Stop counting blueberries

I was excited to hear that Sandro Galea took the mantle at the Boston University School of Public Health. I’m more excited that he’s using that perch to shape discussions about how we can improve the public’s health.

Far too much university research and funding, Dr. Galea said, is dedicated to making increasingly precise tallies for relatively minor issues. Instead of paying researchers to count how many blueberries per day may cut the risk of heart attacks, Dr. Galea said, universities and their funders could more systematically identify and tackle the root causes of social problems — such as tolerance of violent attitudes, indifference to environmental concerns, and large and persistent gaps in wealth, education, and economic opportunity.

Amen.

This is why it’s so hard to launch a health app

(Or any other app for that matter)

Nielsen just announced its list of 2015s top 10 smartphone apps. [Not] surprisingly, all 10 of the apps hail from just 3 companies: Facebook, Google and Apple.

I’ve been a bit of a broken record about this lately, but it’s becoming hard to ignore the obvious: it’s hard out here for an app.

There are no health apps, no apps from startups, and none that rely on connected devices. Given the challenge of getting and retaining users, most of us who create digital health approaches need to identify new routes into consumer’s hands. Looking for some ideas? Start here.

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.