Guiding Evidence for Gun Violence Prevention: Q&A with Daniel Webster

In his 2014 TEDMED talk, Daniel Webster, Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and Director of the Johns Hopkins Center for Gun Policy and Research, examines some surprisingly hopeful possibilities that exist for a controversial public policy conundrum that seems to have no universally acceptable answer. We asked Daniel a few questions to learn more.

I don’t think that the level of gun violence we experience now is here to stay. Nor is it built into American culture or American law.  I believe that within 20 years, the United States can reduce our murder rates by 30% to 50%.

“I don’t think that the level of gun violence we experience now is here to stay. Nor is it built into American culture or American law. I believe that within 20 years, the United States can reduce our murder rates by 30% to 50%.” Daniel Webster, TEDMED 2014

What motivated you to speak at TEDMED?

I felt that I had important perspectives and research to help America address one of its most important and vexing public health problems.  Unless you know the data and have a long-term perspective, it is easy for those who desperately want to see change to think reducing gun violence in America is hopeless.

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

Recent political gridlock in Washington, DC on almost all issues, including guns, can prevent the vast majority who support stronger laws to keep guns from dangerous people from engaging on the issue, surrendering important policy decisions to people with the most extreme views and vested financial interests.  If people realize that there are policies that can keep guns from dangerous people and save many lives and that those policies are supported by an overwhelming majority of gun owners, things could dramatically change for the better.

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

I met Leana Wen– she gave one the best talks that I heard.  Only months later, I was pleased to find that Dr. Wen had accepted the position of Health Commissioner of Baltimore, where I work. She has championed a public health program to reduce gun violence in Baltimore that is run out of the Health Department that I have been involved in evaluating. The program has helped to quell the violence that has taken over many Baltimore neighborhoods since May in the small number of neighborhoods where they are working.

What is the legacy you want to leave?

One of a scientist that has produced solid evidence to show that strong gun laws that are supported by the majority of gun owners save lives. And someone who respects gun owners and knows that that the majority of gun owners favor policies that research suggests would lead to many fewer lives lost.

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

I wish I could have mentioned my latest research findings that show that handgun purchaser licensing laws appear to have reduced homicides and suicides in Connecticut after it adopted such a law while increasing homicides and suicides in Missouri after the state repealed handgun purchaser licensing requirements.

What’s next for you?

I am continuing several research projects examining the effects of background check requirements and firearm restrictions for domestic violence offenders. In Baltimore, we are examining the effects of public health outreach and conflict mediation to reduce shootings, focused deterrence programs directed at those at highest risk for involvement in gun violence, and drug and gun law enforcement approaches.  I’m also deeply involved in studying policy solutions to the epidemic of overdose deaths due to prescription opioids and heroin.

Indigenous economic health: Q&A with Rebecca Adamson

On the TEDMED 2014 stage, Indigenous economist Rebecca Adamson, founder of the First Nations Development Institute and First Peoples Worldwide and a globally recognized advocate for the rights of Indigenous Peoples, shares how culturally appropriate, values-driven, sustainable development based on indigenous principles contributes to a new concept of health. We caught up with her to learn more.

What motivated you to speak at TEDMED?

Understanding health as an emergent property, and seeing the individual’s health as merely a part of society’s collective health, aligns closely with the holistic approach found within Indigenous Peoples’ worldview. This understanding provided me a natural bridge to make the case that the old medical paradigm that has operated until now with a single, limited, linear worldview needed rethinking. I wanted to show how much the Indigenous worldview has been literally and figuratively handcuffed and prohibited from use. Albert Einstein once said, “You can’t solve a problem with the same conscience that created it.”  I wanted to present how culturally diverse perspectives, especially Indigenous perspectives that emphasize the health of the community rather than the health of the individual, are compelling and relevant technologies for today.

Medical science has determined that healthy individuals emerge from a healthy relationship with a healthy society in a healthy ecosystem. This means that the distribution and delivery of healthcare must meet the needs of the whole society, not merely a part of it. For me, this is a game-changer. As a Cherokee Economist, with a lifetime invested in Indigenous development, my experience with western models has been that they focus on accumulation with little attention to distribution. One of the most crucial aspects of the emergent property of health is that well-being is achieved collectively, meaning that the distribution and delivery of our healthcare actually determines the efficacy of our medical system, our individual health, and the well-being of our society. I believe the Indigenous paradigm lends a new perspective in rethinking healthcare and the medical profession.

Rebecca Adamson at TEDMED 2014

“One of the most crucial aspects of the emergent property of health is that well-being is achieved collectively, meaning that the distribution and delivery of our healthcare actually determines the efficacy of our medical system, our individual health, and the well-being of our society.” Rebecca Adamson at TEDMED 2014

Why does this talk matter now?

Indigenous Peoples are still being handcuffed, figuratively and literally. We are being arrested, shot at and killed for our natural resources. This is going on at the same time that many of our sciences (not just medical) are uncovering the interconnectivity of life – all Life. Holistic worldviews are not exclusive to Indigenous Peoples but the millennia of empirical data on how societies can organize politically, socially and economically for sustainability is being lost. Right now there is an overemphasis on the technological and financial aspects of our society. As medical practitioners, you can really see it in the healthcare system. For example, if we know that health is an emergent property then why is so little or no attention given to the distribution and delivery of healthcare for all – not merely a portion – of society? Sure, we need technology and sure, we need to pay for it – but I wanted to challenge my audience to consider a new way of thinking about healthcare and medicine, one that encompasses society as a whole. Remember the distribution of the whale hunt in an Inuit village, compared to the distribution of cash in the same village? Could you imagine our society if healthcare were to be distributed with the same sophistication as the Inuit whale harvest?  However, if we were to map the distribution of healthcare services in our society today, I fear that it would follow the pattern of hierarchical cash distribution, as opposed to holistic asset or resource distribution, where everyone is accounted for.

The efficacy of traditional medicines is just one part of what Indigenous Peoples can offer the field of medicine. Because the Indigenous worldview is holistic, Indigenous Peoples are brilliant systems thinkers. Indigenous systems leverage and account for the inter- and inner-connections between individuals, community, society and even the ecosystem. Today, we are at a critical point of opportunity where changing the distribution of healthcare is imperative for changing the health and wellbeing of our society. An Indigenous paradigm that values the interconnectedness and interdependence of society can serve as a crucial guide in shifting emphasis from financial gain to collective well-being in the medical field.

What impact do you hope the talk will have?

Our healthcare system today is riddled with problems, that I see stemming from an exaggerated focus on the individual and neglect of the collective wellbeing. I hope my talk will lead TEDMED to focus on the importance of access, distribution and healthcare delivery with the same attention that it dedicates to technology, data and finance. The answers lie in alternative ways of understanding healthcare and medicine. TEDMED has a commitment to diversity that it demonstrated in this incredible gathering of experts, both in speakers and in the audience. I challenge you all to do more. Take the mental handcuffs off. Challenge paradigms that prevent diverse voices and perspectives, as they are the only way we are going to solve the complex issues facing us today. An Indigenous way of thought accounts for the collective – an individual is just one part of a community, just as a plant is one piece of an ecosystem. In the Indigenous paradigm, the health of the individual is dependent on the health of the community. I hope my talk inspires those in medicine to begin rethinking how they approach health care, and to begin considering how our current system can reach society as a whole rather than merely a part.

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

Ultimately, I wanted to leave the audience with this question: what do Indigenous Peoples have to share with TEDMED? Remember the distribution of the whale hunt – isn’t that, at its very best, the kind of distribution you would wish for today’s health delivery system? Can you imagine the preventative savings in a health system that reaches everyone? In a society where everyone is someone else’s mother, father, brother, sister, uncle, aunt, cousin… It is the entire society, not merely a part of it, that must survive.

What are some actions viewers can take in support of this cause?

In my talk, I challenged the audience to begin thinking about healthcare from an Indigenous perspective. Now, I challenge them to start working from that perspective – begin exploring how to make healthcare delivery reach the furthermost places in our society; how to begin emphasizing the health of the community over the health of the individual; and how to distribute medicine and healthcare so that it resembles the whale distribution map, and not the cash distribution map. I challenge medical professionals to imagine a society of collective prosperity and health, and to begin a collective discussion on how to achieve that dream.

Music as Medicine: Q&A with Gypsy Sound Revolution

Gypsy Sound Revolution, led by drummer Cédric Leonardi and fellow Gipsy Kings alumni, mixes rumba with Indian raga. They play a unique fusion of Indo-Gypsy music that is both meditative and joyful. We followed up with them to learn more about their project.

"Music is borderless. It is the ultimate expression of love." Gypsy Sound Revolution at TEDMED 2014.

“Music is borderless. It is the ultimate expression of love.” Gypsy Sound Revolution at TEDMED 2014.

 What motivated you to perform at TEDMED?

As a performer, you want to reach as many people as possible with your art form. Music is increasingly accessible digitally and also thrives using many methods of delivery.
Somewhere along the way, it became a business. A big business. Performing at TEDMED was our way of delivering a message and access to the healing power of music. Music came out of the caves of India as medicine. Invoking the divine, but with a modern vernacular, we have seen lives transformed through the joy of our music. TEDMED was a potent forum to express this and continue the medicinal conversation globally, reaching as many people as possible.

What is the legacy you want to leave?

We hope our legacy shows the way for our children to live authentic lives, fully expressed and joyful using the path we have forged with our music. To touch the hearts of people and share the joy of living together on this planet. Music is borderless. It is the ultimate expression of love.

We cherish the poem, “What will matter,” by Michael Josephson, as a reminder of the fragility of life and the speed with which it passes:

Ready or not, some day it will all come to an end. There will be no more sunrises, no minutes, hours, or days. All the things you collected, whether treasured or forgotten, will pass to someone else.
Your wealth, fame, and temporal power will shrivel to irrelevance.
It will not matter what you owned or what you were owed.
Your grudges, resentments, frustrations, and jealousies will finally disappear.
So, too, your hopes, ambitions, plans, and to-do lists will expire.
The wins and losses that once seemed so important will fade away.
It won’t matter where you came from or what side of the tracks you lived on at the end.
It won’t matter whether you were beautiful or brilliant.
Even your gender and skin color will be irrelevant.
So what will matter? How will the value of your days be measured?
What will matter is not what you bought, but what you built; not what you got but what you gave.
What will matter is not your success, but your significance.
What will matter is not what you learned, but what you taught.
What will matter is every act of integrity, compassion, courage, or sacrifice that enriched, empowered, or encouraged others to emulate your example.
What will matter is not your competence, but your character.
What will matter is not how many people you knew, but how many will feel a lasting loss when you’re gone.
What will matter is not your memories, but the memories that live in those who loved you.
What will matter is how long you will be remembered, by whom, and for what.
Living a life that matters doesn’t happen by accident. It’s not a matter of circumstance, but of choice. Choose to live a life that matters.

What’s next for you?

Taking our music and message around the world in 2015. We are also finally going into the studio. We are very much a live band– we believe live interaction with people is the true purpose of music. However as TEDMED live-streaming proves, there are many more people that live streaming can reach in all kinds of obscure pockets of the world. The internet has brought us all closer so its time we stopped resisting and we have started to the process with the conundrum: how do you bottle magic? We will have at least three tracks recorded soon.

Any action items for viewers interested to get involved in the kind of work you do? How do they join the revolution?

We are starting a philanthropic initiative to support the communities of our Rajasthani musicians with a US based Indian company, HP Investments. The project will include music camps for children to keep the music traditions of this original gypsy tribe alive, as well as taking care of the necessities like water and power in their villages. Its a humbling and glorious experience working with musicians who go home to their villages without water and power after they have travelled the world with us. We are one– we have a responsibility to help each other beyond.

Artistic Humor for the Soul: Q&A with Bob Carey

Bob Carey is the photographer and subject of the “Tutu Project.” This series of stunningly silly videos and still self-portraits was originally launched to cheer up his wife, Linda, after she was diagnosed with breast cancer, and later went viral. He spoke about the power of humor to help cancer survivors.

Photographer and cancer activist Bob Carey at TEDMED 2014

Photographer and cancer activist Bob Carey at TEDMED 2014

What motivated you to speak at TEDMED?

Based on the viral nature of the Tutu Project and the impact it’s had, our goal has been to find opportunities to continue to share the images and story, and not only within the breast cancer community. I feel that it’s important to share creative ideas that use art and humor as a means to help live with the many challenges in life. When TEDMED asked me to speak, not only was I excited, I felt it was the perfect opportunity and audience to share my work.

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

It matters now as there will always be challenges in life– and inspiration can impact people every day. I hope that my talk will inspire others to see that there are many approaches–sometimes unusual, unexpected or creative– one can use to cope.

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

The speaker coaches were kind and compassionate, not that I wouldn’t expect that to a certain degree, but I bonded with them and with that, felt empowered to speak with my tutu on– a first for me. Another meaningful connection was with one of the speakers. The staff was wonderful as were the attendees. It seemed that although the subject matter was different, we were all looking for new and creative ways to approach problems.

The Rewards of Risk-Taking: Q&A with Kayt Sukel

On the TEDMED 2014 stage, Kayt Sukel, journalist and science writer, shared insights into the neuroscience of risk-taking and how play during childhood and adulthood impacts the way we make decisions as adults. We inquired for more on brains at play and her favorite TEDMED 2014 talks.

"Too often, we wrap ourselves up in our grown-up suits and avoid play at all costs. And that’s to our detriment—at work, at home and for our overall health." Kayt Sukel at TEDMED 2014

“Too often, we wrap ourselves up in our grown-up suits and avoid play at all costs. And that’s to our detriment—at work, at home and for our overall health.” Kayt Sukel at TEDMED 2014

What motivated you to speak at TEDMED?

I’ve found so much inspiration in many TEDMED talks—and learned quite a bit. As I’ve been working on my book about the science of risk-taking, there were so many things I learned that I wanted to share. I’m honored I got the opportunity to do so on the TEDMED platform.

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

More and more, Americans seem to live in a culture of cultivated busy-ness. We have so much to do that we forget to take time for ourselves. And while we understand that our kids need to play (and take risks as they do so) in order to learn and grow—many of us have forgotten how to play for ourselves. Too often, we wrap ourselves up in our grown-up suits and avoid play at all costs. And that’s to our detriment—at work, at home and for our overall health.

I hope that people will recognize that there is great value in play—not just for children but also for adults– and that they understand that taking risks in playful arenas is a great way to gain critical problem solving, cognitive and emotional regulation skills. I want them to understand that the things we do each day to cultivate health don’t have to be joyless and staid. So if the people who listen to my talk find some time to engage in some kind of play, push the envelope a little, and reap all those beautiful brain benefits, I’ll feel like I’ve done something important.

How can we incorporate play and risk-taking into our daily lives?

I encourage everyone to find something that motivates you—whether it’s learning a new language, taking an improv class or rock climbing. Then, push your limits. You’ll be surprised where risky play can take you.

Tell us about your favorite TEDMED 2014 talks or performances that left an impression with you.

I found the whole program to be tremendously inspiring. But that said, if I have to play favorites, I was bowled over by Jeff Karp’s talk on bio-inspiration. His work on finding inspiration in the natural world and then bioengineering it for modern-day use just blew me away. I would never have thought about translating the properties of porcupine quills into state-of-the-art surgical staples– nor would I have agreed to put said quills into my face as a test–but Jeff did! —and it was a pleasure to learn more about his research and the way he thinks about problem-solving.

Jeff Iliff’s talk on sleep and the glymphatic system was fascinating. I remember one of my own neuroscience professors discussing the mysteries of how the brain clears out its waste almost 20 years ago. It’s such a big question—and one that has implications for neurodegenerative disease. I love that technology has advanced to the point where researchers like Jeff and his colleagues are beginning to figure it out. Also, he reminded me that I really need to make sure I get my beauty rest!

And, finally, I enjoyed Sophie de Oliveira Barata’s talk on the Alternative Limb Project. In a former life, I was the wife of a military officer during Operations Iraqi Freedom and Enduring Freedom. In that role, I met far too many soldiers who lost limbs. While prosthetic technologies are wonderful, many artificial limbs can feel a bit blank and soulless. Her creations moved me. And they show that we can embrace our differences, even those that we did not choose for ourselves, and allow them to be just another canvas to show the world who we are inside.

But I feel like I’m leaving out other great talks and performances—like those by Leana Wen, John Cryan, Carl Hart, Danielle Ofri, Marc Abrahams, Sonia Shah, Cole Galloway, Heather Raffo and Farah Siraj. Really, I could go on and on.

What is the legacy you want to leave?

Our family motto is “experiences over possessions.” I hope that, over the course of my career, I’ll inspire people to explore, to connect, to laugh and to live as fully as they can. And that, of course, requires being open to both playing and taking risks.

What’s next for you?

I’m finishing up my forthcoming book about the science of risk-taking, The
Art of Risk: The New Science of Courage, Caution, and Chance. It hits
shelves March 2016.

Making New Waves in Anesthesia: Q&A with Emery Brown

Emery Brown, anesthesiologist, Professor of Computational Neuroscience at MIT, and Co-Director of the Harvard-MIT Division of Health Sciences and Technology, unveiled the surprising truth about exactly what happens to your brain under anesthesia and what it suggests for understanding the brain and improving treatment.

"Anesthesia works primarily through the production of oscillations that disrupt the way regions in the brain communicate." Emery Brown at TEDMED 2014

“Anesthesia works primarily through the production of oscillations that disrupt the way regions in the brain communicate.” Emery Brown at TEDMED 2014

What motivated you to speak at TEDMED?

When I had the honor to be invited, I realized that it would be a great opportunity to educate the public on general anesthesia and other practices in anesthesiology. The state of general anesthesia is viewed as a blackbox process by the field of anesthesiology, other fields of medicine and the general public. I was motivated by the importance of bringing an informed, modern perspective on general anesthesia to the lay public, the medical field, neuroscientists and anesthesiologists.

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

General anesthesia is viewed as a mystery both within as well as outside of medicine. After nearly 170 years of administering anesthesia in the United States, how anesthesia works is still considered as unknown and by some as unknowable. My research can change this because we can teach medical and lay communities that anesthesia works primarily through the production of oscillations that disrupt the way regions in the brain communicate. This disruption of communication is how the drugs make patients unconscious. These oscillations are readily visible in the EEG patterns of patients under general anesthesia. Different anesthetic drugs produce different patterns. The EEG patterns differ because different anesthetics bind to different targets in the brain and therefore produce oscillations in different circuits. All of these patterns are much larger and highly organized than the awake EEG or the EEG of people who are asleep. Therefore, anesthesia caregivers can learn to read these patterns and know whether a patient is appropriately unconscious to undergo surgery. Reading the EEG to monitor the brain states of patients under general anesthesia can be used to eliminate the frightening problem of awareness (waking up paralyzed). Dosing of anesthetic drugs can be more carefully titrated and the incidence of postoperative cognitive dysfunction and delirium will likely be reduced.

General anesthesia is a profound drug-induced reversible coma. A patient has to be in a state of coma, i.e. being completely insensate and unaware, in order to tolerate the traumatic insults required to execute most surgical procedures. Sleep is a natural state of reduced brain inactivation that is necessary for maintaining normal health. Sleep is defined by two primary states; non-rapid eye movement (non-REM) and rapid-eye movement (REM) sleep. The brain switches approximately every 90 minutes between the non-REM and REM states during natural sleep. The EEG under sleep and a person’s behavioral state (being readily arousable) show that general anesthesia is not sleep.
I hope my talk can provide an accessible forum for the lay public to understand, 1) how general anesthesia works, and 2) that this process which is used every day in millions of people around the world should no longer be viewed as a mystery.

Beyond the need to have general anesthesia for surgery and certain diagnostic procedures, the study of general anesthesia from a neuroscience perspective provides an essentially unexplored way to learn about the brain. This study may also lead to new therapies for treating depression, sleep disorders, pain and facilitating the recovery of patients from coma.

What is the legacy you want to leave?

I hope to have taught the public how general anesthesia works and made it possible for the public to understand that anesthesia is not a mystery. I used this knowledge to improve anesthesia care for the thousands of people in the US and the millions of people worldwide who daily receive general anesthesia and sedation to safely and humanely undergo invasive diagnostic and therapeutic procedures.

What’s next for you?

My next step is to change practice and research in anesthesiology. I will be setting up my Center for the Neuroscience Study of Anesthesia at Massachusetts General Hospital, where we’ll work to gain deeper insights into the altered states of arousal created by anesthetics; develop new neurophysiologically based EEG strategies for monitoring the state of the brain under general anesthesia and sedation; teach anesthesiologists and other anesthesia caregivers how to read the EEG in order to understand the brain states of patients receiving general anesthesia and sedation; develop new ways to precisely control the state of general anesthesia and sedation; study ways to rapidly bring patients out of the state of general anesthesia; create all new approaches to producing general anesthesia and sedation that are side effect free, particularly for children and the elderly; educate the medical professional and the public about how general anesthesia works; show that general anesthesia, when viewed from a neuroscience perspective, offers a new and virtually untapped way to learn about the brain; use knowledge gained from studying the brain under general anesthesia to devise new strategies to treating depression, new approaches to producing sleep, treating pain, epilepsy, autism and facilitating recovery from coma.

Any action items you want the viewer of your video to take?

I would appreciate knowing what viewers think about the work. It’s important for everyone to encourage greater funding for study of the neuroscience of anesthesia by federal and private funding agencies. The benefits will go well beyond simply anesthesia care. I also think that it is important that the public encourage the anesthesiology community to put in place guidelines and strategies to use the EEG to monitor the brain states of patients receiving anesthesia care.

 

The Sound of Health: Q&A with Julian Treasure

In his TEDMED 2014 talk, Julian Treasure discussed the importance of designing health care facilities with acoustic healing in mind. Now he’s shared a bit more about his talk, his time at TEDMED and his vision for the future.

Julian Treasure at TEDMED 2014

“We’re designing environments that make us crazy. It’s not just our quality of life that suffers. It’s our health, social behavior, and productivity as well.” Julian Treasure at TEDMED 2014

What motivated you to speak at TEDMED?

The scandal of noise in hospitals is unacceptable, affects millions – and is virtually unacknowledged by the profession. This must change!

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

I sincerely hope healthcare facilities take my three simple steps for good sound onboard because I am convinced they will transform outcomes almost immediately.

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

Meeting Bob Carey and his tutu… wonderful. And with a young baby we are passionate about breastfeeding, hearing E. Bimla Schwarz give the evidence for the benefits of this wonderful process.

How can we learn more about your work?

My fifth TED talk, How To Speak So That People Want To Listen, was released roughly a year ago and is now in the top 30 TED talks of all time. I have resources free and also links to my courses on conscious listening and powerful speaking on my website.

What is the legacy you want to leave?

Healthy sound in every building we occupy – and a world that sounds beautiful.

Magic Medicine? The wonders of nanomedicine

by Daniel Kohane

The content, views and opinions expressed in this blog post are those of the author(s) and do not imply endorsement by TEDMED. By inviting guest bloggers, TEDMED hopes to share a variety of perspectives that provoke and engage our community in discussion and debate.

Imagine being able to treat your medical condition immediately when you need to, safely, and without input from anybody else. No waiting to see your doctor, no wondering whether that extra dose of medicine will be too much.

Sound like magic? Well, that is exactly what many of us scientists in nanomedicine believe is right around the corner. And we are proposing the use of a “wand” to make it happen.

“Sometimes you can achieve big things by thinking very small.” Daniel Kohane at TEDMED 2014

“Sometimes you can achieve big things by thinking very small.” Daniel Kohane at TEDMED 2014

Here’s how it would work in a patient with chronic pain. Such a patient would likely have pain that would wax and wane throughout the course of the day and during the night. His/her need for relief would also fluctuate, depending on activity and effort level. Currently, oral pain pills would generally be used to treat the condition, which would take effect sooner or later, and might or might not make the patient adequately comfortable. In some cases, the medicines could make the patient too comfortable, or effectively stoned. The wand could make all of this so much better.

The wand would actually be a laser, or another powerful light source. The patient would place the laser over the painful area and press a button, firing near-infrared light into the affected tissue, where the patient’s physician had injected or implanted a reservoir of drugs. That reservoir would have been built with light-sensitive nanostructures (like those in my TEDMED talk) so that it would respond to a specific light fired by the laser by releasing those drugs. So, using the wand would cause pain medications to be released at the site where the pain is – and only there; no getting stoned with this treatment. And by varying the intensity and duration of the light beam, the patient would be able to determine exactly how much pain relief is delivered, and for how long.

This approach need not be limited to pain; it could be used for a wide range of diseases, in many parts of the body. And the wand need not use light. Scientists have shown that similar effects can be achieved with oscillating magnetic fields, ultrasound, electricity, and many other energy sources. In fact, people are now looking at drug-releasing devices that would not even require the wand component – there would be indwelling sensors on the device that could sense when a drug needed to be released. Alternatively, the devices could have computerized programming that would enable complex patterns of drug release suitable for a particular disease. That process would remove the burden from the patient of having to self-administer injectable drugs several times a day.

As nanoscience gets increasingly sophisticated, it opens up possibilities for medicines that are specific, targeted, with fewer side effects, and easier to deploy. While the potential is not truly magical, they are certainly parts of this field that previous generations of physicians, scientists, and patients would have thought impossible.

At TEDMED 2014, Daniel Kohane, Professor of Anesthesia at Harvard Medical School and a Senior Associate in Pediatric Critical Care at Boston Children’s Hospital, revealed some of the amazing work he’s doing with nanoparticle technology to transform the power, safety, and specificity of drugs. 

The active ingredients of placebo effects: Q&A with Ted Kaptchuk

Ted Kaptchuk, Professor of Medicine at Harvard Medical School, directs the Program in Placebo Studies, Healing and Therapeutic Encounter. In his TEDMED talk, he upended many assumptions about what really works in the therapeutic encounter, and what doesn’t, as revealed in placebo research. We caught up with Ted to learn more.

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What motivated you to speak at TEDMED?

My research has implication for the general public.  I want to disseminate the results of my scientific inquiries and encourage patients and the public to demand that health care acknowledge them and their implications for the therapeutic encounter.

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

Health care has become increasingly expensive and dehumanized.  Placebo effects are relatively inexpensive and add humanity (engagement, words and honesty) back into the mix.   I hope my talk will educate the public and encourage people to expect and demand a health care that acknowledges the importance of the human element.  I also hope that health care providers– nurses, physicians, allied health care clinicians, complementary medical practitioners, etc– see that their role as more than using effective interventions, but also a participant involved in a process. Placebo effects tell us, especially for chronic diseases, what the health care provider does actually matters. Symptoms are relieved and the course of illness changes…depending on this interaction. In situations where there are already good drugs and treatments, these interventions become more effective. In situations where there are no good treatments available, the health care provider, by their interactions, can make things better. The placebo effect is about releasing and harnessing powers inherent in the clinical encounter in order to expand what healing is about. Placebo effects are always present. The study of placebo effects encourages patients to expect improvement and encourage clinicians to know that they can always make a difference with engagement, words and honesty. These ideas are too important to disregard. The time is now.

What were your top 3 TEDMED 2014 talks?

Betsy Nabel from the Brigham and Women’s Hospital for discussing humility. Carl Hart for being an inspiration about how to face challenges. Emery Brown for expanding what we know about consciousness.

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

I had several discussions with speakers and participants that I am pursuing in relationship to collaborations and dissemination of research. I’ve invited several people to speak at Harvard and have been invited to speak at various institutions.

What is the legacy you want to leave?

I hope that others scientists will see the possibility of pursuing careers investigating the context of healing and its neurobiological underpinning. I hope practitioners will get smarter about what is going on in the therapeutic encounter. I hope patients will set a higher bar in what to expect in health care.

Any advice you have for the TEDMED community?

Demand better health care. Don’t tolerate a clinician with whom you don’t feel bonded (unless it is something like he/she is the only surgeon who can do a particular surgery.) A clinician should make you feel good about visiting them. Don’t accept less.

Global surrogacy: When making babies is no fun. Op-ed by Leslie Morgan Steiner

The content, views and opinions expressed in this blog post are those of the author(s) and do not imply endorsement by TEDMED. By inviting guest bloggers, TEDMED hopes to share a variety of perspectives that provoke and engage our community in discussion and debate.

Leslie Morgan Steiner at TEDMED 2014

Leslie Morgan Steiner at TEDMED 2014: The inconceivable costs of baby-making

As a mother and writer on women’s issues, I believe nothing is more intimate an issue for every woman—actually, every human being—than the desire to have a child.

Now, my children were all conceived and born naturally. They enjoy full robust health. But I discovered that infertility—the myriad variations of disease and biological abnormality that cause specific men and women to be unable to create children together—strikes randomly. Anyone can be infertile. Infertility is surprisingly common; the inability to have children afflicts 10-12% of the human population.

There is no surefire way to prove you are fertile in advance, for example you cannot use a blood test to screen newborns or teenagers for the inability to have children as one might for hemophilia or celiac disease. Part of infertility’s cruelty is the surprise of its assault. You rarely learn you are infertile until you try, and fail, to have a baby.

When I found all of this out, I wondered: what would I have done if I were infertile?

That was when I stumbled upon the seemingly strange new solution of surrogacy—paying another woman to carry a baby for you. Surrogacy has actually always been a solution to the age-old problem of infertility. In fact, surrogacy (via concubine) is mentioned over 20 times in the Old Testament.

Today, the global medical community, funded by generations of desperate infertile women, has figured out exciting—and disturbing—new ways to create babies no matter the obstacles. The medical term is Gestational Surrogacy (GS). A new-and-improved version of an ancient solution to childlessness.

Today, thanks to in vitro fertilization (IVF) and other advances in assisted reproductive technology, babies can be created with sperm from one source, an egg from another, and a uterus from yet another. In England today, women who are carriers of rare mitochondrial disease can actually use their DNA in a healthy donor egg cell to bypass the defective mitochondria, thereby creating an IVF scenario with three biological sources. Surrogates today are not biologically or genetically connected to the babies they gestate. This simplifies many ethical, legal, and parenting issues.

And creates new ones.

Modern surrogacy is transforming humans’ centuries-old definition of motherhood.

Today a newborn can have two mothers or two fathers, or no mother, or no father. A baby can actually have zero legal parents, as in a few isolated cases where a gestational surrogate carried a baby created with donor egg and sperm, and a clinic mix-up blocked authorities from tracking down and proving any legal parent.

Today anyone—a 25-year-old with uterine fibroids, a 40-year-old woman with a cancerous uterus, two married gay men, a nun—can have a baby, their biological baby, via surrogate.

As long as they can afford it, because surrogacy in the U.S. can cost $100,000 or more.

Gestational surrogacy has become better known in recent years due to international celebrities such as musician Elton John, comedian Jimmy Fallon, and actresses Nicole Kidman, Elizabeth Banks and Sarah Jessica Parker who have all had babies via U.S. gestational surrogates.

But the rise of GS is important for normal people too.

Like Gerry and Rhonda Wile, a nurse and firefighter from Arizona, who shared their story with me for my book The Baby Chase.

Gerry and Rhonda met and married in their late 20s. Gerry was already a father, but he’d had a vasectomy, which he didn’t tell Rhonda about for six years (but that’s another story).

As for Rhonda, for her entire life she had an extremely rare, undiagnosed medical condition that allowed her to get pregnant easily—and she did—but the same condition caused her to miscarry 100% of these pregnancies.

Prior to 20th century medical technology, Rhonda would have gotten pregnant and miscarried dozens of times throughout her reproductive years—as often as 3-4 times a year—for decades, without ever understanding what was wrong with her biologically. For too many centuries, infertility was a lifelong, mystifying curse. A perennial loss that often left sufferers, women in particular, feeling rejected by their husbands, families, communities, and even by God.

So what did the Wiles do?

What would you do?

Today there are several options for the world’s infertile. Treatment, adoption, accepting that you will live your life without children. But for the Wiles, there was only one solution. Surrogacy meant the Wiles could create the family they dreamed of using Gerry’s sperm, Rhonda’s eggs (or what turned out to be eggs from a donor), and an unrelated gestational carrier.

Gestational surrogacy is an exciting, awe-inspiring new medical innovation that makes it possible for infertile couples like Gerry and Rhonda, and millions of other people, to have babies and become parents.

Leslie and the Wiles family

Leslie and the Wiles family

Surrogacy today heralds the end of infertility, the death of an affliction that has plagued humans since the beginning of time. However, surrogacy in the United States is financially out of reach to most people. This is why some people, like Gerry and Rhonda Wile, travel to other countries to find affordable, legal surrogates to create their babies.

The final surprise about surrogacy is that it’s personal. It’s human. It’s about you and me and the people we love.

What if you had to travel 8,000 miles to have your baby—and risk not being able to bring her back with you?

Or had to choose between being openly gay and having your own biological offspring?

Or your health insurance said you were too old, or too religious, or not religious enough to qualify for infertility reimbursement?

Or your God said no, you can’t treat your disease…you must live your life without the children you’ve dreamt of having since you were a child yourself.

Imagine the betrayal you would feel if your country, your political leaders, your neighbors, your God, refused you a baby, merely because the treatment for your disease made people uncomfortable.

Would this make you want—or deserve—a baby any less?

In her TEDMED 2014 talk, Leslie Morgan Steiner, journalist and bestselling author, brought the audience along on her journey to learn the truth about a successful gestational surrogacy industry on the far side of the world–and how it could provide a model to help solve several social problems in the US.