N of 1 Trials, Self Tracking and Personal Experiments

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A talk given by Paul Abramson MD on 8/25/12 at the Medicine of Cycling Conference at the Olympic Training Center, Colorado Springs. Discusses N of 1 experimental design, the Quantified Self movement, and a paradigm for implementing self tracking and the Quant Coach in medical care in order to empower patients.

Gesundheit & Medizin Technologie Business

N OF 1 TRIALS
Self Tracking and Personal Experiments

Paul Abramson MD
My Doctor Medical Group - San Francisco
@paulabramsonmd

Saturday, August 25, 12

DISCLOSURES
no conﬂicts of interest to disclose

Saturday, August 25, 12

THE QUANTIFIED SELF
self-tracking geeks unite

Saturday, August 25, 12

QS CONFERENCE #3
Stanford University, September 2012

Saturday, August 25, 12

QUANTIFIED MANIA
self-tracking goes mainstream

Saturday, August 25, 12

WHY SELF TRACK?

Saturday, August 25, 12

DO YOU HAVE A PROBLEM?
that’s hard to solve

Saturday, August 25, 12

OR A QUESTION?
that matters to you

Saturday, August 25, 12

OR A DESIRED CHANGE?
how can I improve my sleep?

Saturday, August 25, 12

FEEDBACK
gathering data can facilitate insight and change

Saturday, August 25, 12

RANDOMIZED TRIAL
large numbers are better

Saturday, August 25, 12

N OF 1 TRIAL
just you

Saturday, August 25, 12

N OF 1 TRIALS
an opportunity to tailor treatment to the individual

Saturday, August 25, 12

STUDY OF N OF 1 TRIALS

• 70 trials begun, 57 ﬁnished

• 50 trials resulted in deﬁnitive answer

• 39% of trials with enough data resulted in a change in plan

Arch Int Med 1990- PMID 2297206
Saturday, August 25, 12

QUININE AND LEG CRAMPS
• 13 primary care patients already on quinine for leg cramps

•2 week washout

• Three 4-week treatment blocks: quinine vs. placebo

• Outcome measures:

• patient diaries of cramp occurance, duration, severity

• capsule counts
Br J Gen Pract 2005-
• blood quinine levels PMID 15808032
Saturday, August 25, 12

QUININE AND LEG CRAMPS

• 10 patients completed the trial

•3 patients showed signiﬁcant beneﬁt of quinine (p < 0.05)

•6 showed non-signiﬁcant beneﬁt

• One showed no beneﬁt

Saturday, August 25, 12

N OF 1 TRIAL DESIGN
Saturday, August 25, 12

PASSIVE SENSORS
biometric - environmental

Saturday, August 25, 12

ZEPHYR BIOHARNESS
Saturday, August 25, 12

quantiﬁed-mind.com

mymee.com

ACTIVE TRACKING APPS
mindfulness required

Saturday, August 25, 12

OTHER DATA SOURCES
calendar - e-mail - GPS data - government agencies - etc.

Saturday, August 25, 12

VISUALIZATION TOOLS
bodytrack - ﬂuxtream

Saturday, August 25, 12

VISUALIZATION TOOLS
Saturday, August 25, 12

DEFINE THE PROBLEM
speciﬁc - simple

Saturday, August 25, 12

DESIGN THE EXPERIMENT
achievable - time-limited

Saturday, August 25, 12

IMPLEMENTATION
pick tools - assemble team

Saturday, August 25, 12

FEEDBACK AND ADJUSTMENT
data - process - story - coaching

Saturday, August 25, 12

END THE EXPERIMENT
assess the results - tell the story

Saturday, August 25, 12

Quant Coach
Doctor Team Coach

Self Tracker
Other Practitioners

Saturday, August 25, 12

WHERE TO LEARN MORE
•quantiﬁedself.com

•quantdoctor.com

•bodytrack.org

•quantiﬁed-mind.com

•mainstream media
Saturday, August 25, 12

CONTACT INFO:
PAUL ABRAMSON MD

mydoctorsf.com
@paulabramsonmd
ofﬁce@mydoctorsf.com
415-963-4431

Saturday, August 25, 12

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