Call for ideas: What should a 21st-century doctor look like?

In 1900, the leading causes of death in the U.S. were flu, tuberculosis and gastrointestinal infections. Today, they are heart disease, cancer, and chronic respiratory diseases, with stroke and diabetes in the top ten – largely preventable conditions.*

The problem is, our healthcare system, devoted as it is to acute, curative care, still thinks it’s 1900, with disastrous results. As Ali Ansary, Sandeep “Sunny” Kishore and Jacob Scott, all TEDMED 2012 speakers, wrote in The Huffington Post,

“With increasingly tragic consequences, the reactionary medical paradigm has not provided the preventive care or chronic illness management that our culture needs. Healthcare spending currently consumes 17 percent of our GDP and without a radical shift in thinking, this number may grow even higher.”

Change begins with conversation. To that end, the three have launched a movement called Tomorrow’s Doctor, in which they call for ideas on how to reimagine medicine of the future, starting with med ed.  We must re-align priorities, they say, and take advantage of gains already made in technology and public health.

Above all:

“We need to stop the “imaginectomies” and help, collectively, step by step, to make creativity, imagination and compassion the 21st century standards of medical education.”

Read the full article here and visit www.tomorrowsdoctor.org to contribute ideas.

Sources:  Centers for Disease Control and Prevention; New England Journal of Medicine

What will a lateral thinker be when he grows up?

This is a guest post by Sandeep Kishore, a post-doctoral fellow at Harvard Medical School and TEDMED 2012 speaker.

Recently, I’ve been struggling on how to explain to other folks what it is that I do – or what it is that I am attempting to do.

I still don’t really know.

But I have found some clues recently via a Harvard University website called the Catalyst. It effectively catalogues all people at 17 schools and hospitals associated with Harvard University (from those studying anthropology to appendicitis, from molecules to masses), ‘catalyzes’ new connections, and provides pilot grants to help incent people to work on problems together.

 

What I like most is that the translation agenda via this website. It provides a useful frame for PhD basic scientists to communicate with MD clinicians and with the policy/public health community.

In the university community, and certainly in training, there are rifts between bench scientists and the clinical docs. Now add in the fact that the biological/pathogen model is old news, mental models are shifting and there are new behavioral/social issues that add to the canonical biomedical approaches, and now we have a real and urgent need for translation.

The Catalyst profiles a translation agenda labeled T1 thru T4:

T1: Basic Scientific Discovery to Clinical Insights

T2: Clinical Insights to Implications for Practice

T3: Implications for Practice to Implications for Population Health

T4: Implications for Population Health to Improved Global Health

This provides a useful continuum and includes tools to broker linkages along the way. And the curation of resources begins the moment any staff member joins Harvard University. In a moment, your publications, your topic areas, people who publish/think like you and even people who physically sit next to you are highlighted. The website is designed to foster creativity and collaboration – and is blind to exactly where those insights might come from. Anyone, from student to president, can participate and link-up.

Best of all, the site is public so that anyone else can view, learn and engage. This is the sort of multidisciplinary effort that we will need for complex health challenges –and I’m delighted that it’s housed at a major university with access to ideas, young blood and energy.

I connected with Dr. Lee Nadler and Dr. Elliott Antman, founders and leaders of the platform, to learn more on the origins and functions of the Harvard Catalyst. I was looking for practical outputs of this network. They relayed one challenge where engineers and researchers were searching for practical applications of next-generation imaging techniques; and one in which radiologists were searching for, well, next generation imaging modalities. Both groups were unintentionally boxed in their professional silos. The Harvard Catalyst challenged the community – write in 250 words, one big idea to bridge the gap, identify how a biological/medical problem could be solved by imaging techniques.

They expected maybe 30 submissions across the 12,000 people unified on the platform. They received 500.

Next, they arranged a poster session where 150 people presented their idea over three evenings. New ideas including novel ways to image islet cells of the pancreas emerged. Success: People not aware of each other’s existence came together; new teams were formed and there was even a bit of funding for pilot grants to try out the best, most promising ideas. As Drs. Nadler and Antman say, their vision is not to bring institutions together; it is to bring people together.

Sandeep Kishore at TEDMED 2012

TEDMED and a network I co-founded, the Young Professionals Chronic Disease Network (YP-CDN) provide some examples of the sort of ‘safe spaces’ for incubation, networking, curation and then translation of ideas to action. Particularly for the way we train the next generation of university students. These initiatives are exciting in that they provide a new nidus for meet ups that foster imagination, innovation and inspiration and that move us beyond hardened paradigms. This is critical for this generation, and even more so for the next.

It all reminds me of the quote by the playwright Edith Wharton relayed to me by an old mentor: “There are two ways of spreading light: to be the candle or the mirror that reflects it.”

These incubators serve as mirrors that help focus, amplify and merge our individual lights of inspiration. This is a neglected, but vital function, for translators. Maybe I’ll grow up to be a mirror?

Scalpel-free surgery gains ground as treatment for Parkinson’s symptoms

Non-invasive focused ultrasound surgery, which can be performed as a non-anesthetic outpatient procedure — with much less pain and shorter recovery time for patients — is gaining ground as an effective and highly beneficial treatment for the symptoms of Parkinson’s disease and other movement disorders.

As Medgadget reports, InSightec, makers of an MR-guided interventional ultrasound system, received approval in Europe for its ExAblate Neuro system, which is designed to treat Parkinson’s disease, essential tremor and neuropathic pain.

The procedure uses sound waves to target affected areas of the brain. Compared to the current prevalent surgical therapy of deep brain stimulation, which involves drilling into the skull and implanting a pacemaker-like device, the minimally invasive ultrasound procedure poses much less risk to surrounding brain areas.

ExAblate is as yet unapproved in the US to treat Parkinsons, but is in clinical trial at the University of Virginia. A first round showed promising results in controlling Parkinson’s related tremors.

Yoav Medan, vice president and chief systems architect of InSightec, described how the surgery works at TEDMED 2011. Watch his talk:

When is an aspirin a day good public health policy?

Should physicians be mandated to prescribe a daily aspirin as preventive care?

In an op-ed in today’s New York Times, two-time TEDMED speaker David Agus talks about when, if ever, encouraging proven preventive behavior should be made public policy, similar to New York City Mayor Michael Bloomberg’s restrictions on trans fats and soda sizes.

Why not aspirin? The 2,000-hear-old drug, he posits, has shown great benefit in reducing cardiovascular risks and cancer in recent studies as well as, of course, being an effective pain reliever. As we are all essentially paying for one another’s medical bills via Medicare, Medicaid and other taxpayer-financed health programs, it should be public policy for middle-aged people without adverse risk factors to use it. As he says:

The data are screaming out to us. Aspirin, one of the oldest remedies on the planet, helps prevent heart disease through what is likely to be a variety of mechanisms, including keeping blood clots from forming. And experts believe it helps prevent cancer, in part, by dampening an immune response called inflammation.

So the question remains: given the evidence we have, why is it merely voluntary for physicians to inform their patients about a health care intervention that could not only help them, but also save untold billions in taxpayer dollars each year?

Read the entire piece here.

And below is Agus’s speech at TEDMED 2011, in which he talks about the latest research on what works to prevent most major diseases.

Beyond willpower: Three TEDMED talks on how to fight obesity

What’s the best way to combat our national obesity epidemic?

To preview the issues behind our live online Great Challenges conversation about obesity this Thursday at 1 PM EST, we’ve collated three recent talks on the topic, a running theme of which is: It is immensely difficult for any single person to tackle the health issue of obesity alone.

How can America lose weight?
The CEO of Weight Watchers, David Kirchhoff, says America’s obesity crisis isn’t about people eating too much; it’s about our “obesogenic” environment. Beating it will involve lots of collective willpower.

Why can’t America “weight” any longer?
John Hoffman, vice president of HBO documentary films, and Judith Salerno, executive officer of the Institute of Medicine of the National Academies, talk about the HBO documentary The Weight of the Nation, why obesity is indeed a health crisis, and why it demands action on a national scale.

If we can’t cure the patient, can the community do it?
Mark Hyman, MD, best-selling author and chairman of the Institute of Functional Medicine, relates a story of how a stringy chicken in Haiti led to a revelation about using social networks to combat chronic health issues, one community at a time.

An animated look at Open Science

Perhaps you’ve heard of the Open Science Movement — the belief that all scientific research should be broadly distributed online, for free. What’s behind it?  Proponents argue the cost of medical journals and papers makes acquiring knowledge way too difficult, and that firewalls are considerable barriers to scientific collaboration.

Hear more from TEDMED 2012 speaker Jonathan Eisen, who has collaborated with Nick Shockey of the Right to Research Coalition on a short animated video.

TEDMED Day Two: Cookie goes green; gamers do serious science; and a peek inside the FDA

Graphic by Alphachimp Studio Inc.

Highlights from another jam-packed TEDMED day. Kicking things off in a most unusual fashion, NIH director Francis Collins jammed with singer Jill Sobule in an original song

Sam Berns and Francis Collins

called “Disease Don’t Care.” Perhaps an iTunes best-seller some day? He gave proof of the song title by chatting with a 15-year-old progeria patient, Sam Berns, on stage about the complexities of life with the disease.

Mars plant scientist Howard Shapiro talked about improving nutritional qualify of plant foods to help address global malnutrition issues.  On the flip side of that — calories, as we know, not always equalling nutritional quality — Judith Salerno, executive officer of the Institute of Medicine, spoke about “fat as the new normal” – and the woeful health problems that creates.  She appeared with John Hoffman of HBO Documentary Films, who presented a sobering preview of their upcoming documentary,  Weight of the Nation.

A serious issue for sure, but over-medicalization in other areas is rampant and slightly ridiculous, according to Ivan Oransky, executive editor of Reuters Health. Pre-diabetes — yes; attend; pre-cancer, maybe; pre-acne — c’mon.  After all, he pointed all, we’re all pre-death.  Should we spend every moment worrying?

Ultramarathoner Scott Jurek, a vegan like Shapiro, talked about how his mother’s MS inspired him to care for his own health in a big way, and convinced Cookie Monster, who claimed to have similar aspirations, that eating cookies won’t take you far.

The CDC’s Thomas Frieden pointed out the importance of a feedback loop in measuring the success of public health programs. Here’s the Wall Street Journal’s take on the talk.

Epidemiologist and Skoll Global Threats Fund CEO Larry Brilliant sat down for a Q&A with Peggy Hamburg of the FDA. One hot topic: Is the U.S. behind in terms of speed to market of new drugs and devices?

Elizabeth Bonker and Virginia Breen

Seth Cooper of the center for game science at the University of Washington talked about how Foldit, an open-access protein-folding game, reaps the benefits of specialized groupthink. Within weeks, gamers had replicated a protein that researchers had been trying to build for months. Read more on ABCNEWS.com.

David Icke of mc10 offered an intriguing glimpse into paper-thin wearable medtech for both out- and inside of the body, and Virginia Breen had many in the audience in tears as she spoke of the struggles of her daughter, Elizabeth Bonker, to communicate despite being hampered by autism. Elizabeth found a way; she’s a published poet and the mother and daughter together wrote a book, I Am in Here, about their journey.

Blogroll: Medgadget gives a comprehensive play-by-play recap. Med student Ilana Yurkiewicz expounded on Bryan Stevenson’s talk about the importance of shaping, and communicating, identities as people, patients and doctors.  Time.com’s Maia Szalavitz was also inspired by Stevenson’s talk to ruminate on how self-identity can affect personal health.

TEDMED: Day One

TRACES urban acrobats. Graphic by Alphachimp Studio Inc.

Kick-off day at TEDMED! Some 1,500 Delegates streamed through the massive doors of the Kennedy Center toward the Opera Stage to watch Session 1, themed “Embracing the Unconventional.”  So it was.  Legal advocate Bryan Stevenson spoke on the power of proclaiming and embracing identity, and why eliminating health inequities should be a critical part of America’s own identity.

Designer Teresa Monachino presented her own “Sicktionary,” in which she posed questions:  Does anyone really understand pill dosage labeling?  Why do anti-smoking messages focus on disease — when kids who start smoking think they’re invincible? Maybe our messages should focus on how smoking makes you ugly?

The Monachino Sicktionary. Graphic by Alphachimp Studio Inc.

Rebecca Onie, co-founder and CEO of Health Leads, spoke about the devastating impact of poverty on health, and what’s needed:  better access; earlier intervention; better food; better transportation.  All solutions, she says, that are ours for the taking. If we just ask the right questions — are you running out of food at the end of the month? Do you have safe housing? — then the doctor can then prescribe what the patient really needs.

Music and dance liberate the imagination, as TEDMED curator Jay Walker said.  To that end, singer and TEDMED musical director Jill Sobule sang “Modern Drugs,” about how life would be different for various famed artists and scientists if they had taken Prozac — imagine a cheery Edgar Allen Poe. The session closed as the WPAS Children of The Gospel Choir and Step Afrika! shook the stage and drew a standing-O with joyful music and dance.

TEDMED on the web: 

MedGadget does their classic TEDMED synopsis.

From Partner and Great Challenges program sponsor Robert Wood Johnson Foundation: Tackling health care’s Great Challenges; U.S. News and World Report’s Steve Sternberg issues his own challenge to TEDMED.

HuffPost is liveblogging the event as it happens. Artist and patient advocate Regina Holliday, who’s doing a mural of each day’s highlights, titled her first day’s work as the dance of care.

The HealthWorks Collective, sponsored by Siemens, gave a great synopsis of each speaker’s talk.

Alphachimp Studio captured not only the “what” of the day but also the colorful spirit with their digital scribes.

TEDMED 2012 speaker Jonathan Eisen compiled visual notes of Bryan Stevenson‘s talk.

Chris Seper of MedCity Media wrote on “What you need to know about TEDMED.”

And Nurture’s blog looked at the Great Challenges.

 

 

What to watch for at TEDMED 2012

TEDMED 2012 speaker E.O. Wilson as interpreted by artist Hanoch Piven.

It’s almost here: More than 1,500 Delegates from hundreds of diverse medical and non-medical disciplines. Seventy-plus speakers and performers, brilliant innovators all.

TEDMED 2012 begins Tuesday at 5 p.m. on the Opera House stage at the Kennedy Center — and remotely for some 50,000 TEDMEDLive participants from medical schools, non-profits, government agencies and other organizations across the nation.  We’re anticipating three-and-a-half eye-opening, mind-blowing days.

Headline speakers include Otis Brawley/American Cancer Society; Larry Brilliant/Skoll Global Threats Fund; Dr. Lynda Chin/MD Anderson Cancer Center; Francis Collins/NIH; Katie Couric/Stand Up To Cancer & ABC News; Thomas Frieden/CDC; John Hoffman/HBO Documentary Films; Peggy Hamburg/FDA; Billie Jean King/Health and Social Justice Advocate; Gail McGovern/American Red Cross; Gabby Reece/Women’s Health Advocate; and renowned biologist E.O. Wilson.

The Great Challenges: In this inaugural year of the Great Challenges Program, the TEDMED 2012 Delegates and TEDMEDLive viewers will vote on the 20 most complex and pressing challenges facing health and medicine to achieve the multi-disciplinary understanding critical to tackling them. We’ll explore these throughout the following year via TV-style interviews with leaders from across fields, a series of webinars on each of the 20 Great Challenges, and the opportunity for TEDMED community members to add their voice throughout.

Other cool goings-on: Patient advocate and artist Regina Holliday will be painting and blogging on the scene, and visual learning experts Alphachimp Studio will graphically scribe the event (follow them at #TEDMEDScribe). TEDMED’s corporate partners will have interactive social spaces where Delegates can explore cutting-edge advances and issues. And the Innovations Bar will unveil new medtech like Cleveland HeartLab’s new “It” inflammation biomarker test.

Looking to attend TEDMED Live? Find a participating location here.

Calling one and all: Join us by following events online. We’ll be posting updates regularly on Twitter @TEDMED, #TEDMEDLive, #TEDMEDChallenges, on Facebook and here on our blog. We’ll also be posting links to coverage from leading blogs and sites throughout the following days.