Four Thought Leaders Shaping the Future of Health Care

By guest contributor and TEDMED 2015 speaker Thomas H. Lee, MD

For years now, experts have said health care should move “from volume to value,” and the good news is that it’s finally happening. Even within the past few months, the pace of change has accelerated. More and more payments to providers are tied to quality and efficiency, and increasing amounts of data on their performance are being published online.
Empathy suffering health careIn my TEDMED talk, I spoke about how the reduction of suffering was becoming the focus for health care. Today, many health care providers are starting to compete on how well they meet patients’ needs.
As this competition increases, health care providers can look to four key thought leaders whose work influences my own every day: Michael Porter, Leemore Dafny, Ronald Burt, and Nicholas Christakis. Individually and collectively, their contributions provide clarity on what we need to do in health care, why we need to do it, and how to get it done.
Over the last few decades, Michael Porter of Harvard Business School has defined the meaning of strategy for business in general. His work on health care clarifies why an overarching strategic goal is important for every organization, and why that goal should be to create value for patients. He and his colleagues have described how multidisciplinary teams should look, and what kind of information and incentives those teams need to drive improvement.
If Porter’s work describes the “recipe” for what we need to serve in health care, Leemore Dafny helps us understand the heat that is necessary to start things cooking. She is the Harvard economist who has studied payer and provider consolidation and shown how it leads to weaker competition and higher prices. I have long been leery of thinking about health care as a marketplace, concerned about unintended consequences if patients have to act like consumers and make tradeoffs in quality and price. But Dafny and her colleagues are persuasive when they argue that competition in a value-driven market has greater potential to drive improvements in quality and efficiency than the alternatives – and that providers like me should embrace competition and learn to trust market forces.
Porter and Dafny’s work tell us what we have to do, and why we have to do it. But how do we get that work done? Part of the answer is to strive for the creation of social capital.
For the last several years, I have given a book to virtually every new close colleague: Brokerage and Closure: An Introduction to Social Capital by University of Chicago sociologist Ronald Burt. We all know about financial capital (the funds that enable organizations to do things they otherwise could not do), and about human capital (hiring good people). Social capital is about how those people work together. If they are reliable in their coordination, the organization can make leaps in quality and efficiency. Burt provides a clear and useful structure for learning (increasing variation in what is done by brokering ideas) and then converging on best practices (closure).
Then there is the challenge of how do we make collaboration and compassion the norm in health care. Financial incentives cannot get the job done. That is why I think so often of Nicholas Christakis, the Yale social network scientist who has shown how epidemics of values and emotions can spread from person to person. While the work of Porter, Dafny, and Burt define the big picture, Christakis characterizes the nature of the work that needs to be done on the ground.
There are, of course, many more colleagues whose work I respect and learn from, but these four constitute a “package” that I think can accelerate the transition to a new and better health care system.
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TEDMED Speaker Tom Lee, on addressing patient suffering in health careIn his TEDMED talk, quality care pioneer and Chief Medical Officer of Press Ganey, Tom Lee reveals his passionate quest to define empathy as a business asset and patient suffering as an outcome.

Being Wrong Can Help Get It Right

By guest contributor and TEDMED 2015 speaker Anthony S. Fauci, MD

One of the best things I have done in my career is admit that I was wrong.

In the early days of AIDS – before we had the first effective treatments – I was a complete believer in the tried-and-true research-to-pharmaceutical pipeline. This rigorous process, based on the gold standard scientific and regulatory approach to clinical trials, usually required many years to run its course. However, for people living with HIV infection in the 1980s, that was time they did not have.

In the late 1980s, the frustration of those affected by HIV/AIDS was reaching a breaking point. Their anger about the pace of research to develop HIV treatments was often directed at me, as I oversaw much of the government’s HIV/AIDS research as director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. I supported what I knew to be an effective research process. However, it was not until I listened to the activists and began to appreciate their concerns by imagining myself in their place, and by inviting them into my office when they demonstrated in protest on the NIH campus that it became clear that something had to change. At that moment, that something had to be me. I ended up working with the activists to develop an unconventional “parallel track” for drug development, one that provided access to experimental drugs for patients in need at the same time that rigorous clinical trials were still ongoing.

A healthy human T cell uninfected by HIV/AIDS.
A healthy human T cell uninfected by HIV/AIDS.

Change, especially the type of change that asks us to question the systems on which we have built our careers, can be difficult. It requires us to at least question and sometimes change our beliefs and habits, and step into unfamiliar territory. Embracing flexibility is sometimes more difficult than maintaining the status quo; however, having this mindset can generate novel solutions. In the case of HIV, by changing the research paradigm and engaging HIV activists as partners in the research endeavor, we were able to develop effective HIV drugs faster, ultimately saving millions of lives.

As the HIV/AIDS pandemic has evolved over the last 35 years, being open-minded remains crucial to defeating this disease. We must continually step back, reassess, look at the larger picture, and identify solutions to seemingly intractable challenges.

Today, science has presented a clear opportunity to end the HIV/AIDS pandemic. We now know that everyone infected with HIV should be offered antiretroviral drugs as soon as the diagnosis is made, for their health and to prevent further transmission of the virus. Last year, NIH-funded research provided strong evidence of the advantage of beginning treatment soon after diagnosis rather than waiting until immune system damage occurs. Clinical trials also have demonstrated that HIV treatment benefits not only the infected individual, but also his or her sexual partners, as lowering the level of virus in the body reduces substantially the risk of transmitting it to others.

Together, HIV treatment and other proven prevention interventions – such as pre-exposure prophylaxis, or PrEP, a single daily pill containing two anti-HIV drugs – provide a powerful toolbox for ending the HIV/AIDS pandemic. If the tools we already have for HIV treatment and prevention were widely implemented, and all HIV-infected individuals were identified and placed in stable, effective medical care, and uninfected individuals in high risk situations were provided prevention tools including PrEP where appropriate, more than 90 percent of new HIV infections worldwide could be prevented each year.

Sadly, the rate of new adult HIV infections has held steady at about 2 million per year since 2008, indicating that despite innovation and advances, we are still far short of our goal of ending AIDS as a major global health problem. Although we have the tools and knowledge to accomplish this goal, substantial barriers still stand in our way. Economics, race, gender, stigma and discrimination all play a role in preventing people from accessing prevention tools, getting tested, connecting to care and accessing treatment.

Hard-won scientific advances collide with these barriers, impeding the progress that research can bring. Just as we did in the early days of the AIDS epidemic, we must now step back and reassess. We must ask ourselves how we can think differently about bringing about an end to this pandemic by more effectively scaling up the powerful tools of treatment and prevention that we know can bring HIV/AIDS to heel. As I have learned, questioning and sometimes changing how we do things can be the first step toward getting things right.
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Anthony Fauci: Learning from the AIDS epidemicIn his TEDMED 2015 talkNIAID Director Anthony S. Fauci, M.D., shares his deeply personal account of how he had to bend certain overly rigid rules of science to fit with the emergent needs of HIV/AIDS patients and activists.

Getting Out of Diabetes Denial

By guest contributor and TEDMED 2015 speaker Laura Schmidt, PhD

As a society, we are confronting some tough facts about the way we eat and what it’s doing to our health. We live in an environment that bombards us with hyper-palatable foods and sugary drinks on a 24/7 basis—products carefully engineered by scientists to be impossibly tempting and habit-forming. It’s not surprising that many of us find it difficult to summon the willpower to avoid heavy use of these products.

But we can’t ignore the warning signs that our food environment isn’t just making us fat, it’s also making us sick. One is the appearance of adult diseases in children. In my parent’s generation, they called it “adult onset diabetes” because only adults got it. Today, one in four American children will acquire Type 2 diabetes within their lifetimes and an alarming half of our children of color.

shutterstock_293590097When problems get this big and overwhelming, there’s a strong impulse to ignore the problem—to fall into “diabetes denial” just like some people deny the reality of climate change. And at its crux, the junk food problem isn’t all that different from carbon emissions. It’s driven by globalizing industries that reap the economic rewards of free trade as governments struggle—and often fail—to establish regulations that protect human and planetary health.

What’s remarkable is how much progress we have made in the short time that I’ve been involved in food policy, particularly regarding sugar. I was an addiction researcher for years before I wandered into food policy research and got stuck. I got stuck by the sheer enormity of the problem and because I could see that time-tested regulatory solutions for alcohol and tobacco could help us clean up our food environment.

What it takes to fix wicked problems is a “virtuous cycle” of public health policymaking. This is no better illustrated than by the war on tobacco—the single greatest public health victory of the 20th century. Here’s how it works:

It starts with courageous public officials telling people the cold hard facts, thus moving the society out of denial. What follows are policies to tax the most harmful products, which generate funds for public health programs, such as public education campaigns and school-based programs. As momentum picks up, policymakers feel emboldened to pass new regulations, such as product warning labels, as well as measures that directly clean up the environment.

In the short time I’ve been working on food policy, I’ve seen the virtuous cycle take off with regards to some of the most harmful products, namely sugary drinks. Here are just a few highlights:

Courageous public officials speak out: Thomas Frieden, Director of the US Centers for Disease Control and Prevention states that “Taxing sugary drinks at 1 cent per ounce could be the single most effective measure to reverse the obesity epidemic.”

Taxes generate funding for public health: First sugary beverage taxes passed within US borders: the Navajo Nation (2015), Berkeley, CA (2015), Philadelphia, PA (2016)

Policymakers are emboldened: First sugary beverage warning label legislation passed (San Francisco, CA, 2015); first US Dietary Guideline setting an national limit on added sugars (2015); first Food and Drug Administration nutrition label to warn consumers of added sugars (2016)

Direct measures to clean up food environments: First state sales ban of sugary beverages in schools (California, 2009); first city to ban sale on all city properties (New York City, 2012); hospitals begin to ban sales (2011)

The first step in recovering from addiction is to stop denying the problem. It is so gratifying to see our society move from denial to action on sugar in just a few years. May we see many more virtuous cycles that promote human and planetary health to come.


Illustration_0021_Illustration_0012_LauraSchmidt.tif

In her TEDMED 2015 Talk, UCSF researcher and sugar policy expert Laura Schmidt questions whether consumers truly have freedom of choice over the foods they purchase and eat in our sugar saturated society. 

Creating sustainable, delicious meat alternatives

By guest contributor and TEDMED 2015 Speaker Patrick O. Brown, MD, PhD of TEDMED Hive Organization, Impossible Foods

The horse was a brilliant transportation technology until we developed the automobile. The typewriter was a wonder in its time until we invented the personal computer. The carrier pigeon was the state-of-the art in mobile communication, until radio communication was invented. Now it’s the cow’s turn to be replaced by better technology.

Cows, and the other animals we cultivate for food, have, for millennia, been our state-of-the-art technology for turning plants into meat. But we need to do better, and we can.

Cattle Farm - An inefficient source of meatAccording to a recent estimate by the International Livestock Research Institute, 45% of Earth’s dry land — a land area greater than North and South America, Australia and Europe combined — is currently being used to support livestock production. According to the UN Food and Agriculture Organization, animal farming uses and pollutes more water than any other industry and generates as much greenhouse gas emissions as the entire global transportation system. And it is the major driver of deforestation and an unprecedented collapse of wildlife populations around the world.

The world is on a headlong quest to produce ever-greater quantities of meat in the belief that we need a growing supply to feed the world. We don’t. The plant crops harvested in 2015 contained more than enough of every essential nutrient to meet the nutritional needs not only of our current population but the 9 billion people who will share the planet in 2050.

Yet people love, and demand, meat; it is both unfair and unrealistic to ask people to change the diets they love. Fortunately, the problem isn’t that people love meat – it’s how we produce it. And that’s a solvable problem.

We simply need to replace the inefficient, unsustainable animal-based technology we’ve used for thousands of years with a better, more efficient and more sustainable way to transform plants into the meat and dairy foods the world loves.

Five years ago, I founded Impossible Foods, assembling a mission-driven and supremely talented research & development team to take on this challenge. They’ve been developing the know-how and inventing technology for transforming simple nutrients from plants into uncompromisingly delicious, nutritious, affordable and sustainable meats and dairy foods. Our first product, the Impossible Burger, will be available to consumers this summer.

A lifecycle analysis shows that producing an Impossible Burger requires less than 1/12th the land and 1/9th the water and emits only a quarter of the greenhouse gasses, compared to producing the same meat from a cow.

The cow is not getting any better at turning plants into meat and it never will. But with an entirely new approach, we are getting better at it every day, and we’ll keep getting better. And we won’t stop until we’ve made all the foods we currently get from animals — chicken, fish, milk, eggs — directly from plants.

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Pat Brown of Impossible FoodsIn his TEDMED 2015 talk, renowned geneticist and founder of Impossible Foods Pat Brown explains how he uses biochemistry to trick plants into producing the same protein as meat – all while tasting just as delicious – in his quest to eliminate the need for animal harvesting.

In the system of American science, caution has overtaken creation

By guest contributor and TEDMED 2015 speaker Roberta Ness

The scientific community is unwell. Worse, the hospital to which it has been taken is utterly unsuited to cure it. Young professionals feel that the system does not promote, but instead strangles, their creative dreams. The result: the most extraordinary potential for progress in history is being squandered.

InnovationInnovation is society’s engine of progress– our instrument for hope. Our modern love affair with innovation leads us to desire having as much of it as possible and to fear its loss. A quick web search for “innovation” yields about as many hits as the word, “boyfriend”. Yet, our system of science from its funders through its institutions, does not allow practitioners to reach their full creative potential. I know this firsthand because I have encountered so many of these frustrated scientists.. Nearly every time I lectured at a research university about how to improve innovative thinking, a young person would stand up at the back of the room during the question and answer period and say something like, “Dr. Ness, this was inspirational, but you are proposing really radical new ideas. If I tried to do what you counsel, I would never be able to get funded or be published.” I heard this lament perhaps a dozen times when finally it struck me, “duh– there’s a big problem here, and it is not due to these young, bright minds.”

The problem, I came to discover in writing my most recent book The Creativity Crisis is that caution has overtaken creation within the system of American science. Society begs for revolutionary advancement but spends its dollars on tangible products. Ideas are conceived as “individually owned” and intellectual property is shielded by patents rather than shared for the benefit of all. The hierarchy and insularity of science stymies rich collaborative possibilities, so, for instance, the historic opportunities offered by crowdsourcing goes unexploited. A suffocating burden of federal and state restrictions and regulations continue to grow as society becomes increasingly apprehensive about the harms that science can bring.

The result of this perfect storm is that the largest and most difficult problems science must solve-– climate change, emerging epidemics, social inequity, Alzheimer’s disease-– rage unabated. I believe we must find solutions to these disasters-in-progress that are far more radical than the current system permits.

Yet, not all is doom and gloom. Science continues to march forward at a prodigious pace, even if that march often produces things less necessary than nice. Some institutions such as the Howard Hughes Foundation and Google have incorporated a series of systems changes for the focused purpose of tending and nurturing creative innovation.

We need not be satisfied with a system of science that fails to achieve its full potential for advancing societal well-being. To implement original solutions to society’s most threatening problems, we must bring creation and caution into equipoise. The Creativity Crisis examines in detail the ills of modern science and multiple remedies that, by abandoning convention, may contribute to fixing the broken system. I can only hope that this book and related TEDMED talk will launch a discussion in which all of you will help to reinvent the scientific ecosystem. I believe that if you open your minds and your hearts to the potential for creative disruption, together we can solve the creativity crisis and unleash possibility.


Roberta Ness TEDMED Artist Illustration_FotorIn her TEDMED 2015 talk, innovation expert and physician-researcher Roberta Ness imparted her wisdom for combatting science’s creativity crisis and sparking the type of revolutionary innovations that science and medicine so desperately need.

Gaining Wisdom in the Family, Workplace, Community, and Society

By guest contributor and TEDMED speaker, Dilip V. Jeste, MD.

Wisdom is a complex human trait. It includes several components: 1) ability to make appropriate social decisions, 2) overall happiness coupled with control over emotions, 3) helping others through compassion and altruism, 4) self-knowledge and ability to reflect, 5) humility to know the limits of one’s knowledge, and 6) decisiveness when needed. I believe there is an evolutionary purpose to wisdom – it enhances individual well-being along with one’s usefulness to society. Wisdom includes much more than intelligence – that is why wise people are typically intelligent, but not all intelligent people are wise!

The basic concept of wisdom is similar across the globe and has been essentially unchanged over the known history of human behavior. However, there are some cultural differences. For example, spirituality would be considered an essential component of wisdom in some cultures, but not in others. Aging is associated with increased wisdom. As I mention in my TEDMED talk, wisdom likely compensates for the loss of fertility and of physical health that accompanies aging, and allows wise grandparents to transfer their life knowledge to younger generations.

Aging is associated with increased wisdom. (Image: Shutterstock.)
Aging is associated with increased wisdom. (Image: Shutterstock.)

How do these concepts of individual wisdom apply to the wisdom of larger groups such as a family, workplace, sports team, community, or society? A large majority of the members of a wise group would have high levels of wisdom; however, it is not necessary for all members of the group to be particularly wise. Indeed, it is more useful to have diversity in multiple forms including some individuals with varied levels of wisdom. A critical necessity is having wise leadership. Openness to new experience is an essential criterion for group wisdom, but not necessarily for individual wisdom.

A wise workplace will be productive and creative, but will also be happy. Businesses that focus solely on sales or profits would not be considered wise if they require constant or unhealthy competition among their members. Similarly, a collegiate sports team that seeks to win at all costs rather than to ensure high graduation rates and a milieu of collaboration, cooperation, and empathy toward less gifted competitors, is not a wise team, regardless of the number of championships it wins. The trick is in balancing a drive for excellence and hard work, with grace in defeat and magnanimity in victories.

How can wisdom be fostered in such groups? An important means would be through behavioral strategies. Wise parents seek to raise their children to be better decision makers, less impulsive, and with more control over their emotions, more caring of their siblings and friends, while avoiding egotism or ambivalence, and promoting self-reflection. Successful parents do not rely only on teaching their children to embrace these values; they also act as role models of such behaviors by reinforcing positive behaviors and not rewarding untoward ones.

Psychiatrists, psychologists, and other therapists and counselors seek to modify the high-risk behavior of persons with mental illnesses, such as delusions, aggression, or suicidal depression, with cognitive behavior therapy (CBT). The focus of CBT is on 3c’sCatch the untoward behavior, Check that it is unhelpful, and then Change it to helpful behavior. The same principles can be applied to replace unwise behavior with wise behavior at workplace, on sports teams, and in various businesses. While employees who sell the largest volume of products can be rewarded, so too should be rewarded the people who help develop a collegial milieu which increases other workers’ level of happiness leading to greater overall productivity. For example, in basketball, they would reward players with the most assists along with those who scored the most points.

The responsibility for making a group wise lies primarily with its leadership, which then makes sure that the culture promoting wisdom trickles down the chain of command, and reaches the workers on the lowest rung. Ultimately, promoting group wisdom is not merely a nice thing to do– it is a smart thing to do!

 



Dilip Jeste

 

In his TEDMED talk, geriatric psychiatrist and neuroscientist Dilip V. Jeste reveals how our brains compensate for physical aging, and discusses an unexpected evolutionary advantage to growing old–gaining sage wisdom–which holds great promise to benefit society as a whole. Watch Dilip’s talk here.

References:

Jeste DV and Vahia I: Comparison of the conceptualization of wisdom in ancient Indian literature with modern views: Focus on the Bhagavad Gita. Psychiatry 71:197-209, 2008.

Meeks TW and Jeste DV: Neurobiology of wisdom: An overview. Archives of General Psychiatry 66:355-365, 2009.

Jeste DV and Harris JC: Commentary: Wisdom – A neuroscience perspective. Journal of the American Medical Association 304:1602-1603, 2010.

Jeste DV, Ardelt M, Blazer D, Kraemer HC, Vaillant G, and Meeks T: Expert consensus on the characteristics of wisdom: A Delphi Method study. Gerontologist 50:668-680, 2010.
Bangen KJ, Meeks TW and Jeste DV. Defining and assessing wisdom: A review of the literature. American Journal of Geriatric Psychiatry 21:1254-1266, 2013.

Jeste DV and Oswald AJ. Individual and societal wisdom: Explaining the paradox of aging and well-being. Psychiatry 77:317-330, 2014.

Thomas ML, Bangen KJ, Ardelt M, Jeste DV. Development of a 12-item abbreviated three-dimensional wisdom scale (3D-WS-12): Item selection and psychometric properties. Assessment 24, 2015.

Meeks TW, Cahn R, and Jeste DV: Neurobiological foundations of wisdom. In Siegel R, Germer C (eds.): Wisdom and Compassion in Psychotherapy. New York, NY: Guilford Press. pp. 189-202, March 7, 2012.

Sanders JD, Meeks TW and Jeste DV: Neurobiological basis of personal wisdom. In Ferrari M, Westrate MN (eds.): The Scientific Study of Personal Wisdom. New York, NY: Springer. pp. 99-114, 2013.

The Workforce of the Future

Vivienne Ming discusses our future workforce.
Vivienne speaking at TEDMED 2015.

“How can we make students robot-proof?”

This was the question posed to me a few years ago at the Department of Education. They were designing a 6-week job retraining program, but couldn’t divine which skills to teach that would still be employable 10 years from now. They were hoping I could help them devise a short program to teach some crucial knowledge or skill that we knew wouldn’t be displaced by artificial intelligence in the future. Here is the simple truth I shared with them: there is no skill or knowledge which is robot-proof.

Automation, Artificial Intelligence, and Why Automation Is Different This Time

The concerns of the Dept. of Ed. are well-founded. Quite apart from the hysteria surrounding general artificial intelligence – the existential threat posed by a fully aware computer that surpasses us in intelligence – they and many others are focused on a much more mundane problem: basic AI and other computerized automation will displace the world’s labor force, leaving few jobs for humans. The three largest employers in the world–agriculture, transportation, and natural resources–are all seeing huge advances in robotic automation. For example, precision farming involving drones, robotic weeders, and AI-driven irrigation produces more food but needs few humans. The productivity gain truly is a fundamental good, but what happens to the one billion agricultural workers worldwide?

Importantly, AI isn’t only replacing physical labor, but cognitive labor, and it’s doing so at an increasing rate. We now see automated systems outperforming or displacing humans in medical diagnostics, journalism, financial advising, and a vast array of other industries. A recent paper described a deep neural network that can read the technical specifications for software companies’ APIs (the rules that allow one computer system to interact with another), and can then automatically spit out a simple set of instructions for writing code using the API. It would be a rather minor additional step to have a basic AI write the code itself. Despite all the focus in recent years in teaching students to code, it seems unlikely to me that simple programming will be a viable skill 5 or 10 years from now in the same way it is today. I’ll simply “hire” an AI contractor, giving it a set of specifications and even having a conversation around the details. It will quickly and easily spit out prototypes and update them based on real-time feedback. While this sounds wonderful to me as an entrepreneur, software developers might feel like they bought a home just as the real estate bubble burst.

AI Workforce vs. Human Workforce?Techno-utopians may claim that AIs will free everyone to be artists and doctors. They imagine themselves freed of the burdens of rent and the need to take a job just for the paycheck, spending lives of purpose solving deep problems. Our schools and other social institutions, however, are simply not designed to produce a workforce full of problem-solvers. It is much more likely that we would have a world in which the labor of some is worth more than an AI, but the labor of the vast majority is worth less. What a profound divide that would be.

Craftsmen and Their Tools

Research has shown, rather dramatically, that knowledge and skills, and the grades, test scores, and degrees associated with them, are simply not predictive of employability and other life outcomes. Yet schools and so many job-training programs focus exactly on these: how to program, how to factor a polynomial, how to write a grammatically correct sentence, or how to sketch the human form. They are valuable skills, but only in the hands of someone empowered to make use of them. These are just the tools that craftsmen employ, not the craft itself. What predicts life outcomes is the quality of the craftsman. A large and growing body of research links success with qualities like general cognitive ability, metacognition, mindset, emotion regulation, and creativity. These are attributes which we have described as meta-learning–the deeper abilities that enable learning.

A further, fundamental problem is that no tool is robot-proof. There is no basic skill or knowledge which we cannot eventually build an AI to perform more economically than a human. Tools neither differentiate people from one another, nor protect them from robots. Instead of trying to guess which skills kids need to know 20 years from now, we should build craftsmen who can master any tool. A craftsman without their tools is hobbled, but tools without a craftsman are entirely pointless. To robot-proof our kids, we must develop their meta-learning skills, producing a generation of problem-solvers.

A human story

With AI’s providing all of the tools, the future of work is the hyperinflation of work: you’ll show up in the morning, and it will be a different job by the end of the day. The only job description in the future will be that of a problem-solver, with every day posing a different problem (and it sounds damned exhausting). But imagine what a society full of such craftsmen could accomplish with a toolkit full of AI tools. What could be accomplished if we truly were a society of problem-solvers, of craftsmen?

I am a huge advocate of the potential of machine learning, AI, and even the eventual power of augmented intelligence and neuroprosthetics. They are a foundational part of a world in which I want to live. But this is fundamentally a human story, not a technological one. No one is going to stop the rise of AIs. We need to match it with the rise in social institutions built on the core principle that everyone can be amazing. But it takes years, even decades, to “build” an amazing person. If technology continues to outpace culture, the results will be catastrophic.

We don’t have to accept that outcome. While there’s no online course or six-week job retraining program for meta-learning, we know how to develop it over time. We know how to build into kids a belief that their hard work will pay off. The irony is that the solution to humanity’s place in a futuristic world of robots and AIs is as old as it gets. The things that will make us robot-proof are the very same things that are predictive of life outcomes of both kids and adults today, and have probably always have been throughout the history of humankind. The best way to robot-proof your kids is to make them all the more uniquely human.


VivienneMing
This guest blog post is by TEDMED 2015 speaker Vivienne Ming. You can watch Vivienne’s TEDMED talk here.

The future of infusing art into anatomy

Achilles_anatomy
Greek street artist, Achilles, used the rooms of an abandoned building to create a spatial journey through layers of a human head, from the skull to the face.

By guest contributor and TEDMED speaker Vanessa Ruiz

Eaton-Houdon Écorché by Scott Eaton
Eaton-Houdon Écorché by Scott Eaton

When we talk about the future of medical illustration and learning anatomy, it’s often tied to advances in technology. What advances in technology will allow students to learn anatomy faster, allow them to memorize terms more efficiently, or provide better methods for them to interact with anatomy without actually touching a cadaver? But if you look at all of the resulting technologies, such as 3D anatomy apps, augmented reality organs, or virtual reality cadavers, the foundation still lies within an established ideal of anatomical representation. We’ve simply moved the same anatomical imagery from a textbook page to a screen. But instead of trying to change the medium by which we learn to technology, why not change the mindset of the approach to an artistic one, to engage a broader audience? Why shouldn’t the public, rather than just medical professionals, have access to learning anatomy?

Nearly 10 years ago it was difficult to find many artists featuring anatomy as a subject in their artwork. And I’m not referring to “the figure” as it is studied in art. I’m talking about the muscles, skeleton and viscera— what lies beneath the skin. Today the acceptance of anatomical art in pop culture is palpable. It’s pulsing in the trends of film, street art, advertising, interior design, and even fashion. A quick web search for “anatomical heart necklace” yields an overwhelming amount of resulting iterations. What is fascinating is that this anatomical art movement has risen exponentially alongside the rather stagnant practice of anatomy education. With all of the advances in medicine, the time and resources allocated to teach anatomy to medical students is diminishing. This is why students often turn to technology such as anatomy apps to supplement their learning.

Danny Quirk paints the musculature of the forearm on Anna Folckomer of Immaculate Dissection
Danny Quirk paints the musculature of the forearm on Anna Folckomer of Immaculate Dissection

But, as the boundary between science and art blurs, it is no longer sufficient to talk about either on their own. We need to see how each informs the other. This crossover between medical illustration, art, and anatomy learning is beginning to take place. We’ve gone beyond the “Anatomy Coloring Book.”

The dramatic anatomical body paintings by medical artist Danny Quirk, of Immaculate Dissection, are now used to teach anatomy to anyone from physical therapists to athletic trainers to bodywork practitioners; the technique has been so popular that it’s been replicated in anatomy classes around the world.

Sculpting anatomy by hand from the skeleton outward has become a means for not only artists to learn anatomy, but for medical students as well. This is where the distinction between viewing a body in 3D versus tangibly building a body becomes clear; building by hand requires spatial knowledge and memory– tying doing with learning instead of looking and memorizing.

The truest delivery of anatomy to the public takes the form of street art. A growing number of artists are vibrantly broadcasting anatomy on the streets in a vast array of styles. Street artists are pushing their work to be site specific and interactive.

heArtbeats by Lanoc
heArtbeats by Lanoc

Imagine the immersive experience of learning anatomy by walking through rooms of an abandoned building. As dynamic as Achilles‘ warehouse anatomy above, this piece by Croatian street artist Lanoc shows an anatomical heart pumping blood through industrial air ducts. It is site-specific street art, pulsing with life.

Austrian street artist, Nychos, is famous for his explosive views of anatomy. He recently started a series of anatomical charts using his edgy, hard metal style.

The Human Skeleton Anatomy Sheet by Nychos
Imagine seeing this in a doctor’s office: The Human Skeleton Anatomy Sheet by Nychos

While the public is embracing anatomical art, there are many medical professionals that still see medicine and art as two separate subjects. A radiologist approached me after my TEDMED talk and excitedly told me that she creates art from X-rays. When I asked her to see it she said that she never shares it because she doesn’t think it is special or it might be looked down upon by her peers. I encourage artistic expression in medical professionals because it is natural and deeply tied to medicine.

It can be argued that there are only so many ways to represent anatomy, but I counter that by all the astounding ways that artists are able to portray anatomy in their work. Artists have broken anatomy out of the confines of the medical world and are now beginning to reintroduce it back in with a whole new approach and style. The future of medical illustration doesn’t depend solely on advances in technology; it begs to be pushed further by artists. I feel compelled to showcase and catalog contemporary anatomical art, as well as promote the artists and medical illustrators that are pushing the boundaries of anatomical visualization. Because one day, they will be part of the history that leads to something greater– when the public will fully appreciate and understand its own anatomy.


Watch anatomical artist and curator Vanessa Ruiz’s TEDMED talk, in which she shares how she fulfilled her dream to take anatomy to the streets, and make medical illustration– and the resulting public knowledge of the human body– intersect with contemporary art. Check out her website, streetanatomy.com, which showcases human anatomy in art, design and pop culture.

Radiation Doesn’t Scare Me: Negative health effects vs. relocation trauma

By guest contributor and TEDMED 2015 speaker Holly Morris

This spring marks the 30th anniversary of the Chernobyl Nuclear Power Plant accident in Ukraine, the world’s worst nuclear accident. Today, Reactor No. 4 simmers under its “sarcophagus,” a concrete cover hastily built immediately after the accident, now cracked, rusted and leaking radiation. Its long delayed “New Safe Confinement,” the structure being built to cover the reactor, has been repeatedly delayed, and is now years overdue. This story of nuclear disaster is in its early chapters.

Inside Chernobyl’s 1000-square-mile “Exclusion Zone,” known simply as “the Zone,” lies the most contaminated land on Earth, including hundreds of unmarked (and unmapped) burial sites where machinery from the clean up after the 1986 accident was dumped. These days, Ukraine’s four other nuclear power plants also dispose of their spent fuel inside the Zone.

But amidst the complicated real-life equations and compromises–where science and politics meet to duke out the viability of nuclear energy–the long, deep, human parable of Chernobyl is often lost. That story is partly embodied in an unlikely community of some 100 people, called “self settlers” who, today, live inside the Zone. Almost all of them are women in their seventies and eighties; they are the last of a group of some 1200 people who defied authorities and illegally returned home after being evacuated.

“Radiation doesn’t scare me. Starvation does," states Hanna, a babushka of Chernobyl (photos credit: Yuli Sollsken)
“Radiation doesn’t scare me. Starvation does,” states Hanna, a babushka of Chernobyl (photos credit: Yuli Sollsken)

One self-settler, Hanna, told me how she snuck through the bushes back to her village in the summer of 1986. “Shoot us and dig the grave,” she told the soldiers who nabbed her and other family members, “otherwise we’re staying.” Then she handed me a chunk of warm salo, raw fat, from her just-slaughtered pig.
Why would they choose to live on deadly land? Were they unaware of the risks, or crazy enough to ignore them, or both? These women see their lives, and the risks they run, decidedly differently.

It’s all about context– the women had already survived Stalin’s famines, and Nazi atrocities, and were simply unwilling to leave their homeland in the face of an enemy that was invisible–radiation.

So long as they were well beyond child bearing, self-settlers were eventually allowed by officials to return. Five happy years, the logic went, is better than fifteen condemned to a high-rise on the outskirts of Kiev. Despite the hardship, the wolves, the radiation – all of the women chose to return to be near the graves of their parents, and babies; to the villages, they say, where they know, exactly, where the sun will rise. There is a simple defiance common among them: “They told us our legs would hurt, and they do. So what.”
The benefits of hardy live-from-the land realities are complicated by an environment laced with radioactive contaminants such as cesium, strontium and americium. The upper estimates of the eventual Chernobyl death toll are in the tens of thousands. Thyroid cancers are sky high, and that Chernobyl evacuees have suffered the trauma of relocated peoples everywhere, including anxiety, depression, alcoholism, and disrupted social networks.

To be clear, the nuclear accident was a miserable tragedy that clobbered the health and economy of a region. But relocation trauma is another, less-examined fallout of Chernobyl. As one Chernobyl medical technician put it about the old people who relocated: “Quite simply, they die of anguish.”

Home is the entire cosmos of the rural babushka, and connection to the land is palpable. Chernobyl babushka sayings go, “Those who left are worse off now. They are all dying of sadness,” “When you live outside your village, you leave your soul,” “Motherland is Motherland. I will never leave.” The surprising truth seems to be that these women who returned home have, according to local officials and journalists, (and the women themselves) have outlived their counterparts who accepted relocation– by some estimates, up to 10 years.

How could this be? Certainly, their exposure at an older age put them at smaller risk. (Younger animals– this includes humans– are more susceptible to the effects of radiation.) But consider a less tangible though equally powerful idea. Does happiness affect longevity? Is the power of motherland, so fundamental to that part of the world, palliative? Are home and community forces that can rival even radiation? I believe so and without exception, the women of the Zone do too.

I’m traveling to Ukraine this spring to screen “The Babushkas of Chernobyl” with the film’s central characters, Hanna Zavorotyna, Valentina Ivanivna and Maria Shovkuta. They continue to gather mushrooms, brew moonshine, and scare off wild boars who would mess with their gardens. Radiation or not, the babushkas are at the end of their lives. In their 80’s now, they are frail, and smaller; it feels as if they are a whisper away from being gone. But their existence and spirit will live on, leaving us wondering about the relative nature of risk, about transformative connections to home, and about the magnificent tonic of personal agency and self-determination– unexpected lessons from a nuclear tragedy.

Check out the Babushkas of Chernobyl trailer:

The Babushkas Of Chernobyl Trailer by Holly Morris on Vimeo.


 

Holly Morris on the TEDMED stage (photo credit: Sandy Huffaker for TEDMED)Watch Holly’s TEDMED talk, Chernobyl: Flourishing lives in the dead zone.

Follow her @HollyMorris and learn more about Holly’s other projects at HollyMorris.com.

A Culture of Health Includes Everyone

This guest post is by Sam Vaughn, TEDMED 2015 speaker and Neighborhood Change Agent in the City of Richmond, California. You can watch Sam’s TEDMED talk here.

Sam Vaughn 2A person can have a healthy heart and diseased lungs, or a healthy brain and kidney failure. Would you consider that person healthy? Society is quite similar. Until we create a culture of health that is inclusive of all citizens, we cannot consider ourselves a healthy society. Thus, we cannot create a healthy society until we deal with issues of personal security, like crime and gun violence.

As I mention in my TEDMED talk, at the Office of Neighborhood Safety, we identify individuals who are most likely to be perpetrators or victims of gun violence. We work with them through a program called the Operation Peacemaker Fellowship, a seven-step process to help them become self- and socially-aware of their roles in society, and to affirm their God-given and Constitutional rights to happy, safe and successful lives. Perhaps most importantly, we meet and accept them where they are, with no judgement, and recognize the social, structural and strategic injustices that they have faced most of their lives. We challenge them to accept that, despite those injustices, they still have a responsibility to themselves, to their families, and to their communities to do better.

The first step of the Fellowship, and one that is vital to our success, is for us to build a relationship with these individuals. Most young people don’t care what you know until they know that you care. Once trust is established, we create a LifeMAP with them, helping them see that a different future is possible by showing the changes that others have made. We help them envision a future as bright and fulfilling as they can possibly imagine, and we connect them to resources and service providers that can help make that dream become a reality. We connect them to mentors and coaches, a group we call Elders, who are older successful men of color who have successfully made changes in their own lives, and are now reaching back to help others.

Vaughn Picture Request (1)
Sam Vaughn, Devone Boggan, and Fellows on a retreat at the Teotihuacan Pyramid of the Sun, Mexico City.

Additionally, in a step riddled with great risk but even greater reward, we take the Fellows on trips around the globe, to help them see how good life can possibly be and get them addicted to living. The catch to this amazing travel opportunity is that they must travel with someone from what would be considered a “rival community.” As they begin to see themselves, and the world they live in, in a different light, they start to see each other differently as well.

Because we believe hard work should be rewarded, we provide a stipend to our Fellows, a practice that is seen as controversial by some. Critics frequently disparage this, claiming that we are paying criminals not to commit crime. Let me counter that by saying that, when I was young, my parents would give me $5 for every “A” I got on my report card. Were they paying me to go to school? Absolutely not– they were rewarding me for working so hard. We aren’t paying these young men for what they aren’t doing. We are rewarding them for what they are doing.

Our final step is to introduce our Fellows to mainstream society and the workforce through subsidized employment. In this stage, they develop a strong work ethic, effective workplace communication and the skills of being a team player. Eventually, they become employable by their own means, without subsidy.

Frankly, our goal is to provide these individuals with what every young person in this country receives when they grow up in a healthy, nurturing community. We’ve been successful. Of those who have participated in our Fellowship, 94% are alive, 84% haven’t been injured by a firearm, and 79% have not been suspects in new firearm-related crimes. During the period of our interventions with these youth, the city of Richmond, California has experienced a 66% reduction in firearm assaults and a 55% reduction in firearm related homicides between 2007 and 2015. By attending to these young men who are and have been traditionally underserved and abandoned by the mainstream services platform, the City of Richmond is creating a culture of health in a once dangerous city that is today a much more desirable place to live, learn, work and play.