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free-ranging conversation with thomas goetz, author of the decision tree

April 5, 2010

in free-ranging conversations (interviews with wellness innovators)

thomas goetz is the author of an outstanding book about participatory medicine, the decision tree: taking control of your health in the new era of personalized medicine. he’s also the executive editor of wired magazine, a blogger on huffington post and his own blog, the decision tree, a former reporter for the wall street journal, and a contributor to the new york times.

i asked thomas to be a part of this conversation series after reading the decision tree, which the former commissioner of the fda, dr. david kessler, proclaims “a game-changer, a brilliant synthesis of science, public health, and practical advice that puts each of us at the center of our own healthcare revolution.”

thomas and i happened to speak the day after the health care reform bill was passed.

fm: i want to start by asking about your reaction to the bill being passed.

tg: having coverage is essential to health care change. there’s a whole other segment left on the table—comparative effectiveness, pay for performance, using the information we have to advance treatment and empower patients. a lot of that was left out, but there’s still a lot that individuals and the medical community can do now.

fm: and that’s truly what your book is about. can you sum up the decision tree in a few sentences for those unfamiliar with it?

tg: there’s no lack of information, but we have few ways to delve into and use it. the decision tree approach is about finding ways to use information in a way that makes sense to us.

fm: how does a decision tree respond to this?

tg: there’s a disconnect between our rational and emotional self that’s especially fraught when it comes to our health care. and yet it’s important with health that we make smart decisions and can use skills that we don’t use much. we need to help people understand quantitative information, for example. and personalize information, letting an individual input a few particular points from their medical history into a tool that guides them and refines the information they receive as they provide more information.

feedback loops help us assess and fine-tune our progress. with sites like patientslikeme, you can compare your feedback loop to others. you gain support, knowledge, motivation. it’s reassuring and comforting—the emotional side—that we’re not alone.

what’s a new ideal is creating more simple tools with much less friction. they’re less difficult to use and data’s collected automatically.  that’s really where the change is. for example, the ipad’s loaded with apps that make it easier to collect data. that means the individual can focus more on the behavior. i think that’s what’s hopeful. you can engage a larger group, not just those who are prone to tracking information. if all the numbers are automatically there, more people will do it because it’s easier to do.

[note: nike+ and the fitbit are two additional examples.]

fm: what’s interesting about sites like patientslikeme and what you’re really driving at in the book is how much we need to understand, share, and use our own data. yet many people consider their health private. and there’s certainly a strict line around employee privacy.

tg: some of us have a great incentive to share. we want to reap the benefits of sharing. we used to think it [poor health] was a stigma. that’s changing now, as we share and use our information to yield greater insights that benefit us. data now has a “currency,” a value, that will reduce the stigma. there’s also a generational tide against privacy about this data. it’s the same as with online dating. online dating is the norm now. it’s seen as a more efficient way to find a match. there’s an efficiency— a value—in joining these sites that won’t be seen soon as stigmatizing.

employers can set up programs to help employees measure their progress and share data. they need to be individualized tools that are highly motivational. and in terms of privacy, they need to be extremely explicit about what happens with the information.

fm: you talk a little about disease management in your book. i’ve certainly seen the stigma of disease in the way individuals consider disease management programs, and even in employers’ reluctance to promote them.

tg: there is something about a health crisis as a spur to action. the open question is how do we engage people, not scare them.

there are two approaches to health: a pathological approach or a maintaining health approach. for example, physicians get upset when patients are not in compliance—a chronic problem. “how can we get patients involved if they won’t comply?” but some of it is in the terminology: you comply. there’s no emotional, tangible side—where’s my invested side?

if you can start giving people a sense that they’re contributors and partners to their own health, they have control. it’s a change from obeying instructions to engaging in their own health.

fm: sometimes i think there’s a disconnect between what employers are doing and what they could be doing to engage employees and their families.

tg: i am not a wellness program expert, but i’d think it can seem paternalistic from an employee’s point of view, and that’s antithetical to engagement. companies may have programs pointed more toward things that are important for the company. they need to be cognizant about how much ownership they give the individual and make everything an employee-facing tool.

fm: patient engagement is a big goal of health 2.0. shouldn’t companies be playing a bigger role and not be miffed, as one recent survey found?

tg: there’s a moment right now that something new is happening. companies should be aware of and excited about it, and it may improve their effectiveness.  every HR will have to decide when they’re ready to make the jump, but companies should stay engaged with this.

it’s similar to doctors and electronic medical records (EMR). EMRs promised so much, or overpromised, and initially delivered so little. many docs wrote them off and missed their opportunity to realize the upside. we’re converging on a similar moment with employers and wellness efforts and the health tools for them to offer.

i hope that we aggregate these new technologies and offer reassurance to people so they don’t give up on their health.

you can follow thomas on twitter. if you have a question you’d like to ask him, please leave it in the comments.

read more free-ranging conversations with health innovators.

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