Even if you only got a whiff of the product demo sessions at the Health 2.0 Conference in San Francisco this week, you noticed: sensors are getting smaller, cheaper, and more closely integrated into tools we already use.

Consider Pulse Sensor, a dime-sized device that uses a beam of light to measure a person’s heartbeat. For $25, customers get a sensor kit that plugs directly into an Arduino microcontroller, the staple device of any DIY hardware hacker. Attach the sensor to an earlobe or fingertip and the light beam measures changes in tissue volume to gauge a person’s pulse. To date, the company has already raised over $18,000 on Kickstarter.

The other demo that caught my eye was the Google+ health challenge app from a group at CTIS, the winners of the Body Media challenge. Through their armband devices, Body Media uses a number of sensors to figure out how much someone moves and sweats during activity, giving an accurate read on how much energy is burned during the day. (I reviewed this product for Wired magazine back in June 2010). To win the challenge, CTIS built an extension to the Google+ platform that allowed users to create custom health challenges between a group of friends or colleagues, such as competitions to see who loses the most weight over 30 days, or who bikes the most miles in a week.

The idea of creating online health challenges isn’t new. But really, who needs to visit *another* website to track their health challenges? As we’re seeing with news, shopping, and entertainment, people want their online experience streamlined. The fact CTIS built their app into another social platform is key. Zynga has more or less cornered the Facebook game market; I’m waiting to see who will step to the plate with health apps.

Photo via Flickr / Magnet 4 Marketing dot Net

People use Facebook, Twitter, or other social media sites as channels for self-expression. But whether updating or uploading, people are telling their social stories with only two tools: text and images.

But what if social media wasn’t confined to words and pictures, but instead, allowed users to uploaded graphs or tables? In other words, could data, pure data, become a token in our social currency?

That’s the thought contributed during a panel session at the Health 2.0 Conference in San Francisco by Gary Wolf, contributing editor at Wired, and an organizer of Quantified Self, a community whose users meticulously track certain aspects of their lives, some down to infinitesimal levels, such as how they spend every minute of the day (no joke).

Wolf’s comment followed a presentation by Stead Burwell, the CEO of Alliance Health Networks, who demoed Diabetic Connect an information and community site for patients battling diabetes. Alliance spent a great deal of time (read: money) on creating user profiles that would allow visitors of the site to connect with their peers, patients who share similar experiences. But that connection, they found, was key. As Burwell said in his presentation, users not only like to receive badges and virtual rewards, they like to hand them out as well.

Noting how willingly people update their status on social media sites like Facebook, sometimes with unrestrained detail, Burwell wondered how to bottle this social energy to get patients to openly share personal health data.

In my opinion, the limitations aren’t technical. After all there is nothing preventing users on Facebook from uploading a JPEG charting the number of miles they ran in a given month. Sure, social media sites could make tools available to users to facilitate the process, but that’s the easy part – there are already a number of product-related sites, such as Nike+, that do just this. The shift that Wolf describes, and that Burwell hopes for, is more philosophical, a change in the type of information we feel comfortable sharing with our friends, families, and colleagues.

So here’s my request: If you track any aspect of your life, whether your weekly running mileage, calories consumed by food, weight fluctuations, or daily blood glucose readings, share your data with your social network. Let’s see what happens.

Photo via Flickr / Sean MacEntee

The brilliance of Wikipedia is that anyone, at any time, can contribute to the project, and in doing so, the collective knowledge of the world’s largest encyclopedia keeps improving and expanding. In last week’s issue of The New Yorker, Lauren Collins brought up an interesting point about Wikipedia worth sharing; one that anyone interested in dealing with virtual communities should absorb.

To put it simply: in the burgeoning world of virtual communities, there is still a good reason to bring people together in real life. In the course of a few hours on a Saturday afternoon in June, with a group of its curators and 20+ Wikipedia volunteer contributors, the British Library was able to update over 30 of the online encyclopedia’s topics tied to collections housed within its walls. Something tells me this would have been difficult to do with a scattered online group.

I think this example also shows how an organization can harness and direct crowdsourced work in a way that’s a win for both sides. Here, the British Library staff was able to get the content that mattered to the organization updated in Wikipedia for free. And the volunteers? Rather than feeling like they were being exploited, they were empowered by their own sense of accomplishment, and powerfully rewarded by the recognition they received from the library curators and their peers. (And I guess getting mentioned in The New Yorker doesn’t hurt either.)

*Side note: This wasn’t a central theme of the story, but Collins also points out a site called Wikipedia Vision, where visitors get a real-time snapshot of what’s being edited at Wikipedia, and by whom. Text bubbles briefly superimpose on the site’s world map, showing the location of the editor, and what they’re working on. Even people who monitor traffic on websites with analytics tools like ChartBeat, like I do at PLoS Blogs, will appreciate Wikipedia Vision’s slick interface and open nature.

Photo via Flickr / nojhan

One of the biggest battles between strong scientific evidence and those with a downright pigheaded refusal to accept the facts isn’t happening inside a medical clinic, but in the dairy fields of Northern California.

Nothing screams “Foodie” like being a self-proclaimed artisanal cheese connoisseur. Don’t believe me? Check out the lines of people stacked three deep at your local Whole Foods cheese counter on a Saturday morning, all waiting to get their fill of a distinctly bold raw milk cheddar. Trust me, I know what I’m talking about; I’m the one more than likely pushing my way to the front of the line.

Considering the numerous store recalls on tainted cheeses, study after scientific study showing that pasteurization is the most effective way to keep dairy products safe, and, um, I don’t know, the fact that I’m trained as a scientist, some of you will say that I should know better. And you’re right.

I know where the evidence points. I just don’t heed the advice. Well, I didn’t, until now. So, I’m swearing off raw cheese until I conduct a full investigation of what the risks include. (Happy now?) And instead of writing a monster post, I’m thinking I’ll make this into a series. That way, I can incorporate the feedback I get from readers along the way. Plus there are too many avenues to explore and I don’t feel like organizing the structure of a long post. (Yes, I’ve also developed a newfound zeal for brutal honesty, effective immediately.)

I think I know how this one is going to end , but it will still be fun to see what I learn. And who knows, maybe someone else has the same questions.

Photo via Flickr / Royalty-free image collection

One way: to release a top-ten list of the greatest achievements in public health, from triumphs over vaccine-preventable diseases to the boon in tobacco control programs.

The other: instead of releasing the dry, stale prose of a disaster preparedness fact sheet, build a website that tells people how to protect themselves from “zombies…or hurricanes or pandemics.”

The New York Times reported on the creative initiative by the CDC intended to get people’s attention, and get them ready for a disaster. And so far, it’s been doing quite well:

The blog post went up on Monday. “A typical post gets 1,000 hits,” Mr. Daigle said. “We got 10,000, then 30,000 on Tuesday, and then it crashed the server.”

Score one for the CDC on public engagement.

Photo via Flickr / aeviin

That was the gist of a headline I read on The Atlantic this morning.  

At first blush, I thought the commentary by Edward Tenner on a recent NYT report was overreaching a bit.  How could helmets, which protect the head, make sports more hazardous.  But as I read on, I saw the point he was trying to make.

In certain situations, helmets may give an athlete a false sense of security.  With their noggin firmly secured in a near-indestructible plastic casing, the theory goes, some contact sport athletes might deliver hits they’d otherwise shy away from.

The NYT article focuses on women’s lacrosse, where helmets are currently only worn by goalkeepers.  In fact, the other players are banned from wearing helmets.  And many of the sport’s competitors would like to keep it that way.

But the crusaders are facing an uphill battle because the idea that players engage in riskier behavior when they wear helmets, well, that’s difficult to prove.  Most of the evidence presented is anecdotal – like the fact that hockey and football hits became noticeably more vicious after the professional leagues instituted helmet policies.      

Everyone knows I’m a staunch supporter of protective headgear for snowsports and bicycling.  But I can see the points being made for continuing bans on head gear in certain sports.  Strap a helmet on or lacrosse player and the game dynamic changes a bit.  Why worry about finesse and skill when you can just bowl your opponent over?  

Perhaps we need to better define which sports draw higher risks for head injury by their very nature, opposed to those where the head protection creates the danger in the first place.    

Doctors and sports officials need to seriously consider the increasing evidence that concussions are associated with cognitive decline in later life, and the fact that concussions are on the rise in contact sports, a topic I’ve written about before.

Riddell, a football helmet manufacturer, isn’t standing around idly either, and has been working on next-generation gear that might reduce the impact a crushing hit has on the brain.  The company placed tiny accelerometer sensors inside the helmet, and collected a drumbeat of data on what happens inside, presumably where your brain would be — when the headgear is subjected to blows from various angles.

All steps in the right direction, though everyone agrees more data is needed.  And not just for technological shift, but a deeper understanding of athlete behavior is needed, too.  

I have a new feature at Scientific American, describing recent research that shows how stress is linked to neurodegenerative diseases like Alzheimer’s and Parkinson’s.

In the past, we have feared Alzheimer’s, because people rarely get better once they find out they have the disease. We watch in horror, as our aging relatives slowly become different people, donning new personalities, or forgetting who we are. And as more and more Alzheimer’s drugs fail clinical trials, there is certainly a bleak outlook for new emerging treatments.

But when our environment or lifestyle factors into the disease, suddenly we regain control. For instance, thanks to years of rigorous work, we know that by cutting fats and salts from our diets, and getting lots of exercise, we can often keep heart disease at bay. Granted, we understand the effects of lifestyle on the heart much more than how it impacts the brain, but new studies are trudging forward, offering glimpses of hope:

More or less, all of the primates raised in normal size cages had the same amount of plaque. The monkeys housed in smaller cages as youngsters, on the other hand, had much more variation in their plaque level, suggesting stress may affect individuals in different ways. For some, it’s detrimental, while others appeared to take it in stride.

Clearly, these results only provide a correlative link between early life experience and measures of cognitive function, a retrospective peek that implies stress may be more than an emotional burden. But, as Plassman pointed out, we don’t know whether the brain changes the authors observed translated into true cognitive slips. Tuszynski’s team reported that they were simply not able to run tests on cognitive function for this particular experiment, because some of the older monkeys were brought to them just a few weeks before they died.

While a causal link between stress and Alzheimer’s Disease remains elusive, a bevy of research has shown that moderate stress can in fact make the symptoms of neurodegenerative diseases worse – not just in Alzheimer’s, but in animal models of Parkinson’s Disease, too.

Click here to read the full article.

Photo via Flickr / alancleaver_2000

References:
Merrill DA, Masliah E, Roberts JA, McKay H, Kordower JH, Mufson EJ, & Tuszynski MH (2011). Association of early experience with neurodegeneration in aged primates. Neurobiology of aging, 32 (1), 151-6 PMID: 19321231

Tran TT, Srivareerat M, & Alkadhi KA (2010). Chronic psychosocial stress triggers cognitive impairment in a novel at-risk model of Alzheimer’s disease. Neurobiology of disease, 37 (3), 756-63 PMID: 20044001

Smith LK, Jadavji NM, Colwell KL, Katrina Perehudoff S, & Metz GA (2008). Stress accelerates neural degeneration and exaggerates motor symptoms in a rat model of Parkinson’s disease. The European journal of neuroscience, 27 (8), 2133-46 PMID: 18412632

Being a sprinter, I had never done much long distance work. In the past, making it around the 400m track just once was an accomplishment for me. Plus, my closest friends from college are hard-core distance runners. And by that, I mean they are really, really fast. Like 2:30ish marathon fast. Top 50 in the Boston Marathon fast. Fast fast. You get the point. So getting into this road racing business was a bit intimidating. I didn’t even tell my best friends what I was doing until shortly before my first race.

I started out slow, running just twice per week, a sluggish mile or two at a time. Week by week, runs became easier, and I found myself starting to push myself to go further, and faster. I started watching what I ate, making smarter choices on trips to the refrigerator. As the months passed, I began feeling better than ever, and had wrangled my waistline back to its proper diameter. My annual physical revealed more good news, as my cholesterol and blood pressure were now held in check.

You can read the full post here.

In the past few months, since The Decision Tree book came out, I’ve had the privilege to talk with many doctors about the opportunity and challenge of engaging patients in their own health. Some physicians, not surprisingly, have been suspicious, and even hostile to the idea that patients have a role to play. But thankfully, those have been rare exceptions. Most doctors I’ve spent time with have been eager to hear about new tools that might engage their patients, and they’ve been eager to share well-earned advice on where there’s work to be done. It has been a delight and an education to talk about the potential of healthcare with these physicians who are, after all, doing the hard work of providing medical care every day.

A high point in my continuing education came a couple weeks ago, when I was invited to speak at the Minneapolis Heart Institute Foundation‘s Fall Nursing Conference, where I met a number of nurses who are eager to help patients gain some control over their health. A few days later I gave a lecture on patient engagement at the University of Minnesota Medical Center. The invitation came from Dr. David Rothenberger, an esteemed surgeon who has consistently emphasized the importance of innovative thinking in medicine. Dr. Rothenberger also runs a program for physicians with promising leadership potential, and part of my day involved talking with them about the changing nature of clinical medicine, and the challenge of engaging patients in their healthcare.

These were good doctors, deeply motivated to help their patients, and there was scant resistance to the notion of an empowered patient who might seek to engage in their care and treatment. Indeed, they seemed to relish the opportunity to work with such patients.

But as they shared their experience in the clinic, it was clear that empowered patients in the model of ePatient Dave are the exception. Most of us aren’t so savvy, nor so motivated, to roll up our sleeves and drive our care decisions.  Most patients don’t ask to see their records; most patients don’t take their drugs as prescribed; most patients don’t research their treatment options (though most seem to use the Internet); indeed many patients don’t actually do what their doctors advise at all. Most of us don’t follow the basics of good health: get exercise, eat properly, avoid stress. Just judging by the national obesity rate, too many of us squander our chances to improve our health, and the result is what medicine unfortunately calls “non-compliance” – the failure to follow doctors orders. These good doctors of Minnesota see non-compliance every day in their offices and they are frustrated and baffled by it. As we spoke, it became clear that they were searching for some way to get through to those patients who don’t do what they surely know they should.

In part, this frustration was fueled by the increasingly use of pay for performance measures where doctors are scored and evaluated by their patient outcomes. Though I am in favor of pay-for-performance as a strategy for reducing costs and emphasizing health over illness, it’s evident that there’s lots of work to do getting the metrics right. Too often, it seems, physicians are scored by absolute measures without taking into account their patient demographics or the delta between where a patient entered their care. This blunt measure incentivizes doctors to selectively churn through patients, dropping the unhealthy ones who don’t follow orders (or never accepting them as patients in the first place), and it has the opposite of its intended effect.

More than anything, the conversations underscored what I’d known but hadn’t frankly given much thought to: how difficult and vexing it can be to care for patients. Doctors have a hard job, and I am personally deeply awed by their tenacity and perseverance. As one physician noted, “90 percent of my job is education, and I have no training for that. What I learned in medical school only counts for a fraction of what I’m actually doing every day.” Talking to patients, encouraging patients, getting them on board with the task of improving their health is all about cajoling, persuasion, and lots and lots of education. And that’s a daunting thing.

Every doctor, no doubt, has their own quiver of techniques to address this. Places like Sermo help flush some of these strategies out. But it would be disingenuous of me to advocate for patient engagement so vociferously if I didn’t consider the other side of the equation: How physicians might successfully engage their patients. So drawing on the insights of Dr. Rothenberger and his ace stable of practitioners, and inspiration gleaned from the cardiology nurses of Minnesota, I’ve put together a humble five-point prescription for doctors and other care-providers: Five things they should seek to give every patient, strategies to tap the most underutilized resource in medicine, their patient.

1) Transparency: The all-knowing-physician is a myth that no longer serves patient nor doctor. It sets up false expectations for patients, who often come away from the doctor’s office without the definitive diagnosis or treatment, and it holds the physician to an impossible standard of perfection. Better that everyone lay their cards on the table. Physicians might share what they know about a patient’s condition or course of treatment –  and also make clear what they don’t know. When mulling a course of treatment, let the patient know what the range of choices is, and then explain why the recommended course seems to make the most sense. The presumption that patients can’t handle ambiguity, that they can’t parse probabilities, is entirely wrong. Life is ambiguous, it is uncertain, and we all inherently understand that. Outside of medicine, we experience it every day. Making the ambiguities evident, shining a light on the dark, so to speak, lets patients reckon with their health just as they do with other parts of life.

2) Repetition: For doctors and nurses, the hospital or clinic is their office. They’re used to it. It’s routine. For patients it’s anything but. White coat syndrome extends way beyond higher-than-usual blood pressure. Every comment from a doctor or nurse is charged, every word choice studied for inflection. But that doesn’t mean we’re actually grasping what the doctor is saying. Even if our needs are minor, for patients the doctor’s office is charged with anxiety and fear. That look on our face? It means you’ve lost us.

And then, when we’re out the door, anything we did understand is gone. I know this personally:  I have listened deeply to a suggestion that I take an over-the-counter medication, and then, by the time I get to Walgreens, blanked on the dosage and frequency my doctor suggested. Anything that’s not written down – i.e., everything except a prescription – is going to be lost. If your patient doesn’t bring a pen and paper, write your advice down for them.

3) Resources: It’s no surprise that I think patients should get full and immediate access to their records, notes, and lab tests. Even if the patient can’t make heads or tails of it, it’s an important gesture of reciprocity, partnership and, I would argue, ownership. This stuff is ours. But there are other resources that a doctor can help their patients with. I’m not talking brochures and pamphlets – I’m talking about the Internet (again). In part this is simply pragmatic. Patients are going to go there in search of more information and answers, and they might as well start where their doctor suggests they do. And there’s no reason this shouldn’t augment the doctor’s care; they’re already overworked and pressed for time. Use the outside world, identifying informative websites and online support groups.

And about the Internet: Physicians should flush out this elephant in the room. You know your patient is already on there, doing all sorts of research. What they find may not be relevant, but it’s filled their heads with ideas. Even if they don’t come in with papers and print outs, they’ve already got preconceived notions about what’s wrong and what they might do. Get it on the table. Ask patients what they’ve read online about their condition (this is quid-pro-quo transparency). Listen. And then, if necessary, explain why it doesn’t pertain. Even the most misguided patient has taken a worthy first step towards engagement – they care about their health. Start there and use it.

4) Patience: Just because patients don’t do what you tell them to, that doesn’t make them irrational. They may have what, to them, seem like perfectly reasonable reasons to ignore their doctor’s advice. Understanding these reasons, flushing them out, can be a way to pursue other, more promising approaches. Conversely, just because patients may not do what they should doesn’t mean they’ve given up, that they’ve decided to live in ill health. Failure is a part of life, and it certainly is a part of our health (witness the eight or so times it takes a smoker to successfully quit). But humans are resilient creatures, we are persistent, and helping patients understand that they can make their way towards better health with a few missteps comes as a great relief. Take it from a Catholic: Going to the doctor’s office is very much like going to the confession booth, and in both places the confessor is probably embarrassed to tell the full story. Diffusing that anxiety, forgiving the missteps, can be a great motivator.

5) Goals: A great impediment to sustained and better health is the fact that we don’t think about it that much. Most doctor’s visits, after all, are about a problem (it bugs me to no end that the intake form at many doctor’s offices, including mine, presumes poor health with the first question: “What is your Chief Complaint?”). Even if that’s why we walked in the door, that shouldn’t be how we walk out. Rather than send patients out with a to-do list, physicians might send them out on a path, with milestones and purpose. Fact is, we do better when we have an objective, when we feel that we’re making progress towards something – that’s human nature. A great way to create engagement about health is to create a sense of purpose, that the drudgery of tasks required – new drugs and new diets – isn’t just managing our health, but is in fact building towards something.

So that’s my prescriptions for doctors. No doubt putting these into action would require, first and foremost, time – perhaps the most precious resource a physician has. But my hope would be that they could be worked into the habits and dialogue that already take place, and that they might make that communication smoother, less fraught, and more productive. I would be eager to hear if there are other strategies out there.

In other words, when starting a new, healthy behavior (say exercise), knowing ten random people who run may help motivate you.  But if that group of ten people is a close-knit group of running buddies who all know each other, the chances of sticking to your new routine go up.  Way up.

photo via Flickr/vestman