In 2018, a short video circulated on WhatsApp claiming that the MMR vaccine was designed by Indian Prime Minister Narendra Modi to stop the population growth of Muslims. Subsequently, hundreds of madrassas across western Uttar Pradesh refused to allow health departments to vaccinate their constituents.

In 2020, a three-minute video claiming that the coronavirus vaccination campaign was secretly a plan by Bill Gates to implant trackable microchips in people was one of the most widely shared pieces of misinformation online. Alongside a torrent of online COVID-19 vaccine falsehoods and conspiracy theories, sources of medical mis- and disinformation are fostering distrust in COVID-19 vaccines, undermining immunization efforts, and demonstrating how poor information is a determinant of health.

Medical misinformation, referring to inaccurate or unverified information that can drive misperceptions about medical practices or treatments, has flooded the infosphere (all types of information available online). Examples can vary from overrepresentations of anecdotes claiming that complications occurred following inoculation to misinterpretations of research findings by well-meaning individuals.

Considering the many ways in which medical misinformation can shape health behaviors, researchers at the Oxford Internet Institute recently suggested that the infosphere should be classified as a social determinant of health (SDOH) (designated alongside general socioeconomic, environmental, and cultural conditions). This classification, they argue, properly accounts for the correlation between exposure to poor quality information and poor health outcomes.

The connection between information quality and health has been especially pronounced during the COVID-19 pandemic. A 2021 study found that amongst those who indicated that they would definitely take a COVID-19 vaccine, exposure to misinformation induced a decline in intent of 6.2% in the U.K. and 6.4% in the U.S. Further, misinformation that appeared to be science-based was found to be especially damaging to vaccination intentions. These findings are particularly concerning considering the fact that during the pandemic, the 147 biggest anti-vaccine accounts on social media (which often purport to be science-based) gained 7.8 million followers in the first half of 2020, an increase of 19%.

During an unprecedented health crisis, medical misinformation within the infosphere is leaving both individuals and communities vulnerable to poor health outcomes. Those who are unvaccinated are at a higher risk of infection and increase the likelihood of community transmission. This places undue burden on those who cannot get vaccinated—due to inequities and/or preexisting conditions—and increases opportunities for variants to continue to mutate into more infectious and/or deadly forms of the virus. Poor quality information within the infosphere is undermining immunization efforts and threatens to prolong the ark of the pandemic.

Leveraging Healthcare Provider Influence in the Battle Against Poor Quality Information

Healthcare providers are uniquely suited to respond to this challenge. Throughout the pandemic, majorities of U.S. adults have identified their doctors and nurses as the most trustworthy sources of information about the coronavirus. In fact, 8 in 10 U.S. adults said that they are very or somewhat likely to turn to a doctor, nurse, or other healthcare provider when deciding whether or not to get a COVID-19 vaccine.

This influence is especially pertinent considering the state of vaccine resistance across the globe. In March 2021, a Kaiser Family Foundation poll found that 37% of U.S. respondents indicated some degree of resistance to vaccination. If that percentage of Americans remain unvaccinated, the country will be short of what is needed to achieve herd immunity (likely 70% or more vaccinated). Similar levels of resistance to vaccination remain high in countries across the globe, such as Lebanon, Serbia, Paraguay, and France.

Although medical misinformation is contributing to high rates of refusal, it is important to note that drivers of vaccine resistance are complex and intersectional. Vaccine distrust or refusal may be rooted in exposure to anti-vaccine rhetoric, racial injustice or medical exploitation in healthcare, fears that vaccine development was rushed, and/or other drivers. For this reason, responses must be tailored to unique individual or communal motivations. For example, experts have pressed the critical need for vaccine distrust within Black communities to be approached not as a shortcoming of community members, but as a failure of health systems to prove themselves as trustworthy.

With regard to resistance rooted in anti-COVID-19 vaccine misinformation, healthcare providers are leveraging their unique influence through novel, grassroots approaches to encourage vaccine uptake. In North Dakota, providers are recording videos and sending out messages to their patients communicating that they have been vaccinated and explaining why it is safe to do the same. On social media, a network of female doctors and scientists across various social media pages, such as Dear Pandemic (82,000 followers) and Your Local Epidemiologist (181,000 followers), are collaborating to answer medical questions, clear up misperceptions about COVID-19 vaccines, and provide communities with accurate information about the virus. Similarly, the #BetweenUsAboutUs online campaign is elevating conversations about vaccines with Black doctors, nurses, and researchers in an effort to increase vaccine confidence in BIPOC communities. This campaign is especially critical considering the fact that BIPOC communities are often the target of anti-vaccine groups in an effort to exploit existing, rational distrust in health systems.

In addition to these timely responses, evidence-based interventions offer promising opportunities for healthcare providers to improve vaccine uptake amongst their patients. For example, there is a growing consensus around the practice of motivational interviewing (MI).

MI is a set of patient-centered communication techniques that aim to enhance a patient’s intrinsic motivation to change health behaviors by tapping into their own arguments for change. The approach is based on empathetic, nonjudgmental patient-provider dialogue. In other words, as opposed to simply telling a patient why they should get vaccinated, a provider will include the patient in a problem-solving process that accounts for their unique motivations and helps them discover their own reasons for getting vaccinated.

When applying MI techniques to a conversation with a patient who is unsure if they should receive a vaccine, providers will use an “evoke-provide-evoke” approach where they will ask patients: 1) what they already know about the vaccine; 2) if the patient would like additional information about the vaccine (if yes, then provide the most up to date information); and 3) how the new information changes how they are thinking or feeling about vaccination. During these conversations, the MI framework encourages providers to ask open-ended questions, practice reflective listening, offer affirmations, elicit pros and cons of change, and summarize conversations, amongst other tools.

Numerous studies show motivational interviewing to be effective in increasing vaccine uptake. For example, one randomized controlled trial found that with parents in maternity wards, vaccine hesitancy fell by 40% after participation in an educational intervention based on MI. Given its demonstrated effectiveness, MI is likely to help reduce vaccine hesitancy during the COVID-19 pandemic.

With infectious disease outbreaks becoming more likely and resistance to various vaccines increasing across the globe, continuing to leverage healthcare providers’ unique influence through grassroots campaigns while honing motivational interviewing skills as a way to combat mis- and disinformation in the infosphere may prove critical to advancing public health now and in the future.

The post The Infosphere as a SDOH: Leveraging Providers’ Influence to Counter Vaccine Misinformation first appeared on The Incidental Economist.

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I’ll start with an update about my case. Since my radiation treatment ended in September, I’ve gotten two scans to determine whether the treatment actually worked. The initial computerized tomography (CT) scan showed that there were still significant masses at the sites of my tumour and its metastases. A follow-up positron emission tomography (PET) scan showed that these masses glowed in the image, a result consistent with them retaining living cancer cells. This was an unwelcome finding, to say the least.

I can’t get any more radiation, so I was referred to a surgeon. The surgeon, interestingly, was not impressed by the PET scan result, which he believes could be a false positive. He explained that those areas might be glowing because badly injured tissue does that. Or it might be cancer. So we need to biopsy these maybe-tumours and find out. This will not be a needle biopsy in an office, but rather a surgical procedure under anesthesia. And before the biopsy, I will need to get another CT scan, this time with radioactive contrast.

Of diagnostic procedures and their uncertainties, there is no end.

I had the CT scan last Thursday. I’ve read the radiologist’s report (and so far as I know, my surgeon hasn’t, so I may have misread it). The report’s notable finding was that an ulcer is forming at the site of my primary tumour. This is frightening, although again, for all I know, badly damaged yet not cancerous tissue might nevertheless ulcerate. Still, at least the presence of the ulcer explains my experience of continued and, in fact, growing throat pain at the site of the primary tumour. All this will, I hope, be clarified by my biopsy, which according to my surgeon’s administrator, is going to be scheduled for next week.

Or is it? Because now we return to the larger story of the pandemic. On Thursday, April 8, Ontario began its third shut down in response to a third wave of the epidemic. As you can see from the graph, the counts of COVID-19 cases are rapidly approaching their highest levels.

COVID-19 cases in Ontario, Canada.

Why are there so many cases in Ontario? First, Canada is several weeks behind the US in vaccination (see this great graph by @TrevorTombe).

Cumulative vaccination rates in Canada and the US.

As of this morning, only 18.5% of Canadians have received at least one dose. I am not one of them, nor do I have a scheduled visit. In Ontario, you register online to be vaccinated and then wait for them to contact you. My phone hasn’t rung.

Why are fewer Canadians vaccinated? I see no evidence that vaccine hesitancy is greater than in the US. My impression is that, in general, Canadians have been more compliant with public health warnings than Americans. According to Tracey Lindeman, we negotiated a bad deal with the manufacturers.

Without much domestic manufacturing capacity to speak of, Canada had to sign advance-purchase deals with international vaccine companies. The country hedged its bet by mostly going with companies funded by Operation Warp Speed, and so far its strategy has been to overbuy doses in the hopes of securing enough to vaccinate all of its citizens. A mounting critique, however, is that perhaps Canada should have been more specific than “first quarter of 2021” in terms of arranging vaccine-delivery timing. [Toronto Globe & Mail health columnist André] Picard said that Canada, by not giving manufacturers a specific week, or even day, allowed them to push delivery until the outer limit of the quarter.

So why have the Pharma companies placed us at the end of the line for deliveries? Quoting a retired Pharma executive, Lindeman says that

long-standing Canadian policies in three areas [have been] particularly antagonistic to vaccine makers, especially multinationals: patents, prices, and procurement.

Perhaps so, but you could see this another way. Unlike the US, Canadians have bargained hard with the Pharma multinationals to get essential medications at reasonable prices. And now… this is their payback.

Another reason why cases have risen is that coronavirus is evolving, and at least some of the new variants have a substantially higher transmission rate than the earlier coronavirus. The faster spreading new variants will displace the older variants among new cases, and, everything else being equal, accelerate the growth in cases. As you can see in the following graph, the variant viruses have spread rapidly and now comprise 70% of new cases.

Infections with variant viruses as a proportion of total cases in Ontario.

The upshot of the wave of cases is that the number of COVID-19 cases in Ontario hospitals is growing, as you can see from this graph, which I found in @thevivafrei’s Twitter feed.

Increases over time in hospitalized and critical care COVID cases.

Unfortunately, I can’t find a data series that expresses these case counts as a percentage of the province’s total bed or ICU capacity. My spouse participates in daily briefings about hospital capacity, and what she hears from the provincial Ministry of Health is that in many hospitals, both acute and critical care beds are at greater than 100% capacity. That means that all the standard beds are filled and patients are being cared for on gurneys. See my earlier post on ‘hallway medicine.’

If so, this is a dangerous situation. During this pandemic wave, the rate of COVID-19 deaths seems to be lower than during previous waves, possibly because the patients are younger this time. Nevertheless, people in ICUs are there for a reason: they are more likely to die if they are less closely monitored and receive less aggressive care. Unfortunately, cases requiring hospitalization are proliferating, and available beds are not. If the overcrowding gets worse, death rates among both COVID-19 and non-COVID-19 hospitalized patients are likely to rise. This is the precarious edge on which the province stands.

To stem the rise in cases, the government of Ontario declared its third shutdown on Thursday. Likewise, the hospital where I have been getting my cancer care announced that it was cancelling elective surgeries. This is not due to a lack of surgeons or a lack of operating rooms. (However, I expect there is a shortage of surgical nurses due to their secondment to other COVID-related tasks.) The problem is that surgeries require hospital beds for post-operative care, including ICU beds for acutely ill patients. In effect, surgeries compete with COVID-19 for hospital beds. The upshot is that if you have a moving vehicle accident and you need a procedure right now, they will operate. Otherwise, you will wait. I’m fairly certain that they will cancel my biopsy. If so, this will delay any eventual surgery to attack my throat cancer.

So, what is it like to be a cancer patient during the COVID pandemic? Right now, it means that I cannot get the care I need. I am going to try to get more information this week about how long I can expect to wait. If it’s a long wait, or if I can’t get an answer, then I will need to explore whether I can get care in another province or, irony of ironies, in the States.

@Bill_Gardner

To read the Cancer Posts from the start, please begin here.

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Before the COVID pandemic, the United States was in the midst of an opioid epidemic. A menu of health policies has been recommended to battle the rising cases of opioid overdoses including prescription drug monitoring programs (PDMPs), increasing access to naloxone (an opioid antagonist), and pain management clinic laws. Surprisingly, another set of policies adopted by some states—though not intended as a response to the opioid epidemic—was found to be effective in reducing opioid prescriptions: medical marijuana policies (MMPs).

A new study, published this month in Health Services Research, contributes to the literature on medical marijuana by examining the relationship between medical marijuana policies and hospitalizations and emergency department (ED) visits related to opioids while accounting for different types of medical marijuana policies.

Background

Medical marijuana policies take different forms, including permitting active dispensaries to sell medical marijuana and allowing home cultivation of medical marijuana. These policies differ in how much access they afford patients. Access contingent on dispensaries often means needing to register as a patient, gaining access to medical marijuana card, and being able to afford the cost of medical marijuana since it is not covered through health insurance. Furthermore, dispensaries may not be easily accessible for all users.

Home cultivation provides easier access to marijuana by allowing patients to grow marijuana at home. Although home cultivation policies may limit the number of plants that can be grown and the maturity level of plants at a given household, home cultivation provides access to marijuana at almost no cost except for the initial cost of purchasing plants/seeds for cultivation.

Previous literature has emphasized the importance of accounting for these specific types of policies when studying medical marijuana since they are different from each other. Existing research on MMPs have found states with home cultivation of medical marijuana only to be associated with reductions in opioid prescriptions among Medicare enrollees. While a few studies have found MMPs to be associated with reductions in opioid-related mortality, opioid-related hospitalizations, and opioid prescriptions among Medicaid enrollees, these studies have not accounted for different types of MMPs.

Methods

We used state-level quarterly data from Healthcare Cost and Utilization Project’s Fast Stats database to gain access to ED and inpatient visit rates by state. These data were linked with changes in medical marijuana polices in states from 2005 to 2016. Along with the medical marijuana polices, we controlled for a long list of state policies used to combat the opioid crisis including presence of PDMP, mandatory access of PDMP by providers, pain management clinic laws, Good Samaritan laws, availability of naloxone without a prescription, recreational marijuana policy implementation, and Medicaid expansion. In addition, we controlled for state socio-demographic characteristics such as unemployment rate, percent uninsured, population size, median household income, ethanol consumption per capita, and beer taxes.

We used a difference-in-differences regression approach to compare changes in opioid-related inpatient and ED visit rates per 100,000 population before and after a state has implemented a given MMP to those states that did not implement the given MMP. A key identifying assumption was that parallel trends existed in inpatient and ED visit rates among states that implemented MMPs (treatment) and states that did not implement MMPs (control) prior to policy implementation; an event study showed no significant difference between treatment and control groups prior to policy implementation.

Findings

The results of our study showed that states that allow home cultivation of medical marijuana experienced about 12% increase in opioid-related hospitalizations and about 44% increase in opioid-related ED visits compared with states without home cultivation of medical marijuana. However, study results did not find significant associations between medical marijuana dispensaries and opioid-related hospitalizations and ED visits.

We further disaggregated home cultivation into two categories, unsupervised and requiring a permit. We found unsupervised home cultivation to be associated with an increase of 15.6% in inpatient hospitalizations related to opioids though requiring a permit for home cultivation was not significantly associated with hospitalizations. These findings indicate that easier access to marijuana through unsupervised home cultivation may result in adverse health outcomes needing further treatment.

Additionally, implementation of recreational marijuana policy was associated with about 16-17% increase in opioid-related hospitalizations, while it had no significant association with opioid-related ED visits. Access to naloxone without a prescription was significantly associated with an 8% increase in opioid-related hospitalizations though it was not significantly associated with opioid-related ED visits. While naloxone may help reduce mortality by reversing opioid overdoses, individuals that experience overdoses may seek healthcare at inpatient setting. Thus, it is not surprising that availability of naloxone is associated with increased opioid-related hospitalizations.

There are a few limitations in this study. The study uses state-level aggregated data for inpatient and ED visits from only 47 states and 35 states respectively for the period of 2005-2016. Identifying specific reasoning behind opioid-related hospitalizations and ED visits or the source of drugs such as prescription or illicit (i.e., heroin) that resulted in those visits was not possible due to the aggregate nature of the data.

Conclusions

Despite these limitations, the findings of this study provide an important contribution to the policy debate on medical marijuana legalization. The findings indicate that increased access to marijuana via home cultivation is associated with increases in opioid-related hospitalizations and ED visits, suggesting that easier access to marijuana among opioid users may result in adverse health conditions that need treatment at inpatient or ED settings.

While it remains unclear whether marijuana liberalization may be a beneficial public health tool in the fight against the opioid epidemic, the results of this study support the argument that potential benefits and adverse health outcomes associated with different types of MMPs should be taken into consideration when discussing marijuana as a policy alternative in addressing the opioid epidemic.

The post Home cultivation of medical marijuana can result in higher hospitalizations and emergency department visits related to opioids first appeared on The Incidental Economist.

Available wherever you get your podcasts! Including iTunes

This episode of the Healthcare Triage podcast is sponsored by Indiana University School of Medicine whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research and patient care.

IU School of Medicine is leading Indiana University’s first grand challenge, the Precision Health Initiative, with bold goals to cure multiple myeloma, triple negative breast cancer and childhood sarcoma and prevent type 2 diabetes and Alzheimer’s disease.

@DrTiff_PhD

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Sponsored by: Health Services Research and Development (HSR&D) & Quality Enhancement Initiative (QUERI), Veterans Health Administration, U.S. Department of Veterans Affairs

Submission deadline: April 30, 2021

Health Services Research (HSR) and the VA HSR&D QUERI program are partnering to publish a Special Issue on Translating Research into Policy and Action, to be co-edited by Melissa Garrido, PhD, Arleen Brown, MD, PhD, and Amy Kilbourne, PhD.

A recent Presidential Memorandum emphasizes the need to make policy and programmatic decisions that are “guided by the best available science and data.” This memo follows the implementation of the Foundations for Evidence-Based Policymaking Act (Evidence Act), which requires all cabinet-level agencies in the United States government to support policy and budget decisions with rigorous evidence. The HSR&D QUERI program is leading the Veterans Health Administration’s response to the Evidence Act and fosters partnerships among researchers, clinicians, and system managers and leaders to maximize the policy impact of research and ultimately improve health outcomes and equity for patients.

Both within and outside of the VA, implementation and translation of research findings into action can be done more effectively if the needs of affected communities are taken into account. Community engagement is critical to disseminating, implementing, and sustaining evidence-based programs and policies in the real world. This engagement is crucial to improving health equity. However, the generation of evidence to inform policy and the community impact of policy are often considered separately. Most studies that end up informing implementation of evidence-based programs or policies are conducted in settings or populations that are not representative of those that are most adversely impacted by disparities in health or health care.

The goal of this special issue is to highlight research that bridges this gap and engages the community or relevant stakeholders to inform policy and lead to meaningful change.

HSR is soliciting papers that are relevant to the development of evidence-based policy and the translation or implementation of research into action. Papers that highlight novel findings and methodological research directions based on implementation science, community-based participatory research, and similar fields and/or seek to inform health equity and promote active participation of individuals most affected by the research are especially welcome, including those that focus on the VA health care system, as well as other systems and payers. Papers must report the results of original investigations. Framework, review, summary, and commentary articles will be solicited separately.

Illustrative examples of topics within the area of Translating Research into Policy and Action include but are not limited to:

• Research conducted using community-based participatory methods, implementation strategies, or as pragmatic trials to ensure that results are relevant to affected communities
• Interventions to improve equity in health services delivery or public health
• Research on new strategies to expand opportunity and retention for a more diverse U.S. health care workforce that serves vulnerable and marginalized populations
• Development of evidence in underserved communities or settings not traditionally involved in clinical or health services research that directly informs policy at the state or federal level
• Activities conducted in response to the Foundations for Evidence-Based Policymaking Act
• Monitoring the public health impact of policy change

The deadline for initial submission of abstracts is April 30, 2021. Abstracts may not exceed 300 words and must otherwise be formatted as indicated in the HSR Author Guidelines. These abstracts will be evaluated by a multidisciplinary review panel that will select the best abstracts to receive invitations to submit full manuscripts. The evaluation criteria will include: (1) quality, rigor and originality; (2) significance and usefulness for advancing knowledge about evidence-based policy and the translation of research into action; and (3) clarity of writing and presentation.

Manuscripts submitted for the Special Issue will first undergo the same HSR peer review process as all regular manuscripts. However, due to the timeline for publishing the Special Issue, HSR will monitor the progress of manuscripts through the review process and try to shorten it; likewise, authors should expect to be especially prompt in returning revisions. All accepted articles will be published electronically within a few weeks of acceptance using Wiley’s Early View process. Articles published through Early View are fully published, appear in PubMed, and can be cited. Approximately 12 articles will be selected, based on the most original and significant work addressing the theme. Accepted manuscripts that are not selected for the Special Issue will be automatically scheduled for print publication in a regular issue. The print publication date for the Special Issue will be June 2022.

Key dates for authors:

April 30, 2021: Submission deadline for abstracts for the Special Issue

May 21, 2021: Notification of manuscript invitation for the Special Issue

July 17, 2021: Submission deadline of manuscripts for the Special Issue

June 2022: Publication of the Special Issue

If you would like to submit your abstract for consideration, please email your abstract and co-author contact information to the editorial office at hsr@aha.org, using the subject line “Special Issue on Translating Research into Policy and Action”.

The post HSR Special Issue Call for Abstracts: Translating Research into Policy and Action first appeared on The Incidental Economist.

That answer is: Even when you are very sick, do your best to maintain your health by getting or staying fit.

I need to apologize for that answer because it may be out of reach for many readers. I can focus on fitness because more important things have gone well for me:

1. Connection. I have spent lots of time with my wife, children, and friends. Sadly, my kids and many of my friends live in the States, and the pandemic has closed the border. So I haven’t been in the same room with them in a year. However, being sick has freed large blocks of time. That gift of time was generously matched by my friends and family, who have spent hours with me on Zoom.
2. Religion. We are Christians. For better or worse, cancer might scare me a bit less than you expect it to. Secular readers: Go ahead and deduct 15 points from your estimate of my IQ. I don’t mind.
3. Canada. My out-of-pocket costs for my care have been about $100, for co-pays on an ambulance ride and some prescriptions for generic hydromorphone (trade name Dilaudid, a pain medication). Of course, my health care was not free. I prepaid through my taxes at a rate that reflected my income. The Canadian system gave me access to advanced cancer care without the slightest fear that it would bankrupt my family. Likewise, my employer immediately granted me months of paid disability leave. God save the Queen.

Without these foundations, I would surely have been overwhelmed. With them, I have maintained energy, mood, and purpose.

A few years ago, we lost a good friend to ovarian cancer that disseminated to her liver. She maintained her energy, dignity, and hospitality throughout the years of her illness. Part of her secret for thriving despite surgeries and chemotherapy was staying fit and upright through long daily walks with her friends and a standard poodle, which she logged on her Fitbit. Witnessing her exemplary life helped prepare us for my cancer.

I won’t cure my cancer through exercise (or diet, meditation, or prayer); this is how I live with it. I’m not ‘fighting’ cancer; that’s the Cancer Centre’s job. My job is to stay mobile, attend to my daily needs, care for those I love, write a bit, and prevent depression. Fitness is a means to those ends.

You get fit by developing a workout discipline. You don’t get disciplined by gritting your teeth, or at least not just by doing that. Workout discipline comes from joining a team, getting good coaching, evolving a program, and accurately monitoring your effort. Instead of a standard poodle and a Fitbit, I have a King Shepherd puppy and Peloton.

My workout partner, Mika (pronounced ‘Mee Ka’).

Mika joined our family in late June, just three days before I was diagnosed. Dogs are ideal teammates. The anthropologist Pat Shipman argues that the domestication of wolves to collaborate on hunts for large mammals enabled homo sapiens to outcompete the neanderthals for the apex predator niche in the Pleistocene. Mika loves to be with me, and she never gets bored. She unfailingly prompts me at walk time. She has a sweet disposition but can destroy anything if she doesn’t get multiple daily walks. Get a dog and, if you can, get a good trainer to help raise her.

The Peloton bike arrived on October 12, about a month after the end of radiation therapy but perhaps only a week after the physical experience’s nadir (radiation toxicity accumulates for weeks past your last session).

Me, a week before the end of radiation therapy. I have lost 14 kg (30 lbs) since it started.

The bike is overpriced, but what makes it superior to the standard gym stationary bike is the touchscreen display of your pedalling cadence, resistance, power (the watts/joules you are generating), and their averages. Your workout data are saved to the cloud, maintained in an easily accessible history, with lots of graphs and notifications to track your progress. Every fitness app does this kind of thing, but Peloton does it better than anything else I’ve tried.

Cloud-connected device for capturing exertion data and accessing a social network. Also: a stationary bike.

The Peloton brand is online spin classes, but that’s not the best way to think about it. Peloton has a touchscreen-equipped treadmill, as well as outdoor running, strength training, yoga, pilates, barre, stretching, and meditation classes that you can access from your phone or tablet. The instructors encourage you to cross-train, which is crucial. Trust me: if cycling is all you do, you will injure yourself. There is a huge library of recorded modular workouts of 5 to 90 minutes that you can do any time. Use these like Lego blocks to build a weekly fitness program. That sounds intimidating. However, although the instructors radiate spin class glamour, many of them are former physical therapists or strength/endurance coaches. Start by choosing workouts based on the music. You’ll absorb cross-training ideas from the instructors’ monologues and the prompts that follow the completion of a workout. What makes all this work is the pricing. You pay one monthly fee rather than paying by the class, so there is no disincentive to doing, for example, a 5-minute guided stretch after each ride.

Peloton has an active social network. The touchscreen has a camera, so if you do a live class, you can add a video chat with friends on the same ride. I haven’t explored this much, but I’d like to. I used to be an age group triathlete, and group rides were the core of my training (shout out to the Columbus Triathlon Club!).

Perhaps most importantly, the Peloton instructors supply good coaching at internet scale. I recommend Matt Wilpers and his PowerZone training,* but you can pursue lots of other tracks. PowerZone training gives you a method to tailor your workouts to your current fitness. If you are so sick that you can barely turn the pedals, that’s fine. PowerZone reconfigures your touchscreen to rescale the output wattage your pedals are generating to a scale anchored by 0 = no pedal rotation to 7 = a level of exertion that you can maintain for just seconds. The program has a procedure to set these zones to what you can do. Then, when you do a PowerZone class, the instructor calls out a zone, rather than an output wattage  (or cadence or resistance) that might be impossible. This gives you a workout that is feasible — and, in measured doses, demanding — for you. The PowerZone workouts — interval training, in spin class drag — give you a path to build those capabilities.

Matt Wilpers. My cycling coach, and maybe 1 million other people’s too.

Effective coaching at internet scale is an amazing accomplishment. It is what wellness programs promise but fail to deliver. Of course, Peloton — and dog ownership — succeed mostly because the people who commit to them already love dogs and want to be fit. Perhaps this selection effect is the entire story. Who cares? Select yourself in. Fitness will help you live with and recover from cancer.

*Matt Wilpers didn’t invent power zones. Professional cyclists and triathletes all train this way. What he has done is figure out how to teach and support this style of technical, instrumented cycling training for a mass audience.

@Bill_Gardner

To read the Cancer Posts from the start, please begin here.

The post Cancer Journal: How to Live with Cancer first appeared on The Incidental Economist.