BHAG

Right now, the US is facing a terrible, relatively new problem: a surge in chronic disease.

One in two Americans suffers from chronic disease (more than half of those from multiple chronic conditions), which is responsible for more than seven out of every ten deaths annually. We spend more than $2.3 Trillion each year (about 12 percent of our GDP) treating chronic disease, and it’s likely only going to get worse going forward, as the rate of chronic disease in kids has more than doubled in the last twenty years.

Our healthcare system wasn’t built to deal with these kinds of chronic conditions. A century ago, our leading causes of death were acute, infectious disease (the top three: tuberculosis, typhoid, and pneumonia), and most other doctor visits were also for acute problems like appendicitis, gall bladder attacks, etc. For those kinds of issues, the medical system is incredibly effective: go see a doctor, get an antibiotic / have surgery, recover. And with new treatments and technologies coming online, we get better and better at acute treatment every year.

But that same system isn’t well-equipped to deal with chronic disease, where doctors’ current tools are largely focused on suppressing symptoms rather than dealing with underlying causes. If you have high cholesterol or high blood pressure, you can get a drug to take (for the rest of your life) to lower them, but rarely a serious look at why either is high in the first place.

Recent research suggests that more than 85% of chronic disease is caused by environmental factors, like diet, behavior (including movement / exercise), and lifestyle. Dealing with the root causes of those chronic diseases, then, involves helping patients build and sustain new patterns and habits over the long-haul.

Given the heavy load we already place on physicians, it’s not reasonable to expect them to accept responsibility for driving that kind of behavioral change, too. The average primary care provider has about 2500 patients on their roster, and sees each for visits lasting on average just 10-12 minutes. That’s enough time to diagnose symptoms, prescribe medication, and then follow up a few weeks later. But while most people will take a course of antibiotics their doctors prescribe, drastically fewer will make wholesale changes to their lifestyle, without substantial ongoing support.

Currently, the fitness industry is failing equally when it comes to providing that kind of support. Indeed, the vast majority of people who start a diet or join a gym today will be no better off (and often worse) a year from now, having seen little results, given up, and returned to their prior behavior. Roughly, the fitness world today is akin to where medicine was in 1850: a lot of new science is emerging, and a slew of potentially helpful tools and technologies are being developed, but it’s yet to coalesce into an effective standard of care.

Which, in short, is what Composite is really about. Our big, hairy, audacious goal is to bring the rigor of medicine into the world of fitness, to try and develop clinically-demonstrable effectiveness in treating the underlying causes of the majority of today’s chronic disease.

There are a number of other companies, too, living at the intersection of fitness, technology, and medicine, developing new best practices, to whom we look for ideas and inspiration. I strongly believe that, over the next twenty years, we’ll see a whole new fitness industry emerge from those kinds of companies, one that can work hand-in-hand with the existing medical system, to help the US address the problem of chronic disease. And I’m hoping that, with the right team, a bit of luck, and a lot hard work, Composite can help drive that change, can become a leader of that pack.

Best Served Cold

First, an admission: I hate iced coffee.

I love – love! – the hot version, whether a lovingly pulled single-origin double espresso or the cheap crap bodegas sling in paper cups.

But, for whatever reason, the cold stuff doesn’t do it for me. Nonetheless, I realize I’m an outlier, and therefore spend the summer watching my friends and family suck it down. In the past few years, the iced coffee trend has been towards cold brew. Yes, it’s smoother and sweeter than hot-brewed coffee, with less than half the acidity, and more caffeine kick. But, at most joints, it’s also upwards of double the cost of a hot coffee.

In part, that’s due to additional expenses on coffee shops’ part: plastic cups, straws, ice machines to crank out ice. But in larger part, it’s also due to the hipster factor; people really want cold brew these days, so shops up the price because they can.

But here’s the dirty secret: cold brew coffee is super-duper easy to make, dirt cheap, right in your own home.

Here’s what to do:

  1. Buy some coffee beans. Go medium or dark roast, and ideally not crap.
  2. Grind them coarsely; fine and medium-fine grinds will end up cloudy and silty.
  3. Find a big pitcher, and add the grounds and water in a 1:5 ratio. I.e, 1 cup grinds, 5 cups water.
  4. Leave the pitcher somewhere out of the sun for 12-24 hours (any less and the beans won’t properly extract), stirring occasionally during the first few hours.
  5. Strain out the grinds. You can use a French press (pour in the mix, affix and press down the top, pour out the cold brew), pass it through cheesecloth (or, if you’re ghetto-fab / in a pinch, a paper towel), or (for the clearest coffee) put it through a coffee filter lining a funnel or the swung-out body of a drip coffee machine. Really, you should probably just get a Chemex, as it’s perfect for this, and makes truly excellent hot coffee, too.

Voila. You now have cold brew concentrate that will last a couple of weeks in your refrigerator (or, thanks to Jess, about 48 hours in mine).

To serve, fill a glass completely with ice (as the concentrate is strong and needs the ice to properly dilute), pour in the coffee (and milk, if you’re weak), and enjoy.

For bonus points, collect the money saved over time, and fill a swimming pool with it a la Scrooge McDuck; the cold brew makes a perfect poolside drink.

Master

A professor, a CEO, and a janitor are walking through a forest, when they come across a magic fairy.

“I will give each of you what you most desire,” says the fairy. “But first, you must do someone else’s job successfully for a day.”

“I’ll be an elementary school teacher,” says the professor immediately. “How hard can it be to teach six-year-olds to read?”

With a poof, the professor is teleported into a classroom.

A half hour later, the desks are overturned, the kids are screaming, crayon is scrawled all over the walls, and Jimmy, the class’s pet guinea pig, lays dead in a pool of his own blood.

“Get me out of here!” says the professor. And with another poof, he’s back in the forest.

Convinced he can do better, the CEO asks to become a waiter.

“I can certainly do that,” he says. “You just carry food back and forth. No problem.”

And with another poof, the CEO is in a bustling restaurant during the lunch rush.

“I said dressing on the side!” a woman is soon yelling at him. He drops four balanced plates while bussing a table. Three tables stiff him on the tip.

“This is ridiculous,” says the CEO. “I want out.”

And with a poof, he’s back in the forest, too.

The janitor strokes his chin in contemplation.

“I think,” he says, “I’d like to be an artist.”

“An artist?” she asks.

“Exactly,” he replies.

And so the janitor is teleported into an art studio. Surveying the supplies, he begins to smash brushes and palettes into pieces, then slowly glues dozens of those pieces onto a large, white canvas.

A collector walking through the studio sees the work and gasps.

“What a brilliant, evocative deconstruction of the creative process!” he exclaims.

With a snap, he summons his assistant, who offers the janitor twelve million dollars for the work.

And with a poof, the janitor is transported back to the forest, alongside the amazed fairy, professor, and CEO.

“How did you manage to fare so well as an artist?” they ask.

“Oh, it’s simple,” explains the janitor. “I have a master’s degree in art.”

June 30, 2017

Download This

On Tuesday, I was waiting for the subway with Jess and my parents, when an MTA employee announced that uptown train service had been temporarily halted due to a subway incident further uptown.

I pulled out my iPhone, and opened the Citizen app, which provides a real-time stream of incidents reported to 911, as well as a geotagged map of those locations, and live-streamed video from any Citizen user who happens to shoot a given incident.

Citizen told me that a subway had derailed near 125th St. minutes earlier, injuring more than 30 people, and strewing split open train cars across a number of tracks. I sent vibes of health and quick recovery to the injured passengers uptown, and suggested we head to the street to grab a cab; subway service wasn’t going to resume any time soon.

My father asked about the app, which reminded me that I frequently use a bunch of small, helpful, lesser-known iPhone apps. While a number of them are pretty specific, they’re each great if they match your specific use case. So, on the chance that you’d benefit from any you haven’t already discovered, here a handful of note:

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Apnea Trainer (iPhone): If you swim, SCUBA dive, or free dive, Apnea Trainer provides a great breathing exercise that, when done for 5-10 minutes three times a week, hugely increases breath-hold time. Also great for decreasing symptoms of mild to moderate asthma.

Citizen (iPhone & Android): As described, real-time info on emergencies nearby. Currently NYC only.

Coach’s Eye (iPhone & Android): Essential if you coach athletes of any stripe. Allows you to record video of a movement, then play it back in slow-mo / mark it up with highlights and lines. Huge for providing specific visual feedback.

Dark Sky (iPhone & Android): Scary-accurate hyper-local real-time weather forecasts. If you’re considering, say, whether it’s a good time to walk your two small dogs, Dark Sky can tell you it’s about to start raining heavily in 13 minutes, then stopping about 25 minutes later. Useful (though slightly creepy) to get ‘it’s about to start drizzling’ notifications, then hear rain outside the window thirty seconds later.

Editorial (iPhone): A full-featured text editor with Markdown support and powerful automation. If you live in BBEdit, TextMate, Sublime, etc. on the Mac, this is by far the closest you’ll find on mobile. Paired with Dropbox, it’s great for doing work on the fly.

Fantastical (iPhone): The best calendar app on the iPhone, and the Mac, as you can quickly and easily enter events using natural language.

Feedly (iPhone & Android): Given that I write a blog, it probably shouldn’t be surprising that I read them, too. Feedly is by far my favorite RSS reader, both through their website and their excellent app.

Foursquare (iPhone & Android): Less widely used than I’d expect, but my go-to if I want to both find a coffee shop or shoe store nearby, and find out if it’s any good. If you’re using something like Yelp, or just Apple or Google maps, default to this instead.

HRV4Training (iPhone & Android): Using the camera on your phone, this tracks trends in heart-rate variability, one of the best ways to prevent overtraining. As I’ve written about before, if you work out hard, you should definitely be using this.

The Infatuation (iPhone & Android): While I use Foursquare more generally, if I want to find a good restaurant, The Infatuation is my go-to. Based on at least dozens of field tests, I can say their recommendations and ratings have been 100% correct thus far.

Overcast (iPhone): If you listen to podcasts (and you should), this is an order of magnitude better than Apple’s built-in client in terms of discovery, playlist management, and playback.

Pocket (iPhone & Android): Not hugely obscure, but still not as broadly used as it deserves to be. If you find a longer article / video, use the browser plug-in to save it to Pocket, then read it offline from your phone when you’re in a subway, waiting at the doctor’s office, etc. Exponentially increases the amount of content I can consume.

Soulver (iPhone): Super-intuitive hybrid of a calculator and a spreadsheet. When I need to crunch numbers or brainstorm financial projections on the fly – for business or daily life – Soulver has completely replaced the built-in calculator app.

Todoist (iPhone & Android): Still my daily to-do list (though I use text files for longer-range planning, outlining, tracking, etc., I have a slew of recurring tasks, which are much easier managed when automated). Lightning-fast sync, powerful boolean search / filters, etc.

Ulysses (iPhone): Where I write all blog posts and long-form content on the Mac; I mostly use the mobile app for tweaks and edits. A powerful yet minimalist pair.

Zero (iPhone): The science behind intermittent fasting is pretty impressive, and it’s even more effective if your eating window ends as close to sundown as possible. Zero tracks the length of your daily fasts (I shoot for 16 hours), as well as the number of minutes and hours you eat post-sundown. A great way to cut fat, get healthier, etc.

And, finally, since this is already more than long enough, a bunch of other non-Apple apps I use – most well-known, a few less so. As I’m too lazy to link them all: 1Password, Amazon, Audible, Candy Crush, Caviar, Dropbox, Genius, Gmail, Google Maps, GuitarTuna, Instagram, Kindle, MiniBar, Netflix, Open Table, PayPal, Resy, Runkeeper, Seamless, Seconds Pro, Signal, SimpleNote, Tripit, Twitter, Uber, UberEATS, Washington Post, Zipcar. If you don’t know any of them, worth the Google.

June 29, 2017

Completely Foreign

One of the core ideas underlying Composite is that health is about habits – the small things you do day in and day out that add up over time to meaningful change.

To that end, we’ve been developing an algorithmic approach to acquiring new healthy habits. First, we assess clients’ current habits, in areas like movement, nutrition, and lifestyle. Then we automatically build a prioritized stack of new habits that would be maximally beneficial, introducing them a couple at a time. By monitoring compliance through an app (and egging clients on with accountability to a human coach), we can use learning techniques like spaced repetition to determine when we should be adding new habits, and when we should be doubling down on practicing ones already introduced.

As a result, I’ve spent a ridiculous amount of time looking at other algorithmically-based learning systems. Which is what led me to discover language learning site Lingvist.

Lingvist is the brainchild of a physicist at CERN, who had been living in the French part of Switzerland for years, but had never learned the language. He built the prototype system for himself, studied with it for a few months, and developed enough fluency to test out of the equivalent of a high-school French class.

The approach weighs the importance of words by real-world statistical occurrence, so you spend most of your time focused on the parts of the language you’ll actually use. (I discovered the value of this the hard way, when living in Japan as a high school exchange student; though I could say ‘kindly give me the fish of your brother Yamada,’ I couldn’t say ‘hey guys, I think we just ran out of toilet paper.’)

And it uses an adaptive algorithm: based on your real-time performance, Lingvist alters the pace of learning new words, and the frequency of re-testing old words, even within a single practice session.

I’ve spent some time playing with both the French and Spanish versions, and can confidently say Lingvist is très bon / muy bueno. Try it out yourself.

June 28, 2017