Luisa Dillner: TEDMED, day 2

luisa_dillnerThe best thing about TEDMED is its delegates. Firstly they genuinely want to talk to you. Secondly they are all really interesting. Everyone has either worked for NASA or is at the very least a CEO of an entrepreneurial healthcare company. The man I sit next to at one session is a neurologist who has written about the brains of bees, and how bacteria communicate with each other.  

For the speakers, Larry Smarr, a professor in the University of California in San Diego’s department of Computer Science and Technology, kicks off the day by telling us about the MRI scan of his colon. He was told his sigmoid colon was thickened. His doctor didn’t want to know why as much as he did, so Smarr set out on a data collection journey that focused on keeping track of his microbiome. Anyone who does not keep track of their microbiome is seriously behind the times. The National Institutes of Health is running a Human Microbiome project—we have ten times as many microbe cells as human ones and yet know little about the balance and constituents of these organisms in different parts of the body. Smarr’s conclusion from analysing his 50 blood tests and stool tests over 10 years was that he had either Crohns or Ulcerative Colitis—he could not be sure because there was very little data against which to benchmark his microbiome.  His doctor was not impressed and said he knew Smarr’s bowel was fine because he had looked at it. To which Smarr replied that this was about science and not medicine. At TEDMED doctors don’t get the good punchlines.

Still with data, Deborah Estrin from Cornell talks about our digital footprint and how we could use it to tell our own health stories by collecting data from our mobile phones and search engines. It’s not a difficult concept and could have been said in a sentence. But it wasn’t.

Elizabeth Marincola, chair of eLife, a new open access initiative owned by funders expands the data theme to complain about how a handful of publishers control 7000 scientific journals each, how medical journals can charge $20,000 a year, and how research data should be open.  Since she is a “longstanding” advocate she will know the BMJ’s open access policy—our research has been free forever. But no. There is no mention.  Only a plug for eLife. TEDMED does not have questions after sessions (here we receive wisdom).

The crowd pleaser of the morning turns out to be a politician. Mick Cornett is mayor of Oklahoma City, which had the distinction a few years ago of being the fattest city in America. Cornett set up the lose a million pounds challenge and re-engineered his city to be great for people instead of cars. Church groups organised running clubs, a 70 acres park was created, bike paths were set up, and hundreds of miles of new sidewalks were built. In five years Cornett moved his city from the fattest to 22nd fittest.

There is however another contender for crowd pleaser of the morning. Richard Simmons is a US fitness legend who leads a series of on stage workouts wearing a glittery dress and multi-coloured leggings. He looks lovely and the workouts look fun. The surgeon general joins in which adds to the incongruity. “This will get a lot of hits on You Tube,” says someone.  Everyone looks joyful. But this is show business and afterwards Simmons tears up to deliver a series of homespun homilies. A small selection includes: “Be loyal and you will feel royal,” “Don’t nag and don’t brag,” and “those with big egos are not my amigos.”

The afternoon is about models—starting with how we should model ourselves on mice rather than vice versa because they have evolved to withstand endotoxin better than we have (says H Shaw Warren, a physician from Massachusetts General Hospital).

The model of healthcare in the US is ripe for re working and Jonathan Bush, co founder of Athena Health gives us 15 minutes of passion verging on shouting (“He is giving me a headache” said the man next to me) on how de regulation of health providers would allow entrepreneurs to sort out medicine. “Release the hounds around ourselves to define the frontier,” he bellows.  It’s a metaphor of Shakespearean proportion, but might be as Macbeth might have said, “Full of sound and fury, signifying nothing.”

Jay seizes the moment to tell us that Margaret Thatcher (topical as she has just been laid to rest) did a great thing in opening up Britain from an ossified state to a country able to embrace the opportunities of capitalism. Ah yes.

There is a conversation between Jay and an oncologist about what is cancer which turns out to be an extended, uncomfortable analogy between cancer and organised crime, which includes godfathers and mafia references. “Do they think we are stupid?” asks the young woman next to me.  No, just capitalists.

The “are we stupid?” question is fair as after the two Manzari brothers do a tap dance routine (something to do with the human genome, but I can’t recall what) one of the TEDMED editorial team interviews them and asks, “Do you know how your feet make that sound?”

I stop myself from leaping onto the stage to tell her. “What,” she says in astonishment as they patiently explain what a tap step is…“But you only have two pieces of metal on your shoes.”

My two favourite talks are at the end of the day. Gary Slutkin is founder and executive director of Cure Violence and has applied an infectious diseases model to gun crime, identifying (by mapping), and interrupting the transmission of violence through using community trained workers. There are different types of workers, but violence interrupters have a key role in identifying where violence might erupt and having enough influence in the community to diffuse it. Cities have seen their crime rates halved—according to independent evaluations. Not surprisingly the US conference of mayors have endorsed this model. It isn’t new though; there have been articles in the New York Times and even a movie.

The day ends with Zubin Damania, a.k.a ZDoggMD who is a doctor and stand up comic. He had us in stitches.

Luisa Dillner is head of BMJ Group research and development.