Information, knowledge and wisdom

@tedvickey posted this great quote today:

We’re already overwhelmed with data. What we need is information, knowledge and wisdom.
– Dr. John Halamka, CIO of Beth Israel

 

Halamka gets to the heart of what challenges so many of the health apps currently available to consumers. They collect a lot of data. Sometimes, they make pretty dashboards with that data. But what is consistently missing is the knowledge and wisdom of what that data means, what can be done with it and how.

That’s what scientific experts bring to the table. Our years of training and experience are exactly about how to take all that data (believe me, we collect insane amounts of it in every study) and use it to improve – to make weight loss programs better, to improve the feedback that program participants get, to IMPROVE OUTCOMES.

There are a lot of apps that have been created by some smart teams. Many of them have brilliant programmers. But most of them have never run a behavior change program. They haven’t piloted a new approach and had it deliver unprecedented results (or had it bomb terribly – an equally valuable learning experience).

Yes, those folks can go to PubMed and read all about the research that my colleagues and I have spent decades doing. If they’re lucky, they can find a stellar systematic review and meta-analysis that sums it all up in under 4,000 words. But doing isn’t reading. I can read every Berkshire Hathaway Annual Report, but that doesn’t make me the Oracle of Omaha and I can’t imagine someone suggesting to you that taking investment advice from me is a sound financial decision.  So why are we putting our health data and the opportunities it provides for information, knowledge and wisdom in the hands of amateurs?

Lean Academia

I’ve been taking time away from the lab each day for the past few weeks to learn web application development. I’ll post more about the what and why another time.  This week the connection between my program and my lab work came together in another way.

I’m enrolled in class at Starter School (formerly called The Starter League and Code Academy), which sits with-in 1871, Chicago’s premiere start-up incubator and co-work space. Starter School is a 9-month program that teaches the coding, design and entrepreneurship to build software and start companies. (If you want to learn more about what makes this program unique and awesome, check out this WSJ article and the interview with my classmate Chance).  I’m only enrolled in the first 3 months which focuses on coding and programming.  We do start diving into entrepreneurship and it has been an eye opening experience for me.

Our starting point in those classes was The Lean Start-up by Eric Ries and the How to Build a Startup series on Udacity with Steve Blank.  I wish everyone in academic research would watch Blank’s first lesson (which is done in three videos).  I see a number of parallels to academia worth that I’ve been noodling based only on my teaser introduction to the world of Lean Start-ups.

“Start-ups are not small version of big companies.”  The labs of our senior established faculty (the people with endowed chairs who have four R01s (or used to) at a time) seem like big companies.  They have well established systems for moving their research forward. Processes that they’ve built over years, staff that execute details. But the lab of a newly hired assistant professor can’t operate like a smaller version of that.  I don’t think it should.  In the current funding climate, I think allowing (and encouraging) junior faculty to act and think more like start-ups would increase their likelihood of success and increase their ability to innovate.

In recent years, people within and outside the research community have criticized our grant review process as not really promoting the kinds of innovations and leaps we need to truly tackle our goals (as a cancer researcher, these are often written and framed within our failure to “win the war on cancer”). These commentaries assert that we don’t make the kinds of leaps we hope to make, but instead make small incremental advances in our science.  I’ve heard time and again from my peers about the great novel idea they had that got a response of “No one will fund YOU to do that. You’re too unproven” in some form or another from mentors or peer reviewers. These faculty are like entrepreneurs – they have hypotheses about what will work and they need to test them (in academia, we call this getting pilot data). The problem is that we tend to be resistant to pivoting when the pilot data doesn’t play out.  Our resources are so limited that the pilot data is too often seen as a means of showing we can do “anything” rather than “this thing”. Hypothesis testing in the lean start-up is expected to lead to lots of hypothesis rejection or modification until the hypotheses left to test are so low risk (e.g., should the logo be Pantone 165 or 166?) that spending time and money to test them may not be necessary to launch.

Lean start up also aligns nicely with the calls from some of our best scientists to think about alternatives to the randomized clinical trial.  Randomized trials are expensive and time consuming and not conducive to early data that suggests the intervention/product won’t work in the “real world.”  When data to reject “real world applicability” comes to a lean start-up, it MUST re-evaluate the path.  But a junior faculty member trying to build a lab doesn’t have the ability to pivot a randomized trial or it might be the last one she’s funded to run.  She needs to deliver the study she was funded to.  A greater flexibility in the study designs we let drive our decision making would benefit our field.  We would also benefit from giving our faculty and their NIH program officers more flexibility to adapt and make changes mid-study.

Opening academia up to new approaches to building a research program/lab and new ways of thinking seems at least worth contemplating given our tight funding climate. I’d love to hear others’ thoughts on this!

Science and Policy

There are some great books and blogs out there making compelling cases for scientists to get more engaged in policy.  Changes in elected officials lead to changes in committee representation (not just leadership, but also membership) that has the potential to shape scientific and health policy.  PandoDaily has a nice round-up of the changes on the House Committee on Science, Space and Technology that might result from the election.

Men’s Health Week

After a two week vacation from this blog and my twitter account (only half of which was because I was actually on vacation!), I came back today with a guest post over at AICR.  Hop over and join the conversation about what cancer screening strategies are available for prevention.

Home economics is health economics: Why we need to keep home ec

I read a great tweet last week noting that healthy foods are NOT more expensive than unhealthy foods, but they take time and practice to make tasty. It got me thinking about why, first as a struggling graduate student and, now as a working parent, I have always been committed to cooking healthy dinners.

I think a big part of it is that I grew up this way and I learned how to do it from an early age.  My grandmother was a home economics teacher in a small rural town, married to a dairy farmer.  Money was tight and so was time.  My grandmother planned the menu for the week every week. That meant she only bought what she needed at the store and she didn’t have to figure out what to make when she got home.  I remember the menu (& running grocery list of items she’d run out of) being posted on her fridge long after she’d retired and my grandfather sold his cows.  When my mom and her sister got old enough (and at an age far younger than we seem to put them to the task these days), dinner preparation fell to them.  They knew exactly what they needed to do, because it was all laid out for them.  They’d also both grown up in the kitchen, watching and learning.  I have no doubt this is why both are such great cooks now.  I dare anyone to roast a more perfect turkey than my mom or make a better pecan pie than my aunt. This approach wasn’t highly unusual for my grandmother’s generation.  My Dad’s mom knew what she was cooking for the week too!

Growing up, my mom did the same thing as my grandmother.  That meant as a kid I remember, she too came home from a long day of work, got our whole family fed a nutritious tasty meal and then went off to graduate school classes (yes, she WAS super mom!).  My mom took me grocery shopping with her.  I learned how to read nutrition labels to figure our how many grams of sugar were in each and I could pick any cereal with 6 grams or less.  I learned how to balance a checkbook from her after watching her write the check each week.

When I got to junior high, I took home economics and shop (though we called it something funny, like technology, though the most technologically advanced thing in the room was the VCR brought in on days when we had a substitute).  We learned to read a recipe, cook and sew in home economics (things I already knew but many of my classmates did not).  But menu planning wasn’t part of home ec, nor was budgeting.  Nutrition was, sort-of, part of health and banking was, sort-of, part of social studies.  I guess because we were all expected to go to college, we somehow didn’t need to know how to manage a household?  My husband grew up halfway across the country.  He had a class called “Foods” where he learned to cook, but as with me, little else of what my grandmother’s home ec taught.

Many schools have long lost home ec – it was an early victim of budget cuts (though some have retained it and modified it to meet the times in just the ways I suggest). With obesity rates among kids sky rocketing, we need to think about the critical life skills kids need to learn.  Historically, home economics was exactly the transdisclipinary integrated applied course we talk about being novel in education: nutrition, economics, math, chemistry (what do you think baking is?), medicine.  And if you’re lucky, you end up with apple pie. What could sound better (or more American) than that? Just don’t cut PE to pay for it.

Women’s Cancers for Women’s Health Week

Today marks the start of National Women’s Health Week – a fantastic initiative that brings together all kinds of different groups around important issues for women, like physical activity and self-care!  I have the huge honor of guest blogging about women’s cancers over at the American Institute for Cancer Research (AICR) blog today.  AICR is the amazing group behind the reports on nutrition, physical activity and obesity and cancer.  The report, which undergoes continuous updating as new science emerges, is an incredibly comprehensive expert review of the science around food, exercise, weight and cancer.

Check it out the blog and the report!