Exciting New Tech

Mapping human cellular biology. Single-letter gene editing. Bacterial infection diagnosis in mere hours. 3D-printed organs. A mobile ultrasound device that connects to your smartphone. Simple same-day health care. These are some of the bold, cutting-edge ideas from this year’s TEDMED Hive Innovators. In our final Speaker Spotlight of 2018, we’ll be featuring 6 companies that are driving progress in health and medicine. From improving the patient experience to developing new diagnostic tests, these Innovators are pushing the boundaries and thinking outside the box.

With all the advancements we’ve made in health and medicine, it may come as a surprise that we still do not have a map of our human cellular biology. If we did have such a map, computer models of disease progression could be more accurate, which would enable us to discover precision treatment options, faster. Fortunately, Ron Alfa’s team at Recursion is working to create such a map. By using a combination of machine learning and experimental biology, Recursion has set a goal of discovering 100 new drugs by 2025. With one drug currently in an FDA approved Phase 1 trial, and 30 more in the pipeline, the company is well on their way to reaching that impressive goal.

Many genetic diseases are the result of a single-letter misspelling out of billions of bases in the genetic code. However, current methods for gene editing don’t have the precision for making a single-letter correction. Nicole Gaudelli and her team at Beam Therapeutics are working to improve gene editing accuracy, by developing next-generation CRISPR base editing technology to conduct gene correction, gene regulation, gene silencing, and gene reprogramming at the most precise level of gene therapy. Whereas CRISPR is often compared to a pair of scissors, Beam’s base editing “is more like a pencil. When it reaches its target, it finds a letter, erases it and rewrites it as a different letter without disrupting the sequence of other letters around it.” Beam plans to use their gene editing platforms to prevent, modify, or even cure a wide range of diseases that affect people’s lives.

At Prellis Biologics, Melanie Matheu and her team have the ultimate objective of printing an entire vascular system of a complex organ in less than 12 hours. They’re already making important steps toward this goal, having succeeded in creating 3D printed blood vessels—a hurdle that many other companies have yet to overcome. Without a blood supply, cells are only able to survive for a certain length of time; as a result, ultra-high resolution printing is of utmost importance when it comes to developing microvasculature and scaffolding for human tissue. Prellis’s record-speed printing is paving the way for important medical progress and functional organ replacement options.

Day Zero Diagnostics (DZD) is using genomics and machine learning to modernize infectious disease diagnosis and treatment. Current diagnostic tests take 2-5 days to properly diagnose an infection, and this extended wait time is associated with an 8% increase in death per hour. However, Miriam Huntley and the team at DZD have developed a test that rapidly identifies bacteria and their antibiotic resistance profiles, so that patients receive the right antibiotic therapy within ours. By developing a much faster way to accurately diagnose bacterial infections, DZD not only has the potential to reduce hospital costs and the use of broad-spectrum antibiotics, but also to save patients’ lives.

For doctors, having access to an ultrasound machine when it’s needed can be a matter of life and death. However, many hospitals and clinics only have a limited number of ultrasound machines, and some are not able to afford them at all due to the high price tag. The team at Butterfly Network made it their mission to scale down the ultrasound—not only is their handheld probe pocket-sized, but it also costs significantly less than a traditional ultrasound machine. Their technology, called the Butterfly iQ, connects directly to a user’s smartphone and produces clinical-quality full body medical imaging. John Martin, Butterfly Network’s Chief Medical Officer, even used the device to detect a cancerous tumor in his neck on his own. Ultimately, the team at Butterfly Network aims to democratize health care by making medical imaging accessible and affordable—not just for doctors and hospitals, but for patients themselves.

Butterfly iQ

Working on reducing time spent waiting for more common services is Solv, a mobile app that helps people find and book same-day urgent care appointments. According to IBIS World, the Urgent Care Centers industry is growing at an average rate of 5.4% annual and has reached $28 billion in 2018. Heather Fernandez saw a clear opportunity, as well as inefficiencies, in the urgent care system and brought her experience in transparent consumer experiences to the world of urgent care coordination. By creating a seamless, simple, and price transparent interface for a patient to schedule their appointment with a highly-rated convenient care provider, Solv helps patients get the care they need, fast. On the provider’s end, Solv increases online bookings, helps manage appointments, and improves patient satisfaction at clinics and care centers. By easing the coordination of care on both ends, more people are able to get the quality care that they need, when they need it.

There is no question that the future is bright in the world of health and medicine. Each of the Innovators showcased above gives us a taste of what’s on the horizon in healthcare and science. With advances like 3D printed organs, rapid bacterial infection diagnosis, and portable ultrasound imaging, it’s easy to be excited and optimistic about the future of health and medicine. You can check out the full group of 2018 TEDMED Hive Innovators TEDMED.com. If you’re joining us in Palm Springs next week or participating in TEDMED Live, you will see all 16 Innovators speak during the Audacious Session. Be sure to join the conversation surrounding TEDMED 2018, which is taking place November 14-16, using #TEDMED on Twitter, Instagram, and Facebook.

There’s Hope in Our Mortality

Hope is defined as a feeling of expectation and desire for a certain thing to happen. So when we tell you that several TEDMED 2018 Speakers have taught us how to find hope in places such as serious illness and end of life, you might be surprised. Despite the initial discomfort of discussing such difficult topics, there is much to learn from conversations around end of life and cancer diagnoses. Whether it be through sound, support, or a little bit of humor, each of these Speakers has a unique approach to what it means to take on the challenges that life brings us with hope , and their insight can help us learn to become more comfortable and capable of having those difficult, yet critical, conversations about what it means to truly live.  

With a focus on making every moment of our life, down to our last breath, comfortable and full, Steve Pantilat, Chief of the Division of Palliative Medicine at UCSF, works on transforming the healthcare system to improve the quality of life for people living with serious illness and their families. Steve has spent much of his career focusing on how to preserve dignity in some of life’s most vulnerable moments, such as finding better ways to care for people in hospice. As the founding director of the national Palliative Care Quality Network (PCQN), a learning collaborative focused on how to improve palliative care across health care, Steve is creating new ways for doctors and hospitals to collaborate around providing comfort and hope to those living with serious and terminal illnesses. Steve has published over 100 peer-reviewed scientific papers, including one documenting how to set up similar networks to PCQN. While the conversation about death is a critical one to have, Steve’s doing important work to ensure that each person’s wishes are honored during their most vulnerable and difficult times in health care.

While Steve is designing resources for physicians, Yoko K. Sen is designing new hospital experiences for patients. As an ambient electronic musician, Yoko is tuned into sounds in ways that most of us are not. This acute sense was overstimulated when she was admitted to a hospital in 2014 and bombarded with harsh noises from various hospital equipment. This pushed her to ask the question: How do these disturbing sounds impact a patient’s wellbeing and dignity? This question inspired her to found Sen Sound, which not only looks at the impact that alarms and monitors have on the patients in a hospital but also how they affect the hospital staff. Yoko investigated these questions further as the artist-in-residence at Johns Hopkins University’s Sibley Innovation Hub. Turns out, with alarms going off constantly, physicians and patients develop “alarm fatigue” where they stop noticing the alarms altogether. Her effort to redesign the soundscape in hospitals is not merely about eliminating sound but designing the right sound experience for each person. Projects such as My First Sound and My Last Sound think about how to use the hearing sense to provide the best and most positive holistic experience for our most vulnerable populations at the ends of the spectrum of life.

At 34, Kate Bowler was a historian at Duke Divinity School and published author of the “first history of the [American Prosperity Gospel] based on divine promises of health, wealth, and happiness.” A year later, she was diagnosed with Stage IV cancer and confronted with the irony that was being an expert in the idea that good things happen to good people while facing serious illness. Channeling the mixture of emotions that come with such a diagnosis, Kate launched a national conversation about the discomfort we experience while talking about suffering to help not only herself but all of us learn to find hope and comfort in difficult conversations. Often using tongue-in-cheek titles for her articles and books, Kate finds ways to infuse humor into the serious discussions around pain and suffering, helping the reader engage with the difficult content. Aiming to ask the tough but necessary questions such as “What does the suffering person really want?” and “How can you navigate the waters left churning in the wake of tragedy?”, Kate wrote another book, Everything Happens for a Reason (and other lies I’ve loved), and currently hosts a podcast “Everything Happens”. On her show, she interviews guests about topics such as communication, love, and loss when facing illness and death, showing us how to be more comfortable talking about pain.

Whether it be the beginning or end of life, we all wish for our loved ones, and ourselves, to find dignity in the process. Sometimes that means embracing difficult conversations to know what ones’ last wishes are, and other times that means providing support for physicians to provide more options for those suffering. It can include redesigning our sensory experience of a hospital or developing a hospice plan that includes support for all the family members impacted. These Speakers are teaching us how to find hope and beauty in difficult situations and paving the way through what often feels like a dark forest of uncertainty. Be sure to tune into TEDMED 2018 next week, whether in person or online through TEDMED Live, to hear more about their unique perspective on what care can look like in the rawest moments.

The Spread of Disease

It’s no secret that we humans are a pattern-seeking species, trying to organize the chaos that is our universe, our planet, and possibly our closets. This powerful ability allows us to make predictive models of all kinds, shapes, and sizes, unlocking the understanding of how things grow, survive, and deteriorate. This week we’ll be focusing on how scientists and innovators have applied these predictive skills when looking at how disease spreads across a species in order to best predict, or prevent it. Whether it’s geo-mapping zoonotic viruses or the fluid dynamics of a sneeze, you are sure to learn a thing or two at TEDMED 2018 about how pattern recognition could be our best shot at preventing the next pandemic.

With the recent outbreak of Ebola in the Democratic Republic of Congo, we are once again reminded just how vulnerable humans are to viral threats. It’s with these types of threats in mind that leaders gathered to form the Global Virome Project (GVP), an innovative partnership to detect the majority of our planet’s unknown viral threats. Partners are working to develop a global atlas of these threats, with a goal of identifying and characterizing 99% of zoonotic viruses within 10 years of its inception in 2016. With an approximate 1.6 million viral species yet to be discovered in mammal and bird populations, there is much work to be done. Patterns will likely emerge as the map gains more detail, and thus the security system of prevention for these potential epidemics will increase in strength. Thanks to the work of Jonna Mazet, Anchor Author of the GVP, and her team, we can look forward to a future that will be focused more on prevention, and require less reactive treatment.

Mapping viruses are tricky for many reasons, one of which is animal populations shifting geographically. With the average global temperature on the rise, a lot of animal populations are disappearing in some locations, or migrating to new homes, and bringing their zoonotic viruses with them. Daniel Streicker, Senior Research Fellow and head of the Streicker Group at the University of Glasgow Institute of Biodiversity, is working to anticipate and prevent infectious disease transmission between species. Daniel is using patterns from the data of longitudinal field studies in wild bats to forecast how a disease like rabies could spread, giving the government the information they need to take preventative actions.

While it takes a bite for a vampire bat to spread rabies to humans, there are many diseases that spread through fluid transmission. Lydia Bourouiba focuses her research on exactly how fluid dynamics impact disease transmission by finding patterns in events like a human sneeze or cough. As the director of the Fluid Dynamics of Disease Transmission Laboratory at MIT, Lydia combines multiple disciplines to analyze pathogen transmission in humans, animals, and plants. Through their research, her team is developing models that improve our understanding of pandemics, and ultimately finding new ways for us to improve prevention and preparedness. By taking a close look at how a splashing droplet radiates its splatter, her team is able to see how much coverage a droplet of pesticide gets on a leaf. Prior to their work, studies of this kind were focused on more steady configurations, like water from a faucet. By looking at unsteady configurations, like sneezes and sprays, Lydia and her team are helping us to better understand the dynamic process of disease transmission.

Playing with fluid dynamics in a different way, Hive Innovator David Hoey and his team at Vaxxas are developing an advanced platform for needle-free vaccine delivery. Based in Australia, Vaxxas has run clinical trials of their Nanopatch™ technology to deliver vaccines, including one for Polio. While the format is revolutionary, using an ultra-high-density array of short projections to deliver the vaccine to the immune cells immediately below the skin’s surface, that’s not the only incredible aspect of this technology. By packaging the vaccine in the Nanopatch™, they have also made the vaccine shelf stable without refrigeration for more than a year at room temperature. This breakthrough solves one of the greatest challenges remote areas face with vaccines: the high cost of refrigerated transport of these life-saving serums. With their outstanding work, the team at Vaxxas is providing hope that we will one day be able to prevent and stop epidemics and pandemics.

Whether it’s by researching fluid dynamics like Lydia, or documenting the geolocation of the world’s zoonotic viruses like Jonna, it is clear that patterns are the key to preventing the spread of disease. Once we find those patterns, like Daniel did with bat migration, we are able to be smarter about vaccination resources and threat awareness. Fueling efforts for smarter preparedness are companies like Vaxxas, who is working to discover new ways to design vaccines in order to provide protection for the world’s most vulnerable populations. We hope you will join us at TEDMED 2018 to learn more about these fascinating Speakers and Innovators and their work to understand and prevent the spread of disease.

Communication Build Up and Break Down

The nervous system is the information highway of our bodies. So, what happens when there’s a traffic jam, or a rogue traveler refusing to go with the flow? This week’s Speaker Spotlight will focus on those who are working to understand how this system works, and what happens when it doesn’t. Communication in the nervous system is dynamic, ranging from electrical signals to the transfer of genetic material, and the communication can come from some unlikely places, like our gut. This communication is critical, and when it breaks down, we see a variety of ailments and illnesses emerge. The question is, how can we stop this communication breakdown?

A good place to start is to establish just how our neural network communicates. Jason Shepherd, an associate professor at the University of Utah, studies how the brain stores information, as well as how these processes can malfunction due to neurological disorders and age-related cognitive decline. Jason and his team at Shepherd Lab have discovered how Arc, a neuronal gene protein that is critical for long-term memory and synaptic plasticity, is able to form viral-like capsids capable of transporting RNA. Jason sees that the larger implications of this discovery could transform genetic engineering and gene therapy, as many gene therapies often use viruses foreign to the human body, and this protein is native to it. As we learn more about how our nervous system transfers information, we remain hopeful that scientists like Jason will be able to find ways to prevent the communication breakdown from occurring.

When blood flow in the brain is disrupted, leaving the neural communication system without oxygen, a communication breakdown occurs. This can have devastating effects on a person’s life, making stroke prevention and treatment critical for our internal information interstate. According to the American Stroke Association, stroke is the fifth-largest cause of death in the United States, killing nearly 130,000 people a year. It is also a leading cause of long-term disability and the leading preventable cause of disability. Inspired by the loss of a patient who would have benefitted from more immediate care, Chris Mansi and his team at Viz.ai got to work developing an artificial intelligence (AI) platform to dramatically reduce the amount of time it takes to detect and triage strokes. Using machine learning software to evaluate brain scans, Viz.ai’s technology is getting critical patients into treatment faster. In February 2018, the FDA granted a de novo clearance for Viz LVO, the first-ever computer-aided triage and notification platform. Most recently, Viz.ai announced its second FDA clearance for Viz CTP through the 510(k) pathway, offering healthcare providers an important tool for automated cerebral image analysis. While the brain is getting choked by a blood clot or bleed, Viz.ai has found a way to improve the communication system outside the body to treat it.

Sarkis Mazmanian, the Luis & Nelly Soux Professor of Microbiology in the Division of Biology and Biological Engineering at the California Institute of Technology, is looking at how unlikely systems are interacting with the nervous system and impacting brain function. With the majority of research for neurodegenerative diseases, like Parkinson’s Disease, focusing on the brain, Sarkis has turned to the gut, looking specifically at the microbiome and how it communicates with the brain. There are a variety of ways in which scientists are studying the relationship between the gut and Parkinson’s, as well as Alzheimer’s disease. Sarkis focuses on how the specific microbes in a person’s gut can impact the brain. In addition to researching how the gut microbiome impacts our nervous system, Sarkis has done extensive research on the relationship between the gut microbiome and the immune system focused on answering the question: why are these bacteria not attacked by our immune system? Sarkis’s team found that the immune response to these bacteria actually benefits both the bacteria and the host. With his most recent published work focused on how the gut microbiome impacts locomotor behavior in fruit flies, Sarkis continues to deepen our understanding of how our microbiome communicates with our bodily systems.

While a good diet and proper sleep are good for everyone, they can be especially impactful for those who may be prone to Alzheimer’s disease. Zooming out of the microbiome and zooming back into the brain, Padideh Kamali-Zare created computational models to understand the role cell structures play in their function during her PhD studies in Sweden, and she has applied this learning to how Alzheimer’s progresses in the brain. At Darmiyan, Padideh and her team are developing software that can detect Alzheimer’s disease up to fifteen years before symptoms of cognitive decline. Using just regular brain MRI scans, Darmiyan produces maps and scores that can detect the progression of the disease. With early detection, they aim to dramatically change lives and therapeutic development, including incorporating the best candidates for clinical trials in new therapies. By alerting individuals earlier about the potential onset of Alzheimer’s disease, Darmiyan’s technology can empower them to take steps to delay cognitive decline.

Today’s healthcare system places a heavy emphasis on healing the body, but often less so on healing the mind, leading to mental health issues that slip past doctors unnoticed and untreated. And where a mental health need is detected, physical care providers are often disconnected from our outnumbered mental health professionals, making care coordination and referral difficult, at best. Quartet Health is focused on bridging this divide, by providing primary care providers with the technology and tools to identify patients who need care. To do so, Quartet connects primary care providers with four key stakeholders: patients, behavioral health clinicians, medical health providers, and payers. Robert Accordino, Chief of Behavioral Health at Quartet, will join us in Palm Springs to share the exciting potential of Quartet’s approach that connects care of the body with the care of the mind.

Yuri Maricich and his team at Pear Therapeutics are taking a radically different approach to treat matters of the mind. By literally reshaping how we think about therapeutics, Pear has found a way to treat substance abuse, mental disorders, and neurodegenerative diseases—wherever and whenever. Based on the premise that software not only has the power to change behavior, but can also change brain function, Pear created their first app, reSET, to help treat patients with substance use disorder. reSET, a Prescription Digital Therapeutics (PDT), is the first of its kind to receive FDA approval, distinguishing it from the 10,000 other apps that may show up when you search the App Store. Through their work, Pear is finding new ways to repair the brain’s communication system while also providing a better communication system between patients and doctors.

While there is still much to learn about how the human brain functions and communicates, it is clear that we are making significant progress. Whether that is identifying Alzheimer’s disease earlier or improving how we provide treatment for mental health conditions, there are many ways that scientists, researchers, and entrepreneurs are improving our understanding of our body’s vast information highway. With improved understanding, we also are able to develop better technologies and treatments for diseases and disorders of the brain. These exciting discoveries in how the brain functions, as well as innovative ways to treat brain diseases, are shining a light toward a healthier future.

The World Around Us

Nature has arguably been the most consistent source of inspiration for the human imagination, sparking curiosity and wonder. It also inspires us to think about the digital environment that now exists, although not necessarily considered natural, it is becoming more and more integrated into our daily lives and decisions. How can we use the environment, whether natural or digital, to improve our health? And what are we putting into the environment that is negatively impacting our health? This week’s Speaker Spotlight will focus on Speakers and Hive Innovators who have creatively thought about these questions, from biophilic buildings to how noise could be the next public health crisis. Regardless of their answer, each one has found creative ways to think about the input and output of humans’ complex relationship with our environment.

Would you be surprised if we told you that something as simple as having a window with a view of nature in your office can increase job satisfaction and decrease job stress? Award-winning architect Amanda Sturgeon designs with this concept in mind: the more we create a symbiotic relationship between buildings and nature, the happier and healthier humans will be. At the International Living Future Institute (ILFI), Amanda and her team focus on biophilic buildings: structures that utilize and celebrate biophilia (love of connecting with life and nature). She worries that the gap between humans and nature is growing too wide and believes that the relationship needs to be repaired to support healthier lives. By incorporating living elements into her designs, as well as infrastructure that more closely resembles what we would find in natural settings, Amanda strives to provide a way to design not just a building, but the relationship between people and nature.

Road traffic, sporting events, concerts, construction sites, airplanes. Sound or noise? Noise is defined as “unwanted sound”, not merely a volume, so it’s more a matter of perspective. However, the impact that noise has on our health is profoundly different than sound in general. Some consider noise as the next great public health crisis, and TEDMED Speaker Mathias Basner will tell us why. As an Associate Professor of Sleep and Chronobiology in Psychiatry at the University of Pennsylvania Perelman School of Medicine and the President of the International Commission of Biological Effects of Noise, he has spent much of his career exploring the effects of noise on our health, and particularly our sleep. With one of his studies focused on how traffic noise impacts sleep, his team broke down the difference of sleep disruption from road, rail, and air traffic noise. In order to support further research of the impact of disrupted sleep on psychomotor functioning, he worked on improving the validity of the tools used to measure impact. In addition to studying the relationship between noise and humans functioning on the ground, Mathias has also spent time studying sleep in space, and how to best prepare astronauts for a mission to Mars. He’s asking tough questions about how our circadian rhythm is impacted by prolonged microgravity and confinement. Mathias is pushing the boundaries of understanding how our biological rhythms interact with nature.

The CDC’s Most Unwanted List of threats is steadily growing with deadly superbugs that are resistant to antibiotics, making it more and more urgent that we develop new medicines to battle infectious bacterias. When many researchers continue to look for synthetic solutions to this natural phenomenon, Hive Innovator Sean Brady and his team at Lodo Therapeutics are digging in the dirt for answers. They seek new therapeutics to tackle drug-resistant microbial infections and cancers – some of humanity’s greatest dangers. To do so, the team at Lodo is using a gene sequencing technique to extract and sequence microbial DNA from soil. Recently, they discovered a cure for MRSA in rats, an antibiotic-resistant disease that also causes complications in humans ranging from skin infections and sepsis to pneumonia to bloodstream infections. Now working to improve the drug’s effectiveness in hopes of developing a treatment for humans, Sean and his team at Lodo are turning to nature for solutions to life-threatening problems.

Lodo’s Lab

What if our environment, and the devices that monitor us and our surroundings, could feed life-saving information to emergency response services? Michael Martin asked this question, and the answer is his work at RapidSOS. Using data collected by Internet of Things (IoT) devices and companies ranging from biometric sensors and cell phones to automobiles and home security systems, RapidSOS bolsters our nation’s outdated 9-1-1 platform with rich, dynamic information that can help first responders save lives. They’re building partnerships with a wide range of organizations to collect data from multiple sources and are already able to deliver a more exact location of people in need, speeding first responders to their aid. Their goal is to arm EMS with as much information as is possible and relevant to save lives and even contact emergency contacts to activate an extended support network. RapidSOS puts our digital environment to work to provide the best possible care in our times of crisis.

As we design more technology to manipulate our environment, it becomes clearer that we must not lose sight of incorporating natural elements as well. Whether it’s building biophilic buildings that integrate the synthetic with nature or measuring the impact of human-made noise on sleep deprivation and thus cognition, the relationship between what’s natural and synthetic has become more enmeshed, creating the hybrid world we live in. It’s using this hybrid environment for good, such as our personal data being fed to first responders, and digging in the dirt for antimicrobial organisms, that allows us to progress forward, hand in hand with nature instead of fighting it.

Building Beacons of Quality Care

There are endless, and occasionally insurmountable, hurdles that prevent people from receiving quality care. It may be the distance to the nearest hospital, or the lack of resources at said hospital, or that a “nearby” hospital simply doesn’t exist. This Speaker Spotlight will focus on the Speakers and Hive Innovators who are “bringing the mountain to Mohammed,” whether by building hospitals in communities that previously did not have them, or deconstructing the operating room and bringing it to a patient’s home. Each of these leaders has found ways to improve access to quality health care in communities that were often left behind.

Dikembe Mutombo has never lost connection with his home country, the Democratic Republic of Congo. After coming to America on an academic scholarship to study medicine at Georgetown University, Dikembe went on to an impressive eighteen-season career in the NBA. Throughout his career as a professional basketball player, and especially after retiring from the Houston Rockets in 2009, Dikembe has always been committed to using his celebrity status as a force for good. With a passion for improving the lives of the underserved—particularly those living in the Congo and throughout Africa—Dikembe has worked on projects and initiatives that help to ensure that those in need have access to health care and economic opportunities. In 1997, he established the Dikembe Mutombo Foundation, which strives to improve the health, education, and quality of life for the people in the Democratic Republic of the Congo. One major Foundation project was the construction of the Biamba Marie Mutombo Hospital in Kinshasa, Dikembe’s hometown, which has served 300,000 people in the area since opening in 2007. Dikembe lives out the belief that every person, no matter where they live, deserves access to quality care and has built a beacon to share that vision.

Dikembe being honored at Dana-Farber Cancer Institute, Brigham and Women’s Hospital (BWH) and Harvard Medical School’s Global Health Catalyst Summit

As we know, equitable access is not merely an issue of having a hospital nearby. The quality of care within a hospital is critical, and one would hope, equal. However, Elizabeth Howell’s research shows us that outcomes are not equitable in all cases. As the Director of The Blavatnik Family Women’s Health Research Institute, and the Mount Sinai Health System Vice Chair for Research, as well as a Professor in the Department of Obstetrics, Gynecology, and Reproductive Science, Elizabeth witnessed the disparity in outcomes that minority groups, especially Black women, faced in her field. In a study published in 2016, Elizabeth and her colleagues point out that “a significant portion of maternal morbidity and mortality is preventable making quality of care in hospitals a critical lever for improving outcomes.” With this fact in mind, they studied the differences in hospitals in which black and white women deliver. They found that black women are more likely to deliver at higher-risk hospitals, and called for further research to define the attributes that make hospitals high performing. It’s not enough to have a hospital nearby for a woman to deliver, so Elizabeth is leading research that will help ensure that hospitals provide all mothers high-quality care.

When it comes to improving health care for the underserved, Mitch Katz is all about achieving measurable results and lasting changes. As President and Chief Executive Officer of NYC Health + Hospitals, the nation’s largest public healthcare system, Mitch leads an integrated health care system of hospitals, neighborhood health centers, long-term care, nursing homes, and home care, which together function as the public safety net health care system of New York City. Although it’s a big job, Mitch has the right experience: his last few decades were spent directing the San Francisco Department of Health and then the Los Angeles County Department of Health Services. While in those two California cities, Mitch achieved many public health victories including funding needle exchange, the creation of an ambulatory care network, and the elimination of the department deficit through increased revenues and decreased administrative expenses. Having taken over NYC Health + Hospitals in early 2018, Mitch has already set ambitious goals for the system, including achieving fiscal stability and transforming the primarily emergency department-focused system into a primary care-focused system. Many people look at US cities’ health care systems as broken and a nightmare, but Mitch looks at them, sees their potential, and finds a way to turn the oil tanker.

There are around 5 billion people in the world who don’t have access to safe, clean surgical care. Debbie Teodorescu and the team at SurgiBox are looking to change that. Instead of requiring a sterile operating room for surgery—which is difficult in many developing countries where dust, bacteria, and flies are present when doctors are working in the field or can also contaminate operating rooms—SurgiBox is redesigning what safe surgery looks like. With their simple, inexpensive, and ultraportable inflatable surgical environment that fits in a backpack, Debbie and the team are making clean surgeries available anywhere. Instead of requiring a full room for surgery, SurgiBox is simply inflated into a clear bubble around the patient’s surgical site, sealed for sterility, and operated through via ports. Imagine the possibilities for quality health care access with a portable OR!

When faced with glacial sized challenges, it is clear that many members of the medical community roll up their sleeves and get to work, chipping away at the behemoth. While there are few like Mitch, who found a way to reshape massive health care systems to meet the needs of the patients while making the system more sustainable, we know there are many who are fighting the everyday Goliath’s in health care. While Mitch has shown how to make large-scale, systemic changes, there are pioneers like Debbie who are bringing safe surgery to places where it does not exist. Even when there is infrastructure in place, we are grateful for researchers like Elizabeth, who make sure that we know where to hold our systems accountable with the very real statistics facing underserved communities. Regardless of how they reinvent access to health care, each of these champions is forging a way to bring quality care to communities and patients that others overlooked or ignored.

Community Change, From the Inside Out

Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.
—Margaret Mead

From infectious disease to opioid addiction to sexual violence, there’s a myriad of pressing health and social issues facing communities around the globe. Sometimes the global community steps in to help, providing aid where needed, but other times local communities are left to fend for themselves. Unfortunately, low-income and underserved communities not only have limited resources to tackle such issues on their own, but they also often find themselves facing an intricate web of many other deeply-rooted challenges. Despite the injustices of these situations, we often see people within these communities who take it upon themselves to inspire the change they want to see around them. At TEDMED 2018, we’ll feature 4 Speakers and 1 Hive Innovator who are employing innovative ideas and unwavering determination to address the complex challenges facing their communities. Through their work, these individuals are proving that the most sustainable and effective change often starts at the local level—from the inside out.

In Malawi, nearly 1 in 5 babies are born prematurely, and the southeast African country has faced significant challenges supporting these babies with basic functions such as breathing, feeding, and body temperature regulation. Refusing to be a bystander in the face of these heartbreaking statistics, pediatrician Queen Dube and the Queen Elizabeth Hospital have been working with Rice University in Texas, along with other international partners, to test and implement life-saving technologies through the NEST 360 program in order to avoid preventable deaths and save babies’ lives. These technologies are unique in that unlike most medical equipment, they are built to withstand the harsh environments in which many African hospitals operate. In an interview with the BBC, Queen describes one of the life-saving technologies, a bubble CPAP machine, which her hospital uses with premature babies who are struggling to breathe. Between these new technologies, government initiatives, and innovative partnerships, infant mortality rates are now on a steady decline in Malawi.

Infant receiving care at Queen Elizabeth’s Hospital

Sometimes a community is forced to face an onslaught of seemingly insurmountable challenges all at once—such as when it is confronted with a natural disaster. After Hurricane Maria, Puerto Rico found itself in this difficult position. With power outages that lasted over 8 months and an alarmingly high death toll that wasn’t updated until nearly 11 months after the initial tragedy, many Puerto Ricans reported feeling a lack of support in their efforts to rebuild after the storm. Fortunately, amidst the devastation, there were community members like Christine Nieves who rolled up their sleeves and got to work. A few weeks after the hurricane, Christine and other community members opened Proyecto de Apoyo Mutuo Mariana (Project for Mutual Aid Mariana), a “comedore social” (social kitchen) in La Loma that not only provides the community with rainwater collection and filtration for cooking, solar panels, and free Wi-Fi, but also serves up to 300 meals per day. As Christine put it, she saw “Hurricane Maria [as an] opportunity to see the power is in ourselves and not in America.” Following in the footsteps of Christine’s community-led approach, buildings across the island now display a new motto: “Puerto Rico se levanta” (Puerto Rico raises itself). Not only is Christine’s work helping to revive a struggling community, but it is also instilling a strong sense of community pride and inspiring more community-led recovery projects across the island.

While it’s no secret that the United States has an unfortunate history of exploiting its farmworkers, many might be surprised to learn that there are still American farms utilizing slavery practices today. Greg Asbed co-founded the Coalition for Immokalee Workers (CIW), a worker-based human rights organization, to help end the systemic abuses he was seeing in Florida’s tomato fields. In the years following, Greg helped to expand CIW’s standards into a broader framework called the Fair Food Program (FFP), a unique partnership between farmworkers, Florida tomato growers, and select retail buyers. With the help of Gerardo Reyes Chavez—who was a farmworker for most of his life and is now a key leader of the CIW and FFP—the organization has helped to liberate over 1,200 farmworkers from farms where they were being held against their will and forced to work. Additionally, the CIW has gotten major corporations such as McDonald’s and Whole Foods to sign “Fair Food Agreements,” in which the companies agree to only do business with tomato farms that provide workers with fair pay and labor, education, complaint management systems, health and safety agreements, and more. Greg and Gerardo’s Worker Driven Social Responsibility model is now being applied beyond the agricultural industry—as far away as in garment factories in Bangladesh. In addressing and improving the unfair food system, Greg and Gerardo are giving a voice to an underserved community and paving the way for large-scale social impact.

CIW-organized farmworkers’ protest

Affecting community change often demands addressing systemic challenges head-on. Toyin Ajayi co-founded Cityblock Health to tackle the barriers to good health facing people in underserved areas and to provide these populations with the personalized care that they require. Driven by the belief that truly serving a community means extending healthcare services beyond the doctor’s office, Cityblock Health works to become active and responsive members of the communities they serve—providing its member base of those who access Medicaid, who are dually eligible for Medicaid and Medicare, as well as people living in underserved city neighborhoods, with high-quality care where-needed and when-needed. The company’s tech-enabled model not only effectively meets the complex care and social needs of its members, but it’s also helping to shift care away from the reactive, hospital-based acute healthcare system and toward a system that is more focused on prevention and community support. By providing customized local health care, Cityblock Health is improving the health of its community, block by block.

When it comes to driving meaningful change, sometimes it takes someone on the inside to clearly identify the problem and to find the best path forward. From Queen’s work implementing life-saving new technologies in Malawi, to Christine’s inspiring community resilience efforts in the wake of Hurricane Maria, to Greg and Gerardo’s victories in improving working conditions for Florida’s tomato farmers, to Cityblock Health’s implementation of personalized and localized healthcare solutions for underserved neighborhoods, TEDMED 2018 will showcase individuals who are not accepting the status quo. These outstanding Speakers and Innovators are stepping up to the plate and solving health and social challenges from the inside out.

When Our Bodies Have the Solution

The human body is the beautiful coordination and collision of complex systems. While there are some systems that we understand on the deepest levels, other systems have continued to elude us. In the process of unlocking that knowledge of these elusive networks, researches have been able to find solutions to some of our most challenging problems. By amplifying the power of these systems within our bodies, scientists are finding ways to slay the dragons of paralysis and cancer. Coming to the TEDMED stage this November, we have 3 scientists who have found inspiration from within the human body to develop solutions that maximize the impact of the immune and musculoskeletal systems and developed life-changing therapies and technologies for their patients.

Since he was young, Tim Lu was interested in computer programming. He found a way to channel that talent into biology, where his research focuses on engineering bacterial and human cells to perform new functions. Considered one of the founding fathers of synthetic biology, Tim has been working with the Synthetic Biology Group at MIT on designing synthetic gene circuits that encode in DNA. These circuits can be designed to do many things, including distinguishing various cancer cells from non-cancerous cells. With concerns around growing resistance to traditional antibiotics, Tim has looked for inspiration within the body to research how to utilize a person’s immune system to attack the cells that do not belong using bacteriophages. Tim’s research has also focused on immunotherapies for a range of cancers, using synthetic gene circuits that activate when it detects two specific cancer markers. Manipulating the body from the inside out, Tim is leading the way through the synthetic biology revolution.

Also finding inspiration from the human immune system, Carl June designed the CAR T cell immunotherapy for lymphoid leukemia while leading the Center for Cellular Immunotherapies at the Perelman School of Medicine, and the Parker Institute for Cancer Immunotherapy at the University of Pennsylvania. This immunotherapy is the first FDA approved personalized cell therapy for cancer in the US. Carl weaved together his experience as a Navy-funded HIV researcher and his research experience studying cancer to develop the idea of using genetically engineered T cells. Using the body’s own immune system, Carl saw an opportunity for a modified HIV virus to deliver modified DNA to a tumor. While thinking outside the box, Carl dove deep inside of cells and is one of Time Magazine’s 100 Most Influential People of 2018. While the therapy is focused on specific types of leukemia, for now, this gives us hope that may more cancers will be able to be treated using similar therapies.

While Carl and Tim design therapies from the inside out , Kathleen O’Donnell has been designing solutions from the outside in. As an Industrial Designer at the Wyss Institute, Kathleen focuses her work on designing and programming a robotic exosuit to mitigate, or ultimately eliminate, challenges to mobility, such as the impact of partial paralysis caused by stroke. Through a robotic device attached to a patient’s lower limb, the exosuit allows for gait correction and prevents the development of maladaptive compensatory strategies, such as limping. As the team member leading the effort in getting this technology to a clinical setting, Kathleen is working with ReWalk Robotics to mass-produce the design for physical therapy clinics.

The human body is an extraordinary set of systems and has evolved to overcome nature’s most complex problems. Just like we look to optimize our systems to maximize our health, Carl, Tim, and Kathleen have found ways to support powerful systems in our body and guide them to perform in ways that can cure illnesses and impairments that were once thought impossible to overcome. The human body still holds many secrets, but we know that some of the solutions to our most difficult challenges lie within it.