Notes on Engineering Health, October 2020: Show Unfinished Work

Among 10 key pieces of advice for design schools espoused by the Stanford d.school is #3) Show unfinished work:

In the early days in particular, d.school staff were prototyping everything. How the class schedule worked. Various ways to visualize the calendar. Different approaches to class projects.

The original space also had almost no walls. The few walls it did have were made of unfinished 2x4s and skinned with see-through panels, which became work surfaces. So everything was visible.

This hyper-visibility could be frustrating at times, but it was influential in the early development of the d.school and its students: it helped expose work and allowed ideas to flow freely. From the staff’s calendars and diagrams to the students' prototypes and sketches, no one's work could hide.

Later on, this ethos led to a habit of keeping work-in-progress on display.

When we started publishing this newsletter 14 months ago, part of our motivation was to show some of our unfinished work by being more open about problems and technologies that we were interested in working on. By listing scientific papers and articles of interest each month, we hinted at some of our focus areas. But, while the open-rate for the email version of the newsletter has been strong, the click-through rate has hovered around a mere 3% — indicating that perhaps our hints have been a bit opaque.

This month we are introducing a new section of the newsletter, First Five, a curated list of topics that we are working on along with a bit of commentary and links to some of the content (scientific papers, books, podcasts, video, etc.) that is motivating our work. Our hope is that this new format will add some additional openness about our unfinished work, and will further facilitate the free flow of ideas with our readers.

To that end, we hope that you will be in touch with us directly if you see areas of mutual interest. And we hope that you will follow us on Twitter and Instagram where we will continue to post our full reading list of interesting content in health and science.

– Jonathan Friedlander, PhD & Geoffrey W. Smith



First Five

1/ Obesity
A report from the Robert Wood Johnson Foundation on childhood obesity is alarming: roughly one in seven U.S. youth ages 10-17, 15.5%, have obesity according to the newest available data. Native Hawaiian/Pacific Islander, American Indian/Alaska Native, Hispanic, and Black youth had significantly higher rates of obesity than white and Asian youth. Around 1 in 5 youth in households making less than the federal poverty level had obesity, compared to fewer than 1 in 10 youth in households making 400% the federal poverty level.

On the other hand, a series of recent papers highlight progress being made in understanding various aspects of the biology behind obesity:
- A gene that helps to control inflammation increases the risk of obesity and could be turned off in mice to stop weight gain. Nature Metabolism >
- Calorie restriction extends health span, which is thought to be mediated in part through a decrease in core body temperature. Science Signaling >
- A light-sensing pathway in neurons regulates thermogenesis in brown adipose tissue. Nature >
- The microbiota interacts with the enteric nervous system to induce metabolic outcomes. Science >

2/ Metabolomics
We continue to tease apart our understanding of metabolism. This Science paper represents metabolomics at its best as the authors studied more than 270 metabolites and their impact on the heart. Their results confirmed that hearts voraciously consume fatty acids. Hearts secreted, rather than consumed, amino acids, thus revealing active proteolysis. In patients with heart failure, ketone and lactate consumption increased, as did proteolysis. These findings could lead to strategies for fighting heart disease by altering metabolism.

Another interesting metabolomic study looked at 64 metabolites and concluded that changes in the circulating metabolome, especially lower serum levels of asparagine and serotonin, are associated with later diagnoses of alcohol‐related diseases, even after adjustment for the baseline level of alcohol use.

3/ Precision Medicine
Our ability to use long-read sequencing to drive highly precise medical understanding (in this case involving muscle spasticity after nervous system injuries and in painful low back spasm which affect more than 10% of global population) is highlighted in this Cell paper.

A group of researchers in the UK, though, called into question the hype around machine-learning powered precision medicine in this paper in The Lancet Digital Health. The authors argue that the goal of personalised medical care faces serious challenges, many of which cannot be addressed through algorithmic complexity, and call for collaboration between traditional methodologists and experts in medical machine learning to avoid extensive research waste.

4/ Supplements
Scientific evidence for popular health supplements showing tangible human health benefits when taken orally by an adult with a healthy diet is visually set out by information is beautiful. But, there is a counter argument regarding the value of this analysis.

5/ Scientific Freedom: The Elixir of Civilization
Stripe Press has just re-issued Scientific Freedom by Donald W. Braben which was originally published in 2008. In a mailing about the book, Kate Lee, the Publisher of Stripe Press, noted “Among the most substantial impediments to scientific innovation are the layers of bureaucracy that stifle curiosity and limit our ability to make transformative advances. … Braben pioneered British Petroleum’s Venture Research program, which identified and sponsored scientists doing cutting-edge research. Such research can, in fact, be low risk and offer rich rewards. In Scientific Freedom, Don provides a tested framework to discover researchers with revolutionary ideas—and to give these thinkers the requisite freedom to explore.”



Digitalis Commons
Public-Interest Technologies for Better Health.

Digitalis Commons is a non-profit that partners with groups and individuals striving to address complex health problems by building public-interest technology solutions that are frontier-advancing, open-access, and scalable.