I’ve been out of the country for the past weeks, which may explain my silence on the blog.

However, while I was gone, my latest post at Wired Playbook ran on September 29th.

At the 2008 Summer Olympics in Beijing, swimmers set 25 world-record times while dominating the National Aquatic Center’s pool. By comparison, only five world records changed hands during the track and field events. But many of those swimming records fell only as a result of newly instituted bodysuit technology, relative advances that aren’t applicable to runners, high-jumpers, and shotputters.

Have humans reached their peak athletic performance? One study argues that’s the case, and that without the continued use of technology, the past roars of Olympic crowds will one day be nothing but whimpers in the stands.

Read More here.

photo via Flickr/marcopako

Berthelot, G., Tafflet, M., El Helou, N., Len, S., Escolano, S., Guillaume, M., Nassif, H., Tolaïni, J., Thibault, V., Desgorces, F., Hermine, O., & Toussaint, J. (2010). Athlete Atypicity on the Edge of Human Achievement: Performances Stagnate after the Last Peak, in 1988 PLoS ONE, 5 (1) DOI: 10.1371/journal.pone.0008800

Sorry, but this post is nothing but shameless self-promotion!

My first short feature article was published in Scientific American today, which discusses the neurobiology of the father-child bond.  Give it a read!

Last May, I took a trip to San Diego for my brother-in-law’s graduation from college, and to meet his 4-month old son, Landon, for the first time. Throughout the weekend, I couldn’t suppress my inner science nerd, and often found myself probing my nephew’s foot reflexes. Pressured from my wife’s disapproving looks and the blank stares I received from her family as I explained why his toes curled this way or that, I dropped the shop-talk in favor of baby-talk.

Click here to read the rest.

I had the opportunity to write a post at the new blog of The Scientist magazine, “Naturally Selected“.  The post is not about preventive medicine.  Rather, it taps into my neuroscience roots, and discusses the basis of intelligence in animals.  Here’s an excerpt:

Ever since the size of our brains outgrew our closest animal relatives, we humans have declared ourselves far smarter than any other creatures in the animal kingdom.  But our big brains, and bigger egos, may underestimate the intelligence of other critters, simply because we’ve been asking the wrong questions. A study published in January in PLoS One shows that if we define intelligence not in terms of communication but in terms of problem-solving, then our animal brethren may be a lot smarter than we’ve given them credit for – starting with the rat.

Read the entire post here.

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.

In my continuing experiments with getting the message out about the Decision Tree book through all available means and media, I came up with this short video that tries to convey the main challenge facing individuals and their healthcare, and the opportunity that a decision-tree approach offers (engagement improves outcomes).

I was ably aided by my friend David Knowles, a gifted writer and musician who contributed the soundtrack. My thanks to him. Frequent readers of this blog will no doubt be familiar with the ideas, but my hope is that the video may have some potential to engage a broader audience (so link to the video – it’s on Youtube here – and help spread the word!). As the video makes clear, we indeed face in a health crisis in the US (not just a healthcare crisis), and making people aware of the problem and the potential for them to work towards the solution is essential to moving the needle back towards better public health.

Also should say that MP3 podcasts of the Introduction and Chapter 1 are up and available. Enjoy!

In my opinion, our inalienable rights should be restated as the title of this post suggests.  But despite my wishful thinking, health care costs continue to rise.  By 2030, the boomer generation will place 57.8 million people in the 66-84 age group, further burdening current government funding for Medicare.  The outlook is bleak, and the system needs fixing.  One idea for lowering health care costs is to move health services out of the clinic, and into the home.  New web-based services and personal diagnostic equipment now enable patients to receive medical care from the comfort of their living room.  Is it realistic this model will reduce costs and stick?  I’ll cover the web-based services in this post, and follow up with another post on home diagnostic equipment.

Web-based doctor’s appointments are now available in several states.  For example, at $10 per month, and $50 per consultation, SwiftMD offers an online health care plan in New York and New Jersey.  Within 30 minutes of scheduling an appointment, subscribers have either a phone conversation or an online video chat with an available physician.  If prescriptions are required, the physician sends the request electronically to the pharmacy of the subscriber’s choice.  A step further in service, Hello Health adds conveniences such as the ability to text, instant message, or tweet your doctor, and also offers clinic appointments or house calls for more serious conditions.  Both SwiftMD and Hello Health do not cover major medical expenses, so if the subscriber has to go to the emergency room or be admitted to the hospital, the cost is theirs.  Also, neither accepts insurance, but compared to ever increasing health insurance premiums and the number of uninsured patients, an affordable “pay for what you need” model may just work.

A recent article highlighted the services of Hello Health, and discussed the ways electronic media is reshaping health care.  More important than describing cool, new ways to communicate with your doctor, and boutique concierge services offered by modern clinics, the article does a fine job pointing out the importance of social networking in the future of health care.  Physicians use websites such as Sermo and UpToDate to stay abreast of advances in health care and treatment, as well as to network with other doctors in the field.  Patients, on the other hand, have traditionally been stuck with tools such as WebMD, NIH’s MedlinePlus, and the Mayo Clinic site, all of which just give background information on diseases, and pave the way for dangerous self-diagnosis.

Such patient websites provide little help to the proactive patient who is curious if others with a certain condition are experiencing similar symptoms or medication side effects.  Enter PatientsLikeMe, a website that focuses on user-generated data (via self monitoring and reporting) and lets others know what to expect on the road ahead.  PatientsLikeMe provides a useful social networking community if you are already diagnosed with a condition, but what if you are a 40-something male with a BMI of 28, blood pressure at 135/85, and recently diagnosed with metabolic syndrome?  Is there anyone out there with similar stats that can offer information about what regiments have kept them healthy?  In other words, let’s not wait until we are diagnosed with heart failure to seek out advice from our peers — we need social networking tools when we are still just “at-risk” for the disease.

While electronic access to your physician is much cheaper than going to an office visit, to truly drive health care costs down, we need to increase the personal responsibility of the public — we need to heighten our medical knowledge, track our own body metrics, and pool our data.  Social networking sites provide the necessary framework to disseminate such information and personal experiences across large populations.  Armed with the proper information, patients will be able to make their own decisions about their health.  Now that’s a true health care revolution — so go tweet your way to better health.  I’ll discuss home diagnostic testing soon…

Despite the holiday doldrums, there’s been lots of great responses out there to my Truth About Cancer story in Wired. But my favorite is this amusing tidbit: Friends know I’m an avid cyclist – inspired, in fact, by my father in law, a ferocious cyclist and athlete who died of bladder cancer in 2001. The closest I’ve come to fandom in recent years is rooting on Lance Armstrong through his seven Tour De France wins (very eager to see what happens this year with his comeback).

So imagine my glee when I was forwarded this Tweet from Lance’s Twitter feed:

Sitting by the pool reading the new WIRED. Cover story called “The Truth About Cancer”. Good read and right in many ways. about 6 hours ago from TwitterBerry

In addition to his cycling prowess and his famous history with cancer, Lance has turned his Lance Armstrong Foundation into one of the most recognized and most formidable nonprofits out there working on cancer. I’m glad to see that he agrees that early detection and smarter screening are integral to the fight.

A quick note that my latest story for Wired, on the emerging science of early detection of cancer, is now on stands (and online).

The story focuses on the Canary Foundation, a Silicon Valley-based nonprofit that’s funding an innovative approach to cancer research: strictly focusing on developing two-step tests that will spot various cancers in their earliest stages, when the odds of successful treatment are highest.

My effort here was to explore how early detection – which sounds obvious on its face; of course we should find cancer early – in practice creates a series of riddles and/or paradoxes. For instance, when you’re looking for something floating in the bloodstream (a molecular signal of early cancer), how can you be sure it’s present in high enough volumes early enough to be worthwhile as a test? Or: What if a test is great at spotting cancers that, paradoxically, may not actually be lethal, and thus may not merit immediate treatment? What I find admirable about the Canary Foundation approach is that they don’t look at finding a protein or a DNA signal as the be-all/end-all of a valid test – it’s just the beginning the a statistical parsing that may or may not result in something clinically useful.

If it’s not obvious, the connection to the decision tree thesis is this: Finding disease early, when treatment choices are various and have more promise of success, is a far better position to be in than waiting for symptoms and late-stage treatments. My hunch is we’re going to be moving towards more and more screening tests for more and more conditions. The challenge will be striking a balance between good tests that and the expense of too much screening and too many false signals.

Oh, and a shout-out to Wired’s design department, helmed by Scott Dadich, which always does an ace job turning some rather sober writing on my part into something alluring and cover-worthy.