An Open Standard for APIs Could Lead us to Better Health

There’s a parable about the elephant and the rider that’s been used by Chip and Dan Heath, and that originated with Jonathan Haidt, to describe how humans make decisions. A person’s mind can be thought of as consisting of a rider, representing the rational part of human thinking, and the elephant she’s riding, representing emotion. Both of these play a role in how a person decides things, and many of us believe the rider–the rational part–is in charge. The rider taps the elephant with her guide stick, and the elephant obediently moves in that general direction or does a specific task, like carrying lumber from place to place.

Except that’s not how a lot of decisions actually get made. Instead, the elephant sees a bunch of bananas, or a herd of other elephants, or a nice cool river to bathe in, and goes that way instead. And the rider…well, the rider can’t do much about it except, after the fact, rationalize how she always wanted to go in that direction to begin with. Yeah, it was time for a bath, sure

This framing has stuck in my mind for years and it’s a really helpful way of looking at many of the odd things that people do or say, ranging from climate change denial, to believing genetically modified organisms are inherently evil, to smoking despite everything we know about the harms that result, to even saying that Paul Blart, Mall Cop II is really, you know, not that bad–really. And it also speaks to one of the more vexing problems we have in human health. Why do people keep doing things they really probably shouldn’t, and know they shouldn’t, if they want to stay healthy?

I’ve touched before on how the power of digital tools can help make it easier for us to make good decisions. OPower is doing this for power consumption and conservation, and with the advent of tools like Apple’s Healthkit and the proliferation of activity trackers, the time is right to do this for health. Continue reading

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Making Change

And now for something completely different! Short fiction in honor of the recent unveiling of the Apple iWatch and Healthkit.

“I wouldn’t eat that if I were you.”

Sylvia paused, bacon cheeseburger halfway to her mouth, and peered at the neon green band wrapped around her wrist. The wraparound touchscreen was currently showing a cat emoji. It had a frowny face, expression halfway between puzzlement and alarm.

“What did you say?”

“I’m just saying,” said her Best Buddy wristband, “that when we met a few weeks ago, you mentioned wanting to keep your weight in a specific range.” The emoji shrugged. “Little friendly reminder. You know?”

Sylvia carefully put the burger back down and resisted the urge to lick grease off her fingers. She fumbled for her napkin, her fingers leaving translucent streaks on the thin, white paper.

“I–well, yeah. But, I mean, you’ve never said anything like this before like when–” She broke off, remembering the milkshake, the onion rings, the King-size Choconut bar…

“Well it’s not the first thing you do, is it? When you meet someone and you’re just getting to know them?” The cat had morphed into a light pink, animated mouse, standing on its hind legs, bashfully kicking one leg. “But now, we’re friends!” Continue reading

Baseball, Bayes, Fisher and the problem of the well-trained mind

One of the neat things about the people in the baseball research community is how willing many of them are to continually question the status quo. Maybe it’s because sabermetrics is itself a relatively new field, and so there’s a humility there. Assumptions always, always need to be questioned.

Case in point: a great post by Ken Arneson entitled “10 things I believe about baseball without evidence.” He uses the latest failure of the Oakland A’s in the recent MLB playoffs to highlight areas of baseball we still don’t understand, and for which we may not even be asking the right questions. Why, for example, haven’t the A’s advanced to the World Series for decades despite fielding good and often great teams? Yes there’s luck and randomness, but at some point the weight of the evidence encourages you to take a second look. Otherwise, you become as dogmatic as those who still point to RBIs as the measure of the quality of a baseball batter. Which they are not.

One of the thought-provoking things Arneson brings up is the question of whether the tools we use shape the way we study phenomena–really, the way we think–and therefore unconsciously limit the kinds of questions we choose to ask. His example is the use of SQL in creating queries and the inherent assumptions of that datatype that objects within a SQL database are individual events with no precedence or dependence upon others. And yet, as he points out, the act of hitting a baseball is an ongoing dialog between pitcher and batter. Prior events, we believe, have a strong influence on the outcome. Arneson draws an analogy to linguistic relativity, the hypothesis that the language a person speaks influences aspects of her cognition.

So let me examine this concept in the context of another area of inquiry–biological research–and ask whether something similar might be affecting (and limiting) the kinds of experiments we do and the questions we ask.

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Some MLK Day thoughts about evolution, teachable moments, and being human

Maybe my favorite episode of Northern Exposure is the one where Maurice Minnifield (played by the great Barry Corbin), the bigoted, pompous, ex-astronaut is surprised to discover he has a son, Duk Won, conceived during service time in Korea. After grudgingly admitting that Duk Won’s claim is real, Maurice has a conversation with Chris, the town’s DJ and amateur philosopher, about how difficult this is. Their conversation concludes something like this:

Maurice: I wouldn’t have had such a problem with this if only…

Chris: If only he were white?

Maurice: …Yeah…

Chris: Well, that’s a reason for hope.

Maurice: What? What are you talking about?

Chris: Because racism is a learned behavior. And that means it can be unlearned. Continue reading

Could pro sports lead us to wellness?

Comment From Bill
St. Louis is being hindered in the stretch drive by some kind of GI bug passing through (so to speak) the team. Reports have as many as 15 guys down with it at once. That seems a lot, but given the way a baseball clubhouse works, my question is why don’t we see more of that? Answering that baseball players are fanatically interested in sanitation and hygiene ain’t gonna cut it, I don’t think…

12:10
Dave Cameron: They have access to a lot of drugs.

–comment from a chat at Fangraphs, September 24, 2014

So this comment caught my eye. Ever since I began following sites like BaseballProspectus.com and Fangraphs.com, and reading things like Moneyball, I’ve found myself thinking about efficiency and unappreciated or unexplored resources in different situations.

I realize this was a throwaway line in a baseball chat. But it piqued my interest because it seems to point out something that’s maybe underappreciated and understudied about how sports teams go about their business–specifically, the kinds of things they do to keep their athletes healthy.

My question is, does this represent a potential source of “Found Research” data that could help the rest of us reach wellness? Continue reading

Is Opower the model for getting us to wellness and health?

This is a post about nudges. And optimism.

There’s a story I read a long time ago by David Brin. It’s called “The Giving Plague,” and the protagonist is a virologist and epidemiologist who describes his life working on viruses and vectors. The Plague of the title is a virus that has evolved the ability to make infected people enjoy donating blood. Recipients keep giving blood, leading to an exponentially expanding network of people who find themselves giving blood regularly and even circumventing age and other restrictions to make sure they can give their pint every eight weeks.

The central twist of the story is that the protagonist’s mentor, who discovers this virus, realizes people who donate blood also perform other altruistic acts–that the act of giving blood changes their own self image. Makes them behave as better people. And so he suppresses the discovery, for the greater good of society. The protagonist, a rampant careerist, begins plotting murder to allow him to take credit. But before he can act, more diseases strike, the Giving Plague moves through the population, and the protagonist forgets about it in his efforts to cure newer diseases.

And if anyone thinks something like this is too outlandish, I encourage you to read this piece about Toxoplasma gondii and how it makes infected mice charge at cats, the better to be eaten so that T. gondii can spread. Yeah.

But what does this story have to do with the future of wellness and health?

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Trying to figure the way through a 401(k) life

Thomas Friedman’s thoughts on how we’re becoming a 401(k) nation have been kicking around the back of my mind for about a year. His Op-Ed piece described the shift in how retirement plans in the US have largely shifted from pensions to 401(k)s and used that transition to make a point about the changing nature of work.

In a pension plan, a defined input (so many year of work) leads to a defined output (a regular payment that starts upon retirement until the day you die) with the risk assumed by the employer. In a 401(k), there’s still a defined input (regular deposits into a managed investment account) but how much a person gets at the end carries no guarantees and the risk sits squarely with the employee.

Friedman’s insight was that work itself is following that same path. Where once the defined achievements of education and learned skills were enough to guarantee continued employment and a good, middle-class career (at least), that’s not really the case anymore.

The news a some months back that Amgen will be closing its Seattle site this year really drove that point home. It was a reminder that biopharma, like so many other industries, isn’t immune to the implications  of the 401(k) life.

Continue reading