For several months I've been a regular at the Quantified Self meetups, where people of great passion for self-tracking present the results of their experiments in self-monitoring. These vary in everything from people who record themselves sleeping (in search of better sleep) to people who monitor the amount of coffee they drink to the mililiter - and then compare that to their productivity. One thing that I've noticed is that there's a general presumption, among the QS crowd, that self-monitoring - i.e., feedback - is an experiment with evidence behind it. That is, that self-monitoring works, insofar as it helps people reach a goal, whether it's to drink less coffee or get better sleep or lose weight. But there's not often any actual evidence presented, beyond these experiments (where N=1, often enough). So tonight, drawing on research from my forthcoming book, I'm presenting a few points of fact that support the notion that feedback can lead to improvements in health. This post will serve as a primer for those not in the audience, and for those in the audience a repository of links to the research cited.
Read MoreOne morning, a little over a year ago, I woke up with a very sore, and slightly swollen elbow. I remembered that I had cut my arm on a neighborhood bar table while watching a football game with some friends a few days prior, and I wondered if the cut was infected. I made an appointment with my primary care physician, who quickly diagnosed me with bursitis, an inflammation of the fluid-filled sac that pads the elbow. Since I had broken skin, the doctor wisely prescribed clindamycin, an antibiotic, to treat any tissue infection that may have seeped in. As the hours crept by, the pain in my elbow worsened, until I woke up in the middle of the night with extreme arm pain. I immediately checked the elbow that had been swollen the previous day. The swelling had doubled in size, and the skin was an angry-red color. The following morning, I was back in the clinic, and my doctor started to suspect that this was no ordinary infection on my elbow, and may in fact be a drug-resistant staph infection. Gulp. Nonetheless, he felt confident that the clindamycin should clear it up.
Read MoreJust a quick update that I've begun posting now and again at the Huffington Post, for their living section. Some of the material will be familiar to readers of TheDecisionTree.com, where Brian & I wade deeper into the science of personalized medicine, but the more-populist forum of HuffPost is a good way to test the principles and larger messages that are sometimes taken for granted here. My first post a few weeks back, Welcome to the Era of Personalized Medicine, argued that the idea of tailoring healthcare to individuals has arrived - but that it may take some work on our part to take advantage of it. The basic premise is that personalized medicine is about data, more than drugs (specifically the notion of pharmacogenomics where drugs are matched to specific genetic traits).
Read MoreA smart post by The Sunlight Foundation's Nancy Watzman has me thinking about what it really means to have access to all of our personal health data. In the past, I've myopically viewed personal health data as anything that my body produced, in one way or another, and now sits in my shadowy file at the doctor's office. Things like X-rays, MRIs, and blood test results. No doubt, I should have access to all of this information. What about prescription medication? Sure, I can easily make a list of the meds I'm currently taking, or get my doctor to hand this list over if memory fails me. But how much do I really know about these drugs? Most people, myself included, take our doctor's word when he or she decides to put us on a commonly prescribed medications. For example, let's say a patient has blood-work that shows elevated LDL cholesterol on two consecutive screenings, comes from a family where cardiovascular disease runs rampant, and was previously unable to regulate cholesterol levels with strict diet and exercise regimes. If the doctor prescribed Lipitor to treat the problem, a patient may not even think twice about taking it. After all, we see commercials for such drugs on our TV, and we flip past their ads in our magazines. Direct-to-consumer marketing by pharmaceutical companies makes drugs familiar and, presumably, safe.
Read MoreOne of the themes of The Decision Tree - both the blog and the book - has been the idea of self-tracking: the notion that when people monitor their health, they are more likely to improve their health. In the aggregate, that's true - research shows that when people start to track or even care about their health (when the start to feel vested in it, and in control of it) they tend to have better outcomes. That's a powerful and important message, one that I believe hasn't really gotten widespread recognition - and I hope one benefit of the book is that this message will spread and help change people's lives (as well as the approach of care providers, who may have heretofore been reluctant to engage their patients in their own care).
Read MoreI just finished reading Dave Dobbs' new article in the the December issue of The Atlantic, "The Science of Success". Dobbs turns the classic question of Nature vs. Nurture, whether our genes or our environment are the deterministic drivers of our fate, on its head. Traditionally, those who support "nature" say that our genes are most influential in defining us. On the other hand, those that support the "nurture" side say that our environment plays a more important role. Based on new research, Dobbs introduces the idea of two types of people, "dandelions" and "orchids". Dandelions can thrive anywhere, despite their environment or upbringing. Orchids, however, are more temperamental, and require a stable environment to survive. At first glance, the orchids may seem like a liability, and in fact, they often carry genes that make them susceptible to mood disorders and psychological disease. The astounding part of Dobbs' report is that he shows that given the right care, or environment, the orchids don't just do OK, but far surpass the dandelions in perfomance. In other words, given the right training, orchids may in fact be destined for greatness.
Read MoreWhile attending the Institute for the Future's Health Horizons Fall Conference on Monday, one thing became eminently clear. The 21st century will be the era of brain, the last great scientific frontier. Due to societal shifts, environmental changes, and the fact that we are just living longer, we are poised to see a sharp rise in cases of diseases such as Alzheimer's, Parkinson's, autism, and post-traumatic stress disorder. The only thing worse than the increasing prevalence of brain disease is the sobering fact that few viable treatments currently exist.
Read MoreUsually, 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.
Read MoreA few months ago, a story ran in Wired Magazine that described a noticeable shift in the scientific method, and attributed the change to our ability to produce and store large amounts of data.Historically, the scientific method was built around a testable theory. But in the 21st century, theories were becoming obsolete; the data simply spoke for itself.
Read MoreJapan's population is about to tank, and with it, will fall the world's second largest economy. In roughly 100 years, the country's population will decrease from 127 million to 44 million. The outlook is bleak, as birth rates are at an all-time low, and the country maintains the highest proportion of senior citizens in the world. By 2050, the Japanese workforce could decrease by as much as 70%. An entertaining segment on Current TV explored both the cause of, and a possible solution to, Japan's population catastrophe.
Read More