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Why You Need More Fun in Your Life, According to Science

Why You Need More Fun in Your Life, According to Science
—George Bernard Shaw
Most of us want to have fun, it just seems like it is not as easy as it used to be. The reasons are many: guilt (because others aren’t having fun), perceived inappropriateness (because others around us cannot have fun) or lack of time (because our commitment to others won’t let us have fun). Yet, science gives an encouraging nod that we need to make time for fun and should perhaps prioritize it.

Since the term “fun” can be ambiguous and is often used in different contexts, let us first look at the standard definition of the word. Oxford Dictionary of Current English defines fun as: amusement, especially lively or playful. Staying true to the definition we generally connect the word fun to things that are entertaining and enjoyable to do. Fun is also sometimes used interchangeably with play — although there is a distinction as fun is argue that play is a state of mind; a certain attitude we can incorporate into any and every activity (Brown, 2009).

It is important to keep in mind that what is fun for you, might not be fun for somebody else. Therefore, fun can be difficult to investigate using standardized scientific methods. As such, scientific conclusions about the benefits of fun come from subjective observations and less rigorous studies. Nonetheless, there are enough studies that indirectly link to the concept of fun and play that a case can be made that we all need fun.

Here are five reasons science suggests you should have fun:

  1. Fun improves your relationships, both at work and in life

Research shows that when we have fun with others, these experiences have a positive effect on building trust and developing communication. Having fun gives us an opportunity to connect and be creative. When we laugh together, this sends an external non-verbal message that says: “We are alike, we share values” (Everett, 2011).  It can also make us look more vulnerable, but at the same time approachable and friendly, which can help build connections and bonds. Drs. John and Julie Gottmann, relationship experts from the Seattle’s Gottman Research Institute, have been studying happy and unhappy couples (and their patterns of behavior) in a systematic way. They found that couples who are happy know how to have fun together. It appears that when we have the ability to create and partake in acts of humor and affection, our conflict resolution skills improve as well.

Studies show that fun activities at work can improve our relationships with co-workers. These strong bonds developed with our colleagues have been linked to improved performance and productivity (Kansal, Puja, & Maheshwari, 2012).

  1. Fun makes us smarter

According to science, one way to improve our memory and concentration is to have fun. Partially, this has to do with the stress reduction that happens when we engage in something we enjoy. However, the benefits of fun activities seem to stretch further than that. The British Cohort Study — a study that has been following 17,000 people born in 1970 — found that reading for fun improves our language skills, and more surprisingly our proficiency in math as well. It appears that fun activities that introduce us to new ideas and concepts foster self-directed learning. The rewards we gain from these experiences might expand beyond the obvious benefits. Scientists are now also exploring if reading for fun can also protect us against cognitive decline as we age.

  1. Fun reduces stress

You probably do not need science to inherently know this already: engaging in enjoyable activities can be an especially powerful antidote to stress. It has been recognized in several studies that spontaneous laughter has a stress-buffering effect that helps us better cope with stress. According to one study, individuals who laughed less had more negative emotions when compared to those who laughed more. In contrast, those who laughed more showed fewer negative feelings even when stressful situations increased (Kuiper & Martin, 1998). Interestingly, this same study found that there is no correlation between having a good sense of humor and displaying stronger or more intense emotions. As such, therapeutic laughter programs are now being developed and evaluated, and are sometimes offered as treatments for depression, stress and anxiety (Kim et al., 2015). It appears that there is some truth to the adage, “laughter is the best medicine.”

  1. Finding fun in physical activity balances your hormone levels

It has been well-established that high stress levels negatively influence our hormones and neurotransmitters (especially cortisol and noradrenalin). Stress also affects our endocrine, metabolic and immune functions. Hormones can have an amazing effect on our mood — this is true for both genders (Koelsch et al., 2016). Certain hormones, such as cortisol, insulin, testosterone and estrogen, can be particularly influential and cause havoc when we have an imbalance. One way to naturally balance hormones is to engage in pleasurable physical activity (e.g. Abbenhardt et al., 2013). In other words, adaptation is not reliant on intense physical activity but rather consistent recreational exercise. When it comes to exercise, find what fun means to you and bake it in to your routine.

  1. Fun can make you more energetic and youthful

Stress is draining — it can suck the life out of us, making us tired and cranky. When we effectively reduce our stress levels, this can often provide us with a new boost of vitality. Having fun and playing have traditionally been connected with children and the early years of our development. However, many philosophers and psychologists emphasize the importance of play as we get older. Plato professed that life must be lived as play, and George Bernard Shaw famously said: We don’t stop playing because we grow old; we grow old because we stop playing.

Fun at Work

Having fun at work might be just as important as having fun in your personal life. Everett (2011) concludes that since we will spend more than 90,000 hours of our lives at work, we might as well have fun there. Some of the benefits of playing on the job include:

Higher recruitment and retention rates. Organizations that nourish creativity and playfulness in employees have less difficulty recruiting and retaining good staff, and it is an encouraging trend that more modern organizations are balancing work and play than in prior decades (Everett, 2011). For example, here in the Bay Area Google is known for having a fun workplace and is also a very desirable company to work for. Sponsoring fun activities has also been recognized as a measure to prevent burnout (Meyer, 1999).

– Increased job satisfaction. Employees must feel satisfied to be productive. There are many factors that contribute to job satisfaction, which logically also correlates to overall life satisfaction. When we can laugh and have fun at work, we can also build better relationships and help create connections with our workmates. Doing fun things together creates a joint history with our fellow employees. When we have fun together we tend to relate to and identify with our coworkers better. Some authors believe that “teams that play together, stay together,” so it is important to create organizational culture that supports that (Berg, 2001).

Increased customer satisfaction. Customer satisfaction is generally closely linked with employee satisfaction. Workers who have something to smile about are usually better equipped to make customers smile than their melancholy counterparts. Fun seems to be contagious — as shown by studies looking at work environments. For example, when a fun work philosophy was adopted at Sprint, this resulted in their call center agents handling 30 percent more calls, and customers expressing an increased level of satisfaction with their services (Karl & Peluchette, 2006).

Everett (2011) also points out that fun should not be made mandatory. It ceases to be fun then, and can actually contribute to feelings of stress among employees. It is important to consider that people’s perceptions of fun (and what fun means to them) may vary and that they do not necessarily want to have fun in a certain way, at a certain time.

[FUN FACT]: Did you know that according to a study from 1998, adults only laugh on average 17 times a day (Kuiper, & Martin, 1998)?  If you have a good joke, leave it in the comments so we can help push up this average.

 

Sources & further reading:

Abbenhardt, C., McTiernan, A., Alfano, C., Wener, M., Campbell, K., Duggan, C., & … Ulrich, C. (2013). Effects of individual and combined dietary weight loss and exercise interventions in postmenopausal women on adiponectin and leptin levels. Journal of Internal Medicine, 274(2), 163-175.

Berg, D. H. (2001). The Power of a Playful Spirit at Work. Journal for Quality & Participation, 24(2), 57-62.

Brown, S. (2009). Play: How it shapes the brain, opens the imagination, and invigorates the soul. New York: Avery.

Everett, A. (2011). Benefits and challenges of fun in the workplace. Library Leadership and Management, 25(1), 1-10.

Kansal, M., Puja, & Maheshwari, G. (2012). Incorporation of fun and enjoyment in work: Builds the way for success and generation of long term benefits. ZENITH International Journal of Business Economics & Management Research, (12), 98-113.

Karl, K., & Peluchette, J. (2006). How does workplace fun impact employee perceptions of customer service quality?. Journal Of Leadership & Organizational Studies, (2), 2-11.

Kim, S., Kim, Y., Kim, H., Lee, S., & Yu, S. (2012). The Effect of Laughter Therapy on Depression, Anxiety, and Stress in Patients with Breast Cancer Undergoing Radiotherapy (CP). Quality Of Life Research, 20, 84.

Koelsch, S., Boehlig, A., Hohenadel, M., Nitsche, I., Bauer, K. & Sack, U. (2016). The impact of acute stress on hormones and cytokines, and how their recovery is affected by music-evoked positive mood. Scientific Reports, 6doi:10.1038/srep23008

Kuiper, N., & Martin, R. (1998). Laughter and stress in daily life: Relation to positive and negative affect. Motivation and Emotion, 22(2), 133-153.

Meyer, H. (2000). Fun for everyone. IEEE Engineering Management Review, 28(2), 45-48.

What is the Meaning of Legacy and Why Do You Want to Leave One?

What is the Meaning of Legacy?

Have you ever thought what you want on your tombstone? Or wondered what gives you the drive to hustle? Are you the benevolent type, but still have enough ego that you want to be remembered for all the good you did in the world? There are many forces that help drive us to pursue, and the desire to leave a legacy is one of the strongest.

This inherent drive to leave a legacy can manifest in a range of ways: from a desire to have children to wanting to lead a visionary movement that transforms a society. Although the manifestation of the process might differ between individuals, most of us seem to have a desire to create a legacy — to leave something behind when we go. Our desire for legacy can be biological, material, and/or it can be expressed as our values and hard-won knowledge that we pass on to family and friends (Hunter & Rowles, 2005).

What is the Meaning of Legacy?

The word legacy comes from a Latin word legatus, translated as ‘embassador, envoy, deputy.’ In the late 14th century, an old French word legacie was used to describe a body of persons sent on a mission. We can therefore look at legacy metaphorically that when we create a legacy, what we are really doing is appointing our spokesperson for the future. Most of us —  either explicit or unknowingly — have a desire for either symbolic or literal immortality (i.e. literal immortality is some belief that there is an afterlife). This seems especially strong in those of us that understand death is inevitable (Sligte, Nijstad, & De Dreu, 2013). Our legacy, if adequately left, transcends the realms of our physical life and brings symbolic immortality.

As our awareness of mortality grows, it brings into focus internal concerns and questions about why we exist. For many, this quest for purpose begins once we realize that the opportunity to leave our mark is finite. For others, this realization can lead fear — a threat to one’s sense of self that we will likely soon be forgotten. Thus, people try to negotiate what us scientists call ‘mortality salience’ in different ways (Sligte, Nijstad, & De Dreu, 2013). When reminded of our impending death, we often look for ways to transcend that feeling and employ different psychological mechanisms to reach symbolic immortality. For instance, we are compelled to connect with influential social groups, because a group’s existence generally transcends the existence of a single individual. Furthermore, groups also bolster our self-esteem and nurture our belief that the world meets the standards and values within our worldview — a rationalization that everything will end well. This has been explored in depth by Terror Management Theory or TMT, which was proposed by Jeff Greenberg, Tom Pyszczynski and Sheldon Solomon (1986).

To create legacy some of us — I fall into the category —turn to our creative side. By introducing new ideas, designs, novel products and original solutions into our current reality we possess the potential to influence societies (and dare I say the world) in a way that will outlive ourselves. Studies have shown that creativity is often used as a force of legacy, especially when the expression of creativity is socially valued — after all, we love our friends… our peers… our ‘tribes’ and most of us either explicitly or secretly want their recognition (Sligte, Nijstad, & De Dreu, 2013).

Why Do You Want to Leave a Legacy?

The crux of legacy is that we look for ways to be existentially reassured our life mattered. We bargain with death as we go through the psychological cycle of grieving our inevitable non-existence (Ross, 1969). We want to leave a legacy because before we can psychologically accept the reality of our own physical annihilation, we put up one hell of a fight. Science suggests a desire to leave something behind when we pass naturally increases as we age (Newton, Herr, Pollack, & McAdams, 2013). Those of us that have had long and productive careers seem to be challenged the most by the process of aging (Wexler & Long, 2009). Intuitively this makes sense; if you worked hard all your life — inevitably making personal sacrifices along the way — you want to believe your life amounted to something in the eyes’ of others because you will not be around to tell your story. You want some recognition for living a dedicated life. Again, various studies suggest the closer to death we get, the more we crave this immortality. A study of women that were faced with a life-threatening illness showed that all subjects consciously started the process of legacy transmission (Hunt, 2007), which could be interpreted that legacy closely links with our relationship to death and mortality.

Many authors also think that the wish to create a legacy is connected both with generativity and narcissism (Newton, Herr, Pollack, & McAdams, 2013). Generativity is a psychological concept, usually regarded as a positive one — generativity often emerges in midlife and can be connected with parenthood or other social roles, such as mentoring. Erikson (1974) defined it as “…the establishment, the guidance, and the enrichment of the living generation and the world it inherits.” Erikson viewed it as a concept that is often focused on the next generation and an inherent individual care for its well-being. Narcissism, on the other hand, is usually viewed as a more negative concept (though there is a distinction between normal and pathological narcissism). Generativity is focused on others, while the concept of narcissism focuses on one self. We could therefore conclude that wanting to leave a legacy on some level is associated with narcissism since you do not need to be remembered to help society. It appears that legacy is likely a combination of both selflessness and narcissism (Rubinstein, 1996).

Many people indeed associate a need for legacy with ego; an act of ego beyond death. In contrast, the desire to selflessly change the world is viewed as more altruistic in nature — those that do things anonymously and do not wish to be recognized for it. Nonetheless, some point out that legacy has the potential to go beyond the ego and be weighted in altruism. It can surpass cultural constraints and become a broader aspect of human development that is a psychological driver of greater good (Hunt, 2007).

One thing about legacy that science seems to agree on is that this desire is somewhat universally seeded in us. Since it is often connected with having children and passing either goods, values, knowledge and/or wisdom onto them, being childless can (in some people) create a feeling of despair and/or sadness as they feel they are no outlets to leave a legacy (Rubinstein, 1996). It was observed that some childless women looked for other ways to meaningfully influence and support others (e.g. family members, community), or alternatively they wanted to create a legacy that related to the whole human species. This desire can sometimes drive very old people to participate in, for example, antinuclear protests even if building more nuclear power plants probably isn’t going to influence them anymore. Some studies show that older people, it can be more important to pass on values and beliefs than material possessions (Hunter, 2007). It is clear that legacy means different things to different people, but that for most of us it is the pursuit of symbolic immortality that drives us.

 

Sources & further reading:

Erikson, E. H. (1974). Dimensions of a new identity. New York, NY: W. W. Norton & Company, Inc.

Greenberg, J., Pyszczynski, T., & Solomon, S. (1986). The causes and consequences of a need for self-esteem: A terror management theory. In R. F. Baumeister (Ed.), Public self and private self (pp. 189-212). New York, NY: Springer-Verlag.

Hunter, E. G. (2007). Beyond death: inheriting the past and giving to the future, transmitting the legacy of one’s self. Omega, 56(4), 313-329.

Hunter, E. G., & Rowles, G. D. (2005). Leaving a legacy: Toward a typology. Journal of Aging Studies, 19, 327–347.

Kübler Ross (1969). On Death and Dying. New York: Scribner Classics.

Newton, N., Herr, J., Pollack, J., & McAdams, D. (2013). Selfless or Selfish? Generativity and Narcissism as Components of Legacy. Journal Of Adult Development, 21(1), 59-68.

Rubinstein, R. (1996). Childlessness, legacy, and generativity. Generations, 20(3), 58.

Sligte, D., Nijstad, B., & De Dreu, C. (2013). Leaving a Legacy Neutralizes Negative Effects of Death Anxiety on Creativity. Personality And Social Psychology Bulletin, 39(9), 1152-1163.

Wexler, G., & Long, L. (2009). Lifetimes and Legacies: Mortality, Immortality, and the Needs of Aging and Dying Donors. The American Archivist, (2). 478.

Why Behavior Change is a Bunch of #Bullshit and What You Can Do about It

I have generally been an advocate of behavior change science. Designing healthy habits and routines can be an effective way to elicit change in the appropriate environment. However, similar to some of the legitimacy issues executive consulting faced when “life” coaches hit the scene, a wave of unqualified behavioral “designers” have been able to find an audience due to the increased ease at which garbage can be disseminated thanks to the power of the Internet. An important disclosure is I am one of those peddlers, so I am chucking big rocks at my big glass house. That said, it is long overdue to air some dirty laundry — so here we go…

Recidivism

Recidivism

Many popular behavior change interventions are designed for short intervention-behavior lags — i.e. the desired behavior of the user takes place almost at the same time as the intervention is administered. For instance, you see your Fitbit on your arm and get reminded to walk, so you get up from your desk and take a phone meeting outside while walking; or a more common example, a beep in your car nudges you to fasten your seatbelt, you hear the beep and you buckle up. But one of our many dirty little secrets is that these interventions are not particularly useful after the “treatment” has been administered (Rogers & Frey, 2014). For instance, taking the seatbelt example, one study showed that if drivers were reminded to fasten their seatbelt immediately before they drove off, their compliance was significantly better than if they were reminded 5 minutes earlier (Austin, Sigurdsson, & Rubin, 2006). Moreover, and more importantly, a delayed prompt (when there was a 5-minute lag between the prompt and the driver entering the car) the intervention was no more effective than receiving no prompt at all (i.e. the study’s control group). A few minutes seems to be enough for our attention to wander off and for another stimulus to take over — in other words, if an stimuli is not administered in real-time the effectiveness of the behavioral intervention diminishes — if (what people of my sort call) a “trigger” happens after the action that needs changing is taken, the intervention is usually a lot less effective.

Therefore, what behavioral designers and marketers often try to do is alter our thoughts in real time. Real-time stimulus is pretty effective and can acutely change our behavior in the short-term. These tactics are frequently used in conjunction with framing our choice as risk aversion. For example, if you are going to the beach and you get told that by not wearing sunscreen, you will have a higher chance of developing skin cancer, chances are you are more likely to buy sunscreen (for evidence of this see: Detweiler et al., 1999). But, it is questionable at best if you will actually change your habit of generally not buying sunscreen before going out in the sun; in the sunscreen study the perception of risk was only changed in that moment.  Changing thoughts in an enduring matter has proven to be much more difficult. Behavior interventions are supposed to be able to bridge time, but if the intervention is not administered just before the target behavior occurs, this is unlikely to happen. For instance, a study that looked at Biggest Loser contestants showed that during the show — when contestants were bombarded with different inputs, interventions and coaches — participants lost considerable weight. Six years later however they gained back, on average, 70% of the lost weight (Fothergill et al., 2016).

The hard reality about behavior change is it is not easy to create persistence — although there are different pathways that have been connected with the process for lasting behavior change. The problem is these complicated pathways are rarely designed well in novel behavior change models. Instead designers look for dramatic results so they can market themselves and their intervention. That is the bullshit part, so what can you do about it?

In their research paper, Todd Rogers and Kerin Frey (researchers from Harvard University) describe some of the features that are likely to bridge time. These include feeling socially accountable (e.g., not wanting to let down family and friends), linking performance with the intervention, pre-committing to a certain behavior and/or deliberately changing perceptions and consequential thoughts (Rogers & Frey, 2014). The importance of this last one (deliberately changing perceptions and consequential thoughts), has been shown to be extremely important for lasting behavioral change. This is why cognitive-behavioral therapy is touted as an evidence-based, efficient technique for changing habits — science continues to support the idea that deliberate practice creates new and lasting cognitive patterns and pathways (Pearson, Lipton, Cleland, & Yee, 2002).

Self-licensing

Self-licensing

The premise of self-licensing is that when you feel you have invested legitimate effort into something, an internal self-licensing cue can get produced that justifies a negative action, many times in the form of a hedonic action of consumption or self-gratification. Ever remember a time you rewarded your 30 minutes of cardio with a milkshake Jamba Juice. At least one study showed that a self-licensing cue leads to increased snack intake (Witt Huberts, Evers, & De Ridder, 2012). Self-licensing is a distinct behavioral mechanism that has been shown to be associated with unhealthy behaviors — distinct from other self-control failure mechanisms in the sense that the behavioral breakdown is actually masked as a reward.

The rub for you is the phenomenon of self-licensing (sometimes referred to as moral licensing) is widely recognized. Good behavioral designers know when people perform well they will feel liberated to engage in these behaviors (Merritt, Effron, & Monin, 2010). Why do you think most health clubs have a juice bar? Science suggests that even if you simply imagine doing something altruistic, you are more likely to indulge. If you, on the other hand, did not imagine doing a good deed, you are more likely to choose prudent behaviors (Khan & Dhar, 2006). It appears that when we feel virtuous this can often influence our future behavior in a negative way — because, come on, we all like a pat on the back once in a while.

False expectations regarding the future also seem to influence our choices. For instance, if we believe we will have to make a certain choice twice, this influences our decision and might make us more self-indulgent. Studies of consumers performed by Khan and Dhar (2007) showed that participants were more likely to choose an unhealthy snack (a chocolate chip cookie) over a healthy snack (low fat yogurt) if they believed they will have to make the same choice the week after. In other words — in our minds — just projecting we might do something healthy has us doing dumb shit in the present moment. The best advice I have got for you here is to be mindful and simply not do dumb shit. If you are reading this, chances are you are smart, so look at what you are trying to accomplish and gut check yourself to see if you are self-licensing. Since this phenomenon is common with those trying to lose weight I’ll use gym goers as an example. One, your treadmill is lying to you (see: Putting Very Little Weight in Calorie Counting Methods) — if you are looking to create a calorie deficit you are probably already overestimating the calories you have burnt exercising. Two, that fruit smoothie you think is a healthy reward for a job well done — it likely comes close to the caloric intake of a banana split. Not that I am suggesting you drink soda as an alternative, but keep in mind that if that was your guilty pleasure after a hard workout, you would likely be taking in 66% less calories than your average juice bar alternative.

Ego Depletion

Ego Depletion

The concept of self-licensing is similar to what some call ego depletion. Ego depletion and willpower have been blogged to death by folks like me so I won’t go too deep here. I am already stoked you have made it this far. The short version though is willpower is seen as a muscle that can get exhausted when we use it a lot (Baumeister et al., 2008). When our willpower’s capacity is temporarily used up, ego depletion causes us to make less restrained choices (like snacking on cookies or cake, instead of more healthy options like fruit or salad). Moreover, and what fascinates researchers is, when we use willpower resources in one area of our lives, this can backfire in seemingly unrelated areas of our lives. For instance, experiments have shown that when people tried to resist the temptation to eat sweets, they subsequently gave up faster on difficult mental exercises (Baumeister et al., 1998).

If you have read this far then by now you either agree or disagree with me that behavior change is incredibly complex and influenced by multiple factors and circumstances. However, to make these complex concepts comprehensible we have really smart thought leaders in this space dumbing down ideas at the cost of holistic comprehension. Take the very popular behavioral model proposed by BJ Fogg (BJ Fogg’s Behavoral Model) — this model has been accused by many that study behavior change as somewhat overly simplistic (although my guess is that for BJ simplicity was his intention). BJ’s model focuses on three elements of behavior: motivation, ability and trigger. In the model, motivation and ability need to be at certain thresholds for a target behavior to be ‘triggered’. BJ also defines subcomponents of each element — in his model, his three core motivators are: pleasure/pain, hope/fear, social acceptance/rejection. What I see as missing in BJ’s model is a road to long-term behavior change, as most of these levers are acute and episodic. The notable exception is social pressure; as I alluded before social pressure has been shown to be a useful method in some cases when we want to cement a certain behavior (we will not go too deep down the rabbit hole of social contagion here, but the science is interesting for those interested). One scientific example is a study that examined people who thought their neighbors could see a report of their energy usage. This group was more likely to reduce their energy usage, and more surprisingly the effect stayed measurable even years after the initial intervention was removed (Allcott & Rogers, 2014) — meaning these folks were still energy conscious even after the reports that their neighbors knew what they were up to stopped coming to their mailbox.

To be fair to BJ, he clearly knows the role environment contributes to our behavior, but the environment’s importance is downplayed in his popular model — and this model is constantly referenced by would-be behavioral designers. In the information regarding his Tiny Habits protocol BJ does mention three things that can change behavior in the long-run: an epiphany (very rare, like: holy shit, I just had a heart attack I should work out more), change of context (hey, what do you know? environment) and taking baby steps (aka BJ’s 2nd baby after his B=MAT model: Tiny Habits).

The truth is BJ just repackaged stuff from Kurt Lewin, that Lewin himself probably repackaged from someone else. We in the business all do this. As a gestalt psychologist, Lewin believed that a person’s environment determines their behavior, which he expressed with his formula: B= f (P, E). Behavior —in his view — is a function of a person (P) and their environment (E). In one of his original books, Lewin actually originally proposed that behavior is a function of a person’s entire situation: B=f(S) …later Lewin expanded situation (S) into person and environment (Lewin, 1936). Lewin’s contribution to behavior change was an emphasis on all the different elements that need to be considered to attempt to understand our behavior. Another gestalt psychologist, Kurt Koffka, summarized this in his famous (though often wrongly translated) saying: The whole is other than the sum of the parts. In other words, it is folly to approach behavior change using a purely reductionist approach. Lewin (1936) found we are often affected differently by the same physical environment, so even though I am admittedly bullish on them, even environmental changes fail us sometime.

However, in my opinion environmental interventions are where we are seeing the highest return on investment with regards to behavioral design. If you have not already, go down the rabbit hole of Brian Wansink’s work. Wansink is continuing to show us through his research how environmental design can influence our behavior. For instance, he popularized mindless eating ideas that suggest we often eat things without being aware of its nutritional value or volume (Wansink, 2004).

Halo Effect

Halo Effect

A study published this year in JAMA, described a randomized control trial that looked at the efficiency of weight-loss interventions. The hypothesis was that technology-enhanced weight-loss interventions will result in greater weight-loss compared to standard interventions. Surprisingly, the hypothesis was rejected. Participants who received a wearable device and an accompanying Web interface to monitor their diet and physical activity lost less weight compared to those who only received the standard intervention (Jakicic et al., 2016). Other researchers, too, concluded that when it comes to changing behavior, wearables might not be as beneficial as we once believed. I do believe wearables have potential, but it appears they cannot drive health behavior change alone (Patel, Asch & Volpp, 2015). There is a big gap between recording information and behavior change — to be honest after studying this now for over half-a-decade I believe the available data suggests that tracking devices probably cannot bridge this gap. Furthermore, it can take decades for a product to recover from a halo effect (Kerger et al., 2016). To be clear, some wearable devices can indeed deliver change (I am especially bullish on condition specific wearables). Also, some consumer products prove to be useful tools, because  (1) they are often bought by people who are already motivated to change and (2) successful behavioral interventions can be built around them (Patel, Asch & Volpp, 2015). Look: the key to sustainability of behavior change is to transform external motivation into internal — all of us know it — the problem is that it is a bit tricky.

Destination Addiction

Destination Addiction

Reality: we need to believe and be enrolled to some degree in our own behavior change, or we are generally just wasting our time. “Destination addiction” refers to those that are always chasing something, but find no fulfillment in the process of change. Take for instance someone who buys a wearable because they believe that tracking their progress will add enjoyment to something they really do not enjoy doing. A lot of my life is spent evaluating these wearables. Many of these devices actually do the opposite (i.e. they add dissatisfaction) by adding unneeded friction to a process that is difficult to begin with — in extreme cases these devices even risk changing our identity (Lupton, 2015). Furthermore, whether supported by a wearable of not, canned behavioral interventions run the risk of missing the real cause of a problem because many only focusing on symptoms (for instance, personally I am fat because I drink too much, and I drink too much because my baby cries; how is my Fitbit going to fix my crying baby? I am joking of course, but you get the point). Rigged protocols and behavior change technologies that run on static algorithms cannot always perform a deep and comprehensive assessment about your individual situation. It is rare that a single behavior change model applies to a large population. Also, behavioral interventions that use technology and online platforms often reduce the amount of human contact you are exposed to (to be fair to hardware and software designers, investors want to know a product is scalable and human invention is rarely scalable).  What does minimizing human interaction mean for the future behavior change through technology? I am not totally in the hater camp — some studies show that online therapy can be just as effective as face-to-face contact, plus it is more scalable and affordable (Mohr et al., 2012) — these are truths. However, the jury is out about the long-term effects these interventions can have, specifically their lasting effect on the human psychology and the process of socialization we have discussed throughout. Online interventions are very different to personal interventions. From what I can tell online modalities are not evaluated with the same amount of rigor as face-to-face practice. Also, individuals involved in the delivery of such models are not necessarily competent practitioners, especially since interactive computer-based communication has yet to provide an apples-to-apples comparison to face-to-face verbal exchange (Childress, 2000).

So what should you consider when it comes to evaluating behavioral interventions and their appropriateness? Perhaps some of the more obvious things include transparency regarding the intervention so you can determine fit, level of the interventions intrusiveness and the restrictions the intervention will have on your freedom. Our choices are often limited or eliminated altogether when certain goods or behaviors are banned or restricted — when our intrinsic drive is not truly altered and/or the intervention relies on artificial prohibitions, there is a good chance it can backfire (recidivism).

You see, if we can admit we are gaming ourselves, then at least we can enjoy the game. If we look at the world through the philosophical lenses of James P. Carse who wrote the book Finite and Infinite Games, poor behavior change protocols could be described as finite games. Their purpose is to reach a change, to end the process and win (losing weight, for example). When we rig the system in this fashion however, we get the results I previously highlighted in the Biggest Loser study. The game is over and we level set to the mean (i.e. back to our previous state). After all, most change comes with the potential for relapse. In my experience, behavior change protocols rarely have contingencies for this strong possibility. As an example, 80 to 95 percent of people who give up smoking or alcohol relapse within the first 12 months (Brandon, Vidrine, Litvin, 2007). I am not giving extra weight to the idea of Infinite Games by concluding with this concept, but do understanding that:

  • True change is not a destination; and,
  • we (and our users) might as well enjoy the ride.

These two ideas (that I hold as truths) will help us architect behavioral interventions for ourselves and others that have real lasting impact and will not fail us in the long-term.

Man, this post was a lot of words. I would love to stop talking now and learn from you in the comments below. What do you think?

 

Sources & further reading:

Allcott, H., & Rogers, T. (2014). The short-run and long-run effects of behavioral interventions: experimental evidence from energy conservation. American Economic Review, (10), 3003

Austin, J., Sigurdsson, S. O., & Rubin, Y. S. (2006). An examination of the effects of delayed versus immediate prompts on safety belt use. Environment and Behavior, (1), 140-149.

Baumeister, R. , Bratslavsky, E., Muraven, M., & Tice, D. (1998). Ego depletion: Is the active self a limited resource?. Journal of Personality And Social Psychology, 74(5), 1252-1265.

Baumeister, R. P., Sparks, E. P., Stillman, T. P., & Vohs, K. P. (2008). Free will in consumer behavior: self-control, ego depletion, and choice. Journal of Consumer Psychology: The Official Journal Of The Society For Consumer Psychology, 18(1), 4-13.

Botta, F., Moat, H., & Preis, T. (2015). Quantifying crowd size with mobile phone and Twitter data. Royal Society Open Science, 2(5), 6p.. doi:10.1098/rsos.150162

Brandon, T., Vidrine, J., & Litvin, E. (2007). Relapse and relapse prevention. Annual Review of Clinical Psychology, 3, 257-284.

Burnes, B. (2004). Kurt Lewin and the Planned Approach to Change: A Re-appraisal. Journal of Management Studies, (6), 977-1002.

Carse, J. (2011). Finite and infinite games. Simon and Schuster.

Childress, C. A. (2000). Ethical Issues in Providing Online Psychotherapeutic Interventions. Journal of Medical Internet Research, 2(1), e5. http://doi.org/10.2196/jmir.2.1.e5

Detweiler, J. B., Bedell, B. T., Salovey, P., Rothman, A. J., & Pronin, E. (1999). Message framing and sunscreen use: gain-framed messages motivate beach-goers. Health Psychology, (2), 189-196.

Fothergill, E., Guo, J., Howard, L., Brychta, R., Chen, K., Skarulis, M. , & … Knuth, N. (2016). Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity, 24(8), 1612-1619. doi:10.1002/oby.21538

Jakicic, J. M., Davis, K. K., Rogers, R. J., King, W. C., Marcus, M. D., Helsel, D., & … Belle, S. H. (2016). Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss. JAMA: Journal Of The American Medical Association, 316(11), 1161-1171. doi:10.1001/jama.2016.12858

Kerger, B. D., Bernal, A., Paustenbach, D. J., & Huntley-Fenner, G. (2016). Halo and spillover effect illustrations for selected beneficial medical devices and drugs. BMC Public Health, (1), doi:10.1186/s12889-016-3595-7

Khan, U., & Dhar, R. (2006). Licensing effect in consumer choice. Journal of Marketing Research, 43 (2), 259–266.

Khan, U., & Dhar, R. (2007). Where there is a way, is there a will? The effect of future choices on self-control. Journal of Experimental Psychology: General, 136(2), 277–288.

Lewin, K. (1936). Principles of Topological Psychology. New York: McGraw-Hill.

Lupton, D. (2015). Health promotion in the digital era: a critical commentary. Health Promotion International, 30(1), 174-183.

Merritt, A. C., Effron, D. A., & Monin, B. (2010). Moral Self-Licensing: When Being Good Frees Us to Be Bad. Social & Personality Psychology Compass, 4(5), 344-357. doi:10.1111/j.1751-9004.2010.00263.x

Mohr DC, Ho J, Duffecy J, Reifler D, Sokol L, Burns MN, Jin L, Siddique J. Effect of Telephone-Administered vs Face-to-face Cognitive Behavioral Therapy on Adherence to Therapy and Depression Outcomes Among Primary Care PatientsA Randomized Trial. JAMA. 2012;307(21):2278-2285. doi:10.1001/jama.2012.5588

Patel, M. S., Asch, D. A., & Volpp, K. G. (2015). Wearable devices as facilitators, not drivers, of health behavior change. JAMA: Journal Of The American Medical Association, 313(5), 459-460. doi:10.1001/jama.2014.14781

Pearson, F. S., Lipton, D. S., Cleland, C. M., & Yee, D. S. (2002). The effects of behavioral/cognitive-behavioral programs on recidivism. Crime and Delinquency, (3). 476-496.

Rogers, T., & Frey, E. (2014). Changing Behavior beyond the Here and Now. Working Paper Series. Retrieved from http://scholar.harvard.edu/files/todd_rogers/files/changing_behavior.pdf

Wansink, B. (2004). Environmental factors that increase the food intake and consumption volume of unknowing consumers. Annual Review of Nutrition, 24(1), 455-479. doi:10.1146/annurev.nutr.24.012003.132140

Witt Huberts, J. C., Evers, C., & De Ridder, D. D. (2012). License to sin: Self-licensing as a mechanism underlying hedonic consumption. European Journal of Social Psychology, 42(4), 490-496. doi:10.1002/ejsp.861

Interview at the Motionsoft Technology Summit about Big Data

This quarter’s Business, Innovation and Entrepreneurship interview is the compilation of getting to discuss “big data” analytics with four exceptional thought leaders at the Motionsoft Technology Summit this year (2016). These four gentlemen in no particular order are: Jafar Adibi, Ph.D., the President, Co-founder, and CTO of re|unify; Jeffrey Cooper, the Senior Manager of Business Development at Samsung; Mark Newman, the President of Heads Up Analytics, and Keith Catanzano, a Partner at 2River Consulting Group. The answers below are summations of their respective answers, as such they are not represented as verbatim but edited for readability and context.


1) When a company is either building a data model (or working with a third party for this type of service), what considerations should an operator have regarding the crossroad of complexity and usability?  There are scenarios where too many disparate and incomplete data sets can make it difficult to find the signal from the noise; what are the trade-offs as the amount of available business intelligence information continues to increase? And what considerations should we take into account to maximize any investment in mining data?

[Jafar Adibi]: You need to figure out what problem you are trying to solve. Clients will come to me with data, rich sets of data, and say, “Jafar, now go figure out something to do. Find something interesting.” Generally, this is a waste of time. People believe finding correlations (any correlations) are going to help their business, but that is often not the case. When you identify your problem, we are better set up to solve it. There are different analytic methods for classification problems, association problems, and other questions that are not necessarily answered through correlative means. Getting to the right question will help you establish what data sets are important.

Then you need to figure out your budget. There will always be noise in your data, especially data from business intelligence. We can build a model to take the noise into consideration. However, using more data is obviously expensive, so that goes back to what are you trying to solve for. We can exclude data that will not answer your question, which saves you time and money. As such, you want to keep return on investment (ROI) in mind as you think about the question you are asking. Ask yourself, “If I answer this question, how much money with I gain/save?” The answer to the ROI question gives you a ballpark on what it might be worth regarding your investment in a data model.

2) It seems to me that a lot of ad hoc advice about using data for business intelligence is disseminated on broad-based assumptions derived from general population data. However, is this not one of the follies of “Big Data”? Companies are basing important decisions on arguably misleading benchmarks, rather than creating a narrative specific to their population (or at least a sample from their specific population); What are strategies to ensure we are making the best decision based on our company’s unique attributes?

[Mark Newman]: The most important thing is to trust your own expertise. You should intuitively know the customers you are trying to attract. You should have an idea of what strategies you are trying to pursue. You should already know what the important problems are you need to solve. What you don’t want to do is look to data to validate some preconceived answer to your problem. Instead, you want to devote your own educated guesses as to what to do — and then you want to use data to test those rigorously to keep yourself honest.

I think there are two ingredients to doing that. The first is to agree with your colleagues on the definitions of the terms that you are using in your data. If all the stakeholders do not agree on the definition of the numbers, then you all are not going to have an organized lexicon/narrative to work with. You have to agree on key metrics that you are going to use to allow for the monitoring of health and progress within your organization.

The second ingredient that you want to have is to follow an experimental approach that is constantly evolving. Your customers and prospects are going to react differently to your products and services over time. Reasons:

  • They might have more experience with you as your brand matures
  • As consumer groups mature, they change their goals
  • Your previous pitches are now stale, and customers react to them differently
  • Different competitors in the marketplace

What works today does not work tomorrow. Instead of some one-and-done, super solution to what you are trying to accomplish — instead you want to have some kind of innovative, incremental approach in the beginning. If you follow that, then over time, the data is going to have a narrative that reflects who you are, and what you are trying to do, and what works best for you.

3) Until recently, most data aggregation efforts have told a fairly unsophisticated narrative, and inspired relatively unremarkable initiatives in an effort to capitalize on data mining. How can we improve our use of data? And, how can companies do better at making data more actionable?

[Keith Catanzano]: What is the question the company is trying to answer? It is important to not just say, “How do you make data actionable?” We are probably all guilty at some point of looking at a data model and saying, “Look at the results, they’re awesome!” I think intriguing insights can be challenging in terms of making data actionable. There is a ton of data out there. Once you find ways to bring yours together, there is a lot you can see using data by way of insights. At some point you need to do something with the insights. In order to do that, obviously, it’s important to know who your customers are [assuming trying to influence their behavior is your goal], but also why are they customers. However, in this use case the why is more important than the who. The “why” is ultimately what you are going to try to make actionable, because to take action you are going to need to pull some type of lever to influence consumer behavior. There are lots of ways to work with communication or outreach in an attempt to accomplish this, but the effort requires the company to take a deliberate approach regarding how data is used to take action.

It is also important to note that making data actionable is generally not a one-shot deal, and architecting a campaign that changes an entire group’s behavior in some way probably will take a series of events that includes multiple levers I mentioned. So to make data more actionable, an organization should sit down and say, “What is the level of energy I want to put into solving or addressing this problem?” And that’s probably both a financial decision and a brand decision. For instance, a brand manager might ask, “Is this the kind of consumer group that we want to continue to attract? Yes; OK, well … indicators show we may be struggling with this particular group, so let’s double down because from a brand perspective, that’s how we want to be seen.” An alternative scenario here is the data suggests (to the brand manager) that too much effort is being spent focusing on the wrong group. Without asking the right questions, the data just suggests that marketing is ineffective. To finish, a company really needs shared responsibility to make data truly actionable. Ultimately, as an organization you determine what resources you want to put against data analytics, but knowing what question(s) you wanted answered first is important to making data actionable.

4) How will health club and health club member data evolve over the next several years — what will prove to be important signals for our industry in addition to financial, transactional and activity data?

[Jeffery Cooper]: So besides activity data from wearables, there will be a lot of contextual data the health clubs can now potentially get. With corporate wellness taking off you are going to see deep integration with insurance companies and insurance data. I believe, along those lines, health clubs will also be integrated more with the medical industry. As prevention becomes more associated with a basic level of fitness, I believe you will see medical data become relevant.

In that regard, I think prevention of chronic diseases is eventually going to drive a lot of people toward health clubs from the medical side of things. Right now, in most cases, doctors cannot write a prescription for a health club, but that could change as more complex sensors begin to validate the efficacy of fitness interventions.

Genomics data is another revolutionary area. You already have things like 23andMe, but there is a company Helix, which has been recently funded. Their idea is to sequence your genes, and license this data back through health care providers and fitness applications. With genomic data, consumers can make better choices (and health clubs can cater to them better). With this data, people can ask:

  • Am I suited for bodybuilding?
  • Am I suited for endurance?
  • From the limited time I have, where am I going to see the best results?

As science becomes more advanced, these companies will snapshot your genome once, and then as the science learns more and more about the genome — health clubs can take preemptive, proactive actions from that data to keep their members healthier longer, keep them out of the hospital and improve their overall quality of life.

5) Why does “Big Data” often fall short on delivering on its value promise?

[Mark Newman]: Personally, I feel that part of the problem is the way output data get reported. I feel that in data science to deliver a static report, it is potentially a sign that we have not done our job properly. The reason for that is because when we deliver a page of numbers, there is often no context to the end-user. When you are able to create/refine a business question, you generally make the presumptive problem simpler than it first appeared. Before you set off looking to get value from data, your organization should come up with your desired thresholds and metrics. Then instead of looking at static reports that, at best, will give you trailing indicators — build a dashboard that gives you real-time intelligence based on the most important metrics for your business. This dashboard should be something that your employees can always go to — not just some report that gets delivered on your desk — but something that is readily available on an ongoing basis. You also need to evaluate and monitor the efficacy of this dashboard on an ongoing basis. For instance, if you have a forecasting dashboard and there is a forecast your company is trying to meet, is the dashboard valuable and helping you meet your forecast?

I believe both dashboards that monitor things that drive your business forward, as well as insights that are actionable, are at least two things that give you some evaluation of whether “Big Data” is helpful and valuable within the context of your own particular situation. The other thing is that you really want to be doing analyses all the time. You want your data strategy to evolve past sending out graphs and numbers — to actually be working to build a story of what’s going on in your organization — and back up your story with reliable and meaningful communication so every stakeholder is seeing the same thing and you can all agree that your chosen data model(s) is providing value and is meaningful within the context of your particular business.

Interview with Dr. Henry DePhillips about Telemedicine

Dr. Henry DePhillips is the Chief Medical Officer of Teladoc. At Teladoc, Dr. DePhillips is responsible for maintaining the exceptional delivery of clinical care delivered through Teladoc’s telemedicine digital health platform. Prior to Teladoc, Dr. DePhillips held several high-level leadership positions in health care. His positions included a previous role as the Chief Medical Officer at MEDecision, working as the Senior Medical Director at Independence Blue Cross of Pennsylvania, and a role as Head of Business Development, North America for McKinsey’s international Health Systems Institute. Dr. DePhillips is a health technology fanatic who is passionate about telemedicine and shifting health care from a provider-centric model to one that better values the needs of the patient.


1) How do you see telemedicine affecting employee burnout and workplace wellness?

What I am seeing is that telemedicine provides employees quick and inexpensive access to services that contribute to their well-being. Employees also generally perceive the telemedicine experience as more enjoyable than traveling to see a physician. Employees like what we provide, so our service grows as it is better understood by employees. When people get the care they need in a timely manner, this reduces workplace wellness issues — concerns like presenteeism — because employees now have easy access to care rather than “powering through” health conditions that could have unwanted consequences if ignored.  These consequences range from getting other employees sick to compounding personal medical issues by not seeking treatment.

2) What are some of the aspects of American work culture you see uniquely contributing to issues of presenteeism and employees “powering through” illness?

There is a combination of cultural factors here in the United States. One is financial, many American employees can no longer afford to miss a day of work. A second is functional. In many U.S. companies that have downsized staff, if someone misses work then there is no longer anyone to cover their role/position — calling in sick is simply not an option. A third is cultural considerations. In America it is a sign of toughness and/or commitment if an employee powers through their illness. For instance, it can be viewed as a “badge of courage” if you come in with the flu. Lastly, there are logistical considerations. In many cases when someone should see a doctor, they are unable to do so because scheduling is difficult given other considerations. This last factor is where I see services like Teladoc playing an important role. With telemedicine it is no longer a burden to see a doctor. With the traditional approach you generally must take time off work, schedule an appointment, travel from work to see your physician. Now, if an employee is in need of care, it is as close as their keyboard or mobile phone. An experience that used to be three to four hours can now be accomplished in 30 minutes with telemedicine — and unless you need to pick up a prescription, your experience can all take place in a virtual environment of your choosing.

3) How do you see telemedicine playing a role in helping improve the patient experience?

With Teladoc you can update your electronic medical record in minutes, request a board-certified physician to meet with you at a time that works with your schedule, interact with your physician using the digital modality of your choice (phone, video conferencing, digital photos, etc.), and have prescriptions sent to a location that is convenient for you. In my opinion, it is simply a better experience.

4) There are reports that over 15 million people now use telehealth, which is a 50 percent increase in usage from numbers reported in 2013. Who is driving this growth?

Telemedicine is still perceived as a rather new way of receiving care, so we have plenty of early adopters (now) but you are going to see increased utilization blossom as we move into the early majority. Those that would rather take a conservative/traditional approach will likely become more open to telemedicine as the technology matures. “Try it once, and you will like it for life,” really applies to our technology. We see that once users try it once they often return, at least here at Teladoc. In certain populations it is a no brainer — single parents with kids, those that travel for business — again anyone with logistical considerations will likely become lifelong users once they try it once.

5) Why do you think there is a significant proportion of physicians that have an aversion to telemedicine?

It is an evolution. It is a work in progress. Health care as an industry tends to be fairly conservative when it comes to technology. Think back to the Marcus Welby, M.D. days and we have not evolved much since then in regards to care. Health care is still a very provider-centric experience. The provider tells you the times that work for them, you go to the provider’s place of practice, the provider basically makes you adhere to what is convenient for the provider. I see telemedicine as the first major shift towards a consumer-centric approach. Under the current antiquated paradigm, a patient has to say, “I am sick, where must I go to receive care?” However, with telemedicine the patient can now ask, “I am sick, how can I most efficiently get the care I need?” And now, care is as close as the smartphone sitting on the bed stand. The doctor now comes to you, at a time convenient for you. At Teladoc, the average time between requesting a visit and being able to see a physician is 10 minutes. My job as the CMO of Teladoc is to make sure that the quality of care that people expect [from the old model] is the best it possibly can be [in the new model] as we go through this evolution. It is important to note, telemedicine is meant to address a subset of medical problems that has been specifically selected to work with telecare, problems that can be accurately and successfully treated using this form. In most cases I believe telemedicine will provide the end-user a superior experience, but there are going to be some specialties where telemedicine doesn’t make sense, and that is okay too.

Live Life Love | Volume Thirty-Six

Hi Everyone,

So this was not the way I wanted to start the next chapter. As many of you know — and I regretfully inform those who do not — my brother Brian passed away sometime within 24 hours of my hitting send on the previous Live Life Love newsletter. A surreal coincidence to know that as I reported to you how much I enjoyed the experience that he and I had shared, there would never be an opportunity to share another experience with him again. As you might expect, Brian’s death has led to some pretty deep introspection the past few months. As a result, this is a difficult newsletter to write this quarter. The words are not flowing. I could try to end with some catchy quote about life and/or death, but that would be the easy route. The experience has opened an uninvited path to some deep work on my thoughts about the meaning of contribution and legacy. I hope to evolve this “project” into something much bigger than a personal platform. However, for this particular installment I have to go back to basics, which is just remembering to breathe.

Business, Innovation and Entrepreneurship: This quarter’s interview is a compilation about “big data” analytics with four exceptional thought leaders: Jafar Adibi, Ph.D., the President, Co-founder, and CTO of re|unify; Jeffrey Cooper, the Senior Manager of Business Development at Samsung; Mark Newman, the President of Heads Up Analytics; and Keith Catanzano, a Partner at 2River Consulting Group. My collaborative interview focusing on business issues involving “big data” can be read here.

Health and Wellness: My health and wellness interview this quarter is with Dr. Henry DePhillips, who is the Chief Medical Officer of Teladoc. Prior to Teladoc, Dr. DePhillips was the Chief Medical Officer at MEDecision. He also previously served as the Head of Business Development for McKinsey’s international Health Systems Institute, as well as served as Sr. Medical Director at Independence Blue Cross of Pennsylvania. My interview with Dr. DePhillips about telemedicine and telehealth can be read by clicking here.

Life Experience: This quarter I traveled to Baltimore, Maryland, and checked out the American Visionary Art Museum. The museum showcases art from artists who are primarily self-taught. As such, much of the art and installations revealed the personal vision of the artist, rather than following standard conventions.

American Visionary Art Museum | Baltimore, Maryland
American Visionary Art Museum | Baltimore, Maryland

Contribution: My friend Alex lost his wife Samantha to cancer on November 1, 2013. She was a free spirit and certainly would be at home at the American Visionary Art Museum. When she passed, she left behind an unfinished album of songs, and it was bittersweet to be part of a Kickstarter campaign to get it finished. If you would like to learn more about it, or potentially contribute yourself, you can do so by clicking here.

I would like to conclude by simply saying thank you to the many of you that reached out to me and/or my family these past few months. The warmth that was bestowed upon us was overwhelming and helped us tremendously navigate through this difficult time. I love my brother very much, and take solace that his spirit will be interwoven into this effort as I continue forward. Borrowing from his humility and sense of adventure, I will do my best to increase the utility of information this project provides, as well as seek out new experiences that are worthy of sharing — carrying his memory with me.

In health,
Dr. Rucker

P.S. Again, for those of you that knew Brian, my hope is that this is not the medium you are finding out about his passing. Brian’s obituary is available online here.

Live Life Love | Volume Thirty-Five

Hi Everyone,

Roy Amara, a systems engineer who worked at the Stanford Research Institute, is credited for establishing Amara’s Law: We tend to overestimate the effect of a technology in the short run, and underestimate the effect in the long run. This sentiment has now been repackaged by many in motivational and coaching occupations and repurposed to serve as a testament of our inability to accurately estimate human effort. Back in March 2011, I indicated it was the beginning of a new chapter. Today, six years later, I am grateful to share that chapter is closed. The starting line was no job, no kids and an ambitious goal. The finish line is a Ph.D., two healthy kids and recently being honored as one of the top 50 influencers in digital health. Unfortunately, there is no secret sauce to share. Advice from Gary V. and Grant Cardone failed me. Instead, I found diligently and constantly working smarter was better (for me, at least) than trying to work harder. I truly respect those that hustle, but in the final analysis of this “chapter,” when I gunned it looking for short-term wins I consistently fell flat (maybe why I have always been terrible at sales). This long play, though — pretty happy with the end result.

Business, Innovation and Entrepreneurship: This quarter’s interview is with John Gengarella. John is a Harvard graduate, well-known for customer-centric design and application development. In 2015, John was appointed the CEO of Netpulse, one of the market leaders in mobile technology for the fitness industry. My interview with John focusing on the business of fitness technology can be read here.

Health and Wellness: My interview around health and wellness this quarter is with Jill Gilbert. Jill is a lifelong entrepreneur. She created the first comprehensive online directory and resource for senior care, Gilbert Guide. Jill also produces the Digital Health Summit at CES, as well as several other prominent digital health events year round. My interview with Jill about health technology can be read by clicking here.

Life Experience: I traveled to Jackson, New Jersey, to log this quarter’s life experience, which was to ride the largest roller coaster in the world, the Kingda Ka. Reaching a height of 456 feet, there is not a taller roller coaster in existence. I got to enjoy the experience with my brother, which made it even better.

Kingda Ka roller coaster

Contribution: Some great opportunities to log contribution this quarter, which is always gratifying. I was a benefactor for the following charities: Dare to Bare, Cystic Fibrosis Foundation and March for Babies.

If you feel like contributing this week, here is a good deed that will not cost you a thing. One of my neighbors here in Alameda, Dan Goldfield, is extremely passionate and selfless about helping others. He teaches at-risk youth and is trying to get a small grant from Farmers Insurance to take his students to the Point Reyes National Seashore. If this is something you can get behind, please think about supporting him with a vote by clicking here (you need to search Alameda, CA, for his name to come up). You can vote once every day for the next week.

Wishing you a very prosperous summer. Reach out if you are up for a burrito and/or a beer. I have a little more time for either/both than I have had the past few years and I’m really looking forward to the next chapter. Hope to see you in it.

In health,
Dr. Rucker

Interview with John Gengarella about Fitness Technology

John Gengarella is known for his extensive experience in global operations, customer-centric design and application development. He has been connected with highly successful enterprise software businesses for over 25 years. However, John began his career in the fitness industry. Outside of the fitness industry, John has held executive roles including vice president of C3 Energy, Chief Revenue Officer for 24/7 Customer and CEO of Voxify. In 2015, John was appointed the CEO of Netpulse, a company that has been viewed as one of the market leaders in mobile technology for the fitness industry. In addition to his professional work, John is the lead mentor in the non-profit organization StartX, which focuses on the development of Stanford’s top entrepreneurs through experiential education. He is also an angel investor and advisor to various early stage technology ventures.


1) One thing that consistently surprises me is that it usually takes a while for emerging tech companies — ones that specifically focus on health clubs — to realize that the total addressable market (TAM) regarding health clubs is actually fairly modest. In this regard, what lessons can you pass down to anyone thinking about creating technology that caters to health clubs?

I do not agree that it is a small total addressable market. I actually believe it’s enormous.  I think if you look at what’s out there today, you’ve got a handful of groups doing over a billion dollars in sales. If you look at the spend over the entire industry, there are testaments of over a $70 billion TAM. Folks are investing serious money to engage their members. I believe there are 185,000 clubs globally, that’s an enormous market. MINDBODY got a $450 million evaluation, a company that’s focusing on a niche segment of the market — studios.

You can easily build a $100 million company in this space. But it depends on how you define the market. Thirty years ago or so, I had a few clubs. We had index cards that had member’s names on them and you stuffed envelopes with monthly invoices that looked like the things you get at Denny’s. So, if you were assessing the fitness market at that time as an entrepreneur, did you say, “Hey, I’m going to make money on index cards and envelopes,” or did you say, “Hey, I can build a CRM solution, or automated billing system, and completely change the dynamics in a new set of investments in that segment?” I think you have got to look at the market overall and how we’re solving problems. I think if you look at IT spend, for example, that might be a small number. That might only be a billion dollars. But what does an average club spend on marketing? It’s 10x that spend. I bet worldwide clubs spend close to 10 billion annually on member acquisition. I think there is an enormous opportunity for the right entrepreneur in this space. The challenge is you have to go solve a problem. What do I do to engage members? What do I do to attract new members? What do I do to increase my retention? …the same core tenets exist from 30 years ago.

So my assessment is I think the market’s huge. And then, where do you draw the line? Is it Fitbit? Is it Under Armour? I mean the lines are blurring every day, there are tens of billions invested annually in fitness. As a software guy, I’m not as interested in treadmills and those kind of things. The Precors and the Matrixes will make their money selling equipment. 30 years ago, we talked about what was inside our four walls. Today, now we are talking about engagement with members outside of those four walls, as well. The club brand is still alive and well… on your app… on your T-shirt — but the market is changing. It is no longer necessarily simply what is happening in those three hours a week inside the club anymore.

2) As the head of a company that makes a great fitness mobile app — specifically regarding fitness — what is the role of activity trackers as they exist today, when the modern smartphone often rivals the internal hardware of commercial fitness devices?

That’s interesting. There is no question that the Apples and the Samsungs are going to be battling the Fitbits of the world very soon in terms of tracking. You have a few pieces that you’re solving for in this space:

  1. You need a form factor that works
  2. You want as complete of a data set as possible
  3. You want accuracy

I think the biggest challenge for smartphones is form factor. Especially since phones are getting bigger as they also are turning into mini entertainment centers. Also, women often leave their phone in their purse, so it is not constantly tracking activity. I think form factor is a challenge for phones today. What this means is you are also not getting a complete data set. For those who want all their activity tracked, you need to have your phone glued to you 24/7. Accuracy is also an issue. Without separate peripherals you are not going to get heartrate information, at least not accurately. There is still skepticism, even if smartwatches take, that they can accurately track heartrate. 

Phones do have a phenomenal advantage in that they are ubiquitous, and adoption is exceptional. I don’t know anybody that does not have a smartphone today. But what do I get out of that? Do I get the accuracy of my heart rate? Do I get other capabilities that I want to see… capabilities I can get from a wearable that I am in touch with the entire time. Given what we are trying to solve for, it will prove to be an interesting battle.

3) Looking past current wearables on the market today, where do you see digital health taking the health club industry five years from now?

That’s a really interesting question because the potential has become enormous, but just as it has been for the last 30 years, the next five will still be about relationships. What’s the relationship that I have today with my club (as a member)? What’s the relationship that I have with the other members? What’s the relationship that I have with my employer? What’s the relationship I have with my healthcare provider? My doctor? My coach? My team? I think when you look at the evolving way we engage in relationships through technology, you’ll see the digital aspect of that becoming more pervasive. I am not addressing just the customer relations concerns here, but also the relationship an employee has with their employer —  a financial relationship that plays a role in the person’s well-being. The big challenge is going to be the exchange of value. To me, there is a two-way value exchange. For instance, I (employee) let you see my steps on a daily basis, you (employer) give me $300 towards my monthly insurance bill. People love to discuss privacy concerns, but quickly forget it was only a few years ago they were hesitant to store credit card information with Amazon.com. Privacy issues aside, annual healthcare spend is the largest line item on our country’s P & L! Follow the money — over the next five years there will be enormous energy around a digital understanding of each consumer, each member, each employee. I see this evolving into some greater level of personalization that simply does not exist today. How do I get to know a specific person in a meaningful way and understand their needs, provide them value for that exchange, and capitalize on the value associated with that understanding in an ethical way? We’ll answer that question.

4) There is a modern-day narrative that fitness delivery is well-positioned, better than ever, to be on the forefront of the continuum of health care. However, this discussion has been going on for a few years now (e.g. Exercise is Medicine, Exercise is a Vital Sign, etc). In your opinion, do you believe technology has helped, or hindered, progress in this area? 

The challenge is the complexity around data privacy. What are the responsibilities around those that are in charge of the data? How do I protect the consumers’ willingness to share? What level of privacy should I expect in terms of dealing with any manufactured insight, i.e. new personal information generated about me that could effect my livelihood (e.g. credit score)? This problem doesn’t get solved with one “ah-ha” moment. There are going to be step-changes that go along with this because we are a cautious nation when it comes to privacy. There are credit card breaches all the time with little consequence. But, if I let somebody know what your blood pressure is, I can still go to jail. So, I think that we are cautious as a society about health data, but I believe you will see that loosen over time. What are the true risks if I share this information? Truth is, you probably have a great interaction with your doctor and she becomes wonderfully more insightful about your health.

There are valid, historic concerns about the consequences of having a preexisting condition. There’s a scare about how that data can be used and possible negative impacts that could come as a result of someone having that information. Again, fair value exchange becomes important. I’m willing to share, if there is limited risk and I get something in return. Few are going to share data for the fun of it. If people get better care, get a lower rate on insurance, get more personalized programs that are really consistent with their health, they will come around. You can see that today, in the volume of opt-in consumer apps that are out in the market. There will be dissection among the population: those that are willing to share health data and those that are not. There is always a sub-segment that’s going to believe in some conspiracy theory that, “data will always be used against me.” They are not going to participate willingly. Luckily there are many that have a willingness to take that risk. I think the more challenging issues are not around, “Can I collect data and generate insights around this woman’s health and well-being?” The challenges are more going to be around policies and protections that allow the consumers of that information to use it appropriately and ethically. To me it’s not technology that has hindered us so much… people have.  

5) The last couple of questions I have asked you what you think might be different in the future regarding fitness technology, a harder question might be the one I will conclude with: what is going to remain the same five years from now?

Five years from now, mobile will still be the center of our lives. It is the communication mechanism for any audience, whether you are talking about a health club member, you are a member of an airline, a hotel guest, or an Uber rider. Mobile will remain the primary platform for customer interaction in the near future. This bears repeating from my previous answer… thirty years ago, I used to have a few health clubs and the same mandates exist today: a need to acquire new members, a need to retain those members, and a desire to increase the contribution/benefit made to the member base. That’ll be the same in five years… probably for as long as health clubs exist.

With the pervasiveness of availability of information available to the consumer, the fitness industry, like any other mature industry, is becoming more and more competitive. So, the drivers of asset performance will be the same in five years. Mechanisms for personalization will evolve. There will be this quest for personalization. Whether I have a big box or a small box, I will be able to use technology to have the capability to differentiate my offering with personalization, but that is only filling the need that has always been there …building a meaningful connection with your member. 

Interview with Jill Gilbert about Health Technology

Jill Gilbert is a lifelong entrepreneur and the producer of the Digital Health Summit. Jill worked in the film industry for 15 years before moving on to health and technology. After leaving Los Angeles, her initial focus was the crossroads of aging and technology. She created the first comprehensive online directory and resource for senior care, the Gilbert Guide, for which she was praised as the champion of positive change in the aging services industry. In 2015, she launched another event at CES, Robots on the Runway, which focuses on the world of robotics. Her latest project is called Discover Baby Tech, a website and blog that will aim to bring together products and technology for new parents.


1) Behavior change and wearables are two buzz terms often talked about in the same conversation, yet many devices don’t truly deliver on the promise of actively helping someone change their behavior. What’s a favorite example of a digital health product that actively assists the user in building a desired habit?

Activity trackers have become synonymous with the word “wearables.” These devices (activity trackers) will certainly change some people’s behavior, primarily through awareness. Oftentimes, though, they fall short when it comes to behavior change. I’m more excited about closed-loop wearables, devices that are often condition-specific that trigger — or better yet, assist — with the desired next action to treat a particular condition. When you can engineer the need for “change” out of the usage loop, you immediately get a lift with regards to device efficacy. Most behavior change — when it comes to wearables — is going to be as good as the prompt and/or stimulus. The closer we can get the stimulus to inspire (or be) the next desired action in the loop, the closer we get to behavior change being a non-factor. Until activity trackers move our feet for us, I believe they won’t be as successful as other innovations I have seen recently in digital health.

2) It’s clear that the industry is on the verge of some significant breakthroughs. In your opinion, what’s currently being underreported regarding health technology that deserves greater attention?

Mental health is an area where digital health really can play an important role. For instance, pharmaceutical adherence is a huge issue in mental health. Many people with mental health issues suffer when they are not regimented about taking their medication. We are also making strides with regards to digital therapeutics. Cost is a major factor in treating mental health, and advances in the way we can treat people through behavioral modification platforms that are scalable — made possible because of digital health — is exciting. Telemedicine is also making an impact, by allowing patients to benefit from doctors that have excess capacity. Health technology is allowing people to get treatment who are so unwell they cannot leave the house. It is opening up treatment options for those worried about stigma. There are a lot of great things happening here, but it is not getting as much attention as one would think. Look what Lantern is doing, look what Iodine is doing, this is great stuff and not talked about enough. There is also a lot of promising technology to help with addiction as well.

3) Digital health is well-positioned as a valuable tool to help people with their entire continuum of care, with the potential of assisting people in lessening the frequency of doctor visits. What needs to happen so that consumers can have a better coalesced health experience through digital technology?

Interoperability is key. It is so important, and its lack of existence creates so much friction. Because the problem is so complex, we see people design around it (data operability), and what you are left with is disparate solutions. Literally, digital health in a lot of ways is the Wild, Wild West. Yet, on the other side you have hospital systems with antiquated legacy systems that often don’t even have APIs. We are finally making some strides though… Cisco and UCSF have partnered to engineer an integrated health platform that will hopefully get us closer, but the problem is mammoth. We need smart minds and a lot of resources to solve this problem.

4) Technology is inherently always changing. That said, what have been the constants since 2010 that are facets and/or indicators of successful digital health products? In other words, what is foundational for innovators to get right, or avoid getting wrong, in order to be successful in this space?

This sort of piggybacks off my Wild, Wild West comment. This space is inherently complex, and so in a lot of cases processes that work for pure tech start-ups — like creating a minimal viable product (MVP) — fail in this space. Especially if you hope to get FDA approval, there is a lot to navigate and that’s why we always stress strong partnerships. That said, companies still need to be bold. True innovation and breakthroughs come from mavericks who accomplish what others say cannot be done. There is a balance. The good news for innovators is that it is hard for bigger companies to take risks, so often through the “right” type of partnerships a start-up can get significant help from a larger organization. Obviously, there will be unique considerations that depend on the product. A reimbursable product is probably going to have to rely more on outside help than a consumer box product. The good news is there are great partners out there, like Ximedica, whose primary purpose is to help these types of products figure out a proper strategic path and wade through the intricacies of regulation.

5) You have set your sights on baby tech. Why baby tech? And what benefits do you hope to deliver with this next endeavor?

My ideas around baby tech came about from CES, and getting a lot of products sent my way that were meant for babies, new moms, fertility, post-pregnancy, etc. There was/are enough interesting digital baby products out there, and it was clear this is a distinct category worth addressing. Also, I got enthusiastic about it because I was about to become a new mom myself when I first saw this category get exciting. There is so much amazing stuff out there. Moms can go it alone, we have for decades, but [digital products] might help ease some of the burdens. I am creating DiscoverBabyTech.com to share what I know, create a space for product reviews, report new developments in this space and generally create a resource for moms interested in this topic. The plan is to launch next month sometime. We hope to attract people like ourselves to the site, new moms who love tech.