“The future of medicine is in good hands,” says Omry Zuckerman, OMS II. This was his main takeaway from attending TEDMED 2014, a conference on innovation in health care and medicine, earlier this month in Washington, D.C. After spending three days absorbing ideas, Zuckerman says he was struck by visionaries’ ability to turn a simple notion into a potentially game-changing concept.
“Some of the most incredible work came from ‘A-ha!’ moments people had on the job or in their day-to-day lives, and they took the initiative to make their ideas a reality,” says Zuckerman, who attends the Rowan University School of Osteopathic Medicine (RowanSOM) in Stratford, New Jersey.
Such a moment led TEDMED presenter Leana Wen, MD, to found Who’s My Doctor?, a website that encourages physicians to complete and provide online a “total transparency manifesto,” which details any payments they receive from pharmaceutical, medical device and other health care companies, as well as moral and religious views that may affect the services they provide.
Dr. Wen dreamed up the project while her mother was battling breast cancer. Dr. Wen helped her mother find an oncologist, who put her on chemotherapy. But one day, her mother lost her physician’s phone number. When she searched the Internet for it, she was unpleasantly surprised by what she found.
“On several websites, [her physician] was listed as a highly paid speaker to a drug company, and in fact, often spoke on behalf of the same chemo regimen that he had prescribed her,” Dr. Wen said. “She called me in a panic, and I didn’t know what to believe. Maybe this was the right chemo regimen for her, but maybe it wasn’t.”
Dr. Wen established Who’s My Doctor? to help other patients avoid similar revelations and better understand their physicians’ backgrounds, financial motivations and medically relevant convictions.
Timothy Tsai, OMS II, who also went to TEDMED 2014, notes that Dr. Wen mentioned other benefits of physician transparency beyond awareness of financial ties.
“For instance, if you were homosexual, you would want to be certain that the physician was aware of the LGBT community,” says Tsai, who is also a RowanSOM student. “And if you were looking for an abortion, you wouldn’t want to visit a strongly pro-life physician.”
Singling out side effects
Another TEDMED 2014 presenter who stuck out to Tsai was Daniel Kohane, MD, who desires to lessen the side effects of medications. Dr. Kohane said that when he was a pediatric resident, he often prescribed antibiotics to children with ear infections and disliked the fact that drug traversed the whole body to reach the ear, taking out a lot of “innocent bystander bacteria” along the way.
Dr. Kohane and his colleagues developed a drug-containing hydrogel that could be applied directly to the ear by a physician.
“[The drug] was designed so it would pour onto the eardrum easily, and then once it was there, it would form a nice firm gel,” he said. “The gel also contained a special molecule called a chemical permeation enhancer which would cause the eardrum to become more permeable to drugs, allowing the drugs to enter the middle ear and kill the bacteria without having to go throughout the entire body to get there.”
To treat glaucoma, Dr. Kohane and a colleague developed a drug-releasing contact lens that, when tested in rabbits, could provide medicine for several weeks. A drug-releasing lens may be a more effective treatment than eyedrops, which patients often forget to administer, he noted.
For problems deeper inside the body, physicians can use nanoparticles, Dr. Kohane noted, which are between one-millionth and one-billionth of a millimeter in diameter. Nanoparticles are easy to inject into the bloodstream, and they percolate into tissues well.
When researching treatments for heart attacks, Dr. Kohane and his colleagues wanted to send medicine to a specific part of the heart. They knew that some disease tissues express specific molecules more than healthy tissues do, and molecules called ligands can stick to those molecules.
During heart attacks, the oxygen-starved part of the heart overexpresses a protein called angiotensin-II receptor, type 1. Dr. Kohane and his colleagues attached a ligand to that protein on nanoparticles. After injection, the nanoparticles raced to the part of the heart that was starved of oxygen and avoided the normal part of the heart, Dr. Kohane reported.
Watching Dr. Kohane’s presentation gave Tsai ideas for other areas that could benefit from site-specific medication, such as supplements for joint pain.
“The big issue with joint supplements is that you give them to people and they get delivered to the entire body, including places where you don’t need them,” he says. “Targeting a specific site improves efficacy tremendously. Dr. Kohane’s drug delivery model has a ubiquitous application and could really help out in so many fields.”
Testing hands-on skills
The problem that TEDMED 2014 presenter Carla Pugh, MD, is trying to solve is the lack of a standard way to test physicians’ hands-on skills.
“Dr. Pugh spoke about the importance of haptics, which is the power of touch,” Zuckerman says. “Clinicians come in, and they have a very strong background in medicine and are completely well-prepared for their board examinations and medicine in general, but one thing that they often aren’t tested on is actually being able to put their hands on patients and diagnose or treat them.”
After completing her surgery residency, Dr. Pugh began creating sensorized clinical exam models.
“We developed a set of sensor-enabled breast models for competency testing, and this is where we made a fascinating discovery,” she said. “About 15% of experienced clinicians use a haptic technique that’s ineffective.”
That 15% of clinicians missed the synthetic breast’s lesion, and Dr. Pugh learned that they had been taught the ineffective technique they were using.
“What’s exciting about this is that we were able to discover this faulty technique with sensor technology that is readily available today,” she said.
Dr. Pugh envisions a world where similar models are used to train and test physicians’ hands-on competency in all manner of diagnoses—a concept that, Zuckerman notes, is highly osteopathic.
An inspiring break
Presentations were just one aspect of TEDMED—Zuckerman and Tsai note that the event also offers attendees valuable networking opportunities. Roughly 2,000 students, physicians, educators, researchers, entrepreneurs, policymakers and other health care professionals attended TEDMED, which was held in Washington, D.C., and San Francisco.
The conference is also a refreshing break from studying, Tsai says.
“Students sometimes get really bogged down by the everyday of medical school and the monotony of it and really lose sight of the grand picture,” he says. “Events such as TEDMED really show you examples of people who think outside the box and who have performed incredible feats.”
Zuckerman and Tsai run RowanSOM’s Synapse club, a health care discussion group. Fellow club members who went to the conference last year encouraged them to go to TEDMED. Zuckerman and Tsai were excused from school, and Synapse hosted a live stream of several talks on campus, while Zuckerman and Tsai live-tweeted from the event. As a conference volunteer, Zuckerman got free admission to TEDMED, while Tsai’s student status allowed him to receive a 50% fee waiver.
More medical students should attend TEDMED, or at least keep abreast of innovations in the medical field, he says.
“A lot of my classmates may have heard of TED or TEDMED, but never really investigated or looked into it,” he says. “Medical students get tunnel vision sometimes. It’s important to do well in academics, but there’s just so much more to health care than studying and taking exams.”