4. SHARE OF STOMACH
On Lunchables:
Kraft Lunchables pre-packed lunches, loaded with sugar and sodium,
and bringing in nearly $1 billion for Oscar Meyer over the years, were
financially backed by Philip Morris when they were created and
marketed to harried moms in the 1980s. Though they’ve been criticized
for being unhealthy to children,
“Well, that’s what the consumer wants, and we’re not putting a gun to
their head to eat it,” admits Geoffrey Bible, former CEO of Philip
Morris. “That’s what they want. If we give them less, they’ll buy less, and
the competitor will get our market. So you’re sort of trapped.”
February 25, 2013
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5. SENSORY-SPECIFIC SATIETY
The tendency for big distinct flavors to overwhelm the brain,
which responds by depressing your desire to have more.
Pique the taste buds enough to be alluring but don’t have a distinct,
overriding single flavor that tells the brain to stop eating.
February 25, 2013
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6. BLISS POINT
Creating the greatest amount of crave.
“There’s no moral issue for me,” he said. “I did the best science I could.
I was struggling to survive and didn’t have the luxury of being a moral
creature. As a researcher, I was ahead of my time.”
- Howard Moskowitz- studied mathematics and holds a Ph.D. in
experimental psychology from Harvard, runs a consulting firm in White
Plains, where for more than three decades he has “optimized” a variety
of products for Campbell Soup, General Foods, Kraft and PepsiCo.
February 25, 2013
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7. READING/VIEWING
Read: The quantified self, Counting every moment. The
Economist, March 3, 2012.
Additional videos from Todd Park
Todd Park: Opening Data for Social Change
Optional:
Social fMRI: Investigating and shaping social mechanisms in the
real world. Nadav Aharonya, Wei Pana, Cory Ipa, Inas
Khayala,b, Alex Pentlanda. Persuasive and Mobile Computing.
Vol 7, 2011, 643-659.
Hacking Healthcare
Chapter 6: Patient Facing Software
February 25, 2013
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8. ASSIGNMENT
Write a one page essay to be presented in class. Do you find
the quantified self movement appealing? Give examples of
how you would imagine using data to monitor your own
health, or the health of someone you care for.
February 25, 2013
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9. WRITING AN ARGUMENT
Exercise – how to argue
This is taken from the Op-Ed structure. From the Op-Ed Project)
Format:
1. Introduce from the context of the current discussion (LEDE)
or news hook
2. State your thesis argument – what do you believe
3. Provide three relevant examples proving your point (evidence
point one, evidence point two, then conclusion)
4. “To be sure” Provide the counterpoint, then argue against the
counterpoint.
5. Conclude with a recommended action.
February 25, 2013
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11. PLACES TO INTERVENE IN A SYSTEM:
12. Constants, parameters, numbers (subsidies, taxes, standards)
11. The sizes of buffers and other stabilizing stocks, relative to their flows
10. The structure of material stocks and flows (transport networks, population age structures)
9. Length of delays, relative to the rate of system change
8. The strength of negative feedback loops, relative to the impacts they are trying to correct against
7. The gain around driving positive feedback loops
6. The structure of information flows (who does and does not have access to what kinds of information)
5. The rules of the system (such as incentives, punishments, constraints)
4. The power to add, change, evolve, or self-organize system structure
3. The goals of the system
2. The mindset or paradigm out of which the system – its goals, power structure, rules, its culture-arises
1. The power to transcend paradigms
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February 25, 2013
13. 5 THE RULES OF THE SYSTEM
The rules of the system define its scope, its
boundaries, its degrees of freedom.
Power over the rules is real power.
They are high leverage points.
If you want to understand the deepes
malfunctions of systems, pay attention to the
rules, and to who has power over them.
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February 25, 2013
16. THE CHARGEMASTER
Every hospital’s internal price list. Decades ago it was a
document the size of a phone book; now it’s a massive
computer file, thousands of items long, maintained by every
hospital.
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February 25, 2013
17. THE COST CONUNDRUM
Americans like to believe that, with most
things, more is better. But research
suggests that where medicine is
concerned it may actually be worse.
For example, Rochester, Minnesota, where
the Mayo Clinic dominates the scene, has
fantastically high levels of technological
capability and quality, but its Medicare
spending is in the lowest fifteen per cent of
the country—$6,688 per enrollee in 2006,
which is eight thousand dollars less than the
figure for McAllen.
-Atul Gawande.
The Cost Conundrum. What a Texas town
can teach us about health care. The New
Yorker. June 1, 2009.
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February 25, 2013
19. MORE IS WORSE
In a 2003 study, another Dartmouth team, led by the internist Elliott
Fisher, examined the treatment received by a million elderly Americans
diagnosed with colon or rectal cancer, a hip fracture, or a heart attack.
They found that patients in higher-spending regions received
sixty per cent more care than elsewhere. They got more frequent
tests and procedures, more visits with specialists, and more frequent
admission to hospitals. Yet they did no better than other patients,
whether this was measured in terms of survival, their ability to function,
or satisfaction with the care they received. If anything, they seemed to
do worse.
That’s because nothing in medicine is without risks. Complications can
arise from hospital stays, medications, procedures, and tests, and when
these things are of marginal value the harm can be greater than the
benefits.
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February 25, 2013
20. COST VS. PREVENTION
To make matters worse, Fisher found that patients in high-cost areas
were actually less likely to receive low-cost preventive services, such as flu
and pneumonia vaccines, faced longer waits at doctor and emergency-
room visits, and were less likely to have a primary-care physician. They
got more of the stuff that cost more, but not more of what they needed.
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February 25, 2013
21. WHO MAKES THE
RULES?
“Health-care costs ultimately arise from the accumulation of individual
decisions doctors make about which services and treatments to write an
order for. The most expensive piece of medical equipment, as the saying
goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the
pen caps. Doctors do.”
-Atul Gawande
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February 25, 2013
27. QUALITY OF DEATH
“Death, although inevitable, is distressing to contemplate and in many
cultures is taboo. Even where the issue can be openly discussed, the
obligations implied by the Hippocratic oath – rightly the starting point
for all curative medicine – do not fit easily with the demands of end-of-
life palliative care, where the patient’s recovery is unlikely and instead the
task falls to the physician (or more often, the caregiver) to minimize
suffering as death approaches.”
_Quality of Death. Economist Intelligence Unit. 2010.
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February 25, 2013
28. PALLIATIVE CARE
Palliative care is care given to improve the quality of life of patients who
have a serious or life-threatening disease, such as cancer. The goal of
palliative care is to prevent or treat, as early as possible, the symptoms
and side effects of the disease and its treatment, in addition to the related
psychological, social, and spiritual problems. The goal is not to cure.
Palliative care is also called comfort care, supportive care, and symptom
management.
-National Cancer Institute
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February 25, 2013
29. HOSPICE
Hospice is a special type of care in which medical, psychological, and
spiritual support are provided to patients and their loved ones when
cancer therapies are no longer controlling the disease. Hospice care
focuses on controlling pain and other symptoms of illness so patients can
remain as comfortable as possible near the end of life. Hospice focuses
on caring, not curing. The goal is to neither hasten nor postpone death.
If the patient’s condition improves or the cancer goes into remission,
hospice care can be discontinued and active treatment may resume.
Choosing hospice care doesn’t mean giving up. It just means that the
goal of treatment has changed.
-National Cancer Institute
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February 25, 2013
30. THE HOSPICE MOVEMENT
he UK, for example, is well ahead, having led the world in establishing a
dedicated hospice movement, spearheaded by Dame Cicely Saunders, who
founded St Christopher’s Hospice in 1967.
The US followed suit in the 1970s.
In 1988, palliative care was enshrined in the Australian healthcare
agreements, through which the federal government funds expenditures by
the country’s states and territories.
In 2006, according to a study by the International Observatory on End of
Life Care (IOELC, a research body at the UK’s Lancaster University), more
than 150 countries were actively engaged in delivering hospice and palliative
care services.
Yet the IOELC also found many instances where services were localised and
inaccessible to much of the population.
And of the 234 countries it reviewed, only 35 had achieved any notable level
of integration with mainstream healthcare providers.
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33. CULTURAL TABOOS
I have been asked "How are you feeling today?" while I was
throwing up into a plastic washbasin. I have been asked as I
was emerging from a four-hour operation with a tube in every
orifice, "How are you feeling today?"
I am waiting for the moment when someone asks me this
question and I am dead. I'm a little sorry I'll miss that.
- Vivian in Wit. A Play by Margaret Edson.
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February 25, 2013
36. READING
To prepare for next week’s assignment, read:
Protecting Patient Privacy: Strategies For Regulating
Electronic Health Records Exchange NYCLU
Part 2 and Conclusion
http://www.nyclu.org/files/publications/
nyclu_PatientPrivacy.pdf
Optional:
Rekindling the Patient Privacy Debate.
When Patients Tell Their Stories, Their Health May Improve.
Wit. By Margaret Edson. Dramatists Play Service, Inc., Mar
1, 1999.
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February 25, 2013
37. ASSIGNMENT:
Prepare a written and spoken argument (2 pages, 5 minutes) clearly
outlining your position on the topic of open data and patient
empowerment. Do you feel that patients should own their own data? Do
you feel that people should be uniquely identified in an electronic health
system? What are the for and arguments against?
This is taken from the Op-Ed structure. (From the Op-Ed Project)
Format:
1. Introduce from the context of the current discussion (LEDE)
2. State your thesis argument – what do you believe
3. Provide three relevant examples proving your point (evidence point
one, evidence point two, then conclusion)
4. “To be sure” Provide the counterpoint, then argue against the
counterpoint.
5. Conclude with a recommended action.
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February 25, 2013
38. LINKS AND PRESENTATION
Today’s class presentation is available
http://jenvandermeer.com/2013/02/bodies-and-buildings-
class-4-february-25/
And Links from this presentation are available here at
Annotary.
https://annotary.com/collections/10009/bodies-and-
buildings-class-4
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February 25, 2013
