We want What’s App! [API, that is]

Faceboook flustered many in the programming community this week, by not releasing an API for its popular WhatsApp service.

Here’s a sentiment shared by many developers:

“Implementing chat features is hard, especially when it comes down to sharing pictures, sounds etc.,” London-based iOS engineer Kevin Mindeguia explained to Mashable. “It’s actually one of those features you try to avoid as a developer, because of its complexity. Having a ready-to-use API and an SDK would save us great time and money.”

Count me among the flustered flock. WhatsApp is the conduit to vast populations globally — many of whom reside in areas that are resource constrained and have been historically disconnected. A WhatsApp API would be a huge win for digital health science efforts like ours. We would immediately be able to provide remote, disconnected, medically vulnerable global populations with access to health interventions that would otherwise be inaccessible. Help us out, Facebook!

Kinect for fun, not weight loss

(Note: I’m about to date myself).

As a kid, I was a geek pioneer. That’s right, I was part of the first generation of children to be transfixed by the beeps, blinks, and bouncing pixels of video games played on devices like the TI-99/4A, ATARI 2600, (remember that attached audiocassette “drive”?) and Commodore 64. That means I was also part of the first generation that considered staying inside as a reward, not a punishment. For us, there was a linear association between sedentary time and video game proficiency. And I was very proficient.

Every generation since has basically put us to shame. With advances in technology, screens have increased in number, and as screen time has grown, so have our kids’ waistlines.

That’s why so many were excited by the release of Microsoft’s Kinect (and the Wii). Many thought these active gaming approaches would be like those funky vegetable pastas — sneaky ways to get kids to be more healthful (still working on my metaphors).

A fascinating new study suggests that much of our exuberance was premature. The study found that adolescent boys (and only boys, unfortunately) burned more energy while playing Kinect games, compared to playing non-Kinect games or just sitting. But after a day, there was no difference in energy expenditure. This means that at some point, the boys were compensating for the extra exercise they got while playing Kinect.

Compensation is common when we exercise. There’s good science that we tend to eat a bit more after being physically active (and sometimes, more than a bit). Interestingly, in the study, when researchers offered the kids food, there were no difference in the amount that kids ate. This suggests that kids compensated, but we’re not sure how, or when.

TL; DR: Kinect is great fun. Nothing beats using a game as an excuse to hurl yourself around the room dance. However, if you want your kids to do meaningful exercise, turn off the TV.

ResearchKit is flawed [just like most research studies]

(Apologies for this week’s hyper-geeky posts. I’m about to double-down now. In fact, let’s call this part of an ongoing series on the promises and perils of ResearchKit for digital health science. How’s that?)

It seems like Research Kit is a winner out of the gates. Nevertheless, in the reaction to last Monday’s announcement, a number of reports have identified a common concern: limited generalizability.

The idea here is that people who own iPhones differ from the general population (particularly from those who pocket the Android). That’s true. TL; DR: iPhone users are more educated, higher income, and less likely to be males and racial/ethnic minorities, compared to Android users.

(Note: I’ve seen lots of blogs calling this selection bias. Selection bias is a potential issue with ResearchKit, and there are lots of potential selection biases depending on what kind of study you’re conducting. However, what seems to concern people most is limited generalizability).

This is a problem. From a research perspective, it means that what we learn from ResearchKit studies will only apply to iPhone users. But, here’s the thing: most studies have this problem.

Psychological research is based on studies of undergraduates — clear generalizability issues. Our most important research fundings about health risk factors come from big studies that are rife with generalizability issues. Nurse’s Health Study recruited nurses, in part because they are knowledgeable about health, and because they are extraordinarily conscientious about research participation. Framingham Heart Study recruited patients from a single city in the Northeast (an area that is far healthier than the rest of the country). We could go on all day like this.

That said (with widespread use), I think we can mitigate some of these concerns. Here’s how:

  • Recruit large sample sizes. This creates more variability (difference) in your study sample. With recruitment potential at a global scale, this is an area in which ResarchKit can really excel.
  • Expand ResearchKit to Android (and Windows). This would expand the pool of potential study participants to non-iPhone users. If Apple handles the open-sourcing appropriately (and there’s little reason to suspect otherwise), this shouldn’t be a major problem.This one is critical for another reason. Some historically disconnected populations are not only more likely to own smartphones, but they use their phone’s advanced data-related features (e.g., text messaging, watching videos, playing games, taking pictures) more than other groups. I think this might also extend to ResearchKit apps, when they’re properly designed.
  • Targeting specific populations. There is certainly merit in ResearchKit’s ability to recruit huge samples, but there’s also potential for micro-targeting specific groups. We’ll know more in a few weeks, but I suspect that many ResearchKit apps will be distributed using Apple’s enterprise features which allow one to [largely] bypass the App Store. This might allow us to identify folks who meet particular criteria (via social media, in clinic, Mturk) and screen in/out potential participants. I’m particularly bullish on the potential of ResearchKit to help us reach people with rare diseases — this has been a persistent challenge for the research world.

Look — I’m not minimizing the challenge here and the presence of biases in existing research studies is no excuse for introducing them into new studies. Indeed, we will have to be very careful about interpreting data from ResearchKit studies — at least in the short term.

This might deal the death blow to the digital divide

There's good evidence that, during the past half decade, mobile has become the "digital onramp to the Internet". The digital divide in Internet access dissipates greatly when you consider mobile access.

That's what makes announcements like these so exciting. Google's Project Loon would launch balloon access points into the sky, providing easy (and hopefully cheap) Internet access in areas that are challenging to wire.

A single “Project Loon” balloon can now remain in the air for more than six months and provide 4G LTE cellular service to an area the size of Rhode Island, according to Google. Company officials have taken to calling Loon balloons “cell towers in the sky.”

Google plans to launch Project Loon in global locations abroad:

As for where pilot projects will begin, Jabbari said, “given that we have an established launch site in New Zealand and an established recovery zone in Latin America and other places, that's where you're most likely to see us, somewhere around there.” However, “we've had conversations with countries elsewhere and telcos elsewhere, those have all gone really well.” Jabbari said Google wants to create a “ring around the world” with its balloons.

Here's my suggestion: start at home, too.

The proliferation of cheap mobile devices and now, pervasive [and potentially cheap] Internet access could deal the death blow to our domestic digital divide. We need a Marshall Plan of sorts to support the coordination of initiatives like Loon (as well as competing projects from Facebook and some of the telcos). The goal: extend the digital revolution to all Americans.

ResearchKit looks like a winner [right now]

Here’s a researchers dream: Wake up one morning and find that 11,000 people have signed up for your latest study.

“To get 10,000 people enrolled in a medical study normally, it would take a year and 50 medical centers around the country,” said Alan Yeung, medical director of Stanford Cardiovascular Health. “That’s the power of the phone.”

Here’s a researchers nightmare: Losing 80% of those 11,000.

Out of the gate, ResearchKit appears to be a smashing success. However, there’s a problem — with most mobile apps (particularly those that are commercialized by the download or rewarded for large user bases), the crucial question is “if you build it will they come?

The problem is that with research, particularly longitudinal research studies, there’s another [much more important] question: “if you build it, will they stay?

Hyperbolic live blogging Apple’s ResearchKit

It’s always dangerous to post live comments during an Apple live event, particularly if you’re a rabid early adopter, fan-person admirer of Apple products, but oh well…

ResearchKit is an absolute gamechanger for health/medical research. It has potential to be the best thing to happen to behavioral research in a generation.

My real-time almost certain to be amended thoughts (in no order whatsoever):

  • ResearchKit will be open source. That’s great for all of the usual reasons. But it’s a savvy business move. This ensures less friction for integrating ResearchKit applications in National Institutes of Health grants. Counterintuitively [for those who don’t attend to these things], it will also help ease concerns about privacy.
  • We all struggle with patient recruitment, particularly when we don’t see them in clinic. Some of the biggest problems: finding people, recruiting, consenting, paying, and retaining them. Problem solved greatly mitigated.
  • ResearchKit might open a new market for study discovery and participant recruitment.
  • It its promotional materials, Apple is positioning ResearchKit for observational data collection. For this to work with intervention science, we’ll have to build ResearchKit hooks into health/medicine apps. It will be interesting to see what APIs Apple makes available. If Apple history is a guide, don’t expect this to happen right away.
  • If Apple allows ResearchKit to hook into non-resarch apps, watch out. Aside from cool new data, the commercial market for data aggregation will explode.
  • There is potential for changing the way that we run big cohort studies (e.g., Nurse’s Health Study, Jackson Heart Study, CARDIA, Framingham). Will it be cheaper to send every study participant an iPhone, versus the usual approach of creating, sending, scanning, and collating data from paper surveys? Probably. Incidentally, the National Institutes of Health has been funding fewer of these cohort studies, likely given resource constraints. Time to beef up on those epidemiology skills.
  • The ability to collect contextual data is going to be “great.” Beep. “We see that you’re inside Big Jo’s Burger Barn. How many minutes do you think it will take to burn that burger off?” Get ready for new science on in-vivo data collection.
  • We don’t yet know how ResearchKit will integrate with Apple Watch, but there is great potential for integrating new health metrics [particularly as Apple enhances Watch’s sensors].
  • Yes, some people will freak about the idea of a researcher collecting data from their Snapchatting device. There will be at least 1200 blog posts on the topic this week alone. I think that’ll be a short term problem though (how many cameras are pointed at you right now?).
  • That fancy new research data collection platform we’re creating [as I write]? History.

Watch > iPhone

Most health apps rely on frequent phone use. That makes sense, given the obscene amount of time that we spend using our phones.

(Want to feel horrible about yourself some insight into your phone use? Install the Moments app. Then call your psychologist)

However, in the Apple Watch era, we may need to rethink health app design:

People that have worn the Watch say that they take their phones out of their pockets far, far less than they used to. A simple tap to reply or glance on the wrist or dictation is a massively different interaction model than pulling out an iPhone, unlocking it and being pulled into its merciless vortex of attention suck.

One user told me that they nearly “stopped” using their phone during the day; they used to have it out and now they don’t, period. That’s insane when you think about how much the blue glow of smartphone screens has dominated our social interactions over the past decade.

Come work with us


I’m excited to announce that our center — Duke Digital Health — is recruiting a postdoctoral fellow, to start this summer/next fall. We’re looking for innovators who want create digital health interventions that work, scale, and serve high risk patients. Questions? Bug me.

Here’s the announcement [sorry it’s so dry — blame the lawyers]:

Postdoctoral Fellow
The newly established Duke Global Digital Health Science Center is seeking a full-time postdoctoral fellow. Founded in 2014, the Duke Digital Health is the first of its kind — an integrated research program for the discovery, evaluation, and dissemination of digital health interventions for medically vulnerable populations. Our mission is to close health disparities using digital health.

We are seeking a full-time postdoctoral fellow. This fellow will work for up to two years, while being mentored by Center faculty. We are open to applicants with expertise using any type of digital health intervention to address any health outcome. We invite applicants from a range of disciplinary backgrounds and varying levels of technical expertise. Ideally, the fellowship will begin in Fall 2015. The annual salary floor will be based on NIH guidelines. Successful applicants will have an earned doctorate (e.g., Ph.D., Sc.D., MD/MPH), with some training in quantitative methods. U.S. citizenship or permanent resident status is necessary due to funding requirements.

Working with his/her mentors, the fellow will be expected to contribute to the Center’s ongoing efforts, while pursuing independent research activities. The fellow will be provided with professional development funds and will have access to the Center’s software engineering team.

Application instructions:
Review of applications will begin by March 15 and will continue until the position is filled. Please include a cover letter with a statement of research interests, curriculum vitae, 1-2 sample publications, and two reference letters including one from the training director or doctoral committee chairperson/advisor.

Submit applications (as one PDF) to postdoc@dukedigitalhealth.org

Questions may be addressed to postdoc@dukedigitalhealth.org

DGHI/Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual’s age, color, disability, genetic information, gender, gender identity, national origin, race, religion, sexual orientation, or veteran status.

Haggis to the rescue

I’m pretty open-minded when it comes to food. And I’m first in line to try a new obesity treatment, but…haggis?

Turns out that a British MP wants the U.S. to drop its import ban on haggis. Why? Because, public health.

He claimed haggis “satisfied hunger very much more than the junk food which Americans consume”. The surgeon and former shadow health minister…claimed that haggis consumption would help deal with the “obesity epidemic” in the US.

So there you have it. Haggis – a lovely delicacy containing, “sheep’s pluck (heart, liver and lungs); minced with onion, oatmeal, suet, spices, and salt, mixed with stock, and traditionally encased in the animal’s stomach and simmered for approximately three hours” – is the answer. Clearly, the metabolic benefits of the pluck combined with the brown fat promoted by the suet, and the oatmeal-induced GI motility produces rapid weight loss. This must be why the Scots have some of the lowest rates of obesity globally…uhh, maybe not.