Watch the video of Rachel McKendry’s talk at TEDxExeter 2015.
Scroll down the page for the Live blogs of the talks.
Videos about Health
Live blogs about Health
Rachel wants us to take out our mobile phones and hold them up. Virtually everyone in the room has a phone, each of which has more power than the computers which helped to put a man on the moon. And they can help provide an early warning system for viruses.
Viruses and other infectious diseases are some of the main threats to our increasingly interconnected world. Ebola highlights the threat, and the importance of public health. Doctors protect individuals. Public health protects populations. The reality is that most countries have little public health provision, so Ebola went undetected for 3 months, until it was ready to explode.
The flu pandemic in 1918-20 killed more people than World War I. Pandemic influenza is at the top of the UK government risk register, and it’s not ‘if’ but ‘when’. It’s not just a question of health, but the economy and provision of essential services. Also, antimicrobial resistance is growing, which the Chief Medical Officer describes as a ticking timebomb.
If someone is infected, there is an incubation period before symptoms arise, during which there is a risk of passing it on. There are more delays before diagnosis and intervention, which has a serious effect on PH efforts to prevent the virus spreading. So we need to pick up infections at the onset of symptoms.
Rachel’s team, across many disciplines and organisations, is using reporting of symptoms on the web to form early warning systems. There are 7bn mobile subscriptions in the world. Mobiles are the most sophisticated technology in remote villages in developing countries. The first report of SARS in China was by the public.
Many of us use our mobiles to search the web about our health. Google Flu Trends, based on anonymised searches, provides information 2 weeks ahead of official sources. Tweets also provide lots of information about symptoms. Together, they are being used to create a nowcasting service.
But symptoms don’t imply the same diagnoses, so the team is also bringing diagnostic technology to the people. It uses self-swabbing kits, which are posted back to labs. And phone sensors are now being used to do the diagnosis on the ground. Further, the team has produced bio-barcodes, readable by phone cameras, which can diagnose e.g. HIV. This is all linked to the provision of interventions.
Mobile technology was used in the fight against Ebola – text alerts, communication of test results, etc. It’s still early days, though. The challenge is to develop a means of detecting Ebola and the like 3 months earlier. And the public and public education are the main tools. Together we can fight infectious diseases.
Joel got into robots because he thought they were cool. His first robot was Clean3PO, which stumbled around his parents’ kitchen.
His favourite robots are those that are inspired by nature, which to many people are creepy. [I’m not going to look up at the video of an 8-legged overly-realistic robot.]
The most natural movement is in the human hand. Each hand has 29 bones, 34 muscles and 123 ligaments. Is it possible to replicate this robotically without necessarily replicating all these intricacies?
Joel built his first effort from stuff he found around the home, but he still managed to get some realistic movement.
When he studied robotics at university, he found that the options for amputees needing a prosthetic was limited, in terms of cost and functionality. He realised that what he was doing could change people’s lives. He wanted to get the latest technology to amputees at an affordable price.
His next hand was sheet aluminium, and chopped up rubber gloves for a nice touch. This attracted a lot of interest, so he made the design open source.
After a stint at an engineering company, he returned to the project and investigated the potential of 3D printing. He quit his job, bought a 3D printer, and moved back in with his parents(!) He could see the potential of 3D printing for both cheap and tailored production. His design uses free software all the way. His latest model can cope with being knocked about, and has smooth and natural movement. The video looks great, but the model he has on stage only has 2 working fingers. The leading prosthetic costs $18K. He plans to sell his for only $1K. For growing children, he can reprint only the parts that need to be replaced over time. Kids’ hands can be customised to look cool instead of awkward.
Joel has found his only limitation has been in his ambition. The next time you use your hands to do something, taken a moment to think about the complex intricacies. Technology has the power to mimic this freedom, and it doesn’t have to cost the earth.
Here’s a Vine of “Dextrus hand closing and opening. Except for the pinky finger!” If you can’t view the embedded film, it’s available here.
Now, after a delicious locally-sourced (where possible) lunch, we are back for the first afternoon session, on the subject of health.
Allyson Pollock is a professor and writer on the privatisation of the NHS. She’s going back to the beginning, of the formation of the NHS in 1948. There were two main controversies: that it was unaffordable and that people would abuse it. Neither came to pass. Beveridge designed the NHS to combat the 5 Giant Evils of ignorance, idleness, disease, want and squalor. The key to the welfare state as a whole was redistribution, and that was fundamental to the NHS.
The architects also wanted to keep private interests out. There were few private interests back then… only the doctors voted no, but were fought off. Now they are the NHS’ staunchest supporters, and many protested outside parliament when the Health and Social Care Act 2012 was passed in the Commons.
She has brought along copies of both acts. The 1948 Act is a slim pamphlet. The new Act is a weighty tome.
The new Act will remove the duty of the Secretary of State for Health to provide health care for all. That takes two pages; the other hundreds of pages regulate the new market, to determine who will get care and how it will be provided.
Risk selection is the basis of a market – how it is identified, priced, allocated and transferred. All this results in fragmentation, not integration. This is the main thing to remember from her talk.
Structures absolutely matter, as an engineer will tell you, and they follow functions, such as the duty to provide healthcare.
In the old system, the unit was the region. Everyone in the region was covered. In the new market, the unit is the insurance fund. Not everyone is covered, because not everyone can afford to pay.
The nationalised NHS was simple, and it was easy to see who was in charge. Powers were delegated vertically. Areas were contiguous, so no-one fell through the gaps. The new NHS is a rats nest of bureaucracy – commissioning groups (CCGs) and regulatory bodies. It’s difficult to see who is in charge, and CCG structures are no longer area-based but insurance-based. Groups who can’t get access to GPs – such as asylum seekers or homeless people – will be excluded. Older people are at risk of being excluded by entrepreneurial GPs or if they have chronic conditions for which care is no longer funded.
Services are being broken up across the country and put out to tender to commercial companies. There is a complete loss of planning on the basis of need. It’s about choice, but it’s not for patients to choose but to be chosen. The new commercial providers have the power to decide who gets access to care. The NHS is now just a logo providing money – £112bn per year – surrounded by companies like RBS, Virgin, PWC, Circle, Netcare. Many companies have no background in providing health care at all, others are based outside the UK.
Markets cost more, and the cost of health care as a % of GDP has increased dramatically. The US is an exemplar of inefficient market-based healthcare. Inefficiencies include billing, admin, profit, so only 60% is left for providing care and medicines. In the old NHS, only 6% went on admin etc. Then there’s also the waste of providing treatments that are not needed, missed prevention of illness, inflated prices of care and medicine.
What do we need to do? It’s our NHS. We can support David Owen’s NHS Reinstatement bill. Campaign to give the Secretary of State back the duty of providing health care for all. Campaign against hospital closures. Aneurin Bevan said the NHS will be there as long as there are folks left to fight for it. It’s our fight now.
Declan will tell us another hopeful story.
TED stands for Technology, Entertainment, Design. Goodbye Entertainment, hello Systems Medicine. He is focusing on intensive care medicine. The challenge is to save more lives, and reduce the very high treatment costs.
As an engineer, he usually thinks of design in terms of technology, but it can also be thought about in terms of systems. A system is a group of interacting, interrelated or interdependent elements working together, whether an aeroplane or a airport.
There are many trade-offs in designing technological systems, and the objective is to find the ‘sweet spot’. But complexity can defeat the possibility. We need a clear understanding of how elements interact, and computer-aided design as a tool.
Another definition of a system is a group of body organs, e.g. the digestive system. In medicine, there are many trade-offs, such as between disease eradication and side effects.
For example, mechanical ventilation involves a trade-off between necessary gas exchange and avoiding lung injury. The lung is a very complex system, and in patients with lung diseases the functioning of the millions of alveoli becomes even more variable. So Declan and his collaborators are developing computer models to simulate the effects of different ventilation strategies in different patients, and CAD tools to find the sweet spot.
They are still only scratching the surface of the potential. Using computer models could: reduce the use of animals in medical research; steer clinical trials to make them quicker and more efficient; provide more personalised treatment; lower mortality rates.
Systems Biology research at the University of Exeter
Anaesthesia and Intensive Care research at the University of Nottingham
We’re all on the same journeys. Hazel will be 101 in 2050!
And she has ditched her script. This is Hazel unplugged!
Why are we in the UK so bad at preventing the poor health of the poor? Why have billions of £££ of investment in poor communities not made a jot of difference?
Hazel will tell us about what makes a difference – not about £££, but about connecting and listening.
She was a community midwife in Lewisham, and saw all the health inequalities between the bottom and top of the hill. When she moved to Cornwall, she saw some of the worst child-protection challenges ever. Cornwall is the poorest county in the country. She saw all sorts of young people born into poverty.
In the 1990s, the Beacon estate in Falmouth was the poorest ward in the poorest county. As a nurse she had to have police protection there. But she saw a complete rebirth. Hazel and another health visitor couldn’t cope with illness and depression, and knew something had to change. Police and other authorities had abandoned the communities, so they all had to be reconnected. The residents had to lead, and the agencies were invited to join. Three did – police, local authority and education. Five residents were the leaders, the ‘famous five’. They were connected, and over four years magic started to happen. While the residents and agencies were meeting, the community started to come together, and managed to raise £2.2m money in various ways. (Pig racing was nothing to do with the police!) As a result, Hazel and other community visitors could do their jobs again. There was a 50% drop in crime and a 70% drop in unemployment. Boys education retainment went up 100% because post-natal depression was brought down. Asthma was down 50%. Gardens were transformed. People started to feel good about themselves: “We thought we were doing up our houses, but we were doing up our lives.”
This is the power of listening in connecting communities. The community will tell you what they need to heal. For example, the TR14ers in Camborne said they wanted to dance, and the power of dance to heal Camborne was extraordinary. Never ever give up. Do something small, but something wonderful will happen.
Fab talk, loads of laughter, another standing ovation, cheers.
Connecting Communities C2 Programme within the Health Complexity Group at the University of Exeter
Harry Burns, Chief Medical Officer in Scotland, on “Linking mental health indicators to promoting mental health in early life”