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The GreatChallengesProgram

AN OVERVIEW OFPROPOSED 2012CHALLENGES

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TEDMEDThe future of health & medicine is here.

IntroducingThe Great ChallengesProgram atTEDMED2012

What are the Great Challengesof health and medicine?

They are complex, persistent problemsthat have medical and non-medicalcauses…impact millions of lives…andaffect the well-being of all of America.

There may be hundreds of Great Challenges. With helpfrom leading health institutes, think tanks, foundationsand individual experts, TEDMED has identi!ed 50 of themost pressing.

Each year at our annual gathering, the TEDMEDcommunity will vote to determine which 20 GreatChallenges will be TEDMED’s focus for the comingyear. The TEDMED community will then engagein a year-long series of lively national discussionsdesigned to generate broad, multi-disciplinaryunderstanding of each Challenge that can set thestage for truly effective action.

This booklet provides an overview of our 50 proposedChallenges for the community’s consideration in 2012.Many of these Challenges will be revisited andreconsidered in future years.

TEDMED thanks the Robert Wood Johnson Foundationfor its sponsorship of the Great Challenges Program.

Sincerely,

Jay WalkerCurator, TEDMED

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Contents

Section 1:Why America needs a Great Challenges Program . . . 3

Section 2:How the Great Challenges Program Works . . . . . . . . 7

Section 3:TEDMED 2012: 50 Proposed Great Challengesof Health and Medicine

1. Achieving More Medical Innovation,More Affordably . . . . . . . . . . . . . . . . . . . . . . . . . 12

2. Coming to Terms with the Obesity Crisis(Adults) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

3. Making Prevention Popular and Pro!table . . . . 15

4. Shaping the Future of Personalized Medicine . . 16

5. Achieving Medical Privacy and Transparency . . 18

6. Addressing the Doctor/Nurse Shortage . . . . . . 19

7. Medical Innovation: Balancing Riskand Rewards . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

8. Managing Chronic Diseases Better . . . . . . . . . . 22

9. Coming to Grips with End-of-Life Care . . . . . . . 24

10. Preparing for the Dementia Tsunami . . . . . . . . . 25

11. Making “Informed Choice” Work Better . . . . . . 27

12. Faster Adoption of Best Practices . . . . . . . . . . . 28

13. Setting R&D Priorities andAllocating Resources . . . . . . . . . . . . . . . . . . . . . 30

14. Reforming the Medical Ecosystem . . . . . . . . . . 31

15. Addressing the Impact of Poverty on Health . . 32

16. Addressing Healthcare Costsand Payment Systems . . . . . . . . . . . . . . . . . . . . 35

17. Balancing Private Rights and the Public Good . 36

18. Improving Medical Communication . . . . . . . . . . 37

19. The Role of the Patient . . . . . . . . . . . . . . . . . . . 38

20. Eliminating Hospital-Acquired Infections . . . . . 41

3

SECTION 1

Why Americaneeds a

Great ChallengesProgram

2

21. Improving Evidence Reliability and Validity . . . . 42

22. Inventing Wellness Programs that Work . . . . . . 43

23. Eliminating Medical Errors . . . . . . . . . . . . . . . . . 44

24. Food and Technology:Balancing the Trade-offs . . . . . . . . . . . . . . . . . . 47

25. Integrating Effective Complementaryand Alternative Medicine . . . . . . . . . . . . . . . . . . 48

26. Reducing Childhood Obesity . . . . . . . . . . . . . . . 49

27. The Overlooked Cancer Cohort . . . . . . . . . . . . . 51

28. Reducing School Violence and Bullying . . . . . . 52

29. Achieving Better Mental Health Literacyand Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . 54

30. Taking Our Medicine . . . . . . . . . . . . . . . . . . . . . 55

31. Choosing Better Foods . . . . . . . . . . . . . . . . . . . 57

32. Coping with the Impact of Stress . . . . . . . . . . . 58

33. Promoting Active Lifestyles . . . . . . . . . . . . . . . . 60

34. The Caregiver Crisis . . . . . . . . . . . . . . . . . . . . . . 61

35. The Epidemic of Isolation and Loneliness . . . . . 63

36. The Epidemic of Unwed Teen Motherhood . . . . 64

37. Practicing Multi-Cultural Medicine . . . . . . . . . . 66

38. Innovating for Special Needs Patientsand Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

39. Addressing Whole-Patient Care . . . . . . . . . . . . 69

40. Reducing Domestic Violence . . . . . . . . . . . . . . . 70

41. Publishing and Accessing Medical Data . . . . . . 71

42. Elevating Dental Health . . . . . . . . . . . . . . . . . . . 72

43. Inventing Better Metrics . . . . . . . . . . . . . . . . . . . 74

44. Deciding What’s Normal . . . . . . . . . . . . . . . . . . 75

45. Avoiding Over-Diagnosis; Making Trade-offsin Screening & Testing . . . . . . . . . . . . . . . . . . . . 77

46. Childhood Diagnoses: Getting It Right . . . . . . . 78

47. Preparing for “Unimaginable” Possibilities . . . . 79

48. Dealing with Medical Information Overload . . . 80

49. Addressing the Malpractice Dilemma . . . . . . . . 83

50. Developing Tomorrow’s Medical Leaders . . . . . 84

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The GREAT CHALLENGES PROGRAM

Why TEDMED is hosting theGreat Challenges Program

The TEDMED community includes thoughtful individ-uals and institutions from the !elds of medicine, thesciences, technology, government, business, educa-tion, the law, religion, the armed forces, media and thearts. This extraordinarily diverse community gathers atThe John F. Kennedy Center for the Performing Arts inWashington, DC and—via remote simulcast—in big-screen auditoriums across America in medical schools,research institutions, teaching hospitals, universities,foundations, non-pro!ts, health-focused corporationsand state and federal agencies.

TEDMED is hosting the Great Challenges Programbecause our community is dedicated to sharing cutting-edge ideas and unusual perspectives. TEDMED believesthat before America can effectively address its mostcomplex and persistent health issues, we need abroader, richer understanding of these Challenges.

Accordingly, the mission of the Great ChallengesProgram is not to “solve” America’s most confoundinghealth and wellness problems. Instead, we seek toprovide America and the world with a comprehensiveview, incorporating multiple perspectives, that can setthe stage for truly effective action.

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Why America needs aGreat Challenges Program

America has enjoyed a century of scienti!c break-throughs in health and medicine by applying more andmore specialized approaches.

But today we live in a complex socio-economic-cultural-technological “ecosystem” that surprises usevery day with new emergent properties. This surprisingcomplexity extends to the !elds of health and medi-cine. That’s why many of the Great Challenges we facetoday in health and medicine are fundamentallydifferent from those of the past.

From childhood obesity to the “caregiver crisis” andbarriers to medical innovation, our most puzzling prob-lems have many simultaneous causes. Their contributingfactors cut across every sector of society. With this inmind, America needs to move beyond specialization.If we want to tackle these new challenges successfully,we must see them as a whole.

A broadly inclusive, multi-disciplinary understanding ofthe Great Challenges of health and medicine isabsolutely essential if we’re going to create the health-iest possible future for 300 million Americans—and theworld.

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SECTION 2

How the GreatChallenges

Program Works

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The Great ChallengesProgram engages the entire

TEDMED community

Delegates vote at the TEDMED gathering.

During the annual TEDMED gathering in Washington,DC, 50 knowledgeable individuals will serve as Advo-cates for 50 different proposed Great Challenges. TheseChallenge Advocates will circulate among the 1,200onsite TEDMED Delegates at the Kennedy Center,explaining the nature and importance of their individualproposed Challenge and “lobbying” for Delegate votes.

Simultaneously, at hundreds of auditoriums nationwide,as many as 50,000 offsite Delegates will engage theTEDMED stage program via a remote simulcast calledTEDMEDLive. Onsite and offsite Delegates will be ableto learn more about the 50 proposed Great Challengesby using a free mobile app called TEDMED Connect.

Voting for the 20 !nal Great Challenges will take placethroughout the TEDMED gathering. Delegates will useTEDMED Connect to cast their votes. The app will alsoallow Delegates to get more information on each Chal-lenge and to see running vote totals on the GreatChallenges website.

The Great Challenges Program fosters year-longdialog and invites everyone to take part.

In the months following each year’s TEDMED gath-ering, the Great Challenges Program will generate alively national dialog on the 20 Challenges chosen by theTEDMED community.

Many of our Champions, the outstanding leaders from avariety of !elds who graced the TEDMED stage, will beinterviewed in-studio for their thoughts on speci!c GreatChallenges. The result will be a series of TV programstyle segments called “Perspectives.” These segmentswill be shared with the world for free at TEDMED.com.TEDMED community members will be able to post theirown thoughts and feedback to each Perspective.

TEDMED.com will also host and facilitate a series of 40webinars throughout the coming year, two on each ofthe 20 Great Challenges. These webinars will consistof roundtable panel discussions, each featuring four tosix quali!ed individuals who engage in multi-discipli-nary dialog.

The webinars will be permanently available to the world,for free, at www.TEDMED.com. Here again, TEDMEDcommunity members will be invited to take part in thediscussion by posting their own comments and feedback.

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SECTION 3

TEDMED 2012:50 Proposed

Great Challengesof Health and

Medicine

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Coming to Terms with theObesity Crisis (Adults)

In 40 years, the U.S. population has gone from 40%overweight to 68% overweight. Half of American adultsare dangerously obese, leading to many chronic condi-tions and deadly (and expensive) diseases.

Scientists and doctors generally agree the obesityepidemic is behavioral in nature (not the result of apathogen).

The key drivers are our choices of food and activity, butmultiple additional factors also play a role—from familydynamics to cultural roots, stress, economics, lifestyleand many more. Unlike smoking or drinking, eating isnot optional. How can Americans move to healthierlifestyles—or, if we can’t change these trends, how canthe healthcare system cope with the results?

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Achieving More MedicalInnovation, More Affordably

New medical tests, treatments and devices are oftenvery expensive when !rst introduced. Eventually, marketforces bring the prices down. However, since mostpatients don’t pay for healthcare out of their ownpockets, they don’t want to wait.

Patients disproportionately demand the latest, bestmedical products and services immediately—often,even if the demanded good is of marginal relevance totheir condition. Leaving out questions of universalaccess and rationing, how can we make more medicalinnovations more affordable, more quickly, for morepeople?

Which proven strategies from Silicon Valley, the Moonlandings, the Manhattan Project or other successfulmodels could be applied effectively to achieving faster,yet less costly innovation in health and medicine?

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3

Making PreventionPopular and Pro!table

America spends $2 trillion a year on healthcare—mostly treating people after they become sick. Howcan we unlock prevention as a trillion-dollar business inAmerica so we spend less on “sick care” and get Amer-icans to “buy” healthy lifestyles?

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Shaping the Future ofPersonalized Medicine

Science is harvesting more and more information aboutthe human population, and individual patients speci!-cally. Medicine is understanding the roles of genomicsand the environment in a patient’s medical history. Yettranslating this data to practice has proved dif!cult.The fundamental question for a physician is still: willthis treatment work for my patient?

How can the wealth of medical information be factoredinto patient medical records and into everyday care—more quickly, more usefully and more completely?

How can insights into individual patients—gleanedfrom in vitro and in vivo diagnostic tests—allow us tozero in on targeted therapies?

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Addressing theDoctor/Nurse Shortage

America is losing its base of primary care physiciansand nurses—not from lack of demand or need, butbecause !nancial incentives, limited numbers ofmedical and nursing schools, their admissions policies,social prestige, government regulation and otherfactors arguably work against certain specialties andprofessions.

What elements should be built into the U.S. healthcaresystem to help ensure that the supply of medicalpersonnel (all types) meets demand/need?

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Achieving Medical Privacyand Transparency

Electronic health records will soon make it possible toaggregate data from the health records of virtuallyevery American, to create a complete data set aboutmany diseases and conditions for the !rst time. Yetthere are many obstacles: regulatory, technological andpolitical, as well as public attitudes and beliefs aboutmedical privacy (mistaken or not).

How can we enable society to make “big science”medical progress by aggregating “big data,” yet alsoprovide reasonable assurance that individuals’ personalmedical records will not be released to anyone withoutthe patient’s permission?

What areas of U.S. health and medicine would be betteroff with more transparency, and what areas would bebetter off with less transparency (i.e., when less trans-parency means more privacy)? Should every study bepublished or should some studies be withheld?

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Medical Innovation:Balancing Risk and Rewards

All vaccines kill some of the people who are inoculated.Society has recognized it is a price worth paying toaccept these low but real costs to achieve the bene!tof vaccinating much of the population. But the FDA isasked to approve drugs and devices in an environmentthat carries legal and political risk if any fatalities result.

How do we give the FDA the ability to take a prudentrisk by approving a drug that successfully serves aparticular cohort, but may have undesirable side effectsfor some?

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Managing ChronicDiseases Better

Chronic disease is America’s leading cause of prema-ture death and disability. Heart disease, cancer,respiratory illness and certain others are among themost costly and common health problems, yet they areoften among the most easily prevented and controlled.

How can we innovate better approaches to help patientsprevent, manage and treat their chronic diseases andachieve better outcomes?

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Preparing for theDementia Tsunami

It’s no secret that mental health tends to decline as weage (Alzheimer’s, dementia, etc). Some is natural cogni-tive decline; some is disease with severe cognitiveimpairment due to diseases associated almost entirelywith aging.

By 2020 there will be 43 million Americans over 65 and15 million over 85 (double the !gures of 1980). Almostcertainly, we are facing an unprecedented number ofmentally impaired citizens.

Hope for cures is not a strategy. What should we bedoing to prepare to meet the needs of tens of millionsof mentally impaired older citizens?

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Coming to Grips withEnd-of-Life Care

Modern medicine has extended the life expectanciesof many terminally ill Americans. In turn, prolonginglives can mean incurring more intensive care and theassociated costs.

In 2010, Medicare paid $55 billion for doctor andhospital bills during the last two months of patients’lives. Quality end-of-life care requires balancing theinput of doctors, families and patients themselves. Andmaking crucial end-of-life decisions can take physicaland emotional tolls on patients and their loved ones.

How should we help people manage end-of-life carechoices to maximize individual well-being and minimizesocial cost?

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Making “Informed Choice”Work Better

The U.S. healthcare system increasingly assumes anactive, aware, health-literate patient is capable of making“informed choices” about treatment options.

For almost every disease and condition, there aredifferent therapies to choose from, each with its ownbene!ts and trade-offs, and frequently with variablenuances according to individual patient conditions.Doctors are not trained in how to communicate effec-tively to patients, and patients are not educated tomake a scienti!c evaluation of complex choices—yetwe ask doctors to explain and patients to choose moreand more.

With no right or wrong answers available, and withquality of life being a signi!cant factor in many cases,how can doctors and patients work together moresuccessfully to achieve better outcomes?

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Faster Adoption ofBest Practices

Medical progress only occasionally depends on doubleblind, placebo-controlled studies. Most healthcareimprovements come through small, incremental stepsacross tens of thousands of surgeries, procedures andprotocols—from a better way to take a temperature toa better stitch or a better way to ask a question in theER. But most of these improvements are not captured,shared and replicated across the healthcare system.

Even when best practices are identi!ed and publicized,many providers seem slow to adopt them. What canwe do to capture millions of improvements per yearand make best practices available to bene!t manymore providers and patients?

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Reforming the MedicalEcosystem

The U.S. healthcare system has evolved over the pastcentury into a complex, interdependent organism wheresimple inputs are not predictive of simple, linear outputs.

Faced with similarly complex public systems in thepast, America sometimes wipes the slate clean andreplaces a hodgepodge of systems with a centralized,simple, single system (the interstate railroad andhighway systems, the Bell telephone monopoly on longdistance calling, etc.).

In medicine, what are the pros and cons of “wiping theslate clean” in hopes of creating a clean, simple system,vs. reforming and preserving the existing system?

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Setting R&D Priorities andAllocating Resources

Churchill described democracy as “the worst form ofgovernment, except for all the others.” Our currentsystem of allocating government funds for medicalR&D priorities is strongly in"uenced by political factorsat times, and is constantly criticized from all sides.

Are there better systems to rank medical R&D prioritiesand if so, what are they and how can they be integratedinto America’s public allocation system?

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Addressing the Impactof Poverty on Health

The 46 million Americans who live in poverty are meas-urably less healthy and have far worse health outcomesthan the rest of the population. Less certain is howmuch of these negative health outcomes are directlycaused by poverty and how much is caused by otherfactors.

America would be better off if everyone were healthy,regardless of income—especially since governmentprograms cover some of these costs directly. Howshould we think about the role and impact of povertywithin the larger question of health?

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Addressing Healthcare Costsand Payment Systems

The U.S. remains locked in a decades-long controversyover how citizens should pay for healthcare, what health-care should cost, who should pay, how much, and whatincentives, if any, should be “paid” to patients who staywell (or try to).

How do we foster a thoughtful, civil dialog that focuseson science and the public interest, in a way that has areasonable chance of eventually creating an approachwe can all support?

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Improving MedicalCommunication

Physicians are not typically trained in interpersonalcommunications and are not rewarded based on theircommunication skills.

Equally important, patients are often intimidated whentalking to doctors and often feel they don’t have a recep-tive audience, especially when doctors are rushed. Whatcan be done about this on both sides of the challenge(patients and doctors)—including possible initiatives inareas ranging from education to technology, to possiblechanges in the physical workspace? How do we makethis issue a priority?

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Balancing Private Rightsand the Public Good

Some individual behaviors can lead to long-termhealthcare problems—the costs of which are borne bysociety. For this reason, behaviors once considered tobe individual liberties are increasingly discouraged inthe greater interests of the community.

For example, riding a motorcycle today without a helmeton public highways is legal in only two U.S. states.Likewise, if you abuse or don’t feed your children, thestate will take them away.

Today, whether the issue is drinking while pregnant orsecondhand smoke, America seems increasingly willingto intervene as science demonstrates more and morethreats to children’s lives, development or well-being.

What is the extent of the nation’s interest, responsibilityand rightful authority to intervene so as to incentivize(or compel) individuals to live a healthy lifestyle? Howshould we rethink the state’s role in the protection ofchildren in the context of the family unit?

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The Role of the Patient

Patient empowerment can be a double-edged sword.From hospitals and insurance companies to doctorsand patients themselves, much of the medical systemincreasingly treats patients as “customers” or“consumers,” terms that some people love and othershate. If patients are customers, does that mean “thecustomer is king” or does it mean “buyer beware”—orboth?

If patients retain their traditional role, does that meandoctors are in charge? Are both in charge somehow?How is “power” shared among all stakeholders andhow should it be shared?

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Eliminating Hospital-Acquired Infections

In the U.S. alone, HAIs directly cause a reported 50,000to 200,000 deaths each year, depending on how they’recounted. However, a few hospitals have measurablyreduced infection rates to nearly zero through a combi-nation of dozens of different small changes, rigorousmeasurement and intense feedback.

Why aren’t more hospitals adopting this proven,successful model and what steps could help spreadthe use of these “best practices”?

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Inventing WellnessPrograms that Work

From corporate America to the U.S. government andits armed forces, small businesses and even religiousand educational institutions, many large-scale organi-zations have a strong economic motive to encouragetheir workforces to adopt healthier lifestyles (workerwellness means lower insurance rates for employers).

Many organizations have discovered elements thatsupport worker wellness to some degree, but no grouphas put it all together for large scale, long-termsuccess. Compounding this problem is a disagreementover the relative responsibility of the individual versusthe responsibility of the organization for employeehealth (with issues ranging from workplace environ-ment and stress, to on-the-job support for healthylifestyles—or the lack of such support).

What kinds of innovation should we be thinking aboutand how can we encourage them to come to marketas soon as possible?

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Improving EvidenceReliability and Validity

Each year, at least 20% of authors of scienti!c papersdisagree with their co-authors about conclusions sostrongly that they remove their names. In the pastdecade, scientists have increasingly found that originalstudy results cannot be reproduced by subsequentexperiments.

Doctors base billions of life-or-death decisions on thebest available science, but con!dence in researchquality and result reproducibility is steadily eroding—notjust among the public but also among professionals.What innovations could counter this trend?

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Eliminating Medical Errors

All humans make mistakes. Doctors and nurses arehuman; they make mistakes. All systems are imperfect.Medical professionals use systems.

Errors by medical professionals and systems areinevitable (unfortunately, they send 2.4 million patientsto hospitals yearly and are directly linked to 200,000annual fatalities). Regardless of methods used todetect, prove and compensate for medical errors, howmuch better can we do in reducing or eliminatingmedical errors and what areas should we focus on toget the best improvements?

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Food and Technology:Balancing the Trade-offs

Since the Green Revolution of the 1970s doubled cropyields, we have been committed to feeding an ever-growing planet with !nite arable land and waterresources. Science and technology have been increas-ingly applied to food, pesticides, modi!ed organisms,etc. to the point where we can now feed seven billionpeople.

However, there has been some backlash over thepotential for hidden long-term impact and unexpected,emergent properties. How do we identify and maximizethe potential bene!ts (and minimize potential draw-backs) to this global homogenization of our food supply?

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Reducing Childhood Obesity

The challenge of childhood obesity is signi!cantlydifferent, some argue, from the challenge of adultobesity. Children don’t have the power over their lives,decisions, and lifestyles that adults have (parents andadults make many decisions for them and have thepower to enforce certain behaviors).

Social institutions have more impact on kids than onadults (like church, YMCA, and especially school—including school lunch programs, mandatory gymclasses, possible nutritional education, etc.).

Finally, there is the fact that kids are less set in theirways than adults, so it’s easier to change their behav-iors and teach them new concepts. The number ofobese children has just passed 20% and continues togrow. What is the full range of underlying causes forthis trend and which combined causes are chie"yresponsible?

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Integrating EffectiveComplementary andAlternative Medicine

Government surveys show 38% of Americans usecomplementary and alternative medicine (CAM), fromacupuncture to vitamins and supplements, along withtraditional medicine.

How can patients and medical professionals evaluateCAM practices, and integrate the best of them in a waythat assists traditional treatment?

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The OverlookedCancer Cohort

Certain age cohorts tend to be under-represented inmedical research, funding, diagnosis and publishing.For example, the Adolescent/Young Adult sector (ages15-39) is signi!cantly often under-represented—especially in cancer.

This occurs even though AYA cancers have certainunique properties—and despite the disparity in AYA!ve-year survival rates compared to other populations.How do we ensure that this cohort receives attention,resources and energy commensurate with the breadthand gravity of the problem?

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Reducing School Violenceand Bullying

Bullying and school violence remain critical issuesaffecting the health and well-being of young Ameri-cans. Research shows that one in !ve teens said theyhad been bullied at one time, and nearly 160,000 kidsmiss school each day because they are too afraid togo.

There are long-term emotional and physical healthconsequences of violence among school-aged chil-dren. What is the full range of causes behind thisgrowing problem, and what intervention or preventionstrategies might be most successful?

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Taking Our Medicine

According to the U.S. Department of Health & HumanServices’ Of!ce of Behavioral and Social ScienceResearch, on average 50% of patients don’t take theirprescription medications as prescribed. Various studiesreport that patients cite literally hundreds of differentreasons for non-adherence.

Some studies appear to contradict widespread assump-tions about this problem. For example, adherence doesnot necessarily go up as price goes down or even whenmedications are free; nor do “reminder systems” typi-cally generate sustained improvements in adherencerates.

What actual factors cause, and contribute to, prescrip-tion drug non-adherence becoming an epidemic in theU.S.? What strategies (including behavior modi!cation,professional-patient interaction, technology, home orwork environmental changes, and others) show themost promise to increase adherence, especially byaddressing many patients’ reasons simultaneously?

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Achieving Better MentalHealth Literacy and Treatment

America’s mental health challenge has many dimen-sions. There are competing !scal priorities, con"ictingpublic attitudes and questions of knowledge and training(even among some medical professionals).

Mental health issues such as addiction, stress anddepression are often considered secondary issues andare widely misunderstood, as are bipolar disorder, schiz-ophrenia and others. How did this come to happen…can and should it be changed…and what would happenif mental health treatment were integrated with primarycare?

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Choosing Better Foods

There is a general consensus that the food choicesAmericans are making in aggregate are driving currentand long-term health problems.

As we sort out the major and minor contributors to theunhealthy ways that Americans eat, where should wefocus our energies to stop and reverse this trend?

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Coping with theImpact of Stress

Tranquilizers, antidepressants, sleeping pills and anti-anxiety medications exceed 33% of annual U.S.prescriptions. Unhealthy levels of stress are far moreprevalent than most people recognize, and stresscontributes to many other mental and physical healthproblems.

Given that stress is dif!cult to quantify and varies fromperson to person, how do we better understand therole of stress in the larger picture of health?

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The Caregiver Crisis

An estimated 44 million people provide full-time orpart-time care for the elderly, disabled veterans, newmothers, the injured, the sick, etc.—a problem thateventually impacts everyone in the nation.

Caregivers have few tools, few support systems andreceive minimal, if any, training for these responsibilities.What innovations can we develop speci!cally to supportthe caregiver community?

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Promoting Active Lifestyles

There is no disagreement that people who are moreactive have dramatically better overall health. Yet today’saverage American adult burns 500 fewer calories perday than farmers and factory workers did 100 yearsago—while consuming many more calories.

How do we invent broadly popular and achievableways for people to become more active, so as to replacethose “lost” energy expenditures?

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The Epidemic of Isolationand Loneliness

As many as 40 million Americans (12% of the adultpopulation) are socially isolated. The impact of isolationand loneliness contributes to a wide range of diseasesand undesirable health behaviors, from depression toself-neglect and many, many more.

How can we develop a more complete picture of isola-tion and loneliness; and, given the success of socialnetworks and the near-universal use of mobile phonestoday, what innovations (both short-term and long-term) can effectively combat this problem?

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The Epidemic of UnwedTeen Motherhood

Despite hitting 40-year lows, America’s rate of teenpregnancy remains the highest in the industrializedworld (7%). Compared to mothers 20 and older,teenaged mothers receive less prenatal care, get lessnutrition, have more preterm babies, and have babieswith low birth weight.

What is the full range of factors contributing to teenmotherhood, and what price does society pay (in termsof health, education, the economy, culture, etc.) for“children having children?”

Despite the costs to society, little innovation has beenoffered to reverse the trend. What innovations mightwork?

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Innovating for Special NeedsPatients and Children

The explosion of special needs diagnoses and popula-tions are placing demands on public school andhealthcare systems that are unlikely to be met, givenlimited public !nancial resources.

What innovative opportunities and alternatives to thecurrent model are the most promising?

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Practicing Multi-CulturalMedicine

Good communication between speakers of differentlanguages is already a dif!cult challenge in U.S. medi-cine, but it’s expected to grow tougher still as minoritypopulations grow and the number of languages spokenin every American city and region also increases—andthe number of cultures served by the U.S. healthcaresystem grows.

How can the healthcare system and providers copesuccessfully with an ever more multi-lingual, multi-cultural society? For example, could cellphones serveas universal translators? How can medical profes-sionals cope with the sometimes very different valuesystems of various cultures?

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AddressingWhole-Patient Care

Regardless of patients’ roles in their own healthcare,there will always be questions about how doctorsshould approach medical problems—by focusing moreon the symptoms and disease, or on the patient whohas them?

Most doctors specialize due to a variety of pressuresand incentives from economic and technological tosocial, professional and educational. The number ofmedical specialists (and specialties) continues to growwhile the number of primary care physicians continuesto shrink.

In the process, the goal of !tting all these specialtiestogether for effective whole-patient care becomes evermore elusive. How can we treat the whole patient ratherthan the disease?

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Publishing and AccessingMedical Data

In the digital age, publishing models have been revolu-tionized. Music, news, information and entertainmentare increasingly open-source, free access.

This same model is also being promoted for health andmedicine. Yet some believe that traditional publishinghas served us well by providing information to thosewho need it, in a way that is economically sustainable.What are the pros and cons of both systems…and howcan we preserve the best of both?

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Reducing DomesticViolence

Recent research suggests that sexual violence is farmore pervasive in the U.S. than generally understood.There are key tactics in place designed to address theproblem—including efforts to raise awareness, trainingfor healthcare providers, workplace prevention programsand more.

Nevertheless, domestic violence rates continue toincrease. What factors are contributing to the rise indomestic violence and what strategies can be imple-mented to reverse this trend?

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Elevating Dental Health

The U.S. is facing a dental crisis. Dental disease isrampant; 50 million Americans don’t have access todental care; and our already-small oral health work-force is shrinking.

Tooth decay is the most common chronic illness in theU.S.—it is !ve times more prevalent than asthma—yet,it is largely preventable. Why don’t Americans prioritizedental care, and how can we reverse these negativetrends?

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Deciding What’s Normal

The Diagnostic and Statistical Manual (DSM) is aboutto be revised for the !fth time, rede!ning what countsas mental pathology and what doesn’t.

There’s already controversy about making it harder todiagnose Asperger’s syndrome, and making it easier tocount grief as a treatable “condition.” But it’s not onlypsychiatry where the boundaries of normal will shift.They also shift with blood pressure levels and choles-terol levels, to name several major parameters. (Themetrics themselves don’t change—just the ranges thatare considered “normal” readings.)

These de!nitions have huge implications in terms ofinsurance coverage and reimbursement, pharmaceu-tical development, and our very sense of ourselves.Who should decide what’s “normal”—and how?

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Inventing Better Metrics

Blood pressure, temperature, body weight, lifeexpectancy and other traditional metrics are arguablyoutdated in the light of today’s science.

Perhaps it’s not enough to periodically change diag-nostics at the margins, for example by decreeing “newnormal” ranges of readings for traditional metrics.

What brand-new metrics can and should replace themas our standard gauges of patient health? Shouldscience focus instead on such factors as body fatpercentage, blood oxygen levels, healing speed—orhow often patients laugh per day? What other newmetrics might be superior or preferable to today’s stan-dard metrics?

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Avoiding Over-Diagnosis;Making Trade-offs inScreening & Testing

Commercial factors play a role in medical providers’tendencies to label a growing number of conditions,experiences and patterns as a “syndrome” or a “disease”that lead to a medical remedy or response.

What are the pros and cons of “medicalizing” more andmore conditions…and what kind of oversight might beadvisable? In addition, it has become a universal beliefthat early detection and screening is always better.However, with some chronic long-term conditions,early detection screening sometimes has drawbacksas well as bene!ts, especially if therapeutic treatmentscan cause harm, trigger mental distress or are ineffec-tive. For example, in a medical !rst, delayed screeningfor prostate and breast cancers have recently beenrecommended.

What should be our strategy for screening and detec-tion for a broad range of diseases and chronic diseases,taking into account the interests of society and the indi-vidual as well as cost/value considerations? (Also, whatabout the ability of af"uent consumers to purchasetests that might not be paid for by other segments ofsociety?)

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Preparing for“Unimaginable” Possibilities

We are rapidly heading toward the age of the BionicHuman, where prostheses and replacement organs arelikely to be superior to the “original equipment.”

Meanwhile, medicine is reaching the point where we’llsoon have “designer babies” that have been geneticallyor otherwise modi!ed to select for certain traits. In thenext 20-50 years, it is likely that we will be able to iden-tify and treat the disorder that we today call addiction.

As a government and as a society, should we everreach into the human brain and “turn off” potentialmental disorders, or will we declare human personalityand freedom sacrosanct—despite the risk that somepercentage of the population will do harm to them-selves and others?

What should we be doing to prepare for the age of“planned evolution,” and are there enhancements andmodi!cations (such as gender pre-determination) thatwe want to speci!cally prohibit as a matter of nationalpolicy? What does society gain or lose by permitting orprohibiting certain bionic enhancements?

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Childhood Diagnoses:Getting It Right

Even for medical professionals, mental and emotionalhealth diagnosis is often a judgment call. With youngchildren we’ve learned that early intervention leads tobetter outcomes.

Yet there are also costs and risks of labeling a child ashaving a mental or emotional disorder. Among them:prescribing unneeded meds, harming self-esteem ortriggering social stigma. Teachers from kindergartenthrough high school are the front lines of diagnosis, yetthey are not currently trained as mental health experts.

When diagnosis is slippery and the front lines arealready over-burdened with teaching tasks, how cansociety do a better job of identifying which children aretruly at risk and getting appropriate help for them?

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Dealing with MedicalInformation Overload

The number of medical studies published each decadecontinues to soar, and the rate at which total medicalinformation is growing is expanding rapidly.

Some people believe the growth of available informa-tion will lead to signi!cant opportunities. Others fear itwill bury us in “noise,” especially in cases where thedata collected is not numerical. What steps should webe taking to maximize the opportunities of the infor-mation explosion and minimize the risks of overload?

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Addressing theMalpractice Dilemma

Even if the rate of medical errors were reduced by 99%tomorrow, we would still have an ongoing need toprove liability and to compensate victims for theremaining cases where patients are wrongfully harmed.

America’s vaccination system compensates peoplequickly and ef!ciently for harm done by vaccines—without compromising the effectiveness of the regimen,and without imposing unaffordable costs on society orvaccine providers.

The airline industry likewise compensates families foraccident victims, without unduly burdening aviationwith “defensive "ying.” Surely the medical industry cancompensate victims without triggering crippling costsfor defensive medicine and “jackpot” jury rewards.How?

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Developing Tomorrow’sMedical Leaders

While no shortage of medical specialists is likely tooccur, there is a broad consensus that America suffersfrom a critical shortage of multi-disciplinary leaders inhealth and medicine.

How do we attract, encourage, train, grow and rewardthe multi-disciplinary leaders who can show the way tothe transformation in health and medicine that we allseem to want?

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What are theGreat Challenges

of Health andMedicine?

Obesity.

Prescription non-adherence.

The impact of stress.

The shortage of nurses andprimary care physicians.

Barriers to medical innovation.

These are only a few of the Great Chal-lenges that impact millions of people.Their multi-disciplinary causes andcascading effects cut across our entiresociety.

As research uncovers ever-growingcomplexities, we realize there is noquick !x for the Great Challenges ofhealth and medicine. We see howgenetics and human behavior interactwith economics, technology and culture.How pathogens and the environmentconverge.

Often, our actions don’t generate theresults we expected, or had hoped toachieve. Due to their complex andsurprising nature, the Great Challengesof health and medicine bene!t frombroad, multi-dimensional understandingthat blends medical and non-medicalperspectives.

The Great Challenges Program is spon-sored by the Robert Wood JohnsonFoundation.

TEDMEDThe future of health & medicine is here.

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