iWatch, the quantified self and the worried well

(image via 9to5Mac)

It seems almost inevitable that Apple will launch an iWatch later this year, and most pundits agree that “the quantified self” will be the main theme of this new device. An emerging tech trend, the quantified self connects wearable devices with online services to provide continuous monitoring of a user's health and fitness.

This new category has seen some growth, with devices such as Nike’s Fuel Band, Jawbone’s Up and Fitbit generating plenty of press coverage and modest sales. But as with tablets and smart phones before, Apple’s entry into the nascent category could redefine its purpose and massively broaden its appeal.

I’ve been involved in health and fitness tech for many years, both as a user (tracking my runs on Nike+) and as a developer (I co-created Reps & Sets, the gym logging app for iPhone). So I know from personal experience the tremendous potential that exists for using technology to support people in their health and fitness goals. 

But there’s something about quantified self products that troubles me. We often lazily bundle “health and fitness” into a single phase, but they are in fact two distinct things. After all, you wouldn’t get medical advice from a personal trainer any more than you'd ask your doctor to help improve your bench press.

Quantified self products cross the line from fitness to health, and in so doing, they pander to the “worried well”: those whose only symptom of illness is their anxiety that they may be sick. Oddly, as medical science has improved our health, this anxiety has steadily risen.

Be careful what you measure

As any self help book will tell you, it’s best to focus on what you want, rather than on what you don’t want. Fitness tracking products focus on positive goals. The best ones highlight our achievements and progress, providing us with encouragement and motivation to continue.

Quantified self products, on the other hand, medicalise us, tracking metrics such as blood sugar and blood pressure. These kinds of data may provide insights to qualified medical professionals, but will offer little meaning to the average user. Instead, they encourage us to anxiously obsess over inconsequential fluctuations in our body’s normal functioning.

In other words, the quantified self encourages us to look for problems rather than to look for progress.

Looking for problems can create problems

There are two main problems with this. The first is false positives. Health screening can be a highly effective intervention, but it doesn’t always follow that we should screen for every possible kind of sickness. Some types of screening result in high levels of false positives - where a healthy patient may be told they are sick and undergo unnecessary, unpleasant and sometimes risky treatment. Ultimately, scientists must study the data to determine whether the benefits of the screening for a particular disease outweigh these risks. 

No such determination is made with quantified self products. Instead, healthy individuals are subjected to endless ongoing tests for no apparent purpose, and presented with results that they are not qualified to interpret.

The second problem is the vicious circle - the kind of negative feedback loop you can get into when you obsess about your health. The anxieties created by worrying about non-existant health problems can result to very real stress-related health problems. As a result, the worried well may over time become the worried unwell.

Track your fitness gains, not your health problems

As a former cancer patient, I know what it’s like to have every aspect of your health monitored. Chemotherapy is not fun. But fortunately for me it was effective. Now I choose to focus upon the benefits of successful treatment, by pushing my body as far as it can go in terms of my fitness. And that’s what I choose to measure: the progress of my fitness.

Of course, my health is more important to me than my split times on a marathon. That’s why I still go for regular checkups at my hospital, who do all kinds of tests. But I prefer to leave the quantification of my health to qualified medical professionals who I trust.

What’s going on inside your helmet? - Quarterbacks, coaches and patterns of success

The pressure on a quarterback in an American football game is hard to imagine. They alone are responsible for passing the ball by throwing it long distances across the field. And the longer they wait before making a pass, the greater the chance they'll be tackled to the ground. But they don’t face this responsibility alone. Inside every NFL quarterback’s helmet is an earpiece so they can receive instructions from their coach. It’s the coach’s responsibility to call the plays, deciding what the quarterback and offensive team will do on each down.

The coach may call for some some long and difficult passes, and if the quarterback fails to complete a few, he might start to panic. Perhaps the negative self-talk sets in, as the defence starts to undermine his self confidence. Typically in this situation, a coach will give his quarterback a couple of easy passes to calm him down.

If you’re not a quarterback, you probably don’t wear an earpiece for your coach to whisper instructions to you as you work. But perhaps you should.

A good creative professional needs to be both the quarterback and the coach. Throwing a beautiful pass is a bit like coming up with a great new idea, or solving a particularly difficult creative problem. The more challenging the task, the higher the risk of failure.

If you’ve spent a lot of time on a creative problem, and you haven’t come up with any great solutions what would your coach tell you to do? He’d give you a couple of easy tasks to do, so you can get your confidence back. In other words, he’d want you to put that difficult brief to one side for a while and have some fun.

It’s easy to get into patterns of failure, and it’s equally easy to get back into patterns of success, once we become aware of what’s happening. When a quarterback throws a series of incomplete passes, his confidence is undermined, and he get’s into a pattern of failure where his performance suffers. By getting him to throw some easy passes instead, the pattern of failure is broken and a new pattern of success is established. Then it’s time to attempt more challenging passes.

Whether creative professionals are working in groups or as individuals, these same patterns emerge. Often accompanied by negative self talk. In a group, you can actually hear the negative talk set in, as people start to focus on the problem state, rationalising why they can’t solve the brief, and in the process demotivating each other and limiting the group’s potential for success.

The solution is always to put the task to one side, do something easier, and come back to the original task when you’re back in a pattern of success. It often helps to “sleep on it” and come back to the brief with a fresh mind the following morning. Or to approach it from a different context, when you’re in a more relaxed mindset. (I often find that I do some of my best creative thinking in the shower).


But what if there isn’t time? 

Managing a creative agency, an issue I frequently encounter is the expectation that if we have quoted 2 days for a team to work on a creative brief, then the client can expect the job to be turned around in 2 days. I would usually insist on at least a week. Clients often don’t like this because they imagine that their work is being held in a queue and not prioritised. But the truth is quite the opposite.

If you agree to turn around two days of creative work in two days, then you haven’t given yourself any time to put the brief to one side and work on something easier. And you’re potentially compromising the quality of your creative response as a result.

The answer is to share some of this with your client. Explain your creative process to them. And if they still won’t give you the turnaround time that you need, you should seriously consider finding smarter clients to work for.

Seriously.

After all, it’s a question of how good you want to be. Do you want to be known for “quick and dirty” jobs, where you churn through average work at high speed, or do you want to be known for creative excellence, that clients are willing to wait for and pay more for?

Leaky and ambiguous icons

I've created many icons over the years. So I know from personal experience just how difficult they can be to design.

The objective of icon design is usually to produce the simplest possible image that unambiguously communicates a concept. Sometimes that concept is a thing: like a folder or a trash can; sometimes it's an action: like swiping a card or summoning a nurse.

There are two reasons why icons should be as simple as possible:

1. they are less cluttered and work in small sizes;
2. they are less likely it is to "leak" unintended messages.

The first reason is self explanatory. The second is worth exploring in more detail. As an example, take a look at this icon I found in a hospital. The purpose of the button is to summon a nurse. The icon doesn't attempt to convey the action of summoning. Instead, it shows a picture of a nurse. But is that all the icon is communicating?

I see several other messages in this icon:

• Nurses are women
• Nurses are slim and totter around on pin-like legs
• Nurses wear figure hugging clothes with short skirts
• Nurses carry items like drinks
• Nurses wear old-fashioned clothes, or it is appropriate to be nostalgic about when they did.

...and there are doubtless many more. The presuppositions and cultural context of the designer are leaking out of the icon. In this case, the ideas leaked are so far from today's social norms that I believe the hospital should consider changing the buttons. A cost that would have been entirely unnecessary if the icon had been a bell, for example.

But while too much information can be a problem, an icon can also be over-simplified to the point at which its meaning becomes ambiguous. Take this icon for Transport for London's Oyster Card readers, for example.

Oyster Cards are the RFID-based contactless ticket system used on the London Underground and busses. The icon indicates where passengers should "touch in" and "touch out" to start and end their journey at the ticket barriers. The only action required by the user it to place their card against the reader. Perhaps the icon is intended to show a card touching against the circular reader. But instead, many passengers interpret the circular shape as a swoosh, suggesting they should wave their card around in circles. 

The problem is that this rotating motion confuses the RFID sensor, resulting in a delay in reading the card, which often causes passengers to wave the card in even more vigorous circles, making a read almost impossible.

This can be very frustrating to observe if you are stuck behind a card waver at the ticket barrier. Given that this icon is now used throughout the city's transport system, millions of man-hours have presumably been wasted in this way. At who knows what cost.

The meaning of any communication is ultimately how it is interpreted by the recipient. The recipient is never wrong - a misinterpretation is always the responsibility of the communicator. Great icons unambiguously communicate a message. And to do this, they have to be incredibly simple - eliminating extraneous elements, while maintaining sufficient detail to make their meaning explicit. Finding just the right amount of simplicity is not a simple task. But when designers do this hard work, they make it easier for users.

The skin I live in: a 7 year journey

As my latest round of cancer treatment is coming to an end, it has prompted me to reflect upon the mind-body journey I’ve been on.

I’d had rashes all over my body for many years, without realising I had cancer. But in 2007, I found a big lump in my groin, went to the doctors and was diagnosed with cutaneous t-cell lymphoma with mycosis fungoides - a kind of skin cancer.

At that time, I was overweight, unhealthy, stressed and depressed. Cancer seemed like the last straw.

The doctors wanted photos of my rashes, so I was taken to the medical photographer. Standing half naked, with my arms out stretched, my gut hanging over my boxer shorts and my skin covered in lesions, flaking away onto the floor as he took pictures, I felt ashamed.

Four cycles of chemo later, the tumours in my lymph nodes were gone, but the rashes remained and continued to deteriorate over subsequent years.

While my skin was getting worse, my health was otherwise improving. I’d never done any exercise in my life before. But the experience of going through cancer treatment had inspired me to get fit, so I started running and weight lifting. I became very interested in fitness and I even became qualified as a personal trainer.

But by 2013, my skin had worsened so much that I was starting to look like the Singing Detective. I was shedding the top layer of my skin like a snake and I had to stop running because it was just too painful to move. For the second time in my life, it seemed like things were coming to a gloomy end.

Fortunately, however, I was referred to a new consultant who prescribed photo-chemotherapy: a combination of drugs and ultraviolet light treatment. (Essentially high-tech sun beds). Treatment has given me a deep, even, all over tan. It’s the first time I’ve ever enjoyed a side effect of cancer treatment. And more importantly, it has worked. My skin is looking better than it has done in over 15 years.

I’ve now got just one more week of treatment to go. My cancer in remission, my skin has cleared up, and my hard work at the gym is finally starting to pay off. Who knows what the future has in store, but right now, this is a pretty special moment for me.

I'm now looking forward to going on holiday to Greece in May with my partner, Martin. It will be nice, for a change, not to feel ashamed of my skin on the beach, and it will give me chance to top up that tan.

Water fountains, hearing aids, pelican crossings and thoughts on button placement

As designers, when we think about buttons, we tend to focus on what they look like. Should they be shiny, three dimensional and "clickable"? Or should they be starkly simple and borderless? But my experiences this past week have reminded me that there is one feature of a button that is even more important than its appearance - and that is its position.

This weekend, while I was out for a run, I stopped at a water fountain, waiting my turn behind a rather confused lady who couldn't find how to turn the thing on. I pointed the button out to her, she took a quick swallow and then hurried away sheepishly.

I'd used this water fountain on many occasions before during my runs. So frequently in fact, that I didn't even think about where the button was as I pressed it. But now, reappraising the water fountain with the critical eye of a user interface designer, I could see it was flawed. The lady in front of me had expected the button to be close to the water nozzle. She had been trying to push the metal shield that curved over the nozzle, expecting the button to be integrated in some way. Not a bad idea at all. But in fact, the button was on the side of the fountain, partially concealed below the rim of the receiving bowl. It was a convenient position once you knew where it was, but I wonder how many users never found it.

So...  button position learning 1: buttons need to be discoverable - locate them where users will look for them. Usually close to the function they perform.

I may have no trouble using the water fountain, but the position of another button has been giving me grief recently.. Last month I treated myself to a fancy new pair of Siemens Aquarius waterproof hearing aids.  They came with a "Minitec" wireless accessory, which is necessary for adjusting volume and making Bluetooth phone calls. Every time I squeeze the clip on the device to attach it to my lapel, I accidentally press the "Call" button, which is located on the opposite face from the clip. The button is located such that it is virtually impossible to use the clip without pressing the button.  And every time it's pressed, there's a temporary interruption to the essential function of the device: amplification of ambient sound. In other words, this button position makes me temporarily deaf.

Learning 2: buttons should not be located where they are likely to be accidentally triggered.

Finally, I was intrigued by a hidden button concealed on an interface we all use every day - the pelican crossing control box. Hidden on the underside of the box is a button (or rather, a nob) which rotates whenever the green pedestrian light is on. It's designed to provide a tactile feedback to those with visual and hearing impairments.

The nob is so well concealed that you would never know it was there unless you were in the know. So for most crossing users, this extra nob provides no distraction - the front of the control box remains uncluttered, with a single button and a "Wait" light which appears above it. But for those who need it, this essential extra nob is easily accessible.

Learning 3: reveal extra buttons only to those who need them, without distracting those who don't.

Time is never wasted when you're doing what you love

When ParalympicsGB's Jody Cundy was disqualified from the C4/5 1km time trial last week over a problem with the starting gate, he was denied the opportunity to compete in an event for which he had put in four years of arduous training. And in the heat of the moment, he said some things that he later regretted and apologized for.

One comment he made at the time was: "I've just wasted four years of my life." In the circumstances, his frustration was understandable. But when he'd had a chance to cool down, he got back onto his bike, saying "I guess I'll have to do another four years now because there's a kilo title with my name on it. I want it back."

There are no guarantees in life. We can't always expect to achieve our goals. And sometimes the obstacles we encounter along the way are unanticipated, unreasonable and insurmountable. But that needn't stop us from having goals and striving to achieve them.

We should do what we love and love what we do. If Jody Cundy loves cycling, then it's never a waste of time for him to ride his bike. Time is never wasted when you're doing what you love.

And a goal is only as good as the structure it creates. If the structure is good, then the goal is worth pursuing, but if you don't have any appetite to do what it takes to achieve the goal, pick another goal instead. Because you'll spend far more time training than you will relishing your victory, even supposing that you do succeed.

Life is about the journey, not the destination.

Why I'll always support Lance Armstrong

Lance Armstrong was a role model for me throughout my cancer treatment. I kept reminding myself that he had undergone chemotherapy, just like me, and then gone on to win the Tour de France seven times. I can’t describe how important this was to me. It gave me hope that there would be a future for me after my treatment was complete. And it made me aspire to be strong, like Lance.

In his autobiography, “It’s not about the bike,” Lance explained that when he was presented with the stark reality of how tough his chemo regime was going to be, he felt confident because it was a physical challenge, and he said that “as an athlete, physical challenges are something that I’m good at.”

The idea of being an athlete captured my imagination. It couldn’t have been further from who I was at the time – I was not remotely sporty. Far from it. I was unfit and very overweight. I'd never run further than 400 meters in my entire life. But I wanted to be strong like Lance, and I wanted to know that if I ever had to face something like chemo again, I would be ready. I wanted to be an athlete who was good at physical challenges too.

After successful chemotherapy treatment, five years later my cancer is still in remission, and I’m fitter, healthier and happier than I have ever been in my life before. I took up running and weight training. I lost 42 pounds, and then put on 14 pounds in lean muscle. I’ve given up alcohol. I’m always in training for my next marathon, and for the first time in my life, at the age of 40, I have a six-pack. From never doing any exercise, I now do a 2 hour workout every day, and I’ve recently become a qualified personal trainer.

And it's all thanks to Lance. His seven Tour de France wins were victories for cancer patients and survivors everywhere, and no one can take them away from him or from us.

Update:

Well, I was wrong about that last bit. They did take Lance's victories away from him. It's quite a blow to discover that our heroes are in fact all too human. Lance Armstrong has now admitted that he lied, and that he did in fact cheat. There is no justification for this behaviour. The strange thing is though, that apart from the past paragraph, everything else in this blog post remains the truth. 

What Lance did was wrong. No excuses. It's also true that his actions helped a lot of people in dealing with cancer. This is not a justification or an excuse. It's just another fact. Which I think just goes to show how complicated the world is. Few things are black and white. Bad decisions can have good consequences, just as well meaning intentions can sometimes have bad consequences. 

I'm really disappointed that a hero of mine turned out not to be the saint that I thought he was. But then, perhaps that's my fault for idolising him in the first place. Now, with a clearer perspective, I see a complicated individual with both good and bad intentions. I suspect though that at the end of the day he'll leave the world a slightly better place than it was when he arrived. And perhaps that's all that any of us can hope for.