Medical Media Arts Lab | Medical Futures Lab

Feb 24 2014

A Recipe for Public Thinking in Academia

Nicholas Kristof’s latest column on academia’s detachment from public issues raises many excellent questions for intellectual leadership in a digital era. Should academics be more visible in public debate? Should their work more directly address current policy matters? Should academic culture be faulted for fostering insular thinking?

The one question Mr. Kristof didn’t address is the one most worth asking: What can we do about it? How can we better connect academics to social issues, public conversations, and societal interests? As we discuss matters of health design, e-patients, and digital presence in “Medical Media Arts Lab,” can we look beyond the individual to understand the systemic inhibitors of public engagement in academia?

Kristof’s piece suggests the solution is for individual academics to simply become more involved:

Professors today have a growing number of tools available to educate the public, from online courses to blogs to social media. Yet academics have been slow to cast pearls through Twitter and Facebook.

While individual willingness to participate in the public forum is important, these issues run deeper than that. We need more than intent and a platform. What we need is a broad rethinking of the way we educate, evaluate, and engage in academia.

Education. During her training, an academic will learn how to ask a research question and develop a method to test it. What she won’t learn is how to communicate it. And I don’t mean the sort of weighted jargon of p-values and regression coefficients, but the type of dialogue that can spark a bus stop conversation or tell a story at a high school career fair. If we want academics to be publicly engaged, let’s start by teaching them how it’s done.

Evaluation. In today’s publish or perish climate, engagement that can’t be measured in citations or impact factors is an afterthought. What earns tenure is a publication in Science or a major NSF grant, not a Twitter feed or a NYTimes column. To cultivate holistic academics, we need holistic measures of value and impact. Would we need Kristof’s article in a world where public impact was a factor in grant awards or tenure decisions?

Engagement. Perhaps the strongest, and toughest, catalyst for public thinking is a cultural shift where academia embraces its role as a service to the public. Public scholarship isn’t simply ignored in today’s academia, but often actively discouraged. To advocate and engage is to sacrifice credibility and accountability, the currencies upon which research careers are built. Rather, academia should embrace the accountability and responsibility that comes with public research dollars. It should recognize the pedestal for impact and change that their expertise confers, and leverage it for public good. This culture shift won’t be simple, but it’s absolutely critical.

Academics must recognize the importance and imminence of a shift towards public engagement. Those who don’t will soon meet the most compelling impetus of social change: obsolescence. In the age of crowdfunded citizen science ventures, patient-driven medical research, and growing popular antagonism towards science, those who don’t embrace the public sphere will find themselves consumed by it.

This post is a modified version of the original, which appears here.

Feb 23 2014

Communication, Culture, Technology

Hashtag Craziness

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http://www.youtube.com/watch?v=57dzaMaouXA

Using a hashtag in a tweet or in a post on Facebook can be a very valuable way to draw attention to a keyword or phrase of your choosing. However, it is very easy to annoy people and lose the meaning of your post through hashtag abuse. The most clear and hilarious example of hashtag overuse comes from a skit in Jimmy Fallon’s Late Night Show. Throughout the skit hashtag abuse runs rampant as common words and even music lyrics are unnecessarily tagged. Apart from being really annoying after it loses its initial charm, exemplified by Questlove’s clear disapproval, the abuse of the hashtag by Jimmy and Justin scrambles their dialogue, making illogical jumps between topics. In this way, the reader loses the intended message and the meaning is misconstrued.

This skit draws very necessary attention to the rampant hashtag abuse that is omnipresent across all social media platforms. #This and #that is becoming unnecessary and ultimately diminishes the intended importance of the hashtag. According to Twitter’s website a hashtag is meant to be used before a relevant keyword or phrase to categorize it and make it show up in a Twitter search. This can be a very useful tool for a small business trying to create buzz for a new product or for a cancer survivor trying to bring attention and insight to issues from their treatment experience. It is meant to broadcast your message and inform other twitterers that you are bringing attention to this topic and that they can join you if they use the same hashtag. Unfortunately, due to widespread hashtag misconduct twitterers now tend to gloss over hashtagged keywords, disregarding them as spam. Therefore what could be a very successful marketing tool has been mostly discredited.

So how do we sift through all of this #hashtagcraziness and how do we restore its functionality? The former is much easier to solve as there are online tools such as Tagboard which search for a specific hashtag across all social media sites. Secondly, to restore people’s trust in the hashtag perhaps Twitter should impose a limit per tweet. Nonetheless hashtag abuse needs to be limited for what could be a very effective tool in reaching out to others and giving a voice to those who need to be heard is currently being mistreated so it fails to reach its potential.

Feb 18 2014

Communication, Design, Health, Technology

The Plight of the Primary-Care Physician

Type in “reasons for shortage of primary-care physicians” into Google and you will be led to almost 3 million responses. Most of these articles list the same few reasons including:

The lack of financial stability involved in going into primary-care medicine
A shortage of primary-care residency positions
The current state of primary-care, where physicians see too many patients per day while navigating through the convoluted web of medical insurance

Photo Credit: www.dreamstime.com

Now type in “how to solve the primary-care physician shortage” into Google. Again, you will be bombarded with millions of articles, many of which discuss trying to utilize the power of other health professionals some of which include nurses, physician assistants, pharmacists, dietitians, and psychologists. While this seems like a viable solution, the most obvious impediment is communication between these different health providers. Currently, the primary-care physician serves as a reference point between their patients and a sea of other healthcare providers. This only reinforces the current problem with primary-care, where physicians are reaching a cognitive overload. So what can be done to solve this problem? Or more specifically:

Can advances in technology help a primary-care physician maximize their limited time?

Photo Credit: www.hcplive.com

The limited time between a physician and patient is one of the greatest problems in managing complex health problems. One potential solution, mobile applications, allow a physician to be kept up to date on a patient’s progress. Currently, applications allow patients to track various health parameters associated with their chronic condition, and send a report of these results to their doctor. However, the information sent their doctor is often in an unorganized format and is highly variable in form due to the large volume of mobile applications available on the market. In order for this solution to be effective in maximizing the physician’s time, the information must be conveyed in a standard format, and must be available to the physician prior to the appointment.

The other communication problem that drains the time and energy of primary-care physicians is trying to coordinate care with other health providers. Many primary-care physicians still coordinate care over the phone, which can be extremely time-consuming. We need to find ways to streamline communication among different providers. This could include a redesign of electronic health records to better facilitate between physician communication, or an app which not only links a patient to their different providers, but the different providers to each other.

While these changes alone will not solve the primary-care physician shortage we will face in the coming years, they will allow a primary care physician to maximize their time with a patient during a 20-minute appointment. This will lead to better health outcomes, which is the ultimate goal of medicine.

Feb 17 2014

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

5 Lessons from the Quantified Self Movement

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

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

Photo Credit: funnyjunk.com

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

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

Photo Credit: cardiio.tumblr.com

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

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

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

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

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

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

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

Feb 17 2014

Design

Where are the study results?

If you were asked to name at least one specific clinical trial and what the basic outcome of the trial was, would you be able to answer?

I considered this question for a few minutes, and the most relevant thing I could retrieve from my memory was a scene from the 1990 Robert De Niro and Robin Williams movie Awakenings, in which Robin Williams performs trials on a group of long-term catatonic patients in an attempt to “awaken” them from their states. The result of the experiments is that the patients are freed briefly from their catatonic states, and although they eventually relapse, the protagonist’s life is meaningfully changed. Though it is a dramatic story from the realm of entertainment, it is a good example of a positive portrayal of clinical trials.

(http://moviereviewwarehouse.files.wordpress.com/2012/01/awakenings1.jpg)

This one example, however, is the only instance I could produce.

I suspect the result for the average American is probably similar. One could argue that the question is not practical and that it is akin to asking someone to recall the abstract of an article from a scientific journal, but how can someone volunteer themselves for something that they cannot link positive outcomes towards? Many actually have a negative perception of clinical trials. The Center for Infomation & Study on Clinical Research Participation (CISCRP) conducted a survey in 2006 on 900 US adults and found that the public’s perception of clinical trials is that they are for patients that are “very sick without any other options”, or that they are “looking to make money” (http://www.ciscrp.org/professional/facts_pat.html). Furthermore, 34% of Americans said that they “Do Not Admire” people who volunteer for clinical trials.

But why are clinical trials viewed so negatively? Should they not be something that is valorized, much like blood or organ donations are? As clinical trials are a driving force behind innovation in treatment, especially in oncology, it must be that the uncertainty and lack of information about clinical trials is powerful enough to overcome its positive features. A possible solution is to make the results of clinical trials publicly accessible. Over half of the respondents to a survey conducted by CISCRP in 2005 said that “they would have greater trust in clinical research if the results were made available on a public website registry” (http://www.ciscrp.org/professional/facts_pat.html). Since 2005 there have been advances in this area, such as the release of results by ClinicalTrials.gov, but there is still an abysmally low rate of 2-7% accrual for adult cancer patients (Thompson, Social Media in Clinical Trials).

In order to explore the state of clinical trial visibility online, I decided to check ClinicalTrials.gov. Searching “testicular cancer texas”, I looked for studies marked as “Completed”, and found that it is not easy to see clear, positive results from the trials. In fact, for all of the completed studies in my search results, none of them had published results. In addition, I imagine that the descriptions of the studies would not be easily processed by the average person because they use much scientific, medical, and other technical language. Although precise language is a prerequisite for scientific research, could there not be a way to make this information easier to digest for a casual visitor? If such a source existed, then maybe the question posed at the beginning would have been easier to answer.

(http://clinicaltrials.gov/ct2/show/results/NCT00109993)

Medical Futures Lab

A Recipe for Public Thinking in Academia

Hashtag Craziness

The Plight of the Primary-Care Physician

5 Lessons from the Quantified Self Movement

Where are the study results?

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