Bioethics Forum Essay
TEDMED 2012: Great Expectations
TEDMED, which took place in Washington last week, was a beehive of doctors, nurses, medical students, leaders of medical institutions and government health agencies, entrepreneurs, engineers, patients, patient advocates, athletes, musicians, artists, poets, and, yes, bioethicists — a diverse lot united by our interest in and passion for the future of health and medicine.
Expectations were high. Jay Walker, the curator of TEDMED, stoked those expectations by describing the event as “amulti-disciplinarycommunity that seeks to be a powerful force for good.”
“Our 2012 conference takes place at the John F. Kennedy Center in Washington, DC . . . center stage in America’s most powerful city,” he wrote in a letter in the brochure. “The stakes could not be higher.”
Boldfaced-name speakers included NIH director Francis Collins, CDC director Thomas Frieden, FDA director Peggy Hamburg, E.O. Wilson, Katie Couric, and Billie Jean King.
As might be expected from a meeting built around the future of health and medicine, several presentations celebrated the potential of medical technology to make things better.
A talk by Hiep Nguyen, director of the Robotic Surgery, Research, and Training Center and the Pediatric TeleUrology Service at Children’s Hospital Boston, was called “What if R2D2 were your Doctor?” On stage was a robot that looked less like a doctor than like a device for wheeling around luggage. In fact, it’s a home-health aid used in a pilot program at Children’s to check up on children discharged from the hospital following surgery. Though there was nothing humanlike in the robot’s sleek white frame – no face, arms, or legs – a video showed the robot wearing a blouse at work and receiving hugs from young patients.
Given that a giant screen shared the stage with each presenter, being telegenic at TEDMED was key. Even so, bioethics issues, which do not easily lend themselves to telegenic show and tell, had time on the program. Francis Collins touched on the longstanding ethical debates over biomedical research on animals by citing the potential for replacing animals with in vitro tests on human cells in developing new drugs. In addition to being more humane, such tests could improve the process of translating basic research into new drug development.
Ivan Oransky, executive editor of Reuters Health and a medical doctor, spoke with force and humor about the shifting line between normal and abnormal. In a talk about medicalization, he ticked off the growing list of diagnoses that begin with “pre,” such as precancerous and prehypertension. Whether these diagnoses are in all cases pathologies in need of medical action is far from clear. To the string of “pre” conditions, Oransky added, “preposterous.”
Several talks were devoted to good stewardship of medicine. Thomas Frieden, of CDC, made a plea for evidence-based medicine to guide public health efforts. Andrew Read, director of the Center for Infectious Disease Dynamics at Penn State University, characterized the overuse of antibiotics, evolution of superbugs, and development of ever-stronger antibiotics (repeat) as the “drugs-bugs arms race” and called for more judicious use of the medicines. Speaking of the need to keep evolution in mind when doing battle with infectious diseases, he said, “Going to a fight like that without Darwin is like going to the moon without Newton.”
Bioethics was a notable presence off stage, too. Several bioethics issues, including end-of-life care and medical errors, were represented in TEDMED’s “Great Challenges Program,” sponsored by the Robert Wood Johnson Foundation. It consisted of 50 complex, persistent health and medical problems that plague millions of people and “affect the well-being of all America.” Each of the challenges had an advocate, an expert in the area who discussed why his or her challenge deserved attention.
On April 12 participants voted on the 20 greatest challenges among them. These will be the focus of TEDMED’s attention in the year ahead, including webinar panel discussions.
More than half of the winners have bioethics implications, but especially these six:
- The caregiver crisis: What innovations can be developed to support the 44 million people who provide care for aging, sick, and disabled family members and friends?
- End-of-life care: How can we better manage care choices for people who are dying to maximize individual well-being and minimize financial and social costs?
- Addressing health care costs: How do we foster a thoughtful, civil dialog that focuses on science and the public interest in a way that has a reasonable chance of creating a strategy with broad support?
- Future of personalized medicine: We’re beginning to understand the role of genomics and environment in an individual’s health, raising hopes for personalized plans for prevention and treatment. But with this information come concerns about personal privacy and other ethical issues. (They were explored in Cracking Your Genetic Code, a NOVA special that was produced in association with The Hastings Center and aired last month.)
- Whole-patient care: As the number of medical specialists and specialties grow, how can we treat the whole patient rather than the disease? The advocate is Blair Sadler, a Hastings Center Board member and Fellow and associate clinical professor of the University of California San Diego Schools of Medicine.
- Eliminating medical errors: Mistakes in caring for patients are directly linked to 200,000 deaths each year. How can we do better at reducing errors, and what areas should we focus on to get the most improvements?
True to its name TED (“technology, entertaining, design”) MED was a meticulously produced spectacle that presented medical technology with entertainment (there were song and dance numbers, including Francis Collins on guitar) and stylish design elements intended to captivate hearts and minds. And if it motivates enough leaders in medicine and health policy to make a dent in the great challenges, it will also have met Jay Walker’s goal of “being a powerful force of good.”
Susan Gilbert is the editor of Bioethics Forum and public affairs editor of The Hastings Center.
Posted by Susan Gilbert at 04/17/2012 11:52:20 AM |