New year message from 2016 (New Paradigm of Health)

One day when I was running up stairs of my engineering college in Manipal, my head started spinning and I had this intense urge to throw up. A few days later a family physician diagnosed me for hypertension and promptly put me on a beta blocker after ruling out secondary causes. I continued popping that pill day after day and year after year. I trusted the diagnosis without second thought. 

That was 20 years ago. Over the years, my life slowly moved from sedentary to active and from stressful to mindful. Meditation and trekking in the mountains unexpectedly made me more curious about the capacity of my mind and body. I went through several medical explorations - from top hospitals in Manhattan to Buddhist monasteries in the Himalayas to upscale medical centers in the Middle East to rural clinics in South Africa to Chinese hospitals in Laos. I tinkered with the future of medicine through programs at Singularity University and MIT. In the end, I wondered what exactly it meant for someone to be healthy.

A couple of months back I met a well-regarded cardiologist in his late 70s to discuss both my medical condition and explorations. He exhibited the wisdom that comes with vast medical experience - of listening intently to the patient with an alert mind. He skillfully and methodically examined my principal organs and the suppleness of my veins. Finally, almost as a peculiar climax to my story, he said I may never have had hypertension. He went on to suggest that we must be careful in applying reductionist ideas to the ever-changing chaos of the human body.

I’ve observed our healthcare systems at work on the inside as an entrepreneur and on the outside as a patient. I’ve tried to separate chaff from the grain. Here are a few things I learnt.

1. The disease-target-pill paradigm is changing. Since the last 50 years, our obsession with medications has ballooned out of proportion. According to Siddhartha Mukherjee (author of The Emperor of All Maladies: A Biography of Cancer), our current way of medical treatment of have disease, take pill, kill something needs to be re-imagined. Of over 1 million chemical reactions in our body, only 250 can be targeted by our entire pharmacopeia. We need to address the sources of ill-health rather than finding band-aids to diseases.
2. You are much more than your own genes. Micro-organisms outnumber human cells 10 to 1, each carrying its own DNA. Just our gut has 100 trillion ‘bugs’ that we know too little about - we just know they can influence conditions from obesity to depression. What’s more, Rob Knight, the Director of the Microbiome Initiative at UCSD says each of us has our own microbiome fingerprint making us even more unique. I suspect that this microbiome marker is a moving target changing with environment and time. We may be able to influence it more than being able to catch it.
3. The space around you influences your health. From air to food to habits to stress to sleep to exercise, the spaces we live/work in are hugely responsible for our health outcomes. Playing for half an hour in the sun makes us more alive than coffee ever would. People we associate with play a big role in our health behaviors (and vice-versa). Where our food comes from, how and when it’s consumed is almost as important as what we consume.
4. The body is within the mind, not the other way round. Unlike the brain which we can reach more directly (see this creepy demo of taking away someone’s free will and controlling their arm using a DIY kit), the mind seems to be beyond any tangible reach. Unless of course, we use breath and mindfulness practices to center our faculty of consciousness, which in turn impacts our entire physical body.
5. Health inheritance is something that we pass on. For a simple check on your risk factors, list the conditions of your parents, grandparents, uncles, aunts and siblings. This is our health inheritance. We don’t easily recognize that we add to this inheritance and pass it on. Think of genes as the software that we actively program everyday through our behaviors and environment. We then pass this code to perpetuity through our offspring.

Health largely by itself is simple and so are the conditions to maintain it. In a recent company workshop, I asked my colleagues to define health and we didn’t get beyond being disease free. Then I changed my question. I asked how people knew if their kids were sick or healthy. Pat came the responses: a child who’s sick is dull, cranky, doesn’t eat or sleep well and a child who’s healthy is cheerful, enthusiastic and has a definite positive vibe. 

Yet we find it difficult to apply this unambiguous definition of health to ourselves, leave alone our complicated healthcare systems. But we need to.

Why Healthy People Are Healthy

The following note is based on my health-related explorations until the end of 2014.

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Have you played with the Google Ngram Viewer? It displays a graph showing the occurrences of a word or phrase in books from 1800 to 2008. For example, here’s a graph for “data”, “knowledge” and “sex”. Guess which word is most frequently used in today’s times? While “knowledge” surprisingly makes a better appearance than “sex", it’s “data” that explodes, particularly after 1960. But here’s an even more amusing graph - even as “data” increases, “wisdom” gradually declines.

I know you are finding flaws in this data-wisdom hypothesis. I did too but am trained to find data that validates whatever I feel. The healthcare industry is booming with data from every angle - doctors perform more tests, patients wear more tracking devices and the government provides incentives in exchange of data. However, all this data hasn’t yet reduced our disease burden very much. 

According to the CDC and WHO, the leading causes of death relate to heart disease, cancer, respiratory and stomach infections and diabetes - avoidable, delay-able, only if we really wanted. My work and curiosity led to me examine behaviors of doctors, patients and health systems in diverse places (from remote India to Sri Lanka to South Africa to Laos). Regardless of where they lived, some people were healthier than others. Some people were sicker than they should be. Some people didn’t yet know if they were healthy or sick.

Why Healthy People Are Healthy

In reality, healthy people seemed to be largely responsible for their own health - they were not particularly dependent on doctors, society or even a government. Setting aside unavoidable factors (e.g. accidents, undetected cancers, viruses and such), here’s why healthy people are healthy.

1) Inheritance: Just as with wealth, healthy people inherit a large dose of healthy genes that last beyond a lifetime. This overrides most other factors. DNA (our body’s software) is not just what we acquire from our forefathers but also the code that we actively write based on our behaviors and environment. We pass this on to our offspring, which sets the starting line for their health.

2) Environment: Where we live, whom we live with, where we work, the kind of work we do, how we commute, our societal environment as a whole constantly shapes the health of our mind and bodies. Overall, healthy people have simple hygiene - such as washing hands, cleaning utensils, using clean bathrooms, breathing cleaner air that makes them less susceptible to diseases.

3) Physical: Healthy people cultivate a habit of not causing harm to their bodies through drugs, tobacco, narcotics, alcohol, fatty food and so on. They eat in moderation, according to a routine, according to the changing weather and often mindfully. They have a sense of eating a diet in line with their ethnic backgrounds. They are physically active (they walk, dance, play and exercise) and get a fair exposure to sunlight.

Being active, makes them better perceive symptoms - early signals of falling sick. They seek medical help before these symptoms manifest into diseases that cling on.

4) Psychological: Whether through meditation, prayer, family and friends or service to the community, the healthy have figured out a way to view life through its larger lens and stress less. They carry fewer negativities to bed and usually sleep well.

Healthy people are often responsible for someone or something, making them less self-focused, more useful in their own eyes and therefore less lonely (usually the primary cause of depression).

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That’s it. And yet we seem to be making medical care more complicated than it needs to be. Of course, data is extremely useful but the causes of good health are far more simpler.

Using the Ngram Viewer, I searched for other keywords that might match up with “data” - and I found “god” (converges in 2001). Go figure. Happy new year!

(A longer version of these findings is available here. Thoughts from earlier years are here and here).

Death Over Dinner

I recently came across a wonderful book called The Tibetan Book of Living and Dying and became a lot more comfortable about this somewhat taboo/ morbid subject (at least in US and India) but of course a universally definite one - of passing on. 

I read the book while trekking in Bhutan where among its Buddhists, it's a natural, common topic encouraged from childhood.

Here are a few resources to make passing on more interesting:

1) Everplans 
www.everplans.com
A website that deals with planning long before our death and evaluating our end-of-life arrangements among other things.

2) A Mini Workbook
This workbook PDF helps us plan things like Advance Health Directive (living will, power of attorney, Do Not Resuscitate order) and organ donation etc. While it's written from the US-standpoint but the content is broadly relevant.

3) Death Over Dinner
http://deathoverdinner.org/
A charming website to help us invite friends, family etc over and have conversation about this important topic.

4) How Doctors Die
Wonderful article on why doctors choose to pass on more naturally.

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Here's a somewhat mathematical way to think about it:

Regardless of our age, our life at this point of time is a random dot X between two points A and B where one represents the beginning and the other, the end. While A is a fixed point, B is an unknown, moving target. The objective of the random dot X is to reach B sooner or later. But the success rate of X reaching B is 100%.

Enjoy the resources.

Four Shifts in Healthcare Delivery

2013 has been a very interesting year for healthcare technology - we may even look back and say this was around when healthcare delivery changed for good. As part of my work at NextServices and even as a patient, I track various developments (some hands-on) through the year.

Here are four shifts that I would like to highlight:

1. Medicine becomes a data science

Medical diagnosis is becoming less of an art and more of a science because of increasing availability of data from inside and outside the body. DNA tests, microbiome tests, imaging studies provide clues to lurking problems. Further, data from sleep, activity, stress, changing weight, heart rate and so on provide indications of overall well-being. What isn’t happening however is our ability to interconnect these different sources of data to form a cohesive story. But we will soon be able to. With doctors and patients changing the way they deliver and receive care, we will be to unearth diseases before they manifest as symptoms. IBM predicts that in five years, doctors will routinely use DNA in care. Interesting companies like Theranos are changing how lab tests are done - by precise data analysis through micro samples.

When we think about medicine evolving as a data science, three shifts in healthcare become apparent. One, monitoring ailments becomes a longitudinal statistical analysis and not based on disparate episodes of care. Two, doctors need not be in the same location as their patients. Three, a single diagnosis could involve comparisons across patient populations.

2. Human body as an ecosystem of a billion data points

The human body is expected to have a billion-plus data points. Blood biomarkers provide data points in the hundreds of thousands, DNA in the millions and the microbiome in the trillions. Sensors (via chips) will soon be able to conduct lab tests and provide instant results. Upcoming tricorder-like device Scanadu(about 2 inches wide) is attempting to measure oxygen intake, temperature, heart rate, blood pressure and possibly test for urine and saliva. A survey even suggests that 70% of the people will be willing to share their healthcare data via a smart toilet (yes!).

These data points will find their way through the cloud onto the smartphone. There are already several biosensors on the smartphone - apps such as Cardiio measure heart rate by sensing blood flushing into the face. Apple recently filed a patent for an invention that relates to “sensing and reporting events associated with movement, environmental factors such as temperature, health functions...”. See Smartphone Physical that interconnects various smart devices and applications to provide a patient physical exam via a phone. It may not be much longer before sensors are often found inside the body than outside.

3. Complex Data. Simple Interface.

Generating data is of limited use if we can’t find easy ways to interpret them. IBM’s Watson, which is now more capable than human doctors in diagnosing cancer, provides some insight into how to analyze a lot of data. IBM is also making Watson available as an API to allow programmers tinker with it and build apps.

At NextServices, we got early access to Google Glass as part of its Explorer program and succeeded in porting EHR functions (such as imaging, medications and vital signs) onto the head-up display (we also demoed it at FutureMed). We foresee physicians using Glass at the point of care just as they use our iPad app today. In fact, Wired says that wearable tech will be as big as the smartphone. As devices evolve, we will see increasing underlying complexity that enables simpler interfaces.

4. EHRs as building blocks of healthcare delivery

Much of the industry’s focus has been dedicated to implementing electronic health records (EHRs) that are merely building blocks for digital healthcare. EHRs must be viewed as hubs that interconnect patients and doctors where medical information flows back and forth. Coupled with devices that capture data digitally, EHRs will make the need of a physical visit optional (dare I say, redundant half of the time). According to Fast Company, visiting a doctor would even be as alien as going to a video store.

EHRs will possibly cease to be called so (think how absurd an ‘electronic credit card account’ sounds). Doctors and patients will routinely engage over a digital healthcare delivery platform without realizing that they are on one.

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Wish you a fantastic 2014!

Should you get your DNA sequenced and show it to your doctor?

After FutureMed this year, I sent my spit to 23andme to have my DNA sequenced.  They told me that my mom had Tibetan origins and my dad had Andamanese origins - fascinatingly I've traveled to both these regions.  They told me stuff I knew - that my eyes were brown and hair curled a little.  The most discomforting (at least initially) was my disease risks that varied from atrial fibrillation to prostate cancer to Alzheimer's.

I was skittish when I first logged on to find out my results (it took six weeks after I shipped my spit).  There was a prompt that asked something like, Do you really want to see it?  What the heck, I thought and clicked on ahead.  Then I went through a phase of omg, how could I have all this going on inside?  And then I realized this had to be everyone's story.  All our bodies are likely to have something broken inside with the kind of mutations our DNA has been through (consider, interbreeding with Neanderthals).  We just didn't have a means of learning about it, up until now.  For a long time, I did nothing about these results.  I was busy preparing for a trek and work - I just let it lie.

Around my 21st birthday, because of a chance incident, I was diagnosed with genetic hypertension and put on a 50mg daily dosage of Atenolol.  I simply took the tablet for several years and life went on.  More recently, I started exploring ways to get over hypertension to give me the flexibility to trek more freely.  Interestingly, my DNA didn't talk of hypertension as a risk factor.  I decided to show my data to doctors and see what they say.

What doctors say when they see DNA data

I met two types of doctors - one is an allopathic doctor who originally diagnosed me with hypertension and the other a natural therapist who works on the body systemically.  

The natural therapist (also a physician) studied my entire history (family, medical and lifestyle) and over an hour long discursive diagnosis told me that I had what might be essential hypertension.  He explained that when a body has essential hypertension, its systems simply rev faster - it's not a disease but more an internal behavior.  He fixed my diet - from cutting out milk and wheat to other food that made my intestines work harder, therefore requiring the heart to pump more blood.  He curiously looked at my DNA results for a long time and said that it reaffirmed his thinking - I need to fix what I put in my mouth.  He kept reiterating that the essential systems of our body are interconnected - a problem in one area sooner or later affects another - for e.g. the liver affects the lungs that affect the heart.  Our general understanding was to explore getting me off medications slowly to curtail the toxins accumulating in my liver.

In the interim, I had mild wheezing that wouldn't go and a lung doctor suggested I shouldn't be taking Atenelol that may have side effects.  When I met my allopathic doctor (a well experienced general practitioner who also thinks systemically), I told him that - interestingly, he felt the same and took me off the medication altogether.  It's been over 10 days now and when I check my blood pressure daily - the readings are very normal.  Looking at my DNA results (I'm sure I was his first patient to show him that), his alerts went off on the risks it pointed to (e.g. prostate cancer) and he prescribed tests that I must do every two years to keep a watch on my insides.  

What I think as a patient

When doctors see patients in episodes of time and make decisions, they can be flawed.  As with everything, the body is changing all the time and so is its data.  DNA data provides very basic clues on where the problems might be - these are flaws in our machines.  Lab data (such a Lipid profile) only provide data at specific points in time.  What we really need is data that constantly flows - similar to what a cockpit in a plane gets when it flies.  This isn't possible yet but will in the future.

As patients, we see doctors (and specialists) for specific medical problems.  Each doctor fixes his side of the story, often adding problems to other systems of the body.  There are very few doctors who are able to think (and have the patience to think) of the body as a whole and see the interconnectedness of systems.  But we do so as patients (our body is talking to us all the time) and therefore it becomes our responsibility to channel the care our body needs.

I wonder now if I really ever had hypertension or was that an episode in time.  Or did it gradually go away because I took control of it (I eat moderately, exercise, meditate)?  Or is this an episode in time and would it recur?  I'll never really know the answers to these questions.  My job is to track my data continuously - just as a pilot does for his plane.

I realize that I need both the types of doctors that I see - I need to fix the symptoms when they occur through medication but I also need to fix the system.  Systemic problems require systemic correction - largely involving diet, activity and state of mind that mere medication will not fix.

Should you sequence your DNA?

The answer is yes.  Every other disease becomes a symptom as we learn more about it.  In the past, fever was possibly a disease requiring various cures.  We now know that it's actually a symptom - an indicator that our body is showing to let us know that something is not alright inside.  You can fix the fever by popping Tylenol but you gotto fix the systemic problem for the fever to really go away.  Just as a thermometer gives us insight into fever, our sequenced DNA gives us insight into few other indicators that our body is talking about.  

It took me a few hours, after I first saw my results, to accept that health risks exist for me and for everyone and I'd rather know than not know about them.  If anything these results have helped me give focus to areas that need attention - for e.g. what I eat, how I eat, when I eat (I still haven't fixed it but am more aware).  It also helped me prioritize things in general and be more conscious of how I spend my time.  I worry less about what other people think and focus more on doing things that I really want to do.  I was usually reticent about my health in the past but have surprised myself now by being open about it - thinking that if I talk, it'll help other people.

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But the human DNA is just 10% of us.  90% of our body is the microbiome - bacteria and other microorganisms that reside in us.  Sequencing the microbiome (startup ubiome does it) will tell a whole new story.  Now, I just can't wait to ship my poop.

Messing with Google Glass (and How To Cat-Enhance Your Pics)

Yes, we got one.  We've had hardware, software, middleware...now let's welcome Glassware that will help you make cats appear in front of the Taj Mahal.

A Mirror API on Google's servers connects the development environment to the Glass environment, always keeping Google in the loop.  Google let's you develop in a choice of five languages - Go, Java, .NET, PHP and Python.  This allows developers to create timelines/ cards and menu items that users can access by swiping, tapping and speaking.  Google does a nice job of showing how it feels here but here's how it looks when you un-box.

Cat-enhance your pics

I found this wonderful programming story on how to send users facts about cats by the hour.  Below is a short bit from the Glass developer website on how to cat-enhance your pictures.

1. Your user visits your web application and installs Add a Cat to That by authenticating with OAuth 2.0.
2. Your service creates a new contact on your user's Glass called "Add a Cat to That."
3. As your user takes photos, they share them with Add a Cat to That.
4. Your service composites a random image of a cat on to the shared photograph.
5. Finally, your service delivers the cat-enhanced photo to your user's Glass.

Where do we go from here?

I shudder at the glut of Glassware apps that will soon come our way.  Most of them will be photo/video-based consumer apps - with may be you and me in it.  Our perception of what is real and virtual will blur several notches than it is now.  There will be apps that can alter your life's experience (think seeing cat images everywhere you walk on Times Square).  We will focus even less in the real world - we won't have to reach our phones now, we will simply get notifications in front of our eyes.  People will absurdly touch the side of their heads all the time and keep talking to themselves, activating different functions (remember when you first saw someone using Bluetooth).  Employees will walk in with Glass creating confusion about BYOD policies and confidentiality.  Gamers will get to play even while they sit for dinner with you.  There will be porn (though Google restricts) on the street but you won't know it.

But we will still use it anyways.  Plus we will love it.  "Ok, Glass," let's get started.

The Unimportant Maketh The Important

We need light to recognize darkness.  We need to be sick to understand what it means to be healthy.  We need short people to identify the tall ones.  We need to be far to feel close.  We need to be old to miss youth.  We need failures to distinguish success.  We need to be silent before we speak.  We need the unimportant to know what's important.  But if the unimportant is so important as to make the important so - then isn't it more important than the important?

Is Apple Getting Uncool?

I usually tolerate spam from Apple - it's white and colorful at the same time.  But today I got an email that had please-please-buy-me writ all over.  The subject line said, "We spoke too soon."  I clicked to see Apple showing off a prize from J.D. Power and Associates, a company best known for blessing new automobiles.  Ahem.  Ahem.

As a quick-and-dirty survey, I checked traffic sources for this blog.  Here's how it looks:

Macintosh 57% Windows 31% iPad 4% iPhone 3% Android 2% Linux <1% BlackBerry <1% Other Unix <1%

There you go.  More people are on Macs than Windows.  Apple is edging to become a producer of mass consumer products used by everyone.  What must be happening here?

When we obsess about something, we become that obsession.  Apple is more outwardly focused now than it ever has.  It used to be about ignoring customers and thinking differently from within company walls.  Now the focus is less on the inside but more about grabbing market share and protecting its turf.  In its pressure to meet Wall Street's expectations, the company needs an ever increasing growth curve.  While there must surely be a healthy pipeline of products, it needs a churn at a piping hot frequency - not just version changes.  The only alternative for Apple is to find ways to sell more and more.  That's what it's doing, gradually trading exclusivity for quicker bucks.

Samsung, Microsoft and others are getting hipper - diluting Apple's difference.  We are now officially in the tooth-paste phase of computing products, a state of mind-blur where every product is only as interesting as the other.  Differentiation is marginal - not real.  And an iPhone becomes just a smart little phone.  There's a worm lurking in Apple.  Steve must be squirming...somewhere.

The Power of Not Wanting

I want things all the time.  I want sales.  I want money.  I want resources.  I want to build things.  I want people to pat on my back.  I want to be liked.  I want respect.  I want time.  I want to be useful to society (I like this one because it makes me fool myself as a good samaritan).  What if I don't want - even if it is just for a few moments.  Not wanting sets me free.  In that freedom lies great power to do things exactly the way I want because I really don't want.  

Wanting makes me desperate and weak.  Not wanting puts so much faith in my ability to make things happen that I feel heady.  Instead of resisting something that I think shouldn't be happening, I simply say yes and move forward.  This somehow opens doors that I didn't know existed.  Not wanting puts me in a position of saying yes or no.  Wanting puts me in a position of waiting for someone to say yes or no.  Not wanting makes me think of myself as unique and the world as an abundant place full of undiscovered resources.  Wanting makes me competitive, hungry with a hopeless world view that there's not enough out there.  Not wanting triggers that part of my brain that gives me ideas.  Wanting puts emotions at the forefront.  

Not wanting somehow gives me all the things I would think I want.  It gives me time.  When I'm playing with my son and think of that time as his and not mine, it makes me desperate for time.  But when I don't care about time then that time becomes mine and I seem to have infinite time.  When I'm desperate to close a sale, it never closes.  I come across as needy.  When I don't care about the sale, somehow I speak more truthfully and it takes its natural course to closure.  When I don't care if someone likes my work, the focus becomes the work and not useless externalities that dilute it.  

Try not wanting.  Now would that make you want to try it or not want to try it?  Go figure.

Being Okay With Not Knowing

The more I know, the more I seem to get a glimpse of what I don’t.  When I know what I don’t, I soon find that the I-don’t-know part expands and expands.  I don’t seem to know much about the past or the future.  Even better, I don’t seem to know anything about the present.

Let’s travel to our past.  5 years, 100 years, 1,000 years - how about 50,000?  Scientists recently sequenced a Siberian girl’s DNA from her pinkie bone.  Much like me, she had dark eyes, skin and hair but she got to hang out in the Altai mountains back in the days.  They call her kind the Denisovans.  Denisova hominin are an earlier species of humans and Neanderthals - suggesting interbreeding between the two.  What’s more intriguing is that 2.5% of my DNA (and that of most living Asians and Europeans) might be Neanderthal-laced.  This means that my ability or inability to fight diseases today may be the result of sexual choices of my prehistoric grandparents.  Ahem.  Do we really know our past?  How much past is good enough to call it so?

Let bygones be bygones - the present should be more in our grasp.  But time, even in its present moment, is wide and deep.  What we see is not usually what we think it is.  Fungus on old bread isn't just fungus on old bread.  Learning a little about mycelium, I now know that fungus serves as the Internet and circulatory system of our ecology - transferring food and intelligence.  Molecular communication in the environment occurs through cellular mats of fungus, sometimes spreading over thousands of acres.  I'm hardly aware that my lunch is a product of this network that has been in the works for generations past.  So is the present moment really about now?  I don't know.

That leaves our future.  When I think of the future I'm reminded of Sonmi-451, a genetically re-engineered waitress in Cloud Atlas - a deliciously chaotic movie by the Wachowskis and Tom Tykwer.  In the year 2144, Sonmi starts a revolution when she discovers that bodies of her species are “recycled” into food to produce future waitresses.  Centuries later, most humans are destroyed and the tribe that remains worships her as a fearful deity.  This amusing take of the future makes me wonder about the reality of today that embeds unknown influences of the past.  It also makes me wonder about the future that will borrow from an unreal today.  What is future then?

When we only see the red dot on a white board, we miss the vast nothingness that stares at us.  Time is expansive and cannot be contained.  I don’t think Time thinks of itself as linear dots neatly arranged as past, present and future.  In fact, Time possibly thinks of itself as a repetitious sphere going round and round - think night and day, season after season, yearly revolutions, solar and lunar eclipses, water cycles and so on.   Why should our time be any different?

We love the false sense of security that I-know offers.  But in reality I-don’t.  The more immersed we are in I-don’t-know, the more we may indeed know.  May be.

Takeaways from FutureMed (Day 2)

Here are a few of my takeaways (and thoughts) from yesterday at FutureMed 2013.

We are full of sh*t

Just as gene sequencing took off these past couple of years, we will soon see analysis of microbes break new ground.  Companies like uBiome are mapping the microbiome (the sum total of microbes, their genes and the environment).  I learnt during Larry Smarr's lecture that 90% of our cells and 99% of our genes aren't human (whatever human is) but microbes!  Our gut alone harbors 100 trillion bacteria.  Depending on what species are most dominant inside us determines our physiology.  So we are indeed what we put into our mouth!  Read this fascinating article on how Larry quantified himself to the extreme to take control of his health.

Watson is learning about cancer at Kettering and will go live by the end of the year

IBM's Watson is at Kettering devouring knowledge from millions of its encounters.  Senior oncologists at the hospital are spending 50% of their time teaching Watson.  By the end this year, it'll start assisting doctors with therapeutic options for cancer.  Marty Kohn said that IBM has no decision yet on their business model for Watson.  Would this be a big cloud or several mini-clouds?  We don't know this yet.

An inflection every 50 years

Back in 1870, there was germ theory.  In 1920, advances based on medications (example is penicillin).  By 1970, medicine evolved into a science (evidence based).  Fast forward to 2020 and we could possibly be working in a healthcare world that's driven primarily by data.  These thoughts were from Daniel Riskin, MD whose company actively culls out data from EHRs and creates meaning out of it.

A machine is possibly better than 50% of MDs (who are below average)

Vinod Khosla reflected on insights that possibly stare at us in our face.  The most uncomfortable of them was the fact that half of the doctors out there are below average and could possibly provide much better medicine with assistance from a machine.

Elegant visualization and avatars

Among several other things, John Mattison, MD from Kaiser talked about elegant visualization in the world of big data.  As a case in point, a recent study generated 5 terabytes of data for every patient.  To put this in context most of the world's data has been created in the past two years and is unstructured (Mary Kohn).  A better way to make sense of such data would be to use for example heat maps to visualize what's going on.  What if you combined such visualization and connected it with actionable outcomes using avatars?  If your grandma heard from your avatar in your voice, would she be more willing to get active everyday?

4 predictions for health IT

Christopher Longhurst, MD made the following interesting predictions:

1) EMR vendor consolidation and increasing federal regulation will pose challenges to rapid innovation

2) Health IT focus will shift over the next 3-5 years from EMR implementation to analytics-enabled clinical decision support

3) Over the next 5-7 years, we will see a shift from "evidence-based practice" to "practice-based evidence" through the creation of national learning healthcare systems (could HIEs be those hubs?)

4) Personal health records will evolve into personal health advisors

Trusted recommendations at the right time change behavior

Julia Hu from Lark showed the new Lark.  Their approach to development involved capturing and automating expert coaching and providing behavioral alerts to users at the right time.  For example, if Lark noticed that you didn't sleep well last night, have been running around all day, are still in the office at 7PM and have been sitting for two straight hours then it knows you possibly need a push to de-stress for a few minutes.

New age of innovation

Here's 16-year old Jack Andraka's video where he's screaming away joyously when he became the grand prize winner at the Intel Science Fair last year.  He developed a new way to detect pancreatic cancer and is talking to Quest and other labs to commercialize his method.  He closed his presentation talking about how the Internet has no cognition of who you are, your age, your gender and so on but mainly about what you have to say.

More later.

Amazon must invest in bio-data centers

For all the scramble that we've had over cloud computing the past few years, there could be a gentle evolution underway.  Last August, George Church's Regenesis became the first book to be stored in DNA and was replicated 40billion times (it was fun am sure).  It cost about $1,000 to print onto the first DNA chip and then another $50 to replicate via polymerase chain reaction (PCR).   

How it's done

A book constitutes words and images that fit into an HTML file (Church's book has 53,246 words and 11jpeg images).  The file itself occupies a few hundred KB in traditional information storage terms.  Broken down, the file represents a series of 0s and 1s that can be encoded into ATCG equivalents (primary nucleobases found in DNA).  Church's team assigned 0 to As and Cs and 1s to Gs and Ts.  When we do this, we get a few million base pairs and a few thousand DNA segments.  Once the ATCG equivalent of the book is available on a computer, it can be taken to a lab to synthesize.  The result is an extremely compact storage mass with massive capacity to store - an oligonucleotide chip.  But direct encoding of AT, CG into 0s and 1s provides errors and hence newer experiments use a ternary system (not binary) with 0,1 and 2 that try not to confuse DNA readers.  However, we must just remember that the book in our hands will now be all sticky and gooey.  

A DNA Kindle

Just as we need a Kindle for books (basically a hardware device with software capable of interpreting 0s and 1s in a human-readable form), we will now need rapid DNA-readers (sequencers).  Cost of sequencing is expected to drop to less than $1,000 but scientists are still working with humans in mind, not books and other data that we may wish to store and read.  

A device that can take gooey, sequence it to get the ATCGs and then present it in human readable form could soon be a much needed Christmas toy.  Without stretching my imagination too far, I see a possibility where we have bio-printers and readers at home.  We would get our gooey in a dark box in the mail (it has to be protected from sunlight), we pour it, sequence it and print it (from tissue to book to whatever!).

Data centers with a 10,000 year shelf-life

Our current storage systems have poor shelf-life.  A book has wear and tear.  A CD breaks and scratches.  Data servers heat up and die and require expensive backups.  And DNA?  DNA stays.  Think that every DNA base pair in our cells has had an original existence tying us right to the very beginning of life (some 3,900 million years ago when single cell organisms first discovered that sex was a good idea).  It's always been there - not in its current diversity but in its base forms.  I learnt that we now have the complete DNA code of our brethren neanderthals - a genome consisting of 4billion nucleotides.  Read this fascinating scientific study that also explores whether we (humans) messed around with them.

It's possible therefore to foresee the advent of an entirely new industry to store humanity's data in biological form.  Instead of large physical data centers housing hundreds of thousands of servers, coolers and other goodies, we will have micro-scale biological storage systems in cold, dark places.  It's so micro that a single gram of DNA holds 2.2million gigabytes of data.  The Economist says that you can fit the world's data in a lorry (truck for some).

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Amazon Web Services started with a small group of people in South Africa who imagined a brave new world running storage and computing off the Internet (AWS today is an est. $3.8B business).  Amazon hopefully knows it's time to let its engineers mess with biology.  Hopefully Facebook doesn't.  

There's enough time for what you love

Over the past hundred years, we have been conditioned to think of ourselves as responsible industrious citizens when we make time for all things official.  We easily take time from family for important meetings, urgent conference calls, networking events and so on.  But we find it more difficult to take time from work for interesting movies, going to the museum, walking by the beach, meditation and so on.  This oddly dichotomous behavior is so ingrained in our consciousness that we don't even realize it.  We divide life into compartments such as personal and professional lives when it's really referring to the same person.

A field guide to happiness

Happiness has a real simple formula.  It's got nothing to do with what we possess but everything to do with what we experience (sometimes with what we possess).  When we get over our mental hang-ups, we eventually gravitate towards doing things versus owning things.  Desmond Morris who studies animal behavior puts it well in his 1977 classic, Manwatching: A Field Guide to Human Behavior.  If we could return, by time machine, to an early cave-dwelling, we would no doubt hear the same kind of laughter, see the same kind of facial expressions, and witness the same sorts of quarrels, love affairs, acts of parental devotion and friendly co-operation as we do today.  We may have advanced with abstraction and artifaction, but our urges and our actions are probably much the same.  When examined closely, technology can usually be found to be serving one or other of our ancient action-patterns.  The television set, for example, is a miracle of artifaction, but what do we see on it?  Mostly we watch simulations of the quarrels, love affairs, parental devotion, and other age-old action patterns.  Even in our TV armchairs we are still men of action, if only at second hand.

Regardless of our advances as a society, we love to do the same things that we used to do as neanderthals.  We dance, run, swim, have sex, eat, talk, fight and laugh.  These things make us happy.

A really simple exercise 

When you distill your experiences to the essentials (whether it's during a single day or a period of time), you'll come up with the same 4 or 5 things that excite you.  Things that engage you and make you lose track of time...make you happy.  I've conducted a simple exercise with several people to help them discover what they LOVE.  I simply have them ask themselves: What do I really love?  People love the most random things when not under self-created pressure: to listen to people, to trek, to share knowledge, to play table-tennis, to negotiate, to create, to read and so on.  It ALWAYS ties to their natural talents and is invariably action-oriented.  In fact, people are so sure about what they love (when asked) that they can easily prioritize amongst what they love more and what they love less.  

Now the problem

The problem is people never ask themselves what they love.  Even if they ask, they are too afraid to listen to the answers.  Even if they listen, they hesitate to act on it.  Even if they do act, they worry about extracting commercial value soon.  Finally, they focus on creating material goods that they exchange for time. Then they exchange time to do what they love.  It's funny but this is how the cycle goes.

When we actively don't create space in our days for what we love, we resort to distractions that we well know are purposeless but do them anyways.  Think smoking, Facebook, TV, the regular drink, checking news websites, coffee, more coffee, LinkedIn updates, phone-a-friend, BBM, Skype, idle office banter, stock prices and several other fillers that help us getaway.  How come everything else seems to get our time except what we love?

Eventually, we change our work but end up in the same cycle again until we finally finish up.  The problem isn't the work, it's us.

There's time for love

Here's a simple way out.  It's so simple that you'll feel silly reading it.  Make a short list of things that make you happy.  Do them.  That's it.

In fact, do them everyday - at least one or more of these.  When you act on them, you are happy and your days are more fulfilled.  Don't question them.  Act in spite of the seeming loss of everything else.  There are two ways this would go.  You know what you love but don't act and splurge your time on everything else.  You know what you love and act on it at the cost of other things.  The former will give you momentary practical satisfaction but long-term hell through mediocrity.  The latter will give you short-term angst but long-term bliss in having spent your time usefully.

Making space

A friend recently asked me how I compartmentalize my activities (prompting this article).  The reality is I don't.  All I do is trade every hour carefully with something that I love doing.  And when I'm doing that I subtract everything else and create a lot of space around that activity.  Whether it's a client phone call or playing with my son or painting or scoping a new market - it's the same for me.  I love them all and I create space around it.  I don't let my phone, email, Skype, people, Internet dilute this precious space.  It's very difficult with our modern day distractions but I constantly try.  Creating space around an activity brings greater joy.  You are truly respecting the activity or the people associated with it by being fully there.  In its own way, it helps you move forward with ease.

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When you ask most people what they want out of life, they say they want to be happy.  That's really simple.  Find what you love, do it and make space.

Print me a liver, darling

I recently ran into a computer programmer who was tinkering with what looked like a stripped down printer with a whitish blob that looked like hardened you-know-what.  Curious, I asked him what he was up to.  He was printing what would be or could be biological tissue.  Here's a suboptimal explanation of what I saw.

On one side of this bio hackerspace was an area to cultivate cells.  The interesting thing about cells is you just need one.  If it's a bacterium like E. Coli there's so much love going around that they multiply rapidly...1 becomes 2 becomes 4 becomes 8 becomes 16, 32, 64, 128, 248...you get the idea.  f(x) = 1 + 2x + 4x^2 + 8x^3....something...who cares, just fit any exponential equation you jive with but know that you can culture blobs of love.  They are usually found in our gut and smell like poop (don't try).  I also saw white-pink stem cells on a carrot that looked like the unshaven face of a friend I won't name.

Back to the printer.  What I saw was a combination of an undressed laser-jet printer with a cartridge full of cells, an Arduino micro-controller, a CD-disk drive with a slider and a petri dish to catch the droppings.  The micro-controller was programmed to control the print head and spit out cells on an array.  That's basically a printer printing cells according to design.  See it in action.

These are very early days.  So let's fast forward this a bit and imagine what could be printed.  If you print layer upon layer, you could be building a 3-D organic structure.  That structure could be skin or even a part of a much ethanol-laced liver.  That's what Organovo does and I learnt that Autodesk is developing CAD tools to help us print body parts.  Now the good news is unlike ink you don't need to waste much cell to print.  Print a bit and allow the rest to multiply.  Wonder what Mrs. Bobbit would do now.  Ahem.