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.

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).

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.

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.

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.

The problem with algorithms

For those of us who spend time thinking, building, testing, and refining personalization algorithms, it’s all too easy to ignore their key limitation: they’re impersonal. We spend enormous amounts of time adapting algorithms to our user’s particular characteristics and context, but they will [likely] always lack empathy, sympathy, and basic kindness.

This post from Eric Meyer captures the challenge well. If you’ve used Facebook this holiday season, you’ve undoubtedly experienced its “Year in Review” posts hogging your timeline. For Meyer, the algorithmic “feature” reminded him of events that he will not soon forget:”

A picture of my daughter, who is dead.  Who died this year.

Yes, my year looked like that.  True enough.  My year looked like the now-absent face of my little girl.  It was still unkind to remind me so forcefully.

And I know, of course, that this is not a deliberate assault.  This inadvertent algorithmic cruelty is the result of code that works in the overwhelming majority of cases, reminding people of the awesomeness of their years, showing them selfies at a party or whale spouts from sailing boats or the marina outside their vacation house.

But for those of us who lived through the death of loved ones, or spent extended time in the hospital, or were hit by divorce or losing a job or any one of a hundred crises, we might not want another look at this past year.

My experience was similar to Meyer’s. When I received the prompt to see my “Year in Review,” I worked hard to ignore it. After a challenging year, I’m thankful for that decision.

For me, this experience is an important reminder: personalization can be impersonal. When designing personalization algorithms, we have to both predict what our users want to experience, and what experiences they want to avoid.

Update: Facebook apparently agrees.

Prediction: apps are going the way of the dodo

Interesting piece in Slate today about the demise of the mobile app.

… apps are very clearly not going to be around forever. Certainly not in their current, bulky square form. There isn’t enough mobile homepage real estate for each of the web’s 500-million-plus active websites to have its own app…

(The comments section — this time — is worth checking out)

This may seem like an extreme [read: click baiting] position, but the author has a point. With change in hardware configs (big phones with big screens, watches with small ones), we’re likely to see evolution in app interface designs as well.

My prediction? Hate to say it, but I think iOS 8’s “new” widget functionality portends where we might be going. I suspect apps will live in the background and/or cloud, with minimal interfaces, push notifications that are triggered by inputs, context, and biology, with as-needed full “screen” experiences.

The days of icons arrayed in rows and columns will be over sooner than we might expect.

Why buy a wearable when they’re [almost] free?

In this week’s addition of Another Day, Another Wearable, we present the latest offering from Pivotal Living.


Wrist-worn? Check.
UI? Check.
Bluetooth? Check.
Hypoallergenic? Hopefully.
Price? Free (with a $12 annual subscription to their premium app … so that’s more like free-ish).

I’ve long been predicting that we’re going to see wearables (at least the non Apple variety) rapidly enter Commodity Land. It’s becoming more difficult to differentiate on features (although FitBit is trying), it’s hard to justify high prices for cheap innards, and all the action is in the software anyway. Now, for the dreaded self-quote:

I predict that we’ll see these things [on discount] lining the shelves at your local drugstore. Just like paper towels. — Me

Whoops, wrong quote. Try this one.

Commoditization … will redirect the market’s focus where it should be: on the software. After all, the challenge isn’t the [data] collecting, it’s the changing. Tracker makers have done an excellent job in developing cool tools for gathering data, but they’ve been much less creative in designing software that reliably improves people’s health. And it’s the software that offers tracker makers the greatest opportunity for differentiation. — Me

I haven’t yet used the Pivotal Living app and on first glance, I don’t see much that isn’t available in other apps. And remember, we don’t know if any of these apps or devices actually work. But, what’s important is that we’re beginning to see new business models for wearables that prize (and price) the software. If this business model catches on, I suspect that developers will need ways to better differentiate their apps. This might create opportunities for those of us who’ve been clamoring to get evidence-based approaches into the app market. Admittedly, that’s a lot of ifs, but I’m willing to play the long game because I’m convinced that focusing on the changing (vs. the collecting) will give us the best shot at using wearables to improve consumer health.

Humanities + Technology = Apple

I’ve long been interested in Steve Jobs’ approach to design. True, I’m a bit of an Apple fan-person, but my appreciation for the Apple Way runs deeper than that. I constantly struggle with my approach to developing digital health technologies. Is it theoretically-grounded, using evidence-based approaches, technically sound, adopting optimal user experience practices, gathering the right amount of patient feedback and so on.

Jobs’ approach was different. He knew what he liked and he thought we should (vs would) too. And he was right.

I knew that Jobs’ liked pretty things, but I hadn’t tied it to his love of the humanities. This Brian Lehrer interview of Walter Isaacson is a must listen. They cover a range of topics but most interesting is Isaacson’s argument that Jobs’ love of the humanities pushed him to create mashups of great technology and humanistic design principles.

It’s a good reminder for all of us who do this work.