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Co-Housing

Not to be confused with co-working, co-ops, or condos, co-housing is its own cultural phenomenon.

This is a major article in the NYT describing a decades-old phenomenon of co-housing, and updating the phenomenon with present day facts:

Co-housing

20211024

CREDIT: 

The most recent manifestation of the communalist impulse is the postvaccine nostalgia for the pandemic pod. People are now telling reporters that they miss the camaraderie of those pared-down social networks, as well as the frequent physical company of the same group of friends, the “transformative power of proximity,” as the psychologist Susan Pinker calls it.

I was late to find out about co-housing, a species of intentional community that dates back 30 years, in the United States, anyway. (It emerged in Denmark in the 1970s.) Forced to characterize co-housing in a phrase, you might say “living together, separately.” Those living together have built a community based on, well, belief in community. But they live separately, in that they own their homes, condo-style.

Co-housing sounds confusingly similar to co-living but has a whole different vibe. Co-housers aren’t transient. They have a much stickier idea of social affiliation, and they’re not about to rent a bedroom in some random complex. To draw even finer distinctions: Co-housing communities are not communes. Residents do not give up financial privacy any more than they give up domestic privacy. They have their own bank accounts and commute to ordinary jobs. If you were lucky enough to grow up on a friendly cul-de-sac, you’re in range of the idea, except that you don’t have to worry about your child being hit by a car as she plays in the street. A core principle of co-housing is that cars should be parked on a community’s periphery.

This, I thought, was an idea with promise. Co-living accommodates precarity; co-housing seeks stability. Podding is a byproduct of the collapse of society; co-housing builds society.

The most recent manifestation of the communalist impulse is the postvaccine nostalgia for the pandemic pod. People are now telling reporters that they miss the camaraderie of those pared-down social networks, as well as the frequent physical company of the same group of friends, the “transformative power of proximity,” as the psychologist Susan Pinker calls it.

I was late to find out about co-housing, a species of intentional community that dates back 30 years, in the United States, anyway. (It emerged in Denmark in the 1970s.) Forced to characterize co-housing in a phrase, you might say “living together, separately.” Those living together have built a community based on, well, belief in community. But they live separately, in that they own their homes, condo-style.

Co-housing sounds confusingly similar to co-living but has a whole different vibe. Co-housers aren’t transient. They have a much stickier idea of social affiliation, and they’re not about to rent a bedroom in some random complex. To draw even finer distinctions: Co-housing communities are not communes. Residents do not give up financial privacy any more than they give up domestic privacy. They have their own bank accounts and commute to ordinary jobs. If you were lucky enough to grow up on a friendly cul-de-sac, you’re in range of the idea, except that you don’t have to worry about your child being hit by a car as she plays in the street. A core principle of co-housing is that cars should be parked on a community’s periphery.

This, I thought, was an idea with promise. Co-living accommodates precarity; co-housing seeks stability. Podding is a byproduct of the collapse of society; co-housing builds society

Out of the 165 co-housing communities around the country, Eastern Village interested me because it’s urban and vertical, while the majority are suburban or at least suburbanish. I wondered whether co-housing could survive the claustrophobia of city living and the resulting need for personal space. My cheeks still get hot with embarrassment when I remember a remark in an elevator: It was a few years after my son was born, and I’d moved back to Manhattan, hoping to find the something I missed in the suburbs. “You’re not from around here, are you?” a man said, after I tried to start a conversation. Oh, right, I thought. People crammed into a box don’t want to talk to a chirpy lady they might have to edge away from. I never did get to know the other families in the building.

There are other, better-known urban co-housing communities around the country, but Eastern Village has the virtue of not being exemplary. For one thing, it was built from the top down rather than the bottom up. Model co-housing tends to be grass-roots: First the group meets to explore its wants and needs, then it finds an architect who designs a community just right for them, and finally it builds. From the time a group of would-be co-housers forms to the time it moves in, two to five years can pass. The idea for Eastern Village, on the other hand, came from a developer. He undertook the daunting task of retrofitting the building, then asked someone better versed in co-housing to go out, put together a group and teach participants how to live together.

The process still took two and a half years, but it struck me as a more replicable model. If co-housing didn’t have to be handcrafted, I thought, maybe it could be scaled up. And this seems the moment to think about how.

Americans may be about to experience three once-in-a-lifetime opportunities to reconsider how they house themselves. The first is the two big spending bills working their way through Congress. If they pass, they could provide billions of dollars to alleviate homelessness and increase affordable housing. The second opportunity proceeds from the shift to working from home: Record numbers of office buildings stand empty and ready for the refurbishing, and they won’t all be refilled

The third force that could push us to change our way of life is a heightened awareness of isolation. In a 2020 survey by the Harvard Graduate School of Education, one-third of Americans described themselves as seriously lonely — up from one-fifth before the Covid pandemic. Loneliness is now understood as a public health crisis, ranking as high among risk factors for mortality as heavy smoking, drinking and obesity.

Contrary to what one might think, the loneliest people in America aren’t the elderly. They’re young adults (close to two-thirds of them, according to the Harvard survey) and mothers of small children (about half). This makes sense: Young people tend to lead migratory lives, leading to weak social ties. Mothers have their children, although almost a quarter of them are raising those children without a partner; the United States has the highest rate in the world of children living with only one parent. With or without a partner, a mother may still have a hard time finding a fulfilling social life, since paid work and unpaid maternal labor take up so much of her time.

The pandemic lockdown exposed women’s solitude, in particular, as a function not just of time but also of space. Afraid to go out into the public domain, all caregivers — the newly full-time ones as well as those who had already put care at the center of their lives — became painfully aware that the private domain can be a very lonely and demanding place.

Under the circumstances, co-housing has the potential, if nothing else, to furnish ideas of how to build for community. After all, you’d never get away with snubbing people in the elevator at Eastern Village

If there is an adage that informs life in co-housing, it’s treat thy neighbor as thy family. Thy extended family, that is, assuming it’s a happy one. And what do happy families do? For one thing, they share stuff. As Rabbi Kimelman-Block led me through what felt like a labyrinth, he opened several overstuffed “sharing closets.” One was full of expensive, space-hogging items like travel cribs and skis. Another was for things being given away.

What else do families do? Well, chores, preferably cheerfully and collaboratively. And indeed, co-housers are expected to sign up for maintenance and cleanup days. Families also look out for one another. In co-housing that means, among other things, helping keep an eye on all the children. Many communities pay for formal day care. Most important, co-housers eat together. Breaking bread is probably the most effective bonding ritual society has ever come up with, and co-housers take turns cooking for and serving meals to other members. Some communities offer meals as often as six times a week. (Attendance is never mandatory.)

Most co-housing communities are anchored by a large, shared kitchen. It forms the heart of the common house, which may also offer pools, carpentry workshops, dance studios or meeting rooms — you name it, some community has it. In Eastern Village, common spaces have been cleverly tucked around the complex. Wending our way from basement to roof, Rabbi Kimelman-Block and I went through a dining room, a room for table tennis and foosball, a living room with a fireplace and fat leather chairs, a children’s playroom, a lamp-lit quiet room, a game room, a laundry room, an exercise room, a small lending library. The kitchen, though, is a problem. It’s not set up to cook communitywide dinners, in part because the fire marshal insisted that it install a crushingly expensive commercial range, and it went instead with a “warm-up kitchen,” as architect and developer Don Tucker calls it. So Eastern Village is more or less stuck with potluck.

But then again, as my mother liked to say, the perfect is the enemy of the good. We have to make do if we want to make change.

Today, the detached single-family house — the lonesome cowboy model of domestic architecture — dominates the American landscape so thoroughly that it feels as if it were inevitable. As of 2019, there were about 100 million single-family homes in the United States (including mobile and prefab homes), compared to about 40 million multifamily ones. But it didn’t have to turn out this way. Although the home on the farm had been the American ideal since Thomas Jefferson popularized pastoralism, as the country urbanized after the Civil War, many visionaries saw opportunities for a less atomized, more female-friendly lifestyle.

The landscape designer Frederick Law Olmsted, for one, imagined Emerald City-like metropolises with public laundries, bakeries and kitchens, taking some of the burden off housewives. Amenities like sewers, gutters and sidewalks would make streets more appealing for women. Women’s rights activists such as Charlotte Perkins Gilmanand a now-forgotten feminist named Melusina Fay Peirce envisioned Eastern Village-like cooperatives in apartment complexes, complete with communal laundries, sewing rooms, kitchens and dining rooms. Peirce called it “cooperative housekeeping” and thought women should make money at it.

During the early part of the 20th century, however, those reveries retreated into science fiction novels. Many forces converged to rob them of reality, not least the Red Scare, when politicians developed an allergy to anything that seemed to have a flavor of socialism or feminism. Along with builders, they began to promote the single-family dream house, with its Harry Homeowner and his happy housewife.

Today, roughly three-quarters of the residential land in metro areas is set aside for such houses and yards. Hub-and-spoke roads and commuter railways have grown up around them. Elaborate exclusionary zoning codes were written to protect them from the taint of commerce and industry — as well as to keep white, wealthy neighborhoods away from Black and poorer ones. The distance between home and everything else imposed by these laws is the reason most Americans need to drive to shop or work.

Back when the majority of breadwinners were male and made the journey downtown unburdened by domestic concerns, a long commute wasn’t a big logistical challenge. Today, mothers are also making those commutes, but they still have domestic burdens. Working from home improves the situation only if child care is available.

Co-housing arose, in part, as a solution to the work-life problem. In 1969, Hildur Jackson — just one among many co-housing pioneers, but an eloquent one — was living in a house in Copenhagen, a law school graduate unsure whether she should stay home with her two little boys or embark on a law career. “There was no apparent third option,” she wrote in a remembrance. Then she read an article titled “Children Need 100 Parents.”

Ms. Jackson decided to start a six-family community on an old farm in a Copenhagen suburb. The families built homes around two giant lawns, which were used largely for games, particularly soccer. The barn was turned into a common house, and three Icelandic horses were bought for the stables. “We chose to have no borders between our gardens,” she wrote. “We raised chickens, tended a large common vegetable garden and had fruit trees and berry bushes.” Days were set aside for community maintenance. When her husband traveled on business, which he did often, “I never felt isolated,” she wrote. When she had her third child, she had 11 other parents to help.

Co-housing (called “living communities” in Denmark) soon spread throughout Scandinavia and to the Netherlands and Germany; communities are now found all over Europe, as well as in Canada, Australia and New Zealand. In the 1980s, the architects Charles Durrett and Kathryn McCamant, who were married and business partners at the time, began importing co-housing to the United States. (Between the two of them, they have built or been consultants on many of the co-housing communities in the country.) The two got involved in the movement because they wanted children but their lives seemed too hectic: “We would come home from work exhausted and hungry, only to find the refrigerator empty,” Mr. Durrett has written. So they went to Denmark to study another way to build for parenting.

Co-housing is the nonthreatening heir of America’s far more radical communitarian past. And during my many years of self-education, I discovered that communitarianism has often had a feminist face.

Early socialists avowed an egalitarianism so radical that it included housewives. Nineteenth-century progressives, male as well as female, understood wives’ solitary and unremunerated duties as central to their oppression. Socialists set up model villages and touted them as a way to inspire workers to abandon cities, factories and industrial bosses. But they also promised to enfranchise women and free them from the shackles of domestic drudgery.

Robert Owen, the most famous British socialist of his day, and his French counterpart, Charles Fourier, envisioned the collectivization of women’s work in communal kitchens, dining rooms and nurseries, although they seemed to think this would require the construction of vast, ornate (and unrealistic) palaces. Owen’s and Fourier’s followers, known as Cooperators, established close to 50 socialist communities in rural areas in the Northeastern and Midwestern United States in the 1820s to 1840s. The leaders, who were almost always men, rarely put theory into practice when it came to women. As Carol A. Kolmerten, a historian and the author of “Women in Utopia,” a study of American Owenite communities, wrote, it fell to female Cooperators to prepare the food, wash the clothes and teach the little ones. Or, if the women toiled in fields and workshops, they would still cook and clean in the evenings. Wives who had arrived full of hope left, taking their husbands with them.

Male obtuseness was not the main reason these settlements failed. Other realities proved more damaging. Some settlements couldn’t generate enough cash to pay off the loans that paid for the land. Life in the wilderness wasn’t palatial; it involved log cabins and mosquitoes. Refugees from cities didn’t know how to farm. Class differences among members reasserted themselves, leading to factionalism. But the alienation of one-half of the population (the “woman problem,” Owen came to call it) didn’t help.

On the other hand, secular socialists accounted for only a small fraction of America’s intentional communities. Millenarian Christians — Shakers, Mormons, the Oneida Community and Anabaptist offshoots like the Amish and the Hutterites — built many more, and theirs tended to last longer, as Lawrence Foster writes in “Women, Family and Utopia.” Perhaps that’s because when their leaders broke down the walls of nuclear families to create communal ones, they did so to strengthen their members’ attachment to God and commitment to building his kingdom on earth.

What is remarkable about some of these religious communes is the degree to which they defied the gender norms of their day, in some cases going further than the socialists. The Shakers weren’t feminist in a way contemporary Americans would recognize. They didn’t question the gendered division of labor: Women worked in the kitchens and did the weaving, while men did the farm labor. But women’s work wasn’t seen as inferior to men’s. Both helped sustain the community; therefore both were equal in God’s eyes. More important, Shaker leaders were as likely to be female as male.

In the Oneida Community, a sect that eschewed what its leader called the gloominess of “the little man-and-wife circle” and replaced it with nonmonogamy, women were able to participate without restriction in every aspect of life — religious, economic and social.

Collectivizing domestic labor gave groups incentives to come up with labor-saving household devices. The Shakers patented a water-powered washing machine that cleaned clothes by churning them, an improvement on previous devices. Oneidans may or may not have invented the lazy susan (the point is debated); in any case, they used it to reduce the labor required to serve food in a communal dining hall. With the same goal in mind, they came up with, among other things, an industrial potato peeler and a mop wringer.

These old-time religious communes hold lessons for us moderns. “From a feminist viewpoint the major achievement of most communitarian experiments was ending the isolation of the housewife,” wrote Dolores Hayden in her classic study of feminist communalism, “The Grand Domestic Revolution.” “A second achievement was the division and specialization of household labor.”

A

fter the tour, Rabbi Kimelman-Block roped in whoever was around to talk to me. We gathered on Eastern Village’s xeriscaped roof, its communal green space. Most people brought drinks. I ate Ethiopian takeout. Professions ranged from Realtor to social-justice activist. Eastern Village has 110 residents, 30 of them college age or younger. The ones I met were mostly middle-aged, though one couple bought in when they were in their 70s.

Parenting was the leading answer to my question about why they’d chosen co-housing: Kids aren’t stuck in their apartments; they can run downstairs. Neighbors’ kids or older members were almost always around to babysit, and for a while, there was a somewhat more formal day care arrangement. Adults benefit from the ad hoc interaction, too. Instead of planning dinner or drinks weeks in advance, on any Wednesday or Saturday, a sociable soul can find a neighbor to share a snack or a beer with.

One unexpected comment came from Adrienne Torrey, a curly-haired middle-aged woman with a relaxed manner. “Co-housing attracts a lot of introverts,” she said. That hadn’t occurred to me, but inclined to introversion myself, I immediately saw the logic. Who needs a community more than those who have a hard time spontaneously cobbling one together? Or — my next thought — than new parents stranded by their change of circumstance? By contrast, as soon as you show up in co-housing, you are swept into a round robin of meals and festivities and cleanup days.

The most controversial topic that evening was meetings. Almost all co-housing communities make big decisions by consensus. One member complained that arriving at unanimity is cumbersome and unnecessary. The rest disagreed. However long consensus takes, everyone feels heard and learns the art of compromise. That, I’m told, may be the most important key to successful group living.

I

f co-housing offers solutions for so many of the problems from which America’s mothers suffer, if we are now uniquely positioned to put at least some of its lessons into effect — thanks to the pandemic’s unintentional consciousness-raising and the possibility that Congress will pass the Biden administration’s plans to rebuild the economy — what’s stopping us?

During one of my several conversations with Charles Durrett, I asked what he would identify as the biggest obstacle to building co-housing in the United States. “Our culture,” he said promptly. “We tend to think of ourselves as independent pioneers. We’re not a cooperative kind of culture.” But he grew up in a tight-knit neighborhood, he said, and his neighbors “played a huge role in my well-being.”

But planning departments, regional as well as municipal, don’t help. Typical American zoning laws frown on multifamily complexes unless they’ve been exiled to poorer parts of town. Even accessory dwelling units, such as mother-in-law apartments, are unpopular, lest they be rented to “undesirables.” Those are the most notorious restrictions; they’re not the only ones Mr. Durrett has had to fight as he tried to build co-housing.

City planning laws simply don’t envision communities focused on residents’ helping one other and keeping children safe. One city demanded two-car driveways for each unit, a waste of space and money in a community that keeps cars far from houses. When a town insisted that to accommodate the number of people in a proposed community, it would have to pay for a $1 million fire truck, Mr. Durrett asked the officials what the fire department’s most common call was. “Pick up and put back,” they told him, meaning putting seniors who have fallen out of their beds back into them. “We can do that for ourselves,” he said. Finding people who can put other people back in bed is precisely what co-housing is good at.

The other challenge, of course, is that not all people want to share their lives. People have to be willing to sacrifice time (all those meetings, the grounds maintenance) and the luxury of self-absorption (the small talk expected from those on their way to the mailroom). Co-housing may consume emotional energy that would otherwise go to keeping other social circles — work colleagues, college buddies, fellow parents at our children’s schools — spinning in the air. “Living in co-housing is not easy,” said Ann Zabaldo, the person hired by Eastern Village’s developer to recruit and educate its future occupants about the art of co-housing. But, she added, “it is so much richer, like drinking deeply from the well.”

Communal living by itself will never solve any one major social problem, be it loneliness or sexism or anything else. Although much more communal architecture can (and should) be built, you can’t mass-produce community. People have to be able to see the benefits before they’ll make the necessary commitments.

But life is changing in ways that may make collaborative coexistence more attractive. Rents are on the rise. People are getting used to the sharing economy. And then there’s that bottom-line truth exposed by the pandemic: Take away child care, and women stop working for pay and don’t start again, like the nearly two million of them who have dropped out of the labor force since February 2020. Something must be done.

In the past few years, states and cities around the country have started reconsidering single-family zoning or dared to vote to put an end to it. Last month, Gov. Gavin Newsom of California signed into lawbills to limit single-family zoning and permit construction of buildings with up to 10 units near public transit.

A wholesale revision of zoning codes could lead to a new built environment, one that would nudge us toward a new mind-set. We should build co-housing on a large scale. But even if we don’t, we could start reshaping the contours of our hyperindividualist and antimaternalist landscapes so as to encourage solidarity and fellow feeling rather than aloofness: Co-housing communities are centered on their greenswards; we need more parks. Co-housing puts people before cars; towns and cities should do the same. Co-housers live together, meaning they are around in case of need; the least inspiration we can take from that is to make our housing stock more varied, less focused on the nuclear family, so that members of extended families and groups of friends can be there for one another, too.

If this sounds not unlike the best-designed urban neighborhoods in America, well, maybe it’s not. But the pandemic has sparked a flight from cities and a demand for more suburban housing, and the boom in the market right now is in exurbia — low-density, lower-cost suburbs on the outer edges of metropolitan areas. As these neighborhoods are built, in all likelihood old design habits will prevail. But there’s no harm in imagining, and fighting for, a land-use philosophy focused on making life more pleasant for parents and children — and for the introvert in all of us.

I

n the 19 years since I had my first child, I have spent a lot of time thinking about how my life might have been different if I’d known about Hildur Jackson’s “third option.” What if there had been tens of thousands of co-housing communities in America instead of a couple hundred? Maybe I would have moved into one rather than back to unfriendly Manhattan.

If I had to single out one feature of cooperative living I find particularly attractive, it would be regular, spontaneous contact with people of all ages. I had my children later in life, and my parents weren’t healthy enough to spend as much time with their grandchildren as all of us wanted, and then, as happens, they died. I’m nostalgic for an intergenerational experience I never had.

A few weeks ago, I watched my teenage daughter spend an entire meal talking conspiratorially to two of my best friends. How often do American teenagers open up to their parents’ friends? What would it have been like for her to be able to do that throughout her childhood with surrogate aunts and uncles and grandparents? The three of them sat just out of earshot, making it hard for me to eavesdrop, which I’m sure was the point. But the sight of them gossiping made me think that maybe, despite the blank suburban streets and the chilly city elevators and my never quite figuring out where we should live, I’d done something right.

Judith Shulevitz (@JudithShulevitz) is a cultural critic and the author of “The Sabbath World: Glimpses of a Different Order of Time.” She still lives in New York City.

Microbiome Update

Microbiome update

20210318

Credit: https://www.nytimes.com/2021/03/18/well/eat/microbiome-aging.html?action=click&algo=bandit-all-surfaces-decay-decay-02&block=trending_recirc&fellback=false&imp_id=986584686&impression_id=0cc53dd8-8b11-11eb-87e0-b362713e87cd&index=8&pgtype=Article&region=footer&req_id=227739339&surface=most-popular-story&variant=2_bandit-all-surfaces-decay-decay-02

By Anahad O’Connor

The secret to successful aging may lie in part in your gut, according to a new report. The study found that it may be possible to predict your likelihood of living a long and healthy life by analyzing the trillions of bacteria, viruses and fungi that inhabit your intestinal tract.

The new research, published in the journal Nature Metabolism, found that as people get older, the composition of this complex community of microbes, collectively known as the gut microbiome, tends to change. And the greater the change, the better, it appears.

In healthy people, the kinds of microbes that dominate the gut in early adulthood make up a smaller and smaller proportion of the microbiome over the ensuing decades, while the percentage of other, less prevalent species rises. But in people who are less healthy, the study found, the opposite occurs: The composition of their microbiomes remains relatively static and they tend to die earlier.

The new findings suggest that a gut microbiome that continually transforms as you get older is a sign of healthy aging, said a co-author of the study, Sean Gibbons, a microbiome specialist and assistant professor at the Institute for Systems Biology in Seattle, a nonprofit biomedical research.

“A lot of aging research is obsessed with returning people to a younger state or turning back the clock,” he said. “But here the conclusion is very different. Maybe a microbiome that’s healthy for a 20-year-old is not at all healthy for an 80-year-old. It seems that it’s good to have a changing microbiome when you’re old. It means that the bugs that are in your system are adjusting appropriately to an aging body.”

The researchers could not be certain whether changes in the gut microbiome helped to drive healthy aging or vice versa. But they did see signs that what happens in people’s guts may directly improve their health. They found, for example, that people whose microbiomes shifted toward a unique profile as they aged also had higher levels of health-promoting compounds in their blood, including compounds produced by gut microbes that fight chronic disease.

Scientists have suspected for some time that the microbiome plays a role in aging. Studies have found, for example, that people 65 and older who are relatively lean and physically active have a higher abundance of certain microbes in their guts compared to seniors who are less fit and healthy. People who develop early signs of frailty also have less microbial diversity in their guts. By studying the microbiomes of people of all ages, scientists have found patterns that extend across the entire life span. The microbiome undergoes rapid changes as it develops in the first three years of life. Then it remains relatively stable for decades, before gradually undergoing changes in its makeup as people reach midlife, which accelerates into old age in those who are healthy but slows or remains static in people who are less healthy.

Although no two microbiomes are identical, people on average share about 30 percent of their gut bacterial species. A few species that are particularly common and abundant make up a “core” set of gut microbes in all of us, along with smaller amounts of a wide variety of other species that are found in different combinations in every person.

To get a better understanding of what happens in the gut as people age, Dr. Gibbons and his colleagues, including Dr. Tomasz Wilmanski, the lead author of the new study, looked at data on over 9,000 adults who had their microbiomes sequenced. They ranged in age from 18 to 101.

About 900 of these people were seniors who underwent regular checkups at medical clinics to assess their health. Dr. Gibbons and his colleagues found that in midlife, starting at around age 40, people started to show distinct changes in their microbiomes. The strains that were most dominant in their guts tended to decline, while other, less common strains became more prevalent, causing their microbiomes to diverge and look more and more different from others in the population.

“What we found is that over the different decades of life, individuals drift apart — their microbiomes become more and more unique from one another,” said Dr. Gibbons.

People who had the most changes in their microbial compositions tended to have better health and longer life spans. They had higher vitamin D levels and lower levels of LDL cholesterol and triglycerides, a type of fat in the blood. They needed fewer medications, and they had better physical health, with faster walking speeds and greater mobility.

The researchers found that these “unique” individuals also had higher levels of several metabolites in their blood that are produced by gut microbes, including indoles, which have been shown to reduce inflammation and maintain the integrity of the barrier that lines and protects the gut. In some studies, scientists have found that giving indoles to mice and other animals helps them stay youthful, allowing them to be more physically active, mobile and resistant to sickness, injuries and other stresses in old age. Another one of the metabolites identified in the new study was phenylacetylglutamine. It is not clear exactly what this compound does. But some experts believe it promotes longevity because research has shown that centenarians in northern Italy tend to have very high levels of it.

Dr. Wilmanski found that people whose gut microbiomes did not undergo much change as they got older were in poorer health. They had higher cholesterol and triglycerides and lower levels of vitamin D. They were less active and could not walk as fast. They used more medications, and they were nearly twice as likely to die during the study period.

The researchers speculated that some gut bugs that might be innocuous or perhaps even beneficial in early adulthood could turn harmful in old age. The study found, for example, that in healthy people who saw the most dramatic shifts in their microbiome compositions there was a steep decline in the prevalence of bacteria called Bacteroides, which are more common in developed countries where people eat a lot of processed foods full of fat, sugar and salt, and less prevalent in developing countries where people tend to eat a higher-fiber diet. When fiber is not available, Dr. Gibbons said, Bacteroides like to “munch on mucus,” including the protective mucus layer that lines the gut.

“Maybe that’s good when you’re 20 or 30 and producing a lot of mucus in your gut,” he said. “But as we get older, our mucus layer thins, and maybe we may need to suppress these bugs.”

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If those microbes chew through the barrier that keeps them safely in the gut, it is possible they could trigger an immune system response.

“When that happens, the immune system goes nuts,” Dr. Gibbons said. “Having that mucus layer is like having a barrier that maintains a détente that allows us to live happily with our gut microbes, and if that goes away it starts a war” and could set off chronic inflammation. Increasingly, chronic inflammation is thought to underlie a wide range of age-related ailments, from heart disease and diabetes to cancer and arthritis.

One way to prevent these microbes from destroying the lining of the gut is to give them something else to snack on, such as fiber from nutritious whole foods like beans, nuts and seeds and fruits and vegetables.

Other studies have shown that diet can have a substantial impact on the composition of the microbiome. While the new research did not look closely at the impact of different foods on changes in the microbiome as we age, Dr. Gibbons said he hopes to examine that in a future study.

“It may be possible to preserve the aging mucus layer in the gut by increasing the amount of fiber in the diet,” Dr. Gibbons said. “Or we might identify other ways to reduce Bacteroides abundance or increase indole production through diet. These are not-too-distant future interventions that we hope to test.”

In the meantime, he said, his advice for people is to try to stay physically active, which can have a beneficial effect on the gut microbiome, and eat more fiber and fish and fewer highly processed foods.

“I have started eating a lot more fiber since I began studying the microbiome,” he said. “Whole foods like fresh fruits and veggies have all the complex carbohydrates that our microbes like to eat. So, when you’re feeding yourself, think about your microbes too.”

Anahad O’Connor is a staff reporter covering health, science, nutrition and other topics. He is also a bestselling author of consumer health books such as “Never Shower in a Thunderstorm” and “The 10 Things You Need to Eat.” 

Arivale busts: a scientific wellness darling

Arivale – the end of a promising “scientific wellness” company

Anyone who cares about well-being, particularly that subset of well-being that many labeled as the “scientific wellness” movement, should note a decade-ender: the failure of Arivale. 

They burned through $50 million. They sold 5,000 customers over their lifetime. The customers were paying $99 per month on LABS tracking and health coaching that was tailored to the person’s genomes and other critical lab work. 

Their conclusion: customers would not pay for what it cost to serve them. In the future? Maybe. But not now. 

=======ARTICLE ON ARIVALE FOLLOWS=======

CREDIT: https://www.geekwire.com/2019/scientific-wellness-startup-arivale-closes-abruptly-tragic-end-vision-transform-personal-health/

Scientific wellness startup Arivale closes abruptly in ‘tragic’ end to vision to transform personal health

BY TODD BISHOP & TAYLOR SOPER on April 24, 2019

Arivale, the genetic testing and personal health coaching startup co-founded by genomics pioneer Leroy “Lee” Hood, shut down unexpectedly Wednesday — bringing an abrupt end to its ambitions to transform the lives of Americans through a new field that Hood dubbed “scientific wellness.”

All of the Seattle-based company’s approximately 120 employees were let go as of noon today, Arivale CEO Clayton Lewis confirmed in an interview. Arivale raised more than $50 million over its lifetime. The company offered ongoing wellness and nutritional coaching tailored to the results of each person’s genetic, blood and microbiome tests.

FOLLOW-UP: Why Arivale failed: Inside the surprise closure of an ambitious ‘scientific wellness’ startup

The decision was a surprise to many Arivale employees and customers. In a message to Arivale customers this afternoon, the company attributed the decision to “the simple fact that the cost of providing the service exceeds what our customers can pay for it.”

The message added, “We believe the costs of collecting the genetic, blood and microbiome assays that form the foundation of the program will eventually decline to a point where the program can be delivered to consumers cost-effectively. However, we are unable to continue to operate at a loss until that time arrives.”

Lewis told GeekWire that the high cost of acquiring customers also played a role in the decision.

“What is tragic on so many levels is that we were not successful in going out and convincing consumers that you could optimize your wellness and avoid disease with a little bit data and some changes in your lifestyle — that there’s not a market for that product that I believe in passionately,” Lewis said. “And that’s what we were trying to do.”

About 5,000 people took part in the Arivale program over the lifetime of the company, and Lewis said he is “incredibly proud” of the results. The program launched at a cost of $3,500 per year, but the price had dropped to the point where most customers were paying $99 per month for the flagship Arivale program, Lewis said.

The larger personal wellness industry includes heavyweights such as 23andMe, a genetic testing startup valued at more than $1 billion, and smaller players including EverlyWell, which raised a $50 million round last week, and Viome, the Seattle-area microbiome company led by Naveen Jain that just announced a new $25 million funding round from investors including Salesforce CEO Marc Benioff.

Global Wellness Institute estimates that the preventative and personalized medicine and public health industry is worth $575 billion.

Some of Arivale’s underlying work will continue at the Institute for Systems Biology (ISB), the not-for-profit biomedical research organization co-founded by Hood, where the ideas that led to Arivale were originally developed. ISB is now part of Providence St. Joseph Health, where Hood is chief science officer. Clayton said ISB is expected to hire some of the employees let go by Arivale as part of its closure. He declined to disclose details of the severance offered to employees, but said the same package was provided to all executives and employees.

Investors in Arivale included Arch Venture Partners, Polaris, and Maveron, where Lewis worked full-time before joining Arivale as co-founder and CEO.

Its scientific advisory board included George Church, a professor at Harvard and MIT; James Heath, president of Institute of Systems Biology; and Ed Lazowska, computer science professor at the University of Washington.

“Lee Hood sees the future with unmatched clarity,” said Lazowska, an early participant in the Arivale program. “A clear view, however, does not always imply a short path. Scientific wellness, as pioneered by Arivale, will be a foundation of 21st century medicine. But not right now. Right now, the cost of providing the service (the tests, the coaching) exceeds what people are willing to pay. Those costs will fall in time, and Arivale’s model and Arivale’s discoveries will see another day.”

Lewis said he has come to believe that Arivale was about a decade too early.

Arivale’s executive team included Sean Bell, chief operating officer; Jennifer Lovejoy, chief translational science officer; Mia Nease, head of healthcare and life sciences partnerships; Andrew Magis, director of research; Ashley Wells, chief product officer; and others.

Hood, who led the Caltech team that pioneered the automated DNA sequencer, said in a 2015 interview with GeekWire that Arivale was “the opening shot in a whole new industry called scientific wellness, and it really stands a chance of being the Google or Microsoft of this whole arena.”

GeekWire chief business officer Daniel Rossi was a longtime paying customer of the program, and we chronicled his early experience with Arivale in series of articles in 2017. “Arivale was crucial to my health journey,” Rossi said. “From them I learned not only the genetic hand I was dealt but also the best ways to maximize my health and well-being. I am most thankful for the weekly calls with my coaches who encouraged me every step of the way. I’ll miss this program. It was terrific.”

Here’s the text of the message sent to Arivale customers earlier today, a version of which was also posted to the Arivale website.

To Our Customers,

We are very sorry to inform you that, effective immediately, Arivale can no longer provide our program to you and our other customers. This letter explains why we are ending the consumer program and answers the questions you are likely to have about the process.

Our decision to terminate the program today comes despite the fact that customer engagement and satisfaction with the program is high and the clinical health markers of many customers have improved significantly. Our decision to cease operations is attributable to the simple fact that the cost of providing the program exceeds what our customers can pay for it. We believe the costs of collecting the genetic, blood and microbiome assays that form the foundation of the program will eventually decline to a point where the program can be delivered to consumers cost-effectively. Regrettably, we are unable to continue to operate at a loss until that time arrives; in other words, we have concluded that it is simply too early for a direct-to-consumer scientific wellness offering to be viable.

We founded Arivale with the vision of making personalized, data-driven, preventive coaching a new wellness paradigm in the United States. Since its launch in 2015, the results of the Arivale program have been remarkable. To cite but one example, our scientific paper describing the improvements seen in multiple health markers in ~2500 participants was recently accepted for publication in the journal Scientific Reports.

While our direct-to-consumer model isn’t yet sustainable, we know that the Arivale program improved the lives of our customers and showed great scientific merit. We are proud of everyone at Arivale for their dedication and devotion to our mission and grateful to you and all of our other customers for joining us on this journey. Together, our efforts have launched a new paradigm—scientific or quantitative wellness—which, we are confident will become a major component of 21st century medicine.

================== END ARTICLE==============

Written by: Todd Bishop is GeekWire’s co-founder and editor, a longtime technology journalist who covers subjects including cloud tech, e-commerce, virtual reality, devices, apps and tech giants such as Amazon.com, Apple, Microsoft and Google. Follow him @toddbishop, email todd@geekwire.com, or call (206) 294-6255.

Charisma

CREDIT: www.nytimes.com/2019/08/15/smarter-living/what-makes-people-charismatic-and-how-you-can-be-too

What Makes People Charismatic

Ask people to name someone they find charming and the answers are often predictable. There’s James Bond, the fictional spy with a penchant for shaken martinis. Maybe they’ll mention Oprah Winfrey, Bill Clinton or a historical figure, like the Rev. Dr. Martin Luther King Jr. or Mahatma Gandhi. Now ask the same people to describe, in just a few seconds, what makes these charmers so likable.

It’s here, in defining what exactly charisma is, that most hit a wall. Instinctually, we know that we’re drawn to certain people more than others. Quantifying why we like them is an entirely different exercise.

The ancient Greeks described charisma as a “gift of grace,” an apt descriptor if you believe likability is a God-given trait that comes naturally to some but not others. The truth is that charisma is a learned behavior, a skill to be developed in much the same way that we learned to walk or practice vocabulary when studying a new language. Other desirable traits, like wealth or appearance, are undoubtedly linked to likability, but being born without either doesn’t preclude you from being charismatic.

Quantifying charisma

For all the work put into quantifying charisma — and it’s been studied by experts through the ages, including Plato and those we talked to for this piece — there are still a lot of unknowns. There are, however, two undisputed truths.

The first is that we are almost supernaturally drawn to some people, particularly those we like. Though this is not always the case; we can just as easily be drawn in by a charismatic villain.

The second truth is that we are terrible at putting a finger on what it is that makes these people so captivating. Beyond surface-level observations — a nice smile, or the ability to tell a good story — few of us can quantify, in an instant, what makes charismatic people so magnetic.

Perhaps it’s evolutionary. As a species, innate instinctual feelings lead to things we often describe as gut feelings. These feelings are actually a subconscious response to dozens, or possibly hundreds, of verbal and nonverbal cues that we unknowingly process in every interaction with others. It’s a necessary skill, one that allows all mammals to gauge the intention of others by taking continuous inventory of things like body language, speech pacing and subtle movements that may allude to a threat.

John Antonakis, a professor of organizational behavior at the University of Lausanne in Switzerland, notes that charisma, at its most basic, is merely information signaling. “Basically put, charisma is all about signaling information in a symbolic, emotional and value-based manner,” he said. “Thus, charisma signaling is all about using verbal — what you say — and nonverbal techniques.”

For comparison’s sake, what Dr. Antonakis described is essentially a simpler version of the fight-or-flight response. Instead of fighting or fleeing, however, we’re making constant micro-decisions about whether the person demanding our attention is deserving of it. 

The three pillars of charisma, and how to practice each

Olivia Fox Cabane, a charisma coach and the author of the book “The Charisma Myth,” says we can boil charismatic behavior down to three pillars.

The first pillar: PRESENCE

The first pillar, presence, involves residing in the moment. When you find your attention slipping while speaking to someone, refocus by centering yourself. Pay attention to the sounds in the environment, your breath and the subtle sensations in your body — the tingles that start in your toes and radiate throughout your frame.

The second pillar: POWER

Power, the second pillar, involves breaking down self-imposed barriers rather than achieving higher status. It’s about lifting the stigma that comes with the success you’ve already earned. Impostor syndrome, as it’s known, is the prevalent fear that you’re not worthy of the position you’re in. The higher up the ladder you climb, the more prevalent the feeling becomes.

The key to this pillar is to remove self-doubt, assuring yourself that you belong and that your skills and passions are valuable and interesting to others. It’s easier said than done.

The third pillar: WARMTH

The third pillar, warmth, is a little harder to fake. This one requires you to radiate a certain kind of vibe that signals kindness and acceptance. It’s the sort of feeling you might get from a close relative or a dear friend. It’s tricky, considering those who excel here are people who invoke this feeling in others, even when they’ve just met.

To master this pillar, Ms. Cabane suggests imagining a person you feel great warmth and affection for, and then focusing on what you enjoy most about your shared interactions. You can do this before interactions, or in shorter spurts while listening to someone else speak. This, she says, can change body chemistry in seconds, making even the most introverted among us exude the type of warmth linked to high-charisma people.

Scratching the surface

All of our experts agreed that charisma isn’t a one-size-fits-all descriptor; it’s more of a hierarchy. Some people exude charm through warmth and generosity, while others are likable in a sort of evolutionary sense — the alpha types who radiate confidence and success.

Going back to the three pillars, the most charismatic people you know on a personal level have generally achieved a high level of success in only one, or perhaps two, of these traits. A rare few, though, show a mastery of all three.

Dr. King, for example, displayed signs of mastery in each of these pillars, leading to the rare classification that Ms. Cabane calls “visionary charisma.”

If that’s the top of the hierarchy, the next three examples would reside somewhere in the middle.

Steve Jobs, the co-founder of Apple, exhibited mastery in power and achieved high marks for presence. However, according to his daughter Lisa Brennan-Jobs, in her 2018 memoir “Small Fry,” he lacked warmth. Tesla’s chief executive, Elon Musk, also arguably lacks warmth. He’s a classic introvert who makes up for his lack of people skills with mastery in presence and above-average levels of power.

Mr. Jobs, according to Ms. Cabane, is best classified as having “authority charisma,” while Mr. Musk has “focus charisma.”

Then there are those like Emilia Clarke, who starred on HBO’s “Game of Thrones.” Clarke’s exuberance earns her high marks in “kindness charisma,” a classification for those who excel at the warmth pillar, while maintaining a high presence but low power.

This is just scratching the surface, of course. But the important takeaway here is that charisma isn’t a singular thing. Instead, it’s often best to think of it in the same way you would consider intelligence. Earning high marks in math and science is a signal of intelligence, but so is mastery in art or music. Trying to compare one intelligent person to another just leads to more confusion.The same can be said for charisma.

Charisma training: Low-hanging-fruit edition

If you’re looking for a good starting point to be more likable, Dr. Antonakis suggests storytelling. The most charismatic people in a room, he says, are those who speak metaphorically, providing substance to a conversation through exemplary use of anecdotes and comparisons. They aren’t recounting events but paraphrasing action while using facial gestures, energetic body language and vocal inflections to frame key points. They’re experts at using moral conviction and reflections of group sentiment, as well as employing questions, even rhetorical ones, that keep people engaged. In short, they just tell a good story.

In fact, a theme emerged while speaking to experts on charisma, one that becomes instantly recognizable to anyone who has taken a public-speaking course or sat in on a Toastmasters meeting: The most charismatic people are often the most effective public speakers.

Charisma goes beyond being a refined and engaging speaker, however. Charismatic people are well liked not just because they can tell a good story, but also because of how they make others feel. Aside from being humorous and engaging, charismatic people are able to block out distractions, leaving those who interact with them feeling as if time had stopped and they were all that mattered. They make people feel better about themselves, which leads them to return for future interactions, or to extend existing ones, if only to savor such moments.

The quickest way to be more likable is to get out and practice being more likable. It starts at home, by removing your own self-doubt and focusing instead on being an active participant in conversations and interactions with others.

From there, it requires little more than saying yes to more social invitations, joining a public speaking class (or a local group like Toastmasters) and continuing to look for ways to show off your strengths while leveling up your weaknesses. Each interaction offers a chance to practice, to study and to employ new strategies.

Much like learning any other skill, sometimes it will go well and often it won’t, especially at first. But if you think of charisma as a skill tree, each practice session is merely a way to brush up on the many ways to climb it.

Bryan Clark is a journalist from San Diego who lives at the intersection between technology and culture. 

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Digital Immortality

In this week’s Sunday NYT Magazine, a discussion was recorded about the future of technology. One of my favorite writers, Sid Mukerjee, discussed chronic disease. In that discussion, he touched on a notion of immortality that I have been pondering for some time.

Here is what he said, and after is what I say in response.

MUKHERJEE: “In terms of longevity, the diseases that are most likely to kill us are neurological diseases and heart disease and cancer. In some other countries, there is tuberculosis and malaria and other infectious diseases, but here it’s the chronic diseases that dominate. There are three ways to think about these chronic diseases. One is the disease-specific way. So, you attack Alzheimer’s as Alzheimer’s; you attack cancer as cancer. The second one is that you forget about the disease-specific manners of attacking diseases and you attack longevity or aging reversal in general. You change diet, change genes, change whatever else — we might call them “trans factors,” which would simply override the “cis factors” that existed for individual diseases. And the third option is some combination of that and some digital form of immortality, which is that you record yourself forever, that you clone yourself and somehow pass along that recording. Which is to say that the body is just a repository of memories, images, times. And as a repository, there’s nothing special about it. The body per se, the mortal coil, is just a coil.

This is the first time I have heard a major thinker put immortality into this context. And yet – its so obvious to do so!

For example:

– wouldn’t it be fair to say that every autobiography ever written would be a sincere attempt by the writer to achieve some form of immortality?

– in like manner, isn’t the task of the biographer, in part, to immortalize their subject?

– more broadly, how do societies around the world remember their ancestors? Their memories are their attempts to allow ancestors to live forever!

This point is nicely illustrated by the Irish culture. In my work on the History of Ireland, the centrality of “oral tradition” was crystal clear. I came continually across how the Irish told stories to revere their ancestors. The Irish would distill their ancestors into a wide variety of stories that helped the present generation understand the past.

So, by extrapolation from this point (which is obvious), can this be asked: “Can I be immortalized digitally?

Digital storage costs have plummeted. Methods of organizing and tagging video and audio recordings are now commonplace. Search engines are commonplace. Pattern recognition combined with search is exploding.

So what will prevent me in the future from immortalizing myself digitally? What prevents me from storing who I am, what I did, what I learned, where I have been, what I have experienced, who I knew, who my ancestors were, who my children and grandchildren were, etc etc?

Perhaps the answer is: nothing. Nothing prevents me from being digitally immortal.

Climate Change Language

We Need A Better Language for Climate Change – that Acts as a Call to Action

============================

Below is as essay that makes the case for a new six-box classification system for global climate change – two columns and three rows. The core idea here is to move climate change out of a subject for the editorial page and into a subject for daily new – much like how storms, earthquakes and epidemics are covered. We want a language that serves as a “call-to-action”.

The news would inform the world about climate-change related occurrences that have impacts that are “major”, “disaster”, or “global disaster”, and that are either “incidents” (one-time) or “recurring”.

I worked this out with Karen . I am the scribe. Obviously, this is DRAFT 1.

=============================
Climate Change Language

CREDIT: Karen Flanders-Reid
CREDIT: https://www.nytimes.com/2018/08/08/opinion/environment/california-wildfires-trump-zinke-climate-change.html

Karen and I read today’s NYT article about California wildfires, and found ourselves musing – is the language of climate change right? Why is a “wildfire” just an isolated incident? Why isn’t it part of a larger wildfire classification system (“BREAKING NEWS: THE CALIFORNIA WILDFIRE HAS JUST BEEN RECLASSIFIED AS CATEGORY V.”?

We went on to ask: if climate change is the critical issue of our day, why Why isn’t the wildfire in California an climate change incident – part of a larger climate change classification system?

Why do the NYT editorial writers have to scream – everything is related to climate change!!!! After all, news breaks when a Hurricane is re-classified: “BREAKING NEWS: THE TROPICAL STORM OVER CUBA HAS JUST BEEN RE-CLASSIFIED BY THE WEATHER SERVICE AS A HURRICANE.”

Why doesn’t climate change have its own global classification system? How do we move from the editorial opinion desk to the news desk? How do we move from “The science is being ignored.” To “BREAKING NEWS: THE WILDFIRES IN CALIFORNIA HAVE JUST BEEN RECLASSIFIED BY THE WEATHER SERVICE FROM A CLIMATE-RELATED INCIDENT (CRI) TO A CLIMATE-RELATED DISASTER (CRD).”

EXAMPLES OF POWERFUL GLOBAL CLASSIFICATION SYSTEMS

To identify a powerful classification system, and the new language it implies, it first would be useful to identify the other global classification systems that exist – especially those with imply a call to action.

There are at least four:

Storms; Classified by the World Meteorological Organization (WMO), using the Saffir–Simpson scale:

Tropical Depression
Tropical Storm
Hurricane/Cyclone Categories 1-5

Source: https://en.wikipedia.org/wiki/Maximum_sustained_wind

Earthquakes: Classified by the US Geological Service, using the Richter Scale:
Moderate (above 8)
Strong (7-7.9)
Major (6-6.9)
Great (5-5.9)

Infectious Disease; Classified by the global centers for disease control, the classes are:

Outbreak (more incident than expected)
Epidemic (spreads rapidly to many people)
Pandemic (spreads rapidly to many people globally)

Source: https://www.webmd.com/cold-and-flu/what-are-epidemics-pandemics-outbreaks#1

A NEW GLOBAL CLASSIFICATION SYSTEM FOR CLIMATE CHANGE

To Begin

We recommend s simple structure, with easily understood terms, that evolves over time:

Starts with a few terms, and adds terms over time.
Begins classifying major occurrences only, and evolves to classify most occurrences.
Begins classifying evidence-based occurrences only (where science is conclusive that the occurrence is climate-change-related) and evolves as science becomes increasingly conclusive.

Initial Terms

“Occurrence” – a natural phenomena that occurs somewhere

“Climate-Change-Related” (CR) – a shorthand for saying that the preponderance of science indicates that a given occurrence is a contributor to or the result of climate change.

“Incident” (I) – an episodic occurrence (with a beginning, middle, and end)
“Recurring” (R) – an on-going occurrence (no end in sight)

“Major” (M) – an occurrence with sufficient size to merit being classified.
“Disaster” (D) – an occurrence, with major impacts
“Global Disaster” (G) – an occurrence with major global impacts

Initial Classification System:

Climate-related Occurrences shall be identified.

Once identified, they shall be classified in one of six classes:

Either “incidents” or “recurring”.
Either “major”, “disaster”, or “global disaster”

“Climate-Change-Related Event” (CRE) – any occurrence that is deemed to be a contributor to climate-change.

“Climate-Change-Related Outcome” (CRO) – any occurrence that is deemed to be the result of to climate-change.

All major climate-change-related occurrences would be classified as follows:

CR Incident (CRE-I): An episodic event, with a beginning, a middle, and an end.
CR Disaster (CRE-D): An episodic event, with global impacts

The Weather Service would be tasked with implementation, and aligning with the World Meteorological Organization (WMO) and other agencies around the world.

SmartWatch Technology Reliably Detects Afib

The quantified self movement strikes again!

CREDIT: Cleveland Clinic Article on Detection of Afib via SmartWatch

Smartwatch Technology Reliably Detects Afib Prior to Cardioversion
Study suggests a role for KardiaBand when paired with physician review

A newly FDA-approved smartwatch accessory can record heart rhythm and successfully differentiate atrial fibrillation (AF) from normal sinus rhythm (SR) through an automated algorithm, according to a Cleveland Clinic investigation. The study, which will be presented March 11 at the American College of Cardiology’s 67th Scientific Session, also showed that the accuracy of interpretation gets even better when the accessory is supported by physician review.
The findings suggest that the wearable technology, known as KardiaBand™, can help screen patients before presentation for elective cardioversion to avoid unnecessary procedures, among other potential uses.
KardiaBand, which consists of a software app for an Apple Watch® and a sensor band that replaces one of the watch’s straps, provides a 30-second recording of an ECG rhythm strip when the wearer places a thumb on the sensor band. The app contains an algorithm for automated detection of AF.
“Our objective was to determine how accurately KardiaBand and its algorithm can differentiate AF from sinus rhythm compared with physician-interpreted 12-lead ECGs,” says senior author Khaldoun Tarakji, MD, MPH, a Cleveland Clinic electrophysiologist. In November 2017, the device became the first smartwatch healthcare accessory to be approved by the FDA, “but we wanted to test it ourselves to determine how well it would perform in clinical practice,” Dr. Tarakji explains.
Study essentials
To that end, he and Cleveland Clinic colleagues prospectively enrolled 100 consecutive patients (mean age, 68 ± 11 years) with chronic AF who were scheduled to undergo cardioversion. Upon presenting for the cardioversion procedure, all patients were given a KardiaBand-equipped smartwatch and trained in its use, after which they underwent traditional ECG assessment and a 30-second KardiaBand recording. If cardioversion was still indicated, they underwent ECG and KardiaBand testing after the procedure. KardiaBand recordings were then compared with the physician-reviewed ECGs and also reviewed by two blinded electrophysiologists, with these readings compared to ECG interpretations.
Eight patients did not undergo cardioversion because they presented in SR; these patients were excluded. Among the remaining patients, a total of 169 pairs of ECG and KardiaBand recordings were available for comparison (each patient had two before and two after cardioversion).
Key findings
• Of the 169 pre-cardioversion KardiaBand recordings, 57 fell out as “unclassified,” meaning that the KardiaBand algorithm did not draw a conclusion of either AF or SR.
• Among the remaining 112 pairs of recordings, the reviewing electrophysiologists determined that the KardiaBand algorithm correctly detected AF with 93 percent sensitivity and 84 percent specificity compared with ECG.
• When the blinded reviewers bypassed the automated algorithm and interpreted each patient’s KardiaBand strips against his or her ECG, sensitivity rose to 99 percent and specificity was 83 percent. Further, in the 57 unclassified cases, the reviewers were able to use the strips to correctly diagnose AF versus SR with 100 percent sensitivity and 80 percent specificity.
“This study shows that KardiaBand provides excellent sensitivity and good specificity in identifying AF,” says Dr. Tarakji. “The numbers improve further with physician overview of these recordings, indicating that even unclassified KardiaBand strip recordings could be of value to reading physicians.”
Smart devices demand smart use
KardiaBand carries the benefit of enabling patients to record their rhythm at any time, as opposed to only when they are wearing a Holter monitor or at a physician’s office. “We can catch intermittent episodes when they happen, and we’re not limited to a specific duration of monitoring time,” Dr. Tarakji says. He adds that wearable devices like this can also reduce time spent responding to false alarms if a recording taken at the same time shows normal rhythm.
Yet many questions remain about how KardiaBand and similar products may ultimately be used in practice. Dr. Tarakji cites a few examples:
• Which patients are best suited to this technology? For many patients dealing with AF, KardiaBand can provide reassurance when they need it. But for others, having constant access to their ECG data may lead them to check their rhythm obsessively, raising anxiety. “In general, however, patients value the instant feedback they get,” Dr. Tarakji observes.
• Do physicians have the IT infrastructure in place to make these devices part of their practice? Wearable devices can mean a flood of event reports to clinicians’ email boxes. At Cleveland Clinic, information from patients’ KardiaBands bypasses the email system and feeds into a cloud-computing platform that physicians can access anytime.
• How should clinicians respond to short episodes, particularly in asymptomatic patients? “We currently have a gap in our clinical knowledge about whether brief, random episodes that are asymptomatic warrant anticoagulation or not,” Dr. Tarakji explains, adding that ongoing studies are trying to address this important question.
“Future studies will focus on how we can use these smart devices intelligently to make sure they’re improving quality of care rather than just producing noise for physicians,” he observes.
A parallel goal, he says, is to ensure that the devices provide value by making care delivery more efficient. Noting that patients currently need to pay for KardiaBand out of pocket, Dr. Tarakji says that “developing a richer body of research evidence is the best way we can demonstrate cost-effectiveness to healthcare payers.”
Tech like this can’t be ignored
Indeed, KardiaBand could prove cost-effective by allowing patients who are in SR to avoid needless trips for elective procedures, such as in the case of the eight patients in the study who were found to be in SR when they presented for cardioversion and did not require the procedure. Other potential uses of KardiaBand for the longitudinal management of AF patients could well prove cost-effective too.
Regardless of how quickly such cost-effectiveness evidence may come, Dr. Tarakji says clinicians cannot be passive in the face of technologies like KardiaBand. “Patients will come to us with new products, and we can’t turn away,” he observes. “We need to test these products and find ways of responding to the information they deliver in a way that improves patient outcomes, all while remaining mindful of both patient and physician satisfaction.”
The researchers report that KardiaBand’s manufacturer, AliveCor, provided smartwatches for the study but was not involved in the study’s design, implementation, data analysis or interpretation.

Well-Being – Real Time Revisited

NOTE: This post revisits a post titled “Well-Being Real Time”. The original post was May, 2014, and can be found at: http://johncreid.com/2014/05/well-being-real-time/.

Well-Being – Real Time Revisited

Well-being is arguably the central mega-trend of the 21st century. As we look to the future, we have an obligation to “unpack” this dense concept, and find its essential component parts.

We describe these components here as “ACE” – ACT, CARE, and EAT. The wish we have for ourselves and for others is to be well. “Be Well” is our salutation and our call to actions.

How far out are we looking?

The future is now. ACE is here – together with real time measuring and monitoring. ACE is our pathway to greater and greater levels of personal well-being.

ACE measuring and monitoring will be supported by all elements of the quantified self movement. FitBit, Apple Watch, and so many other new monitoring devices will allow us to to bring personal well-being into a real-time modality.

ACE represents three pillars, each deceptively simple:

A – ACT: ACT is short for activity. The call to action is “stay active”. Well-being activity has physical activity at its center, but the pillar also embraces social activity, and activities of the mind. Staying active is a critical element of being well.
C – CARE: CARE is short for well-being care. The call to action is “care for yourself” and “care for others.”Well-being care of course has health care at its center, but there is so much more. e.g. genomics, massage, essential oils, acupuncture, etc. “Caring for myself” and “Caring for others” are elements of this pillar. “Preventive care” regular check-ups, colonoscopies after age 50, mammograms, pre-natal care for expecting mothers, etc.
E – EAT: EAT is short for eating and drinking. The call to action is “Eat well.” Well-being eating is the exploration of how what we eat and drink contributes to our well-being.

As simple as these pillars appear, each is complex: deep enough for a life-time of focus. Each represents bodies of research, skills, capabilities, and areas of professional endeavor. All together, these pillars represent pathway that each of us will follow as we attain greater and greater levels of personal well-being.

Discussion:

ACT

A – ACT (walking, running, calories burned etc)

Staying active is a critical element of being well. Well-being activity has physical activity at its center: sports, walking, lifting, climbing, yoga, and all of the other activities that light up a FitBit. The pillar also embraces activity of other kinds, e.g. social activity, and activities of the mind.

CARE

Well-being care is all about promoting health. Of course, it has health care at its center, but there is so much more. e.g. mental health, addictive behaviors, massage, genomics, essential oils, acupuncture, etc.

“Caring for myself” and “Caring for others” are elements of this pillar. “Preventive care”, eldercare and aging, palliative care are included, but so are regular check-ups, colonoscopies after age 50, mammograms, pre-natal care for expecting mothers, etc.

The ability to routinely monitor vital signs at home or at the office will be a part of this pillar. Lab work – including saliva, blood, and stool samples, will be more real time, more regular and less expensive. These trends will be one of the keys to progress in the care pillar. On the innovation side of this pillar will be many technologies, but breakthroughs in genomics will certainly be high on the list. Telemedicine is another innovation that will alter access to well-being care.

Predictive modeling will be more relevant than never. Am I headed for pre-diabetes? If so, what evidence shows me a path to avoid that condition?

CARE-MMEDS (what MEDS I take, what compliance I have, etc)

CARE-RResting Metabolic Rate (calories burned at rest)

CARE-VVITALS (pulse, BP, etc)

CARE-LLABS (blood testing, etc)

CARE-SSleep (duration, deep sleep, etc)

EAT

EAT is short for eating and drinking. The call to action is “Eat well.”

Well-being eating is the exploration of how what we eat and drink contributes to our well-being. Naturally, there is a social element, where eating and drinking together makes the experience more fulfilling. There is a physiological element, having to do with ingestion, osmosis, calories, glucose and glycogen, enzymes, etc. There is a psychological element, related to the feelings of satiety, or hunger, or thirst, and their related cravings. There is a sensory element, where sweet and sour contrasts, aromas, and their related metaphorical associations, play a part.

Eating delicious food and drink with friends is certainly a component. But achieving a balanced diet, with moderation as a central tenant,

On the one hand, this pillar is ancient. For thousands of years, elders have taught daughters and sons how to cook well. and cooking techniques have evolved

On the other hand, this pillar is ripe for innovation. The new breakthrough science related to the micro-biome is a part.

EATS (what I eat and drink, especially calories)

Implications

Monitoring all components of ACE (MEDS, Activity, Resting Metabolism,VITALS, EATS, LABS, Sleep) is now going to accelerate at an exponential rate.

There will be three settings where ACE monitoring will accelerate:

Employees in Workplaces: Employers will offer employees routine monitoring as part of employee benefits and/or health insurance.
Residents in Communities: Communities will offer residents routine monitoring as one of their amenities. Wellbeing facilities and programs will become as important as golf courses and swimming pools. Look for HOA’s,Condo and Coop associations, and subdivision developers to increasingly view MARVELS as critical to “place-making”.
Clients of service-providers: Hotels, spas, assisted-living centers, nursing homes, and many others will increasingly offer MARVELS monitoring as one of their base services.

The Privacy Imperative will be the critical success factor for all of these pushes into the future. It is foundational.

Without it, there will be no progress.

With it, personalized, real-time care will flourish. Each individual will be able to opt-in to his care-coaching community (and to opt-out whenever they choose), and get the extraordinary benefits that such a community can provide.

Want to talk to your well-being coach? FaceTime them, and they – with your permission – will help you sort out what’s going on with you.

Feel like you might need a check-in with a doctor? Send them an email – with your ACE history embedded in it, or get them on the phone or FaceTime, and see if they need you to come in.

The future is now.

BEWELL Centers will be everywhere. Look for:

DWELL CENTERS (part of BEWELL Centers) – for community ACE measuring and monitoring support. Target population is neighbors in the community.

Employee BEWELL CENTERS (part of BEWELL Centers) – for employees in workplaces ACE measuring and monitoring support. Target population is employees in the workplace.

CLIENT BEWELL CENTERS (Part of BEWELL Centers – for service-providers ACE measuring and monitoring support.Target population is clients of the service provider.
(Walgreens and CVS are already moving aggressively in this direction>

References:
The Privacy Imperative
LABS revolution
LABS By Disease
Quantified Self Movement

Amazon, BH, JPMorgan

With 1.2 million employees, Amazon, Berkshire Hathaway, and JP Morgan have decided to venture together into health care for their employees.

Following in the grand tradition of Henry Ford, who set up Henry Ford Hospital in Detroit, these three giants are stepping in too.

They have no illusions about how difficult it will be. But with premiums rising 19% per year, its clear that Congress is doing nothing, and someone has to do something.

“Planning for the new company is being led by Marvelle Sullivan Berchtold, a JPMorgan managing director who was previously head of the Swiss drugmaker Novartis’s mergers and acquisitions strategy; Mr. Combs; and Beth Galetti, a senior vice president at Amazon.”

The article points out that there are others working on this.

“Robert Andrews, chief executive of the Healthcare Transformation Alliance, a group of 46 companies, including Coca-Cola and American Express, that have banded together to lower health care costs.”

“Walmart contracted with groups like the Cleveland Clinic, Mayo and Geisinger, among others, to take care of employees who need organ transplants and heart and spine care.”

“Caterpillar, the construction equipment manufacturer, sets its own rules for drug coverage, which it has said saves it millions of dollars per year, even though it still uses a pharmacy benefit manager to process its claims.”

Suzanne Delbanco, the executive director for the Catalyst for Payment Reform, a nonprofit group that mainly represents employers”

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CREDIT: https://www.nytimes.com/2018/01/30/technology/amazon-berkshire-hathaway-jpmorgan-health-care.html?smid=nytcore-ipad-share&smprod=nytcore-ipad

TECHNOLOGY
Amazon, Berkshire Hathaway and JPMorgan Team Up to Try to Disrupt Health Care

By NICK WINGFIELD, KATIE THOMAS and REED ABELSON
JAN. 30, 2018
SEATTLE — Three corporate behemoths — Amazon, Berkshire Hathaway and JPMorgan Chase — announced on Tuesday that they would form an independent health care company for their employees in the United States.

The alliance was a sign of just how frustrated American businesses are with the state of the nation’s health care system and the rapidly spiraling cost of medical treatment. It also caused further turmoil in an industry reeling from attempts by new players to attack a notoriously inefficient, intractable web of doctors, hospitals, insurers and pharmaceutical companies.
It was unclear how extensively the three partners would overhaul their employees’ existing health coverage — whether they would simply help workers find a local doctor, steer employees to online medical advice or use their muscle to negotiate lower prices for drugs and procedures. While the alliance will apply only to their employees, these corporations are so closely watched that whatever successes they have could become models for other businesses.

Major employers, from Walmart to Caterpillar, have tried for years to tackle the high costs and complexity of health care, and have grown increasingly frustrated as Congress has deadlocked over the issue, leaving many of the thorniest issues to private industry. About 151 million Americans get their health insurance from an employer.
(Why will health care be so difficult for these companies to untangle? Analysis from The Upshot.)
But Tuesday’s announcement landed like a thunderclap — sending stocks for insurers and other major health companies tumbling. Shares of health care companies like UnitedHealth Group and Anthem plunged on Tuesday, dragging down the broader stock market.

That weakness reflects the strength of the new entrants. The partnership brings together Amazon, the online retail giant known for disrupting major industries; Berkshire Hathaway, the holding company led by the billionaire investor Warren E. Buffett; and JPMorgan Chase, the largest bank in the United States by assets.

They are moving into an industry where the lines between traditionally distinct areas, such as pharmacies, insurers and providers, are increasingly blurry. CVS Health’s deal last month to buy the health insurer Aetna for about $69 billion is just one example of the changes underway. Separately, Amazon’s potential entry into the pharmacy business continues to rattle major drug companies and distributors.
(Here’s a look at how the even the threat of Amazon’s entry into an industry can rattle stocks.)

The companies said the initiative, which is in its early stages, would be “free from profit-making incentives and constraints,” but did not specify whether that meant they would create a nonprofit organization. The tax implications were also unclear because so few details were released.
Jamie Dimon, the chief executive of JPMorgan Chase, said in a statement that the effort could eventually be expanded to benefit all Americans.

“The health care system is complex, and we enter into this challenge open-eyed about the degree of difficulty,” Jeff Bezos, Amazon’s founder and chief executive, said in a statement. “Hard as it might be, reducing health care’s burden on the economy while improving outcomes for employees and their families would be worth the effort.”

The announcement touched off a wave of speculation about what the new company might do, especially given Amazon’s extensive reach into the daily lives of Americans — from where they buy their paper towels to what they watch on television. It follows speculation that the company, which recently purchased the grocery chain Whole Foods, might use its stores as locations for pharmacies or clinics.
(We asked health care experts to imagine what the three corporations might do.)

“It could be big,” Ed Kaplan, who negotiates health coverage on behalf of large employers as the national health practice leader for the Segal Group, said of the announcement. “Those are three big players, and I think if they get into health care insurance or the health care coverage space, they are going to make a big impact.”

TAKING ON ‘THE HUNGRY TAPEWORM’
A look at the three companies that announced a joint health care initiative on Tuesday.

Total employees: 1.2 million 
Amazon: 540,000 
Berkshire Hathaway: 367,000
JPMorgan Chase: 252,000.
Individual strengths 
Amazon: logistics and technology
Berkshire Hathaway: insurance
JPMorgan Chase: finance.

Jeff Bezos of Amazon:
“The healthcare system is complex, and we enter into this challenge open-eyed about the degree of difficulty.”
Warren E. Buffett of Berkshire Hathaway:
“The ballooning costs of healthcare act as a hungry tapeworm on the American economy. Our group does not come to this problem with answers. But we also do not accept it as inevitable.”
Jamie Dimon of JPMorgan Chase:
“The three of our companies have extraordinary resources, and our goal is to create solutions that benefit our U.S. employees, their families and, potentially, all Americans.”

But others were less sure, noting that the three companies — which, combined, employ more than one million people — might still hold little sway over the largest insurers and pharmacy benefit managers, who oversee the benefits of tens of millions of Americans.

“This is not news in terms of jumbo employers being frustrated with what they can get through the traditional system,” said Sam Glick of the management consulting firm Oliver Wyman in San Francisco. He played down the notion that the three partners would have more success getting lower prices from hospitals and doctors. “The idea that they could have any sort of negotiation leverage with unit cost is a pretty far stretch.”

Even the three companies don’t seem to be sure of how to shake up health care. People briefed on the plan, who asked for anonymity because the discussions were private, said the executives decided to announce the initiative while still a concept in part so they can begin hiring staff for the new company.

Three people familiar with the partnership said it took shape as Mr. Bezos, Mr. Buffett, and Mr. Dimon, who are friends, discussed the challenges of providing insurance to their employees. They decided their combined access to data about how consumers make choices, along with an understanding of the intricacies of health insurance, would inevitably lead to some kind of new efficiency — whatever it might turn out to be.

“The ballooning costs of health care act as a hungry tapeworm on the American economy,” Mr. Buffett said in the statement. “Our group does not come to this problem with answers. But we also do not accept it as inevitable.”

Over the past several months, the three had met formally — along with Todd Combs, an investment officer at Berkshire Hathaway who is also on JPMorgan’s board — to discuss the idea, according to a person familiar with Mr. Buffett’s thinking.

The three chief executives saw one another at the Alfalfa Club dinner in Washington on Saturday, but by then each had already had dozens of conversations with the small in-house teams they had assembled. The plan was set.

Mr. Buffett’s motivation stems in part from conversations he has had with two people close to him who have been diagnosed with multiple sclerosis, according to the person. Mr. Buffett, the person said, believes the condition of the country’s health care system is a root cause of economic inequality, with wealthier people enjoying better, longer lives because they can afford good coverage As Mr. Buffett himself has aged — he is 87 — the contrast between his moneyed friends and others has grown starker, the person said.

The companies said they would initially focus on using technology to simplify care, but did not elaborate on how they intended to do that or bring down costs. One of the people briefed on the alliance said the new company wouldn’t replace existing health insurers or hospitals.

Planning for the new company is being led by Marvelle Sullivan Berchtold, a JPMorgan managing director who was previously head of the Swiss drugmaker Novartis’s mergers and acquisitions strategy; Mr. Combs; and Beth Galetti, a senior vice president at Amazon.

One potential avenue for the partnership might be an online health care dashboard that connects employees with the closest and best doctor specializing in whatever ailment they select from a drop-down menu. Perhaps the companies would strike deals to offer employee discounts with service providers like medical testing facilities.

“Each of those companies has extensive experience using transformative technology in their own businesses,” said John Sculley, the former chief executive of Apple who is now chairman of a health care start-up, RxAdvance. “I think it’s a great counterweight to what government leadership hasn’t done, which is to focus on how do we make this health care system sustainable.”

How Amazon Rattles Other Companies
The e-commerce giant’s actions – some big, like buying Whole Foods Markets; some smaller, like Amazon meal kits – have led to stock sell-offs for a wide range of businesses.

Erik Gordon, a professor at the University of Michigan’s Ross School of Business, predicted that the companies would attempt to modernize the cumbersome process of doctor appointments by making it more like booking a restaurant reservation on OpenTable, while eliminating the need to regularly fill out paper forms on clipboards.

“I think they will bring the customer-facing, patient-facing thing into your smartphone,” he said.

Amazon has long been mentioned by health care analysts and industry executives as a potential new player in the sector. While the company has remained quiet about its plans, some analysts noted that companies often use their own employees as a testing ground for future initiatives.

The entry of Amazon and its partners adds to the upheaval in an industry where much is changing, from government programs after the overhaul of the tax law to the uncertain future of the Affordable Care Act. All the while, medical costs have persistently been on the rise.

Nationwide, average premiums for family coverage for employees rose to $18,764 last year, an increase of 19 percent since 2012, according to the Kaiser Family Foundation. Workers are increasingly paying a greater share of those costs — they now pay 30 percent of the premium, in addition to high deductibles and growing co-payments.
“Our members’ balance sheets speak for themselves — health care is a growing cost at a time when other costs are either not rising or falling,” said Robert Andrews, chief executive of the Healthcare Transformation Alliance, a group of 46 companies, including Coca-Cola and American Express, that have banded together to lower health care costs.

Other major employers have also sought more direct control over their employees’ health care. Walmart contracted with groups like the Cleveland Clinic, Mayo and Geisinger, among others, to take care of employees who need organ transplants and heart and spine care. Caterpillar, the construction equipment manufacturer, sets its own rules for drug coverage, which it has said saves it millions of dollars per year, even though it still uses a pharmacy benefit manager to process its claims.

Suzanne Delbanco, the executive director for the Catalyst for Payment Reform, a nonprofit group that mainly represents employers, said controlling rising prices is especially hard in markets where a local hospital or medical group dominates. While some have tried to tackle the issue in different ways, like sending employees with heart conditions to a specific group, “it’s piecemeal,” she said.

She added, “There are so many opportunities to do this better.”

The issue is not solely a 21st-century concern: In 1915, Henry Ford became increasingly worried about the quality of health care available to his growing work force in Detroit, so he opened the Henry Ford Hospital. It is still in existence today.

Nick Wingfield reported from Seattle, Katie Thomas from Chicago and Reed Abelson from San Francisco. Michael J. de la Merced contributed reporting from London, and Emily Flitter from New York.

A version of this article appears in print on January 31, 2018, on Page A1 of the New York edition with the headline: 3 Giants Form Health Alliance, Rocking Insurers. Order Reprints| Today’s Paper|Subscribe