Over the exhilarating four days this past week, we all fell in love a little bit -- with the city, the Center, the meeting, the ideas, and one another. The city was Washington, DC, a touch past its cherry-blossom blush; the meeting was, of course, TEDMED. The ideas were of about honoring our health, environment, food, and about making health and healthcare efficient and kind for all.
I fell in love with dreamers. Though their dreams were varied, their paths to fulfilling them all converged into the same stream. Like a trip down the Amazon that the biggest dreamer of all, Jay Walker, the curator and the force behind the meeting used as a metaphor for TEDMED 2012, they accepted their tortuous and demanding journeys and, much to our delight and benefit, made a stop at the Kennedy Center. And although I will only mention a few, many others will stay with and inspire me for the months to come until TEDMED 2013.
I fell in love with Bryan Stevenson, who spoke about his grandmother and identity and justice.
I fell in love with Rebecca Onie, who, while transforming the care of the urban poor is also transforming the face of student activism.
I fell in love with Traces, a Montreal performance group who made my heart stop with their daring acts of precision. Our healthcare system can learn a lot from these young people.
I fell in love with Jacob Scott and Sandeep Kishore, both of them young, energetic and passionately committed to changing the face of medical education.
I fell in love with Ed Gavagan, who told the story of his confrontation with death with courage, humor and honesty.
And yes, I fell in love with and was made to weep by Robert Gupta's transcendent violin and Stephen Petronio's defiant vulnerability.
TEDMED 2012 was a feast, and now I am back to the journey of my real life: calls to make, e-mails to return, analyses to do, papers to write, talks to give, a book to get to market. It all seems just a little drab compared to the four days I spent in this intellectual and emotional climax. But like a great yoga session, TEDMED was restorative, rejuvenating, and remarkably inspirational. The mix of hard core science, the arts, history and frank curiosity sparked personal ideas and renewed personal commitments to executing my dreams for a better society. Spurred by Sekou Andrews' and Steve Connell's raw poetry performance, like a youngster in love for the first time, I am ready to GO! So I am off to do what E.O. Wilson suggested a scientist needs to do: think like a poet and work like a bookkeeper.
If you like Healthcare, etc., please consider a donation (button in the right margin) to support development of this content. But just to be clear, it is not tax-deductible, as we do not have a non-profit status.
Thank you for your support!
Showing posts with label TEDMED. Show all posts
Showing posts with label TEDMED. Show all posts
Saturday, April 14, 2012
Thursday, April 5, 2012
Happy to be in the "top three"
So, I must be in the "top three" then :)
If you like Healthcare, etc., please consider a donation (button in the right margin) to support development of this content. But just to be clear, it is not tax-deductible, as we do not have a non-profit status.
Thank you for your support!
If you like Healthcare, etc., please consider a donation (button in the right margin) to support development of this content. But just to be clear, it is not tax-deductible, as we do not have a non-profit status.
Thank you for your support!
Thursday, March 8, 2012
Three central questions about medical technologies
Every day my inbox gets filled with announcements for and invitations to attend all kinds of conferences. While many of them are of the traditional medical education sort, more and more I hear about meetings where new technologies and gadgetry in healthcare are the focus. And while the former feature healthcare professionals speaking medicalese from the stage to rapt audiences of other healthcare professionals in dimly lit halls, the latter capture their audience' imaginations with the promise of the future, in all its glitter and glory. And naturally, the latter are what attract techies and patients alike, steamrolling over our staid medieval medical conventions. I heard that the HIMSS conference in Las Vegas last month attracted 37,000 attendees! And the excitement was palpable even through Twitter feeds. This is clearly the preferred way to effect public engagement with healthcare.
But here is the thing: medical advances happen much more slowly than the speed of technology development. That is why, year after year, we go to our professional society meetings and have deja vus all over again. Year after year we hear the same people present the same studies, sometimes, if we are lucky, with a slightly different twist. The last group of breakthroughs I heard about at one of our critical care meetings was over a decade ago. And we have had to backpedal from that quite a bit with the removal of Xigris from the market, and with the realization that tight glucose control had to be used with extreme caution, so as not to kill more critically ill patients than it was meant to save.
This disconnect between the glacial pace of true progress in the clinical sciences and the lightening speed of technological progress raises some obvious questions about our assumptions. If we are not making dramatic breakthroughs in medicine every day, what is this breakneck pace of technology innovation delivering, save for the glitter and a seductive promise of health and wealth? Is there evidence supporting this promise? You might counter by saying that we have years, maybe even decades, of translational catching up to do, bringing all the advances from the bench to the bedside. I would have to say that the magnitude of such advances, as well as clinicians' resistance to them, may have been overstated. You might also point out that the vast advances in computing capabilities have not penetrated sufficiently into our healthcare system, and there I cannot disagree. But whether bringing these advances into clinic without careful planning will improve our health or our healthcare finances remains in question.
Moreover, I see numerous downsides to rushing ahead without thinking through what we are rushing toward. Ostensibly, the light at the end of this bright technological tunnel is better health. What concerns me is that the journey has become a sort of an end in itself: the sheer beauty of the tunnel has itself become the prize. To regain our compass, we need to ask three tough questions, each of them central to understanding the impending advent of too much out-of-context information:
1. Do we really want to walk around with sensors (pdf document, see page 16)? Personally, I find 24/7 monitoring of our vital functions to be a depressing prospect. Furthermore, I sincerely doubt that this is a better (or more cost-effective) way to achieve health than through focus on public health and socioeconomic equity.
2. What is the use of having your genome in your pocket?
How is that going to help us at the stage where all we can do is identify certain levels of risk (bracketed by broad intervals of uncertainty) in isolation from all the influences that modify that risk?
3. Do we want an epidemic of false positive findings and pseudo-disease?
We have enough trouble interpreting positive findings from medical screening tests. Do we really want the public falling prey to the anxiety and over-testing that false positives bring? As a healthcare system, can we sustain such an avalanche? As clinicians are we able to mange these screening snafus?
(I have done so many posts on this issue that you can barely navigate this site without stumbling over their debris).
All of the above is not sexy or shiny, and it brings in the ugly four-letter word "risk" to balance the discussion of the holy grail of benefit. So, how do we sell it to people so hypnotized by technology? I am asking this question quite seriously. I, and many of you out there, really would like people to become more cognizant of these nuances, but how do we accomplish this? Do we need to change our byzantine approach to medical meetings to start attracting a broader audience for our messages? If so, let's get started. Perhaps other forums that are already exceedingly successful can teach us how. I commend TEDMED (which I am attending as a Front-Line Scholar) for starting to bring this important viewpoint to their audiences. Now, how about having HIMSS, Health 2.0 and others join to clarify this other edge of the medical sword? Perhaps we can prevent the wild pendulum swings by thinking things through now. And think how much more credibility we all will have if, by thinking and debating now, we minimize the unintended consequences later?
But here is the thing: medical advances happen much more slowly than the speed of technology development. That is why, year after year, we go to our professional society meetings and have deja vus all over again. Year after year we hear the same people present the same studies, sometimes, if we are lucky, with a slightly different twist. The last group of breakthroughs I heard about at one of our critical care meetings was over a decade ago. And we have had to backpedal from that quite a bit with the removal of Xigris from the market, and with the realization that tight glucose control had to be used with extreme caution, so as not to kill more critically ill patients than it was meant to save.
This disconnect between the glacial pace of true progress in the clinical sciences and the lightening speed of technological progress raises some obvious questions about our assumptions. If we are not making dramatic breakthroughs in medicine every day, what is this breakneck pace of technology innovation delivering, save for the glitter and a seductive promise of health and wealth? Is there evidence supporting this promise? You might counter by saying that we have years, maybe even decades, of translational catching up to do, bringing all the advances from the bench to the bedside. I would have to say that the magnitude of such advances, as well as clinicians' resistance to them, may have been overstated. You might also point out that the vast advances in computing capabilities have not penetrated sufficiently into our healthcare system, and there I cannot disagree. But whether bringing these advances into clinic without careful planning will improve our health or our healthcare finances remains in question.
Moreover, I see numerous downsides to rushing ahead without thinking through what we are rushing toward. Ostensibly, the light at the end of this bright technological tunnel is better health. What concerns me is that the journey has become a sort of an end in itself: the sheer beauty of the tunnel has itself become the prize. To regain our compass, we need to ask three tough questions, each of them central to understanding the impending advent of too much out-of-context information:
1. Do we really want to walk around with sensors (pdf document, see page 16)? Personally, I find 24/7 monitoring of our vital functions to be a depressing prospect. Furthermore, I sincerely doubt that this is a better (or more cost-effective) way to achieve health than through focus on public health and socioeconomic equity.
2. What is the use of having your genome in your pocket?
How is that going to help us at the stage where all we can do is identify certain levels of risk (bracketed by broad intervals of uncertainty) in isolation from all the influences that modify that risk?
3. Do we want an epidemic of false positive findings and pseudo-disease?
We have enough trouble interpreting positive findings from medical screening tests. Do we really want the public falling prey to the anxiety and over-testing that false positives bring? As a healthcare system, can we sustain such an avalanche? As clinicians are we able to mange these screening snafus?
(I have done so many posts on this issue that you can barely navigate this site without stumbling over their debris).
All of the above is not sexy or shiny, and it brings in the ugly four-letter word "risk" to balance the discussion of the holy grail of benefit. So, how do we sell it to people so hypnotized by technology? I am asking this question quite seriously. I, and many of you out there, really would like people to become more cognizant of these nuances, but how do we accomplish this? Do we need to change our byzantine approach to medical meetings to start attracting a broader audience for our messages? If so, let's get started. Perhaps other forums that are already exceedingly successful can teach us how. I commend TEDMED (which I am attending as a Front-Line Scholar) for starting to bring this important viewpoint to their audiences. Now, how about having HIMSS, Health 2.0 and others join to clarify this other edge of the medical sword? Perhaps we can prevent the wild pendulum swings by thinking things through now. And think how much more credibility we all will have if, by thinking and debating now, we minimize the unintended consequences later?
Subscribe to:
Posts (Atom)