Pioneering Ideas

This Week We Are Reading About TEDMED

This year’s TEDMED conference was packed with engaging speakers, exciting presentations, and promising innovations.  If you weren’t able to attend or you just want to see what other attendees had to say then we have some links for you.

Want a comprehensive day by day rundown of TEDMED 2009? Medgadget has just what you are looking for.  Check out their recaps of Day 1, Day 2 and Day 3.

Looking for more detail on a specific speaker or innovation? Chances are that mobihealthnews has a recap for you. The future of wireless stethoscopes; the state of 23andME’s genome database; the findings from Penn Schoen Berland National Healthcare Survey for TEDMED; and  how iMeds will be bigger than iTunes.

Finally, make sure to check out twitter and YouTube to see what big ideas TEDMED participants had when asked,  “If someone handing you a blank check — what would you do to transform the future of health and health care?”  

As we mentioned last week, we don’t want to limit the conversation to the group at TEDMED – let us know how you would transform the future of health and health care via twitter -- make sure to tag your "tweets" with the #blankcheck hashtag.

Connecting Revolutions in Neuroscience with Health and Health Care

As a national leader in health and health care, the Robert Wood Johnson Foundation is continually searching for opportunities to generate greater impact. One of the charges of the Pioneer team, the most explicitly future-oriented of RWJF’s program areas, is to identify and investigate areas where transformative breakthroughs feel most possible.

In line with this charge, working with the Monitor Institute, we’ve invited a provocative group of academics, researchers, physicians and industry leaders in neurotechnology, neuroscience and behavioral health to step to the ledge of current innovations in these fertile and promising fields – and then step beyond it – begin to anticipate what near-term and distant innovations in these fields could mean for health and health care.  

On November 11-12, this group, along with staff from the Foundation and Monitor, will engage in a series of highly iterative, forward-looking discussions that will culminate in a wrap-up that integrates the thinking across all three disciplines and outlines connections and implications for the future of health and health care.

This event is a new approach for Pioneer. It is not connected with any prospective funding initiative. Rather, we play the role of convener, focused on bringing together the experts who hold the key to identifying and advancing the next generation of innovations in this space.

I, for one, can’t wait to see what everyone has to say. If you would like to follow the conversation about the Forum on Twitter — leading up to, during and following the event — please use the #rwjfneuro hash tag.

Interested in more information?

Pre-read

Participants

A Few Links to Share...

It looks like we are not the only ones to find the research Pioneer grantees Drs. Lisa Schwartz and Steven Woloshin did on the effectiveness of prescription drug labels interesting and innovative.  Here is a round-up of some of the coverage following the release of their paper in the NEJM this week. 

Prescription Drug Labels -- What the Companies Don't Tell

Want a quick synopsis on Schwartz and Woloshin’s paper? The Baltimore Sun’s daily column, Picture of Health, has just what you are looking for. 

 

Getting the FDA to Share What it Knows About Drugs

You can learn a bit about the pilot test conducted by Schwartz and Woloshin where FDA reviewers compile “Prescription Drug Fact Boxes” that lay out the benefits and harms of a drug in an easy-to-read table, in The Los Angeles Times health blog, Booster Shots. 

 

NEJM: Drug Labels Lack Key Info

FirecePharma wonders ‘are drug labels too optimistic?’"How can I decide if the potential harms of this drug are worth the risk?” Dr. Woloshin asks “…if I don't know how well the drug works, and vice versa?"

Information Lost Between Review and Drug Label

Finally, wondering what the manufacturers think about Woloshin and Schwartz’s article?  medpagetoday.com offers comments from Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America.

 

Don’t forget to read Al Shar’s prespective – you can check it out here.

 

This Is a Brainstorm

There is no such thing as a blank check — particularly in this economic climate. Resources are not endless; parameters exist. But the Pioneer Portfolio is dedicated to powering ideas that have the ability to truly transform health and health care and — to do so — we need to encourage people to THINK BIG.

From October 27-30, members of the Pioneer team will be in San Diego to participate in TEDMED2009. While we are there, we will ask other participants — if someone was to hand them a blank check — what they would do to transform the future of health and health care? What kind of problems do they see as being “stuck” and that, if solved, could bring about significant improvements 5, 10, 15 or more years down the road?  Where are the breakthrough opportunities?

But we don’t want to limit the conversation to the group at TEDMED; we want to take the conversation to Twitter and ask a broader audience for their ideas. Like you.
 
There is no blank check.
 
This is not a call for proposals.
 
This is a brainstorm.
 
We want to hear your ideas because they inspire us and because we hope you might inspire each other.
 
If you would like to participate in the conversation and let us know how you would transform the future of health and health care, please tag your “tweets” with the #blankcheck hashtag. We’ll “retweet” them to share with those who follow Pioneer on Twitter and we’ll share them with everyone at TED MED through a live feed we’ll have playing throughout the event. If you don’t want to share your own ideas, but want to see what other people are thinking, you can follow the conversation here. And please consider telling others about the #blankcheck conversation.

Better Informed Managers of Our Health

Most of what I read and almost all of what I believe is that we, as individuals, must assume primary responsibility for managing our health. I'm also told that I need to become a more informed consumer when making health and health care decisions. As a person who's spent a good part of my career doing research I think that I'm more ready than most to investigate, consider and make informed decision. However, no matter how ready I am, no matter how skilled I am at analytic reasoning, I can not make an informed decision if the information is not available to me.

I know that some of the data is hard to acquire and may be harder to analyze. It is difficult even for hospitals to predict the total cost to the patient of a hospital stay. For drugs used to treat many conditions it can be hard to understand the cost versus the benefit, especially where there are competing choices. The prescription drug situation is further complicated by the fact that there is so much direct to consumer advertising of patent medicines that almost never reveal enough data to make an informed decision.

The perspective article in the recent New England Journal of Medicine discusses the fact that, although the FDA collects and makes available what may be extremely important information about prescription drugs, it does so in a relatively haphazard way. The authors, Lisa M. Schwartz, M.D., and Steven Woloshin, M.D. have developed a format for a "Prescription Drug Facts Box" that has been shown to provide clearer, more actionable information to consumers. We funded an FDA pilot of the Facts Box and, most recently, the FDA's Risk Advisory Committee recommended that the FDA adopt these boxes as the standard for their communications. It seems to me that this is one relatively straight forward way that we can become better informed managers of our health.

Fun Behavior.

Earlier this month, Volkswagen launched a competition for ideas to help change people's behavior. The premise is that the best way to change behavior is to make things fun. They call it The Fun Theory: http://thefuntheory.com/.  One example: get people to switch from the escalator to the stairs by changing the steps into a working piano. There are three videos that will make you smile. The competition closes Nov. 15; first prize is 2,500 euros.

What We Are Reading

This week we are reading about the Health 2.0 conference. With over a hundred speakers and almost as many live demonstrations – there is a lot to catch up on. Matthew Holt, the conference co-founder, has a thorough rundown of the conference over at The Health Care Blog.

 

If you’d rather watch something from the Health 2.0 conference, healthGAMERS has a video interview between Andre Blackman and Douglas Goldstein of iConecto/Games4Health. The two talk “what experiential media is and why it’s important to improve the health of our society.”

 

Ever wonder how innovators think? Harvard Business Review contributing editor Brownwyn Fryer, Professors Jeff Dyer of BYU and Hal Gregersen of Insead, participate in a question-and-answer session about a six year study which revealed five ‘discovery skills’ that distinguish innovators thinking. 

 

Finally, next week the Society for Participatory Medicine will launch the Journal of Participatory Medicine.  Interested in what the Journal will address? Jessie Gruman, Ph.D. and Charles Smith, MD, Co-Editors-in-Chief, have a post at e-patients.net which gives an overview on what to expect.

CBS Sunday Morning to Feature Common Good, Health Courts

This weekend, tune in to CBS Sunday Morning for its lead story on Common Good, which, together with researchers at the Harvard School of Public Health, has been analyzing and testing the viability of a system of administrative health courts to more rationally handle medical injury claims.  The CBS piece will look broadly at legal fear in America, a key thread in Common Good Chair and Founder Philip Howard's new book, Life Without Lawyers.  Interviews touched on health courts and their potential to reduce errors, boost patient safety and improve the overall quality of care, in addition to producing a more functional and effective process for resolving medical liability disputes.  Click here to find out where and when to watch in your area.

Are questionable dosing practices fueling antibiotic resistance?

This post comes to us from Patricia Geli Rolfhamre over at Extending the Cure.  More in-depth conversation about antibiotic resistance and the future of our nation's supply of antibiotics is happening on the ETC blog.

Are there ways in which we can reduce the spread of antibiotic resistance by treating patients more strategically? The dosing and duration of antibiotic treatment have been shown to be critical determinants of the likelihood of curing an infection and of the emergence of resistance.   Adjusting these factors to a patient’s individual condition instead of treating every patient with the same antibiotic regimen may be an easy step toward fighting resistance.

Research reports from the American College of Emergency Physicians annual meeting in Boston earlier this week revealed that doctors who work in hospital emergency rooms rarely adjust antibiotic doses for obese patients. The consequences are an increased risk of treatment failure and resistance development. Yet it is unclear how much this will spur the growing resistance epidemic. Given the fact that more than a third of the US population is obese - this trend is worrying. But solving the obesity problem or adjusting the doses for obese patients is only a part of the answer. The other important parameter for successful treatment and for which a one-size-fits-all approach has generally been applied is the duration of treatment.

Seeking Disruption? Look for Delight.

The New York Times' John Tierney recently wrote an article in the New York Times and posted on his blog about a paper by Samuel H. Preston and Jessica Y. Ho of the University of Pennsylvania titled, “Low Life Expectancy in the United States: Is the Health Care System at Fault?”

 

Tierney wrote that Preston and Ho found “no evidence that America's health care system is to blame for the longevity gap between it and other industrialized countries. In fact, [they conclude], the American system in many ways provides superior treatment even when uninsured Americans are included in the analysis. ''‘The U.S. actually does a pretty good job of identifying and treating the major diseases,’'' says Dr. Preston, a demographer at the University of Pennsylvania who is among the leading experts on mortality rates from disease. ''‘The international comparisons don't show we're in dire straits.'”

 

This is not big news.  And it’s not big news that the formal health care system—on the whole—has struggled to do prevention well and is only beginning to pay attention to wellness. The question I’ve been thinking about is where will the innovation come from that produces a system that is not only more efficient in what Preston and Ho assert it currently does well— detecting and treating disease—but that also does prevention and wellness well.

 

In their book, The Innovator’s Prescription, Christensen, Hwang and Grossman suggest integrated, fixed-fee systems, such as Mayo, Kaiser, and Geisinger are likely candidates because in highly fragmented industries, such as health care, disruptive innovations can be accelerated when there is an orchestrator of change that is integrated across multiple pieces of a system.

 

I think there is another source for big innovation in health and health care that’s worth watching: consumer product companies and retail chains. Think Procter & Gamble, Best Buy and Wal-Mart. When you move the focus from detection and treatment to prevention and wellness, there are lots of opportunities to develop products and services and relationships that improve health, extend life and don’t require medical professionals. I can imagine a whole bunch of consumer products and services that focus on wellness. And once established in that market, it’s not too big a step for these companies to begin to offer products and services that do require medical professionals…it’s already happening with minute clinics.

 

The big difference would be the way consumer product companies and retailers approach this space and the experience they would offer.  Karl Ronn from P&G gave a great talk on the perspective a consumer products company brings to this space at a recent conference put on by the Mayo Clinic’s Center for Innovation.

 

In his talk, Ronn discusses that consumer product companies seek to create products and experiences that “delight” consumers. The closest health care gets to “delight” is “patient-centeredness.”

 

Ouch.

 

Given a choice between a health care experience that was a delight and one that was patient-centered, most people, I suspect, would choose to be delighted.