At some point, the clapping stops.
The attention ends. The adoration subsides.
It's just you, and it's the ultimate thrive or dive: What you do when no one else is looking.
When no one is looking; no one is clapping; and, no one is glorifying your performing, you define yourself as the Patient of One.
That's when the Patient of One thrives.
Why?
We have data-, tradition-, custom-, and ancestral-embedded mythology to guide the way; epistemocrats have fruitful fiction to live by: "epoche," they say.
Let's find out why.
I truly enjoy physics (hence, Richard Feynman as one of my 'hero of heroes').
Though, I favor human psychology even more (including all things 'choice architecture', grace 'nudges', behavioral economics, decision-making / cognition, and beyond).
But, Physics + Psychology = a particularly interesting meritage -- a bricolage of the 'seen' and the 'unseen'.
Like Dr. Atul Gawande, I gravitate towards interdisciplinary inquiries into the human condition (via essays -- thanks to Dave Lull).
As a heuristic, it serves as a helpful default to track back to physics occasionally for grounding (in every sense of the word).
As our bodies show (objective observations from our real-time open 'lab'), many of our current and ongoing empirical experiments in health, healthcare, and medicine have been failing fast for some time now. Self-experimentation can empower us to do better. Epistemocratic tinkerers and entrepreneurs, like the good folks over at Hello Health(Jay Parkinson, Sean Khozin, et al.) or up at the Innovation Cell (Carlos Rizo, Neil Seeman, et al.) don't mind failing fast -- it's an inevitable part of the pathbreaking process -- but these resilient leaders rebound from failure even faster (think of Tiger Woods making a birdie after a bogey; the 'bounce-back' stat). The Patient of One can 'bounce' because he/she has a trampoline-like platform standing firmly beneath him/her. When we fail -- and we will fail (we will falsify parts of our ongoing narratives) -- we don't want our entire foundation to fall out from underneath us -- we don't want to 'blow up' and have our 'legs cut out from underneath us' -- we want to land safely on our feet, brazen not broken. Instead, failing fast means failing with clipped downside risk (as much as possible), then picking ourselves back up and engaging in trial-and-error yet again with a Barbell portfolio diversification strategy.
The key is to have a strong platform to anchor to, to return to -- a home base of sorts. Cognitive psychology research shows that human development requires reliable and dependable home bases from which we can explore the world, uncover novelties, and then return home to recharge, reflect, retool, re-edit our stories, and mature as a result.
When it comes to health, Ancestral Fitness is one such platform, one foundation to anchor to and bound from.
Take, for instance, the Barbell approach to eating; that is, eating hyper-conservatively -- "I just decide what foods fit my latest nutrition story and stick to them until I think my prediction about them has been falsified." -- while also engaging in some tinkering and re-editing from time to time -- "Then I edit them out of my story and edit other foods in or just stay with the standard so-far-unfalsified elements of my story until I'm ready to experiment with something else." It's like Nassim Taleb's approach to investing -- and you are investing when you are eating and drinking (investing in your health): keep the majority of your portfolio invested in the 'safe' (I'll side-step the philosophical debate about whether 'safe' exists), such as cash (and hire a bodyguard), and then explore the 'spice of life' sometimes to maintain exposure to the envelope of serendipity and the positive Black Swan hits that may emerge unexpectedly.

The two insightful quotes inserted in the above paragraph come compliments of Dave Lull. His approach captures a valuable message that is simple, yet elegant: it's sage-like sophistication in action.
For me, this Barbell nutrition strategy looks something like this (I employ the same diversification approach to energy expenditure as well, which I will save for another post):
There are the current 'tried and true' (they are in the regular rotation; the 80-90% of my nutrition portfolio) items that have not been falsified yet (they do not cause inflammatory responses for me, and I am not allergic to them; they do not make me feel bad after I eat them) -- here are five sample highlights (there are many more, such as onions and mushrooms sauteed in olive oil and balsamic vinegar):
1) Classic FAGE Total yogurt with almonds, coconut, and pistachios (a 'non-losing' combination -- notice the 'negative empiricism' statement, rather than a 'winning combination')2) Wild Sockeye salmon with slices of raw milk cheddar cheese3) Cobb salad, always with extra bacon and eggs, minus the tomatoes*4) Tuna (love that high myoglobin content in Ahi)5) Fish/Flax oil supplement
And then there are the items on the horizon, those un-exercised options that I may 'call in' at some point through further inquisitive self-experimentation -- here are a few possibilities:
1) Goat cheese2) Sardines3) Kefir4) Send me suggestions!
Clearly, right now, my 'fructose-free' (*as little fructose as absolutely possible, that is) self-experiment influences the composition of investment holdings in this personal nutritional portfolio. I have yet to experience an observation that falsifies this fructose reduction approach, but I will keep my eyes peeled and ears alert for negative results.
So, then, where do physics and psychology enter this scene? Well, physicists tell a particularly fruitful story, a materialistic mythology of sorts, that includes the useful and practical concepts of inertia and momentum. Psychology research shows that these two core physics concepts play out in human affairs cognitively and emotionally every day. When we hit the gym or trail for a high-intensity, low-duration interval training session, for example, we must break the inertial barrier -- 'break a sweat' -- and get our hearts pumping in order to generate enough momentum ('flow' for athletes) to help us stretch the ceiling -- 'raise the roof' -- of our physiological headroom.
Thankfully, for the Patient of One, mythology provides the venture capital (energy) funding to jumpstart tinkering. As self-directed and self-owned scholars, epistemocrats can stumble about in the PubMed Anthology (as one resource) to find short-stories to motivate testing. Here are a few short-stories (by Bains) that may spur some folks to raise or continue raising the 'n=1' self-experimentation flag:

1: Med Hypotheses. 2008;70(4):719-23. Epub 2007 Oct 23.
The Biomedical Mutual Organization: a new approach to developing new medical treatments.

Bains W.
Self-experimentation is an efficient, productive and proven way to generate new treatments for mild and serious disease. But it is limited by materials available to the individual and the amount of testing one person can do. I advocate the formation of Biomedical Mutual Organizations, self-funded groups of individuals that provide mutual support for exploring new ideas in medical treatment. Such groups could achieve three things. Firstly, they could pool analytical services to validate the quality of materials and analytical services used in self-testing and self-medication, including verification of the identity and purity of medicine ingredients sourced from non-traditional sources. Secondly, they could pool resources to conduct group experiments in new treatments, interpret the results, and generate new hypotheses which could in turn be tested. Thirdly they could conduct more formal clinical trials on the group as a whole of new, indeed radical, therapies, in effect becoming a self-funded biotechnology company. While many practical objections remain to all of these, especially the last, and the last option may actually be illegal in some countries, some of the ethical objections that prevent such arrangements outside the context of a Mutual Organizations are overcome by the alignment of interests of those involved.

1: Med Hypotheses. 2008;70(4):714-8. Epub 2007 Oct 29.
Truly personalised medicine: self-experimentation in medical discovery.

Bains W.
Biomedical research need not be carried out solely by 'Them': distant, dissociated, enormously costly institutions and companies. It can, and increasingly in the 21st century will, be carried out by 'Us', the informed non-professional. Conventional clinical trials treat humans with the same experimental model as laboratory rats - regarding them as mute, variable, unreliable material from which results must be obtained as fast as possible to maximise return on investment and patent life. The alternative is longer term, self-reported clinical studies of new treatments, based on the assumption that the experimenter is informed, intelligent and aware. A wide variety of new treatments for chronic disease are available, involving elements of diet, behaviour, environment and non-prescription medication as well as ethical pharmaceuticals, and previous experience suggests that they can be enormously effective. The key is objective, quantifiable measures of outcome. These can be achieved with over-the-counter diagnostics for a variety of parameters, as well as with self-built test systems, and careful and systematic observations of symptoms. Hypothesis generation is a key part of this process.

As these mythologies indicate, self-experimentation in the Information Age needs platforms for helping people run their 'n=1' clinical trials. Dr. Davis does this already over at Track Your Plaque, and other patient-centered startups are advancing rapidly on this front as well -- see Facet of Life to start tinkering with ways to reduce chronic pain. Through practical, user-focused and accessible platforms like these, by creating an inviting, respectable, and open community of Patient of One self-experimenters — an epistemocracy for health — we can all learn from each other, regardless of where we are on our Ancestral Fitness treks. Whether still debating whether to get our feet wet or already going full throttle with all things Paleo / Primal / Evolutionary / Ancestral and beyond, as long as we are engaged in some level of inquiry, some level of continual searching together, our collective bottom-up knowledge base will both inform practice (Practice to Theory) and will motivate others to continue their journeys, continuing the never-ending maintenance and improvement process (momentum).

The most challenging human psychology hurdle (inertia), I suspect, though, is how do we create a culture of experimenters, of trial-and-error solution-searchers: “If I could just get folks to experiment …” is the phrase that continues to rattle my brain.

Our current experimental set up is empirically broken; our bodies tell the story lucidly. We need to scrap the existing lab set up, pull the Food Pyramid poster down from the laboratory bulletin board, hirer some new lab techs, edit the laboratory manual, and start testing new hypotheses aggressively: we need to operationalize many new mythologies for health.

This is the power of 'n=1' for the Patient of One –> the goal is to get the self-experimentation engine started, overcoming inertia and empowering exploration. Psychologically, we all need support ‘getting our feet wet’ and ‘testing the waters’, so whatever baby steps we can get going to overcome inertia are monumental: hopefully, in time, as momentum builds, the engine will be self-funded and self-perpetuating (complexity science suggests this much: feedback loops matter and spiral according to momentum). Personally, I didn’t change over night. I did all of the above on my road to discovering the Ancestral Fitness lifeway. No doubt, the machine is well-greased at this point, thankfully, but the startup was not so fast, nor easy.

Interestingly, I have a good friend and golf buddy -- he's the leanest person I know -- who played quarterback in the NFL, among numerous other athletic achievements, and he has slowly stumbled his way in the dark (with my prodding, of course) toward Ancestral Fitness, leaving the old Soviet-style football training regimes behind for ancestral energy expenditure patterns and mimicry and, more importantly, shifting his eating and drinking (energy fueling) practices to align more with ancestral nutrition principles. In order to motivate this transition, he has disregarded science, theory, and clinical studies, opting for the following storytelling exercise instead:
"I choose not to eat ____ because my body doesn’t feel good after eating ____ , and I like to feel good. I am happier when I feel good, feel fit and feel healthy. Thus, eating _____ does not make me any happier; in fact, it makes me feel worse (including 'carb crashes', inflammation, dry skin, digestion problems, etc)."

From this world-class (and I mean world-class) scholar athlete who learned by years of 'hard knocks', I have learned the following: The best ceaseless question for 'n=1' self-experimentation is: “How do I feel after I eat ___?” “How do I feel after I perform ____ (in regards to exercise)?” All that matters is what happens to our own bodies in our specific cases -- does it work, meaning has it not been falsified yet?

Thus, I listen to my body — it knows more than the rest of us combined, especially when nurtured in the right ecological manner. My body talks to me when no one else is listening; this feedback trumps everything else.
Mark Sisson's Primal Blueprint Health Challenge, Richard Nikoley's Free the Animal, Keith Norris' Theory to Practice, Dr. Doug McGuff's Body by Science, Stephan Guyenet's Whole Health Source, and Kurt Harris' PaNu (Paleolithic Nutrition), to name just a few, all provide wonderful Ancestral Fitness 'choice architecture' by providing 'social scaffolding points' to help the Patient of One overcome inertia, discover connections, and then generate, maintain, and build momentum.

But, at the end of the day, sustainable self-experimentation requires searching and acting diligently, when no one else is looking -- when the clapping stops. The Patient of One internalizes this agency approach and triages away either way.
In this light, I suspect the medical system would be wise, given impending resource constraints, to facilitate, advise, oversee, and empower self-directed, patient-centered healing modalities, such as 'safe' self-experimentation, where practical and appropriate (ie. don't tinker with your ankle when it breaks; go to the ER instead). However, bringing patients and providers together to team up in 'n=1' trial-and-error requires overcoming stigmas and preconceived notions, but the goal persists: We need to overcome stigmas associated with and elevate the status of self-experimentation in medical practice and research. We also need to elevate the status of nutrition. Hence, I perceive room for synergy and 'killing two-birds with one stone' here. Self-experimenting with nutrition is one concrete way to cultivate these processes in parallel. Experimenting with nutrition is relatively safe and is practical since patients shop for their diets already, so increasing patient participation in their health experiences through physician-supported (practitioner-supported, more generally) nutrition experimentation represents a vehicle that could contribute to a cultural transformation and evolution in medicine.

The full-scale essay (book, perhaps) on this fascinating topic, could start something like this:
Nutritional Bricolage: Tinkering with Diet as a Vehicle for Raising the Status of Self-Experimentation in Medical Practice and Research
You are lost. It is dark, but the sun is shining. You look left; you look right, but things just seem so opaque--opaque because you cannot seem to figure out what path to take. Where are you? You are in the grocery store down the street from your house--stuck somewhere in the cereal aisle, mesmerized by the sea of marketing-screaming boxes--trying desperately to decide which foods and drinks to buy that are good for your health: 'Bueno para mi salud' is the phrase that dances through your mind. You are a reflective person, so you think about the existing nutrition models that could help inform your decision-making process. Of course, there is the Food Pyramid that asserts one set of nutrition values. Diets like Atkins, South Beach, and others swim in your head as well. It is all so confusing; you throw your hands up in the air; "I give up. They cannot all be right," you tell yourself, frustrated with the uncertainty that a simple activity like grocery shopping involves. This situation represents opacity--opacity is defined as a concept or condition (scenario) that is difficult to perceive correctly, such as how best to eat and drink to restore, maintain, and enhance health. In the face of such nutrition opacity, you unleash the scientist within and draw a sophisticated, humble conclusion: "If no one knows anything about nutrition and proper diet, then I will just have to start self-experimenting with my food and beverage choices and simply see how I feel while eating and drinking different diets. My friend told me about this concept called Ancestral Fitness the other day, so I will start there. Chronic illness and obesity seem to have spiked rapidly ever since that Food Pyramid scheme came out anyways. For three months, I will consume a diet that mimics, as much as possible, the patterns of my pre-agriculture, paleolithic ancestors and see how it goes. Time to tinker away. What aisle is the salmon on again?"

As each week passes, you record your experimental results diligently using an online tool, Bricolage Labs. Bricolage Labs allows you to set up and run your own self-experiments ('n=1' clinical trials) online, empowering you with the ability to make graphs and track progress along the way (you can even 'Tweet' observations, such as your energy level scores directly after leaving the gym following a new type of workout). Literally, bricolage means to create something from diverse materials that happen to be available, such as your grocery store, your own body, and your online platform in Bricolage Labs. In this fashion, the Bricolage Labs Web site reads: "Improve your life. Discover connections. Leverage serendipity by engaging in discovery through self-experimentation, tinkering, and trial-and-error. You can capture your hypotheses and experiments here, learn from the community, and vote-up interesting and useful results." By the end of three months, you have recorded your mood, weight, and general health outlook using self-created scales and measurement methods. The results are stunning: while tinkering with Ancestral Fitness principles, personalizing your eating and drinking habits to accommodate your personal and aesthetic preferences, you discover that you are leaner, have lost ten pounds, have experienced clarity of thought, feel more positive with your general mood, and are sure that your overall health has improved as a result. "Wow. That's pretty fascinating--I learned more about myself, nutrition, and health in these past three months than ever before. I feel a sense of agency; I am an active participant in my medical care. I am the Patient of One," you conclude to yourself, leaning back in your computer chair, repeating, "Yes, I am the Patient of One. It's the statistics of individuals: no one in the world is like me--I have a unique biochemical makeup and genetic composition, for instance--so self-experimenting is an unavoidable and inherent requirement to uncovering just how best to navigate that treacherous grocery store safely and effectively. I am going to tell my doctor about this revelation; I bet other patients could benefit from this process as well. Perhaps physicians could assist patients' tinkering efforts and help them learn by trial-and-error in safe ways using tools like Bricolage Labs. This seems to be the next step in Web-based medicine. Exciting stuff. Plus, nutritional bricolage is much more conservative and practical compared to the pharmaceutical, surgical, and procedural bricolage efforts that comprise most of modern medicine." In this way, you frame self-experimentation with nutrition as a 'cheap health option'--a way to figure out what is healthy by engaging a process that has clipped downside risk (food allergies, for example) but possesses much upside benefit potential (you lose enough weight and regain insulin control to levels that cure you from diabetes, as one possibility). As an individual within a healthcare system that typically views public health through a populations lens, you feel comforted by realizing that individuality in medical care is quite scientific, empirical, and yet achievable at the same time.

A few months pass, you are still thriving on your Ancestral Fitness lifestyle, learning little things from experience each and every day that help you along the way--you realize that skipping breakfast a few days per week and intermittent fasting for at least twelve hours proves fruitful in stimulating your energy levels, as one gem that you discover on your treasure hunt. You visit your primary care physician for a physical, and you pop the question: "Doc, have you ever viewed medicine as an experiment; like a series of live experiments in people's bodies? Maybe when you prescribed a drug that you were not sure would work; how did you approach those scenarios?" With a wry smile, your physician chuckles, and then responds: "Why yes--I encounter that situation every day. Every prescription I write is an experiment, on some level. Each person is unique--people react differently to standard treatments all the time, and usually in unexpected ways. My job is to make sure that these experiments 'first do no harm' and second, help my patients heal." Impressed, you answer back: "Well, that is encouraging to hear. How about with nutrition? Have you ever helped patients experiment with their diets to heal, as opposed to drugs, that is?" "No, but tell me more," your doctor states, the tone of his voice expressing genuine interest. Seizing the opportunity to share your newfound wisdom, you explain: "For the past five months or so, I have been tinkering with Ancestral Fitness principles and have recorded my observations and tracked my results online using this free Web-application called Bricolage Labs. The results have been promising. I learned a lot about myself, both positive and negative. I learned that I feel good after eating salmon and tuna, but I do not like eating beef, even grass-fed varieties. I also found out that I needed more fat and probiotics (good bacteria) in my diet and minimal sugar in order to stay lean and keep my energy levels high and my immune system strong. The rest is all there online, like a live diary that I share with the world. Other people can see my self-experiment and conduct their own, copying my lab set up or generating novel hypotheses to test. It seems like a great way to engage patient's in taking more responsibility for their personal health states, but more importantly, it provides a platform for searching in the face of opacity." Impressed and enthused, your physician exclaims back: "Opacity; yes, the art and science of medicine is defined by the non-linear task of decision-making under uncertainty, in the face of opacity. I think you are on to something here. I see much value in self-experimentation in medical practice and research--it's a noble tradition in medicine, in fact--especially using nutrition as a vehicle to get the ball rolling. We do need a cultural revolution in this regard. Unfortunately, there are some stigmas associated with self-experimentation. Paternalistic approaches tend to receive higher status in medicine. But, as our health system resources become more scarce, patients are going to have to make more and more health choices for themselves, so physicians could help assist this shift by working closely with their patients to run personalized tinkering trials in all things 'lifestyle'--when and where appropriate, of course. Certainly, this is a relatively untapped domain in medical practice and research. Here, show me this Bricolage Labs site on my laptop; I want to learn how to use this participatory medicine device."

Minimally, the 'physics of tinkering' suggests that contextualized information, embedded in a story like Ancestral Fitness, could help people jump the psychological hurdles that inertia presents, engaging mythology to build and maintain momentum for leading healthier, happier, and more fulfilling lifeways.
When no one else is looking, the Patient of One will thrive by living this epistemocratic way.
Triage (tinker) away, Doc.

REFERENCES
http://en.wikipedia.org/wiki/Self-experimentation (*see reference to Seth Roberts)
http://en.wikipedia.org/wiki/Self-experimentation_in_medicine
http://www.scientificamerican.com/article.cfm?id=self-experimenters
http://www.marginalrevolution.com/marginalrevolution/2007/02/all_my_life_for.html
http://www.jyi.org/features/ft.php?id=1326
http://www.stat.columbia.edu/~cook/movabletype/archives/2005/03/learning_from_s.html
http://www.amazon.com/Who-Goes-First-Self-Experimentation-Medicine/dp/0520212819
http://www.mpiwg-berlin.mpg.de/en/research/projects/DeptIII-KatrinSolhdju-Self-Experimentation
http://cebp.aacrjournals.org/cgi/reprint/6/7/475.pdf
http://www.uihealthcare.com/depts/med/orthopaedicsurgery/research/ioj/2009/historyofmed/history.pdf
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0005192
http://www.news.harvard.edu/gazette/2004/04.29/11-selfexperiment.html
http://www.marksdailyapple.com/richard-nikoleys-self-experimentation-and-transformation/
http://www.newscientist.com/article/dn16735-eight-scientists-who-became-their-own-guinea-pigs.html?full=true
http://www.springerlink.com/content/64685g8161m75652/
http://www.insightjournal.net/Volume1/Using%20Self-Experimentation%20and%20Single-Subject%20Methodology%20to%20Promote%20Critical%20Thinking.pdf
http://www.harpers.org/subjects/SelfExperimentationInMedicine
http://www.jstor.org/pss/30053887