I initially reviewed this article for my interest in the question, “What kind of diet is best for losing weight?” (with good news for low carbohydrate and Mediterranean dieters), but I quickly became fascinated with the way this study was performed - on the worksite, at the Nuclear Research Center Negev, in Dimona Israel.

To quote:

As Okie recently suggested, using the employer as a health coach could be a cost-effective way to improve health. The model of intervention with the use of dietary group sessions, spousal support, food labels, and monthly weighing in the workplace within the framework of a health promotion campaign might yield weight reduction and long-term health benefits.

I think this is as significant as the weight loss intervention itself - that the study authors worked to modify the work environment to support the study aims. In the supplemental materials (linked here), you can see an example of the signage placed in the cafeteria to alert employees to the different food choices available, depending on which arm of the study they were in.

I think this fact of the study design is under-emphasized and marks an important trend in supporting interventions like this moving forward. With thanks to the Research Center in Dimona for teaching the world about more than nuclear science.

I think word has gotten out that I am something of an urban dweller; Susan Edgman-Levitan was nice enough to ask me, “Ted, are you hanging in there?” as we spent several days in Yountville, California at the American Board of Internal Medicine Foundation forum on Achieving Patient-Centered care.

I ended up doing just fine - it’s about the content, not the place, and a scenic jog through the vineyards of Yountville can’t be argued with.

And the content was right up my alley, with thanks to the ABIM Foundation for hosting this discussion. The discussions at the Forum are being compiled by the ABIM Foundation, so I will let them report on that rather than me, but I can share my perceptions of the event here.

First of all, patients and families were involved throughout, as faculty and equal participants. This continues an important precedent in helping health care leaders achieve comfort with this idea.

One of the most powerful moments was Margaret Murphy sharing the story of her son Kevin’s death (You can read more about it here) within the Irish health system. I really appreciated Mrs. Murphy’s use of images in her storytelling - in the future, a presentation without at least 50 % images and a video or two is going to be minimum bar to go in front of an audience. There was discussion about Kevin’s death being the result of diagnostic error. I think that’s true, and I also think that if the family had access to all of his medical information from the beginning, it might have changed the diagnostic approach or caught the fatal series of errors before they happened.

For my part, I presented the following slides in the 10 minutes I had alotted, around the topic of the use of health information technology to put patients, families, and communities in the center of care.

Enjoy (I hope) and thanks to the ABIM Foundation for hosting this discussion and follow-up.

Click on any image to see them larger

click on the image to see it full size

I took this photograph as I was walking to Georgetown and noticed the Ghost Bike placed in Dupont Circle by the Washington Area Bicycling Association. The ghost bike was placed in a ceremony on July 10 (more information here) following the death of 22-year old Alice Swanson, who was killed by a garbage truck while riding her bike to work on July 9, 2008, in Dupont Circle.

As I walked by, I noticed the words written on the tire by Alice’s mother. They had an impact on me. They will on you too. Click on the image to see them for yourself.

Jonah Froelich, MPH, California Healthcare Foundation’s resident expert on health information technology sent this along to me and I wanted to post it. It shows the spirit of health professionals who are changing the way they practice because they want to perform better for their patients. Scenes like this are happening all over the United States. Thanks and congratulations to West County Health Centers and (again) to the Redwood Community Health Coalition for sharing their enthusiasm with patients everywhere.

The world is not flat; place matters.

I couldn’t agree more with the latest work by Richard Florida. This book looks at the importance of place not only in the global economy but in a person’s life. I personally had a good idea that this made a huge difference some time ago, despite living and working in a world where colleagues work for organizations for which home base is irrelevant.

On this, my 300-day DCVersary, I can confirm that my experience bears this out. Moving from one of the smaller “mega-regions” (Cascadia, Portland, Seattle, Vancouver, 9 million people, $260 billion light-based regional product) to the second largest one in the world (Bos-Wash, Boston-Washington, DC, 54 million people, $2.2 trillion LRP) has undeniably made a significant difference in everything I do, even in a technology-related occupation. As Florida describes, people cluster:

(There is) the tendency of creative people to seek out and thrive in like-minded groups, and (there is the) self-perpetuating economic edge that comes from doing so.

Florida does a good job of reviewing the evidence that place matters, and the idea that its impact on personal and professional happiness has been underemphasized. He combines original research as well as data currently available to create a compelling picture of both the importance of place and the factors about it that matter. One of the interesting explorations in the book is about the personality of cities - extroverted people and agreeable people tend to be localized east of the Mississippi, where “open to experience” people tend to be localized to the coasts, with dominance in California and Bos-Wash (okay, maybe the extroversion doesn’t stretch as far east as DC, and maybe the “open to experience” doesn’t stretch as far South, but I’m pretending they do - you always see the best in something you like).

Throughout, It’s nice to imagine where you might “fit” but also how your own experience stacks up, because an important criteria of a place its aesthetic.

I have been using a curious measure for the past few years to judge aesthetic, the “touch-down” measure. It is, “In what city do you say to yourself, ‘I’m home,’ when the plane touches down on the runway.” I think you can’t fake that. Alternately, it’s the city that when the plane touches down, you say to yourself, “I can’t believe I don’t live here.”

I give strong kudos to Florida for acknowledging the role of diversity and tolerance in a place, not just for minorities, but for all people. He says:

It’s not about tolerance for tolerance’s sake. As my previous research has shown, places that are intolerant simply do not grow. And, as the Place and Happiness Survey confirms, people in intolerant places are less happy and less fulfilled than those in tolerant an open-minded ones.

This finding is similar to research that shows the same thing about organizations. As a patient said to me a very long time ago, “We don’t tolerate diversity (within the organization I work for). We LIVE diversity.” That describes a place that has a better chance of thriving, and one that most people (including me) want to be involved with.

A book by an author that writes a blog is a better read

It is worth mentioning that as I read the book, the positive impact of Florida having experience writing a blog came across, because (a) he brought his personal experiences and those of his colleagues into the story and (b) he crowd sourced several of his ideas, bringing in commentary from blog entries. This made for a much more engaging read, and I can’t help thinking that without this experience, the work might feel less connected to the experience of real people. I think this is an interesting way that blogging is changing traditional publishing because those who blog are forced to become more personal in their communication to be successful. I like it. A lot.

And the winner is…

I have experience living in three mega-regions described in the book: Bos-Wash, Nor-Cal, Cascadia and it was interesting for me to compare the decisions I’ve made with the characteristics of each. All of them offer so much. My recent experience with Bos-Wash has been, well, fantastic, both in terms of livability, ability to be extroverted, and exposure to diverse populations and cultures. Nor-Cal scores high in my book as well as it shares many of the livability and diversity attributes, as well as strong dominance in technology and innovation. Cascadia was definitely enjoyable for the time I spent there.

Who’s Your City? Feel free to post your experiences…

• More on iPhone 3G availability at sharding/blog - For those of us intently interested in this right now. It's interesting that Apple has decided to centralize distribution to just its stores and not take advantage of a more dispersed AT&T retail presence. I think they will look back at this as a mistake.

• Maintaining Metro - washingtonpost.com - For those who live in Washington, more information about what's happening during those 30-45 minute delays on weekends when they are replacing switches. Things related to place matter even to those working to change the world. The world is not flat.

• Think Before You Voicemail - Sentiment about older modes of messaging. If the general public doesn't like it, maybe we shouldn't force our patients to, either.

• Just A Language Change, Or A Step In Slouching Towards Gomorrah? - Interesting change in CMS incident-to rules. This does have impact in EHR installations.

• Health Populi: Corporate reputation: pharma, gas and finance tie for the penultimate position - Nice analysis from Jane Sarasohn-Kahn about the latest data around corporate reputations