Fred Wilson, a venture capitalist, gave a talk at Le Web that touches on health, but even better, provides a framework for thinking about how technology is transforming the world in general:
Pew Research has data to back up each of his points on mobile, video, dating, social networking, news gathering, education, our networked lives in general, etc.
If you want to hear specifically about what he sees coming in the health space, skip to minute 20, when he says, “Health and wellness is what keeps you out of the health care system.”
If you want another shortcut, DataFox published a very good summary of the talk. You might also enjoy the lively discussion on AVC, Fred’s own blog.
Here’s my comment:
Fred is spot on when he talks about the huge potential for tracking our own health — 7 in 10 U.S. adults do so now (source: Pew Research Center). The hitch is that half do so “in their heads,” one-third with paper and pencil, one-fifth using any kind of tech. Most people are not yet convinced that an app or device will help them.
I also agree that networks are going to revolutionize health (if not health care, eventually) but I’m personally more interested in peer-to-peer networks among patients and caregivers (esp. parents of kids with rare diseases) than those developing networks for clinicians. In this, I’m following the swarm — the many, many people who are connecting online to get answers, or even better, to improve their questions. HumanDx should consider adding expert patients to their roster of “experts.”
Methinks the “hitch” you cite exemplifies what cannot possibly be seen in a conference that examines the space only from the vendor perspective.
Anytime there’s massive overspending compared to consumer value, there’s a big disconnect somewhere. (Either that or everyone in the space is stupid, which ain’t the case here.) After 200+ speeches (yeah, I count things) and 300+ healthcare events, I’m clear that the disconnect is that people aren’t looking at the problem and the use cases from the consumer’s perspective.
I’m not being righteous about this – I’m being businesslike. Hospitals are learning that it’s effective to “onboard” new patient advisors, the same as they do with new employees, and develop their skills as team members. I’d like to see something similar for patient conference speakers: take people whose primary asset is astuteness about the patient’s role, and show them the ropes of the conference world.
Just remember, all, ya ain’t gonna get that kind of expertise for free. Panelists and keynoters at almost all events can be there because their day jobs support them; not so with patients. And dat is de source of de disconnect. Fix it.
Yes, I agree.
Here’s an analogy that has helped me:
I imagine that we are all wearing headlamps and where we look is illuminated — just that circle. If you want a broad view of the landscape you need to sweep your own headlamp from side to side, up and down. That’s tiring.
You could also try to stand next to someone who has a perspective that is different from yours and look at what they see. That’s a little easier.
The best strategy might be to gather a lot of people in one place with very different perspectives and get them to describe what they see, one after the other. That’s like a thoughtfully-curated conference. Or a great Twitter feed. Or a lively discussion thread. It saves everyone time in the end.
I’m learning more about the power of owning our subjectivity (as opposed to objectivity), our choices about where to look, what to describe, etc. The key is to know that you are making a choice. Also: Never assume that what you are seeing or experiencing is everyone else’s reality.
Another thought, this time from my friend Rajiv Mehta, who gave me permission to quote from an email he sent to me after the publication of The Diagnosis Difference:
Boy, I have such mixed feelings about Rajiv’s words. I think I get what he’s saying – I agree, but isn’t it a two-stage process?
There’s the question of what to “snapshot,” but it seems there’s a separate question of whether to interpret the pixels.
I’m also concerned about the dual meanings of “manipulate.” In this context I agree with his words in sense 1, but I worry that people will infer that he means sense 2 Oxford:
Rajiv, I’m guessing you’re out there – is #1 in the same league of problem as #2?
Hi Dave,
As far as photography is concerned, I’ll grant those two senses of the word, but it’s not so obvious which is “worse” or if it really matters.
As an example, it has been argued to me that seeing and physically removing a soda can from a scene *before* taking the photo is OK, but that removing the soda can using Photoshop *afterwards* is not OK. The second photo is considered to be manipulated whereas the first is not. To me this is non-sensical. To me, both photos are the same, they both show what the photographer intended to show.
But the deeper point I was making is that there is no such thing as totally objective photography because the photographer has to first choose what to photograph, and in that he is making a judgement as to what he thinks is important. Even subtle changes in framing can have a huge impact on what is perceived by the viewer of a photograph. What he chooses to photograph is also limited by his own vision, by his own ability to see. (Having worked with great photographers, I’m used to being flabbergasted at how little I see.)
With regards to Susannah’s research, the questions she chooses to ask, and how she frames the question, are subjective decisions. She reports the resulting data as objectively as she can (she doesn’t use Photoshop), but she can’t get rid of the original subjectivity.
Thanks, Raj! As I wrote above, I’m learning as I go, deeply appreciative of teachers and friends like you. I now see it’s a strength, not a weakness, to acknowledge subjectivity.
Raj, this is getting tasty. 🙂 Let’s dig further (even though I’m theoretically hookying from my other tasks today, ahem).
For the record, I don’t disagree with anything you said, but you’re poking at really deep issues.
> physically removing a soda can from a scene *before*
> taking the photo is OK, but that removing the soda can
> using Photoshop *afterwards* is not OK. The second photo
> is considered to be manipulated whereas the first is not.
1. This runs smack into “What’s the purpose of a photograph?” If it’s to say “See?? This happened! I have a picture!” then editing the pixels is indeed manipulation.
2. But what if the pixels DON’T show what the eye saw? I worked in color printing years ago, and they HAVE to do all KINDS of “manipulation” to get the same viewer experience as the person who first saw it. (For them it’s not just the photo (however you’re viewing it) – the photo has to be split into process color inks, smooshed onto some color of paper, then viewed in god-only-knows-what lighting.)
3. The deeper information theory lesson is that when reality gets encoded into bits for transport, you have to be careful that the decoded-and-viewed info comes out as intended.
4. For that reason, in a digital printing trade group I led, there was a huge issue of “intent” (e.g. “Coca-Cola Red”) vs “process.”
5. And that discussion went kablooey when someone raised “the James Bond example”: it’s fine to say “I understand the technology so my consumer doesn’t need to,” but what if you have a savvy buyer whose intent *is* that you use a specific process: “Shaken, not stirred.”
Ultimately I think it comes down to epistemology – how do we know what we think we know – which must be understood before we venture into the world of *conveying* information.
Lots more for further replies to your comment, later, but for now I’m horsewhipping myself back on track.
Hello Susannah,
I have to agree with Dave’s comments. Speakers like Fred seem to be preaching to the choir, to the tech hypesters of the world, busy high-fiving each other over their saviour-of-health-care predictions, almost as if they haven’t looked at what the Pew surveys actually found, which is this: while 7 in 10 U.S. adults may now be tracking their health, only one-fifth are using ANY kind of technology to do so at all. THAT is the lead in this story. It either reflects a golden “Next Big Thing” opportunity (as the hypesters insist) or it simply reflects reality.
I’ve frequently observed that this lead is consistently buried behind that misleading “huge potential” in most media coverage particularly among the tech/Quantified Self community of the worried well, and even in Pew reports. Surprisingly, very few headlines run the real news from your ‘Tracking For Health’ report, which is and should be: “Only 21% Use Technology to Self-Track!” Even here in this post, it’s telling to observe the “hitch” is added as if it’s an afterthought to Fred’s conclusions, instead of what it actually is: the lead. I wrote more on this earlier this year at http://ethicalnag.org/2013/02/22/self-tracking-tech-revolution/
Fard Johnmar once described this reality gap as “the disconnect between consumers’ low appetite for technology and the activities of those developing new self-tracking technology tools.” If we’re only reading and watching and quoting the latter, no wonder the headlines continue to reflect what’s not actually going on out here in the Real World.
Finally, I too am interested in peer-to-peer networks, yet even there the reality is surprising. We know, for example, that we have over 42 million women in the U.S. currently living with heart disease, yet as of today only 13,345 of them participate as members of that demographic’s largest online support group, Inspire’s ‘WomenHeart’ community. So it’s hard to extrapolate from that reality how online communities are going to “revolutionize” healthcare.
Would that Fred Wilson read my reports! While his comments about health may be speculative and based on the experience of people he knows or has met (the anecdote about people who have lost 50 lbs, for example) I would still highly (HIGHLY) recommend listening to the entire talk and taking his broader comments to heart. The guy definitely knows what he’s talking about when it comes to tech trends.
I’d love to hear what you & Dave (and others, please join in!) about the breakdown of bureaucratic heirarchies and the rise of technology-driven networks. Also, his points about “unbundling” of services — do you see examples of this happening in health and health care?
And you might guess my favorite: “We’re all connected, all the time.” That went straight to my heart, but not because of his specific examples. Yes, Kenya’s mobile payments revolution is amazing, but I’m more intrigued by the work being done in mobile empathy.
I agree that today’s reality falls short of everyone’s wishes — including your example, Carolyn, of the low rate of adoption of online support groups among women with heart conditions. Let’s look over the horizon, though, at what could be, even just for today, during this interregnum between Christmas and New Year’s 🙂
> You could also try to stand next to someone who
> has a perspective that is different from yours and look at what they see.
Oo, clap clap clap clap! That alone is worth today’s price of admission.
Those same gatherings, though, often remind me that additional lamps aren’t welcome if people are troubled by what they illuminate, or if someone loses stature in the process – whether or not they realize it.
[Are we off topic yet?]
Hi Dave,
This is in response to your long response (#s 1-5!) above. The system’s not letting me just “reply”; probably user error.
Anyway, yes, these certainly are non-trivial issues. And sometimes it feels like we’re parsing the meaning of the word “is” like Clinton (or was it Gates?).
To your point #1 — to me both photographs are just as accurate, or inaccurate, as regards representing the photographer’s intent (what he wanted you to see). Is that soda can pertinent to his image? Perhaps the can got there because it fell off his car and rolled there (in which case it’s ridiculous to argue that the can was part of the scene). Even if the can had been there before the photographer got there, what if he framed the scene such that the can was out of view (out of the frame completely, or hidden behind a bush)? Has he manipulated the scene by consciously choosing to not show the can? If you say Yes, then I think you’re arguing that if chooses to leave anything out of the image then he’s manipulating. Which means every image ever taken is manipulated.
Dorothea Lange’s famous photo “Migrant Mother” is a straight photo (no Photoshoping), but the one everyone knows consciously leaves out the woman’s oldest daughter. (She was in one of the other shots Lange took that day.) The editor, who choose the famous photo, wanted to make sure that viewers would be sympathetic to the woman (and to the plight of other Depression-era migrants), and didn’t want to risk losing that sympathy by showing such a grown-up child (implying the mother had been promiscuous at a young age). Is that manipulation?
Also, Alexander Gardner’s famous photo “Home of a Rebel Sharpshooter”, from the Civil War, is very much manipulated — he moved and posed a dead solider, and placed a rifle (which wasn’t even that soldier’s). And yet, it gave a more accurate picture of the reality of war than would have been possible with straight photography (due to the limitations of photo technology at the time).
To your point, considering the purpose of the photograph, and how true it is to that purpose, is far more important than simplistic positions on manipulation (e.g. Photoshopping-bad / cropping-okay).
For the moment … I’m going back to family events in the living room. We’ve got plenty of unsolvable, weighty conversations going on here. Seems to always happen when you get family together 🙂 And then there’ll be more food!
Great, Raj – to be continued 🙂
Not user error — the way the replies are nested, there’s a limit to how many times you can comment on a single thread. Thanks for the forbearance!!
Great conversation!
I’d like to add a dimension. People usually assume that the photograph they look at was an end in itself. But what if it was just a step in the creative process? How can you then talk about “the truth”? It all sounds to be part of this fundamentalist, binary vision of people motivations and way of thinking. I don’t buy it. As a (former) artist, photos are just one way to catch an idea, a concept or a situation. And, as every artistic creation, there isn’t a single way to do it.
Raj, I am having fun lately by remove, one at a time, the “photographic” elements in some digital pictures, all the way to the point where it become fun to use different artifices to recreate a photorealist feeling. Not very different from the 70 layers of materials I used to add to a sheet of paper to recreate sculptures or to create portraits with a seemingly 3 dimensional aspect.
Bravo for your comments about the 2 famous pictures. How can anyone say that photo cropping is acceptable while any other form of post-production is not. What about the essence of old-style, film-based photography. Every famous historical or artistic B&W photo is the result of much post-shoot “manipulation” including the multiple steps involved in development.
About perspective: I have been saying that every young doc should take a course on perspective to make them understand what patient-centricity really means and how unprepared they are to understand it. Only a physical understanding of perspective can accelerate this understanding, IMO
Hi Giles,
I very much resonate with your comments. I remember once hearing Andy Grundberg lecture on some post-modern photography, and he managed to make an incredibly boring set of pictures of a brick wall interesting. The artist was depicting the passage of time, and the pictures were just a means to an end. I also once saw a display of several prints of Ansel Adams’ “Moonrise, Hernandez, New Mexico”. Each one was printed about a decade apart from the same negative, but each was quite distinct, as Adams’ artistic vision and post-production techniques evolved.
A friend commented to me recently that we need to find a way to give *young* docs (and nurses and other health professionals) the patient-perspective. He felt that it might be too late for established professionals, that they’re too invested in their all-knowing facade. I’m not as pessimistic, but it certainly would be easier when they’re still young and idealistic.
Thanks, Gilles & Raj, for sharing yet more wisdom about photography. I love the idea of including radical perspective infusion into medical training.
Just because it gave me an excuse 🙂 And to demonstrate my earlier point.
http://www.patientdriven.org/2013/12/extreme-wearable-qs-healthfoo-2013/
More about the perspective issue:
Error of Perspective and Map Issues: The Health Care Edition
My good friend Hugh Dubberly creates wonderful “concept maps”. Some are available at http://www.dubberly.com/concept-maps — my favorites include “A Model of the Creative Process” and “How to Play Baseball”.
He and I have collaborated on attempts to map or frame health from the person’s perspective. Here’s a paper “Reframing Health to Embrace Design of Our Own Well-being” (http://www.dubberly.com/articles/reframing-health.html), and a recent talk “Health Technology for the Other 99%” (http://www.slideshare.net/rajiv.mehta/health-technology-for-the-other-99-130517-final).
Lately I’ve been working on a map of family-caregiving activities, in a way that highlights activity frequency (many times per day … once in a lifetime). It makes it starkly clear that most of what caregivers do is almost completely unsupported. I showed a few people a very rough sketch at the recent HealthFoo, and got strong, positive reactions. A long way to go to turn it into a Dubberly-esque concept map, but it seems it’ll be worth the trouble.
One more thought on photographic honesty …
I was thinking of Eugene Smith’s famous photo essays “Country Doctor” and “Spanish Village”, and came across a blog post in the New York Times with a wonderful quote from Smith regarding his staging of photographs and whether that is okay: “The honesty lies in my — the photographer’s — ability to understand.”
The blog is here: http://lens.blogs.nytimes.com/2013/01/03/w-eugene-smith-i-didnt-write-the-rules-why-should-i-follow-them/
I was thinking of Eugene Smith because I’d love to create a series of photo-essays on a day-in-the-life of a family caregiver. It occurred to me that by the nature of things, to create a great photo-essay would likely require similar staging, but that this would be okay because the overall result would be an honest portrait of what caregiving entails.
> How can you then talk about “the truth”?
My point, exactly. Thanks for saying it well.
I just stumbled on another thoughtful VC’s essay about how he intends to keep his perspective fresh (and therefore profit by it). Since I’ve heard it said that profit is the best proof of concept, even in health care which has a dual personality as a “helping” industry encompassing 18% of the GDP in the U.S., I want to draw attention to Charlie O’Donnell’s thoughts as well:
Read the full essay here: Paul Graham and the world out there
A couple of things to think about:
1) If you haven’t yet read the comments on Fred Wilson’s blog, check them out. He gives credit to community colleagues who have educated him, which speaks to me of someone who is approachable and remains in learning mode.
2) Also check out Chris Schroeder’s book, Startup Rising: The Entrepreneurial Revolution Remaking the Middle East. He profiles men and women who are coming up with fantastic ideas for new technologies and businesses, solving problems and creating solutions we all can learn from.
Obviously I think there are connections to health care all over this conversation.
In case anyone read O’Donnell’s post and thought Paul Graham has some explaining to do:
What I didn’t say
I am sympathetic to his situation since I too have been placed in the awkward position of accepting a phone call that turns unexpectedly formal. I prepare differently for a chat vs. a recorded interview and have even begged off calls when it’s clear that the person on the other end of the line has turned from a colleague or friend into an “interviewer” who is taking notes.