Living and Learning

Healthy living is a part of who I am.  I started running late in high school and my enjoyment from it hasn’t tapered off thankfully.  I also tend to think of my dietary choices as smart a majority of the time.  But in this game of life there are always small tweaks we can benefit from.

With the help of my smartphone, I have begun to undertake what hopefully I will in the long run chalk up as small wins.

One thing that has become glaringly obvious to me in recent months is the pace at which I eat food.

  • Am I competing in some kind of race?
  • Am I worried someone is going to steal my food?

While I may not be known as the world’s biggest eater, I am of the opinion that I definitely eat more than my body wants because I don’t give it a chance to tell me its full.  It takes your body about 20 minutes to do so.  I have recently begun using the mind Bloom app to provide myself casual reminders about eating more slowly.  


Wherever I go, occasionally my phone will buzz gives me occasional  reminders.  For all purposes, this is a crude measure but I feel it will be effective.  I hope to give myself a greater awareness of this eating habit to better guide me during meal time.  Let’s hope I end up savoring a bit more and eating a bit less.



Another little thing I’ve is made use of in recent weeks is the Fooducate app.  Its advertised as a great resource for the grocery store -and it is.  But even of more immediate use than that is my refrigerator and pantry.  I am making great use of this at the store, but more importantly, what about the products I already have and regularly consume?

One thing to know about me is that Chips and salsa are a near-religious experience.  Yet a lay-person sees salsa varying on taste profile, not health profile.  A gross inaccuracy it would seem.  Just the other day I scanned the product in my refrigerator and was quite shocked when the app reported, “one of the worst products in its category”.  That is the kind of statement that will wake me up.  Hopefully it will do the same for others.


Be Well.



The Digital Health Corner

The government recently released its final revision to the proposed rules governing accountable care organizations (ACOs)  These organizations will herald the beginning of outcomes based reimbursement which will replace volume-based payment systems. Three sub-agencies will be coordinating Medicare and Medicaid payment policies.  The IPAB (Independent Payment Advisory Board) will concentrate on Medicare. It has already been criticized as having too much power for a small board. The Center for Medicare and Medicaid Innovation will be testing new payment and delivery systems, and the PCORI (Patient Centered Outcome Research Institute) is charged with evaluating comparative effective research.

Outcomes based reimbursement has many implications aside from the way money will be distributed.  It will change hospital workflow.  Electronic health records (EHRs) were initially mandated to be in place of 50% of primary care physician practices of an ACO.  The final version no longer retains this requirement but does reward for…

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Waste Not, Want Not

Americans, Europeans and people from around their world waste their food.  Yes, we know this.

It happens at home, at restaurants, at the supermarket, during production, and cultivation.  I knew that we wasted food.  But two recent media pieces brought it right back front and center.  On Fareed Zakaria GPS, I was slapped upside the head with hard facts.  Americans waste 40% of their food.  40% of food in India is ruined before it reaches the market.

This morning I listened to a TED talk by Tristam Stuart.  As intended, much of the presentation was jarring and upsetting.  For me, I was most taken aback by the piles of food left out to rot that was deemed “undesirable”.  Piles of bananas, oranges, parsnips, potatoes, and more that were harvested and simply left to rot because they were not cosmetically accurate.  After all, a funny looking banana may taste funny [insert sarcasm here].

Surely we can take the following steps to avert this waste.

  1. Eat food regardless of how it looks.  Starting a campaign to demand food be brought to market
  2. Use our increasingly connected global marketplace to put those with “(cosmetically) undesirable” or surplus product in contact with markets that are in need of food.

Surely there must be small steps we can take to avert even portions of this loss and waste.  For the long run, we must shoot for changing consumption mindsets and raise a global awareness of need and possibility.

Its the Little Things



I liked Quick Health Tips recently noted by the Harvard School for Public Health.

The question is, if these little things can make a big difference, why aren’t more people doing them and how can we change that?  How can we create better habits or at least stabilize routines?  Just before reading this, I ate a piece of leftover pizza.  I knew in the back of my mind I could make a healthier choice, but there wasn’t someone (or something) around encouraging me to make the healthier choice.

Could mhealth solutions be the key?

  • Text message reminders
  • Seamless calorie trackers
  • Social media contracts that create a responsibility to healthy eating?

Healthcare is complex and if our mobile devices are omnipresent in our lives, perhaps they are what it connects us to can help make the little changes more permanent.

Digital health patents shaping the market?

With an announcement this week form Airstrip regarding a patent for its mobile monitoring platform the line has been drawn.  Not only can apps garner approval from the FDA but enterprises are digging in to best serve and capture market.

Patent wars and approvals both mark the way for increased competition.

Source: mobihealthnews

mHealth and Extreme Uncertainty

7 billion people.  6 billion mobile connections.

What do we know based these two numbers?  We know that mobile has brought (and continues to bring) instant information and connectivity to people in far reaching parts of the planet for the first time.  It has created new methods for banking and it threatens to end the regular use of cash.

The possibilities of of mobile are far reaching and the claims of what it will do go even further.  In spite of the certainty that mobile will drastically change our planet, the question is, “do we really know how those changes will unfold?”  The answer is that existing roadmaps show where we will likely go, but the journey ahead will be a bumpy and uncertain one.

Eric Ries, author of The Lean Startup writes that an entrepreneur is anyone operating in an environment of extreme uncertainty.  So my latest pondering has left me wondering, is the whole field of mHealth is marred by extreme uncertainty?

One point Ries makes in regards to my field of planning and forecasting is the difficulty to predict the behavior of an industry that lacks a stable operating history and a relatively static environment.  The mobile industry is anything but static.  Mobile device activation and acquisition statistics are exponential, devices constantly change, and how consumers use them continues to evolve.

The underlying point Ries is trying to strike here is not railing against strategy, but advocating against large amounts of time spent in “the lab” testing your product.  Experiments withdrawn from reality can be of little value in an uncertain environment because its difficult to know how it will be received by your customer.

There is of course a place for strategy and planning in business, but Ries is correct when stating that learning in such an environment needs to be validated to mark progress and reveal necessary changes in your strategy.  Along the same lines, I found great value in Ries’s statement, [rather than hypothesizing how a customer will behave, or asking them how they will behave; experiment by providing them with a prototype to see how they behave when using it].

Extreme environments have not and will not eliminate a need for strategy. They merely remind us that the customer does know best and they must not be treated as the recipient of a product or service, but as a co-creator.


“In preparing for battle I have always found that plans are useless, but planning is indispensable.”

General Dwight Eisenhower

Crisis Text Line

Text messages have a 100% open rate.  They may not all fully sink in, but the message gets through.  This was the most important takeaway from this video for texting as a viable method of prevention, management and monitoring.

Texting may not have beautiful interfaces or be able to aggregate all sorts of data at a time, but its realtime and generates responses.

Amidst all the chronic diseases to manage and wellness apps that are proliferating the healthcare space, its important to remember that mhealth could help us resolve people who fall into or are trapped in crisis.

May we all remember the higher calling we wish to serve.


What Does it Mean to “Own” Something?

Everyone in every business can learn something from recent studies by The Atlantic  and USA Today.  In a world where access to things is becoming faster and simpler -not to mention the abundance of choices-, owning a particular item is becoming less important to Americans, especially millennials.

So if possessing something -or being able to call it yours- is becoming less critical, what does ownership mean anymore?  The remaining trait I see is having “on demand” access to the device, content, channel, etc.  Advances like cloud technology are certainly making this more possible.

The biggest takeaway from the Fast Company article I found is that what is scarce is no longer things but “connection”.  The death of ownership is being brought about by a scarcity of and greater demand for connection.  We see and hear all the time in our lives the impact of social media but the need for connection is now changing the economic climate.

If the value of a product/service now lies in what we can do with it, enterprises, non-profits and entrepreneurs must ask the question “what does using this good/service help my customer do?  It doesn’t mean the entire wheel needs to be reinvented; but you certainly must make sure that the consumer is deriving value from your offering?

Three ways Fast Company suggests to think about what you offer:

  1. Does our good or service give customers a sense of empowerment?  Individuals desire a sense of autonomy and ability to act (see “Drive” book reference).
  2. The joy of having something is shifting away from possessing to sharing it.  What can consumers tell people about our product?  How does it help build a community?
  3. What does our product say about those that have it?  How does it represent them and their choices?

It should be said that each company doesn’t have to answer each of these categories well, but ensuring that your good or service satisfies one should be seen as crucial.


Source: Fast Company

Precision Medicine Will Fight Pre-Posterous Medicine

Ivan Oransky of Reuters Health does a great job talking about how much medicine works to make us leap to treat illnesses that may or may not exist.

Just-in-case you should do this right now.  It comes with all sorts of unpleasant side effects but think of the flip side, you may or may not get this disease.

Speaking of this, a new study has come out this morning showing that statins contribute to fatigue. No one wants a heart attack but at what point do we stop using potentially harmful medications to treat illnesses we don’t even have yet?

Be Well.

What is Lifestyle but a Series of Rationalizations?

Last week I heard Dan Ariely speak about his new book The (Honest) Truth about Dishonesty.  Yet again the renowned behavioral economist is taking our day-to-day lives apart and explaining why we act the way we act.  What makes his work so provocative is that it makes us feel powerless in our own lives.  He explains intricacies that we either fail to recognize or assume we have control over.

The book’s primary takeaway is that we all use rationalizations to cheat just a little from time to time.  And not just some of us, but nearly all of us cheat to a small degree.  From a healthcare perspective we need to consider this in relation to lifestyle and behavior.  Ariely espouses that rationalizations largely are born out of social signals -what our environment is telling us-, from individuals in and peripheral to our lives.

The signals we receive from our environment are largely driven by societal and social rules.  When it becomes less clear what rules we are bound by or what norms people follow, it becomes easier to rationalize a decision.  If our social network cheats a little on their incomes taxes, we find it easier to do because they’re doing it too.  If our co-workers go out for fast food everyday, we find it easier to rationalize it (“I can’t let them eat alone”, “I shouldn’t be anti-social”).

Ariely also reveals how a lack of a close or personal relationship with an individual or party is more likely to encourage cheating.  Its easier for us to cheat the government or an insurance company because they are a large institution we can rationalize taking  a little as something that won’t hurt them.

So in regards to lifestyle decisions this is how I see it applying.  If your doctor or personal trainer followed you around all day would you make smarter and healthier choices?  I think yes.  While it is not financially feasible or realistic to take clinician or trainer around with you everyday, we take our phones everywhere (office, bedroom, bathroom).  If we are able to deploy solutions via mobile technology into our lives that remind us of “the rules” and make our behaviors more social, it seems that we would be more likely to take better care of ourselves.  Skip out on the third donut of the day, take the walk we said we would, get the sleep we need.

These examples are really just the beginning but as care becomes more continuous through mobile, we will need to take steps to make sure the “distant” or impersonal nature of remote care doesn’t leave us feeling like it is elective.

Be Well.

As a side note, beyond Ariely’s work, I recommend reading the findings of Nicholas Christakis and the influence of our social network has on our lives.  I think close ties can be drawn between the two.

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