Expectations and disappointments

As I am getting ready for Tuesday, long day and full of expected disappointments, I think it's time to reflect on a couple more things before letting the matter rest for a while.

  • What do I expect of those around me?
    • Are those expectations realistic?
    • Are those expectations fair?
  • Do I want to continue building my expectations of others the way I have been doing it so far?
  • Do I honestly want to continue working on education?
    • What do I have to fall back on if the answer is that I don't want to continue working on education?
    • Is that something that I can enjoy long term?

They are not easy questions to ask and, most definitely, are not going to be pleasant questions to answer or to have answered for me. Like I've said before expecting a certain answer doesn't make it any easier to swallow when you do get it and I think that tomorrow is going to be one of those days. 

I managed to get meetings that, hopefully, will address some of the questions I have but I can't shake that "careful what you wish for" feeling.  I have a feeling that I will get confirmation over what I've been told before about the intended nature of my job and the things that I won't be allowed to do because of it.

it's about 11:55 AM on 5/27 and I've been officially unemployed for a couple hours.

It caught me completely by surprise to say the least although it shouldn't have in light of recent conversations with Scott. The fact that Laura basically stopped talking to me and my problems with Ann. I was given one set of reasons which are flimsy at best and they invite a lot of scrutiny.... Scrutiny that I'm trying very hard not to dwell on because it means that I failed at some point and that what Bill Evans mentioned when I was hired came to pass even more drastically than I would have guessed

Best thing I can do for now is to regroup, go to TTIX, prepare for the GRE, finish my application essay and get a job for as long as necessary until I get to grad school.

The first day after Chico State.

It feels so weird to be up before 6 but have to constantly remind yourself that you don't have to go to work anymore. 

I've been busy starting to tie the loose ends that I wasn't allowed to tie yesterday. I had to let a few people know that I'm no longer employed at the university (and still have, I'm anywhere near done) and I still need to figure out what is it that I want to do work-wise

As I am typing this piece, after walking back from the fortress (if you have to ask you're not in Chico and you're not a gamer), Chris Brogan posted this piece on taking risks and the fact that taking risks is a good idea but in measured steps. I think that's where I failed... I allowed confrontation to become my only tool and that obviously backfired. Remember the questions I had asked earlier... 

  • Do I honestly want to continue working on education?
    I think so. As shitty as the experience was it reflects on management at CSU, Chico and not on the kind of job I want to do in education
    • What do I have to fall back on now that I don't have a job?
      Rattling bushes among friends to see if I can get something. Also debating if I want to spend the money on a professional resume or not
    • Is that something that I can enjoy long term?
      We'll just have to see, won't we?


    • Daryl Hall (Dreamtime)
    • Janet Jackson (Escapade)


    • Legacy of the force: Invincible


    • Job Hunting
    • Getting ready for TTIC


    • NCIS Reruns

    What do you really need?

    Image shamelessly taken from: This other blog


    Maslow's hierarchy of needs

    I haven't looked at the hierarchy of needs before, although it has been in my mind during conversations with my therapist.  You know? The more I look at this list the more I realized that I am ok in some areas but am so lacking in those same areas when I really come to think of it.

    Physiological needs are pretty much taken care of and don't need much dwelling on.

    Neither is safety.  One of the biggest resolutions I've made recently is that, if/when I leave a job or a situation, it'll be on my terms, not anyone else's. I've done well enough on my evaluations and performance reviews that, save me screwing up an inch short of WWIII, I won't get fired, at least I hope I won't.

    When we get to the top 3 items in this little pyramid is where I find myself struggling and finding behavior in myself that I have never approved of and which I hate seeing in me.  I've become judgmental; I've allowed my friends (and so called friends) actions dictate how I deal with them, some times not realizing that I am guilty of the same behavior I'm so sharply criticizing in others.  I want sexual intimacy (who doesn't?) but I have to be honest and accept the fact that I don't like being vulnerable to the degree that being in a relationship entails. 

    Over the last 5 years or so I've managed to build my walls to the point where I won't jump down someone's throat just because they made me feel vulnerable, but the walls have never been strong.... I've never been one of those "thick skinned" people who will smile and nod regardless of how brutal you are with them. Quite the opposite: I'm strong enough to be able to function in a team environment but not strong enough to handle when a team exercise becomes mud slinging 101. 

    And this is how I get to self esteem which is, perhaps, the weakest of all my needs in terms of being fulfilled, (even if it's the weakest need on my own eyes only). As I said before, self esteem is shaky but it exists. I am good at what I do even if sometimes I wonder whether what I'm doing is correct or not, whether other people are actually giving a damn about what I'm doing or not, whether what I do makes a difference or not and whether it matters if it's me doing what I do. I had one of those situations today as a matter of fact. I got assigned to do a survey and it was painful to get it over with; then I sent out a draft to the rest of the team and I got... 1 feedback response! then today we had a team meeting where everyone started picking it apart.... My thinking, at the time, was that it would have been wonderful to get that feedback as I was putting the report together rather than bitching about it at a meeting.... Intellectually I know everyone is busy and has a shitload of stuff to do, but if this is reflecting on the entire team then they owe it to themselves to make sure it's the best product we can make, right? Someone in the gallery is saying that it's only because of the standard I hold myself to or that it's frustration with how things are currently happening at work and that's partly it but I'm also feeling like I'm working on a vacuum and I don't like that.

    Intellectually I know I've achieved a lot yet I don't feel like I have.  Someone used to tell me to be careful with always giving 100% because people would start expecting nothing but 100% from you and I think that has been the case here and at SJSU.  Give your 100% but don't do it consistently or set the expectations of your peers and managers accordingly.

    At the top level of the hierarchy I'm lacking in spontaneity, lack of prejudices and creativity. I'll speak to each one of them in turn:

    Spontaneity: For the first time in a long time, I am concerned about boundaries, particularly after getting my hands slapped for doing what I thought was necessary. Perhaps too concerned, to the point where I'm not making decisions but only carrying out other people's instructions and not enjoying my work because it is not really mine and the situations and people I'm with because there is resentment all around.

    Is it satisfying? Most definitely not... necessary? yes, at least until I solidify what my position is or until I'm accepted at UGA and move out for my "next 4 years" 🙂

    Creativity: Since I was deemed to be "spending too much time in extra curricular activities on university time" I've tried to keep those to a minimum. Unfortunately, those extra curricular activities included most, if not all, my creative and "shut brain down and let the brainstorm happen" time.  It is frustrating because there are a lot of things that I think we should be doing and we may well be, but there's no way for me to find out because I don't get those pollination times that I so like.

    Lack of prejudices (and the adoption of other people's annoying behavior): Over the past few months I've become judgmental and prejudiced.  I've also allowed myself to take some behaviors of those people I don't particularly care for.


    • Utada Hikaru (Automatic)
    • Linkin Park


    • Managing Humans
    • How to get $20 out of a stubborn coworker


    • Blogging and putting off writing papers


    • Reruns of JAG and NCIS

    Trickle Theory

    From randsinrepose


    Back at the start-up, we were shifting gears. After six months of talking about shipping a product, we needed to ship a product and nothing gets everyone’s attention like a deadline. The good news was that QA had been doing its job and there was a pile of work in our bug database. The bad news was that no one had looked at the database in months.

    We had a Rent-a-VP at the time, and as temporary executives go, he was sharp. He quickly deduced our goal — “Ship a Quality Beta” — but he also quickly discerned that we had no idea about the quality of the product because of our pile of untriaged bugs.

    He called a meeting with me, the QA manager, and the tech support manager. His advice: “Triage every single bug in this fashion and tell me how many bugs we’ve got to fix in order to ship this Beta.” And then he left.

    Every single bug. 537 bugs. You gotta read the bug, possibly reproduce it, and then make an educated team decision. Let’s assume an average of five minutes per and you’re talking about… crap… 45 hours of bug triage. It’s an impossible task. I’ve got features to fix, people to manage, and I haven’t seen the sun on a Saturday in two weeks.

    Let’s take a brief segue and talk about the huge value that exists in a bug database. In just about every company I’ve worked at, the only source of measurable truth regarding the product is the bug database. Marketing documents get stale. Test plans become decrepit. Test case databases slowly mutate into the unusable personal to do list of QA. The bug database is the only source of data regarding your product.

    I know this. I know that once I’ve effectively scrubbed the bug database, I’ve got the single most informed opinion regarding the product.


    537 unscrubbed bugs? 40+ hours of bug drudgery?

    Please. I’ve got a product to ship.

    My normal approach when faced with an impossible task is analysis because analysis gives you data, which in turn allows you to make a confident decision. So, I do what I did above: carefully estimate how long it will take to complete… 5 minutes x 537 = impossible. This fair estimate freezes me with fear. How in the world am I going to get my other five jobs done whilst scrubbing 40 hours of bugs? Once I’m good and lost in that fear, the impossible task, I’m no longer thinking abut getting the task done, I’m thinking about the fear.

    My advice is: START.

    “But Rands… I’ve got three hundred tests to run and one day to…”

    Stop. Go run one test. Now.

    “Wait, wait, wait. Rands. Listen. They need this spec tomorrow @ 9am…”

    Shush. Quiet. Go write. Just a paragraph. Now.

    Welcome to Trickle Theory.

    Our Villain

    My traditional first move when managing impossible tasks is to put the task on a to-do list.

    “There! It’s on the list. AaAaaaaaah… didn’t that feel good? It’s on the to-do list, which must mean it will be done at some point, right?” Wrong. Putting the task on the to-do list does one thing: it avoids The Critic.

    Every story needs a villain and in this piece our villain is The Critic. This is your internal voice which does careful and critical analysis of your life and he’s gained a powerful place in your head because he’s saved your butt more than once.

    He’s the one who told you that offer from the start-up smelled too good to be true. You remember that company, right? The one that simply vanished three months after you declined that stunning offer letter. It was The Critic who said, “How in the world can they afford to give anyone this type of offer when I don’t even understand their business model?”

    The Critic was the one who calmed you inner nerd and convinced you to not buy HDTV three years ago and he told you not to trust that fast talking engineering manager who emphatically guaranteed his team would be done on schedule. The Critic said, “People who talk fast are moving quickly to cover up the gaps in their knowledge.”

    The Critic was right. The Critic gained credibility, but for this piece, he’s still the villain.

    I know it feels great to get that impossible task on the to-do list. I know it feels like you actually did something, but what you’ve done is avoid conflict. You know that if you start considering the impossible task, The Critic is going to chime in with his booming voice of practicality, “RANDS, what are you THINKING? NO ONE ADDS FEATURES TWO WEEKS BEFORE A SHIP DATE!”

    “Ok, alright, you’re right, but the boss wants it and when the boss gets something in his head it takes a lot of work to blah blah blah…” Now, you’re justifying, you’re worrying, and you’re arguing with The Critic when what you should be doing is starting.

    Nothing Happens Until You Start

    Let’s first break down impossibleness. For the sake of this article, there are two types of impossible tasks. First, there are impossibly dull tasks. This is work which requires no mental effort, but is vast in size. Bug scrubbing is a great example of this. At the other end of the spectrum are impossibly hard tasks. These are tasks like, “Hey Rands, we need a new product by Christmas. Yes, I know it’s October. Ready. Go!”

    Oddly, attacking both boring and hard tasks involve the same mental kung-fu where your first move is starting.

    Such silly, trivial advice… start. Still, take a moment and examine your mental to-do list or just look at your written one. How many terribly important tasks have been there more than a month? More than a year? Embarrassing, huh? It’s not that they’re not important; it’s just that you didn’t begin and you didn’t begin because the moment you think about starting, The Critic weighs in, “How will even start? You’ll never finish! You don’ t even know where to start.”

    Begin. Go read the first bug. Don’t think about how many are left. Go to the next one and watch what happens. In just a few minutes, you’ll have made something resembling progress. Two more bugs and it’ll start to feel like momentum. Progress + momentum = confidence. The moment you see yourself tackle the smallest part of the impossible task, the quieter The Critic becomes because you’re slowly proving him wrong.


    The second piece of advice is simpler than the first, which is hard to imagine. Iterate. Once you’ve kicked yourself out of stop, iterate becomes a little easier, but if you’re truly tackling an impossible task, The Critic simply isn’t going to shut up.

    “Wow, you’ve closed five bugs… Only 532 more to go, sport!”

    Iteration and repetition aren’t going to silence The Critic. Progress will. A beautiful thing happens when you point your brain at an impossible task. Once you’ve begun and start chewing on whatever the task is, you’ll start to see inefficiencies and begin to fine-tune your process. This is how an engineer who tells you, “It’s going to take two weeks to write that code” comes back after the weekend and says, “It’s done”. He honestly believed that it was a two week task, but as soon as he started chewing on the problem, he realized he’d written similar code a year ago, which, with a half a Saturday of tweaking, provided the same functionality.

    The same applies to small, duller impossible tasks. Above where I estimated it’d take 5 minutes of triage for each bug, I didn’t take into consideration that
    after about 50 bugs, I was going to be really good at scrubbing bugs. I’d start to identify people who generally wrote good bugs versus those who didn’t have a clue. I’d learn the problematic areas of the product and learn where I could make snap judgments regarding bug viability. What was a five-minute triage window for the first 50 bugs was one minute for the next 50 and that turned into an average of 15 seconds per bug for the second hundred when I really got rolling.

    This means that my original estimate of needing 45 hours for bug scrubbage turned out to be roughly 7 hours. What I thought would take a week is actually going to take one solid day.

    Do not believe that this gives you the authority to slice every single estimate by 5. Turns out that impossible tasks, upon consideration, actually are terrifically hard. Believe this; an individual tends to be very bad at work estimates until they’ve begun the work.


    Crap. You’ve been saddled with an impossible task and after a weekend of no sleep you have confirmed, yes, the task is impossible. In fact, you’ve started, you’ve iterated, and you still have no clue how to actually complete the task. Story time.

    This spring I had a crew come up to clear some brush on the property. Now, the property is a pleasant combination of oaks, bays, and redwoods, but much of it had become overgrown and inaccessible. My first thought when I moved in was, “Hell yes, I’ve got clearing mojo!” My thought after one weekend of clearing, when I was partially successful at clearing up 50 square feet of 5 ACRES OF FOREST was, “Impossibly boring”.

    This attitude gave me a unique curiosity when the crew of three men showed up, chain-saws in hand, to clear the land. They had no issue starting and they clearly had the iteration thing down, but they also demonstrated the last and most component to Trickle Theory: mix-it-up.

    It went like this: one guy would cut and drag brush into the fire, another would cut trees down, and the third would trim fallen trees. This went on for a while and then they’d all switch. Now, drag guy was cut guy, cut guy was hauling wood guy and trim guy was stack guy. During lunch, I sat down and asked, “When do you guys switch jobs?”

    “When we’re bored.”

    Beautiful, beautiful Trickle Theory. How cool is this? If you’re working on an impossibly hard or impossibly dull task and you find yourself mentally blocked by boredom or confusion, stop and do something else. The benefits of stopping are stunning.

    First, stopping smacks The Critic squarely across the face. See, he’s also the voice in your head saying, “Uh, if we don’t work hard on this, we’re screwed”. And the longer you sit there grinding out the impossible task when you don’t want to, the louder he gets.

    Second, stopping to do something else is fun for you and your brain. It breaks the cycle of whatever tasks you’re doing and points your grey matter at a whole new problem and your brain loves new, it consumes new with vim and vigor, and that puts spring in your proverbial mental step.

    Third, and most important, even though you are stopping, your brain is bright enough to keep background processing the impossible task. This is why we find so much inspiration in the shower; you’re stopping and letting your brain wander, and your brain is smart. Your brain knows how important it is to rewrite that feature in two days and your brain is always working on that feature whether you know it or not.

    “Wait, wait, wait. Rands, let me get this straight. Your suggestion when I’ve got a looming impossible deadline is to stop working on my deliverables?”

    What I’m saying is, when you’re facing an uphill mental battle with yourself regarding the impossible task, it’s time to choose another battle… that isn’t a battle.

    Entropy Always Wins

    My life appears to be an endless series of tasks which are geared to slightly tidy up my world. Viewed as a whole these tasks represent a lot of work. Viewed against the actual amount of entropy in play in my small part of the world, these tasks represent a futile effort.

    Fact is, your world is changing faster than you’ll ever be able to keep up with and you can view that fact from two different perspectives:

    1) I believe I can control my world and through an aggressive campaign of task management, personal goals, and a CAN DO attitude, I will succeed in doing the impossible. Go me!


    2) I know there is no controlling the world, but I will fluidly surf the entropy by constantly changing myself.

    Surfing entropy takes confidence. This isn’t Tony Robbins confidence, this is a personal confidence you earn by constantly adapting yourself to the impossible.

    # September 25, 2006


    It's the end of the world as we know it (and I feel fine)

    That's great, it starts with an earthquake, birds and snakes, an aeroplane -
    Lenny Bruce is not afraid. Eye of a hurricane, listen to yourself churn -
    world serves its own needs, regardless of your own needs. Feed it up a knock,
    speed, grunt no, strength no. Ladder structure clatter with fear of height,
    down height. Wire in a fire, represent the seven games in a government for
    hire and a combat site. Left her, wasn't coming in a hurry with the furies
    breathing down your neck. Team by team reporters baffled, trump, tethered
    crop. Look at that low plane! Fine then. Uh oh, overflow, population,
    common group, but it'll do. Save yourself, serve yourself. World serves its
    own needs, listen to your heart bleed. Tell me with the rapture and the
    reverent in the right - right. You vitriolic, patriotic, slam, fight, bright
    light, feeling pretty psyched.

    It's the end of the world as we know it.
    It's the end of the world as we know it.
    It's the end of the world as we know it and I feel fine.

    Six o'clock - TV hour. Don't get caught in foreign tower.
    Slash and burn, return, listen to yourself churn.
    Lock him in uniform and book burning, blood letting.
    Every motive escalate. Automotive incinerate.
    Light a candle, light a motive.
    Step down, step down. Watch a heel crush, crush.
    Uh oh, this means no fear - cavalier.
    Renegade and steer clear! A tournament, a tournament, a tournament of lies.
    Offer me solutions, offer me alternatives and I decline.

    It's the end of the world as we know it.
    It's the end of the world as we know it.
    It's the end of the world as we know it and I feel fine.

    The other night I tripped a nice continental drift divide. Mount St. Edelite.
    Leonard Bernstein. Leonid Breshnev, Lenny Bruce and Lester Bangs.
    Birthday party, cheesecake, jelly bean, boom! You symbiotic, patriotic,
    slam, but neck, right? Right.

    It's the end of the world as we know it.
    It's the end of the world as we know it.
    It's the end of the world as we know it and I feel fine...fine...

    Sure as hell change is scary! But it's in that scariness that I find my mental health and peace of mind. I started my application to UGA's PhD program in IT.... I can hear the gallery crying "It's about fucking time." And it is but now I'm 100% into it and nothing will stop me from getting there.  Application is done, all I need is to contact the department to make sure that I'm sending the right information to the right  people. I'm also applying to USU's Doctoral Program in IT as an insurance measure and for the additional challenge.

    This is my way of telling my instincts that I'm sorry for not having paid attention to them and to my brain to say it's time to start the next challenge.

    I'm also starting to think beyond the PhD programs I'm applying to now. I have to be optimistic about getting accepted to at least one of the schools above. But I also have to be realistic enough to know that I may not.  In that case I may just go for a doctoral degree at Berkeley's School of Information or maybe a doctorate in curriculum studies and teacher education at Stanford and take it from there.

    I didn't see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.

    Steve Jobs' Comencement @ Stanford

    It is so freeing and relaxing to be in this situation! I think it's the first time in months that I can relax and not worry about what's coming next, at least until I take the GRE in June 🙂

    Supernatural or Superserious?

    R.E.M (Accelerate)

    "my brain is the key that sets me free" - harry houdini, 1874-1926

    everybody here
    comes from somewhere
    that they would just as soon forget
    and disguise

    at the summer camp where you volunteered
    no one saw your face,
    no one saw your fear
    if that apparition had just appeared
    took you up and away
    from this base and sheer

    of your teenage station.

    nobody cares
    no one remembers
    and nobody cares

    yeah you cried and you cried
    he’s alive he’s alive
    yeah you cried and you cried and you cried and
    you cried
    if you call out “safe”
    then I’ll stop right away
    if the premise buckles
    and the ropes start to chafe
    the details smart
    but the story’s the same
    you don’t have to explain,
    you don’t have to explain

    of your teenage station.

    yeah you cried and you cried
    he’s alive he’s alive
    yeah you cried and you cried and you cried and

    realized your fantasies
    are dressed up in travesties
    enjoy yourself with no regrets

    everybody here
    comes from somewhere
    that they would just as soon forget
    and disguise

    yeah you cried and you cried
    he’s alive he’s alive
    yeah you cried and you cried and you cried and
    you cried

    now there’s nothing
    dark and there’s nothing weird
    don’t be afraid i will hold you near.
    from the seance where you first betrayed
    an open heart on a darkened stage.

    a celebration
    of your teenage station.

    inexperience, sweet, delirious.
    supernatural, superserious.
    inexperience, sweet, delirious.
    supernatural, superserious,

    Feeling down

    My December
    Linkin Park (Hybrid Theory)

    This is my December
    This is my time of the year
    This is my December
    This is all so clear
    This is my December
    This is my snow covered home
    This is my December
    This is me alone

    And I
    Just wish that
    I didn't feel
    Like there was
    Something I missed
    And I
    Take back all
    The things I said
    To make you
    Feel like that
    And I
    Just wish that
    I didn't feel
    Like there was
    Something I missed
    And I
    Take back all the
    Things I said to you

    And I give it all away
    Just to have somewhere
    To go to
    Give it all away
    To have someone
    To come home to

    This is my December
    These are my snow-covered trees
    This is me pretending
    This is all I need

    And I
    Just wish that
    I didn't feel
    Like there was
    Something I missed
    And I
    Take back all
    The things I said
    To make you feel like that
    And I
    Just wish that
    I didn't feel
    Like there was
    Something I missed
    And I
    Take back all the things
    I said to you

    And I give it all away
    Just to have
    Somewhere to go to
    Give it all away
    To have someone
    To come home to

    This is my December
    This is my time of the year
    This is my December
    This is all so clear

    And I give it all away
    Just to have somewhere
    To go to
    Give it all away
    To have someone
    To come home to

    How to Stop Checking Email on the Evenings and Weekends

    Via (Lifehacker)

    Best-selling author Tim Ferriss offers digital minimalism tips to reduce the amount of time you spend in your email inbox.

    Investment bankers aren't known for their impulse control. Several global firms in Zurich don't allow their bankers to check email more than twice per day. The reason is simple: the more they check email, the more compelled they feel to send email. Technologist Robert Scoble has said that for each email he sends, he gets 1.75 to 2 messages in return. This phenomenon highlights the unscalable nature of most time-management approaches: striving to do more just produces increasingly more to do.

    Fifty email messages beget 100, which beget 200 and so on. It's impossible to manage this with a results-by-volume (or frequency) approach. There are two cornerstone behavioral changes for reversing this trend: check email less frequently (so we send fewer messages) and send fewer messages when we do check (so we trigger fewer exchanges).

    Here are eight concrete tips and services for digital minimalism that can help eliminate—as a start—compulsive inboxing during the evenings and weekends.

    Treat all of them as short experiments and customize.

    1. "Batch" email at set times.

      Have an email-checking schedule and do not deviate. There is an inevitable task-switching cost otherwise—U.S. office workers spend 28% of their time switching between tasks due to interruption, and 40% of the time, an interrupted task is not resumed within 24 hours. Use template autoresponders to alert people of your email schedule and encourage them to call if something needs faster attention. The "urgent" email-to-call conversion is usually less than 10%.

      This gives you breathing room to focus on predefined to-do's instead of responding to manufactured emergencies and ending the day with nothing to show for it.

      Alternative approaches include appending your signature with your email schedule, having only email from certain contacts forwarded to your Crackberry/PDA, and—if a manager of a small group—setting an inbox checking schedule for internally-generated email. Ensure that your first batch is around 10 or 11 a.m. and never first thing in the morning, as you want a meaningful volume (1/4-1/3rd of the daily total), and you should accomplish at least one critical to-do before going into reactive mode.

    2. Send and read email at different times.

      Go offline and respond to all email from a local program such as Outlook or Mail to avoid having the outgoing flow interrupted by immediate responses.

      Ever noticed how effective it is to respond to your email while on an airplane? Manufacture that environment by going offline to batch send.

    3. Don't scan email if you can't immediately fix problems encountered.

      One simple example: don't scan the inbox on Friday evening or over the weekend if you might encounter work problems that can't be addressed until Monday. This is the perfect way to ruin a weekend with preoccupation. Remember that just as income has no value without time, time has no value without attention.

    4. Don't BIF people during off-hours.

      "BIF" stands for "before I forget" and refers to emails sent on evenings or weekends out of fear of forgetting a to-do or follow-up. This sets a mutual expectation of 24/7 work hours and causes a plethora of problems. There are a number of better alternatives. First, use a service like Jott.com instead that allows you to send voice reminders via cell, which are transcribed and sent to your inbox or someone else's. If to someone else's, be sure to add "no need to respond until [next work hours]." Second, if you prefer low-tech, externalize follow-ups and to-do's in a small notebook like a Moleskine instead of entering the "bet you can't eat just one" inbox.

    5. Don't use the inbox for reminders or as a to-do list.

      Related to 4 above. Don't mark items as "unread," star them, or otherwise leave them in the inbox as a constant reminder of required actions. This just creates visual distraction while leading you to evaluate the same items over and over. Put them into a calendar (or Moleskine or other capturing system) for follow-up and archive the email, even if that calendar item is just "Respond to 2/10 email from Suzie." (Editor: See Lifehacker's "Trusted Trio" system for moving email messages out of your inbox and into one of three places: Archive, Hold (calendar item for a later date), or Follow-Up (your to-do list.))

    6. Set rules for email-to-phone escalation.

      One Senior VP in a Fortune 500 company recently told me that he's established a simple policy with his direct reports that has cut email volume by almost 40%: once a decision generates more than four emails total in a thread, someone needs to pick up the phone to resolve the issue.

    7. Before writing an email, ask yourself: "what problem am I trying to solve?" or "what is my ideal outcome?"

      Unclear purpose, usually a symptom of striving to be busy instead of productive, just requires later clarification from all parties and multiplies back-and-forth volume. Be clear in desired results or don't hit that Send button

    8. Learn to make suggestions instead of asking questions.

      Stop asking for suggestions or solutions and start proposing them. Begin with the small things. Rather than asking when someone would like to meet next week, propose your ideal times and second choices. If someone asks, "Where should we eat?", "What movie should we watch?", "What should we do tonight?", or anything similar, do not reflect it back with "Well, what/when/where do you want to...?" Offer a solution. Stop the back and forth and make a decision. Practice this in both personal and professional environments. Here are a few lines that help (my favorites are the first and last):

      "Can I make a suggestion?"
      "I propose..."
      "I'd like to propose..."
      "I suggest that... what do you think?"
      "Let's try... and then try something else if that doesn't work."

    Remember: in email, the small things are the big things. If you can cut an exchange from six to three email messages, that's a 50% reduction in your inbox volume over time. This can make the difference between working all the time and leaving the office (both physically and mentally) at 5 p.m.

    Less is m

    Timothy Ferriss is author of the #1 New York Times bestseller, The 4-Hour Workweek.

    Read More:

    Practicing Patients

    Published: March 23, 2008
    Todd Small was stuck in quicksand again. It happened, as always, on the floor of the Seattle machine shop where he worked. His shift complete, Small was making the 150-yard walk from his workstation to his car, when he realized that his left leg was sinking deep in the stuff. Though this had happened before — it happened nearly every day now — he stopped and glanced down at his feet. His Nikes looked normal, still firmly planted on the shop’s concrete floor. But he was stuck, just the same. His brain was sending an electrical pulse saying “walk,” but as the signal streaked from his cerebellum and down his spinal cord, it snagged on scar tissue where the myelin layer insulating his nerve fibers had broken down. The message wasn’t getting to his hip flexors or his hamstrings or his left foot. That connection had been severed by his multiple sclerosis. And once again, Small was left with the feeling that, as he described it, “I’m up to my waist in quicksand.”
    For the 400,000 Americans with multiple sclerosis, Todd Small’s description will most likely ring true. Muscle stiffness is a hallmark of the disease, and “foot drop” — the term for Small’s quicksand feeling — is a frequent complaint. The condition is usually treated, as it was in Small’s case, with baclofen, a muscle relaxant that works directly on the spinal cord. Every day for 14 years, he took a single 10-milligram pill. “My neurologist always told me if you take too much it will weaken your muscles. So I never wanted to go over 10 milligrams.” It didn’t seem to have much effect, but he carried on as best he could.
    Small would have continued just as he was had he not logged on last June to a Web site called PatientsLikeMe. He expected the sort of online community he’d tried and abandoned several times before — one abundant in sympathy and stories but thin on practical information. But he found something altogether different: data.

    After choosing a user name and filling out a profile, Small was asked to list his symptoms and treatments. He entered the 200 milligrams of Provigil he takes daily to fight fatigue along with the Tysabri injection he takes to slow the progress of his disease. And then he clicked on baclofen, and the Web site informed him that nearly 200 patients registered at PatientsLikeMe were taking the drug. He clicked again, and up popped a bold bar graph, sectoring those 200 across a spectrum of dosages. And there it was. Contrary to what his neurologist told him years ago, 10 milligrams wasn’t the maximum dose. In fact, it was at the low end of the scale. “They’re taking 30, 60, sometimes 80 milligrams — and they’re just fine,” Small recalls. “So it hits me: I’m not taking nearly enough of this drug.”

    A few days later, Small asked his neurologist to up his dosage. Now Small takes 40 milligrams of baclofen a day. His foot drop isn’t cured — there are no miracles in M.S. — but he has found that after 14 years, he can walk to his car without sinking into quicksand. “Oh, man, I really dreaded that walk,” Small recalled when I spoke with him recently. “All shift, it’d be in the back of my mind. Am I going to have trouble? Is it going to get me? Now I almost got it figured it out. I don’t struggle like I used to.”

    There are a little more than 7,000 Todd Smalls at PatientsLikeMe, congregating around diseases like Parkinson’s, multiple sclerosis (M.S.) and AIDS, all of them contributing their experiences and tweaking their treatments. At first glance, the Web site looks like just any other online community, a kind of MySpace for the afflicted. Members have user names, post pictures of themselves and post updates and encouragements. As such, it’s related to the chat rooms and online communities that have inhabited the Internet for more than a decade.

    But PatientsLikeMe seeks to go a mile deeper than health-information sites like WebMD or online support groups like Daily Strength. The members of PatientsLikeMe don’t just share their experiences anecdotally; they quantify them, breaking down their symptoms and treatments into hard data. They note what hurts, where and for how long. They list their drugs and dosages and score how well they alleviate their symptoms. All this gets compiled over time, aggregated and crunched into tidy bar graphs and progress curves by the software behind the site. And it’s all open for comparison and analysis. By telling so much, the members of PatientsLikeMe are creating a rich database of disease treatment and patient experience.

    And that’s no small thing. As modern medicine has reduced infectious disease in the U.S., the country’s population — like those in other developed nations — has shifted to longer-term, chronic ailments like heart disease and diabetes, diseases that patients must cope with for years and even decades. What’s more, conditions like high cholesterol and obesity demand years of vigilance to minimize their chances of leading to more serious health problems.

    Disease management has become a national reality, a common experience that demands uncommon attention. And PatientsLikeMe is a tool that allows patients to manage their disease with a sophistication and precision that would have been unimaginable just a decade ago. The
    7,000 members of PatientsLikeMe, in other words, are beta testers — they may be the vanguard of how we all will care and treat our résumé of chronic diseases. They’re not typical patients, in the sense of waiting for advice from a doctor. They are, rather, co-practitioners treating their conditions and guiding their care, with possibly profound implications. “People who use it will live longer; people who don’t won’t,” boasts Jamie Heywood, the provocative co-founder of PatientsLikeMe. “That’s evolution.”

    Of course, turning patients’ experiences into usable data raises a host of questions for medicine. When patients take the reins of their own treatment, what role do doctors play? What’s to keep patients from misinterpreting the streams of data and finding false hope — and what’s stopping them from embarking on unproven and even risky treatments or dosages? And what happens if the real-world information at PatientsLikeMe contradicts the clinically proved protocols of medical science?

    For many in the medical community, these are unexpected and unsettling questions. And they reflect the broader concern that many doctors have with the Internet’s emergence as a powerful source of medical information. According to a 2006 study by the Pew Research Center, 80 percent of Internet users, or about 113 million adults in the U.S., get health information from the Internet. Some physicians disdain this trend, bemoaning their hyperinformed patients as “Googlers.”

    Yet even doctors who consider themselves advocates of online medical information raise concerns about patients self-medicating or self-treating. Erik Ensrud, a neurologist at Brigham and Women’s Hospital in Boston, specializes in many of the diseases that PatientsLikeMe focuses on. “The nervous system is the most complicated system in the body,” he says. “It’s so often much more difficult to quantify and study than we think it will be.”

    For the members of PatientsLikeMe, though, the Web site can seem like a revelation — it’s a community forged not only around shared circumstance but also around a shared purpose. They say they are part of a project that may change the way their disease is treated and could change the way medicine is practiced. It’s an experiment in the future of medicine, running in real time.

    PatientsLikeMe started with a single case of amyotrophic lateral sclerosis. In 1998, Stephen Heywood, a 29-year-old carpenter, learned that he had A.L.S., a neurodegenerative disorder commonly known as Lou Gehrig’s disease. Jamie, his older brother, quit his job to find a cure. An M.I.T.-trained mechanical engineer with a knack for neuroscience, Jamie founded the A.L.S. Therapy Development Institute in Cambridge, Mass., the following year. So began a radical quest to save Stephen’s life. They tried experimental drug therapies, they tried a stem-cell transplant and they tried a neural implant, each effort building on the previous one. After six years, Stephen was among the most documented A.L.S. patients in the world.

    The sheer volume of Stephen’s data gave Jamie an idea — a notion hatched while browsing Match.com, the online dating site. The aspiring singles there had posted a trove of information about themselves — their likes and dislikes, their dating histories, their height and weight — all to find a perfect match. Jamie realized that a similar tool might be useful in the realm of disease, for treatment rather than romance. If patients shared their information and could find someone with a similar symptomatology and disease history, then they might better plot their own course of treatment and care. And it didn’t just have to be A.L.S. — it could work for any disease.

    Jamie tapped his brother Ben, who also went to M.I.T. before earning his M.B.A. at U.C.L.A., and Jeff Cole, a college classmate of Ben’s who’d spent several years building dot-coms. They started with Stephen’s own case history, breaking it down into drug dosages, symptom severities and so on. In March 2006, PatientsLikeMe opened for business. Within a few months, the company added communities for M.S. and Parkinson’s disease. Last fall the company opened a community for people with H.I.V. Earlier this month, the company placed its biggest bet on the model of collective experience, creating a community for the millions of Americans with a mental-health condition.

    The Web site gathers patient information on two levels: first there’s a quantitative breakdown of symptoms and dosages, data that the software instantly turns into charts and graphs. Second are the forums, where members share advice and provide more nuanced feedback on a certain drug or treatment issue. The site is designed so that relevant data bolster the conversations in the forums and vice versa.

    “Our job is to allow a conversation with the computer that will match a conversation between two patients,” Jamie explains. “Then we capture that dialogue and turn it into useful, clean data.”

    Stephen died the day after Thanksgiving in 2006, but his profile, under the user name ALSKing101, still contributes to that dialogue. Like many people with advanced A.L.S., in his last three years, Stephen was living in a wheelchair, completely paralyzed and breathing through a mechanical vent. One night his breathing tube snagged and disconnected, and he suffocated while he was sleeping. Such a death isn’t unknown for A.L.S. patients, and many PatientsLikeMe members — about 75 are on ventilators — have expressed fears about dying that way. Their main concern is that suffocation is a painful, unpleasant way to go.

    As it turns out, the PatientsLikeMe community tries to allay that fear. At least two other members of the site have, in fact, had their breathing tubes accidentally disconnected and suffocated until passing out — only to be found and resuscitated, just in time. They have, in other words, almost died in just the way Stephen did, in the way so many have feared, but lived to tell about it: “Long story short, my vent hose came off in ’97, and I was certain I was going to die. I stared at the clock for exactly 10 minutes until I got tunnel vision then passed out. Nothing painful, stressful or anxious about it. It was like I just got sleepy and went to sleep. Suffocation was nothing like what I expected. Lol.” Laugh out loud, indeed.

    The company is located in the brick-walled basement of a former twine factory, less than a mile from the M.I.T. campus in Cambridge. With just 15 employees, it is very much in start-up mode. Cole, who is 36, manages the site’s design and software team; Ben Heywood, also 36, handles overall operations and management; Jamie, 41, is the frenzied visionary, ever eager to sketch out how powerful a database of 7,000 patient
    profiles can be. The company, which is financed by private investors, eschews advertising; the business model instead seeks to exploit the value of the databank itself. By and large, this means working with pharmaceutical companies. The company has had discussions with several drug firms to sell anonymized patient data on various symptoms and treatments. They have also recruited PatientsLikeMe members to be participants in clinical drug trials. Ultimately, the company expects that the data will generate insights with considerable scientific — as well as economic — value.

    One afternoon in late November when I visited the office, Jamie turned to a nearby whiteboard and traced out an x-y axis, slashing a descending line from left to right. “We have the ability to run a probability engine,” he said. “We can mathematically model each patient. We can tell them what’s going to happen in their life. We can tell you when you’ll need a wheelchair.” He made a mark along the line. “And we can even tell you the day you’ll die, with remarkable certainty.”

    Of course, Jamie’s spiel is part bravado. The company hasn’t started to predict specific patients’ prognoses — though they have filed for a patent covering such prediction tools. And not all quests for scientific precision are likely to succeed or prove worthwhile. But for the patient coping with the cascade of day-to-day decisions that come with managing a disease, the site’s aggregations offer a remarkable tool.

    Every day, like 453 other members with M.S., Laurie Fournier gives herself an injection of Copaxone, a drug that impedes the disease’s progress. Together, the group has generated what amounts to a checklist of best practices. Fournier has learned that by doing the injection herself, “John Wayne-style,” rather than using an auto injector, she can avoid some of the bruising that’s a particularly aggravating side effect. And she has learned that the optimal needle stick goes through the skin and into the fat layer — but no further. “You don’t want to get muscle,” she relates. “Last time I did that, I couldn’t use that leg very well for a day and a half.”

    Fournier, a self-described information junkie, relates all these details with a blasé precision. Her willingness to put so much information about herself online may seem immodest, even imprudent. But not to her. “I don’t worry too much about that,” she says. “Pretty much everybody I know over 45 has some kind of medical condition. Some people have had cataracts surgery, or they have high blood pressure, or high cholesterol or diabetes. Everyone has something. And if everyone has something, that really levels the playing field.”

    “Any disease that is treated as a mystery and acutely enough feared will be felt to be morally, if not literally, contagious,” Susan Sontag wrote in 1978, in “Illness as Metaphor.” “Contact with someone afflicted with a disease regarded as a mysterious malevolency inevitably feels like a trespass; worse, like the violation of a taboo.” The antidote to such stigma, she suggested, is “to rectify the conception of disease, to demythicize it.”

    But the myths surrounding disease are hard to dispel, our impulse to hide in metaphor difficult to shake. We still talk of wars on cancer and plagues of lawyers. “Leper” endures as a metaphor for stigma, long after leprosy itself has been eliminated from most of the world.

    Stigma endures in more material ways, as well — most pointedly in concerns over medical privacy. For decades, our personal health information has been protected largely by disorganization and chaos, suggests Mark Rothstein, a bioethics and health-policy professor at the University of Louisville. But now, with major health-maintenance organizations and hospitals finally adopting electronic records, fallow storerooms of paper records are being converted into neat and portable digital form. “Technology is racing ahead of society,” says Rothstein, who advises the Department of Health and Human Services on electronic privacy. “If this is sensitive information — sexual history, mental illness, substance abuse — even if nothing bad happens, people are subject to stigma and embarrassment.”

    The government has tried to protect patient privacy, most notably with the Health Insurance Portability and Accountability Act, or Hipaa. Enacted in 1996 to help streamline the adoption of electronic records, Hipaa was modified in 2002 to address concerns over how those records might be misused or distributed to unauthorized people. The law stipulates that if 18 categories of personally identifiable information are stripped from records then they may be transferred for research purposes without a patient’s consent.

    Perhaps not surprisingly, Hipaa satisfies no one — not the privacy advocates, who argue against most any form of electronic record, and not the medical researchers, who now face onerous restrictions on their work. PatientsLikeMe upends this dialectic; in technology terms, it routes around the problem. Since the company is an opt-in service and not a health-care provider, Hipaa doesn’t apply. Good thing, really, since the site identifies members’ cities and their ages, two of Hipaa’s 18 prohibited categories of personal information.

    But Hipaa is extraneous not just legally but philosophically as well. Many PatientsLikeMe members volunteer even more information from those 18 categories. They not only post their photos but also post photos of their children and spouses. They add brief autobiographies and describe their conditions in precise detail — including potentially embarrassing particulars on sexual function, bladder control or constipation. And though they all have user names, most go by their first names on the site’s forums.

    PatientsLikeMe’s privacy policy clearly sta
    tes that this sharing carries risks. It acknowledges that since anybody can register at the Web site, anybody can look at member profiles. It makes clear that there’s no guarantee that registered members are, in truth, who they say they are. And it nods to the fact that, yes, this is a business, not a public service — some personally identifiable information may be sold to “approved vendors.” But this is boilerplate. The most striking notice is the company’s Openness Philosophy, a manifesto posted prominently on the site.

    “Currently, most health-care data is inaccessible due to privacy regulations or proprietary tactics,” it declares. “As a result, research is slowed, and the development of breakthrough treatments takes decades. . . . When you and thousands like you share your data, you open up the health-care system. . . . We believe that the Internet can democratize patient data and accelerate research like never before.”

    In 1990, Alan Westin, a political scientist at Columbia University and an expert in privacy issues, offered a useful taxonomy of Americans’ attitudes toward privacy. On one end of the spectrum were what he called privacy fundamentalists — the 25 percent of Americans who feel that their privacy is paramount and that no one, not the government or corporations or their family, should have access to their personal information without explicit permission. At the other end of the spectrum were the privacy-unconcerned — about 15 percent of Americans — who paid no mind to privacy issues and didn’t figure they had anything to hide. In the middle were the vast majority, the 60 percent whom Westin called privacy pragmatists: those who felt that they could give a company they trusted some information — birth date, ZIP code, telephone number — for particular benefits.

    The members of PatientsLikeMe aren’t all radicals culled from the privacy-unconcerned, though no doubt some are. Most more likely fit the profile of pragmatists. “I know it sounds like really personal information, but it’s not like I’m putting my phone number up,” says Jennifer Jodoin, a hotel manager in Palm Beach, Fla., who has changed her M.S. medications based on information gleaned at PatientsLikeMe. “I’m not posting my address and saying, ‘Come on by.’ It’s an exchange of information to get help and to give help.”

    That pretty much defines pragmatism, and it exemplifies these strategic information-for-benefit exchanges people make like taking a blood test to get life insurance or consenting to a background check to secure a new job. Only now, at places like PatientsLikeMe, information has a currency that’s far more liquid than ever. Converted into data and bundled with information from those like us, private information can be invested for both immediate gains and long-term returns.

    And there’s a fortunate side effect to converting your health history into data — it strips it of metaphor, of secrecy, of stigma. It becomes concrete, manageable and valuable. It becomes, just as Sontag suggested 30 years ago, demythicized.

    As diseases go, A.L.S. or M.S. or Parkinson’s or even H.I.V. are relatively rare afflictions, at least in the United States. Mental illness, on the other hand, afflicts a vast swath of the country. Nearly 60 million Americans have a diagnosable mental disorder, according to the National Institute of Mental Health, a population that includes everything from depression to bipolar syndrome to anxiety. For PatientsLikeMe, that population represents a huge market, not to mention the potentially lucrative bounty of data related to antidepressants and other mood-disorder drugs. But it also presents a challenge.

    Creating a PatientsLikeMe mental-health community — or as they call it, a “mood community” — requires a new strategy for measuring mental health. The challenge is in part semantic. Where the argot around A.L.S. or M.S. is largely clinical, the vernacular around mental health is more subjective. The official diagnostic criteria for major depression, for example, include “feelings of worthlessness” and “indecisiveness.” So PatientsLikeMe faces an input problem: how to convert the ambiguities of mental illness into metrics?

    Whatever its ultimate worth, the site’s answer is elegantly straightforward. Members can update their mood status every hour on a scale of 1 to 4, from very bad to very good. How they feel may be subjective, but the resulting data can be mapped across time. The site treats sessions of therapy as if they were a dose of Prozac; the type of therapy (say, group or individual) stands as the treatment, and the length of a session (say, 50 minutes a week) as the dosage.

    Such efforts at precise measurement and comparison are not the norm in evaluating mental-health treatment. Americans spend about $12 billion a year on antidepressants, but we still have little understanding of how or whether they work. In 2006, the National Institute of Mental Health released the results of the largest and longest depression study ever undertaken, the Sequenced Treatment Alternatives to Relieve Depression Study, or Star-D. Star-D rejected typical clinical study design and aimed to create a real-world representation of how patients actually experience and treat depression: through trial and error, taking one drug after another, searching for one that helps.

    The results were mixed. Star-D found that if you’re depressed and spent three months on a potent psychotropic drug, you had a one-third chance of achieving remission. After almost six months on drugs, your chances bump up to about fifty-fifty — a coin flip — and you still risk side effects like sexual dysfunction, insomnia and weight gain. Those may be good odds for the industry, but it seems a poor bet for a patient.

    At PatientsLikeMe, Ben Heywood sees pure opportunity in such statistics. “Those odds just aren’t good enough,” he says. “So you try Wellbutrin, and after six weeks it doesn’t work. Then Prozac. Doesn’t work. Now what? Where do you go next?” Plugged in to a community of patients sharing their depr
    ession histories and treatments, Ben argues, patients could readily find someone with symptomatology close to their own, compare drug regimens and go straight to the drug that may be more likely to work for them.

    This, for patients, is the promise of a mental-health community: better tailoring of treatments. It is also the promise of the site as a business. The pharmaceutical industry should be eager to improve the accuracy and efficacy of its treatments. After all, sometimes side effects can turn into blockbusters, most famously when Pfizer scientists learned that their hypertension treatment was causing erections in men, leading the way to Viagra. Since PatientsLikeMe forgoes advertising, selling its data to pharmaceutical companies is its best apparent way to make money. But so far, it seems, the drug industry has balked at the prospect of knowing so precisely what happens to their products after they reach the market.

    If Jamie Heywood talks about his company as an incendiary force in the health-care industry — “This is the way it worked before ethics destroyed medicine,” he told me at one point — the American Medical Association would pretty much agree. From the perspective of many doctors,

    PatientsLikeMe raises many more questions and quandaries than it answers.

    Joe Heyman, a practicing physician in Amesbury, Mass., and the chair-elect of the A.M.A.’s board of trustees, praises the potential benefits of a tool like PatientsLikeMe for patients. He’s just uncomfortable with who’s minding the toolbox. “The idea of them is a wonderful thing,” he says. “But you know, as a physician I have a code of ethics. We have licensing boards and accreditation and all these people keeping an eye on us.” Heyman suggests that if physicians themselves aren’t sole stewards of the patient data — his first choice — then there should be some national standards or a law that covers a company like PatientsLikeMe that traffics in such data.

    Heyman is also uncomfortable with how PatientsLikeMe encourages patients to take their medical information and then act on it. “Sometimes patients misunderstand what a doctor says to them,” he says, “so by the time it gets to the third or fourth party it’s like a game of telephone. It’s not as reliable as coming from the horse’s mouth.”

    Heyman may be speaking from the perspective of the injured party — PatientsLikeMe could be seen as a direct challenge to physicians’ omniscience — but there’s still something to his concerns. PatientsLikeMe not only lets members track their disease; it also tacitly encourages them to take action. While PatientsLikeMe advises users to consult a doctor before changing their treatments or dosages — patients can print out an exhaustive status report, replete with graphs and charts, to take on doctors’ visits, and personal physicians can register as caregivers on the site — there will inevitably be patients who treat the Web site’s apparent rigor and depth as a substitute for a physician’s training and expertise.

    Erik Ensrud, the neurologist at Brigham and Women’s Hospital, worries that patients could spot an animal study or early-stage trial investigating an off-label usage of a drug and then start taking that drug in the hope that the researchers are onto something. “Even if a treatment seems promising, it could result in a very serious reduction in lifespan,” he suggests. “We’re talking survival.”

    In fact, some PatientsLikeMe members have already started doing pretty much what Ensrud warns against. Last November, the A.L.S. community was abuzz with word that researchers in Italy had found that taking lithium seemed to slow the progression of A.L.S. significantly. The Italian study hadn’t actually been published yet, but that didn’t stop 34 members with A.L.S. from soliciting lithium prescriptions from their doctors and coalescing into an ad-hoc clinical trial. There are now 109 members using lithium and tracking their progress with the data tools on the site. The company has rolled out new features to monitor the group with the hope that they will be able to lend a little credence — or cast a little doubt — on the Italian study in a matter of months.

    Jamie insists that PatientsLikeMe isn’t encouraging A.L.S. members to start taking lithium. But he is unmistakably excited by the endeavor. As he sees it, the experiment perfectly illustrates how PatientsLikeMe might complement large-scale and long-term clinical research by conducting observational research “on the fly.” Drawing on the notion of personalized medicine, Jamie calls this “personalized research.” And it has a certain logic: for those who already have A.L.S., traditional science works at far too plodding a pace. “The system is broken for terminally ill patients,” says Hanns Riederer, a music producer in Los Angeles who has joined the group of A.L.S. members taking lithium. “It makes us wait five to seven years for results, when we don’t even have that time. Even if it’s half-true, it’s still groundbreaking. I don’t want to wait for something else. I don’t have time to wait.”

    While the members of PatientsLikeMe may seem exceptional today, they will be fairly typical tomorrow. As we learn more about disease and are able to identify it earlier, more and more Americans will fall under the rubric of “patient” and will need to navigate an array of confusing health decisions. Doctors don’t like to admit it, but “most treatment decisions right now are still based on doctors’ judgments that don’t have real research behind them,” says Jodi Halpern, a physician and bioethicist at the U.C. Berkeley School of Public Health. “But it takes real data to make the right decisions, especially for patients. There’s a powerful improvement in health outcomes, people’s quality of life, when people are better-informed.”

    Physicians, of course, have known this for decades; the idea of “evidence-based medicine” — that all decisions should be based on real data — was hatched in the 1980s. But the pace of traditional research is slow, and the number of outstanding questions far exceeds the body of evidence to answer them. Only now, with technologies like PatientsLikeMe, is the pace accelerating. What’s more, it’s becoming evident that data — the foundation of evidence and research — are present not just in laboratories or universities or the proverbial halls of science but in everyday life.

    Really, when you start looking, information can be found everywhere. If we could gather in structured communities and create databanks to inform our approach to life decisions, not just health decisions but also gardening or parenting or car-buying decisions, we could do everything in a more informed manner. Were we all to avow a philosophy of openness and churn our experiences into hard numbers, we could presumably improve our odds in all sorts of decisions. Why not a PregnantLikeMe or
    a ParentsLikeMe or even, really, an all-encompassing PeopleLikeMe?

    One evening, I suggested this bigger idea to Jamie and Ben. They shared a glance and a mock-conspiratorial smile, and then looked back at me. “We know,” Ben said. “We already own all those domain names.”

    Thomas Goetz is the deputy editor of Wired magazine.