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Jay Parkinson — Wed, 01 Sep 2010 16:55:51 +0000

The Futurama exhibit from the 1939 World's Fair, although pretty in exhibition form, looks like a terrible place to live. It's a world of machines, concrete, and efficiency. How boring! Futurists have always imagined the "what can we do?" scenarios. They've never really asked the questions:

What should we do?
What do people want that would make them feel more alive and more happily human?

Jane Jacobs, in her excellent book The Death and Life of Great American Cities, argues that communities that don't grow organically, don't survive and thrive. In fact, our nation's 11th "largest" city, California City, CA, has only 14,000 inhabitants:

In 1958, Nathan Mendelsohn, a Columbia University sociology instructor turned developer, acquired 82,000 acres of desert in eastern Kern County, 100 miles from Los Angeles. Today a mere 14,000 souls call California City home. Most are clustered at one end of the massive tract. It's a sleepy outpost with its own school district and public bus service but no hotel or chain grocery. The police chief is also the director of parks and recreation, and the Rite Aid is the busiest place in town. The rest of Mendelsohn's eccentric dream unfurls to the east, some 185 square miles of mostly unpaved streets — a ghostly monument to overreach that, from above, looks like a geoglyph left by space aliens. Only Los Angeles and San Diego leave a bigger footprint in the state.

We must design solutions by truly understanding how humans use tools, form communities, live, move, engage with friends, and love. If we don't we risk designing California City's and digital ghettos. We face massive problems today. How do we design health systems that deliver healthcare to 300 million people? How do we design communities that maximize physical activity and real relationships? How do we understand the sequelae of a generation that's getting married at an average age of 28? If people are getting married later and having children later, then those children will have parents that die sooner. How will children whose parents die when they are teenagers deal with having no parents as twenty and thirty-somethings? What will come of kids who grow up with no grandparents? What do we do about the prediction that 70% of the earth's population in 2050 will live in cities and, even in the best of circumstances, the new age of the megacity might well be an era of unparalleled human congestion and gross inequality? The real questions are:

Do we want the future?
If not, how and when are we going to rebel against a future we don't want?

Humans are an amazingly adaptive and protective species. When something is uncomfortable, we chase comfort. Does concrete make us happy? Do little pockets of trampled green grass in megacities make us happy? Is there any amount of technology that can change this? Can we build technology to help people marry earlier? Or maybe we can build technology to help us connect better with friends? Do these kinds of technologies actually make our lives better and more fulfilling? We believe a rebellion is beginning in our culture. We're longing for simplicities. We want local food. We want corner shopkeepers, not faceless corporations. We want less information coming at us. We want to log off. We want small and manageable. We want the comfort of real relationships. We want less choice, and more curation. Grant and I are facing these very issues in our work with the NHS and the Freelancers Union. How do we design small, curated, organic solutions that arise based on need, desire, and authenticity...not what futurists think we can do. But what should we do.

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Jay Parkinson — Sat, 28 Aug 2010 16:09:21 +0000

Grant and I are honored to be featured in the latest issue of GQ Japan about our thoughts on the the future of health and the "hyper body." If you're in Japan, pick one up and send us the translation. We'd be eternally grateful!

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Jay Parkinson — Mon, 23 Aug 2010 14:10:15 +0000

Almost every Sunday night, I walk to this one restaurant in my neighborhood for some comfort food (we're creatures of habit aren't we?). I pass a church on my way where an Alcoholics Anonymous meeting is held almost every night. As I walk through the crowd of smokers, I look at them and they look at me. They don't know that I know they're recovering addicts. And they put a smile on my face. They've taken the initiative to change their lives, restructure their lifestyle, and improve their health. They've realized that overcoming bad lifestyle takes friends, family, and professionals. What does the social science community know about AA? Not much:

Alcoholics Anonymous and its steps have become ubiquitous despite the fact that no one is quite sure how—or, for that matter, how well—they work. The organization is notoriously difficult to study, thanks to its insistence on anonymity and its fluid membership. And AA’s method, which requires “surrender” to a vaguely defined “higher power,” involves the kind of spiritual revelations that neuroscientists have only begun to explore. What we do know, however, is that despite all we’ve learned over the past few decades about psychology, neurology, and human behavior, contemporary medicine has yet to devise anything that works markedly better. “In my 20 years of treating addicts, I’ve never seen anything else that comes close to the 12 steps,” says Drew Pinsky, the addiction-medicine specialist who hosts VH1’s Celebrity Rehab. “In my world, if someone says they don’t want to do the 12 steps, I know they aren’t going to get better.”

Overcoming addiction doesn't happen in silos. Health is social. Lifestyle change is social change. Positive change is about you, your friends, your family, and the physical environment of your home and neighborhood-- that is where health happens. That is not where medical care happens. Bad lifestyle isn't a medical issue, it's a social one, hence the reason why "contemporary medicine has yet to devise anything that works markedly better." Doctors are just so bad at lifestyle and behavior modification. Or maybe they're just uninterested, or ill-prepared, or not reimbursed for social change? Maybe individual physicians think fixing these big hairy problems is too big of an issue for them to exert any effort? Medical care has pills and scalpels-- not urban design, portion size, influential friends, walkability, and the complexities of the modern family structure. I should know. I got about 4 lectures in medical school on topics other than sickness. I had to seek out, on my own, solutions for the real problems our modern culture face-- hyperlocal relationships with other people and with our environment that make choosing health difficult. AA is one of those hyperlocal solutions because it fundamentally understands that alcoholism doesn't happen in silos, nor does it happen in institutions-- it takes a restructuring of your lifestyle in your own neighborhood to kick the habit. How do we change our lifestyle? Good question. There's not as much research happening on this topic compared to medical interventions. You can't bottle up and sell "lifestyle change" and turn it into a multi-billion dollar market, so who's going to do it? And how does patient privacy fit with solutions that require your friends, family, and acquaintances? Can you do meaningful outcomes research on these kinds of social solutions? Are there technology solutions to lifestyle change? Or can we simply design things that people use and want? Is it good enough to just have a 1.2 million person following like AA? Or must we have to put numbers on its effectiveness? Social solutions are notoriously difficult to measure. AA has been going strong for 75 years and it's still an enigma, but it's the kind of solution that will save us from the deadliest disease we know-- unhealthy lifestyle. Do we need more AA-like solutions? We'd say yes. We can chase our tails for 75 years looking for a +/- 5% difference or we can design engaging solutions that people enjoy. Should we care about measurability? Good question. photo by Bill Henson

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grant — Mon, 16 Aug 2010 15:54:49 +0000

"A commentary in last week’s Journal of the American Medical Association brings us a rematch between “nutritionism” and food. Written by leading health experts David S. Ludwig and Dariush Mozzafarian, Dietary Guidelines in the 21st Century— a Time for Food, is the more rigorous, scientific backing to what layperson authors such as Michael Pollan have been writing for the past few years. It’s a short article (10 minutes reading), but unfortunately you’ll need a subscription to access it in its entirety. The storyline is simple. For most of man’s history, nutrition science did not exist. However by the early 20th century, we started to understand more about the relationship between specific ailments and the nutrient responsible for them. During the great depression and WWII, government began to mandate the addition of some of these nutrients to food staples (flour, for example) as a means to ensure population wide exposure. Examples of nutrients and the disease they got rid off are thiamine (beriberi), niacin (pellagra), vitamin D (rickets), vitamin A (night blindness), iron (anemia), and iodine (goiter). It was with this mindset that nutrition science continued to evolve after the war, in a period where most people were not lacking in food anymore. Measuring individual nutrients and finding innovative ways to add them to food became the cutting edge of food science. But the industry was solving the wrong problem. By the 1970’s, food excesses began to lead to chronic disease – heart attacks became a national plague. Despite its initial appeal, attempts to extend the nutrient deficiency–based approach for prevention of chronic diseases have been problematic. The RDAs are methodologically and conceptually inappropriate for this purpose, necessitating formulation of other measures such as adequate intakes and acceptable macronutrient distribution ranges. However, these newer nutrient-based metrics are hampered by imprecise definitions and inconsistent usage. Moreover, translation of nutrient-based targets to the public has proven difficult. Few individuals can accurately gauge daily consumption of calories, fats, cholesterol, fiber, or salt." My take (I've removed "our" to protect the innocent!) Recommended daily amounts are bunk. Read the label on a bottle of water (should your tap be broken) and you'll see the label shows it's completely useless for nutrition. As I said, its bunk. Eat food, quite a lot, if you are hungry. If you're not, don't. And make as much of it as you can, from as simple ingredients as you can find. You might be able to trust the middle men. But maybe you can't. Thank you to Fooducate for this article.

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Jay Parkinson — Fri, 13 Aug 2010 12:37:26 +0000

Grant and I have been asked to decide what the above hospital becomes. The picture was drawn in the late 1880's as it was originally built under the direction of Florence Nightingale in a neighborhood just north of Notting Hill. It looks a bit different nowadays, but it's still retained its beauty and charm. It's no longer needed as a hospital. So what should it become? That's what we get to design. It must:

Promote the health of a community
Be financially sustainable
Be an innovative way to engage and entertain

We want this space to be the future of urban health. We want it to be entertaining-- to define the new "cool." To be designed so it's just so easy to live a healthy, active, happy, social life. The other day Grant and I were talking about the unfortunate connotations "health" has had in the past. Most of the conversations about health have been a paternal pronouncement about what you can't do and what you should do because "you're doing life wrong." It hasn't been about designing your neighborhood so that you don't even know you're being healthy-- being active, connecting with friends and family, eating nutritious food, and stretching your mind via inspirational concepts. And it also hasn't been much about saying ok to occasionally having fun and being a bit "unhealthy." Health in the past has been so black and white. X is good for you. Y is bad for you. But nobody's life works in such extremes. We live in reality-- the world is grey. So we've coined the phrase a "moderately healthy" experience. We want to build an icon-- an "aggregation of health inspiration." How do we connect with the right people and create this community? How do we make well-being cool? How do we make it entertaining? What are the services and experiences we put in there to inspire people to be as healthy, happy, and creative as possible? We've got a ton of great ideas. If you're doing something interesting engaging people with their health and well-being in fascinating, new ways, let us know. We're looking for the right partners from the UK, Europe, and the US to help build this experience. Shoot us an email or comment here. Let's talk.

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Jay Parkinson — Mon, 09 Aug 2010 23:06:22 +0000

Susannah Fox at the Pew Internet & American Life Project recently posted a comment made on a blog about the internet and health:

The remaining 95% of “patients” out there are not motivated to become informed, or invest the time/energy/money in using any of these tools. These are the folks that know that fast food isn’t healthy, but are just too tired to choose differently. Some (emphasis on some) will do a standard Google search when they receive a new diagnosis at best. Yet these are the folks – often folks with multiple chronic (often preventable) health problems, many overweight, on multiple medications, sometimes social problems – that have the real issue that needs fixing. So we can all sit and perfect the tools for a few folks that never needed them anyway, or we can recognize that the kinds of solutions required for healthcare in the US today have nothing to do with fancy IT, or prioritization on search engines, and everything to do with low-tech, unsexy approaches toward grass-roots public health. Sorry to be the voice of reality guys.

We at The Future Well have been struggling with this concept for quite some time. What effect will the internet have on our health in our daily lives? Will it have such a negligible effect that we don't even know it? Will it have a huge effect for a few very engaged people? What should we use the internet for in creating health solutions? Let's start with two facts:

Healthcare is local.
The internet has revolutionized the way we communicate and transact.

Has the internet improved our physical activity? Has it made us eat better? Has it improved our social relationships so we're happier? Has it given us access to new information that helped us improve our health? The answer is yes-- for a tiny fraction of us. But something like walking 30 minutes a day decreases your risk of diabetes by 40%. Will we sacrifice internet time to walk? So how should we use the internet for health? We say the same way we currently use the internet for everything else:

Let people make appointments with their local doctor online.
Let people communicate via email with their local doctors and other caregivers for questions and requests.
Let people learn from others with the same interests (either an interest in an illness or a wellness activity).
Provide accurate, not confusing, information about what the scientific community currently thinks is true.

Will the "digital natives" save us. They use the internet in totally new ways right?? Probably not. This is what a recent article in Spiegel says:

Young people have now reached this turning point. The Internet is no longer something they are willing to waste time thinking about. It seems that the excitement about cyberspace was a phenomenon peculiar to their predecessors, the technology-obsessed first generation of Web users. For a brief transition period, the Web seemed to be tremendously new and different, a kind of revolutionary power that could do and reshape everything. Young people don't feel that way. They hardly even use the word "Internet," talking about "Google", "YouTube" and "Facebook" instead. And they certainly no longer understand it when older generations speak of "going online." "The expression is meaningless," Tom says. Indeed the term is a relic of a time when the Internet was still something special, evoking a separate space distinct from our real life, an independent, secretive world that you entered and then exited again. Tom and his friends just describe themselves as being "on" or "off," using the English terms. What they mean is: contactable or not.

We're still humans with 200,000 years of ingrained behaviors that only changed to a sedentary lifestyle in the past 100 years or so. So we need real human to human interactions to encourage us to fight our modern conveniences, move, and eat food, mostly plants. This isn't sexy. It's low-tech. It's real relationships with family, friends, and local professionals trained in behavioral modification. All of this, of course, needs to be packaged up in a sexy experience for people. They need to feel comfortable surrounded by an aesthetic that makes them feel good. So go local, embrace low-tech, maximize real relationships, and make it sexy. This will be the future of effective healthcare in a community. Our life expectancy has almost flatlined compared to the explosive growth in the last 100 years. We don't think anyone wants to live as a 90 year old for 40 years. If doctors want to be just as effective in the next 100 years as they were in the past 100, we'll have to focus on optimizing happiness and satisfaction with life in the healthiest years of our lives...and not simply prolonging life. (photo by me of Grant and his wife Amanda in his backyard in London...taken with my iPhone)

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Jay Parkinson — Wed, 04 Aug 2010 21:35:36 +0000

I spent all of last week in Melbourne, Australia and Tasmania. I was invited to speak at a conference about Aged Care in Australia. Like everywhere in the world, Australia's population is aging and the country faces a mismatch of supply of aged care services and growing demand. GE, in partnership with Ben Fry, built a beautiful interactive visualization depicting the wave of senior citizens hitting countries over the next 40 years. Taking care of this population with limited resources will be one of the biggest challenges. Innovative technology combined with new business models of paying for sustainable healthcare delivery for this population will provide some relief, but new processes of healthcare delivery must be invented for effectively keeping this population healthy. A new kind of service and its associated processes must be designed from the ground up. Literally, every country struggles with the same outdated processes of healthcare delivery. If you ask anyone anywhere in the world, "What's the difference between going to the doctor today versus going to the doctor when you were a kid?" you get the same answer: Not that much. (photo taken by me in Tasmania with my iPhone 4)

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Jay Parkinson — Wed, 04 Aug 2010 14:14:41 +0000

My grandma caught this fish sometime during the 1930’s while fly fishing back in Missouri with a 2 pound line. She died about two years ago. The last five years of her life weren’t too pretty. She just didn’t seem to enjoy much of her time. Her medical care was aggressive and some family issues went unresolved. Atul Gawande’s latest piece in the New Yorker called Letting Go really hit home. When I was a pediatric resident, I was fortunate enough not to have to witness too much death. But I’ll never forget the conversation I had with a family of a dying patient of mine. It was simply time to let that little guy go. At the end of the conversation, they realized it too. Being a good doctor is about knowing when to stop. It’s about admitting “defeat” from the brainwashing we get in medical school and residency— to prolong life at all costs. Some pertinent quotes:

"Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their live." "Technology sustains our organs until we are well past the point of awareness and coherence. Besides, how do you attend to the thoughts and concerns of the dying when medicine has made it almost impossible to be sure who the dying even are? Is someone with terminal cancer, dementia, incurable congestive heart failure dying, exactly?" "The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter."

In order to have a financially and emotionally sustainable healthcare system for the future , all doctors need to think like hospice workers. The goal for what's known as healthcare shouldn’t be about prolonging life…it should be about prolonging happiness and meaning. I would take this one step further and suggest that hospice care needs a redesign and probably a new conversation. They've got a branding problem. It's been painted as Atul says, "The picture I had of hospice was of a morphine drip." Hospice is about dignity, maturity, and perspective. A well-designed and well-executed hospice program should reflect it's true nature and enable more people to leave this world in peace. Please take some time and read this article. You’ll need it one day.

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grant — Mon, 02 Aug 2010 08:05:00 +0000

You know the bit in Monty Python's Life of Brian when they are talking about what the Romans ever did for them and they ended up saying "nothing... well except for the roads, the water system, the law etc etc? In London we have the same kind of relationship looking back to the Victorians who, with the engine of the Industrial Revolution, built a lot of what we see around us. It was all very modern in 1880. But not so modern now. And instead of knocking things down, we are challenged here to think creatively about how to use something built for another age and another set of problems. There were a lot of hospitals built in Victorian times, many using the latest designs impacted by Florence Nightingale. They brought light and ventilation and a sense of beauty and tended to treat acute conditions. 140 years later we still have the buildings, but we have new problems in health. Particularly diseases and conditions of lifestyle which need a healthcare system that engages in a whole new way. To truly affect lifestyle conditions the new healthcare system must be with me in my home, and with my friends, wherever, whenever. But we still have many hospitals that would not be out of place in a Harry Potter movie. Like the water trough for cattle, we need to retool and rethink how we use these spaces. But it'll be more difficult for the NHS than filling them with flowers.

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Jay Parkinson — Wed, 21 Jul 2010 03:55:53 +0000

David Cameron has been talking up his concept of "Big Society" and delivered a speech this week where he said:

Comprar cipro (Ciprofloxacin) barato, "The Big Society is about a huge culture change – where people, in their everyday lives, in their homes, in their neighbourhoods, in their workplace – don't always turn to officials, local authorities or central government for answers to the problems they face but instead feel both free and powerful enough to help themselves and their own communities. It's about people setting up great new schools, Kjøp Discount cipro (Ciprofloxacin). Order meridia no prescription, Businesses helping people getting trained for work. Charities working to rehabilitate offenders, ordering cipro (Ciprofloxacin) no rx. Utah UT, It's about liberation – the biggest, most dramatic redistribution of power to the man and woman on the street."

In accordance with the Big Society, acheter meridia bon marché, North Carolina NC N.C., last week, the UK's Health Secretary unleashed a major shakedown for the NHS releasing a white paper that promised three major upgrades for healthcare in the UK:

put patients at the heart of everything the NHS does;

focus on continuously improving those things that really matter to patients - the outcome of their healthcare; and

empower and liberate clinicians to innovate, order cipro (Ciprofloxacin) online, Order meridia online, with the freedom to focus on improving healthcare services

This is essentially unleashing private enterprise in conjunction with primary care physician groups, instead of the NHS Primary Care Trust management, comprar cipro (Ciprofloxacin) barato, Florida FL Fla., to support and coordinate the delivery of the highest quality, most cost-effective healthcare for people in the UK, Virginia VA Va..

Immediately after the announcement, rumor has it there were many calls from health-related companies (like Health IT and health management) in the US trying to figure out what that means for the possibility of expansion into the UK, comprar cipro (Ciprofloxacin) barato. Billig cipro (Ciprofloxacin) apotek, This is what could happen if US Health IT and health management companies enter the newly-formed UK market:

Health IT companies will offer initial low cost solutions to physician groups in order to lock them into their higher cost, siloed, farmacia cipro (Ciprofloxacin) barato, New Hampshire NH N.H., proprietary technology that looks and functions like Windows 95. That is their business model, pharmacy cipro (Ciprofloxacin). Comprar meridia barato, Beware.

Health management companies will offer to micro-manage healthcare for physician groups. Micro-management increases costs and leads to high dissatisfaction in both patients and doctors.

If the UK wants to do the right thing for the future of their healthcare, California CA Calif., αγοράζουν online meridia, now is the perfect time to foster the development of an open-source, web-based health platform with APIs to power the future of healthcare, buy meridia pill. Comprar cipro (Ciprofloxacin) barato, This system would have, at minimum, the following standardized parameters:

an open-source, standards-based, exportable data format that allows structured data to freely flow between systems

a physician profile

a patient profile

a standardized physical location format (each address and each physical exam/procedure room)

a time slot (like CalDAV) for scheduling (imagine a person in London doing a web search for the nearest physician with availability in the next two hours with H1N1 vaccines in stock)

a focus on communication (think gMail), project management (think Basecamp), and efficient transmission of clinical data (think of a secure Facebook with open APIs that enable third parties to build applications (such as Farmville) on top of the platform)

a focus on gathering and learning from outcomes via today's kind of communication with patients (email, SMS, etc)

built in Customer Relationship Management (think Highrise or salesforce)

a robust patient interface that empowers patients with information and tools to help solve their acute problems or manage their chronic illnesses

Since patients will soon have the freedom to choose any doctor as their doctor, the physician groups and practices that truly deliver an elegant experience with excellent customer service will thrive, and those who don't will struggle to survive. Buy meridia, We see a huge opportunity in building physician practices that choose a certain target market (think internet savvy, young urbanites) and deliver an experience that caters to their market's needs (think of a doctor's practice that looks and functions like an Apple Store for when your computer breaks), For meridia online. Montana MT Mont., All of these practices should be networked together via the open-source platform described above.

Although it's an exciting time for the NHS, cipro (Ciprofloxacin) without a prescription, Buy meridia online cheap, it's also a cautionary time. United States Health IT and the US version of top-down micromanagement in private health enterprise are not models to emulate, kjøpe cipro (Ciprofloxacin), Meridia price, but models from which to learn.

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(The photo of the new Apple Store in Shanghai is by Roy Zipstein, Nevada NV Nev.. Order cipro (Ciprofloxacin), The other photo is of the Tsukasa Clinic in Japan) .