The ‘Wellness’ Phone

NTT DoCoMo Inc. has prototyped and presented a “wellness mobile phone” that can measure body fat ratio, pulse, breath odor, how far the user has walked and give health advice.

This was a joint development with Mitsubishi Electric Corp. and the company assumes that it will be commercialized in the future, although it has not determined a marketing schedule yet. The company’s booth was filled with many visitors who came to try the prototype.

Based on a mobile phone embedded with a touch panel type LCD, it has sensors to measure various types of biometric information. For example, an infrared sensor measures the pulse using via absorption of hemoglobin. For the measurement of breath odor, a gas sensor set at the bottom of the handset has been used (seems very Japanese to me, but sometimes we all need a reminder!).

A pedometer can sense whether a user is walking, running or climbing up or down stairs. Reflecting such situations, the mobile phone calculates the user’s energy consumption accurately, the company said. Along with an application that monitors and shows the user’s health data in chronological order, the company believes the mobile phone will be used in combination with dietary control services and applications related to fitness management, mental healthcare and the like.

The Elements of Influence

Why is influence important?While many of us need to influence others in our work and personal lives, we are aware that bare persuasion doesn’t always work. Influence really means being aware of others needs and leveraging their likes and dislikes to help them act.

From Robert Cialdini interviewd on Smartplanet.

There are six universal principles of influence. If we use them as touchstones, they will allow us to be significantly more successful in our influence attempts. They are:

• Reciprocation. People give back to you the kind of treatment that they’ve received from you. If you do something first by giving something of value—be it more information or a positive attitude—it will all come back to you.

• Scarcity. People will try to seize those opportunities that you offer them that are rare or dwindling in availability. This is an important reminder that we need to differentiate what we have to offer that is different from our rivals and competitors. That way, we can tell people honestly “You can only get this aspect or this feature by moving in our direction.”

• Authority. People will be most persuaded by you when they see you as having knowledge and credibility on the topic. You’d be surprised how many fail to properly inform their audience of their genuine credentials before launching into an influence attempt. That’s a big mistake.

• Commitment. People will feel a need to comply with your request if they see that it’s consistent with what they’ve publicly committed themselves to in your presence. The implication there is to ask people to state their true priorities, commitments and features of the situation that they think are most important. Then align your requests or proposals with those things. The rule for consistency will cause them to want to say yes to what they’ve already told you they value.

• Liking. People prefer to say yes to your request to the degree that they know and like you. No surprise there but a simple way to make that happen is to uncover genuine similarities or parallels that exist between you and the person you want to influence. That person is going to like you more and be more willing to move in your direction.

• Consensus. People will be likely to say yes to your request if you give them evidence that people just like them have been saying yes to it too. I saw recent study that showed if a restaurant owner puts on the menu “This is our most popular item” than it immediately becomes more popular.

Patient Genetics and Online Collaboration

Is the future in controlled clinical trials, or IT driven collaborations to share health experiences? The answer is obviously a mixture of both, but patient/industry collaborations are making some very positive steps towards becoming a powerful tool.

This great article from NYTimes highlights some collaborations already formed.

For example, in June this year, the Belgian pharmaceutical company UCB announced a partnership to build an online epilepsy community with PatientsLikeMe, among the first private companies to develop a platform for data sharing by patients. PatientsLikeMe, based in Cambridge, has as members tens of thousands of patients who contribute detailed information about their diseases, drugs, doses and side effects. Mark McDade, UCB’s chief operating officer, said the regulatory approval process should be changed to incorporate not just safety and efficacy but also measurements on how drugs affect patients’ lives — data that is now slow and expensive to collect.

Genetic companies have also taken up patient-driven research. The Silicon Valley company 23andMe, for example, started a program this summer called “Research Revolution.” People can buy a stripped-down version of 23andMe’s genetic service, which gives people DNA information on ancestry and risk for certain diseases, for $99 and then contribute their genetic data toward research into the disease of their choice (NYTimes).

Are Placebo’s Getting More Effective?

At least some people believe they are – particularly those drug companies whose pipeline champions are being sunk by the famous effect. This Wired article offers a great list of drugs recently entombed by the placebo effect. It also explains it’s history and the concern it is causing in drug development. But I disagree that the placebo effect is ‘increasing’ as they suggest.

The drop in drug approvals they cite and many of the specific examples they give are probably not due to an ‘increasing placebo effect’ but poor trial design, less effective new therapies and the lack of low hanging fruit. I would even suggest that the perceived change in the effectiveness of Prozac is actually the result of better experimental measurement leading to better data that demonstrates what clinicians have always known.

Trials are becoming harder to design as there is less money available – in part because potential profits from new drugs are not what they used to be. Studies are ‘powered’ at an absolute minimum, and resources sent offshore to clinics with high capacity but lower quality guarantees. This is of particular concern in studies where drug efficacy is highly dependant on patient or clinician reporting rather than hard measures such as well defined lab tests. They Merck scientist in fact demonstrates this when he says they saw different effects in Spain and France.

They author also fails to mention that many new drugs being trialled are in therapeutic areas fairly well served by existing drugs. there is less room for improvement and therefore it is harder to create more efficacious drugs. Early phase testing is easily misleading due to small sample size and other biases.

When the article delves into the cognitive neuroscience behind the placebo effect they indeed point to the fact that by definition, the placebo effect can’t ‘increase’ unless the human brain changed substantially in the last 40 years.

Despite this it is a great article and I look forward to hearing more about the Placebo Response Drug Trials Survey.

Innovation and Change

Words on everyone’s mind in the health arena. Here are some interesting tips from the experts.

Change (from MindTools)

Richard Beckhard and Rubin Harris first published a change equation in 1977 in “Organizational Transitions: Managing Complex Change”, and it’s still useful today. It states that for change to happen successfully, the following statement must be true:

Dissatisfaction x Desirability x Practicality > Resistance to Change

This seems to be a simple statement, but it’s surprisingly powerful when used to structure a case for change. Let’s define each element, and look at why you need it:

* Dissatisfaction: Your team has to feel dissatisfied with the current situation before a successful change can take place. Without dissatisfaction, no one will likely feel very motivated to change.

Dissatisfaction could include competition pressures (“We’re losing market share”) or workplace pressures (“Our sales processing software is crashing at least once a week”). Dissatisfaction can be any factor that makes people uncomfortable with the current situation.

* Desirability: The proposed solution must be attractive, and people need to understand what it is. If your team doesn’t have a clear vision of what things will be like after the change, and why things will be better, then they probably won’t be willing to work to deliver it. The clearer and more detailed you make this vision, the more likely it is that your team will want to agree with the change and move forward.

* Practicality: Your team must be convinced that the change is realistic and executable.

* Resistance to change: Resistance to change includes people’s beliefs in the limits of the change (“A new system won’t fit with our unusual business process”), stubbornness toward any change (“I don’t want to have to learn how to use a new system”), and general inertia or lack of interest at the beginning.

Innovation (BNET lessons from Apple)

It may take several years to cultivate new skills and rebuild your industry. You’ll need funding to create a dedicated innovation team and sufficient capital to rethink your systems and products.

Strategic clarity: Innovating effectively means creating your own opportunities in a crowded marketplace to avoid both mediocrity and commoditization.

Patience: Creativity is a fickle thing, and it doesn’t always follow the clock. False starts and the occasional flop are part of the process and must be accommodated.

Strong leadership: Innovation doesn’t happen by committee. Visionaries with effective management skills are hard to find, but they’re a critical ingredient for success.

Genome and Metabolic Scans the new anti-Cancer Weapon

New cancer treatments are one of the most precipitous of all drugs to develop. But a renewed focus on the DNA mutations that make each cancer unique is about to expand our ability to find new treatments.

Cancer biomarkers may be detected using Mass Spectrmoetry

Traditionally, cancer drugs have been developed by identifying compounds, more recently antibodies, that have a highly toxic effect on cancer cells and animal models in the lab. They are then tested on small, then larger groups of patients to prove their efficacy. But this model is yielding less and less success. In the last 30 years, for example, there has been no real improvement in the drugs able to treat metastatic melanoma from which about 1000 Australians die every year.

The reason is that scientists have been slow to figure out ways to truly capitalize on our molecular knowledge of cancers. Our approach to disease is very linear – X mutation leads to Y disease – despite us knowing that most diseases are polygenetic in origin.We tend to work on particular molecular pathways in isolation. For example, individuals labs will often use one animal model for their own research.

In this article, the founders of Sage, a biomedical networking company, explain how our approach has to begin to use our knowledge of full molecular networks. They say that much of Merck’s metabolism pipeline was developed using such molecular knowledge.Another great example is the AstraZeneca/Biowisdom Safety Intelligence Program (SIP), described as the “largest forever-expanding collection of known chemical effects occurring in different tissues, drug effects on clinical biomarkers of tissue injury, and drug molecular mechanisms.” Currently, SIP contains almost 100,000 individual facts, or “assertions,” related to the liver’s response to more than 5,500 different compounds in over 20 species.

Fundamentally, this new style of research relies on powerful new approaches to sequencing and decoding genomes – something that DNA arrays initially promised, but never really delivered. I’ve previously written on this topic, but every month new astounding results come out of cutting edge labs that herald a new era in molecular science and particularly cancer treatment.

Helicos Biosciences, a company founded in 2004 to commercialize single DNA sequencing technology has just become the fourth next-gen sequencing platform to complete a genome. At the same time, a second leukemia genome has been fully sequenced leading to discoveries of previously unknown mutations and new potential drug targets.

The next step is to capitalize on these discoveries by testing the association between these markers and the various drugs on offer. As an example, these researchers at MIT have found that when both p53 and ATM (common tumor markers) are abnormal, tumors are highly susceptible to DNA-damaging chemotherapy. Tumors in which ATM is mutated but p53 is not, are highly resistant to chemotherapy. Tumors in which p53 is mutated but ATM is not seem to be less responsive to chemotherapy.

This is a solution that is applicable immediately. “You could use this today,” the author says. “You do immunohistochemistry for the tumor, for p53 and ATM, and based on [the results] you can choose anthrocyclines [if appropriate], or taxol as an alternative based on this data.”

Drug companies are beginning to use bio-markers more and more in their studies, but I would contend still not enough. If you do a medical literature search of recent cancer clinical trials, how many trials report collecting bio-markers such as p53 and ATM?

In a closely related field – metabolic profiling–an analysis of chemical reactions in the body- there has been a positive recent advancement. Metabolic profiling may help optimize drug use in patients.

Today, most doctors rely on broad measures like weight, sex and age to determine which drug and dose is most likely to be effective. It’s a notoriously hit-or-miss approach that commonly requires follow-up doctor visits and changes in drugs and dosing. Now are groups of UK scientists have determined that the chemicals created during the process of metabolism and then excreted in the urine could be a more effective tool for personalizing therapies.

To test their theory, scientists at Imperial College London and Pfizer took a urine test of 99 men who were given paracetamol, a common painkiller. What they found was that ascertaining the level of a compound in the urine–para-cresol sulphate–gave the scientists a clear picture of how the men would metabolize the drug. Higher levels of the compound, which is produced in the gut, indicated that men would metabolize the drug less effectively. They theorized that higher levels of the compound indicated that their bodies were depleted of sulphur, which many drugs rely on to work safely. Sulphur helps to detoxify the body. Engineering the bacteria in the gut could fine tune how a body metabolizes a drug.

The advantage of this pre-dose metabolite profiling is that it related to both genetic and environmental factors influencing drug treatment outcomes. Again, this is another step that will soon put an end to centuries old hit-and-miss medicine.

Recruiting Stars

Most managers would consider the purpose of HR is to hire the best and brightest, from other good firms is possible. But the story is not so simple.

This great article from Jeffrey Pfeffer suggests talent should not be over-rated as your workplace probably has as much impact on your measured performance as your talent. It cites some interesting studies to back it up.

Innovation opinions by McKinsey

McKinseys had a few good articles on innovation posted yeasterday. I’d recommend them for a read – and particularly the comments below each article which are quite insightful and perhaps better in content terms also.

This article, on how economic downturns drive innovation was quite controversial. I found one of the comments by a Paul Hamann quite insightful:

Here’s three big ideas for innovation resulting from this recession:

1. Medicine will become an application of computer science. This innovation will finally end the health care crisis and expose the incompetence of most doctors. That’s why the Obama administration won’t compromise on linking physician compensation to outcomes. It’s also why they won’t cap malpractice awards. That’s 17% of GDP finally subject to competition. Info Tech companies will take most of it. Google and Intel will do well. They already are.

2. Computers will become carbon-based instead of silicon, resulting in unlimited compute cycles that are nearly free. This advance will result in absolute ubiquity. It will also enable NP-complete problems to be efficiently solved. That will lead to enormous leaps in engineering and science.

3. The distinction between mobile phone, desktop, and server will go away. We’ll see hardware and Linux-based OS’s become interchangeable across the three categories. This innovation will ultimately benefit Google and end Microsoft’s dominance in software. It will also give a huge boost to the open source movement, benefiting developers and niche software providers. Finally, it will severely disrupt the economics of cloud computing. After all, every new technology gets over-hyped. It’s already time to ask what the cloud computing bust will look like.

I included all three of his points for completeness, but can only comment about the first. It’s a fairly broad sweep but there is some truth in it. It’s by no means an original idea, with the likes of Clayton Christensen and the author of ‘Supercrunchers’ (name?) predicting the exposure of doctors incompetence when health goes truly digital.

The next question for doctors is then how to best prepare for this from an educational perspective. Do we just wait for the innovation? Or should we begin to change our ways of practising medicine in anticipation?

I believe many doctors already are adapting as patients gain access to knowledge and tools they never had previously. As I’ve suggested before, we are becoming more like health managers than health teachers.

The Dangers of Mixing Medications

Well known to geriatricians, the dangers of mixing medications are significant with around 21% of the elderly reportedly on a bad combination of drugs. CHOICE seems unsure who to blame citing historical, practice and industry factors. I would say the blame should fall squarely on no one.

We have very little data on real-life interactions of medicines and must therefore go with automated warnings on GP’s desktops and criteria such as Beers. CHOICE suggests pharmacists need to get more involved – particularly as allied health acquire more prescribing rights.

The practical experience of anyone that’s spent more than a few days in any public hospital says that until patients are given better information and control over what medication they are on, why and where they get it from, we will continue to be in the same situation.

The Choice article does offer some great tips (primarily for clinicians), however, that we should apply in the meantime.

Want to Reform Healthcare? Start with the Workplaces

According to the World Health Organization, the U.S. spends by far the most per capita on health care but by most measures ranks not even in the top 30 countries in terms of health-care outcomes. If we want to improve Americans’ health and reduce our health-care expenditures, we need to understand why. There are many causes, of course, but I’m convinced one of the most important — and most overlooked — is our work culture. Working in America is literally hazardous to your health.

Read the rest of this interesting opinion piece by Jeffrey Pfeffer of BNET.