Chatting about digital health and food at James Beard

I had a great time at this year’s James Beard Foundation Food conference — what an amazing group of food thinkers and makers. My panel, Health or Hype: Dealing with Information Overload, was particularly fun (and stocked full of Dukies — 3 of us). Check out the video.

Am I taking a student in 2016?

It’s that time of year again. I’m a faculty member in the clinical psychology program at Duke. Clinical psychology programs are kind of competitive.  During application season, I get lots of questions about whether I’m taking a graduate student, as well as what I’m looking for.

Back when I applied to graduate programs in clinical psychology, I had an entire kitchen table full of brochures, letters, and file folders for each university. We didn’t apply electronically, so I had an assembly line with stacks of printed personal statements, letters of recommendation in sealed envelopes, and special sections for schools — like Duke at the time — that required extra stuff.

Some things change, some things stay the same. Then, as now, I remember wondering whether individual faculty would be taking students in my application year. I really appreciated those faculty who were transparent about their plans, so I aim to do the same. Therefore:

tl;dr: Yes, we are [probably] taking a student next year.

Now, a few pieces of totally presumptuous advice:

As most of you know, clinical psychology programs that adopt the scientist-practitioner model operate along a continuum from clinical-heavy to research-heavy emphasis. Duke’s clinical program resides at the research-heavy end of the continuum. Duke offers absolutely splendid clinical training. We have outstanding clinical supervisors and a diverse set of training settings. Our alums become very strong clinicians. But we remain a research-heavy graduate program. If you are primarily interested in becoming a clinician or are not sure about your research interests, then I would strongly consider whether a research-heavy program is right for you. My opinion: they’re probably not.

Next, when it comes to evaluating potential research mentors, fit should be your primary consideration. I cannot emphasize this enough. For better or worse, many graduate programs still use an apprentice training model. This means that you will spend at least the next four years working very closely with a research mentor to develop the skills necessary to pursue an independent research career.

Here is a universal truth about graduate study:

If the fit with your mentor stinks, your graduate experience will too. -Me

Look, we know that there are lots of good reasons to pursue graduate studies at Duke. We are one of the best research institutions in the country. We have the country’s most beautiful campus. We have the best men’s and women’s basketball teams in the nation. Our faculty actually play basketball. We have will soon have the best football team in the country. We have the best food and food trucks in the country. We have the best dance festival in the country. We have the prettiest gardens and forests in the country. We have the best weather in the country. We have the best college chapel in the country (I was married there). We have the most spirited undergrads in the country. Did I mention that I am an alumnus? Duke is an amazing place, but if the fit with your research mentor stinks, very little of this will matter.

In that spirit, here’s what I’m looking for. First, know that my team designs, tests, and disseminates interventions for obesity treatment in medically vulnerable populations. This means a few things:

  • We’re looking for those who want to learn how to develop interventions.
  • We work in real-world settings with medically vulnerable populations; for obesity this means socioeconomically disadvantaged, rural, older aged, and racial/ethnic minority groups. We’re less in determining what works for obesity treatment in highly motivated populations. We work in busy primary care settings, often far from campus.
  • We use digital health approaches. We don’t use paper, pencils, workbooks, food models, or in-person individual or group treatments.
  • Although psychology is an individual discipline, our research program is heavily invested in population health.
  • We work on the public health challenge of adult obesity. We don’t work in eating disorders (although Duke has great faculty in this space). We’re getting more interested in work with kids, and will probably start with families.
  • Finally, when evaluating a graduate application, I’m looking for those who have demonstrated an ability to think big, articulate focused research questions, work independently, execute in the field, meet deadlines, work well with colleagues, and communicate effectively – all while knowing how to have fun.

Good luck and Go Duke!

Do this in your next health app

(It’s funny how far we haven’t come, no?)

Hoping to build search interface on your new health app? This should be your inspiration goal.

Forget all that you can do with a quantified self-style interface. People want answers. Not more numbers, figures, charts, and talking avatars. Imagine an interface that allowed people to ask things like:

  • Am I exercising enough?
  • How long is it going to take me to lose 10lb?
  • How much weight should I lose to get off this blood pressure pill?

Is digital health bad news for academic medicine?

Here’s an interesting piece about the emigration of medical students from top-tier West Coast medical schools and into digital health startups.

Bay Area-based medical students from Stanford and UCSF have among the very lowest rates of pursuing residency programs after graduation compared to the rest of the country. Stanford ranked 117th among 123 U.S. medical schools with just 65 percent of students going on to residencies in 2011…UCSF is 98th on the list, with 79 percent of its graduating students going on to residency…“We’ve seen that many of these Bay Area-based medical students are drawn to startup opportunities,” said Jeff Tangney, CEO of Doximity. “It used to be biotech, and now it’s more often digital health.”

This is tough news for medicine – both clinical and academic.

It will be tempting for some to de-trend these findings, questioning whether these emigrees should’ve ever entered medical school in the first place. Others might argue that these departures are actually good news for future patients. But these perspectives miss the underlying trend.

It used to be the case that if you were interested in improving patient care and creating better, more efficient treatments, you went into academic medicine. If you found innovation more compelling than full days of patient care, you could find an academic position, secure a more limited clinical role, and start creating. Today, given funding restrictions, beauracracy, and the long [long] road to impact, the startup economy is a more attractive option.

In short, I wonder if people are running to digital health, or running away from academic medicine.

What do we need from digital health science?

Not another app. There I said it [again]. The market is crowded and science can’t (and shouldn’t) compete on design, updates, integrations, marketing, etc.

So what is there for a behavioral digital health scientist to do?

Answer the tricky, confounding, unanswerable questions that are constraining the growth and utility of digital health.

Like this.

Vanessa Friedman wrote great piece in the Times last week about breaking up with her Apple Watch (I’ll take it). Amidst her litany of concerns was this:

Likewise…the fitness-app aspect — the tracking of my steps, the measuring of my heart rate, the telling me to stand up when I am in the middle of an article — seems more like a burden than freedom…I have worked hard to wean myself from a reliance on exercise machines telling me how hard I had worked…because I knew I was cheating pretty much all the time anyway and thus could not trust the results, and in part because it became an excuse to modify, or not, my ensuing behavior…But the truth is, I know when I am in shape… The watch threatened to drag me back into a numbers-driven neurosis, and that’s a temptation I would rather not have.

Her comments are no surprise for anyone who’s helped a patient to change her behavior (especially the masses who aren’t interested in the quantified self approach). It’s dangerous to treat anecdotes as data, but I suspect her experience is widely shared. I’ve yet to meet a patient who was motivated by the reams of data that we scientists like to provide.

So, how do we fix this? That’s the question.

Africa may lead the way with mHealth

I'm guessing that Africa is where we'll see the most exciting breakthroughs in mHealth. Need some evidence? Take a look at the latest Pew data on cell phone adoption.

Landline use is almost non-existent (and importantly, were really never used):


Cell phone use is surging.


Importantly, people are using their phones for texting. This is critical. We have dozens of evidence-based texting interventions for a wide range of conditions.


And we'll see rapid penetration, because people smartphone penetration is lagging. This may seem disadvantageous, but we've shown that you can deliver highly personalized, fully automated, health system linked interventions through regular old feature phones (who came up with that name). This means that there are no pesky [expensive, time intensive, expertise-demanding] visual interface issues to get in the way.


It's hard to overestimate how important these changes could be. When have we seen such rapid changes in infrastructure that can revolutionize the health system in low income countries?

The only Apple Watch review you need

Lots of Apple watch reviews are out today.

(If you’re short on time, read Gruber’s review)

Taken together, the early reviews have been the tech equivalent of the multipurpose Southern maxim, “bless your heart.”

Apple Watch apparently needs work, even if no one wants to say it directly. From the NYTs Manjoo):

“The most exciting thing about the Apple Watch isn’t the device itself, but the new tech vistas that may be opened by the first mainstream wearable computer…For now, the dreams are hampered by the harsh realities of a new device.”

From Gruber:

“To me, the breakthrough in Apple Watch is the Taptic Engine and force touch. Technically, they’re two separate things. The Taptic Engine allows Apple Watch to tap you; force touch allows Apple Watch to recognize a stronger press from your finger.”

“And without taps, Apple Watch is rather dull.”

Call me contrary, but I think these reviews are pretty exciting. They sound precisely like those of the first iPhone.