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.

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.

Diabetes Tech

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

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

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

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

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

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

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