Mr. Walker Takes TEDMED to Washington

Common sense suggests that alluding to the naive politician played by Jimmy Stewart in Mr. Smith Goes to Washington to describe a decision by the founder of Priceline, billionaire Jay Walker, is awfully wrong-headed.

Yet there is blunt idealism in the 46-year-old Walker's language about re-positioning the social-intellectual-scientific-policy-business venture called TEDMED to the nation's capital. The movie in which Walker is directing and acting -- "curating" is his preferred term -- is shaping up as a contradictory mix of money and mission.

At Walker's first opportunity after purchasing TEDMED with a group of business associates, he wrenched the event out of its quiet, autumnal, community-fostering nest in San Diego's beachside Hotel del Coronado. With the incisiveness of the medical sub-specialists whose technological innovations TEDMED often celebrates, Walker cut the community from its mooring and transplanted it in both time and space to springtime at the Kennedy Center in Washington, D.C.

It's clear that the TEDMED Walker purchased was always meant for a larger stage.

On April 10-13, 2012, some 1500 attendees -- Walker frames them as "delegates" -- will gather for the first TEDMED driven by his vision. He explains: "In the world of health and medicine, all roads go through Washington. You don't have a choice if you want to create a discussion of the future of health and medicine, not just health care." Walker's success metric for this year's event is to "stimulate a national conversation at a much larger level than ever with TEDMED."

I reached Walker for a brief interview. He reflected on the Hotel del Coronado venue: "It's nice to have that view of the Pacific. But we'll have the Potomac right there."

The TEDMED gathering will not be without its allure for typical Beltway players. The roughly $5000 entrance fee for non-scholarship participants will be an inexpensive price to purchase access for some. On the program, and likely milling around with the other participants for a time at least, are the director of the National Institutes of Health, the executive officer of the Institute of Medicine, the Chief Technology Officer for the United States, and the director of the Center for Disease Control and Prevention.

When we spoke in January, I asked Walker how many federal officials would be invited to speak. He replied that he was "more interested in having them in the audience than on the stage." He called policy makers "an audience that matters."

But an audience for what?

The answer on Walker's TEDMED website evokes the naivete that Jimmy Stewart portrayed so well: "TEDMED has no agenda and no policy prescriptions. Instead, we seek to serve the nation -- and the world -- by creating a safe place where people with very different ideas can come together to talk, to learn and to celebrate the amazing world we live in." The gathering is of "a community of people who are passionate about imagining the future of health and medicine." The portrait is democratic. All of the delegates will vote to identify the top 10 Great Challenges Walker promises will shape the TEDMED program in the ensuing year.

TEDMED may have no agenda. But Walker has some surprisingly strong views relative to medicine's shortcomings and its optimal future. I'd met him through my work in the whole health-focused field of integrative health care. A colleague who is a philanthropist in integrative medicine had covered my entrance fee to attend TEDMED 2011. Walker also curated though he hand't been responsible for the line-up. In 2009 and 2010, two or more of the reigning dieties of integrative medicine -- Dean Ornish, Andy Weil, Mehmet Oz, Deepak Chopra and Mark Hyman -- had represented some version of the integrative medicine form of innovation. Though the field was unrepresented in 2011, Walker had shared in an electronic note his view that "integrative medicine is very important for the future."

Walker picked up the theme in the interview: "Health care doesn't exist in the U.S. Sick care exists. In our Orwellian way we've named it health care. There is no system for health care." He paused: "Much of what we want is trending horribly." He spoke of how it is "absolutely essential to have a broadly inclusive, multi-disciplinary understanding of health and medicine." (At the time I spoke with him, no speaker associated with integrative medicine had been announced. Author and functional medicine leader Hyman is back as a presenter.)

I reminded Walker that I'd urged him and his colleagues to consider that the greatest challenge in U.S. medicine and health is that our capitalist system fattens up on disease. What we need instead is a thriving industry of health creation.

Walker responded: "It's in our Great Challenges. How do we make providing health care more profitable than disease care?" The theme is listed as #3, "Making Prevention Popular, and Profitable." The description is: "America spends $2 trillion a year on healthcare -- mostly treating people after they become sick. How can we unlock prevention as a trillion-dollar business in America so we spend less on 'sick care' and get Americans to 'buy' healthy lifestyles?"

Great question -- the great ethical question for capitalist medicine. The words are music to the ears of anyone who believes that the path to meaningful reform is actually a transformation toward a health-focused system. A potent incentive structure would need to support it.

But here is where the cognitive dissonance of TEDMED's "no-agenda" screeches at high enough decibels to make a dog howl.

TEDMED's major sponsors include Siemans, Phillips, Mars, Booz Allen, General Electric and Xerox, plus Cleveland Clinic and the Robert Wood Johnson Foundation. All but one is invested deeply in the high tech methods of the disease care system. The TEDMED Board of Advisers tilts heavily toward innovation of the high tech sort. No sign of integrative health there. For these, Great Challenge #1 reads like a tax-cutting, anti-regulation, lobbying agenda for this industry: "Achieving More Medical Innovation More Affordably."

Now there is a potentially multi-billion dollar reason to bring TEDMED to Washington.

TEDMED 2012's other major sponsor, Mars, is invested in the Snickers-M&Ms vector of disease associated with many of the nation's worst and most costly conditions -- including Great Challenge #2, "Coming to Terms with the Obesity Crisis." Such chronic ills keep the other sponsors busy.

Meantime, outside this very public, national dialogue are many who are also "passionate about imagining the future of health and medicine" but simply can't pay the poll tax to participate in TEDMED's brand of democracy. Most everyone associated with the innovations in high-touch, low-tech, whole person, patient-centered integrative care would be in this camp.

TEDPMED -- Technology, Entertainment, Design & Policy -- is an unwieldy and awkward acronym. I am sure the mix of elements will prove a fascinating, stimulating and pleasureful event. But by bringing this sponsored, exclusive dialogue out of its parlor at the Hotel del Coronado onto the still very troubled national health policy stage of the Kennedy Center at Washington, D.C., Mr. Walker has opened some unwieldy and awkward questions.