If you can quantify the self, can you also program it?

Fred Trotter on how the "Programmable Self" can be applied to healthier living.

The Quantified Self health movement, once thought limited to elite athletes or patients suffering from chronic disease, has been steadily expanding beyond body hackers and body builders. Recent research on how the Internet is shaping healthcare from the Pew Internet and Life Project contained an eye-opening fact: fully one quarter of online adults were tracking their own health statistics. There’s clearly something important going on here.

To learn more, I turned to Fred Trotter (@fredtrotter). Trotter and David Uhlman are writing a book on health information technology for O’Reilly, titled “Getting to Meaningful Use and Beyond.”

Trotter has advanced the Quantified Self discussion one step further by asking, if you can quantify the self, can you also program it? He’ll be talking about hacking yourself with open source software at the upcoming OSCON conference in Portland, Ore.

Our interview follows.

Does the Quantified Self relate to better healthcare outcomes?

Fred TrotterFred Trotter: I think that’s what the Quantified Self is, this notion of examining yourself and enabling data about yourself to this super-high degree. For a lot of behavior change, it comes down to either a motivational problem or an information problem. If you are really motivated to change something about yourself, but you just don’t know what to do, then mere information is very valuable. Just doing the Quantified Self ends up causing a behavior change.

The problem is that there are certain issues that even if you know what the right thing is, you don’t do it. Diet is a great example. Almost everyone knows what it means to eat right, and yet the knowing is not enabling the doing. That’s the motivation problem.

Health IT at OSCON 2011 — The conjunction of open source and open data with health technology promises to improve creaking infrastructure and give greater control and engagement for patients. These topics will be explored in the healthcare track at OSCON (July 25-29 in Portland, Ore.)

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How does behavioral economics play into these trends?

Fred Trotter: We get a lot of mathematical models that are supposed to predict what happens in the real world, but they don’t work because people are not rational. Behavioral economics says: “We know people aren’t rational, so let’s start taking a look at how they’re not rational. Let’s try to quantify that and then, instead of putting that assumption into the economic formulas, we’ll put these kind of fuzzy numbers in and see what happens.” The takeaway is not just that people are irrational, but they’re irrational in predictable ways.

There are a few key concepts. One is this notion that you’re not the same person today as you are tomorrow. We make obligations for our “future selves” that our “present selves” almost always ignore. Like this morning, for instance, I should probably go for a jog. That’s what my previous self — my past self — would want to obligate my future self to do. My present self doesn’t really feel like going for a jog at all. So the present self is very lazy. All of these obligations are put on the future self, but those obligations are not fulfilled when the future becomes the present. Part of it is a time disjoint: our plans for the future never apply to the present.

Even more useful is the way behavioral economics solves problems. What you can do is create contracts from the past or present and then obligate your future self through those contracts. When the future self becomes a present self, the contract enforces the behavior you want.

The best book about this is “Carrots and
” by Ian Ayres. The website Stickk is also worth checking out. It’s a place where you can create contracts for yourself. Essentially, you put some money up and if you do whatever it is you promised yourself, you keep the money. If you don’t, the money goes to charity or it goes to an anti-charity or some other place where you don’t get it. That’s a very clever idea, and I think it needs to be taken much farther. Those kinds of things create a way for us to programmatically create relationships. That’s a really neat concept because if I can program it, then I can overlay it with other programming techniques. We can get to what I call the “Programmable Self,” which is to use software to create motivation.

So how would you explain the “Programmable Self” to my mother?

Fred Trotter: The basic idea is that I’m going to make a contract with myself to change, and software will manage that contract. There’s things that software can do, but it’s a very limited palette. You can have software embarrass you by posting something to Facebook. You can have software encourage you or praise you by posting something to Twitter. You can have software take your money, or software can give you money. By focusing on software’s motivational components, you can try to program yourself.

What are the most important differences between programming a computer and programming your body?

Fred Trotter: Whatever you’re programming, you need to recognize the idiosyncrasies of the programming platform you’re dealing with. When you’re programming yourself, the platform has rules that normally do not apply. For example, the source code you’re working with has to be very short. You can only get simple messages across when you’re talking about modifying your own behavior.

In addition, you can think of motivational problems as a segmentation fault. If you divide by zero on a programming platform, it just doesn’t work. The whole system crashes. Similarly, if your task is beyond your motivational capacity, you’ll fail. That failure is not just an error case, either. If you plan to run 20 miles a day over the next week, that’s probably not going to happen unless you’re an ultra-marathoner. Because you tried to do something outlandishly hard, your motivation has been used up and you’re not going to try anything else.

You have to recognize that motivation is something that has a finite amount. It’s not like memory on a computer, where once you clean it out you can get it back. Motivation is a leaky resource and you need to protect it.

Is the body a platform to build things on?

Fred Trotter: Yes, but you have to understand the difference between a platform that people build and a platform evolution creates.

Engineers who build platforms draw very clean lines between systems to keep them entirely independent. If you look at a car, for instance, you can take out a broken carburetor, replace it, and then the car will work again. The carburetor is modular.

If you evolve something, you don’t have clear lines between systems. People talk about the “cardiovascular system” or the “limbic system” or the “neural system” as though those are separate things. While it’s interesting and helpful to create lines to talk about different things inside the human body, we know that those systems are not modular.

When you want to program the body, you have to remember that any system is deeply tied to the rest of the body. You can’t pop and swap things out the way you can in an engineered system. That ends up being a benefit in some cases. Because everything is so tied together you can use one data type for one system to measure the whole thing. Heart rate is the best example. There’s a lot of mental changes you can measure with heart rate. There’s actually some indications that if you take the derivation of changes in the heart rate you get this nice sine wave that offers a good indication of a lot of subtle things.

What will we be measuring in the near future?

Fred Trotter: Movement has become an important measurement because of the high-quality accelerometers in mobile devices. You can also monitor changes in connectivity in the skin and there’s a bunch of stuff happening with the brain, including measuring brain waves and using the brain as a controller.

There are some indications that stress will be the next area people focus on. How do you get automated device-driven stress data? Whoever cracks that nut is going to have a lot of popularity.

This interview was edited and condensed.

Photo on home and category pages: pg 226 Our Brain by perpetualplum, on Flickr

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  • Alex, Fred, thanks for unpacking this topic and explaining it so clearly. Let’s all think about Alex’s mom when we are discussing health, IT, etc. This is lovely: “I’m going to make a contract with myself to change, and software will manage that contract.”

    As an experiment in this type of pursuit, I’m playing Health Month, a game in which I place bets with myself about whether I can stick to a few resolutions.

    For the first month I went solo, checking in every day or so and enjoying how it prompted me to front-load my week with exercise (so my Future Self wouldn’t get stuck running extra miles — or losing points).

    This second month I joined a team and checking out more of the social aspects, like the tips from everyone else trying to cut down on sugar intake. I’m personally more responsive to the positive reinforcement prompts – and I think the literature bears this out as a widespread preference – but I could see a role for public shaming techniques (“Susannah hasn’t skipped dessert for 5 days.”)

    Fred, what other tools are you seeing to help people like me (interested in changing a few health behaviors, but not interested in serious self-tracking)?

  • Ronnie McKnight

    These are very interesting and thought changing topics, each topic seek a point or position of stability in the social realm.