Why behavior change is hard?

Next month I’ll be back at Connected Health, joining a group of leading behavioral scientists to talk about why behavior change is hard and what you can do about it.

As a teaser to that, I have a post up on the CH blog – https://www.connectedhealthconf.org/boston/2019/news/context-matters-behavior-change-digital-health

Hope you can join us in Boston for a fun discussion!

Conversation matters

Over the course of launching and running ScaleDown, I was fortunate to build a great community of colleagues and friends in health innovation. Some were fellow entrepreneurs, some work at huge cache brand organizations. They provided wise counsel, belly laughs and a shoulder to cry on.

Over the last six or so months, one of the most joyful things I’ve done at work is help bring some of those people together for conversations through the To Health With It podcast.

My co-host, Brad Lawson, is one of the people I met in that ScaleDown journey and then had the pleasure of working with on a day to day basis for a little over a year. Brad has been in the health and wellness industry for 20 years working with small start-ups and huge corporations. He’s also one of the people I know most dedicated to his personal health. If you want to talk Orange Theory splat points, Brad is your guy.

Brad and I have been fortunate to talk to a range of delightful and interesting players in health and healthcare. The conversations are on some pretty serious topics – pain management, cancer, national health policies. But we also have some pretty good laughs.

In the harried lives that we lead, we can forget the value of a great conversation. I’ve been fortunate to have some great ones – and we have some more great ones still to air.

Start-up post mortem v1

The hours and days after your start-up, your baby, is acquired are a natural time for reflection. This is my v1 and I expect I’ll realize I forgot important moments, or, god forbid, important people.

Deciding to leave a safe stable, salary guaranteed, life as a tenured professor is not a minor detail. It is the sort of thing that causes your parents to freak out. But from the moment it was on the table, my spouse was behind me, sometimes behind it more than I was. Without his unwavering, unconditional support, I wouldn’t have been a part of ScaleDown and for all of that, I must confess, that I struggle to summon the words of gratitude.

Starting a company with a friend. It is a scenario that the internet seems happy to characterize with oodles of horror stories. I considered Gary Bennett a friend before we started ScaleDown. That I consider him a better friend, one of my best friends, four years later must then be noted. And a testament to his willingness to ride this crazy wave with humor, discretion, patience and humor (it really is that important). I had deep admiration for Gary’s significant other before this adventure began, that she became a sage advisor and friend during our journey was one of ScaleDown’s many blessings.

Dori Steinberg is truly a woman of enormous faith. She worked her tail off as a scientist to build a successful research program and then put its future in the hands of industry – our company and our partners. Her courage and confidence in those decisions cannot be under appreciated and I will be forever grateful to her. Beyond that, her willingness to ask hard questions made me a better shepherd of the ScaleDown program.

Building a robust, evidence-based, behavioral science program is no minor undertaking as an academic researcher. Seeing that science become a successful company must be an incredible feeling. I am so proud to have been a part of that with Gary and Dori. And I must say, I am incredibly impressed that as ScaleDown’s reputation and scientific credibly grew, they both remained stellar scientists. I would not have had their poise or grace had a colleague at my institution taken my research, bastardized it and tried to  turn it into a competitor. But Gary and Dori have remained confident that quality science and execution will beat cheap imitations and I’m better for knowing both of them for it.

ScaleDown wouldn’t be what it is without the team that built it. We were fortunate to work with some of the best developers in Ben Block, Jeff Cohen and Colin Kuhn. Our product and commitment to our customers were better for Casey Sanli’s phenomenal efforts and willingness, as our first hire, to do whatever needed to be done.

Our customer support team in Angie, Felix and Jill along with the friends, colleagues and friends of friends who helped us build our product and platform were integral.

On a personal note, friends have a choice when you make a life course deviation in how to respond. They can ask hard, but necessary questions. They can provide genuine support or blow smoke. And along the way, when you start to doubt yourself, they can pick you up and help you ride the wave, or remind you of your doubts. I consider myself incredibly fortunate to have an older brother and some very dear friends (Biz, Catherine, Jenny, Lauren, Maggie, Natalie, Shari, Theresa) that did everything right. Without them and the unwavering support of those above, I wouldn’t have started this adventure that I am so grateful for.

In addition, the Chicago healthcare start-up community provided me with a cushion against the lonely life of an entrepreneur, friendship, advice and a genuine belief that you don’t have to be on a coast to make a difference. Thank you to MATTER Chicago for creating that community.

I don’t regret the path we took for a second. We learned so much and I wouldn’t trade it for anything. As a kid, I watched my mother suffer through a job that was unfulfilling (and that would be rather timely in today’s news, but thats a story for another day) and I hope she’d be proud of my decision to pursue a dream, work hard to realize it and be joined by the best of the best.

ScaleDown is in great hands with a new owner who believes deeply in the value of daily weighing paired with personalized feedback. We were incredibly fortunate to find a team that used and loved our product and wants to take it to new levels – and has the resources to do things we never could.


V2: I would be remiss to not point out that Jeff, Ben and Colin all came to ScaleDown because I went and learned to code at the very first learn to code program in the country. Neal and Mike and team at the Starter School brought Jeff into my life and planted the seed in my mind that I could do this. People who seek to lift others up are unique and the Starter School community is full of them.

People can’t help seeing signals, even in noise.

A recent NY Times article included a line that has stuck with me over the last few days, “So great is people’s confidence in their ability to glean valuable information from a face to face conversation that they feel they can do so even if they know they are not being dealt with squarely.”

The article is about job interviews, and the frequency and degree to which people will overestimate their ability to rate a candidate better than a set of data. Even when given nonsensical data, people had no trouble crafting a narrative about the candidate and using that to justify a hiring decision.

In how many other scenarios, do we create stories from unrelated data, and use it to justify a decision?

This is perhaps why AI has become so appealing in healthcare. (The New Yorker also examined the human vs machine decision making this month.)

As someone who works in AI and algorithms to support health decision making, this struck me as another place where it isn’t either/or, but both. The challenge is that finding the role for human and algorithm/machine will vary depending on the health condition and the data available. Behavior change counseling isn’t diagnostic radiology. But in both cases, we should be interested in whether people are making up compelling stories from the data because they can.

More pithy titles, still ignoring data

Tech Crunch has a great title in a post today:

Your Fitness App Is Making You Fat

Catchy isn’t it? The article goes on to explain the reasoning, drawing on the pseudo-science of journalist Gary Taubes, who has spent more than a decade slamming the research community. Here’s the thing, there is great research on what is missing from apps and wearables. The consistent conclusion, is that apps and wearables are self-monitoring tools. Self-monitoring is a cornerstone of successful behavior change – be it to increase activity (for its myriad health benefits beyond weight loss) or to lose weight. But self-monitoring is not sufficient. Apps and wearables don’t work because they don’t provide feedback. Feedback is what drives engagement and engagement drives long term success. None of that is new. Behavioral science has known it for sometime. It is just new to apps and wearables.

I’m glad to see the tech community paying attention to the outcomes from apps and wearables, but it would be great if it also paid attention to the science – the kind that comes from scientists.

What’s the MATTER?

It was recently announced that Coeus Health, the company I co-founded, was selected as one of the first members of MATTER.

We’re thrilled to be part of this amazing community of healthcare entrepreneurs working to push innovation forward. For the last few months, Coeus has been working out of 1871, another amazing resource Chicago offers to entrepreneurs. We’ve been fortunate to take advantage of the networking and mentoring opportunities at 1871 and are really excited by what we are hearing about the opportunities MATTER will provide.


If it is October, it must be time to raise awareness about breast cancer

Typically this time of year, I roll my eyes at all the posts about raising awareness about breast cancer. As if anyone isn’t aware. My push is always on taking action – because there is a lot we can do to PREVENT breast cancer. Current scientific estimates are that half of breast cancer could be prevented by lifestyle and chemoprevention strategies alone. (To read a great review on this: http://onlinelibrary.wiley.com/doi/10.3322/caac.21225/full)

A recent post from my colleague Graham Colditz, argues that breast cancer prevention efforts need to start much earlier, and that by doing so, we could prevent 70% of breast cancers!

For an (evidence-based) list of behavioral approaches, click here: http://www.cancernewsincontext.org/p/8ight-ways-to-prevent-cancer.html