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10 Highlights from the 2007 Aspen Health Forum

AspenThe Aspen Health Forum gath­ered an impres­sive group of around 250 peo­ple to dis­cuss the most press­ing issues in Health and Med­ical Sci­ence (check out the Pro­gram and the Speak­ers bios), on Octo­ber 3–6th. It was the first con­fer­ence, by the way, where I have heard a speak­er say: “I resus­ci­tat­ed a woman yes­ter­day”.

Key high­lights and trends:

1- Glob­al health prob­lems require the atten­tion of the sci­en­tif­ic com­mu­ni­ty. Richard Klaus­ner encour­aged the sci­en­tif­ic com­mu­ni­ty to focus on Glob­al Prob­lems: mater­nal mor­tal­i­ty rates, HIV/ AIDS, nutri­tion, can­cer, clean water.  Bill Frist, for­mer Sen­ate Major­i­ty Leader, added to that list the increas­ing epi­dem­ic risks of glob­al zoot­ic dis­eases (trans­mit­ted between humans and ani­mals), sup­port­ed by 2 inter­est­ing data points: at any one moment, there are 500,000 peo­ple fly­ing world­wide; in a year, air­lines trans­port the equiv­a­lent of 2 bil­lion pas­sen­gers.

2- “Let’s get real…Ideology kills”. Mary Robin­son, for­mer Pres­i­dent of Ire­land, on what it takes to stop HIV/ AIDS: “I am from Ire­land, a Catholic coun­try. And I am Catholic. But I can see how ide­ol­o­gy kills..we need more empa­thy with real­i­ty, and to work with local women in those coun­tries who need things like female con­doms.” She was implic­it­ly crit­i­ciz­ing the large bud­get devot­ed to unre­al­is­tic absti­nence pro­grams. This ses­sion includ­ed a fas­ci­nat­ing exchange where Bill Frist rose from the audi­ence to defend the role of US aid, explain­ing how 60% of retro­vi­ral drugs in African coun­tries have been fund­ed by the Amer­i­can tax­pay­er, high­light­ing Pres­i­dent Bush’s courage to make HIV/AIDS a top agen­da item in many devel­op­ing coun­tries, and crit­i­ciz­ing oth­er coun­tries for not doing enough. Which made Nobel Prize Lau­re­ate Peter Agre, also in the audi­ence, stand up and encour­age the US to real­ly step up to the plate and devote 1% of the GDP to aid, as a num­ber of Euro­pean coun­tries do, instead of 0.1%.

3- Where is the new “Sput­nik”?: Basic sci­ence is cru­cial for inno­va­tion and for eco­nom­ic growth, but it is often under­ap­pre­ci­at­ed. Sci­en­tists are not “nerds”, as some­times they are por­trayed in pop­u­lar cul­ture, but peo­ple with a deep curios­i­ty and dri­ve to solve a Big prob­lem. Many of the speak­ers had been inspired by the Sput­nik and the Apol­lo mis­sions to become sci­en­tists, at a time when the pro­fes­sion was con­sid­ered cool. Two Nobel Prize Lau­re­ates (Peter Agre, Michael Bish­op), talked about their lives and careers try­ing to demys­ti­fy what it takes to be a sci­en­tist and to win a Nobel Prize. Both are grate­ful to the tax­pay­ers dol­lars that fund­ed their research, and insist we must do a bet­ter job at explain­ing the Sputniksci­en­tif­ic process to soci­ety at large. Both are proud of hav­ing attend­ed small lib­er­al arts col­leges, and hav­ing evolved from there, fueled by their great curios­i­ty and unpre­dictable, serendip­i­tous paths, into launch­ing new sci­en­tif­ic and med­ical fields.  Bish­op list­ed a num­ber of times where he made deci­sions that were con­sid­ered “career sui­cide” by men­tors and col­leagues, and men­tioned “I was con­fused” around 15 times in 15 minutes…down to earth and inspir­ing.

4- We need a true Health Care Cul­ture: Mark Ganz sum­ma­rized it best by explain­ing how his health provider group improved care when they rede­fined them­selves from “we are 7,000 employ­ees” to “we are a 3 mil­lion strong com­mu­ni­ty”, mov­ing from being a cost con­troller with a pater­nal­is­tic atti­tude to a health facil­i­ta­tor, look­ing under­neath symp­toms to iden­ti­fy and deal with under­ly­ing pat­terns. Mark also announced the launch of the Aspen Health Stew­ard­ship Project to 1) iden­ti­fy levers to change the cul­ture of con­trol, 2) frame the upcom­ing polit­i­cal health care debate, 3) cre­ate a report­card to screen all polit­i­cal pro­pos­als. Will be inter­est­ing to check the progress of the ini­tia­tive in next year’s con­fer­ence.

Relat­ed to this, there were pan­els on how to improve Med­ical Edu­ca­tion, includ­ing train­ing doc­tors to be mem­bers of a team and improve patient-based prob­lem solv­ing and “soft skills” such as how to apol­o­gize to patients and their fam­i­lies. And on Elec­tron­ic Med­ical Records, that have proven to reduce med­ical mis­takes and over­all health­care sys­tem costs, yet many physi­cians resist their use due to the time required to fill out the online forms and work­flow changes required. An inter­est­ing data point: in 65% of vis­its to the doc­tor these days, patients bring some­thing print­ed from the inter­net.

5- You can’t man­age what you can’t mea­sure. We heard many times how defin­ing and mea­sur­ing out­comes, so com­mon in the pri­vate sec­tor, is crit­i­cal to ensur­ing a good allo­ca­tion of resources in the health and sci­en­tif­ic fields, that use so much tax­pay­er mon­ey. For exam­ple. NIH fund­ing grew from $9B in 1994 to $29B in 2007, yet the results are not clear. The same hap­pened with health care as a whole, a sec­tor that now con­sumes 16% of the US GDP with health out­comes (infant mor­tal­i­ty, patient deaths in hos­pi­tals) worse than oth­er coun­tries that invest far less. There is an appar­ent con­sen­sus that sci­ence and health­care need more resources but will only get them once they clean house.

6- The ris­ing role of pub­lic-pri­vate part­ner­ships: There are mul­ti­ple ini­tia­tives launched to bridge the increas­ing gap between acad­e­mia and indus­try. The Foun­da­tion for the NIH has facil­i­tat­ed key con­ver­sa­tion between the FDA and phar­ma com­pa­nies. The Gates and Clin­ton Foun­da­tions have launched inno­v­a­tive part­ner­ship mod­els to tack­le glob­al health prob­lems. The Myelin Repair Foun­da­tion was launched to build bridges once its founder, who had “assumed some­one had a plan”, dis­cov­ered that lit­tle progress had hap­pened in 20 years to help patients with mul­ti­ple scle­ro­sis.

7- From Lifes­pan to Health-span. Pop­u­la­tion dis­tri­b­u­tion in devel­oped coun­tries is shift­ing from a “pop­u­la­tion pypupulation pyramidramid” to a “pop­u­la­tion rec­tan­gle” (see Japan pop­u­la­tion “pyra­mid”, right). There was a good deal of empha­sis on the biol­o­gy of aging and healthy aging, both on how the envi­ron­ment can reg­u­late gene acti­va­tion and on genet­ics. Cyn­thia Keny­on, a UCSF researcher showed her research on how dis­abling one spe­cif­ic gene in a worm can dou­ble that wor­m’s lifes­pan, and men­tioned how that study has been repli­cat­ed with fruit flies and mice, and could, con­cep­tu­al­ly, help humans live longer & health­i­er lives. The point of much ongo­ing research is not “how to spend more time on the nurs­ing home” but how to slow down the process of aging, so we can live health­i­er longer.

8- Patient-advo­ca­cy groups are hav­ing an impact. We heard many exam­ples on how small groups of moti­vat­ed indi­vid­u­als have built large patient advo­cate move­ments that influ­ence pub­lic pol­i­cy. Michael Milken talked about the Can­cer March, that helped increase NIH fund­ing from $1.5B to 5$B. Hala Mod­del­mog, from the Susan G. Komen for the Cure, explained how they have 1 mil­lion peo­ple engaged in pro­mot­ing can­cer research and pre­ven­tion. Robert Klein, key advo­cate of the Cal­i­for­nia Propo­si­tion 71 (that will pro­vide $6B for stem cell research through long-term bonds) explained how the propo­si­tion was passed, includ­ing engag­ing over 80 patient-advo­ca­cy groups.

9- There’s a new empha­sis on under­stand­ing “how sys­tems work” instead of “how iso­lat­ed genes make things hap­pen on their own”: Genomics is start­ing to help pre­dict sus­cep­ti­bil­i­ty to dis­ease and to ther­a­pies. Now, we must remem­ber the dif­fer­ence between strong and weak genes (only spe­cif­ic com­bi­na­tions of which may cre­ate pre­dis­po­si­tions), and keep in mind the role of our expe­ri­ence and envi­ron­ment in turn­ing some genes on or off. Reg­is Kel­ly pro­vid­ed a won­der­ful overview of neu­roimag­ing, learn­ing and neu­ro­plas­tic­i­ty, and high­light­ed how many biol­o­gists are mov­ing from think­ing about “how genes make things hap­pen” to “how sys­tems work”, giv­en than in humans manip­u­lat­ing just one gene may trig­ger changes in 500 oth­ers.

10- The impor­tance of our Lifestyle-Each of us owns our own health. 70% of heath­care costs derive from lifestyle-relat­ed dis­eases (such as smok­ing-induced can­cer). We heard sev­er­al calls to action for insur­ance com­pa­nies to incen­tivize behav­ior mod­i­fi­ca­tion to pro­mote good lifestyle habits that improve qual­i­ty of life and can delay dis­ease symp­toms, result­ing in bil­lions of dol­lars of cost sav­ings. Yet, in my view, the dis­cus­sion was too con­cep­tu­al in this area, and not spe­cif­ic or action-ori­ent­ed enough.

In short, a very stim­u­lat­ing inau­gur­al 3‑day con­fer­ence. I hope the one next year is even bet­ter, and includes more in-depth con­ver­sa­tions on the role of pre­ven­tion and lifestyle in dri­ving health out­comes, and builds more bridges with neu­ro­science and psy­chol­o­gy. I would sus­pect the top­ics dis­cussed in our Neu­ro­science Inter­view Series will have sig­nif­i­cant impli­ca­tions on the grow­ing health­care and pre­ven­tion debate.

Update: you may enjoy the post The Alfred Nobel lega­cy: 2007 Nobel Prizes.

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