Hooked, health markets but the mind is wandering… to pooh and data privacy

Hooked by Nir Eyal

One of the things I learnt many years ago was that there were four fundamental basics to increasing profits in any business. You sell:

  • More Products (or Services)
  • to More People
  • More Often
  • At higher unit profit (which is higher price, lower cost, or both)

and with that, four simple Tableau graphs against a timeline could expose the business fundamentals explaining good growth, or the core reason for declining revenue. It could also expose early warning signs, where a small number of large transactions hid an evolving surprise – like the volume of buying customers trending relentlessly down, while the revenue numbers appeared to be flying okay.

Another dimension is that a Brand equates to trust, and that consistency and predictability of the product or service plays a big part to retain that trust.

Later on,  a more controversial view was that there were two fundamental business models for any business; that of a healer or a dealer. One sells an effective one-shot fix to a customer need, while the other survives by engineering a customers dependency to keep on returning.

With that, I sometimes agonise on what the future of health services delivery is. One the one hand, politicians verbal jousts over funding and trying to punt services over to private enterprise. In several cases to providers of services following the economic rent (dealer) model found in the American market, which, at face value, has a business model needing per capita expense that no sane person would want to replicate compared to the efficiency we have already. On the other hand, a realisation that the market is subject to radical disruption, through a combination of:

  • An ever better informed, educated customer base
  • A realisation that just being overweight is a root cause of many adverse trends
  • Genomics
  • Microbiome Analysis
  • The upcoming ubiquity of sensors that can monitor all our vitals

With that, i’ve started to read “Hooked” by Nir Eyal, which is all about the psychology of engineering habit forming products (and services). The thing in the back of my mind is how to encourage the owner (like me) of a smart watch, fitness device or glucose monitor to fundamentally remove my need to enter my food intake every day – a habit i’ve maintained for 12.5 years so far.

The primary challenge is that, for most people, there is little newsworthy data that comes out of this exercise most of the time. The habit would be difficult to reinforce without useful news or actionable data. Some of the current gadget vendors are trying to encourage use by encouraging steps competition league tables you can have with family and friends (i’ve done this with relatives in West London, Southampton, Tucson Arizona and Melbourne Australia; that challenge finished after a week and has yet to be repeated).

My mind started to wander back to the challenge of disrupting the health market, and how a watch could form a part. Could its sensors measure my fat, protein and carb intake (which is the end result of my food diary data collection, along with weekly weight measures)? Could I build a service that would be a data asset to help disrupt health service delivery? How do I suss Microbiome changes – which normally requires analysis of a stool samples??

With that, I start to think i’m analysing this the wrong way around. I remember an analysis some time back when a researcher assessed the extent drug (mis)use in specific neighbourhoods by monitoring the make-up of chemical flows in networks of sewers. So, rather than put sensors on people’s wrists (and only see a subset of data), is there a place for technology in sewer pipes instead? If Microbiomes and the Genetic makeup of our output survives relatively intact, then sampling at strategic points of the distribution network would give us a pretty good dataset. Not least as DNA sequencing could allow the original owner (source) of output to connect back to any pearls of wisdom that could be analysed or inferred from their contributions, even if the drop-off points happened at home, work or elsewhere.

Hmmm. Water companies and Big Data.

Think i’ll park that and get on with the book.

Grain Brain: modern science kills several fundamental diet myths

Having tracked my own daily food consumption (down to carbs, protein, fat levels, plus nett calories) and weekly weight since June 2002, I probably have an excessive fascination with trying to work out which diets work. All in an effort to spot the root causes of my weight ebbs and flows. I think i’ve sort of worked it out (for me here) and have started making significant progress recently simply by eating much fewer calories than my own Basal Metabolic Rate.

Alongside this has been my curiosity about Microbiomes that outnumber our own cells in our bodies by 10:1, and wondering what damage Antibiotics wreak on them (and their otherwise symbiotic benefits to our own health) – my previous blog post here. I have also been agonising over what my optimum maintenance regime should be when I hit my target weight levels. Above all, thinking a lot about the sort of sensors everyone could employ to improve their own health as mobile based data collection technology radically improves.

I don’t know how I zeroed in on the book “Grain Brain”, but it’s been quite a revelation to me, and largely boots both the claims and motivations of newspapers, the pharmaceutical industry and many vogue diets well into touch. This backed up by voluminous, cited research conducted over the last 30 years.

A full summary would be very too long, didn’t read territory. That said, the main points are:

  1. Little dietary fat and less than 20% of cholesterol consumed makes it into your own storage mechanisms; most cholesterol is manufactured by your liver
  2. There is no scientific basis to support the need for low cholesterol foods; allegations that there is an effect at blocking arteries is over 30 years old and statistically questionable. In fact, brain functions (and defence against Alzheimer’s and other related conditions) directly benefit from high cholesterol and high fat diets.
  3. The chief source of body fat is from consumption of Carbohydrates, not fat at all. So called low fat diets often substitute carbs and sugars, which further exacerbate the very weight problems that consumers try to correct.
  4. Gluten as found in cereals is a poison. Whereas some plants open encourage consumption of seeds by animals to facilitate distribution of their payload, wheat gluten is the other sort of material – designed specifically to discourage consumption. There is material effect on body functions that help distribute nutrition to the brain.
  5. Excessive consumption of carbs, and the resulting effect on weight, is a leading cause of type 2 diabetes. It also has an oxidising effect on cholesterol in the body, reducing it’s ability to carry nutrients to the brain (which is, for what it’s worth, 80% fat).
  6. Ketosis (the body being in a state where it is actively converted stored fats into energy) is a human norm. The human body is designed to be able to manage periods of binge then bust systematically. Hence many religions having occasional fasting regimes carry useful health benefits.
  7. The human genome takes 60-70,000 years to evolve to manage changes in diet, whereas human consumption has had a abrupt charge from heavy fat and protein diets to a diet majoring on cereal and carbs in only the last 10,000 years. Our relatively recent diet changes have put our bodies under siege.

The sum effect is guidance err on the side of much greater fat/protein content, and less carbs in the diet, even if it means avoiding the Cereals Aisle at the supermarket at all costs. And for optimum health, to try to derive energy from a diet that is circa 80% fat and protein, 20% carbs (my own historical norm is 50-55% carbs). Alcohol is generally a no-no, albeit a glass of red wine at night does apparently help.

Note that energy derived from each is different; 1g of protein is typically provides 4 kcals, 1g of fat is 9 kcals, and 1g of carbs is 3.75 kcals. Hence there is some arithmetic involved to calculate the “energy derived” mix from your eating (fortunately, the www.weightlossresources.co.uk web site does this automatically for you, converting your food intake detail into a nice pie chart as you go).

There is a lot more detail in the book relating to how various bodily functions work, and what measures are leading indicators of health or potential issues. That’s useful for my sensor thinking – and to see whether widespread regular collection of data would become a useful source for spotting health issues before they become troublesome.

One striking impression i’m left with is how much diet appears to have a direct effect on our health (or lack thereof), and to wonder aloud if changes to the overall carbs/protein/fat mix we consume would fix many of the problems addressed by the NHS and by Pharmaceutical Industries at source. Type 2 Diabetes and ever more common brain ailments in old age appear to be directly attributable to what we consume down the years, and our resulting weight. Overall, a much bigger subject, and expands into a philosophical discussion of whether financial considerations drive healer (fix the root cause) or dealer (encourage a dependency) behaviours.

For me personally, the only effect is what my diet will look like in 2015 after I get to my target weight and get onto maintenance. Most likely all Bread and Cereals out, Carb/Cake treats heavily restricted, Protein and Fat in.

I think this is a great book. Bon Appetite.

Footnote:  I’m also reminded that the only thing that cured my wifes psoriasis on her hands and feet for a considerable time were some fluids to consume prescribed by a Chinese Herbal doctor, and other material applied to the skin surface. He cited excess heat, need for yin/yan balance and prescribed material to attempt to correct things. Before you go off labelling me as a crackpot, this was the only thing that cured her after years of being prescribed steroid creams by her doctor; a nurse at her then doctors surgery suggested she try going to him under a condition of her anonymity, as she thought she’d lose her job if the doctors knew – but suggested he was able to arrest the condition in many people she knew had tried.

I suspect that the change in diet and/or setting conditions right for symbiotic microbiomes in her skin (or killing off the effect of temporarily parasitic ones) helped. Another collection of theories to add to the mix if technology progresses to monitor key statistics over millions of subjects with different genetic or physiological characteristics. Then we’ll have a better understanding, without relying on unfounded claims of those with vested interests.