In these days before the book comes out – tomorrow! – there have been some wonderful write-ups about the book. Just thought I should note them here.

Kent Bottles wrote a piece titled “Check Lists and Decision Trees” that mulled whether structures like a decision tree can help people negotiate the huge information dumps that come with data-driven medicine. Besides the flattering proximity to Atul Gawande’s book, Bottles was generous in grasping the fact that I’m not claiming a decision-tree paradigm depends solely on rational decision making (which is inevitably unrealistic) but that I’m trying to find a way to bring our rational capacity together with our emotional needs – and therein lies better healthcare.

Brian Ahier wrote a terrific post on O’Reilly Radar, largely about the book. Riffing off one of my set phrases – it’s data, not drugs – Brian – who’s not only a health IT expert and blogger but also a member of his city council – nailed the promise and riddle of turning to a data-intensive model for healthcare. As he puts it, “Putting the patient at the center of healthcare and creating a strategy to process all of health data available today is a great start towards meaningful healthcare reform.” I was especially glad that Brian recognized the flexibility of my three principles for patient-centric health: Early is better than late; Let data do the work; and Openness is a powerful thing.

And Susannah Fox of the Pew Center lobbed a characteristically provocative take recently on e-patients.net. Her take: that the book could be retitled What to Expect When Your Expecting a Long Life. (Fine with me; those What to Expect books are huge!). In addition to the flattering notion that the Decision Tree compelled Susannah – a longtime health expert – to rethink her own health decisions, she astutely recognizes that I’m not just calling for self-tracking gadgets and gizmos – I’m really arguing that we should use whatever tools we have, including messaging from the FDA and other official bodies – to make health information clearer and more personalized.

It’s very heartening to me that three people who constitute experts in the field all seem to think the book is in tune with their own knowledge – that the notes are right, and that the composition is in the right key. My hope, of course, is that the book will also find a larger, less-expert audience, but my hunch is that unless I convince the experts, the lay audience won’t be there. If these three are any indication, I’m on the right track.

Lastly, I want to address some Twitter kibbitzing that these ideas are simplistic, naive, or somehow dangerous. I take some assurance that so far, this chatter comes from people who haven’t read the book – because the book itself goes to great lengths to explore both the promise as well as the perils and challenges of engaging in patient-centric healthcare (challenging both for the patient and the system). There is ample evidence presented in the book; the bibliography alone runs to 15 pages. Of course, I’ll answer this head-on when I have the chance. But broadly, I’ll offer this:

There is hope in the book, yes; there is a simplicity to the idea, indeed – but naive or simplistic it is not.

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Just a quick post to acknowlege a few changes here. First, we’ve redesigned the website for www.thedecisiontree.com. Based on recommendation from Wired’s Nick Thompson, I hooked up with Jefferson Rabb, a brilliant designer and thinker (& musician!) to retool the blog.

Jeff also gave life to something I’d been thinking about but couldn’t, on my own, have ever created: The Decision Tree widget, which lets you build your own Decision Tree for a variety of health concerns. The widget is a great way to give people an idea of what the Decision Tree trope actually means, to put the idea to work. Jeff has done a superb job turning this whim into reality, and I’m eager to hear what people make of it. It’s also an experiment in – possibly – viral media. The widget is sharable, and you can embed it on Facebook or your own site (click the little icons or the “EMBED CODE” line at the bottom). Please feel free to play with it, pass it around, and let me know what comes of it.

Next, there’s an adaptation of the book in the new February issue of Wired. You can see it here online, but it even works better in the print magazine.

Last, I’ve put up an excerpt of the book – which is now less than a month from official release – here on the site. It’s chapter 1, and it gives a good peek at the style and ambition of the book, which (I hope) offers a synthesis of public health research, technology trends, and reporting.

OK – that’s all for now. Next word here will be about science & healthcare, not book marketing.

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Usually, we think of preventive medicine as a first-person experience, e.g. what we can do to keep ourselves healthy. But preventive medicine includes steps to keep our families healthy as well, as in the case of an elderly relative, or a newborn baby.

My first postdoc stint was in a developmental neuroscience lab at UCSF, where many talented researchers spent years answering questions like, “How do different types of environmental noise affect the development of the auditory system?”. So when a friend of mine sent me a message the other day, asking about using a white-noise generator to stop her crying, colicky baby, some red flags immediately went off in my head. Because I’ve been asked this question several times over the past few months, I decided to post my take here.

There’s been a lot of anecdotal evidence that white-noise calms a crying baby. In fact, some parents swear by the method. But this is a clear case where the science disproves the hype. In 2003, our lab at UCSF published a study in Science Magazine with a striking finding. The auditory system of newborn rat pups, which normally progresses like clockwork, was under-developed after the pups were exposed to white noise compared to animals raised in normal conditions. But why would white noise cause a problem with the development of the brain?

First, let’s look at what happens to the auditory system during normal development. When rats are born, the area of the brain responsible for making sense of sounds, the auditory cortex, undergoes constant changes. Scientists refer to this phenomenon as brain plasticity. Newborns are unique because brain plasticity occurs just by passive exposure to sounds during a very well-defined time in development called the “critical period”, which lasts through several postnatal days in rats. A correlate in humans might be the fact that children learn new languages just by being exposed to sounds, while adults have to spend hours studying, memorizing, and practicing. This developmental period is a crucial time for a newborn, where the brain “sets” itself to efficiently process its native language.

When white-noise was played for the newborn rats, the lab found that the “critical period” remained open indefinitely, which means there was a delay in normal brain development. For this reason, members of the lab were against using white-noise generators on newborn babies. Theories suggest that the white-noise might interfere with a newborn’s ability to grasp its native language, leading to progressive developmental problems.

Even if the results found in rats did not directly carry over to humans, I really feel that you just shouldn’t screw with Mother Nature when it comes to brain development. I’m not a parent, and I can only imagine the empathy, or even frustration, that ensue when a baby is crying hours on end. But using white-noise generators just doesn’t seem like the best answer. Our brains evolved to process biologically- and socially-relevant sounds, and exposing newborns to extremely unnatural sounds seems like an needless gamble.

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We are excited to let our readers know that all of our posts here at The Decision Tree will now also appear on Medpedia’s News & Analysis site.  Medpedia has created an exciting collaborative health and medical information portal, that seamlessly integrates with patient communities, health-professional networks, and discussion forums.

As one of the blogs featured in their News & Analysis section, our posts, along with posts from some other really fantastic sites, will help Medpedia bring the most relevant health-related information from the blogosphere to its readers.

If you haven’t done so already, head over to Medpedia and check out their site.  Read it, bookmark it, and get involved with it!

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We had some technical issues here at The Decision Tree, and had to do some site maintenance to get the blog up and running again.  So, we apologize for not having any activity recently.  It looks like we are back up and running, and we hope to get some really good posts up here soon.

In other news, I am working on a side project over at Nutrition Wonderland, where I will be focusing specifically on diseases of the brain.  My first post went up today!  It’s a great site that deals with the intersection of diet/exercise and disease, so wander over there and check it out.

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My first exposure to cells, DNA, and genetics was in the 4th grade.  Our first assignment was to create a cell model, complete with organelles, a nucleus, and DNA, out of clay and candy.  My gray-colored clay cytoplasm was laden with jellybean mitochondria, a licorice nucleus, and Tic Tacs to represent chromosomes.  It was a modest simplification of the true wonders of our cells and genetic structure, but it was the highlight of the lesson.  Although not at all to proper scale, and biologically unsustainable due to missing structures like M&M golgi bodies and a gummy worm endoplasmic reticulum (which ended up in my stomach instead of in the clay), the lesson brought biology to life for me.

So I was thrilled to hear the National Society of Genetic Counselors (NSGC) is participating in National DNA Day 2009 by reaching out to students across the country.  Genetic counselors will talk to the kids about DNA, genetic testing, and the genetic counseling profession.  Apparently our education system has come a long way on DNA education from its candy-model roots.  With the advent of personal genomics upon us, it is crucial for the rising generation to understand what genetic screening is all about — and who better to present this information than NSGC members, who are the interface between genomic technology and its users.

A press release describing all of the efforts of the NSGC on DNA Day 2009 can be read here

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Though predictive medicine and preventive health are common sense to some people, sometimes I have the feeling that I’m shouting into a hurricane about how the right tools & the right information can change healthcare. So I’m always thrilled – truly thrilled – when somebody tells me: “I read what you wrote – and I’ve been thinking the same thing.”

A couple years ago I had this experience when I got an email from a fellow with some astute questions about my approach to writing about science. Except this wasn’t a journalist – this was from a scientist. And that both flattered and scared me. Flattered, in that a bonafide PhD took my stuff seriously. Scared, in that a bonafide PhD was reading my blog – and taking it seriously.

This fellow’s name was Brian Mossop, and he proved an especially intriguing guy. I’ve spent 20 years figuring out how to keep abreast on the zeitgeist, but this guy – in his mid-20s – seemed to already be surfing the wave. He got the power, the promise, and the pitfalls of healthcare technology. And he understood that the real power of medicine wasn’t when it was deployed on a one-to-one basis, but when it could be catylized to hundreds or thousands. In other words, giving people access to information could be more important than the creation of that information (research) in the first place.

And so we kept talking. And sure enough, when I came around to the whole Decision Tree idea, Brian Mossop was one of the first on board. Not only did he get what I was talking about, he was already starting to research the same stuff – predicitive medicine, personal metrics, genomic data, health information in the hands of the individual – all on his own.

Well, this made no sense to me. He didn’t even have a blog, & here he was thinking the same stuff. So now he has a blog. This blog. I’m proud and happy and once again flattered to announce that Brian Mossop will be joining me here at TheDecisionTree.com, blogging about the frontiers of health care. And in the process, he’ll be helping lay out the themes and particulars that I’ll be exploring in the book.

Here are his bonafides: Brian received a BS in Electrical Engineering from Lafayette College, and a PhD in Biomedical Engineering from Duke University in 2006, where he worked on electric field-mediated gene and drug delivery, primarily for cancer treatment.  He did postdoc work at UCSF, then a few a Bay Area companies, and now he focuses on basic neuroscience and neurodegenerative disease (using electrophysiology and imaging). He won’t be blogging about his day-job here – he’s here strictly as a science-savvy informed observer of where data and openness and prediction are taking our healthcare system.

In his own words: “The concepts behind the Decision Tree will help create a more proactive healthcare system, where consumers and patients take initiative in the prevention and treatment of disease.  I have worked in multidisciplinary teams since moving into the biomedical field, and I have learned that progress is best made when you look at problems from different points of view.  I hope to continue this philosophy here at the Decision Tree, and leverage my scientific training to address some of the issues facing the rise of predictive medicine in society.”

It’s a real thrill to have such a partner in making this blog all it can be. Please make Brian welcome – but hold him to the same standards you would me. In other words, feedback is welcome.

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