Patient Self-Management Tools

Technologies used by patients to manage their health issues outside of medical institutions are gaining momentum.  The explosion of the technological innovations, concerns about the cost of healthcare, shifting patient habits and the expectation for shared decision-making with their doctors, and political interests in stimulating competition among providers are some of the reasons for this surge of interest.

Self-management tools can be categorized by patient roles and the complexity of the technologies:

    Subordinate: tools such as video monitoring or home surveillance sensor systems provide limited patient discretion beyond agreement to use the tools.

    Structured: these are tools that provide more active self-management, but in highly defined ways. Examples include sound and text reminders from a tabletop appliance or perhaps a personal digital assistant or telephone, or devices allowing a patient to transmit data such as blood pressure readings.

    Collaborative: this category includes decision support aids, online interventions, chronic disease management aids, and patient education materials.

    Autonomous: tools for autonomous roles do not require regular participation or input from professionals. Internet sites such as eDiets and home heart defibrillators are examples of this category of tools.

Tools that support subordinate roles offer added convenience, greater precision, fewer errors, and less stress;  tools for structured roles still require  adoption by clinicians; collaborative tools are preferred and mostly used by better educated patients and the aspiration of some doctors; and tools supporting autonomous roles don’t require doctor participation and their use depends on patient preferences and personal circumstances.

Source:  California Healthcare Foundation, June 2010

Releasing The Hidden Potential Of Our Mind

What if we all could demonstrate amazing abilities such as: near total recall of memories, the ability to count a large number of items simply by glancing at them (numerosity), incredible musical talent, etc. Allan Snyder the director of the Centre for the Mind at the University of Sydney thinks we can!

Certain individuals, often called savants display these cognitive feats while often suffering from a neural disorder like Autism. Snyder believes that these abilities arise as Autism (or other phenomenon) grants the individual ‘privileged access’ to data that would normally be overridden in the brain. With magnetic pulses, Snyder has even been able to temporarily ‘unlock’ savant-like abilities in average people!

Snyder has published numerous papers on cognitive processing and brain performance. His paper in The Philisophical Transactions of the Royal Society B (biological sciences) summarizes his work (and related work from others). To grossly paraphrase his findings: the right hemisphere of the brain seems to accumulate detailed quantified data from the sensory organs unconsciously. This data is effectively overwritten or forgotten as the left brain packages information and imposes labels and organization upon it. When the left-right communication is disturbed or somehow faulty, the detailed data can sometimes be accessed by the conscious mind.

Occasionally though, people’s brains function differently. Snyder thinks they are granted ‘privileged access’ to the unpackaged data and gain “Rain Man” type talents. This can cause problems, such as all the negative symptoms associated with Autism, but it opens the possibility that this data is potentially available to everyone. Our conscious mind seems to work in a very top-down sort of way, with hierarchical thinking giving rise to the problem solving skills that make our species a success. But what if we could temporarily disturb that arrangement by shutting down one part of the brain to regain what that structure has cost us: exact recall of detailed data and calculations.

What other conditions (positive or negative) might we induce simply by temporarily shutting down different centers of the brain? We might learn languages faster, or have insights into our most difficult problems, or even just think of jokes more easily. There’s so much to explore here. One day we may have electromagnetic implants that restrict different parts of our brain to grant us conscious control over the rest. It’s all very theoretical at this point. Yet we may find that the core of the advanced computer of the future has already been built and has been resting in our skulls all this time.

Source: Singularity Hub, Aaron Saenz, August 4th, 2010;, Center for the Mind, Snyder et al Royal Society 2009 ;

A Highly Evolved Human Brain

According to David Linden a professor of neuroscience at Johns Hopkins University, the human brain relies heavily on structures found in lower animals. These functions play key roles in our everyday life.

A lizard brain is about survival — it controls heart rate and breathing, and processes information from the eyes and ears and mouth.

When mammals like mice came along, the lizard brain didn’t go away. The evolution slapped more brain on top of the lizard brain which then became the brain stem. These new parts gave mammals more memory and a wider range of emotions. It also allows them to do things a lizard can’t, like using experiences to anticipate danger instead of just responding to it.

And then the evolution added another layer to the brain that allows for example apes to reason and live much more complicated lives than mice.

In these brains you can find all of the very same parts that you would see in a human brain; except that the brain of an adult human is about three times the size of a gorilla brain. Much of the size difference appears after birth. The human brain continues to grow rapidly for the first five years after birth. It takes 20 years before all the circuits are laid out and connected up, Linden says.

As a result of having a bif size brain, there are enough neurons in our cortical circuit, massively interconnected, that the amazing human traits emerges from, such as: the ability to know what others are thinking based on social cues that people give them, other forms of observational learning and high-level cognition.

…and the highest payoff of our massive brain is the feeling of love and compassion.

Source: N.P.R; Jon Hamilton, August 9, 2010

Dopamine-Oxytocin Combo

Dopamine and Oxytocin enhance pleasure, but how? When we are first exposed to sexually arousing stimuli, certain neurochemical changes take place. Our brain releases dopamine, a neurotransmitter involved in a plethora of functions- pleasure, arousal, desire, and attraction, to name a few. Dopamine also plays a big role in motivation and drive, which is why dopamine-enhancing drugs work well in syndromes like ADD, where lack of motivation is an issue. Because of the strong association dopamine has with both arousal/desire and motivation, it is also thought to play a role in addiction.

After our brain releases dopamine, we feel attracted to the object of our attention. We are compelled to draw closer to it, to experience it more fully. If we are stimulated enough to a point of high arousal, like right before or during orgasm, oxytocin is triggered. Oxytocin is a neurotransmitter that is associated with attachment. When we interface with a person or object, and our brain releases oxytocin, we naturally form an attachment to it. Oxytocin has been found to be a big player in mother-baby bonding, and there have even been very recent studies that show artificial administration of oxytocin makes males more sensitive and helps autistic children form social relationships.

The Dopamine Oxytocin (DO) combo can be a pretty strong weapon in the game of attraction- a pure biochemical love-potion, if you will. And the thing is, you don’t even have to engage in sexual activity in order to prime these neurotransmitter responses, which is why fantasies are so powerful. You create the sexual images in your mind, and your brain responds neurochemically, even in the absence of tactile stimuli.

So one can argue that fantasies can be just as arousing as a flesh and blood person, maybe even more so. It all boils down to Classical Conditioning. Research has already shown how paired association of a pleasurable stimulus with a neutral stimulus can cue the release of dopamine from the neutral stimulus following training. You can think of past sexual experiences as the “training condition”, and the DO combo as the cued response. After you’ve experienced the pleasure of sex, certain images and conditions that remind your brain of that experience can cue that DO combo response even in the absence of the the stimulus (sex).

If you are able to deftly prime those neurotransmitters to be released, you can effectively chemically coerce people into just about anything. The mere image of sexual activity or the strong suggestion of it can be enough to cue the response, get that dopamine flowing, and oxytocin comes running in right behind.

The point is, all things equal, if you are presented with two things, and one of them induces a sexual response, that is the item or person you will be drawn to. It doesn’t matter if it is real, virtual, 2D, 3D, 4D, or all in your mind. All it needs to do is trigger the DO combo, and it is a done deal. As the author puts it “nothing like being a slave to your neurotransmitters, eh?”

Source: Science 2.0; The Science Of Pleasure: Your Brain On Sexual Imagery; Andrea Kuszewski; August 14th 2010