Blog Odyssée

Just discovered Julie Winegard… looks like this year, in spite of recent Trumpisms could be pretty poetic after all if they decide to make Hula hoop again.

Larry Husten (@cardiobrief) just commented on a large new systematic review and meta-analysis published in The BMJ. In short, his point is that screen and treat strategies to prevent type 2 diabetes are doomed to failure unless screening is supplemented by broader public health approaches.

In his paper, Larry Husten quotes Victor Montori (@vmontori) who, when asked to comment on the BMJ study, expressed a trully hindsightful opinion:

It is so hard to articulate the issues because there is obvious good in preventing bad things, but let’s give this another go:

• Type 2 diabetes is a bad thing when it reduces the quality of your life, because of its symptoms, complications or the burden of its treatment.
• So preventing diabetes is obviously a good thing.
• The scale of diabetes is huge and the proportion of people who live one step before that diagnosis is very large. (The review shows we will disagree in labeling who exactly is one step closer to the diagnosis depending on what definitions we choose and the ideology behind the definition selection.)
• Individuals who choose to live more actively and eat healthier meals do better and delay diabetes, but they do so by swimming against the current, which explains the very high rates of drop offs and "failures."
• The response should be massive in scale and persistent in time directed at the determinants of the environments, at the environments themselves, and at the lifestyles that emerge as people adapt to those environments. These changes should make healthier lifestyles the easy default —= the direction of the current that drags those who are and are not interested in swimming.
• Screen and treat is a clinical response, individual, one-at-a-time. It seems ideally suited to people who already are chronic patients by virtue of their comorbidities and thus are already in the healthcare system as it requires the resources of the healthcare system for its success. However, any clinical success leaves the determinants of the environments and the environments unchanged, guaranteeing a steady stream of candidates for screen and treat forever. Furthermore, patients with prediabetes who "fail" to improve with lifestyle interventions may be considered candidates for diabetes drugs like metformin – in essence they are preventing the diagnosis of diabetes by ensuring they get treatment for diabetes instead— a lousy proposition.
• Meanwhile people bemoan the low quality of treatment of type 2 diabetes, in part because of lack of time, training, and resources. These are lacks from the same system we are ready to load with people who screen positive for prediabetes. And since the epidemic hits the underserved hardest (suggesting again problems with the contexts in which people try to make a living rather than a massive epidemic of poor judgment among the poor and socioeconomically distressed) and these folks have trouble getting healthcare in the first place, a solution reliant on healthcare access, if effective, would make disparities in the incidence of diabetes worse.
• Thus, we need solutions that don’t leave the conditions that have created the epidemic intact, making the efforts of those set on improving their lifestyle often seem futile in the long run, producing more at-risk people, burdening the sick-care system with healthy people seeking wellness. In all these ways, policies of screen and treat are accidentally (I hope) cruel, particularly toward the sick and the needy, people living "in the shadows of life."
• I wholeheartedly endorse the priority of preventing type 2 diabetes, but effective sustainable solutions are more likely to be found through evidence-informed deliberative democracy (the population version of shared decision making). The work there is to determine the kind of environments we want — for ourselves and our children — and the public health policies that must be implemented to realize them.
• Those who seek a more expedient solution to match the urgency of the problem would do best to start this long-term process as soon as possible rather than waste time, attention, and resources, in palliating the problem one screen-and-treated patient at a time.

Emphasis (bold) is mine.

Two pictures to start this new year well. First, by John Saddington (@8BIT), The Emotional Journey of Creating Anything Great. Actually, it applies to creating anything at all; the greatness is about ending joyfully, but lame (or simply ordinary) creations mostly share the same path. The real message here is "look at what happens the days, months or years after the glorious instant when you decide that Yes You Can"

The second picture, by Niels Pflaeging (@Complexitools), delineates a clear separation between the keywords to be used in our current complex universe versus the concepts that have always been used in (only) complicated environments. The blue domain is the place where "Puzzle Makers" can keep working as usual while the red area describes a world that already shifted to a highly networked universe. Better embrace the red… if you are not to retire really soon

Harold Jarche (@hjarche) shares its best finds in 2016, and I specially liked his "quotes" chapter:

@Tom_Peters: "Presidents rarely get good advice. Every ‘presenter’ presents a totally biased solution–often suppressing competing evidence."

@atduskgreg: "Machine learning is automated bureaucracy. It spits back the systemic biases we feed it in feature vectors, training sets, reward functions."

"The demagogue is one who preaches doctrines he knows to be untrue to men he knows to be idiots." ‐ H.L. Mencken via @normsmusic

@HughCards: "As the Internet makes everything cheaper, access to real networks (Harvard, Wall St., Silicon Valley etc) gets even more expensive."

"Power not only corrupts, it addicts." ‐ Ursula Le Guin via @ndcollaborative

"The object of life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." ‐ Marcus Aurelius via @MickFealty

The most beautiful eyes in cinema were permanently closed this morning… and it makes me sad because I must confess that I have always considered Michèle Morgan as very close from the perfect woman.

Image from Passage to Marseille (1944)

Portrait by Ernest Bachrach (1940)

Yet another great post by Seth Godin (@ThisIsSethsBlog) describing the typical idea awareness cycle.

Listening to your customers isn’t figuring out what they want — it’s figuring out their needs.

We don’t always know what’s missing. Sometimes thirst feels like hunger. Sometimes a headache means stress. Sometimes we’re so deep within ourselves that we can’t read ourselves.

The art of business is anticipating needs. It’s going above and beyond. It’s being so attuned to your customers’ needs that you figure out their solution before they’ve identified the problem.

Naming the invisible problem is the first step to creating the visible solution.

Image and text by @gapingvoid

You may feel that it is yet another interpretation of the apocryphal Henry Ford quote: If I’d asked customers what they wanted, they would have said "a faster horse".

It is also close from the theories behind Interaction Design: you shouldn’t ask people to describe the products or services they would need, but what wishes they would ask the "genius out of the lamp" to fulfill for them… then build accurate enough Personas to be able to design the solutions that fit.

Finally, it is less about asking good questions (any question can lead to the proper answers if you listen properly) than it is about keeping in mind that innovation occurs out of the box and that, if innovators must have enough skin in the game to deliver consistent solutions, they also must keep dreaming in the wild.

If Trump governs as an authoritarian like he has promised, it will be critical that Americans do the following 10 things: https://t.co/ib56XSPTSe

— Evan McMullin (@Evan_McMullin) December 4, 2016

1. Read and learn the Declaration of Independence, the Constitution, and the Bill of Rights. Know that our basic rights are inalienable.
2. Identify and follow many credible sources of news. Be very well informed and learn to discern truth from untruth.
3. Watch every word, decision and action of Trump and his administration extremely closely, like we have never done before in America.
4. Be very vocal in every forum available to us when we observe Trump’s violations of our rights and our democracy. Write, speak, act.
5. Support journalists, artists, academics, clergy and others who speak truth and who inform, inspire and unite us.
6. Build bridges with Americans from the other side of the traditional political spectrum and with members of diverse American communities.
7. Defend others who may be threatened by Trump even if they don’t look, think or believe like us. An attack on one is an attack on all.
8. Organize online and in person with other Americans who understand the danger Trump poses and who are also willing to speak up.
9. Hold members of Congress accountable for protecting our rights and democracy through elections and by making public demands of them now.
10. And finally, in the words of Abraham Lincoln, have "malice toward none, with charity for all" and never ever lose hope!

The NHS Alliance’s 2016 Action Summit just occurred on December 1, 2016. It titled "In search of health creation: community by community". The subtitle read "None of us as smart than all of us" and I guess that I would have loved being there.

I discovered this Change Agents plot from this image embedded in a tweet:

Since the brits are often "borderline punks", I was not that astonished that they can write such things as Our mission is to infect the NHS with wellness. And what follows is rock’n'roll as well:

We’ve committed to address health inequalities through the concept and practice of Health Creation. Our mission is to infect the NHS with wellness.

Our Summit on December 1 is all about being forward thinking. It’ll be highly interactive and focus on how we can achieve big change. If you’d like to attend – and be part of a new, determined movement, please get in touch with us at conference@nhsalliance.org.

The complete program is there… but it is unfortunately too late to attend to it.

Everybody knows that the boat is leaking
Everybody knows that the captain lied…
…. Everybody knows
pic.twitter.com/qahTrCqPrD

— Panh Rithy (@RPanh) November 11, 2016

In a great blog post, Richard Martin (@IndaloGenesis) explained why you have to experience other people’s viewpoint in order to have a proper understanding of the world around… even if you must be conscious that, doing this, you are still elaborating a perspective that is plainly yours, and, as thus, plainly unique.

While exposure to a diversity of perspectives is essential to any attempt to understand how other people see and interpret the world around them, it is impossible to divest ourselves of all our own accumulated knowledge, experience, culture and filters. To assess someone else’s description or to sit in another’s chair, does not alter the fact that we are still using our own eyes, not theirs.

This text resonates with my own work since I have been working for more than twenty years on a "dual" issue: considering that multi-disciplinary teams (typically in health) are composed of people with very different viewpoints (a viewpoint being the sum of a view angle and a focus point, say a job and a specialty), what kind of "common perspective" (called an "artifact" in the knowledge management jargon) can we provide them so that they can contribute to a common project?

Richard would argue that, as a Neo-Generalist, he is more interested in turning around a vase of flowers Nevertheless, his text contains all the concepts (viewpoints, artifact) to understand why a "record of records" (piling up each others views) will never be a tool for those who have to contribute to the (health or whatever) project of one of their fellow human being.

Back to work on the Ligne de vie

To be unproductive is pretty easy; as pointed out by Anna Vital (@annavitals), it is just about doing mundane things "as usual".

To be productive seems considerably more complex… to the points it actually seems you have to become fully unproductive in order to invest in understanding how to become productive.

Not long ago, if someone mentioned the work "network"; we thought: TV or radio.

Now we think: Facebook, LinkedIn, Twitter… these networks have become far more valuable to us. They exist because we contribute to them. They are where our best ideas can spread and have impact. Sometimes they even democratize power.

Of course they are more powerful than an individual… even a powerful individual- and they are more powerful than the ‘old’ networks, because they carry our voice.

It follows that what we can do as part of a network, as part of a collective, is far more impactful than what we can do all by ourselves.

Are you using all the networks available to you to amplify your voice?

Image and text by @gapingvoid

Not so long ago – yesterday night to be accurate, I once again realized how hard it is to convince French Medical Doctors of this obvious reality. Being very busy working alone and only having trust in "authorities" keeps being the rules to them… the network being considered as a futile place where others are wasting time.

Weirdly enough, lots of people talk about a Web 3.0 or 4.0 or even 5.0 in health (yes, 5.0) when the very basics of the Web 2.0 remain largely to be understood (you know, no longer a hierarchy, but a network; a meshed society with the people inside… and maybe one day joined by their care givers as soon as they have left both their pedestal and the tyranny of "what is validated from above").

The flying Citroëns by Swedish artist Jacob Munkhammar are a perfect example of retrofuturism. I really felt in love with this DS décapotable in the Tuileries gardens.

This flying Ami is poetically staged in a vintage flyer.

These flying DS will certainly find their owners pretty soon. Notice the picture on the wall… Jacob Munkhammar is a perfectionist!

Yet another insightful twitter series by @EskoKilpi

1. value is not created at the point of production but at the point of use #jyuEMBA

— Esko Kilpi (@EskoKilpi) September 2, 2016

2. contextual problem definition and problem solving creates more value than mass solutions

3. transactions are replaced by interactions and network relations

4. relations now precede assets. People work more from their relations than their skills

It makes sense at large, but resonates specifically in health where, so far, the usual way remains to have "highly skilled professionals" do their best in isolation while applying Evidence Based Medicine guidelines that where validated for "the statistical patient".

In case you didn’t get the memo: There is no secret validation committee, deliberating on what your destiny is allowed to be.

So that strategy about waiting for your life to be finally green-lighted by someone else?

Sorry, you’ve been wasting your time.

There is no green light. Or red light. Or yellow light.

There’s just you. And what you intend to do about the present moment.

But I suspect you already knew that…

Image and text by @gapingvoid

This issue resonates with the current status in health information system where most of those who could address the genuine problems faced by suffering people feel that they have to "get a permission" (an order form) by the system (read the Minister, a major company, a well known professor…).

At a moment when it has never been so easy to engage with the people (the true customers, the ones in need of solutions) while big organizations are "lost in complexity" in current paradigm shift moments, I often ask the hard question : are you the kind of people that can address real people issues, or just a player by the rules that builds on outdated specifications?

This black drawing accurately sums up the reason why I decided several years ago to always vote blank. The first step toward a new paradigm has always been to stop playing by the rules of a system that no longer makes sense. It is now time to invent the Meshed Society that should come next.