REMEMBERINGEnabling Experimentation

Rajiv MehtaQS Show & Tell #18, San Francisco, 23 Mar 2011rajivzume@gmail.com

Hi, Iʼm Rajiv Mehta.My efforts are focused on helping people take care of their own health, their self-care efforts.Iʼve spent a lot of time studying the situation of people with chronic diseases.Self-tracking has the potential to be very useful for such people.But, it turns out that the difficulty of remembering is a major barrier to good experimentation.

Advice: Keep it Simple!Impact of coffee consumption ... on productive work time

Impact of butter ... on math solution time

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Easier to do experiment ... easier to analyze

One of the key lessons from QS speakers who have had success in their own experiments is to keep things simple ... as in Robin Barooahʼs coffee experiment, or Seth Robertsʼ buttermind experiment.Having just one variable and one observation makes it easier to carry-out the experiment as planned, and to learn something from the results.

6a 9a noon 3p 6p 9p midnightMEDICATIONS

Morning supplements (6)Albuterol (nebulizer)

Hypertonic saline (nebulizer)Pulmozyme (nebulizer)

Tobi antibiotic (nebulizer)Pancreatic enzymes

AdvairNoon supplements (4)

Evening supplements (4)Bedtime supplements (4)

Caloric shakeTHERAPIES

VestAcapella

BIOMETRICSWeight

OBSERVATIONSSleepMood

Coughing episodeOTHER

Clean / Sterilize nebulizers

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What if “simple” not a choice?

Medications: ~13Other items: ~7Times/day: ~18

But, “simple” isnʼt a choice for some people.This is a day-in-the-life of someone I know with Cystic Fibrosis.Sheʼs in her early 30s, married, has a son.Her illness has made it difficult to hold onto a job, but sheʼs active in social causes.

<> The green dots are moments when she has to do something.The blue marks are activities that require full attention for a certain amount of time.The yellow bars represent things that happen when they happen.

<> There are 13 medications, including pills, a drink, an inhaler, and several taken via nebulizers.There are 7 other critical items in her daily health regimen, including therapies, watching her weight, keeping track of some symptoms, and a critical chore.And, these things happen at 18 different times spread across the day.

Itʼs really hard to remember and do all these things consistently.You can easily forget to do something, or not remember whether or not you had done something.Which makes it difficult to be consistent.Which makes experimentation difficult — both remembering to carry out the experiment, and interpreting the results through the noise.

TONIC Self Care Assistant

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Remember and keep track of everything in your health regimen

Iʼve been working on an app to help with this.Tonic basically helps the person remember and keep track of anything in their health regimen.It supports an individualʼs personal health practice, whatever it is.Tonic is designed in a way that allows the user to customize it to their health activities.

One of the hopes for Tonic is that it will make it easier for people to have success carrying out their health practices, and so make it easier for them to learn about themselves.Iʼm going to share with you some stories from beta users.

StevenLong-time self quantifier

Regimen

•PAGG fat-loss regimen (The 4-Hour Body)

Wants to Learn

•Does it work?

5

Medications: 4Other items: 1Times/day: ~4

The first story is of Steven, who is deeply involved in QS, and has been doing self-tracking for a long time.Iʼd only reached out to him for feedback on the apps overall design & usability.He does not have a complex situation, so not exactly our target user.Also, heʼs one of the most disciplined people I know, with well-structured days, and so not someone who would seem to need a tool like Tonic.

But, heʼs been trying to follow one of the regimens from Tim Ferrissʼs book “The 4-Hour Body”.Itʼs pretty simple: 4 different nutritional supplements taken before breakfast, lunch, dinner, and bed.And yet he had found that heʼd been forgetting about 20% of the time, making it difficult to judge how well the regimen was working.Once he started using Tonic, thereʼs been no forgetting.So, even for him, remembering is non-trivial.

SaraParkinson’s Disease

Regimen

•6 meds; different combinations; 6 times a day

•physical therapist; gym; stretching program

•weight

Wants to learn

•Balance: What impacts it? How to measure?

•Cognition: Impact of medication, sleep & mood? How to measure?

6

Medications: ~6Other items: ~3Times/day: ~8

Sara has a more complex situation, with Parkinsonʼs Disease.Sheʼs about 40, an accomplished engineer, running a successful engineering consulting firm, and also studying health at a major health institution.Daily she has to take 6 different meds, in different combinations, at 6 different times.There are also various physical exercises she does throughout the week.She cannot afford to screw things up — making a mistake leads to immediate consequences.So she lives a very disciplined, regimented life.

Only after she started using Tonic did she realize how much mental effort all that discipline was costing her. She was shocked to find how quickly she relied on Tonicʼs reminders. She commented to me that sheʼs noticed how she no longer checks her watch all the time.

This discovery, this freedom, has now led her to start thinking more deeply about what she would like to learn about her health.Sheʼs started thinking about what kinds of self-experimentation might be possible, in particular how she can measure some of the things she cares about.

JulieCystic Fibrosis

Regimen

•8 Rx (pills, inhaler, aerosolized) & 5 OTC meds

•Eat every 2-3 hours

•Vest, exercise, meditation; weight; med/device prep

•Recent past: in-home IV treatment — more complexity

Wants to learn

•Impact of “caveman diet” on how I feel, on energy level

•Why am I not sleeping? ... coffee? TV news?

7

Medications: ~13Other items: ~6Times/day: ~20

Julie has Cystic Fibrosis, like the diagram I showed you earlier.Sheʼs about 50. Sheʼs a retired doctor, but runs a personal wellbeing consulting business.Her daily regimen is just as complicated as that earlier diagram, some times more complicated.

She has tried all sorts of ways to be organized and to remember everything in her regimen.What sheʼs been finding most useful at the moment is a daily morning ritual of arranging her meds and other items for the day ahead.She also has a couple of important visual cues.The traditional plastic pill box is too small for needs — also inadequate as her meds include inhalers and aerosolized meds — so she has a tackle box (like a fisherman).Another visual cue is a large, 3-shelf cart, on rollers, with a lot of her equipment, that she moves around the house with her.

Her expectation was that Tonic would be most useful for helping her recall whether she had done something or not.I call this short-term tracking — answering the question “Oh, did I remember to ...”Thatʼs different than the long-term tracking we usually focus on in Quantified Self discussions — answering the question “What can I learn from ...”

In fact, like Sara, Julie was also surprised at how she quickly she became reliant on Tonicʼs reminders.This really hit home when she had to live without her iPad for a few days, and only then realized how much of a mental burden all that remembering is.

She has also now started thinking more deeply about what she might be able to learn about her health

AndreasChild w/ Cystic Fibrosis

Regimen

•8-10 Rx; enzyme supplements; sunflower oil

•Diet journal; pain journal

•Therapy exercises; spirometry; weight; med/device prep

Wants to learn

•Impact of therapy/exercises on lung function

•Impact of diet on stomach pains

•Impact of using Tonic on child’s sense of well-being

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Medications: ~12Other items: ~7Times/day: ~12Caregivers: 5

Finally, Andreas is a father, caring for a child with Cystic Fibrosis.He's a lawyer, and also deeply involved in patient participation at a major health institution.He estimates he has spent 4,500 hours in caring for his childʼs health so far.

In addition to the normal complexity of Cystic Fibrosis care, there's the additional challenge of 5 regular caregivers: the two parents, a physical therapist who visits weekly, and two adults at the child's school. That's not counting doctors and such who are involved much less frequently.

Both by personality, and by the nature of the situation, Andreas is not as regimented as the other three examples.There's a plan, and it gets done through the routine.He's tried many organizational tools, but found that they caused more hassle rather than make life easier. So, he was very skeptical about Tonic.Now, he's very excited.

His personality hasn't changed.For example, he doesn't use Tonic for the whole regimen, but just those aspects that the's most interested in at the moment.Tonicʼs flexibility — that he can focus on remembering and tracking these things this week, and those things next week — is key to his enthusiasm.He does not want to be a slave to a tool; he wants the tool to work for him.

For example, he had been most concerned about stomach pains his child was complaining about, and interested in how they were related to diet.But, recently he's more concerned about getting better at some home-therapy treatments and their impacts on lung function. The challenge is figuring out what might be a good, but easy-to-do, measure of lung function.

Also, heʼs thinking of getting an iPod touch for his child, so she can use Tonic to note stomach pain events. He wonders whether just this engagement will make a difference in the childʼs sense of well-being.

Importance of enabling experimentation

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Design(hypothesis)

Do(experiment)

Learn(analysis)

Tonic: www.tonicselfcare.com

Rajiv Mehta: rajivzume@gmail.com

In our discussions at the Quantified Self, we seem to focus most on:- What self-experimentation we should do? On the design of experiments.and on:- What have we learned? How do we analyze the data?

Iʼd suggest that it would be worthwhile to focus some effort on making it easier to DO the experiments. After all ...- What good is a great experimental design if people canʼt carry it out?- What good is analyzing data from a poorly conducted experiment?

We need to keep in mind that Doing the Doing is harder than it looks.