 All right, my name is Hamilton Staples, and it's my great pleasure to introduce Dan Pardee today. Dan is founder and CEO of Dan's Plan and is a PhD candidate at Leiden University in the Netherlands. The title of this talk today is Recreating Old Behaviors in a New World. A crazy paradox of how quantified self-technologies and the Internet of Things will help us live more like our ancestors. Please join me in welcoming Dan Pardee. Thank you, everybody. It's great to be here. You'll see the irony of Dr. Staples introducing me in one moment. I did not know that that was going to happen. If you cared to tweet my hashtag and the AHS symbol up in the right-hand corner. So, in March 2013, Dr. Staples ran a survey of the ancestral health community to better understand the attributes of the people that make it up. And what he found was that there was two big classifications that us, these people, fit into. They can be defined as the unsatisfied sick or people who have unsuccessful resolution of the health issue and are seeking alternative solutions to try to create a better outcome for themselves. And also performance optimizers, people that are looking for the best techniques to improve their performance, physical performance, mental performance, and also to age well. Now, the characteristics of these groups are interesting. They tend to be both of them highly motivated, self-directed, challenge authority a bit, and also are educated with resources. And what Dr. Staples surmised in his presentation is that paleo will grow modestly, but it will not go mainstream. And the reason he gave is that there were some serious obstacles for it going mainstream. One, that neolithic foods are woven into the fabric of our culture. And we also, societally, we seek fun over flourishing. And also that these foods are addictive. Now, the ancestral health movement is not simply defined by foods, but those are markers of why it's going to be difficult for it to go mainstream. However, many health paradigms face identical challenges of the ancestral health community. In order to scale a philosophy, if that philosophy is less convenient, more expensive, and more challenging than the default baseline behavior, then you must master an understanding of what influences behavior in order to improve adoption. So really we're talking about behavior change when we're talking about increasing adoption of this philosophy, this paradigm. So what is currently used to increase or create adoption? And this is things like books, blogs, podcasts, conferences, webinars, and then things like recipe sites and apps. Now, most of these techniques are about giving information and basically about why something is important and what to do about it. But behavior modification is not simply about giving information. We can't simply lob information provisions at people in hope that they take that information, learn it, and then adopt it perfectly. We do not act rationally as humans. So we're really talking about behavior change. And in order to do that, we first need to ask the question, what is behavior? So behavior is a response of an organism to various stimuli or inputs. Now, they can be thought or action that you can recognize them or they can happen beyond your awareness. You can do it conspicuously or you can do it in a clandestine fashion or you can do it on purpose or you can do it on accident. They can happen without your permission. So essentially, behavior is a manifestation of brain activity. And if that's the case, then what is controlling brain activity? Well, first of all, we have instincts. Instincts are typically fixed patterns of behavior in response to certain stimuli. And an example of this is salmon are born, they swim thousands of miles, and when it's time to mate, they know how to get back to where they were born so that they can mate. And this pathway back home is imprinted in their genes and passed down from generation to generation. Next, another example is baby loggerhead turtles. They are born and they clumsily walk from the beach into the ocean and they join large kelp beds. And they know how to do this right when they're born, right? And they'll travel hundreds of miles within the first few days. It's very complex behavior. They don't learn this. And again, it's imprinted. It's instinctual. But acting by instinct is not the only thing that influences what we do. We can also learn. So in this section, I'm going to be talking about how we form memories and how we then can learn new behaviors. So I ask a question. Why do we form long-term memory? The purpose of long-term memory is to simulate and predict the future. The same areas of the brain, like the dorsolateral prefrontal cortex and the hippocampus, that are used in memory formation are also used in future simulation, right? This helps us remember, remembering, excuse me, helps us predict, entertain a reward, avoid harm, create and achieve goals, and also make anticipatory responses that help us behave appropriately in our world. So there are two broad classes of long-term memory. One of them is declarative memory, which facilitates cognitive learning. Now these are memories that we can recall consciously. And there's two different subclassifications. One of them is episodic. This is the autobiography of your life, right? The times, events, emotions, contexts that are the facts about you, the event that you went to, the people you were with, the emotions that you felt, right? There's also semantic memory, which is factual memory, right? So what US President practiced law without a degree, held a patent, right? This is Abraham Lincoln, right? It's a fact, all right? So one thing that declarative memory empowers is it allows us to inferentially exploit lawful consistencies of our world. What do I mean by that? It means that you don't have to fall off the cliff in order for you to understand what happens, right? You can learn rules about how the world works, and you can apply these rules to myriad situations that help you behave in a self-preserving manner, all right? So what is another way to form? What is another type of long-term memory? That's declarative conscious memory. What about procedural associative learning? Procedural memory, associative learning. These are memories that are subconscious and are involved in things like habit formation. So whenever we speak about associative learning, you tend to think about a guy named B.F. Skinner, all right? Operin conditioning, or Ivan Pavlov, which I had to remove for timing out of this presentation. So he's a 20th century psychologist, probably the most famous psychologist of the 20th century, in fact. And what he believes is that, or what he showed is that a stimulus can stimulate a behavior, and if that behavior is followed by a consequence, the consequence will modify whether or not that behavior happens again or not in the future, right? It'll influence its reoccurrence. And this is the concept of reinforcement and punishment. So reinforcement, anything that reinforces will increase the likelihood that a behavior will happen again. And there's two different types. There's positive reinforcement, all right? And this is after the behavior a rewarding stimuli is provided, the animals like it, and they want to do it again. They want to get that reward again, all right? So for example, you give a dog a treat after it sits, and it learns that, hey, sitting is good. I get a treat and I like that. You also have negative reinforcement, which is a little bit confusing. A lot of times people will associate negative reinforcement with punishment, but negative reinforcement also increases the likelihood that a behavior will occur again, but this time by the removal of a stimulus. So for example, a dog will sit if you remove a muzzle. They don't like the muzzle, and they learn that if they sit, they can have it taken off. And then there is punishment. Now this decreases the likelihood that a behavior will occur, all right? So this happens with the application of an aversive stimuli, right? Punishment by contingent stimulation. Now if you found your dog, you came home and you found your dog was chewing on your shoes, you might yell at it, bad dog, right? And the dog would feel embarrassed and it would learn not to do that again, hopefully, unless you're my dog. Also, you could remove a desirable stimulus. So last time we provided an aversive stimulus that they didn't like, now we take something away that they do like, all right? So example, you're grounded, no more video games for a week, all right? Oh man, I'm not gonna do that again. But interestingly, at the end of Skinner's career, he surmised that, or he concluded that punishment is not a great, well it certainly can shape behavior. It's not a great long-term modifier of behavior, right? And the reason why is that people ultimately end up avoiding the consequence instead of the behavior, all right? But a very interesting, so how else, what other sort of procedural learning product affects our behavior in a very significant way? All right, so if we think about Skinnerian conditioning, what else does it influence? It helps us to formation of habits, and I'll read you a quote. We are, all of us, creatures of habit. We fall naturally and easily into the manner and customs which long usage has implanted ineradically within us. And this prescient quote by Burroughs highlights several key aspects of habits. They develop from reinforced, repetitious behavior, and they're hard to get rid of once they're formed. All right, so how are habits learned in the first place? Well, the keys to the habit loop are key routine and reward. Does this look familiar to anything that we just saw? Yes, stimulus behavior consequence, all right? So interestingly, as we repeat a behavior, feedback loops between the sensory motor cortex and the striatum become strongly engaged. And it helps us stamp a routine into something called a single chunked activity, a single memory unit. So the entire behavior is one functional unit. So what is the purpose of this? The purpose of this is to make routine behaviors automatic so that we waste less energy thinking about them. You don't want to have to put in a lot of thought to think about brushing your teeth. The more you do something, the less mental energy is required and it can help you focus your attention elsewhere. So let's look at a really interesting example of this automaticity. Any World Cup fans here? Yeah, all right. So this is someone named Neymar de Silva Santos. He's widely regarded as one of the best soccer players in the world. And in 2014, a group of Japanese researchers did FMRI imaging on Neymar's brain. And what they had them do is they had to move his ankle and they looked at the amount of activity in his brain and they also did this with control subjects. And what they found is that Neymar's brain used 10% of the activity of a normal control subject to do the same thing. He was incredibly efficient at performing that activity through years and years of repetition. Now he is a really remarkable at this, so let's celebrate or experience him in action. So you can see here he has the ball, he splits some defenders, makes a beautiful pass to one of his teammates, gets the ball back, shucks off a defender, does a beautiful move around somebody else, beats a final defender to the ball. This is eight great plays in one. Let's watch it again. It's really amazing. If you want to have your presentation like just showed Neymar videos, wow, it's brilliant. He's operating at such a high level. He's not thinking about it. He is just reacting almost instinctually. So now that's the good side of the brain's ability to create these efficiencies for common behaviors, but of course there's a dark side too. And as I mentioned, the more routine a behavior becomes, the less we are aware of it. We lose full surveillance of that behavior, and remember that the entire behavior is instamped into this memory unit, so it can be elicited without our permission and it can go to completion without our awareness. In fact, it makes habits very difficult to get rid of. In fact, it's better to try to replace a habit than to suppress it. So on that note, let's move on to behavior change. So what is behavior change at a very high level? It's trying to replace a health impairing behavior with a health enhancing one. So I'm going to talk about some of the psychological constructs that explain what motivates a person to change. And actually these are some theories and models that do this, or they describe the change process, or they actually provide a framework to implement behavior change. So there's three models, theories of reason and action, social cognitive theory, and theory of planned behavior. They're basically all centered around the idea that a person's intention to change is shaped by their attitude and their belief that change can happen. And this intention is directly related to the sense of control they have over that behavior. Which is then also shaped by past experiences. Have you tried that behavior in the past and failed? And also what people around them are doing? Do you see other people modeling this behavior? And if you do, that may make it more likely that you believe you can do it as well. There's the trans theoretical model, which is then saying change happens in five different stages. There is a pre-contemplation stage, a contemplation stage, a stage where you prepare for change, then there's the doing, and then there's maintaining. Health action process also describes behavior as a sequence. There is a goal setting phase, and then there is a volition phase. So again, it's thinking about I'm forming my intentions, I'm forming my motivations, and now I'm doing. And there's lots of subcategorizations with that. And then BJ Fogg, who's at Stanford, created an equation for behavior, which is as follows, B equals MAT. Behavior is motivation, plus ability, plus triggers. So how motivated are you to do it? Can you do it? What is your natural ability to do it? And then what sort of stimuli in your environment reminds you to do it at the right time? It's very popular, it's very popular with health applications that are currently being made, like apps, et cetera. Then there's Nearyall's model, which is essentially looking at Skinner's model, and using that to create better adoption. Now this can be used both for good and bad, but he's applying that model to make products sticky and usable. And then there's the loop model to sustain health behaviors, and this is a model that I developed, and basically it asks four different questions. Why do you do something? What is the big idea that is convincing you, persuading you that something is important and how to do it? Then there is how do I do it? Translating this concept into what does it look like over a 24-hour period of a day, or a 168-hour period of a week, where does the rubber meet the road? Next, am I doing it? I know why I'm doing it, I know how to do it, am I actually doing it? Getting feedback that informs you if you're actually meeting your goals that are consistent with your ideas and your intentions. And then lastly, is it working? I know why I'm doing it, I know how to do it, I know am I doing it, is it working for me? This is validation. This is cognitive performance tests, mental performance tests, some blood work, something that gives you a deeper insight into am I getting the results that I would expect? Okay. So many of these models overlap, and a central element of most of them is a concept of self-efficacy. This is Albert Bandura, he's a Stanford University psychologist and a pioneer of behavior change and motivation, and he started his work in the 1960s, and his self-efficacy states that the more that we believe we can meet a goal, the more likely we will be to do so. And he also was fascinated by the potential of feedback loops to affect behavior, and he observed that giving an individual a clear goal and then the means to evaluate their progress towards that goal greatly increased their chance of achieving it. And this idea segues into the final portion of my presentation, which is persuasive technology. At the highest level, this is technology that engages us, that gets us to play with it, to want to use it. Anybody have a cell phone in here? Anybody check messages? That modifies our behavior. So this is a great quote by Peter Drucker, management consultant and winner of the Presidential Medal of Freedom in 2002. What gets measured gets managed. If you measure it, you manage it. Now, there's a caveat to this as well, that not everything that can be counted counts. And not everything that counts can be counted. Now, we're finding early in this movement, which I'll describe more in a moment, is that there are some examples where a device or an apple tracks something because it can. And it'll focus the attention on that thing because it has an ability to do so. But we want to do is say, what are the things that you can measure and what are the things that matter? We want to be right where these intersect. So let's take a look at the quantified self-movement and a time-live of it. All right? This is in... The first pedometer was invented in 1780 by Swiss urologist or watchmaker Abraham-Louis Perrelle. In 1965, a pedometer called the Manpokai was introduced in Japan and marketed. And it means 10,000 step meter. And this was based off of research that felt that walking 10,000 steps a day was very healthy for you. And in 2007, Fitbit was founded by James Park and Eric Friedman. And this coincided with the modern day quantified self-movement. In 2008, the quantified self-meatup formed and their tagline is self-knowledge through self-tracking. A couple years later, they had their first confidence, 60 presentations. And then just last year, or just this year, earlier in the year, at the consumer electronic show, 40 new devices were introduced into the market. All right? We are seeing an explosion of interest and growth within this space. And why is that? It's because recent technologies are enabling this to happen. We have small inexpensive sensors, wireless data streaming, cloud storage, surveillance, information exchange. And you can put these in small, attractive devices like a scale, a wireless scale that transmits your weight to a phone or some sort of system that monitors it. Wearable devices like a Fitbit that you can wear on your wrist and it tells you how many steps you're taking or what your sleep is like at night. And then next is biosensors. This is going to be in the form of tattoos and pills and also having the ability to transmit that wirelessly. So it's going to become more frictionless and you're not even going to be aware that you're wearing them, right? They're going to use passive sensors that collect information and why is that important? Well, first of all, what can we collect that on? Well, it's our activity, our physiology, our endocrinology, a huge list of things that we might be interested in for a myriad of reasons. All right, so overall you can break this down into two big categories. There's big data and there's a lot of interest in this and this is the aggregation of many different people's data and hopefully it can yield population insights. Then we have personal data. Is this end of one experimentation? Is that what I mean? Where you do these self-studies? Well, we know that doing self-experimentation is rife for cognitive bias. You will look for something that you think might be there. I think the real benefit of collecting data on yourself is implementation of valid behavior change techniques. Implementation of a smart paradigm, health paradigm, and then awareness of whether or not you're doing it or not. So let's get back to the feedback loop to illustrate the value of data capture. There are four stages of a feedback loop and the first one, the evidence stage, is data collection. This is a key part to this feedback loop. The behavior is measured, captured, and stored. Next is the relevant stage. You can analyze the data and relay the information in a context that makes it emotionally resonant, that gives you insights into your life. Next, there's a consequence stage. This is information illuminates one or more path forward. I've collected data, I have visibility into what I'm doing, and here's what I can do about it right now. And then there is the action stage. It provides a clear moment where the individual can recalibrate their behavior, they can make a choice, or they can act. So this action is let's actually move on to the idea then is this is really interesting, but does it work? Can it work? And are there markers of it working? And I think the best research to date illustrates the potential efficacy of data enabled decision modification or behavior modification systems was done by something called Hope Lab. They did an analysis across 12 studies of a thousand different children to evaluate if a step tracker named Zamzi was able to increase moderate to the vigorous physical activity in children, and yes it was. They showed that Zamzi increased physical activity by 60%. So now let's, and by the way, if you translate that, that over a course of a month this is the additional of running two more marathons than the control subjects. But did the effect persist? So here on the y-axis you have moderate to vigorous activity per week. And on the x-axis you have from baseline out, number of weeks. So this goes six months. And what do you see? You see that Zamzi not only caused a really significant improvement in physical activity levels, but also sustained that level over time. So now let's synthesize this information. All right. Being healthy hasn't always will require a personal effort. All right. However unlike times of our past from this point forward being healthy will also require some form of personal intention to make it so. So unhealthy choices will become increasingly available and increasingly tempting. And so they'll always be tough choices to make. So facilitating health efficacy requires two parts. One effective health paradigm. And the ancestral health community looks at pre-modern lifestyle patterns as the basis for modern-day health directives. And I think that that's really smart. I think there's a lot of wisdom in learning to be gained there. And next number two, you have to have effective behavior modification techniques. So the quantified self-moving is powered by personal data tracking, but it doesn't stop there. It's not just about tracking information. It uses data to implement valid behaviors support techniques, making it more likely that these behaviors occur in an ongoing fashion. So you're not just playing with this as a toy. It's actually one of the critical part of your health. And why I say playing with this as a toy is because right now there is actually some problems with usage. People will and I will actually move ahead here and I want to show you something about this. 10 minutes, perfect. So this is activity tracker usage over time. So on the y-axis we have rates of sustained utilization and on the x-axis we have time in months. So do people continue to use these products over time? And you see that at 18 months usage drops to less than 50%. And why is that? Well if you think about this device as a really bad exercise tracker then you're not going to use it. If you think about the steps is not being important in your physical activity practice then you're not going to empower it with value. You need to empower this with value which means you can't simply hand somebody a device and hope that it's going to be a solution. Now the simpler the better, but it requires some education, it requires an understanding of why this works how it works and the meaning of it in a person's life. So I actually did a analysis of my own Fitbit friends to see if this matched up and I have 47 different connections in Fitbit and 22 are active and 25 had no activity. So this is less than 50% so this seemed to match up pretty well with that data from Endeavor partners. I think that these devices will become as I mentioned earlier as they become smaller there's less friction and also as they become more attractive and stylish people will want to wear them. Right now this form factor doesn't appeal to everybody but there will be an increasing amount of form factors that do. You might want to wear it as a piece of jewelry you might want to wear it as something that just looks interesting as a part of your outfit or it might be a tattoo that you don't notice at all but it's doing the data capture for you. And I want to mention one thing about the Internet of Things because I did have it in the title of my talk but I wasn't sure if I was going to have time to get to it. So the Internet of Things is an entirely different concept. It's thought to be the next industrial revolution and the estimates are that by 2020 there will be 50 billion connected devices. This is a multi-trillion dollar industry that is forming and every little device will have some sort of sensor on it so everything will be connected. It's the Internet of Things. Now how is this interesting to health? Well right now let's use light as an example. If you want to control your light environments first of all you have to have knowledge about what you want to be doing in the first place. Do you want to just have lights on or do you want to affect the intensity and the tone of light over the course of the day? And if you do you have to go multiple times to the real state of the dimmer switch and you have to manually change it. That requires a lot of action. The Internet of Things you can set it and forget it. If you want to mimic a more natural lighting environment in your home which is incredibly important for circadian rhythms then you can set it one time and then your environment will automatically be conducive to provide a better lighting tone and intensity for that time of day and that's going to be incredibly powerful for our health. This is just an example of that but our environment will adjust around us and if you want you can program it to live a more natural lifestyle. So let me go back to the conclusion of my talk here. So in order for the paleo movement to grow beyond current levels it needs to harness the power of technology to implement best in class behavioral support techniques so that individuals and communities can better adopt can create better adoption and better success with the paradigm and the easier and more accessible the paradigm becomes it can transcend early adopters and the exceptionally motivated that can have a broader appeal to a different audience and with that I will end my presentation and I will be happy to take questions from anybody in the audience so thank you for your attention. Does anyone have any questions? Well hi there, thank you for that presentation there's been a lot of tension toward the fact that heat stroke is more common than people thought may involve rhabdomyalysis and nasty stuff like that are there any ways that people can easily measure their core body temperature? So with these biosensors that is going to be increasingly a possibility. So there are now pills that you can swallow and right now they're able to emit a signal and the first purpose of them is for medication adherence are older people taking the medications as they should because that's a big problem but they're also able to measure heart rate these pills they're also able to measure core body temperature and so in the future in near future you'll be able to swallow a pill perhaps before exercise and have really accurate feedback you know that is sent to a device and perhaps the device doesn't alert you unless there's actually a problem that you need to be aware of and you can develop something called haptic feedback where something that you wear on your body an external device, a wearable vibrate if your core body temperature starts to rise so yeah so that is a possibility yeah I just wanted to make one philosophical point which is that your description of B.F. Skinner's operating conditioning is really of the same form of Bayes' theorem that I described and in other words that although Bayes is described in terms of belief which is a cognitive idea it really is in terms of behavior and if we have adequate application of Bayes' theorem and we really see that our behavior has to change as a consequence of experiment then operating conditioning will increase conformity to what the science is telling us yeah I don't know if that made any sense well you know it's an interesting point because there's two different types of possibilities that come from a condition response with skinnerian conditioning there can be an implicit response which happens subconsciously that it can affect our behavior but there can also be an explicit conscious response you can recognize a consequence like it and it can form cognitive incentives I want this to happen which then enables executive functioning which is the ability to form a goal strategize create a strategy remember that goal and then execute on it and so all these systems even though we talk about them separately they end up working together the implicit and the explicit to modify what we do Skinner said it was all unconscious he did yeah he gave very little credit to the cognitive aspect except how it reinforced except for reinforcement contingencies but a lot of what he had some brilliant work but a lot of his beliefs were proven wrong ultimately some of them well yeah but consistent with your main idea if it shows up in reinforcing behavior will make progress yeah yeah I have one more question back here and then we can stick around after and also ask Dan some more hey Dan I don't disagree with you at all but I'm a start-up guy and an investor and all that stuff and a biohacker and QS and all this I am not excited about the current state of tracking I think it's absurdly boring these are biomarkers that we've had for 50 years 100 years a thousand years in some cases the FDA just recently gave Apple's health clearance to track our body weight heart rate our blood pressure and whiz bang our glucose where is the C-reactive protein where's the vitamin D levels where's the ferritin levels where's the 100 other biomarkers that have tried and true technology locked in the industrial medical insurance complex and as far as I can tell the only reason is regulation it's the purest form of censorship we're not allowed to know these details about our body you have to have a doctor as an intermediary and that's the lab on a chip that plugs into our iPhones what do you think it's a really interesting comment now the ability to track some of those markers will come there's a so the ability to do so will be there there's a company called I think Sano Biosciences they're early in development but it's a patch that you wear on your body for two weeks and it can tech up to 50 different biomarkers there's some limitations about what it can and cannot tech tech in the interstitial space but it's going to give us a new level of insight into what's happening and in fact I don't even know if we're going to know what to make of it for a while because where else do you have continuous time series data over several weeks at a time in a large population so I think there's going to be a learning curve right because right now we just do these punctuated samplings every you know I mean if you're lucky every couple weeks of a biomarker and you know depending on circadian timing and what else is going on in the body it's kind of hard you just have to look at it versus normal data but I think that so there's going to be two aspects we're going to have more data than we've ever had before and we're going to have to have a period where we learn to understand what it is but I also is one of the reasons why I really wanted to emphasize behavior modification techniques that these devices are only as good as the techniques that they utilize right how to change behavior one of the reasons people give them up as a toy is if you focus somebody's attention on things that don't really matter right things that are not actionable you know you might find it as a play with it as a toy for a few weeks and then give it up because it's not benefiting your life right so that's why you know instead of showing you lots of different examples of these devices I really wanted to emphasize that it's the modification techniques that matters most right this is just empowering and enabling them and then the other thing that really matters as well of course is the of course the health paradigm what are you using these devices to try to get people to do right so you could actually have an effective behavior modification technique but it could be having somebody you know drink milkshakes before bed right you could get people to do that but it might not what matters is the union the unification of the technique I want to sign up for that the technique and then also the modification technique and also what you're trying to have people do Dan that device you mentioned today would require a doctor's requisition or a prescription correct you know I do not know probably yeah probably I believe it's Sano Sano Sano intelligence thank you okay I think you know what's happening there yeah some Boston guys that's why you know all right well we have to transition into our other speaker so if you want to stick around after we'd love to talk more thank you guys so much and thank you Dan