Physician Replacement Therapy

The family doctor or nurse’s job is an impossible one.  Given our imperfect description of symptoms, and possibly a blood test, they have to figure out what intervention will help us return to a stable, healthy life.  The problem is that human beings are probably the most complicated system that we can imagine to try to regulate.  Our environment, psychology, and life habits interact deeply with dozens of major internal organs and body systems which manifest tens of thousands of possible known problems. We know a great deal about the components of our body, but what we do know is dwarfed by what we don’t know about how these components interact with one another.  After a brief digression into what makes medicine a hard problem, I’ll introduce some ideas for what we, as patient participants, can do to improve the problem solving process, our own care, and healthcare at large.

Network Medicine

A recent TEDMED talk by Albert-László Barabási highlights the rich system of interconnected networks the exist both within and outside our body; networks are a way of viewing the world that we are only beginning to understand.  The functioning of our body is not independent from our mind and environment.  The bugs in the soil communicate with the symbiotic bacteria that enable us to digest food, the micro-RNA of the plants we eat may directly change our gene expression, the inactive ingredients in breast milk line a baby’s intestines and protect it from external pathogens until the immune system has matured, and our expectation of a treatment’s effect can physically transform how our bodies function (the so-called placebo effect).  

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What can we learn from our E-Mail logs?

Recently I’ve been observing via RescueTime that I spend 3 hours or more hours in my e-mail application most days.  However, I don’t have a good breakdown of how much of this is scheduling, looking up information, commenting on something substantive or social discourse.  There is a tremendous amount of information locked up in the time-series of e-mail’s sent and received that can provide insight into aspects of my behavior such as focus of attention (time of day e-mail is sent), social relationships (what organizations I interact with in a given week), the density of idea generation, etc.  E-mail logs contains a wealth of raw data that can be instrumented to uncover important information about our life.

Our E-mail logs are also rich archive of useful information such as phone numbers, addresses, what we said to someone, when we said something to someone, edits to papers, attachments, etc. With a proper set of tools, many of which have been built for analyzing social media, we can turn this archive into a database of useful information that can significantly enhance e-mail-based  instrumentation.

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Aggregated Self-Experiments is runner-up in REACH Challenge

AcademyHealth announced the winners of their REACH Challenge contest including my own project, Aggregated Self-Experiments.  The project was a collaboration between the MIT Media Lab, Lybba, and the C3N Project of the Cincinnati Childrens Hospital and Medical Center.  The project submission was a demonstration of a web-based platform for authoring, execution, sharing, and aggregation of self-experiments.  

This platform will be opened up to the public later this month and used to field test the ideas I’ve been writing about this last year, but you can pre-register today.  Further, a research study I’m running on the site for people with chronic diseases (initially focused on psoriasis) will be opened for recruitment in the next few days.   Pre-registration for the study is also available.

The Collaborators of C3N

It has been gratifying to recieve some great press coverage of C3N; the ideas we are exploring are clearly starting to capture the imagination of a larger audience.  However, C3N is a larger and far more collaborative project than the articles imply and this post aims to provide some detail from my own perspective, expanding on my earlier introduction.

Origins of C3N
C3N is a platform in the broadest sense.  It consists of human, process, and technology components.  It was initiated by a transformative research grant from the NIH Director’s Office in 2009, the result of a proposal developed by Jesse Dylan of Lybba, Peter Gloor of MIT, Neil Halfon of UCLA, and Peter Margolis and Michael Seid of Cincinnati Children’s Hospital and Medical Center.   The inspiration for the effort emerged largely from Jesse’s vision of bringing patients into the care system as equal partners and Peter Margolis’ experience developing large networks of clinicians that standardize care and apply process improvement techniques to optimize care and improve outcomes for pediatric patients with Inflammatory Bowel Disease in the ImproveCareNow network.  

The Law of Unintended Consequences in Health Policy

A discussion I had earlier today reminded me of an argument I’ve had with friends in the scientific community on multiple occasions.  The argument revolves around the belief that conclusions of science, such as the effect of cholesterol on heart disease, suggests specific interventions, such as reducing the dietary fat that we believe causes high cholesterol.  In essence, we debate the means by which new scientific evidence should be used to influence public policy and private behavior. Taking strong evidence of a specific causal link between a cause and an undesireable outcome as prescription for a population intervention to remove the causative factor is fraught with danger. There are many reasons for this, but the two most salient are confounding and the law of intendended consequences.  

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Schema support for Clojure HBase Client now called clojure-hbase-schemas

My github fork of the Clojure library for HBase, clojure-hbase is now deprecated.  I’ve extracted the functionality from David Santiago’s original library (with permission) along with a duplicate of his admin functions to create a parallel repository with the schema-oriented API I developed.

The new repository is owned by Compass Labs and can be found here.  The library can also be referenced via Maven / Leiningen:

com.compasslabs/clojure-hbase-schemas "0.90.4"

On the Road Again

After a summer travel hiatus to work on research projects, I’m back on the road again this week.

Today, I’m chairing a break-out panel at Mayo Transform 2011 to talk about the power and opportunities in sharing health data across organizational and discipline boundaries.  Tomorrow I’m participating in a break-out discussion featuring Hugh Dubberly on self-tracking and visualization, also at Transform.  Check out the alternative announcmeent on the fantastic new Lybba.org website and blog.

On Thursday I’m participating on a panel about Innovation Scaning sponsored by the Office of the National Coordinator for Health Information Technology and the Health 2.0 team in DC.  

It feels great to exchange ideas in real-time with my collaborators the larger health innovation community again.  As always, Transform is off to a great start!