Think

The way in which we think about a disease has an effect on the outcome.

“The trouble with every one of us,” said Thomas Watson in 1912, “is that we don’t think enough. We don’t get paid for working with our feet — we get paid for working with our heads.” Soon after that, Watson famously made “THINK” the enduring mantra of IBM.

IMHO, there are far more important reasons to think than to make money. Even so, a few decades after IBM asked “every one of us” to think more, our nation’s moral savior observed: “Rarely do we find men who willingly engage in hard, solid thinking. Nothing pains some people more than having to think.”

That observation jives with my personal experience of folks, but Martin Luther King Jr. didn’t leave it at that. He added that people should be “tough-minded,” in order to think well (not just more). They need to become sharp, penetrating, astute, discerning (his words). Cognitively attentive and retentive, yes; but also inquisitive, brave, original, determined (my words).

The modern notion that everybody should be “tough-minded” was taken up by the United Negro College Fund in 1972, a few years after MLK’s sacrifice. UNCF coined a moving slogan that became a building block of popular American culture to this day: “A mind is a terrible thing to waste.” Watson apparently felt the same way.

And so did Michael Jackson in 1988 when he brought the tough-minded man to the stage as a Man in the Mirror, daring arenas full of crazy fans to think different about what matters most to all of us. A decade after that, Steve Jobs started urging everybody, everywhere, to Think Different — picturing MLK and several like-minded luminaries in Apple spots during the Super Bowl.

Is that man in the mirror — thinking and moreover thinking differently — really the same as a person who is tough-minded? Practically they are the same, in my view.

How might such noble people avoid wasting their minds on this terrible and beautiful planet? Perhaps by “breaking through the crust of legends and myths and sifting the true from the false.” That’s MLK again, lofty and authentic at the same time: his rare and urgent gift.

The problem with urging everybody to think, though, is that nobody really understands what that means. Everybody thinks of course, but who really knows how or even why?

You think I’m exaggerating? Think again. People are much better at being told what to do than demanding to think things out for themselves. That seems to be true throughout American health care (my pet peeve), where the tough-minded are providers only, and most patients are milquetoast.

The dreadful implications of that intellectual disparity in health care hit home when I read Normal Cousins’ Head First: The Biology of Hope (1989), where he claims “The way in which we think about a disease has an effect on the outcome.” Hold on, did you get that? The way we think changes our own clinical outcomes. Since when has thinking become medicinal?

Probably since the placebo effect was felt, roughly at the beginning of human civilization. Then as now, people tend to avoid, prevent and recover from illness by thinking wellness. You can’t think wellness without some proverbial fire in the belly, but if you have that —if you’re tough-minded — you may be able to defend your body against threats and frailties right along with the surgery and the drugs and the annual checkups you may think your body depends on.

Most people don’t think wellness when it comes to their bodies, not because they can’t, but because it’s incredibly hard. Humaginarium makes it easier by using slick technology, but it’s still hard. Nobody gets to think Diabetes Agonistes is a walk in the park. It’s more like a slog through Mirkwood, and I wouldn’t want it any other way. Nor would Thomas, Martin, Michael, Steve or Norman. Nor should you.

“One of the unfortunate aspects of health education,” wrote Cousins, “is that it tends to make us more aware of our weaknesses than of our strengths. By focusing our attention and concerns on things that can go wrong, we tend to develop a one-sided view of the human body, regarding it as a ready receiver for all sorts of illnesses. Proper health education should begin with an awareness of the magnificent resources built into the human system.”

Diabetes Agonistes isn’t proper health education. It isn’t health education at all, but it does develop keen awareness of magnificent resources of the body, resources available to the person who owns the body and whose life depends on it.

You know who that person is: the man or the woman in your mirror, longing for you to toughen up your mind and think different.

Conditioning

Experience is the best teacher.

Diabetes Agonistes is art for art’s sake. It is nothing other than entertainment — a thing of beauty, a technical marvel, a source of amusement, a way to pass the time and take a load off. If it ever becomes more than that, it may fail.

For example, if it becomes healthy like exercise, or educational like school, or prescriptive like medicine, or covered by health insurance like a benefit, it will probably skid off the road and wind up in a ditch of “things that are good for me.” Diabetes Agonistes is not good for you. It doesn’t show you what to do. It’s not a safety cap or a warning label. It isn’t a mutant form of health care.

Yet Diabetes Agonistes promotes health, more widely and effectively than anything else I can think of. It is educational technology that endows millions of people with competence as owners (not renters) of a body. Their own body, the one they were born with but never got to know except in a mirror, though the mirror lies.

How can this be? How can frivolous entertainment promote health; and even harder, promote the health of folks with chronic illness? The answer is, by conditioning.

Conditioning refers to learning that is experiential rather than didactic. The experience of what there is and what is happening in the surroundings of an active individual. Active is vital, because people must engage directly with their surroundings to learn from their experience.

Yes of course, I know that engagement may also be as quiet as observation and reflection, without lifting a finger, while zillions of neurons fire in a silent brain and nervous system. Okay, but that is not active engagement; it is passive. And it is not what works for regular folks.

The regular folks in line for Diabetes Agonistes rarely learn from quiet contemplation. They don’t learn from reading instructions and answering diagnostic questions, because all that is intellectual. It is voluntary rather than necessary, speculative rather than felt, pondered rather than suffered . Passive engagement may inform but it doesn’t condition, so the competence gained from it is fragile and often transient. Here today, gone tomorrow. Most health education works that way, which is to say it really doesn’t work at all.

Regular folks actually learn about health, not from TED Talks and books, but by experiencing the wounded body. Their own, in the case of folks with chronic illness, or another, in the case of caregivers.”You can’t see or understand me if you haven’t walked in my shoes.” And if you have, and walked enough times, your response has most likely been conditioned.

Conditioning helps regular folks perceive and adapt to a body’s needs — without thinking for a long time, without googling the research, without sinking into the quicksand of WebMD — just by deciding and doing what comes naturally. Insight and habits are ready for action and waiting for that decision, thanks to conditioning. Of course, things coming naturally is no guarantee of being right.

Conditioning that warrants competence rather than prejudice is catalyzed by science. Science is the only way that “gut” feelings, about something as complicated and dangerous as chronic illness, can evolve into useful intuition. Folks who are conditioned to respond to the body’s needs do it correctly if their responses express health acumen. Otherwise, they just have a dumb hunch, like the orangeman had about hydroxychloroquine.

This is why Diabetes Agonistes is built on a core of scientific knowledge about human metabolism. The core is manifest in a dynamic, user-controlled model of homeostasis, caving to metabolic syndrome and further eroding, like a dyke crumbling before a raging sea, into diabetes type 2.

But the regular folks who take up Diabetes Agonistes will never see that dynamic model, will not be aware of it unless they read the backstory, and will not think about it as they fight for their virtual lives. Yet everything they experience in the interactive entertainment will abide by the model. The competence that emerges from their active engagement with fantastic demons in the game will accord with science, will come naturally from autonomous healthy choices, and will stand up to opposition when it enters new contests in the real world.

Why may Diabetes Agonistes fail if it becomes something other than frivolous entertainment? The reason is simple. It would lose its audience if the audience even suspected it of teaching or preaching. Not because those are inherently bad services, but because they have little or nothing to do with folks gaining control of their own body and health.

Diabetes Agonistes is the kind of learning that empowers lots of people do to what they want, if they want, when they want, the way the want, and still wind up making the healthiest choices for themselves. In other words, it is nothing other than entertainment.

Scientific entertainment. Morgentoilette (1841), by Christoffer Wilhelm Eckersberg. An asymptomatic woman prepares to socialize while antibodies keep her dangerous pathogens in check.

Masquerade

In Humaginarium everybody wears a mask.

Wearing a protective mask is a cardinal rule for avoiding and preventing the spread of Covid-19. Refusing to wear a mask is a cockamamy badge of libertarian courage. We may choose the wearing in order to conserve health and well-being, or not wearing as a privilege of personal freedom, or lazily decide nothing and go with the flow (if you want, whatever, fuggedaboutit). Options 2-3 may be the most popular in the United States during this pandemic, as indicated by tragic health statistics and my personal observations of Joe and Ms Sixpack in the heartland.

Of course any resistance to masking is ludicrous. Masks are just materials that cover the face; and the less we see of some faces (e.g. orange ones), the better! Covering the face is what many people do every normal day at work, in sports and weather, with cosmetics, coiffure. fashion, and also on special occasions like Halloween and bank heists. Masks are useful, sometimes attractive; they don’t challenge habits and lifestyles or interfere with work or play or even sleep. To refuse to wear a mask for the sake of conserving health (yours and others) isn’t courageous in any sense of the word; it’s stubborn, selfish and stupid. That kind of dull, intransigent behavior is fairly common when it comes to health (e.g. resistance to medicine and proper nutrition), so we’re accustomed to it, but that doesn’t make it right.

For hundreds of millions of years, masks have evolved in nature for protection, disguise, self-expression of animals and plants. Homo sapiens have never grown masks on their bodies, of course, but we started crafting them for ceremonial and practical purposes in the Iron Age, tens of thousands of years ago. Our oldest extant masks were fashioned by ancestors in the Judean Hills near Jerusalem, about 7,000 years before Christ arrived there. In ancient historic times, participants in Greek bacchanalia, Roman saturnalia and medieval carnivals donned masks; likewise today’s revelers at Mardi Gras, the Carnival of Brazil and countless other festivities wear brilliant costumes including masks. They love doing it!

Humans are fond of masks because they enjoy pretending to be something or somebody else. It seems to take a load off! Creative pretense involving masks gives pleasure, makes meaning, does magic, creates illusions, enhances beauty, produces power and advantages. We masquerade in order to escape mundane reality and replace it, for a while, with a contrived fantasy. We do this to see ourselves, not as we are in mirrors, but in dreams where we drive a Batmobile or leap over tall buildings. That’s why masks have purportedly played a crucial role in understanding “what it means to be human.” They facilitate escapism and catharsis, which are also two major benefits of Humaginarium.

In fact Humaginarium is health promotion masquerading as interactive entertainment. Meaning: it’s a thing pretending to be something else. In order to deceive? On the contrary: in order to reveal complicated, difficult, unpleasant yet vitally important truth. To the Sixpacks of course, and others.

Those who choose to attend masquerade balls hosted by Humaginarium in the cloud get to escape into fantasies of adventure and exploration of the world within, the world every human being creates and sustains and sometimes suffers, every single day of their lives. It’s a world so large and dynamic and awful and mysterious and elusive and beautiful and threatening and comforting that it boggles the mind, until the mind urges retreat, thinking “this cannot be, this fantasy is bewildering and false.”

The rational mind, when it thinks that about any fantasy including ours, is incorrect. The actual world within truly is as vast and intriguing as the Milky Way, just as present to our senses, even more accessible to our understanding. That’s why Humaginarium hosts creative expeditions there. There is so much to discover and celebrate and use.

Folks who thrive on fantasy in Humaginarium also have a dream that governs their choices and decisions and helps them persist even when the challenges of simulation seem insurmountable. Their dream is to leave behind the dreadful chronic illness they had when they entered. Not to be miraculously cured, only to be free and proud and in control for once and in their minds forever.

A masquerade is precisely the right way to do this, though it is never otherwise done in healthcare or health education. When Joe or the Ms arrive for a medical appointment in the real world, they never wear masks and neither does clinical staff. From start to finish of their helpless, hapless, horribly expensive visit, they listen carefully to diagnoses they don’t understand, prescriptions they won’t take and instructions they won’t follow. That unfortunately is their sad reality.

In Humaginarium everybody wears a mask. Everybody is free and empowered to explore what it’s like to be something or somebody else, for a while: what it’s like to be a happy human being whose perfect body is healthy and strong because they themselves decided it must and it shall be.

Disparities

Because they look dissimilar they are pronounced inferior.

Diverse, or disparate, that is the question. We prize the former, we loathe the latter, and yet they mean much the same thing. They mean different, dissimilar, distinct and distinctive: self-contained, unlike others, “not me,” us versus them. Diversity in a biological or sociological sense is a presumed source of strength. Disparities are signs of weakness or vulnerability. Regarding health in particular, disparities are cumulative indicators of morbidity and premature death. Most of that preventable or avoidable or treatable in theory; in reality, not so much. Why, and how is that?

I think it’s because diversity connotes a balance or blend of differences that yield an efficient system and process. In biology, for example, the microbiome within our bodies is very large and diverse, such that most of our cells are not even human; yet contained by the body as they are, they boost resiliency and vitality. Our existence and authenticity as Homo sapiens depend on the active participation of other organisms within and upon and around us. They are not us, they are different from us, yet they make us whole and keep us well.

Disparities do not make us whole. Just the opposite: disparities fracture and fragment, exaggerate our differences, hobble our ability and desire to function competently, turn our distinctions into antipathies, belittle or marginalize some of us for the benefit of others. In biology again, disparities manifest in racial characteristics that are just plain human, as human as anything else in the body, yet because they look dissimilar they are pronounced inferior.

Diversity builds us up as individuals (healthier, wiser, more competent, nicer) and as a species (social, adaptable, empathic, industrious). Disparities push us down and tear us apart by making individuals alienated, suspicious, stupid, aggressive towards others who are different; while clinging manically to rogues who seem more like ourselves.

Back to the question: Why do we prize diversity? Because diversity is natural; it is evolutionary; it is progressive; it is liberating; it affirms the bounty of life. Diversity is self embracing non self and engaging rather than exploiting the differences. The engine of diversity is Eros, or love. We are diverse when we love our neighbors as ourselves though they are not ourselves, they are different. Why do we loathe disparities? Because disparities are unnatural, arbitrary, ugly, toxic, malevolent, egotistic, vicious, futile, unnecessary. The drivers of all disparities are pride and greed.

Yet health disparities are so pervasive that they practically run the healthcare industry and the government that regulates it. Health disparities are the twisted distribution of health outcomes resulting from social rather than biological determinants. The obvious determinants are race, ethnicity, income, community, food insecurity, risky behavior, local medical incompetence and malfeasance, medication noncompliance. Far more damaging determinants are health illiteracy and learned helplessness: the inability of people to understand their bodies enough to care for them without medical supervision, and their unwillingness to try. In other words, the origins of health disparities are mental: ignorance, foolishness, bias, resistance to change, irresponsibility. The things that Humaginarium was born to mitigate.

Such social determinants are not baked into Homo sapiens; they are concocted by policymaking and economic interests. Why? Because they cost some of us nothing to ignore and they support a $3+ trillion industry that makes a good profit from sickness. Literally. Do not for a moment believe that the business models of healthcare promote health, because they don’t. They promote treatment, which unfortunately has such a random correlation with health that I doubt it is statistically meaningful for most of the population. Treatment correlates closely with economic measures, not with health outcomes. Our civic response to Covid-19 demonstrates this, but my point about disparities doesn’t need a crisis to stick. All it requires is individual experience of routine medicine in normal times.

Diversity is good, but we lack it because we are too damned prejudiced and self-interested to promote it. Disparities are bad, but we tolerate them because they reinforce injustice that benefits some individuals at the expense of others. What to do?

Whether ’tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles
And by opposing end them.

We are all swimming in that sea of troubles these days, some wearing life vests, some clinging to soggy boards, others floundering and going under. Taking up arms is a tough call for people who shoulder the most severe disparities. Most of them have little leisure or means for nobility in the mind.

Yet there is something awe-inspiring about that refrain, “No Justice, No Peace,” echoing in the streets and perhaps one day breaking down the doors of our clinics. Each of us in their own way, we must “end the heart-ache and the thousand natural shocks that flesh is heir to.” We can start by hallowing diversity rather than giving it lazy, mindless lip service, and ending disparities even if there is no investment-grade case for doing so.

Equity

Health care for Americans is a privilege, not a right.

What is equity? Equity is the experience of justice: of treatment or behavior that is fair to all concerned, without bias or discrimination towards any. Health equity is likewise the experience of justice, in this case regarding access to clinical care and the achievement of medical outcomes.

Heath equity doesn’t guarantee “good” outcomes. Outcomes are only as good as medicine can make them under circumstances that medicine doesn’t necessarily control. After all, most illness is caused and complicated by genes, behavior, culture, environment and chance. Heath equity doesn’t excoriate those causes and complications. I think it’s vital to acknowledge that justice per se doesn’t make anybody well. It just levels the playing field. Outcomes depend more on the hands that individuals are dealt in life and how their cards are played.

Because of extreme economic and racial disparities, there is less health equity in the United States than in any other industrialized nation, or even in many developing nations. Health care for Americans is a privilege, not a right. The privilege entitles individuals to varying standards and quality of care based not on medical science but on social determinants like their ability to pay for diagnosis and treatment, the communities where they live, the benefits offered by their employers, the constraints imposed by their health insurers, their level of education and their race. Health care for Americans is a privilege, not a right. We get only what we pay for, not necessarily what we want or need; and not necessarily what cures or heals.

Take for example Thomas McKeller, a young African American elevator operator in Boston just after the Spanish Flu pandemic slaughtered 675,000 of his fellow Americans. By virtue of his race, socioeconomic status and lack of health insurance, he had access to inferior, substandard health care even though he was within walking distance of one of the best hospitals in the world (Massachusetts General). Contrast McKeller with John Singer Sargent, the eminent society painter whose portrait of McKeller is “humagined” at the bottom of this page. Sargent had access to state-of-the-art care in Boston or anywhere in country he needed it. Both men were Homo sapiens: specimens of the same species and endowed with the same biochemistry and physiology. Yet one was far more likely to contract, suffer and die from illness. Not because of medicine, but because of injustice. Their society lacked health equity.

Health inequities common in the early 1900s are still common a century later. This was brought into startling contrast by Covid-19, which has infected and killed our McKellers far more than our Sargents. The same was true of other maladies before the current pandemic and will likely still be true a hundred years hence. Why? The reason is mostly the disparities previously mentioned. Health care for Americans is a privilege, not a right. Health care in the United States is an industry that for sure exists to create equity, just not health equity. It exists to create the equity known as shareholder value.

That kind of equity is the experience of wealth, not justice. That kind of equity is what Donald J. Trump had in mind when he said that the murdered George Floyd was having a great day. The unemployment rate had dropped slightly and more importantly the stock market indices had inched upward. Trump’s wealth had increased, therefore Floyd can be happy in heaven. He did not die in vain.

It is easy to recoil from the obscenities of Trump in disgust, but hold on. Isn’t his exuberance what most of us feel and even say when it comes to health care? Americans have some of the worst health care and health insurance among all advanced economies, but our providers and insurers are among our most valuable corporations. The industry that produces inequitable outcomes is also fabulously wealthy. Coincidental? I don’t think so.

American health care thrives on inequity. Its business models, from hospital corporations to big pharma, earn revenue and profit from sickness and death. That being so, we must not expect “big structural change” any time soon. Health equity is a good idea, for others, but it will not make America great again.

What will? In my opinion, not the profiteers and their minions. Health equity may increase as people become smarter about their bodies, have more health literacy and health acumen, gain more control of their spend and outcomes. In other words, things may improve when folks can take better care of themselves and rely less on the medical-industrial complex.

That is the foundation of Humaginarium’s business model. Health equity is baked into our technology and philosophy. Our customers — our McKellers and Sargents — will benefit the same from what we do and no industry mugwump is ever going to change that.

Scientific entertainment. Nude Study of Thomas E. McKeller (1917-1920), by
John Singer Sargent. McKeller, a rare African American subject of society portrait painting, is pictured here with neurons that are exactly the same for all races.

Solace of Art

People do what is good only when they want to.

Last week, when I found myself in times of trouble, Mother Mary didn’t come to me. She was in a different neighborhood of Minneapolis with other matters to attend.

The trouble I found that day was not racist murder in the street, but mass murder in the air. Not perpetrated by four deranged police officers, but thousands of passive-aggressive shoppers and sales associates at The Home Depot. Most of whom were utterly indifferent to Covid-19. I watched as they crowded into and out of the big box emporium, with checklists and parcels, without face coverings or hand sanitizers — NIH and CDC be damned! I watched and wondered: have I witnessed a more convincing demonstration of ingrained stupidity? Ever? I have not.

I sometimes refer to regular folks like those at The Home Depot as Joe and Ms. Sixpack — thus trying to dignify a condescending meme coined by a political moron more than ten years ago. I have claimed — without much evidence — that the Sixpack clan will overcome their acute health illiteracy and risky habits, their blimpy form factors and medication maladroitness, and they will take better care of themselves and their families, if only they are better informed about the science of the body and nudged to wellness. My self-appointed job is to inform and nudge; their job is to be happy and live in peace.

As a passionate health promoter, I have watched for months as governments and the fourth estate flooded the entire population with health information (scientific and otherwise), across all media, at all times of the day and night, from every conceivable point of view. A sentient adult cannot by now be ignorant of the incurable and unpreventable Covid-19, nor of the potentially mortal consequences of being infected or infecting others, nor of the ONLY ways to control it: social distancing and personal hygiene. According to my understanding of the Sixpacks, this worldwide tsunami of health promotion delivered more than enough information to warrant their high health literacy and acumen from coast to coast, at least when it comes to communicable disease.

To judge by my observations in Minneapolis, I was wrong. The Sixpacks were blithely committing mass murder in public and private spaces like The Home Depot in Minneapolis, where coronavirus can freely swirl into faces and smear onto the hands of every incautious person who happens to be present, and afterwards into and onto everybody else they meet. Given the quality of health promotion that preceded this dreadful historical moment, the pandemic should not be continuing now. Yet more than 100,000 deaths and more than a million infections later, with dire predictions of a nasty resurgence coming in the autumn, the evidence so far seems to show that health promotion doesn’t work and doesn’t matter in the United States.

I don’t accept that conclusion, but at the same time concur that it’s reasonable. After all, Humaginarium was founded on a premise that traditional health promotion — including health education — doesn’t work and has never worked well; that a different approach is needed to produce a different outcome. The rationale being that people will do what is good for them and others only when they want to. This new approach is conditioned by the solace of art.

Art is using the imagination to create and experience beautiful things. Art has existed as long as Homo sapiens; it is arguably what makes us human. Solace is the comfort we give or seek in grief, the alleviation of pain or fear or anger or anxiety. As a word for being cheered up and amused despite sorrow, solace has been around since the 12th century.

A few hundred years after solace entered the Middle English lexicon, a poet named John Donne wrote his Devotions Upon Emergent Occasions (1624). In these lines, he both defined and exemplified the solace of art: its power to heal and encourage, no matter what the circumstances are.

How does art do this? By writing a prescription? No. By telling the Sixpacks what to do? No. By making them oblivious or stupid? No. By improving their healthcare? No. Art works by facilitating understanding, choices and decisions to do what is right and good for ourselves and for others we rely on, and who rely on us.

I’m giving you a particular Devotion below without further explanation; you’re an adult, you’ll figure out what it means without my help, if you want to. But I’m giving it to you with an earnest request in these times of trouble: that you read it slowly and slowly think about its meaning. What it means not to me or to society or history or Ernest Hemingway, but to you individually and personally, right now.

Because believe it or not, you yourself are the most beautiful and wonderful thing in all of creation, and you deserve to be happy and healthy, and you have the right to demand it, and the power to achieve it. And now in memory of George Floyd and with love for every person who will someday come to Humaginarium with an illness that may never end, I declare and insist that no person is an island; and that even one person’s needless suffering or death diminishes us all.

For Whom the Bell Tolls, by John Donne
No man is an island,
Entire of itself.
Each is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thine own
Or of thine friend’s were.
Each man’s death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.

Hairy Balls

The best of all lives, now and forever.

There was a day last week when I juggled three hairy balls. It made me tense. It wasn’t fun. I kept thinking: I don’t know how to do this; I don’t want to do this; I can’t do this; I just won’t! Yet I persisted as my stress increased.

Those four escalations — from not knowing to not trying — may be typical of Humaginarium customers. It’s what I expect. I’m asking folks to play very, very challenging video games that are damn hard to figure out and win. At the same time I’m asking them to dwell on an illness they have, or most likely will get: something they prefer not to think about at all, ever.

Yet despite these difficulties, I expect folks to persist. Despite feelings of inadequacy, ignorance, vulnerability, resignation, victimhood, anxiety, helplessness, anger, resentment, anguish, denial — despite who they think they are — I expect them to get better.

Better as in happier, calmer, stronger, smarter, healthier. Better as in more confident, centered, resilient, competent and accepting no matter what their circumstances may be. Better not because of what Humaginarium does for them but because of what they choose to do for themselves. Not wishing for a life they can’t have, but honoring the one they do have: for each of them, after all is said and done, the best of all lives, for now and forever.

My juggling a few days ago was nowhere near that lofty. I was investigating and trying to master, within my own pathetic mindscape, three subjects that seemed to defy easy understanding: metabolism, time management, and illustration. Everybody knows these words. Everybody thinks they know what the words mean. Until they try to use them and suddenly the ground rumbles and crevasses open in the ice and they no longer know where to put the next step.

The hairy ball of metabolism is a subject so vast and complicated that it seems like a name for God. It is the process of turning death into life, other into self, entropy into growth… and so forth. It happens on the atomic level of synthesizing molecules right up to the organismal level of masticating calamari, and on all the barely perceptible gradient levels in between; and maybe on the cosmic level too, since we are stardust. Metabolism is the epic subject of Diabetes Agonistes.

The hairy ball of time management is business rather than science. In the course of configuring the beta version 2 of OfficeTime, I had to think very carefully about how I spend my time, which is not normal for me. As with money, I spend my time somewhat cavalierly, mostly going on habit, intuition and instinct, rarely thinking about systems. Now I was applying systems thinking to my role of CEO at Humaginarium. When I finally got the app running, it broke.

The hairy ball of illustration is technology rather than business or science. For years I have dipped into Adobe Illustrator like a pilgrim visiting a shrine, gazing cravenly at its burning candles. Lately I have been taking Deke McClelland’s 20-hour Lynda course Illustrator 2020 One On One Fundamentals. The Illustrator app is so complicated and powerful that sometimes I feel I am watching a course on advanced astrophysics rather than basics of digital art. Upon closer inspection I see that the candles are a burning bush. Thanks, Deke.

Juggling all three of these balls in the same day represented an enormous cognitive load: intrinsic, extraneous and germane. Extremely hairy and requiring much self-determination to persist in the face of probable defeat and very uncertain payoff. But I did persist, and I am continuing.

Why? Because by juggling hairy balls, I myself walk the talk of Humaginarium. I do these things (and others like them) not because they are enjoyable and rewarding (though they’re fun during bivouacs), but because they are hard and push me right up to my suffocating limits. Not in order to stop there and wonder, but rather to put my foot on the opposite edge of the crevasse and step over the yawning blighter.

Dark Matter

Monetizing new technology for the healthcare industry.

The MATTER Healthcare Incubator in downtown Chicago is closed for coronavirus. My membership there ended in December 2019, so dark MATTER doesn’t directly affect me. Still, I own a budding health tech startup and identify with the MATTER community, even if I’m not sure there is one. I may have imagined it.

I used to pay $320 a month for basic MATTER membership. That let me into a co-working space that I called the commons: filled with long tables lined on both sides with swiveling desk chairs a few feet apart. No desk lamp, no phone, no coat rack, no book shelf or stand, no library, no office supplies, no Ethernet; only a shared power strip to charge my mobile device and WiFi.

The commons also housed windowless, whiteboarded conference rooms and a classroom that are bookable for a couple of hours a pop. There’s a tiny kitchen with a coffee urn (yum, but empty most afternoons and evenings) and a vending machine for snacks. No seating in the kitchen; it’s not a break room.

Having no phones in the commons doesn’t mean it’s quiet there. Members often make calls on their mobile devices. That along with loud conversations, and the atmosphere gets pretty noisy at peak times. I usually donned AirPods and listened to music, to block the noise with more noise; there was no way to cancel it.

$320 sounds like a lot for a month of this, and it is, but it was less than MATTER membership at the next level up which includes baby office space. Glass-walled cubes may be fine for startups without real offices, though they’re a tight fit for more than a couple of occupants. Pricey again.

For comparison, MATTER membership costs about six times more than Polsky membership. The Polsky Exchange incubator actually has nicer space but it’s rather distantly located at the University of Chicago in Hyde Park; and is more for high-brow students and faculty than community. Polsky is now closed for coronavirus too.

I joined Polsky in 2016 and MATTER in 2018, not for office space of course or convenience. I joined to meet tech entrepreneurs with similar backgrounds and ambitions, mentors with keen business acumen, investors who have ardently mastered the business economics of innovation. I came to both for collegial interactions that might help me formulate Humaginarium right after the Big Bang, when its universe was filled with stardust.

I found some of that collegial interaction, though more by accident than design, and I’m glad. Yet most of the other members I met did not have similar or even comparable backgrounds and ambitions; and little was done by organizers of the incubators to facilitate new relationships among members.

Mentors too were kind of limited, coming from backgrounds that were generally solid but rarely exceptional. Most didn’t seem notably wise or experienced or well-connected. Not one shared my passion for health literacy, health acumen and medical self-efficacy — or even understood what these words mean. They and investors whom I met seemed impatiently interested in monetizing new technology for the healthcare industry — a thorny topic that sometimes seemed beyond their skill sets! I often felt some were there to learn rather than inform or coach or finance.

Which brings me to an awkward confession. I’m not interested in monetizing new technology for the healthcare industry. In fact I hate the contemporary healthcare industry and have no desire to put shiny new lipstick on its porcine face.

My passions are not for healthcare, Lord knows, but for people — known as patients in the healthcare marketplace, just people to me. Researching health promotion, I inevitably found that the most effective medicine in the United States today is named placebo effect; and the #1 cause of death in hospitals is clinical mistakes. I am not intrigued by a sinkhole where these awful things are true, no matter how personally enriching it may be. Monetization doesn’t make it good or right.

Now that MATTER is temporarily dark, would it be fair to say, when it was lit up and bustling, that healthcare incubation is about monetizing new technology for the healthcare industry rather than promoting the health and wellness of ordinary people? Yes, I think that’s a defensible observation.

Would it also be fair to say that the MATTER community — somewhere out there — is more excited about money than medicine and the well-being of ordinary people; that its raison d’être is to cut juicier slices from the pie of an overpriced, underperforming, now calamitous healthcare industry? That sounds very harsh indeed, but yes, it’s also a defensible observation.

Even if my observations are valid, they don’t change anything. MATTER is what it is bless its heart. Dark and light come to the same thing and, who knows, maybe household disinfectant or hydroxychloroquine will cure COVID-19 as well as a placebo. Sounds innovative. What do we have to lose?

Scientific

What one observes and what one imagines are mutually reinforcing.

Last week I poured a dollop of health literacy and a gobbet of health acumen into a shaker, and shook. Shaken thus (not stirred), they yield a heady cocktail known as self-determination. Why does that matter? Because the self is the most instrumental determinant of health outcomes. Literacy and acumen each by itself informs and weighs; together they empower.

I always call this cocktail “scientific entertainment,” an oxymoron that evokes what Humaginarium is about. We know what entertainment is: it is art; it is artifice that tells the truth and gives pleasure; it is amusement, enjoyment, fun that replaces what actually is with what might or should be in a world of our own making. Everybody knows what entertainment is because everybody needs it, wants it, pays for and uses it; goes out of their way to get it and feels anxious or frustrated when they don’t get enough. But what about scientific? Most of us use that word without knowing (or maybe even caring) what it means.

Science is knowledge; or more precisely systematized knowledge; or more precisely still, systematized knowledge that results from observation and investigation, and that is consistent with evidence. That last bit is the main difference between science and art. Both generate knowledge, but science is empirical while art is philosophical. No big deal. Many people believe that one is more valuable, practical, truthful, influential than the other, but they are wrong. Not only are science and art equal in importance, but each is incomplete and hobbled without the other. Art and science together are another heady cocktail whose parts may also be enjoyed separately, but why on earth would you?

The usual answer is, because science is hard whereas art is easy. Science is technical whereas art is creative. Science is boring whereas art is exciting. Scientific insight resists and eludes discovery and application, whereas artistic insight just lies there waiting to be apprehended, and is useless. All of these contradistinctions are drivel: they just aren’t true. Yet we organize many civilized endeavors, including health promotion, according to our beliefs in them.

I say “scientific entertainment” to prevent the two concepts from coming apart at Humaginarium. My oxymoron is a frank declaration that empiricism and philosophy are not, or should not be, distinguishable. I push this to the farthest extreme by dovetailing the most erudite of all sciences (biomedicine) with the silliest of all arts (fantasy). For Humaginarium, when it comes to health and well-being, what one observes and what one imagines are mutually reinforcing. Always! I am, therefore I think; I think, therefore I am. (Descartes got it half right.)

You will not find health acumen mentioned by the World Health Organization or the Centers for Disease Control and Prevention in their campaigns of health promotion. Only health literacy. The reason for that is probably because literacy is scientific; acumen is fluff. Consequently, because of this scientific bias, their institutional essays on health literacy are generally unsatisfactory, futile, trivial, beside the point. Humaginarium hopes to improve the balance.

Nor will you find WHO and CDC tipping their hats to the arts as they bow to science, except on very rare occasions. Artists have no seats at the table of health promotion; all of the permanent seats are occupied by scientists and clinicians. Is that right and proper? No, it isn’t; it is disastrous. At Humaginarium we hope to do something about that as well.

Our hopes are not effusions of a company that has a dissociative identity disorder. Humaginarium is not trying to meld things that don’t belong together. We are not trying to be clever by getting funky with subject matter that is essentially technical. We are merely doing what needs to be done to break the cognitive chains that hold down the 98% whom I mentioned last week. Science can’t do it alone.

Or to put it a different way, we are making a heady new cocktail that is greater — far greater — than the sum of its parts. Shaken thus (not stirred).

Acumen

88% of American adults have reading skills equal or inferior to a child in middle school.

Literacy is the ability to read a vernacular. In the United States, about 18% of all adults are functionally illiterate. Either they can’t read at all, or their reading skills are less than basic: at best, equivalent to a competent third grader’s, 8-9 years old.

About 34% of American adults are basically literate. They can glean simple information from printed matter, but not make much use of it. At best, their reading skills are equivalent to a competent fifth grader’s, 10-11 years old.

About 36% of American adults are functionally literate. They can understand the meaning of straightforward text, but can’t parse or interpret it for implications and consequences. They have workaday reading skills, at best equivalent to a competent eighth grader’s, 13-14 years old.

All of that said, about 88% of American adults have reading skills equal or inferior to a child in middle school. Leaving only about 12% with purported “adult” literacy. Hold on, that’s actually an overstatement.

About 10% of adult Americans have adolescent literacy: reading skills equivalent to a competent tenth grader’s, 15-16 years old. Only a tiny 2% of all Americans have genuine adult literacy, the kind of reading comprehension that is mandatory for higher education and professional endeavor.

I had to give this context in order to introduce the topic of health literacy: an ability to read the vernacular of health care. The vernacular of health care is the text printed on forms, handouts and signage in clinical and pharmaceutical settings. It’s the text in books, articles and websites with health-related subject matter. Most health-related subject matter is applied or theoretical science. For example, it’s not about how to use soap (function); it’s about why soap produces better health outcomes (cognition).

The vernacular of health care varies quite a lot — from papers in the New England Journal of Medicine at the high end to printouts stapled to prescriptions at Walgreens — but all of it has this in common: it is practically unreadable and therefore useless for around 98% of American adults.

When Humaginarium announced, at its founding, that it will promote health literacy at scale, it rose to an enormous challenge that generally goes unnoticed, despite its gargantuan economic costs and impact on health disparities. We had to come up with a way to promote adult health literacy across a population that overwhelming lacks adult literacy of any kind. Now we have done that. We have invented a way that should work well for the first 87 million adults who use it; and we are preparing to build and test a prototype of this amazing innovation. That is kind of exciting.

However our research also exposed some deflating limits of health literacy. Even if and when we demonstrate and prove exquisite technology that increases the health literacy of most American adults, will their newfound literacy effectively ameliorate health disparities among them? Put another way, will mastery of the vernacular of health care actually make most people healthier, happier and more secure?

The answer is no, it will not. The best outcome we (or anybody) can expect from adult health literacy is more participative medicine. By that I mean better quality of communication between patients and their clinicians and makers of medicines. That’s a pretty good outcome, but not good enough. It is not the game changer we seek.

To finish the job we started, we also have to promote health acumen. That is the key to medical self-efficacy. Acumen is an ability not just to read, but to exercise good judgement; to make healthy choices in the absence of external direction and authority; to possess keenness and depth of perception when observing what is obvious to any inquiring mind; to discern what is going on below the skin and the palpable symptoms in a body; and to discriminate between meaningful and false signals from blood, flesh and bones.

Understood thus, health literacy is no guarantor of health acumen. It’s just a prerequisite. Because without mastery of the vernacular of health care, critical thinking that fosters acumen must be so profoundly impaired that it’s practically impossible. People cannot exercise good judgement if they are grossly ignorant of the relevant science; and biomedicine is not the stuff of middle school.

This is why I no longer say that Humaginarium promotes health literacy at scale. Instead I say that Humaginarium promotes health literacy and health acumen at scale. Not just for the 2% who already have their linguistic ducks in a row, but for the 98% whose ducks are paddling aimlessly around the pond while the sky over their heads darkens; those who foolishly hope or expect the health care industry to make healthy choices for rather than with them. To have health acumen is to believe that “I will figure this out; I will decide; and I will make my decisions stick, come hell or high water.”

Like Gandalf, Humaginarium has found a way. We found our version of Thrór’s Map and a key that opens the door in the Lonely Mountain of health care. Beyond that adamantine door, Smaug is dreaming atop a gleaming horde of stolen treasure. After a long and perilous journey, Humaginarium is coming for him.