Great Challenges: Conversations Continue

The top 20 Great Challenges were announced yesterday. Perhaps one of the most exciting things to come out of the Great Challenges program, sponsored by the Robert Wood Johnson Foundation, was the amazing conversations that these topics catalyzed. Below are highlights from conversations with advocates for some of the top 20 Challenges.

Suzanne Geffen Mintz, National Family Caregivers Association, and Lincoln Smith, President and CEO of Altarum Institute

“Patients themselves might not have the capacity to engage in their own care,” said Lincoln Smith, President of the Altarum Institute. “It’s draining.” Challenge #34, The Caregiver Crisis, came out second in the list of top 20 Great Challenges. The bad news is that health outcomes may be worse for caregivers because of the time, financial and stress burdens they face. Suzanne Geffen Mintz, National Family Caregivers Association Co-founder and advocate for Challenge #34, said what she wants most as a caregiver herself is for someone to, “document what we do. We’re like illegal aliens. We need to be in medical records — both in the patient’s records and in our own.”

This would help identify who needs support and resources, and help to connect them with what they need. Businesses lose billions of dollars in productivity due to caregiver struggles, said Geffen Mintz, and that’s because, “It impacts every sector of society and no family is immune.”

Christine Ferguson, Challenge Advocate, with newfound TEDMED friends Marty Kearns and Patrick McCrummen

Challenge #2 brings attention to another pervasive problem at crisis levels, Coming to Terms with the Obesity Crisis. “It’s interesting,” said Christine Ferguson, JD, Director of the STOP Obesity Alliance and Challenge #2 advocate, “when we have cancer affecting around 8% of the population, diabetes around 10% and obesity 35% — what has preventing us from addressing it?” Barriers include the perception that the problem is too complicated, or that it’s just a matter of willpower, she said. The “pull yourself up by the bootstraps” mentality that used to exist for mental health issues too, needs to go away before we can truly make progress, said Ferguson. She quoted some startling statistics — over 70% of obese people know all of the relevant health messages such as portion size, and have tried to change at least once; while 70% of primary care providers say no one in their office had any training on helping overweight and obese people get healthier. People are motivated and trying, but they don’t have the resources or support for change.

Marty Kearns, Project Director of PreventObesity.net, a project of the Robert Wood Johnson Foundation, said his organization is working to change policies and environments to help children and families eat well and move more, and by fostering, engaging and connecting a base of advocates who are willing to take action. Partick McCrummen, Senior Director for Corporate Contributions at Johnson & Johnson, also talked about the value of collaboration, and said J&J is hoping to serve as a convener for thought leaders and global organizations.

As we’re working so hard to improve the health of the world, what’s the one thing we’re all forgetting? “It’s the secret health crisis that’s right in front of our face,” said Russell Sanna, PhD, Executive Director of Harvard Medical School Division of Sleep Medicine and advocate for surprise add, Challenge #51. The big culprit? Sleep. We all know we need it, and none of us get enough. Why not? “There is an uncoordinated conspiracy against sleep health,” said Sanna. Feeding the conspiracy are Facebook, mobile phones, entertainment, an over-achieving society and pervasive sleep illiteracy. Embarrassingly, Sanna quickly uncovered this reporter’s own sleep illiteracy — sleep bulimia (“I’ll catch up on sleep this weekend”) doesn’t work? The color blue triggers your circadian rhythm (think Facebook), keeping you up when you should be winding down?

“There’s hope,” said Sanna. NBA stars are now hiring sleep consultants to ensure better performance despite hectic schedules (sound familiar?). Sanna hopes this is the start of a massive culture shift that will no longer encourage or allow bad sleep habits. Possible solutions: encourage employers to trigger a “go-dark” period on company Blackberries, and Facebook to turn its blue background grey at a user-specified hour as a reminder to shut down and get some sleep.

But every solution won’t necessarily work for every person. “Each individual has different health risks,” said Rebecca Sutphen, President and Chief Medical Officer of InformedDNA and advocate for Challenge #4, Shaping the Future of Personalized Medicine. “The genome is the key to paying attention to the right things,” said Sutphen, who urged us as a society to move medicine forward by unlocking the solutions that lie within our own bodies.

We spoke with many more advocates and overheard some fascinating conversations. Stay tuned for more on the 20 Great Challenges throughout the year.

TEDMED Day 3: Cancer eyes, hidden medical data and the healing power of poop

Graphic by Alphachimp Studio

A third day brought revelations, fascinating science, humor, great art and more than a little emotion at TEDMED 2012.

Evolutionary biologist Jonathan Eisen brought down the house with his talk about decoding the microbial genome, explaining that we humans basically depend upon their existence. He threw small stuffed microbes into the audience to give us a better glance at the tiny freeloaders that colonize our bodies.

We encountered more wiggling creatures during Andrew Read’s talk as he spoke about the evolution of disease in malaria-bearing mosquitoes and among cancer cells. Motto: If we don’t head them off at the path, they’ll evolve faster than we can find cures.

Gail McGovern, president and CEO of the Red Cross, introduced a new term to the

Stephen Petronio's "intravenous lecture" explored censorship, physical and otherwise.

TEDMED audience — cancer eyes — to describe the way friends and colleagues reacted to her first bout with breast disease: An uncomfortableness and sympathy and perhaps fear that they couldn’t disclose.

Consumers — patients — are averse to healthcare, too, particularly basic prevention testing, said Quest Diagnostics CMO Jon Cohen, to the point where many companies are giving employees incentives to get them.  A better answer, he says, may be to move to a desire-driven system where patients understand the value of quality healthcare and prevention.

You could hear a pin drop as legendary biologist E.O. Wilson took the stage and exhorted future doctors and scientists to approach their careers with imagination rather than rite:  “The ideal scientist is one that thinks like a poet and works like a bookkeeper.” And violinist Robert Gupta continued to pose his TEDMED question, “Does beauty have the power to heal?” by making extraordinarily beautiful music.

Jonathan Glass and Nick Boulis talked about the latest in stem cell therapy for ALS disease and role-played the patient/FDA/biotech merry-go-round that is the process for getting new treatments into trial and production in the U.S. He urged us to better calibrate the risk-reward scale.

Alexandra Drane, founder of the Eliza Corporation, interviewed surfer Laird Hamilton, who appeared with pro-volleyball player and health advocate (and Laird’s wife) Gabby Reece, about what it takes to attain the heights of physical achievement and, as she put it, to “put some sexy into health prevention.” They certainly do that, but they also have a heartening message for the 99 percent of us who will never approach anything near such bodily human perfection.  But, as Reece put it, “You can always be better” — and they sure are inspiring.

Author and MD Ben Goldacre asked – where’s the missing data?  Goldacre was referring to the truth that only roughly half of all research is published thanks to bias — positive results are twice as likely to be published. Asking doctors to prescribe with only a fraction of the info they really need to make decisions is, he says, tantamount to medical malpractice.

Speaking of lunacy, self-described “lunatic farmer” Joel Salatin, of Ominvore’s Dilemma fame, was anything but crazy when he talked about how you can’t have nutritious food without nutrient-rich, microbe-rich soil, and how our mechanized, chemicalized food production has little to add to that. The world isn’t for machines, he says, but for beings; he sees the world as a lover to be massaged, not dominated.

TEDMED’s Top 20 Great Challenges for the coming year were announced: See the results here. You’ll be hearing much more about as their Advocates lead online discussions and other events over the coming year.

Lastly, health advocates and social icons Katie Couric and Billie Jean King sat down to interview each other, kicking off with the history of the women’s movement over time and today, and its effect on women in sports and and healthcare.  Looking back on their own healthy influences, they remembered grueling daily gym classes from certified teachers, and home-cooked family dinners — where they ate whatever mom cooked. Yep, it may be that simple. On what seems to be a running TEDMED theme of personal responsibility in preventive health, King said she doesn’t like working out, but she does it anyway, because she loves the results. Couric also emphasized the importance of creating an environment where people have access to the choices they need to take responsibility — like making sure there are farmer’s markets or other options in “food deserts.”

King asked Couric for a status report on cancer awareness, and Couric credited success to a devoted “dream team” of women helping her get the world out.

“Health hath no fury like some pissed off women,” Couric said.

Blogroll:  Medgadget gives a  thorough roundup; Scott Hensley of NPR’s “Shots” blog recaps the day’s highlights; ABCNEWS.com covers Francis Collins’s talk, Teaching Old Drugs New Tricks for Rare Diseases; WSJ blogs Jon Cohen’s talk; HuffPost’s Liveblog.  David Ewing Duncan of The Atlantic wrote about the need for integration in biomedicine as expressed by TEDMED speakers; the WSJ covers E.O. Wilson’s advice to med students:  Don’t let the math scare you.

20 Great Challenges: Votes are in!

Jay Walker just announced the results of voting on the 20 Great Challenges of health and medicine. The program, sponsored by the Robert Wood Johnson Foundation, looks at the most persistent and complex issues facing health and medicine today.

The Top 20 Great Challenges:

#22.  Inventing Wellness Programs
#34.  The Caregiver Crisis
#19.  The Role of the Patient
#2.    The Obesity Crisis
#1.    Achieving Medical Innovation
#8.    Managing Chronic Diseases
#18.  Medical Communication
#26.  Reducing Childhood Obesity
#3.    Making Prevention Popular
#9.    End-of-life Care
#51.  Causes of Sleep Deprivation
#15.  Impact of Poverty on Health
#12.  Faster Adoption of Best Practices
#32.  Impact of Stress
#4.    Future of Personalized Medicine
#33.  Promoting Active Lifestyles
#10.  Preparing for Dementia
#16.  Addressing Healthcare Costs
#39.  Whole-Patient Care

#23.  Eliminating Medical Errors

Throughout the year, the Great Challenges Program will generate a lively national dialog on the 20 Challenges chosen by the TEDMED community. The program will include TV-style interviews with leaders across fields, a series of webinars on each of the 20 Great Challenges, and the opportunity for TEDMED community members to add their voice.

Thanks for voting! Now let’s get to talking.

TEDMED Partner Spaces: Stats of the Union, brainstorming in the Cloud

Exploring the TEDMED partner spaces in the ” Social Hub” tent uncovered some more fascinating experiences, including a way to check the nation’s vital signs and an opportunity to brainstorm in the cloud.

Which state has the most major depression? The highest unemployment rate? Delegates could find out with the interactive Stats of the Union application from GE. They’ve created a mash-up of data from the Census, the Department of Health and Human Services, the Department of Labor and other sources, in a free app that presents the results in a visual infographic. Kathleen Voboril, Digital Marketing Manager for GE Capital, walked us through some data visualizations, where we saw striking differences in major depression across the country (low in the Northwest region; very high in Tennessee).

Mary Gillum demonstrates GE’s daily health session tool used with employees

GE is also piloting a new, free diabetes management program for their employees in Cincinnati, where the company builds jet engines. The program provides employees with an FDA-cleared medical device that looks a whole lot like an iPad, and facilitates a “daily health session” — checking in on vital signs, filling out a survey of symptoms, and getting a dose of good old health education. It also pushes out reminders, and sends feedback to a clinician who can follow up on dangerous symptoms. Six months in, GE is finding that participating employees engage more fully and feel more accountable for the management of their condition, said Mary Gillum, a clinical applications specialist with Care Innovations, an Intel-GE company.

Part of the reasoning behind GE’s efforts is to “make healthy communities a competitive advantage like good schools,” said Voboril. The hope is for the whole community to get involved. “If we take personal responsibility and collective responsibility at the same time, can we effect change?”

Booz-Allen Hamilton is working on another critical question, and the hope is that you will respond. “As an industry, what should we be doing right now to improve healthcare that will have the greatest impact on patients?” The company is calling on TEDMED Delegates, TEDMEDLive viewers and fans everywhere to join in the conversation through a global BrainStorm that will take place — get ready — on the Cloud. They’re hoping to foster diverse ideas, a perfect goal for the TEDMED crowd, and will ask users to vote on the best ideas to help unearth trends, said Carrie Bittman, Senior Consultant for Booz-Allen. The top ideas will be presented in a paper to TEDMED. Ideas so far range from the health impact of meditation to tools that support the transfer of knowledge between physicians during shift changes at hospitals. In the meantime, artists are capturing the ideas as they come in with posters at the Booz-Allen space.

Under the big tent at TEDMED

In a 30,000-square-foot tent next to the Kennedy Center, TEDMED’s corporate partners and contributors are showing their latest products and thinking on healthcare innovation in interactive displays that made for some fun wandering.

After being stalked for a while by what looked like a newly slim R2D2, I discovered that it

Mimi Englander via the VGo

was actually Mimi Englander from Boston via the VGo, a remote communications system used by docs to make home visits — remember those? — and to monitor patients, and by kids facing illness or disability who would otherwise not be able to visit classrooms.  We had a friendly talk — once I got over the strangeness of conversing with a roughly three-foot-tall machine — and I could see the benefits of having your doc visit by VGo instead of waiting for her to wend her way through vast hospital corridors.

On to Philips, which has been polling Delegates about the significant health issue of sleep deprivation, and displaying the results in a visual outline with graphics.  The size of the wall graphic suggests that many of us are struggling with the issue, although there were reportedly heated arguments over whether exercise, reading, health and pets helped or hindered sleep.

Graphic by illustrator David Stanley

Lastly, I was able to catch up with in situ artist and patient advocate Regina Holliday, who was doing a painting of the a female form inspired by Jonathan Eisen‘s earlier talk about microbes and how humans are basically base camps for their tiny but mightily active colonies. The 51 circles modestly adorning the female represent TEDMED’s 51 Great Challenges, while the subject sips a cup of human fecal matter which, as Eisen explained, is being used as transplant therapy to treat bacterial infections.

Regina Holliday at work

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

Graphic by Alphachimp Studio Inc.

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

Sam Berns and Francis Collins

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

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

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

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

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

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

Elizabeth Bonker and Virginia Breen

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

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

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

Great Challenges: Voting underway

The Great Challenges tables in the Robert Wood Johnson Foundation partner space have been a hotbed of passionate discussion and lobbying for votes to encourage Delegates to nominate. With so many complex and — well, challenging — Challenges, it won’t be an easy choice.

As of early Thursday, the top three Challenges leading the polls so far were:

#22. Inventing Wellness Programs

#19. The Role of the Patient

#34. The Caregiver Crisis

"e-Patient Dave" and Delegate Sarah Farrell

“This is the only industry I’ve ever seen where strategy and quality don’t start by asking the ultimate stakeholder what they want,” said Dave deBronkart, better known as “e-Patient Dave,” advocate for challenge #19, the role of the patient. deBronkart said it’s a myth that if patients were given choices, they would choose everything and health care costs would rise. He told a rapt crowd of TEDMED Delegates about a Dutch infertility program that gave patients access to a wiki, told them to decide on health care priorities together, and promised to fund them. A number of the top picks were requests that didn’t cost a dime — more empathy, and a waiting room separate from the pregnant patients. “If the consumer is at the center of the health care universe, everything else makes more sense,” said deBronkart.

Helen Osborne, President of Health Literacy Consultings and advocate for challenge #11, making “informed choice” work better, advocated for giving patients the tools they need to be thoughtfully engaged in their health decisions. Some interesting approaches to improving informed choice for patients include using songs, puppets and analogies, said Osborne.
Kedar Mate, Country Director, IHI South Africa Program and advocate for Challenge #12

Challenges #1, achieving more innovation more affordably, and #12, faster adoption of best practices, both touched on similar themes — getting innovative health care practices or products to the people who need them, quickly and efficiently. On best practices, advocate Kedar Mate said, “We know they exist — they’re in the journals and they’re here at this conference. The challenge is getting people to use them. Research says it takes 17 years to go from journal publication to widespread use.” And that’s too slow, said Kedar, Country Director for the IHI South Africa Program, who likened it to having to wait until his new-born son’s 17th birthday for an innovation that could have helped him at birth.

Don Rucker, Vice President and Chief Medical Officer at Siemens and advocate for challenge #1, talked about another hurdle to getting innovations out into the world. “The FDA should be accountable not just on safety but also on availability of new treatments,” said Rucker.

Rucker wasn’t the only advocate talking about the role of government in the public’s health. Challenge #17, private rights versus public good, generated some interesting discussion. Topics included making the healthy choice the easy choice, and what to do next to make sure people take advantage of that choice, as well as defining when an unhealthy choice by one person makes for an unfair burden on the rest of society.

Michael Roizen, Chief Wellness Officer for the Cleveland Clinic

Making the healthy choice easier also came up as a solution from Michael Roizen, Chief Wellness Officer for the Cleveland Clinic and advocate for challenge #8, managing chronic disease. Cleveland Clinic revamped its vending machines for employees and offers financial incentives for healthy check-ups.

Making prevention popular and profitable, challenge #3, was another popular topic among Delegates and TEDMEDLive viewers alike. “We’re trying to take prevention and put it in your local shopping mall,” said Mary Jane Rotheram-Borus, PhD, Director of the UCLA Semel Institute Global Center for Children and Families and pioneer of the UCLA Family Commons program, funded by the Robert Wood Johnson Foundation. Rotheram-Borus is not an advocate, but a self-proclaimed big fan of prevention. The Family Commons program is training and equipping “mentor moms” to spread the word on prevention, and support other families in building a healthy life.

That’s just a small slice of the great conversations we heard today. Join in the fun at #TEDMEDChallenges on Twitter, and don’t forget to cast your vote here and make your voice heard.

TEDMED Partner spaces: Saddle up to the Inspiration Bar, experience schizophrenia and try Touchless Technology

The Social Hub was abuzz today with good conversation, good food and great opportunities to interact with innovative experiences, technologies and thought leaders in the partner and contributor social spaces.

Healthcare today is unsustainable — but we can change that, according to Siemens Healthcare, a trendsetter in medical imaging, laboratory diagnostics and health IT. Escalating costs, the growing burden of chronic disease and an aging population explosion all conspire to create an untenable healthcare landscape. What’s the solution? It lies at the intersection of higher quality and lower cost.

In the Siemens space, Delegates guessed at where the United States and other countries land along the cost-quality curve — at a surprising disadvantage, as it turns out. Innovation and new technologies, like advanced imagery that allows for more personalized, less wasteful medicine could move the system in the right direction, said Donald Rucker, MD, Vice President and Chief Medical Officer of Siemens Medical Solutions. Siemens also showcased “touchless interaction,” a tool surgeons can use to navigate their way through less-invasive but complicated surgery on a video screen that can be manipulated with the swipe of a hand from across the room, using the Kinect sensor currently used on X-boxes.

Johnson & Johnson (J&J) has a 125-year history of improving health through innovation — from band-aids to creating sterile environments for surgery. They’re here at TEDMED for the innovation, collaboration and “diversity of thinking, which has been a part of Johnson & Johnson’s culture for a long time,” said Michael Sneed, Vice President of Global Corporate Affairs. “People come here with their minds open. They’re not shy about coming up and talking to us.”

The J&J space at TEDMED is about more than just talk, though. We tried out some immersive experiences designed to help truly understand what patients are going through. It may not be pervasive in medical school curricula (yet), but empathy is a critical skill in health and health care. Among the exhibits:

  • A 3-D, immersive program that lets you experience what it’s like to live with schizophrenia. The experience is rattling, and really comes to life with smells of rotten coffee, a simulation of wind on your face and disturbing hallucinations. The program is deployed in mobile units to providers and emergency first responders who support patients in crisis, to help them understand and better counsel these patients.
  • Rheumatoid arthritis gloves, which simulate hand movement constrained by the stresses and limitations of severe rheumatoid arthritis. With the gloves on, try opening a jar or opening a ziploc bag — both everyday, but near impossible tasks with the gloves. These are intended help providers and those who design products better understand how rheumatic arthritis patients can handle necessities like pill bottles.

The Inspiration Bar offered fascinating discussion with Cleveland Clinic innovators, physicians and researchers. Topics this week include the healing impact of art and music, myths and facts about chocolate and red wine (sign us up!), an interactive session on “Wellness Coaching” from Chief Wellness Officer Dr. Michael Roizen, and the truth about diets.

At today’s talk on lessons learned from treating some of the greatest athletes in the world, led by Dr. Thomas Graham, Vice Chair of Orthopedic Surgery, we learned that perhaps the ultimate American innovator developed a novel process in 1968. In the first year, he achieved 75% adoption of his method, and that climbed to 100% at the four-year mark.

Was he a top researcher? Nope. Dr. Graham was referring to Dick Fosbury, the Olympic track and field athlete who was the first to try the high jump “back-first,” now known as the Fosbury Flop. “He thought completely differently, and it resulted in a sea change,” said Dr. Graham. That’s what we need to do in health care, he said. “Medicine cannot be stagnant. We need to be always looking for big ideas.”

The Cleveland Clinic also offered a “Walk With a Doc” program throughout TEDMED, an idea gaining national traction among medical centers. The program allows patients to get their health questions answered while getting some physical activity under their belts in a roving, group doctor’s visit.

Around and about TEDMED: Take two

Surprise! The U.S. Surgeon General’s in the house! Regina Benjamin spoke briefly today about bringing joy to prevention — in other words, we should eat apples because they’re tasty and might make us feel good and not just whip ourselves for eating those fries.

TEDMED Curator Jay Walker, U.S. Surgeon General Regina Benjamin, and TEDMED co-host and Program Director Lisa Shufro backstage.

TEDMED’s Great Challenge Advocates continued to work the crowd talking about these complex health issues and why the Challenge in which they are offering expertise deserves to be chosen as one of the 20 most critical for further study.

Below, David S. Ludwig, director of the New Balance Obesity Prevention Center Boston Children’s Hospital, gave his pitch: Being obese as a child sets the stage for more severe weight issues as adults. Not to mention the $200 billion dollars it costs our health system to address weight-related issues now, and the $1 trillion that obesity-related disease is estimated to cost by the time these children are adults in 2030.

Panasonic was on hand to offer Delegates scans of their carotid artery, which, along with a brief medical history, offered a snapshot of risk for heart disease and stroke within about five minutes.

Catherine Andrews of Homefront Communications - aka the Voice of TEDMED Tweets - gets the Panasonic scan.