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What's Next Health: A Primer On Epigenetics

Jul 16, 2014, 9:00 AM, Posted by Nancy Barrand

Randy Jirtle Photo courtesy of Duke University Medical Center

Each month, What’s Next Health talks with leading thinkers with big ideas about the future of health and health care. Nancy Barrand, RWJF’s senior adviser for program development, hosted Randy Jirtle, senior scientist at the University of Wisconsin-Madison McArdle Laboratory, for a fascinating discussion about his work in epigenetics. Randy’s pioneering work in this field holds far-reaching implications for understanding and addressing the interplay between our genes and our environment. Randy answered follow up questions from Nancy to help lay out the basics behind epigenetics and what it might mean for our work moving forward. (Randy’s opinions are not necessarily those of the Robert Wood Johnson Foundation.)

Nancy Barrand: What is epigenetics?

Randy Jirtle: Epigenetics simply means above the genetics, and it refers to the study of heritable changes in gene function that occur without a change in the DNA sequence. So we now know that chemical modifications of the DNA, and the histones the DNA wraps around, actually determine whether genes are functional or not functional. These chemical modifications can be caused by environmental factors that we are exposed to, such as the nutrients we eat—or those our mother ate—or stress at critical junctures in our development.

Understanding how a single epigenetic change can totally disrupt the action or expression of a gene is providing us for the first time with information that will ultimately allow people to prevent diseases and conditions from ever happening, rather than just treating them after they occur.

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What's Next Health: Designing an Elegant Health Care Process

Mar 20, 2014, 8:00 AM, Posted by Pioneer Blog Team

Jay Parkinson, founder of Sherpaa Jay Parkinson, founder of Sherpaa

Each month, What’s Next Health talks with leading thinkers with big ideas about the future of health and health care. Recently, we talked with Jay Parkinson, founder of Sherpaa, who challenged us to consider what a more "beautifully designed" health care system might look like. As you'll read in his post below, Jay’s trying to do just that through his work at Sherpaa. (Jay’s opinions are not necessarily those of the Robert Wood Johnson Foundation.)

By Jay Parkinson

Everything great comes from an elegantly designed process. Just think of all of the experiences we love and use on a daily basis. Consider the iPhone. Apple re-imagined what a phone, or rather, a tiny computer in your pocket, could be and created a revolutionary device. Steve Jobs designed not only the interface that changed computing forever, but Tim Cook designed the manufacturing and material sourcing processes that enabled them to produce a remarkably complicated device at a relatively inexpensive price. They understood that, in order to deliver an exceptional user experience, they had to design the entire process, from the interface to the factory.

Health care was never designed. It just happened, revolving mostly around doctors’ needs and wants, in a culture that strongly believed “doctor knows best.” But our culture changed with the democratization of health information and other industries quickly evolved, raising consumers’ expectations of what health care could and should be.

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What’s Next Health: The Motivation Bias

Nov 27, 2013, 7:00 AM, Posted by Pioneer Blog Team

Debra Joy Pérez, vice president for Knowledge Support at the Annie E. Casey Foundation Debra Joy Pérez, vice president for Knowledge Support at the Annie E. Casey Foundation

Each month, What’s Next Health talks with leading thinkers about the future of health and health care. Recently, we talked with BJ Fogg, director of the Stanford Persuasive Tech Lab, to discuss motivation versus ability, and to better understand which matters more in creating long-term change. In this post, Debra Joy Pérez, former assistant vice president for Research and Evaluation at the Robert Wood Johnson Foundation, who is now working with the Annie E. Casey Foundation, shares her impressions of BJ’s model and how it might impact the work of organizations like ours.

By Debra Joy Pérez

There is something magically simple in how BJ Fogg’s Behavioral Model addresses behavior change. When just three elements coincide—motivation, ability and a trigger—behavior change happens.

From my own experience, I can tell you that BJ’s model can work in developing new and healthy habits. I heard from BJ that immediately after he pees, he does push-ups. He is attaching a new habit he wants to create to an old habit he already has. Every time he relieves himself, he is triggered to perform a simple action that has him looking and feeling healthier. Like BJ, I wanted to improve my health (motivation)—specifically, I wanted to drink more water. My trigger was green tea. I drink a lot of it, so after each cup, I remember to fill the empty cup with water. I’m pleasantly surprised when I see that I’m nearing half a gallon by the middle of the day. It's working.

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What’s Next Health: Microbiomes Where we Live, Work, Learn and Play

Sep 4, 2013, 12:30 PM, Posted by Pioneer Blog Team

Jessica Green

Each month, What’s Next Health talks with leading thinkers about the future of health and health care. Recently, we talked with Jessica Green, founding director of the BioBE (Biology and the Built Environment Center), to explore how a better understanding of the microbiome in our built environment might lead to healthier buildings and healthier lives.

By Jessica Green

We’ve known for some time about the invisible microbes in us and around us—small organisms including viruses, bacteria and fungi. There was a time when most believed that these microbes were all bad for us. After all, they were the ones responsible for getting us sick. But now, we know that many microbes are either benign or actually beneficial to us.

As a nuclear engineer, I had experience modeling things I couldn’t see. When I learned people were modeling biological systems showing how microbes interact with each other—systems we know as microbiomes—and using big data to understand them and how they affect us, I was immediately intrigued. When I thought about microbes in the context of my interest in conservation and biodiversity, I became hooked. And I am not alone. This is a rapidly growing field and through our collective work, we have been learning more and more about the potential of microbiomes to be agents of health, especially in their work to support vital functions in and on the body. Now we are also starting to examine and rethink how microbes move among us and our surroundings and what this means for how we design our built environments.

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What’s Next Health: Flipping the Visit

Jul 18, 2013, 3:00 PM, Posted by Pioneer Blog Team

Rishi Desai Rishi Desai, medical fellow at the Khan Academy

Each month, What’s Next Health talks with leading thinkers about the future of health and health care. Recently, we talked with Sal Khan, founder of the Khan Academy, who shared his vision for “reimagining education” and what that means for health and health care. Khan Academy medical fellow and Pioneer grantee, Rishi Desai, MD, MPH, shares thoughts on how Khan Academy's approach to learning can help transform the patient experience.

By Rishi Desai

In my pediatric clinic, I generally get 20 minutes with each patient, which is long by many standards. I spend most of that time asking questions and sharing a treatment plan, leaving only two or three minutes to really talk with people about my assessment and address their thoughts and concerns. As a result, patients (in my case, a child and their accompanying adult) too often go away unconvinced or confused about what to do next.

But what if we flipped the visit? What if I could spend time quietly listening to a patient who comes to me already informed and prepared to talk about her child's health and any issues she might be facing? What if the doctor/patient visit allowed us to build better trust—to work as partners instead of me “giving a lecture”?

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