Would you make this choice? (photo credit: notsogoodphotography)

“Bias is the worst disease from which the society of our nation suffers” – Albert Einstein
.

What is bias and how does it affect your health?

Well, it turns out human brains have a number of cognitive biases that can interfere with good decision making (and delay your progress toward feeling better). For example, people tend to worry about the risk of taking a new treatment, while underestimating the baseline risk of doing nothing about their suffering.

Here are a few of the colorful biases we have as humans:

.
1. Bandwagon bias – the tendency to do things because other people are doing them. “Everyone else is on the Atkins diet, so I’ll try it too.”

.
2. Confirmation bias – the tendency to search for or interpret information in a way that confirms your preconceptions. “See, I have shortness of breath, so I must be having a heart attack.”

.

3. Expectation bias – the tendency to keep data that agree with your expectations for the outcome of an experiment, and to disregard data that conflict with those expectations. “Well, that meal didn’t count because…”

.
4. Framing effect – drawing different conclusions based on how data is presented. “If I only look at the last 2 days, I’ve been sleeping 7 hours a night.” (disregarding the insomnia from the last 3 weeks).

.

5. Wishful thinking bias – forming beliefs and making decisions according to what is pleasing to imagine instead of by appeal to evidence or rationality. “I can have 8-minute abs with no effort just sitting on my couch.”

.
6. Availability bias – estimating what is more likely by what is more available in memory, which is biased toward vivid, unusual, or emotionally charged examples. “I’m more likely to die in a plane crash than a car crash because I see more plane crashes on TV.” (but car crashes are much more likely)

.
7. Selection bias – a distortion of evidence or data that arises from the way that the data are collected. “I’m only going to measure my blood pressure on weekends.”
.
Despite the dozens of biases we have, we manage to function pretty well most of the time, right?

Yes, but it’s still a good idea to take a second to check in on these biases before making any major decision. But keep in mind that sometimes the biases can’t be overcome even if we know about them.

For more fun reading on cognitive biases, see Wikipedia’s comprehensive (and entertaining) article on the topic. Do you have any of these biases?

.

Related Posts

How To Run A Successful Self-Experiment

Feel Better – How To Find A Treatment That Works

Getting Diagnosed – How To Choose The Right Test

New relationship = more sex, new baby = more weight gain (Photo credit: juhansonin)

“Whatever course you decide upon, there is always someone to tell you that you are wrong. There are always difficulties arising which tempt you to believe that your critics are right. To map out a course of action and follow it to an end requires courage.” - Ralph Waldo Emerson

.
Say you’ve chosen to try a new treatment or new intervention for your health. How do you really know how well it is working?

The key is to run a self-experiment, to have the numbers tell you what’s happening. This is easier to do with some treatments than others, but here are 5 general principles that will help you do a successful self-experiment:
.

1. One test at a time. Keep it simple. Don’t try to test too many new variables at once, or your results will not be meaningful. Change one thing and one thing only, trying to keep everything else the same, and see what happens.
.

2. Define your outcome variables. What do you want to measure? If you want to see if something is affecting your mood or sleep, track how happy you are or how many hours you sleep. If your new treatment is to help with pain, track pain levels. Try to keep the things you measure to a minimum too – identify the one or two things you really want to change and see if they are changing.
.

3. Track these over time (longitudinally). One day of data isn’t enough to see how well something is working. Depending on what you’re measuring, you might need a few weeks of data to start seeing patterns. Or you might notice a change sooner than that. Ideally, start measuring yourself BEFORE you start the treatment, so you’ll have a baseline measurement to compare your new results to. For example, if you want to lower your blood pressure, start by knowing what your blood pressure is, then you’ll know if it’s improving or not.
.

4. Do an N=1 randomized controlled trial on yourself. Here’s where you can start to get fancy if you want more scientific results. CureTogether will soon be able to set up a randomization schedule for you, where you take a treatment some days and a placebo on other days. This might not work for some medications where not taking them would mean severe withdrawal or other side effects, but would probably work fine for things like lifestyle or dietary interventions
.
.

5. Self-blind your study. For uber-geeks, you could even go so far as to create your experiment so that you don’t know whether you’re taking a treatment or not. This would eliminate any placebo effect and give you the most definitive results from your self-experiment.
.

On the other hand, if this is getting complicated, watch Professor Seth Roberts’ “Stop Worrying and Start Experimenting” talk on experiment design and keeping it simple.

Seth Roberts on experiment design from Kevin Kelly on Vimeo.

.
Once you have your data and have analyzed your results, now it’s the time to make decisions on how to continue your course of treatment.

If it’s working, keep going!

If it’s not, rinse and repeat your self-experiment with a new intervention.

At the same time, keep in mind that our decisions can often be biased, which will be the topic of our next blog post, “Are You Biased? How To Make The Right Decisions”.
.

Related Posts

Feel Better – How To Find A Treatment That Works

Do You Have A Condition? How To Find Out

Getting Diagnosed – How To Choose The Right Test

Traditional Chinese Medicine of Bamboo Cupping (photo by johey24)

.
Fall seven times, stand up eight. – Japanese proverb

You’ve received a diagnosis. A mix of emotions sets in – relief, panic, confusion. What do you do next?

The menu of treatment options can seem overwhelming.

.
Here are 3 simple principles to get you started:

1. Ask your doctor. Chances are your doctor has a good handle on your history, the context of your condition, any other prescriptions or supplements you are taking that can interact, etc. See what her recommendation is, then do your homework looking it up online. Wikipedia and PubMed are good places to go for reliable information.

.
2. See what the crowd has to say. Have a look at the stats at CureTogether as another piece of information that can help you decide. Treatments for over 400 conditions have been reported by patients at CureTogether.
 You might see some ideas on the list that you hadn’t thought of before.

.
3. Don’t forget about cost. There are 3 kinds of cost to look at when it comes to considering a new treatment:

- the financial cost to your monthly budget

- the cost to your body in terms of risk of potential side effects

- and, on the flip side, the cost of not getting the condition treated – what’s it likely to cost you in terms of quality of life and ability to earn a living?

Find or figure out the numbers for all these costs before you make your decision.

The next step is to see how well each treatment you try is working for you. Stay tuned for our next blog post on “How To Run A Successful Self-Experiment”.

.

Related Posts:

Do You Have A Condition? How To Find Out

Getting Diagnosed – How To Choose The Right Test

13 New Discoveries at CureTogether

Say “Aaaahh!” (Photo credit: superfantastic)

“First the doctor told me the good news: I was going to have a disease named after me.” - Steve Martin
.

Say you’ve decided to go ahead and get a diagnostic test done to have a more definite answer on whether you have a condition like depression.

Now what? Where do you start?

First off, here are some general factors to consider in choosing a test:
.

1. Informativeness is basically how good the test is at telling you something useful. How informative a test is comes from both its sensitivity (how likely the test is to diagnose you as positive if you do have a condition, or avoiding false negatives) and specificity (how likely the test is to not diagnose you if you don’t have it, or avoiding false positives).

The ultimate test is both sensitive and specific – and most likely to give you an answer you can trust.

.
2. Invasiveness is how disruptive or uncomfortable the test is to perform. A questionnaire is non-invasive, a laparoscopic surgery is invasive.

Try to minimize invasiveness if there is a choice between two otherwise equal diagnostic tests.

.
3. Cost is definitely a factor for many people, even with insurance. People with higher deductibles or no insurance altogether will have to pay even more attention here.

.
Using depression as an example, the diagnostic test consists of a visit to a doctor or therapist’s office and a series of questions drawn from the DSM IV.

Sensitive? Yes, 86% chance it will diagnose you if you do have depression.

Specific? Yes, 82% chance it will not diagnose you if you don’t have depression.

Invasive? No.

Cost? $130+. Of course, if you want to continue therapy, start medications, or find alternative treatments, that will increase your costs.
.

You can find a list and helpful descriptions of common diagnostic tests at Harvard Medical School’s Family Health Guide.

And for tips on how to find the best treatment for you, stay tuned for our next blog post: “Feeling Better – How To Find A Treatment That Works”.
.

Related Posts:

Do You Have A Condition? How To Find Out

5 Free Self-Tracking Tools to Help You Get In Shape

Depression Sufferers 3x More Likely to Have Anxiety

Be an investigator into your own health! (Photo credit: chrisbb)

“Trust yourself. You know more than you think you do.” – Benjamin Spock

How do you know if you have anxiety, migraine, anklosying spondylitis, or something else?  If you haven’t already been diagnosed with it, here are a few simple, general pointers to set you on the right path:
.

1. Is your condition rare? In the case of anxiety and migraine, no – they affect tens of millions of Americans each. But it’s always a good idea to look at prevalence data to figure out your baseline risk. In other words, don’t overestimate your risk of having a condition just because you have one of its symptoms.

Wikipedia often has prevalence data for conditions, and disease foundations are another good source for this.
.

2. Do your symptoms match up? If you think you may have a condition, compare yourself with others who have that condition to see how well you fit. Take a quick look now to see if you have most of the common symptoms: over 7000 people at CureTogether have reported symptoms for 469 conditions.

Search for the one you’re looking for here and see if you match up.
.

3. Should you get diagnosed? If your symptoms do match, you might want to get a more definite answer on whether the condition you’re looking at might be causing these symptoms in you, so that you can find support and appropriate treatment. If it’s a problem in your life, it’s a good idea to get diagnosed.

To learn more about choosing a diagnostic test and finding relief from your symptoms, stay tuned for our next blog post: “Getting Diagnosed – How To Choose The Right Test“.
.

Related posts:

13 New Discoveries at CureTogether

Depression Sufferers 3x More Likely to Have Anxiety

5 Free Self-Tracking Tools to Help You Get In Shape

h+ Magazine asked me to write an article about self-tracking, so I did! It’s in the Winter Issue of h+, available for download now.

It talks about Gordon Bell’s self-tracking work at Microsoft, the Quantified Self, my own tracking, and CureTogether.

I think the Quantified Life is worth living, do you?

CureTogether is 1 year old this month! To celebrate and thank our amazing members and supporters, we’re giving away free T-shirts.

Create a video (under 1 minute) on how you cured yourself, how CureTogether has helped you, or any cure-related theme. The best 20 videos get this beautiful T-shirt!

To enter, upload your entry to YouTube or any video-sharing site by August 13 and send the link to Alexandra at alexandra@curetogether.com.

Good luck!

News Update

CureTogether was also mentioned in these articles recently – many thanks to the authors and readers who keep encouraging this work!

Wired: “Know Thyself: Tracking Every Facet of Life, from Sleep to Mood to Pain, 24/7/365“

Wall Street Journal: “Health Data Proves Contagious on Social Media”

Brainandspinalcord.org: “A Novel Approach to Self-Empowered Healthcare“

One person with a plan can inspire great change.

The person? Harold S. Luft, Director of Palo Alto Medical Foundation Research Institute and Caldwell B. Esselstyn Professor Emeritus of Health Policy and Health Economics at the University of California San Francisco.

The plan? Total Cure, published last year by Harvard University Press, summarized in Dr. Luft’s words: “To change the health care system, combine the collective action potential of government with the flexibility and innovation of well-designed markets.” Read the rest of this entry »

We are excited to announce today the release of “Endometriosis Heroes: 137 Women Share Their Experiences and Treatments.”
.

What’s Inside?

137 women share stories, symptoms, and resources
Surprising data on co-morbid conditions
Detailed comments on treatments by real patients
.

Please spread the word!

Blog or tweet http://www.curetogether.org/EHeroes

All proceeds from Endometriosis Heroes go to fund the endometriosis data community at CureTogether.org. A FREE PDF version is available if you invite 19 friends to CureTogether.

.

What People Are Saying

“Congrats – hands together for you and the amazing disruptive women at CureTogether!” — Jen McCabe Gorman (@jenmccabegorman on Twitter)

“Health 2.0 in action. CureTogether uses real patient stories to bring light to under-recognized condition Endometriosis.” — Chris Hogg (@cwhogg on Twitter)

“With endometriosis, early diagnosis is important. I went from age 13 to age 23 undiagnosed. This is a common time lag for endo diagnosis. There should NOT be such a lag! Endometriosis awareness matters!!” — Jeanne, of Jeanne’s Endo Blog

“This is great. I am just starting to really appreciate what awesome power CureTogether can have.” — CureTogether member

To order your copy, visit http://curetogether.com/EHeroes/

Thank you for your support!

———

UPDATE: Since the book release, we have received comments expressing concern about hysterectomy being rated highly as a treatment for endometriosis in the book. In order to balance this view, please read this post: http://endochick.wordpress.com/2009/03/23/jeannes-endo-blog-new-post-hysterectomy-story/

With all the media attention on self-tracking lately (Wall Street Journal, Globe and Mail, GOOD), you might be wondering whether to give it a try for yourself. But the polarized comments on these articles and the labeling of self-tracking as narcissism might be causing doubt.

Here’s a special guest post from CureTogether co-founder Daniel Reda to offer reasons for why tracking yourself is a good idea. And a beautiful image compiled by the Globe and Mail, on the cover of today’s Life section.

——

“Whether it’s science, business, politics or your personal life, you can’t effectively understand, manage or improve what you don’t measure.

Human intuitive judgments, even those of experts, are systematically biased. Hundreds of studies have revealed that our decision making, memories, evaluations, estimates (e.g. how long a project will take to complete) and even assessments of how happy something made us in the past or predictions of how happy we would be if something happened in the future (e.g. if we won the lottery) turn out to be quite inaccurate.

It’s humbling, but increasingly clear that the human mind has been optimized over millions of years to solve certain kinds of problems essential to our survival very well (e.g. is this food safe to eat? is this a good mate? is this person a friend or a foe?). It was not optimized to practice law or medicine, do project management or even to predict what will make us happy.

Collecting data and analyzing it objectively is an effort to overcome our very real human limitations – to become better at managing all aspects of our lives, both personal and social.

Whether it’s applied to improving the quality of sex or to improving medical care in developing countries, its superiority over intuitive decisions is increasingly difficult to dispute. To label it narcissism is to judge its application, not its power.

The funny thing is that quickly dismissing it as narcissism is itself one of those intuitive judgments that turn out to be wrong when you look at the data (http://www.kk.org/quantifiedself/2009/02/are-self-trackers-narcissists.php)

You are free to live life by the seat of your pants, but you can’t deny that if you want to improve something, those who objectively measure, test and optimize will consistently achieve better results.”