Wanted: Adaptive Encouragement
Or, Health Horizons S&T Map Blog Posts, New Year’s Edition.
I am sick, writing in bed, but that seems to be good, since I don’t really want to do anything, so I might as well write.
It’s that time of year again. The global holiday of January 1, and with it, the annual ritual of self-improvement: setting New Year’s resolutions. It’s a time when we’re called on to reflect on our lives and the behaviors we might want to change—and bombarded with ideas on how to do so. It’s the time of year that makes me crave the realization of one of our Science and Technology forecasts: Adaptive Encouragement.
Adaptive encouragement: From self-quantifiers to life doulas
Imagine a digital advisor that interprets your raw health data and offers continuous support along with interactive data visualization and recommendations for changing—and maintaining—daily routines or medications.
Embodied in intelligent programs, mobile devices, and the cloud, a life doula (like a birth doula) will remind us of our goals in moments of weakness. It will offer suggestions and encouragement in context to help us make healthy choices.
This kind of adaptive, personalized support will improve chronic illness management with automated diet tracking, in-home blood marker monitoring, and realtime analysis of genetic, metabolic, and protein data.
A quasi-intelligent automated system that takes the heavy lifting out of learning about your habits and changing them? Sold!
This vision is part of a future when roles like life coaching are automated and extended through ever-present technology. It also points to the possibilities of adapting care systems to optimize the well-being of people with chronic ailments: rather than a slap on the wrist at the doctor’s office, you get a gentle vibration to get you out of your chair and moving. Haptic feedback and sensitivity, emotional support and peer interactions are the future of this softer side of mobile health, beyond the expert-fed prescriptive reminders. This is a future of gentle nudges to show us the actions that will help us increase our capacity for well-being, but also remind us to do nothing when that’s what’s really best for us.
Our colleague Alex Charmichael over at the Quantified Self wrote this forecast, and I’ve heard it echoed in the desires of my of the quantified selves I’ve been interviewing for our project for the RWJF building and refining the QS Guide to Self-tracking Tools. For those of us who generally only embark on self-improvement binges once a year, there are a lot of lessons and tools we can learn from both the continuous and episodic efforts of the QSers. One tool I learned about in interviews that might be of particular interest to New-Years Resolvers is Health Month—a game that helps you focus on making progress towards your goals on a daily basis. (The game starts promptly on the first of each month, so start on Jan 1st to get credit for your progress!)
Most importantly though, one of the key lessons I’ve heard that’s especially crucial for new years resolutions is self-compassion in all your self-tracking and self-improvement efforts. Shame and frustration at little slip ups can do a lot of harm—so this year, try staying future-focused and forgiving.
Writing, death, and vat-grown kidneys
Hey, wasn’t I going to blog more and stuff? Did somebody die or something?
Oh wait. Actually, yes.
So my SB challenge and so many other things have been on hold for the past week. I’m not done grieving, and won’t be for a good long while, but I do need to start writing again. My kick in the pants came from the realization that it was Viv’s turn to do the regular blog post in our blogifying map forecasts series.
I started writing it and then I stopped. I decided to share her words instead. It still took me most of the day to track down links and proof and whatnot. It was both cathartic and helpful to tiptoe around the cognitive dissonance of writing about forecasts bathed in optimism bordering on hubris with ruminations on mortality rattling about my brain.
Here’s the post:
Replacement parts: “We can rebuild him, we have the technology”
Regenerative medicine will replace, restore, maintain, or enhance tissue and organ functions, dramatically improving patients’ health and quality of life, and potentially reducing the cost of their care. Tissue engineering will heal diabetic foot ulcers, reducing the need for amputations; organs grown in a lab will ease our dependence on donor transplants; and tendons, cartilage, and bone regrown with autologous cells will be used to repair injuries and joints. Advanced prosthetic devices and biomechatronic-based limb replacements will interface with the body’s nervous systems to give users a range of natural function and movement.
When we first presented this forecast at a conference, our colleague Vivian told a story that illustrates the potential, and some possible pitfalls, of the growing capacities of regenerative medicine. It was part of a complicated dance of vignettes and exposition with Vivian, Bradley and myself that will remain one of my fondest memories of working here.
Image by Rachel Hatch
Of course, when you get sick enough, you end up having to go to the doctor for help.
That’s what finally happened with Eric, who has Type 2 Diabetes. He is a very successful 56 year old lawyer. He has a history of working too much and not taking very good care of himself. He was overweight, ate poorly, and didn’t track his blood sugar levels consistently. As a result, he has had some serious complications from his illness. Last year, he developed a foot ulcer that just wouldn’t heal. The doctors had to amputate his foot. His eyesight also deteriorated because of damage to his retina. And his doctors have been warning him that he may need to go on dialysis. Eric’s body is failing him.
Remember that TV show in the ’70′s? The Six Million Dollar Man? Do you remember the show’s tagline? “We can rebuild him. We have the technology.”
One for the road and I’m back on the town…
…with a spoon full of sugar to help the medicine go down. (The Constellation’s Southern Gothic has been my soundtrack to life the last few weeks. It’s getting weird up in here.)
Welcome back, therapy blog. Oh, didn’t I tell you? I started this blog partly as exposure therapy for my fear of public writing. That’s also part of why I’m so inconsistent about actually posting things. I’m surprised it isn’t more of a thing in this day and age, but there are apparently other “scriptophobes” out there.
HOWEVER…I picked this as my first game of the SuperBetter beta I managed to squeeze into, so dagnammit, I’m gonna be writing (here and at the orders of magnitude more trafficked IFTF blog) in the next six weeks, come hell or high water. My epic win is around posting consistently, but seeing as how I’m studying quantified selves at the moment, I’m thinking of tracking and keeping mission journals of minute/word count ratios as well.
Consider this my first skirmish against a minor henchman: Scorn of Off the Cuff Posting. Take that back to your foul master, Auditor Perfecto. Score one achievement: Admitting You Have a Problem.
Optimizing Healthspans: branching paths of longevity and death post up
This took me a uper long time to write, resolving my conflicting feelings about extreme longevity as a topic. This is another one of the Science, Technology and Well-being 20202 Forecasts.
Again, full post available here.
To clear up your first question, (what’s a healthspan?), by healthspan we mean the length of healthy, quality living. In the last hundred years we’ve seen a dramatic lengthening of our life expectancy, and radical life extension hopes to lengthen our lifespans, but what we’re grappling with now and in the next decade is optimizing our chances of those added years being happy and healthy.
So, how will we do that?
Source: Flickr user kevindooley
Programming Immunity post up
This was a post about one of the handful of forecasts boldly written last year by my colleague Alex Carmichael, which it fell upon me to perform, promote, and continue investigating from our recently released forecast map on Science, Technology and Well-being. I must admit that I am personally less technologically optimistic than many of the forecasts on that map. With this forecast, my own personal experience with immunomodulators is that we are still at the blunt instrument, barely-know-what-we-don’t-know stage of understanding, more than a decade away from precision interventions for anybody, let alone brad accessibility. Luckily the week before there was a major breakthrough in this area: the first success of gene therapy, which promised to be just around the corner back when I was in high school biotech classes. And what this therapy did was effectively re-train patient’s immune systems in a specific, fine-tuned and persistent way. So, maybe this forecast is on a much shorter horizon than I originally gave it credit.
Excerpt from the full post:
Our immune systems are the key to humans’ profound resilience in the face of all the other organisms around and inside of us.
Over the last few decades we’ve made great strides in understanding the workings of various parts of our immune systems, as they function normally and as they get jammed up in strange ways. This forecast posits that over the next decade we’ll be able to put this knowledge to striking use: honing our immunomodulation therapies, mainstreaming the maturing promise of gene therapy, and hacking our immune systems to accelerate our resistance to all kinds of infections.
Deciphering a Meal
Momentous news! Maybe. The USDA has graduated from geometry into (okay, still pretty symbolic) imagery today as they released the new food guide, which lays the 19-year-old food pyramid to rest.
But aside from the purported question of how to convey to Americans what to eat, this image actually does something more specific, and I think, more important. By depicting our choices on a dinner plate, the USDA has pulled our conversation explicitly to meals. Everyone understands the structure of meals. But meals are not the only way we eat.
When I saw that image, my nerdy brain went immediately to one of my favorite articles by classic British anthropologist Mary Douglas: “Deciphering a Meal.” A structuralist, her focus is on boundaries, comparisons, and the operation of ordered elements in social contexts. This results in the delightful dizzying table here, where she maps the grammar of meals (in a decidedly English way, from continental breakfast to high tea to nightcaps).
And (although she is actually depicting in weird ven diagrams what is fit to eat) these images in their resonance to her discussion of what actually appears on a plate in a meal had a profound influence on me when I was studying charity meals as a social phenomenon in school.
In “Deciphering a meal,” Douglas’ major foil for the unit of the meal is “drinks,” structurally and socially distinct from meals in a number of interesting ways. But, for today’s issues and question the more pertinent contrast is meals and snacks. Much of the food industry thrives on snacking–what doesn’t fit into the unit Meal. I’ve actually heard as a research question in RFP’s “what are the new ‘eating occasions’ for X?” These things fit into the old food pyramids, however elliptically. They are not eaten off of plates. They are eaten out of wrappers, out of bags, out of cleverly designed dispensers to fit into all the nooks and crannies of modern live that are not sitting down at a table, with a dinner plate, and eating a meal.
I think it will have legs. It uses patterns and logic that have solid cultural foundations, that I’ve heard echoed from women arranging their daily meal on a chipped plate at a soup kitchen to enthusiastic design students hoping to curb obesity. And I agree with Marion Nestle when she notes that there’s more science behind this than any previous incarnation. But I think it’s also important to remember that meals are only one element of our daily menus.
Wonder
But wonder is a response, an attitude of mind and heart, a graced completion of a circle between observer and observed.
-Lyanda Lyn Haupt, Crow Planet
Just beautiful. That book has stolen my imagination and tucked it into a nest somewhere with other bits of shiny and distressed twigs.
I’m only writing about buses and jet lag because I can’t figure out how to make my presentation work with what I really want to talk about: earthquakes, uprisings, and crows. You think people will actually stick with me long enough to wind our way back to well-being from there?
This is not a blog post.
I have more half-written posts right now than I can count.
Okay, that’s not true, and hanging out at the Quantified Self conference almost all weekend reminded me that I can usually be more specific, always. I have FIVE partially written blog posts, ranging from incoherent jottings to fully formed hostages to my perfectionism. (I also know, lightheartedly, that I spent twelve hours of my long weekend engaging in what I would categorize as “work,” I got a paltry 125 minutes of sunshine, received five business cards, lost three of them, and have only 247 words of the ~1000 words of my talk that I really want to have at least drafted by tomorrow.) With that, you know why this post is what it is, and not the above-mentioned five actual pieces of thinking.
Dancing in the Park
A teenager in yellow jeans shifted a little into a shadow of a dance step, furtively mimicking the handful of more exuberant men and women twirling and gesturing gracefully in the center of the clearing. A man in a suit sits on a bench, flipping through the music on his karaoke machine, filling the area between three large trees with a few bars at a time of music both grand and pop. The dancers are unconcerned, continuing their movements and tailoring them every minute or two to the new music.
This was just the beginning. This is what I came here, to Purple Bamboo Park, to see. This was my first day “off” in a week of interviews and facility tours across Beijing, two to three each day. Today I spent walking—over 8 miles all told—visiting places that people we interviewed mentioned as significant to their well-being. Time and again we heard that the “health dances in the park” were where someone got out to, socialized and exercised. So here I was, in this enormous park that is only the seventh largest in Beijing, looking for dance.
I had been wandering around for hours, watching joggers wind through the bamboo groves, parents and children and elders using the public cardio and self-massage equipment. I was actually on my way out, ready to give up, when I stumbled on this scene in a clearing, surrounded by benches and coat racks, with a few dancers and their audience.
A discordant blare broke the mad rhythm of the indecisive karaoke box.
There was another speaker on wheels in the clearing, louder, indicating they were ready to provide the music now. The style was older—chanting choirs and a vaguely military rhythm. The handful of pioneers dancing to the light of the setting sun became more synchronized in their movements. As they danced, a cluster of a dozen people approached the new music master with friendly greetings, then fanned out to join the dancing. (Adding more videos when I get around to editing them. I took a lot of video. Video is slow.)
As twilight set in I was now swaying on the edges of a sizable group of thirty or so people, arrayed roughly in a grid, stepping and swaying and gesturing in unison. Sometimes they would rearrange, and the men and women would trade-off in some pre-determined pattern. Another few dozen people were on the outskirts like me, swaying and stretching and bouncing in a more partial mode of participation. The ages now ranged from 16 to 60.
I noticed I could hear other music now. I skirted the group and wound my way to the next clear spot—a wide plaza by one of the park gates. There fifty or so women with bright red pom-poms and fans did their own choreographed thing. 
As I watched them someone set up another karaoke machine on the bench on the other side of the widening path from me, and before I knew it there were 3-4 couples doing competition-level ballroom dancing in suits and dresses, with a fast-gathering circle of fans. Just beyond them in the gathering gloom, over the heads of men clustered around dimly lit games of mahjong, was yet another dance area in a wooded courtyard, filled with several dozen couples swaying.
A gregarious autodidact approached me, eager to practice his English. He was in his mid fifties, all smiles over a gray Mao jacket. I asked him if this was a typical turnout for a Tuesday night in the park. He asserted that this was typical every night it didn’t rain—even in the winter people dance in coats. “The everyday people, you see, the workers, not the cadres, they can’t afford to go to fancy cinemas, things like that. This is real entertainment. And it’s free! Free for everyone. Every night.” (It’s amazing how just a few years variation in age between the cohorts in their 40s, 50s, and 60s makes all the difference in whether someone speaks the language of the cultural revolution with caution, irony, sincerity, or nostalgia. After a while the conversation turned to wages, housing, family, and the comparative necessities of a good life in the US and China.)
When I lived in China as a child, I dimly remember the early mornings in the park filled with people practicing tai chi in large groups; marching and dancing with my pre-school classmates in our yellow Transformers jumpsuits. And I’ve read Judith Farquar’s extensive and nuanced analyses of the park as a site of civic life, biopolitics, and embodied nationalism. But dim memories and scholarly imagining didn’t quite prepare me for the scale, the rigor, the total experience of hundreds of people gathering nightly to dance in public.
And in the back of my head, some distance away from my observe-describe [and participate just a little] ethnographer’s brain, I kept wondering,
“WHY CAN’T WE DO THIS BACK HOME?”
People dance a little at street fairs, at concerts, they pay to dance in clubs, in gyms. There are flash mobs and performance artists and the self-consciously alternative Burning Man frequenters. But why can’t teenagers and elders dance in any park, any time?
What would it take to get anybody to dance together as if nobody was looking, for free, in public, any night of the week?
Seriously. Any ideas?
May Showers.
I’m sitting on my patio right now, surrounded by my latest attempts to grow some beautiful and tasty things before the spider mites kill them, listening to the rain. I’ve spent a lot of time out here the last few weeks, enjoying my favorite smell (rain on pavement) and sound (rain and wind on tree leaves), reading, thinking, and writing.
Sometimes it just does take five months to get around to your New Years resolutions. I resolved back in January to write a post about my intent to write more. Ha! Truth is I’ve been in a survival mode over the last several months, desperately clinging to some semblance of work-life balance and chasing inspiration across one (or more) too many projects. But I am emboldened by the last few weeks, which were dominated by the beautiful words DONE and NO. I’ve traveled halfway around the world and back, gone from about 12 outstanding tasks to 5, and said “no” successfully no less than four times, which is some kind of record for me.
And, unlike previous bouts of emerging-from-under-the-rock syndrome, I feel like the words are more uncorked by my relative productivity than spent. I hope I can turn this into a new norm. Knocking on wood.
