Great Challenges

The 20 Great Challenges of Health and Medicine

The 20 Great Challenges
About the Great Challenges
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The Role of the Patient

Patient empowerment can be a double-edged sword. From hospitals and insurance companies to doctors and patients themselves, much of the medical system increasingly treats patients as “customers” or “consumers,” terms that some people love and others hate. If patients are customers, does that mean “the customer is king” or does it mean “buyer beware” — or both?

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

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Managing Chronic Diseases

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

How can we innovate better approaches to help patients prevent, manage and treat their chronic diseases and achieve better outcomes?

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The Obesity Crisis

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

Scientists and doctors generally agree the obesity epidemic is behavioral in nature (not the result of a pathogen).

The key drivers are our choices of food and activity, but multiple additional factors also play a role — from family dynamics to cultural roots, stress, economics, lifestyle and many more. Unlike smoking or drinking, eating is not optional. How can Americans move to healthier lifestyles — or, if we can’t change these trends, how can the healthcare system cope with the results?

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The Caregiver Crisis

An estimated 44 million people provide full-time or part-time care for the elderly, disabled veterans, new mothers, the injured, the sick, etc. — a problem that eventually impacts everyone in the nation.

Caregivers have few tools, few support systems and receive minimal, if any, training for these responsibilities. What innovations can we develop specifically to support the caregiver community?

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Eliminating Medical Errors

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

Errors by medical professionals and systems are inevitable (unfortunately, they send 2.4 million patients to hospitals yearly and are directly linked to 200,000 annual fatalities). Regardless of methods used to detect, prove and compensate for medical errors, how much better can we do in reducing or eliminating medical errors and what areas should we focus on to get the best improvements?

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Achieving Medical Innovation

New medical tests, treatments and devices are often very expensive when first introduced. Eventually, market forces bring the prices down. However, since most patients don’t pay for healthcare out of their own pockets, they don’t want to wait.

Patients disproportionately demand the latest, best medical products and services immediately — often, even if the demanded good is of marginal relevance to their condition. Leaving out questions of universal access and rationing, how can we make more medical innovations more affordable, more quickly, for more people?

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

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Reducing Childhood Obesity

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

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

Finally, there is the fact that kids are less set in their ways than adults, so it’s easier to change their behaviors and teach them new concepts. The number of obese children has just passed 20% and continues to grow. What is the full range of underlying causes for this trend and which combined causes are chiefly responsible?

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End-of-life Care

Modern medicine has extended the life expectancies of many terminally ill Americans. In turn, prolonging lives can mean incurring more intensive care and the associated costs.

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

How should we help people manage end-of-life care choices to maximize individual well-being and minimize social cost?

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Preparing for Dementia

It’s no secret that mental health tends to decline as we age (Alzheimer’s, dementia, etc). Some is natural cognitive decline; some is disease with severe cognitive impairment due to diseases associated almost entirely with aging.

By 2020 there will be 43 million Americans over 65 and 15 million over 85 (double the figures of 1980). Almost certainly, we are facing an unprecedented number of mentally impaired citizens.

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

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Whole-Patient Care

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

Most doctors specialize due to a variety of pressures and incentives from economic and technological to social, professional and educational. The number of medical specialists (and specialties) continues to grow while the number of primary care physicians continues to shrink.

In the process, the goal of fitting all these specialties together for effective whole-patient care becomes ever more elusive. How can we treat the whole patient rather than the disease?

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Making Prevention Popular

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

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Medical Communication

Physicians are not typically trained in interpersonal communications and are not rewarded based on their communication skills.

Equally important, patients are often intimidated when talking to doctors and often feel they don’t have a receptive audience, especially when doctors are rushed. What can be done about this on both sides of the challenge (patients and doctors) — including possible initiatives in areas ranging from education to technology, to possible changes in the physical workspace? How do we make this issue a priority?

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Faster Adoption of Best Practices

Best Practices Medical progress only occasionally depends on double blind, placebo-controlled studies. Most healthcare improvements come through small, incremental steps across tens of thousands of surgeries, procedures and protocols — from a better way to take a temperature to a better stitch or a better way to ask a question in the ER. But most of these improvements are not captured, shared and replicated across the healthcare system.

Even when best practices are identified and publicized, many providers seem slow to adopt them. What can we do to capture millions of improvements per year and make best practices available to benefit many more providers and patients?

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Addressing Healthcare Costs

The U.S. remains locked in a decades-long controversy over how citizens should pay for healthcare, what healthcare should cost, who should pay, how much, and what incentives, if any, should be “paid” to patients who stay well (or try to).

How do we foster a thoughtful, civil dialog that focuses on science and the public interest, in a way that has a reasonable chance of eventually creating an approach we can all support?

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Impact of Poverty on Health

The 46 million Americans who live in poverty are measurably less healthy and have far worse health outcomes than the rest of the population. Less certain is how much of these negative health outcomes are directly caused by poverty and how much is caused by other factors.

America would be better off if everyone were healthy, regardless of income — especially since government programs cover some of these costs directly. How should we think about the role and impact of poverty within the larger question of health?

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Promoting Active Lifestyles

There is no disagreement that people who are more active have dramatically better overall health. Yet today’s average American adult burns 500 fewer calories per day than farmers and factory workers did 100 years ago — while consuming many more calories.

How do we invent broadly popular and achievable ways for people to become more active, so as to replace those “lost” energy expenditures?

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Inventing Wellness Programs

From corporate America to the U.S. government and its armed forces, small businesses and even religious and educational institutions, many large-scale organizations have a strong economic motive to encourage their workforces to adopt healthier lifestyles (worker wellness means lower insurance rates for employers).

Many organizations have discovered elements that support worker wellness to some degree, but no group has put it all together for large scale, long-term success. Compounding this problem is a disagreement over the relative responsibility of the individual versus the responsibility of the organization for employee health (with issues ranging from workplace environment and stress, to on-the-job support for healthy lifestyles—or the lack of such support).

What kinds of innovation should we be thinking about and how can we encourage them to come to market as soon as possible?

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Causes of Sleep Deprivation

While sleeping too few hours each night can have serious health consequences, we now know that better sleep is a tool that can be applied to many other Great Challenges of health and medicine. More and better quality sleep can fight obesity, help reduce medical errors, improve outcomes for the chronically ill, help special needs children cope better in society, fight stress, etc.

Sleep fights an uphill battle as American society seems to conspire against it. Children set off for school at dawn. Tough financial times push cash-strapped workers to take multiple jobs. Shift work conflicts with the body’s natural clock. Type A personalities push themselves to work long hours and take redeye flights. Undiagnosed sleep apnea is rampant. Med students work 30-hour shifts with no sleep. Teenagers text into the night.

What is the full range of causes (social, medical, technological, economic, etc.) that engender and promote this widespread problem? What are the first-order and second-order effects, and beyond, of sleep deprivation? What would it take, and what would it mean, for America to view sleep as the third pillar of total health, alongside diet and exercise?

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Impact of Stress

Tranquilizers, antidepressants, sleeping pills and antianxiety medications exceed 33% of annual U.S. prescriptions. Unhealthy levels of stress are far more prevalent than most people recognize, and stress contributes to many other mental and physical health problems.

Given that stress is difficult to quantify and varies from person to person, how do we better understand the role of stress in the larger picture of health?

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Future of Personalized Medicine

Science is harvesting more and more information about the human population, and individual patients specifically. Medicine is understanding the roles of genomics and the environment in a patient’s medical history. Yet translating this data to practice has proved difficult. The fundamental question for a physician is still: will this treatment work for my patient?

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

How can insights into individual patients — gleaned from in vitro and in vivo diagnostic tests — allow us to zero in on targeted therapies?

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About the Program
How it Works

The Great Challenges of Health and Medicine are complex, persistent problems that have medical and non-medical causes, impact millions of lives, and affect the well-being of all of America – beginning with patients, and extending to families and citizens everywhere.

These knotty problems are not susceptible to simple cures, magic bullets or “one-size-fits-all” solutions because they stem from broad, interlocking social, economic and psychological sources as well as from medical or scientific triggers. What’s more, each challenge creates multiple, overlapping effects that may cut across all sectors of society.

The mission of TEDMED’s Great Challenges Program is not to solve these complex problems. Instead, we propose to provide America and the world with an unbiased and broadly inclusive view of these challenges, incorporating thoughtful, multidisciplinary perspectives.

TEDMED believes that through an open, ongoing dialog with our intellectually diverse community, we can move toward a broad-based understanding of each challenge. Such an understanding can, in turn, set the stage for truly effective action.

The Great Challenges Program encourages everyone’s input. Doctors, scientists and researchers, of course – also technology innovators, business and government leaders, patients, legal experts, representatives of the armed forces, and the media. Quite simply, if you have a stake to protect…an idea to contribute…or a cause to promote, we want to hear from you!

To learn more about how the program works, click here.

How the Program Works

For the coming year, the Great Challenges Program will conduct a lively national dialogue on 20 challenges chosen by the TEDMED community. For each challenge, we have assembled a different Challenge Team, consisting of a multi-disciplinary group of leaders in their fields, each of whom brings a passionate and thoughtful perspective.

Conversations among Challenge Teams will take place through next March on TEDMED.com and during a series of live web-based sessions. TEDMED community members are encouraged to add their voices and unique points of view. You can participate by posting comments and follow-up questions, engaging in real-time, multi-disciplinary dialog with all members of a Challenge Team as well as other members of the TEDMED community.

Ultimately, success of the Great Challenges Program will be defined by lively, far-reaching and meaningful discussions that lead to deeper understanding of these complex challenges.

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Challenge: The Role of the Patient

George Margelis: The recent publication of the "Open Notes" trials suggests that transparency between patient and provider is a great way of supporting informed decision making by patients. The key is to make sure we don't make assumptions about what information is suitable for patients, and which is not. Make all the data available, and let the patients choose what they want to do with it. Smart developers will make tools that manage the information for the patients in a way that suits them, and provide choice.

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Challenge: Achieving More Medical Innovation, More Affordably

Hayman Buwaneswaran Buwan: As a clinician and a technophile, I am at times also frustrated with the pace of innovation in healthcare. However, when change does take place it's for the better. My only growing concern with this drive for change is that people are going after the low-lying and lucrative fruit without addressing also the more critical systems within the 'trunk and roots.' We can definitely do things with the small incremental innovations, but we also need some bold approaches (with government push) to 'update' the underlying systems. An OS update, if you may, to our Healthcare IT.

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Challenge: Eliminating Medical Errors

Robert Coli: Errors by human medical professionals using imperfect paper or computer system-based patient records are indeed inevitable. However, before the February 2009 passage of the ARRA/HITECH Act policy makers, patient advocates and health IT system vendors had entirely overlooked one important area within the electronic medical records domain where user interface redesign can help physicians and collaborating patients to eliminate unnecessary testing, significantly reduce diagnostic and therapeutic errors and save billions of currently wasted dollars.

The basic problem is that contemporary EHR, PHR and HIE platforms are inadvertently providing physicians and patients with an antiquated user interface that uses variable reporting formats to display diagnostic test results as incomplete, hard to read, fragmented data.

Ultimately, the efficient viewing and sharing of cumulative results by collaborating physicians and patients will require the development and adoption of a clinically intuitive, standard reporting format that can display the cumulative, integrated results of all 7,500 available tests as actionable information.

As American healthcare replaces the flawed provider-centric, fee-for-volume model with a consumer-centered, value-driven system based on accountable care and patient outcomes, and Big Data analytics, the incentives will finally exist to enable physicians and their patients to efficiently view and share lifetime test results.

Perhaps this TEDMED Great Challenge Team can evaluate this user interface problem as one specific area where a constructively disruptive IT innovation could produce measurable improvements in medical error and patient safety rates and reduced per capita costs.

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Challenge: Coming to Terms with the Obesity Crisis (Adults)

Douglas Robb: Obesity is not a disease...it is a symptom of disease. By focusing on this one symptom, we ignore all of the other nasty stuff that our Lifestyle Disease is causing. This disease has numerous causes...all related to our hectic "modern" lives.

The real question is how do we hold on to the great parts of our society while eliminating all the bad - poor physical health, poor mental health, poor emotional health, etc....

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Challenge: The Caregiver Crisis

Ann Haehn: Over the past two years, I've been a caregiver for my daughter, my best friend and my mom, all who battled different forms of cancer. As their caregiver, I learned a whole new language and culture - each disease and treatment is so different. I almost feel as though I've earned my RN stripes. I know how to clean and flush ports, administer medicine, and help a loved one through a seizure. Yet I've never taken a single nursing course. My 34 year old daughter had two rare blood cancers and a stem cell transplant so her caregiving has been extensive. My best friend had brain cancer and I helped her along the way for three years until she finally succumbed to the disease in Feb of 2011. And my mom had breast cancer, passing away last December. As Chris MacLellan states, it is an honor to be a caregiver, and yet it is also all consuming and exhausting. I would never trade away my role though. So . . . let me know what you need and I'm here to share my stories if they will help others on the caregiving path. As well as to help me.

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Challenge: Coming to Terms with the Obesity Crisis (Adults)

Evan Walker: I think this crisis is the probably the hardest medical problem America faces today. It has so many variables and many of its causes are so deeply imbedded in our society that an honest look at the problem leaves you wondering where to even begin.

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Challenge: The Role of the Patient

Dave deBronkart: Ha - I typed this into the wrong block, and it disappeared .. starting over:

How come in the Profile page, where we identify our industry, there's no option to identify myself as a patient?

How ironic: we're here to discuss "the role of the patient" and there's no way to self-identify that way in the site's demographics. :) It's PERFECTLY symptomatic of why healthcare has ended up so not-patient-centered ... can we add that as an option, please?

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Challenge: Inventing Wellness Programs that Work

samata vasisht: Sharing a model of holistic wellbeing created by me few years ago and have received outstanding results in working with groups and organisations in informing whole system based on data gathered and worked with ,as well as transformative on group/individual level.
Dimensions of holistic wellbeing being:
1.Physical wellbeing
2.sexual wellbeing/intimacy
3.financial wellbeing
4.Intellectual and creative wellbeing
5.Occupational wellbeing
6.Interpersonal/social wellbeing
7.Self awareness
8.Resilience
9.Higher awareness
10.Environmental wellbeing

We work intensively and extensively on 7,8,9 aspects which I call the Spiritual wellbeing aspect/core of a person where intrinsic motivation,values and perspectives to life are held.Notice there is no emotional wellbeing as we experience emotions every moment and its a dynamic energy avialble in every dimension.It is worked with in every dimension.

Sorry,unable to post the visual of the holistic wheel,would love to share more.

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Challenge: Inventing Wellness Programs that Work

samata vasisht: Sharing a model of holistic wellbeing created by me few years ago and have received outstanding results in working with groups and organisations in informing whole system based on data gathered and worked with ,as well as transformative on group/individual level.
Dimensions of holistic wellbeing being:
1.Physical wellbeing
2.sexual wellbeing/intimacy
3.financial wellbeing
4.Intellectual and creative wellbeing
5.Occupational wellbeing
6.Interpersonal/social wellbeing
7.Self awareness
8.Resilience
9.Higher awareness
10.Environmental wellbeing

We work intensively and extensively on 7,8,9 aspects which I call the Spiritual wellbeing aspect/core of a person where intrinsic motivation,values and perspectives to life are held.Notice there is no emotional wellbeing as we experience emotions every moment and its a dynamic energy avialble in every dimension.It is worked with in every dimension.

Sorry,unable to post the visual of the holistic wheel,would love to share more.

Reply
Challenge: Coming to Terms with the Obesity Crisis (Adults)

Javier Herrera: The reason, Sean, that highly processed food is cheaper, is very simple, the government is subsidizing the corn, wheat and soybeans to the tune of more than $12billion/yr to big agribusiness. So its a whole lot cheaper to get the burgers and fries instead of the broccoli, brussel sprouts, beans and beats! :-)
Unless we change our governmental leaders and remove the influence of the big agribusiness lobbyists, AND focus those $12billion to local organic farmers who produce around our cities locally, decreasing the cost of shipping and eating locally grown harvest, in season. We will continue on the road to ruin, practicing McMedicine, and seeing the continued demise of health in our country. Oh and yes the good news is that China, our biggest competitor, is also headed full speed into the unhealthy abyss, with the increased availability of YUM corp(KFC, Pizza Hut, Taco Bell) and of course McD's. We need more education at the local level to demand change, educating of children about healthy foods and habits is our only way out of this mess!
Whew sorry... just had to get that off my chest...

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Challenge: Reducing Childhood Obesity

Abdul Ghaffar: Reduce the consumption of sugary beverages, increase
activity level, compulsory physical education.

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Challenge: Addressing Healthcare Costs and Payment Systems

diana reed: Expanded and Improved Medi care for All HR676 a current bill in Congress would save us an estimate. $400 Billion and cover everyone. It is not an entitlement but would be a % of income and thus predictable for whom it matters most: the Patient. The savings would come from the 31% admin costs from insurers, negotiation With big pharma and can you imagine how many Innovators and Entrepreneurs would leave the jobs they hate if it weren't for the insurance costs? Not to mention quality. We rank 37th overall in health quality behind every industrialized country, and it is not because we have bad doctors or hospitals. The countries ahead of us have some form of NHS a safety net for their people. They spend 1/2 on average. They know their taxes are going to a good cause. Prevention, scientific and research grants are available without strings, wellness treatment for people with mental illness and emergency care will be accessible to all without copays deductibles Coin surance or lifetime max. Medicare cards can be designed to carry your PHI or be in the cloud and salaried MDs can have time allotted to answer tweets emails instead of filling out mtns. Of forms for Ins.cos. Simplified payer systems would also allow doctors in small private practices like me stay independent. If for no other reason than compassion for those less fortunate we all know that no one should die on our doorstep for lack of their basic needs, food shelter and access to affordable healthcare !

Reply
Challenge: Addressing Healthcare Costs and Payment Systems

diana reed: Expanded and Improved Medi care for All HR676 a current bill in Congress would save us an estimate. $400 Billion and cover everyone. It is not an entitlement but would be a % of income and thus predictable for whom it matters most: the Patient. The savings would come from the 31% admin costs from insurers, negotiation With big pharma and can you imagine how many Innovators and Entrepreneurs would leave the jobs they hate if it weren't for the insurance costs? Not to mention quality. We rank 37th overall in health quality behind every industrialized country, and it is not because we have bad doctors or hospitals. The countries ahead of us have some form of NHS a safety net for their people. They spend 1/2 on average. They know their taxes are going to a good cause. Prevention, scientific and research grants are available without strings, wellness treatment for people with mental illness and emergency care will be accessible to all without copays deductibles Coin surance or lifetime max. Medicare cards can be designed to carry your PHI or be in the cloud and salaried MDs can have time allotted to answer tweets emails instead of filling out mtns. Of forms for Ins.cos. Simplified payer systems would also allow doctors in small private practices like me stay independent. If for no other reason than compassion for those less fortunate we all know that no one should die on our doorstep for lack of their basic needs, food shelter and access to affordable healthcare !

Reply
Challenge: Improving Medical Communication

Timothy Landers: One of the problems is that there are so many providers involved in the care of patients -- especially those with complex needs. Primary nurses, attending physicians, facility staff, consulting physicians, therapists, residents, nurse practitioners, technicians can all interact with a patient over the course of treatment.
I thought that the TED MED app and its ability to track a "network" of contacts -- including photos, name, and title -- would be an innovative way to capture contacts for patients as well. A patient-directed system could also show a "social network" of health care providers seen by a patient including contact information for the professionals.

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Live Events

Join us for TEDMED Thursdays when we will host live video chats as a way to further explore these great challenges. Participate by submitting questions and sharing your perspective with Challenge Team members and the TEDMED community in real-time. Join us for these live events here on TEDMED.com (see schedule below). To submit questions, follow us on Twitter @TEDMED and tag your questions with #GreatChallenges. Check this schedule regularly for weekly updates.

Google Hangout Recasts

Did you miss one of our Great Challenge live events? Check out a recast of one today.

The 20 Great Challenges of Health and Medicine

The Role of the Patient

Managing Chronic Diseases

The Obesity Crisis

The Caregiver Crisis

Eliminating Medical Errors

Achieving Medical Innovation

Reducing Childhood Obesity

End-of-life Care

Preparing for Dementia

Whole-Patient Care

Making Prevention Popular

Medical Communication

Faster Adoption of Best Practices

Addressing Healthcare Costs

Impact of Poverty on Health

Promoting Active Lifestyles

Inventing Wellness Programs

Causes of Sleep Deprivation

Impact of Stress

Future of Personalized Medicine

How the Program Works

Live Events

Google Hangout Recasts

Future Events Schedule