Aspen Ideas: The Best of Spotlight Health

Every year, we look back at the dizzying ten days of the Aspen Ideas Festival, and try to pick out its biggest ideas, most notable nuggets, and best thought-provoking quotes. The 2017 edition of this feast of knowledge and dialogue did not disappoint — hundreds of accomplished, creative-minded speakers brought their ideas forth in fields spanning the spectrum from the arts to the sciences, from the humanities to the highest technologies.

In this post, we focus on Spotlight Health, three days’ worth of panels, discussions, lectures, and interactive sessions focused solely on health — in its many iterations. Next time, we’ll bring you a selection of ideas on a broader array of topics. Enjoy.

TO PONDER
Spotlight Health kicks off with a selection of speakers who present, one at a time, their “brave idea.” This year’s brave ideas included an empathetic robot companion, a global disease surveillance system, and how opening one’s heart can help save the world. Here are a few other brave ideas to ponder, from the opening session and others:

Anita Goel, a nanobiophysicist and founder and head of the research institute and incubator Nanobiosym: “Your DNA is like a piano, and the music you play as an organism is an interplay of information in your environment and information in your DNA.”

 

Binagwaho_DBAgnes Binagwaho, Rwanda’s former minister of health, who now teaches at Harvard and Dartmouth and is vice chancellor of the University of Global Health Equity: “Provide education, health, and love, and war will go away.”

Binagwaho was speaking on a “Deep Dive” panel about growing a global health workforce in light of an impending US and global shortage of health care workers. From her perspective as a Rwandan and in her global role, she had some pointed words about the US health system. Such as,

“Without social capital, your pills are less effective.” And,

“You give me $11,000 per capita (the amount spent annually on health care in the US), and I’ll cover all the planet with good primary care.”

Psychiatrist and University of Zimbabwe researcher Dixon Chibanda presented his brave idea for treating depression globally, an idea that seems to parallel his Friendship Bench project, which uses specially trained lay health workers to help treat mildly depressed or anxious people.

“More than 400 million people are living with depression globally, and the challenge is not enough psychiatrists or psychologists to help people. My brave idea is to work with ordinary people in communities and empower them with evidence-based talk therapy, particularly grandmothers, because our work over years has shown that grandmothers are extremely effective in cognitive behavioral therapy. I want to reach out to thousands of grandmothers all over the world and empower them with cognitive behavioral therapy, because they are reliable, they will always be there, they never leave for greener pastures — they only leave to go to heaven — and they are comfortable sitting on a park bench and providing therapy.”

Larry Brilliant, a global health physician who chairs the the Skoll Global Threats Fund and is perhaps best known for being instrumental in eradicating smallpox: “We never see our own rooster tail as we go through life. It’s a reminder of everybody else seeing who we are.”

Willie J. Parker is a deeply religious physician who is a traveling abortion provider in Alabama and Georgia. Since coming to believe that helping women without moral judgement was the Christian thing to do, he has been an outspoken reproductive justice advocate with a focus on violence against women and sexual assault prevention. Parker’s words at the opening of Spotlight Health were inspirational:

Willie Parker_DB“Imagine if all men could exercise the power we all hold no matter our race, religion, or station in life: the power to betray patriarchy. We all could become traitors to that birthright of male privilege. Divesting ourselves of what I feel is the cornerstone of most structural oppression in the world would cause many injustices to crumble: racial and ethnic tensions, class wars, sexual oppression, and Islamophobia. Imagine if men could see reproductive injustice as their battle to fight, not from a place of chivalry but from a duty to humanity. We could then all realize that on this spaceship we call Planet Earth, there are no passengers — we’re all crew. My brave idea is that I will continue to divest myself of patriarchy, and I call on all patriarchs, male and female, to join me. Only then can we all be linked, and not ranked.”

Raj Panjabi, CEO of Last Mile Health: “Illness is universal; access to care is not.”

Miriam Zoila Pèrez, a writer, doula, and advocate focused on race and gender: “Just the act of witnessing someone’s experience is right and good and has a huge impact on people. What is it like to walk through the world with empathy?”

Cecile Richards, president of Planned Parenthood: “Whatever you’re doing now, it’s not enough. Don’t wait for instruction — figure out what you can do and do it.”

 

TECHNOLOGY
From robots to other artificial intelligence, from big data to portable diagnostics, the latest in technological progress is always a major theme of Spotlight Health. But, it’s not just all about the promise technology holds, but how technology intersects with humanity, and the moral and ethical questions it raises, that gets the spotlight.

In a session entitled “Can Artificial Intelligence Revolutionize Medicine?” two proponents of AI discussed its potential, and how humans fit into it. These highlights that framed the discussion:

Kraft and DiSanzo_C2Deborah DiSanzo, general manager for IBM Watson Health, who prefers the term “augmented intelligence” to “artificial intelligence”: “It’s between man and machine — it’s not the machine itself. The best machine learning the best artificial intelligence can only be best between the interaction between a human and cognitive technologies.”

Daniel Kraft, faculty chair of medicine at Singularity University: “Part of the potential of AI is you start to synthesize reams of genomic data, personal data, and it’s like a mirror that doesn’t just show you today, but shows the you of tomorrow.”

It was curiosity and diligence that led Stephen Keating to identify his own brain tumor, and then a singleminded determination that included enrolling in medical school and not taking no for an answer when he attempted to collect his own medical data — which was shockingly hard to get. Eventually, having gathered 200 gigabytes of information, Keating was able to become the master of his own process, and since then he’s been on a crusade advocating for patient data access, its proper use, and the ability to share it to improve health care and treatment for all. Listen to his full story here — otherwise, here’s a few choice quotes from Keating:

Keating_RS“In every other industry, the consumer is put first, but in health, we’re put last.”

“How come it’s hard to get your own medical data? How come doctors and researchers can see the data but I can’t? For most patients, if you have to wait two weeks and get 30 CDs, that’s it. If you have to become a medical student to understand your data, for most people, forget it.”

“The patient must be their own advocate, and with more tools it makes that job a lot easier.”

 

MENTAL HEALTH
Brain science is exploding, with knowledge of how mental health works and is connected to just about everything else expanding almost by the day. Sharing insights from the perspective of many disparate fields, Spotlight Health speakers challenged us to look at the mind in entirely new ways.

Jenara Nerenberg, an innovation and science writer and neurodiversity activist, who has ADHD and Asperger’s: “Enormous gifts are being withheld from the world by how we frame mental differences and how we normalize a neurotypical viewpoint, which is a form of able-ism. Providing space for folks to open up about who they are and what their struggles are enables a huge amount of growth and thriving. My brave new idea is making it as acceptable and normal to talk about our inner lives as it is to talk about the weather.”

Sharon Begley, senior science writer at STAT, the life sciences publication of the Boston Globe: “I think we are in an age of anxiety, whether it’s the bomb or planes running into skyscrapers or other acts of terrorism, or climate change. It doesn’t even have to be that catastrophic: because of online options, you never know if you’ve made the right choice. It’s little things, but it’s just more chronic. We can’t control much of this stuff, so you control the things you can, and sometimes they seem like a compulsive kind of control.”

Begley(Begley spent a part of her talk, based on her recent book about compulsions, talking about whether there could be a medical/cognitive explanation behind Donald Trump’s behavior. Noting that there are plausible theories that cannot be verified because there hasn’t been a diagnosis, she explained the science behind compulsion, which is driven by anxiety. Of Trump, she said, “When he blasts out a tweet to his 25 million followers, it fits the pattern of an anxiety-driven compulsion, and by executing the compulsion, that drains away the anxiety away, at least temporarily.”)

One panel discussed “The Neuroscience of Poverty,” which researchers are learning more and more about — with the hopes that once the links and issues are well understood, interventions and better care are not too far behind.

Martha Farah, a neuroscientist at the University of Pennsylvania: “Poverty is a many-headed beast. It affects children’s life chances through nutrition, exposure to toxins like lead, compromised pre-natal care, and a bunch of psychological factors including diminished learning opportunities and stress. You don’t need a researcher to tell you poverty is stressful — but it’s astonishing the gradient of day-to-day stress in poverty.

“A large percentage of Americans think people are poor because they make bad choices. One thing about framing this in a neurological framework is, neurons aren’t good or bad, they just do what neurons do.

Neuroscience of Poverty_DB

“The Neuroscience of Poverty” panel, including Farah, speaking, and Beers (far right). Photo by Dan Bayer

“The brain is the most plastic and changeable in response to the environment at younger ages. But there isn’t a person too old to be plastic. There’s always hope of rewiring. And in particular in terms of early-life trajectories, there’s increasing evidence now that adolescence represents a second peak in plasticity.”

Lee Beers, a pediatrician, professor, and medical director at Children’s National Health System: “While the best thing to do is eliminate stresses, what’s exciting about neuroscience is it’s able to buffer some of these changes. So strong loving relationships with consistent caregivers can mitigate these brain changes and mitigate the impacts of poverty.”

 

THE BUSINESS OF HEALTH
As the health care debate rages, cost of care is top of mind. Here’s some of the unique things experts are seeing in the American health marketplace.

investing in health_DB

This panel includes Smolinski (far right), Jayasuriya (second from right), and Chen (second from left). Dan Bayer photo.

Mark Smolinski, chief medical officer and director of global health threats at the Skoll Global Threats Fund: “We see investment in public health as also an investment in health care by reducing the burden on those systems.”

Anula Jayasuriya, an investor in life sciences and health care: “Venture capital companies traditionally don’t invest in prevention, because the money is in treatment.”

Stanford University researcher and law lecturer Lanhee Chen, a presidentially appointed member of the Social Security Advisory Board: “So much of the decision-making is driven by government agencies. We need to migrate the health system away from thinking about sick care to thinking about well care, but also think about how to incentivize that. The question is, how do we speed up the innovation cycle so we see more cures and more developments, so we have a marketplace that’s fuller rather than a forced distribution system? With a top-down system, it’s going to stunt the innovation we need.”

Mark Weber, senior vice president of health care development at Infor: “If you can move the needle to have people be cared for at home rather than in a rehab center, you could significantly change the cost of care. If you can provide physical therapy at home, you could dramatically lower the cost. To do that you have to align the information, align the care. Technology is starting to come together where we can actually do that.”

 

BASIC HEALTH, GLOBAL HEALTH
Primary care for common illnesses and injuries is how most of us interact with health care providers. But in some area of the world, that can’t be taken for granted. And sometimes, viruses and bacteria are unstoppable. Here’s some thoughts on the basics of medicine.

Andrew Morris-Singer practices and teaches family medicine. He is president and founder of Primary Care Progress and a strong believer that the primary care business in the United States is badly broken and needs to be fixed:

“You have a better chance of getting access to your cable provider than your primary care provider. Primary care is not giving you the level of service that you get and expect from virtually all other services in your life. Increasingly, primary care is not working for so many of you. From a business perspective, right now the reimbursement for primary care services is so low, if we don’t churn through a short fast visit, we cannot stay in business. More and more practices are running on fumes, and primary care clinicians are running on fumes, too.”

Panjabi_DBRaj Panjabi, CEO of Last Mile Health, on a solution for the one billion people on the planet who have no close physical access to health care: “Making community health workers part of the medical team means that we can bring modern primary care to places where primary care would otherwise never reach. And we need technology to help us train faster and better than ever before.”

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) at the US National Institutes of Health, discussing antibiotic-resistant bacteria and the need for antibiotics to be prescribed sparingly and appropriately: “How do you convince a company to develop an antibiotic that you don’t want to use very often? It’s an oxymoron.”

Here’s Fauci on pandemics: “Pandemics happen. They happened before we were here, they’re happening now, and they’ll continue to happen. What is next? We don’t know. That’s the whole point, you can’t predict it. One thing we can be sure of is we’re going to continue to have emerging and reemerging infections — and it’s our job to prevent pandemics.”

How to stay ahead of a pandemic? Here’s a thought from Luc DeBruyne, president of global vaccines at GSK: “Since we don’t know what the next virus or bacteria will be, we should be constantly developing platforms where we can plug in different viruses or bacterias when an epidemic shows itself.”

 

DISPARITIES AND WELL-BEING
There was a lot of discussion at Spotlight Health about conditions that have not always been associated strictly with medicine. Like social capital, which was debated during a session entitled, “How Social Capital Influences Well-Being.” Social capital, according to editor and psychotherapist in training Nidhi Berry, “is what individuals have in order to better themselves in the world.”

Here’s some thoughts about how social capital is built and how it intersects with well-being:

Jenara Nerenberg, innovation and science writer: “Historically, social capital is boundaried by who our neighbors are, what racial and ethnic classes we belong to. The power of social capital is reaching across those boundaries.”

Angel Kyodo Williams, Zen sensei and spiritual leader of the Center for Transformative Change: “Social capital begins before we’re born. There’s a statistic that says African American communities are 200 years behind in their gathering of social capital. … There’s entitlement to health and wellness that comes with increasing contact with people of certain types of class. So expecting juice to be fresh, expecting fruit at the table is part of social capital, and it’s a social capital that depends on where you come from, where you’ve been historically located by society, and where you’re currently located. Your perception of what you’re entitled to and what you have access to — all of these things are part of social capital. ”

social capital well-being_RS

The session, “How Social Capital Influences Well-Being,” included Nerenberg (left), Berry (second from left), and Williams (second from right). Riccardo Savi photo.

Williams also discussed what happens with social capital when communities allow themselves to cross race, class, and other historical divisions:

“When you mix, you have these openings in which people are able to see themselves in a different light as reflected off of one another. When we’re intentional in allowing the mixing, we come back and re-form the idea of what it is to be human with one another and not being just part of our particular group.”

Here’s Williams in a panel discussion about how race disparities play into health outcomes. She has chronic lupus, and is aware of the data that says many minority communities are underrated for pain: “As an empowered black woman, I’m always aware of the low-level tension of having to make the excuse to say (about being prescribed drugs) that I’m not an abuser of painkillers. The stigma is a stressor in and of itself. … I’ve seen my chart, and in it they write that I’m intelligent and well-spoken. It’s like I’m one of the good black people, so I noticed I was handled differently, and I benefit from being handled differently. We are shaping people inside of those biases.”

So what’s needed? Garth Graham, a cardiologist, professor of medicine at University of Connecticut, and president of the Aetna Foundation, has a thought: “There are hundreds of thousands of articles on health disparities. What we need now is more practical research that shows what interventions make changes.”

 

POLITICS OF HEALTH
Political discussion is the bread and butter of the Ideas Festival, and this year’s Spotlight Health closing sessions brought in two big names in the messy world of politics and health. Tom Price, US secretary of health and human services, was interviewed first, by Jeffrey Goldberg of The Atlantic. Then, Planned Parenthood President Cecile Richards spoke. It goes without saying that they had very different views of the current political health care debate. Here are some nuggets:

Tom Price:
“The goal we have as an administration, that the president has, is we need a system that has heart. And for him that means making certain every American has access to a health system that they want not that the government forces them to buy. That makes sure preexisting conditions are covered, and that there is a transition phase to any new plan, so you’re not pulling the rug out from anybody. And hopefully, there’s more people insured under the new plan than are currently insured.”

Tom Price_DB“Nobody’s talking about booting someone out of the nursing home. We do envision that an individual ought to have the freedom, the right, the privilege to purchase the kind of coverage they want for themselves and their family, not what the government forces them to buy. That’s how you get a system that’s responsive to patients.”

“Health care is something every single person in this nation needs to have access to, and society has to decide how that works. If you view it as the role of the government to provide health care for everybody, that’s a way you can move, but there are consequences that I believe violate the principles I suspect we all hold dear, and that’s decreasing quality, decreasing affordability, decreasing choices. If you have a system more fully represents individuals and the society we’ve been accustomed to that allows individuals to be choosing their coverage, then you’re moving in the kind of direction we’re going.”

Cecile Richards:
“If more members of Congress could get pregnant, we wouldn’t be fighting about birth control and Planned Parenthood.”

Cecile Richards_vert_DB“Women are the backbone of the economy. The largest reason for our participation in the workforce is we are able to plan when pregnancies happen. We cannot continue to build this economy and hold back half of the people.”

“Abortion is supposedly legal in the United States, but now we’re implementing policies that are going to make it impossible for women in the US and globally to exercise their right.”

“It’s scary that we have an administration that not only wants to end access to abortion but to birth control. I worry not only that women won’t have access to Planned Parenthood, but to birth control anywhere.”

“I think we’re in a shifting moment in a world in which fathers believe their daughters should have every opportunity their sons have. Now, we need you to make sure that’s possible. It’s unthinkable to me that my two daughters will have less rights than I do, but in Texas right now they do.”

Want more? Go to the Aspen Ideas Festival website to search for full videos of many sessions (also found on the Aspen Institute’s YouTube channel) and audio recordings of many more. You can also subscribe to the Aspen Ideas to Go podcast and find transcripts of select sessions. All photos by Dan Bayer, C2 Photography, and Riccardo Savi, courtesy of the Aspen Institute.

 

 

 

 

 

 

 

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