We design, speak, and consult to inspire health. Let's work together.

Grant
Grant Harrison

What Do We Do?

We identify business opportunities and design practical and elegant solutions that positively impact health and happiness. Sometimes we identify the opportunity and find the right partners to execute it and sometimes we build it ourselves. Other times, we help guide clients so their product or service is simple, elegant, and wrapped up with a business strategy that leverages their core competencies.

What Have We Done?

Jay
Jay Parkinson, MD, MPH

Introducing: Sherpaa

We're very excited to announce that we’ve officially launched Sherpaa. Who it’s for: Currently it’s for tumblr’s employees. In the near future, we’ll be signing up other NYC-based companies. Why: When you’re sick or hurt, figuring out exactly who and what you need and when you need it is difficult. You need an accessible, friendly doctor you can call and email 24/7 who will either solve the problem right then and there or guide you to the highest quality, health professionals with the best personalities who will provide exactly the care you need. Our wonderful friends at tumblr are our first clients. And that means that all of tumblr’s employees can now email or call our doctors (or Guides as we call them) 24/7 when they have a health concern or question. Our Guides are well connected, in-the-know local doctors. Sometimes they can solve everything for you right away, and other times they’ll collaborate with other New York City specialists to arrange the most appropriate care for you. They make your health simple. And that’s our mission. We’re starting slow. We’re focusing on working exclusively with tumblr for a while and will soon be signing up other NYC-based companies. If you’re interested in joining Sherpaa, please do let us know. We’ve been quite busy for the past few months getting Sherpaa started. And we're super proud of it. It’s a service designed and built by us at The Future Well. We’re doing wonderful things and I’m a happy, happy guy.
Posted in design |

In an arm wrestle, who wins; your Gut or Health Science?

I know they are unlikely to meet at arm wrestling competition, but stick with me.  If you are reading this post I believe you know exactly what you need to do to be really healthy.  I believe your Gut can tell you all you need to know.  And I believe the health scientists are way behind you. Jay recently reblogged Dr Mike Evans who made a nice cartoon of the science behind exercise benefits and the huge impact it makes compared to pills and scalpels.  Nice reasoned argument.  But do we really need to hear this?  I know it already and I believe that you do to. Back in 2003 we set up Virgin Health Miles in the U.S. specifically to reward people for play and movement .  Everyone on the team believed in their gut that it was the right thing to do and that exercise is the best medicine. Personally, I'm lucky.  Coming from New Zealand and being brought up by the beach I have always been hugely into the benefits of exercise and play.  I did a Physical Education degree, I played competitive tennis, soccer and basketball.  And I "played" at everything from hacky sack, to swimming, skiing and snorkelling.  I now also play golf, but just to be clear here - golf is not exercise.  It's a good walk spoiled... Then, after moving to the U.S. and setting up Bcycle I went mad for cycling - mountain, road and a Brompton folding bike to get to meetings around London. I probably now cycle about 8 hours a week.  And love the aesthetic of the speed and movement and the sheer pain. I see a dichotomy in my friends.  Those who commit themselves to exercise and those who do not.  Those who find a way to get out-and-about even with work pressures and kids and the like and those who commit to their excuses and then stick doggedly to them. The key is not waiting for the inspiration, just go and do something, the inspiration will grow over time.  And if, after one month you're still not inspired, suck it up and keep going.  There are no excuses. Forget searching the literature and reacting to the latest newspaper headline about lipitor going generic or the latest celebrity weight loss plan. Get out, play and sweat.  And do more tomorrow than you did today.  Go at it as hard as you can.  Put your feet up when you're dead.  Until then go for it.  
Posted in design |

Doctors should inspire.

As doctors, we have pills to treat infections and high cholesterol. We have scalpels to replace hips and open clogged arteries. But beyond pills and scalpels, what tools do we have? Walking out of the doctor’s office without a prescription is a rare occurrence these days. And the famous surgeon tagline has always been “a chance to cut is a chance to cure.” We see people when they’re sick and we’re trained and expected to do something. But do we want more than one of every five kids and nine of ten older Americans taking prescription drugs? Do we really think that more heart stents are the secret to longevity? Of course they are if we believe our job as physicians is to treat the symptoms rather than the cause. I’m trained in Preventive Medicine, one of the twenty four specialties recognized by the American Board of Medical Specialties. Out of the nearly 16,000 medical students that graduate every year, only about 120 choose Preventive Medicine. Does that really mean that less than one percent of doctors think preventing disease is more important than treating it? I’m afraid so. Maybe it’s because our medical culture hasn’t figured out how to profit off health, rather than sickness? Or maybe it’s because our doctors simply aren’t creative enough to think beyond pills and scalpels? Of course it’s a mixture of both and many more, but I think the main reason is we’re absolutely clueless how to treat bad lifestyle from the confines of the 8 minute office visit. It’s a horribly outdated tool for the problem at hand. Health happens in your home and in your neighborhood, not in the exam room. Health is all the little routines you have in your life, some of them good and some of them bad. But in order to lead a wonderfully fulfilling life, we have to look at health as being the optimal mix of good food; fun movement; real relationships with people you love; financial success; a job that leverages your best skills; a neighborhood that makes health easy; and the wild card-- sex, drugs, and rock & roll. I threw that last one in because health has traditionally been so burdensome and black and white. But in real life, health is grey and life is fun. And being a good doctor is much more than writing prescriptions and doing procedures, it’s about knowing your patients and inspiring them. My first practice was strictly a house call practice where I’d see patients in their apartments here in Brooklyn and follow up with them via email or Skype. It was lean and cost $1500 to launch. I was profitable in the first month because my overhead was only about 10%. My patients paid me via PayPal and my visits were typically less than $100. I couldn’t have done any of this without my iPhone and my MacBook. I used today’s technology to practice yesteryear’s medicine. It enabled me to be real-time traveling somewhere in my neighborhood awaiting my iPhone to alert me of my next appointment. Granted, I couldn’t see 40 patients a day like other doctors. But I wanted quality, not quantity. I wanted a real relationship with good, respectful communication. And 6 to 8 house calls a day in your neighborhood gives you way more information about people than 40 harried visits in some faraway institution. But that’s just the business side of things. Most importantly, I saw how people lived. I could see the chubby person’s potato chips on the counter, the mice droppings in the asthmatic’s ultra-cool Williamsburg loft, or the depressed person’s evidence they spent a lot of lonely time by themselves staring at glowing rectangles. My neighbors were my patients and I couldn’t walk more than two blocks without someone saying “Hey Doc!” I liked to think that every time someone said that, they were reminded about living healthier. They saw me at the farmer’s market on Saturdays, going to the gym, having barbecues in the backyard with friends, and drinking at the corner bar. I became a regular fixture in their neighborhood. Hopefully, I was this occasional little familiar nudge that inspired them to chase the good life. And if you ask me, that’s what we as doctors need to be asking ourselves the next time we write a prescription-- am I inspiring or am I perpetuating a broken system?
Posted in design |

Do celebrities get the best care?

I bet celebrities and other VIPs (as they’re known in hospitals) get some of the worst healthcare in America. And, when I mean worst, I mean the most. I did my residency in the West Village in NYC. There seemed to be a new celebrity in the ER every other day. “Oh my god, Lindsay Lohan is in bed 3!” I took care of my fair share of them— I won’t say who. But there was always this understanding from everyone in the hospital that “they were VIPs” and needed extra special treatment. The problem with extra-special treatment in our healthcare system is that it almost always means more care than anyone else would get. For example, celebrities often get every test imaginable done on them in order to rule absolutely everything out. A hospital doesn’t want to be known as the one that killed Lindsay Lohan. This of course leads to more tests and sometimes, more procedures. More procedures can often equal more complications. You get the deal. One hundred thousand people in America die every year due to medical mistakes, unnecessary surgeries, hospital-acquired infections, and drug complications. And they’re not VIPs. Everyone in the health community is speculating on what happened to Steve Jobs, so here’s the rough timeline:
  • Some time in the second half of 2003: Jobs undergoes some sort of scan which finds an incidentaloma, which actually later that evening, it was biopsied and found out to be a pancreatic neuroendocrine tumor, a slow growing kind of pancreatic cancer.
  • The next nine months: Jobs tries a special diet hoping to kill or slow the cancer’s growth. Either it doesn’t work and the cancer grows or the doctors convince Steve that there’s more evidence for a Western medicine intervention than a special diet.
  • July 31, 2004: Jobs undergoes surgery to remove the tumor.
  • June 2009: Jobs undergoes a liver transplant. It’s unclear why.
  • August 24, 2011. Jobs steps down as Apple’s CEO because he is unfit for his duties.
As a physician, it’s our job to do something. We can prescribe pills or we can perform some sort of procedure on you. When we find something abnormal, it’s in our nature to do something about it. Sometimes, it’s in your best interest to actually not do anything about it. The problem is, we don’t know when we should not do something because we don’t always know how you and your body will handle something abnormal. All we have are stats from population-level studies, an intuition, personal experience, and some labs or imaging. I learned from a professor in medical school that we all get cancer a few times a day. Out of tens of trillions of cells in our body, it makes sense that a few of them will occasionally go haywire. But, there are very elegant processes in our body that ensure these mutated cells actually kill themselves (see Knudson’s Hypothesis). Steve Jobs’ had an incidentaloma. It may have taken this tumor 15 or 20 years to cause symptoms. However, it may have taken 1 month. We won’t ever know. We do know that incidentalomas sometimes simply go away without rhyme or reason. And we do know that, in Jobs’ case, the doctors intervened with two major surgeries and, now, 8 years later, his health is severely compromised. Maybe if his doctors actually did nothing for him, he’d still be just fine today. There’s no real way to know. I do think that his docs did the right thing as competent doctors, but, again, there’s no way to know if they were competent in Steve Jobs’ case nor will we ever know that if they just left him alone, he would have been just fine. He probably doesn’t have many years, if not months, to live. And that makes me very, very sad. He was one of our heroes. But I’ve got to wonder to myself, how were his doctors affected by the fact that they had Steve Jobs as a patient? We’ll, of course, never know. But I surely wouldn’t want to be his doctor. For further reading, please read The Atlantic article, How American Healthcare Killed My Father.  
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The Future Well in Vogue

We're happy to be included in Vogue Living's "Being Human" edition, curated by Ilse Crawford, that highlights from around the world "design that puts people first." This is exactly our mission with The Future Well.
Posted in design | Tagged |

Bcycle wins Fast Company plaudits

Fast Company has recently rated Bcycle as number five in the list of 10 most innovative companies in transportation.  I'm really proud of this. When I was VP of Consumer Innovation at Humana, I built Bcycle in collaboration with Trek and Crispin, Porter + Bogusky. And I'm even more proud that Bcycle launched in Boulder this week and is down to the final two for New York City! This is good stuff. This is health.
Posted in design |

Freshocracy.

This is health: Freshocracy
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This is health.

I spoke in Boston on Friday at Health Tech 2011 about “What is health?” and how the internet can enable better health for you and your community. I've articulated before on this site our definition of health, but it's obviously a complicated concept. So we're starting a weekly theme on the site, "This is health." Here's the first: Called “Favela Painting,” this brightly colored village is the work of Dutch artists Jeroen Koolhaas and Dre Urhahn. Working in a slum outside Rio, their goal is to use art “as a tool to inspire, create beauty, combat prejudice, and attract attention.” The care and passion embodied by the murals effectively transforms the favela from outside in. Some really thoughtful words about the effects of this project, on the Magical Urbanism site:
‘Favela painting’ affects the aesthetic order of how favelas are perceived from within and outside its natural embryonic growth. Colour brings hope. It brings a different understanding of space and its people, inviting others to co-create and co-represent much more constructively and positively life here. It appeals to our senses in a way that we do not reject but embrace these places and the potential for better life. It articulates a different discourse of social change; of engagement, contributing to improve life for favela dwellers.
It’s hard to say it any more succinctly than “color brings hope.” Thank you, Aesthetics of Joy!
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Health apps are about as effective as public health ads.

A quick glance at the iPhone app store for medical and health-related iPhone apps shows that, if you want to manage your health via your iPhone, you have a ton of options built with relatively little effort and cost. I have about 100 apps on my iPhone, but the average user has about 40. I use at most about 6 to 8 every single day (Instapaper, Calendar, Clock, tumblr, remote) which is probably more than the average user. Research shows that "the vast majority of apps downloaded from the App Store are in use by less than 5% of users after one month has passed since the download." How many apps can you use on a daily basis? Better yet, how many health apps can you use on a daily basis? How many health apps make consistently changing your behavior for the healthier something you truly want to engage with because it's fun, sexy, and dead stupid simple? Answer: very, very, very few, if any. Are there any home runs in the health app world that engage users consistently over time and truly changes behavior? People claim Nike+ and Livestrong's Calorie Tracker, as reflected by sales in the App Store. There's no reason to assume that any of these apps have better than 5% usage after one month of downloading them. In fact, the majority of these apps require an active engagement such as inputting your food to count calories. Try doing that for longer than a week and see what happens. Active data collection is ridiculously cumbersome, time consuming, and a bit socially inappropriate when eating with others. Even when the data collection is passive (install something once and data just flows to you), what will you do with the data? Collin over at Frog Design installed the TED 5000 energy monitoring system in his house and lived with it for a month. His conclusion:
"I watched everything closely for the first few days, but the novelty of active monitoring wore off quickly. It took less than a week to recognize the rhythm and patterns of our everyday life...while I’m more aware of my use, the 5000 hasn’t done much to change it."
So I think we can safely assume that the promise of apps radically revolutionizing our health is heavily inflated. So, then, what good are health apps? Health apps are about the equivalent of old school public health advertising. Just as I see an ad when I get on the subway telling me that this soft drink has 40 packets of sugar, I whip out my iPhone and see the Livestrong app on my homescreen reminding me that I need to eat well. I don't really want to use it because it's just such a drag. It's cumbersome and a reminder that there's this big downer in my life that I want to change. And there's a 95% chance I won't use it a month after downloading it. But I see it every day on my home screen. Therefore, this app may be about as effective as a subway ad telling me to stop drinking 40 packets of sugar in that Starbucks Trenta.
Posted in design |

Most health solutions aren’t medical, they’re social.

A few months ago, I discovered that my stove was broken. I've lived in the same apartment for over three years. I never cooked. I always went out to eat at restaurants in my neighborhood. I live in Williamsburg, Brooklyn. We've got some of the best places to eat in all of NYC. I ate fresh, whole foods, just cooked by someone else for an obvious price premium. I formed relationships with people who worked at my favorite places. They knew me as Dr. Jay, the regular. But about four months ago, my life changed. I started spending a lot of time with someone who loves to cook. She bought Jamie Oliver's book, Cook, and we set ourselves loose trying to cook as much as we could. Then the holidays happened, and my best friend realized my new interest in cooking and bought me Mark Bittman's Kitchen Express while she got Mark Bittman's How to Cook Everything from her family. And I invested in kitchen equipment I should be able to keep for the rest of my life. I now eat out once a week. Over the summer, I visited Grant in London. Grant is a regular cyclist. He had an idea-- we'd rent a bike for me in London instead of using taxis or the tube. I fell in love with biking. But not only did I fall in love with biking, I fell in love with biking with someone else as we moved from point A to point B and chatted in between. I bought a Brompton during the next visit to London and now have a portable, stylish bike I travel with all over the world. I go to the gym 3 or 4 times a week and lift weights. About two months ago, I simply got bored with weights and jumped on the stair machine. I seriously sweated at the gym for the first time of my life. I'm now at the gym 6 days a week. I decided to up the ante on my life and push my body. In the past 4 months, I've changed my life for the better in three significant ways. Why? My relationships changed, and thus my everyday changed. I began eating with someone who ate differently than me. I adopted her eating habits, which spurred me to change how I ate. I also spent more time with Grant, who introduced me to the world of urban cycling. I adopted his lifestyle and his interests. And then I changed myself and started pushing my heart in the gym. My friends were kind enough to give me the best parts of their life and I was savvy enough to implement them into my own life. On a related note, Atul Gawande's latest piece in The New Yorker, The Hot Spotters, answers the question, "Can we lower medical costs by giving the neediest patients better care?" In other words, can we lower medical costs by changing the everyday lifestyle of the neediest patients? Dr. Jeffrey Brenner in Camden, NJ found that:
Between January of 2002 and June of 2008 some nine hundred people in the two buildings accounted for more than four thousand hospital visits and about two hundred million dollars in health-care bills. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million.
Brenner started finding these high cost patients and forming relationships with them. He wanted to know what the problems were and what creative, personalized solutions he could use to fix their medical problems. He found that what's traditionally been thought of as medical problems, non-compliant patients, were really social problems. One chronically ill patient Brenner "treated" was a person he called Frank Hendricks:
But, out in the world, Frank's life was simply another hospitalization waiting to happen. By then, however, Brenner had figured out a few things he could do to help. Some of it was simple doctor stuff. He made sure he followed Hendricks closely enough to recognize when serious problems were emerging. He double-checked that the plans and prescriptions the specialists had made for Hendricks’s many problems actually fit together—and, when they didn’t, he got on the phone to sort things out. He teamed up with a nurse practitioner who could make home visits to check blood-sugar levels and blood pressure, teach Hendricks about what he could do to stay healthy, and make sure he was getting his medications. A lot of what Brenner had to do, though, went beyond the usual doctor stuff. Brenner got a social worker to help Hendricks apply for disability insurance, so that he could leave the chaos of welfare motels, and have access to a consistent set of physicians. The team also pushed him to find sources of stability and value in his life. They got him to return to Alcoholics Anonymous, and, when Brenner found out that he was a devout Christian, he urged him to return to church. He told Hendricks that he needed to cook his own food once in a while, so he could get back in the habit of doing it. The main thing he was up against was Hendricks’s hopelessness. He’d given up. “Can you imagine being in the hospital that long, what that does to you?” Brenner asked.
Dr. Brenner helped Frank by giving him resources and the relationships to change his lifestyle. Only about 10% of the solutions that got Frank back on track were medical, the rest were social situations that lead to lifestyle change. This is a significant paradigm shift. The companies that realize the future of health is about life and happiness rather than sickness, death, and medical solutions are the ones that will lead in the next decade. More importantly, the companies that can find a business model around social solutions for the neediest, most costly patients, are the ones who will not only make a killing, but change the face of healthcare in the world. image via Telegramme Studio
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