Archive for: February 2010

Super-empowered, Hopeful Individual.

Feb 17, 2010, 12:50 AM, Posted by Deborah Bae

This is a phrase  Jane McGonigal, game designer, used to describe the type of individual she believes gaming can produce. But the term is also fitting for what I feel right now after attending TED2010. I listened to some of the most intelligent, passionate speakers on a broad range of issues — from zapping mosquitoes (Nathan Myhrvold) to suspended animation (Mark Roth). I feel super excited, energized and optimistic, but I’m left with the question, “now, what?”  Of course, I’ll talk about TED with friends and colleagues in the coming days and I might use www.wolframalpha.com for computational type searches, or download Andrew Bird’s album — but is that it?

One talk that feels “actionable” is Esther Duflo’s presentation on using randomized trials to study the impact of anti-poverty interventions in Africa.  Instead of trying to answer the big, controversial question, “Does (monetary) aid work?,” Duflo tries to answer smaller, local questions that provide insight to the big question. For example, mosquito nets are highly effective for preventing malaria, but they’re not being used widely. Duflo wanted to know why and whether cost had something to do with it.  Are poor villagers were more likely to use mosquito nets if they have to pay for them (at a low, subsidized price) versus getting them for free?  Her research showed it’s more effective to give them away for free.

While Duflo talked about global health and poverty alleviation, the concepts she talked about can be applied to the U.S. health and health care system. Instead of asking big questions like “Does prevention work?” or “Do we need universal coverage?” perhaps we can ask a series of smaller, answerable questions. 

What are some of these smaller questions that can provide insight into the bigger health and health care questions?

Behavioral Economics and Public Health at TED2010

Feb 16, 2010, 12:58 AM, Posted by Paul Tarini

I particularly enjoyed the TED talk by Elizabeth Pisani, author of the book, The Wisdom of Whores. A former journalist whose work now focuses on drug users and sex workers, Pisani has a PhD in infectious disease epidemiology from the London School of Hygiene and Tropical Medicine and spoke on the second morning, one day after Princeton’s Daniel Kahneman, the father of behavioral economics.


Pisani voiced frustration during her talk about the mismatch between government policies and public health approaches and what influences the choices sex workers and drug users make. Her argument drew on the analytical framework behavioral economists like Kahneman have used so effectively to describe and understand the choices people make.


Pisani dismissed the field of public health as being limited by its reliance on a rational model to develop intervention programs. (TED likes iconoclasts.) In the case of sex workers, public health initiatives tell them engaging in unsafe sex with multiple partners can seriously compromise their health, presuming they will stop because it’s the rational choice to make. But Pisani argued that, in Indonesia, women become sex workers, in part, because they can make as much as five dollars a day when the average daily wage is 20 cents per day, a context that shapes their decision making.

I spoke with Elizabeth after her talk and asked her whether the field of public health could benefit from importing principles from the field of behavioral economics to improve analyses and interventions. She believes we need to focus on government and train political scientists in order to have better policy.


Thoughts?

The 90-minute TED

Feb 16, 2010, 12:36 AM, Posted by Steve Downs

Much is has been written about TED 2010, so I thought I’d just chip in with a quick list of my five favorite TED talks that I urge people to watch online once they’re posted. (We’ll let you know via Twitter  — @pioneerrwjf —  when they are.) Before I get to the top 5, though, I do want to plug the talks by two of our Pioneer grantees – Nicholas Christakis and Philip Howard. If you haven’t had a chance to hear Christakis take you through the discoveries he made about the role of social networks in obesity and happiness or Howard put forth his ideas on how to change the legal system (and with it the way we approach malpractice in health care), please check them out on TED.com.

In no particular order, my five faves were as follows:

  • Michael Sandel – a master teacher takes the audience through the meaning of justice.  Warm, funny and profound.
  • Mark Roth – a natural storyteller tells a captivating tale of scientific inquiry as he seeks to understand a new and surprising way of saving people’s lives.  You get such an authentic sense of Roth’s curiosity and the joy with which he pursues his work.
  • Sam Harris – a forceful argument for bringing expertise, knowledge and discoverable facts about how communities flourish into discussions of morality and values.
  • George Whitesides – a thought-provoking and highly functional interpretation of simplicity.  “Simple” components are reliable, repeatable and predictable – thus they can be “stacked” to create remarkable systems
  • Jake Shimabukuro – a virtuoso ukulele performance that you have to watch with the screen maximized and the sound way up.  Pure exhilaration.

Oh – and check out blippy.com – a site where you stream your credit card transactions to a social network, which sounds like the definition of conspicuous consumption but it might not be as crazy as it sounds – you could eliminate expense reports, for one thing.

You Have More Personal Health Data. Now What?

Feb 10, 2010, 1:31 AM, Posted by RWJF Blog Team

All of the attendees of the Pioneer Portfolio-sponsored luncheon, "The Coming Revolution Data-Driven, Patient-Centered Health Care," tomorrow at TED will receive a BodyMedia Fit personal health monitoring device, courtesy of BodyMedia. The gracious folks at BodyMedia believe, as we do, that "getting to know your body better will help you make powerful, positive changes in your health."

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The Pioneer Portfolio wanted to provide everyone who attended the luncheon with the opportunity to have these devices because we see it as a simple illustration of how personal health data can be used to make better decisions about diet, sleep and exercise, all of which could lead to better health outcomes.

At the event, Paul Tarini, Pioneer's Team Director and the moderator of the discussion, will ask each of the participants to — after they have used the device for a day — to visit Pioneering Ideas to share their experience with the device. We don't want to know if it clashes with their outfit or if they can't turn it on (although BodyMedia would be happy to provide them with technical assistance). What do we want to know? We want to know that — now that they have this information — what are they going to do with it? Is it causing them to adjust their diet? Is it compelling them to get more sleep? Is it providing the incentive they need to get up and get more exercise? Are they going to consider any of the data patterns and share them with their doctor the next time they have an appointment?

Come back and see what they have to say.

How Can Health Data Transform Health and Health Care?

Feb 10, 2010, 1:15 AM, Posted by RWJF Blog Team

As Susan said, the Pioneer Portfolio is at TED this week.

In preparation for the event, we produced a video, "The Coming Revolution Data-Driven, Patient-Centered Health Care," calling on team members, other experts and Pioneer grant recipients to share their viewpoints on how actionable health data could transform the top-down, doctor-driven status quo of health care on its head.

The interviewees included the following:

  • Patricia Flatley Brennan, R.N., Ph.D., Lillian L. Moehlman Bascom Professor, School of Nursing and College of Engineering, University of Wisconsin-Madison, and National Program Director, Project HealthDesign
  • Dr. Tom Delbanco, M.D., Richard and Florence Koplow-James Tullis Professor of General Medicine and Primary Care; Chief, Division of General Medicine and Primary Care Beth Israel Deaconess Medical Center and Project Director, OpenNotes
  • Stephen Downs, S.M., Assistant Vice President for Health and Pioneer Portfolio team member, Robert Wood Johnson Foundation
  • David Eddy, M.D., Ph.D., Founder and Chief Medical Officer Emeritus of Archimedes
  • Thomas Goetz, executive editor of Wired magazine and the author of the book, The Decision Tree
  • James Ralston, M.D., M.P.H., practicing internist and investigator at Group Health Cooperative and at the University of Washington in Seattle, Project HealthDesign
  • Paul Tarini, M.A., Team Director of the Pioneer Portfolio, Robert Wood Johnson Foundation
  • Steve Woloshin, M.D., M.S., professor of medicine at the Dartmouth Institute for Health Policy and in clinical practice in the VA Outcomes Group at the White River VA in White River Junction Vermont; Project Director, Drug Facts Boxes

There were a number of points that rose to the surface for us in our conversations:

  • Data on its own is not enough. It needs to be actionable.
  • Data needs to be accessible — to patients, policy makers and health care providers — to enable them to make better decisions.
  • "Every day" data needs to be considered and can be as valuable as lab tests in its impact on your health outcomes: how much you sleep, how much exercise you get, whether or not you are fighting with your spouse.
  • The focus needs to move away from the clinical setting to the individual's homes and the other settings where they live their lives. Doing so will require a number of changes, including the need to address how health care providers are able to bill for their services.
  • Patients and providers need to look at their relationship as a collaboration, which is going to require shedding old baggage about power dynamics in the doctor-patient relationship.
  • Technology offers new opportunities, but it is not the silver bullet. The technology cannot be intrusive; it needs to be a part of an individual's life.

What do you think? What would you add to the list? How can health data lead to better health outcomes and transform health and health care?