Talking our way to better health: what’s next

I’ve been dictating papers, notes, emails for more than 15 years (and have a copy of Dragon Naturally Speaking v1 and a closet full of mics to prove it). Some of you know that I regularly dot my spoken langauge with dictation hyphen speak comma and frequently don’t know that I’m doing it exclamation mark.

So, I think there is great potential for the voice interface movement (see the Amazon Echo, Siri, Cortana, etc) to revolutionize the way that we interact with technology. We’re still in that early haphazard phase, in which companies are trying to inject voice into every box, app, tool, and small animal monitoring device — all to see what sticks. This is pretty common in the lifecycle of new technologies (see wearables — who exactly needs pulse ox), and I think we’ll soon see that voice interfaces have huge potential in digital health. Voice will help us improve accessibility, a much overlooked challenge for digital health apps. But just imagine the improvements we can make in hard-to-monitor factors like eating, activity, symptoms, and mood.

And with price points dropping on voice tools (like Amazon’s Echo Dot), there is potential to make voice entry ubiquitous.

(This is not an Amazon commercial — really — but) Amazon is making it easier than ever to make conversational voice (and text) agents with their new Lex framework.

I’ve played with several similar frameworks, but the sophistication in the language parsing, interoperability, flexibility (same logic for Messenger or Twilio), and cost efficiencies really makes Lex standout.

Next time, #thinktwicebeforeyouapp and go voice.

Healing the poor, digitally

(In case you’re looking for something to take your mind off the election, watch this).

I was thrilled to close out the Duke Forward road events in New York City, along with my graduate student colleague, Shelley Lanpher. Shelley and I talked about our work using digital health to improve obesity treatment in medically vulnerable populations.

Oh, and make sure you #waitforit — there’s a “surprise” reveal at the end.

When genetic tests are basically horoscopes

Fantastic piece in today’s Inside Stat.

The tips I got back were almost comically generic. One piece of advice from Kinetic Diagnostics on how to compensate for my increased risk of muscle cramping? “Do proper stretching and muscle warm ups before and after exercise.”

DNAFit’s recommendation to make up for a variant that predisposes me to to see fewer gains from endurance training? “Stay sufficiently hydrated.”

Kinetic Diagnostics said I was at elevated risk of high blood pressure; DNAFit said I was likely to experience fewer problems with blood pressure. They both offered the same advice, supposedly tailored to my genotype: exercise.

(When I later asked them about this recommendation, the companies acknowledged that such advice could benefit anyone but insisted that people with my genotype would find it especially useful.)

I suspect that this will mostly be interpreted as an indictment of the athletics genetic testing “industry.” And, they seem to deserve it. But there’s a bigger issue here: many similar companies enter the market with laughably limited evidence that their “personalized recommendations” are actually informed by science.

Then there were the interpretations that flat-out contradicted one another.

The tests each looked at different regions of my genome — which may have been necessary to distinguish themselves from their competitors, but which in and of itself suggests just how much this field is in its infancy. So it wasn’t possible to compare the complete results from each company head-to-head.

But among the scores of data points, I found 20 genetic variants that showed up on two or more test results. The companies all gave me the same genetic readout on those variants, so I have little doubt they correctly analyzed the cells in the cheek swab I’d sent them. In six cases, however, the interpretation I got from one company directly contradicted the interpretation from another.

I’m sensitive to the idea that [the long time it takes to generate] evidence frequently slows the process of bringing innovative tools to market. However, this is a helpful reminder that speed can also disadvantage consumers (while rewarding founders).

Go it alone and you [probably] won’t lose weight

Nice NY Times piece from Gina Kolata, amplifying the findings from today’s University of Chicago poll on obesity.

The self-help route has not been successful for most. Ninety-four percent of the survey participants who were obese had tried to lose weight with diet or exercise, to no avail. A quarter of those people said they had tried five to nine times, and 15 percent said they had tried more than 20 times.

“Trying 20 times and not succeeding — is that lack of willpower, or a problem that can’t be treated with willpower?” asked Dr. Louis Aronne, the director of the Comprehensive Weight Control Center at Weill Cornell Medicine and NewYork-Presbyterian, who was not involved with the study.

Too many Americans (read: most all of us) are attempting weight loss using approaches that have no evidence base. Upwards of 1 in 5 American deaths is related to obesity. Obesity causes a wide range of health conditions that sap our physical function, quality of life, and money. And yet, we’ve become all too comfortable treating obesity with what amounts to well intentioned snake oil. I challenge you to think of another chronic disease where we embrace treatments that, well, don’t work.

How did we get here? Too little training in med school, too little [and otherwise anemic] treatment reimbursement policies, research that focuses on scaling outcomes vs scaling treatments, and lots and lots of stigma.

We have to do better.

The geek’s atlas

Yes, it is a slide deck, but it’s also one of the most eagerly anticipated collections of facts in Silicon Valley. Mary Meeker is ready with her 2016 internet trends report, which she is delivering today at this year’s Code Conference.

Is it problematic that I enjoy flipping through all 213 pages of this thing? Don’t answer that.

What’s next in digital health (vol 211)

Part of our ongoing, intermittent, and highly speculative series about what’s next in digital health

Invisible apps are what’s next in digital health. These are some of the best.

We’ve yet to see many invisible apps for digital health. But they’re clearly what’s next. As design focused as I am, it’s becoming increasingly clear that we can develop usable, sticky apps without graphical interfaces (there’s a trend to call these no-UI apps, but graphics do not an interface make).

Our studies show that we can achieve 12-month engagement of 84% engagement with a health app that’s delivered via interactive voice response and text. This means that 84% of participants will text or voice us at least weekly for a year.

Compare that to my rule of 70 which, in part says, most of your app’s users won’t come back for a second try.

Plus, these invisible apps have huge reach (91% of us text), lower cost (thanks Twilio), are easier to code (notifications APIs rock), and are easier on the MVP budget.

GirlTrek is what’s next in [digital] public health programs

The New York Times blog, Fixes, featured one of my favorite organizations today. Girl Trek is the best public health program you haven’t heard about [yet]. Look, I’m a scientist, a wonk, a tinkerer. I’m technically inclined, and quantitatively oriented. I’m hyperbolic and excitable, but I’m not easily inspired.

But GirlTrek inspires me [big time].

Here’s a gross simplification — recruit nearly 60k women nationally, women who are mostly sedentary, who lead busy lives and who don’t [yet] take enough time for themselves. Link them with groups, comprised of women, similar and dissimilar, of all ages and backgrounds. Then, motivate them to walk. And walk. And keep walking.

Physical inactivity is one of the most pressing public health crises of our time. And yet, many of our public health efforts haven’t gotten the population moving. This is especially true in high risk groups, like Black women.

GirlTrek is different. They reach, engage, motivate, and inspire with an approach that’s organic, culturally resonant, and technologically sophisticated. My take?

“We’ve spent an enormous amount of money on research-based approaches to obesity prevention and treatment, and almost none of them have worked with black women,” says Gary G. Bennett, a professor at Duke University and a leading researcher on obesity. “One of the key predictors of positive treatment outcomes is really high levels of engagement. I’ve been doing work on obesity as it affects medically vulnerable populations for 15 years, and I don’t know of anything in the scientific community or any public health campaigns that have been able to produce and sustain engagement around physical activity for black women like GirlTrek does. Not even close.”

And, it’s working.

Their secret? Focusing on what matters to women today. Not the health benefits that might accrue in the far future.

“It wasn’t about looking good or weight loss or fitting into a certain type of clothing,” she recalled. “It wasn’t, ‘Hey, you fat person, you need to do this or you’re going to die.’ It was, ‘I love you and I want you to love yourself enough to invest in 30 minutes a day, to walk yourself to freedom like Harriet Tubman did.’ And that spoke deeply for me because my life work is showing up for other people, but I wasn’t showing up for myself.”

We researchers can occasionally have a bit of hubris (!) about what it takes to improve public health. But the data don’t lie. For some of these issues, we need bright, creative, and novel ideas that can work — at scale.

Look no further than GirlTrek.