I’m sitting in the historic Hotel Del Coronado in San Diego at the TED MED conference (www.tedmed.com) reflecting back on the event so far. TED MED, the brainchild of Richard Saul Wurman and currently being reinvigorated by Marc Hodosh of X-prize fame, is legendary for bringing together some of the most innovative, thoughtful pioneers of healthcare technology, media, and entertainment into one big four-day “dinner party” to learn from one another and mix people up from different disciplines and industries to solve big problems in healthcare. It has been an intellectual, social, and visual smorgasbord so far–one that has left me with a mix of emotions.
On the one hand, I have seen some amazing presentations and technologies–the learnings per second at TED MED are very high. There has been a lot of discussion of personal genomics (spit on a chip and get your genetic disposition to a range of diseases and drug therapies) and many speakers showing science-fiction like breakthroughs in tissue regeneration (replace your damaged organs with synthetically grown versions) and personalized medicine (using your own stem cells to develop catered, custom cures just for you). I won’t pretend to understand all of these technically or medically, but there are cool demos and compelling visions and visualizations of cells, tissues, organs, and systems in 3D scans that we couldn’t have imagined even 15 years ago. And, as always, the relationships and connections with amazing people here is the real payoff.
On the other hand, so much of what is being shown still feels to me to be reactive medicine, not proactive healthcare. It is still the “mainframe” healthcare model of hospital-based acute care that glorifies the medical experts, technologies, and institutions. While there is a lot of talk about prevention in this auditorium, most of the examples are about miraculous (and presumably expensive) technologies for repairing damage already done by disease or injury. Of all the conferences and communities, I would expect the TED MED folks to be thinking very differently about how and where healthcare delivery occurs, but even these pioneers, for the most part, are embracing the medical model of care and intervention in a mostly unquestioned way. There seems to be some small battle for the soul of what healthcare really is about, but the reigning champion is still “medicine,” as perhaps symbolized by the anchoring word “MED” in the rhyming title of the conference. TED HEALTH anyone?
I suppose this is an important reminder that the medical model–the mainframe mentality–is well entrenched in our culture and will be hard to move beyond. Our curriculums, our conceptions, our R&D programs, our venture capital, our reimbursement models, our care infrastructure, and our healthcare policies are dominated by an assumption that healthcare is about medical experts fixing problems with miraculous, breakthrough, highly-engineered technologies used in a hospital or clinic. You can see this way of thinking manifest in our television dramas (there must be five new TV shows this year about hospitals or surgeons or trauma units!) that herald the high-tech and hero-ize the high priests of healthcare who perform medical miracles (and get involved in steamy love affairs on the way) each night at 8:00pm EST, 7:00 central and mountain.
Nonetheless, I am heartened by the amount of innovation, creativity, and compassion in the room at TED MED. Here are some key moments for me:
· Tony Atala showed heart stem cells beating in a petri dish. Amazing polymer scaffolding used to build synthetic muscles and blood vessels, baked in an oven like device, and then implanted in patients. Described an inkjet printer they have filled with cells, instead of ink, to “print” a synthetic bladder or kidney. Wow!
· One of my favorite moments was when Damien Bates passed around plastic containers in the audience that were filled with live skin replacement tissue they had synthesized. Wow, and yuck.
· Jack Lord from Navigenics gave a great talk about personalized genetic testing, and hidden in his talk was a comment that “the ritual of going to the doctor hasn’t changed” along with our rituals of going to church. Reminds me of how long and hard it is to change culture…and that remaking our rituals of care is the real challenge.
· John Abele gave an interesting talk about collaboration. Apparently, the medical dictionary doesn’t have the word “collaboration” in it, which to me shows just how challenging our healthcare reform effort around “coordinated care” is going be. We have to change the incentive structure to require collaboration–it’s a shame we need laws to mandate collaboration, but we do. As John put it, “managing the divas is really important in healthcare.” I loved his idea of handing out squirt guns at meetings to let people shoot anyone who is being a diva or pontificator. Watch out Intel colleagues–we’re going to need bibs!
· David Agus gave one of my favorite talks, starting with the sobering fact that cancer death rates haven’t changed in 50 years, while so many other diseases have made much more progress in that period. I was thrilled with his comments that we need to stop referring to cancers by what organs that have invaded and to, instead, focus on a cancer vocabulary based on how the mechanisms by which different cancers emerge and propagate. He reminded us of something that is so core to the work we are doing at Intel around remote patient monitoring in the home: “We go to the doctor once a year, which is crazy,” he said, “we don’t measure things dynamically.” He also pushed for controlling cancer, instead of spending so much money describing it.
· Vic Strecher was one of the few people, refreshingly, who focused on changing health behaviors–an area he has done pioneering work on at the Center for Health Communications Research at the University of Michigan. Much cool work on how to tailor messaging to patients to help change and sustain behavior, and a lot of focus on “digital health coaching” which we work on at Intel and Oregon Health & Science University. This is definitely work to pay attention to.
· Martha Stewart was one of the few people to, importantly, give voice to the need to focus much more on family caregiving and care for seniors, which has been a surprisingly absent topic given the rise of “consumer healthcare” and the age wave. Somehow the conference has talked more about the gear and gadgets than the army of family members and friends who need to use those tools to care for their own loved ones. Stewart’s Center for Living is really focused on finding new models of long term care, and she is soon to put out a book on caregiving which I think will bring great visibility to caregiving issues.
· Goldie Hawn gave what to me was a mesmerizing talk about working with neuroscientists to build up an “optimistic” education curriculum for kids–it is called the ‘Mind Up’ program–that teaches them the cognitive and life skills for better managing self reflection, relationships, and emotional resilience. They shared data about how this approach to education improved the emotional and social intelligence of the kids, which then, not surprisingly, boosted math and English skills as well. Hawn was amazingly knowledgeable, passionate, and articulate about the subject.
· Ezekiel Emanuel, an oncologist by training and brother to White House Chief of Staff, Rahm Emanuel, flew in to talk to the audience but, disappointingly, said he couldn’t talk about healthcare reform. (It’s kind of like bringing Michael Jordan in but saying he can’t talk about basketball.) I enjoyed his critique of medical school (1. loads of memorization forced on us just seemed crazy; 2. incredibly hierarchy of medicine treated the professor as god even if they were wrong), and his frustration with healthcare being driven by tradition (“that’s how we’ve always done it”) instead of data. Not surprisingly, my favorite moment was when he mentioned my call to action to the audience to drive 50% of care out of institutions and into the home in 10 years. He said he didn’t know if we could make it that far that quickly, but that the goal is worthwhile and a lot of care can and should be done at home.
· David Pogue from the New York Times gave a hilarious view of how the i-Phone could save your life, showing but a few of the apps for patients and providers out of the thousands that have emerged on the flexible, swiss-army-knife type platform that the i-Phone has become. He even sat at the piano singing a song to the tune of a Brittney Spears hit about the topic. Cracked me up. He was very entertaining, but also the disruptive implications to the things shown in his talk have not yet been internalized by the medical establishment. Times, they are a changin’!
That’s all for now. Good night.
Great summary! I’ll promote it on Twitter. :)