#247Health at #Scio13

Jan 08 2013 Published by under [Medicine&Pharma]

I will facilitate a session at Science Online dealing with mobile technology and healthcare (#247Health). Cheaper, faster technology has changed the way we read and communicate and work. Now it can change the way we treat disease and preserve health.

I have posted several times on the use of mobile devices as personal coaches for physical activity and diet (see bulleted list below). This can be useful for maintaining or improving health, as well as the management of some diseases. More than 600 apps for the iOS platform address diabetes management  Some blood glucose meters are now smart phone attachments! Other chronic monitoring can be performed as well, including sphygnomanometers that send their blood pressure reading to an iPhone and heart rate and rhythm monitors.

In The Creative Destruction of Medicine, Eric Topol addresses many of these issues. One problem, though, is that while the technology to monitor a lot of stuff is just around the corner, we still do not know what to do with these reams of data. I have standards to judge a 24-hour ambulatory blood pressure recording; I do not know what to do with a week's worth of round-the-clock values at this time. He envisions a future where we can all have our full genomes sequenced at birth and use the data (and periodic assessments of epigenetic changes and environmental issues) to prevent chronic disease. Right now, you could hand your doctor your full genome sequence, but aside from a handful of genes and variations, we have no idea what it means.

Topol envisions a future where each treatment and recommendation can be tailored to each individual's particular characteristics, rather than our present approach of starting with whatever works in large-scale groups (such as a prospective clinical trial). Unfortunately, we have to collect these massive data sets and analyze them before we can individualize our approaches completely. We have been successful with some aspects of pharmacogenomics as he discussed in his book; I hope that I see further individualization such as he describes during my career.

A short article in this month's The Scientist addresses the movement of lower-cost technology to improve diagnostic testing both for the developed and developing world. Blood tests that require a tube through an analyzer here in the states can be read in 10 minutes on a postage-stamp-sized paper. Perhaps most fascinating to me is the advent of low-cost ultrasonography. Mobisante produces a portable US device that records images on a supplied smart phone. While its $7,500 price tag is quite a bit more than standard medical instruments, it still places this technology in the reach of most medical practices. The device proved its worth assessing trauma after the 2011 Joplin tornado, and it has great potential for the developing world as well. Some medical colleges are teaching their students to use US from day 1 to supplement their physical exams.

Just to show you how cool this is, the demo of this device can be seen here:


Healthcare is changing in our brave new world. I can't wait to discuss these frontiers at Science Online on Saturday morning.

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Healthier, One Month At a Time

Jan 03 2013 Published by under General Health

FitBit GalleryEvery time I glance at the FitBit App Gallery I find a new aid in my ongoing quest for fitness. I just started using Health Month, a game-based platform for habit change.

It began with a group of friends challenging themselves to improve their health:

Health Month, at least this geneological line of it, started on April 3rd, 2002 whenRick Webb got dumped by his girlfriend and he decided he wanted to lose some weight. In January of 2003 his friend Keith Butters joined in and another friend helped create the official set of rules. Over the next couple years the monthly ritual gained popularity at the Barbarian Group and amongst some friends in New York and Seattle. The draw of the event was more about doing something drastic and dramatic, with friends, as a form of penance for the previous year. Improving long-term health habits wasn’t so much the goal… proving that you could go 30 days without a drink (and justifying a spirit of over-indulgence the rest of the year) sort of was.

In 2008 livejournal community was born. In 2009, a Facebook Group was born. Then the bickering started. Were the rigid all-or-nothing rules of Health Month too black and white? Was it not healthy to eat some meat? Wasn’t yogurt a good kind of dairy? Isn’t dark chocolate supposed to be good for you? Was fat even a bad thing? Without a consensus about what was healthy and what was not, the group that originally started mostly as a self-dare became fragmented with worries about what true health actually was. Even though over 600 people signed up for the Facebook Health Month group in 2009, 2010 was pretty much a dud, and everyone did their own things.

In the meantime, I built an iPhone app related to learning more about how to eat locally called Locavore and a social game called 750 Words that was a private journaling social game of sorts. My brain was a mess of nutritional information and social gaming ideas. After my son, Niko, was born in May of 2010, I gave myself 90 days to either build something new or get a real job.

Health Month was (re-)born.

In its latest incarnation, the players define their health rules from some set lists as shown in this video:

So how do you score points?

After you commit to your rules, you start each month with 10 shiny new life points. The goal is to end the month with at least 1 life point. You lose a life point whenever you don’t stick to one of your rules, but don’t worry if you lose all of your life points — that’s what friends are for! Friends and other players of Health Month have your back when you need to be healed (this is a big part of why Health Month totally rocks compared to other health plans and services). This game is NOT about making you feel guilty. It’s about helping you discover what works for your current lifestyle (do more of that) and what doesn’t (skip it). Also, if you accidentally over-commit yourself and and lose all of your life points (I’ve seen some people go to -100 life points and more! Maybe there should be an award for being ambitious?), it just means you can take it a little easier next month. Life is long. Small improvements will make a bigger impact long term. And, by the way, you can still play the game if you are -100 life points… everything still works as usual.

Of course, those of us with a competitive streak can find friends and strangers with whom to compete. You can share your progress on all the usual sites, and it integrates well with a number of other fitness apps.

Click to Enlarge

Click to Enlarge

The other figure shows my progress so far this month. The yellow lizard notes my degree of difficulty. I have only set 3 rules and I rated them all fairly easy.

Health Month looks like a great way to progressively challenge myself to make small healthy regular changes to my routines. I just upgraded to the premium account (first 6 months for $20.13 instead of $30); if it helps my changes stick, I will renew in July and update here.

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The Power of Mobile Health: #scio13

Oct 12 2012 Published by under General Health

The other day I made a grocery run. About halfway to the store, I realized that my phone still rested on my kitchen counter, and I seriously though about going back for it. What if the car broke down?

Never mind that the first 35 years of my life I had left my home without a phone and somehow survived.

Now our phones do far more than provide communication lifelines. They give us instant access to the wealth of the internet, including information and entertainment.

For Science Online 2013, I will help moderate a session on mobile health technology. There are several aspects to this issue, and over the next 3 months I will blog about some of them. Mobile technology allows me, as a physician, to have almost instant access to a wealth of information.  When I am on call, I can pull up medical records at home and double-check the medications the patient is relaying.

Patients can also use these devices to access information. Apps also allow us (I'm a patient, too) to track our health. How can we make these ubiquitous devices even more helpful? Could they become virtual health coaches?

The latest FitBit

Example one: FitBit.

FitBit makes a number of devices to help track your activity. This tiny item provides more than a step count. It uses the power of our wired world to track distance walked and its altimeter tracks "flights of stairs" climbed. I put that in quotes because a day out trekking in an area with few stairs resulted in 15 flights based on the hills. A soft wristband lets you sleep with it, and it will track how long it takes for you to quit moving, how many times you get up, and how well you sleep. The software for smartphones and computer provides a diet log; however, you can also link the device to Lose It!, MapMyRun, and other popular fitness programs.

You can also find fitness buddies and follow each other via the FitBit web site.

I lost 8 pounds in the first 3 months I had my FitBit. Unfortunately, my son came home from college and constant exposure to freshly cooked bacon and salty snack foods undid my efforts. I am back on track at the gym. Now I just have to get back on track with healthier eating again.

Science Online falls at the end of January, a time when many of us are slipping in our New Year fitness resolutions. Perhaps we should form a Science Online virtual fitness group. Maybe the FitBit folks would give us a special offer on their new device that includes Bluetooth so it can synch directly with a mobile phone!

If you're interested, let me know in the comments below or via email {pascalelane at gmail} and I will contact the company.

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