Content

Content begins on the outside and ends up inside.

With written briefs and schedules flourishing in the rear view mirror, we’re beginning our approach to another early milestone: content. That word seems to mean everything and nothing at the same time. Let’s dispel the ambiguity.

In my view, content derives from information. It happens like this.

  1. Information is sculpted into communication
  2. Communication is rendered as media
  3. Media promote experience
  4. Experience is distilled into ideas
  5. Ideas are summoned into knowledge
  6. Knowledge is the safe harbor of content.

Phew! If all that is true, then it’s fair to say that content begins on the outside and ends up inside. Content bends the objective to the whims of the subjective. It starts as facts and finishes as perception. Content is what we think we know and what we think we can use to achieve our aims. Content bestows power.

Our briefs claim that the streaming content of Diabetes Agonistes is formed from six tributaries: biology, chemistry, psychology, environment, community and aesthetics. Biology and chemistry: these are scientific, decidedly factual. Psychology is less scientific because it is more tolerant of speculation and ideology. (I think therefore I am? Arguable. I am therefore I think? Indubitable!) Environment is the physical world that supports or harms life, and is very scientific. Community is the moral world of connections and relationships, interdependence and conflict: dynamic, metamorphic, cultural. Aesthetics are the human spirit, a force field that makes the cosmos personally meaningful, for better or worse.

All of these tributaries form the almighty stream of content in our project. Our schedule says we will survey the stream by July 2020, in time for designers to paddle its churning rapids, keeping us onboard as we twist and bobble onward.

Our first step of content discovery is to create a framework: the loose contours of information that we gather way upstream, in the placid pools of scholarly and popular literature. We do this to appreciate how others understand human metabolism, healthy and otherwise.

Framework in hand, we interview a gaggle of subject-matter experts in several disciplines: asking them questions about the literature, uncovering leads to additional information that we missed in our framework, learning how to bend information to the learning objectives of our curriculum.

Yes, our curriculum, because even though the thing we are making is a drop-dead gorgeous, butt-kicking, soul-riveting video game, under its covers it will be a competence builder; it will not teach, but will prompt and empower people to learn.

After the interviews, a great slog begins. The slog is a spreadsheet Topic Index. Word by word, row by row, an inventory of accurate and useful information that users may turn into knowledge while playing our video game — whether or not they want to. In fact we know they won’t want to and that’s why we won’t tell them they’re learning. Instead we’ll encourage them to feel they are winning, which after all beats learning in any head-to-head competition.

Once our Topic Index is written, we may rest. Our labors regarding content will be finished for the time being. We will set it aside and turn full attention to the next milestone: a technical marvel we call evaluation website.

The evaluation website is a test bed for our modular proof of concept, of which an elaborate simulation and a competency model are very important parts. Why mention them in this post about content? Because the content we delineate in the Topic Index will be plowed into the simulation and the model long before they see the light of day in a video game. The evaluation website is where stakeholders in our success will observe, manipulate, and comment on the content we have mustered for their immediate enjoyment and lasting benefit.

Scientific entertainment. Le Repos (1911) by Félix Edouard Vallotton, pictured with neurons that may be firing in the model’s limbic system as her friend approaches with a glass of milk and a cookie.

Briefs

What are the roots that clutch, what branches grow?

For the poet TS Eliot, April was the cruelest month. For Humaginarium, it wasn’t too shabby. It began with completion of a grant proposal and ended with a synoptic schedule and briefs for our project. We did exactly what we said we would do, and that feels nice. Hopefully a sign of things to come.

The project schedule spans 28 months, from approval of our Phase 1 Project Pitch to completion of our Phase 2 proposal. The blocks of planned activities are:

  1. Proposal development: 12 months (43%)
  2. Project preparations: 6 months (21%)
  3. Research and development: 9 months (32%)
  4. Phase 2 proposal: 1 month (4%)

Six months of slack time are anticipated, three of which we’ve already used. Slack time buffers the impact of uh-oh pivots and koala-like performance.

Our project preparations kicked off on April 6. By September 30, we’ll have devised a detailed schedule in MS Project that allocates 33 professionals and 2,000 testers to a hierarchy of tasks that aggregate in five complex, glorious, interdependent milestones. This glorious amalgam is our modular proof of concept: empirical evidence with a direct bearing on our next project starting on January 4, 2022.

The briefs are 3-4 page orientations for members of our professional cohort. They cover all the major bases of on-ramp:

  1. Content brief
  2. Creative brief
  3. Curricular brief
  4. Evaluation brief
  5. Office brief
  6. Scheduling brief
  7. Technical brief

The briefs are not restatements of our proposal, but narrative seasonings for kicking it up a notch. Since the subject matter of the briefs has been top of mind for a full year, they were surprisingly hard to write. Hopefully easy to read.

Their overarching theme may be quoted from the technical brief. It applies to everything we’re doing from now on:

Innovative popular systems are the technology of this project. We also have lofty and arguable philosophical, social and economic ideas, but the project is not about them. It is technical and pragmatic. Our only job is to demonstrate that the systems we plan to build are feasible.

The content brief concerns six classes of information that will be mustered for our simulation: biology, chemistry, psychology, environment, community and aesthetics. These data are the knowledge that we impart to users without uttering a word. Like magic.

The creative brief concerns art and entertainment. It says our greatest invention is a way to make science and education more palatable and engaging to those who couldn’t care less. It claims that Humaginarium is the most fun you can have with your body. And we mean it!

The curricular brief says that our video game inculcates a competency model that makes healthy choices and healthy habits likely, if not inevitable. There’s no teacher. Experience teaches! Our technology merely facilitates. Users get to be thank god-almighty free at last.

The evaluation brief concerns the website we will build in the digital public square to demonstrate our technical and aesthetic wizardry. Thousands of people may drop by and leave feedback, and while there enter a lottery for valuable prizes. Money can’t buy me love? Not.

The office brief describes our virtual office, which is actually our Business G Suite account with twinkling lights, glass balls and tinsel. It explains how colleagues around the United States will receive assignments, post work and get paid. Work happens, meetings are ad hoc.

The scheduling brief explains our techniques of project management that somehow combine careful planning, practically unlimited flexibility and iron-clad budgeting. We want to know how and when everything will happen, and yet not mind of it doesn’t work out that way. Zen.

The technical brief is the one I was afraid to write, because it is technical and I am not. However it pleased technical lead Dave Walker so I’m more relaxed after all. Feasibility is the gist of this brief. It poses many of the questions we must answer well to qualify for Phase 2.

So then, April at least in this case has not been the cruelest month. You may ask along with the poet, “What are the roots that clutch, what branches grow Out of this stony rubbish?” I will tell you now. They are the seedlings of health literacy, health acumen, and medical self-efficacy for patient sufferers who may not, who cannot be fooled again, because soon they will know better.

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?

Scheduling

Plans are containers for snappy bits.

“It is a curse having the epic temperament in an overcrowded age devoted to snappy bits!” That’s me thinking about Humaginarium in 2020 — quoting JRR Tolkien thinking about The Lord of the Rings in 1944.

Both projects (his and mine) are gigantic and erudite, yet made for untutored masses with purportedly short attention spans. How odd! Both are outlandish and amusing, steeped in adult fantasy and occult imagery, yet each feels natural and familiar to regular folks who are purportedly empirical and pragmatic. How peculiar! Tolkien’s project characterized the deranged evil that threatened himself, his family and friends and civilization. Mine models poorly controlled illness that threatens me, my family and friends and civilization. How curious! Nobody paid Tolkien to devote years of his life to his project. He was merely asked to write a sequel to a successful children’s book. Nobody has paid me to persist in my project after my first successful startup, yet I do. How strange!

We both know why. Epic undertakings occur because their makers want them, not because “users” or “customers” demand or even expect them. The efforts such undertakings require are their own sweet reward, not a down payment on fame and fortune that may never come. Large, innovative projects have no ulterior motive. They truly exist for their own sake, though makers may want them to change the world a little, for the better: in my case to make it a happier and healthier place to live, in Tolkien’s to justify a personal commitment to virtue in a fallen world. When makers work hard, great things may come about. It’s just possible. On the other hand their projects may fail, they may give up and turn back. When that happens, problems like evil and illness may become even harder to fathom, as though the human spirit perceives them and doesn’t care. The fallen world doesn’t change, but its problems do. They grow worse.

An epic temperament is all very well. It’s the mother of invention. It kept Tolkien going and keeps me going more conscientiously than orders and lucre ever have. What makes the temperament a curse is not the inspiration, but the perspiration. The curse of snappy bits: pesky details of how and when things will be made. As avaricious angels — who may have never had an original idea of their own — are fond of saying to makers: “ideas are basically worthless.” Execution matters. Stuff has value. If it doesn’t sell it doesn’t count.

Stuff rarely just happens. It must be inspired, ideated, investigated, planned, prepared, washed-dried-ironed-folded, assigned, designed, developed, tested again and again, repaired and refined and finally launched — or at least saddled and walked out of the barn. Tolkien did that with The Lord of the Rings. He not only wrote and typed and recited his story again and again for years before it was printed. He also wrote a “history” of the different world in which his story unfolds; he invented languages spoken there, animated deities adored and feared there, empowered supernatural laws and fierce traditions that shaped reality there; and he created newfangled geography, morphology, astronomy and physics so his story would make perfect internal sense to every one of the purported nincompoops who would eventually buy and read his very long and complicated novel. He did all of this not to please them, but to please himself and a few individuals he loved. He had no customers or bosses or investors or contracts, so he made The Lord of the Rings in his spare time after work while raising a family, and gardening, and fixing the plumbing, and running errands on his bicycle. How impractical! What a stupendously foolish way to create one of the most beloved and best selling stories of all time! If only there had been an Innovation Corps or incubator or creative writing program to show him how to do things the right way!

Tolkien and I planned our respective projects. Plans are containers for snappy bits. They tell makers what will be done, by when, for how long, by whom, with what results. Plans are details of execution: how an epic temperament actually makes the things it wants.

Unlike Tolkien, my plan is a schedule. Correction: right now it is the outline of a schedule. Relatively little is scheduled just yet, just enough to inform the National Science Foundation how my execution will play out. For this reason, Dave Walker and I have begun writing a proper schedule: him in Microsoft Project, me in Merlin Project. What snappy bits may our schedule contain? Here’s what I know:

  1. The project is named Diabetes Agonistes
  2. The start date is April 4, 2020
  3. It has three phases: preparatory, generative, evaluative
  4. Preparatory ends no later than September 2020
  5. Generative and evaluative end no later than June 2021
  6. The schedule involves 24 credentialed professionals
  7. It also involves 2000 online testers (the “nincompoops”)
  8. The project produces evidence rather than product
  9. Evidence lowers the risks of product development that follows
  10. Evidence is collected in five milestone deliverables
  11. Milestone deliverables cohere in a modular proof of concept
  12. The project allocates cash of $233,613 and equivalent sweat equity

The preparatory phase, which we’re in now, produces our detailed project schedule, two websites, seven briefs, and an ineluctable sense that the epic temperament of Humaginarium is mastering the snappy bits and throwing off a nagging curse, in our overcrowded age: turning “worthless ideas” into treasure worthy of Khazad-dûm.

Writing

George Mallory had similar thoughts, standing at the foot of Mount Everest.

One year to write 20 pages! That is how long they took. Even for me — the slowest of the slow, the latest of the late — this is a personal best. How did it take so long?

Easier question: why didn’t it take longer? Answer: because there was a time limit imposed by somebody else. A timer was set in April 2019, giving me no more than one year to finish or be damned. Not liking the eternal-infernal option, I finished my writing with precisely four days to spare (phew).

Same sort of thing happened in 1975, when I “finished” (i.e. stopped) my doctoral dissertation in English Letters at the end of a fifth year living in the UK. There is evidently something about limits that makes me want to exceed or at least ignore them, as long and as much as possible.

My recent year of writing was an NSF SBIR Phase 1 proposal. Together with documentation it turned out to be 10 x 20 pages, but the Pareto principle applies to just those measly 20 pages comprising the Project Description and Technical Discussion of a game changer known as Diabetes Agonistes.

The National Science Foundation does very nice things for aspirants and martyrs who want to cross the chasms of technical innovation. They carefully publish an explicit Solicitation telling applicants how to write a proposal; and they reinforce the Solicitation with a Proposal and Award Policies and Procedures Guide that kind of “tells ‘em what you’re going to tell ‘em” — with more detail in different words. They further reinforce those helpful documents with myriad web pages of procedural, referential, social and historical information that strikes aspirants with awe and turns some of them into martyrs. Reading this stuff feels a bit like gazing at a Himalayan summit from a safe distance and thinking, “it’s not that tall after all.” All told, there are hundreds of fact-packed government pages that are not only helpful, but also debilitating. Even for me, a person who loves reading for its own sake, that textual mountain was a lot to take in. Consequently much of my year spent writing was actually devoted to getting ready to write and then afterwards checking to make sure that my text was complete and compliant with standards. Even now I’m not sure that it is. The summit is shrouded in mist, and there is a throbbing red glow within it.

As usual with anything related to health care (e.g. Diabetes Agonistes), there is a way to leapfrog the labor by delegating it, with cash. You can hire a consultant, one who is well versed in government documents, as your sherpa. The consultant tells you what to write, and when to write it, and how to revise it until it is ready for primetime. Alternatively, you can hire a consultant as your ghostwriter and project manager: a magus who will use you as a subject-matter expert, write a splendid proposal for you to sign, and afterwards (if successful) manage the entire project for a reasonable fee.

I considered consultants. I attended a two-day workshop hosted by one of the best, and interviewed four others who came highly recommended. I chose not to engage one because (idiot that I am) I wanted to learn and master this writing process myself. I felt there is no text in the English language that I can’t wrestle to the mat (hubris), and if I don’t do the heavy lifting myself, I won’t do all the necessary thinking either. Then I would lose an ineffable chance to experience something new: crossing one of the wider chasms of technical innovation. I’m sure that George Mallory had similar thoughts, standing at the foot of Mount Everest.

Apart from reading and processing freight cars full of documentation, another cause of my slowness was poetics (so-called). Hard as it may be for readers of this blog to believe, I am very careful about every word I write, often writing them over and over in different ways until they sort of chime in my ear and look good to my eye. For this reason, what I want to express is perhaps 30% of my writing. Wordsmithing is 70%. The nutty thing about that is, my subject matter here for the most part is technology, and literary style is certainly not one of the criteria for evaluation of my proposal. Nonetheless, I can’t help myself. My muse insists.

As soon as my writing job was done a few days ago, I turned to (what else?) more writing. I quickly wrote a Project Pitch for educational technology that may bend the curve of COVID-19. Fascinating proposal which will go nowhere, of course, but deserved to be written. Then I started writing an SBIR Phase 1 proposal for the National Institute of Diabetes and Digestive and Kidney Diseases, one of the National Institutes of Health. And also began writing a series of briefs for the NSF project team, in case that proposal isn’t kicked out like a stray dog.

Will I set a new record for slowness with NIH? I think not. Having practiced and sort of mastered the process of parsing technical documentation with NSF, I am likely to cross the next chasm like a hare rather than a tortoise. I will certainly let you know when that happens.

Scientific entertainment. Female nude, back view (1831), by Alexandre-Jean Dubois-Drahonet. Pictured with coronavirus on the prowl.

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.

Market

Healthcare treats health literacy as noise on its uneconomical fringes.

The mission of Humaginarium is health promotion. Yet strangely, there’s no market for health promotion. People aren’t buying it.

According to the World Health Organization (WHO), “Health promotion enables people to increase control over their own health. It covers a wide range of social and environmental interventions that are designed to benefit and protect individual people’s health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure.”

The emphasis here is on “individual people,” meaning consumers or patients – those I call regular folks. They are the targets and beneficiaries of health promotion.

The emphasis is also on “control,” meaning medical self-efficacy among those selfsame individuals. Health promotion is not supposed to benefit the healthcare or wellness industries that sell services to consumers. It benefits the people who have or risk illness.

The specific pillar of health promotion that concerns Humaginarium is health literacy. WHO says that health literacy enables people to “acquire the knowledge, skills and information to make healthy choices, for example about the food they eat and healthcare services that they need. They need to have opportunities to make those choices.”

Thus health literacy is not knowledge or skill or behavior, and certainly not health outcomes. It’s merely the ability of regular folks to learn, in order to make sense and use of their own choices.

In effect health literacy is a competence rather than an outcome, and it’s one that never comes naturally. It must be learned, and there’s the rub. Most folks may be educated, but few have even the most basic health literacy. They didn’t learn it in school. They didn’t learn it in clinic. They didn’t learn it from friends and family. They didn’t learn it by surfing the Internet. Why is that?

Well, I know of two reasons. One is biology as a second language. We must dismiss the advertising we’ve seen and remember that healthy choices are not consumer packaged goods in the supermarket. They are expressions and perceptions that employ the semantics of science. Healthy choices are really hard! The second reason is the information itself: the intelligibility and utility and consequences of choices even after you know what the words mean.

For example, you probably know the word bacteria, but what good is that without knowing how certain pathogenic bacteria got into your mouth and throat and lungs; and how they managed to thrive; and what they’re doing there; and how your body is coping with them? You cannot gain health literacy – you cannot become an individual who exercises control – without some level of scientific acumen that makes you aware of things like this going on in your body.

Mundane health promotion doesn’t make you aware in that way. It typically doesn’t increase your ability to understand and use scientific information. That privilege is reserved for denizens of the laboratory and clinic. Consumers get to pay the salaries of those professionals, with taxes and co-pays and health insurance. That’s mostly where their role ends, for now.

Taking a new approach, Humaginarium promotes health literacy by helping folks experience and play with science of the human body, so they can discover their own truth and make meaning personal. Few health promoters have inspired regular folks to believe they can do that. Maybe Humaginarium has found a way.

However there’s a problem. Remember what I said about the market for health promotion: there isn’t one. Humaginarium can’t go selling health literacy where nobody is buying it. We’ll have to sell it where customers are likely to show up and pay.

That isn’t in the healthcare industry, which treats health literacy as noise on its fringes. Healthcare rarely addresses or prevents the root causes of ill health, but focuses on treatment and cure. That’s understandable; it’s how companies create shareholder value. As a healthcare executive once said to me: “We’re not interested in wellness; we make money from illness.”

Thus the fringes of healthcare are littered with low-budget crap like self-help books and infomercials. Humaginarium doesn’t like fringes; we want to be the center of attention. So we turn to entertainment, where there is a huge market of individuals seeking to exercise control: the market for commercial video games.

In the video game market we know we can render scientific health information visually and dramatically, without bewildering language. Not to teach but to inspire many individuals with the experience of discovering and controlling healthy choices. First in enjoyable, escapist fantasy chock full of risky adventure; then with the real and persistent challenges of their own body and life.

Scientific entertainment. Male Nude, with Arms Up-Stretched (1828-1830), by William Etty. Pictured with small polymorphic bacteria which cause pneumonia, genital and urinary infections in stressful situations like this one.

Vision

To master chronic illness with understanding and control

A funding application on the workbench prompted me for a “vision.” Oh that’s easy, I thought; I’ll write one while the kettle boils.

I sort of did that; and the next day, when I saw the turd I had created, I suddenly realized that I don’t know what a vision is. Actually that’s not true. I know what a personal vision is; and I know what a shared vision is; but I don’t really know what a corporate vision is.

That’s because corporations, in my nonlegal opinion, are not people; they are abstractions. They exist only when you’re using or talking about them, whereas a real human being, or a group of folks, just exists. So how can an abstraction have a vision?

Stumped and stymied by this weighty question, I did what everybody does these days instead of praying: I googled it. Lo and behold as usual, Google answered with delightful speed and precision (which rarely happens with my prayers). It linked me to an article from down under, the other side of the world, where day is night; an article that explains – not how an abstraction can have a vision – but what that vision should be like. It was now time to set aside philosophy and (re)write the damn vision of Humaginarium.

I normally don’t share external links in this blog, but because this one is particularly useful and may save other entrepreneurs some time, I am inserting it here. You may read it if you wish; if you do, it may help you answer the question at the bottom of this page.

So then, drum roll please. The vision of Humaginarium is: Popular video game entertainment that inspires regular folks to master chronic illness.

Romantics like me expect visions to be exciting, even breathtaking, like Elon Musk making a crazy announcement or Steve Jobs throwing down the gauntlet. That comes from the notion that a vision statement is a coming attraction, but according to the experts down under, it is not. It’s not a call to arms, not an expedition to the Misty Mountains, not something you run up the flagpole and salute. It’s humbler than that. A vision is a very, very short description of what will be different in the world when the work is done and the dream has come true.

Popular video game entertainment that inspires regular folks to master chronic illness. My vision statement is appropriately short and it does sound matter of fact. Nonetheless it’s aspirational. I shall explain.

The word “popular” in it means accessible, affordable, convenient, easy to use and much loved: different from all past and conventional health promotions. If Humaginarium makes health literacy cool, it will be f***ing amazing.

Video game entertainment” is our flagship product; not the only thing we make, but the main thing. Why? Because our addressable market of 100 million consumers who like video games and have a chronic illness may flock to Humaginarium if it’s really fun to play. A few hundred may come if it’s merely edifying.

Our work “inspires” by awakening ambition and self-determination. These conative attributes are supportive of self-efficacy (the pillar of our brand). I say “conative” with trepidation because, though the word is older than the English language and is just as meaningful as “cognitive” and “behavioral,” I have never uttered it in mixed company without being asked, “What’s that?” I’ll save you a trip to the dictionary with this handy definition of conation: the mental faculty of purpose, desire, or will to perform an action. Inspiring!

Regular folks” are the kinds of consumers we serve. I borrowed the phrase “regular folks” from Chris Anderson (the futurist and writer, not the TED founder). He uses it when referring to people who are not differentiated by affluence or education. Regular folks is pretty much everybody I meet who is not pretending to be somebody different.

These folks “master chronic illness” by means of understanding and asserting control over it – in our games and in their lives. The chronic illness may be one they have or one they risk; both kinds of threats are mitigated by health literacy that is generated by Humaginarium.

So what do you think. “Popular video game entertainment that inspires regular folks to master chronic illness.” Good enough?

Shameless

The mirror always lies.

Mirror, mirror in my hand, who’s the fairest in the land?” It depends who’s asking. If the Evil Queen asks, she’s usually the fairest. Anybody else – like you or me for example – fuhgeddaboudit! We look in the mirror but can’t see a body there. Instead there’s a body image: a placeholder for the real thing. Most folks find their own body image fascinating and true. Yet nobody else can see it, because it’s also unreal. Like Humaginarium minus the fun.

Basic body image is contrived self-awareness of personal beauty, or lack of it. It’s a mental model, a projection rather than a reflection, something like Peter Pan’s shadow. Body image is a creative reconstruction of the organismal self: physical, behavioral, visible, expressive. It’s everything that reflects sunlight in the real world, though it isn’t actually there.

Body image is superficial yet complicated, sometimes disturbing. We rarely see one without feelings of surprise and delight, or curiosity, or suspicion, embarrassment, even shame. When body image feels out of control, we try to master it with stuff – fashion, coiffure, cosmetics – that make the image look, well, more beautiful in the mirror than the body is in real life. At least we try. It gets expensive.

Folks have positive and negative body images that alternate, like having two of those wily Peter Pan shadows. The images switch on and off with moods, health conditions, social interactions; and they produce different, confusing outcomes. Positive yields satisfaction and acceptance of self. When our body image is positive, we’re like the Evil Queen when her Magic Mirror says, “You are the fairest!” – or at least fair enough, fuhgeddaboudit. Negative body image by comparison is stressful. It unleashes feelings of sadness, anger or alienation. “Snow White is now the fairest,” says the Magic Mirror unexpectedly to the Evil Queen. “You’re kind of a mess.”

Was the Magic Mirror body shaming the Evil Queen? The fairy tale doesn’t say, but yes, I think that’s what happened. The Evil Queen felt humiliated because her outward appearance was somehow, suddenly flawed though it hadn’t changed one iota. In a modern retelling of Snow White, the Evil Queen would not begin a criminal conspiracy to murder and cannibalize her rival. Instead she would enroll in a gym, reduce the size of her portions and meals, try a different hairstyle, consult a plastic surgeon, move her shopping from Bloomingdale’s to Bergdorf Goodman.

But none of that would matter. Why? Because it isn’t true that the Magic Mirror never lies. The mirror always lies! False positives and false negatives abound, making folks complacent or anxious but rarely indifferent and often inauthentic. How they look determines how they feel; and how they feel about themselves may damage their selfsame body – the one that is invisible in the mirror but is the only incontestably real thing about them. Agonizing body dysmorphic disorders may start when the mirror is mistaken for a magician.

Humaginarium also performs magic, but not with mirrors. Rather than judging relative body shape or size, rather than identifying flaws in a body that have to be masked or fixed, rather than exaggerating the importance of irregular features, it flatly states that the human body is a miracle. To be clear and unequivocal: every human body is a living, breathing, sentient miracle; not because of how it looks, but how it works and acts.

Perceiving and appreciating the intrinsic beauty of this miracle yields something far more satisfying than positive body image. It yields a positive body, full stop! That’s a good foundation for resilience, self-worth and self-determination that pursues and preserves health. It’s a good attitude to take to all those mirrors in the dressing room and bathroom: proud of your beauty, inside and out, and utterly shameless.