Diabetes Tech

Everybody would know what everybody else is talking about and even patients could join the conversation. Imagine that!

On November 8 I presented a poster at the Startup Company Showcase of the Diabetes Technology Society meeting in Bethesda, Maryland. The Showcase featured a variety of gizmos, most notably for monitoring and measuring risks and symptoms, enhancing delivery of medications, and managing dietary and lifestyle choices. Humaginarium uniquely made a case for diabetes education and was one of just two solutions that empower autonomous self-care.

The three-day meeting agenda listed many speakers from around the US and overseas. Most were academic, many were corporate, a few were government officials from the FDA and the NIDDK. I observed more than I understood because typical presentations were given in science lingo over PowerPoint slides that looked like pharaonic walls in the Valley of the Kings. I’m not complaining about that. If presentations were given in a vernacular over artistic images, there would be far less need for the Rosetta Stone that Humaginarium is carving. Everybody would know what everybody else is talking about and even patients could join the conversation. Imagine that!

My observations and interactions with attendees led me to this provisional conclusion: Humaginarium is making a kind of health education that doesn’t already exist for diabetes, has never been tried, makes a lot of intuitive sense to providers and payers, and complements a pervasive, relentless, seemingly desperate search for solutions that empower patients. Desperate is a strong word, but in light of the widely acknowledged catastrophe threatened by type 2 diabetes, it’s no exaggeration.

I even received encouragement from two executives with a pharmaceutical company. They so liked the idea of Humaginarium that they asked if I could make similar media for their marketing and education groups. I was amused. Before customer discovery earlier this year I had actually included B2B revenue streams in our business model, but later removed them because I learned from stakeholders that big pharma invests in sickness rather than wellness. (You may think I made that up, but it’s true.) Anyway I shared this anecdote with my DTS interlocutors and stated confidently that their company wouldn’t care for things Humaginarium is making. They politely disagreed and walked away.

To me one of the striking things about the Diabetes Technology Society meeting was an almost complete absence of educational technology. Apart from my poster, not a single other session I attended, or read about on the program, acknowledged the existence of edtech or its utility in the struggle with chronic illness. Is that because diabetes treatment and management don’t rely on health and medical education? No, it is not. Education plays an enormous role, but I sensed that educational technology doesn’t (yet). Diabetes education is still an analog business pretty much, like the conference itself, and powerful affordances of instructional systems are overlooked rather than resisted. Some of this may be for economic reasons, but my intuition is that the real reason is unawareness. The diabetes experts aren’t resisting educational technology; they just don’t know much about it and haven’t talked with a lot of people who do.

Still the knowledge and passion of conference attendees really impressed me. These are the kinds of people that I want to work with, and several stepped up to advise the Humaginarium prototype project Diabetes Agonistes! I plan to cultivate their interests and collaborate with some to create maybe the greatest diabetes education in the world so far. A portfolio of products that everyone can use, enjoy, and share when and where they want to. I know, I know, “greatest” is a strong word, but in light of the observed status quo, it’s no exaggeration.

Value Props

Impact isn’t inevitable; it depends on what customers do with what they experience and learn.

Every startup must have value propositions (plural), at least one for each customer segment and just one for everybody. The big kahuna is called a universal value proposition (UVP). The One Ring to rule them all.

Before identifying our customer segments, I’ll mention that Humaginarium serves two types of customer: fans of the arts and consumers of health care. Though the same people are found in both categories, the categories don’t necessarily overlap. The way to keep them separate in your mind is to mark a basic difference between fans and consumers. A fan is an ardent admirer or enthusiastic devotee. Fans have passion. They buy what they love. A consumer on the other hand is a user of goods. Consumers have problems. They buy what they need.

During customer discovery in I-Corps, I tried to explain these customer types to our facilitators. They had a different mental model which I call materialistic. They understand consumers, they don’t understand fans. You can infer from this, as I did, that they obviously don’t understand behavioral science and economics, but that’s a topic for a different blog.

Humaginarium caters to fans of:

  • Strategy video games
  • Casual video games
  • Popular science
  • Science fiction/fantasy

These fans are equivalent to four customer segments. If customers don’t really truly love at least one of these genres of arts and entertainment, they’re not in our fandom. Though they may still be customers. Here’s why.

Humaginarium also caters to consumers of health care; specifically those who have a chronic illness. It’s safe to say that nobody loves health care but everybody needs it. The chronically ill need it more than others. We cater to two segments among consumers who have a chronic illness:

  • Those who are resisting (been diagnosed, being treated)
  • Those who are avoiding (at risk, maybe in denial)

These consumers are equivalent to two customer segments. If they aren’t resisting or avoiding a chronic illness, we don’t serve their needs. They may still be customers if we spark a passion.

So, seven customer segments show up in our business model. They can be refined and narrowed, but they’re good for now. The segments don’t necessarily overlap; people can be in just one. However it’s common to be in more than one. When that happens their perception of value in Humaginarium steeply rises. If you both love and need something or someone, that tends to rule some of your choices and decisions.

The gains we offer fans and consumers who use our product are listed below. Notice they are imminently palpable and harden with repeated use:

  • Pleasing entertainment
  • Useful health literacy
  • Aptitude for self-care
  • Deep physical self-awareness
  • Actionable framework for wellness

These gains produce beneficial aftereffects when they influence behavior beyond the product. For example in scenarios where consumers can control for things like:

  • Ignorant choices and decisions
  • Risky behavior and lifestyle
  • Irrational medical outcomes
  • Weak patient engagement
  • Avoidable medical costs

As with all entertainment and education, real-life impacts that minimize losses are not inevitable; they depend on what customers do with what they experience and learn. That’s one reason why repeatability (deliberate practice) is a pillar of video games. Practice makes perfect.

What about our UVP, the One Ring to rule them all? I’m still thinking about that, but for now I can’t do better than this:

A nudge to wellness.

May not sound like a big deal, but it is. Critical questions about every value proposition are: “Do customers care?” “How do we know they care?” “Even if they care, will they buy the product to see if they like it?” My answers are:

  • Customer discovery has strongly suggested that they care
  • They already spend liberally to satisfy or offset similar wants and needs
  • They don’t have to buy the product; they can use it for free

Easy. Frictionless. Risk-free. Huge upside potential.

Solving for X

We’ll have nine product portfolios with dozens of nifty products.

Size is a conundrum for startups like Humaginarium. We’re born infinitesimally small with no employees, no address, no products, no customers, and no capital. Unlike most hatchlings, we don’t even have parents to foster our growth. We start with just an idea and then a panoply of ideas as immaterial as energy. Yet somehow ideas cause startups to grow. How?

Or more specifically, how fast, how large, and to what end? The answers seem irregular and obscure to me. I listen to How I Built This, the invaluable podcast hosted by Guy Raz, and every success story is more than different; it’s unique. I attend fireside chats with VCs like Ben Horowitz and haven’t caught a whiff of the secret sauce. On the other hand experts like Ron Adner, Chris Anderson, Steve Blank, Geoffrey Moore, Alex Osterwalder, Eric Ries, and Noam Wasserman have published standard methods, tools, templates, and models to explain how startups grow, but I’m still not convinced they figured it out. For one thing, many fine entrepreneurs haven’t read their books or followed their advice. For another, many like me, who did, found it’s about as useful as scripture for writing code.

Yet growth is crucial. So I’m pondering “how I’ll build this” along lines like these. Two years ago we started at an infinitesimally small Point A. We’re now advancing to a minimally viable Point B. In a few years we’ll end up at a big Point X, when we make our way to the exit.

I know what Point A looks like. It’s the company I founded named Humaginarium LLC. We’re earnestly building Point B. It’s named Diabetes Agonistes, our very first minimally viable product with at least one paying customer (hopefully more than one). I’m using the Unit Model Method to inform the design so that it’s repeatable and scalable. Because Diabetes Agonistes has to contain DNA for transforming intellectual energy into subject matter that consumers will learn with and enjoy again and again and again. Without that, it’s just a game.

Now what about Point X? As I say, I’m working on it, but I don’t care much for cookie cutters and a unit model feels a bit like one of those. Make it once, sell it many times. That’s not for me. I want to make many things once and sell each of them many times. This ambition leads me out of the neighborhood of type 2 diabetes and into the realm of chronic illness.

To my way of thinking, Humaginarium is a safe and trustworthy place where people of all stripes go to reckon with their chronic illness, and have fun with it, and practice killing it. Starting with type 2 diabetes and ending with… what?

The answer goes something like this. Diabetes Agonistes is a product. It’s going to lodge in a product portfolio. All told we’ll have nine product portfolios in Humaginarium with dozens of nifty products. The nine portfolios are:

  1. Cancerous
  2. Cardiovascular
  3. Endocrinological (home of diabetes)
  4. Hepatic
  5. Immunological
  6. Neurological
  7. Renal
  8. Respiratory
  9. Rheumatological

Have I left out any types of chronic illness? I have indeed, but I also included enough to bound what Humaginarium is, and what it isn’t. It’s very big, huge actually, but exactly the size needed to bend the curve of the #1 cause of sickness, suffering, and death in the United States and worldwide.

If you already know that half of humanity has at least one chronic illness, and if you already know that chronic illness is our #1 killer, and if you already know what each chronic illness is, and if you already know what you can do about it, then you are much farther along than millions of regular folks who may want Humaginarium because we built something they need. Therein lies Point X.

William-Adolphe_Bouguereau_Seated_Nude_(1884)

Scientific entertainment. Variation on Seated Nude, by William Bouguereau

Pillars

The assumption that health science is inscrutable for all but a few brainiacs is preposterous.

Right now Humaginarium is making. Making a prototype; making a production path; making a pitch deck; making several models that go with. Making though is contextual. It happens in a space full of influences. I call these influences “pillars” because they hold up the roof of a moral universe.

One of our pillars is behavioral economics. Our slogan Nudge To Wellness springs from this pillar. It means, essentially, that we want people to exercise free will, according to their own nature, when deciding how they’ll deal with a chronic illness. Unlike authority figures like doctors and nurses, we don’t tell people what’s good for them or what to do. Instead we present an engaging “choice architecture” that informs and conditions people so they’ll decide themselves and experience consequences. This pillar is one of the things that makes video games like ours enormously entertaining and influential.

Another pillar is game theory. In order to craft a coherent choice architecture, we first have to understand the logic and dynamics of choice when it comes to managing a chronic illness. What are the options in a given situation; what are their relative advantages; who gets to make the choices, when, how and why? How do certain choices limit or expand freedom and autonomy? Game theory maps questions like these ultimately to experience design for a simulation. A matrix of if-then events that may lead, of their own accord rather than prescriptively, to each individual’s different and preferred way to win.

Deliberate practice is also a pillar. It evokes the Hole in the Wall (or Hole in the Web) metaphor that explains what Humaginarium is getting up to. We start by rejecting inferiority. The assumption that health science is inscrutable for all but a few brainiacs is preposterous. The belief that health science is useless to regular folks is ridiculous. Health science (i.e. knowledge of a body we spend our entire lives with) is not hard intrinsically. The keys are reductionism (so that folks are not thrown by obscure rhetoric) and deliberate practice (i.e. sustained engagement until challenges become second nature). Because gamers often play a couple of hours a day every day, video games are a pretty good fit for deliberate practice. (Just imagine how proficient you could be on the guitar if you practiced two hours a day every day!)

Constructivism is the last pillar I’ll mention. This one is about building; how building things is maybe the most efficient way to learn. Not only how to make stuff, but also fundamentals like the laws of nature, behaviors of systems, ways to communicate, what to fear, how to overcome anxiety and depression, when to fight and when to flee. This pillar puts the responsibility for teaching where it belongs: with the learner cum builder. It trains the hands, the senses, and the the intuition to figure things out. No skill is more important in play, nor in dealing with a chronic illness that seems to thrive on pain and suffering.

I haven’t mentioned technologies like programming languages, instructional systems, game engines, digital imagery among our pillars because they are all, loosely speaking, means to an end. The pillars I named here are not that at all. They are mental models in Peter Senge’s sense of that term: ways to approach problems creatively and successfully, when outcomes cannot be planned or predicted, even when they are life or death.

MATTER

I parachuted into MATTER and loved the place. It felt like an agora.

Humaginarium recently applied for membership in the MATTER Healthcare Incubator and was accepted. For the first time we’re joining a community of dreamers, thinkers, designers, and makers whose values and aspirations are pretty much the same as ours. All focused on bending the curve of health.

This milestone is an end as well as a beginning. As I applied to MATTER, I ended my membership in the Polsky Exchange of the University of Chicago, where Humaginarium started in 2016. The Polsky Exchange is a nice shared workspace on both sides of 53rd Street in Hyde Park. Location is the catch. Humaginarium is in Oak Park, Polsky is in Hyde Park, and end-of-the-world traffic is smack dab in the middle. Even the genius of Google Maps can’t make that drive tolerable during business hours and there’s no quick mass transit.

Polsky was a blessing in some ways. As a member I met four dozen mentors with varied expertise and life stories; some became friends. Most were patient folks who listened as I stumbled through lame stories of Humaginarium and asked questions ranging from naive to inane. I may have impressed (or bored) a few with my passion, but not with my ideas. For a long time I apparently didn’t know what I was doing, but I kept reading and talking my way onward. Daniel Kahneman famously explains that people think, fast and slow. I’m one of the outliers who thinks slow only, and it sometimes takes forever to actually do things.

A valuable aspect of Polsky was its partnership with MATTER. I parachuted into MATTER events and workshops as a Polsky member. They were meaningful, often inspiring, and I began to love the place. It felt like an agora jammed with philosophers, geeks, creatives, teachers, scientists, clinicians, and business people. And perhaps because MATTER isn’t an academic incubator, the atmosphere felt pretty exciting.

A thing I didn’t sufficiently recognize about Polsky and about I-Corps as well, is their roots and culture in higher ed. They’re academic institutions designed for students and faculty rather than “community members” off the street. As a dyed-in-the-wool academic, I should have realized this sooner, but I tended to take their rhetoric about “business” innovation too literally. In retrospect I would say that both programs exist to advance academic careers and commercialize institutional IP. They’re an imperfect fit for refugees from the Ivory Tower like myself.

As our new era of incubation begins, I’ll be able to enjoy a 20-minute ride on the Green Line to Clark and Lake, my stop for MATTER on the 12th floor of the Merchandise Mart in the Loop. It’s the apex for health care innovation in Chicago. See you there!

Alexandre_Cabanel_Birth_of_Venus

Scientific entertainment. Variation on The Birth of Venus, by Alexandre Cabanel

Prototype

We’ll escape the dungeon of prototype development and bask in the sunshine of MVP.

After two years of dreaming and thinking, writing and arguing, Humaginarium is getting around to making. A prototype actually! We’re coming to the job from several starting points at the same time, weaving loose threads into tapestries that tell a fabulous story.

This is our second prototype project. In the first a few years ago, when Humaginarium was no more than a sparkle in my eye, three collaborators made some beautiful pictures and movies. We tried to make a vision of health education tangible and we succeeded to some extent, but the project was backasswards. I know now that prototypes should describe structure and flow, mechanics, utility, feasibility, usability. Ours was merely storytelling. You can view pieces of it on the Humaginarium channel of YouTube. It’s no big deal.

This time around we’ll start with a Paper Prototype, and probably go no farther for a while. A Paper Prototype is rough sketches paired with design specifications. In other words, a script and a flip book or a set of storyboards explaining how Diabetes Agonistes software may work. A Paper Prototype itself doesn’t work. It just lies there making people think and think again until “fabulous” begins to stir.

Sketches are visual, so there is a visual dimension here. A Paper Prototype is more than words, but it’s not the slick CGI that we produced the first time around. Our sketches will demonstrate how people control software operations; how they interact with objects on a screen and with other players; the kinds of content they view and touch; the way objects behave when they show up and perform; how learning is fostered by entertainment; and then how new knowledge gets used beyond the fantasy, in a player’s real life.

A team of Humaginarium creatives will make the Paper Prototype. Our technical partners at AWS will offer practical advice and connect us with resources that can validate, or at least critique our designs from expert and naive perspectives. Naive because the purpose of any prototype doesn’t end with self-expression. A Paper Prototype must be shared with people like the customers we have in mind – those who love to play video games and have a chronic illness – who have no functional or economic stake in what we’re doing. Their questions and suggestions should give the “fabulous” in our Paper Prototype a boost.

The Paper Prototype will take weeks or months to finish. What then? More prototypes actually.

  • A Proof-of-Principle Prototype to demonstrate core functions in our software specifications. It may draw little more than lines, shapes, and characters on a screen, but will show that our mechanics are feasible and compelling.
  • A Working Prototype to grow out of these coding experiments. Based on iterations known as Horizontal and Vertical Prototype, we’ll get to an integrative system that can be tested and optimized.
  • A Visual Prototype that returns us to the artistic realm of storytelling, where we were a few years ago. Here we decide how things look and feel not just in sketches, but with colorful illustrations and animations.

At that point, after much exploration and decision making, we’ll leave the dungeon of prototype development and bask in the sunshine of MVP: minimum viable product. An MVP is Diabetes Agonistes all worked up (pretty much): unfinished, imperfect but ready for showtime. The MVP is given to people who play with it and offer feedback; and since they’re playing in the Cloud, their usage analytics will generate bundles of fresh insight for product optimization.

We hope that the distance between MVP and launch will be very small because by the time we get to MVP, “fabulous” will no longer be a goal. It will be a certainty.

Infrastructure

IAAS is the “how” of how things get done in the 21st Century.

Humaginarium is fascinated by Amazon Web Services. And why not? AWS is new and different. Rock solid and continuously evolving. Hard to fathom as dark energy, yet earthy and ineluctable. I see AWS as our ideal business partner, though I’ve barely begun to figure it out.

I noticed AWS last year, when the Amazon Lumberyard (beta) game engine appeared on our horizon. Lumberyard is called that because it’s for building stuff, though precisely what and how were unclear. After all beta means in-progress, unfinished, experimental, randomly documented, high-potential, go-away-and-let-me work-on-this. I didn’t even know how to ask questions about it.

Maybe for just that reason, Lumberyard had charisma. It made no overt claims, but I felt a powerful brand promise sloshing in its amniotic fluid. The kernel of an idea that high-end graphic animation and massive, immersive interactivity can be made by a small company and delivered straight from the cloud to millions of screens.

Intrigue deepened when I started reading about AWS, Amazon Game Studios, Amazon Game Tech; and attended an AWS Media and Entertainment Symposium in Los Angeles on July 31. You know, I make the point almost daily that reading is not the best way to learn (and I say that as an avid reader). Case in point: it’s quite easy to spend an afternoon reading web pages about AWS and still be mystified. Attending the Symposium in LA and then the Amazon Startup Day in Chicago on September 6 was better for me. Listening to practitioners tell how they made things, even things that have nothing to do with games or medicine or education, produced helpful insights.

After drinking from a proverbial fire hose for a year, I can suddenly step back and hold up my discovery: IAAS (infrastructure as a service). Amazon is maybe technology’s greatest example of an adage, the whole is greater than the sum of its parts. IAAS is the whole of AWS. The parts are myriad ideas, people, systems, and companies that are to digital enterprise what transportation is to travel. IAAS is the “how” of how things get done in the 21st Century.

What is the whole of IAAS for Humaginarium in particular? It’s hard to overstate it. IAAS makes us feasible. It empowers us make and deliver numerous portfolios of exquisite scientific entertainment without having to beg investors for beaucoup millions in capital. It de-risks our business model and accelerates our production of things people love that they don’t already have, but which they need. It equips us for a long journey to success with a mass market, and shortens the journey with many amazing shortcuts. Most of all perhaps, it partners us with a company that shares our values and thinks the way we think, even though we have to work very hard to understand everything about it. Or maybe, because we do.