Tuesday, August 30, 2011

Book Reviews: "Over-Diagnosed" and "Worried Sick"

These two books -- one recently published, the other dating back to 2008 -- raise profound questions about current medical practices, and conclude that the healthcare system is often causing far more harm than good. Most people in the healthcare industry are unlikely to agree with these authors—otherwise these books wouldn't have had to be written—but both are authored by highly-respected doctors with deep experience, and they resonate strongly with me.

In Over-Diagnosed: Making People Sick in the Pursuit of Health (2011), Dr. Gilbert Welch, and co-authors Dr. Lisa Schwartz and Dr. Steven Woloshin, write that “[they] believe overdiagnosis is the biggest problem posed by modern medicine.” Overdiagnosis is defined as “when individuals are diagnosed with conditions that will never cause symptoms or death.” Which means that “there’s nothing to be fixed—[the patient] will neither develop symptoms nor die from his condition—so treatment is unneeded. An overdiagnosed patient can only be harmed.”

The authors point out that the medical community has been constantly moving the goalposts, changing the threshold at which a person is labeled as having some medical condition, such that ever more people are diagnosed. For example, a person was once said to have diabetes when his fasting blood sugar level was 140. When the threshold was changed to 126 an additional 14% of the population was defined as having diabetes. Similar changes in thresholds have led to a 35% increase in hypertension, a 86% in hyperlipidemia (high cholesterol), and a 85% increase in osteoporosis in women.

The consequences are enormous, write the authors: "[Overdiagnosis] has led millions of people to become patients unnecessarily, to be made anxious about their health, to be treated needlessly, and to bear the inconvenience and financial burdens associated with overdiagnosis. It has added staggering costs to our already overburdened healthcare system." The authors also note enormous obstacles to fixing the problem: financial gains from all the unneeded treatments; blind faith amongst doctors in existing practices; a legal environment that punishes under-treatment but not over-treatment; and popular media that promotes the types of practices that the book decries.

In Worried Sick: A Prescription for Health in an Overtreated America (2008), Dr. Nortin Hadler writes that “we are at grave risk of what I call 'Type II Medical Malpractice'—doctors doing the unnecessary, albeit very well (as opposed to Type I Medical Malpractice, which is doctors doing the necessary unacceptably poorly.)”

Hadler argues that we must change our social perceptions of what it means to be well, that we should not medicalize every deviation from some imagined state of perfect health. “To be well is not to be free of symptoms—of morbidity—continuously or for long periods of time," he writes. "It is abnormal to escape heartburn and heartache, backache and headache, sad days and days when we’re aware of our bowels...we are challenged to cope with these predicaments of life and of living.”

Hadler labels himself a "revolutionary," and uses strong language to denounce many widely accepted medical practices as a “vast marketplace for unnecessary and unproven remedies” and what he terms “disease mongering.” Not only do doctors treat us unnecessarily and inappropriately, they make it more difficult for us to be well. “To be well is to be able to cope with morbid episodes. And coping may not be easy. It can be thwarted by the intensity of the morbidity, or by complicating and confounding factors,” continues Hadler. Standard medical advice, which makes you worry that you are sick, being one of the major confounding factors.

Both books urge that there should be much less “medicalization” of the normal ups and downs of health, and that more efforts be focused on helping people cope, without drama. In Over-Diagnosed, Welch concludes: “[H]ealth-promotion efforts need to be judged using a broader set of parameters than is traditionally used for medical care. My coauthors and I would rank highest those health-promotion efforts that lead people to feel more resilient, either physically or emotionally. By resilient I mean feeling strong, able to participate in and enjoy the life you lead—and capable of meeting and dealing with adversity when it comes.”

Both of these books resonated strongly with me. The more I have looked into the science behind today's healthcare practices, the more I have learned how weak the foundation is. Skilled doctors are certainly in a far better position than the average lay person to deal with medical emergencies. But, for day-to-day health we would be much better off discarding simplistic health rules, and instead empowering and enabling people to lead themselves, to "cope" as Dr Hadler puts it, or to be "resilient" as Dr Welch says.

Monday, August 29, 2011

The Rise of Participatory Health-Care

If you don't know the Pew Internet & American Life Project already, you should definitely sign up for their reports; the organization studies the social impact of the internet - all the ways we use the web, mobile, games, and more and how it affects us. Susannah Fox is the associate director, digital strategy, at the Project and her reports always make for interesting reading.

Earlier this month Susannah published a new report that says that much like the music industry was transformed by people sharing songs with one another (what's called "peer-to-peer"), healthcare can go in the same direction if it allows people - consumers, patients, and caregivers - to share what they know. She cites "our ancient instinct to seek and share advice about our health" coupled with another powerful force: "our newfound ability to [seek and share] at internet speed and internet scale."

Those of us creating tools for self-care have known this for quite a while, but it's exciting to see the movement picking up steam at last. Susannah explains the new landscape of what she calls "peer-to-peer healthcare" in this report - it's good reading! (You can see a slideshow of Susannah's presentation here.)

Do you connect online or on your phone or tablet with others about your health? What do you talk about? Do you offer advice and guidance as well as receive it?

Image: Words people in a survey used to describe their smartphone, courtesy of Pew Internet & American Life Project

Friday, August 26, 2011

How Healthy is Your County?

There's a lot you can do to take of yourself - eat right, exercise regularly, stick to your prescribed medication regimen. But where you live has a big impact on your health, too. The Robert Wood Johnson Foundation, along with the University of Wisconsin Population Health Institute, knows this fact well. That's why they've collaborated on a project called County Health Rankings, which crunches a wide variety of statistics about health behavior, education, jobs, health-care quality, and the environment in every county in the U.S. to come up with a report for each state. It's only when community leaders can see what's going well where they live - and what isn't - that they can begin to improve the health of their citizens, says the Foundation.

Click on your state on this map, then choose your county, to find out how you're community is doing and how it compares to the rest of the country. You can also see how other communities are tackling their challenges to improve the health of their citizens.

Image: http://www.onlineatlas.us/map/united-states-map.gif

Thursday, August 25, 2011

Rajiv Mehta, creator of Tonic, in today's New York Times

If you caught the article, "A Dashboard for Your Body," in the August 4 edition of the New York Times, you saw writer Farhad Majoo's profile of five mobile health apps that track a variety of health-related metrics, including calorie burn, weight, body fat, body temperature, blood pressure, and more.

Rajiv Mehta, creator of the Tonic Self-Care App, wrote in response to the NYT article, noting that many of the tools profiled in the piece focused on long-term tracking of health, while millions of Americans -- especially those with chronic diseases like diabetes, high cholesterol, and arthritis -- also need help tracking day-to-day health, symptoms, and staying on top of tasks like adhering to a medication regimen. See below for Raj's letter to the paper, and tell us what you think!

Wednesday, August 24, 2011

Why I Love My Tonic App: Steven Dean

"I still use Tonic every day. My nutritional supplement regimen changes all the time and I love that I can use it to easily set up and modify any new regimen. I have a Saturday and Sunday regimen that's different from weekday regimen. I could put all these reminders in my calendar but I don't want them there. I want the simple reminder that pops up and alerts me on my phone daily. It's the simplest trigger I've seen to remind me to do something." -- Steven Dean, New York, NY

Monday, August 22, 2011

Video: How to Get Started with Tonic

Not sure how to use the Tonic Self-Care App? Want to get a better idea of all the things it can do to make it easier to stay healthy, feel better, or improve the health of someone you love? Watch this short "Getting Started" video to find how easy Tonic is to use, and all it can do.

Tuesday, August 16, 2011

The Rise in Consumer Health Mobile Apps

What new health technologies are consumers using, and how do they help? Rajiv Mehta, co-creator of the Tonic Self-Care App, covered this topic at a recent panel discussion on mobile health technologies held in Silicon Valley, in California.

"Self-quantifiers are at the forefront of managing their health, by taking advantage of the latest technologies," said Rajiv. Self-quantifiers, such as those that participate in the Quantified Self, keep track of various aspects of themselves and their lives, with the expectation that they will learn something, and often experiment with small changes in their lifestyle, diet, medications, and more to see if they can improve their health. Some focus on specific issues such as pain and sleep, while others are more concerned about more general conditions such as alertness and mood.

Rajiv went on to give an overview of the thousands of mobile tools available today, each generally focused on some specific issue. There are devices for tracking physical activity such as Philips DirectLife, FitBit, BodyMedia, and Basis; for tracking sleep such as Zeo and WakeMate; as well as improved devices for common measurements such as weight and blood pressure from Withings. And tracking apps like LoseIt! for weight and diet, RunKeeper for exercise, Foursquare for location, Equanimity for meditation, GlucoseBuddy for glucose and insulin, and I'm Expecting for pregnancy.

Health is something we deal with every day, and though it is commonplace, it is incredibly, and increasingly, complex, stressed Rajiv. "The fact is that many people have much more than just a single specific health issue to deal with," he said, noting that Tonic addresses this need for simplifying the complex, adding that there's a need for both tools like Tonic, that provide the foundation for day-to-day self-care, and for rich, focused tools like those above that are used as needed for specific problems.

You can watch the full video here;, Rajiv's talk begins at 42:20.

Or you can view the slides from the presentation here:

Friday, August 12, 2011

Tonic Gets a Shout Out in Shape Magazine

We're excited to share some news: The Tonic Self-Care app was just covered in the August issue of Shape magazine, one of the country's biggest fitness magazines! The brief write-up (look for it on page 90) gives the magazine's readers (women interested in fitness, health, and nutrition) a quick overview of what the app can do. What do you use Tonic for?

Wednesday, August 3, 2011

Tonic v1.2.1 Released — Usability Improvements

Tonic v1.2.1 is now available on the App Store, a free upgrade for all current users.

This update features several usability improvements suggested by user feedback:

* Streamlined creation of unscheduled events — capture your moods, symptoms, etc. even more quickly

* Journal entry enhancements — to let you express your thoughts more freely, and to write as much as you want
- Journal text now scrolls
- Carriage Return now allowed in journal text
- Commas in journal text are included when exporting data

* Visual indicator to make more obvious that there are options for Daily & Weekly schedules — because some people didn't realize that they could choose every 2nd day, or just weekdays, or every 4th weekend, or ...

* History of entries for a particular tonic can now be deleted in one step — to make it easy to wipe the slate clean