Innovation means change. Doing or achieving something in a new, improved way inevitably means changing what was done before. And yet one of the most often-repeated observations in health care is that “doctors are resistant to change”.
In my TEDMED talk I examined what I believe underlies doctors’ behavior and why I think their so-called resistance is a lazy interpretation of a more complex problem.
In essence, doctors are taught to doubt, as this is what helps them make the right decision for their patients. This same behavior also makes them build mechanisms to ensure that the system they work in is safe and effective. I call these mechanisms the “web of trust”.
Innovations disrupt the web of trust, which causes discomfort for doctors. This manifests as resistance. Innovators need to better understand the role of trust in health care (or why doctors doubt) in order to build trust into their innovations. Few, if any, do, which is why I think most current innovations in health care are bound to fail.
But health care is about more than doctors. The burden of disease is changing from episodic things that were treated in hospital to chronic things that are part of our daily lives. As a result citizens want more understanding and control of their daily health, which is why we’re seeing more and more innovation outside the traditional boundaries of health care institutions.
It would be a mistake, though, to see the citizen space in isolation. Instead, it’s part of a continuum that extends into primary and then specialist care. This means that whatever tools a consumer uses to manage his or her health needs to be trusted by the clinicians that may ultimately be called upon. Without that trust, care will be fragmented and perhaps ineffectual.
Other industries have learnt how to create these new, distributed forms of trust. In the hotel industry, for instance, AirBnB has enabled ordinary people to rent their spare rooms to strangers. Their website is specifically designed to provide the kind of information people look for when deciding whether to trust someone, either as a host or a guest. Although there is a specific technology that has made all this possible (peer-to-peer platforms, often abbreviated to P2P), it’s about more than just technology. It’s about society embracing opportunity made possible by new forms of trust.
With more and more citizens taking charge of their health, traditional health care needs to understand and embrace a new, distributed form of trust. It’s only with such trust in place will radical innovations that tackle today’s seemingly intractable health challenges be possible. Riffing off P2P, I call this new form of trust, “We2C” – how we, the people, can lead and engage clinicians in a productive manner underpinned by trust.
Follow Pritpal S Tamber at @pstamber where he will be further developing We2C.
TEDMED’s Chief Storyteller, Webb reports from Jerusalem, where he is attending The Israeli Presidential Conference along with a number of TEDMED community members.
TEDMED 2011 and 2013 speaker Dr. David Agus is a prominent speaker this week at the semi-annual Israeli Presidential Conference, taking place at the International Convention Center in Jerusalem.
On Wednesday, David addressed the 5,000 registered attendees at the June 19-20 event, offering an upbeat view of the future of health and medicine in the mid-day general session.
Commenting on the recent U.S. Supreme Court decision that placed limits on what can be patented, David said: “The U.S. Supreme Court has democratized our DNA and allowed all of us to use it. This will herald a democratized approach to medicine.”
David added that he is an optimist about the future of health, saying that new technology and a new culture of patient activism will drive improvements.
“Your body talks to you all the time,” he said. Pointing to a series of new diagnostic tools that are advanced yet affordable, he added: “We now have the ability to listen.”
In a separate breakout session, David predicted that medical intervention – designed uniquely for each patient, based on family history and on personalized diagnostic data — will replace today’s “one size fits all” prescriptions.
“[Diagnostic] medicine is [still largely] an art today,” he added. “The hope is, through technology, we’re going to make it a science.”
David’s next book, “A Short Guide to a Long Life,” is due for publication in January 2014.
A two-time TEDMED speaker, Dr. Larry Brilliant, will address the Presidential Conference on its closing day.
Also present at the Presidential Conference this week are TEDMED 2013 speaker, United Hatzalah founder/president Eli Beer; and TEDMED Chief Storytelling Officer Marcus Webb.
Convened by Israel’s president Shimon Peres, the June 19-20 Presidential Conference is a TEDMED-like gathering featuring multi-disciplinary perspectives on tomorrow’s challenges and opportunities.
Headliners – to name just a few — include leaders from:
Government (Mr. Peres; Israeli PM Benjamin Netanyahu; former president Bill Clinton; former PM Tony Blair; Prince Albert of Monaco);
Technology (Microsoft international research head Dr. Jeanette Wing);
Economics (Larry Summer; Martin Wolf);
Science (Harvard psychologist Dr. Dan Gilbert; Dr. Leroy Hood, founder, Institute for Systems Biology);
Business (Cisco CEO John Chambers);
Nonprofits (Natan Scharansky, head of the Jewish Agency for Israel);
Education (Hebrew University president Menahem Ben Sasson; Teach for All founder Wendy Kopp);
Energy (Prof. Brenda Shaffer);
Armed services leaders (first-ever female Major General in the IDF Maj. Gen. Orna Barbivai);
Clergy (Reform Judaism president Rabbi Rick Jacobs);
Social activists (Ms. Ayaan Hirsi-Ali, author of “Infidel”);
Historians (Dr. Edward Luttwak);
Media (Maurice Levy, CEO of Publicis Groupe);
And the arts (Barbara Streisand, Robert DeNiro, Sharon Stone).
A highlight of the Conference’s first session on Wednesday was the presentation of the President’s Award, Israel’s highest civilian honor, by Mr. Peres to former president Clinton, who was lauded as a strong friend of the Jewish state.
At least two prominent TED presenters also have high-profile roles at the Presidential Conference this week, including behavioral economist Dan Ariely, author of “Predictably Irrational,” and Daphne Koller, co-founder of Coursera.
Mr. Peres, who launched these Presidential Conferences in 2008, offered his own thoughts on leadership throughout the morning’s first session.
“The real power of our time is not [coercive] power but the strength of goodwill,” he said. “You would be surprised by the people who don’t like laws, how fast they move to volunteer.”
For this reason, suggested Mr. Peres, as well as due to the deep uncertainty in so many fields regarding the right directions and policies, today’s most effective leadership proceeds from consensus.
“Leaders today should not lead [in any dictatorial sense],” he stated. “They should agree to be led by the people.”
Parkinson’s Voice Initiative founder and TEDMED 2013 speaker Max Little is an applied mathematician whose goal is to “see connections between subjects, not boundaries…to see how things are related, not how they are different” – which gives him an unusual perspective on how big data could change medicine. We interviewed him via e-mail to find out more.
You’ve been working to discover the practical value of abstract patterns in various fields, with surprising results in areas as varied as diagnosing Parkinson’s disease over the phone to predicting the weather. Can you explain your approach?
As an applied mathematician, my training shows me patterns everywhere. Electricity flows like water in pipes, and flocks of birds behave like turbulent fluids. In my projects, I collate mathematical models from across disciplines, ignoring the assumptions of that discipline to a large extent, I put in overly simple models. I use artificial intelligence to throw out inaccurate models. And this approach of exploiting abstract patterns has been surprisingly successful.
For example, during my PhD I stumbled across the rather niche discipline of biomedical voice analysis, originating in 1940’s clinical work. With some new mathematical methods, and combining these with recent mathematics in artificial intelligence, I was able to make accurate medical predictions about voice problems. The clinician’s methods were not accurate. This sparked off research in detecting Parkinson’s disease from voice recordings – the basis of the Parkinson’s Voice Initiative.
But, success like this raises suspicions. So, with collaborators, I tried to make this approach fail. We assembled 30,000 data sets across a wide range of disciplines: exploration geophysics, finance, seismology, hydrology, astrophysics, space science, acoustics, biomedicine, molecular biology, meteorology and others. We wrote software for 9,000 mathematical models from a deep dive into the literature. We exhaustively applied each model to each data set.
When finished, a very revealing, big picture emerged. We found that many problems across the sciences could be accurately solved in this way. In many cases, the best models were not the ones that would be suggested by prevailing, disciplinary wisdom.
Are you doing other research that might have implications for clinical diagnosis?
Here is another example: There is a decades-old problem in biomedical engineering: automatically identifying epileptic seizures from EEG recordings. But, we found over 150 models, some exceedingly simple, each of which, alone, could detect seizures with high accuracy.
This challenges quite a few assumptions – but it is not as if we are the first to find this. It happens often when new approaches to address old problems are attempted: for example, in obesity, a new, simple mathematical model revealed some surprising relationships about weight and diet.
You’ve also used fairly simple algorithms to successfully predict weather.
After my PhD, I teamed up with a hydrologist and an economist. We wanted to try weather forecasting using some fairly simple mathematics applied to rainfall data. Now, weather forecasting throws $10m-supercomputers and ranks of atmospheric scientists together, and they crunch the equations of the atmosphere to make predictions. So, competing against this Goliath with only historical data and a laptop would seem foolhardy.
But after two years of hard work, I came up with mathematics that, when fed with rainfall data, could make predictions often as accurate as weather supercomputers. We even discovered that models as simple as calculating the historical average rainfall, and using this as a forecast, were sometimes more accurate than supercomputers. We were all surprised. but this finding seems to line up with results that others have found in climate science: it is actually possible to make forecasts of future global temperatures using simple statistical models that are as accurate as far more complex, general circulation models relied upon by the Intergovernmental Panel on Climate Change.
Is this a new way of doing science?
If we divide science into three branches: experiment, theory and computer simulation, then what I am describing here doesn’t quite fit. These are not just simulations: the results are entirely reproducible with just the data and the mathematics. This approach mixes and matches models and data across disciplines, using recent advances in artificial intelligence.
In your TEDMED talk, you expressed concern that advances in science have stagnated. Can you explain?
Like many scientists, I’m concerned that science is becoming too fragmented. So many scientific papers are published each year that it is impossible to keep track of most new findings. Since most articles are never read, much new research has never been independently tested.
And, unfortunately, scientists are encouraged to ‘hyper-specialize’, working only in their narrow disciplines. It is alien to we applied mathematicians that a scientist who studies animal behavior might never read a scientific paper on fluid mechanics! In isolation from each other, could they just be duplicating each other’s mistakes?
What can we do to create a more unified approach?
First of all, open up the data. There is far too much politics, bureaucracy and lack of vision in sharing data among researchers and the public. Sharing data is the key to eliminating the lack of reproducibility that is becoming a serious issue. Second, don’t pre-judge. We need to have a renewed commitment to radical impartiality. Too often, favoured theories, models, or data persist (sometimes for decades), putting whole disciplines at risk of missing the forest for the trees.
More collaboration would also greatly speed advances. Is first-to-publish attribution of scientific findings really that productive? I think of science as a collaborative journey of discovery, not a competition sport of lone geniuses and their teams.
Scientific theories that can withstand this “challenge” from other disciplines will have passed a very rigorous test. Not only will they be good explanatory theories, they will have practical, predictive power. And this is important because without this mixing of disciplinary knowledge, we will never know if science is really making progress, or merely rediscovering the same findings, time and again.
Join TEDMED Speaker Peter Attia, MD, for a Facebook Chat on Nutrition & Obesity on Thursday, 6/20 at 2pm ET
Can we trust anything we think we know about nutrition? What do we really know so far about how our food intake and our weight gain? Why are we working harder than ever to eat well and be healthy, with no reductions in obesity and with diabetes rates skyrocketing? Could it be that official dietary guidelines are based on science that’s not rigorous enough to draw real conclusions?
This Thursday, June 20th at 2pm ET, Peter will answer questions about NuSI’s work to date, and what he sees as the best way to understand and combat obesity. Join us to discuss his contrarian and potentially revolutionary approach. Check out the Facebook event page for details and to RSVP.
People in every age think they’re living in a time of transition (I’m sure Adam turned to Eve and said, “Darling, I think we’re living in a time of transition”), but some ages really do usher in broad and deep change. Right now in American workplaces, I believe we’re experiencing a transition with regard to well-being. An increasing number of employers and employees alike are acknowledging that the current model of success isn’t working, and is in fact leading to burnout, stress, decreased productivity, and — an epidemic with especially personal resonance to me — sleep-deprivation.
Often, when I speak in public, my first mention of sleep elicits a bit of a laugh. But it’s a knowing one, because all of us recognize on some level how sleep underpins our ability to function. And how does it in turn affect our organizations? Let me count the ways. Fatigue is the enemy of creativity and memory. It costs American businesses $63 billion a year in lost productivity. One study found that, because of its effects on decision-making and cognitive function, sleep-deprivation opens the door to unethical behavior. Another study found that sleep-deprivation is noticeably reflected in facial cues, enough so that other people are likely to register a sleep-deprived person as lacking energy and unhealthy. (Not the best face to put forward to a customer.) The worst costs arise from the fact that sleep deprivation causes safety lapses and contributes to other health issues. (For instance, the World Health Organization classifies shift work as a Class 2A carcinogen, due to the rates of breast cancer among women shift workers.)
Fortunately, many employers, in every industry imaginable, are learning to appreciate that the health of employees is directly connected to the health of the bottom line, and making concrete changes. At the Harvard Medical School Division of Sleep Medicine’s Corporate Leadership Summit last month, Attacking the Sleep Conspiracy, companies like Walmart, Procter & Gamble, and Eli Lilly came together to discuss how businesses can partner with sleep experts and organizations to meet the health challenges associated with sleep problems.
Perhaps they are taking a cue from the world of sports. Olympians now get state-of-the-art nap rooms in addition to their highly monitored diets. In the NBA, stars like Steve Nash and Kobe Bryant have led the way, making pre-game naps part of their warm-up routine. Now, the NBA’s deputy commissioner says, “Everyone in the league office knows not to call players at 3 pm. It’s the player nap.”
More conventional workplaces are catching up. Twenty-five percent of large U.S. businesses offer employees some kind of stress reduction initiative, like meditation or yoga. At The Huffington Post’s office in New York, we’ve installed two nap rooms. At the beginning, our reporters, editors, and engineers were reluctant to use them, afraid that people might think they were shirking their duties. But it’s a sign of our time of transition that, these days, our nap rooms are always booked. We have to change workplace culture so that what’s stigmatized is not napping but walking around drained and exhausted.
As we approach a critical mass of awareness of the importance of sleep, we’re also learning that some of our most admired historical figures have been in on the secret for a long time. So along the way to taking on the biggest challenges and seizing the greatest opportunities, let’s hope the next generation of leaders will note the performance advantage enjoyed by some of history’s famous nappers — from Leonardo DaVinci to Winston Churchill to John F. Kennedy.
Times of major transition are often precipitated by “perfect storms” combining powerful forces. Behind American’s growing concern with well-being are at least three elements: a dysfunctional health care system, an abundance of new technology, and a new ability and desire to monitor and take control of one’s own health. As this perfect storm hits the American workplace, and the movement responding to it takes hold, expect great change to happen.
Arianna Huffington is the chair, president, and editor-in-chief of the Huffington Post Media Group, a nationally syndicated columnist, and author of thirteen books. She is a member of The Executive Council of the Division of Sleep Medicine at Harvard Medical School.
If a media time grab could give a snapshot of the unique and varied personalities that comprise the TEDMED community, these past couple of weeks might suffice.
Ankita Rao of Kaiser Health News, in collaboration with USAToday, profiled physician/rapper/community healthcare innovator Zubin Damania, who spoke this April, about his often, um, “indelicate” viral videos that poke fun at pop culture while at the same time delivering valuable PSAs on health, or offering acerbic commentary on the state of healthcare. His wit has a serious side, though:
Damania delivered a talk at the 2013 TEDMED conference in Washington in April called “Are Zombie Doctors Taking Over America?” In it, he offered his take on the physician lifestyle right now: a hazy mix of rounds in the hospital, hours on the phone with insurance companies, tedious paperwork and getting home late, only to worry about mistakes made somewhere along the way.
“There are so many pieces, but fundamentally the human relationship is ignored in this system,” he said.
How does the world die? In a piece titled, “Life, Not Death, is Focus of New Health Metrics,” Discover magazine reported on Christopher JL Murray‘s breakthrough global health data measuring system and it’s surprising revelations about how disease risk factors vary according to where and how we live, and new definitions of infirmity and wellness. As Jeremy Smith wrote:
Around the world, for example, chronic obstructive pulmonary disease claimed roughly twice the number of lives as HIV/AIDS in 2010, but HIV/AIDS was much more fatal to young people, and therefore appears higher in the DALY ranking. Likewise, as risk factors, not eating enough fruit out-rivals illicit drug use. For years, experts have said that most of the world’s major childhood diseases could be eliminated with clean water. What global burden suggests is that while lack of access to water and sanitation is a concern, five times worse for the world is indoor smoke from cookstoves, a major contributor to respiratory illnesses, communicable diseases, cardiovascular problems and cancers.
Watch Murray discuss and see more examples from his TEDMED talk:
Another maverick, TEDMED 2013 speaker Sandeep Kishore, appeared in the pages of Weill Cornell Medicine magazine in a piece by Beth Saulnier, titled, “The Doer,” about Kishore’s global health activism. He’s the founder of The Young Professionals Chronic Disease Network, a group promoting research, policy and advocacy work targeting NCDs; has worked on a half-dozen submissions to the WHO; serves on the board of the NGO Universities Allied for Essential Medicines; has won a Howard Hughes Fellowship — and he’s still in med school.
And TEDMED Managing Editor Lisa Shufro offered a peek behind our stage curtains in the Huffington Post, profiling David Blaine — who gave one of TEDMED’s most watched talks ever in 2009 — and what might scare him even more than repeatedly risking his life on death-defying stunts.
We leave a long trail of digital breadcrumbs every day as we go about even the most mundane tasks: Answering e-mail; making phone calls; using GPS to find a post office; shopping for dinner; tracking our sleep and steps with a Fitbit.
Data collected from search engines, social networks, and mobile carriers, combined with smart apps, can turn these tracks into a continuous, real-time picture of our personal health, said Deborah Estrin, co-founder of the non-profit open software builder Open mHealth and a professor of Computer Science at Cornell Tech, speaking at TEDMED 2013 in April.
“I’m not taking about doing detailed medical diagnosis…replacing the communication between you and your doctor and with your loved ones or even your own self-awareness. I’m talking about enhancing each of these with personalized, data-driven insights…such as early warning signs of a problem or gradual improvement in response to a treatment,” she said.
She continued, “I like to think of it as a digital social pulse, because it’s a single measure that I can look at over time that represents my well being, and social because it’s something I can selectively share with a small number of friends and family. Once we as patients can get access to our small traces — our small data — we’ll be able to fuel a new market of apps and services,” she said.
Though our daily behaviors are already monitored and analyzed extensively, the results are unavailable to users and there’s no vehicle to make them accessible, Estrin said in an interview today.
“There’s nothing lost by letting an individual have their data back, and having them do things that are useful with it,” she said. “It simply plays into having people manage their lives and their health and welfare. Imagine the utility that I will get out of an app that helps me figure out whether I’m taking supplements in an effective dose or not, or helps me monitor a my kid whose going away to college who has a complicated health issue.”
Though Estrin co-founded Open mHealth in 2011, the group is already working on a number of initiatives, including a web app called ClinVis that trends subjective units of depression (SUD) scores. Estrin is already building a coalition of service providers and app developers for this venture. She’ll meet with a few major phone and network service providers in a few weeks to start a smaller-level “virtual testbed” in New York City. Wikilife, a collaborative that seeks to anonymously collect and share health data to measure the health impact of lifestyle choices and nutritional habits, among other measures, is also considering implementing Open mHealth’s API, she said.
Some carriers are apprehensive about appearing to violate privacy regulations, Estrin acknowledges, but adds, “There is a lot of interest in making sure this is done securely, and receptiveness to the notion of personal data vaults within the cloud. I think that the minute we can prototype an initial viable product and a couple of feeds and let people come together and run some apps, we’ll see a lot of uptake,” she says.
The apps will be built on an open-source development platform, which dovetails with the project’s goal of shared knowledge.
“Part of the story of small data is having it happen in an open architecture content because you can then build upon each other’s skills. You’re not counting on any one vendor to build the system, and you get a very exciting Internet economy,” Estrin says.
Watch her talk at TEDMED 2013, and click here if you’re interested in a compilation of your own small data.
We’re drowning in health information on all fronts with very little guidance on how to make sense of it. How can we go about finding clarity and seeing sensible patterns in a morass of data?
Larry Smarr, perhaps the world’s most-quantified man, chronicled his bodily input and output in minute detail for months. He used the resulting mountains of microbiotic data — and a supercomputer — to self-diagnose a gastrointestinal illness, much to the discomfort of his doctor, who told him, “that’s science, not medicine.” Still, Smarr may well be the patient of the future. Watch him tell his tale at TEDMED 2013.
What’s really driving our scourge of obesity and its related metabolic diseases, including diabetes, Alzheimer’s disease, cancer, and heart disease? The medical community generally holds that we eat an overly large number of calories, causing an “energy imbalance” that leads to fat accumulation — and most of its advice to the general population speaks to that: “Eat less and exercise more!”
Yet, after 50 years of studying the problem and about a decade trying hard to fix it — mainly via health messaging — we continue to gain weight exponentially. Obesity has increased 250% since the 1960s, and diabetes more than five-fold. Why can’t we solve this?
For starters, what if all of our efforts to fight weight gain have been based on inconclusive science? What if our “treatment” is then incorrect, rather than conventional wisdom that says people just can’t follow it?
TEDMED 2013 speaker Peter Attia and his non-profit organization,Nutrition Science Initiative (NuSI) hope to help science, and eventually public policy, reach the truth. Attia and co-founder Gary Taubes, a science and health journalist and author of “Why We Get Fat,” founded NuSI a year ago. They hold that research on nutrition has not been nearly rigorous enough to date to make existing claims about the relationship between nutrition and health due a host of factors, including a lack of proper controls, difficulties in meticulously monitoring subjects, and insufficient resources to conduct the necessary experiments to show cause and effect.
Supporting their claim, a meta-search published in the New England Journal of Medicine last January concurs, saying that most popular dietary recommendations concerning obesity, from the value of eating breakfast and more fruits and vegetables, to the evils of snacking, are unproven.
To begin its quest, NuSI is funding and facilitating what it hopes will be the most rigorous research to date on the relationship between nutrition, obesity and metabolic disease to date, starting with three large experimental collaborations at six leading academic institutions over the next three years.
NuSI will release details on the projects in the next few months. We do know that, as the Wall Street Journal reports, the Laura and John Arnold Foundation (LJAF) of Houston, Texas has recently agreed to fund approximately $40 million of research over the next three years. We’ll give updates here.
With the recent news about Angelina Jolie’s double mastectomy due to a faulty gene, cancer prevention — and the lengths to which it should go — became an even hotter topic in healthcare, grabbing at least 15 minutes of frenzied public attention about genetic testing and breast cancer.
Cancer took center stage at TEDMED 2013, too, as physician and author David Agus joined TEDMED curator Jay Walker to explain, as Agus told us today, why “cancer is not something the body gets, it’s something the body does.” In other words, most of us are living with cancerous cells at any given time; it’s our body’s environment that decides whether they will multiply and flourish into disease.
“Anglelina Jolie doesn’t have cancer, and the BRCA1 mutation doesn’t cause cancer. It makes your cells more susceptible to getting these mutations that cause cancer,” he said. “What this is telling us is that her body has a systems issue.”
Agus is in favor of widespread genetic testing, particularly in cases of a family history, but in context.
“We’re in favor of getting all the information we can to help make decisions. Not that everyone should go out and have preventive mastectomies; BRCA1 mutations only cause 5 to 10 percent of all breast cancers. This is a small piece of the puzzle of information, but it’s an important piece,” he says.
What testing can do for us, he says, is help influence daily behavior.
“We’re not good at thinking about tomorrow, we’re only good about thinking about today. So if knowing your information changes how you live your life — whether you’re sedentary, whether you smoke or not, what you eat, how much you sleep — it’s still a major win.”
Agus talked more about the issue on CBS Today and yesterday published an op-ed in the New York Times about the cost of a gene test. He spoke at TEDMED 2011 about redefining cancer.