The 20 Great Challenges of Health and Medicine

3_role_of_the_patient.jpg The Role of the Patient
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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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8_reducing_childhood_obesity_1.jpg Reducing Childhood Obesity
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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 17% 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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5.jpg Achieving Medical Innovation
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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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18_healthcare_cost_1.jpg Addressing Healthcare Costs
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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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12_impact_of_poverty_1.jpg Impact of Poverty on Health
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Impact of Poverty on Health

The 46.5 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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9_making_prevention_popular_1.jpg Making Prevention Popular
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Making Prevention Popular

America spends $2.8 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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2.jpg The Caregiver Crisis
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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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6.jpg Managing Chronic Diseases
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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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13_best_practices_1.jpg Faster Adoption of Best Practices
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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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10_end_of_life_care_1.jpg End-of-life Care
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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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7_improving_medical_communication_1.jpg Medical Communication
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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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4.jpg The Obesity Crisis
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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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16_active_lifestyles_1.jpg Promoting Active Lifestyles
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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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1_inventing_wellness_programs_1.jpg Inventing Wellness Programs
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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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15_personalized_medicine.jpg Future of Personalized Medicine
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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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14_coping_with_stress.jpg Impact of Stress
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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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17_dementia_tsunami_1.jpg Preparing for Dementia
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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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19_whole_patient_care_1.jpg Whole-Patient Care
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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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11_sleep_deprevation.jpg Causes of Sleep Deprivation
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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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20.jpg Eliminating Medical Errors
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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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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.

  • Challenge: Achieving More Medical Innovation, More Affordably
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    Jake Turner: I feel that one of the most useful and underutilised resources is medical students. Often we come in with no preconceived ideas of patient care, technology or pathways, and so there is a lot of potential for innovation there. For instance, a patient was bringing up what could either have been phlegm or small bits of vomit, and in order to see which it was I used a pH strip to test the fluid. My consultant had not considered this, and I hadn't thought about it at all, it just seemed obvious.

    I feel that this is a big part of innovation, using new, fresh and outside eyes to try and see problems and solutions in new ways.

    The big problem then becomes how to formalise a way of communicating these ideas into practice, and frankly I'm open to ideas about that!
    Reply
  • Challenge: The Role of the Patient
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    Rev. Imani (Melanie) Roby: At our Free Clinic, the only literature available is patient education literature. It has been my experience that the Health Care system does not provide adequate teaching of patients. We provide comprehensive one-on-one education to each patient regarding chronic health conditions which include basic pathophysiology and include all medication education. We hold our patients accountable for being compliant with their doctors' orders and keeping follow-up appointments. We inform them that we, in the clinic (ALL volunteers) are committed to healing or stabilizing their health; however, it is THEIR RESPONSIBILITY as to what they do once they leave the clinic.
    Reply
  • Challenge: Addressing the Impact of Poverty on Health
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    Musa Bundu: Some developing countries are lack of trained and qualified doctors and it can never solved the problems of health care in those particular countries. I think they needed to be more practical than just focus on theory.
    Reply
  • Challenge: Addressing the Impact of Poverty on Health
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    NGOZIKA EBERE-OKOYE: In developing countries where HIV/AIDS prevails, the poor are the most affected. Going through statistics of people who died of this virus, 95% are the poor. This is also the case with other health challenges. Certainly, the poor do not always have access to conditions that make for healthy living. Usually the environment where they live is nothing to write home about. Polluted or unclean environment is a big challenge to good health.
    Reply
  • Challenge: Addressing the Impact of Poverty on Health
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    NGOZIKA EBERE-OKOYE: There is obviously a direct relationship between poverty and health. My NGO --CETRUP--works in rural communities where poverty and all kinds of diseases prevail. There is no doubt the impact health education can do in the lives of people living below poverty line, BUT, alleviating their their poverty, giving them good food and clean water can do much more than we can imagine. Taking care of their basic needs ( shelter, food and clothing) can go a long way at ensuring good health and healthy living.
    Reply
  • Challenge: Addressing Healthcare Costs and Payment Systems
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    Sara McFarland: We believe that a huge component of lowering health care costs in our country, is full quality and price transparency for procedures. Patients are clearly becoming more like consumers, meaning that they are looking for prices and comparing costs at various providers. This trend will likely grow in the next few years and it's already being seen by websites like Save On Medical for uninsured patients and the programs being set in place by Insurance providers like Aetna, who are creating transparency tools within their websites for patients. Transparency will help lower costs and narrow the price gap between different providers.
    Reply
  • Challenge: Addressing the Impact of Poverty on Health
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    Chau Nguyen: I've helped to coordinate several dental and medical missions to Cambodia and Vietnam. I noticed that poverty has a direct impact on health. However, I also noticed that "EDUCATION" is a much greater impact on health. If we can increase health education and push for more health awareness and knowledge, the degree of poverty on health might be reduced. On one mission, a mother with a child is standing online for free medical treatment. I asked the mother, what problems does the child have? The mother said "..the child has a cold". Upon examination, the Doctors confirmed the child has a cold. The Doctor asked the mother, "what are you giving the child to reduce the ailment?". The mother responded "..I gave her a can of coke and some cookies". The Doctor was puzzled. Why coke and cookes? For poor families, the parents might give their child items which are considered luxury goods to reduce the feeling of being sick. Its a means to appease and reduce the feeling of pain. Anyways, the Doctor told the mother "It would be better if you gave the child some oranges or tangerines which were locally available and abundant. In addition, you should also give the child more clean water to drink. The oranges and tangerines contains nutrients which will help fight the cold". Vitamin C and Water. The concept of Vitamins....a foreign concept to the new mother.
    Reply
 

Live Events  

Join us for TEDMED Tuesdays 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 on TEDMED's Google+ page. To submit questions, follow us on Twitter @TEDMED and tag your questions with #GreatChallenges. Check this schedule regularly for updates.

Join the conversation today by sharing your ideas and comments at #GreatChallenges.
 

Coming Up

Tuesday April 22, 12:00pm EST
Making The Grade: Examining the Case for Patient Activation Measures 

Tuesday May 6, 12:00pm EST
How do we empower the child? (Childhood Obesity)

Tuesday May 20, 12:00pm EST
What happens in health if supply cannot meet demand? (Healthcare Costs)

Busted: Outing the Top Health Myths - Watch the Recast

Tuesday March 25th at 12:00 PM EST 

You can get the flu – or worse — from a vaccine. Only old folks get strokes and heart attacks. Calories in, calories out. X-rays cause cancer. Sleep eight hours a night and drink eight glasses of water a day. Skip the sunscreen on a cloudy day. Take a multivitamin every day – just to be on the safe side. An apple a day keeps the doctor away. Exercise more to lose weight.

You’ve heard these before – maybe even one or two from your own doctor. They’re myths and sayings of dubious value that just won’t go away, and knowing the truth about them makes a big difference about how you approach preventive care. Join a live Google + Hangout as we out the most popular and damaging tall tales and find out the truth once and for all.

What are the most popular health myths, and how do they spread? Does social media spread scams faster than dispels them? What are the most popular myths, and how do they spread? Does social media spread scams, or help dispel them? How can doctors help patients see the light – and keep up on current research themselves? Nominate your top health myth at #GreatChallenges and we’ll get to the bottom of each with our panel of health experts and nominate the top five of all time.

Watch the Recast


 

Andrew Holtz, MPH, is an Independent Journalist with more than 20 years specialty experience covering health, medical research, health care and health policy. Andrew's experience includes work as a TV network correspondent, national magazine writer and columnist, and internationally published author. He is renowned for his work exploring how medical television shows, such as House, Grey’s Anatomy &
Monday Mornings, reflect and reinforce popular myths.

Follow Andrew on Twitter: @HoltzReport
 

Zackary D. Berger, MD, PhD, is an internist and epidemiologist and an Assistant Professor in the Department of General Internal Medicine at Johns Hopkins School of Medicine, with joint appointments in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and in the Berman Institute for Bioethics at Johns Hopkins. His research interests include the patient-relevant effects of public reporting, patient-doctor communication, overuse, and the exercise of patient autonomy in the context of limited clinical information.

Follow Zack on Twitter: @ZackBergerMDPhD

Rachel Vreeman, MD, is an Assistant Professor of Pediatrics at the Indiana University School of Medicine in the divisions of Children's Health Services Research and Pediatric Infectious Diseases. In addition, she is Co-Director of Pediatric Research for the Academic Model Providing Access to Healthcare, an academic collaboration that provides comprehensive HIV treatment for over 150,000 patients in Kenya. She also investigates how common medical beliefs become accepted, even in the face of evidence to disprove them. She has co-authored two books on medical myths -- Don't Swallow Your Gum! Myths, Half-Truths, and Outright Lies About Your Body and Health and Don't Cross Your Eyes... They'll Get Stuck That Way! And 75 Other Health Myths Debunked. Her third medical myth book will be published by St. Martin's Press in July 2014.

Follow Rachel on Twitter: @RachelVreeman

 

James Garrow, MPH, is a nationally recognized proponent and advocate for the use of social media and digital tools in the execution of public health activities. Jim's role as the Director of Digital Public Health in Philadelphia is among the first in the country charged with using new digital tools and techniques like social media, crowdsourcing, and big data utilization. 

Follow Jim on Twitter: @JGarrow

 

 

Rusty Hofmann, MD, is an actively practicing physician and Professor at Stanford School of Medicine, Chief of Interventional Radiology as well as the Medical Director of the Cath Lab at Stanford University Medical Center, and Co-Founder of Grand Rounds, Inc. He has devoted his career to providing state-of-the-art care to patients and has published over 100 scientific articles on minimally invasive treatment of blood clots (DVT) and cancer. 

Follow Rusty on Twitter: @RustyHofmannMD

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Watch Recasts of our Live Events 

Did you miss one of our Great Challenge live events? Check out a recast today by selecting from the list below.

 
     

The Storytelling of Science: ​
Great Challenges Day

To cap off TEDMED 2013, we convened a special afternoon session devoted to the 20 Great Challenges of Health and Medicine and explored how storytelling and narrative framework can be utilized to help us gain a deeper understanding of these critical topics. 

We invite everyone to explore the collaboration from Great Challenges Day and then add your voice to the conversation!

We invite you to:

  EXPLORE: Community Collaboration   WATCH: The Storytelling of Science   SHARE: Join the Conversation
 

Explore conversations the community has engaged in across 20 of the most pressing issues we're facing in health and medicine today...then join in. Check out discussions brought together through Storify, as well as those captured at TEDMED 2013 and at our first-ever Great Challenges Day as infographics, community statements and action commitments.

 

Watch these videos and discover the power of storytelling and the important role it plays in science. Three master storytellers, Randy Olson, Ben Lillie and Erin Barker help us challenge assumptions and tap into new insights.
 


Randy Olson | Watch


Ben Lillie & Erin Barker from
​The Story Collider | Watch

 

Share your perspective by creating your own ‘And, But, Therefore’ statement, reflecting your input on the challenges you are most passionate about. Throughout this summer and fall, we’ll feature selected statements as part of our ongoing dialog online and via Google Hangouts. Join the conversation today!

About Great Challenges Day


To cap off TEDMED 2013, we convened a special afternoon session devoted to the 20 Great Challenges of Health and Medicine and explored how storytelling and narrative framework can be utilized to help us gain a deeper understanding of these critical topics. 

The purpose of Great Challenges Day was to:

  • Gather the Great Challenges Community for a hands-on working session that challenged our assumptions, inspired new perspectives and encouraged collaboration as we seek to better understand these important issues
  • Explore how storytelling captures attention and stimulates action while helping us gain a deeper understanding of a topic
  • Facilitate the composition of story narratives for each Great Challenge into a single statement and community actions during the working session
  • Inspire the submission of stories and actions from every member of the Great Challenges Community

We invite you to explore the work from Great Challenges Day and contribute your voice to the Great Challenges by creating statements and action commitments for yourself, your home, your workplace, or even your local community.

We also encourage you to join the TEDMED community and learn about the Great Challenges program and the Great Challenges team members, live events, and social media communities on Twitter, Facebook, and Google+ and then join the conversation by sharing your stories and reflections. 


The Importance of Storytelling

 

Though research and data are vital, effective storytelling is key to any compulsory exercise in the thinking and exploration of a topic, and mastering the art of storytelling is carefully integrated into the TEDMED experience. Stories create receptivity, engagement, and connection that dissolve during a presentation of cold hard facts.

To make change in the world around us we need to capture other people’s attention; we need them to care; and, ultimately, we need to provoke passion and ignite action. Storytelling provides this difference.  

At Great Challenges Day, the community heard from three master storytellers to learn how to compose an effective narrative and how to identify their own story within their research and work. The community spent the afternoon uncovering new insights and challenging assumptions as they leveraged a narrative framework to create a single statement representing each challenge. Learn more by watching these videos of the experience.

 
The "And, But & Therefore" of storytelling
Randy Olson
Why your life is as interesting as your research
Story Collider
Ben Lillie
 
Erin Barker
 

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