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Authors@Google: Thomas Goetz
Poziom:
Temat: Życie codzienne
Katie >> Welcome everyone, thanks for coming
to an Authors at Google talk featuring Thomas
Goetz. We're really excited to have you here.
Thomas Goetz is executive editor at Wired
Magazine and has more then 15 years of experience
in Journalism having worked at the Village
Voice, The Wall Street Journal, and the Industry
Standard. He frequently writes about science,
health, and medicine and he has a Master of
Public Health degree from UC Berkeley. He
is not a doctor though but even given that,
he's written that things that kills us today
aren't infections or epidemics. They are diseases
of lifestyle, in other words, more than half
of us are the agents of our own demise which
sounds kind of scary but he's actually pretty
optimistic about healthcare. He's here today
to talk about "The Decision Tree" and his
main sort of argument is that the more people
see themselves as decision makers in their
own healthcare, the better their behavior
and outcomes, and he also talks a lot about
how technology can help people control their
health better. So, we have discounted books
so after the talk if you'd like to go purchase
one and speak to Mr. Goetz, he will gladly
sign a copy for you as well and then if you
have any questions, we have a mic here after
the talk. Please feel free to come up and
ask so with that, please welcome Thomas Goetz.
[applause]
Thomas Goetz >> Thanks. So you guys don't
have to stay so far back. If you come closer,
it's easier for me but, your choice. So I'm
very happy to be here at Google to talk about
this. I actually um-- A lot of these ideas
that are in the book were hashed out,
some of them, in this very room when I would
come to SciFoo over the last few years which
is a little conference that Google and Nature
and O'Reilly put together, so it's fun to
be here to talk about the same ideas again.
What I wanted to talk about today was this
idea of, you know, there's been a lot of discussion,
especially of late, about a healthcare crisis
and a need for healthcare reform in the US.
There is also--, that is true and it needs
addressing and we need to engage our government
in providing coverage for people and making
sure everyone has access to healthcare, but
there's another issue involved which is not
so much a healthcare crisis as a health crisis
which is happening in the country and basically
that as Katie alluded to, we are making all
sorts of decisions that lead to consequences
that really doesn't have to work out that
way. We're making poor decisions, poorly informed
decisions, that basically lead to a consequence
of poor health and I just want to explain
that and discuss that a little bit today.
So, there's no end of health information,
right? There's no end of access to information
about our health. We are inundated with a
cacophony of information in fact, we are barraged
with a stern list of things we should do and
shouldn't do, mostly shouldn't do, and the
trick is we don't actually do them. Only three
percent of Americans manage to pull off four
basic health behaviors, behaviors that any
one of you would probably be able to
recite off if I put you to it but they are
to not smoke, maintain a healthy body weight,
get some regular exercise, and don't drink
too much. So only three percent of Americans
manage to do all four of those behaviors consistently,
which is pretty startling. What it means is
that we are basically somehow
disengaged from all that information that
is coming at us. We don't really have a way
to put it into an action and what happens
is that we are not only making poor decisions
for ourselves but we're making poor decisions
for our families and we are failing to act
when we can, when we have these little moments
of making choices we are making the wrong
choices. We think our health doesn't matter,
health too often is something that we decide
that we don't want to engage in and that is
somehow a source of anxiety or fear for many
people, for many Americans. For these people,
that's probably the case, right? You don't
want to think about it. I think that's unfortunate
and it's not the way it needs to be. What
happens in practice, what's happening in this
country is that we are getting a series of
decisions are cascading to more and more serious
conditions so you have what I call a "cascade
of cormorbidities". You have one disease leading
to the other disease leading to the next disease
and this is the way most of us get sick and
die in this country. In fact, seventy percent
of Americans die of chronic disease, so these
are diseases that are not infectious diseases,
these are not diseases that come out of the
blue, they are diseases that slowly build
and it's the deterioration of health. Likewise,
seventy percent of the money that we spend
on healthcare in this country is spent on
managing chronic diseases. So when you look
at healthcare reform and where we should be
directing some of the issues of reforming
the cost side, well this is part of the problem,
right? It's that these chronic diseases are
causing us to spend too much money to keep
people alive when they have already had a
disease beset themselves. It's not where we
want to be, and then of course you get this
stat that was alluded to. 55 percent of Americans
die of something that can be traced back to
a personal decision. This was a study done
by Ralph Keeney out of Duke University. He's
an operations researcher which is one of these
fascinating disciplines. You've got, maybe
some of you are in operations research, but
what he did is he took the kind of standard
CDC data, right? The mortality data that the
CDC gathers on all of us and he analyzed it
in a slightly different way. What he wanted
to do was see how many of the
mortality statistics could be attributed if
you work your way back to a choice, when somebody
had a choice. What he did was he excluded
some of the things that we don't necessarily
think of as a choice such as getting in your
car, right? Getting in your car, we pretty
much have to do that if we want to be a functioning
member of society, but getting in your car
drunk or getting in your car and texting,
well that's a decision so those decisions
would be ones that would fall under this 55
percent. It's startling when you think about
it that if more than half of us are dying
because of these decisions, why are we making
these decisions? Where do we lack this opportunity
to engage? Right. So that's a problem and
that's the depressing part of the talk. What
I want to do now is turn towards this idea,
what I actually think is a very helpful and
hopeful way of righting this wrong, particularly
I want to talk about three experiments. These
are three experiments that are in the book
that I think are, to me, offer a new structure
and new approach to our engagement with our
health. The first experiment takes place in
London, on Whitehall Street. In the 1960's,
in 1967, a couple of researchers from the
London School of Hygiene came to Whitehall
Street and decided that this was the place
to conduct a unprecedented experiment. Whitehall
Street is the epicenter of British government.
It is the equivalent of, when you say Whitehall
in the UK it's the equivalent of saying Washington
here. At the end is Big Ben, that's the Halls
of Parliament, around the corner is 10 Downing
Street, and up and down Whitehall Street are
all the government offices, right? So the
Labor office, the Treasury, all the kind of
offices of government. What's great, and what
made Whitehall especially in the 1960's such
an important place to do a population study,
was that it was, as the researchers called,
"exquisitely stratified". So you had through
the ranks of the civil service, through the
ranks of people who worked on Whitehall, you
had five distinct categories. You had an executive
class, an administrative class, a clerical
class--, No, I'm sorry. an executive, an administrative,
a professional, a clerical, and at the bottom
was another category; these were the messengers,
the janitors who kind of did all the work
that was left for them.
What the researchers found was that, let me
back up, they specifically wanted to study
the causes, not the causes of heart disease
but who was most likely to get heart disease,
so that's why they were drawn to Whitehall
Street because they had this great stratification
by class. So what they found was that the
people at the bottom of the group, of the
18,000 people, the people at the bottom had
four times the risk of dying of heart disease
as the people at the to. So there was something
really negative about being at the bottom
and there was something protective about being
at the top. Well, we could all imagine what
some of these things are, right? So it looked
like the people at the bottom tended to smoke
a little bit more, people at the bottom tended
to not have as healthy a diet, they tended
to be a little heavier, so those were known
risks for heart disease and so they factored
all those things out of the study but they
were still left with this profound relation
between status and heart disease. The people
at the bottom now, with all the factors excluded,
all the known factors excluded, the people
at the bottom are still twice as likely to
die of heart disease at the people at the
top, and there was no known reason for this
association so it was pretty stunning.
They didn't know what to make of it. They
thought at first that maybe there was something
protective about being in the upper classes,
maybe there was some genetic inbreeding that
maybe protected you if you were part of the
aristocracy or the elite, that didn't hold
water for very long.
So what they were left with was the idea that
maybe status in and of itself was the correlation,
maybe status was the driver towards good or
bad health. They distilled it to this idea
of control of destiny, that the people at
the bottom had very little control of their
destiny. When they made decisions, they were
only somewhat likely to come true because
they were subject to all the other decisions
of everybody above them while the people at
the very top, they made a decision and that
was pretty much the way things went, right?
They were in control and the people at the
bottom had very little control and we all
know what this feels like. I mean, the people
we deal with these kind of ideas all the time.
When we call customer service, those are people
at the bottom, right?
So when we call customer service and they
can't help us with our cell phone plan, we
say, "Can I speak to your supervisor?" And
they can't help so we say, "Can we speak to
your supervisor?", and we go up and up the
chain until we get somebody who can make a
decision, right? Somebody who has some control,
somebody who has some authority. Likewise,
we know what it's like to be at the other
end of the spectrum, we know what it's like
to have control. We know what it's like to
be, you know we have all these phrases, when
we're in the flow we're in the top our game,
we are surfing the wave, this is a good feeling,
we like to be in control. So, the second experiment
that I want to talk about takes place in the
bathroom, particularly it takes place in 5,000
bathrooms around the country. There was this
great research study that's ongoing out of
Brown University and it's called the National
Weight Control Registry and what they've done
is they've selected 5,000
people, 5,000 Americans, who have successfully
lost weight. They've lost at least thirty
pounds and kept it off for at least a year
and so basically if you want to study what
are the secrets to losing weight, these are
the people you want to talk to, right? So
they asked them, they've surveyed them for
all the tricks that they might have, all their
behaviors, everything that they do, they've
given them surveys after surveys. And what
they found is a lot of the things that you
might expect. They tend to exercise a little
more than the average person and they tend
to watch what they eat a little better, so
they have better nutritional choices. You
might have heard that when you tend to eat
at breakfast regularly, that it actually correlates
with maintaining a health body weight, that's
comes out of the National Weight Control Registry.
But one of the other things they found that
was quite surprising that they didn't expect
to find at all was the simple fact that the
people who successfully lost weight stepped
on a scale a lot. In fact, 80 percent of them
stepped on a scale at least once a day, and
50 percent--, I'm sorry 80 percent of them
stepped on a scale at least once a week, 50
percent of them stepped on a scale once a
day like this woman, Jody Green, who every
day steps on a scale, takes a picture of it,
and posts it on Flickr with a fancy pair of
socks. What they've all realized is that this
tracking, this idea of monitoring their progress,
is a very powerful, helpful way to engage
in successful behavior change. Now it's known
by the phrase, in public health they call
it feedback, right? So when you get people
involved in a feedback loop and you help them
monitor their progress, they tend to be able
to successfully or have better success at
changing their behavior. Now you combine this
feedback loop with the idea of groups and
you get even more potential for change so
this is the secret in fact of Weight Watchers,
right? I don't know if, when I started this
project I was actually very skeptical of Weight
Watchers. What it turns out is that it's one
of the few diet programs that actually works
because they give you feedback, they have
this point system that some of you may have
heard of that basically translates the nutritional
information box on the cereal and the food
products into a formula that gives you a number
of points that you're allowed and that's a
very simple way of getting people involved
in this feedback loop. Likewise, they have
these meetings, right? With Weight Watchers,
they go to the meeting. They call it the magic
of the meeting and when you're able to share
your information, when you are able to share
your progress and track and compare your progress
with other people's progress, it turns out
to be an effective way to change behavior.
so that's what we get out of the National
Weight Control Registry. The third experiment
that I wanted to offer today takes us to Kansas
City, Missouri and an orthodontic clinic.
There was an orthodontic clinic a few years
ago that, as many orthodontists do, they deal
with teenagers, lots of adolescents who have
braces and what they had was a group of kind
of incorrigibles who wouldn't brush their
teeth. They had these kids who had just really
bad oral hygiene. So they--, in fact, they
had to, this is the way that you monitor this
is to take photographs of your teeth and then
you can analyze it for plaque coverage, so
they had forty kids who had about 70 percent
of their tooth surface was covered with plaque,
right? So 70 percent was the baseline. They
took-- they split the forty kids into two
groups, one, they said, they brought them
into the office and said, "We'd like you be
part of this study with this new experimental
toothpaste", so they gave them the toothpaste
and it said experimental in big, black letters
on the side and they said, "Go home and brush
your teeth like we'd told you before. Brush
your teeth twice a day, two minutes a day."
They even gave them a little kitchen timer
to time it, "and come back in three months."
So that was the experimental group. The control
group were twenty kids who were members of
the clinic but they didn't tell them they
were going to be an experiment. They had signed
a kind of blanket waiver as a patient of the
clinic so they didn't have
to tell them they were going to be in the
experiment, they were just on track to come
back in three months anyway. So after three
months, you can imagine where this is going,
after three months the kids in the experimental
group had profoundly improved dental hygiene.
It's not going to sound that profound but
their coverage had gone from 70 percent down
to 50 percent which was, actually after three
months, considered quite good progress. The
control group meanwhile, their hygiene had
actually gotten a little worse. They had ticked
up to nearly 80 percent coverage so there
was a real significant difference, right?
At least 30 percent difference between the
control group and the experimental group.
The question is what was in that toothpaste?
What was the secret toothpaste that they gave?
Well, it was Crest with fluoride, right? It
was ordinary Crest. The magic wasn't in the
toothpaste at all, it was in the fact that
these kids were in an experiment and they
knew they were in an experiment, so no doubt
some of you already know what this is called.
This is called the Hawthorne Effect. It's
named after this kind of mythical study that
was done in the 1920's by Western Electric
Company. They wanted to see if they could
get their workers to be more productive, so
they would experiment with the lighting in
the factory. They were making relays and when
they would raise the lights to see if they
made more relays or they would lower the lights
to see if they would make more relays. It
turned out when they did either one, lights
went up, lights went down, they made more
relays because when the lights change, the
workers knew that the experiment was on so
this has become kind of the mythical way of
describing this phenomenon that when people
are under observation, they tend to change
their behavior. So it's related to placebo
effect, it's the same thing that you see Heisenberg
uncertainty principle, these are kind of well
known phenomena throughout the sciences. They
are particularly vexing with experiments that
involved human subjects so during clinical
trials for drugs, for instance, the Hawthorne
Effect is this thing that researchers try
to accommodate and try to kind of factor out.
There are all sorts of ways of trying to get
ride of the Hawthorne Effect. What was really
interesting about these orthodontists in Kansas
City was they decided what happens if we try
to put the Hawthorne Effect to work? What
happens if we try to put it to work and engage
people in the idea that they're in an experiment
and it turned out to work. So what do we do
with this? What do we do with these three
experiments? The idea
of control of destiny from Whitehall, the
idea of feedback in groups that we've gotten
out of the National Weight Control Registry,
and then this idea of making your life an
experiment out of the orthodontic clinic in
Kansas City? To me, it becomes, in essence,
an algorithm, which being at Google makes
sense to talk about. It's a formula that we
can actually use to start being more active,
more engaged in monitoring our health, start
taking some control of our health. If we can
use the opportunity to monitor where we are,
chart our progress, compare it to other people,
actively use the data that we are generating
all the time every day in our lives and in
our health, we can actually start to engage
with that information and have some control
even though in the other senses of our lives,
it we may not feel like we do have a great
dealof control.
It turns out that other research has borne
this out as well. When you give people, when
you give patients, an opportunity to participate
in their care, when they are simply involved
in the decision making, their averages, their
outcomes on average tend to get much better.
In fact, they tend to get about 20 to 25 percent
better then people who aren't involved in
the decision making. So it's also auspicious
that I'm talking to you guys about this because
this idea of feedback in groups as powerful
members or powerful drivers of behavior
change, can be pretty much easily translated
into the terms data and social networks, right?
They are almost analogous terms and the fact
is that even though public health researchers
have known for many years that feedback in
groups are good ways of getting people to
engage behavior change, it hasn't been that
easy, right? So you have to go through all
these kind of fancy research studies or you
have to sign up with a program like Weight
Watchers, there's a lot of friction involved
in getting people to actually go through the
process of feedback and behavior change. But
if you translate it into data and social networks,
if you start using information technologies
to tap into these same ideas, it becomes a
lot easier. There is far less friction involved,
it's far more easy for anybody to get access
to these tools and strategies. This to me
is what makes it so auspicious, that we're
at this moment in our healthcare system when
we can start developing new tools and new
strategies to work on these principles and
start engaging people in their health. So
one way that this looks, one way that this
kind of comes to life, is all the tracking
apps that are on the iPhone. So this is my
iPhone that I've loaded up with about 18 apps
here. There are actually thousands of tracking
apps on the iTunes store. I have my Nexus
One and I'm going to suitably load that up
with apps as well but it's remarkable. There's
the app with the scale there, Lose It!, it's
been downloaded four and a half million times
and what it does is, it's a really nifty,
very simple free app, that you enter your
weight and then you enter your target weight
and it calculates how many calories you should
consume a day. Then every time you eat something,
it gives you a menu of preloaded library of
foods and with just a few a clicks, you are
able to register how many calories you're
consuming and it's constantly adding it and
keeping you on track towards that overall
calorie goal. Now this is a much easier way,
it has far less friction than the traditional
way of getting people to write everything
down. The food diaries that people traditionally
have to do to engage in this stuff. Likewise,
there are some awesome little calculators
that are working our personal data into this
kind of huge body of health research that's
out there. When you think about the first
slide I showed, that cacophony of information
that we get, one reason that that doesn't
work is because it doesn't have relevance
to us, right? It's all generic, impersonal
data. You know, if a study says that 50 percent
of people are deficient in Vitamin D, the
question is are you in the 50 percent that
is deficient or do you have enough? You want
to be--,you want to know which side of the
coin you're on so there are these new predictive
tools, these online calculators that are being
developed. Very, very, actually, not, not-they
are aggregating to cover more and more of
our health and they are remarkably effective
at combining our personal information, our
personal metrics, with this aggregate of generic
information. So this is developed by a lab
at Harvard University, it's called Lifemath.net
and you basically just fill out a few little
drop down menus so I did it here and it calculates,
it gives you a specific list of actions that
you can take, personal actions that you can
take that will, according to general research,
correlate to improved life.So it's integrating
our own metrics, our own data with what's
known and what's generally told to everybody,
what everybody kind of hears; take an aspirin,
cut down on alcohol, but all of a sudden that
information becomes very, very compelling
and relevant to us in explicit terms. So there
are all sorts of examples of this. The--,
kind of--, since I started writing the book
two years ago, this was very scattershot.
There were a few tools here or there. In fact
when I started work on the book, things like
Microsoft Healthvault and Google Health didn't
even exist, or they hadn't been announced
yet. So in that time, in that span of two
years, there have been dozen of tools that
have emerged. Everything from 23andMe on one
end that kind of gives us a look at our genetic
information and how we can start building
a baseline of our health based on our genetic
predispositions all the way to PatientsLikeMe
at the other end which lets us build our personal
data when we have a disease from Parkinson's
to a mood disorder and share that information
with other people, and come to more insights
and better engagement, and so I want to leave
you with these three idea take aways. The
first is that data means more when it's our
data. When we're given relevant information,
it becomes incredibly more powerful driver
of behavior change. It's demonstrated not
just in the studies that I talked about here
but in dozens of other studies, and the second
is, that the more that we engage, the better
our health so this is the idea that I touched
on, that when people are given a role in their
health and when they are participants of their
health, they tend to have better outcomes.
Likewise, there was a study done, a meta analysis,
of decision tools so these are specific tools
that when somebody say is diagnosed with a
cancer and they want to know what chemotherapy
they might be able to take, these are simple
online calculators that help people understand
the risks and benefits of every different
chemotherapy guiding them to what is hopefully
an informed choice in correlation, in association
with their doctor of course. It turns out
that this meta analysis showed that again,
when people are given these decision tools,
when they are given an opportunity to actually
make decisions for their health and for their
choices, even not just preventive decisions
but treatment decisions, care decisions, when
you are faced with a disease and really life
or death stakes, the outcomes improve. The
third principle is as simple as this: every
decision counts. So we are constantly making
decisions about our health, from those little
micro decisions about where to park and how
far are we going to walk to work to what we
are going to eat to whether we are going to
go to the gym that day. Every decision that
we make adds up to our health, you know. We
set off on these trajectories of health basically
and too often the approach is that it's kind
of fate is taking us on our course, right?
That our health is something that we are not
necessarily in control of, we are not necessarily
even participating in and I think that's exactly
wrong and that's what I'm hoping that people
will start to realize, is that they become--,
we all are the drivers of our own health trajectories,
and that's the essence of what I'm getting
at. Because as far as I'm concerned, it seems
like life is an experiment. None of us know
at the end of the day or at the beginning
of the day,what the end of the day is going
to hold, right? When we get up in the morning,
we are never really sure. We might have a
very clear agenda but we are never really
sure how things are going to play out, on
any given day or any given week or even given
month. There are inputs and outputs that we're
all in control of, we don't necessarily have
a way to get perfect health but we can help
move the lever where we have some influence.
We can help drive our way to better health.
So that's the idea, that's some of the stuff
that's in the book. I'd love to hear your
questions. I hear that you guys are good and
pretty versed in making people think on their
toes so I look forward to some questions.
If you want to get in touch with me otherwise,
this is how. Thanks very much.
[applause]
Somebody's got something.
Do you have to use the microphone?
>> How did you tackle this topic? Because
you said your background was in, or is in,
journalism, so what persuaded you to go into
the medical industry?
Thomas Goetz >> So I come from a family of
healthcare workers. My father is a doctor,
my mom is a nurse, my sister's a surgeon,
and my other sister was a public health worker
so I was the black sheep of the family as
a journalist. That was the easy way out so
eventually I just, one of the cool things
about working at Wired, was that we are in
the thick of it. We are not just covering
things, we are really trying to engage in
change and I realized that in order to be
better at my job, not just as an editor but
as a writer, it seems prudent and even a little
bit fun to cross the bridge into Berkeley,
so I worked out a way to go to Berkeley in
the morning and work at Wired in the afternoon
and so this book basically came out of some
of the studies I was doing at Berkeley.
>> So when you are looking at these tests,
these feedback, 80 percent on the scale and
people joining groups, how do you separate
out the fact that those 80 percent are super
motivated, that's why they're on the scale
every day versus being on the scale every
day, you know? Cause versus effect?
Thomas Goetz >> Right, right, right. So part
of what you're getting at is to what extent
do these strategies scale to broader populations,
right? So you get self selecting in terms
of the groups but also the question is if
you are going to start asking people to track
their health, how many people are actually
going to get to do that, right? There are
certain groups of people who are more predisposed
to engage in data, people who are more happy
or comfortable with quantitative information,
so that's all true and in many ways, this
is a kind of a classic early adopter phenomenon.
What I mentioned was the idea of friction,
right? So right now it takes a fair amount
of work. Even the tools that I'm talking about,
you have to actually work to find the tools,
you have to work to use them. They are fairly
easy to use but you have to figure it out.
It's, as I say, working out the classic kind
of early adopter curve is that it's just getting
easier. You have things like the Moore's Law
of sensor which is making tracking movement
much more passive and automatic, right? So
you have little gizmos like the Fitbit that
right now, for 99 dollars, clip it on your
waist and you can track not only your cadence
and your calorie count but also your sleep
quality. It's becoming easier and easier,
so I look to things like high blood pressure
and cholesterol which 20, 30 years ago were
not numbers that the general public was familiar
with at all. In fact, cholesterol was, there
was a lot of debate whether it even mattered
for people but now you know, large percentages
of the population know their blood pressure,
they know their cholesterol count, and they
know which way they want to be driving those
numbers. I think one interesting thing that
might be relevant to you guys is that, I just
read this over the weekend, Americans are
now reading three times as much text today
then they did in 1980. That's not books, that's
not magazines unfortunately, it's just texts.
It's because of the Internet, right? We are
consuming much more information and I feel,
that to me, that's a very hopeful sign that
we are becoming more comfortable as a nation
with the idea of consuming information and
working it into our lives and making choices
based on it.
>> So beyond the book, what are you doing
with this information? You're saying that
as more people engage in their health then
it would improve so is this kind of, is there
anything being done in terms of trying to
help improve the general populous?
Thomas Goetz >> So what am I personally doing?
Well, that's a good question. I wrote the
book. Hopefully, people will read it. That's
part of what I can do, right? I mean, as a
writer and an author, that's the way I communicate
but I'm also, there are programs like the
Robert Wood Johnson Foundation which has this
really clever group called the Pioneer Portfolio
which is trying to identify a lot of the kind
of trends in this book or in what I was talking
about today and support those groups, so I
am a champion of them. I try to identify the
kind of precursors of this stuff and you know
to me, it's a trend that; one of the things
that is fun about working at Wired and about
writing this way is that you are able to help
people understand how technology is going
to change their life. That's really what I
think the mission of the magazine and the
mission of the book is, that it's not just
to write about a technology but it's the technology
that is going to kind of really transform
people's lives and helping people understand
that is what I can do and it's what I'm hoping
to do. That's something.
>> So, I actually thought your book was maybe
on something slightly different and I think
it may cover this area as well so I'll just
go ahead and ask the question. I think the
things you talked about were in terms of keeping
a healthy weight and not drinking too much
and not smoking are fairly well established
and you can find consensus everywhere in the
medical profession, that those are things
to be avoided, but as far as medical decisions
or dietary decisions that are more marginal,
that are things that are a subject of debate,
the typical way that has worked in the past
is somebody has talked to a physician and
the physician has handed down a dictate or
a mandate and said, "This is what you should
be doing and this is what you shouldn't be
doing", and as I think everyone here is aware
of, the availability of medical information
online and directly to the individual has
been increasing for the last twenty or thirty
years. How have you seen this kind of,these
systems used to influence sort of the well
care that people have been doing for themselves
for things that may or may not be as cut and
dry as don't smoke? I mean, I know you mentioned
taking aspirin on an earlier slide. That is
a little bit less universally -
Thomas Goetz >> Right. So the reason I chose
to focus on things like obesity in this presentation
is because it really underlines the disconnect
between the way we deliver health information
and what people actually do, right? So even
though everybody, so there's this great paradox.
Everybody knows what they're supposed to do,
but we don't do it. And so that's the problem
that is kind of besetting us in terms of our
health, so what I'm trying to do in terms
of this presentation is nip off a strategy
for dealing with that, so that's why I was
dealing with those things that are kind of
truisms, but trying to change those truisms
into something that you can actually effectively
work on. Now in terms of the other stuff that
is less cut and dried, the book does talk
about it. For instance, screening tests, right?
So a screening test is a great idea and a
great resource if it's a good test and if
you are somebody who should be screened for
that disease. So for instance, something like
prostate cancer, you may wanna-- when you
hit 40 or when you hit 50, men might want
to get examined for prostate cancer and might
want to get what called a PSA test.
The question is what course of action should
you take when you get those results? Because
something like 50 percent of men over age
70 have some trace of prostate cancer. So
that's a lot but only 10 percent of men will
actually die of prostate cancer, so the question
is how do you know what fraction you are part
of, right? So you want to go down this road
of being treated for prostate cancer which
often boils down to radiation or removal,
both of which carry potential side effects
of impotence and incontinence so serious,
serious life changing side effects. Do you
want to go down that road even though you
only probably have on a statistical level
a small percentage of dying of that disease?
That's a decision that everybody needs to
make for themselves and negotiate those probabilities
and statistics, right? So at every step of
the way, do you get a PSA test to begin with?
If you show up with a high level of PSA, do
you want to get a biopsy? If you do get a
biopsy, do you want to actually go radiation
or removal? These are all percentages, right?
There are statistics behind every one of these
decisions. This is what a decision tree is.
My hope is that by making it clear that there
are always, that all of these choices have
very clear numbers behind them and opportunities
to parse the numbers. Actively, proactively,
that individuals can better go down these
courses and better understand what they are
getting into. I think right now we, as you
say, look to our doctors to kind of guide
us but the problem is that isn't the full
bevy of information that's out there. By necessity,
they are a human filter, right? So we want
to be getting all the information but tailoring
it to what our circumstances are so again,
that gets into the percentages of where do
you fall, so to me that's an example of how
we need to be mindful of the fact that this
is all probabilistic, that there are no sure
things.
>> So as long as I'm up here, I'm going to
follow up with one more,which is--.
So my experience has indicated that even people
who are otherwise intelligent, have a high
probability of being enumerate in that when
you present them with something like a statistical
probability, even beyond just you know the
emotional impact of whatever is being talked
about, death or debilitation, they are just
not able to understand the mathematics. They
are not able to understand numbers, and What
are the best things that are being done right
now in terms of medical information to present
those numbers in a way that is useful to the
large percentage of people who don't really
see them as useful as numbers?
Thomas Goetz >> Right, right. So one of the
answers is stuff like those predictive tools,
those decision tools that I mentioned like
that Lifemath.net. So when you are able to
process your information and make those statistics
more specifically about you rather than about
a generic average. That's one gesture. There
are some specific things that people are doing.
There is a wonderful project out of Dartmouth
University a couple of researchers are trying
to develop tools that make, for instance,
drug facts much easier to understand, so following
the footsteps of the nutritional information
label, that kind of box, they are developing
a drug facts box where all that kind of fine
print of the side effects and the risks of
a drug that none of us can ever understand.
The drug facts box that they propose reduces
that to very simple terms of who is this drug
for, what are the potential risks, what are
the potential side effects, and what are the
odds that it is going to work for you. It's
these very clearly stated, clearly presentative
information that help people understand exactly
the pros and cons of a drug, and they've done
studies that have shown that people are much
more, when they are given information, information
in that form, they are much better able to
parse the information. More broadly, there's
some great work being done here at Google
among other places in information design,
right? We are actually, in my mind, we are
entering this golden age of information design
where we're understanding how to use graphical
presentation of information to help people
understand. There is a lot of, this goes to
kind of the behavioral economics approach
on this, is that people are irrational, right?
And they can't understand numbers and even
they tend to make bad decisions even when
they are given the good information. I don't
entirely buy that, I agree that it exists
as a kind of status quo, but I don't buy that
that's where things end. There are a lot of
efforts such as what's happening at Dartmouth,
such as what's happening. There's this other
researcher at Cornell called Valerie Reyna
and she's come up with this theory called
The Fuzzy-trace Theory. The idea is that yes,
when we give people just cold hard numbers
and we ask them to just engage rationally,
they tend to mess up. They tend to generally
not understand the numbers, but when you give
them a kind of fuzzy sense of what the numbers
mean, she calls it the gist, when you give
them the sense of the gist of the data, where
they are able to kind of draw on their emotional
intuitive reasoning skills as well as their
rational reasoning skills, they tend to make
much better decisions. And so to me, that's
incredibly hopeful, that kind of research
that you know it isn't this kind of cold duality
between our emotional/rational, emotional
and rational selves, but actually that you
can kind of use both of our sides of the brain
and help people understand information. I
think that that holds great promise.
>> With this current generation, and I'm beyond
the current generation, but so many people
are involved in games, interactive things
that are not only engaging but a lot of fun.
And how important is fun going to be in involving
people in their own healthcare decisions and
changing their behavior?
Thomas Goetz >> That's a great question and
some of the people that are doing some innovative
stuff about this like a local group called
Hope Lab. They are trying to develop games,
video games, that help people kind of make
health decisions in a game format. Weight
Watchers for instance, this point system,
a lot of people play it as a game, right?
If you are kind of working the numbers and
trying to stay under your points for a day,
it becomes a game. There is a lot of new research
that's showing that when you are able to kind
of have people play and work towards goals,
that's one of the cool things about this data,
right? It's your data, but you're able to
move the numbers and move the targets and
kind of play with it. So this Fitbit that
I mentioned, you can go and read all the numbers
and look at the graphs and your progress and
stuff like that, but it also has this very
easy simple display of a flower that the more
you walk around, the more calories you burn,
the taller the flower grows. It's a very simple
reward mechanism that is playful and I think
those are really auspicious roots for helping
people engage in that way, but we need more
of it. I mean, there is a lot of cool stuff
that could be done in that area.
Alright, well thank you very much.
I appreciate all your time.
[applause]
