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.

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.

Biology as a Second Language

We understand the body about as well as we understand my first paragraph.

When the amygdala perceives sensory information from the thalamus to be threatening, it engages the paraventricular nucleus in the hypothalamus resulting in the stimulation of corticotropin-releasing hormone (CRH), which begins the stress hormone cascade. This hormone then stimulates the pituitary to release another hormone called adrenocorticotrophic hormone (ACTH). This hormone travels down to the adrenal cortex gland, which produces the stress hormone cortisol. Cortisol in turn will feedback to the hypothalamus and the pituitary.

I’m quoting above from a book named The Science of Stress. The authors explain to the general reader how the HPA axis responds to internal and environmental stressors of the human body. I bring this up here for two reasons.

First, the axis is implicated in metabolic syndrome and diabetes mellitus type 2, the subject of our prototype projects Diabetes Agonistes and Metabolic Genii. The HPA axis is a kind of tripwire: the cause of and the mechanism for incredible biological activity in our bodies: every body, every hour of every day. The axis keeps us healthy or makes us sick depending on forces that we, rather than it, control. If the axis didn’t work properly, with phenomenal speed and precision, we would suffer and even die. Yet most of us willfully undermine the axis with some of the behavior typical of our personalities.

Personality is a vague concept, but I think it’s fair to say that personality or self (ego, id, superego) is neither inherited nor determined by environment. It’s a product of the individual imagination – a creative projection of the mind – that tends to take the body for granted. “I think therefore I am.” Until – inevitably – the body breaks down and it’s hard to think straight. We choose to behave as we please, often dangerously, because we understand the body about as well as we understand my first paragraph; i.e. we’re clueless.

My second reason for quoting The Science of Stress is to make a point about health literacy. We know that literacy is the ability to write and read language. And in our society, basic literacy is purportedly equivalent to eighth-grade communication skills. In other words, to be nominally literate in America, in 2019, is to communicate like an adolescent.

That is why my first paragraph is a challenge for regular folks. It is written in English that a scientist or clinician, with abundant education, easily understands. It is not written in the English that the vast majority of their fellow Americans can even read, and none could ever write. For that reason, the meaning of the paragraph doesn’t exist for them. They can’t interpret or use it, and that’s a problem.

You could say those scientists and clinicians are certified BSL: biology as a second language. They’ve been trained to read and write the language of biology. Not for its own sake of course, but in order to use biology in their professions. The humanities majors among us, and the greater number who never got past high school, are literate in that adolescent way. We are not BSL certified. We can’t understand and use biology because it’s wrapped in esoterica.

Or can we? Of course we can’t teach BSL to the masses. We could however extricate biology from its language wrapper and render it in forms that regular folks can easily understand – and even enjoy. That’s what Humaginarium is doing with the biology of chronic illness. Making it animated and visual with symbols and pictorial narrative. Making it tangible so folks can touch it, play with it, fight with it, figure it out and master it. Not biology as a second language, but biology in a visual language of color and shape that folks are already fluent in, and capable of probing for meaning.

Now, some would say that regular folks cannot understand biology, not because they’re baffled by the language, but because biology is way too complicated. This may be why most promotions of health literacy avoid science like a plague and focus on behavioral adherence to rules. I’m betting those promoters are wrong. Based on my experience as a parent, a patient and an educator, there is nothing in or about biology that is beyond the capacity of an average adult to understand.

All those average adults are organisms at the top of the food chain. They are outcomes of billions of years of evolution. Their minds are the most wonderful things that nature has ever made. They are not stupid! They certainly have the capacity and the motivation to understand, interpret and use science to fight chronic illness. Only first, they have to take off the gloves, and we have to take off those bewildering, jargony wrappers.

Scientific entertainment. Dante and Virgil in Hell, by William-Adolphe Bouguereau; pictured with histology of the pituitary gland.

Mechanics

Health may be a human right for others, but you’re going to fight for it.

Users cross the morbid frontier with a plan, a map, a wallet, provisions and a cache of clues. They have a tough job ahead in Diabetes Agonistes. Seize the minions of chronic illness! Reclaim the birthrights of strength and safety! End the pain; end the suffering; end the fear of your own body!

Whoa, whoa, not so fast. Everything you try in this godforsaken fantasy will be challenged or opposed. What you see and feel is a fraction of what’s actually there; and much of that is out to get you. So be careful.

The minions you’re chasing are feral, ugly, numerous, devious, nuanced, complicated and uncannily intelligent. They’re thriving like a nest of vipers while you gingerly probe their squirming skins. When you grasp one it may throttle or bite, or emit begging sighs that lure you inward or downward, but probably not onward. After all, you want to live strong but the minions of chronic illness frankly want you to die. They might go so far as to kill you! It’s not hopeless though. Their crushing powers to confuse and depress may yield eventually, but not to chemical or nuclear weapons. Only to insight tempered with rare, gemlike passion you store in your heart for this quest. Health may be a human right for others, but you’re going to fight for it.

There are structural mechanics in the morbid frontier. By that I mean programmatic activities. Remember you’re in a video game now where NOTHING happens unless you trigger it. The good news is that your path is packed full of affordances. They are the logical, functional, evocative, riveting means to your ends. They’re also symbolic and deeply disturbing. Purpose-built to ignite learning and motivation. In the morbid frontier, everything you’ll do to overcome The Problem inflames your own personal desire to learn and go farther, and accomplish more.

Let’s begin to envision the game mechanics of Diabetes Agonistes.

Trusted Advisor. You may traipse solo through the morbid frontier, if that’s your style; or bond with a droid who has special powers. To interpret clues, weigh choices, fabricate tools, detour into branches, avoid pitfalls, barter, negotiate, interrogate, assassinate. All handy services, but beware of friends. Droid talents and loyalties are time and place dependent, devilishly restricted. You won’t know their limits until you test them; and you won’t be able to test a droid until you badly need it. You must learn when to fire and replace trusted advisors before they steer you into deep shit.

Meaning Maker. You may journey through the morbid frontier for the fun of it, as though it were some grotesque carnival. That would be thrilling and satisfying, but not winning. To win you must continuously make meaning from your experience. The meaning you make guides you onward, makes you more resilient. Emerging knowledge gradually transforms you into a master of fate. Take note of this. Diabetes Agonistes doesn’t teach you; it teaches you nothing. You force the quest to reveal truths that you can use. Making meaning is like fetching the key that turns the lock, from a ring of glittering duds.

Highways and Byways. You enter the morbid frontier with a map. Unfortunately, the map is a character with a quirky personality, a hidden agenda, and is somewhat unreliable. It doesn’t show you which way to go; doesn’t show all the ways to go; it merely indicates topography and suggests possibilities. You interpret the map, filling in gaps with your intuition and discoveries. You treat the map as a data store rather than a bundle of insight. You filter it for wisdom while suspecting it may be lying to you or mistaken. By improving the map in time you will gradually become a skilled cartographer for higher, more difficult levels of the morbid frontier.

Profit and Loss. You carry a digital wallet, starting in the Arcade and throughout Diabetes Agonistes. The wallet is initially stocked with enough capital to float your quest; but not enough to complete it. The wallet holds identity cards, credit cards, biocurrency and tokens that have specialized uses and surprising half-lives. In the morbid frontier you draw down this capital to pay for provisions and clues, bail, gadgets, services like protection, ferries and contract kills, healing balms and magic incantations. You may replenish your capital by earning rewards, trading objects, robbing minions and their bosses, ransacking their troves, trading on the Metabolic Exchange. The wallet is your permanent and personal property. It goes with you when the game is over and you’re on to a new quest in Humaginarium.

Are there more mechanics than these I’ve just shared? Indubitably. I want to keep writing about them. I’ll resume in my next post.

Morbid Frontier

This frontier is a newfangled transubstantiation of the body.

The exposition of Diabetes Agonistes turns on goal-setting, surveillance, and discovery of The Problem – by users who are going to experience and try solving it. In the real world The Problem is called metabolic syndrome – a nexus of chronic illness including diabetes mellitus type 2. In the fantasy of Diabetes Agonistes The Problem has no name. It’s an ominous presence, an irresistible force that manifests metaphorically, visually, dramatically as a vague, existential threat. More suicide bomber than complex medical condition.

Up to this point, users have glimpsed and probed the borders of a frontier full of hazards and portentous implications. They’ve observed and gathered biological phenomena that eerily materialized before their eyes – each unpacking different clues and warnings about what lies ahead in a quest. The clues suggest where and how The Problem may be found, observed, engaged. Warnings promise enrichment and fun to “all ye who enter here,” while darkly insinuating ambush and horror for hapless adventurers.

The frontier I’m talking about is a new transubstantiation of the human body. Rather than body into wafer, this is body into earth and sea. The frontier is underpinned by computational models of physiology and biochemistry that we’ve exploded and reorganized, reshaped and robed as a chronological, three-dimensional space like Eä and Arda and Middle-earth. Those dreamscapes are symbols of nature at every level and civilization in every moment. They are make-believe geography and history that were created to be explored, claimed and defended by questers pursuing salvation and truth along with victory and peace. Somewhat like the mythos of yesteryear, our new biological fantasy evokes metabolic structures, forms, content, mechanics and processes of a diseased human body; not as a body per se, but as a world that users bravely traverse and strive to master.

A typical user enters this frontier by choosing among three trails that present different perspectives on The Problem. Each trail attracts a different kind of user, but all lead precariously to the same endgame.

The first trail is elemental. It winds through the biochemistry of a metabolically disordered body at its least visible and experiential; its most enigmatic and elusive. From the elemental perspective, the constituents of metabolism have existed for billions of years – since life on earth began in the primal slime – and will continue long after their human hosts have departed. They are like the Valar. They make human life possible; they can sustain or end it in a snap; but all the same they are woefully indifferent to it. Their concern is all life, not human life in particular; and their fate is not bound to ours. This is a molecular agon.

The second trail is combinative. It makes its way among microbial tribes of the afflicted body, populated by wholly formed and determined agents who have unique personalities and life stories. Some tiny organisms are virtuous, others malevolent; some are brilliant, others mechanical; some are empathetic, resilient, capable of serving the greater good; others selfish and moronic, having little on their minds beyond the next meal and procreation. Neither immortal nor transcendent, they persist as long and as well as their tribe does; causing or enduring metabolic disorders and maybe overcoming them alone or with help; but rarely able to survive far from home. The whole of their population is equal to the sum of its parts. This is a cellular agon.

The third trail is civic. It cuts across the anatomy of an unwell body in which relations between tribes are modulated by rules, authorities, competing interests and economic pressures. The actors encountered here are systems rather than molecules or cells. When they are not disoriented by morbidity, they rest in balance and harmony: the endgame of homeostasis. However they are extremely vulnerable to attack, and in defending themselves these organs, tissues and fluids may spiral into conflict and chaos that end badly. This is a physiological agon.

Three trails through one frontier, with discrete beginnings but myriad links, dependencies and interferences. No matter where users begin, their quest ranges through all, interweaving their bewildering and frightful perspectives. What will it be like to play on and in them? That’s for my next post.

Green Light Redux

Two federal agencies have invited us to request SBIR Phase 1 funding.

I’m taking a break from game design this week to talk about progress on another front.

Back on April 10, I announced that the National Science Foundation approved Humaginarium’s Project Pitch. Today I’m announcing that the National Institute of Diabetes and Digestive and Kidney Diseases has approved our Specific Aims. Two US federal agencies have thus invited Humaginarium to apply in 2019 for substantial, non-dilutive, SBIR Phase 1 funding. In my opinion, that’s cool!

Specific Aims is a single page argument that our groundbreaking idea for biomedical innovation is a good fit for NIH support; and that it’s a good candidate for commercialization. I dubbed the idea Metabolic Genii.

In popular culture, a genie is Robin Williams magically springing from a bottle to make jokes and grant wishes. I’m fine with that; it fits our brand well enough, but the word genie is actually more meaningful. It’s a variant of genius, and a genius (plural: genii) is an attendant spirit: a force that influences actors for better or worse.

Metabolic genii are digital affordances that empower folks who have or risk developing metabolic disorders. The genii enable them to inquire what’s up with their bodies and gain a bit more control over their medical outcomes.

Like any genius worthy of that moniker, metabolic genii are extremely creative. Ours are creative like scientists rather than sorcerers. They intelligently pan for the personal gold in every individual they meet, ultimately enabling users to feel a little like Aladdin, with wishes that now make a lot more sense and eventually may come true.

The terminal objective of our Specific Aims is a set of six precise, repeatable techniques that reliably convert basic health literacy (acquired in a separate project) into resolute behavior. These six techniques are drawn from a social science palette that includes situational awareness, choice architecture, scenario planning, nudge theory, decision science, and reinforcement theory of motivation. According to my reading of research literature, these powerful and accessible affordances have never been synced to produce sustainable medical outcomes. We’re about to sync them in order to discover what happens next.

What do we expect to happen next? Empowerment. Users will demonstrate their ability and desire to make evidence-based decisions about illness and wellness; and furthermore make those decisions as sticky as flypaper. Sound easy? Sorry, it’s never been done before. That may be why health education mostly doesn’t work. At all.

Who is going to benefit from this project? Of course Humaginarium and its investors will benefit, but more importantly 60% of the adult population stands to benefit. That is the proportion who already have a poorly controlled chronic illness (the numbers are increasing). That’s also the proportion who play video games, the medium we are using to generate basic health literacy (and yes, those numbers are increasing too).

What will our R&D be like? It begins with a re-review of secondary research that bears on our terminal objective. From there it takes the form of agile discovery. We are not going to think this problem to death. Instead we shall design activities that a large number of experts and ordinary consumers can experience and comment with feedback. Each of these activities generates data that indicate efficacy and flow into other parts of the Metabolic Genii system.

Our Phase 1 research and development yields proof-of-concept of this system; and verifies its theoretical efficacy. If results are encouraging, we will migrate our hardening techniques into a Phase 2 design-build-test-deploy project. At that point, our world begins to resemble an oyster.

Metabolic Genii and it’s counterpart Diabetes Agonistes are now as two horses pulling a chariot named Humaginarium. Our chariot isn’t racing against competitors; there is none working at our level. We’re racing against time. We want to stymie metabolic disorders and other chronic illnesses as quickly and as soon as possible.

Click here to read the Specific Aims.

Provisioning

Success depends not on what users know but what they discover and use.

This is the game objective of Diabetes Agonistes:

  • Seize the causes of metabolic disorders
  • Confound their powers to harm
  • Claim the birthright of homeostasis

Reminder: this serious objective is met with play, not with study. It’s pursued in a fantasy; not real life. Users solve tough problems on a personal quest through the make-believe. Yes, they will eventually do similar things in their own real life; and they will do it better because they practiced first in Diabetes Agonistes. But I’m not concerned with that now. Right now I’m thinking only about how to play a really good game.

Each of the three jobs I mentioned – seize, confound, claim – is an agon. Each is beautiful and magical, yet difficult and messy. Users who don’t carefully prepare before questing will fail fast and often.

Players who are MDs and RNs – there will be plenty (real and aspiring) among our play testers – may opt to ‘damn the torpedoes’ because they’re confident of their scientific and clinical acumen; they may plunge headlong into the fight to prove they can beat this silly game sim in record time. By design though, they’ll get plastered by adversaries who have even more confidence, and with good reason.

Preparation for questing is necessary and also voluntary. Like everything else in Diabetes Agonistes, success here depends not on what users know but what they choose to discover and then use. It depends on clue finding and strategy. Diabetes Agonistes does not leverage motor skills like an arcade game.

Users who earnestly examine their surroundings for clues soon find a checklist that helps them prepare. The checklist is for provisioning. It helps them acquire and create things they’ll need to survive an agon. A checklist guides individual discovery of things like:

  • Who are my adversaries?
  • Why are they adversaries?
  • What are their powers?
  • Where are they now?
  • Do they morph and mutate or always stay the same?
  • Are they immortal or can they be killed?
  • Who are my allies?
  • What can they do for me now and later?
  • Why should I join this quest; what’s my purpose here?
  • What do I win; what larger difference may I make?

Our principal mechanic for clue finding in Diabetes Agonistes is a metaphor for geolocation. Users can (if they wish) lease a dirigible airship with credits stored in their key. They can steer this airship above a phantasmagoric terrain that elegantly symbolizes human biology and physiology. This landscape is not a funky realistic model of the human body as in most healthcare simulations; it’s not like Lemuel Gulliver in Brobdingnag, or Frankenstein’s cadaver, or a Russian scientist in the movie Fantastic Voyage. Instead it’s an experiential metaphor that showcases metabolism in the human body as a fabulous, habitable world.

Users survey this world from high and low altitudes. They probe it for insights that can be used when pursuing the game objective, but they don’t do that peacefully. Adversaries who dominate the terrain have radar; they sense when their empire is being scrutinized and they don’t like it. The knowledge of others inflames them! Once detected, they do everything they can to capture or kill users who spy on them, knowing that those who escape may come back to haunt them.

In addition to geolocation, users may discover clues in curious containers. Some containers explode when touched inappropriately, others open when gently coaxed; some open freely, others unlock with credits stored in a key; some are unique and can’t be shared, others can be traded. Some are useful and endow users with powers to heal or cure, others are evil and extremely dangerous.

When users guess they have all the clues they need for what comes next, their questing may begin. I’ll describe that beginning in my next post.