As I began writing this column, the TEDMED conference—my inspiration for it—was ongoing in Washington, D.C. I wasn't there. I was in Boston, writing in the lobby of the Westin hotel, watching police patrol the pavilion between the hotel and the Boston Convention Center, where I was scheduled to give a talk, and which, like the rest of Boston, was on lockdown. My session wound up being canceled. Sometimes, a good idea just doesn't work out as hoped.
I suppose if the powers that be thought I had ideas worth sharing, I might have been at TEDMED. But since I didn't make that cut, I will instead share some ideas about the Ideas shared at TEDMED this year, and about the sharing of ideas in general.
I love good ideas, and consequently, I generally love TED talks. I have watched many TED videos over the years, and found real inspiration in quite a few. But on the other hand, I have some real concerns about what happens when we just keep sharing new ideas, instead of putting old ones to work.
Admittedly, I have not seen all of the TEDMED 2013 presentations; that would require days of dedicated attention. I have only managed to look through the presentations selectively. But my ideas about ideas are couched accordingly and don't pretend a more intimate knowledge than I have.
This year's TEDMED conference featured 20 "great challenges." Following a standard script, and with limited improvisation, the moderator for each "great challenge" session identified his or her content area as one of "the most complex problems in health and medicine."
But just because that's in the script doesn't make it true. Consider, for example, that "promoting active lifestyles" is on the list. Are you really willing to concede that this is one of the most "complex" challenges between us and wellness? Basically, we are talking here about things like walking, taking the stairs and fitting in recess.
For a society that has sent people to the moon, and fits computers that can read beams bouncing off satellites into our pockets—do we truly want to catalog "figuring out how to walk more" as one of the great complexities of our time?
There's nothing at all complex about it. Rather, something can be simple—and still not be easy. Lifting a big rock is a good example. It's not complex; it's just hard. We don't need a whole new batch of innovative ideas to do it—but we do need to bend our back (or, more ergonomically, our knees).
I suppose if by "promoting" active lifestyles, the intended meaning is a whole array of societal changes based in policy, there is a case to be made for complexity. But this is a bit like turning the effort to move a rock into policies about rock moving, requiring the work of innumerable committees. You might just go ahead and move the rock!
So, for instance, my colleagues and I have long offered a free physical activity program for schools, of proven benefit, that can allow for 30 minutes of daily exercise at no cost and with no reduction in teaching time. Honestly, it's not complex.
We have a comparable program for adults in the workplace—and it's not complex, either. And of course, my shop is by no means the only one offering such programs. Simpler still, and requiring no program at all, would be a daily walk or some comparable exertion. Far from complex, that's just a matter of converting an idea we know is important into a personal, and perhaps cultural, priority.
Admittedly, that is just one consideration among the many shaping our wellness or lack thereof, and just one small area of content within the domain of ideas addressed at TEDMED. But it does serve to illustrate an important principle: something can be hard without being complex. Fitting in some exercise every day may be hard—but involves no rocket science.
The "obesity crisis" is on the list of great complexities, but here, too, that perspective is suspect. We eat way too much highly processed junk and get less and less exercise. Admittedly, eating well in a world of willfully addictive junk food may be hard—but it's not really complex. Getting more exercise is simpler still. I have similar inclinations about other great challenges, from whole patient care to the primacy of prevention.
My other general concern about the themes is that they seem to propagate our tendency toward reductionism. Why, for instance, is childhood obesity on the list separately from "the obesity crisis"? If the only way to fix either of these is to fix them both together, then carving up one problem into two may be a problem in its own right. In my opinion, it is exactly that—and one that forestalls progress.
I have academic colleagues whose appetite for data seems all but insatiable. Mine is not. If my foot were to catch on fire, I would not need a randomized clinical trial to fetch a pail of water. We do a disservice to ourselves, our children and the capacity to advance the human condition by routinely conflating "hard" with "complex." A job can be hard instead of easy, yet still be simple—not complex.
Among my many correspondents are some who routinely seek my advice about the next great diet, health or fitness book they should read. But let's be blunt: What is the likelihood that the 11th, or 23rd or 62nd legitimate (I have no interest in the illegitimate ones!) health and wellness book will provide an epiphany about eating well or exercising that the first 10, 22 or 61 did not? In fact, the more books you read on wellness, the less likely it becomes that the next will say much of anything you don't already know. So my advice is: Read less, walk more.
There is nothing truly complicated about not smoking; eating a wholesome diet made up of foods close to nature, mostly plants; and getting a salutary dose of exercise every day. Hard, perhaps, but complicated? Not so much.
And we have known for literally decades that these three behaviors—better use of feet, forks and fingers—would suffice to eliminate 80 percent of all chronic disease. In other words, nothing complex and no truly innovative ideas are required to achieve arguably the single greatest advance in the history of public health.
I love good ideas— and, in general, TED talks. Everybody loves TED talks. There is both potential real-world benefit and the chance for the thrill of revelation when ideas worth sharing are shared. But, just as a huge bazaar or retail mega-store can induce 'choice paralysis,' perhaps the same is true with all of these ideas. Maybe an emphasis on more ideas, as opposed to doing more with those we already have, is part of what takes us from "just get off your rear end" to active lifestyle showing up on a list of great complexities.
TEDMED is a great event and does indeed collate great ideas addressing important themes. But my idea worth sharing is that maybe we've shared enough ideas, and now we just need to carry the rock. Maybe there is a point at which the institutionalization of sharing ideas becomes a highly intellectualized form of procrastination.
If nothing else, I guess we now have an idea about why I wasn't invited to TEDMED!
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David L. Katz, MD, MPH, FACPM, FACP, is a specialist in internal medicine and preventive medicine, with particular expertise in nutrition, weight management, and chronic-disease prevention. He is the founding director of Yale University's Prevention Research Center, and principal inventor of the NuVal nutrition guidance system. Katz was named editor-in-chief of Childhood Obesity in 2011, and is president-elect of the American College of Lifestyle Medicine.