REMEMBERING Enabling Experimentation Rajiv Mehta QS Show & Tell #18, San Francisco, 23 Mar 2011 email@example.comHi, 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 Easier to do experiment ... easier to analyze 2One of the key lessons from QS speakers who have had success in their own experiments is to keep thingssimple ... 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 tolearn something from the results.
What if “simple” not a choice? 6a 9a noon 3p 6p 9p midnight MEDICATIONS Morning supplements (6) Albuterol (nebulizer) Hypertonic saline (nebulizer) Pulmozyme (nebulizer) Tobi antibiotic (nebulizer) Pancreatic enzymes Advair Noon supplements (4) Evening supplements (4) Bedtime supplements (4) Caloric shake THERAPIES Vest Acapella BIOMETRICS Weight Medications: ~13 OBSERVATIONS Sleep Mood Coughing episode OTHER Other items: ~7 Clean / Sterilize nebulizers Times/day: ~18 3But, “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, keepingtrack 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 theresults through the noise.
TONIC Self Care Assistant Remember and keep track of everything in your health regimen 4Iʼve 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 healthpractices, and so make it easier for them to learn about themselves.Iʼm going to share with you some stories from beta users.
Steven Medications: 4 Other items: 1 Long-time self quantiﬁer Times/day: ~4 Regimen •PAGG fat-loss regimen (The 4-Hour Body) Wants to Learn •Does it work? 5The 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 wouldseem 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 theregimen was working.Once he started using Tonic, thereʼs been no forgetting.So, even for him, remembering is non-trivial.
Sara Medications: ~6 Other items: ~3 Parkinson’s Disease Times/day: ~8 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? 6Sara has a more complex situation, with Parkinsonʼs Disease.Sheʼs about 40, an accomplished engineer, running a successful engineering consulting ﬁrm, and alsostudying 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 sheʼsnoticed 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 learnabout her health.Sheʼs started thinking about what kinds of self-experimentation might be possible, in particular how she canmeasure some of the things she cares about.
Julie Medications: ~13 Other items: ~6 Cystic Fibrosis Times/day: ~20 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? 7Julie 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 otheritems 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 andaerosolized 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 thehouse with her.Her expectation was that Tonic would be most useful for helping her recall whether she had done something ornot.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 thequestion “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 ofa 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
Andreas Medications: ~12 Other items: ~7 Child w/ Cystic Fibrosis Times/day: ~12 Caregivers: 5 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 8Finally, Andreas is a father, caring for a child with Cystic Fibrosis.Hes 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, theres the additional challenge of 5 regular caregivers: thetwo parents, a physical therapist who visits weekly, and two adults at the childs school. Thats not counting doctors andsuch 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.Theres a plan, and it gets done through the routine.Hes tried many organizational tools, but found that they caused more hassle rather than make life easier.So, he was very skeptical about Tonic.Now, hes very excited.His personality hasnt changed.For example, he doesnt use Tonic for the whole regimen, but just those aspects that thes most interested in at themoment.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 howthey were related to diet.But, recently hes more concerned about getting better at some home-therapy treatments and their impacts on lungfunction. 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 wonderswhether just this engagement will make a difference in the childʼs sense of well-being.
Importance of enabling experimentation Do (experiment) Design Learn (hypothesis) (analysis) Tonic: www.tonicselfcare.com Rajiv Mehta: firstname.lastname@example.org 9In 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. Afterall ...- 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.