What’s the really big news about pregnancy and birth?

It’s rare that any birth holds so much of the world’s attention as one did this week. Media attention was so frenzied, in fact, that some of its members began to spoof each other: “Woman has baby!” said the cover of one London tabloid. Was this birth really so incredible?

Well, yes, it is. So is any birth, for that matter, from a scientific standpoint. A typical baby has 60,000 miles of blood vessels by the time of birth. How does this intricate development unfold over a course of mere months? How does a woman’s body support this human engineering marvel?

Seeing it happen with the naked eye brings home how marvelous the process really is. TEDMED 2011 speaker Alexander Tsiaras, Founder, CEO and Editor-in-Chief of TheVisualMD.com and a journalist, artist and technologist, has compiled a timeline of conception and pregnancy from scans and computer-generated images. As Tsiaras wrote on The Huffington Post, his own son was in utero as he collected and reviewed scans of fetal development, which added a new dimension of meaning to his work.

““Even though I am a mathematician, I look at [fetal development] with marvel: How do these instruction sets not make mistakes as they build what is us?” he said of the project. See the astonishing images below he presented at TED. (Includes graphic content.)

The intricate system does break down occasionally, however, with consequences that are devastating. As the World Health Organization reports, some 800 women die every day from preventable causes related to pregnancy and childbirth — 99 percent of them in a developing country. Even in the U.S., one in nine babies is born pre-term, which leads to a higher risk of disability or death.

Michael Rosenblatt told the audience at TEDMED 2011 about the devastating effects of maternal mortality, which can last for generations.

There are collaborative efforts at work by governments, international development agencies and non-profits at work, however, that have made progress in reducing maternal deaths by interventions such as improving access to skilled birthing assistance, providing post-natal care for women and newborns and treating infections. Some 30 countries managed to cut their rate of maternal death in half between 1990 and 2010 — a feat also worthy of headlines.

 

 

Why is trust essential to innovation?

By Pritpal S Tamber

Innovation means change. Doing or achieving something in a new, improved way inevitably means changing what was done before. And yet one of the most often-repeated observations in health care is that “doctors are resistant to change”.

In my TEDMED talk I examined what I believe underlies doctors’ behavior and why I think their so-called resistance is a lazy interpretation of a more complex problem.

In essence, doctors are taught to doubt, as this is what helps them make the right decision for their patients. This same behavior also makes them build mechanisms to ensure that the system they work in is safe and effective. I call these mechanisms the “web of trust”.

Innovations disrupt the web of trust, which causes discomfort for doctors. This manifests as resistance. Innovators need to better understand the role of trust in health care (or why doctors doubt) in order to build trust into their innovations. Few, if any, do, which is why I think most current innovations in health care are bound to fail.

But health care is about more than doctors. The burden of disease is changing from episodic things that were treated in hospital to chronic things that are part of our daily lives. As a result citizens want more understanding and control of their daily health, which is why we’re seeing more and more innovation outside the traditional boundaries of health care institutions.

It would be a mistake, though, to see the citizen space in isolation. Instead, it’s part of a continuum that extends into primary and then specialist care. This means that whatever tools a consumer uses to manage his or her health needs to be trusted by the clinicians that may ultimately be called upon. Without that trust, care will be fragmented and perhaps ineffectual.

Other industries have learnt how to create these new, distributed forms of trust. In the hotel industry, for instance, AirBnB has enabled ordinary people to rent their spare rooms to strangers. Their website is specifically designed to provide the kind of information people look for when deciding whether to trust someone, either as a host or a guest. Although there is a specific technology that has made all this possible (peer-to-peer platforms, often abbreviated to P2P), it’s about more than just technology. It’s about society embracing opportunity made possible by new forms of trust.

With more and more citizens taking charge of their health, traditional health care needs to understand and embrace a new, distributed form of trust. It’s only with such trust in place will radical innovations that tackle today’s seemingly intractable health challenges be possible. Riffing off P2P, I call this new form of trust, “We2C” – how we, the people, can lead and engage clinicians in a productive manner underpinned by trust.

Follow Pritpal S Tamber at @pstamber where he will be further developing We2C.

Pritpal S Tamber is a TEDMED 2013 speaker, its Clinical Editor, a physician, and the founder of Optimizing Clinical Knowledge, a consultancy based in the UK.

What’s the new way to ask big questions in science?

Parkinson’s Voice Initiative founder and TEDMED 2013 speaker Max Little is an applied mathematician whose goal is to “see connections between subjects, not boundaries…to see how things are related, not how they are different” – which gives him an unusual perspective on how big data could change medicine. We  interviewed him via e-mail to find out more.

You’ve been working to discover the practical value of abstract patterns in various fields, with surprising results in areas as varied as diagnosing Parkinson’s disease over the phone to predicting the weather. Can you explain your approach?

Max Little
Max Little

As an applied mathematician, my training shows me patterns everywhere. Electricity flows like water in pipes, and flocks of birds behave like turbulent fluids. In my projects, I collate mathematical models from across disciplines, ignoring the assumptions of that discipline to a large extent, I put in overly simple models. I use artificial intelligence to throw out inaccurate models. And this approach of exploiting abstract patterns has been surprisingly successful.

For example, during my PhD I stumbled across the rather niche discipline of biomedical voice analysis, originating in 1940’s clinical work. With some new mathematical methods, and combining these with recent mathematics in artificial intelligence, I was able to make accurate medical predictions about voice problems. The clinician’s methods were not accurate. This sparked off research in detecting Parkinson’s disease from voice recordings – the basis of the Parkinson’s Voice Initiative.

But, success like this raises suspicions. So, with collaborators, I tried to make this approach fail. We assembled 30,000 data sets across a wide range of disciplines: exploration geophysics, finance, seismology, hydrology, astrophysics, space science, acoustics, biomedicine, molecular biology, meteorology and others. We wrote software for 9,000 mathematical models from a deep dive into the literature. We exhaustively applied each model to each data set.

When finished, a very revealing, big picture emerged. We found that many problems across the sciences could be accurately solved in this way. In many cases, the best models were not the ones that would be suggested by prevailing, disciplinary wisdom.

Are you doing other research that might have implications for clinical diagnosis?

Here is another example: There is a decades-old problem in biomedical engineering: automatically identifying epileptic seizures from EEG recordings. But, we found over 150 models, some exceedingly simple, each of which, alone, could detect seizures with high accuracy.

Empirical

This challenges quite a few assumptions – but it is not as if we are the first to find this. It happens often when new approaches to address old problems are attempted: for example, in obesity, a new, simple mathematical model revealed some surprising relationships about weight and diet.

You’ve also used fairly simple algorithms to successfully predict weather.

After my PhD, I teamed up with a hydrologist and an economist. We wanted to try weather forecasting using some fairly simple mathematics applied to rainfall data. Now, weather forecasting throws $10m-supercomputers and ranks of atmospheric scientists together, and they crunch the equations of the atmosphere to make predictions. So, competing against this Goliath with only historical data and a laptop would seem foolhardy.

But after two years of hard work, I came up with mathematics that, when fed with rainfall data, could make predictions often as accurate as weather supercomputers. We even discovered that models as simple as calculating the historical average rainfall, and using this as a forecast, were sometimes more accurate than supercomputers. We were all surprised. but this finding seems to line up with results that others have found in climate science: it is actually possible to make forecasts of future global temperatures using simple statistical models that are as accurate as far more complex, general circulation models relied upon by the Intergovernmental Panel on Climate Change.

Is this a new way of doing science?

If we divide science into three branches: experiment, theory and computer simulation, then what I am describing here doesn’t quite fit. These are not just simulations: the results are entirely reproducible with just the data and the mathematics. This approach mixes and matches models and data across disciplines, using recent advances in artificial intelligence.

The three branches of science. What happens when we add computational algorithms to the mix?
The three branches of science. What happens when we add computational algorithms to the mix?

I don’t know what to call this approach, but I’m not the only one doing it. The most enthusiastic proponents are computer scientists, who do something like this regularly in mass-scale video analysis competitions or one-off prizes financed by big pharma for molecular drug discovery as do statisticians working in forecasting.

In your TEDMED talk, you expressed concern that advances in science have stagnated. Can you explain?

Like many scientists, I’m concerned that science is becoming too fragmented. So many scientific papers are published each year that it is impossible to keep track of most new findings. Since most articles are never read, much new research has never been independently tested.

And, unfortunately, scientists are encouraged to ‘hyper-specialize’, working only in their narrow disciplines. It is alien to we applied mathematicians that a scientist who studies animal behavior might never read a scientific paper on fluid mechanics!  In isolation from each other, could they just be duplicating each other’s mistakes?

What can we do to create a more unified approach?

First of all, open up the data. There is far too much politics, bureaucracy and lack of vision in sharing data among researchers and the public. Sharing data is the key to eliminating the lack of reproducibility that is becoming a serious issue. Second, don’t pre-judge. We need to have a renewed commitment to radical impartiality. Too often, favoured theories, models, or data persist (sometimes for decades), putting whole disciplines at risk of missing the forest for the trees.

More collaboration would also greatly speed advances. Is first-to-publish attribution of scientific findings really that productive? I think of science as a collaborative journey of discovery, not a competition sport of lone geniuses and their teams.

Scientific theories that can withstand this “challenge” from other disciplines will have passed a very rigorous test. Not only will they be good explanatory theories, they will have practical, predictive power. And this is important because without this mixing of disciplinary knowledge, we will never know if science is really making progress, or merely rediscovering the same findings, time and again.

Follow Max Little @MaxALittle.

 

 

Can we paint a personal health picture from our daily digital traces?

We leave a long trail of digital breadcrumbs every day as we go about even the most mundane tasks: Answering e-mail; making phone calls; using GPS to find a post office; shopping for dinner; tracking our sleep and steps with a Fitbit.

Data collected from search engines, social networks, and mobile carriers, combined with smart apps, can turn these tracks into a continuous, real-time picture of our personal health, said Deborah Estrin, co-founder of the non-profit open software builder Open mHealth and a professor of Computer Science at Cornell Tech, speaking at TEDMED 2013 in April.

“I’m not taking about doing detailed medical diagnosis…replacing the communication  between you and your doctor and with your loved ones or even your own self-awareness. I’m talking about enhancing each of these with personalized, data-driven insights…such as early warning signs of a problem or gradual improvement in response to a treatment,” she said.

She continued, “I like to think of it as a digital social pulse, because it’s a single measure that I can look at over time that represents my well being, and social because it’s something I can selectively share with a small number of friends and family. Once we as patients can get access to our small traces — our small data — we’ll be able to fuel a new market of apps and services,” she said.

Though our daily behaviors are already monitored and analyzed extensively, the results are unavailable to users and there’s no vehicle to make them accessible, Estrin said in an interview today.

“There’s nothing lost by letting an individual have their data back, and having them do things that are useful with it,” she said. “It simply plays into having people manage their lives and their health and welfare. Imagine the utility that I will get out of an app that helps me figure out whether I’m taking supplements in an effective dose or not, or helps me monitor a my kid whose going away to college who has a complicated health issue.”

Though Estrin co-founded Open mHealth in 2011, the group is already working on a number of initiatives, including a web app called ClinVis that trends subjective units of depression (SUD) scores. Estrin is already building a coalition of service providers and app developers for this venture. She’ll meet with a few major phone and network service providers in a few weeks to start a smaller-level “virtual testbed” in New York City. Wikilife, a collaborative that seeks to anonymously collect and share health data to measure the health impact of lifestyle choices and nutritional habits, among other measures, is also considering implementing Open mHealth’s API, she said.

Some carriers are apprehensive about appearing to violate privacy regulations, Estrin acknowledges, but adds, “There is a lot of interest in making sure this is done securely, and receptiveness to the notion of personal data vaults within the cloud. I think that the minute we can prototype an initial viable product and a couple of feeds and let people come together and run some apps, we’ll see a lot of uptake,” she says.

The apps will be built on an open-source development platform, which dovetails with the project’s goal of shared knowledge.

“Part of the story of small data is having it happen in an open architecture content because you can then build upon each other’s skills. You’re not counting on any one vendor to build the system, and you get a very exciting Internet economy,” Estrin says.

Watch her talk at TEDMED 2013, and click here if you’re interested in a compilation of your own small data.

How did the world’s most quantified man diagnose his own illness?

We’re drowning in health information on all fronts with very little guidance on how to make sense of it. How can we go about finding clarity and seeing sensible patterns in a morass of data?

Larry Smarr, perhaps the world’s most-quantified man, chronicled his bodily input and output in minute detail for months. He used the resulting mountains of microbiotic data — and a supercomputer — to self-diagnose a gastrointestinal illness, much to the discomfort of his doctor, who told him, “that’s science, not medicine.”  Still, Smarr may well be the patient of the future. Watch him tell his tale at TEDMED 2013.

The art of TEDMED speakers from RISD

In an intellectual and creative adventure, five Rhode Island School of Design (RISD) faculty members and 20 students have contributed their talents by creating portraits of TEDMED’s 2013 speakers.

In his STEM to STEAM initiative, RISD President John Maeda — who will be on stage at TEDMED 2013 as a speaker — is attempting to transform thinking about the role of art and design in civic life, in commerce, and as an agent of innovation in the fields of Science, Technology, Engineering and Mathematics.

RISD’s Illustration Department has long pursued partnerships in learning through its practical course offerings and partnerships with academic, corporate and research institutions, working side-by-side with physicians, scientists, computer programmers and engineers.

“With the TEDMED project we jumped at the chance to immerse our students and faculty in worlds of inquiry that have broadened our enthusiasm and scope of understanding about the terrific work these people are doing,” said Robert Brinkerhoff, Professor and Illustration Department Head at RISD.

“That partnership alone has expanded the thinking of the illustrators involved in the project, but we must also recognize that artists and designers are able to formulate deep questions and observations that can help propel research and discovery into new territories. Behind all innovation are eloquent, imaginative, creative personae and it’s been an absolute pleasure to convey the energy underlying such fascinating enterprise,” he said.

The portraits will be featured in the TEDMED conference book and throughout the event.

Do our cells have their own IP address yet?

By Ali Ansary

In the future, implanted chips will have the ability to stop food absorption when caloric intake reaches 2200. Cells in our forearm will be able to monitor our glucose levels and adjust our insulin appropriately. These implantable cells or “chips” have their own IP address with their own circuitry that is connected to a network 24/7. Through this network, cells communicate with real-time super computers to synthesize the next step for an individual’s body. If Dr. Anthony Atala can utilize 3D printers to create a new kidney, then it is only a matter of time before we can incorporate the circuitry within an organ necessary to monitor its function wirelessly.

Ali Ansary at TEDMED 2012.

This was the future I was challenged to paint in my talk at TEDMED 2012 at the Kennedy Center for the Performing Arts in Washington, DC. As TEDMED 2013 commences, I ask myself, where are we one year later?

A caveat: The following are simple overviews on novel technologies I had been tracking over the past year and does no justice to the many amazing leaps we have made in innovative science and medicine during this time.

Implantable Sensors

Thomas Goetz beautifully discusses in The Atlantic that diabetics, although “loath” it, have been self-monitoring for years. Goetz goes on to say that the “….distaste falls into three categories: self monitoring for diabetes is an unremitting and unforgiving labor; the tools themselves are awkward and sterile; and the combination of these creates a constant sense of anxiety and failure.”

However, what if we had an implantable sensor that simply monitors an individual’s glucose? In 2010, Dr. David Gough from the University of California, San Diego demonstrated that you could potentially monitor an individual’s glucose by wireless telemetry. A patient can be in San Francisco with his or her physician having access to the data in Los Angeles.

And what if the immune system renders the chip incapable of functioning? Dr. Melissa Grunlan at the University of Texas A&M has been working to develop a self cleaning mechanism that prevents implantable glucose sensors from being “shielded” by the body’s immune system.

Dr. Giovanni de Micheli and Dr. Sandro Carrara at the École polytechnique fédérale de Lausanne in Switzerland have developed a 1.4 cm implantable device that can measure proteins and organic acids in real time. Imagine a signal being sent to your cell phone, and your doctor’s phone, indicating an increase in cardiac enzymes- potentially a heart attack. This device functions on a battery-less system that connects to a patch resting on the surface of the skin.

Natural anatomy acts as a barrier to implantable batteries. Yet, as Dr. Ada Poon and her team at Stanford University have developed a medical device that can be powered wirelessly using electromagnetic radio waves. Now, the tiny devices we envisioned can circulate into the depths of our vascular system without fear of losing power. Reminds me of “The Magic School Bus” episode when Ms. Frizzle takes her class on a field trip through the human body.

A personal favorite of mine:  At the Massachusetts Institute of Technology, Dr. Konstantina Stankovic has demonstrated the ability to use the natural electric potential from electrolytes in the inner ear to power devices that can monitor biological activity in people with auditory and balance issues.

Early detection is fundamental in many of these devices, especially for cancer patients who have aggressive diseases prone to metastasis. Take, for example patients with malignant melanoma, one of the deadliest cancers and one that has seen little progress in its treatment. Dr. Shuang Hou and his team at UCLA have demonstrated a proof of concept of a “nanovelcro” chip that can capture highly specific and isolated circulating tumor cells.

And what about regulating food intake and nutrient absorption? Intrapace has created Abiliti, an implantable gastric stimulator and food detection system that is implanted into the stomach. As soon as food is detected, it stimulates the stomach to create a sense of fullness. I can see eventually a system that can monitor an individual’s caloric input over, say, 24 hours. This would allow us to eat normally without overindulging.

Wearable Sensors

A quick mention on a hot topic. As popular discussions emphasize trends like the Nike+ FuelBand, one step closer to wearable sensors are what Dr. John Rogers at the University of Illinois at Urbana-Champaign has developed: An electronic sensor that can be directly printed onto your skin using a rubber stamp and last for up to two weeks as highlighted in MIT’s Technology Review. The potential for this goes beyond saying.

The Fine Line

This is just a short list of exciting new innovations. Of course many people may be taken aback by such technologies, which is fine. The purpose of my talk was to create discussion while painting a potential future that may be upon us soon. It is important for all of us to be active in our own healthcare. If we aren’t, then someone else will be.

Knowledge about our glucose or hemoglobin and hematocrit in our time is just as important as knowing whether or not to fuel our cars with unleaded or diesel.  But we still need an expert mechanic’s help.  Let me explain. I do believe that growth in this field, like anything else in medicine in the 21st century, will need to be not only through adoption by the empowered and informed patient, but also via healthcare providers.

Old mechanics would drive a problematic car themselves to assess damage. Simple things such as hearing a funny sound or seeing the car pull to the left would give them enough information to diagnose the problem.  Today the engineering of a car is so sophisticated that sensors continuously monitoring the “health” of the engine alert the driver when something is wrong. That unwelcome signal – a picture of a wrench, perhaps, or a flat tire – notifies the driver and the mechanic what part has gone wrong, what’s wrong with it, and what needs to be done.

So the mechanic had to evolve the way he (or she) fixed a car. The physician today is much like that mechanic.  While the human body is far more sophisticated than even a brand new Mercedes Benz, newly trained physicians need to adjust how they care for their patients’ health.

Growth in this field, like anything else in medicine in the 21st century, will need to be not only through adoption by the e-patient, but also via tech-savvy healthcare providers.

Let’s have dinner and talk about death.

How would you like to die?  How would you like to be remembered?  And what’s the best death you’ve ever seen?

It’s difficult thinking about these questions, let alone verbalizing answers. There are consequences, though, for trying to avoid the inevitable.  Some 70 percent of Americans say they would prefer to die at home, yet only 30 percent actually do.  Dying in a hospital, perhaps with unplanned or unwanted treatment, can be hugely expensive for patients’ families and for taxpayers: The Wall Street Journal reports that in 2009, the 1.6 million Medicare patients who died that year accounted for 22.3% of total hospital expenditures.

A new project, Let’s Have Dinner and Talk about Death, aims to give people the opportunity to broach what might be perhaps the toughest subject of all over a table rather than a hospital bed rail.  It’s built around the idea that mealtime discussions offer a convivial forum for participants to talk about, quite simply, how they would like to die.  Hopefully, expressing wishes out loud will lead to having an end-of-life plan in place with family and healthcare providers.

"How would you like to be remembered?"

The concept comes from chef Michael Hebb, a TEDMED 2013 speaker, and Scott Macklin, a Teaching Fellow and Associate Director at the University of Washington’s (UW) Digital Media program.  Hebb says humans have an innate urge to communicate over a meal.  “The table and the fire are where we first concentrated calories by cooking,” he says. “There is a safety and comfort among food and drink, and a sense that issues of gravity can be discussed.”

A web site devoted to the experience, www.deathoverdinner.org, which will be fully operational this summer, will share ideas for hosting dinners devoted to morbidity and will invite users to share their stories in its online community. It’s also the basis of a new UW course. The enterprise is a division of the non-profit Engage With Grace, and two TEDMED partners, Shirley Bergin and Jonathan Ellenthal, are advisors.

Michael Hebb

And what’s the ideal menu for such a dinner?  First, Hebb says, serve something you know how to cook. “Unless you are a culinary wizard, I wouldn’t suggest molecular gastronomy or any new kitchen terrain,” he says. “Make something that makes you happy, both to prepare and to eat.”

For more about the project, visit www.deathoverdinner.org and follow #deathoverdinner.