong, health goes wrong. Not only do life challenges sap our capacity to care for ourselves in traditional ways (eating well, taking our meds, exercising, sleeping, taking care of our preventive screenings…) – they actually make us sick as well. Solve the problems real people want solved, redefine “vital signs” to include what is most vital. Meet us in the messy realities of our lives, where we live, work, and play (or pray!) – and not only will we engage, we’ll finally be enabled to make real change to our health. I recently had the great fortune to work with RWJF on their Pioneering Ideas effort, and through that was introduced to the work of Sendhil Mullainathan out of Harvard. Sendhil talks about the difference between something being important and something being urgent. Going to the gym is important – making sure your marriage isn’t collapsing is urgent. Given his additional assertion that time and attention are scarce commodities – how do we incorporate the reality of “attentional real estate” in our attempts to foundationally impact health?  He’s building some super sexy tools to help – so listen here when you get a chance: RWJF’s Pioneering Ideas podcast.

How do we involve patients in crafting policy changes for patient-centered care?

Alyssa: Including patients on hospital and community health center boards and committees to hear their feedback and to involve them in finding and implementing solutions has gotten excellent results.

Dr. Selby observed that measuring patient experience is difficult to do via objective measures (which I think is true). Yet clinicians often show reluctance to embrace subjective assessments. What can be done to change this culture? 

Steven: This is also an excellent question! There are several ways this can change. One is the continued tying together of surveys with critical outcomes. This may include freedom from suffering, duration of illness, complications of treatment and longevity. The ones that I feel strongly about, for which we have barely put a toe in the water, include objective laboratory assessments of inflammatory markers and gene expression. Although “hard” measurements, they may be influenced by “soft” intervention such as meditation, empathy, exercise, diet and sleep.

Unlocking Human Potential: Q&A with Tiffany Shlain

Speaking during TEDMED 2014’s “Human Nature Inside and Out” session, filmmaker Tiffany Shlain captivated her audience with a personal and insightful talk about the unique strengths of the human brain and how we can unlock our potential. We reached out to her for more insights from her talk topic.

Tiffany Shlain on the TEDMED stage [Jerod Harris].

Tiffany Shlain on the TEDMED stage [Photo: Jerod Harris, TEDMED 2014].

 

What motivated you to speak at TEDMED?

I love the mash-up of scientists and artists coming together. Combining art and science is at the root of all of my films, talks, creativity and my upbringing.

Why does your talk matter now?

These days, there is a great deal of conversation about how technology can impact humans. These conversations tend to either be based on fear and anxiety, or are overly idealistic. Meanwhile, there are also conversations taking place about revamping the education system, and focusing on the sciences and engineering. The problem is that I haven’t seen those conversations overlap yet. I want to emphasize what they point to the potential of humanity. Our focus should be on the strengths that are unique to humans, and how we can work in concert with the things we can program machines to do, in order to flourish in the 21st century. This is the conversation we need to be having.

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

My talk was the basis of a new film my team is in the process of finishing, called “The Adaptable Mind.” That film will then be the beginning of a longer project we’ll be working on over the next few years. People are ready for this conversation, and I’m excited to dive deeper into it.

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

I hope people will practice the human strengths I discuss – metacognition, empathy, creativity, and initiative – and begin working them into their daily lives.

What is the legacy you want to leave?

Through my talks and films, I hope to inspire people to ask questions, laugh, and think deeply about what it means to be human in our ever-changing world.

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.