Aisle & Window Seat Brain Power

Archive for September, 2014

Figure1 @AmericanAir 1636

Figure 1Figure 1Figure 1

I’m fascinated by the Figure 1 app. It’s the Instagram for the medical profession, creating a way to safely share & discuss clinical cases. It has also become a forum to showcase the vagaries & oddities of the human body in a scroll of crowdsourced chronicles. Today, I’m following 3 cases — a patient with tuberous-sclerosis, a patient with an edematous rash that is dry & pruritic who needs a diagnosis (comments are offering thoughts & questions), and a nurse practitioner who is polling for anomaly identification — comments quickly identified as a dual ureter system.

Posts can be graphic & difficult to view.  @jessiwrites who wrote about the app for Fortune, noted that the images could “make your stomach turn”.  Ashley Feinberg @gizmodo said that it, “approximates the fruit of an unholy union between Instagram and the Discovery Health Channel.”  And it’s true that your finger can just as easily pause at a gaping wound from an unfortunate encounter with a fuchsia bush, as a vivid polycystic kidney — just #lichenification for truly “never seen by most people, not sure we should have seen that” images.  Yet there are also strangely lovely things to ponder, like the fluro imaging of a stomach with a deep sea moodiness, complete with jelly-fish like creature, or melodic-esque cardiac stress test results.

Co-founder Joshua Landy is an MD from Toronto, and reflecting his commitment to patient care & privacy, the app has elegant medical, safety, consent & privacy solutions.   Only medical professionals can post photos and make comments, and these are verified by a medical officer and moderation team prior to posting.  The rest of us can only view their content.  For compliance, users must sign a one-click, one-signature waiver with every photo.  There are also only body parts, no recognizable faces, due to a face detection software that blacks out identifying features.  However, I’ve noted that the community tends to self-govern on this with care taken to show the area of medical interest only.  The patient consent element is an in-app “tap, type & sign” form.  This app is technologically sophisticated.

Figure 1 is currently available in North America, the UK, Ireland, Australia & New Zealand.  The US community has more than 145,000 users, exceeding 30 million views since its May launch, so spending time with the medical minds here is good medicine for informing any healthcare perspective.  Or diagnosing a nagging itch.

@American Air #1448, 19F

Missing my FitBit on today’s trip.   FitBit #3 leapt from its customary jeans loop spot (right side, first loop) about 3 weeks ago at family ice cream time. Sadly, #3 followed in the paths of #1, who over-indulged in watery dip, and #2 that preferred to stay in Prague. The first few days after the #3 FitBit AWOL incident, I relished my newfound freedom from my “digi-sessory”, that wearable that tracked my movements, and with which I willingly shared every morsel I ate, wink of sleep I got, and extra activities beyond tracked steps (barbell, yoga, circuit).

But now I’m in full blown miss mode, a state which my new iPhone 6 is making even more acute. It’s taunting me with the new Health capabilities — what could I learn if only I could pair my digital health information across my devices? I’m one of the roughly 69% of Americans who would like direct access to my health records.  This means that these records must be updated to show an accurate view.  So, sharing my health & fitness data consensually seems reasonable … even favorable. Nirvana if I could do that completely unobtrusively, my private window into my own biology. Managing my own physiological evolution through a fully quantified self — in a cycle of listening, knowing and choosing based on knowledge of what is actually happening within my own body.

The ultimate in unobtrusive? Subcutaneous! Getting under someone’s skin … literally.

Imagine this:

… an asthma sufferer walks into a building lobby & the sensor in her wrist reads the air quality, immediately sending her a message on her smart device of elevated levels of her asthmatic triggers. She gets this message before her body suffers a reaction, and leaves the area, avoiding an unforeseen attack,

… high blood pressure, glaucoma & high cholesterol patients, typically some of the highest non-compliant with their prescriptions, receive a mild vibration from an ear chip when its medication time. This vibration becomes more insistent and longer in duration until the medication is taken,

… a cancer patient undergoing chemotherapy has vital sign information continuously transmitted to the doctor’s smart device from an ankle insert, with the doctor responding to any changes in condition in real time.

In a healthy digital future, we could move beyond trivializing scientific health wearables as “digi-sessories”, and treat them as serious & vital devices that drive humans to knowledge & action. We can skip the “fashion do or don’t” debate, and get to substantive outcomes faster.

Yet, today, I’d be happy if I just knew how many steps I took from the plane to the taxi.

(thank you @_Cooper #inspiration)

TEDMED, Day 2, San Fran

Surfing … in the gym … sweat dripping off the end of my nose … full body bench pressing the board, then sweeping my feet underneath me, finding my balance … sticking the landing — this is a TEDMED morning workout.  Hard core beginning for the body & brain …

And right into the hard stuff with a “Don’t You Dare Talk About This” session that delved into difficult to discuss subjects … like the number of times children get stuck with needles through the immunization process (more than 40!), and the impact to their fear and loathing of needles and pain avoidance reactions into adulthood, addiction & obesity causes, organ donation difficulties, physician transparency resistance and violent threats … and in a raw, witty and candid talk, Elizabeth Kenny revealed her harrowing journey through antidepressant pharmacology.   I held my breath for her when she described the terror of being held at gunpoint in her home … and the greater terror when her brain could simultaneously tell her that no person was actually there … I celebrated with her when sanity returned to her, recognizing that “you’re not crazy, you’re toxic.”

TEDMED also tackled the tough issue of taking time to play, debunking our “work till you drop” mentalities that has many of us wearing our work schedules and sleeplessness as badges of honor and stamina.  @jillvialet is a Recess Champion with a powerful thought that “play matters because it gives us a brief respite from the tyranny of apparent purpose”.  She challenged us with the idea that “Work is not the opposite of play.  The opposite of play is depression.”  I spoke to Jill after the session … and was struck by her commitment to live what she shared … she was on her way home to be with her children … to play … with a sense of purpose and pride and happy expectation.

I had the gentlest, most thoughtful finger pricking of my life — actually warmed my forefinger — by @theranosinc.  This is the brainchild of Elizabeth Holmes — taking a single drop of blood, and running multiple tests at a fraction of the diagnostic costs, with a completely transparent pricing model.  This a fundamental shift in patient access and equity — a unique combination of new technology brought forward with a new way to think about access and business.

We ended today exploring “Stealing Smart”, blowing away the collaboration model in favor of a full-on melding of intellectual power.  Dr. Barbara Natterson-Horowitz, a Zoobiquitous Physician, @zoobiquity, called out the snobbery that blocks physicians from respecting and reaching across medicines disciplines to explore knowledge and experience.  She’s a cardiologist whose patients include gorillas, lions, macaws … and people.  She is passionate about the evolutionary commonalities between human and animal bodies, and is pioneering connections between physicians and veterinarians.  Vets know how to treat and heal multiple species … this valuable expertise can be applied to humans.

Lest we were left thinking that physicians are chiefly characterized by white coats and busy schedules, we closed with Rupa & the April Fishes … Rupa is a doctor who rocks the songs she writes on an orange guitar …


Riding waves

Riding waves

TEDMED ’14, Day 1

TEDMED is my yearly pilgrimage of inspiration & discovery. Typically in April, this year it slid to September, with a dual simulcast in Washington DC & San Francisco. Ambitious in scale … 2 states, 2,000 delegates, 90 speakers, 80 startups & 6,700 affiliates in 140 countries — and noble in purpose … unlocking imagination in service of health & medicine … TEDMED is an achevement in combining intellect & creativity in a myraid of logistical details that somehow all works.

Yesterday, I heard the stories from an autistic 16 year old, Rosie King who stirred the group with her simple questions, “What’s so special about being normal?  Have you ever felt great because someone told you how normal you are?”, a bioethicist who is more worried about the privacy of her credit card data than her genome sequencing data, and scientists who shared how to clean up your brain (sleep releases a chemical that flushes & cleanses), and that opossums are tick killing machines that impact lyme disease rates.  Good stuff even by TEDMED standards.

Yet, the talk that sits in my head is from Danielle Ofri @danielleofri, who spoke of “errors as the human metabolism.”  I was struck by her wisdom and candor in acknowledging imperfection, and owning our vulnerability in the relentless pursuit of learning more.  Her sensibility that errors are less about exposure for shame and punishment, and more for the illumination & discovery of new possibilities both for ourselves and others.  Maya Angelou said, “Now that I know better, I do better.”  Reflection, discussion & collaboration around our experiences help us know better.  And in that knowing … comes changes … and it is as simple and as complicated as that.





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