You look down and see a yellow pencil lying on your desk.
Your eyes, and then your brain, are collecting all sorts of information about the pencil: its size, color, shape, distance, and more.
But, how exactly does this happen?
The ancient Greeks were the first to think more or less scientifically about what light is and how vision works.
Some Greek philosophers, including Plato and Pythagoras, thought that light originated in our eyes and that vision happened when little, invisible probes were sent to gather information about far-away objects.
It took over a thousand years before the Arab scientist, Alhazen, figured out that the old, Greek theory of light couldn't be right.
In Alhazen's picture, your eyes don't send out invisible, intelligence-gathering probes, they simply collect the light that falls into them.
Alhazen's theory accounts for a fact that the Greek's couldn't easily explain: why it gets dark sometimes.
The idea is that very few objects actually emit their own light.
The special, light-emitting objects, like the sun or a lightbulb, are known as sources of light.
Most of the things we see, like that pencil on your desk, are simply reflecting light from a source rather than producing their own.
So, when you look at your pencil, the light that hits your eye actually originated at the sun and has traveled millions of miles across empty space before bouncing off the pencil and into your eye, which is pretty cool when you think about it.
But, what exactly is the stuff that is emitted from the sun and how do we see it?
Is it a particle, like atoms, or is it a wave, like ripples on the surface of a pond?
Scientists in the modern era would spend a couple of hundred years figuring out the answer to this question.
Isaac Newton was one of the earliest.
Newton believed that light is made up of tiny, atom-like particles, which he called corpuscles.
Using this assumption, he was able to explain some properties of light.
For example, refraction, which is how a beam of light appears to bend as it passes from air into water.
But, in science, even geniuses sometimes get things wrong.
In the 19th century, long after Newton died, scientists did a series of experiments that clearly showed that light can't be made up of tiny, atom-like particles.
For one thing, two beams of light that cross paths don't interact with each gwhite@example.com.
If light were made of tiny, solid balls, then you would expect that some of the particles from Beam A would crash into some of the particles from Beam B.
If that happened, the two particles involved in the collision would bounce off in random directions.
But, that doesn't happen.
The beams of light pass right through each other as you can check for yourself with two laser pointers and some chalk dust.
For another thing, light makes interference patterns.
Interference patterns are the complicated undulations that happen when two wave patterns occupy the same space.
They can be seen when two objects disturb the surface of a still pond, and also when two point-like sources of light are placed near each other.
Only waves make interference patterns, particles don't.
And, as a bonus, understanding that light acts like a wave leads naturally to an explanation of what color is and why that pencil looks yellow.
So, it's settled then, light is a wave, right?
Not so fast!
In the 20th century, scientists did experiments that appear to show light acting like a particle.
For instance, when you shine light on a metal, the light transfers its energy to the atoms in the metal in discrete packets called quanta.
But, we can't just forget about properties like interference, either.
So these quanta of light aren't at all like the tiny, hard spheres Newton imagined.
This result, that light sometimes behaves like a particle and sometimes behaves like a wave, led to a revolutionary new physics theory called quantum mechanics.
So, after all that, let's go back to the question, "What is light?"
Well, light isn't really like anything we're used to dealing with in our everyday lives.
Sometimes it behaves like a particle and other times it behaves like a wave, but it isn't exactly like either.
In this rather long sort of marathon presentation, I've tried to break it up into three parts: the first being a whole lot of examples on how it can be a little bit more pleasurable to deal with a computer and really address the qualities of the human interface.
And these will be some simple design qualities and they will also be some qualities of, if you will, the intelligence of interaction.
Then the second part will really just be examples of new technologies -- new media falling very much into that mold.
Again, I will go through them as fast as possible.
And then the last one will be some examples I've been able to collect, which I think illustrate this at least as best I can, in the world of entertainment.
People have this belief -- and I share most of it -- that we will be using the TV screens or their equivalents for electronic books of the future.
But then you think, "My God!
What a terrible image you get when you look at still pictures on TV."
Well, it doesn't have to be terrible.
And that is a slide taken from a TV set and it was pre-processed to be very sympathetic to the TV medium, and it absolutely looks beautiful.
Well, what's happened?
How did people get into this mess?
Where you are now, all of a sudden, sitting in front of personal computers and video text -- teletext systems, and somewhat horrified by what you see on the screen?
Well, you have to remember that TV was designed to be looked at eight times the distance of the diagonal.
So you get a 13-inch, 19-inch, whatever, TV, and then you should multiply that by eight and that's the distance you should sit away from the TV set.
Now we've put people 18 inches in front of a TV, and all the artifacts that none of the original designers expected to be seen, all of a sudden, are staring you in the face: the shadow mask, the scan lines, all of that.
And they can be treated very easily; there are actually ways of getting rid of them, there are actually ways of just making absolutely beautiful pictures.
I'm talking here a little bit about display technologies.
Let me talk about how you might input information.
And my favorite example is always fingers.
I'm very interested in touch-sensitive displays.
High-tech, high-touch.
Isn't that what some of you said?
It's certainly a very important medium for input, and a lot of people think that fingers are a very low-resolution sort of stylus for inputting to a display.
In fact, they're not: it's really a very, very high-resolution input medium -- you have to just do it twice, you have to touch the screen and then rotate your finger slightly -- and you can move a cursor with great accuracy.
And so when you see on the market these systems that have just a few light emitting diodes on the side and are very low resolution, it's nice that they exist because it still is better than nothing.
But it, in some sense, misses the point: namely, that fingers are a very, very high-resolution input medium.
Now, what are some of the other advantages?
Well, the one advantage is that you don't have to pick them up, and people don't realize how important that is -- not having to pick up your fingers to use them.
(Laughter) When you think for a second of the mouse on Macintosh -- and I will not criticize the mouse too much -- when you're typing -- what you have -- you want to now put something -- first of all, you've got to find the mouse.
You have to probably stop.
Maybe not come to a grinding halt, but you've got to sort of find that mouse.
Then you find the mouse, and you're going to have to wiggle it a little bit to see where the cursor is on the screen.
And then when you finally see where it is, then you've got to move it to get the cursor over there, and then -- "Bang" -- you've got to hit a button or do whatever.
That's four separate steps versus typing and then touching and typing and just doing it all in one motion -- or one-and-a-half, depending on how you want to count.
Again, what I'm trying to do is just illustrate the kinds of problems that I think face the designers of new computer systems and entertainment systems and educational systems from the perspective of the quality of that interface.
And another advantage, of course, of using fingers is you have 10 of them.
And we have never known how to do this technically, so this slide is a fake slide.
We never succeeded in using ten fingers, but there are certain things you can do, obviously, with more than one-finger input, which is rather fascinating.
What we did stumble across was something ...
Again, which is typical of the computer field, is when you have a bug that you can't get rid of you turn it into a feature.
And maybe ...
(Laughter) maybe a mouse is a new kind of bug.
But the bug in our case was in touch-sensitive displays: we wanted to be able to draw -- you know, rub your finger across the screen to input continuous points -- and there was just too much friction created between your finger and the glass -- if glass was the substrate, which it usually is.
So we found that that actually was a feature in the sense you could build a pressure-sensitive display.
And when you touch it with your finger, you can actually, then, introduce all the forces on the face of that screen, and that actually has a certain amount of value.
Let me see if I can load another disc and show you, quickly, an example.
Now, imagine a screen, which is not only touch-sensitive now, it's pressure-sensitive.
And it's pressure-sensitive to the forces both in the plane of the screen -- X, Y, and Z at least in one direction; we couldn't figure out how to come in the other direction.
But let me get rid of the slide, and let's see if this comes on.
OK.
So there is the pressure-sensitive display in operation.
The person's just, if you will, pushing on the screen to make a curve.
But this is the interesting part.
I want to stop it for a second because the movie is very badly made.
And the particular display was built about six years ago, and when we moved from one room to another room, a rather large person sat on it and it got destroyed.
So all we have is this record.
(Laughter) But imagine that screen having lots of objects on it and the person has touched an object -- one of N -- like he did there, and then pushed on it.
Now, imagine a program where some of those objects are physically heavy and some are light: one is an anvil on a fuzzy rug and the other one is a ping-pong ball on a sheet of glass.
And when you touch it, you have to really push very hard to move that anvil across the screen, and yet you touch the ping-pong ball very lightly and it just scoots across the screen.
And what you can do -- oops, I didn't mean to do that -- what you can do is actually feed back to the user the feeling of the physical properties.
So again, they don't have to be weight; they could be a general trying to move troops, and he's got to move an aircraft carrier versus a little boat.
In fact, they funded it for that very reason.
(Laughter) The whole notion, then, is one that at the interface there are physical properties in that transducer -- in this case it's pressure and touches -- that allow you to present things to the user that you could never present before.
So it's not simply looking at the quality or, if you will, the luxury of that interface, but it's actually looking at the idea of presenting things that previously couldn't be presented before.
I want to move on to another example, which is one of a different sort, where we're trying to use computer and video disc technology now to come up with a new kind of book.
Here, the idea is that you're going to take this book, if you will, and it's going to come alive.
You're going to sort of breathe life into it.
We are so used to doing monologues.
Filmmakers, for example, are the experts in monologue making: you make a film and it has a well-formed beginning, middle and end, and in some sense the art of it is that.
And you then say, "There's an opportunity for making conversational movies."
Well, what does that mean?
And it sort of nibbles at the core of the whole profession and all the assumptions of that medium.
So, book writing is the same thing.
What I'll show you very quickly is a new kind of book where it is mixed now with ... all sorts of things live in there, but you have to keep a few things in mind.
One is that this book knows about itself.
Each frame of the movie has information about itself.
So it knows, or at least there is computer-readable information in the medium itself.
It's just not a static movie frame.
That's one thing.
The other is that you have to realize that it is a random access medium, and you can, in fact, branch and expand and elaborate and shrink.
And here -- again, my favorite example -- is the cookbook, the "Larousse Gastronomique."
And I think I use the example all too often, but it's a great one because there is a classic ending in that little encyclopedia-style cookbook that tells you how to do something like penguin, and you get to the end of the recipe and it says, "Cook until done."
Now, that would be, if you will, the top green track, which doesn't mean too much.
But you might have to elaborate for me or for somebody who isn't an expert, and say, "Cook at 380 degrees for 45 minutes."
And then for a real beginner, you would go down even further and elaborate more -- say, "Open the oven, preheat, wait for the light to go out, open the door, don't leave it open too long, put the penguin in and shut the door ..."
(Laughter) whatever.
And that's a much more elaborate one than you dribble back.
That's one kind of use of random access.
And the other is where you want to explain the same thing in different ways.
If you're in a classroom situation and somebody asks a question, the last thing you do is repeat what you just said.
You try and think of a different way of saying the same thing, or if you know the particular student and that student's cognitive style, then you might say it in a way that you think would have a good impedance match with that student.
There are all sorts of techniques you will use -- and again, this is a different kind of branching.
So, what I will show you is ... it's a rather boring book, but I'm afraid sometimes you have to do boring books because your sponsors aren't necessarily interested in fiction and entertainment.
And this is a book on how to repair a transmission.
Now, I don't even know what vintage the transmission is, but let me just show you very quickly some of it, and we'll move on.
(Video) Narrator: And continue to get descriptions for each of these chapters.
Nicholas Negroponte: Now, this is his table of contents.
Just a picture of the transmission, and as you rub your finger across the transmission it highlights the various parts.
Narrator: When I find a chapter that I want to see, I just touch the text and the system will format pages for me to read.
The words or phrases that are lit up in red are glossary words, so I can get a different definition by just touching the word, and the definition appears, superimposed over the illustration.
NN: This is about the oil pan, or the oil filter and all that.
This is relatively important because it sets the page ...
Narrator: This is another example of a page with glossary words highlighted in red.
I can get a definition of these words just by touching them, and the definition will appear in the illustration corner.
I can get back to the illustration, but in this case it's not a single frame, but it's actually a movie of someone coming into the frame and doing the repair that's described in the text.
The two-headed slider is a speed control that allows me to watch the movie at various speeds, in forward or reverse.
And the movie is displayed as a full frame movie.
I can go back to the beginning ... and play the movie at full speed.
Here's another step-by-step procedure, only in this case -- NN: Okay, this movie is ...
Everybody's heard of sound-sync movies -- this is text-sync movies, so as the movie plays, the text gets highlighted.
We highlight the text as we go through the movie.
Repairman: ...
Not too far out.
Front poles, preferably.
Don't loosen them too far.
If you loosen them too far, you'll have a big mess.
NN: I suspect that some of you might not even understand that language.
(Laughter) OK.
I'm at the third and last part of this, which I said I would make an attempt to at least give you some examples that may be more directly related to the world of entertainment.
And of course, good education has got to be good entertainment, so my first example will be drawn from a very recent experiment that we've been doing -- in this case, in Senegal -- where we have tried to use personal computers as a pedagogical medium.
But not as teaching machines at all; the whole notion is to use this as an instrument where there is a complete reversal of roles -- the child is, if you will, the teacher and the machine is the student -- and the art of computer programming is a vehicle that sort of approximates thinking about thinking.
But teaching kids programming per se is utterly irrelevant.
And there are just a few slides I want to go through, but there's a story I'd like to tell.
And that was when, before we did this in any developing countries -- we're doing it, in fact, in three developing countries right now: Pakistan, Colombia and Senegal -- we did it in some pretty rough areas of New York City.
And one child, whose name I've forgotten, was about seven or eight years old, absolutely considered mentally handicapped -- couldn't read, didn't even make it in the lowest section of the school's classes -- and was pretty much not in school, though physically there.
But did hang around the, quote, "computer room," where there were quite a few computers, and learned this particular language called Logo -- and learned it with great ease and found it a lot of fun, it was very interesting.
And one day, by chance, some visitors from the NIE came by in their double-breasted suits looking at this setup, and none of the children who were normally there, except for this one child, were there.
He was, and he said, "Let me show you how this works," and they got an absolutely ingenuous, wonderful description of Logo.
And the child was just zipping right through it, showing them all sorts of things until they asked him how to do something which he couldn't explain and so he flipped through the manual, found the explanation and typed the command and got it to do what they asked.
They were delighted, and by the time it was time to go see the principal, whom they'd actually come to see -- not the computer room -- they went upstairs and they said, "This is absolutely remarkable!
That child was very articulate and showed us and even dealt with the things he couldn't do automatically with that manual.
It was just absolutely fantastic."
The principal said, "There's a dreadful mistake, because that child can't read.
And you obviously have been hoodwinked or you've talked about somebody else."
And they all got up and they all went downstairs and the child was still there.
And they did something very intelligent: they asked the child, "Can you read?"
And the child said, "No, I can't."
And then they said, "But wait a minute.
You just looked through that manual and you found ... " and he said, "Oh, but that's not reading."
And so they said, "Well, what's reading then?"
He says, "Well, reading is this junk they give me in little books to read.
It's absolutely irrelevant, (Laughter) and I get nothing for it.
But here, with a little bit of effort I get a lot of return."
And it really meant something to the child.
The child read beautifully, it turned out, and was really very competent.
So it actually meant something.
And that story has many other anecdotes that are similar, but wow.
The key to the future of computers in education is right there, and it is: when does it mean something to a child?
There is a myth, and it truly is a myth: we believe -- and I'm sure a lot of you believe in this room -- that it is harder to read and write than it is to learn how to speak.
And it's not, but we think speech -- "My God, little children pick it up somehow, and by the age of two they're doing a mediocre job, and by three and four they're speaking reasonably well.
And yet you've got to go to school to learn how to read, and you have to sit in a classroom and somebody has to teach you.
Hence, it must be harder."
Well, it's not harder.
What the truth is is that speaking has great value to a child; the child can get a great deal by talking to you.
Reading and writing is utterly useless.
There is no reason for a child to read and write except blind faith, and that it's going to help you.
(Laughter) So what happens is you go to school and people say, "Just believe me, you're going to like it.
You're going to like reading," and just read and read.
On the other hand, you give a kid -- a three-year-old kid -- a computer and they type a little command and -- Poof! -- something happens.
And all of a sudden ...
You may not call that reading and writing, but a certain bit of typing and reading stuff on the screen has a huge payoff, and it's a lot of fun.
And in fact, it's a powerful educational instrument.
Well, in Senegal we found that this was the traditional classroom: 120 kids -- three per desk -- one teacher, a little bit of chalk.
This student was one of our first students, and it's the girl on the left leaning with her chalkboard, and she came ... within two days -- I want to show you the program she wrote, and remember her hairstyle.
And that is the program she made.
That's what meant something to her, is doing the hair pattern, and actually did it within two days -- an hour each day -- and found it was, to her, absolutely the most meaningful piece ...
But rooted in that, little did she know how much knowledge she was acquiring about geometry and just math and logic and all the rest.
And again, I could talk for three hours about this subject.
I will come to my last example and then quit.
And my last example -- as some of my former colleagues, whom I see in the room, can imagine what it will be.
Yes, it is.
It's our work -- that was a while ago, and it still is my favorite project -- of teleconferencing.
And the reason it remains a favorite project is that we were asked to do a teleconferencing system where you had the following situation: you had five people at five different sites -- they were known people -- and you had to have these people in teleconference, such that each one was utterly convinced that the other four were physically present.
Now, that is sufficiently zany that we would, obviously, jump to the bait, and we did.
And the fact that we knew the people -- we had to take a page out of the history of Walt Disney -- we actually went so far as to build CRTs in the shapes of the people's faces.
So if I wanted to call my friend Peter Sprague on the phone, my secretary would get his head out and bring it and set it on the desk, (Laughter) and that would be the TV used for the occasion.
And it's uncanny: there's no way I can explain to you the amount of eye contact you get with that physical face projected on a 3D CRT of that sort.
The next thing that we had to do is to persuade them that there needed to be spatial correspondence, which is straightforward, but again, it's something that didn't fall naturally out of a telecommunications or computing style of thinking; it was a very, if you will, architectural or spatial concept.
And that was to recognize that when you sit around the table, the actual location of the people becomes rather important.
And when somebody gets up, in fact, to go answer a phone or use a bathroom or something, the empty seat becomes, if you will, that person.
And you point frequently to the empty seat and you say, "He or she wouldn't agree," and the empty chair is that person and the spatiality is crucial.
So we said, "Well, these will be on round tables and the order around the table had to be the same, so that at my site, I would be, if you will, real and then at each other's site you'd have these plastic heads.
And the plastic heads, sometimes you want to project them.
And there are a number of schemes, which I don't want to dwell on, but this is the one that we finally used where we projected onto rear screen material that was molded in the face -- literally in the face of the person.
And I'll show you one more slide, where this is actually made from something called a solid photograph and is the screen.
Now, we track, on the person's head, the head motions -- so we transmit with a video the head positions -- and so this head moves in about two axes.
So if I, all of a sudden, turn to the person to my left and start talking to that person, then at the person to my right's site, he'll see these two plastic heads talking to each other.
And then if that person interrupts, then those two heads may turn.
And it really is reconstructing, quite accurately, teleconferencing.
I'm going to be talking to you about how we can tap a really underutilized resource in health care, which is the patient, or, as I like to use the scientific term, people.
Because we are all patients, we are all people.
Even doctors are patients at some point.
So I want to talk about that as an opportunity that we really have failed to engage with very well in this country and, in fact, worldwide.
If you want to get at the big part -- I mean from a public health level, where my training is -- you're looking at behavioral issues.
You're looking at things where people are actually given information, and they're not following through with it.
It's a problem that manifests itself in diabetes, obesity, many forms of heart disease, even some forms of cancer -- when you think of smoking.
Those are all behaviors where people know what they're supposed to do.
They know what they're supposed to be doing, but they're not doing it.
Now behavior change is something that is a long-standing problem in medicine.
It goes all the way back to Aristotle.
And doctors hate it, right?
I mean, they complain about it all the time.
We talk about it in terms of engagement, or non-compliance.
When people don't take their pills, when people don't follow doctors' orders -- these are behavior problems.
But for as much as clinical medicine agonizes over behavior change, there's not a lot of work done in terms of trying to fix that problem.
So the crux of it comes down to this notion of decision-making -- giving information to people in a form that doesn't just educate them or inform them, but actually leads them to make better decisions, better choices in their lives.
One part of medicine, though, has faced the problem of behavior change pretty well, and that's dentistry.
Dentistry might seem -- and I think it is -- many dentists would have to acknowledge it's somewhat of a mundane backwater of medicine.
Not a lot of cool, sexy stuff happening in dentistry.
But they have really taken this problem of behavior change and solved it.
It's the one great preventive health success we have in our health care system.
People brush and floss their teeth.
They don't do it as much as they should, but they do it.
So I'm going to talk about one experiment that a few dentists in Connecticut cooked up about 30 years ago.
So this is an old experiment, but it's a really good one, because it was very simple, so it's an easy story to tell.
So these Connecticut dentists decided that they wanted to get people to brush their teeth and floss their teeth more often, and they were going to use one variable: they wanted to scare them.
They wanted to tell them how bad it would be if they didn't brush and floss their teeth.
They had a big patient population.
They divided them up into two groups.
They had a low-fear population, where they basically gave them a 13-minute presentation, all based in science, but told them that, if you didn't brush and floss your teeth, you could get gum disease.
If you get gum disease, you will lose your teeth, but you'll get dentures, and it won't be that bad.
So that was the low-fear group.
The high-fear group, they laid it on really thick.
They showed bloody gums.
They showed puss oozing out from between their teeth.
They told them that their teeth were going to fall out.
They said that they could have infections that would spread from their jaws to other parts of their bodies, and ultimately, yes, they would lose their teeth.
They would get dentures, and if you got dentures, you weren't going to be able to eat corn-on-the-cob, you weren't going to be able to eat apples, you weren't going to be able to eat steak.
You'll eat mush for the rest of your life.
So go brush and floss your teeth.
That was the message.
That was the experiment.
Now they measured one other variable.
They wanted to capture one other variable, which was the patients' sense of efficacy.
This was the notion of whether the patients felt that they actually would go ahead and brush and floss their teeth.
So they asked them at the beginning, "Do you think you'll actually be able to stick with this program?"
And the people who said, "Yeah, yeah.
I'm pretty good about that," they were characterized as high efficacy, and the people who said, "Eh, I never get around to brushing and flossing as much as I should," they were characterized as low efficacy.
So the upshot was this.
The upshot of this experiment was that fear was not really a primary driver of the gwhite@example.com.
The people who brushed and flossed their teeth were not necessarily the people who were really scared about what would happen -- it's the people who simply felt that they had the capacity to change their behavior.
So fear showed up as not really the driver.
It was the sense of efficacy.
So I want to isolate this, because it was a great observation -- 30 years ago, right, 30 years ago -- and it's one that's laid fallow in research.
It was a notion that really came out of Albert Bandura's work, who studied whether people could get a sense of empowerment.
The notion of efficacy basically boils down to one -- that if somebody believes that they have the capacity to change their behavior.
In health care terms, you could characterize this as whether or not somebody feels that they see a path towards better health, that they can actually see their way towards getting better health, and that's a very important notion.
It's an amazing notion.
We don't really know how to manipulate it, though, that well.
Except, maybe we do.
So fear doesn't work, right?
Fear doesn't work.
And this is a great example of how we haven't learned that gwhite@example.com.
This is a campaign from the American Diabetes Association.
This is still the way we're communicating messages about health.
I mean, I showed my three-year-old this slide last night, and he's like, "Papa, why is an ambulance in these people's homes?"
And I had to explain, "They're trying to scare people."
And I don't know if it works.
Now here's what does work: personalized information works.
Again, Bandura recognized this years ago, decades ago.
When you give people specific information about their health, where they stand, and where they want to get to, where they might get to, that path, that notion of a path -- that tends to work for behavior change.
So let me just spool it out a little bit.
So you start with personalized data, personalized information that comes from an individual, and then you need to connect it to their lives.
You need to connect it to their lives, hopefully not in a fear-based way, but one that they understand.
Okay, I know where I sit.
I know where I'm situated.
And that doesn't just work for me in terms of abstract numbers -- this overload of health information that we're inundated with.
But it actually hits home.
It's not just hitting us in our heads; it's hitting us in our hearts.
There's an emotional connection to information because it's from us.
That information then needs to be connected to choices, needs to be connected to a range of options, directions that we might go to -- trade-offs, benefits.
Finally, we need to be presented with a clear point of action.
We need to connect the information always with the action, and then that action feeds back into different information, and it creates, of course, a feedback loop.
Now this is a very well-observed and well-established notion for behavior change.
But the problem is that things -- in the upper-right corner there -- personalized data, it's been pretty hard to come by.
It's a difficult and expensive commodity, until now.
So I'm going to give you an example, a very simple example of how this works.
So we've all seen these.
These are the "your speed limit" signs.
You've seen them all around, especially these days as radars are cheaper.
And here's how they work in the feedback loop.
So you start with the personalized data where the speed limit on the road that you are at that point is 25, and, of course, you're going faster than that.
We always are.
We're always going above the speed limit.
The choice in this case is pretty simple.
We either keep going fast, or we slow down.
We should probably slow down, and that point of action is probably now.
We should take our foot off the pedal right now, and generally we do.
These things are shown to be pretty effective in terms of getting people to slow down.
They reduce speeds by about five to 10 percent.
They last for about five miles, in which case we put our foot back on the pedal.
But it works, and it even has some health repercussions.
Your blood pressure might drop a little bit.
Maybe there's fewer accidents, so there's public health benefits.
But by and large, this is a feedback loop that's so nifty and too rare.
Because in health care, most health care, the data is very removed from the action.
It's very difficult to line things up so neatly.
But we have an opportunity.
So I want to talk about, I want to shift now to think about how we deliver health information in this country, how we actually get information.
This is a pharmaceutical ad.
Actually, it's a spoof.
It's not a real pharmaceutical ad.
Nobody's had the brilliant idea of calling their drug Havidol quite yet.
But it looks completely right.
So it's exactly the way we get health information and pharmaceutical information, and it just sounds perfect.
And then we turn the page of the magazine, and we see this -- now this is the page the FDA requires pharmaceutical companies to put into their ads, or to follow their ads, and to me, this is one of the most cynical exercises in medicine.
Because we know.
Who among us would actually say that people read this?
And who among us would actually say that people who do try to read this actually get anything out of it?
This is a bankrupt effort at communicating health information.
There is no good faith in this.
So this is a different approach.
This is an approach that has been developed by a couple researchers at Dartmouth Medical School, Lisa Schwartz and Steven Woloshin.
And they created this thing called the "drug facts box."
They took inspiration from, of all things, Cap'n Crunch.
They went to the nutritional information box and saw that what works for cereal, works for our food, actually helps people understand what's in their food.
God forbid we should use that same standard that we make Cap'n Crunch live by and bring it to drug companies.
So let me just walk through this quickly.
It says very clearly what the drug is for, specifically who it is good for, so you can start to personalize your understanding of whether the information is relevant to you or whether the drug is relevant to you.
You can understand exactly what the benefits are.
It isn't this kind of vague promise that it's going to work no matter what, but you get the statistics for how effective it is.
And finally, you understand what those choices are.
You can start to unpack the choices involved because of the side effects.
Every time you take a drug, you're walking into a possible side effect.
So it spells those out in very clean terms, and that works.
So I love this.
I love that drug facts box.
And so I was thinking about, what's an opportunity that I could have to help people understand information?
What's another latent body of information that's out there that people are really not putting to use?
And so I came up with this: lab test results.
Blood test results are this great source of information.
They're packed with information.
They're just not for us.
They're not for people.
They're not for patients.
They go right to doctors.
And God forbid -- I think many doctors, if you really asked them, they don't really understand all this stuff either.
This is the worst presented information.
You ask Tufte, and he would say, "Yes, this is the absolute worst presentation of information possible."
What we did at Wired was we went, and I got our graphic design department to re-imagine these lab reports.
So that's what I want to walk you through.
So this is the general blood work before, and this is the after, this is what we came up with.
The after takes what was four pages -- that previous slide was actually the first of four pages of data that's just the general blood work.
It goes on and on and on, all these values, all these numbers you don't know.
This is our one-page summary.
We use the notion of color.
It's an amazing notion that color could be used.
So on the top-level you have your overall results, the things that might jump out at you from the fine print.
Then you can drill down and understand how actually we put your level in context, and we use color to illustrate exactly where your value falls.
In this case, this patient is slightly at risk of diabetes because of their glucose level.
Likewise, you can go over your lipids and, again, understand what your overall cholesterol level is and then break down into the HDL and the LDL if you so choose.
But again, always using color and personalized proximity to that information.
All those other values, all those pages and pages of values that are full of nothing, we summarize.
We tell you that you're okay, you're normal.
But you don't have to wade through it.
You don't have to go through the junk.
And then we do two other very important things that kind of help fill in this feedback loop: we help people understand in a little more detail what these values are and what they might indicate.
And then we go a further step -- we tell them what they can do.
We give them some insight into what choices they can make, what actions they can take.
So that's our general blood work test.
Then we went to CRP test.
In this case, it's a sin of omission.
They have this huge amount of space, and they don't use it for anything, so we do.
Now the CRP test is often done following a cholesterol test, or in conjunction with a cholesterol test.
So we take the bold step of putting the cholesterol information on the same page, which is the way the doctor is going to evaluate it.
So we thought the patient might actually want to know the context as well.
It's a protein that shows up when your blood vessels might be inflamed, which might be a risk for heart disease.
What you're actually measuring is spelled out in clean language.
Then we use the information that's already in the lab report.
We use the person's age and their gender to start to fill in the personalized risks.
So we start to use the data we have to run a very simple calculation that's on all sorts of online calculators to get a sense of what the actual risk is.
The last one I'll show you is a PSA test.
Here's the before, and here's the after.
Now a lot of our effort on this one -- as many of you probably know, a PSA test is a very controversial test.
It's used to test for prostate cancer, but there are all sorts of reasons why your prostate might be enlarged.
And so we spent a good deal of our time indicating that.
We again personalized the risks.
So this patient is in their 50s, so we can actually give them a very precise estimate of what their risk for prostate cancer is.
In this case it's about 25 percent, based on that.
And then again, the follow-up actions.
So our cost for this was less than 10,000 dollars, all right.
That's what Wired magazine spent on this.
Why is Wired magazine doing this?
(Laughter) Quest Diagnostics and LabCorp, the two largest lab testing companies -- last year, they made profits of over 700 million dollars and over 500 million dollars respectively.
Now this is not a problem of resources; this is a problem of incentives.
We need to recognize that the target of this information should not be the doctor, should not be the insurance company.
It should be the patient.
It's the person who actually, in the end, is going to be having to change their lives and then start adopting new behaviors.
This is information that is incredibly powerful.
It's an incredibly powerful catalyst to change.
But we're not using it.
It's just sitting there.
It's being lost.
So I want to just offer four questions that every patient should ask, because I don't actually expect people to start developing these lab test reports.
But you can create your own feedback loop.
Anybody can create their feedback loop by asking these simple questions: Can I have my results?
And the only acceptable answer is -- (Audience: Yes.) -- yes.
What does this mean?
Help me understand what the data is.
What are my options?
What choices are now on the table?
And then, what's next?
How do I integrate this information into the longer course of my life?
So I want to wind up by just showing that people have the capacity to understand this information.
This is not beyond the grasp of ordinary people.
You do not need to have the education level of people in this room.
Ordinary people are capable of understanding this information, if we only go to the effort of presenting it to them in a form that they can engage with.
And engagement is essential here, because it's not just giving them information; it's giving them an opportunity to act.
That's what engagement is.
It's different from compliance.
It works totally different from the way we talk about behavior in medicine today.
And this information is out there.
I've been talking today about latent information, all this information that exists in the system that we're not putting to use.
But there are all sorts of other bodies of information that are coming online, and we need to recognize the capacity of this information to engage people, to help people and to change the course of their lives.
Thank you very much.
(Applause)