A conversation with Thomas Goetz: When it comes to healthcare data, it’s all how you look at it

Thomas Goetz is co-founder of IODINE, a new company that uses data information design to inform patient decisions.  He’s been a TEDMED speaker, executive editor of Wired, and wrote “The Decision Tree,” about using technology to help make health decisions.

You’re now Entrepreneur-in-Residence for the Robert Wood Johnson Foundation, working on two projects to improve the patient experience. Can you first talk about Visualizing Health?

We’ve created a library of validated health visualizations. When people talk about communicating health information to individuals, there’s a dearth of validated examples of what the information should look like.  For example, if you’re trying to communicate heart risk information – if you quit smoking, your risk will of cancer will go down from 50% to 30%  — what does that look like in actual practice?

Thomas Goetz

Thomas Goetz

There are the Edward Tufte’s of the world who have an expert [design] sense.  But we wanted to actually validate, though statistical surveys and other testing instruments, what works best for different groups.  We tested pie, bar and spread charts and different visualizations on various audiences and now have a library. We’ll be putting it online, hopefully by early February, for people to use as a reference point under a creative commons license.  Our hope is that these will become templates that people can inspire and adopt in their own patient communications efforts, whether they are commercial or non-profit.

 

It seems that over the course of human history we’ve been all too willing to give over responsibility for our health, letting the apothecary leach blood or trusting that the medicine man’s dance will cure us. What accounts for this new era of patient engagement?

In many ways it’s a continuum from the 1950s or ‘60s.  We’re now in a place where we can implement things more deliberately. One of my favorite surveys to reference is a 1961 survey that asked oncologists how many of them would tell their patients that they had cancer. And 90 percent of said they would not disclose the diagnosis; that their patients were probably not ready to know. Of course, that seems completely unethical now.

The gradual change in terms of doctors learning to include their patients in diagnosis and care is forced not just by a sense of ethical duty, but also by system structures such as the burden of cost of chronic disease care.  A patient with chronic [illness] may be obligated to do a lot of care on his or her behalf when they can’t have help 24/7.  All of these things are coming to a head, and we’re realizing it’s not just a matter of good practice but one of simply executing what we need to do.  The patient has to be part of the system.

Another of your projects with RWJF is Flip the Clinic, which talks about how to rethink a typically brief doctor’s visit to make it more productive and meaningful.

We’ve been trying to come up with some tools to put in the ecosystem that people can adopt or give feedback on, including ones we’ve gestated internally but also deconstructing things out there that have worked.  We haven’t invented the idea of improving the doctor-patient encounter, but we’ve been amazed to see Flip the Clinic resonate already as a sort of GitHub – the open software collaborating site — around the practice of clinical medicine.  The idea is to help people not reinvent the wheel and [adapt what’s available] to their own needs.

When it debuts, fliptheclinic.org will have two main areas: A hub for content – actual tools and strategies people can bring into their own institutions – and secondly will have a community component where people can exchange what they’ve learned, offer new ideas, connecting, say, people from Seattle to New Jersey and helping them understand what has worked in one place that may help solve a similar quandary in a different city.

What qualifies as real change?

It’s a balancing act – we want to have real innovation but we need to  offer tools that don’t just appeal to the converted; they need to work far and wide.

Late last month, I had a morning where first I talked to a nurse practitioner at a pediatric clinic in Camden, New Jersey, which is in an underserved community.  They’ve having their clinic budget hatcheted every quarter.  Physicians are frustrated.  This is a facility in true need of new approaches and something that re-orients them toward a positive engagement with their population. I went from that call to one with the Mayo Clinic; they were interested in how they might be able to participate. These are institutions on the opposite end of the spectrum, and one of our core objectives is for Flip the Clinic to work in both places.

In initial discussions, it turned out that both providers and patients wanted more control over clinic visits.  What else do they want?

We also earned there was a mutual yearning for some joy and positive emotional experience out of that encounter from both sides, and especially from the physician.  So one of the things we’ve been trying to be careful about is trying to stuff more into this already limited resource of a 15-minute doctor visit.  For everything we add to that visit, we need to take something off their plate. The challenge is to make these things pragmatic and executable in reality and not just say, “Do more.”

Goetz moderated a Great Challenges Google+ Hangout last week about rethinking the clinical visit to maximize value for both providers and patients.  Watch the recap, below.

TEDMED Great Challenges: Meaningful Minutes: Reinventing the Clinical Visit

 

Regarding your new venture, Iodine, which uses data design to help inform patient decisions: Is good design late to the game with healthcare?  Or it is on the same trajectory as other industries?

I think design is an underexploited tool in healthcare, though it’s ahead of the curve in some ways. Health care and medicine are already based upon a data paradigm; there’s a lot of information flowing through the system. But best practices in design thinking are not well applied, and they’re not oriented towards the patient.  Our goal is to leverage data, to translate it and visualize it, so that ordinary people can act on it and make better decisions about their medications. That’s not an easy problem.

It’s a hard thing to get people out of their routine, especially in a demanding world like healthcare. But that doesn’t mean it’s impossible – and design is essential to that. That’s where the inherent data orientation of healthcare offers some low hanging fruit.  Iodine’s core tenets are data-slash-analytics, behavioral science, and design.  They’re the three legs of the stool for visualizing and presenting information in ways that increase the likelihood that any individual will act to do something better for their health. [Ed. note:  Iodine will formally launch in February.]

While you were at Wired you ran a great piece showing how design could help patients understand their test results. How come doctors haven’t already demanded better design for their own information? It must be hard looking at that gobbledygook all day. 

Unfortunately, this brings us to the horrible world of EHRs. The prevailing industry products are really crappy in this regard; they come from an enterprise software perspective that’s 10 or 20 years old. A physician is almost always not making decisions on technology procurement. Unfortunately, sometime it doesn’t matter what your frontline needs are compared to the cost determinations of your IT department.

The cool thing is that there is another set of savvy tools going straight to the physician that are lightweight and easy to adopt.  There are some companies like Practice Fusion and Pingmd doing innovative things with communications or messaging component. And other companies are working on visualizing lab data, like WellnessFX. That’s a much more interesting strategy and more fun to watch. Sometimes developers use the iPad strategy — taking what physicians are already using and making that your platform, rather than the institutional computer system.

One can’t imagine the current generation of medical students going into the clinic and being satisfied with old-school data design.

That’s precisely where one of these pressures is going to come. The current generation of physicians is being dragged along into the EHR world.  The next generation is going to lead the way, I think. They’re going to demand better tools, both for themselves and for their patients. That’s the world I want to live in; that’s the world I want to in some way help create.

Interview by Stacy Lu

Visionaries Q&A: Artist Raghava KK on learning to be creative

Raghava KK is an artist, TEDMED/TED speaker and National Geographic Emerging Explorer.

Q. In your talk at TEDMED 2013, you showed us your latest work, in which brain wave technology helps viewers shape your art according to their thoughts and moods. How have people responded so far? 

Contrary to what I anticipated, my talk at TEDMED received an overwhelmingly positive response. I thought the TEDMED audience would predominantly think in fundamentals, and there would be a disconnect. But any science taken to a certain level becomes art. It goes into the ability to transcend to abstract the essence of its thing, and apply it beyond a single application. There’s only a limit to which you can be trained in any one thing.

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From doctors to scientists, there are now a lot of people who are in conversation with me about how we can add value to each other’s methods of inquiry. I’m really excited that I’ve gotten to write the forward to a textbook on cultural sensitivity using perspectives in psychiatry that is being brought out by Massachusetts General, Harvard’s teaching hospital.

Did you learn anything surprising about the brain during this project?

Yes! It shocked me the number of emotions we can go through in one minute.

We like to think about ourselves in absolutes, but we are dynamic and continually changing. Also, I’m surprised by the degree to which you can control brain activity. I can manipulate my art pieces on cue. When some people have that feedback, it can make them feel uncomfortable; with others, it helps neutralize their feelings of fear.

You’re working with an education innovation initiative, NuVu, that stresses creative problem solving skills, and have said, in an interview with Dowser, that education now should be about welcoming instability. Your art encourages dynamic perspectives as well. What is it about the world we live in that makes this so important? Can you point to something in your life or learning that led you to embrace the impermanent?

The one thing we know about the world for sure is that it’s constantly changing.  Evolution is not a ladder that’s built on linear progress. It’s more like a round treadmill, where we’re constantly adapting in relation to a dynamic environment.

So it seems appropriate that we learn in a manner that correlates to the state of the human condition and environment. I’ve reinvented myself many times. I’ve always felt that my education was great; it taught me who I am.

But it’s been my creativity that has constantly told me I can be much more. I could have never planned my whole art career and trajectory. I allowed it to unfold by taking an active role in my life and my future. I think that the incident that really sparked this idea was my decision to quit formal education, and to embrace and learn from impermanence. I haven’t had a formal education since high school, so the world has been my classroom.

A screen for POP-IT, an iPad app designed by Raghava KK. Viewers change the characters by shaking the tablet.

A screen for POP-IT, an iPad app designed by Raghava KK. Viewers change the characters by shaking the tablet.

In that same interview, you said, “Even in my own life, I keep putting myself in uncomfortable situations because of the amount I learn.” Can you give a few examples?

Here are three. First, I recently moved back to India, although I was well settled in New York. I wanted to have my third child here, and expose my children to this impossible democracy, which is an experiment in bringing together multiple, dissimilar perspectives and thus gives us so much to experience and to learn from.

Second, I’m starting a company from scratch and learning about entrepreneurship, because I really want to make an impact with this idea, to transcribe it among audiences. It’s a web-based and mobile educational platform called Flipsicle, and it allows you to actually see multiple visual perspectives on any topic. It’s a man-powered Google for images that uses collaboration and crowdsourcing.

We are producing and consuming more pictures than ever before, but desensitizing us to the fact that pictures are only a single view on an event and truth. Even in our schools, we start out with absolutes and go to abstract at a later stage, like high school, which is far too late. We need to disrupt this teaching and go to abstract thinking at a much earlier stage to really teach perspective.

Third: Once my wife and I accidentally found ourselves in a nudist resort.

This is what happens when an Indian books a holiday without knowing the difference because naturist and nature, because in California “naturist” means “nudist.”  We checked in late in the evening; everyone was wearing clothing, because it was cold.  In the morning I opened the window and saw a guy doing yoga in the buff. Then, my wife and I walked out and we were the only people clothed. So – do we stay here, or we go back home and pretend this never happened? But we thought,  ‘What the hell do we have to lose?’ And it led to an entire series of paintings I did on eros and nudity.  I discovered that it’s the continuum that’s erotic, not the absolute states of nudity. The feeling of the weight of clothing is something you just forget; it’s a change of the clothed state you notice.

"Untitled" by Raghava KK, acrylic on canvas, 2011.

“Untitled” by Raghava KK, acrylic on canvas, 2011.

You mention often that you hope your work will inspire empathy. Can you name a piece of art, or an artist, who inspired that in you, or who/that greatly changed your own perspective?

An artist need not look to art to be inspired, but to life. I see a need for empathy in the world, and that’s what inspired me.

Empathy is fashionable word right now, and it can be easy to misrepresent.

To me, empathy is a tool and it has survival value based on context.  For example, sometimes apathy is important. Extrovertism is overrated. Leadership is overrated; not everyone is a leader. We need to understand these things as continuums that have value based on context. So empathy means contextualizing where I come from, where you come from.

For example, I don’t measure myself by the same metrics by which others do, whether it’s the art world or the commercial world or the entrepreneurial world or the TED world. For someone to understand what I – or anyone — does, they have to have an understanding of how I measure my actions. The need for human dignity comes from these factors. It’s a constant need. And I need to be more than an artist. Life is just a tool. Art is just a tool.

Interviewed by Stacy Lu, @stacylu88

What’s the new way to ask big questions in science?

Parkinson’s Voice Initiative founder and TEDMED 2013 speaker Max Little is an applied mathematician whose goal is to “see connections between subjects, not boundaries…to see how things are related, not how they are different” – which gives him an unusual perspective on how big data could change medicine. We  interviewed him via e-mail to find out more.

You’ve been working to discover the practical value of abstract patterns in various fields, with surprising results in areas as varied as diagnosing Parkinson’s disease over the phone to predicting the weather. Can you explain your approach?

Max Little

Max Little

As an applied mathematician, my training shows me patterns everywhere. Electricity flows like water in pipes, and flocks of birds behave like turbulent fluids. In my projects, I collate mathematical models from across disciplines, ignoring the assumptions of that discipline to a large extent, I put in overly simple models. I use artificial intelligence to throw out inaccurate models. And this approach of exploiting abstract patterns has been surprisingly successful.

For example, during my PhD I stumbled across the rather niche discipline of biomedical voice analysis, originating in 1940′s clinical work. With some new mathematical methods, and combining these with recent mathematics in artificial intelligence, I was able to make accurate medical predictions about voice problems. The clinician’s methods were not accurate. This sparked off research in detecting Parkinson’s disease from voice recordings – the basis of the Parkinson’s Voice Initiative.

But, success like this raises suspicions. So, with collaborators, I tried to make this approach fail. We assembled 30,000 data sets across a wide range of disciplines: exploration geophysics, finance, seismology, hydrology, astrophysics, space science, acoustics, biomedicine, molecular biology, meteorology and others. We wrote software for 9,000 mathematical models from a deep dive into the literature. We exhaustively applied each model to each data set.

When finished, a very revealing, big picture emerged. We found that many problems across the sciences could be accurately solved in this way. In many cases, the best models were not the ones that would be suggested by prevailing, disciplinary wisdom.

Are you doing other research that might have implications for clinical diagnosis?

Here is another example: There is a decades-old problem in biomedical engineering: automatically identifying epileptic seizures from EEG recordings. But, we found over 150 models, some exceedingly simple, each of which, alone, could detect seizures with high accuracy.

Empirical

This challenges quite a few assumptions – but it is not as if we are the first to find this. It happens often when new approaches to address old problems are attempted: for example, in obesity, a new, simple mathematical model revealed some surprising relationships about weight and diet.

You’ve also used fairly simple algorithms to successfully predict weather.

After my PhD, I teamed up with a hydrologist and an economist. We wanted to try weather forecasting using some fairly simple mathematics applied to rainfall data. Now, weather forecasting throws $10m-supercomputers and ranks of atmospheric scientists together, and they crunch the equations of the atmosphere to make predictions. So, competing against this Goliath with only historical data and a laptop would seem foolhardy.

But after two years of hard work, I came up with mathematics that, when fed with rainfall data, could make predictions often as accurate as weather supercomputers. We even discovered that models as simple as calculating the historical average rainfall, and using this as a forecast, were sometimes more accurate than supercomputers. We were all surprised. but this finding seems to line up with results that others have found in climate science: it is actually possible to make forecasts of future global temperatures using simple statistical models that are as accurate as far more complex, general circulation models relied upon by the Intergovernmental Panel on Climate Change.

Is this a new way of doing science?

If we divide science into three branches: experiment, theory and computer simulation, then what I am describing here doesn’t quite fit. These are not just simulations: the results are entirely reproducible with just the data and the mathematics. This approach mixes and matches models and data across disciplines, using recent advances in artificial intelligence.

The three branches of science. What happens when we add computational algorithms to the mix?

The three branches of science. What happens when we add computational algorithms to the mix?

I don’t know what to call this approach, but I’m not the only one doing it. The most enthusiastic proponents are computer scientists, who do something like this regularly in mass-scale video analysis competitions or one-off prizes financed by big pharma for molecular drug discovery as do statisticians working in forecasting.

In your TEDMED talk, you expressed concern that advances in science have stagnated. Can you explain?

Like many scientists, I’m concerned that science is becoming too fragmented. So many scientific papers are published each year that it is impossible to keep track of most new findings. Since most articles are never read, much new research has never been independently tested.

And, unfortunately, scientists are encouraged to ‘hyper-specialize’, working only in their narrow disciplines. It is alien to we applied mathematicians that a scientist who studies animal behavior might never read a scientific paper on fluid mechanics!  In isolation from each other, could they just be duplicating each other’s mistakes?

Max Little at TEDMED 2013

What can we do to create a more unified approach?

First of all, open up the data. There is far too much politics, bureaucracy and lack of vision in sharing data among researchers and the public. Sharing data is the key to eliminating the lack of reproducibility that is becoming a serious issue. Second, don’t pre-judge. We need to have a renewed commitment to radical impartiality. Too often, favoured theories, models, or data persist (sometimes for decades), putting whole disciplines at risk of missing the forest for the trees.

More collaboration would also greatly speed advances. Is first-to-publish attribution of scientific findings really that productive? I think of science as a collaborative journey of discovery, not a competition sport of lone geniuses and their teams.

Scientific theories that can withstand this “challenge” from other disciplines will have passed a very rigorous test. Not only will they be good explanatory theories, they will have practical, predictive power. And this is important because without this mixing of disciplinary knowledge, we will never know if science is really making progress, or merely rediscovering the same findings, time and again.

Follow Max Little @MaxALittle.

 

 

Visionaries: Vic Strecher says living with purpose inspires good health

Why don’t we always do what’s best for us?

It’s a question that has long preoccupied Vic Strecher, founder and head of the Center for Health Communications Research at University of Michigan and TEDMED 2009 speaker.

After years of teaching health education and helping to create computer-based interactive programs that inspire better personal choices, Strecher is working on a website and a graphic novel based on new thinking in the field and on his own momentous life experience. TEDMED spoke with him about his new projects.

So…why don’t people make more healthful choices? There’s no lack of available health information, and yet lifestyle choices have led many to develop chronic diseases.

VS We know that the choices we make can slowly kill us, like frogs that will stay in water that’s slowly heated until they literally boil to death without jumping out of it. And we’re learning that one reason we resist health messaging is defensiveness. We have this wall around our ego for evolutionary reasons, and ironically our wall has been getting thicker with all the societal messaging we’re getting. With the barrage of junk information and all the choices we face, we’re less able to make competent decisions.

How do you prod people out of that warming water?

VS There’s a relatively new idea being explored called self-affirmation theory. It says that the process of affirming your fundamental beliefs — core values — reduces defensiveness. For example, if you write down or are rating your core values, such as your faith or your commitment to family, and then are exposed to a health message that you may normally process defensively, you’re more likely to accept it.

When you start to put things in writing, you realize, “Hey, my values differ from my behaviors, don’t they?” Research shows that cigarette smokers who affirm their core values are more open to anti-smoking messaging.  People are more likely to participate in diabetes risk assessments if they have just completed their values list.  So how can we get people to start making that kind of connection?

Some of your recent talks have mentioned how empathy can lead to healthier behaviors.  Can you explain? 

VS Jennifer Crocker of Ohio State University, a psychologist who studies self-esteem, wanted to take a look at people’s thoughts while they were affirming their values. And what they were doing was thinking of a connection with loved ones, their friends and family and community, and things bigger than themselves; it drew on something called self-transcendence.

What started you down this path of looking at the bigger picture?

VS Two years ago my daughter passed away; she was 19 years old. I went through a significant grieving process, which included struggling with lethargy, and as a behavioral scientist I was noting my own reactions. I began studying the old philosophers – the Stoics, Existentialists – some like Kierkegaard who were very religious, and some who were atheists.  They all said you have to have a purpose or meaning in your life. Victor Frankl, a Holocast survivor, found out people who were losing their purpose were dying faster in the death camps.

That started me thinking about the epidemiology of this in the medical and health field. People that have a purpose in life are 2.4 times less likely to die from Alzheimer’s Disease, less likely to have a heart attack, and more likely to have good sex. Having a purpose can also help repair our DNA, potentially promoting a longer life. We spend so much time scaring the crap out of people about death and disease, and we should be thinking about teaching them to have purpose in life. We’re so used to telling people, ‘Smoking is bad for you,’ and then ratcheting that fear up. Why not just focus on a totally different direction for this?

You’re working on several new projects with this in mind. Can you share details?

VS I’m self-publishing a graphic novel, “On Purpose,” working with a comic book illustrator and a screenwriter. I decided to put together a story that connects my own personal tale with the related science. It will be about the importance of finding purpose in your life in a nihilistic world, basically. It touches on themes from ancient and modern philosophy, literature, neuroscience, and Egyptology.

I’m also working on a web site. There will be a blog app for people to share their stories. I want to build a community where people can record their purpose and see others’. There will be some kind of filter to group people through their common core values, in a way they might not expect. Some of the real beauty of life is discovering things that you wouldn’t expect to discover or to agree with.

Interviewed by Stacy Lu

Visionaries: Elissa Epel on why toxic stress is public health enemy #1

Elissa Epel

TEDMED 2011 speaker Elissa Epel, a UCSF psychologist, has studied the health impacts of stress, from its effects on our DNA to its relationship to overeating, for two decades.

Q Some of your research has centered on the way that stress hormones contribute to increasing our drive to eat, particularly high-carbohydrate and high-fat “comfort foods.” To what degree is stress contributing to our national obesity crisis, in your opinion?

EE We can’t quantify exactly how big of a role stress plays. It could be huge. It’s invisible and it’s easy to ignore; it’s pervasive. Most of us have gotten so used to living in a matrix of stress – time pressure, demands, rushed social interactions, rushed eating – that we don’t even notice it. So we might not realize how stressed our body really is. But the effects of stress can still stimulate our appetite, and shift us to choosing more ‘white food’ – what we call “comfort food,” – high-calorie, high-fat food. This promotes metabolic disease because it causes us to store calories in the visceral area and liver. And that stored fat is at the core of many chronic diseases, not just diabetes.

Q I was surprised to see your study showing educational attainment is also related to telomere length. What might the mechanisms for that be?

EE That relationship is multi-layered and needs to be unpacked. One common theme in trying to understand health disparities is testing whether part of it stems from  greater stress exposure or reactivity over a lifetime. For example, the effects of more years of education early in life can be seen decades later, in longer telomere length. Higher education, or maybe it’s the quality of education, can create an infrastructure in the brain for more adaptive coping – it can help with strengthening what we call ‘executive function’ –which helps us think clearly under stress.

Conversely, there are many active ingredients in the milieu of low socioeconomic status that cause wear and tear. Interestingly, though, perception can play a large role here. We have measured this by giving people a picture of a ladder and asking them to place themselves on a rung (the bottom rung being the lowest status).  Rating oneself as low, regardless of actual income or education, relates to poor adaptation to stress.  Specifically, when given the same task to do in the lab, people low on the ladder reacted hotly each time, as if it were new, instead of habituating to it. There is also the built environment of low socioeconomic status, which doesn’t leave opportunities for buying healthy food and places for exercise or safe walking. And the built environment can feed back and affect how people feel.  For example, fewer parks or more liquor stores predict a decreased feeling of neighborhood trust and cooperation.

Q There seems to be a big disconnect between what people know is good for their health, and their actual behaviors. Is mindfulness – focusing on what we’re doing right now, in the present moment – the missing link, do you think?

EE I think that’s right on. We can’t possibly regulate our behavior and feelings, and suppress those pesky but strong impulses and other distractors, if we are not paying attention. In a high-stress environment, our brain activity shifts toward the limbic system and the emotional stress response, and away from the parts of the pre-frontal cortex that house executive control systems, the rational and analytical drivers of our behavior. So we react automatically and impulsively when we are under stress and not paying full attention.

Watch: The Mindful Human Genome

And even if we are focusing a lot of effort on eating better or exercising, but in a really self-critical way, this can sabotage our efforts as well. Very few people meet their exercise, sleep, and nutrition goals each day. So mindful attention includes both an intention and a kind attitude, and these help clear our mind of unhelpful or intrusive thoughts, and improve our ability to carry out our intentions.

Eating is an interesting example of a behavior that is not under our full conscious control, although we have not admitted that yet. Eating is something that we can do without paying attention. Otherwise, if it took focus and effort, that wouldn’t be part of adaptive evolution. Overeating is related to stress but also altered neurobiology of the reward system, the source of our strongest motivational drives. This reward area responds to palatable food. This can drive compulsive behavior that feels out of control, an experience similar to being a drug addict for some people. We have to better understand how powerful certain types of foods can be, and that certain conditions, including stress, make people especially susceptible.

In some of our studies, we are trying to help low-income people who feel very little control over their life, with their weight. We are teaching mindfulness to pregnant women, and it looks like the training might be helping not only them but also their babies. We have to think of ‘stress reduction’ where it matters most – which includes the womb. Prenatal stress exposure can affect a child’s health for a long time, possibly a lifetime. For example, mothers who have experienced major stresses while pregnant have offspring with shorter telomeres.

Dr. Elissa Epel : The Science of Stress

Q One of many intriguing facts you mentioned in your TEDMED 2011 talk was that technology can actually increase stress in various ways. At the same time, we’re seeing a slew of new apps aimed at helping us to calm down.

EE I think mobile apps for stress reduction are a fabulous potential use of technology, if they really work. For example, we could be using our mobile phones to remind us to rejoin with the moment, and to breathe fully, to notice our physical body and become embodied again. We live mired in our thoughts, above the neck, and this is made worse by multitasking.

But technology devices can become part of multitasking, thus adding to the strain on our limited attention, splitting it yet one more way. There are a lot of wellness apps out there, but I also think that we need data. Almost none of them are evaluated so although they seem promising, do people really benefit from them in a way that would lead to meaningful change? This is a powerful way to reach people, and I admit that even I am involved in an effort to test a stress reduction app!

There are so many answerable questions: Can we take people deeper into a meaningful life, or do these technology interventions contribute to fractured attention and more shallow social interactions? Do people stick with them? Do the apps make a dent in chronic stress arousal over time? As a society we desperately need stress reduction. Let’s hope we can use technology to get there.

Q If you had the power to enforce one public health measure based on your research, what would it be?

EE Public policy makers try to use their resources well to help people, but don’t always think about how to make policy motivating to an individual, nor take into account fundamental causes of societal and individual stress. Stress is caused by a perception of lack of control and unpredictability. Policymakers can promote empowerment, helping disadvantaged people gain a sense of control over their daily life.  Social scientists understand which social and structural factors need to change to help individuals change.

A main message of research today, from epigenetics in basic models to epidemiology, is that adult health is shaped early in life, in important ways we can no longer ignore. So resources are best spent early in life, with the goal of promoting good health and habits, and preventing disease. Good quality education is critical, particularly for girls. It directly translates to better health behaviors and eventually health for the next generation. Resources are just much less effective when applied to diseases that are incurable and costly to manage. Our money is spent in an unbalanced and illogical way. We skimp on education — particularly in California — and spend a tremendous amount of money and time trying to cure incurable diseases such as obesity. Instead, we spend big money on bariatric surgery and costly band-aid procedures.

Q Has your research changed any of your own personal or work habits?

EE It has, but only in an incremental way over many years. I have been studying the field of stress for almost 20 years, so I know all too well what we should be doing, and how my behaviors such as curtailing sleep and having too many demands placed on me affects my daily physiology, and cellular stress. Does that mean I get enough sleep, exercise, meditate every day, keep work manageable, and prioritize the things that are most meaningful, versus the most urgent? No. I am closer to that than I used to be, and maybe in another stage of life… I still experience plenty of challenging situations, and have my reactions, but now in a more mindful way, and that is a qualitatively different experience. Like most people, I am a work in progress.

–Interview by Stacy Lu

 

Visionaries: Scott Parazynski practices extreme healthcare in Antarctica

Scott Parazynski in space gear

Meet the South Pole’s top doc. TEDMED 2010 speaker, Scott Parazynski, is the new medical officer and director of the Center for Polar Medical Operations at the University of Texas Medical Branch (UTMB), where he’ll oversee medical screening and on-ice care of all personnel in the National Science Foundation’s United States Antarctic Program.

Parazynski is also a former NASA astraunaut who flew on five shuttle missions and conducted seven spacewalks, a mountaineer who scaled Everest, a pilot, a competitive luge racer and Olympic luge coach.

Q When will you be leaving for Antarctica? How are you preparing yourself and the staff, medically?

SP I’ll be heading down around Halloween and will spend about a month on the ice at McMurdo [Station]. It’s my first time on the ice. In the spring, I’ll go to the other side of the ice, to the Palmer Station. It’s a strange marriage here in Texas, operating all the medical activities in Antarctica from the most sweltering spot in America.

Winter storm in McMurdo. Photo: NSF

Right now we’re sending hundreds of people down to Antarctica, so it’s the busiest time for us. I used to have a career in the space program, and of course we were scrutinized in incredible detail when we were selected, because it costs a lot to train an astronaut for those incredibly expensive missions. They knew everything about us. It’s quite similar in the Antarctic environment, but we can’t afford to do the same level of medical screening. I also suspect that in general the Antarctic personnel are not as physically fit nor quite as young as the astronaut corps. But we do have medical facilities at all three major stations in Antarctica, so we try and get as many folks on the ice as we can safely.

Q What are the working conditions like?

SP We have the wherewithal to handle the likely medical scenarios. We don’t have CT or MRI scanners, or an operating room and ICU, but we have functional urgent care centers so we can take care of problems for a short time. Occasionally, you have to lift someone off, though it’s a very difficult task in the wintertime to actually get someone off the ice. It’s a very risky rescue operation.

I’ve done a lot of things in remote environments, such as the Himalayas, and I always ask the people I recruit, ‘Have you had to MacGyver medical solutions in your clinical practice? We don’t have the range of equipment and medication that you have in your hospital. Are you capable of thinking on your feet and coming up with real-time solutions?’”

However, UTMB is a world leader in telemedicine, so we can guide people through real-time procedures from our base in Galveston. Healthcare delivery in Antarctica is kind of like medicine on Mars. You have a very austere environment.

What are some of the conditions you’re most likely to see?

Standard working gear at McMurdo. Photo: NSF

SP Slips, trips, falls, sore throats and runny noses are the basics. But it’s a unique environment with a higher incidence of orthopedic issues. It certainly does set you up for frostbite, but you get good protection with the heavy uniform. It’s like walking around inside of a marshmallow suit. Snow blindness is a problem. The South Pole station is 11,000 feet above sea level, and people fly there from McMurdo, so you have altitude sickness. We also run dive operations, so there’s the potential for dive injury.

Q Can you talk about ongoing medical research in Antarctica that may have implications for future treatments or interventions?

SP I have to reflect back on my days in NASA as well to answer this. The kind of technologies and solutions that we develop for these extreme environments have great value for general healthcare. For example, the advances in telemedicine that we’re working on for Antarctica may have great potential for family care practice in rural America or remote Africa.

Also, we aim for miniaturization and specificity of medical tools, such as handheld devices for the medical clinics. These will one day be the medical devices for your doc-in-the-box. They’re very expensive at the outset, but with economies of scale they’ll be useful in the general public one day, off the ice.

Another unique element of Antarctica is the isolation component. We send people to these austere environments where it’s dark 24/7 for months at a time, and you’re seeing people day in and day out with no hopes of leaving. So there are longitudinal investigative studies useful for studying seasonal affective disorder.

Q You’ve lived and worked in Africa and the Middle East. Have you taken away healthcare lessons from other cultures that impressed you? Any that might help the U.S. in our current situation?

SP I was going to do a long-duration space flight aboard Mir and I went to Star City, Russia to do my training. I had to go through a bunch of doctors poking and prodding me to see if I was ready for their training program. I’m a pretty fit guy, and I thought it would be a slam dunk.

But a few years prior, I had had a minor ski accident skiing in a whiteout. I hit my shoulder on a snow bank and had to nurse it for several months. In one medical examination, the Russian surgeon noticed a very subtle difference in my [pectoral muscles]. I couldn’t even tell by looking in the mirror, but he knew that I had asymmetry in my muscle group.

We’ve become too focused on technology in America, and there is still an art to medicine that many people in the world practice, certainly in these remote environments and in rural America. Perhaps now with the financial pressures upon us with healthcare reform, we’re going to need to get back to that and look for subtle findings, make better clinical judgments, hone our skills, and MacGyver solutions using the equipment available.

Q You’ve been an astronaut; you’re a diver and a mountaineer. It seems that many of your career choices are driven by the desire to explore limits and to tap the unknown. Is this a conscious choice?

SP Life is an adventure, and the people that inspired me the most when I was growing up were all scientists, engineers and creative, inventive people. But they also had skin in the game. They were also out there doing things, participating in discovery. I like to build new things in challenging new environments. I’m not much of a steady state person.

Q Are you taking anything special with you to the Pole? Any special plans to mark the visit?

SP Yes, you do want to bring some bling with you to these places. For this, I’ve been training myself to do a good handstand. I really want to get the bottom of the world and do a  handstand, and have an Atlas photo.

Q Have you had to conquer fear, and if so, what’s the one thing you always tell yourself?

SP I have been fearful at times that I wouldn’t succeed. I had this spacewalk on my last mission [STS-120 Discovery], and it was very high stakes, and if I hadn’t succeeded there would be huge repercussions for the program, and it was up to me to finish the job.

Scott Parazynski, the first astronaut to summit Mt. Everest

Also, there was summit morning on Everest. The experience is weird — you leave your tent in the middle of the night. And you do think, ‘What’s this day going to be like?’ There are doubts: ‘Am I going to summit? Am I going to make a round trip out of this?’ I’m hoping I’m worthy and strong enough and that I’m going to make the right decision. I had various doubts along the way, but I just focused on the fundamentals: Buckle in carefully, listen to your body and stay hydrated.

Q Countless kids all across the U.S. want to grow up to be just like you. Who were your idols as a kid? Who are they now?

SP For me it was John Glenn, Yuri Gagarin, [Edmund] Hillary, [George] Mallory and [Andrew] Irvine, Lewis and Clark, Jacques Cousteau — folks who were explorers, scientists and who really had skin in the game. Sir Roger Bannister really amazed me, and he was a physician as well. He broke the mile down and said, ‘I need to run at this pace, at this or that piece.’

I still think space is the place. I hope kids still want to grow up and become astronauts. It’s a different environment now. I grew up in the shadows of Apollo, and now kids have computer games with space planes and all kinds of wild stuff. Can they suspend belief and go out and actually do these kinds of things? I’m the chairman of the board of the Challenger Center for Space Science Education. We hope to inspire kids to go out and explore.

I really admire the commercial space flight industry. These are folks that are so passionate that they’re willing to spend their own time and energy to make this happen.

Also, Jim Cameron’s descent in Challenger Deep was an amazing technological feat. Only a couple of guys have been down there, and the last time was decades ago. It was really an audacious accomplishment.

–Interviewed by Stacy Lu

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For more about practicing medicine in extreme environments, watch Scott Parazynski’s TEDMED speech.

This interview has been edited for space and content.

Visionaries: Peter Diamandis says innovation will increase exponentially

Peter Diamandis: To innovate, we must be fearless dreamers

Peter Diamandis is founder and chairman of the X PRIZE Foundation and co-founder of Singularity University, a TEDMED 2011 speaker, and author of “Abundance: The Future is Better Than You Think.”

What kinds of external conditions lead to innovation on an individual and societal level, and how can we bring those conditions to more people? 

We need to be a society that is full of people who are willing to dream and are willing to take risks. We also need to be a society that also doesn’t pre-judge who can come up with a breakthrough.

The challenge is that right now, we’re unfortunately filled with fear, and that is problematic. If you’re fearful, you become risk averse. You have to view failure as acceptable, because trying something new requires the ability to do that.

If you really want to have a breakthrough, know that the day before it’s a breakthrough it’s a crazy idea, and that you’re going to have multiple failures on the way to success.

In Silicon Valley failure is accepted – two, three failures before success are considered normal. In other parts of the world, failure represents a black mark that you’re going to have a hard time overcoming. It’s mostly old-world Europe, and Asia and Japan. It’s less so in the U.S., which is why we have such a high rate of entrepreneurship.

Was there any era in human history particularly conducive to innovation, in your opinion?

There was a lot of innovation at the turn of the century when people were experimenting, and if you failed and screwed up in a royal fashion you could move someplace else and no one would know and you could start afresh. The ability to have a frontier to move to was very important. Now, if you can screw up anyone can find out on the web. But the web also promotes the rapid exchange of ideas. As populations increasingly move into cities now, too, people are exchanging ideas that drive innovation.

If, per your TED talk, we preferentially pay attention to negative news, what does it take to point people towards the forward-looking optimism that innovation requires?

I think it’s basically to make sure that you are cognizant of the fact that the news media is a drug pusher, and negative news is the drug.

When you hear something negative you need to realize that it’s not probably a full story.  You need to make sure to proactively look at whatever field you’re aware of to find the good news.

Launching the Google Lunar X PRIZE

There are websites and blogs like Singularityhub.com and Kurtzweilai.net that will share with you each day the latest breakthroughs in curing cancer, life extension, imaging molecules, new ways of communicating, and new discoveries on the elements of physics. It makes you realize how fast things are progressing.

We have, and will have more of, access to personal technology. Do people value intangible benefits – better communication, access to knowledge across fields – as part of human abundance?  If not, why not?

When humans get a new capability, they accept this new baseline, and they don’t value it until it’s gone and they lack access to it. It’s like, ‘What has technology done for me lately?’ This stuff didn’t exist two years ago – Google, YouTube.

We get this new stuff this is cool, this is great, it improves our lives and that becomes the new normal.  You forget that it didn’t exist before.

Plus, I think when we get something new, we expect it to work right away.  We’ve become spoiled to some degree.

Have we become accustomed as well to an ever-greater influx of new innovations?

Yes, and that will continue.  The rate of innovation is a function of the rate at which ideas exchange and mutate. As there are more people connecting online – five billion on the Internet by 2020, up from two billion in 2010 – that’s going to increase the rate of exchange.  Tools of artificial intelligence and cloud computing, and our move to the cities, will also allow us to exchange ideas at greater rates.

Can you speak to some specifics as to what abundance brings to medical advances, such as research data and drug discovery and dissemination?  Do you have case studies to share?

What we’re going to be seeing is an increase in pro-active diagnostic tools.  We have recently announced the Qualcomm Tricorder X PRIZE, a competition that will award $10 million dollars to any team in the world who builds a hand-hand mobile device that can diagnose you better than a board of certified doctors.

We have also launched the Nokia  Sensing X Challenge.  This is about developing a new generation of biometric sensors that will detect the air you breathe, the food you drink, the body’s vital measurements and all of the sensory information that will become part of a Tricorder chip.

When I drive my BMW, it has about 60 to 80 microprocessors monitoring what’s going on in the engine at any time.  When I fly my plane, we’ve got about an equal number of microprocessors. But as a human, I get only a few bytes of data once a year from my doctor.  I should be living in a world where I get a few gigabytes of data daily. This allows me to become the CEO of my own health. I can monitor my own data and know when anything is out of whack. Plus, if you have millions of people being monitored, we start to have knowledge of what’s going on, such as disease breakouts in environmentally dangerous places.

Can you speak further about how inventions like Dean Kamen’s Slingshot will actually help us either create new resources – energy, materials, food – or make better use of what we’ve got?

Technology takes that which is scarce and makes it abundant, and makes more of what we’ve got.  We talk about scarcity of water, but we live on a watery planet.  We talk about energy scarcity, but we live on a planet bathed in energy.  We have vast amounts of mineral deposits.  For planetary resources, we’re looking at mining asteroids.

It seems we already have the technology that would lead to greater abundance for those in dire need of essentials in developing nations.  What kind of capacity-building forces, market or otherwise, need to come to pass to make these innovations commonly available?

I think that is happening automatically. Much of the technologies that are being developed today are frankly going end up in the developing world anyway.

Many of the top technologies in the Tricorder chip, for example, may not end up in the U.S. because of regulatory concerns.   A lot of things may begin in Africa because there are fewer regulations.

–Interviewed by Stacy Lu

Click here to watch Peter’s 2011 TEDMED talk.

Visionaries: Alexandra Drane engages with grace

Following is Part Three of our email interview with Alexandra Drane, TEDMED 2010 speaker and founder of Eliza Corporation. Here are Part One and Part TwoIn this final installment, Drane discusses work she considers critically important both personally and nationally, and what she does to maintain her own good health and considerable vitality.

Engage with Grace, the movement you co-founded to help families be better informed about and to cope with end-of-life decisions, is a force behind National Healthcare Decisions Day on April 16th. Can you talk about which current challenges in health and medicine have made these decisions more critical than ever?

We just don’t do end-of-life well in this country – and that stinks for a lot of reasons.

First, you only die once. Thank you, Atul Gawande, for making that incredibly straightforward point – among others – in this remarkable New Yorker piece about making our last days as pleasant as possible.

Second, since you only die once, die the way you want, and make sure your loved ones get that same honor. It’s a gruesome concept – except it’s not.  Stay here for a minute. We live with such intent, why wouldn’t we want the end of our lives to have that same grace? Why wouldn’t we want to make sure our loved ones are treated with that same dignity?

Third, doing end-of-life well is a gift that keeps on giving, for the person who has a far better experience at the end of a life well lived, but as importantly for those who are left behind. There is no worse hell than second-guessing how you supported a beloved in his or her last days, particularly when what the system often provides – not by willful mal-intent, just by not knowing how to do anything else – is unnecessary and I would even say inhumane.

Fourth, with the demographics shifting the way they are, the magnitude of this problem is quickly going to become unmanageable. It’s bad for us as humans. It’s bad for us as a country.

And this is one of the only places in healthcare where we are all naturally aligned! Most people want less care at the end of life (70% of people want to die at home, yet only 30% do), and less traditional/intensive care usually produces better outcomes and a higher quality of life. Check out stats from the Coalition to Transform Advanced Care. The potential savings are enormous.

In other words, just by designing a system/process where people are informed and get what they want, we get better outcomes, and massive savings.  Here’s the most beautiful thing about it, though. We don’t even have to bring up the cost savings!  While they are relevant to those concerned with the disaster-pointing cost trajectories of our shifting demographics under current care models, just by getting people what they want, the savings will take care of themselves. So don’t focus on the cost; it takes away from the beauty of the story! Instead, focus on this: Just by giving informed people what they want at the end of their lives, we get better outcomes and a better quality of life. Why would we not want that?

When the ‘Death Panel’ fiasco came along, a lot of people, understandably confused by the baloney that was trumpeted about, stood up and articulated that they did not want Death Panels. Based on their understanding, they were right. But they missed the opportunity to stand up for what they did want. And every day that we let the current reality of how end-of-life usually happens continue, we all miss that opportunity.

Let’s agree together to do this better – for ourselves, for our loved ones, for everyone.  Let’s articulate clearly, and loudly, a better reality.  Doctors, we want to know what’s going on with us and with our loved ones in an advanced illness situation. We don’t want false hope, we just want you to be direct, and gentle in how you share with us.  We want to hear our options, all of them, not just the ones that include more and more traditional care delivered in a hospital.  We want you to involve our friends and family in these discussions. Let’s think together based on what options exist in these hard situations.  We want our doctors to be okay with our choices – even if they include intentionally requesting less invasive care in return for a better quality of life.  And most importantly?  Most of us just want to go home.

This discussion matters. We need to have it on a national level, and we need to have it as individuals, as mothers and fathers and children and siblings and cousins and co-workers and friends, and as a population that cares a whole heck of a lot about living a good life, because the end of each of our stories should be just as glorious.

Engage with Grace.

What’s one thing you do every day (or as often as possible) to maintain your own health?

I laugh – all the time – at myself, at the inanity of how many mistakes I make, at how hard this all is, at how beautiful we all are with our extraordinary complexity and yet insane simplicity.

I say inappropriate things, because I can’t help myself, and because they are usually true, and because having real conversations is just fun.  And people are generally more productive when you’re starting from a baseline of authenticity and joy and soul and humor.

I revel in the humility of the great joy that we, at this very moment, are alive. And that in and of itself is a gift. One to be cherished, one to be leveraged, one to be celebrated.  I’m realizing in my old age that being successful is not about being perfect, or sometimes even particularly good at what you do. It’s about being slightly less screwed up than everyone else – at least for this moment – and caring a whole lot in the process.  When you remind yourself that you’re lucky to be alive, that it’s never going to be perfect (for anyone), and then focus on the importance of what you’re trying to achieve, you just feel better.

And finally, I try to sleep more, love my family a lot, and remember to seduce my man on a regular basis.

I guess that’s more than one.

For more from Alexandra Drane, watch her TEDMED 2010 talk.  

Visionaries: Alexandra Drane on crafting seductive health messages

Alexandra Drane

In Part Two of our email interview with Alexandra Drane of Eliza Corporation, she talks about how most health messaging fails miserably at inspiring change in behavior.

Here’s Part One of the interview.

Your latest new venture, Seduce Health, talks about why so many health messages, both in the private and public sectors, fail miserably to change behavior. What are they missing?  What’s your favorite example of a bad message, in form or content? A good one? 

One of the most gorgeous things about the healthcare space is almost everyone in it is here because they care. They are mission driven to make this world a better place for people – particularly as it relates to health. And that’s a good thing!!  But it’s also our Achilles’ heel. We often project that fanatical level of interest in health and healthy behaviors on the people we are trying to influence, as if they too are spending most of their waking hours thinking about and obsessing over what creates better health-related outcomes. Sadly for all of us, they’re not. In fact, the average person would rather eat worms than read my thoughts on healthcare! They’re out reading about who slept with whom or which team won what or feeling secretly delighted that Facebook’s stock is down because they don’t own any and they don’t work there (at least, that’s what I’m doing).

By virtue of the fact that we sometimes think we’re ‘all that,’ we seek to influence people in ways that don’t resonate because we presume a level of baseline interest or engagement that is just not there. One of my favorite examples is to look at the advertising and marketing efforts of the food, tobacco and beverage companies, and then compare them to most of ours. We send pictures of diseased kidneys; they feature smokin’ hot models with grease from a bacon double cheese burger running down their arms.  Hmmmm – who’s going to win there?  That’s not always true, but you get the point.

My pleasures are fleeting.

The problem (opportunity?) is also compounded when you consider that we as an industry spend 30 cents for every $30 our ‘competition’ (those same food tobacco and beverage companies) have at their disposal. They’re simply spending more money. And with a greater self-awareness about what sells, what resonates, what inspires and seduces and beguiles. And not to pile on, but to be fair – their job is easier! I can sell the pants off how good a donut would taste right now (or Fritos, or a sausage, or …), but convincing you that carrots will hit that same spot?  Slightly more challenging.

So, is the answer to just use beautiful models in all that we do? Of course not. It’s far more complicated than that. But it does require that we inhale more humility about what the average person finds intriguing, what real people are interested in spending time thinking about, and that we design our outreach efforts in a way that fully and unabashedly incorporates that very different perspective.

Bite me! I

How can we do that? By adding joy, soul, humor to our approach…by paying attention to the universal conversations that are happening at the water cooler, at the dinner table, at the bar…. by meeting people in the messy realities of their lives, speaking with them in a way they can understand, one that doesn’t feel condescending or academic, and working to help them solve the problems they care about, which may or may not be the ones on which we are focused.

We work hard to infuse our health messages with a true consumer approach, and we do all we can to avoid tactics like medical terrorism – a favorite go-to of many health organizations – even though the literature (and common sense) shows that terrifying someone into action may work once but has a very short half-life. Many of our favorite examples of what we love, and what we don’t, live at Seducehealth.org. Roll around in them for a bit and share what you think!

It’s not hard to do on paper – the tough part is being brave enough to roll out this kind of approach in the real world.  Luckily, we’ve been able to convince (coerce?) some of our customers into trying fresh approaches, and they work! For example, we reached out to women due for a mammogram with a flirty approach and found that women were 26% more likely to schedule a mammogram after hearing this message versus a straightforward reminder:  “Believe it or not, there’s a mammography machine out there that really misses you. You don’t call, you don’t write. Do you think you’ll visit soon?”

The one thing we know for sure is no one has figured out how to really nail this yet. But we think with time, with more experience, with more data, with more humility, and really with more bravery to try genuinely unorthodox and thrilling approaches to engagement – approaches that DON’T presume people are sitting around waiting to get lectured – we’re going to get there.

–Interviewed by Stacy Lu

Visionaries: Alexandra Drane on why women rock healthcare

This installment of our Visionaries Series features Alexandra Drane, Founder, Chief Visionary Officer and Chair of the Board of Eliza Corporation, a pioneer in health engagement management via a patented speech recognition technology, rich web and multi-modal delivery platform.

In Part One of our email interview, Drane talks about women in healthcare and how to make it as a startup.

Looking at yourself and other female entrepreneurs in healthcare, and at the growing number of women entering medical school, would you say that women are increasingly having more influence in health and medicine, both in the U.S. and worldwide? What kind of changes might that bring about, both in the business of healthcare and how it is delivered?

There is nothing that makes me happier than diversity of any kind in the healthcare space – why?  Because we humans are kind of a big ole’ mess. We are complicated…and a more collaborative and inclusive perspective on who we (as in the universal ‘We’) are, and how we make choices, is far more likely to succeed when what we’re trying to inspire are healthier behaviors in a day-to-day way, because that’s hard to do.

Alexandra Drane at TEDMED 2010

Also, as it relates to gender specifically, my favorite people in the world usually have a mix of masculine and feminine traits. And in my old age, I’m coming to believe that knowing how to apply traditionally gender-ascribed skill sets dynamically, regardless of your actual gender, is where real impact lives. It’s the balance that has the most value.

The unique relationship between women and the healthcare space is not new. I just think it’s evolving. A few fun stats on this:

  • Women make 80% of the healthcare decisions in their families, and are more likely to be the caregiver when a family member falls ill.
  • Women build stronger relationships and have greater brand affinity for their health plans. Eliza measures engagement using our Eliza Engagement Index, and we find that women are 30% more engaged than men with their health plans.
  • Women are savvy online searchers. 65% of women gather health information online versus 53% of men.
  • Women share what they know. 14% of all American moms are “mommy bloggers.”

So women are engaged – and they’re more ‘experienced,’ so to speak – and in a way I think that makes them more informed and more valuable to the overall process. It’s hard to comment when you have no context. Women historically have more context about what health is, and how it lives/manifests itself, so getting them more influence over the systems being built to impact that makes sense.

Finally – and this is going to get me in trouble – I just find women more willing to point to the blue elephant in the corner. And dagnabbit, there are a lot of blue elephants in the corner in healthcare! I have come to believe that most of us working in the healthcare space have two personalities: The personality we take with us to work where we feel comfortable preaching what people should do and proclaiming edicts to that end (I do this all the time), and then the personality we take home, where we have a third glass of wine and don’t schedule our mammogram and sleep for four hours and have chocolate for breakfast while blowing off the gym for the 7th day that week (story of my life).

Sometimes what we need to remember in our wood-paneled conference rooms is that getting people to live healthy is not as easy as just telling them to do that. Most people get that they are overweight, they get that they are not taking care of themselves. That’s not the problem. The problem is getting them to start, and keep, making different choices on a day-to-day basis; choices, by the way, that are not easy for any of us to make!

I find women are faster to both remember, and bring, this perspective to the work they do, so we can spend more time developing solutions that have a chance of working. Maybe this is because they’ve been more out of control for longer? So their context is more ‘real life’? Maybe it’s because they have tried and failed in their efforts to control the behaviors of their own families, so they carry those scars and that deep rooted respect for just what a challenge this is in all they do? Or, maybe it’s just because I’m a woman, so I’m inclined to think we are superior. :)

You’ve been mentoring companies that back health and medical startups, such as Rock Health and Blueprint Health. What are some of the major goals of startups these days? Are there new and/or recurring themes?

Well, the primary goal of a startup is and should be the same as it’s always been – to survive! It’s bloody hard to get one of these things started, and that’s only more true in healthcare where what we’re selling is just not necessarily what folks – the actual citizens of the U.S. and our end-users, so to speak – want to buy: Less of what they love like meat, cheese, sweets, alcohol, and laziness, and more of what they don’t such as exercise, discipline in food consumption, and taking their medicine, especially for asymptomatic conditions when the medicine has nasty side effects.

And, because of that, there is a universal and never-ending component to what all of us are (and have been) trying to do to make a difference, which is to get people engaged and enable them to make healthier choices. I have been in this space for twenty years now, and what we worked on when I was getting started is the same thing we are talking about now – even after 700 million interactions – getting the right message to the right person at the right time. What’s changed? We’ve added ‘in the right channel,’ to reflect the gorgeous proliferation of technologies that allow us to connect with individuals in real time wherever they are, and increasingly to do that in a way that leverages the far greater (and slowly but surely more relevant) amount of data we have on individuals, like the way they make decisions, for example.

The buzz you’ll hear about are things like mobile, gaming, incentives, provider-centric solutions…and these things are valid components of an overall successful approach. But they do not represent the missing and holy grail that will now ‘save us.’ We, as an industry, have a very ‘run to the light’ mentality: ‘Medical home will save us!’, ‘Texting will save us!’ The reality is no one thing is going to save us. Doctors matter, yes. Mobile phones are a great new channel, yes. Playing a game is better than being lectured, yes.

But living a healthy life is an exhausting and unrelenting day-to-day challenge (opportunity?). We will find success when we finally learn to not only coordinate all these efforts, but coordinate them in a singularly focused outside-in, person-centric way, when we come to realize that there is no one-size-fits-all solution, that there is no one-hit wonder, that we are going to have to try and fail a lot to get to more examples of what works. And we can’t keep throwing out approaches because they don’t deliver the immediate success we seek. Human behavior is messy, it’s complicated, it’s unpredictable – and anyone who questions that need only look at their own health behavior. Few of us are doing all the things we should be doing to be our best selves, and this is our job!

Read Part Two of our interview with Alexandra Drane on Monday, June 11th. To watch her TEDMED 2010 talk, click here.