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Choosing the TEDMED 20 Great Challenges of Health Care

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Next week TEDMED will hold its annual conference on health and medicine in Washington, D.C. 1,200 innovators, entrepreneurs, industry and government stakeholders, artists, and health care practitioners will attend in person at the Kennedy Center from April 10-13, and thousands of others around the world will watch via livestream.

The conference is different by design. In-person attendees apply or are invited to attend, experience every three- to 18-minute presentation together, and have ample time for discussion with fellow attendees. It is in effect a 3.5-day-long dinner party with a curated group of people who have the same interests but varied skills, perspectives, and backgrounds. Presenters, who do not typically use notes or slides, have included Michael Graves on hospital design and Lance Armstrong on fighting cancer.

This year the organizers have done two things to enhance TEDMED's impact on the national health care discussion. First, they have moved the venue from San Diego, Calif., to Washington, D.C. Secondly, Jay Walker, a former entrepreneur and now Chairman of TEDMED, and the conference organizers have initiated a Great Challenges Program in which they have identified 50 "large, intractable problems of health care," accompanied by a provocative question: Which would you pick as the most important 20?

Each Challenge has a Champion that is leading the lobby to convince attendees to prioritize that Challenge. Privileges of being named to the top 20 include top billing in TEDMED video publications over the next year. The Great Challenges Program's objective, as stated by the conference organizers, is not to solve these problems, but to "provide America with a comprehensive view, incorporating thoughtful perspectives from every discipline and from all sectors of society." At the very least, the program will engender lively debate around the Challenges. In the best cases, new ideas to address them will emerge from the ensuing discussions.

I decided to have some fun and prioritize the Great Challenges from three different perspectives: my gut, objective data, and a pseudo-scientific method. First, I picked a top 20 based on a pure gut feeling. This was a very satisfying task. It allowed me to consider which are most relevant from a societal perspective, without thinking too much about why I felt the way I did. Second, I considered a "Googlized" view of the list -- i.e., Googling the key phrase associated with the challenge and recording the number of hits associated with that phrase. I was curious to know what level of noise each of the Challenges is generating. There are more sophisticated tools for evaluating online metrics, but Google served as proxy in lieu of having access to the awesome data of bit.ly or another source. Third, I guesstimated each Challenge's potential economic impact and target population size. My guesstimates are based on 15 years working as a consultant in health care, growing up in a family of physicians, and having a proclivity to learn and read about anything at the intersection of health care, innovation and technology.

I had at least three insights based on this process:

1. We have pre-determined priorities when it comes to health care. The same 17 Challenges rise to the top using both my gut and the guesstimating methods. This raises the question of what and how strong our biases are, and what the Challenge Champions for the bottom 30 will need to say to convince me and others like me. The challenge when considering the Challenges will be to keep an open mind.

2. We always want to include something else on a list about health care. There are at least two Challenges that I would add to the list: "Leveraging Big Data" and "Data Standards and Interoperability." Given the continuing rise of genomics, implementation of electronic health/medical records, the large numbers of clinical trial centers and protocols, and increased open data -- e.g., last Thursday's announcement of a "big data" initiative by the U.S. Office of Science Technology and Policy -- these should be on the list.

3. For better or worse, Google and I strongly disagree. The number one Challenge according to Google hits, "Achieving Medical Privacy," makes neither my gut list nor my scientific method list. On the other hand, "Achieving Medical Innovation" makes both my gut list and scientific list -- and is 49th out of the 50 for number of Google hits. This indicates that either the health care world thinks about priorities differently, or that the world in general does not consider the Challenges in the nomenclature in which they have been presented. Most likely, it is both.

I am a consultant, biomedical engineer, a sometimes patient, and an entrepreneur. My picks reflect my background and personal experience. I'm eager to hear what a nurse, a doctor, a cancer patient, a diabetic, someone from big pharma or a payor, and others with very different perspectives have to say.

The full list of my 20 picks is below. What are your picks? I look forward to discussing and debating with you during TEDMED and beyond.

  • Medical Innovation
  • The Obesity Crisis
  • Making Prevention Popular
  • Future of Personalized Medicine
  • Managing Chronic Diseases
  • Reforming the Medical Ecosystem
  • Addressing Health Care Costs
  • Improving Evidence Reliability
  • Eliminating Medical Errors
  • Food and Technology
  • Reducing Childhood Obesity
  • Taking Our Medicine
  • Choosing Better Foods
  • Impact of Stress
  • Promoting Active Lifestyles
  • Whole-Patient Care
  • Accessing Medical Data
  • Elevating Dental Health
  • Inventing Better Metrics
  • "Unimaginable" Possibilities

Luckily for all of us, the remaining 30 Challenges certainly need not be under-addressed. For a comprehensive view of the 50 Challenges, here are the remaining 30.

  • Achieving Medical Privacy
  • Addressing Doctor Shortage
  • Balancing Risk and Rewards
  • End-of-life Care
  • Preparing for Dementia
  • Informed Choice Work Better
  • Faster Adoption Best Practices
  • Setting R&D Priorities
  • Impact of Poverty on Health
  • Private Rights and Public Good
  • Medical Communication
  • The Role of the Patient
  • Eliminating HAIs
  • Inventing Wellness Programs
  • Integrating Effective CAM
  • Overlooked Cancer Cohort
  • Reducing School Violence
  • Better Mental Health Literacy
  • The Caregiver Crisis
  • Isolation and Loneliness
  • Unwed Teen Motherhood
  • Multi-Cultural Medicine
  • Special Needs Patients
  • Reducing Domestic Violence
  • Deciding What's Normal
  • Avoiding Over-Diagnosis
  • Childhood Diagnoses
  • Medical Information Overload
  • Malpractice Dilemma
  • Tomorrow's Medical Leaders

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