I recently finished The Facebook Effect by David Kirkpatrick.  This is the most detailed account of the Facebook phenomenon thus far.  I think it’s worth a read if you want to understand precisely how Facebook evolved to its current form.  The book offers a history of Mark Zuckerberg’s climb more than a compelling discussion of Facebook’s cultural impact or meaning.

What struck me most about this book was Zuckerberg’s drive.  While his trademark fleece hoodie and Adidas flip-flops had many believe that his success was all a matter of luck, his relentless vision of relational connectivity tells another story.  And it was never about money.  From the earliest 10 million dollar bid while a student at Harvard to more recent stratospheric offers, Zuckerberg’s core motivation was to change the way the world communicates.  At every turn he resisted silicon valley’s build-and-flip culture to offer something with bigger value and meaning.

Perhaps what was most revealing to me was Mark Zuckerberg’s core beliefs surrounding privacy.  From his earliest days, Mark Zuckerberg has harbored some pretty extreme views on transparency and the greater good.  He and his Facebook leadership embrace what has been referred to as “radical transparency” – the belief that an enveloping transparency should and will overtake modern life.  Some of the direct quotes in the chapter on privacy are actually chilling.

Understanding Facebook’s history and Zuckerberg’s early ideas lends real insight into today’s Facebook product.  While the detail was a bit fine for me I’d recommend The Facebook Effect and predict that this will live in the long tail as Facebook’s early story.

The rest of the story has yet to be told.

Apparently we’ve got a lot of time on our hands.  That’s according to Clay Shirky in his new book, Cognitive Surplus – Creativity and Generosity in a Connected Age.

It goes something like this:  Things have changed since the mid-twentieth century.  The postwar trend of urban growth and rising education lead to an abundance of folks paid to think or talk rather than produce.  This postindustrial transition created an abundance of free time for us.  Clay Shirky refers to this aggregate potential of time and energy with the newfound capacity to create as the cognitive surplus.  It’s effectively the potential to do together what was never before possible.  Free time is a social asset to be harnessed for the greater good, Shirky tells us.

Cognitive Surplus starts with this basic assertion and drills down to how the availability of this resource has set us up for where we are today.  Because free time alone, of course, isn’t enough to cause the changes happening around us.  If that were the case the revolution that we’re experiencing would have occurred half a century ago.  It’s the availability of new tools and opportunity that are allowing us to leverage the cognitive surplus.  Cognitive Surplus explores our intrinsic motivations to participate and finishes with the challenge of figuring out how we might use this resource to produce real civic value.  Big picture stuff.

All of this is weaved together in a well-referenced, 200 page argument that’s relatively brief given the size of its message.  Cognitive Surplus is an easy read and I highly recommend it to anyone trying to grasp what’s happening around us.

As someone who thinks a lot about this stuff, Clay Shirky helps me understand the redefinition of media in the broader context.  And while there’s no shortage of people talking about the forces behind the social media revolution, there’s nothing of the depth and insight seen in Cognitive Surplus.

Read Cognitive Surplus.  Let me know what you think.

Problem:  I read a lot of nonfiction.  But 6 months after finishing a book I forget the key messages.

Solution: So what I’ve done recently is to use Evernote to outline a limited number of key take home points with every non-fiction book I read.

Simple.  Effective.  And it seems it pays off when I least expect it.

For example, during SXSH (social health unconference) I was in a session on community and the issue of movements came up in the discussion.  I had read and taken some notes on Seth Godin’s Tribes which were relevant to the discussion.  On my own I wouldn’t have been able to recall his definitions and points concerning tribes, communities and movements.  I had notes on my iPhone Evernote App which immediately brought back Seth’s key points.This scenario has played out a few times with the couple of dozen books that I’ve ‘outlined.’Breaking it down, here’s how I read non-fiction these days:

Start by underlining.  Despite owning a Kindle, much of my business reading is done on paper.  This allows me to scribble and underline in pencil.  At the end of each chapter I open my Evernote note for the book and boil down the chapter’s key points or definitions.  I usually limit this to a dozen or so points or thoughts.Keep it brief. I don’t have time to be elaborate (but I can’t afford to forget what I read) so I keep my summary points brief. If what I do is unmanageable, I’m unlikely to do it.  And remember that something’s better than nothing.

Enter on my machine – Read on my iPhone.  It’s faster for me to enter text on my Macbook Pro so I usually start there. I type it in a way that I’ll be able to see it when it renders on my iPhone – I add an extra space between points and I put the chapter titles in bold.  I keep formatting to a minimum since that just adds time to the process.

Keep a notebook. I keep all of my book notes in a separate Evernote notebook.

You may have heard that Evernote Premium account members are allowed to share notes and notebooks. While this is an option for you and your likeminded friends, it’s important to be able to recall what you think is important in language that you understand.  It’s always tricky interpreting someone else’s summary language.

Remember that what you read is always obvious and fresh when you’re reading it.  But at a time and place in the future when you may need to remember a brilliant point made by an author, your Evernote App will really come in handy.

Check out my corresponding Cinchcast on Using Evernote to Remember What You Read

In 1951 a young black woman by the name of Henrietta Lacks came to Johns Hopkins with cervical cancer. Doctors took her cells, grew them in a dish, and created the famed HeLa cell line. It was HeLa cells that created the cornerstone of some of the 20th century’s greatest medical advances.

One small detail: The treating physicians who took Henrietta’s cells never asked permission.

This story of the famed HeLa cell line is the subject of Rebecca Skloot’s recent book, The Immortal Life of Henrietta Lacks. In this thorough, well-referenced debut book, Skloot resurrects the once sketchy HeLa story and weaves it into a compelling narrative that sits squarely at the intersection of medicine, race, ethics, and patient rights. Perhaps most importantly, the depiction of Henrietta’s family offers a critical window into the vulnerable mind of the medically unsophisticated – A population at risk for passive exploitation by the medical profession.

As fascinating as Henrietta’s story is the path to the publication for The Immortal Life of Henrietta Lacks. Beyond its germination in Skloot’s community college biology class and her relentless pursuit of the jaded Lacks family, the story of how she endured three publishers and personal turmoil make for an equally compelling story.

Indepenent of her dogged persistence, Rebekka Skloot is an impressive writer. Her capacity for such riveting nonfiction puts her in the category of one of my favorite contemporary authors, Steven Berlin Johnson.

This one is worth a read.

Check out interviews with Rebecca Skloot:  LA Times, The Wall Street Journal, Smithsonian Magazine

If you want to see the difference between how doctors and patients think, read Jerome Groopman’s How Doctors Think and Thomas Goetz’s The Decision Tree.

The contrast is striking.

How Doctors Think, while offering a comprehensive review of the cognitive missteps made by physicians, is terminally physician-centric in its analysis of the relationship we share with patients. The Decision Tree, while offering a novel blueprint for self-reliance in health, seems almost sheepish in its recognition that physicians are even really that important. The muted physician cameos of The Decision Tree stand in stark contrast to Groopman’s Harvard-trained Masters of the Universe.

If I had it my way Groopman would tell us about how patients are thinking and Goetz would discuss how doctors factor practically in to the Decision Tree.

Of course a smart editor would never let this happen. Groopman’s readers pine for the stereotype physician hero. Goetz’s readers want the kind of empowerment that leaves physicians in the dust.

But reading, fiction and non-fiction, is ultimately about the fulfillment of fantasy. It’s about how we want to see things and what we want to believe as patients or even physicians. Both books offer generous helpings of red meat to its respective base.

What’s amazing is that despite the vocal movement to empower patients, no one has put together a well-referenced, readable book to help patients understand how they should use personalized medicine to influence their health. Until now.

Enter The Decision Tree – Taking Control of Your Health in the New Era of Personalized Medicine (Rodale 2010), something of a blueprint of patient liberation written by Thomas Goetz, executive editor of Wired magazine. It offers constructive narrative not only about the importance of the decisions we make but how to apply the concept of an old-fashioned decision tree in making those decisions.

“We are constantly making a series of decisions, some unconsciously, some with great intent, that combine to create our health.” It’s these decisions, argues Goetz, that define our medical destiny. These health decisions are centered around three fundamental principles that include early decisions, utilization of data and open collaboration. How we might make health decisions in the context of current social and medical technology comprises The Decision Tree’s 250 pages.

It’s an excellent read but I do have a couple of thoughts that I think are worth mentioning.

Personal genomics push

The Decision Tree does its part to encourage the use of personal genomics to steer individual health decisions.

It’s an incontrovertible fact that decisions influenced by the understanding of our individual DNA will drive health decisions in the 21^st century. And I believe that the practical application of this technology isn’t far away. But I’m not ready to believe that the benefit of personal genomic screening outweighs the confusion and misunderstanding that it often creates.

And I would have preferred that The Decision Tree draw more serious attention to the concerns and criticisms of those experts who have spent the better part of a generation identifying the genes and technology that serve as the foundation of the personal genomics movement.

Some of the genomics discussion falls victim to the health infosphere’s greatest fallacy: information = power. But
information without understanding is useless. Genetic information delivered out of context is alphabet soup – fun to look at but largely nonsensical.

But a naysayer I’m not. I embrace a future as predicted by Mr. Goetz. The most exciting generation of medicine is before us as we progressively and methodically link our understanding of the genome with the practical care of patients.

Silly old doctors

Perhaps I’m sensitive but I found that The Decision Tree at times portrayed physicians as benevolent old naysayers, dated in our thinking, and bypassed by advances in areas such as genetics. This is an unfortunate generalization. And the book repeatedly cites AMA statistics as representative of physician thinking but conveniently waits until the final pages of the book to disclose that the AMA actually doesn’t represent the beliefs of most doctors.

But who’s gonna trust a patient empowerment book that empowers doctors? I get this – empowerment is about breaking the ties with those who might control access to the information about our health.

So let’s get untied.

There’s muted mention of partnering with professional providers to help sort out these complicated issues. I think some discussion of how to identify and access new generation professionals would have strengthened the book.

Read it

In the final analysis, The Decision Tree is an approachable, well-referenced wireframe for a generation working to take health matters into its own hands. Goetz does a remarkable job of capturing this early stage of the e-patient movement. And more than a personal roadmap to health The Decision Tree perhaps plays a stronger role in offering a cultural roadmap to the changes underway in health care.

More important than the loosely branded concept of a Decision Tree (all caps) is the overriding principle that we are now responsible for ourselves. We are, as Goetz points out, stewards of our own health.

The Decision Tree has landed a comfortable place in the early discussion of personalized medicine and for that it will enjoy long backlist success.

Check out the following reviews:

Susannah Fox’s review: The Decision Tree:  What to Expect When You’re Expecting a Long Life

Brian Ahier’s review: Data Not Drugs

Kent Bottle’s review: Check Lists & Decision Trees v. Spontaneity & Imagination

]]> http://33charts.com/2010/05/the-decision-tree-an-early-roadmap-to-the-future-of-personal-health.html/feed 0 http://33charts.com/2009/10/vaccinepreventable-disease-the-forgotten-story.html http://33charts.com/2009/10/vaccinepreventable-disease-the-forgotten-story.html#comments Thu, 22 Oct 2009 08:00:00 +0000 DrV http://02d880f.netsolhost.com/2009/10/vaccinepreventable-disease-the-forgotten-story.html

I’ve always suggested that when we publicly put a human face on the victims of vaccine-preventable disease we would begin to win the war against antivax propaganda.

We’ve arrived.

This month Texas Children’s Hospital published Vaccine-Preventable Disease – The Forgotten Story, a compilation of first hand stories told by the families of those touched by vaccine preventable disease. Vaccine-Preventable Disease – The Forgotten Story is written and produced by the experts in the Texas Children’s Hospital Center for Vaccine Awareness and Research (CVAR) and is sold at cost.

Vaccine-Preventable Disease – The Forgotten Story is impressive in its simplicity. Flipping through you can’t help but be drawn to the compelling first-hand narrative of families touched by preventable childhood illness. Each story is matched with black and white photographs that are as much haunting as touching. I can’t seem to put it down.

Behind each person who has contracted a vaccine-preventable disease is a story of a life interrupted, a family devastated. This book tells the long-forgotten story. It will be a game changer in the battle against fear and misinformation.

In just a few short weeks since its initial printing Texas Children’s Hospital has sold over 15,000 copies and demand is escalating. As an understated but powerful social essay, I predict that Vaccine-Preventable Disease – The Forgotten Story will reach distribution in the hundreds of thousands and serve as an emotional anchor for those looking to advocate for those who can’t advocate for themselves.

You can purchase your own copy here.  The Forgotten Story posters for seasonal flu, measles, hepatitis B and pertussis are also available.

The Forgotten Story is written by Rachael Cunningham, MPH; Julie A. Boom, MD; and Carol J. Baker, MD

]]> http://33charts.com/2009/10/vaccinepreventable-disease-the-forgotten-story.html/feed 1 http://33charts.com/2009/10/direct-red-a-direct-look.html http://33charts.com/2009/10/direct-red-a-direct-look.html#comments Thu, 08 Oct 2009 04:00:00 +0000 DrV http://02d880f.netsolhost.com/2009/10/direct-red-a-direct-look.html

I think the world has reached its quota of medical memoirs. If you’ve read one, you’ve read them all. Formulaic stories of quirky patients, crises of conscience, awkward med students coming-of-age and overbearing superiors are all too much for me at this stage of my medical career.

So why I might have been drawn to Gabriel Weston’s Direct Red – A Surgeon’s View of Her Life or Death Profession?

I stumbled on Direct Red at my local bookstore. I read the first few pages and was drawn to Weston’s beautiful voice. So I brought Direct Red home and couldn’t put it down.

Direct Red details Gabriel Weston’s training and early career as ear, nose and throat surgeon in London. Her book is divided into chapters based on her categorized clinical experiences. Each chapter serves as a repository for what seem, at times, to be loosely connected experiences. Sex, death, beauty, hierarchy, and ambition among others all have equal time.

The drama brought to Direct Red is not contrived. Weston’s humble view of hospital life is real. Her point of view lacks the self-absorbed position that one might expect of a surgical memoir. In fact, Weston mocks her own smallness in the face of the sick. While her flawless writing is at times unapproachable, her tendency towards self-deprecation keeps it real. Everybody loves a humble surgeon.

While I was drawn to Direct Red’s almost poetic narrative, I have to admit that I’m more accustomed to a looser American voice. And to read Direct Red you have to put up with Weston’s British medical lingo. It was only in the context of her story that I understood a trolley was something other than a train that tourists hang from in San Francisco (that would be a gurney or stretcher on this side of the pond).

I loved Direct Red. I suggest that it should be required reading for medical students. Medical trainees should feel the texture that Weston brings to an increasingly mechanical, featureless world of doctors and patients.