Forget the Obvious Solutions: Go for "Stealth" to Establish Self-Awareness in Healthy Decision-Making?

There are a lot of reasons why we believe the stealth interventions will produce longer-term, more sustained effects that are of a greater magnitude than other strategies that have been tried in the past.

From: "Stealthy leads to healthy in effort to improve diet, study shows." Via @physorg.

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The Remains of Kung Foo Lettuce Salad

For @dtran320's #getupandmove kitchen challenge...

I seriously have never had so much friggin fun in the kitchen in my entire life. Thanks David! More kitchen and food challenges most welcome... Challenge me here: http://getupandmove.me/jensmccabe. Request Flip video coverage if you like ;)

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Holy Sh*& - Someone Wants to Create an Alternative Adverse Event Reporting Database; Who is the Empowered Patients Coalition?

Patients who have been the victim of an adverse medical event will now have a new way to share the details of their experiences, according to the Empowered Patient Coalition. The San Francisco-based not-for-profit group, in collaboration with the Austin, Texas-based Consumers Union Safe Patient Project, has released a 40-question online survey that patients can use to report on their perspectives of incidents of medical harm.

The survey prompts respondents to provide the details of the incident including the state where it occurred, the type of provider involved, contributing factors, whether they considered litigation and providers' response following the event. Patients have the option of submitting the surveys anonymously.

Patients can also choose from several checklists to indicate the procedure or treatment that was associated with the adverse event. For instance, in the section of the survey related to surgical errors or complications, the respondent can check boxes to indicate “wrong-site surgery” or “post-operative complication.” There are also fields to provide details about healthcare-associated infections, falls, adverse medication events and other types of incidents.

“In the aftermath of such an adverse medical event, patients and their loved ones often have a strong need to share information about their experience,” the coalition said in a news release. “In the United States and Canada, there is no comprehensive system in place to capture and disseminate information on adverse events, and patients often feel excluded and unheard.”

In addition to providing a forum for patients who have experienced medical harm, the coalition also plans to aggregate the data and use it to analyze patterns that could lead to adverse events, according to the release.

From: "HITS - Modern Healthcare's daily IT e-newsletter."

The Consumers Union Safe Patient Project could be the start of a very interesting workaround for a lack of cohesive national, public variance reporting.

However, the "considered litigation" factor worries me a bit; will we see lawyers logging in and using the public database (if it's ever open) to find potential clients and suggest suits?

Even though patients and their families can leave responses anonymously, it will be interesting to see if early responders choose this option, or whether a culture of anonymity emerges.

The early community on Quora.com for example encouraged self-identification, but in the last few weeks a greater percentage of both questions and individuals posting answers choose to be 'anonymous' rather than to self-identify.

In the hospital where I served as a Patient Advocate and often filed variances in the ED, we *could* submit variances anonymously but were encouraged not to do so...the CQI root cause analysis tended to be more complete when as much information about the event and participants as it was possible to obtain, including names, was entered.

The Empowered Patient Coalition is new to me, but I'll be making friends in short order.

I'm especially interested in their goal of building a thorough adverse event database and where they hold and aggregate the data and analyze patterns.

A few questions...

1. Do they plan to release the data to the public?
2. What do they gain from building this body of data about adverse events? Do they plan to become a consulting body for hospitals and other organizations about CQI?

We'll see. This is one to watch.

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Strange Bucketfellows: The Colonel and Breast Cancer Research

Very interesting combo of consumer/health marketing...

And no, I did NOT buy a bucket ;)

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New CureTogether Research: Exercise "Popular and Effective" for Treating Depression...

But looks like a daily focus on sleep, talk therapy (BST anyone?) and personal growth workshops - along with small acts of microfitness - pack a powerful combo punch in fighting depression.

Amazing community-sourced research @accarmichael - and thanks for sharing it in a visualization where the import's easy to grasp.

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The Problem Every Behavior Change Platform Should Shed Blood, Sweat, and Tears to Have...

Interesting - after using the brilliant #getupandmove for 4 months, running is so integrated into my life that I no longer need the app #qs

To build something so useful at providing social support and helping motivate behavior change that -


Wow, this is a first.

The good news: #getupandmove is WORKING.

The bad news: most of us fall off the wagon after a bit (cough cough Susannah, self).

(Notice I do not believe the bad news is people stop wanting to #getupandmove, or stop wanting to use our platform).

Unfortunately, the bad news is that behavior change maintained over time takes anywhere from 18-260+ days, depending on your personality, environmental variables, and a whole host of factors we don't currently know how to track and then optimize.

Right now at Get Up and Move we're taking a look at how to build a kick-a#$ platform that:

1. helps guammies "level up," or go from individual/1x use;

2. lets you discover a fun new occasional activity you then repeat (like bed jump challenges or reading an article);

3. builds you up to prep for hitting a goal with a group (like our Bay to Breakers crew training - and I use the word loosely - in San Francisco);

4. and then helps you maintain (routinize) healthy microchoices you personally find fun and valuable, like Alex's running.

How can we do this?! That's a damn good question.

Alex's achievement represents our ultimate goal - building a platform that 'plugs in' near-real-time, extrinsic social support so useful that you no longer need it...motivation to move becomes internalized, intrinsic.

You own your goals. You own your microchoices. And you use them to be, well, better. .

That's the point where we think you can do one of several things:

1. you can pay it forward and challenge a friend or family member. (1:1);

2. you can adopt new guammies. (1: many - we're working on 'groups' features to help with this sort of thing);

3. you can motivate others to make micromovement a part of their daily decision tree so they too can see macro results.

But hell, why stop at achieving just one?

Speaking of which, I'm heading back offline to remind myself why we're so focused on building this online support platform.

See you all on the road to better health.

And may you too, one day, no longer need us ;).


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Genomics Keeps Getting More Exciting: Forget DNA. Give Proteomics a Pass...

U.S. and Swedish scientists say they've discovered tiny bits of genetic material known as microRNAs can move from one cell to another.

MicroRNAs were first characterized during the early 1990s as regulating the activity of genes within cells. Now researchers at the Duke Institute for Genome Sciences & Policy, in collaboration with the Universities of Helsinki and Uppsala, have shown microRNAs can move from one cell to another to send signals that influence gene expression

on a broader scale.

The scientists said they made the discovery while investigating the intricate details of plant root development in Arabidopsis, a highly studied mustard plant. Although the researchers haven't determined how the microRNAs travel, they said it appears the mobility allows them to play an important developmental role in sharpening the boundaries that define one plant tissue from another.

"To our knowledge, this is the first solid evidence that microRNAs can move from one cell to another," Professor Philip Benfey, director of the Duke IGSP Center for Systems Biology, said.

The finding adds microRNAs to the list of mobile molecules -- including hormones, proteins and other forms of small RNA -- that allow essential communication between cells in the process of organ development.

RNA is where it's at...(or, at least, where it's heading).

From: "Study shows micro-rna's can move - UPI.com."

Why am I working so hard/fast/furious on Contagion and Get Up and Move?

Because, after some crazy group of folks saves healthcare, someone has to focus the genomics sect on something other than RNA therapies.

My next startup will work with practical applications of the RNA-centric genoanthropology theory.

I love startup Halcyon Molecular, but until someone has the microscopy to show us RNA action/movement in real time, we won't really know what we're missing.

DNA molecules are the cars on the highway, but RNA are the drivers.

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Walking the Walk

There are two types of people: those that talk the talk and those that walk the walk. People who walk the walk sometimes talk the talk but most times they don't talk at all, 'cause they walkin'. Now, people who talk the talk, when it comes time for them to walk the walk, you know what they do? They talk people like me into walkin' for them.

From "Hustle & Flow."

Lesson of the day: Walk the walk. Then, don't let yourself get talked into walking someone ELSE's walk. (Harder than it sounds).

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Social Games for Health Players Mean Move FAST: Wellness Companies, Are You Ready to Update 1x/Week?

He also noted that the company’s games like Pet Society and Restaurant City are updated once a week “reacting to players and testing that sense of the game being alive. It keeps people there and when we launch new features they will tell you right away if they like it or not.”

Mr Segerstrale also noticed that this frequent interaction with players means the company is able to understand their likes and dislikes better.

“We are developing a long-term relationship with a specific user and that means if someone is a hardcore Pet Society player, chances are we shouldn’t push Gangster City at them.”

Mr Perry saw the value in that and seemed to suggest that, in the future, perhaps Facebook will need social gaming more than social gaming will need Facebook.

“The thing is you are now building on a platform and your platform is your community. That is why you will survive.”

From: "Spotlighting social gaming — World's Geekiest Dad | World's Geekiest Dad."

I was speaking with a venture capitalist last week about the social gaming for health space.

The ability to move fast, listen to users, and adapt quickly by releasing new features (or ruthlessly pruning ones that don't work) is one reason why larger, entrenched companies are hesitant to give up choice and control and allow 2 way challenges.

Even the most advanced, forward-thinking health insurers and medication reminder groups I know are still thinking that 'prescriptive' challenges issued by an authority figure - like your doc or a disease management nurse paid to give you a call to see if you're taking your pills - is the ideal way to go.

At Contagion, we think that's a bunch of bunk. The people who know you best - friends and family - these are the people who can provide the motivational support, in real time, that we need to make healthier daily microchoices.

Programming for contagious wellness is the only way to go, but it means you've got to:
1. Be willing to give choice and control BACK to your users;
2. Admit early when your assumptions are wrong;
3. Recognize quickly when you've baked in your own biases to platform design;
4. Move quickly to do all of the above.

Community Managers become vital 'software' in social gaming startups for precisely these reasons. The human machine/human code interactions are only one piece of the puzzle.

Being an active part of your community is another (this will, luckily, be a default if you build something to solve one of your own problems).

Health insurers, how many of you USE your own wellness portals on a weekly basis? If you haven't built something you want to use, what makes you think we will?

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My Guammies Keep Me Honest...

Even though they span thousands of miles and multiple social networks. Shockingly, my use of Get Up And Move has changed not just the way I think about taking cabs vs. walking, or taking the stairway to health, but also the way I eat (and what foods I choose to buy and cook, real time, at the point of purchase). Try it! Try tweeting or sending a Get Up and Move challenge for healthy food choice support next time you're a breath away from succumbing to junk food temptation. Just knowing I'm accountable for the debits and credits on my body's balance sheet to people other than myself means health becomes both community resource and an individual asset. Am I really going to intentionally pollute that? Sometimes yes, best intentions will fail me. But not today. Today I'm inputting blueberries. Thanks guammies! #getupandmove strikes again ;)

Sent from my iPhone

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You've Got Five Minutes...

Go outside. Take off your shoes. Plunge your toes into damp spring grass. Wiggle 'em. Life is good. Thanking @gwachob for this post-#getupandpace moment.

Sent from my iPhone

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CBT Via the URLs - Treatment for Depression Online May Be as Effective as Group-Based Therapy IRL

Cognitive behaviour therapy (CBT) via the internet is just as effective in treating panic disorder (recurring panic attacks) as traditional group-based CBT. It is also efficacious in the treatment of mild and moderate depression. This according to a new doctoral thesis soon to be presented at Karolinska Institutet, Sweden.

From: "Panic disorder and depression can be treated over the Internet."

There's a great short story by Anne McCaffrey about a female psych/compsci student named Nora Fenn, who in a course discovers a lower incidence of psychosis and need for CBT after computer journaling became commonplace (cough cough socially acceptable catharsis on Twitter and Facebook anyone?).

Note: I think the collection of short stories is Get Off the Unicorn, and I highly recommend it as required reading for any self-respecting female scifi/fantasty geek.

Seems like Nora Fenn got it right. Some similar incidences in the cathartic value of sharing experiential patient narratives has surfaced in my Redefining Patienthood work as a Kisaut Fellow at the Health Strategy Innovation Cell.

The power of using "I" based narratives, and the opportunity to share them at will for community referential value, seems to have as yet unquantified cathartic gains for individual users.

Someday soon, someone's going to figure out the power of combining "I" and "you" to drive behavior change. Oh wait, @shazow, sound familiar? :)

I want this doctoral thesis candidate as a Contagion researcher. Anyone speak Swedish?

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Get Up and Move Featured on Crosscurrents (KALW News/NPR)!

From: "Crosscurrents: April 8, 2010 | San Francisco Bay Area News - Crosscurrents from KALW."

Giving some guammie-love to @joemfbrown, who introduced Get Up and Move to Crosscurrents and KALW news yesterday!

Note: Skip ahead to 10:50 for Joe's segment on local SF tech innovations. #getupandmove appears right around 13:30!

"Whenever we can bleed that social networking on the web and social networking in the real world, it's good."

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For @chimoose

Why we go to work in the morning...at night...and all points in between.

Billboard in SFO. Sent from my iPhone

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Trying Daytum: Why Self-Tracking Just Ain't Doin' the Job

This afternoon I was typing an email to a new contact at Brute Labs in Mountain View, an awesome nonprofit that's partnered with Red Rock to launch Run! There, a geo-relevant social health program for collaborative run tracking in the MV area. 

Our new #getupandmove buddy asked us if we'd seen Daytum.org. I replied that I used it last year to track things like sleep (or lack thereof), alcohol/caffeine intake. In fact, in that reply I finally hit on a relatively simple explanation of just throwing up personal biometric data all over a user doesn't necessarily drive 'healthy' behavior change.

Here's the transcript. After reading, chime in. Do you agree? Disagree? Does seeing data that hammers home how 'unhealthy' you allow yourself to be (for 'lifestyle' related conditions; many of us have chronic conditions that are outside our individual scope of choice + control) REALLY help you make better decisions?

"In fact, using Daytum helped me realize one of the biggest challenges with visualizations of health/wellness data...how to get people to change? Turns out it isn't about the data for most folks.

In health/healthcare we tend to assume (erroneously) that just by presenting data a person will become self aware and make better, healthier choices.

I found that is often NOT true, in fact, sometimes it's the opposite: If you don't like what the data shows you (a lack of delta, you're not improving) you do NOT change your behaviors - you simply shut off the data stream. That's what I did when Daytum calculated my average caffeine intake....

I now think about it this way. One of the best forms of information architecture for health is the typical American bathroom. In most, you can't avoid that vanity mirror, that startling light. If all it took to make us change our behaviors to 'get healthy' was a datastream, wouldn't the daily visual view of our bodies in the bathroom mirror halt most of us from overeating? I'll be blunt - most of us don't wake up obese one morning...our weight is often the cumulative effect of daily microchoices. Seeing the data, even literally right in front of our faces, that we are not making healthy choices is just the first step.


Figuring out how to provide real time, location-oriented, social decision-support in an n=1 personal context for each individual user is the challenge (and promise) of social health, and it's precisely what we're working on with #getupandmove.

Thanks for working on it with us, guammies. Sometimes seeing the data just ain't enough, and playing with your self-tracking gets lonely after awhile...:)

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Secret Garden, Somewhere Along Howard Street, Downtown San Francisco

You discover magical things venturing out on new #getupandmove adventures. Thanks to @limedaring for the run! Do yourself-and your health-a favor. Go get lost on a walk in your town. Take ten minutes for self+surroundings. You won't regret it.

Sent from my iPhone

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#getupandmove Looks HOT on Ur New iPad!!!!

Doing crunches for @litomikey with the iPad hitching a ride on my abs ;) Sent from my iPhone

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Sent from my iPhone

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Lesson for Health Tech Types - Don't Take Yourselves Too Seriously...

From the awesome team at ZocDoc.com...

@karsten, you guys really outdid yourselves on this one.

Also, note to startups looking for interns; do they get to do fun stuff like this?!

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