Integrated Human Practices

This page explains how we recorded those conversations, who the end user actually is, where we stand with every stakeholder, and what changed as a result. The conversations themselves are the other three tabs above.

Early on we wrote meetings up as summaries. The summaries were useless, because they recorded that a conversation had been pleasant without recording what it did to the project. From the clinical webinars onward every engagement has been forced into four fields, and every record on this page uses them.

It is tempting to say our end user is a malnourished child. That is the beneficiary, not the user. A child does not decide to take a probiotic, does not obtain it, and does not administer it. If we design for the beneficiary and ignore the chain of people who have to agree before anything reaches them, we build something nobody can deliver.

We assessed each stakeholder group on two axes: how much influence they have over whether this project could ever reach a child, and how much our engagement with them has actually changed it. The gap between the two is the agenda for next year.

This table is the test of whether any of the above counts as integrated. Every entry in the right-hand column points at something on another page of this wiki.

The striking thing about that table is how much of it agrees with itself. Five people who have never met, working in behavior analysis in Texas, clinical dietetics in Houston, general pediatrics in Iowa, public health in Bangladesh and sustainable agriculture in India, told us the same thing in five different vocabularies: appetite is one item on a list, and the items above it are usually more important.

We did not plan that convergence, and we could not have manufactured it. It is the reason we are confident the change it produced is real rather than politeness. A single expert telling a student team their premise is too narrow is an opinion. Five independent experts say it is a finding.

The project did not get bigger because of Human Practices. It got smaller, and true.

Two changes matter more than the rest, and both came from questions we did not think to ask. Ms. Gardner mentioned in passing that clinicians withhold probiotics in intensive care because of translocation risk, not knowing our chassis is a live organism destined for a gut that malnutrition has already made permeable. That single remark produced our exclusion criterion and moved the whole intervention from the acute phase to the recovery phase. Dr. Raghunathan pointed out that host enterocytes already express FAAH, which is the kind of fact that is obvious once said and invisible until somebody says it. Neither appeared on any list of questions we had prepared.

We would change one thing about how we did this. Our first expert conversation, with Dr. Corona Moreno on 6 July, shaped everything public we built. The other eight landed in September and October, after the meal plan and the expo were finished. That worked, but it worked on the strength of one well-chosen early conversation rather than by design. The recommendation we would pass to next year’s team is to front-load the expert sessions, write the Questions down before each one.