Drinking problems (and some solutions)

Image by Samir Weres. Some rights reserved.

“It’s unpleasantly like being drunk.” 
 “What’s so unpleasant about being drunk?” 
 “You ask a glass of water.”

― Douglas Adams, The Hitchhikers Guide to the Galaxy

I’ve been thinking a lot about our relationship with alcohol recently. This article in the Economist about alcohol misuse in America particularly peaked my interest.

Between 2006 and 2010, an average of 106,765 Americans died each year from alcohol-related causes such as liver disease, alcohol poisoning and drunk driving — more than twice the number of overdoses from all drugs and more than triple the number of opioid overdoses in 2015.

The trend, particularly among women, minorities and the elderly in America is getting worse.

That’s not good because the health implications of alcohol are, as the article implies, very bad. David Nutt is one of the most interesting scientists in the field and in this programme for the BBC he talks about how alcohol would fare in the current testing regime for drugs were it to be tested for the first time today. His conclusion is that by current standards we would recommend something like one glass of wine a year.

The social implications of alcohol are no less problematic. The total tax take from alcohol is about £11 billion but the costs of policing Friday and Saturday night drinking hotspots is billions alone, not counting the impact of crime on citizens.

At the moment Brits drink more than Americans, but the trend on this side of the Atlantic is in the opposite direction. Each year we’re drinking less.

BGV portfolio company Club Soda’s Mindful Drinking Festivals and have tapped into this brilliantly. There are a whole host of new drinks companies springing up and the established brands are also creating new product lines that cater to people who would rather remember their evenings. It’s interesting to watch the large drinks companies realise they have a problem.

I do drink but I’m also acutely aware that alcohol is a habit and the amount I drink is socially influenced, particularly when it comes to work events. I totted it up and I go to nearly a hundred work-related evening events a year and alcohol is the norm. Although it was a bit awkward for us (as Nesta is one of our investors), I did like Laura from Club Soda’s public return of their New Radical Award. Nesta aren’t the only culprits of this but she’s absolutely right.

While we always make sure there are non-alcoholic alternatives at BGV evening events, we do still assume that some people will want alcohol. Perhaps we shouldn’t. This piece by Bethany Crystal at USV got me thinking — it sounds like a worthwhile challenge to create clear-headed evening events.

The genius of Parkrun

Photo some rights reserved by Darren Foreman.

We’ve been told we need to exercise more for years now, but finally it seems to be sinking in. While the stats for the proportion of people who are overweight or obese are still awful and the number of people who get little to no regular exercise are nothing to be proud about, there are more and more organisations catering to growing demand for physical activity.

Alongside teams we’ve worked with at BGV like GoodGym, Run an Empire and The Hard Yard, my favourite example is Parkrun. It’s been going since 2004 but has really started ramping up in the last few years and now operates in 15 countries with over a hundred thousand people all running a timed 5km on a Saturday morning just for fun.

To begin with we collated all results on paper and the finish tokens were washers from the local hardware store! But eventually we ramped up the technology, and so the parkrun registration and barcode result system was born.

It is a genius system — so simple but effective, which could be said of the design of the organisation as a whole. It’s completely reliant on volunteers and every Parkrun around the world has the same basic pattern. This leads to Parkrun tourism with people racing to see how many different runs they can do. I’ve got my eye on the busiest Parkrun in the world which is in North Beach in Durban, South Africa where they had over 2,000 runners last weekend.

I love going along to my local event in Mile End Park in London. There were over 400 people there this weekend and I don’t think that was just because the IAAF World Athletics Championships were taking place round the corner. There’s plenty of room to grow and I think we’ll see more and more organisations catering for the demand from people to get more active.

What really lives in your lower intestine?

I surprised myself by really enjoying Gut by Giulia Enders. I’m generally fairly squeamish about all things medical but I I’m glad I picked this one up. It’s full of interesting stuff from the emerging science of our digestive systems. There are some great sections about what actually happens in all the processes we don’t like to talk about and Enders has a lovely turn of phrase, writing that the movements involved in burping or breaking wind “are as delicate and complex as those of a ballerina”.

Gut bacteria are such an interesting area and we barely understand anything that goes on in there. For a long while we thought that there were very few types of bacteria but it turned out that there were many other types but they just didn’t survive when they were cultured outside the body. We’ve probably still only just started to scratch the surface of the types of creatures that are in there and we know even less what they do.

Gut science has also taught us a bit about human history. By looking at the strain of Helicobacter Pylori in our stomachs we can see where people in particular countries came from. So when the strain in the stomachs of pacific islanders was found to be the same as those from latin america it proved that they’d come that way round. The scientists who proved that there was a bug capable of living in stomach acid did so by drinking the stomach contents people with ulcers and making themselves ill. They won the Nobel prize for medicine 20 years later.

One of the lovely things about the book is Ender’s absolute fascination with her subject. She’s a young doctor who has specialised in gut research but she writes so well (and not without humour). The book was written in German so some credit should go to the translator as well because it’s a fantastic read.

We focus so much on heart health and brain health but actually gut health is just as important. There’s pretty good evidence that it can be linked to depression, heart disease and many other things. I think we’ll see it develop as an area pretty rapidly over the next few years as the tools to decode the composition of the bacteria and other critters in our intestines start to be understood.

A few notes on quantified self tools

I’ve been playing with a few quantified self tools over the last year (really since I went along to the Quantified Self Europe conference in November 2011). Thought I’d just scribble a few notes about what I’ve found.

  • Fitbit was good for a while — I’ve actually gone through four of them though. I lost the first one, the second one wouldn’t synch, I had one for 10 months which worked perfectly but disintegrated eventually and then one where the battery would run out within a few hours. So it’s really not really very robust and it was also a bit rubbish at measuring sleep.  I think the new ones probably are better (they synch through your phone for example). What did I learn? The main thing was that there’s a big difference between days when I’m sat at a desk and days when I have meetings. Typically I head all over town and usually walk between places.
  • I used MyFitnessPal for a couple of months and it definitely made me eat more healthily. It’s a bit of a faff filling it in each time but it gets easier as you build up your own ‘favourites’. One thing I found was that I ended up cooking more ‘standard’ meals because then I knew what was in them.
  • I actually really like the Nike+ Running app and have been using it a lot recently. You get the feeling that somebody’s actually put some thought into the psychology of it (although I’m not sure that Lance Armstrong is quite the right person’s voice to use these days). There’s a bit of a discrepancy between the distance data and Google Maps which I’m not sure about. I did have a Nike+ widget in my trainers but that seems to have been made redundant by the new app.
  • I’ve just started trying out a Zeo that we got free from a friend who got it in a conference goody bag. The first night wasn’t good as I’ve ended up with a bruise on my forehead but I think I will try it for a while.
  • For work productivity I measure a few things like words written each morning, emails sent during the day, tasks completed (from Things) and pomodoros completed. I pop all that into one tool that I have persevered with which is a little Google Spreadsheet. It’s evolved over the year but is pretty useful.

What have I learned overall? Measuring stuff is pretty useful. Once you’ve done something for a while you can often see what you need to change and then you don’t need to measure it as often because you’ve set your motivation. Some things you do need to keep measuring because the measurement in itself is the motivation. I’ve also just downloaded Lift which is based on a lot of the thinking in The Power of Habit — I’ll see how that goes.
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I’ve been reading quite a bit about behaviour change over the past few months, partly because I think it’s an interesting investment area but also just out of personal interest and wanting to improve my own health and productivity. Lily suggested I read Switch by Chip and Dan Heath which is great and I definitely recommend it.

The book’s a couple of years old now so I’d heard quite a few of the examples already but the basic framework of the book was new to me. It’s all set up with a slightly cheesy analogy but one which works I think — that any person’s behaviour is a function of both head and heart, or as the Heaths put it a rider and and an elephant.

The book is then split into the three things that you need to get right in order to get both rider and elephant where you want them. These are:

  • Direct the rider: set clear, easy to follow instructions to be acted upon
  • Motivate the elephant: help people feel good about the eventual goal
  • Shape the path: make the environment as conducive as possible to positive behaviour

Get any of those pieces wrong and not a lot will happen. I nodded along to most of the book, seeing things that I’ve done in various situations that didn’t cover off all three principles and hence went wrong or just fizzled out. It gave me a lot of ideas about how I could improve my own ability to get things done both personally and at work. It also gives you some insight into how these techniques are used in marketing and advertising — not always to make the world a better place it has to be said.

To be honest I did find The Power of Habit more interesting from a science point of view and the storytelling meant it felt better written but nevertheless, if you’re interested in changing behaviour in any context, Switch is well worth a read.

Photo Some rights reserved by brendonhatcher.

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Software’s unbalanced diet

I’ve been thinking a bit more about what’s going on in the economy and its relationship with technology. It was Albert Wenger’s post about whether the rise in consumer debt had something to do with technology’s effect on the economy that got me thinking although I’d been wondering for a while whether technology had something to do with the rise in public sector spending.

Marc Andreessen writes that ‘software is eating the world’ but I’ve started to think that it’s eating a very strange and unbalanced diet which is having nasty consequences. The fact that we’ve used technology to only revolutionise certain industries is a bit like just eating all the fatty, sugary stuff and skipping the healthy parts. The reason we haven’t really noticed that software has avoided making great leaps forward in some of the most important sectors is that they’ve actually been improving without it.

Take education, which in the UK seems to be getting better and better. The statistics are of course a bit controversial, but one example is that 11 year olds have gone from 49% reaching level 4 or above in 1995 to over 80% in 2011. However education is also getting a lot more expensive. It’s doubled in cost since 1997 and some forecasts I’ve seen show it continuing to increase over the coming decades simply because of the increases built into the current system (buildings needing to be replaced, teachers getting more expensive as they get more experienced and qualified etc).

Likewise, healthcare. Between 1997 and 2009, the National Health Service made a 20 per cent reduction in the mortality rates of cancer patients aged under 75 and a 40 per cent reduction in mortality rates of heart disease patients under 75. But, again, it’s getting a lot more expensive. It went from costing £50 billion per year to £120 billion between 1997 and 2011. That increase went into new buildings, new staff and better pay and conditions for those staff. It also went on technology but in such a terrible way that it likely made the system more inefficient overall.

You could blame the increase in cost of both of these on the Labour Government but I think it’s much more systemic than which flavour of politician is in power. Other countries saw similar trends and even in the US where healthcare is run outside of the public sector, the costs rocketed in both real terms and as a percentage of GDP. The truth is that we’ve entered a period of history where we need good education and need good healthcare but compared to the efficiencies that technology has created in other parts of the economy (see Race Against the Machine), healthcare and education remained almost untouched. Even worse, the changes that technology has created in other parts of the economy, left us unable to raise the taxes to pay for the rises in costs.

Now I think if we have any chance of retaining the improvements in quality we need to make public services radically better and cheaper. Some work that Mastodon C did during the BGV programme found over a quarter of a billion of unnecessary overspend in GP prescriptions. Another of our companies, Dr Doctor,  is looking at how missed and cancelled appointments affect the NHS and has found another £900 million of potential savings. The problem is that IT has been seen as a cost in the NHS for the last 20 years whereas we actually should only be using it to save money AND improve outcomes. I think things will get better and I’m bullish about health and education because I know that good people are already working on them and investors are moving into them as areas as well. But there are services that are getting worse and more expensive which I really worry about —  social care, prisons and the courts for example.

Another worry I have is that no matter whether the economy starts growing or not, we’re still going to have a really difficult time creating more jobs. Andrew McAfee and Eric Brynjolffson’s research points to this but this piece for Planet Money is even more stark — economists just can’t find a future scenario where US employment will return to pre-2008 levels. Put simply — society is going to get better but we’re going to have less jobs. On the one hand, that sounds great (we’re going to have to work less). But society just isn’t set up for it (if you don’t work, you don’t count). I can’t pretent I have an answer to the conundrum but for me it means that what your startup does is a much more important decision than it used to be. Software isn’t eating the world, it’s eating the unhealthy bits and unless we rebalance our efforts to use it to make publicly valuable sectors vastly more efficient, we’ll be in even worse trouble than we are now.

Personalised exercise

A couple of weeks ago, I watched a very good programme on BBC Four called The Truth About Exercise presented by Michael Mosley.

Instinctively I guess I knew that different people responded differently to exercise but I hadn’t really looked at the science. One study mentioned in the programme found that in a sample of 1,000 people given the same WHO recommended exercise regime for 20 weeks, 15% had a dramatic improvement in their fitness but 20% showed no real improvement at all (so-called ‘non-responders’). It also seems that there are genetic markers that can predict where you will be on this distribution.

The programme then looked at some of the research that’s going on into High Intensity Training which sounds too good to be true and has led to a few somewhat dramatic headlines. The idea is that you can get many of the same fitness benefits of the WHO recommended regime based on just a few minutes per week of really pushing yourself in full body exercise. What was interesting was that Michael Mosley is in the ‘non-responder’ group but the High Intensity Training did still have a benefit to him — it improved his insulin sensitivity by 24% which in his case (with a history of diabetes in the family) was very important.

It brought me back to my hatred of gyms which was what got me interested in Good Gym in the first place and thinking about how we could radically improve the health of a large percentage of the population. Only about a third of the UK population meet the recommended levels of exercise for a healthy lifestyle and it’s costing the NHS billions of pounds and probably having all kinds of other effects on the economy and society as well.

I think there’s a huge need for tools that make preventative healthcare work. Unfortunately the NHS  (which is really a national ill health service) isn’t set up to build them so I think they’ll have to come from elsewhere. I’d like to see services that can offer advice and motivation to people about exercise on a personalised basis. They could involve some element of genetic propensity to benefit from different types of exercise as well as looking at other lifestyle issues such as your activity levels (the programme singled out sitting down at work as probably the UK’s biggest killer) and devise nutritional and exercise advice that takes into account budget and lifestyle.



 Some rights reserved by Josiah Mackenzie
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Outsourcing motivation

I’ve been watching the quantified self movement gather pace for the last year or so with increasing fascination. If you haven’t come across it before, it’s a group of people making the most of technology to measure elements of their life so they can better understand themselves and hopefully improve. There are a number of good talks about the subject, including this introduction by Gary Wolf of Wired Magazine in the form of a short TED talk, and a few good feature articles, the best of which is this one from the FT Magazine which covers the first big conference on the subject held in Silicon Valley in May this year.

There are a number of apps that I’ve had a play with, although I have to admit that I’ve struggled to keep up with all of them because some of them require quite a lot of data entry. The ones I’ve settled on are:

  • MyFitnessPal — noting down what I eat
  • NHS Drinks Tracker — noting down what alcohol I drink
  • iMapMyRun — measuring how much exercise I’m doing
  • TallyZoo — noting down a few other things I like to track such as how many coffees I’m drinking

So far at least, there’s no app that does all the things I want, so I put this data in a Google Spreadsheet that I try to keep up to date. It started out as a way of measuring my productivity including how many of my tasks on Things I managed to do each day, how many emails I sent and how many words I was writing each day, but I’ve expanded it over time to track the health related data.

There is something very geeky about all this. It suits people who love numbers and data and perhaps those hackers who are always looking for ways to do things that avoid hard work. You have to measure the right things which I guess is dependent on what matters to you — there’s little point in measuring things you don’t care about. But I do think it helps with motivation. In many ways it’s like outsourcing your motivation so you don’t need to worry about it yourself. Once you’ve understood your targets you have something that keeps you honest — be that a gadget or a website that gives you feedback from other people.

I’m fascinated by whether you could create much easier ways to help people analyse their nutrition and activity so that they could avoid health problems. I’m sure not everybody would want to but I think more people than we like to admit are a bit obsessive in hidden ways. The number of people on diets or with tiny things they have to do every day to remain happy is huge.

Personalised preventative medicine, if we can make it work, should be a lot cheaper than personalised medicine where treatment is needed. The savings for the NHS could be enormous. One idea I have is to give people an app that formats data in a way that is useful to them but also to GPs. The app itself is free and if you keep it up to date, you get free prescriptions. The idea would be that over time it would save GP surgeries money because patients wouldn’t be claiming prescriptions as often because they would be getting feedback on their nutrition and lifestyle that would improve their health. Taking on the extra cost of the prescription would be negligible for the GP surgery and the problem of older people not being able to use the technology wouldn’t matter because they currently get free prescriptions anyway.

I’ve decided I’ll head over to the European Quantified Self Conference in Amsterdam at the end of November to find out more. In the meantime I’ll keep collecting the data about my own health and productivity. Maybe by the time we come to the event I’ll have something to share.
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