The future of health and medicine is here

The tag line was bold and mundane all at once.

It has probably been used at innumerable conferences before this one. But when the gathering in question is TEDMED 2012, the world takes notice.

How would some of the best minds (70 speakers, over 1000 delegates) give new meaning to a discipline mired in financial, ethical and scientific stalemate? What mind-boggling breakthrough would emerge from this three-and-a-half day idea orgy?

Not that I needed any convincing. As a proud, longstanding TEDaholic, having my scholarship application accepted was all I needed to pack my bags and head to the Kennedy Center in Washington D.C., the new home of TEDMED.

I came. I saw. I took in the grandeur of all the historic conference locations: the Opera House, the Library of Congress, the National Portrait Gallery and the National Building Museum.

I left with some invaluable connections, a couple of personal insights, and a few memorable ideas.

The future of health and medicine, in my view, will be built on the following themes:

1. Making prevention popular and profitable

To my delight, one of the biggest ideas – both on the stage and behind the scenes this year – was centered around the largest public health problem of the 21st century. Chronic disease (obesity, diabetes, cancer, hypertension, mood disorders) is now the leading cause of death in both the western and developing world.

Current healthcare models are built to address the aftermath of chronic disease – way, way downstream. So too are the incentives for healthcare providers.

The absurdity of this set-up was brought home by Ivan Oransky, Executive Editor, Reuters Health who regaled us with stories of prevention gone wrong a.k.a. the obsession of the medical community with indiscriminate screening for “sub-clinical” disease. In this paranoid state, no one is spared from being a “previvor” (those at risk of cancer who never develop the disease) or at the very least, suffering from “pre-death”. He urged us to take a “less is more” approach in an era where the cost to benefit ratio of the search for “pre-conditions” is dangerously high.

Meanwhile, the horrific results are in plain sight. Zooming in on the obesity epidemic were John Hoffman, Vice President, HBO Documentary Films andDr. Judith Salerno, Executive Officer of the Institute of Medicine of the National Academies, as they presented Weight of the Nation, a four-part series and large scale public health campaign premiering May 14.

But there is hope.

As Sandeep Kishore (precocious and passionate Co-chair of the Young Professionals Chronic Disease Network) astutely pointed out, medical education is based on a paradigm that is a 100 years old. Chronic disease is a systems issue, where the “pathogens are social, man-made; as are the vectors”. He pointed out that of the 30+ years gained in life expectancy in the past century in the U.S.A., only 5 years could be attributed to medical care – the rest reflect societal change.  Calling for a medical student led revolution, he hoped a new model of thinking based on addressing the “causes of the causes”of chronic disease would emerge.

This is great news for those of us who subscribe to systems thinking. The behavior of a system is dependent on its structure. System structure trumps willpower over and over again. The epidemic of chronic disease has been nurtured by an intentionally convoluted, ethically bankrupt coalition of government, medical, pharmaceutical and food industry cohorts. Reversing the trend will require a collaborative social solution, rather than guilt-tripping the masses over their lack of personal responsibility.

2. Social justice = better health

There was no shortage of brilliant examples of social justice advocacy making real impact in health care.

Bryan Stevenson, Executive Director, Equal Justice Initiative challenged us to talk about the things that nobody talks about: the state of the poor, the incarcerated and the condemned. He reminded us that years from now, we will not be judged by our technology, entertainment or design, but by those“lurking in the shadow”; our identity will be revealed by how we tackle issues of poverty and injustice. Quoting Rosa Parks, he reminded us that this work will “make you tired, tired, tired…..and that’s why you must be brave, brave, brave”.

Rebecca Onie has certainly heeded the call. Co-founder of Health Leads and one of Forbes magazine’s top 30 social entrepreneurs in the world, she advocates for prescription of basic resources – food, housing, utilities – by doctors to their population of  low-income patients. A team of college volunteers then works to connect the prescription with available community resources. The most creative use of hospital waiting room real estate!

Violinist Robert Gupta raised the emotional quotient of the audience several levels with his sublime musical performance and storytelling. A musical prodigy and past medical researcher, Robert created Street Symphony: a musical outreach concert series using music to help heal the mentally ill living within homeless, incarcerated and Veteran communities.

3. Interdisciplinary research, crowd-sourcing and the power of networks

A glimpse into the frontier labs reveals an amazing world of collaboration: physician scientists working together with mathematicians, engineers and video gamers.

Seth Cooper, Co-creater of Foldit, a scientific discovery game, uses crowd-sourcing & the “power of play” to help solve complex protein folding problems that translate to biochemical solutions.

Meanwhile Francis Arnold, Professor, California Institute of Technology, indulges in (safe) sex on the petridish: bringing together protein sequences from different species that reassemble into 3-D functional protein molecules. The result? Enzymes with longer lives that are used in cancer therapy or enzymes that help extract alcohol from plants for biofuel. The possibilities are endless.

The physician of the future will be a “networkologist”, claimed Albert-Laszlo Barabasi, Director of the Center for Complex Network Research, Northeastern University. The days of organ-based and “silo” medicine are over. Human disease, at the cellular level, is a complex network of infinite connections that transcend neat little anatomical delineations. Decoding these maps will translate into a new approach to cure.

The thought was echoed by Jonathan Eisen, Professor, UC Davis Genome Center, who reminded us that our bodies are a “teaming ecosystem of microbes”. This cloud of non-pathogens, rather than being inert, are a functioning organ, actively influencing our genetics and behavior, and vice-versa. The Human Microbiome Project aims to sequence the DNA of this community, with the hope that it will help us better understand the pathogenesis of various metabolic and immune diseases.

4. Art as medicine

Not a novel idea, but one that is perhaps often forgotten. The TEDMED community was treated to a fantastic range of music and performance that ranged from the invigorating acrobatics of TRACES to the sublime spoken word artistry of Sekou Andrews and Steve Connell.

Perhaps E.O. Wilson summarized it best: “The ideal scientist thinks like a poet and works like a bookkeeper”.

Beyond the speakers, it was the connections made at the Social Hub that will stay with me for a long time: a fantastic meeting of hearts and minds working towards a common goal – bringing the present front lines of medicine closer to a healthier future.