Pioneering Ideas

Positive Health Lecture Series Kicks Off With Sir Michael Marmot

In 2008, Pioneer funded Dr. Martin Seligman to extend his influential work in the area of positive psychology in to the realm of "positive health"--a new approach to improving well-being that emphasizes “health strengths” rather than the conventional mix of disease diagnosis, treatment and prevention.  Building on progress in the positive psychology field, which applies validated interventions to boost the strengths and virtues that help individuals thrive in daily life, Seligman and his team are exploring whether positive health may reveal a variety of potent, low-cost approaches that can serve as a buffer against physical and mental illness and, more importantly, enhance people’s overall health strengths.

The project is hosting a speaker series that kicks off next week at University of Pennsylvania's Medical School.  First up is Professor Sir Michael Marmot, chair of the World Health Organization Commission on Social Determinants of Health and director of the International Institute for Society and Health, University College London.  Marmot will address the Commission’s work to examine underlying social determinants of health and how it is transforming global and national policy debates to improve health.

Admission is free and open to the public, so feel free to spread the word among those in the NJ/PA/DE area.  Here are the details:

Date: Wednesday, March 4

Time: 12:00-1:00 pm

Location: Dunlop Auditorium in Stemmler Hall at the University of Pennsylvania School of Medicine, near 36th and Spruce Street in Philadelphia.

Need more specifics?  Click here.

When Simple Works

Good health information ideas that work don’t have to be complex, use lots of technology and be hard for the user to understand. That’s the way I read the article “Communicating Drug Benefits and Harms With a Drug Facts Box: Two Randomized Trials” by Lisa M. Schwartz, MD, MS; Steven Woloshin, MD, MS; and H. Gilbert Welch, MD, MPH that appeared in the newest issue of the Annals of Internal Medicine. If you don’t want to read the whole thing, USA Today ran a good summary of the study outcomes.

 

The idea is fairly simple: replace the brief summary page that accompanies print advertisements for prescription drugs with a “drug facts box,” a table that quantifies outcomes with and without the drug. The idea is similar to the nutrition information that is standard on foods sold in supermarkets. The article discussed two trials, a symptom drug box trial using direct to-consumer ads for a histamine-2 blocker and a proton-pump inhibitor to treat heartburn, and a prevention drug box trial using direct-to-consumer ads for a statin and clopidogrel to prevent cardiovascular events. Since the pharmaceutical industry spent more than $5 billion on these ads in 2007 – more than twice the total U.S. Food and Drug Administration (FDA) budget – finding a way to help inform consumers is important.

 

The results were impressive. In the symptom drug box trial, 70% of the drug box group and 8% of the control group correctly identified the PPI as being “a lot more effective” than the histamine-2 blocker (P 0.001). In the prevention drug box trial, 72% of the drug box group and 9% of the control group correctly quantified the benefit of the statin. (See left for a sample).

Last August Pioneer helped fund a collaboration between this research team and the FDA in the development of 10 prototype boxes. Unfortunately, right now the FDA seems absorbed with, once again, studying the “best” way to work. Sometimes striving for perfection impedes actions that can have a positive effect right now. This might be one of those times.

Freakonomics Blog Sparks Debate On "Designing for Better Health" Competition

Major thanks to Steven Levitt of the New York Times Freakonomics blog (and co-author of the book by the same name) for publishing a post on the new Changemakers competition, "Designing for Better Health."  The competition, which seeks innovative "nudges" that can influence people to make healthier choices for themselves or others, has kicked off a really interesting string of comments among Freakonomics blog readers.  Add your perspectives, either there or on the Changemakers competition site.

Posting from TED: Bacteria May Be The World’s Best "Risk" Players

According to Dr. Bonnie Bassler’s TED presentation on Friday, bacteria operate inside your body in way that’s similar to the game of Risk.  Bassler’s a molecular biologist at Princeton and she studies the way bacteria communicate with each other.  She said they’ve found that bacteria send out a simple chemical signal that can only be read by bacteria of the same type.  When there’s enough bacteria sending enough like-minded signals, the bacteria launch an attack (technically, it exercises a specific behavior it’s genetically programmed to exercise…in some cases that could be good for the host, in others, such as with MRSA, it could be really bad).  This communication is called quorum sensing.

It’s more complicated and more elegant, though.  Bacteria have a second simple chemical signal they send out.  This one can be read by all bacteria.  It tells a particular type of bacteria what other types of bacteria are in the host and how much of it is there.  Too much of bacteria Y, and bacteria X won’t launch its attack/exercise its behavior.

In Risk, it was always one thing to get control of Australia and another to gain enough reinforcements to successfully attack another piece of territory.  And the question of whether to attack was always informed by the size of your opponent’s army.

Bassler’s work is more than just a game.  It suggests a new approach to dealing with bacterial infections, one that involves interfering with the communication mechanism of the bacteria.  This may open up whole new avenues for pharma companies working to fight infections in this age of intensified antibiotic resistance.  In a related vein, policy changes that could facilitate the development of new antibiotics were outlined in the report "Extending the Cure: Policy research to extend antibiotic effectiveness," produced under a grant led by Ramanan Laxminaryan. 

Posting from TED: Health, Design and Game-Changers

Sorry for the lapse in TED posting…never have I seen an event program as packed as this.  It’s made getting back to the hotel a challenge, and throw in some tenuous wireless connections…well, you get the point.  But here’s a recap of RWJF’s luncheon at TED, held Thursday. 

We had a packed room of 60 TEDsters--including the creators of Del.icio.us and hotornot.com, heads of design schools, the president of user experience design firm Adaptive Path (developer of the Charmr, from an earlier Emily Culbertson post), execs from venture capital and game development firms, David Pogue (technology columnist for the New York Times and one of my favorite writers) and the founder of DNA Direct (a genetic testing and management company)—with about 30 who lined up to attend, but unfortunately we couldn’t accommodate due to space limitations.

Pam Omidyar, founder of HopeLab gave a great recap of the inspiration behind and clinical outcomes linked to Re-Mission, the video game developed for kids battling cancer.  There were cheers when she showed the results, which demonstrated that kids who played the game had higher levels of treatment adherence and more knowledge about their disease ,and were more empowered to fight back.  She showed amazing MRI imagery that showed players’ brains on Re-Mission.  Areas tied to emotional processing lit up, which was key to internalizing the lessons underlying the challenge and excitement of the first-person shooter game.  We were honored to have Taylor Carol and his dad, Jim, with us – Taylor is now in full remission from leukemia, played the game during his six months in the hospital, and is the star of our promise story on Re-Mission. 

John Maeda, president of RISD, outlined distinctions in mission and change vision between designers and artists, and called on more designers to apply their skills, thinking, creativity and ingenuity to save the world.  Having given some of the more popular TED Talks in years past, he provoked the group to think differently about the potential of this space.

The group then turned to the game jam, led by Ben Sawyer and game designers Noah Falstein and Larry Holland.  The crowd first decided to tackle the issues of chronic disease, and then refined the challenge further to focus on actions and behaviors.  Some of the ideas they proposed that seemed promising to the game developers included:

• Addressing metabolic syndrome, using a game approach to help navigate the different associated conditions and co-morbidities, trade-offs among treatments, and patients’ abilities to manage aspects of their condition.
• Developing a realistic, action-based approach to the immunization debate that can inform decisions around vaccine safety.
• A game focused on how to manage depression…when asked why that intrigued them, the developers replied, “Because it seems hard.”  
• Helping patients better navigate health care systems and services.

Noah and Larry continued to work through these possibilities in to the evening on Thursday and all day Friday.  The results of their concept development will be unveiled at our TED Lab exhibit space this morning.

We’re grateful to Pam, John, Ben, Larry and Noah for joining us and shining a spotlight on the potential for games to spark big change in health and health care.  I think people came away with a sense for that potential to touch people’s lives and help them pursue health goals and make informed decisions in uniquely powerful ways. 

Ben and his team are going to see where these ideas may go from here, so let us hear your input on how this exploration can lead to the next breakthrough health game.

Posting from TED: the Raw or the Cooked?

In the afternoon session of Day 1 at TED, Tim Berners-Lee, credited as inventor of the World Wide Web, made a simple request, one he’s trying to build a movement around: put your data on the web.  In Berners-Lee’s view, data held in the hands of the few is a lost opportunity.  It’s like the complaint leveled against the researchers who held on to the Dead Sea Scrolls for so long and wouldn’t let other researchers work with them or analyze them…only we’re talking about digitized data, not papyrus-based data.

Putting data on the web in a format that allows linking would open it up to all manner of exploration and analysis.  “When you connect data together, you get power,” he said. This spirit is what’s behind our support of Rapid Learning, which is being championed by Lynn Etheridge.  Rapid Learning proposes to link patient data bases from various provider organizations for research purposes.  It’s also embedded in our support for ARCHeS, the effort to build a user interface for the Archimedes model that would enable more people to harness its power to answer questions.

Berners-Lee pushed the idea of putting data on the web to its limits, leading the audience in a chant of “Raw Data Now, Raw Data Now.”  For some people, looking at some kinds of data, the idea of just posting it on the web is disconcerting.  Assuming one takes proper steps to assure privacy and confidentiality, should all data be open for mining and analysis, or are there limits to what should be shared in its raw form?

Is the country ready for health reform?

Health reform seems to be on everyone’s mind these days – and why not? Our system doesn’t deliver great value overall, it is inequitable, and the economic crisis promises to make it much worse unless we can do something about it.

I came across two views of health reform Sunday – one by David Leonhardt and the other by Janet Rae-Dupree – both in the New York Times. Leonhardt placed health reform in the context of big picture economic strategy over decades; Rae-Dupree brought the lens of disruptive innovation to health reform. Leonhardt singles out health because it is such a daunting fiscal problem, even in the context of the worldwide economic crisis. The future unfinanced obligations under Medicare plus a distinctly inefficient system makes the future price tag of health reform bigger than the estimated bailout. That is not what most people have in mind when they think of health reform – they think of more people having insurance coverage and improving the care people get.

Rae-Dupree applies Clayton Christiansen’s concept of disruptive innovation to health care, drawing on his book The Innovator’s Prescription, and holds out this pathway for getting beyond the current gridlock of inefficiencies. She describes promising examples, some based on emerging scientific discoveries that point the way.

Both views underscore the need for fundamental changes. But I can’t escape the feeling that much of the country isn’t really prepared for the consequences of health reform that would address some of the basic problems with our system. Disruptive innovations replace existing business models, they would change the way care is delivered – when, who, how, where, costs, and perhaps even our very conception of health-improving services. Health reform may have to combine these two views, addressing the looming budget challenge and encouraging disruptive innovations. Figuring out what the country will do about future Medicare obligations may just require a system that fosters the benefits that disruptive innovations can bring. It will certainly test the country’s resolve to improve health through reform at a time when all of us will be called upon to sacrifice.

Seeking Your Input - Project HealthDesign's Next Stage

Over on our sister blog, Project HealthDesign, Steve Downs is describing RWJF's/Pioneer's plans for the next phase of the Project HealthDesign national program and its vision for the future of personal health records.  RWJF just awarded a $5.3 million renewal grant to Project HealthDesign, and Steve and the program staff want to share insights on its future directions and get your best thinking on some critical questions.  For one thing, we'll be looking at how to integrate and deploy next-generation PHRs and related data captures in to clinical care processes.  A new call for proposals should come out later this spring -- to be notified of its release, click here.

As Steve says, "I wanted to share our thinking on the program with you for two reasons: to give anyone interested in participating the chance to start thinking about these challenges and start lining up potential collaborators; and to get some ideas on a few of the issues we’re working through."  The questions: What is the potential to integrate information on "observations of daily living" - how you slept, what medications you took, what you ate, when and how you exercised, how you felt - into conventional health care processes?  What is the role of PHR platform services like Dossia, Google Health or Microsoft HealthVault?  Please take a look - Steve and all of the Project HealthDesign team are interested in your thoughts and suggestions.