Refocusing Tech Investments to Impact the Population: TEDMED Musings From Ben Sawyer

Dec 16, 2010, 12:11 AM, Posted by

The below post was submitted to Pioneering Ideas by Ben Sawyer, founder of the Pioneer Portfolio-sponsored Games for Health program, which seeks to forge productive connections between the health and gaming arenas.

What did I learn at TEDMED this year?  And how does it relate to the games for health space?

In a big picture, what TEDMED has shown me more than ever is that a lot of powers that be are quickly hurtling us toward a very different approach to healthcare. However, we're in a tumultuous period where multiple vectors are not in sync and we don't have a real pecking order established. Will technology, policy, or re-invention of doctrine and practice lead the way? In truth, that pecking order will never be pre-established, but it seems very uncertain at the moment, at least to me. I have this feeling that we're in the storm before the calm, rather than the other way around, but that just may also be a "Ted Effect."

So my quest here is to formulate my very earliest thoughts - this is not an end point summary, but a beginning of my overall thought process about what this year’s TEDMED meant.

What seems to make things all the more uncertain is technology is making such incredible leaps. Meanwhile, at TEDMED, we heard some very smart people declaring current ways of operation dead -- that there has to be a complete restart.  So it's hard to anchor things down in the world of health between what was said at TEDMED and the overall health reform legislation now being implemented, as lots of change is happening.

Now, despite that, it does seem like broad outlines of care are coming together and here's what I think they are.

Personalized medicine & individual model of health progression

We are going to enter an age of truly personalized medicine designed to allow for procedures that normally couldn't be provided, because we had to throw the baby out with the bathwater. So, for example, if your DNA is of a certain state, you can have this drug that currently is forbidden because in a clinical trial there are too many unlocalizable side effects.

I also began to see the outlines of a more complete set of complex health systems that include not only genomics, but proteomics, personal biomes, environment, and personal behavior. Biochemistry has been the dominant form of medicine (along with surgery) for so long and now we're going to have to blend in all of these very important intertwined elements we're just beginning to understand better.

That is mind boggling. It is only through information technology that I can imagine we can really begin to do this.

We are also going to enter an age where devices are going to have an even bigger role, and these devices are going to compete against drugs in terms of how we treat a condition. What Medtronic showed in terms of its pacing technology and where it's headed was pretty eye opening, for me at least. They showed a next generation lead-less pacemaker that's about the size of a nickel. Even more impressive, with the version slated for just after that, you will be able to fit 10 on the head of a penny. They can put these in all over your body, connect to them, and program them remotely. It allows them to potentially have solutions for many other places in the body where electrical regulation could be quite useful.

So add increased computerization to the above list.

Toolset of cures

So the toolset of "cures" (and I use that term very loosely) is going to go up quite a bit and hopefully that means we get some better ROI, because even with all the money and supposed advances in an area like cancer, it's still really tough to get dramatic gains. In fact, it's easy to lose sight that things are at times more incremental then they appear, considering some of the incredible technology shown and discussed at the conference.

The Fight...The Tension

What this all means is that the battle between what "cures" or "manages" a disease and ideas that prevents onset of disease are really going to become far bigger deals then they are today. At least from where I'm sitting, the biggest uncertainty is what will be the right mix of prevention vs. response. 

And what makes this hard is that it is also a fight between population and individual. Prevention is something we're trying to focus on population, while response is tied up much more heavily on the individual. 

Games Feel Small

So at times, what all this does is make games feel small. Yet when you think about how to navigate this all, how to motivate audiences of people on a public health level and how to divert people to less costly behavior based medicine vs. these expensive, complex, but amazing technological achievements, it doesn't seem so small.

Feeling small in the face of such overwhelming changes in medicine is not a bad thing. Feeling small is about being humble. If you can't be humble in the face of health, it's easy for enthusiasm to generate arrogance, instead of perseverance.

As technology is over invested on the side of treating people, as individuals, who are sick, it will require perseverance to rebalance this investment going forward to find equal leverage for interventions based on behavior and focused on larger populations worldwide.

Somewhere in there are seeds of advice for the games for health space, let alone other areas in health and healthcare.

This commentary originally appeared on the RWJF Pioneering Ideas blog.