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Bodies and buildings nyu itp 2 25 2013

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Bodies and buildings nyu itp 2 25 2013

  1. 1. BODIES &BUILDINGSNYU ITP LECTURE COURSE SPRING 2013CLASS 3: FEBRUARY 25, 2013JEN VAN DER MEER @JENVANDERMEER WWW.JENVANDERMEER.COM
  2. 2. BODIES IN THE NEWSFebruary 25, 2013 2  
  3. 3. February 25, 2013 3  
  4. 4. 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, werefinancially backed by Philip Morris when they were created andmarketed to harried moms in the 1980s. Though they’ve been criticizedfor being unhealthy to children,“Well, that’s what the consumer wants, and we’re not putting a gun totheir head to eat it,” admits Geoffrey Bible, former CEO of PhilipMorris. “That’s what they want. If we give them less, they’ll buy less, andthe competitor will get our market. So you’re sort of trapped.” February 25, 2013 4  
  5. 5. SENSORY-SPECIFIC SATIETYThe 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.February 25, 2013 5  
  6. 6. 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 moralcreature. As a researcher, I was ahead of my time.” - Howard Moskowitz- studied mathematics and holds a Ph.D. inexperimental psychology from Harvard, runs a consulting firm in WhitePlains, where for more than three decades he has “optimized” a varietyof products for Campbell Soup, General Foods, Kraft and PepsiCo. February 25, 2013 6  
  7. 7. READING/VIEWING Read: The quantified self, Counting every moment. TheEconomist, March 3, 2012. Additional videos from Todd ParkTodd Park: Opening Data for Social Change Optional: Social fMRI: Investigating and shaping social mechanisms in thereal world. Nadav Aharonya, Wei Pana, Cory Ipa, InasKhayala,b, Alex Pentlanda. Persuasive and Mobile Computing.Vol 7, 2011, 643-659. Hacking Healthcare Chapter 6: Patient Facing SoftwareFebruary 25, 2013 7  
  8. 8. ASSIGNMENT Write a one page essay to be presented in class. Do you findthe quantified self movement appealing? Give examples ofhow you would imagine using data to monitor your ownhealth, or the health of someone you care for. February 25, 2013 8  
  9. 9. 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 believe3.  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. February 25, 2013 9  
  10. 10. TRUE COST OFHEALTH& END OF LIFE CAREBODIES & BUILDINGS 10  
  11. 11. 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 flows10. The structure of material stocks and flows (transport networks, population age structures)9. Length of delays, relative to the rate of system change8. The strength of negative feedback loops, relative to the impacts they are trying to correct against7. The gain around driving positive feedback loops6. 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 structure3. The goals of the system2. The mindset or paradigm out of which the system – its goals, power structure, rules, its culture-arises1. The power to transcend paradigms 11  February 25, 2013
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  13. 13. 5 THE RULES OF THE SYSTEM The rules of the system define its scope, itsboundaries, its degrees of freedom. Power over the rules is real power. They are high leverage points. If you want to understand the deepesmalfunctions of systems, pay attention to therules, and to who has power over them. 13  February 25, 2013
  14. 14. THE COST OFHEALTH CAREBODIES & BUILDINGS 14  
  15. 15. BITTER PILL 15  February 25, 2013
  16. 16. THE CHARGEMASTEREvery hospital’s internal price list. Decades ago it was adocument the size of a phone book; now it’s a massivecomputer file, thousands of items long, maintained by everyhospital. 16  February 25, 2013
  17. 17. THE COST CONUNDRUMAmericans like to believe that, with mostthings, more is better. But researchsuggests that where medicine isconcerned it may actually be worse.For example, Rochester, Minnesota, wherethe Mayo Clinic dominates the scene, hasfantastically high levels of technologicalcapability and quality, but its Medicarespending is in the lowest fifteen per cent ofthe country—$6,688 per enrollee in 2006,which is eight thousand dollars less than thefigure for McAllen.-Atul Gawande.The Cost Conundrum. What a Texas towncan teach us about health care. The NewYorker. June 1, 2009. 17  February 25, 2013
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  19. 19. MORE IS WORSE In a 2003 study, another Dartmouth team, led by the internist ElliottFisher, examined the treatment received by a million elderly Americansdiagnosed with colon or rectal cancer, a hip fracture, or a heart attack.They found that patients in higher-spending regions receivedsixty per cent more care than elsewhere. They got more frequenttests and procedures, more visits with specialists, and more frequentadmission 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 todo worse.That’s because nothing in medicine is without risks. Complications canarise from hospital stays, medications, procedures, and tests, and whenthese things are of marginal value the harm can be greater than thebenefits. 19  February 25, 2013
  20. 20. COST VS. PREVENTION To make matters worse, Fisher found that patients in high-cost areaswere actually less likely to receive low-cost preventive services, such as fluand pneumonia vaccines, faced longer waits at doctor and emergency-room visits, and were less likely to have a primary-care physician. Theygot more of the stuff that cost more, but not more of what they needed. 20  February 25, 2013
  21. 21. WHO MAKES THERULES?“Health-care costs ultimately arise from the accumulation of individualdecisions doctors make about which services and treatments to write anorder for. The most expensive piece of medical equipment, as the sayinggoes, is a doctor’s pen. And, as a rule, hospital executives don’t own thepen caps. Doctors do.” -Atul Gawande 21  February 25, 2013
  22. 22. END OF LIFE CAREBODIES & BUILDINGS 22  
  23. 23. COST OF END OF LIFE CARE 23  February 25, 2013
  24. 24. COST OF END OF LIFE CARE 24  February 25, 2013
  25. 25. STATE OF CARE 25  February 25, 2013
  26. 26. DAYS IN HOSPITAL 26  February 25, 2013
  27. 27. QUALITY OF DEATH“Death, although inevitable, is distressing to contemplate and in manycultures is taboo. Even where the issue can be openly discussed, theobligations implied by the Hippocratic oath – rightly the starting pointfor 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 thetask falls to the physician (or more often, the caregiver) to minimizesuffering as death approaches.”_Quality of Death. Economist Intelligence Unit. 2010. 27  February 25, 2013
  28. 28. PALLIATIVE CAREPalliative care is care given to improve the quality of life of patients whohave a serious or life-threatening disease, such as cancer. The goal ofpalliative care is to prevent or treat, as early as possible, the symptomsand side effects of the disease and its treatment, in addition to the relatedpsychological, social, and spiritual problems. The goal is not to cure.Palliative care is also called comfort care, supportive care, and symptommanagement.-National Cancer Institute 28  February 25, 2013
  29. 29. HOSPICE Hospice is a special type of care in which medical, psychological, andspiritual support are provided to patients and their loved ones whencancer therapies are no longer controlling the disease. Hospice carefocuses on controlling pain and other symptoms of illness so patients canremain as comfortable as possible near the end of life. Hospice focuseson 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 thegoal of treatment has changed. -National Cancer Institute 29  February 25, 2013
  30. 30. THE HOSPICE MOVEMENT he UK, for example, is well ahead, having led the world in establishing adedicated hospice movement, spearheaded by Dame Cicely Saunders, whofounded St Christopher’s Hospice in 1967. The US followed suit in the 1970s. In 1988, palliative care was enshrined in the Australian healthcareagreements, through which the federal government funds expenditures bythe country’s states and territories. In 2006, according to a study by the International Observatory on End ofLife Care (IOELC, a research body at the UK’s Lancaster University), morethan 150 countries were actively engaged in delivering hospice and palliativecare services. Yet the IOELC also found many instances where services were localised andinaccessible to much of the population. And of the 234 countries it reviewed, only 35 had achieved any notable levelof integration with mainstream healthcare providers. 30  February 25, 2013
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  33. 33. CULTURAL TABOOS I have been asked "How are you feeling today?" while I wasthrowing up into a plastic washbasin. I have been asked as Iwas emerging from a four-hour operation with a tube in everyorifice, "How are you feeling today?"I am waiting for the moment when someone asks me thisquestion and I am dead. Im a little sorry Ill miss that. - Vivian in Wit. A Play by Margaret Edson. 33  February 25, 2013
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  35. 35. ASSIGNMENT:MARCH 4 35  February 25, 2013
  36. 36. READINGTo prepare for next week’s assignment, read: Protecting Patient Privacy: Strategies For RegulatingElectronic Health Records Exchange NYCLU Part 2 and Conclusion http://www.nyclu.org/files/publications/nyclu_PatientPrivacy.pdfOptional: Rekindling the Patient Privacy Debate. When Patients Tell Their Stories, Their Health May Improve. Wit. By Margaret Edson. Dramatists Play Service, Inc., Mar1, 1999. 36  February 25, 2013
  37. 37. ASSIGNMENT: Prepare a written and spoken argument (2 pages, 5 minutes) clearlyoutlining your position on the topic of open data and patientempowerment. Do you feel that patients should own their own data? Doyou feel that people should be uniquely identified in an electronic healthsystem? 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 believe3.  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. 37  February 25, 2013
  38. 38. 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 atAnnotary. https://annotary.com/collections/10009/bodies-and-buildings-class-4 38  February 25, 2013

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