Published! ‘Incorporating Care in Silicon Valley’…

My esteemed colleague (and mother) Jan English-Lueck and I have officially been published in the most recent issue of the Anthropology of Work Review. There you can find our article, sadly behind a pay wall.

We ask: is the vaguely California-Buddhist (but mostly utilitarian) “caring” of Silicon Valley corporations a good thing? We answer, very academically: maybe, sometimes, someday. But today, it mostly stands in agonizing juxtaposition with horrendous inequality.  If some by long-shot thoughtful stars align…yes someday it could be some definition of good. We are trying to force some alignment from our humble positions. Join us?

If you think that seems interesting, this article is worth a read.

Here’s the abstract:

The struggle for labor rights is often one of asserting embodied care. Workers negotiate for rest and safe physical conditions. In the United States, further embodied care is translated into health care and family leave benefits. In Silicon Valley, while labor still struggles in the service and manufacturing sectors, professional high-tech work constitutes another set of challenges and expectations. Startup culture draws on the university-student lifestyle—where institutionalized care includes a broad palette of wellness care, cafeterias, and structured recreation. So it is not surprising that yoga, massage, food, and managed fun made their way into high-tech workplaces of the late twentieth century. Increasingly, however, that corporate care is a requirement, not a perquisite, of progressive companies recruiting elite workers.

Effective care requires personal awareness and corporate surveillance in order to be effective. Corporate responsibility in Silicon Valley workplaces embraces discourses in which worker productivity and care intertwine. This care is not evenly distributed or available to all workers, but still points to an emerging set of corporate care practices. Knowledge workers are expected to work more intensively, and employers sustain them by providing care. That logic of care shaped the social experience of both care providers, such as chefs and concierges, and workers, who learn to be the subjects of such care. Based on two decades of fieldwork in companies from Apple to Yahoo, this article outlines the uneven evolution of Silicon Valley’s corporate care.

And here’s an excerpt, which I think is within the limits of what I’m allowed to post here. Specifically, the prologue, which I wrote based on field notes from one of the more surreal experiences of my entire life.

A deep bell sounds at the hands of a brown-robed monk as hundreds of people bow their heads over trays carefully balanced on their laps. It is the fall of 2013 and the corporate dining room of an iconic Silicon Valley company is transformed as rows of workers, vendors, and guests sit in silent contemplation. Thich Nhat Hanh, renowned mindfulness teacher, leads the room in a guided meditation over the vegan lunch of subtly spiced Southeast Asian vegetables and rice. We are participants attending a workshop designed to cultivate a wonder of food in the larger ecosystem and an awareness of the act of eating.

The teacher asks us to savor each bite. He asks us to contemplate how dietary choices like these can heal a climate-disturbed planet. He asks us to consider the life of these plants, and all the human hands—farmers, cooks, and workers—who made it possible for us to eat the plants in that moment. Thousands more watch this performance through cameras placed around the room, possibly eating on their own, in homes and offices around the world. The organizers, chefs, and workers convinced that technology and compassion could do more together than apart, invited the monks to give their peers a transformative experience and to enlist allies.

Four months later, presenters from that same corporation, while reporting on that experience and the larger effort around mindfulness at the Wisdom 2.0 conference, were interrupted by an onstage protest. Local San Francisco activists waved signs reading, “Wisdom Means Stop Displacement” and “Wisdom Means Stop Surveillance.” The company’s efforts to care for its own workers and the planet, though literally fashioned on “noble intentions” drawn from Buddhist and secular compassionate practice, are mired in an inescapable context of a system that produces economic inequality and unequal access to physical resources. Diverse stakeholders contest the values around information flows and privacy. The ubiquitous computing that fuels the Silicon Valley economy also produces a panopticon of available information, which changes the lives of its workers and the communities in which they live. Those care practices also require a degree of self-disclosure and behavioral observation to be effective. If an employer wants its workers to be at “peak performance,” it needs to know how to promote that productivity year after year, and how to help its workers attain it for themselves.

Wanted: Adaptive Encouragement

Or, Health Horizons S&T Map Blog Posts, New Year’s Edition.

I am sick, writing in bed, but that seems to be good, since I don’t really want to do anything, so I might as well write.

Bang! Posted.

 

It’s that time of year again. The global holiday of January 1, and with it, the annual ritual of self-improvement: setting New Year’s resolutions.  It’s a time when we’re called on to reflect on our lives and the behaviors we might want to change—and bombarded with ideas on how to do so.  It’s the time of year that makes me crave the realization of one of our Science and Technology forecasts: Adaptive Encouragement.

Adaptive encouragement: From self-quantifiers to life doulas

 Imagine a digital advisor that interprets your raw health data and offers continuous support along with interactive data visualization and recommendations for changing—and maintaining—daily routines or medications. 

 Embodied in intelligent programs, mobile devices, and the cloud, a life doula (like a birth doula) will remind us of our goals in moments of weakness. It will offer suggestions and encouragement in context to help us make healthy choices. 

 This kind of adaptive, personalized support will improve chronic illness management with automated diet tracking, in-home blood marker monitoring, and realtime analysis of genetic, metabolic, and protein data.

A quasi-intelligent automated system that takes the heavy lifting out of learning about your habits and changing them? Sold!

This vision is part of a future when roles like life coaching are automated and extended through ever-present technology.  It also points to the possibilities of adapting care systems to optimize the well-being of people with chronic ailments: rather than a slap on the wrist at the doctor’s office, you get a gentle vibration to get you out of your chair and moving.  Haptic feedback and sensitivity, emotional support and peer interactions are the future of this softer side of mobile health, beyond the expert-fed prescriptive reminders. This is a future of gentle nudges to show us the actions that will help us increase our capacity for well-being, but also remind us to do nothing when that’s what’s really best for us.

Our colleague Alex Charmichael over at the Quantified Self wrote this forecast, and I’ve heard it echoed in the desires of my of the quantified selves I’ve been interviewing for our project for the RWJF building and refining the QS Guide to Self-tracking Tools. For those of us who generally only embark on self-improvement binges once a year, there are a lot of lessons and tools we can learn from both the continuous and episodic efforts of the QSers.  One tool I learned about in interviews that might be of particular interest to New-Years Resolvers is Health Month—a game that helps you focus on making progress towards your goals on a daily basis.  (The game starts promptly on the first of each month, so start on Jan 1st to get credit for your progress!)

Most importantly though, one of the key lessons I’ve heard that’s especially crucial for  new years resolutions is self-compassion in all your self-tracking and self-improvement efforts.  Shame and frustration at little slip ups can do a lot of harm—so this year, try staying future-focused and forgiving.

Writing, death, and vat-grown kidneys

Hey, wasn’t I going to blog more and stuff?  Did somebody die or something?

Oh wait.  Actually, yes.

So my SB challenge and so many other things have been on hold for the past week.  I’m not done grieving, and won’t be for a good long while, but I do need to start writing again.  My kick in the pants came from the realization that it was Viv’s turn to do the regular blog post in our blogifying map forecasts series.

I started writing it and then I stopped.  I decided to share her words instead.  It still took me most of the day to track down links and proof and whatnot. It was both cathartic and helpful to tiptoe around the cognitive dissonance of writing about forecasts bathed in optimism bordering on hubris with ruminations on mortality rattling about my brain.

Here’s the post:

Replacement parts: “We can rebuild him, we have the technology”

Regenerative medicine will replace, restore, maintain, or enhance tissue and organ functions, dramatically improving patients’ health and quality of life, and potentially reducing the cost of their care. Tissue engineering will heal diabetic foot ulcers, reducing the need for amputations; organs grown in a lab will ease our dependence on donor transplants; and tendons, cartilage, and bone regrown with autologous cells will be used to repair injuries and joints. Advanced prosthetic devices and biomechatronic-based limb replacements will interface with the body’s nervous systems to give users a range of natural function and movement.

 When we first presented this forecast at a conference, our colleague Vivian told a story that illustrates the potential, and some possible pitfalls, of the growing capacities of regenerative medicine. It was part of a complicated dance of vignettes and exposition with Vivian, Bradley and myself that will remain one of my fondest memories of working here.

Viv presenting, by Rachel Hatch

Image by Rachel Hatch

Of course, when you get sick enough, you end up having to go to the doctor for help.

That’s what finally happened with Eric, who has Type 2 Diabetes.  He is a very successful 56 year old lawyer.  He has a history of working too much and not taking very good care of himself.  He was overweight, ate poorly, and didn’t track his blood sugar levels consistently.  As a result, he has had some serious complications from his illness.  Last year, he developed a foot ulcer that just wouldn’t heal.  The doctors had to amputate his foot.  His eyesight also deteriorated because of damage to his retina.  And his doctors have been warning him that he may need to go on dialysis.  Eric’s body is failing him.

Remember that TV show in the ’70’s?  The Six Million Dollar Man?  Do you remember the show’s tagline?  “We can rebuild him. We have the technology.”

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Optimizing Healthspans: branching paths of longevity and death post up

This took me a uper long time to write, resolving my conflicting feelings about extreme longevity as a topic.  This is another one of the Science, Technology and Well-being 20202 Forecasts.

Again, full post available here.

To clear up your first question, (what’s a healthspan?), by healthspan we mean the length of healthy, quality living. In the last hundred years we’ve seen a dramatic lengthening of our life expectancy, and radical life extension hopes to lengthen our lifespans, but what we’re grappling with now and in the next decade is optimizing our chances of those added years being happy and healthy.

So, how will we do that?

 Flickr user kevindooleySource: Flickr user kevindooley

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Programming Immunity post up

This was a post about one of the handful of forecasts boldly written last year by my colleague Alex Carmichael, which it fell upon me to perform, promote, and continue investigating from our recently released forecast map on Science, Technology and Well-being.  I must admit that I am personally less technologically optimistic than many of the forecasts on that map.  With this forecast, my own personal experience with immunomodulators is that we are still at the blunt instrument, barely-know-what-we-don’t-know stage of understanding, more than a decade away from precision interventions for anybody, let alone brad accessibility.  Luckily the week before there was a major breakthrough in this area: the first success of gene therapy, which promised to be just around the corner back when I was in high school biotech classes. And what this therapy did was effectively re-train patient’s immune systems in a specific, fine-tuned and persistent way.  So, maybe this forecast is on a much shorter horizon than I originally gave it credit.

Excerpt from the full post:

Our immune systems are the key to humans’ profound resilience in the face of all the other organisms around and inside of us.

Over the last few decades we’ve made great strides in understanding the workings of various parts of our immune systems, as they function normally and as they get jammed up in strange ways. This forecast posits that over the next decade we’ll be able to put this knowledge to striking use: honing our immunomodulation therapies, mainstreaming the maturing promise of gene therapy, and hacking our immune systems to accelerate our resistance to all kinds of infections.

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Emotional Networking (Crosspost)

Here’s the piece I wrote over the weekend for the Health Horizons blog.  I didn’t get to meet them, but on Friday I listened rapt and gawked at the webex of Emota.net, our neighbors in Palo Alto who are doing some seriously cool stuff. It’s on the HH and Future Now blogs HERE.

I just got a note in my email.  My aunt is busy with her own appointment, and nobody had yet volunteered to pick my uncle up from the VA hospital tomorrow, after he recovers from surgery.  Hey, it’s a Friday.  I can take off a little early to pick him up, and get him to my cousin’s place over the hill.  I respond to the email, volunteering. In a grocery store across town, my aunt’s phone chimes in her purse.  On the tray attached to my uncle’s hospital bed, a digital picture frame brightens, and my little bobble head avatar floats forward and let’s him know he can expect me when it’s time for him to check out.

I could live with this future. A couple years ago, the same arrangement would have taken at least a dozen stressed-out calls between my aunt and my mom, my mom and me, me and my five cousins, me and my aunt, and finally me at the VA with my mom, trying to find my uncle’s room in the biggest dead-cell zone in the valley.  At the end of the day, while everyone’s relieved when the surgery goes well, everyone has a headache.

This streamlined future of ambient, collaborative caregiving isn’t quite here yet, but today at IFTF we heard a fantastic talk from one of our neighbors, Emota.net. They’re bringing this future to life. They’ve coined their discipline “emotional networking, which complements existing telehealth solutions to address not just clinical health, but emotional and social aspects of elder care.” They’re building a platform that can operate across numerous devices, and facilitate the convergence of multiple communications media to bring different generations together.

The purpose is to distribute caregiving practices among a support network of family, friends and care professionals, while giving this network a tangible presence in a person’s everyday environment.  It takes “ambient co-presence” to a functional extreme, creating a gentle convergence of email, updating services, and virtual worlds. Image that you’re hanging out on your grandma’s kitchen table, tossing her hearts and flowers on a break while she reads your status updates (if she’s so inclined). And she bobs around in an app on your desktop, or phone, or tablet. If she needs help, you’ll get a notice, or if she’s really sick, her nurse will get a notice.  Otherwise, you’re just there: framed on the table with her other family, friends, caregivers.

This all sounded awfully familiar.

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