Education | Medical Futures Lab

Apr 17 2014

Culture, e-patient, Education, Health, Humanities, Humanity, Medicine

Instant Access to Yourself

With our constant obsession with technological advancements and the fashionable desire to be the first owner of the newest products, we must remember what we already have. And this isn’t just a banal platitude about being grateful for what we have. Even though the answers to the world’s problems seem to lie in the continued miniaturization of sensors and further embedded systems, have we forgotten what is already available to us? Perhaps we should shift the focus from finding the most sophisticated devices to becoming more proficient with what already exists.

In the summer of 2013, I took a psychiatry course at the Geffen School of Medicine at UCLA. The course had the rather grandiose title: “Personal Brain Management,” yet that was exactly what the physician taught. It turns out that by having a greater control of what we think and how we think can protect us from a wealth of illnesses. The only technological advancement I needed to supplement my project was a thermometer, yet that was enough.

Photo Credit: stress-relief-tools.com

My independent project focused on utilizing biofeedback for Mindfulness-Based Stress Reduction (MBSR). MBSR advocates that practicing mindfulness meditation can help reduce stress and promote greater mental and physical health. By using a simple stress thermometer, I was able to increase my awareness of my body temperature. While such a physiological marker may seem to be beyond our control, managing our internal thermostat is surprisingly possible. Roughly speaking, more relaxed states are correlated with increased body temperature, and the thermometer served as a means to quantify these changes.

With just a crude thermometer in hand, I was able to cultivate my relaxation response (in contrast to the familiar stress response). At the end of a six-week trial, I found that I was better able to control my body temperature, and I scored significantly lower on a battery of stress measures. For my project, I did not need a smartphone or the newest Nike product or the most sensitive sensors. I needed myself and 30 minutes of my day. And am I really so important that I cannot sacrifice the entirety of 30 minutes to myself?

Photo Credit: clintonpower.com.au

In our constant and desperate search for what is new, let’s not forget that we have instant access to ourselves. While innovative electronic devices can help us organize data and take measurements, let’s not get carried away with their seemingly whimsical promises. It is as much our duty to discover and invent as it is to make more effective use of what already exists. By remembering that the first generation of iPhones was released in 2007, we become aware of the humbling reality that perhaps society can function without a supercomputer in hand.

While simple and sophisticated mobile health applications can encourage patients to become more empowered, decreased reliance on digital technology is in its own right just as empowering. My project at UCLA showed me that I could become more self-sufficient and cultivate my body’s natural capacity to heal with a minimalist approach to technology use.

Feb 17 2014

Culture, e-patient, Education, Health, Medicine, Technology

5 Lessons from the Quantified Self Movement

When it comes to health, we often go through the motions, blissfully unaware of ourselves. We imagine that we cannot manage our health; when we get sick, it’s not our fault. We complain that our friends gave us the virus and that our classmates are the vectors of disease. Rarely do we accept the responsibility of sickness. That would be a display of weakness, and we don’t have the time to address our health. Just give us a pill, so that we can get back to work. We have school, we have jobs.

Hopefully, that passage elicited some cringes. Its message is not foreign, and unfortunately, we tend to extrapolate our American grab-and-go philosophy to health. We believe that we are far too busy to appreciate our health, and we only begin to pay attention to health when we are already sick. Wouldn’t it make more sense to nurture health while we are healthy? Why wait until it is too late?

Photo Credit: funnyjunk.com

The Quantified Self Movement (QSM) has its roots in health and wellness improvement. The idea is to promote self-knowledge through self-tracking. As Mark Moschel eloquently states, we are “taking control of something conventional wisdom has told us is not ours to understand.” We can effectively incorporate technology into our daily lives to track what is important to us. With the inception of mobile health technologies, health measurements are becoming readily available at all times.

Today, we have devices that make the Fitbit and Nike+ seem archaic. With the Cardiio iPhone application, we can detect heart rate and respiratory motion through an iPhone camera. By using Eulerian video magnification developed by MIT, these unattached sensors have accuracies comparable to hospital-grade monitors. Apple also recently patented a new model of their iconic earphones that can detect blood oxygenation levels, heart rate, and body temperature, while you casually listen to music.

Photo Credit: cardiio.tumblr.com

Given these available technologies used by the members of the Quantified Self Movement, we learn several lessons:

1) It is possible to be engaged. If Cardiio can detect your heart rate while you are holding your phone in front of you, you are hardly deviating from your typical daily behavior.

2) Make time for your health. It’s truly fascinating that health is treated so nonchalantly, as if we have more than one life and can suddenly resurrect ourselves from preventable illnesses and death.

3) If it is possible to track health while healthy, it is certainly possible to track health while sick. Arguably, unhealthy patients have a greater incentive to track their health because they want to get better.

4) If self-tracking devices can take measurements automatically, there is no excuse of being too busy. You are going through the motions of everyday life while these recordings are happening.

5) These communities are vibrant and alive. You won’t be alone, and you can become engaged before you become a patient. We can even imagine QSM members as healthy patients practicing preventative medicine.

So join us. There are meetups around the globe, and registration is just a click away. You can even join us here in Houston. See you there!

Feb 07 2014

1 Comment

Communication, e-patient, Education, Health, Medicine

Leading Patients into the Unknown

The most glaring impediment to scientific progress in medicine is patient enrollment in clinical trials. Adult enrollment is worryingly low and demands an impactful solution. While the current situation of patient involvement in clinical trials is dire, my team is hopeful the solution exists in remedying communication and awareness issues. Undoubtedly, both of which can be aided through the use of burgeoning social media technologies.

When I lay everything out like I just did this problem seems to have an easy solution. Not so. While one can determine that the origin of this issue stems from patient communication with doctors and awareness of clinical trials, one must fully understand why this issue has persisted and no effective solution has yet been implemented. At the end of the day, it is up to the patients to forgo standard of care and take a leap into something they know very little about.

Like any reasonable human being, the patients are reluctant to try something unknown to them. No one wants to be a guinea pig for a clinical trial they know nothing about. What my team will attempt to create is a more transparent and immersive patient experience to increase their involvement in the healing process. Eventually this will accomplish our goal of markedly increasing enrollment in clinical trials.

We already know from research conducted by the Pew Center that patients with chronic conditions are more likely to be online, exploring further treatment options and commentary. From this data it is evident that our target patients are already eager to explore any possible solution. By utilizing a medium of which patients are already well aware we can more effectively educate and familiarize them with the clinical trial process, making the unknown known.

In order to further decode the reasons why a patient should consider clinical trials as a treatment option, it is imperative that we increase collaboration. Increasing patient involvement by providing them the framework to organize and discover clinical trials themselves will surely make them more knowledgeable and possibly be able to incorporate others like them into the process. This sort of self-sufficient growth is the ultimate prize in increasing the awareness of any unfamiliar subject. For us awareness means participation and participation means success.

Jul 12 2013

Art, Communication, Design, Education, Electronic Medical Record, Prototyping, Story

Transmedia Hackathon @ OEDK!

Earlier this week the Medical Futures Lab parachuted into Matthew Wettergreen’s class in the Oshman Engineering Design Kitchen at Rice University to run a two-day transmedia hackathon inside a summer engineering design course. Our goal: explore how the visual and narrative representation of problems shapes our ability to find solutions to those problems. Students engaged in a series of experiments using different communication and representational tools to develop their understanding of how the form of representation for a problem shapes the way we analyze and solve that problem. By exploring with different tools, students saw different dimensions of their problems, which included doctor-patient communication about a variety of complex subjects, including risks & benefits of genome sequencing, end-of-life conversations, and talking about socially uncomfortable topics.

Peter Killoran started things off with a narrative medicine + EMR re-design warm-up exercise, routed through two classics: IOM’s To Err is Human (1999) and Edward Tufte’s Visual Display of Quantitative Information (1992). We spent a lot of time talking about the role of storytelling in design, and then these incredible students went about prototyping (in about 90 minutes) consumer-facing EHRs that could also be useful to clinicians. The beauty of the non-expert approach was definitely on display, as these young creatives weren’t hampered by all the restrictive protocol (HIPPA, can you hear me?) and instead could concentrate on the core message: get the patient’s story into the EMR.

Later in the day, Allison Hunter ran the group through some eye-opening visual arts exercises in flow-charts and mood-boards. The next morning, I launched the group into a session on doing things with words. We did exercises on metaphor, simile, and analogy, both textual and visual. We also worked on point-of-view as a critical dimension of design. After a final session on storyboarding with Allison, students were tasked with a problem to solve using a set of tools (written, visual, moving image, audio), and at the end of the hackathon they presented their experience of experimenting and identifying which tool best helped them develop a solution to the problem.

This was a laboratory designed to generate ideas and strategy for the Medical Media Arts Hub, and my big take-homes included affirmation (again) that collaboration across difference is truly critical to engineering design, to medical problem-solving, and to tackling the wicked problems of the world; that art+engineering+storytelling is the answer to many problems; and that listening to future users’ needs is everything. Mind-expanding experience, and fun to boot. Next time, we’re taking it public, so stay tuned – we’ll be seeking local “wicked problems” to tackle soon!

May 24 2013

Art, Design, Education, Health, Humanities, Story

Angelina Jolie: Teaching Medicine through Literature

Guest post by Olivia Banner

I’ve been thinking a lot about Angelina Jolie’s New York Times op-ed (“My Medical Choice”) because I include a section on breast cancer when I teach Literature and Medicine for pre-med students. In her piece, Jolie reveals that she underwent a double mastectomy after testing for the BRCA1 gene; she had reconstruction and implants too.

In my class, we read poet Audre Lorde’s Cancer Journals: she too underwent a double mastectomy but had no follow-up surgeries, and she criticizes the assumption that every woman will immediately want reconstructive work and implants. Lorde recounts a visit by a health care worker, who assumed Lorde would want implants and who encouraged Lorde – for the sake of her emotional heatlh – to get them. Lorde refuses the treatment, and she is very clear that within that encouragement lurks a culture that values women according to their desirability, and that assumes a woman’s emotional health will be influenced by how well she fits into cultural norms for appearance. Lorde’s story often surprises my students: many of them too assume all post-mastectomy women must want implants.

It is especially interesting to hear students respond to the health care worker’s visit, as they come to terms with what this scene reveals: many medical professionals have internalized this way of valuing women, and such encouragement reinforces cultural expectations for bodies, without actually addressing real health concerns (such as the high rate of complications after reconstruction and implant surgeries).

Many people called Jolie’s revelation brave: for some people there was bravery in undergoing the arduous surgeries themselves; for other people, it was brave of a woman whose career depends partly on her breasts to reveal that she’d had them removed. Yet perhaps the even braver choice would have been, like Lorde, to refuse reconstructive surgery and implants. To what extent, I wonder, did Jolie’s physicians encourage her this decision? This may seem a silly question — again, after all, her career has been built on her physical attributes. But it’s an important question for women generally. (A follow-up article in the New York Times stated that in fact many women feel pressured by physicians to get larger implants.

One of the issues I ask students to examine throughout our Literature and Medicine course is whether certain assumptions that we’re socialized into — assumptions regarding norms of appearance and behavior — might make it hard for them, once they’re physicians, to see the alternatives to standard treatments that patients might wish to pursue.

We examine how people make art out of their post-mastectomy bodies, through chest tattooing and other visual works, so that students can consider other ways to conceive what makes a body beautiful. What else should we be looking at?

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Category Archives: Education