Transparency and beautiful data

PUBLISHED ON  January 3, 2015

WRITTEN BY  Roni Zeiger

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compost-transparencyAll the talk about transparency in healthcare will eventually make a difference. Much current focus is on price, because we know how to measure it. Quality is harder because we don’t have enough randomized trials to prove what really works and because data in our healthcare system is still a mess. This will improve, especially as we learn to analyze big data to answer questions in a more scalable (if much less perfect) way than randomized trials can.

In the meantime, let’s not forget that data can teach us what questions we should be asking in the first place. At home, we mused about this while enjoying our new composting bin in the kitchen. It has an accidental transparency feature, which lets us observe what we’ve been eating, and ask questions like… Which are the healthiest fruits? What food don’t we put into the compost bin (what data aren’t we measuring)? How can the beauty of this data inspire us?

What are they thinking?

PUBLISHED ON  December 9, 2014

WRITTEN BY  Roni Zeiger

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Yesterday, I helped my son with homework for the first time. He’s in first grade. The two memorable parts of this milestone were (1) I had to explain to him what a VCR is since it was part of a word problem, and (2) when he was done, he said: “Well, that was boring.” At least he thought it was interesting that we used to rent video tapes and pay extra if we forgot to rewind them.

Then this morning I biked to school with my daughter (in 5th grade). We ended up talking about how staying safe on the road means you have to get good at guessing what others are thinking. Do they see me? Are they going to try to exit the parking lot before or after I pass?

I realized that homework is often about the same thing: guessing what the person who wrote the question was thinking. This is actually a really useful skill, but I’m afraid he’s going to get good enough at in a few weeks.

Why hasn’t homework changed as much as VCRs?

Uber for tissue banking

PUBLISHED ON  November 22, 2014

WRITTEN BY  Roni Zeiger

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Soon, might a courier from Uber show up to the operating room to take your cancer tissue?

I’ve been learning a lot about how important tissue is for many cancer patients. In this era of molecular medicine, it’s often more important to know what mutations your cancer has (e.g. ALK positive) than what organ it happens to be in (e.g. lung cancer). That means a piece of your lung cancer tissue not only needs to be looked at under the microscope, but also tested for mutations. The basic tests we used to run were done — and done well — at every lab, including the one at the hospital where you had your cancer surgery or biopsy. These new molecular tests, however, are evolving quickly. In many cases, you might want a piece of your tumor to be sent to another medical center or a private lab that specializes in molecular testing. Here’s where it gets interesting.


The medical center that performed your surgery or biopsy has your tumor sample, and they are required to send a piece of it to another testing center if you request that they do so. But they don’t have much of an incentive to do this. They might prefer that you get more testing done at their lab or might prefer to keep as much of your tissue as possible for their researchers. Or they simply might not want to invest in making it easy for you to take your “business” elsewhere. This issue is going to get bigger as private testing companies and select medical centers are the ones investing heavily in next generation testing.

So maybe we need a new entity here, which I’ll call Uber for Tissue Banking, or just Uber for short. The incentives for this Uber are set up so that they focus exclusively on:

  • Handling your tissue professionally so that as much of it as possible is preserved for the tests you are most likely to need
  • Sending a sample piece of your tissue, when and only when you request, to the testing center(s) of your choice
  • Upgrading their technology for storing and preserving your tissue in the ways needed by the most current and promising testing centers
  • Alerting you of relevant new testing opportunities
  • Avoiding conflicts of interest, e.g., not setting up exclusive or preferential relationships with any testing centers

I’m not sure if I want Uber handling my tissue anytime soon, but I do think this is yet another area that is ready for some disruption.