Op-ed: The primary nature of access to care, by Danielle Ofri

The content, views and opinions expressed in this blog post are those of the author(s) and do not imply endorsement by TEDMED. By inviting guest bloggers, TEDMED hopes to share a variety of perspectives that provoke and engage our community in discussion and debate.
Daniel Ofri speaks on the TEDMED stage. [Photo: Sandy Huffaker]
Daniel Ofri opens up about medical errors on the TEDMED stage. [Photo: Sandy Huffaker]

“Doctor, it’s taken so long to get this appointment with you.” This is the opening line of so many medical visits these days, and I find myself constantly apologizing to my patients for the delay. Even though both the patients and I know that it’s a systemic issue, it’s still front and center in our personal interaction. They are frustrated that they can’t get a timely appointment, and I’m aggravated because too many medical issues pile up in the interim, making the visits we do have massively overburdened.

The difficulty with access to medical care has been extensively highlighted at the VA hospital system, but is endemic to our entire medical system, even for patients with good insurance plans. Since the Affordable Care Act, some 10 million more Americans now have health insurance. This is an impressive achievement that should be celebrated, but of course insurance is only the first step in improving overall health. Now, these 10 million Americans must find doctors. A survey of 20,000 doctors from the nonprofit Physicians Foundation reports that fewer than a fifth of American doctors are able to take additional patients. More than 80% of doctors are over-extended or at capacity.

What does this mean for American medicine? One possibility is that the Affordable Care Act has placed us on an unsustainable path, something we hear frequently from those who oppose Obamacare. But this only holds water if the prior status quo—allowing a significant swath of America to remain outside the healthcare system—is considered acceptable. Luckily, we are slowly coming around to the ethical conclusion that the rest of the world has already made, that health care is something that all people deserve. Political realities may have forced awkward contortions in our health-care reform, accommodating multitudes of private insurance plans rather than offering a public option—concrete progress has nevertheless been made. So now the health care system must adapt. It can no longer survive on the expediencies of ignoring 15% of our population—it needs to start thinking about caring for all Americans.

A first step is considering how we allocate our existing clinical resources. The Physicians Foundation survey reported that doctors spend 20% of their time doing non-clinical paperwork. If you visualize that statistic carved out from the total number of doctors, it’s equivalent to about 170,000 doctors whose stethoscopes are sitting idle. This is a mind-boggling waste. To not be able to get an appointment with your doctor because she is spending a fifth of each day doing paperwork would sound ludicrous if it weren’t so dangerous. But patients and their serious medical conditions are getting short shrift as their doctors and nurses drown in metastasizing paperwork. Freeing up doctors’ time to see patients—a true measure of efficiency!—could make a real difference in the access problem. Amputating off even half the paperwork would be the equivalent of 85,000 new doctors available for patients.

A second step is to start planning ahead for healthcare that fits the needs of our patients, now that we are getting serious about taking care of all patients. For that, we need to delve a little more deeply into the access issue. Other countries have access issues also, but their long waiting lists relate primarily to specialties and procedures. What is uniquely American about our access problem is that it is particularly difficult to get primary care. Our inability to provide basic medical care for all Americans is what torpedoes the net efficacy of our medical system. Despite our superior technological advancements, we rank dead last in overall health outcomes compared with other developed countries. There is no secret about how to improve this—it’s tending to the basics. Research shows that the more primary care patients receive, the healthier they are and the longer they live. But the American system is not set up for this. Going forward, the only way to have a significant impact on our nation’s health is by improving access to primary care. Expanding training slots in family medicine, internal medicine, geriatrics, gynecology, and pediatrics is a necessary step, because the sheer growth of the American population means that we will need at least 20,000 more primary care doctors, if not more. But alongside increasing the pipeline of primary care doctors, we have to rethink the way we value and reimburse medical care.

It is an embarrassing truth that in the United States access to medical care relates to how lucrative that care is. It’s much faster and easier to get expensive tests and procedures than to take care of your general health. The fee-for-service system has consistently weighted procedure-based services (surgeries, endoscopies, MRIs) as having more “value” than cognitive-based services (treating diabetes, asthma, or heart failure). This absurd and patently profit-driven assessment means that we end up with more procedures and higher bills but poorer health and ultimately less access to basic medical care. Newer payment systems—bundled payments, pay-for-performance, accountable care—have the potential to jigger the balance somewhat. But our fundamental hierarchy remains completely backwards. Until we reverse this and make primary care, well, primary, getting an appointment with your general doctor in the United States will be the Achilles’ heel of medicine. Unless, of course, that heel needs a botox injection.

Danielle Ofri is an internist at Bellevue Hospital, an associate professor of medicine at NYU, and editor of The Bellevue Literary Review. Her most recent book is What Doctors Feel: How Emotions Affect the Practice of Medicine. In her TEDMED 2014 talk, she makes a powerful against-the-grain case that one of the things medical professionals are most resistant to doing would lead to dramatic improvements in care and undoubtedly save many lives. 

Illuminating the importance of light design

This is a guest blog post by Mariana Figueiro, Light and Health Program Director at the Lighting Research Center (LRC) and Associate Professor at Rensselaer Polytechnic Institute. Her talk at TEDMED 2014 reveals, surprising facts about the effect of light – its presence, its absence, and its patterns – on human health.

Mariana Figueiro
“We are all swimming in a sea of light” – Mariana Figueiro at TEDMED 2014

All creatures, great and small, are governed by the natural 24-hour, light-dark cycle. Every cell and physiological system in plants and animals exhibits a circadian cycle. In the absence of a regular 24-hour light-dark cycle, a circadian cycle in humans runs with a period close to, but not exactly, 24 hours. Daily exposures to morning light, especially blue light, reset the timing of our biological clock and synchronize our circadian rhythms to the local sunrise and sunset. Disruption of these circadian rhythms resulting from exposure to irregular light-dark patterns or exposure to light at the wrong time of day can compromise health. For example, it has been shown in animal models that circadian disruption is linked to increased risk for diabetes, obesity, cardiovascular disease and even cancer.1-5  Therefore, receiving the right light at the right time can be the key to good sleep, good health and wellbeing. We are swimming in an ocean of light, but like fish that take water for granted, we generally pay little attention to our environmental light. Light is the conductor of our internal symphony, influencing when we sleep and wake, our cognitive abilities, how much we eat, and even how well our medicine works.6-8

Recognizing the impact of light on the individual and on a global scale, the United Nations has proclaimed 2015 as the International Year of Light, citing that light plays a vital role in our daily lives, has revolutionized medicine, and that light-based technologies promote sustainable development and provide solutions to global challenges in energy, education, agriculture and health.

Just last year, the Nobel Prize in Physics was presented to the inventors of the blue LED, Isamu Akasaki, Hiroshi Amano and Shuji Nakamura.

At the Lighting Research Center (LRC) at Rensselaer Polytechnic Institute, we focus on the myriad effects of light on human health at all ages. We are working on developing a lighting system that can be used with premature infant incubators in the NICU to provide cycled lighting, which has been shown to improve health outcomes in premature infants. We are also investigating effective ways to deliver light as a treatment to improve sleep, depression and agitation in Alzheimer patients.

Beyond the long-term health benefits of synchronizing our circadian rhythms to the local time on Earth, light has an acute effect, an alerting boost, like a cup of coffee, which can help give us the energy we need when we wake up in the morning and also help to fight the post-lunch dip. We are trying to figure out how red light impacts alertness and performance during the day and at night. This could benefit shift workers, because red light can increase alertness without affecting melatonin levels. The suppression of melatonin by light at night has been implicated in health problems such as breast cancer in these shift workers.

The newly constructed 24-hour lighting scheme demonstration room at LRC provides cycled electric lighting with cool, high light levels during the day and warm, low levels at night. Construction of the room was made possible through funding and donations from the Light & Health Alliance, led by Dr. Figueiro. Light & Health Alliance members are Acuity Brands, Ketra, OSRAM Sylvania, Philips Lighting, Sharp, and USAI Lighting.
The newly constructed 24-hour lighting scheme demonstration room at LRC provides cycled electric lighting with cool, high light levels during the day and warm, low levels at night. Construction of the room was made possible through funding and donations from the Light & Health Alliance, led by Dr. Figueiro. Light & Health Alliance members are Acuity Brands, Ketra, OSRAM Sylvania, Philips Lighting, Sharp, and USAI Lighting.

Aside from the special light needs of these select populations, there is every reason to believe that introducing a regular 24-hour pattern of light and dark by modifying the amount of electric lighting we are exposed to daily, could improve the health and productivity of everyone. We are currently looking at the impact of artificial light and natural daylight on the health and wellbeing of federal employees working in buildings owned and leased by the U.S. General Services Administration. To further study this question in the home environment, we are also developing a lighting system that could be incorporated into the design of Swedish homes. The availability of daylight in Sweden during winter months is very limited, and so we are designing a “healthy home” using lighting principles that will promote health and wellbeing not only in Swedish homes, but in other places where daylight availability is limited. The system will provide cycled electric lighting with cool, high light levels during the day and warm, low levels at night. This type of cycled lighting is ideal for circadian health, encouraging restful sleep at night and increased alertness and performance during the day – not to mention many other general health benefits, such as improved mood and reduced risk of diabetes, obesity, cardiovascular disease and cancer.1-5, 9 DSC03686

An important component of the healthy home concept is the “Daysimeter” – a personal circadian light measurement device. The Daysimeter measures how much circadian light an individual receives over a 24-hour period, and then via smartphone it automatically adjusts lighting in the home and office to provide the ideal type of light needed to support health and wellbeing.

Imagine wearing this small, unobtrusive device, that would measure a dark, snowy day in January with little or no circadian-effective light, and then adjust the lighting in the morning to provide cool, high light levels to entrain you to the 24-hour solar day and give you an alerting boost of energy. In the afternoon, light levels would be adjusted based on how much light was received during the day, as measured by the Daysimeter. In the evening, the lighting would automatically adjust to provide warm, low levels of soothing light to ensure restful sleep. Thanks to advances in LED technology, the healthy home of the future could realistically happen in the next decade. We have developed the 24-hour lighting scheme and Daysimeter and have completed extensive testing in the lab and in the field, and are now working to study the real-world effects of this lighting scheme with people living their normal, daily lives. Today, many people think of light as just part of a building. In the future, we believe light will become more personalized, customizable, and tailored to the needs of each individual. Perhaps 2015 is the year that we will see the world in a new light.

References 1. Leproult R, Holmback U and Van Cauter E. Circadian misalignment augments markers of insulin resistance and inflammation, independently of sleep loss. Diabetes. 2014; 63: 1860-9. 2. Ye HH, Jeong JU, Jeon MJ and Sakong J. The association between shift work and the metabolic syndrome in female workers. Annals of Occupational and Environmental Medicine. 2013; 25: 33. 3. Young ME and Bray MS. Potential role for peripheral circadian clock dyssynchrony in the pathogenesis of cardiovascular dysfunction. Sleep Medicine. 2007; 8: 656-67. 4. Maemura K, Takeda N and Nagai R. Circadian rhythms in the CNS and peripheral clock disorders: role of the biological clock in cardiovascular diseases. Journal of Pharmacological Sciences. 2007; 103: 134-8. 5. Schernhammer ES, Laden F, Speizer FE, et al. Rotating night shifts and risk of breast cancer in women participating in the Nurses’ Health Study. Journal of the National Cancer Institute. 2001; 93: 1563-8. 6. Hrushesky W. Circadian timing of cancer chemotherapy. Science. 1985; 228: 73-5. 7. Hrushesky W, Wood P, Levi F, et al. A recent illustration of some essentials of circadian chronotherapy study design. Journal of Clinical Oncology. 2004; 22: 2971-2. 8. Zhang R, Lahens NF, Ballance HI, Hughes ME and Hogenesch JB. A circadian gene expression atlas in mammals: Implications for biology and medicine. Proceedings of the National Academy of Sciences. 2014; 111: 16219-24. 9. Figueiro MG, Plitnick B, Lok A, et al. Tailored lighting intervention improves measures of sleep, depression and agitation in persons with Alzheimer’s disease and related dementia living in long-term care facilities. Clinical Interventions in Aging. 2014; 9: 1527-37.


Watch Mariana’s talk from TEDMED 2014

 

3 Deadly Myths That Masqueraded as Knowledge in Women’s Health

by Betsy NabelPresident of Brigham and Women’s Hospital and Harvard Medical School professor.

Knowledge in science is something we never fully grasp because it is continually reshaped by new information. Information – such as the fact that women and men are different, from cells to selves – doesn’t change. Information is bounded in certainty. But we are at a particular disadvantage when the information that serves as the foundation of our limited knowledge is itself shaky. In the case of women’s health, myth and misinformation have been rampant and deadly.

Women's health leader Betsy Nabel at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED].
“Humility is the secret ingredient that unveils truth.” Women’s health leader Betsy Nabel at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED].

No myth has been more pernicious, or has cost as many lives, as the one that might easily have killed a patient of my own. It was 1983, and I was a young, hotshot cardiology resident, who of course, “knew everything.”  One night, a 32-year-old woman arrived in the emergency room where I worked. She described vague symptoms: aches, fatigue, a low-grade fever – nothing terribly specific. I ran some tests, didn’t find anything telling, and sent her home with Tylenol.  Two days later she came back with a full-blown heart attack.

The problem was, I knew that was impossible. I had been trained by the best, and the best had taught me what the best had taught them: Heart disease was a man’s disease, and the primary symptom of heart attacks was chest pain, which my patient did not have.

Thank goodness, that woman survived.  Her case has driven my career-long commitment to understand the difference between men and women’s health, and to raise awareness of women’s heart health in particular. Today we know not merely that women die of heart attacks, but, crucially, that women experience an entirely different profile of symptoms than men do.

In that case, we simply didn’t know what we were certain we did know. The same was true of a second myth that scarred women’s health for quite some time: that hormone replacement therapy improved women’s health. The model was simple: as women enter menopause, estrogen levels drop, and health problems ensue. The solution seemed intuitive and logical: replace the estrogen.

For years, the medical community relied on dogma — received knowledge — that these treatments worked.  Two in five menopausal or post-menopausal women received hormone replacement, in part to prevent heart disease.

But then scientists challenged the known, by putting this “knowledge” to the test. A multiyear, multimillion-dollar study by the National Institutes of Health – the Women’s Health Initiative (which is the brainchild of then-NIH Director Dr. Bernadette Healy) – examined more than 160,000 women and made a startling discovery. Not only did hormone replacement therapy not prevent heart disease; it actually caused it.

That visionary study — undertaken, significantly, by the public sector at sustained public expense — has saved countless women’s lives.

Today, a third myth is killing women, and this one remains enshrouded in misinformation. Just like we used to think heart disease was a man’s disease, today we think of breast cancer as the most important women’s cancer. Of course, in many ways it is. But lung cancer kills more women than any other cancer — nearly 200 every day, most within a year of diagnosis.

Yet, perhaps because of the stigma associated with lung cancer stemming from an inaccurate perception that the only way to get lung cancer is to smoke – which is especially wrong when it comes to women — research in this disease is chronically under-funded, especially measured by the harm it causes to individuals and families.

Women who have never smoked appear to be at greater risk of developing lung cancer than men who have never smoked. Of the 20,000-25,000 nonsmokers diagnosed with the disease each year, more than 60 percent are women.  Women also develop lung cancer at an earlier age than men. Yet, unlike breast and prostate cancer, for example, there is no widely accepted screening test for lung cancer.

Lung cancer thus presents a double myth: first, that it is solely a smoker’s disease; and second, that it is a cancer women don’t need to worry about.

These myths are a compelling reminder of the need for researchers and clinicians alike to treat men and women as what common sense tells us they are: different. That means clinical trials need to impose a gender lens at every stage of discovery and explore the unique effects of diseases and therapies on women as well as on men, which will lead to better health for both sexes.

An oft-shunned word, ignorance, carries great importance when we consider it as the driver of scientific inquiry, and thus, the molder of new knowledge. Yet when myths are widely believed to be facts, ignorance can kill. We owe half the world’s population much more than that.

Elizabeth Nabel, the President of Brigham and Women’s Hospital and a professor at Harvard Medical School, shared a personally revealing story on the TEDMED stage that pointed to how the limits of knowledge can be a weakness and how accepting our ignorance can be a strength. We are honored she has written an original piece for the TEDMED blog.

Learning by accident: Q&A with Patricia Horoho

Patricia Horoho, Lieutenant General in the U.S. Army and the first woman and first nurse to serve as the Army’s Surgeon General, revealed how health care can cause harm by sins of commission and omission. We followed up with Patricia to answer a few additional questions about her topic.

Patricia Horoho at TEDMED 2014 [Photo: Sandy Huffaker for TEDMED]
Patricia Horoho at TEDMED 2014 [Photo: Sandy Huffaker for TEDMED]

What motivated you to speak at TEDMED?
TEDMED presented a wonderful opportunity to present a difficult subject in a supportive environment. The other speakers, facilitators, and the audience provided a unique opportunity to participate in a remarkable forum. I also saw TEDMED as an opportunity to clearly demonstrate that Army Medicine isn’t afraid to confront the issues of medical errors and harm.

Why does this talk matter now? What impact do you hope the talk will have?
The facts aren’t new – we’ve known about the tremendous cost in lives and health of medical errors for at least a decade. Many leading healthcare institutions and researchers have addressed the issue, but we still haven’t made significant progress in addressing the underlying root causes. TEDMED allowed me the opportunity to highlight existing research and present the issue from my vantage point as the Army Surgeon General. I have traveled around the globe since TEDMED talking to Army Medical teams about the subject of preventable harm.

What kind of meaningful or surprising connections did you make at TEDMED?
The opportunity to talk with Delegates after my talk was incredibly rewarding. Many shared with me their personal experiences of medical harm or the challenges of getting their organizations to recognize and address the problem. What I heard over and over again was that the fear of litigation or the shame of making a human error kept good people and organizations from openly discussing the issue.

How has the military responded to your talk and your message about preventable harm?
I found that Army Soldiers and their families appreciated our collective willingness to discuss preventable harm on a national stage. Thousands of military health professionals are engaged in the detailed work that is required to turn the dial down on preventable harm.

I think the military medical community received the talk generally the same way the civilian healthcare community did. As you might expect, there were at least two major groups: 1), those who recognize the problem of preventable harm across American medicine and welcome the discussion even though it is uncomfortable and 2), those who don’t believe there is a problem or think that the issue is being blown out of proportion. The latter group often doesn’t appreciate the difference between “harm” and “preventable harm.” In medicine, we talk about “adverse events” which is a sterile euphemism for harm. However not all adverse events are the same. Some, in fact most, occur due to circumstances that are not under the control of healthcare professionals. When we talk about preventable harm, Army Medicine is addressing both the human and system errors that reach the patient and cause unnecessary harm. These human and system errors can be anticipated and we can improve our processes to ensure that they don’t reach our patients.

What’s next for you?
In the next weeks and months, I will continue to travel to Army Medicine facilities around the world speaking face-to-face with the leadership of every Army hospital about how we will eliminate preventable harm. In addition, I have opportunities to share Army Medicine successes and challenges with numerous members of Congress and oversight committees.

Entrancing dance: Q&A with Art of Motion Dance Theatre

Art of Motion Dance Theatre, known for using dance to explore body and mind as creative instruments, performed a piece celebrating the divinity of nature at TEDMED 2014. We reached out to learn more about their art.

Art of Motion Dance Theatre, a modern repertory dance company, at TEDMED 2014. [Robert Benson for TEDMED.]
Art of Motion Dance Theatre, a modern repertory dance company, at TEDMED 2014. [Robert Benson for TEDMED.]
What is the legacy you want to leave? 

We hope to have vicariously reached our audiences and impacted the way they see dance, understand the complexity of the human body, brain, mind and spirit. The AOMDT’s unique movement vocabulary and repertoire seeks to impact communities with its cocktail of motion fusing elements of street dance with eastern and western vocabularies including the formality of classical ballet, the abstraction of modern dance and the discipline of yoga. We rely and thrive on the collaborative process.

Art of Motion Dance Theatre at TEDMED 2014. [Sandy Huffaker for TEDMED.]
Art of Motion Dance Theatre, a modern repertory dance company, at TEDMED 2014. [Sandy Huffaker for TEDMED.]
What is next for Art of Motion Dance Theatre? 

The AOMDT continues to create new work, perform, tour, teach and collaborate with musicians, orchestras, costume and lighting designers. We are working on varied projects from a “Salute to Disney Homage” to an evening of live music to a new, avant garde work with a NYC composer, Richard Carrick. Richard wrote the score for “Prisoner’s Cinema,” and created a film based on research of prisoners in solitary confinement. We are also creating an in-depth evening inspired by the “Secret Life of Plants.”

Learn more about AOMDT’s experience at TEDMED 2014 here or check out their website for upcoming performances.

More than a gut feeling: Q&A with John Cryan

John Cryan, a neuropharmacologist and microbiome expert from the University College Cork, reveals surprising and perhaps strange facts and insights about how our thoughts and emotions are connected to our guts.

Butterflies in the brain? Neuroscientist and microbiome expert at TEDMED 2014 [Photo: Sandy Huffaker for TEDMED].
Butterflies in the brain? Neuroscientist and microbiome expert at TEDMED 2014 [Photo: Sandy Huffaker for TEDMED].

What motivated you to speak at TEDMED?

It is an amazing opportunity to put forward a relatively novel concept, in my case that the microbiome may be a key regulator of brain function. The microbiome is one of the hottest areas in medicine and this opportunity allowed me to bring this within a neuroscience context.

Why does this talk matter now? What impact do you hope the talk will have?

The talk summarizes the research on microbe-brain interactions. This is a rapidly evolving field and truly multidisciplinary in nature; I hope my talk reflects this. This research has implications across many aspects of medicine, including psychiatry, gastroenterology, obstetrics, gynecology and pediatrics.

Is there anything else you wish you could have included in your talk?

Recently, we have been focusing on why, from an evolutionary context, microbe-brain interactions emerged; I wasn’t able to go into this very much during my talk. At TEDMED I talked about how bacteria are required for brain development and social behavior but don’t ask why; in a recent paper we collaborated with the evolutionary microbiologist Seth Bordenstein from Vanderbilt to discuss some of the reasons behind this.

What’s next for you?

Right now we are looking to understand the mechanisms as to how microbes could influence the brain. Moreover, we are investigating the impact of naturalistic disturbances of the microbiota on brain function and behaviours such as Cesarean delivery, antibiotic use and early life stress.

Join us for a live Twitter Chat with John at 2:30pm EST on Thursday, March 19, as part of Brain Awareness Week! Tweet your advance questions #TEDMED and #BrainWeek. Check back on our blog for chat topics!

Letting bio-inspired solutions evolve: Q&A with Jeff Karp

Jeff Karp, bioengineer and Associate Professor at the Brigham and Women’s Hospital, Harvard Medical School, illuminates the art and science of adapting medical tools, treatments, and technologies from solutions found in nature. We interviewed Jeff to learn more about his views on innovation and bio-inspired work.

“Successful problem definition must precede a successful problem solution.” Jeff Karp at TEDMED 2014.
“Successful problem definition must precede a successful problem solution.” Jeff Karp at TEDMED 2014.

Why does this talk matter now? What impact do you hope the talk will have?

Solving medical problems is very challenging; we often encounter barriers that seem insurmountable. Instead of relying on our limited intellect and narrow thinking, there is opportunity for us to turn to nature for inspiration. Every living thing has overcome an enormous number of challenges; in essence, we are surrounded by solutions. My hope is that this talk will help others, through inspiration from nature, overcome challenges they face.

What is the legacy you want to leave?

Innovation is not simply coming up with new ideas. I believe that being innovative means actually doing things that help people. Thus, innovation can only be retrospectively defined. My hope is that when I look back on my career, I can claim that many of the projects that we pursued were innovative.

If you had more time on the TEDMED stage, what else would you have talked about?

There are many projects we are working on that I would love to have shared, such as our new battery coating to prevent injury from accidental ingestion of coin cell batteries by kids. There are 3,000-4,000 accidental ingestions of coin cell batteries each year, mostly in young children, and many result in major injuries including death. We also have a drug delivery system that delivers drugs on demand, which we have shown can be used to prevent transplant rejection, achieve longterm sustained delivery for treatment of inflammatory arthritis, and reduce toxicity and dosing requirements for treatment of inflammatory bowel disease. Additionally we have a technology to administer cells via intravenous infusion and target them in the bloodstream to diseased or damaged tissues — a type of stem cell based GPS system. When I talk about the baby tape innovation, it’s worth pointing out that the nurses and doctors in the neonate units emphasized that it’s okay to leave the glue entirely on the skin, as we can easily detackify it by addition of baby power (so it will not stick to bedding). We also found that by adding baby powder to the remaining glue on the skin, we can place another adhesive directly on top with the same level of adhesion. In addition to the video that I showed where we can seal holes in the heart with our slug inspired glue, we have also shown that the glue can affix a patch inside a beating heart, directly to the septum that separates the chambers of the heart where septal defects are located. We have launched a startup based on this technology, Gecko BioMedical; we hope to have our first products in use soon.

Giving Sight to Innovation: Q&A with Uzma Samadani

Uzma Samadani is the cofounder of Oculogica, a neurodiagnostic company that, through eye movement tracking, specializes in detecting concussions and other brain injuries otherwise invisible on radiologic scans. She shared her journey of discovery on the TEDMED 2014 stage. We caught up with Uzma and learned more about her vision and methods of discovery.

Uzma Samadani at TEDMED 2014 discusses her eye tracking innovation for diagnosing brain injury.
“I hope people who hear my talk are inspired to work hard and make their own discoveries.” Uzma Samadani at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED]

Who or what has been your main source of inspiration that drives you to innovate?

Necessity was the mother of invention, and serendipity the father. We sought to develop an outcome measure for a clinical trial for severely injured vegetative patients when we developed the eye-tracking algorithm that we subsequently realized could detect concussion. We had expected to use the eye-tracking algorithm to calculate how well people could pay attention and fixate their gaze, but then were surprised to find that it actually showed us what was wrong with the brain. Now that we have discovered this technology, we understand its implications: it enables us to detect previously ‘invisible’ brain injury. We are inspired, driven even, to innovate and make this technology available to everyone who has sustained trauma. We can help people who previously would not have had objective measures indicating brain injury.

Why does your talk matter now? What do you hope people learn from your talk?

My talk is not so much about brain injury directly as it is about a moment of discovery – the rare shock of finding something remarkable and considering its implications, then the doubt, and the concern about artifact. And then, the gradual realization that we have discovered something real and potentially extremely helpful for humankind. I hope people who hear my talk are inspired to work hard and make their own discoveries.

What is the legacy you want your work to leave?

Brain injury is the single greatest cause of death and disability for Americans under the age of 35 years of age. By creating a biomarker and outcome measure for injury, we can test treatments and therapies and also evaluate prophylactics such as helmets. The true measure of our success will be its utility: to other researchers, to clinicians and to the people who sustain injury.

Brain in Progress: Why Teens Can’t Always Resist Temptation

by Nora Volkow, Director of the National Institute on Drug Abuse at the NIH

It’s National Drug Facts Week, when middle and high schools all over the country host events to raise awareness about drugs and addiction, with the help of scientists from the National Institute on Drug Abuse (NIDA). The issues I discussed in my TEDMED talk—the changes in the brain common to obesity and drug addiction—are especially pertinent to the struggles teens face to resist drugs, because adolescence is a crucial period both of susceptibility to the rewards of drugs and of vulnerability to the long-term effects of drug exposure.

“My obsession is to engage the health care system in addiction.” Nora Volkow on Nora Volkow at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED.]
“My obsession is to engage the health care system in addiction.” Nora Volkow at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED.]

Adolescence is a time of major brain development—particularly the maturation of prefrontal cortical regions involved in self-control and the neural circuits linking these areas to the reward regions. The prefrontal cortex, where we make decisions and comparative judgments about the value of different courses of action, is crucial for regulating our behavior in the face of potential rewards like drugs and food. Adolescents are prone to risky behaviors and impulsive actions that provide instant gratification instead of eventual rewards.  In part, this is because their prefrontal cortex is still a work in progress.

The incomplete maturation of the prefrontal cortex is a major factor in why young people are so susceptible to abusing drugs, including alcohol, tobacco, marijuana, and prescription drugs. There are numerous pressures in their lives to try these substances (stress and peers, for example), but inadequate cognitive resources to help them resist. Because their brain architecture is still not fully developed, adolescents’ brains are more susceptible to being radically changed by drug use—often specifically by impeding the development of the very circuits that enable adults to say “later” … or “not at all” … to dangerous or unhealthy options. Thus, when drug abuse begins at a young age, it can become a particularly vicious cycle. Research shows that the earlier a teen first uses drugs, the likelier he or she is to become addicted to them or to become addicted to another substance later in life. It is likely that the same dynamics are at play when it comes to fattening food and the brain’s reaction to it.

Though parents may get frustrated by their teens’ poor decisions at times, they usually forgive them—because on some level adults understand that kids’ internal guidance systems aren’t yet fully functional. People often have a harder time extending that same forgiveness to adults who suffer from addictions or obesity, because we think they should be better able to control their impulses.  But, the fact is that their internal guidance systems, too, are compromised. For such individuals, it is not a question of free choice or just saying no to temptation; in many cases, only externally offered support and treatment can create the conditions in which their guidance systems can be gradually restored to proper working order.

Averting obesity and drug use also requires that, as a society, we take responsibility for the environments we create for young people. Instead of school cafeterias with an array of cheap, tempting foods high in calories and low in nutrients, we must expose young decision makers to food options that strengthen their health and resolve. Instead of stress-filled or empty time that promotes drug use, kids need access to appealing, healthy, and meaningful activities that encourage them to take pride in themselves and their behavior. Arming young people with scientific information about their bodies, brains, and the substances that can affect them is also crucial—which is the goal of National Drug Facts Week.

Obesity and drug abuse are medical issues, not moral failings. It is gratifying to present the converging science clearly showing this in a forum like TEDMED, composed of people who are informed and curious about the latest medical science. My hope is that the general public becomes more compassionate about these issues, supports wider access to treatment, and understands the importance of greater investment in research on the dynamic ways our brain can be changed by our behavior and vice versa.

Neuroscientist Nora Volkow, director of the National Institute on Drug Abuse at the NIH, applied a lens of addiction to the obesity epidemic in her TEDMED 2014 talk. We are excited to share Nora’s original piece on the TEDMED blog.

Check out our archived Facebook chat discussion with Nora about food addiction from studying the brain chemistry of people with drug addictions.

Sink or Swim, Do or Die: Q&A with Diana Nyad

Marathon swimmer Diana Nyad returned to the TEDMED stage in 2014 to share lessons of her world record-setting solo 110-mile swim from Cuba to Miami at age 64. We caught up with the open water swim champion about her TEDMED experience and what’s up next for her in 2015.

When you achieve your dreams, it’s not so much what you get, it’s who you become.” Diana Nyad on the TEDMED 2014 stage. Photo: Sandy Huffaker for TEDMED

What motivated you to speak at TEDMED 2014?

TEDMED 2010 was my first TED experience. The range and brilliance of the speakers blew my mind. These dedicated innovators are quite literally solving the medical mysteries of our time, and so I was both humbled and honored to appear on stage in their midst. It was a no-brainer to accept the 2014 invitation and to again mix in with our leading health and medical minds.

What kind of meaningful or surprising connections did you make at TEDMED 2014?

I found Marc Koska and his world-changing work with one-time-use syringes deeply moving. This is a classic tale of a man with a social conscience, determined to literally save millions of lives with plain determination. Thirty years ago, Marc was casually reading a magazine and it shocked him to his very core to learn how many millions of people worldwide either die of or are infected with horrific diseases, due to the use of contaminated syringes. He was shot down everywhere he went but eventually implemented the one-time-use needle that cannot be picked up and used to prick the skin a second time. Marc Koska is a shining example of both the work that TEDMED spotlights and those human beings who refuse to let humanity suffer when there are other choices.

How can we learn more about your upcoming book and one-woman show?

Knopf will publish my “Memoir of Inspiration” sometime in 2015. The world premiere of my one-woman show, “ONWARD!” will be on February 19022, 2015 at Studios Theater in Key West, FL and then we move to a bigger theater in Ft. Lauderdale the following weekend. We hope to develop the show for Broadway next!