3 Smart Cures for What Ails Us
How can the United States collectively face rising health care costs, a broken healthcare system, and public health epidemics such as obesity and diabetes? Three top medical innovators offer solutions.
What's the Big Idea?
Nanobots, the Mars Rover, dark matter, and artificial intelligence – subjects we often cover on Big Think – are all brain candy for curious minds fascinated by scientific discovery and the far reaches of human knowledge. But human health presents one of the most massive and ongoing practical challenges to our technological capabilities and personal understanding. The exciting opportunities and developments in medicine, as well as the daunting obstacles we still face, have led Big Think to partner with TEDMED 2013 – and to reach out to you, our readers, for your insights into the medical frontiers of the 21st century.
At 2012’s Nantucket Project, a conference Big Think co-produces, we brought together a panel of distinguished experts to address this simple (yet incredibly complex) question:
How can the United States collectively face rising health care costs, a broken healthcare system, and public health epidemics such as obesity and diabetes?
The panel included Dr. Toby Cosgrove, president and CEO of the Cleveland Clinic, ranked among the top three hospitals in America by US News and World Report, Dr. Daniel Kraft, who chairs the Medicine track at Singularity University, and Dr. Douglas Melton, co-director of the Harvard Stem Cell Institute. Drs Cosgrove, Kraft, and Melton proposed far-reaching solutions to the healthcare crisis, ranging from portable medical technology to a new vision of collaborative medicine.
1) Stem Cell Therapy
“Our body’s innate power for replenishment and renewal,” says Dr. Douglas Melton, holds the key to the future of personal health. Stem cells are responsible for the constant replenishment of red blood cells in our system. Our skin, too, is in an ongoing state of death and regrowth. “We should be able to harness that power and then make stimulants to keep us healthier and younger for a longer time,” says Melton.
The current health care crisis, Melton argues, is the result of our system’s focus on treating illness over preventing it. He believes we need to go much farther in supporting research into technological advances that eliminate illnesses in advance, and therefore the need to treat them.
Stem cell therapy is one such area. According to Melton, the ability to offer medical treatments that use stem cells to regenerate damaged muscle tissue isn’t far off. In the long run, stem cell therapies may enable the body to reverse the aging process in multiple areas, keeping us younger and healthier. These therapies, he believes, won’t be a substitute for exercise and healthy eating – rather, they’ll work alongside a healthy lifestyle as part of the package of total personal health.
2) Portable Medical Technology and Gamification
Dr. Daniel Kraft has a portable EKG on his cellphone. “It’s not yet FDA approved,” he admits, because the FDA isn't sure how to categorize such devices. By touching his thumbs to the two leads on the back of the phone, Kraft can see an instant picture of his heart rhythms. Better yet, he can see at a glance his EKG patterns over time and transmit them to his physician.
Having an at-a-glance snapshot of what your heart is doing when can be enormously useful in avoiding activities and environments that are cardiovascularly unhealthy. But it turns out that even more powerful is the “feedback loop” of sharing that data with your physician. In a study Kraft cites, diabetic patients who used a smartphone-based glucometer to track their blood sugar and shared that data with their doctor on a regular basis lowered their hemoglobin A1c (an indicator for diabetes) by 2 points, vs. .6 points for patients who tracked but didn’t share their info. Kraft argues that ongoing personal health data-tracking and sharing can “gamify” personal health care and thereby incentivize healthy choices.
Regular tracking can also enable individuals and their physicians to spot worrisome patterns – sleep disruption, heart fluctuations, blood sugar changes – far enough in advance to intervene before they manifest as illness.
On a larger scale, Kraft points out, the ability to track and collect individual, longitudinal health data on a grand scale will enable researchers to identify and analyze national health trends and make valuable correlations between behavior and health outcomes.
3) Cost Control Through Collaboration and Motivation
Taking the macro view, Dr. Toby Cosgrove of the Cleveland Health Clinic argues that one hospital “cannot be all things to all people.” Hospitals need to specialize, he says, and build hospital systems that enable them to transport efficiently “the right patient to the right place at the right time.” Increasingly hospitals including the Cleveland Health Clinic are doing just this – recognizing it as the only sustainable model in an age of rising healthcare costs and overburdened emergency rooms.
That’s how you lower costs at the systemic level. At the individual level, Cosgrove argues, we absolutely need to do something to stop unnecessary behaviors (like smoking) that lead to illness, and to promote positive behaviors (like exercise) that can prevent it. As a private institution, Cleveland Clinic has taken several steps in this direction. Smokers, for example, need not apply for jobs at the Clinic. The entire organization has banned smoking among its workers. Obesity? Well, the Americans With Disabilities Act forbids discriminating against an employee on the basis of obesity (which is viewed under the act as a disability), so the clinic has instead removed fried foods from its cafeterias and candy bars from its vending machines. New York City public schools have been taking similar steps, limiting the availability of “junk food” and promoting public health.
For things to change at a societal level, Cosgrove believes, we need to remain vigilant about public health education, and about disincentivizing unhealthy behaviors and incentivizing healthy ones.
Taken together the ideas presented in this panel tackle rising healthcare costs and public health issues on four main fronts: research, technology, education, and systemic organization. They offer complementary visions for confronting and overcoming the medical challenges we collectively face. TEDMED 2013 will continue to explore these challenges and the most exciting solutions emerging across disciplines.
We would be honored for you to join the Big Think delegation at TEDMED 2013, and in advance of this event, we invite you to contribute your ideas as well. Please lend your perspective by answering this question in the comments below:
"What is the most serious obstacle that needs to be overcome in order to ensure a healthy future?"
- The meaning of the word 'confidence' seems obvious. But it's not the same as self-esteem.
- Confidence isn't just a feeling on your inside. It comes from taking action in the world.
- Join Big Think Edge today and learn how to achieve more confidence when and where it really matters.
If you're lacking confidence and feel like you could benefit from an ego boost, try writing your life story.
In truth, so much of what happens to us in life is random – we are pawns at the mercy of Lady Luck. To take ownership of our experiences and exert a feeling of control over our future, we tell stories about ourselves that weave meaning and continuity into our personal identity.
Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.
- Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
- They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
- The research raises many ethical questions and puts to the test our current understanding of death.
The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?
But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.
What's dead may never die, it seems
The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.
BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.
The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.
As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.
The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.
"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.
An ethical gray matter
Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.
The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.
Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.
Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?
"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."
One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.
The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.
"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.
It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.
Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?
The dilemma is unprecedented.
Setting new boundaries
Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."
She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.
A space memorial company plans to launch the ashes of "Pikachu," a well-loved Tabby, into space.
- Steve Munt, Pikachu's owner, created a GoFundMe page to raise money for the mission.
- If all goes according to plan, Pikachu will be the second cat to enter space, the first being a French feline named Felicette.
- It might seem frivolous, but the cat-lovers commenting on Munt's GoFundMe page would likely disagree.
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