TEDMED Themes: Nine Parts of Imagination

Screen Shot 2014-08-07 at 9.38.20 PMAs TEDMED convenes its first ever dual-location event September 10-12, speakers will lead Delegates in exploring nine overarching themes with the ultimate goal of unlocking imagination, both individually and collectively, to address the toughest conundrums and most exciting innovations happening today.

Session One: Turn It Upside Down

What lies beneath the obvious? What could we be doing better, if only we looked more closely or from a completely different angle? Speakers will address insights that flip beliefs and question standard operating procedures in health and medicine.

Speaking and performing for this session will be:

Erica Frank, Professor and Canada Research Chair in the School of Population and Public Health, and the Department of Family Practice at the University of British Columbia

Farah Siraj, Jordanian singer and songwriter

Elliot Swart, co-founder and CTO of 3Derm Systems

Jared Heyman, founder of CrowdMed

Sonia Shah, investigative science journalist and historian

NANDA, acrobaticalists

Ted Kaptchuk, Director of Harvard Medical School’s Program in Placebo Studies and Therapeutic Encounter

E. Bimla Schwarz, women’s health expert and scholar of evidence-based data

Danielle Ofri, attending physician at Bellevue Hospital and Associate Professor of Medicine at New York University School of Medicine

Thomas Goetz, health journalist, science writer, and entrepreneur

Heather Raffo, actress, playwright, and librettist

Session Two: We Just Don’t Know

This session celebrates science’s eternal quest to understand as much as we can about the workings of the universe, while realizing that the more we know, the more we realize we don’t know. The speakers in this session illuminate the thrill of even incremental discoveries and the wonder of exploring new terrain.  They are:

Daniel Webster, Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and Director of the Johns Hopkins Center for Gun Policy and Research

Rosie King, Emmy Award-winning spokesperson and educator

Elizabeth Nabel, President of Brigham and Women’s Hospital

Ben Folds, leader of the rock band Ben Folds Five

Gary Conkright, CEO of PhysIQ

Amy McGuire, Associate Professor of Medicine and Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine

Tig Notaro, stand-up comic

Jeffrey Iliff, Assistant Professor of Anesthesiology and Perioperative Medicine at Oregon Health & Science University

Applications are open to join TEDMED 2014 in San Francisco, CA or Washington, DC. To apply, click here.

Live event: Can rethinking the healthcare workforce help drive down medical costs?

There’s no shortage of news, or worry, about the coming scarcity of healthcare workers. But is there really a problem? What if we’ve got enough hands, but just need to align tasks better?

shutterstock_172496525According to a study from the Annals of Family Medicine, one doctor can reasonably help 983 patients in a year working solo. As part of a team and delegating some tasks to others, that same doctor could potentially reach 1, 947 patients.

As Ed Salsberg, a research professor at the George Washington University Center for Health Workforce Research and Policy, said:

How we use workers also directly impacts costs, efficiency and quality. If we only allow highly educated practitioners to provide certain services…we are likely to drive up costs and may limit access. If we allow a lesser-educated caregiver to provide services, it may be beyond their skills and training. So how do we know who is qualified to provide what services?

What needs to happen on all fronts to make that work? How can we handle rural and under served areas? Who should play bigger roles: Nurses, pharmacists, technicians? What would that mean for costs? What are our future healthcare needs, and how can we meet them?

Join a TEDMED Great Challenges live event this Tuesday, May 20 at noon ET with Salsberg and others on the forefront of rethinking the healthcare workforce. Kick off the conversation today by tweeting your questions and comments to #GreatChallenges and we’ll discuss them on air.

Better outcomes for engaged patients may start with an empathic doctor

An engaged patient, one who is knowledgeable about his condition and feels confident in his skills to help manage his own care, may in turn contribute to improved outcomes and reduced costs for himself and for the system.  There are even ways to measure their ability to take a stake, including the Patient Activation Measure (PAM).

On last Tuesday’s Great Challenges Hangout, we gathered a team of thought leaders to explore PAM and how well it measured patient engagement. Of course, getting patients to take a more active role is a two-way street; well-managed care involves solid clinician-patient collaboration.

What, then, can providers do to make this happen, and who tracks how well they do it?  We’re not talking about best-doctor magazines or web site rankings, but an across-the-board measure of how doctors succeed in relating to patients – a “doctor activation measure,” as one of our Community Members called it in his tweet.

As it turns out, there’s no universally used rating for clinician engagement. But there is one trait that has, in study after study, shown to positively affect patient engagement and outcome: empathy.

Clinician empathy leads to greater patient satisfaction, increased compliance and better outcomes. It boosts job satisfaction for providers.  It may be particularly helpful in cases of chronic illness; In one study, patients with diabetes had measurably better outcomes when their doctors scored higher on the Jefferson Scale of Empathy, a tool that measures patients’ perceptions of physician caring. A recent systemic review and meta-analysis concluded that the patient-physician relationship had a small but measurable effect on patient health outcomes.

Yet with so many patients seen in limited time increments, and the increasing specialization of medicine, how can doctors get – and remain – empathetic?

Here’s the neat part:  They can be taught. Researchers as Massachusetts General Hospital gave residents three 60-minute empathy training modules. The courses explained the neurobiology of empathy, showing physiological responses to dismissive comments. Based on another scale, the Consultation and Relational Empathy (CARE) measure, the group with training showed higher scores than those without.

Understanding how our brains process and respond to verbal and physical cues is key to shaping behavior, says Helen Riess, a psychiatrist who developed the modules and led the study. As grounded in science as clinicians are, they can forget their autonomic nervous systems may lead them to act in ways they don’t intend.

That doesn’t mean a physician needs to or should feel deeply emotional about a patient’s outcome. More important is an awareness of how actions might be perceived.

“Empathy has cognitive, emotional, behavioral and moral components. Sometimes we really feel for another person; another time we cognitively understand what they’re going through, but we may not feel it because we’re tired. That still leaves us a choice to behave in a more empathic and caring way,” Riess says.

Empathy among med students tends to erode in the third year.  Perhaps this is where intervention can begin; as this blog has reported, some schools, including Harvard Medical, are exploring ways for doctors to learn to see patients holistically, including a curriculum called the Longitudinal Integrated Clerkship in which students follow a patient’s case from beginning to conclusion.

In the end, showing empathy can start with measures as sitting down to listen to a patient and making eye contact.

“If you can learn empathic behaviors and be respectful and kind, that’s really what the patient is going to remember at the end of the day,” Riess says.



Gene therapy discovery may help the heart to heal itself

Could a heart damaged by disease or cardiac arrest be coaxed to repair itself?

Immunostaining Highlights New Cardiomyocytes in Ventricular Tissue
Immunostaining Highlights New Cardiomyocytes in Ventricular Tissue

Hina Chaudhry, MD, is leading research of a gene therapy that has shown promising results in animal studies. She co-authored a study published today in Science Translational Medicine that details how the gene, cyclin A2, helps cardiac muscle cells – cardiomyocytes – undergo cell division in pigs, regenerating healthy tissue and helping the heart to repair itself. Normally the cyclin A2 gene is silenced, preventing further cellular division, post-birth in mammals.

The procedure is backed by the biotech company VentriNova, Inc., a TEDMED 2013 Hive company founded by Dr. Chaudhry, who is also a TEDMED Innovation Scholar.

The company claims that no other regenerative strategy on the market or in clinical development has the ability to grow new heart muscle cells in the diseased heart.

“Everybody else has been doing something different — injecting stem cell transplants in the heart, and it has generally failed. You have to understand how cells divide. Why do they stop? That’s where you see the vast mortality of heart disease,” Chaudhry says.

Though there is some rate of cell turnover in the human heart, it is not enough to repair muscle damage after a cataclysmic event such as myocardial infarction. Instead, scar tissue forms. Certain metazoan species, though, do have the ability to regenerate; the newt can replace injured body parts, and the adult zebrafish heart may be able to regenerate up to 20% of its volume, the study reports.

Chaudhry’s team used an adenovirus to deliver cyclin A2, a cell cycle regulatory gene, which induced cell mitoses. Animals that received therapy showed improved heart function compared to controls. The authors also observed significantly decreased fibrosis and  increased numbers of cardiomyocytes.

Hina Chaudhry, with Amaresh Ranjan (left) and Mount Sinai Graduate Student Jerry Saunders
Hina Chaudhry with study co-author Amaresh Ranjan (left), and Mount Sinai graduate student Jerry Saunders

Dr. Chaudhry, who is Director of Cardiovascular Regenerative Medicine at Icahn School of Medicine at Mount Sinai in New York, has been working on the project for close to two decades; she got the idea working as a research fellow.

“This is the most exciting publication of my life,” she said to TEDMED. “I can’t wait until it goes into clinical trials, and I’m very hopeful that it will work in human patients.”

Study co-authors are Drs. Scott Shapiro and Amaresh Ranjan, also from Mount Sinai.

— Stacy Lu

The brave new world of monitoring sleep for stress, and a visual test to spot early-stage Alzheimer’s

We’re learning more about how Alzheimer’s affects the brain — and when — by looking into it, but what if there is a way to more quickly spot early signs of the disease by observing how the brain looks at the world?

The premise of a technology developed by Neurotrack is deceptively simple:  Subjects are given a computer-based test that measures how well they remember images on a screen via an eye-tracking device. An algorithm analysis detects Alzheimer’s in relatively early stages, before behavioral symptoms appear and allowing early intervention. The program was developed by neuroscientists from Emory University and the University of Washington, who brought on an entrepreneur to help them bring their idea to market.

Testing so far bodes very well for its predictive value: Of subjects who scored below 50 percent, all went on to develop full-blown Alzheimer’s within six years. The test has other big advantages: It’s noninvasive, requires no special training to administer and is easy and relatively inexpensive to disseminate.

Neurotrack, one of the companies represented at TEDMED’s 2013 Hive, finished Series A funding with $2 million from Founders Fund and Social+Capital, and has begun the long trek toward FDA approval.

Elli Kaplan, co-founder and CEO, says the road to recognition hasn’t been easy for a start-up that grew from academia and continues to progress independently – versus flying under the wing of a pharmaceutical sponsor – but it also has creative advantages. An idea developed by a smaller group is less likely to get lost in the shuffle of a larger organization, and to be discarded if it doesn’t fit a predestined outcome.

“For us, if it doesn’t work for ‘x’ it might work for ‘y.’ We’re a young company, so we think instead, ‘We put all this work into this, so if something’s not working how can we change our plan to bring things to life?” she says.

Stress, the Ill Felt ‘Round the World

If you’re stressed and you know it, raise your hand.

You probably can read stress signals, especially thanks to attention from health care providers and the media. Your breathing becomes more rapid; your muscles rigid; your skin flushes. And even if you don’t notice, there are great gadgets out there that can clue you in.

shutterstock_65065507But what about the other, less hidden symptoms, like poor sleep and varied speech patterns?

SOMA Analytics, a London-based start-up, has developed a smartphone app that tracks these less-noted symptoms. Named after the Greek work for body, the SOMA app monitors movement patterns at night (yes, you have to sleep with your phone), and voice and typing during the day. It then offers interventions tailored to observed needs. For example, not all sleepers are the same; some do better waking early, some sleeping fewer hours; thanks to genetics. There’s no way to scientifically know which group you’re in, short of spending a weekend at a sleep lab.

Co-founder Johann Huber and two friends came up with the idea after watching a fourth friend slide incrementally into depression.

“We had the feeling there was something going on with him, and in between [times we saw him] he got bags under his eyes and had incredible mood swings. He himself didn’t feel it. Humans don’t notice gradual changes over time,” Huber says.

Why not, then, invent something that does and couple it with something so many of us own and know how to use – the smartphone?  The group worked with a number of hospitals to refine its product, which is already in market and geared towards businesses with a concern for employees’ productivity and well-being.  It stacks up well against metrics gathered in sleep labs.

A native of Germany, Huber said the company moved to London for what he says is a business environment more fertile for start-ups. The world seems ready for SOMA; the company was one of 50 companies selected to join TEDMED’s Hive innovation showcase in 2013 and was one of only 20 Digital Health startups on the continent to be part of the Johnson & Johnson Digital Health Masterclass.

With experience in so many countries and it’s technology, will SOMA’s leadership be able to determine who is less stressed, Americans or Europeans?

Pondering, Huber says, “I studied in the U.S. and I had the impression than Americans were far more laid back than Germans especially,” he says, but allows that intense U.S. work schedules may flip the equation.

“The big question is — who is more productive? If it helps productivity to rest, then I would strongly argue for testing that,” he says.

Preventing childhood obesity: It’s never too early to start

What’s the best way to prevent children from becoming obese?

While theories abound, one thing we’ve learned so far: It’s never too early to start.  A New England Journal of Medicine study last week showed that children who are overweight in kindergarten are much more likely to become obese teenagers. Other recent research suggests risks begin in the womb, and include a mother’s weight gain, blood sugar levels and smoking habits.  Risks may even stretch back generations; the great-grandchildren of a group of rats exposed to DDT had higher levels of fat and weight gain than progeny of those not exposed.

TEDMED 2013 speaker Peter Attia, an MD who conducts what his organization, NuSI, considers the most comprehensive research on the causes of diet-related diseases to date in adults, says that factors likely to trigger children to become overweight in the first place may indeed be present at birth, and are tough to surmount.

Does a typical school lunch contribute to food-related diseases?
Does a typical school lunch contribute to food-related diseases?

“Genetic factors aren’t as likely to explain changes over relatively short periods of time. The epigenetic factors – genetic factors turned on by environmental triggers – may have a lot to do with a mother’s eating behaviors while a child is in utero.  [Studies so far] certainly suggest that the quality of a mother’s diet plays a role in a child’s susceptibility to obesity and insulin resistance,” Attia says.

And these influences are only likely to grow along with a child, he says.

“There’s a whole host of systems and structures that got that child to be where they are; they’re probably related to socioeconomic status, education, and what the child consumed for the first five years of his or her life. All of those factors aren’t going to go away,” Attia says.

Communities are scrambling to catch up, and many are looking at the school environment as a logical start point. In TEDMED’s Google+ Hangout last week, Great Challenges team members and special guests discussed measures schools are taking to educate kids about good nutrition and ensure that they receive it on school premises. They include efforts to help schools procure locally grown fresh food for cafeteria lunches; on-site gardens where children harvest and study the science of food; and nutrition education and cooking classes. (Watch a video of the insights shared here.)

Will these interventions happen quickly and go far enough? Attia has hypothesized that foods high in sugar — juice, soda, candy bars, sugary cereals, and sauces — are prime culprits of diet-related illnesses like type 2 diabetes and fatty liver disease.  And right now they’re commonly available in cafeterias and on school property.

The fast rise of these ills in children – as many as seven million cases of fatty liver disease in the U.S. – should be a wake-up call that vast changes are needed, starting with improved medical research on their causes, Attia says.

“Do we honestly want to continue reiterating the same dogma for the next 30 years that says ‘Just eat less and exercise more, and if you have the right moral fortitude you’ll be fine?’

“It’s been a scientific and policy failure in adults. All you have to do is look back when the mantra started, and look at how many people were obese, and how many had type 2 diabetes, and follow through on the amount of spending that’s gone to propagating that message, and compare that to the numbers today,” he says.

What’s happening to kids also reinforces what Attia expressed in his TEDMED talk:  That we mistakenly attribute obesity and its related diseases to a failure of personal responsibility.

“ ‘People who are obese and diabetic are morally corrupt.’ We don’t come out and say that, but that’s the implication. ‘These are bad people. These are lazy people who lack discipline.’

“But do we really believe that children are morally bankrupt, lazy, slothful entities who just choose to be gluttonous?  We have a hard time believing that for a five-year-old,” he says.

Stacy Lu

The Power of One

You took 5,322 steps yesterday, burned 686 calories exercising, and made 12 phone calls. You were stressed at work, so you sent 20 texts in 10 minutes to vent to a friend, while a gadget on your wrist marked your skyrocketing heart rate. Your smartphone calendar reminded you to book a follow-up with the podiatrist – again – and you ignored it – again.

If all of those gadgets could talk to each other in one easy-to-use platform, they might be able to give you – and your doctor – a vivid snapshot of your overall health picture, along with suggestions on how to improve it. (See the podiatrist.)

Deborah Estrin presented the benefits of converting our “digital breadcrumbs” to a vast overall health picture at TEDMED 2013. She has been making this vision reality since 2011, when she founded Open mHealth, a non-profit that develops open source code to normalize and provide information frameworks and interfaces for health data, improving analytics among apps, platforms, developers and users.

“If you just take the words blood glucose – well, there are 300 different types of blood glucose. There’s no alignment on how data is being represented,” says David Haddad, Open mHealth Director. (For more about open mHealth architecture, read his blog post.)

Haddad says the group’s work was initially a “conceptual challenge” for many potential partners, but that the past year has seen a big bump in interest levels. The group has ramped up projects with Kaiser Permanente, with Qualcomm Life, which has a wireless platform that captures medical device data, and has received funding from WebMD.

One Patient, Eons of Data

If one is given the tools to be able to self-monitor, visualize and report health information, the discoveries can be eye-opening for both patient and provider. To that end, Open mHealth has assembled teams for case studies on various chronic illnesses.

Screen Shot 2014-01-30 at 12.08.53 PM

Alex Freeman, a pediatric nurse with type 1 diabetes, had problems keeping her blood sugar levels stable, even though she exercised regularly. Open mHealth worked with a number of partners, including My Comparisons – a mobile, patient-facing data comparison tool, and GreenDot ‘blip’ – a web-based, clinician-facing diabetes data application – to gather input on her insulin levels and diet. In the end, Alex’s doctor was able to see that she actually overcompensated with insulin before eating high-carb foods, like pizza.

Another pilot measured the day-in, day-out stressors of a man with PTSD (Post-Traumatic Stress Disorder).

“He was texting us in between clinical visits, and his mood went down and his PTSD symptoms got worse. It turns out this was a result of his wife having gestational diabetes.  The clinical term [for what he was suffering] is separation anxiety, and it could be dangerous for somebody who has been diagnosed with PTSD,” Haddad says.

Next up, the Open hHealth platform will be used for a University of California at Davis trial involving an app that tests pain intervention, called Trialist. The app allows patients to conduct their own “N for 1” study, a variant on the randomized controlled trial in which a single patient is the entire research cohort, and which can be especially helpful in determining causality and how individual variables influence outcome. Trialist will measure the effectiveness of various medical and lifestyle pain treatments, from drug treatments to meditation, with the ultimate goal of determining the lowest effective dose of medication.

A Once-a-Day Dose for Diabetics

The power of one is also a theme for Sensulin. The startup is developing a once-a-day insulin therapy that responds to glucose levels, a potentially revolutionary therapy for diabetics who struggle with pumps, injections and laborious carb counting to stay healthy – and alive.

Mike Moradi is working on the breakthrough with Ananth Annapragada, Ph.D, Director of Basic Research in the Edward B. Singleton Department of Pediatric Radiology at Texas Children’s Hospital. Annapragada theorized in the course of his work that as blood sugar stimulates the release of insulin, a drug might be developed that is also released to that stimulus.

Sensulin's proprietary Agglomerated Vesicle Technology (AVT).
Sensulin’s proprietary Agglomerated Vesicle Technology (AVT).

“The technology could eliminate the need for separate basal-prandial insulin injections. We know that it works. Right now, we’re optimizing our system so that it releases over a 24-hour-period and withstands the Western diet,” Moradi says.

Sensulin has been awarded a $225,000 STTR (Small Business Technology Transfer Program) grant from the National Science Foundation, and successfully held a $500,000 1st closing on its Series A round. It’s also received a Notice of Allowance from the United States Patent and Trademark Office on its key patent.

The company hopes to have a final formulation some time early next year and will then prepare for a human clinical trial – the “blocking and tackling” of pharmaceutical development, as Moradi puts it.

A biochemist early on, Moradi was on his way to dental school when he heard the call to become an entrepreneur in nanotechnology.

“Around that same time a number of people in my family were being diagnosed with type 2 prediabetes and diabetes, and I thought I could use my talents for something more personally rewarding. When I saw this opportunity, it was so compelling I felt it was some strange force. It’s exciting to wake up every morning and feel you’re on the cusp of something awesome,” he says.

One of his biggest boosts comes from the patient community, Moradi says.

“Diabetes patients are some of the best patient advocates out there. They’re very vocal about helping get things through the FDA,” he says.

Catalyst is a regular series about innovation in health and medicine, with a focus on companies from TEDMED 2013 Hive. Click here to read previous posts.


Catalyst: Stress triggers vs. wellness in the workplace, and spotting constellations in a galaxy of health data

What’s the most stressful part of your work day: Your commute, the big meeting – or lunch?

Neumitra has a bio-sensing watch that will tell you. The wearable sensor gives clinically valid measurements of the psychophysiology of stress, such as increased heart rate or body temperature. The triggers are matched with data from a smart phone app, like calls and calendar items, to discern what is creating stress, and vibrates when stress signals appear. For clinicians, an iPad app records sessions to show which events can trigger stress.

Screen Shot 2014-01-23 at 1.35.45 PM
Neumitra’s “Neuma” biosense watch

Neumitra is also working with Fortune 500’s to quantify how cumulative stress affects operations and health costs across industries. After all, stress shuts down the brain and impacts decision-making, the very thing employers least need from their knowledge workers.

Not surprisingly, results so far show that commuting is one of the most stressful times of the day.

“Companies are paying for lower productivity when they expect people to arrive at 9:01 every morning ready to work. People arrive in fight-or-flight mode and read the newspaper or check email to calm down, and then by 10 a.m. or so, getting down to work. In response, we’re looking into how flex hours would help organizations,” says Rob Goldberg, Neumitra co-founder.

There may be limits to just how long you can happily face co-workers at any one time, too.

“We’re using accelerometers to weight physical stress versus mental stress. It turns out that long meetings equate to intense exercise. So, when you have these two-hour meetings it’s almost like asking people to run ten miles,” he says.

Think lunch is a break? Some unfortunate eaters also have a stress spike during mealtimes for reasons yet unclear, Goldberg says, though it may have to do with internal messaging.

He says corporations are receptive to Neumitra’s feedback, with particular interest from typically hard-driving Asian countries.

“Even in Wall Street, we’re finally hearing that firms are cutting back on the number of hours people work. Their mission is to treat their knowledge workers well. We’re realizing it’s all about the quality of output,” he says.

Tracking Wellness Around the World

It’s not all stress in the office. Companies working with ShapeUp have a link to tech-based social networking and wellness solutions. Employees can log in to the platform to monitor their fitness goals and team up with others; challenging those slackers in accounting to an exercise contest, for example.

ShapeUp reported the following milestones for 2013:

  • Acquiring over one million participants across 128 countries
  • Shipping over 400,000 activity tracking devices to members worldwide
  • Launching ShapeUp Complete, a turnkey wellness platform designed to support small- and medium-sized companies with 100-5,000 employees; and conversely working with multiple companies with more than 100,000 employees
  • Working with Fitlinxx to offer a wireless tracking device for outcomes-based incentives
  • Raising $7.5 million in new investment capital to fund mobile technology and global capabilities along with new engagement tools

The company has also been working toward major product enhancements that will be announced in early 2014, including expanding its native mobile app. In addition to activity tracking capabilities, goal setting, and progress reporting, the ShapeUp mobile app will leverage GPS, accelerometers, co-processors, and companion smart watches — there’s the watch theme again — to provide personalized feedback and broader functionality.

Picturing a Pattern in Big-Data Static

Why do drug researcher and best practice guidelines often cling to only one outcome measure in what may be mountains of data?

As someone with type 1 diabetes, Anna McCollister-Slipp has worked hard to manage her blood sugar levels for 28 years. With an insider’s view into a complex chronic disease, she’s frustrated by what she sees as healthcare’s narrow scope of outcome measures and lack of comparative effectiveness research. The disease is a case study for a general weakness in the system, she says.

“Drug companies are generally looking at one outcome measure, and they’re going to advance the one that’s most likely to approved and reimbursed. There’s a degree of complacency that’s incredibly frustrating as a patient,” she says.

Graphic: Galileo CosmosAt the same time, data mining is a time-consuming and expensive procedure normally left to experts. In response, McCollister-Slipp founded Galileo Analytics and created a real-time visual data mining platform, Galileo Cosmos™, in which users can explore large, complex data sets, finding patterns and investigating outcomes. Cosmos delivers visual results for easily digestible information that’s also appealing for users. The system requires no technical expertise; in fact, one could easily see the platform being used for other sectors such as journalism and manufacturing.

Last spring, Galileo contributed its platform to a bold, far-reaching prototype learning health system called CancerLinQ™ in development by the American Society of Clinical Oncology (CancerLinQ’s advisory committee is chaired by Amy P. Abernethy, TEDMED 2013 speaker). It will use patient data to support oncologists’ clinical decisions. Some day, patients may be able to additionally use it to scope constellations of information from the countless facets of information that comprise their health galaxy.

Jay Walker joins National Academies Board on Science, Technology and Economic Policy

We at TEDMED are excited to announce that Jay Walker, TEDMED’s curator, has joined the Board on Science, Technology and Economic Policy (STEP) of the United States National Academy of Sciences.

STEP’s mission is to advise federal, state and local governments on how best to create and apply new scientific and technical knowledge, both to enhance productivity and boost American prosperity.

“Innovation is critical to our economic vitality.  We’ve already seen how advances from varied disciplines and groups of all sizes are absolutely revolutionizing healthcare and medicine and propelling us into the future.  We have the will and we have the imagination.

“I’m honored to be invited and glad that I can help the National Academies and STEP reinforce our readiness to be in the forefront of science and technology,” Jay Walker said.

Along with his work curating TEDMED, Jay is well known as a digital innovation leader.  He is 11th on the list of the world’s most patented living inventors, is named on more than 450 issued and pending U.S. and international patents, and was founder of Priceline.com.

We at TEDMED are excited to announce that Jay Walker, TEDMED’s curator, has joined the Board on Science, Technology and Economic Policy (STEP) of the United States National Academy of Sciences.

STEP’s mission is to advise federal, state and local governments on how best to create and apply new scientific and technical knowledge, both to enhance productivity and boost American prosperity.

“Innovation is critical to our economic vitality.  We’ve already seen how advances from varied disciplines and groups of all sizes are absolutely revolutionizing healthcare and medicine and propelling us into the future.  We have the will and we have the imagination.

“I’m honored to be invited and glad that I can help the National Academies and STEP reinforce our readiness to be in the forefront of science and technology,” Jay Walker said.

Along with his work curating TEDMED, Jay is well known as a digital innovation leader.  He is 11th on the list of the world’s most patented living inventors, is named on more than 450 issued and pending U.S. and international patents, and was founder of Priceline.com.

The STEP board includes industrial managers, investors and former public officials in a wide range of policy areas. They are:  Chair, Paul Joskow (Alfred P. Sloan Foundation); Ernst Berndt (MIT); Jeff Bingaman (Former U.S. Senator); Ellen Dulberger (Ellen Dulberger Enterprises LLC); Alan Garber (Harvard University); Kathryn Shaw (Stanford University); Laura Tyson (UC-Berkeley); and Hal Varian (Google Inc.).

Congratulations, Jay, and thank you for your leadership.

A conversation with Thomas Goetz: When it comes to healthcare data, it’s all how you look at it

Thomas Goetz is co-founder of IODINE, a new company that uses data information design to inform patient decisions.  He’s been a TEDMED speaker, executive editor of Wired, and wrote “The Decision Tree,” about using technology to help make health decisions.

You’re now Entrepreneur-in-Residence for the Robert Wood Johnson Foundation, working on two projects to improve the patient experience. Can you first talk about Visualizing Health?

We’ve created a library of validated health visualizations. When people talk about communicating health information to individuals, there’s a dearth of validated examples of what the information should look like.  For example, if you’re trying to communicate heart risk information – if you quit smoking, your risk will of cancer will go down from 50% to 30%  — what does that look like in actual practice?

Thomas Goetz
Thomas Goetz

There are the Edward Tufte’s of the world who have an expert [design] sense.  But we wanted to actually validate, though statistical surveys and other testing instruments, what works best for different groups.  We tested pie, bar and spread charts and different visualizations on various audiences and now have a library. We’ll be putting it online, hopefully by early February, for people to use as a reference point under a creative commons license.  Our hope is that these will become templates that people can inspire and adopt in their own patient communications efforts, whether they are commercial or non-profit.


It seems that over the course of human history we’ve been all too willing to give over responsibility for our health, letting the apothecary leach blood or trusting that the medicine man’s dance will cure us. What accounts for this new era of patient engagement?

In many ways it’s a continuum from the 1950s or ‘60s.  We’re now in a place where we can implement things more deliberately. One of my favorite surveys to reference is a 1961 survey that asked oncologists how many of them would tell their patients that they had cancer. And 90 percent of said they would not disclose the diagnosis; that their patients were probably not ready to know. Of course, that seems completely unethical now.

The gradual change in terms of doctors learning to include their patients in diagnosis and care is forced not just by a sense of ethical duty, but also by system structures such as the burden of cost of chronic disease care.  A patient with chronic [illness] may be obligated to do a lot of care on his or her behalf when they can’t have help 24/7.  All of these things are coming to a head, and we’re realizing it’s not just a matter of good practice but one of simply executing what we need to do.  The patient has to be part of the system.

Another of your projects with RWJF is Flip the Clinic, which talks about how to rethink a typically brief doctor’s visit to make it more productive and meaningful.

We’ve been trying to come up with some tools to put in the ecosystem that people can adopt or give feedback on, including ones we’ve gestated internally but also deconstructing things out there that have worked.  We haven’t invented the idea of improving the doctor-patient encounter, but we’ve been amazed to see Flip the Clinic resonate already as a sort of GitHub – the open software collaborating site — around the practice of clinical medicine.  The idea is to help people not reinvent the wheel and [adapt what’s available] to their own needs.

When it debuts, fliptheclinic.org will have two main areas: A hub for content – actual tools and strategies people can bring into their own institutions – and secondly will have a community component where people can exchange what they’ve learned, offer new ideas, connecting, say, people from Seattle to New Jersey and helping them understand what has worked in one place that may help solve a similar quandary in a different city.

What qualifies as real change?

It’s a balancing act – we want to have real innovation but we need to  offer tools that don’t just appeal to the converted; they need to work far and wide.

Late last month, I had a morning where first I talked to a nurse practitioner at a pediatric clinic in Camden, New Jersey, which is in an underserved community.  They’ve having their clinic budget hatcheted every quarter.  Physicians are frustrated.  This is a facility in true need of new approaches and something that re-orients them toward a positive engagement with their population. I went from that call to one with the Mayo Clinic; they were interested in how they might be able to participate. These are institutions on the opposite end of the spectrum, and one of our core objectives is for Flip the Clinic to work in both places.

In initial discussions, it turned out that both providers and patients wanted more control over clinic visits.  What else do they want?

We also earned there was a mutual yearning for some joy and positive emotional experience out of that encounter from both sides, and especially from the physician.  So one of the things we’ve been trying to be careful about is trying to stuff more into this already limited resource of a 15-minute doctor visit.  For everything we add to that visit, we need to take something off their plate. The challenge is to make these things pragmatic and executable in reality and not just say, “Do more.”

Goetz moderated a Great Challenges Google+ Hangout last week about rethinking the clinical visit to maximize value for both providers and patients.  Watch the recap, below.


Regarding your new venture, Iodine, which uses data design to help inform patient decisions: Is good design late to the game with healthcare?  Or it is on the same trajectory as other industries?

I think design is an underexploited tool in healthcare, though it’s ahead of the curve in some ways. Health care and medicine are already based upon a data paradigm; there’s a lot of information flowing through the system. But best practices in design thinking are not well applied, and they’re not oriented towards the patient.  Our goal is to leverage data, to translate it and visualize it, so that ordinary people can act on it and make better decisions about their medications. That’s not an easy problem.

It’s a hard thing to get people out of their routine, especially in a demanding world like healthcare. But that doesn’t mean it’s impossible – and design is essential to that. That’s where the inherent data orientation of healthcare offers some low hanging fruit.  Iodine’s core tenets are data-slash-analytics, behavioral science, and design.  They’re the three legs of the stool for visualizing and presenting information in ways that increase the likelihood that any individual will act to do something better for their health. [Ed. note:  Iodine will formally launch in February.]

While you were at Wired you ran a great piece showing how design could help patients understand their test results. How come doctors haven’t already demanded better design for their own information? It must be hard looking at that gobbledygook all day. 

Unfortunately, this brings us to the horrible world of EHRs. The prevailing industry products are really crappy in this regard; they come from an enterprise software perspective that’s 10 or 20 years old. A physician is almost always not making decisions on technology procurement. Unfortunately, sometime it doesn’t matter what your frontline needs are compared to the cost determinations of your IT department.

The cool thing is that there is another set of savvy tools going straight to the physician that are lightweight and easy to adopt.  There are some companies like Practice Fusion and Pingmd doing innovative things with communications or messaging component. And other companies are working on visualizing lab data, like WellnessFX. That’s a much more interesting strategy and more fun to watch. Sometimes developers use the iPad strategy — taking what physicians are already using and making that your platform, rather than the institutional computer system.

One can’t imagine the current generation of medical students going into the clinic and being satisfied with old-school data design.

That’s precisely where one of these pressures is going to come. The current generation of physicians is being dragged along into the EHR world.  The next generation is going to lead the way, I think. They’re going to demand better tools, both for themselves and for their patients. That’s the world I want to live in; that’s the world I want to in some way help create.

Interview by Stacy Lu