Bodies and buildings nyu itp 2 25 2013

BODIES &�BUILDINGS NYU ITP LECTURE COURSE SPRING 2013

CLASS 3: FEBRUARY 25, 2013

JEN VAN DER MEER @JENVANDERMEER WWW.JENVANDERMEER.COM

BODIES IN THE NEWS

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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.”

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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.

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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.

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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

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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.

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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.

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TRUE COST OF HEALTH �& END OF LIFE CARE

BODIES & BUILDINGS

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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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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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THE COST OF HEALTH CARE

BODIES & BUILDINGS

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BITTER PILL

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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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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.


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.


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.


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


END OF LIFE CARE

BODIES & BUILDINGS

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COST OF END OF LIFE CARE


STATE OF CARE


DAYS IN HOSPITAL


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.


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


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


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.


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.

ASSIGNMENT: MARCH 4

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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.


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.


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


Bodies and buildings nyu itp 2 25 2013

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