America’s Biggest Problems: Our Behavior and Our Culture

Question: What are some medical costs and conditions that Medpedia is aiming to tackle?

James Currier:
So there's a whole lot of them. Seventy-five percent of medical costs stem from behavioral and cultural issues, overeating, eating too much corn syrup, smoking, lack of exercise, the basics. The absolutely basics are causing tremendous cost in the system and tremendous misery among the people who have the conditions. Helping people understand their role in their own health, helping people move through a mental space where they actually participate in making their health better, which ends up producing costs for their companies and for their insurance companies. Is what we need to use this technology to do and lots of people might respond to the ability to earn money by keeping yourself healthy.

But some people might not. Some people might only responds to other motivations like loosing money or social pressure, or entertainment, or being in the know - being helpful to others. If you give someone an opportunity to be helpful to others with your condition you see their health improve dramatically, for some personality types. At our last company Tickle we had 100 million registered users, 20 billion questions answered. We had five PhDs on staff around the psychology of your personality and where you work and that sort of thing. Taking that understanding about human motivations and creating a set of experiences which address the seven or eight main motivation types which apply to seven or eight different personality types is going to start to deepen our ability to help people move through behavioral changes they need to make to really change their health and the costs of their health - of maintaining their health.

So that's one of the things that we're trying to do. The main cost comes from diabetes, heart disease, obesity, and asthma, and allergies. Those are the sort of main low hanging fruits. That's where if you look at where your costs are coming from, that's where they're coming from. You know diabetes is an epidemic in this county. Eight percent of people have diabetes at this point. That's a major cost center. So going after those diseases with these new methodologies, you know, we've tried disease management in the past but it’s generally been only going after one personality type which is a nurse calls you twice a week to berate you into maintaining your health.

That works for some people but it only works for one personality type. You need to apply many more tools to getting people to change their behavior. And you need to deploy them in a  much more cost effective way which having an experience nurse twice a week to the whole population is a pretty experiences way to do it. And so those are models that have failed but there are many more models to try and some of them are going to work over the next five or ten years. And so that's what Medpedia is. It's a platform for trying out all these different ideas and then capturing those stats about what's working and then iterating on that. And focusing people on the things that are actually working.

Those are evidence based sort of behavior change and that's where we're going. Another big cost canter is misdiagnosis. So in your local area you're going to have a physician diagnosis you and they may or may not have the up to date information about how to diagnosis someone with these things. It's estimated that upwards of 40 percent of serious cancer cases are misdiagnosed. No that you don't have lung cancer, it's just what type of lung cancer and the stage you're at could be misdiagnosed, which causes you to have the wrong drugs, or the wrong program for taking those drugs, or the wrong treatments.

And if it's 40 percent, that's an incredible cost to the person to be misdiagnosed and an incredible cost to the system to have to treat them for five or six months in the wrong way before they actually get the proper treatment. So that's another way Medpedia can help is by processing the information more effectively and having the most up-to-date stuff available to everyone including your local physician who can then tap into that knowledge base and help that physician diagnose you properly more often that not.

Recorded May 27, 2010
Interviewed by Andrew Dermont

Most of the United States’ health care costs come from diabetes, heart disease and obesity—problems that could be fixed by changing our behavior.

To boost your self-esteem, write about chapters of your life

If you're lacking confidence and feel like you could benefit from an ego boost, try writing your life story.

Personal Growth

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.

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Yale scientists restore brain function to 32 clinically dead pigs

Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.

Still from John Stephenson's 1999 rendition of Animal Farm.
Surprising Science
  • 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.

Ashes of cat named Pikachu to be launched into space

A space memorial company plans to launch the ashes of "Pikachu," a well-loved Tabby, into space.

GoFundMe/Steve Munt
Culture & Religion
  • 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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