What’s an NCD?

With the UN NCD Review this week in New York City, we recap on what Non-Communicable Diseases are… And why they matter.

This week in New York City, all eyes in the Global Health community will be on the UN NCD Review. As the last three years have flashed by since the 2011 High-Level Meeting, now is the moment to take stock and reflect on the progress – and challenges – of tackling this growing epidemic.

General Assembly resolution 66/2 of 19 September 2011, containing the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases called for the convening of a comprehensive review and assessment in 2014 of the progress achieved in the prevention and control of non-communicable diseases.

 

Forgotten what NCDs are? Watch this short voxpop from NCDFREE and jog your memory…

 

So what are the facts on NCDs?

- Non-Communicable Diseases are a group of varied and often chronic conditions including diabetes, heart disease (including stroke), cancers, chronic lung diseases and mental illness.

- Together, NCDs are the leading contributors of global morbirity and morbitity accounting for 60% of global deaths in 2010.

- 80% of global NCD mortality occurs in the world’s low and middle-income countries, representing a barrier to economic and social development.

- NCDs threaten to slow, halt and at worst, reverse progress on the MDGs and their replacement agenda.

 

To understand more, click on the e-lecture below to learn what NCDs are, who they affect and what you can do.


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Dr Alessandro Demaio (@SandroDemaio) is Postdoctoral Fellow in Global Health at the Harvard Global Equity Initiative, Harvard Medical School and an Assistant Professor at the University of Copenhagen.

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A Peruvian Story of Cancer, and Health

This week, we bring you the latest in our Global Health short films, by Alessandro and the team at NCDFREE - partnering this time, with GlobalRT. Set in Lima, the films follows the stories for two young females affected by and affecting cancer. This film was commissioned and co-funded by GlobalRT, UICC and NCDFREE.

 

 

Earlier this year, I wrote a short piece on cancer care while shooting a global health film in the Peruvian capital, Lima. Highlighting the progress, myths and challenges in oncology and public health – and exploring some of the incredible work of innovative healthcare providers in resource-poor settings.

As an academic, I see an essential mandate of my role is to break down the barriers between science and the community. Not only to develop and further science – but also to communicate it to a broad audience in a way that is engaging, understandable and relevant.

To do this, I am always looking for new, effective ways to connect with a wide audience and with them, question the things we do as a society. Challenge the everyday rhetoric and flag processes, conditions or ideas that are unjust, unsustainable, inefficient or inequitable. Focusing on Global Public Health.

One very important way I see we as academics can continue to reach and engage everyone in science in 2014 – is through film. With this in mind and together with our sensational team at NCDFREE, we have now made a handful of short video-based narratives over the last 12 months – each focusing on an important health issue, hero or message.

For this latest film, we travelled to Peru to capture the story of a young cancer survivor and mother – and the doctor who made her survival possible. Entitled “Veronica: a Peruvian story of cancer, and health” – we highlight the journeys of two strong young woman affected by and affecting Non-Communicable Disease (NCDs). We aim to engage, inspire and challenge you – and your ideas about health.

Supported and commissioned by GlobalRT and the UICC – this film was shot working closely with an incredible local videographer, Lali Houghton.

For more information on radiotherapy and the important work of GlobalRT – or on NCDFREE and the making of this short film – head to the websites.

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Dr Alessandro Demaio is Postdoctoral Fellow in Global Health and NCDs at the Harvard Global Equity Initiative, Harvard Medical School and an Assistant Professor at the Copenhagen School of Global Health. To follow the next journey in Global Health film, connect with Sandro on Twitter via @sandrodemaio and @NCDFREE.

The Conversation

The Conversation

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Translating the Untranslatable #imaginemed Part 3

This week on PLOS Translational Global Health, Alexandra Abel brings us the final part in the #imaginemed series.

Welcome back to Imagining the Future of Medicine at the Royal Albert Hall.

The final session began promptly as an eager audience clambered to re-take their seats. One man even hopped up on stage in an effort to more speedily access the stage-side stalls seating area! If you’ve been reading from Part 1, you’ll recognise this as our unanticipated stage invasion. Thankfully, hundreds didn’t follow after Dara quipped, “I like the way you climbed up on stage there”. After that tiny bit of excitement, on to session three… Translating the Untranslatable.

Alison talks about Music as a Healer. Photography: Alan Liu

Alison talks about Music as a Healer. Photography: Alan Liu

Someone very accustomed to being on stage at the Royal Albert Hall is Alison Balsom, who wanted to tell us about the healing power of music.

This is something very dear to me as I have always thought of music this way, and at uni, investigated benefits of learning a musical instrument for older people.

Alison started off with, of course, a beautiful trumpet performance, and then explained that a lot people say music can be medicine, but without much thought as to why this might be.

“As a musician, I feel that music is meditation. It’s self-expression. It’s physical. It’s thrill seeking. And it’s cerebral.” – Alison

Brass for Africa empowers young people through music and humanitarian programmes.

Brass for Africa empowers young people through music and humanitarian programmes.

Alison went on to show a video made especially for ImagineMed, filmed during her recent trip to Kampala with the fantastic Brass for Africa. This charity engages children from disadvantaged communities and works with them through music on wider issues they are experiencing. Brass for Africa’s most important projects are in two orphanages, The Good Shepherd Home and the Bethlehem Orphanage; and for the children there, the music project is the highlight of their week. The film showed how music had profoundly affected the lives of these children, and Alison’s message was that music can engage, empower, and repair, and has a vital place in science and medicine.

“Some people would argue that you don’t need music like you need food and water, but I would say it’s about flourishing as a human being, not just surviving.” – Alison

Tali talks about The Surprising Science of Future Thinking. Photography: Alan Liu

Tali talks about The Surprising Science of Future Thinking. Photography: Alan Liu

Next up was cognitive neuroscientist Tali Sharot, who began by asking the audience how they would talk themselves out of eating an imaginary ‘naughty treat’ placed in front of them. Would they think, ‘that will make me fat’, or would they think, ‘I’ll be healthier if I don’t eat that’. Most of the audience went voted for the fat option, but Tali went on to explain how this isn’t the best way to encourage positive behaviour. Along with our natural optimism bias, another focus of Tali’s research, she has found people are also resistant to warnings. We tend to tell ourselves not to worry about things that might happen, rather than implementing early mitigation measures, and we are naturally more receptive to information we want to hear. We appear to have an inability to learn from bad news, and children, teenagers, and the elderly are least likely to learn from warnings.

When a known camera was installed at a hospital to monitor staff’s practice of hand washing between seeing patients, only 1 in 10 people washed their hands. But when an electronic board was introduced, stating how well the ward were doing, i.e. “hand washing rates on this ward are at 60%, higher than average!” hand-washing rates rose dramatically to 90%. This is because of three principles that drive action to progress: immediate rewards, social incentive, and progress.

Katherine talks about How to Have a Good Death. Photography: Alan Liu

Katherine talks about How to Have a Good Death. Photography: Alan Liu

Penultimate speaker of the day was palliative care specialist Katherine Sleeman, who had the audience applauding in the first minute as she explained that despite the incredible advances in health and medicine over the last century, global death rates still remain unchanged at 100%!

Katherine explained that the success of modern medicine has resulted in death being viewed as failure, and just 0.1% of the NHS budget is put towards palliative care. The majority of us will live with, and die from, chronic medical conditions, resulting in a slow deterioration of function. She noted that a ‘good death’ may mean different things to different people, but sophisticated hospital care may paradoxically be worsening, not improving, our quality of life… and quality of death. Palliative care can be very individual, finding out a patient’s worst problems and trying to improve them, but it may not be a case of quality versus quantity as studies have shown palliative care helps cancer patients to live longer.

Palliative care doesn't have to be quality of life versus quantity. Photography: Alan Liu

Palliative care doesn’t have to be a case of quality of life versus quantity. Photography: Viviana Motta

Society needs death as much as it needs new life, and yet it is often so poorly planned for. Katherine’s message was that people find it hard to talk about death, but it is an important conversation to have so we can start ‘saving deaths’ as well as saving lives. I can safely say that Katherine’s talk was one of the most warmly received, and it was fantastic to see such a wonderful reaction to an incredibly important topic generally regarded as morbid or taboo.

“Stop whispering and start talking.” – Katherine

Ben talks about Bad Science. Photography: Alan Liu

Ben talks about Bad Science. Photography: Alan Liu

Our final speaker of the day was Bad Science writer Ben Goldacre. I mean someone who writes about bad science, not a bad science writer as one lovely tweeter noted (thanks, George Ward, for pointing out my grammatical ineptitude early on). Ben is actually a rather good science writer and an excellent science speaker, and it was fantastic to have him close the show at ImagineMed.

Ben outlined the need for, and success of, his popular All Trials campaign, which calls for greater clinical transparency and the results of all trials to be published. He explained that 85% of drugs prescribed today came on the market over 10 years ago, and the trial data for these medications needs to be available now so we can be certain we are using evidence-based interventions. Ben showed us 47 slides in 15 minutes, but his message was simple: access to full methods and results matter.

Ali says we must believe in the power of imagination. Photography: Alan Liu

Ali says we must believe in the power of imagination. Photography: Alan Liu

Just before the end of the show, our wonderful director Ali Rezaei Haddad took to the stage to say a few closing words and thank the many people who helped make this event possible. A few years ago, when Ali founded the Avicenna Project, he never thought it would lead to a full day event at the Royal Albert Hall. A children’s cancer lecture series for 50 people at our university led to a general forum on health and medicine for 500 people at the Royal Geographic Society in 2013; and the day after our 2013 event, he picked up the phone and called the Hall (without fear of sounding stupid). Ali’s message was that we must all believe in the power of imagination, or exciting ideas will never take form.

~ That’s all, folks! ~

A very happy team at the end of the show!

A very happy team at the end of the show!

The event was live streamed by the fabulous Be Inspired Films, and we are extremely happy to say that people from 44 different countries tuned in to watch the live stream.

We also hosted a multilingual live blog on our homepage throughout the day. At one point during the show, our server actually crashed because thousands of people were trying to access the website at once!

Thank you to our multilingual live blogging team, Nadia Ceratto, Christina Wong, and Mahiben Maruthappu, and social media coordinator Reena Wadia. Also to our photographers Alan Liu, Vivana Motta, and Ellie Pinney, and programme artist Conor Farr.

Post-show festivities in the gallery. Photography: Zinah Sorefan

Post-show festivities in the gallery. Photography: Zinah Sorefan

Videos of all of the talks and performances are now available to view on the ImagineMed website.

A massive thank you to all of our speakers and performers. And to our host, Dara, who hopefully collected some interesting anecdotes for his doctor-dominated dinner parties.

Thanks to the team at the Royal Albert Hall, including: Chris Cotton and Jasper Hope; Ed Cobbold and Caroline McNamara for their tireless efforts in the planning of this event; Rick Burin for delightful emails and concurrent expert press exec-ing; Mo Crowe for knowing absolutely everything and keeping us all calm backstage; Jess Silvester for never losing patience with marketing requests; Lord Matt Griffin for first-rate digital content management in the face of tricky web CMS; and Ellen Morgan, who managed to get one of our top online game scores, even higher than the girls who set the questions.

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The ImagineMed circle.

The Royal Albert Hall really is an incredible place. Not only is it a world-renowned performance venue, it is also a charity dedicated to increasing access to the arts and sciences, supporting the cultural life of the country, and inspiring future generations. Officially named the Royal Albert Hall of Arts and Sciences, it has played host to a number of science events featuring leading experts such as Stephen Hawking, Richard Dawkins, even Albert Einstein. And Einstein knew a thing or two about imagination…

“Imagination is more important than knowledge. For knowledge is limited to all we now know and understand, while imagination embraces the entire world, and all there ever will be to know and understand.” – Albert Einstein

 

I hope you enjoyed the #imaginemed series. Thanks for reading, and please do watch the videos when you have the time! Again, you can find them here.

Alex

Alexandra Abel is a graduate from Imperial College London and the Royal College of Music. She has a keen interest in both Global Health and Performing Arts. From September, she will be a medical student at Hull York Medical School.

Join her on twitter @alexandraabel

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Medicine Without Borders #imaginemed Part 2

This week on PLOS Translational Global Health, Alexandra Abel continues the round up of her #imaginemed event.

Welcome back to Imagining the Future of Medicine at the Royal Albert Hall.

The Kaos Signing Choir for Deaf & Hearing Children. Photography: Alan Liu

The Kaos Signing Choir for Deaf & Hearing Children fill the stage. Photography: Alan Liu

Straight after the break, The Kaos Signing Choir for Deaf & Hearing Children began their performance, with beautiful renditions of ‘One Earth, One Sky’, ‘True Colours’, and ‘Respect’. The choir is the only integrated deaf and hearing children’s choir in the UK. They quickly got the audience singing and signing along with them, and we were dancing backstage. Their beautiful performance really has to been seen to be appreciated so please do watch their performance when the videos are available.

Time for Medicine Without Borders, a session all about global health and global medical innovation. Session two began with maxillofacial surgeon Leo Cheng, who is quite possibly one the nicest and most inspiring people you could ever hope to meet. Leo told us of his incredible work with Mercy Ships in West Africa where he and other dedicated volunteers offer life-changing and life-transforming surgery as well as medical advice, materials, and training.

Leo talks about Offshore Medicine. Photography: Alan Liu

Leo talks about Offshore Medicine. Photography: Alan Liu

Some of the patients who come for surgery are so demoralised because of the way they have been treated by society. Leo said the first thing he does is go up to his patients, look them in the eye, introduce himself and shake their hand – immediately reminding me of Kate Granger’s wonderful #hellomynameis campaign. This basic human contact and understanding is so important in medicine, especially to these patients; and as Leo so beautifully explained, “all healing starts with acceptance”. Mercy Ships’ aim is to ‘bring hope and healing’ to thousands of people who would never have believed it possible, and Leo’s talk reminded me of the lovely proverb, “he who has health has hope, and he who has hope has everything”.

Leo went on to tell us more about Africa Mercy, a 16 and a half thousand ton ship, the biggest non-governmental hospital ship in the world. There is a library, a gym, a doctor and dental clinic, a school for primary and secondary pupils, and even a Starbucks! Leo explained that there really is a part to play for everyone who wants to help. His wife and daughters have joined him volunteering on the ship. And even those with no medical training are able to help out, for example, preparing food for the people on board. Leo’s message was that anyone can use their compassion to help others in some way, and urged us to turn our emotion into compassion and action.

Ali talks about Smart Healthcare. Photography: Alan Liu

Ali talks about Smart Healthcare. Photography: Alan Liu

Next up was healthcare entrepreneur Ali Parsa. He began his talk with a story about a frog, which pointed to the conclusion: innovation is never about what you have and what you’ve got to give, it is always about what people need. Ali explained that basic access to a doctor is real problem worldwide, particularly in rural areas of developing countries, before unveiling his new app, Babylon, with an exciting on stage demonstration.

“Nowadays, whether you are in Kenya or Kentucky, you can get your music at the same time… can we do that with healthcare?” – Ali

The aim of Babylon is to make peoples’ day-to-day access to healthcare as simple as possible, and the name of the app comes from the fact that Ali has always been fascinated by the Babylonian people. 2,500 years ago, when the people of Babylon were sick, they were asked to go and stand in a square, and for passers-by, it was their civic duty to ask the sick people what was wrong. If they’d come across that ailment before, they would share their wisdom. As a result, Babylonians had the longest life expectancy in the world.

Starfish_Goa_2007

A starfish on the beach in Goa.

Having started his talk with a story about a frog, Ali ended with a delightful story about a starfish. In Goa, where the beach runs for miles, hundreds of starfish are washed up on the shore and bake in the sun. The story goes that one day, a child was picking up these starfish one by one and throwing them back into the sea. An old man came along and said, “child, why are you doing that? What difference will it make, you will never be able to throw all of them back”. The child picked up another starfish, threw it back into the sea, and said, “it made a difference to that one”. This beautiful story represents the way Ali feels about his new venture; he said that Babylon may not be the answer to everything, but if it can go some way to advancing this type of accessible healthcare, he will be happy.

In his post-talk Q&A, Ali explained that Babylon aims to do for healthcare what Amazon did for the delivery of books, and what iTunes did for the delivery of music.

At this point in the programme, we were very pleased to welcome on stage our special guest, Jay Walker. Many will know Jay as the curator of TEDMED, but he is also the creator and curator of The Library of the History of Human Imagination, which holds an impressive collection of artistic, scientific, and historical artifacts. Jay’s library, with its floating platforms, glass bridge, and connecting stairways contains some truly remarkable treasures, including an original 1957 Russian Sputnik, and a 1699 atlas containing the first maps to show the sun, not the earth, as the centre of the known universe (a map that divides the age of faith from the age of reason).

I think I can speak for our entire team when I say that Jay, a noted expert on human imagination, is one of the most knowledgeable men we have ever had the pleasure of meeting. He is also extremely passionate about sharing this knowledge, and using his expertise and experience to benefit others – something that we, and our speakers, truly appreciated throughout the day.

Jay talks about The Next Revolution in Health and Medicine. Photography: Alan Liu

Jay talks about The Next Revolution in Health and Medicine. Photography: Alan Liu

Jay took us on a journey from the moment life began on earth, to the point that humans started to create more sophisticated tools, learn ways to communicate – started to have imagination! At this point, man, above all other animals, takes control of the natural order, and ‘Civilisation 1.0’ emerged from this point, 10,000 years ago. More recently, the dawn of The Scientific Method unleashed a torrent of change in the world, and placed man in control of the entire shape of civilisation.

But Jay provided some evidence to prove how little we currently understand about our bodies. Firstly, for 25% of all people who die of heart disease, the very first symptom is death. Secondly, the smallest cancerous tumour we can find is 100 million cells, and if you have a tumour of 100 million cells, you’ve had cancer for 6 years. So the earliest we can detect cancer is 6 years after it initiates! And thirdly, in our bodies, our own cells are outnumbered 9 to 1 by bacteria, but before about 5 or 6 years ago, we couldn’t even sequence the genome of these bacteria – we knew nothing of the microbiome.

Jay explained that we have reached another turning point, and are entering a new era, ‘Civilisation 2.0’! We are on the cusp of being able to understand what is going on in our bodies internally, but we also being able to take control of it. For the first time in the history of the planet, synthetic biology, the name we give to the manipulation of the data of life, is going to compete with natural selection.

Paul and Jay discuss The Age of Information Meets the Age of Bio-Science. Photography: Alan Liu

Paul and Jay discuss The Age of Information Meets the Age of Bio-Science. Photography: Alan Liu

Imperial’s Paul Freemont, co-director of the EPSRC Centre for Synthetic Biology and Innovations, joined Jay on stage for a fascinating discussion about the age of information and bio-science. Paul talked about his work on the development of synthetic biology platform technologies and biosensors. He explained that they have been doing this kind of work for about 10 or 12 years now, but it is accelerating incredibly rapidly, and the applications of synthetic biology are wide ranging, from healthcare to bio-mining.

 

That’s all for session 2.

Check back next week for #imaginemed part 3.

Alex

Alexandra Abel is a graduate from Imperial College London and the Royal College of Music. She has a keen interest in both Global Health and Performing Arts. From September, she will be a medical student at Hull York Medical School.

Join her on twitter @alexandraabel

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A quest for a Healthy Tax Reform in Chile

This week on PLOS Translational Global Health, Sebastián Peña, MD, MSc, from the Department of Health, Municipality of Santiago discusses the Coordination of the Front for a Healthy Tax Reform.

Chile is undergoing the largest tax reform since the return of democracy in 1989. The goal is to increase the tax revenue in $8,200 million to finance a deep educational reform that will provide free, public and quality education for all.

Flickr / geezaweezerIn this context, the Government of Michelle Bachelet has included a raise in sugar-sweetened beverages (SSBs) and alcohol as “corrective taxes”. The reform seeks to increase an existing ad-valorem tax on non-alcoholic beverages of 13% to 18% for sugar-sweetened beverages. Alcohol taxes would change from its current structure (15% for beer and wine and 27% for spirits) to an ad-valorem base tax of 18%, 0.5% extra per each degree of alcohol content and 0,03 monthly tax unit per litre of pure alcohol. This would result in a raise of 7-23% in tax, affecting more alcoholic beverages with higher alcohol content and cheaper prices, the latter resulting from the per unit tax.

Reactions against these taxes where almost immediate. The day after the announcement, a Senator argued that the alcohol tax was a “grave to the small producers of pisco [a spirit produced from grapes]”. A few days later, Andrónico Luksic, owner of Chile’s largest alcohol producer Compañia Cerverías Unidas -, expressed his concerns about the raise in alcohol taxes. Soon after, 8 MPs signed an agreement to request President Bachelet to drop alcohol taxes to protect the producers of pisco. Flickr / geezaweezer

Taking into account this scenario, a group of public health professionals started to discuss the need to take action to demand a raise in SSBs that would effectively reduce consumption (from 13% to 33%, as suggested by PAHO), to prevent alcohol taxes to be dismantled completely from the reform and to request including a significant raise in tobacco taxes. Perhaps more importantly, our main objective is to bring to the forefront the role of Governments in the health of populations and the use of taxes as cost-effective ways to reduce consumption of alcohol, tobacco and SSBs and the resulting death, disability, low productivity and violence.

With these objectives in mind, we created the Frente por una Reforma Tributaria Saludable (Front for a Healthy Tax Reform). An invitation was sent to a wide range of organizations from the civil society, professional associations, scientific societies and colleagues to join the Front. Currently, the Front consists of 13 organizations including well-known academic institutions, NGOs, trade unions, parents and medical associations and scientific societies. The advocacy work has been divided in three areas: media, parliament and civil society and we have organized three massive twitter events (#ReformaTributariaSaludable), written several columns in national newspapers and blogs, given an open letter for the Minister of Finance and met with the Minister of Health and several members of the Parliament.

Flickr / Latin America for LessThe day after our first Twitter event, the Minister of Finance gave up to pressure from the MPs and agreed to eliminate the per unit tax, resulting in a 50% drop in the alcohol raise. As compensation, the Government introduced a tobacco tax that would only result in a 1% price rise.

Our advocacy work has continued and we are starting to see some results. 50 MPs signed a petition for the Government to raise SSBs taxes to 30% and include a tax on all sugary and salty products. Later and following our proposal, the request has been to include a tax on all processed foods with an energy density higher than 275 Kcal/100 grs, following the recommendations of the World Cancer Research Fund and the experience of Mexico.

But this is a big fight and the opposition, fierce. Two weeks ago Coca-Cola, Nestlé, Compañia Cervecerías Unidas and Carozzi announced the creation of a coalition to fight the raise in corrective taxes. El Mercurio, Chile’s largest newspaper wrote an editorial arguing against “healthy taxes” as effective means to reduce consumption. In their opinion, education was instead a much more effective way.

Flickr / antifluorThe quest for a healthy tax reform in Chile is ongoing and now the discussion has moved to the Senate. The public health community is organized to challenge the economic and political power of the food, alcohol and tobacco industry. To what extent we will succeed remains to be seen.

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Dr Sebastián Peña is a Chilean MD with a European MSc International Health. He is Chief of Quality Unit, Department of Health, Municipality of Santiago and currently a visiting scholar with the National Institute for Health and Welfare, Finland. Follow his work via Twitter - @spenafajuri.

This blog represents the views and ideas of Dr Sebastián Peña.

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#imaginemed: Thinking Outside the Box (Part 1)

This week, PLOS TGH is handed over to the talented and articulate Alexandra Abel. Combining a passion for medicine, global health and the arts, she reports on the recent #imaginemed event, London.

Sandro

The day before show day, like true scientists, we stood up in the gallery at the Royal Albert Hall contemplating what could possibly go wrong. We recalled the time that over 100 members of the audience decided to join Pete Doherty on stage during his solo performance in 2008, but swiftly noted we did not anticipate the same problem at our event. As exciting as cardiothoracic and maxillofacial surgery are, particularly to us, they don’t generally trigger mass stage invasion. Not during lectures anyway.

A pre-show view from the ImagineMed stage. Photography: Alan Liu

A pre-show view from the stage. Photography: Alan Liu

The following day, while setting up and trying to keep to time, I think we all took at least one unscheduled moment to appreciate just how breathtakingly beautiful the Hall really is. When we worked with Focus Active Learning to make our online game, we learned a lot about the Hall in the process.

For example, there are over 13,000 letter ‘A’s around the Hall to commemorate Prince Albert, over 6 million red bricks make up the Hall’s distinctive exterior, and there are 14 bars (as in drinking ones) in the Hall. But no fun facts compare to standing on the stage looking up at the tiers and the fluted aluminium roof and looming diffuser discs.

 

Meanwhile, over at the Sir Alexander Fleming Building of Imperial College London, an important inaugural event was already underway. Biotech showcase The Cell, in partnership with NeuroPro, sought to showcase a variety of innovative healthcare technologies, and Neuropro showcased their EEG headset, NeuroTrail, which wirelessly monitors real-time EEG. Fifth Sense introduced Scentee, a smartphone attachable olfactory device that can be used to examine users’ sense of smell and indicate anosmia.

Delegates try the Hypnagogic Light at The Cell. Photography: Ellie Pinney

Delegates try the Hypnagogic Light at The Cell. Photography: Ellie Pinney

One of the most lively exhibits was serious games company Focus Active Learning, where delegates tried their hand at several board games including The Nutrition game and Infection Control Game. Among other companies in attendance were socially-minded software company uMotif; Imperial’s MSk Lab; the HELIX Centre, a collaboration between the Royal College of Arts and Imperial looking at design in healthcare; Light Eye Mind, who maintain the UK’s only publicly available Hypnagogic Light; and the revolutionary GoodSAM App for first responders.

The biotech showcase was only our morning activity, and Cell-goers went on to join other attendees as they selected their seats in the Hall. At 2pm, the lovely Dara Ó Briain, who kindly gave up his Easter Monday to host the event, took to the stage to welcome our four thousand strong audience to Imagining the Future of Medicine (ImagineMed)!

Welcome to ImagineMed! Photography: Alan Liu

Welcome to ImagineMed! Photography: Alan Liu

Dara, whose wife is a surgeon, is no stranger to being outnumbered by doctors at social gatherings; and, of course, many attendees were doctors (or medical students), but there was also a number of non-medical, even non-scientific, individuals with an intellectual curiosity, eager to hear about the future of healthcare from the people involved in shaping it.

The first session was called Thinking Outside the Box. Hollywood screenwriter Ira Steven Behr once noted, “…usually when we use that cliché, we think outside the box means a new thought. So we can situate ourselves back in the box, but in a somewhat better position”. Following on from this analysis, and in the spirit of ImagineMed, I like to think ‘outside the box’ represents human imagination. The speakers in this session have certainly all put their imagination to good use, and provided important new perspectives in their areas of expertise.

Francis on stage. Photography: Alan Liu

Francis talks about Looking and Seeing. Photography: Alan Liu

First up was cardiothoracic surgeon Francis Wells, who developed a new way to repair mitral valves after being inspired by the medical drawings of Leonardo da Vinci. Francis noted that in an age where everyone is risk averse, it sets the challenge of ‘how do you make new advances?’ He went on to outline three interconnected principles that have helped him overcome this challenge: 1) Ask the right questions. If we begin with the ‘why’, we can then begin to understand the ‘how’ and the ‘what’. 2) Looking and seeing. We are surrounded by visual data all the time, but turning looking into seeing and perceiving is really important.

“Drawing is a line around a think.” – Francis’ daughter

Francis, a keen artist, explained that drawing and thinking are intimately related, and went on to show some of da Vinci’s astonishingly accurate medical drawings. 3) Form and function in nature. All of us are formed by the forces acting upon us; those forces can be genetic, gravitational, osmotic, or emotional, but everything in nature is a diagram of the forces acting upon it. Francis described how in 1515, da Vinci determined the vortex mechanism by which heart valves close, and five hundred years later, a publication in Nature proved him right. Now with imaging technology, many other vortices have been discovered in the heart leading to a whole new way of looking at how the heart functions as it begins to fail.

Jamil talks about building a brain stethoscope. Photography: Alan Liu

Jamil talks about building a brain stethoscope. Photography: Alan Liu

Second speaker of the day was Jamil El-Imad, Chief Scientist at Swiss-based company NeuroPro. Jamil’s background is in software engineering, but his fascination with neuroscience began when his friend began doctoral research at Imperial College five years ago. He and his friend engaged in an extensive discussion one evening, and came up with their hypothesis: if a healthy brain is rhythmic, then an unhealthy brain must behave in a non-rhythmic fashion. They thought that if they attempted some pattern matching to brain signals, they might learn something new. This approach is very similar to using anti-virus software, which looks for any patterns corresponding to known viruses detected in the past. They wanted to build a brain stethoscope!

They decided to first target epilepsy, a disabling condition that affects 1% of the world’s population. When a seizure strikes, physical injuries result from people losing control and hurting themselves as they fall. Jamil and his friend imagined a portable device, or mobile technology, that can monitor the patient’s EEG readings in real time, and give a prediction or warning before a seizure strikes, allowing the patient to lie down comfortably and safely. Their concept for predicting seizures led to the construction of a headset that can be universally used, to building a mobile lab that can speed up research trials, and some amazing visualisation tools to assist diagnosis.

“Computing has become a utility like electricity and water… opening up a whole new space for us in pursuing opportunities in personalised healthcare.” – Jamil

In his post talk Q&A, Jamil noted that the headset technology can be used for a variety of functions – at the moment, they are using it monitoring coma patients.

Mark talks about Caring Outside the Box. Photography: Alan Liu

Mark talks about Caring Outside the Box. Photography: Alan Liu

Our third speaker of the day was consultant neurosurgeon and prehospital care specialist Mark Wilson. Mark used the stories of his Nan, and a man called Dan, to illustrate how different care is appropriate in different contexts. Nan, one sunny summer’s day, surrounded by family, had ‘keeled over’ in their back garden. Mark’s initial reaction to this situation wasn’t to start CPR. “I thought, wow, what a wonderful way to die,” said Mark, to many chuckles from the audience. Dan is a young man who wrapped his car around a tree a few years ago and suffered a brain injury. Patients like Dan might not look that unwell, but there’s a time-critical emergency going on in their head. Dan had a subdural hematoma (a blood clot on the outside of the brain pushing over the brain).

Mark explained that there is a constant loop between what you can find out from extreme physiology and critical care, and his advice to anyone hoping to find something new is to look off the beaten track. People have extreme physiology immediately following an accident, and it’s an area we don’t do much research on firstly, because we’re often not there; and secondly, when we do get there, it’s often dangerous, or it’s raining – it’s not conducive to research. But it’s an area where Mark believes we can make a massive difference. The best time to minimise secondary brain injury is in the first few minutes following an accident, but patients die because we’re not 100% at managing these secondary injuries. He believes if we can intervene at this early stage, outcomes would be much better.

“If you’re not dead when the emergency services arrive, you shouldn’t die.” – Mark

Nan's fine, she's over there! Photography: Alan Liu

Nan’s fine, she’s over there! Photography: Alan Liu

Fortunately, Dan made a good recovery, and was even sitting in the audience with his girlfriend; but at the ward round Mark did that morning, he had 10 patients very similar to Dan. Trauma is the commonest cause of death worldwide in under 45s, and brain injury is the commonest cause of that trauma. Dan went through a system of care: pre-hospital care, emergency care, intensive care, surgery, and then rehab. Mark believes that care is the most valuable thing doctors do, but it doesn’t appear on any tariff, and therefore, what makes good quality of care is difficult to define. Mark said he feels very privileged to be able to care for people with brain injury because is not like other types of injury – it can change a person profoundly, and he is very passionate about maintaining people as they are.

So what happened to Nan? Luckily, she had only fainted, and was also sitting in the audience.

Talented teenagers from Islington Community Theatre. Photography: Alan Liu

Talented teenagers from Islington Community Theatre. Photography: Alan Liu

Final speaker of the first session, Sarah-Jayne Blakemore, brought 25 teenagers with her to illustrate her interesting research on the teenage brain. But they weren’t just any teenagers; they were very talented members of Islington Community Theatre, who created a unique performance. Sarah-Jayne explained that during adolescence, we develop a very strong sense of self, especially social self. Research shows that teenagers feel worse than adults do after being ‘left out’, suggesting that adolescents are hypersensitive to social exclusion. This might also help to explain why some adolescents are more prone to taking risks, especially when they’re with their friends.

Brain-imaging studies have shown what happens in the brain when we think about other people are thinking and feeling – this is called mentalising. The social brain network is involved in this mentalising, and the social brain undergoes significant change during adolescence. When adults and adolescents do the same mentalising tasks, different brain regions are shown to be active. Sarah-Jayne said these findings show that the adolescent brain is not broken or dysfunctional, it is just activating differently.

 

That’s all for the first session.

Thanks to Cell Coordinator Zinah Sorefan for her information on the activities of The Cell.

Check back for #imaginemed Part 2!

Alex

Alexandra Abel is a graduate from Imperial College London and the Royal College of Music. She has a keen interest in both Global Health and Performing Arts. From September, she will be a medical student at Hull York Medical School.

Join her on twitter @alexandraabel

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NCDFREE Bootcamp for Global Health Advocacy, Melbourne

10320451_729359773753428_5023284381833903433_nA mid-week morsel from NCDFREE.

The wrap-up film from their recent Advocacy and Innovation Bootcamp. Bringing together 50 bright young minds from all disciplines the organisation had three outcomes in mind. The first, for the group to mingle, strike friendships and develop new link and maybe collaborations with other sectors. The second was to impart new skills in design and innovation thinking, leadership, public speaking and social entrepreneurship. Finally, NCDFREE wanted something from these bright young minds. NCDFREE sourced their next film and campaign ideas through a challenge-pitching competition.

A fun day for everyone, but enough talk, here’s an insight into the real deal…

 

Sandro_circle

Follow Sandro on Twitter.

 

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Interview: Global Health Film-Maker

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This week, we continue our PLOS TGH podcasting – as Melbourne-based Global Health enthusiast Lilli Morgan interviews film-maker Lali Houghton on location, as he films a short film for NCDFREE, GlobalRT and UICC in Lima, Peru.

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Wearable. Edible. Huggable. #WIREDHEALTH

This week we hand over to regular blogger Alex Abel – who recently returned from London’s WIRED Health.

Earlier this year, in a blog post for the World Economic Foundation, Jamie Ferguson said:

“The so-called revolution in digital health has been slow moving for many years, more like an undercurrent. But, lately it has become a tide, with all stakeholders fully invested and ready to catch the wave.”

We were certainly riding the face of that wave at London’s WIRED Health.

Main Stage talks took place in the comfortable Brunei Auditorium.

Main Stage talks took place in the comfortable Brunei Auditorium, hosted by editor David Rowan and science editor João Medeiros.

This inaugural event was held at the Royal College of General Practitioners on 29 April, and focused on innovation in the health sector.

Unsurprisingly, how we can collect, analyse, and benefit from our individual health data dominated discussion at both the Main Stage talks hosted by David Rowan, and the parallel Bupa Startup Stage where a range of companies gave 9-minute pitches to a panel of judges.

Sensors and self-monitoring

Maneesh’s wearable counts step, but also notifies him of tube delays. Image via @ManeeshJuneja

Maneesh’s wearable counts step, but also notifies him of tube delays. Image via @ManeeshJuneja

With the vast array of wearable sensors available (Amazon.com even launched a wearable tech store last month), we can now keep track of every waking (and sleeping) moment of our lives. My friend Jing noted that there seemed to be so many health-tracking devices that he couldn’t quite see the need for all of them. How many, and what kinds of tools, do we really need? But Sonny Vu, founder of Misfit Wearables, more than adequately addressed this common question with a nice analogy:

“I’ve heard people say, oh wearables, that’s a really crowded space. No. That’s like saying in 1997 that the Internet is really crowded because there’s a lot of websites.”

Aside from keeping check on general health, sensors have huge potential to aid the management of chronic disease as people with chronic conditions are already self-managing 8700 hours a year, and only 3 hours a year with their clinician. Andrew Thompson explained that when a patient swallows a Proteus pill, it connects and communicates with their mobile phone, letting them know if they are responding properly to the medication. The sensor in this smart pill is made of silicon, copper, and magnesium – designed to be cheaply and easily embedded into any product. Andrew hopes that ‘digital pills’ will enable patients and doctors to better monitor and treat chronic conditions without the need for endless physical checkups.

From management of complex chronic disease to prediction… Jack Kreindler of the CHHP has been using expensive biosensor technology for a very long time, helping David Walliams swim the length of the Thames recently, but he explained that self-tracking devices used by elite athletes can now be used to predict major health problems, reducing unnecessary hospital admissions.

Jing and I meet Teddy the Guardian, a huggable sensor for children.

Jing and I meet Teddy the Guardian, a huggable sensor for children.

A particular favourite of mine from the Startup Stage was Teddy the Guardian. Certainly the cuddliest sensor tech around, Teddy can measure a child’s temperature, heart rate, and oxygen levels through his ‘smart paws’ in about six seconds. When Teddy’s owner checks their pulse, the bear’s LED heart beats at the same rate, a soothing effect intended to create a bond between child and bear. Teddy data is transmitted in real-time to a mobile app where data is analysed, managed, and downloaded by medical staff and parents.

Apps, wearables, and even edibles empower people to manage their own health and wellness, but we need to aid and guide the take up and use of these devices. As Sir Mark Walport explained, “Science without the social science will not reach its maximum”. The main message of the day can be nicely summed up by the content of one slide, which read: Sensor technology + big data + expert support = success. The challenge becomes how we can best harness our data for personal and global health purposes, and how to secure this expert support when and where it is required.

“We want indiscriminate, continuous, multi-sourced data streams to really realise the global health impact and great potential of digital health.” – Leslie Saxon

And the winner is…

Startup Stage winner was Peter Hames for his novel insomnia-fighting CBT app Sleepio. Their placebo-controlled RCT was published in Sleep in 2012, showing Sleepio users had improved sleep efficiency compared with the online placebo course, and those who continued with usual treatment for insomnia.

Fun fact of the day

Catherine Mohr (Intuitive Surgical) on stage. The dog's nose is a key talking point.

Catherine Mohr (Intuitive Surgical) on stage. The dog’s nose is a key talking point.

A dog’s nose is an amazing diagnostic tool. Dogs can detect ovarian cancer with 90% accuracy. Billy Boyle, Co-founder of the exciting Owlstone Nanotech, told us how this keen chemical analysis has led to their creation of diagnostic sensors that can ‘sniff out’ a range of cancers.

Sharp statistics

One in three couples that have IVF could conceive naturally (Claire Hooper, DuoFertility).

Someone in the world develops Alzheimer’s disease every 6 seconds (Elli Kaplan, Neurotrack Technologies).

Most inspiring statement

“Never under-estimate your ability to make a difference.” – Elli Kaplan

Visit #WIREDHEALTH in 2015

WIRED Health's partner Cisco showcase their Internet of Everything #TOMORROWstartshere

WIRED Health’s partner Cisco showcase their Internet of Everything.

There were twenty-two incredible talks in one day, but every speaker captivated me and made me want to learn more about their work.

After a thoroughly enjoyable day at the RCGP, I was inspired to walk the five miles home, monitoring my heart rate the old fashioned way because I’m a bit short on wearables.

The talks are now available to watch via the WIRED UK YouTube Channel.

WIRED Health will be returning to London next year, and I’d highly recommend it to anyone.

Many thanks to João Medeiros for inviting me, and curating such a wonderful programme. Congratulations to the entire organising team, and best of luck for 2015!

 

Alexandra Abel is a graduate from Imperial College London and the Royal College of Music. She has a keen interest in both Global Health and Performing Arts. From September, she will be a medical student at Hull York Medical School.

Join her on twitter @alexandraabel

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Supporting population-based approaches to preventing NCDs

For our latest post, we go to Oxford, UK with regular blogger Dr Kremlin Wickramasinghe who explains some exciting news in research on Global Health and NCDs.

This week, the British Heart Foundation Centre on Population Approaches for Non-Communicable Disease (NCD) Prevention in the Nuffield Department of Population Health, University of Oxford was officially designated as the WHO Collaborating Centre on Population Approaches for NCD Prevention.

Dr Shanthi Mendis, Senior Advisor, NCDs, World Health Organization Head Quarters, explained how this new collaborating centre would contribute to the Global action plan for the prevention and control of NCDs 2013-2020, which set a global target of reducing the premature mortality from NCDs by 25% by 2025. She indicated that the new centre will mainly contribute to the following two objectives of the Action Plan:

  • To reduce exposure to modifiable risk factors for NCDs through creation of health-promoting environments
  • To promote and support national capacity for high quality research and development for prevention and control of NCDs

She said that an interesting question to ask  is why  we need another collaborating centre in a developed country when we see more than 80% of NCD deaths occurring in low and middle income countries (LMICs)? In her answer she pointed out that we have large research and evidence gaps to support the implementation of the most cost effective interventions in high income countries and well as in LMICs and that collaboration with this new centre would enable the sharing of experience and the strengthening of the WHO’s response to the growing problem of NCDs.

Forum at the WHO CC launch. Photo:Prachi Bhatnagar

Forum at the WHO CC launch. Photo:Prachi Bhatnagar

Dr Gauden Galea, Director, Division of NCDs and Life Course in the WHO European office discussed current population based approaches in Europe. Although 50 countries in the region have ratified the WHO Framework Convention on Tobacco Control, the majority of those countries have struggled to implement important population based interventions fully. Only two countries have successfully introduced pictorial warning on cigarette packages and only three countries have completely banned advertising, promotions and sponsorships.  He demonstrated that similarly, in tackling alcohol and unhealthy diets, countries have shown a higher level of adoption of policies that raise public awareness or that provide information but smaller numbers of countries have implemented interventions such as taxes and other measures to affect food prices and the re-formulation of food products to reduce unhealthy nutrients. He demonstrated how the new centre would continue to work with the WHO on areas such as nutrient profiling, fiscal interventions, marketing of unhealthy food and the use of new data sources for NCD prevention.

Mr Simon Gillespie, Chief Executive, British Heart Foundation (BHF) welcomed this recognition for a research group they have funded for more than 20 years. As the leading funding body for cardiovascular disease research in the UK, he mentioned that the BHF would continue to support cardiovascular disease prevention research to make a greater impact nationally and internationally.

Dr Mike Rayner Director of the new collaborating centre emphasised the importance of population based NCD prevention approaches to create healthy societies rather than just healthy individuals. He argued that the aim of a population based approach should be to shift the distribution of risk factors for NCDs in the population rather than those at greatest risk and to focus on more the distal risk causes of  NCDs such as the price of goods and services. He concluded by saying that a population approach is complementary to an individual/high risk approach but that population based approaches have been neglected.

Picture, left to right: Dr Gauden Galea, Dr Shanthi Mendis, Dr Mike Rayner, Professor Rory Collins, Mr Simon Gillespie.

Picture, left to right: Dr Gauden Galea, Dr Shanthi Mendis, Dr Mike Rayner, Professor Rory Collins, Mr Simon Gillespie. Photo:Andrew Trehearne

This workshop also highlighted wider trends that NCD prevention community should focus on such as global warming, resource depletion and  rising food prices. It was mentioned that the post 2015 development agenda discussions should be used as an opportunity to link NCD prevention with the sustainability agenda. New areas such as the use of social media data and supermarket data for surveillance and prevention of NCDs were also mentioned by speakers during the panel discussion.

When a question was raised about the advice for the next generation it was mentioned that one important role would be to identify research gaps in areas where countries are struggling to implement cost effective interventions and try to improve our understanding on how to implement them. This would require stronger collaboration within and outside the population health disciplines such as economics, anthropology and politics.

The new collaborating centre will be working with the WHO, the BHF and other partners in capacity building by organising workshops and short courses, contributing to WHO’s work in the development of guidelines/manuals on population level NCD prevention, assisting WHO to develop methods for evaluating NCD prevention programmes and providing WHO with statistical analysis and systematic reviews related to population level NCD prevention.

This launch brought NCD prevention experts from leading academic research groups, the World Health Organization and a major non-governmental organisation concerned with NCDs  (the British Heart Foundation) to a single forum. Discussions ranged from generating evidence, using that evidence to developing guidelines, providing technical support to countries, funding actionable research and advocacy by these different organizations. It was evident that bringing these different organizations to the same forum allowed us to understand how these different roles would contribute to unpack the complexity around determinants of NCDs and the importance of working in collaboration, to develop sustainable solutions.

Connect with Kremlin on Twitter via @KremlinKW

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