Pioneering Ideas

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.

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.

The H1N1 Flu Prediction Market

As kids across the country are starting to go back to school this month, parents, health officials and school administrators are wondering whether or not we will see a resurgence of H1N1. While no one can forecast the future, we asked Phil Polgreen and Forrest Nelson, the directors of the Iowa Electronic Health Markets, to explain what they’ve learned so far from their H1N1 market, a pilot prediction tool, and discuss what their expert traders believe will happen in the fall. The Iowa team has been running prediction markets for avian influenza (bird flu) and for seasonal influenza for several years.

On Friday, April 24, some of the first news reports about a frightening new influenza virus surfaced here in the United States. That news prompted us to re-tool our prediction market for the bird flu in order to develop a market for this new strain. We immediately started working on the questions for the new market and recruiting traders.

We had already assembled a group of microbiologists, doctors, public health officials, epidemiologists and others that had inside information about influenza, including trends in seasonal and bird flu. We gave those experts $100 in virtual money (makeshift dollars that can be used to buy and sell shares on the market) and asked them to start trading. By April 28, the H1N1 market was up and running.

Right off the bat, most of our traders predicted that by the end of May, there would be more than 1,101 cases across the U.S., with a low the mortality rate. As it turned out, they were right: As of June 1, the Centers for Disease Control and Prevention had reported 10,053 cases of swine flu in all 50 states and the District of Columbia with 17 deaths at that time.

What’s remarkable about the forecast is that in late April, news reports played up the danger factor, reporting that the virus was killing young, relatively healthy people in Mexico. The fear was that H1N1 would spread rapidly in the U.S. too and be a formidable killer. Our expert traders didn’t buy into the hype, betting instead on a future that resembles the course actually played out by H1N1. In fact, the market predicted that H1N1 would spread widely and quickly but the mortality rate would be less than 1 percent during the first few weeks of the outbreak.

Can Green Cleaning Products Prevent and Control HAIs?

We’ve written several times on Pioneering Ideas about the impact of hospital acquired infections (HAIs) on lives and hospitals as well as the costly drain HAIs have on the health care system.  Simply increasing the use of cleaning and disinfecting products to tackle HAIs can create a host of other health hazards for both health care facility workers and patients – not to mention significant harm to the environment.

This conundrum has led to the development of wide range of green cleaning methods, but at this point there remains a need for more evidence of about the extent to which these programs meet infection control and prevention goals. In a recent white paper, Health Care Without Harm(HCWH), in collaboration with the Global Health and Safety Initiative(GHSI), explores whether there are cleaning strategies for the health care sector could effectively prevent and control infection in a way that would be both healthier and friendlier to the environment.

The paper, which was produced with support from Pioneer, does not present any final answers, but it does lay out some out compelling recommendations for “closing the knowledge gap.”  Please take a look and let us know your thoughts.

Now that’s Progress

1899

 

2009

 

My family dog, Chance, testing the latest prototype. 

Credit to my wife, Naomi, for the idea.

The back story: Chance is about seven months old. He learned to swim in a local creek the other day. Then, in his excitement, he jumped off a bridge and landed on ground 10 feet below. I think he figured if he could swim, then he could also fly. We spent a good five hours at the emergency room, most of it waiting. The vet on call wanted a specialist to see him. The specialist, a doggie ortho surgeon, thought they would need to operate—to the tune of $4,000.  Additional x-rays showed no broken bones, but some torn tendons. It was just like a visit to a human ER, only with a lot more fur. Chance should be ok in three or four weeks.  In the mean time, he claims to be receiving podcasts from New Zealand.

Can a Reduction in Hospital Acquired Infections Cut Health Care Costs?

There is no denying that hospital acquired infections (HAIs) are an expensive drain on the system and impact the lives of an estimated 1.7 million hospital patients a year – killing nearly 99,000 annually. Is it possible that simply instituting best practices in infection control can substantially reduce these infections and save the nation’s healthcare system billions of dollars a year?  Yes, according to an article in last week’s Roll Call by Ramanan Laxminarayan of the Extending the Cure initiative, a Pioneer grantee, and Ed Septimus from HCA Healthcare System.  Laxminarayan and Septimus propose several ideas and incentives, which they believe will reduce the rate of resistant HAIs and control the rise of antibiotic resistance. 

Are hospital acquired infections really the low hanging fruit that will benefit patients and cut health care costs?  Check out the article and then come back here and let us know what you think.   

 

Using Games to Support Children's Healthy Development: Opportunities & Challenges

We welcome Ann My Thai to our guest blogger series.

Ann My Thai is the Assistant Director of the Joan Ganz Cooney Center at Sesame Workshop and the co-author of Game Changer: Investing in Digital Play to Advance Children’s Learning and Health. Ann leads the Center's strategic partnership efforts with high tech and gaming industries, and oversees organizational growth and strategy. Before joining the Center, she served as a consultant for Education for Development, Vietnam, a nonprofit organization that develops informal educational programming for disadvantaged children in Ho Chi Minh City, Vietnam. Thai received her bachelor's degree in Political Science from Yale University and a master's degree in Business Administration from the Ross School of Business at the University of Michigan.

Readers of the Joan Ganz Cooney Center’s latest report, Game Changer: Investing in Digital Play to Advance Children's Learning and Health might be asking why we chose to discuss how digital games could advance both children’s learning and health in the same paper. Named for its founder, the Center’s roots lie in Sesame Street’s “whole child” approach, which encourages learning that supports many different aspects of a child’s healthy development—from literacy skills, to social and emotional development, to practicing healthy habits.  A solid base of research tells us that children who eat healthfully and are more physically active are also able to learn more easily.  It also tells us that children who suffer from health threats such as obesity do worse in school and are less successful later in life.  Given the inextricable ties between learning and health, and the parallel efforts in each field to harness the power of games, we wanted to address the potential role they might play in health and education reform together.

The idea that digital games might actually help improve children's learning and health is, in some quarters, a radical one, but for authors of the report, it is also a pragmatic one. The medium has a high penetration, with 97% of American teens playing computer or video games.  Furthermore, digital games are reaching children at younger and younger ages for longer periods of time.  The average child begins playing games at age 6, down from 8 years old a few years ago, and the amount of time a child plays on average more than doubles between age 6 and 9.  This level of play shows that it is no longer a question of whether we should enlist games in our learning and health efforts but how we may do so.  Game Changer aims to spark a productive dialogue about the opportunities and challenges of using games to support children’s healthy development.

To kick off this dialogue, we unveiled the report on Tuesday with the Woodrow Wilson Center for International Scholars at an event in Washington, DC.  It featured a panel of experts from industry, research, and policy and hosted nearly 100 participants and a web audience from these key sectors. 

A key insight raised at the event was the lack of training available to health researchers to engage in the type of multi-disciplinary game R&D requires. Dr. David Abrams, Executive Director of the Schroeder Institute at the American Legacy Foundation, which focuses on accelerating the reduction in tobacco use, especially for young people in the U.S. population, said that the health care sector has “not looked beyond itself” to consider the whole child in advancing children’s health. The current generation of health researchers is too often isolated from the broader perspectives or tangible incentives to engage in a multi-disciplinary approach.  

Some of the biggest challenges of the day—such as childhood obesity or the fourth grade reading slump—are too broad and complex to be addressed by the expertise of any one discipline.   These are problems couched in layers of social, economic and other environmental factors, as well as developmental factors distinct to each child.  Responding to these issues from a whole child perspective will demand greater investment toward funding and collaboration models and infrastructure that support multi-disciplinary collaboration.  Such investment is essential if we are to tap into the digital media that surrounds today’s children in a purposeful way.  

Marketing the Concept of Games for Health

We continue our guest blogger series with Nedra Weinreich. 

Nedra Weinreich is a social marketing consultant who helps nonprofits and government agencies strategically promote health and social issues through her company Weinreich Communications. She is the author of Hands-On Social Marketing: A Step-by-Step Guide, writes on social marketing issues at the Spare Change blog and is the director of Social Marketing University. Nedra has an MS degree in Health & Social Behavior from the Harvard School of Public Health.

Games for health intrigue me because they have such potential for achieving the behavior change-related objectives we in public health often struggle to reach - changing awareness and attitudes about an issue, educating people with key facts, building necessary skills, and even the holy grail of engaging in healthful behaviors during the course of the game. Health gaming shares the roots of its success with other entertainment education approaches (like health topic "product placement" in television plotlines) by engaging its players emotionally, embedding learning opportunities within fun activities, and allowing people to try out new skills (either vicariously or in actuality).

Forward-thinking people in the behavior change business know all this. Unfortunately, many others hear the words "digital health games" and either say, "Ho-hum, how exciting can a game about health be?" or immediately conjure up the negative stereotypes of video games as a cause of violence or sedentary behavior. Whether it's parents, teachers, children, health professionals, game producers or funders, all need to be on board for these products to be viable. Let's explore how to market the idea of games for health as a serious intervention for many different public health and medical challenges.

Good marketing is always based on research with the target audience, so a key first step should be to learn more about how each group views digital health games for children. What do they see as the key benefits? What would stand in the way of their adopting or supporting them? How might games for health best fit into their personal or professional lives? Clearly, each of the groups listed above would need different approaches to persuade them of the merit of these products. In fact, within each audience may be several subgroups; for example, parents of young children likely have very different concerns and experiences with digital games than those with teenagers. Teachers at each grade level have different learning objectives for their students. In any case, the more individuals from each audience are involved in the actual development of the games, the more likely they will be successful.

Let's look at the product itself. The way health games should be framed depends on to whom you are talking. For health professionals and funders, positive research results are the key. Focus on the games as an intervention that has demonstrated success (and work hard to accumulate the hard evidence to back up your claims). Parents and teachers will respond best to an emphasis on learning and skills building that will serve to help the kids stay healthy as they navigate through life. For kids? It's got to be all about fun. If it's not fun, the game needs at least to be interesting enough to capture their attention. And game producers will be concerned with one thing: are games for health marketable? The Wii and Wii Fit have been game-changers (pardon the pun) in their popularity and may open up many more doors in this direction.

We also need to determine the main barriers that stand in the way between each audience and its unbridled support and use of health games. Adults will need to give up their views of what games are and what they can be. Many may feel that information conveyed in the form of a game means that the importance of an issue is being downplayed, or may worry about these being just another video game with negative behavioral effects. Again, the way to break down these barriers is by emphasizing results in the form of health outcomes, compliance, patient satisfaction, or positive changes in other measures of knowledge, attitudes and behaviors. For kids, the kiss of death for any activity is if it's perceived to be boring, especially if it's billed as "good for you." Health games must be banana splits, not broccoli, and promoted to kids with the emphasis on "game" rather than "health."

From a marketing perspective, let's think about how best to fit games for health into people's lives. What are the times and places they will be most able and interested in playing or prescribing these games? Some key ideas, many of which are already being implemented, include making them portable so people can use them anywhere, making sure that the games fit with the consoles or equipment they already have, and finding ways to combine digital games with real-life situations. Health professionals need to know what games are available for various health conditions so they can match their patients with the right interventions, perhaps via a centralized database. And when the idea comes from their doctor, a parent can feel more comfortable with letting their kids play.

Promoting the concept of health games will also have to be targeted to each audience. Perhaps they will become more acceptable as a health intervention as more "clinical trials" of their outcomes are published in peer-reviewed journals. Skeptical parents, teachers and children may become more convinced of the benefits of games when given the opportunity to try them out themselves. Many a person has been convinced of the exercise value of the Wii after trying it out at a friend's house and realizing their muscles are sore afterward. Game producers may need specific incentives from funders or investors to move into what they perceive as less robust markets until they see the demand from consumers.

Working with organizations and public agencies to craft policies friendly to these new interventions can help create fertile ground for health games to bloom. For example, when certain games have been proven to improve health outcomes would health insurers extend coverage for purchasing them with a doctor's prescription (and send a Wii-fund as reimbursement)? Can we increase the number of school districts that have incorporated Dance Dance Revolution into their physical education curriculum?

Finally, building partnerships that reach across categories will be beneficial to all involved. Working with trusted organizations or familiar characters creates games that start from a strong position with consumers in all categories. Thanks to the Robert Wood Johnson Foundation for cultivating these alliances with key partners and building the foundations for games for health to emerge as a pillar of health interventions.