Monthly Archives: March 2014

entrepreneurship, healthcare, policy, quantified self, startup

Rock Health visits Australia – preview

 

 

 

FUELLING CHANGE IN AUSTRALIA’S HEALTHCARE THROUGH TECHNOLOGY; LESSONS FROM ROCK HEALTH

By Melia Rayner | February 27th, 2014 in Intelligent Thinking First, Technology Second

Cellscope oto

Above: Rock Health funded startup CellScope are reinventing the otoscope (image courtesy of Yahoo)

Social change through technology is all around us, in the way we shop, communicate, pay bills and arrange services. So why has the incredibly important area of health been so slow to move in line with the digital economy? Australia has led medical breakthroughs in the past; from the implementation of the first bionic ear in 1982 to the cervical cancer (HPV) vaccine in 2007, but the past few years have seen our healthcare landscape struggling to get further than the ‘middle of the pack’.

Elsewhere, the digital health movement is growing rapidly. In Washington, a startup called KitCheck helps hospital pharmacies process medication kits faster and without error, whilst in San Francisco CellScopehas built a smartphone-enabled diagnostic toolkit, including a digital otoscope. Even global magnates have put resources and teams into developing health innovation, such as General Electric’s Logiq; which is an ultrasound for the whole body, and Walgreens’ Pill Reminder app and Find Your Pharmacist web tool.

All the companies above have capitalised on the need for social change in healthcare through the vehicle of technology. Utilsing innovations in technology to solve human problems is behind everything we do at Portable. The point at which culture and technology meet is where social change can really happen. It’s in this mission that our maxim ‘Intelligent thinking first, technology second’ hits home; in the utilisation of technology to support social change rather than commandeer it.

This is why we’re bringing out a digital health innovator like Dr. Nate Gross as part of our Portable Talksseries. Nate’s company Rock Health provides startups (such as KitCheck and CellScope) with funding and full service support to advance the healthcare industry through technology. Their partnerships across the industry – from medical institutions to venture capital firms and corporates – give them unparalleled knowledge of how to innovate change in a highly regulated industry. In addition, Nate’s successful development of healthcare game changers such as Rock Health and Doximity makes him uniquely qualified to present to Australian audiences on lessons in innovation from Silicon valley and how to break down barriers to entrepreneurship and communication in this sector.

We spoke to Nate about the importance of change in healthcare and some of his other key maxims in advance of his recently announced tour for Portable Talks in May.

https://www.youtube.com/watch?v=V7Q9y1zRdXQ

Above: Nate speaks briefly about the story of Rock Health.

 

Why did you decide to come all the way to Australia for Portable Talks?

Well, that’s easy: Australia and Portable Talks. It seems to be a very exciting time in Australia, where the next engine of growth could be technology, healthcare, or both — and the [Australian] people are consistently applauded for living healthy lives. And of course, Portable’s reputation preceded itself as I had watched several previous [Portable Talks] series online, thus knowing there were amazing and in-depth conversations to be had.

 

How can the USA learn from Australia’s approach to health innovation, and vice versa?

I think we can learn from the approaches and we can learn from the businesses themselves. The startup community in Australia is smaller but accelerating, and most importantly the quality is high, a recipe for wins that will attract more entrepreneurial ideas and capital.

We can also learn from the businesses themselves — many successful concepts may be translated or shared due to some similarities between the mixed private and public components of our healthcare systems. That’s not to call our systems too similar, of course, as there is much to learn from Australia about accessibility and affordability.

 

In your opinion, what are the three biggest hurdles facing digital health innovation internationally?

Differences in incentives is often at the top of the list, which can make cost a barrier to different parties in different healthcare systems.

The funding environment is another. I think many cities and countries are ready to scale up their innovation efforts, but it can be a chicken-and-egg problem where some local wins are first required to attract capital to the area.

Language itself is a barrier, which Australia is perhaps more cognizant of than Silicon Valley, as it’s a leader in the Asia Pacific region. And there are many other hurdles that may become more relevant depending on the venture: market size, privacy, interoperability, the US regulatory process, infrastructure, consumer readiness.

 

Health is often perceived to be a topic that individuals outside the industry don’t actively engage with. Why should individuals from outside health and medical fields engage with in this industry?

Two reasons: First, because you don’t want to wait until you get sick to start solving these problems. And second, healthcare is an entrenched industry, which means there’s a lot of entrenched thinking. Outside perspective can lead to fantastic innovation, and many of the startups that have come through Rock Health have been founded by “outsiders”.

What is the key message you’d like to bring to your talks in Australia?

It’s the right time to get involved in digital health. There has never been a better time to be a health entrepreneur, and there are many ways you can get involved to transform the healthcare sector.

Nate will be discussing topics such as trends in digital health, innovation in heavily regulated industries and breaking down barriers to entrepreneurship and communication in healthcare throughout his Portable Talkstour in early May. This event is a must-see for those working in digital innovation, healthcare, technology, startups, or high-tech funding. The tour will cover Melbourne and Sydney with tickets available here – be quick to secure an earlybird discount. Nate will also spend a day as Portable’s ‘Entrepreneur in Residence’, delivering a new agenda with the team to help encourage innovation and creative thinking in cross disciplinary fields.

To find out more about the Rock Health Portable Talks tour or to enquire after a private company consultation with Dr. Nate Gross, please contact Kate at kate(at)portablestudios.com.au

For all other tour enquiries please contact Mikala Tai at mikala(at)portablestudios.com.au

cool, data saving lives, entrepreneurship, quantified self, silly

Fashionable wearables…

Where tech meets fashion…

Classy photos of integrated wearables in this story.

http://www.wired.com/design/2014/02/can-fashion-tech-work-together-make-wearables-truly-wearble/

What’s the Secret to Making Wearables That People Actually Want?

shine

Misfit Wearables launched the Shine, an activity tracker that can be worn almost anywhere on your body. Image: Misfit Wearables

 

Last September, right around spring/winter Fashion Week, an unexpected group of people gathered for a round table discussion at the main offices of the Council of Fashion Designers of America in New York City. Present was Steven Kolb, the CFDA’s CEO, a few higher-ups from Intel and a handful ofCFDA members who also happen to be big names in fashion and accessory design.

Intel had called the meeting to discuss the idea of starting a collaboration between the company and the fashion industry at large, with the ultimate goal of figuring out a way turn their decidedly unwearable technology into something people—fashionable people—might actually want to put on their bodies.

‘Tech companies know what is useful, but do we know how to make something desirable?’

Earlier in the summer, Intel, like most every other big technology company out there, had started a division to explore the future of wearable technology. Best known for supplying the processor chips you find in your computer’s guts, Intel has the technology to build what could eventually be a very smart device. They did not, however, have the design and fashion expertise to create stylish hardware.

“Technology companies know what is useful, but do we know how to make something desirable?” says Ayse Ildeniz, Intel’s vice president of business development and strategy for new devices. “We have thousands of hardware and software engineers looking at sensors, voice activation and how to build smart devices, but we wanted to create a platform where they can meet with the aesthetic gurus. There needs to be an alignment and discussion, so breakthroughs can actually come about and flourish.”

Enter the Hipsters

During CES this year, Intel announced the formalization of its partnership with the CFDA, Barney’s and Opening Ceremony, an ultra-hip fashion company tasked with designing the first wearable product to be born from the collaboration. If that wasn’t proof enough that Intel was taking wearables seriously, the company also announced its Make It Wearable competition, which will award $1.3 million in prize money ($500,000 for the grand prize) for whoever who comes up with the most promising design in wearable tech this year. Those are some pretty good incentives.

UB1B2411 argent

Netatmo’s June is a UV tracker that takes the form of a jewel designed by French jewelry designer Camille Toupet. It syncs up with your smartphone to help keep track of your skin health. Image: Netatmo

We’ve only recently begun to see technology and fashion take each other seriously. A few months ago, Apple hired Angela Ahrendts, Burberry’s former CEO, and before that they poached Paul Deneve, Yves Saint Laurent’s CEO. Given the optimistic projections for wearable tech’s influence, the union between these two worlds seems inevitable. If wearable technology makers have learned one thing so far, it’s that just because you make something, it doesn’t mean people are actually going to wear it. Adoption of wearable tech depends on striking a delicate balance between style and functionality, and no one has leveled that see-saw quite yet. And the fashion crowd, as progressive as they are, have never been trained to think through the rigors of product design, ranging from use cases to demographics.

“Products are often made with good intentions, but in a vacuum,” says Kolb. “You have programming people thinking about wearable technology but not necessarily, and I don’t mean this with disrespect, thinking about the aesthetic. Then you’ve got fashion people who are very much focused on the overall look but don’t have the technological language or vocabulary.”

Kolb explains that oftentimes, fashion people have a sci-fi understanding of what technology can do. On the flip side, technologists and even industrial designers have a difficult time grasping what it means to create something people feel good wearing. “Fashion designers are always thinking about things like, how does that clasp close, how does this leather feel?” he says. “That element might not necessarily be on the radar of a tech person, but it’s definitely on the radar of a fashion person.”

Image: Misfit Wearables

Image: Misfit Wearables

Up to this point, technology companies have approached wearables with a one-size-fits-all mentality. Even Google Glass’ Titanium Collection, while certainly more stylish than the original, hasn’t gotten it quite right. A choice of frames that say, “I write code and like to shop” is a start, but in order for people to really want to wear Glass, we have to be able to seamlessly integrate them into our own very personal style. We have to feel like we’ve had more of a choice in the matter.

The Missing Link: Modularity

“I think fashion and accessory brands in the near future will make glasses that work with Glass in the same way we have accessories and covers for our mobile phones,” explains Syuzi Pakhchyan, accessories lead at Misfit Wearables. “The key here is to design technology that can be modular and allow others to develop an ecosystem of products that work with your technology.”

Misfit is the maker of the Shine, a pretty, smoothed-over disc that acts as an activity tracker. As far as wearable tech goes, the Shine is actually quite lovely. Misfit’s offering is part of an increasing number of wearables that make an honest effort to look good. There are others like Netatmo’s June, a UV tracker disguised as a sparkling rhinestone that can be worn as a broach or on a leather band around a wrist, and the collaboration between Cellini and CSR to create a Bluetooth-enabled pendant.

Working Together Earlier

The intentions are good, but they all fall a little short, as though the styling was a last minute gloss instead of baked into the actual product. In order for wearables to feel authentically cool, fashion and technology need to begin working together from the earliest moments of product development, discussing what current technology enables and having an an open-minded conversation about how it could be worn.

‘Products are often made with good intentions, but in a vacuum,’ says Kolb.

As Pakhchyan points out, much like our clothes, not everyone wants or needs to wear the same piece of technology, and we don’t necessarily have to wear it all the time either. Tech companies have been chasing the elusive silver bullet smartwatch, but maybe it’s not such a bad thing to treat wearables like the other wearables in our life: As separate, individually-valuable pieces of clothing that can work together to ultimately create the perfect outfit. Staying focused, at least while we’re figuring out what form and functionality works and what doesn’t, might not be such a bad thing.

Right now, the collaboration between Intel and the CFDA is just getting started. How it will shape up depends on what each organization is trying to achieve. But at least by beginning to build a real bridge between the fashion and technology worlds, we’re opening up discussion about how these industries can benefit each other, which hopefully will lead to some great innovations.

For what it’s worth, Pakhchyan figures it’s only a matter of time before the parallel paths of technology and fashion intersect for good. And when they do? We’ll probably be seeing a lot more people actually wearing wearables. “I think we’re going to see a lot more beautiful and interesting wearables coming out in the next few years,” she says. “I have a feeling we’re going to look back at these plastic wrist-worn things and be like, ‘Oh, that was kind of an awkward stage.’”

Image:TK

This pendant prototype, a collaboration between CSR (developers of Bluetooth Smart and jewelry designers Cellini), communicates phone alerts via the glowing green light. Image:CSR

Liz Stinson

Liz is a Brooklyn-based reporter for Wired Design. She likes talking to people about technology, innovation and pretty things.

Read more by Liz Stinson

Follow @lizstins on Twitter.

data saving lives, healthcare, policy, quantified self

Physicians coy on apps…

Physicians won’t prescribe apps because there’s no regulatory oversight…

 

http://www.fiercemobilehealthcare.com/story/physicians-split-use-mhealth-apps/2014-02-24#ixzz2uTHTX4hO%20

Physicians split on use of mHealth apps

February 24, 2014 | By 
A poll of 1,500 physicians across the country finds that 37 percent have prescribed a mobile medical application to their patients, according to QuantiaMD, a social learning network for physicians.

An additional poll of 250 physicians found:

  • Forty-two percent won’t prescribe apps because there is no regulatory oversight of them
  • Thirty-seven percent have no idea what apps are out there
  • Twenty-one percent never recommend apps to patients
  • Twenty-one percent won’t prescribe apps because there’s no longitudinal data on apps’ effectiveness
  • Another 21 percent won’t prescribe apps because it would generate an overwhelming amount of patient data

Mike Paskavitz of Quantia, Inc. compared the effectiveness of medical apps to prescription drugs, which have roughly seven years of data about their effectiveness and safety giving physicians assurance when prescribing them to patients. Medical apps have no history of this sort, he pointed out, which is important to keep in mind this week at the Healthcare Information and Management Systems Society (HIMSS) Conference in Orlando, Fla.

“So as hundreds of medical app developers gather in Orlando for HIMSS, it’s important to note that physicians are still split in opinion on whether they should ‘prescribe’ medical apps to their patients–the main reason being the lack of regulation, especially as the movement to enable self-care is advanced through tools such as medical apps,” Paskavitz said in the announcement.

The regulation of mHealth apps has been contentious for a while now–asFierceMobileHealthcare reported last week, the PROTECT Act, a bill introduced in the Senate, removes Food and Drug Administration regulation from some high-risk clinical decision support (CDS) software, mobile medical apps and other medical device functionality.

FierceMobileHealthcare Editor Greg Slabodkin argued that the PROTECT Act was too dangerous in an editorial last week.

“Patient safety must always come first,” Slabodkin wrote. “In the end, the so-called PROTECT Act would only serve to protect app developers in their zeal to make a quick buck free of government regulation.”

Nonetheless, while regulation is debated in Washington, mobile medical apps continue to emerge daily. Just last week, the American College of Cardiology and the American Heart Association announced a mobile and web-based app for healthcare professionals to use with their patients in determining risk for developing atherosclerotic cardiovascular disease (ASCVD), a major cause of heart attack and ischemic stroke.

To learn more:
– read the announcement

cool

Global solar vs standard time deltas

How cool is this map. OMG. Everything explained…. and east coast Australia on time.

Solar time versus standard time around the world

Solar time versus standard time around the world

MARCH 3, 2014  |  MAPPING

How much is time wrong around the world?

After noting the later dinner time in Spain, Stefano Maggiolo noted relatively late sunsets for one of the possible reasons, compared to standard time. Then he mapped sunset time versus standard time around the world.

Looking for other regions of the world having the same peculiarity of Spain, I edited a world map from Wikipedia to show the difference between solar and standard time. It turns out, there are many places where the sun rises and sets late in the day, like in Spain, but not a lot where it is very early (highlighted in red and green in the map, respectively). Most of Russia is heavily red, but mostly in zones with very scarce population; the exception is St. Petersburg, with a discrepancy of two hours, but the effect on time is mitigated by the high latitude. The most extreme example of Spain-like time is western China: the difference reaches three hours against solar time. For example, today the sun rises there at 10:15 and sets at 19:45, and solar noon is at 15:01.

cool, data saving lives, file note, healthcare, policy, politics, rapid learning health systems

NPR on health care price transparency

  • Very cool, very powerful
  • I+PLUS can do it already (excluding PHIs that aren’t on board)
  • Think we should go for it
  • Could potentially take it to the US

Audio: 

http://www.npr.org/blogs/health/2014/02/12/276001379/elusive-goal-a-transparent-price-list-for-health-care

Elusive Goal: A Transparent Price List For Health Care

by ERIC WHITNEY  3:36 AM

Some states are trying to make health care prices available to the public by collecting receipts from those who pay the bills: Medicare, Medicaid and private insurers. Some states’ efforts to make these prices available are in jeopardy.

Coffee is important to many of us, but let’s say your coffee maker breaks. Finding a new one is as easy as typing “shop coffee maker” into your browser. Voila — you’ve got models, prices and customer reviews at your fingertips. But say you need something less fun than a coffee maker — like a colonoscopy. Shopping for one of those is a lot harder. Actual prices for the procedure are almost impossible to find, and Bob Kershner says there’s huge variation in cost from one clinic to the next. “You see the range is from $2,800 down to just about $400,” he says, pointing to a computer screen displaying some colonoscopy prices in Denver. Kershner works for a nonprofit called CIVHC, which is starting to make health care prices publicly available in Colorado. His boss, Edie Sonn, says knowing prices can change the whole health care ball game. “Knowledge is power,” she says. “None of us have had much information about how much health care services actually cost, and how much we’re getting for our money.” A database that includes all health claims in a particular state, she says, “gives you that information, so you can become an empowered consumer.” Colorado is one of eleven states that are starting to make public a lot of health care prices. It’s taken years. An “all payer claims database” is the first step in Colorado. It’s basically a giant shoebox that aims to collect a copy of every receipt for a health care service in a given state. Since doctors and hospitals generally don’t tell people how much services cost beforehand, the best way to figure out the price is to get receipts from the parties that pay the bills: insurance companies, Medicaid and Medicare, mostly. The more such information is made public, Sonn says, the more people will “vote with their feet” and migrate away from high-cost providers. However, turning this information about price from eye-crossing rows in a spreadsheet into consumer-friendly formats is hard. Colorado’s effort has taken years. Laws had to be passed to get insurance companies to send in their claims data (the receipts for what they’re paying), and sorting through all the information is a lot tougher than organizing a pile of paper receipts in a shoebox. “Claims data is dirty,” says Sonn. “It’s really dirty. It takes a lot of scrubbing to make sense of it. It’s complicated, time consuming and expensive.” Colorado has had funding to do that from private grants, but those are drying up. In order to keep on making basic price information accessible to the public for free, the state wants to sell more complicated, custom data reports to businesses within the health industry. There is a growing market for those sorts of reports, says Dr. David Ehrenberger, the chief medical officer for Avista Adventist hospital, outside Denver. He would like to see reports that show not just how much his competitors are charging, but also whether their patients have more or fewer complications. That would give him better negotiating power with big insurance companies. “The insurance industry still has a dramatic advantage over, particularly, smaller physician groups and smaller health care organizations. There’s not a level playing field there,” Ehrenberger says. That’s because big insurance companies pay bills at hospitals all over the state, so they have a big picture view of how much everybody charges for procedures, and of details such as complication rates. Individual hospitals only know their own prices. It’s as if only customers could get a list of prices for different coffee makers, but Cuisinart and Mr. Coffee couldn’t, so they wouldn’t know if they were asking too much or too little for their coffee makers. The better view Ehrenberger can get of the entire marketplace for health care services, the better he can set prices. “What we want to do is be able to have the data that shows, unequivocally, that we can provide a better quality product — and [at] a cost they can afford,” he says. But there’s a glitch. In order to get the kinds of reports Ehrenberger and other health care providers want, they have to include price information from all payers, and one of the biggest is Medicare — it pays about a fifth of all health care bills in Colorado. At the moment, Edie Sonn explains, they cannot use that Medicare data in any of the custom reports they want to sell. “Current federal law restricts what we can do with that Medicare data,” she says. “The only thing you can use their data for is public reporting.” Sonn’s organization and others like it have found support on Capitol Hill to let them sell Medicare data. It turns out that Democrats and Republicans agree that price transparency is key to controlling costs. A measure that would make that change is now part of a bigger Medicare bill (find it in section 107) working its way through Congress. If it passes, Colorado will be one step closer to making shopping for health care as easy as shopping for a coffee maker. This story is part of a partnership between NPR and Kaiser Health News.

complex adaptive systems, cool, data saving lives, file note, musings, rapid learning health systems, technology

Andrew Ng: How to build your very own Skynet

Andrew Ng on Deep Machine Learning via Large Scale Brain Simulation

https://www.youtube.com/watch?v=5elcmFNRCWk

The key determinants of learning accuracy are accessing as much data as possible and being able to process.

Partnered with the Google speech team.

Deep learning works well in two different settings:

1. Learning from labeled data > speech recognition, streetview images

2. Learning from unlabeled data >

 

AndrewNg_LearningPerformance

 

AndrewNg_HumanVsMachineLearning

 

Up to now, humans have been driving performance due mainly to a lack of data and processing. With both of these now becoming available in abundance, machine learning will soon overtake human learning to become the dominant driver of performance.

Sky net.

business, facts & data points, file note, healthy habits, musings, nutrition, policy, politics, quotes & aphorisms

“There is no freedom in addiction”

Michael Bloomberg was laughed at for suggesting that New York City businesses limit soda serving sizes. It was never a perfect plan, but his public shaming shows how closely we equate food with ‘freedom.’ The problem is, there is no freedom in addiction. As the Nature Neurosciencestudy showed above, rats and humans alike will overeat (or eat less healthy food options) even if they know better.

Hence the magic bullet at the center of McDonald’s letter: a precise combination of fat, sugar and salt that keeps us craving more. As NY Timesreporter and author of Salt Sugar Fat: How the Food Giants Hooked UsMichael Moss said in an interview

These are the pillars of processed foods, the three ingredients without which there would be no processed foods. Salt, sugar and fat drive consumption by adding flavor and allure. But surprisingly, they also mask bitter flavors that develop in the manufacturing process. They enable these foods to sit in warehouses or on the grocery shelf for months. And, most critically to the industry’s financial success, they are very inexpensive.

PN: The fallacy in the rump of this discussion is that cigarettes are not that more harmful than a big mac. I’m just as likely to die from smoking a single cigarette in front of you, as I am if I were to eat a big mac in front of you. The problems arise when you smoke/eat these products every day of your life.

http://bigthink.com/21st-century-spirituality/should-big-food-pay-for-our-rising-obesity-costs

Should Big Food Pay For Our Rising Obesity Costs?

FEBRUARY 25, 2014, 4:29 PM
Bt-big-food

Paul McDonald didn’t expect his letter to go public. The Valorem Law Group partner had queried sixteen states, asking leaders to consider investigating Big Food’s potential role in paying for a percentage of the health system’s skyrocketing obesity costs. The Chamber of Commerce got wind of this letter and made it public, setting off a national debate over food marketing, ingredient manipulation and personal responsibility.

McDonald’s premise is simple enough: if large food companies are purposefully creating addictive foods to ensure consumer loyalty, adding to the rising obesity levels in this country, they should be responsible for covering costs associated with treatment. The backlash was immediate and biting.

Comparisons to the Big Tobacco companies came first to mind. In the 1998 Tobacco Masters Settlement Agreement, major players in the tobacco industry agreed to pay $246 billion to offset health risks and diseases associated with its product. Critics of McDonald’s idea believe there is no link between tobacco and food.

Advertising

On the face of it, this would appear true: you don’t need to smoke, but eating is a necessity. Smoking is a choice, and therefore if you choose to smoke, you pay the consequences. Eating falls into an entirely different category.

Yet the neural mechanisms might be similar. A 2010 study in Nature Neuroscience found that rats consumed well past their limits when offered high-calorie foods such as bacon, sausage and cake, speculating that humans, when faced with an equivalent scenario, also choose to overeat.

Harvard University Professor of Medicine, Emeritus David Blumenthal’s study, Neurobiology of Food Addiction, found a similar link between food and drug abuse. In the summary he writes

Work presented in this review strongly supports the notion that food addiction is a real phenomenon…although food and drugs of abuse act on the same central networks, food consumption is also regulated by peripheral signaling systems, which adds to the complexity of understanding how the body regulates eating, and of treating pathological eating habits.

The argument against food addiction is a tough one, waged by industry insiders who want to keep 60,000 products on American shelves. The real question, however, is: are food companies purposefully producing addictive foods that change our neurobiology? If so, should they be held economically accountable?

American obesity costs are currently $147 billion per year. The CDC estimates that 35.7% of adults and 17% of children ages 2-19 are obese—a number that has risen dramatically over the last two decades. A joint report between Trust for America’s Health and the Robert Wood Johnson Foundation estimates that 44% of American adults will be obese by 2030. The report predicts that will add between $48-66 billion to our costs, some of which is paid for by taxpayers.

Yet food is such an emotional topic. For example, when informing someone that I’m vegan, they immediately let me know why they could never do such a thing (I didn’t ask) or that it’s ‘wrong’ for them, and sometimes by extension, me (last week’s annual blood work shows me in perfect shape).

Michael Bloomberg was laughed at for suggesting that New York City businesses limit soda serving sizes. It was never a perfect plan, but his public shaming shows how closely we equate food with ‘freedom.’ The problem is, there is no freedom in addiction. As the Nature Neurosciencestudy showed above, rats and humans alike will overeat (or eat less healthy food options) even if they know better.

Hence the magic bullet at the center of McDonald’s letter: a precise combination of fat, sugar and salt that keeps us craving more. As NY Timesreporter and author of Salt Sugar Fat: How the Food Giants Hooked UsMichael Moss said in an interview

These are the pillars of processed foods, the three ingredients without which there would be no processed foods. Salt, sugar and fat drive consumption by adding flavor and allure. But surprisingly, they also mask bitter flavors that develop in the manufacturing process. They enable these foods to sit in warehouses or on the grocery shelf for months. And, most critically to the industry’s financial success, they are very inexpensive.

Inexpensive to companies, not to consumers. Paul McDonald is striking an important nerve in how we manufacture, distribute and consume food in our country. There will be a lot of resistance and debate from both industry and citizens. But if we don’t begin this conversation now, our national and mental health is only going to continue to decline.

Image: Aliwak/shutterstock.com

healthy habits, policy

Activity guidelines shun sitting…

Oh yes. Could really have seen the Tele lap these guidelines up… especially the standing agenda item piece. Terrific.

 

http://www.abc.net.au/health/features/stories/2014/02/24/3947295.htm

Why the exercise guidelines take a stand on sitting

by Claudine Ryan

For the first time our physical activity guidelines are not only telling us to get more exercise, they’re also telling us to stand up for our health.

sitting_300x150GIULIO SAGGIN, FILE PHOTO: ABC NEWS

Australia’s exercise guidelines have recently been overhauled, and they’re going to come as a rude shock to many of us. Not only are we being told we need to do a lot more physical activity, but we’re also being urged to get out of our chairs – even if we do the right amount of exercise.

The new guidelines are now officially known as Australia’s Physical Activity and Sedentary Behaviour Guidelines, and they focus not just on the exercise but on the amount of time we spend being sedentary.

Listen

ABC Health & Wellbeing producer Claudine Ryan spoke to Julia Christensen from ABC Local Radio in Darwin about the new guidelines, and why we all need to to ‘sit less’.

11 mins 42 sec | 2.6 mb | Download mp3 audio

Sedentary behaviour is the term used to describe physically inactive tasks that don’t require a lot of energy, basically sitting or lying down. Activities are often measures in METs (Metabolic Equivalent of Task),sedentary activities are in between 1 and 1.5 METs, walking at a moderate pace ranges from 3 to 3.5 and jogging is about 7.

In recent years, a growing body of research has linked sedentary behaviour to obesity, type 2 diabetes, heart disease, some cancers and premature death. It’s considered such a risk that one US expert has gone so far as to suggest sitting for most of the day may be as dangerous to your health as smoking.

Experts say we’re sedentary on average for seven to 10 hours a day (and this doesn’t include our time spent sleeping). Even if you are meeting, or exceeding, the recommended 60 minutes a day of moderate intensity physical activity, you can still be considered sedentary. (This group of people is sometimes referred to as ‘active couch potatoes’.)

While researchers are still trying to understand exactly why sedentary behaviour has such a negative effect on our health, it appears to be related to how our bodies process fats and sugars. There are enzymes involved in this process that are released when certain muscles contract during standing. When you sit for prolonged periods the production and activity of these enzymes appears to slow down.

The guidelines don’t make any specific recommendations about how long you should sit for, instead they say we should “minimise the amount of time spent in prolonged sitting” and to “break up long periods of sitting as often as possible”.

However, some experts recommend breaking up any period of sitting that lasts longer than 20 to 30 minutes. You do this by simply standing up for a couple of minutes or taking a short walk. (It’s also worth noting, that neither the guidelines, nor those working in this field, are suggesting that you need to spend your entire day standing.)

Here are some ways to cut back on the amount of sitting you do:

At work:

  • Try to encourage standing or walking meetings. If this doesn’t work, see if you can get your colleagues to include a standing break, or ‘standing agenda’ item.
  • Stand up when using the phone, or when reading emails, documents or reports.
  • Set up printers, rubbish bins, drawers, and other things you may need during your work day, away from your desk so you need to get out of your chair more often.
  • Try walking to your colleagues to talk to them instead of using email if possible.
  • Set yourself a reminder on your computer to stand up regularly.
  • Make it a habit to drink more water throughout the day. You’ll have to move to get your regular glasses of water and their effect on your bladder will mean you’ll take more regular trips to the toilet.
  • Break for lunch, even if it’s just a ten-minute walk.
  • Walk or ride to work.
  • Get off public transport or park your car a little further from your work and walk some of the way.

At home:

  • Stand up and walk around when using your phone.
  • When watching TV, stand and do household chores, such as folding clothes and ironing.
  • Put your remote control away so you are forced to get up to use manual controls.
  • Embrace household chores.
  • Stand when catching up on news via the newspaper, phone or tablet.
  • Walk or ride when you need to do things that are closer than a certain distance to your home.

Published 24/02/2014

cool, quantified self, rapid learning health systems

Samsung Gear Fit Launch at Mobile World Congress

Very cool device. Doesn’t have an altimeter. Does have a heart rate monitor. Probably needs a Samsung phone.

http://www.afr.com/p/technology/digitallife/samsung_gear_fit_wins_hearts_and_sKscE6g5LdRMHnlSeVAw6K

Samsung Gear Fit wins hearts and minds

Samsung Gear Fit wins hearts and minds

JOHN DAVIDSON

The Galaxy S5 phone might have been Samsung’s biggest announcement at Mobile World Congress, but it was a much smaller device that made the biggest impression: Samsung’s Gear Fit.

The fitness band, designed primarily to be worn on the wrist, easily has the brightest, most colourful screen ever to be included in such a device – for what it’s worth, Samsung says the screen is the world’s first 1.84-inch curved Super AMOLED display – and it does far more than your typical fitness bands do, too.

The Gear Fit counts your steps and monitors your sleep like most of its competitors, but it also has a heart rate sensor built into it (another first), allowing it to be used as a sort of impersonal personal trainer, vibrating whenever your pulse rate drops below some threshold you have set for yourself, to warn you to speed up or try harder. And it has a stopwatch and a timer, which many of its competitors lack.

More than that, it uses Bluetooth to attach back to your smartphone quite like a smartwatch, allowing it to show you an almost complete range of notifications from the phone. You can’t accept or make a call with the device, the way you can with Samsung’s Gear 2 and Gear 2 Neo smartwatches, but you can reject calls, view incoming emails, texts and social media feeds, and control what music is playing back on the phone. You can even look at your calendar, all without ever pulling out your phone.

While it doesn’t run Tizen, the new Samsung operating system that runs the Gear 2 and Gear 2 Neo, the Gear Fit does have an operating system capable of running apps, meaning that new features could be added to the device over time.

In short, the new fitness band does many of the things the smartwatches do, but it does it in a much more appealing, much easier to wear package. The device can even be popped out of its rubber band, allowing it to be added, say, to a clip that attaches to your clothing, or to a choker so you can wear it around your neck, though of course the heart rate sensor may not work when it’s worn like that.

The only thing really wrong with the Gear Fit is that, for the moment at least, the screen is incapable of modifying its orientation to account for how it’s being worn. When you wear it on the top of your wrist, for instance, the icons and text in the user interface face the wrong direction, and can be hard to read without twisting your arm in a most unnatural fashion. You have to wear it with the screen on the underside of your wrist if you want to read it easily. But the designer of the user interface, who is here at Mobile World Congress, said she was “looking into” getting the UI to re-orient itself depending on which way the device is facing, in much the same way a tablet goes from landscape mode to portrait mode depending on how it’s being held.

Pricing has yet to be announced, but it should be significantly cheaper than the Gear 2 and Gear 2 Neo, too. Unless you want to make calls and take photos with your wearable computer, the Gear Fit looks like a better alternative.

healthcare, meaning, musings

On Medical Student Burnout…

Lydgate discovers that he has become a mouthpiece for benighted views he initially abhorred, arguing that “I must do as other men do and think what will please the world and bring in money.” Everyone needs to make compromises, but such compromises should not come at the cost of abandoning core aspirations. Quite the reverse, the primary goal should be to allow such aspirations to develop and express themselves in the challenging world of contemporary medicine.

http://www.theatlantic.com/health/archive/2014/02/for-the-young-doctor-about-to-burn-out/284005/

For the Young Doctor About to Burn Out

Professional burnout is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice.

Tertius Lydgate from Middlemarch by George Eliot (The Jenson Society, NY)

Our health depends in part on health professionals, and there is mounting evidence that many young physicians are not thriving. A recent report in the journal Academic Medicine revealed that, compared to age-matched fellow college graduates, medical students report significantly higher rates of burnout.

Specifically, they are suffering from high rates of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. College students choose careers in medicine because they care, because people matter to them, and because they want to make a difference. What is happening to the nearly 80,000 U.S. medical students to produce such high rates of burnout?

It is tempting to invoke the usual suspects: too many hours of study, too little contact with patients, and overwhelming anxiety concerning grades and test scores. Such stressors are compounded by exploding rates of change in medical science and technology and the general cloud of socioeconomic uncertainty hanging over the profession of medicine.

Yet the real roots of the problem go far deeper, and it is only by plumbing their full depth that we can hope to formulate an accurate diagnosis and prescribe an effective therapy. On closer inspection, burnout turns out to be a symptom of a more fundamental disorder that calls for curative—not merely symptomatic—therapy.

Nothing is more needed than nourishment for the imagination. Medical educators, learners, and those who care about the future of medicine need to understand not only the changes taking place in medicine’s external landscape but the internal transformations taking place in minds and hearts. Humanly speaking, are we enriching or impoverishing students? What alterations are we asking them, explicitly or implicitly, to make in the ways they act, think, and feel? In what ways are we bringing out the best elements in their character—courage, compassion, and wisdom—as opposed to merely exacerbating their worst impulses—envy, fear, and destructive competitiveness?

To a minority of students who care very little about such matters, such questions are likely to seem of little moment. Such students see clearly what they want to achieve—to gain admission to medical school, to graduate, to obtain a residency training position, and to take up the practice of medicine—and they do not trouble themselves about the ways in which their education is reshaping their humanity. When such students show up in class, they simply want to know what will be on the exam, and no matter how intricate or abstruse the material might be, they learn it sufficiently well to pass—and in many cases, ace—the tests.

But there are other students for whom medical school is not simply a proving ground, a gauntlet to be run, or a ticket to a well-paying and secure career. When they see a patient treated poorly, encounter a fellow student who is struggling with confusion and discouragement, or deep in a maze of tests and grades find themselves beginning to lose sight of the goals that brought them into medicine in the first place, they do not merely knuckle down and redouble their efforts. Instead they take such matters into their hearts, muse over them, and find themselves questioning whether medicine is what they really want to do with their lives.

Where can we turn to understand what goes on in the minds and hearts of highly intelligent, genuinely compassionate young adults who find themselves in a state of moral distress about the path they have chosen in life? Who or what can help them find the words to describe what they are going through, to know that they are not alone, and to locate a light at the end of the tunnel that can give them the hope and courage necessary to carry on? To understand and help such students, we need to find and apply the best resources available. One of the best guides on the matter I have ever encountered also happens to be one of the greatest novels in the English language.

The novel in question is Middlemarch. Written by Mary Ann Evans (1819-1880) who, in order to be taken seriously felt compelled to write under the pen name George Eliot, Middlemarch concerns the affairs of a fictitious British Midlands town of the same name. The title evokes not only a kind of provincial mediocrity but also a deep authorial concern with what happens to people training for the professions, echoing the opening of Dante’sDivine Comedy, “In the middle of life’s journey … ”

One of its principal characters is an idealistic if somewhat unreflective young physician, Dr. Tertius Lydgate, a character whose story provides deeper insights into burnout than any social science study I have encountered.

Lydgate is a handsome, well-born young physician with high aspirations as both a medical scientist and a servant of the needy. He comes to Middlemarch intending to found a charity hospital and to write a scientific treatise on typhus, one of the great scourges of the poor. Yet there is a problem. Over time, he abandons his ideals. He allows prevailing attitudes toward success to supplant his deeper sense of calling. He ends up investigating not typhus but gout, a rich man’s disease. Though outwardly successful, he comes to see himself as a failure. In short, he burns out because he loses his way. To paraphrase the novel, Middlemarch not only swallowed Lydgate whole. It assimilated him very comfortably.

Such changes can and do occur among contemporary medical students. Studies have documented both declining empathy and rising cynicism over the course of medical education. What happens? Having enrolled in medical school with a goal of helping people, students soon find financial considerations—including their own exploding debt—dominating their career plans.

With a growing avalanche of new knowledge and skills bearing down on them, they feel increasingly overwhelmed by what they do not know. They soon discover that, instead of expanding their capacity to make a difference in the lives of others, the rigors of medical school have constricted their field of view to their own survival.

Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice. When a great ship steams across the ocean, even tiny ripples can accumulate over time, precipitating a dramatic shift in course. There are many Tertius Lydgates, male and female, inhabiting the lecture halls, laboratories, and clinics of today’s medical schools. Like latter-day Lydgates, many of them eventually find themselves expressing amazement and disgust at how far they have veered from their primary purpose.

Lydgate discovers that he has become a mouthpiece for benighted views he initially abhorred, arguing that “I must do as other men do and think what will please the world and bring in money.” Everyone needs to make compromises, but such compromises should not come at the cost of abandoning core aspirations. Quite the reverse, the primary goal should be to allow such aspirations to develop and express themselves in the challenging world of contemporary medicine. Books like Middlemarch are no panacea, but they offer precisely the imaginative nourishment so often missing from contemporary medical education, a powerful antidote to the insidious forces that produce burnout.

PRESENTED BY

RICHARD GUNDERMAN, MD, PhD, is a correspondent for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman’s most recent book is X-Ray Vision.