Lineage

We don’t have lineage among our bona fides?

Lineage is a product of continuity, and continuity is a product of evolution. Lineage has history, pedigree, familiarity, assurance. It reinforces our mental model of how good things happen and work. Because we like what we know and we know what we like, usually.

Innovation is a product of disruption, and disruption is a product of revolution. Innovation lacks history, pedigree, familiarity and assurance. It’s risky and uncomfortable. It may satisfy needs, but it takes a lot of getting used to and learning to trust. We usually don’t like what we don’t already know.

I hold these truths to be self-evident, but like most truths of that sort, they’re fraught with tension. That’s because people typically want to have their cake and eat it. They want lineage and innovation at the same time though the two may be diametrically opposed.

If you have attained lineage or you value and reward it, you probably don’t do innovation. You are less interested in the new than the known. Clayton Christensen coined the term “sustaining innovation” in order to connect the opposites — to argue that some innovators make incremental rather than transformational improvements, but that’s a mare’s nest. Making something better is a process of extending its lineage; it’s not an organizing principle of innovation.

The people who want to have their cake and eat it, those are individuals like ourselves, but also organizations such as employers and federal agencies like the National Science Foundation (“Where Discoveries Begin”) and the National Institutes of Health (“Turning Discovery Into Health”). Those agencies are much on my mind at present, because I’m sending SBIR (“America’s Seed Fund”) proposals to each.

The charter of SBIR is to promote innovation in part by selecting for lineage. That’s why most SBIR funds are given to nicely situated academic teams. Wait, let me clarify. SBIR funds are for corporate entrepreneurial teams, but in reality most of them are led and staffed by academic stakeholders who want to commercialize their previously funded academic research. Such stakeholders provide a project with lineage whereas scrappy inventors have only their wit and passion to recommend them, usually.

Unless memory fails me, as a former academician I’m pretty sure that college professors are generally risk averse. They are conservative, self-centered, they don’t like to put skin in the game, in fact they don’t like playing games with their career but prefer the certainties of job security, organizational hierarchy and the comforting sameness of job responsibilities that change only a little from season to season. The ubiquitous tenure system ensures that innovators are largely excluded from academia because they are disruptive.

That is why SBIR requirements for both lineage and innovation are an unacknowledged oxymoron. Unacknowledged because both are explicitly and unapologetically written into NSF solicitations and NIH funding opportunity announcements.

The best way to qualify for SBIR with these agencies is to derisk a project by summoning lineage as evidence that it’s a sure bet. And yet the best way to qualify for SBIR is to explain that the project is so risky that private investors won’t touch it with a ten-foot pole; therefore taxpayer money should finance it.

Humaginarium is one of those scrappy inventors born of a garage rather than an ivory tower. We have an innovation that is damned risky, and we don’t have lineage among our bona fides. What would you do in our place?

Well, we can’t become less innovative. Innovation is what makes our project meaningful and fun. And we can’t borrow lineage, can we?

Actually we can. Because the technologies we are bringing together have been developing for decades, in many cases with government funding, only not for our purposes. System dynamics, computer modeling of health, bioinformatics, biochemical engineering, predictive simulation, adaptive experiential learning, instructional technology. These are the cross threads of our invention, forming a new fabric of impact and consequence.

Precisely what consequence I can’t reveal here, not because it’s a secret but because I’m out of space. For now, suffice it to say that pretty soon you’re going to love what you don’t already know. That goes double for people with chronic illness.

A griffin of classical antiquity combining the eagle (innovation) and lion (lineage) into a mythic animal that embodies an impossible ideal. (Image courtesy of Pixabay.)

Healthcare

Changing mental models of health from spectator to change agent.

My focus has been on determinants of health. These are the causes of chronic illness that regular folks can perceive in themselves and their surroundings.

Perceive — at a minimum that means to recognize, but it also means to understand because seeing is not necessarily believing. You need to believe something is true and meaningful before you’re willing to take risks and action.

(Precisely what you do is the raison d’être of Humaginarium. We won’t go into that here.)

Much study and reflection had brought me to a conclusion that the determinants of health occur in four categories. I believed all causes of chronic illness fall into one or more of these, but I was wrong.

One category of determinant is the somatic, which is basically your physiology and biochemistry. The somatic is what you see in the mirror and in body scans like CT and MRI. If you are one of the gamers entertained by Humaginarium, you perceive very little of yourself that is somatic. Instead there is fantasy, memory, or even nothing at all.

Another category is the psychosomatic, which is basically your thought processes and emotions. The psychosomatic includes the rational mind and imagination. It also includes feelings that have little to do with cognition and more to do with nerves and hormones. Most regular folks perceive the faintest glimmer of their psychosomatic self, though many may live and die for it.

Yet another kind of determinant is the social, which is basically relationships, dependencies, culture and community. Social determinants of health are not of you or another; they are all that occurs between you and others; all that makes us valuable or useful to each other. Politics, which makes many of us sick, is a social determinant of health that most can’t fathom, as usual for the category.

I thought that the final category is the environmental, which is basically the space that supports life. Metabolism is the cardinal difference between living and not living, but nobody knows how or why it started. We only know it cannot happen without an environment that sustains it. There are no martians and there never will be, Elon.

Now I realize there is a fifth determinant of health; a fifth cause of chronic illness that is painfully obvious but often overlooked. It is healthcare, which is basically the medical industry. It is your primary and specialty care, medical devices, drugs, clinics, hospitals and god almighty insurer. I hate to say this about an industry that vacuums up nearly $4 trillion a year from our collective human capital, but most of us do not understand this determinant of our health, no more than the other four. We perceive only the faintest glimmer of what medicine is — even when it’s being practiced on ourselves.

Five determinants hints at an analogy with Peter Senge’s five disciplines for creating learning organizations. Let’s see if it works. Here they are:

  1. Personal mastery is a discipline of continually clarifying and deepening our personal vision, of focusing our energies, of developing patience, and of seeing reality objectively.” Check! That’s what Humaginarium does with and for folks dealing with chronic illness.
  2. Mental models are deeply ingrained assumptions, generalizations, or even pictures of images that influence how we understand the world and how we take action.” Roger that! Humaginarium is changing mental models of health from spectator to change agent.
  3. “Building shared vision — a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance.” Our concept of commitment and enrollment is not in an employer health plan, but in the individual sense of well-being that comes with self-actualization.
  4. “Team learning starts with ‘dialogue’, the capacity of members of a team to suspend assumptions and enter into genuine ‘thinking together’.” Our program is 1:1 with and for each individual to become more comfortable in their own skin. That looks to me like a prerequisite for thinking with others.
  5. “Systems thinking – The Fifth Discipline that integrates the other four.”

The Fifth Discipline is the title of Senge’s book and also an organizing principle of Humaginarium. Though we do not create learning organizations, we use systems thinking and dynamic models of health and healthcare for a far humbler purpose. To create learning individuals, one by one, millions at a time.

These individuals suffer with chronic illness that they do not control. We can’t cure their illness, but we can lessen their suffering by helping them perceive how much power they have, and can get, to live better.

I Saw the Figure 5 in Gold (1928) by Charles Demuth, bequeathed by Georgia O’Keeffe to the Metropolitan Museum of Art in New York. The painting is a mental model that illustrates The Great Figure (1920), by William Carlos Williams:

Among the rain
and lights
I saw the figure 5
in gold
on a red
firetruck
moving
tense
unheeded
to gong clangs
siren howls
and wheels rumbling
through the dark city.

Robodoc

Doctors play to practice. Patients play to win.

Doctors learn from their experience with patients. As if you didn’t know. It starts by observing and assisting other practitioners. It expands with supervised diagnosis and treatment. It peaks in autonomous encounters with patients over the entire course of a medical career.

Some of those encounters with patients are routine. Many are unique, exploratory, to some extent baffling. A doctor in those thorny encounters is an investigator, a clue finder, a person who doesn’t know but needs to find out. The patient is ideally there to help. A patient in those encounters is a witness, a fellow pathfinder and problem-solver, maybe even a coach.

I don’t know the proportion of medical education that is face-to-face with patients, but it’s a safe bet that learning from practical experience with patients far exceeds learning that occurs in lecture halls and libraries. Learning with patients is so valuable that it’s been boilerplated in technologies known as a simulated patient and a virtual patient.

The simulated (aka standardized) patient emerged in medical schools during the 1960s, around the time that healthcare started morphing into the wondrous industrial process that we have today. A simulated patient is an improvisational actor (professional or amateur) who performs the role of a real patient with certain knotty health issues.

The actor may have personal experience as a patient with the issues that are simulated, but is also well prepared to make a contrived performance seem real. Like audience members called up to the stage in a comedy club, doctors role-play diagnosis and treatment of the simulated patient.

And it works! So well that role-plays with simulated patients are required for getting a medical license in the United States. Doctors must play to practice. In addition to sharpening clinical skills, the role-play helps doctors improve their social and communication skills and polish their comportment for awkward or embarrassing moments in the office or clinic.

The downside with simulated patients is cost. The simulations are expensive to run, even for an industry that hemorrhages billions in carefree ways. Hence the introduction, starting in the 1990s, of the more economical and scalable virtual patient.

A virtual patient is a digital replicant, like a special-effects monster in a movie. Just kidding, the virtual patient is not like a monster in a movie, but like an avatar in a video game. The avatar is programmed to have health and other issues that must be recognized, understood and treated by the real doctor who plays with it.

The virtual patient is a computer simulation, unlike a live simulated patient, but the purpose is the same: learning medicine by means of role-play. A virtual patient is endlessly replayable and easily modified to simulate different clinical scenarios and produce different outcomes. Virtual patients are much less expensive to run than simulated patients, much more accessible, convenient and versatile to use, and may be just as capable of increasing medical competence.

Which brings me to the question I’m here to ask. If simulated and virtual patients are so good at increasing the medical competence of doctors, why haven’t simulated and virtual doctors been used to increase the health competence of patients? There are one million doctors in the United States receiving the benefits of this lavish educational technology. There are over 300 million patients in the United States who don’t have a clue.

Why not offer this powerful, effective educational technology to patients? Wrong question, because there isn’t a good reason. Better to ask what for, and when.

I call virtual doctors robodocs, which I am entitled to do because I invented them. Before you came to this blog, you probably never heard of simulated or virtual doctors, so don’t argue. We can call them robodocs from now on.

On the other hand… one sec… here it comes… Robodoc™. Now I can charge you to use the term! That would make me feel more like a medical device or drug maker. (Pass the Milk of Magnesia, please.)

What would patients do with a robodoc if one existed for them? They would role-play being a patient to learn how it’s done. They would learn simple things, like how to participate in their medical treatment, how to discuss their condition and needs with a doctor, how to seek the right care in the labyrinthine health marketplace, how to pay as little as possible for care that is needed, how to avoid and prevent the care that is not wanted.

Simple things that must be learned from experience. There is no better way. Doctors know that and so should you.

I gave a name to patient learning from experience — Constructive Health Competence™ — and Humaginarium is building video game simulations to promote it. Video games for adults with chronic illness who depend on the medical industrial complex much more than others have to.

And yes, robodocs will be present in our video games. Helping real patients find their way.

Robodocs are virtual doctors that make role-play for patients feasible, both technically and economically. Playing with them lets patients safely practice their performances in the doctor’s office, lab, ER, ambulance, clinic, hospital and assisted care facility where the gold-plated meters are running and ordinary life and well-being are on the line.

Please don’t say that it can’t work. Simulated and virtual patients are already working for a million doctors including yours. Don’t say that it won’t work. Entertaining video game sims are already working for hundreds of millions of consumers including your coworkers, friends and family.

Instead ask what difference we can make if it does work. The answers are pretty straightforward: happier, healthier patients and fewer, smaller medical bills.

These are fruits of patient empowerment that is no longer the first priority of providers, payers and candlestick makers. To hell with that, let’s get it on.

You’ll need to sign these forms and get labs before the doctor can see you.

Poster

Fixing the Achilles’ heel of health literacy

The Institute for Healthcare Advancement is hosting the 20th Annual Virtual Health Literacy Conference on May 25-27, 2021. You can register for free and learn by attending live sessions on your device.

My contribution to the conference agenda is a poster about Constructive Health Competence (CHC), which combines health literacy with other useful skills that are likewise lacking across most of the population.

An image of the poster follows this text. The image is rather large and perhaps will be slow to open. Those who wish to read it can open it large in the browser or download it. In the conference, the poster is accompanied by my voice-over. I am inserting the script of that here.

This poster acknowledges an Achilles’ heel of health literacy. The crazy assumption that folks will understand and use the information they read.

That’s not true of many people. The average adult in our midst reads like a child in middle school. Half of all adults can’t even do that. Others read better, so long as the text isn’t health information.

That’s because health information is not written in a vernacular. It’s by and large a professional rhetoric, a technicalese that requires higher education to understand and use.

Yet health literacy is not a professional or cultivated competence. It’s just regular folks being able to understand their healthcare, in order to inform their medical choices and decisions.

We can agree that health literacy is an important skill, too important to let language get in the way. So this poster outlines a fix for the Achilles’ heel. The fix removes textual obstacles to understanding complex information, and replaces them with pleasurable sensations.

Sensations are the fodder of art and entertainment; in this case, AAA video games. Visual and behavioral sensations are catalyzed by game mechanics and aesthetics. This is the stuff of visceral experience rather than quiet study.

That’s why playing video games is constructive. A game is a multifaceted kit that lets players themselves build the knowledge and skills they need to win. And in our games, the way to win is to defeat the illness lurking within.

So, assume we disconnect health literacy from language literacy. Can we now build effective health promotion? Nay, more is wanted. We add scientific literacy, another competence that most folks lack. We provide opportunities for regular folks to understand and use biomedical and social sciences in the game. We believe they can and they will.

The project enhances these literacies with health acumen, an ability to deal with perplexing unknowns that make us afraid or angry or depressed or unable to resist. And with medical self-efficacy, the ability to get anxious clinical situations under personal control.

The poster sums it up as constructive health competence. And because CHC emerges in the magic circle of play, regular folks can get into it. They can escape from suffering into a fantasy that brings them back to their true selves. Selves that are not dominated by chronic illness.

Copyright 2021 Humaginarium LLC

Yin and Yang

Does Humaginarium make video games or health promotion?

“Do I have a split personality?” The question may arise when we hold two contrasting or conflicting beliefs, at the same time, and instead of trying to resolve or erase them, we let their differences flourish. Indeed, we may expect benefits from the tension.

There are different ways to perceive a split. On the one hand, we may cringe in the presence of cognitive dissonance, a symptom of unbalance and stress. On the other hand, we may proudly quote F. Scott Fitzgerald, who wrote “The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.”

(He wrote function, not prosper. Just making that clear to contrarians in our midst.)

Oxymorons are beloved by folks with a split personality. Take the oxymoron serious games, for example. Games are played, and by definition gameplay is amusing, frivolous, entertaining, somewhat meaningless. A wonderful miniseries, The Queen’s Gambit, weaves an entertaining tale of struggle and conquest by a chess player, but chess itself is just a game. When you learn how to play it, the only benefit is that you now know how to play it.

(The miniseries has other ideas.)

So why pair game with serious, when serious is mindful, thoughtful, analytical, earnest. I once asked Clark Abt, who coined the oxymoron as the title of his book in 1970. He said that his editor came up with the title, it seemed catchy, and he didn’t think more about it.

When Oscar Wilde wrote The Importance of Being Earnest, A Trivial Comedy for Serious People, he had just this sort of oxymoron in mind. As an aesthete of the decadent fin de siècle, he thought a great deal more about it. Ultimately, it cost him his life.

Well then, there are two contrasting or conflicting beliefs whirling through my mind these days, not fatal but nonetheless twisty. They are video games and health promotion.

I believe in both. There’s even an oxymoron that I coined, scientific entertainment, in order to pace Clark and jolt readers or listeners into paying closer attention to my project. So far, I have preserved my ability to function, though I’m still striving to prosper.

So does Humaginarium create video games or health promotion? The answer is, both at the same time. Yes, I know that you can survey the field of health promotion and not find a single video game sprouting in its barren soil. You can likewise survey the video game industry and not find anything that quacks like health promotion. That’s because video games and health promotion have nothing to do with each other.

(Until now.)

While claiming that Humaginarium makes video games and health promotion, at the same time, and expects to benefit mightily because of it, I am challenged every day to put them in order, to prioritize, to say we do one in order to do the other (not the other in order to do the one).

This challenge was a damned nuisance until I referenced it to the concept of yin and yang, or dualistic-monism (another oxymoron): a “fruitful paradox.” Yin and yang are complementary (rather than opposing) forces that interact to form a dynamic system, in which the whole is greater than the sum of its parts.

Thus I arrived at the wheels within wheels of a conceptual breakthrough:

— Video games that are health promotion
— Art that is science
— Play that is work
— Freedom that is limiting
— Pleasure that is painful
— Silly that is smart
— Vulnerability that is strength
— Knowledge that is power

This list could go on. You probably have examples of your own.

The taijitu symbol famously depicts dualistic-monism. I chose a version of the symbol for this post, that reminds us, with markings around the circumference, that yin and yang are not reducible to this and that, subject and object, you and me. Instead it is a vortex of possibilities, in which every inferred possibility is accommodated and allowed to flourish. It is all-inclusive and balanced.

Not coincidentally, the quest of Humaginarium is for balance, or homeostasis. We are not trying to make sick people well, we are trying to make them happy. That may be the germ of our ultimate oxymoron.

Tai Chi Pa Kua Tu, the diagram of Tai Chi with Eight Trigrams, from Wikipedia

Literacies

Hey you, WHO, CDC, OECD: go stuff your endless texts!

There are many kinds of literacy. One that we all recognize is the ability to read and write in a native language. The average adult literacy, of that kind, in the United States, is utterly abysmal.

So bad, in fact, that health information should be written at no higher than an eighth-grade reading level (13-14 years old). That’s according to the American Medical Association, the National Institutes of Health, and the Centers for Disease Control and Prevention, as reported by Wylie Communications.

You might say: it is what it is, we do the best we can. But publishing health information, at the level of younger adolescents, is bound to reinforce health inequities. The reason for that? Even when information is dumbed-down thus, about half of all adults still won’t understand it. Not because they’re morons, of course, but because they lack reading skills.

This is a problem for anybody who produces health information, health education, or health promotion. Those are three pillars of self-determination, for controlling and improving health. They are meant to empower people. Problem is, most of what gets published under those headings is text. It must be read rather than watched, heard or experienced.

Ergo: no read, no learn; no learn, no improve.

There’s an additional problem for those who have proficient reading skills. Shown text that is written for juvenile eyes, they are more than likely to be bored. People tend to check out when boredom occurs. They don’t pay attention. They don’t engage. They don’t learn.

If we add the 50% of the adult population, who can’t understand the basic text of health information, with the 15% of the adult population that gets bored reading Golden Books, that leaves only 35% in the crosshairs of epitomic health information, health education and health promotion. No wonder the pillars are wobbly!

(Literate persons reading this may have noticed that health care is not listed as a pillar — for obvious reasons, to anybody who has received health care on a regular basis. It doesn’t empower through self-determination. Just the opposite, with rare exceptions. For better or worse, usually for worse, health care is a system of command and control.

However, I digress.)

The ability to read and write is a foundational literacy. It must be present in order for other literacies to flourish. Two others that are particularly important to Humaginarium are health literacy and scientific literacy.

According to the World Health Organization (WHO), health literacy is the ability of individuals to access, understand and use information in ways which promote and maintain good health.

According to the Organisation for Economic Co-operation and Development (OECD), scientific literacy is the ability of individuals to engage with science-related issues (including medicine), and with the ideas of science.

Each of these definitions, in their contexts, requires proficient foundational literacy to understand. The language is tortured. But for me they refer, somewhat allusively but inevitably, to reading skills: in one case, reading the rhetoric of medicine, in the other, reading the rhetoric of science.

Professionals spend decades in school and training, acquiring health or scientific literacy. And the 85% of adults in the United States, who have less than proficient reading skills? They don’t have a clue or a chance. They are sitting quietly, in the last row, waiting for the bell to ring.

That’s a problem that feels like an opportunity, at least to me.

Humaginarium has an opportunity to solve that problem. After noticing that the literatures of health information, health education and health promotion are banal and ridiculous for adults who are not morons (i.e. almost everybody), we cut a new path to empowerment. We obviously can’t develop the reading skills of folks with chronic illness, so instead we made reading optional. In fact, we made reading unnecessary. To be clear, people who come to our brand read nothing.

Instead of reading, they do what comes more naturally, no matter what level or kind of literacy they have attained. They get to:

  • Look at beautiful pictures
  • Play with amusing things
  • Crush thorny brain-teasers

In other words, they play video games. Our novel video games are health promotion in disguise.

Nobody will recognize the health promotion, because there’s no command-and-control text on the screen telling them what to think or do. Instead there are persuasive voices asking them to explore and act according to their own self-interest, their intimate wants and desires.

And for what? To win the game. To control the illness. To increase their share of well-being.

So hey, you, WHO, CDC, OECD: go stuff your scrolling pages of text already! Read my lips. The work needs to be about much more than information. It needs to be about empowerment!

Nurse Nancy, a Little Golden Book, now available from Amazon, and others since the 1950s

Determinants

Humaginarium operationalizes the force of self-determination.

Humaginarium addresses the problem of health incompetence, and we do it in a new way.

Not by telling folks how to avoid, prevent and control chronic illness, but letting them figure it out by themselves.

Not by imparting sterile medical information, but empowering them to make choices and decisions that satisfy underlying needs.

Not by picking apart symptoms and treatments, but nudging folks to understand and deal with causes.

Those causes are called determinants of health. According to Humaginarium, the determinants of health fall into four categories:

  • Physical
  • Psychological
  • Social
  • Environmental

Physical determinants are tangible properties of the body. Physiology, biochemistry, the tissues that give it shape and weight, the growth and decay manifest in them. Physical determinants can be seen under a microscope, on an x-ray and CT scan, in a DNA sequence. They’re as tiny as molecules swarming the mitochondria, as large as 25 feet of neatly folded intestines hosting trillions of symbiotic bacteria.

Psychological determinants are properties of the mind — conscious and subconscious, voluntary and reflexive, rational and emotional, learned and instinctive. Psychological determinants can’t be seen, yet they can be felt and measured. They’re as fleeting as appetite and rooted as depression. As a professional focus of mind-body medicine, and having biochemical agency, they are psychic fluff that both augurs and stymies disease.

Social determinants of health are properties of lifestyle. Extrinsic, situational, interpersonal rather than organic and evolved, they manifest in customs, culture, class and community as behavioral norms, relationships and traditions that organize and regulate the tribe. Social determinants of health include wealth and poverty, education, race, religion, vocation, zip code and lately ideology. Sex and violence are also big among them.

Environmental determinants of health are both naturally occurring and built — in biosphere and atmosphere, urban sprawls and outback. The water we drink, the air we breathe, the weather that rains on our parade, the ground we frack, the mountains we strip and decapitate, the rivers we pollute, the trees we incinerate. Environmental determinants are palpable yet easy to ignore. They not only cause sickness, but also extinction!

There we have it, four determinants of health by category. There’s a fifth one I haven’t mentioned, the secret sauce of Humaginarium: it’s the determinant of self.

As in, self-determination. An individual’s firm intention to achieve a desired end. Self-determination theory explains out how it works and what it means; conation gives it linguistic pedigree; motivation, grit and ambition haul it into common parlance.

Self-determination is what a person exercises to assert cause, rather than be wrangled by the causes of others. Self-determination can be positive as with Laurence of Arabia, or negative as with Billy Budd. Either way, it is the single most potent counterweight to the other determinants of health that I listed. And of course, it is largely ignored by healthcare and biomedicine as we know them.

As players in Humaginarium develop their own firm intention to prevent, avoid and control the chronic illnesses they meet in our fantasies, it shall happen, they will win, both in game and real life.

But as long as they lack the gumption and inspiration and wherewithal to stand up and fight, it will not happen. I believe that as surely as I believe the sun also rises.

That Humaginarium has found a way to operationalize self determinants at scale, quickly and easily, simply means that the days of the other determinants of health may be numbered. They have ruled and tortured folks with chronic illness enough. Shut the back door. Game on!

From The Little Engine That Could

Resolve

Striving to go beyond, not back to normal.

The worst of bad years has finally ended. A hopeful New Year has begun. It’s time to make a New Year’s resolution. But hold on, wait a minute — resolve means very different things!

In one sense, resolve is to fashion a solution. I may resolve a conflict or a problem by settling differences; or resolve a mystery by explaining how something happened. Resolutions of that sort are answers and remedies. They can help the troubled and distracted get back to normal.

That’s typically not what New Year’s resolutions are for.

In a different sense, resolve is to make a decision. When feeling disquiet, uncertainty, challenge, yearning, I may resolve to make a change, or make a difference, or make something new. When I do that, I’m bravely striving to go beyond, not back to normal.

Going beyond is what New Year’s resolutions are for. They’re wholesome, even heroic gestures of self-determination. We pooh-pooh them because they’re hardly ever kept, and that’s sad, but also beside the point. Keeping a resolution is the end of trying. Making resolutions is the beginning.

Resolve is the beginning of a change process. How often do complicated new processes work as planned? Not often. How often do they generate unplanned results? Quite often. Even when change processes collapse, they may illuminate defects and limitations that were easy, even convenient to ignore.

Resolve in the sense of decision-making is a driver of constructive health competence promoted by Humaginarium. Constructive health competence is Humaginarium lingo for patient empowerment — though I don’t much like the word “patient.” It sounds so wounded and dependent and vulnerable. I prefer consumers or customers or just plain folks, because those words are full of agency, implying at least the potential for self-determination.

Resolution is cardinal to constructive health competence because people who use our video games come to understand and take better care of their own one-and-only (i.e. their body). They become excellent stewards of the self. They really want to live better and they’re ready to do something about it. That’s a big change!

I insist that foolish, ignorant, fearful, timid, anxious, feckless, angry and deluded people can’t be good stewards of anything, much less their health. So our program replaces those self-limiting conditions with resolve. Resolve to do whatever it takes to win in the imagination, and in life.

Our customers will learn how to make good resolutions on New Year’s and every other day too. Let us all do the same.

The principals of Humaginarium made several fine resolutions on January 1, 2021. Will we keep all of them? Any of them? None of them? I don’t know, and nobody else does either.

I don’t know how my story ends, only that it begins and begins again, and again and again, because it is well worth trying, and I would be absurd not to try.

As we proudly, nay bravely stand on the threshold of 2021, that’s what most matters to me.

Wants, and Needs

Don’t all patients participate in health care?

Wants and needs. The words are so close in meaning, they’re often interchangeable; almost synonymous — yet not quite. Humaginarium uses them to differentiate customer motivations, when it comes to playing our unusual video games; and also the payoffs that follow.

To be clear: Wants are desires. Needs are necessities. And both matter.

In the pragmatic world of tech startups — where Humaginarium occasionally visits and all problems are reducible to algorithms — wants are fluff and needs are raisons d’être.

Did you get that? I’ll elaborate.

  1. Wants are subjective. Needs are objective.
  2. Wants are “take it or leave it.” Needs are “gotta have it.”
  3. Wants are choices. Needs are imperatives.
  4. Wants are rewarded. Needs are met.
  5. Wants are pleasurable. Needs are painful.
  6. Wants are emotional. Needs are physical.
  7. Wants are fanciful. Needs are empirical.

People love what they want and hate what they need. I could go on like this for hourst. It’s a tense dichotomy in human nature.

Wants are addressed in art and entertainment, where they seek catharsis. Wants are addressed in industries like fashion and hospitality, that rely on customers enjoying themselves; that strive to please, since they know their customers have many choices and moreover control their choices.

Humaginarium makes art and entertainment in the form of video games. Not talking about serious games (grody) or gamification (gag me) or educational games (with a spoon). Talking about blockbuster, bestseller, AAA, dumbass games that are good for one thing only: escapism.

Except ours are not good for one thing. They’re good for two: escapism, and competence. Wants, and needs. Our games build skills called “constructive health competence,” which means the capacity of folks to take better care of themselves; to collaborate fully in medical decision-making; to participate actively in personalized healthcare.

Wait, don’t all patients already participate in healthcare? No, they don’t; no more than the chicken in your sandwich participated in agriculture and gastronomy. It’s not that folks don’t what to collaborate and participate, but they’re stymied: they don’t know how to begin or what to expect.

Humaginarium understands that health literacy, health acumen and medical self-efficacy are desperately needed by millions of people, but are nowhere available. Nowhere! So we address those needs in ways that are also desirable.

Because, let’s be honest, nobody likes healthcare. In this year’s presidential debates, when candidates said, “if you love your healthcare, you can keep it,” I wondered why they were talking to British or French or German voters — or practically anybody on earth other than patients living in the United States.

In fact, when we peel away the PR and bureaucracy, it’s clear that everybody in America hates healthcare, but puts up with it, because they have bloody needs. They put up with scary, clinical, patronizing, embarrassing, dehumanizing, baffling, riddled with mistakes, impoverishing, infuriating, futile — because they have unmet needs for control; especially control of chronic illness.

The problem is, putting up with healthcare isn’t fun. Even thinking about it is stressful.

The solution is, make it fun so folks want to think about it. Effective may follow. Health usually follows happiness. And that’s how Humaginarium performs its magic. By folding the wants of folks for escapist art into their needs for health competence, we have invented a way to empower. Empower is the opposite of telling folks what to do. It is enabling them to do for themselves.

Should you care about meeting your needs by satisfying your wants? Yes, most definitively you should care, if you’re a gamer. If you’re not a gamer, well, you can easily change that by learning how to play.

You’ll be glad to find that Humaginarium video games respect what you want, and respect what you need, and they don’t require a prescription.

The Business Plan

Think different?

One of the first and last words entrepreneurs hear when forming a tech startup is “pitch.” Referring not to the black muck that’s used to pave roads, nor the slant of a roof that prevents snow from piling up, nor a thrown ball that dances past a bat. This pitch is a PowerPoint deck.

Actually two decks: vanilla with about 10 slides and Neapolitan with about 50. Vanilla is for stakeholders who don’t dawdle. It cuts to the chase. Neapolitan is for slackers who need time to imagine that the venture wants only three years to pay out 10x what’s put in. A deck is paired with a script that couches the bulleted points in persuasive storytelling.

Prominence of a pitch contrasts with obscurity of a business plan. According to pundits who pass through startup incubators like roving bounty hunters, business plans are fossils. They take time to research and write and evaluate (diligence), they involve demonstrable facts and testable assumptions (empiricism), and they are not viable (so yesterday). Dude, if we’re going to bet on PITS (pie in the sky), let’s go fast and break things! The investing equivalent of high-throughput screening.

What a designer famously wrote about websites may be said about the pitch: “don’t make me think.”

A good pitch makes people think in a certain way, of course. That’s called fantasy. A business plan makes people think different, in a way called dialectics. It took me a while to realize this, and I am now creating the Humaginarium business plan (better late than never). Using the cloud app LivePlan to organize and prompt my writing, the business plan covers operations and markets; in an appended business pro forma, it covers commercialization and finance. Slowly. Carefully. Decisively. Come what may.

Writing a business plan feels to me like exploring majestic terra firma, after imagining a new world while sailing, surrounded by sea and sky.

To fresh entrepreneurs who have been threading the needle of a just-right pitch, I can recommend that you set it aside for the loom of a business plan and pro forma. Put first things first. Prove to yourself and stakeholders that you have the right stuff for a moonshot. Don’t mistake an albatross for a necktie.

The time will come later to whistle a happy tune in a dainty little pitch.

Covey’s Habit #3: Put first things first (the chicken before the egg).