Once upon a time at TEDMED: The story behind a groundbreaking cancer research collaboration

When we heard that two former TEDMED speakers, Drs. David Agus and Anthony Atala, had been awarded an NIH grant to develop the first-ever integrated bioengineered/computational model of metastatic colon cancer, TEDMED investigated the backstory of their unique collaboration.

It turns out the two met at TEDMED, which makes us proud; our mission is to be a petrie dish in which minds from many realms can mingle and imagine entirely new phenomena. The Agus/Atala collaboration is one example of many — a book arose from a chance meeting in the mens’ room at one TEDMED – and has the potential to make a huge impact on human health.

We asked David Agus to explain how it all came about.

Can you describe how you and Dr. Atala got the idea for this project?

I heard his talk, and he heard mine, and we met at a speaker reception – TEDMED is also very much about what happens between the talks.  When you speak at TEDMED, you’re presenting so the general audience can understand.  But when the two of us got together, we were talking about not just where the technology is today, but where could it go in the future.

shutterstock_75799198We’re both from different domains — I’m an oncologist; Anthony is a surgeon. My group has developed methods of computational cancer modeling; he has a system upon which you can put in a cancer cell and model its growth. Some of the biggest advances in science happen when you cross domains. The NIH had put out a call for submissions to help answer provocative questions in cancer.  So we said, ‘Can we put our two technologies together and make this happen?’

TEDMED has always been viewed as an organization for presenting big ideas about science and medicine.  But it’s also an organization for progress. You get people in the room, you give them a substrate — normally a glass of wine — and let them go, and things happen.

What drew you together to work on this?

Listen, we’re both nerds, we’re both into science, but we’re also both clinicians who take care of patients, and that combination is unusual.  We’re also both driven by seeing people dying from disease. It took a couple of years for this project to come to fruition, but both of us are very fortunate to have remarkable teams to help us do that. Many organizations don’t have the resources to do the pilot experiments and to take the risk.

What does it take to get researchers from various fields to come together on something like this?  Are other critical areas making strides?

For good or for bad, cancer doctors are willing to take a lot more risk than those in other areas.  The cancer field is on the forefront of change; the patients want to take more risk, and regulatory agencies have given us the leeway to do so. We don’t have a choice. There have been over a million published papers on cancer; billions of dollars spent on research. Yet, our understanding of disease metastases has made very little progress. We’re obligated to do things differently. For a more chronic disease like Alzheimer’s, risk taking has a different scenario.

Will current students of science and medicine have an easier time of crossing bridges for collaborative discovery once they begin their careers? 

The notion of cross domain thinking, and getting a physician and mathematician and stem cell scientist together is novel and new. Science rewards only the first author and last author on publications, and we’re talking about a team here of six scientists. Who’s going to get credit?  We have to push change.

What have been some of your favorite TEDMED talks?

One experience that truly changed me was hearing Jay Walker talk about the history of the flu. I was shocked; I thought it would be the goofiest presentation in the world. Yet it changed the ways I’ve thought about things and impacted many things that I think and what I write about.

I’ve started going back to primary sources and the historical side of medicine, whether with Hippocrates and epidemiology, or the plague in London. Doctors take care of patients and create observations that may be even more valuable today.  Back then, we had hours to observe, and we’ve lost that power. Anecdotes and stories are all we have to go on in medicine, and these are stories we need to pay serious attention to.

Have you started other collaborations at TEDMED? 

For me, it’s about the relationships I’ve developed, a broad network of individuals whom I now talk to on a regular basis who have ideas that inspire me. For example, Danny Hillis and I met separately at TEDMED, and it’s led to a lot of collaborative work.

When I go to a cancer meeting, it’s only cancer doctors there. The beauty of TEDMED is that we really get people from many different domains coming together. It may not be a direct influence – you do this part of a problem, and I’ll do that — but hearing how others from different disciplines solved problems changes how you approach your own.

TEDMED 2013 Day 1 – The Paradox of Design in Medicine and Inspiration from Seventy-Two Thousand Nadis

By Mike Moore, Medgadget

We’re here at TEDMED 2013, excited to be part of a unique group of people passionate about the future of medicine and curious to walk the path that will take us there. We’ll be reporting through the rest of the week on the talks, demos, and people that make TEDMED the world’s premier medical conference.

The first session of TEDMED 2013 opened with performing artist Kishi Bashi setting the stage with music. That led the audience to, in the words of TEDMED curator Jay Walker, “being present” in the moment and ready to engage for the next few days with the presenters, delegates, and the ideas that permeate the Kennedy Center in Washington, D.C. this week.

John Maeda

As the first presenter of the session, designer John Maeda began with a discussion of the intersection of leadership and design by stating that “leadership isn’t about going up the mountain, it’s about jumping off the mountain.” He continued with his observations about the ubiquitous need for design, and then focused on the ways that having an eye for design can help us understand effective systems and structures; in other words, his “5 Things About Design.” He then discussed how good design can help the healthcare industry. For Maeda, answer is art, which he admitted, based on his recent experience with surgery, is a bit paradoxical.

As he stated, when you are a surgeon doing a procedure, “I don’t want you to be creative,” but instead to do the procedure in a standardized way. However, looking at the challenges that health care providers face today in terms of their barriers to successful practice, the primary questions we face are not just can we survive, but can we thrive? In Maeda’s words: “Art and design can help us thrive.”

After John Maeda’s talk, Jay Walker acknowledged the Boston Marathon bombings, stating that citizens were a critical part of the response. For example, runners donated blood right after finishing the marathon, running an extra mile to the donation location to do their share. TEDMEDLive was recognized, and Jay went on to describe his vision of TEDMED as a community. He also introduced the TEDMED editorial team and remarked on its diversity, and reiterated the value of a diverse community, including those from healthcare, education, business and other areas.

The next presenter, Danny Hillis, professor of research medicine at USC Keck School of Medicine and co-founder of Applied Minds, stated “I dreamed of becoming a physician,” and recounted vivid memories of the streets of Calcutta, and his memories of people dealing with chronic disease without healthcare. In this struggle, the hospital was not the main event.

Ayurvedic medicine, the traditional medicine of India, was the primary way that the ordinary person dealt with that struggle. As he examined this traditional model of medicine with its focus on balance of humors, especially in contrast with Western medicine that focuses on a being in a state of either sickness or health. Though the Western medicine model of vaccination, sanitation, and antibiotics that served us so well in dealing with infectious disease was certainly effective, Hillis noted an aesthetic preference for the complex balanced view of seventy-two thousand nadis in intricate diagrams.

As he started his studies in modern neuroscience, he realized that the state of knowledge about the brain and nervous system was not really much better than seventy-two thousand nadis.

In his search for ways of understanding neuroscience, he was pulled into the artificial intelligence community where one could design intelligence and learn from it that way. There Hillis discovered not just the technology, but the data and models that he could use to study neural systems, and then finally the technology started to catch up to be able to look at the body. And as we look at the body, what we see is that the body is in a constant struggle against disease. He noted that when you can see what is going on with the patients, you can be preemptive, and that you can see the struggle before the body loses the battle, changing the way we look at the traditional “sickness and health.”

TEDMED’s Clinical Editor, Pritpal S. Tamber followed up Hillis’ talk with the observation that “good ideas not getting traction happens all too often in healthcare,” and refocused the audience on that mission.

America Bracho

America Bracho then gave a stirring presentation on access to health care by underserved populations based on her work with Latino populations in her native Venezuela. She also discussed these ideas with Harvey Fineberg of the Institute of Medicine.

Rafael Yuste, originator of the Brain Activity Map (BAM) project, then gave an inspiring talk about the challenges and rewards of science. He compared his two passions: science and mountaineering. They are similar in that you need big goals, a passionate and committed team, and you must analyze the problem and plan a route, break your plan into small steps, and perhaps most importantly, always keep your eye on the ultimate goal.

Rafael Yuste

As he looked at scientific mountains to climb, mapping the brain seemed like the “Everest” standing before science. He noted that we still know very little about how the brain works, we treat brain symptoms only because we do not understand the causes of problems in the brain. This gave him the idea of the Brain Activity Map (BAM) project as the grand challenge of science of 21st century.

In his view, these grand challenges show the role of science in our society, the role of moving knowledge forward, improving science as a business, building creativity. In Yuste’s view “Science has so many problems to solve, we can’t afford to dream small dreams.”

The remainder of the session was devoted to a short inspirational talk by the Surgeon General Regina Benjamin, and a vocal performance by acapella group Afro Blue.

This has been reprinted with permission from Medgadget.com, where Mike Moore is a guest blogger.