Post a Comment On: A picture of health

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This was a really enjoyable (if exhausting) project to work on. The brief? To expand on a traditional "pharmaceutical transport" diagram - which shows what happens to drugs we use once we have consumed or disposed of them. We ended up creating the information graphic above, which is intended to reveal to the viewer their own place in a complex system - with many loops, feedbacks and choices to be made..

I was working with two colleagues at the University of Exeter / University of Plymouth - Dr Clare Redshaw, an environmental chemist, and Dr Mat White, a behavioural psychologist. We wanted to expand a "traditional" pharmaceutical transport diagram (from Petrović et al. 2003), and perhaps work towards an academic paper on the subject. These diagrams normally start with what happens when we dispose of the pharmaceutical products that we use every day. As you can see from our scrawled annotations, we wanted to include what happens "upstream" of this point - including psychological "influence" routes that could affect the amount of pharmaceutical products entering the environment before drugs were even prescribed:

[Image] Based on diagram from Petrović et al. 2003
Also, the idea was also to go into more detail about what happens to these pharmaceuticals once they arrive in our environment. With many more boxes added, I knew that the diagram would become quite complex. To make the diagram easier to interpret, I tried adding an illustration to every box in the diagram - trying to make it clear at a glance what was being represented. I wasn't really trying to replace the text in the boxes (symbols often need the support of text) - but I wanted to make the information in each box look different at a glance. This way, once you've learned what the pictures are intended to show, it's quicker to look around the diagram and get an overview of what is happening:

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By the time I'd got to the bottom of the drawing, I realised that it was starting to look like a city. Or, with the pipes, perhaps a (pale imitation of a) Richard Scarry drawing: http://scienceblogs.com/worldsfair/2006/11/20/wouldnt-it-be-great-if-richard/
So, with the river now flowing directly through the centre of the whole graphic, providing a focal point, and using an isometric (pseudo-3D) viewpoint, I came up with this:
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Of course, to fit this all in, there was plenty of erasing and redrawing of the pencil lines. You may notice on the right that I shifted "metabolism" inwards, when I realised that the whole thing was going to fit pretty neatly into a square shape. Also note how horribly out of place the flat "household waste" symbol and the digger at the landfill site look - although I don't mind the "usage", "metabolism" and "body" images so much... Perhaps because they are more abstract concepts anyway.
As you can see, the team and I had a good go at that version, and we came up with many alterations and additions:

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One thing that bothered us was that it still looked mostly like a one way process. Everything went into the poor river. While this was a potentially useful revelation in itself, it didn't show the way that these pharmaceutical products also travel further (and return to earlier parts of the system).
Also, the diagram was already pretty detailed and complex for a small page of an academic journal, probably printed in black and white - and we wanted to put more in! As it happened, I also wanted something to submit as a poster for the NSF/AAAS science and engineering visualisation competition, so we decided to see what we could do with an A0 poster format, including text to explain our ideas about the system - so it was back to the drawing board for me:
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I decided that it was actually helpful to have a couple of the "end points" in the diagram sticking out from the square form - and the extra space of the poster format allowed it. So back out to the side went the "metabolism" symbol... (and the "incineration" one).
We made numerous additions in this version:     - explanatory text boxes     - underground caves for "ground water"     - water tower & water abstraction to show one route back to the consumer     - shops to show routes back to the consumer through food     - biosolids now linked to landfill and incineration     - two more "end points" added - degradation and "where next?" text box     - added in spills from manufacturing and transporting
The centre was very crowded - but I decided that, as I had some extra space in the top right, it wasn't a huge problem. I should probably have rubbed out the entire medical literature, training, health professionals, people at home and shops section and redrawn it further to the top-right, but I made the decision to to address this on-screen to save time (that sound is my graphics tutors spinning in their graves, by the way).
So I finally got to boot up Illustrator - several weeks into the project! If I'd thought that the drawing was a lot of effort, I was in no way prepared for how long it would take to get everything laid out on screen...

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Every design starts somewhere - in this case with the river (and a few outlines that I could work to)
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The roads aren't joined up here. To get the corners mathematically correct, I sliced up circles and added them to the correct places:
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The buildings soon start to give a sense of perspective to the graphic. I decided early on to try and give a consistent light direction - from above and slightly to the left.
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The course of the river had to be diverted many, many times during the process:
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A colour change here for the background, to fit in with the colours I decided on for the influence arrows - 100% magenta for the influences, and 100% magenta, 100% cyan for the pharmaceutical transport. I also started adding in the buildings that I wanted - much further towards the top-right than in the sketch, to give more room in the middle. An unexpected consequence was that a second billboard was necessary to get the link from promotion to health professionals easily.
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Initially, the pharmacy had the medical cross, and the health professionals were going to be represented with a stethoscope. It was a pretty weak symbol though, and I ended up changing the pharmacy to a pestle and mortar that I found easier to represent:
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I considered having all buildings in the correct colours for influence / transport. However, some (like people at home) are part of both, and it looked a bit too garish anyway. If I ever do an interactive version, it might be a useful effect on rollover. Also notice how I had to play with the arrows to "people at home" a lot to fit in everything I wanted:
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The shop symbols took a few different goes as well. Here the "meat" one is a cow - although that didn't seem quite right, as we rarely buy whole cows from shops.
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With the addition of colour to the shop symbols, a burger became much more recognisable (it didn't work at all in one colour). Also another change to the arrows leading to people at home - to fit in the influence of promotion direct to the consumer:
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The sink and toilet were quite fun to draw. The pipes were not. The gradients on the corner pieces took a lot of attention at different stages throughout the design (depending on which version of Illustrator I had available to me at the time - as my work laptop had a meltdown in the middle somewhere).
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The name labels for "non-use" and "disposal" caused a few minor headaches. I also seem to have changed the arrow from "pharmaceutical companies" to "promotion" to a slightly different angle. I'm afraid I can't remember why, but I guess most of the rest of them are "flat" - and there was a rather obvious gap in front of the left board.
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As different elements appeared in different colours, I felt more comfortable with using different colours for building symbols I'd drawn earlier:
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Quite a lot of extra things in this version, including the underground section - although I was worried it was a bit flat-looking compared to the rest of the diagram. The arrowhead from "leachate" to "ground water" is also a bit hard to see:
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Getting from "surface water", "fields" and "landfill" to the "degredation" text box I wanted on the left of the diagram was a bit challenging. It would have been okay if I could use horizontal arrows, but that would break the pattern of only having vertical, 60 and 120 degree angles in the rest of the diagram:
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I changed them to vertical arrows, suggesting that pharmaceuticals were being "removed". This also gave me enough space to make the underground caverns look a bit less flat by taking a "bite" out of the soil.
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Even though not all of the diagram was in place, I had to add in some dummy text at this point, to give the text authors an idea of how much space they would have at this point (we were working to a deadline and we needed to work at the same time).
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Ah, the water tower... This was a complete pain to draw with all those legs to get right (and really don't talk about the pipes). It ALSO caused problems with trying to get that pipe back to the people at home - so I had to move the shops, redraw the shops arrows and make a little hump-back bridge so it didn't obstruct the road.
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The final section was basically all arrow, and was hugely confusing. Also, positioning the "manufacturing waste" and "returned items incinerated" text boxes was tricky. We also decided to remove the "up" arrows from surface water, fields and landfill - as it could be seen as evaporation / vaporisation. The types of molecules we are talking about are unlikely to become gases due to their chemical properties, so this idea would be misleading. Degradation (or "losses") also happens at many different places in the diagram, not just these three. We also switched from "end points" to "fates" - an accepted environmental chemistry term that more accurately describes the way that pharmaceuticals rarely disappear entirely from the system.
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The solution to the confusing arrows on the left was to combine the "household waste" and "biosolids" arrows - as they both ended up going to the same two places. Also, the first complete version of the real text went in, breaking the whole layout, of course :)
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After some very useful advice from the lead designer at Nature, who I met at a conference (thanks Kelly!) I realised that the "end points" needed to be linked more strongly with their accompanying texts. I also found (and got carried away with) a cool new way of doing smoke, involving lots of circles, with transparent ones on the outside of the central solid "cloud".
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The volume of text was still a problem - and I needed to fit on the references at the bottom - so the size of the whole diagram sadly had to be reduced. This was one of those times when I really really appreciated Illustrator and its ability to resize EVERYTHING in seconds. This gave me space to make the final "routes to sustainability"box a bit more interesting, also:
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I briefly considered colouring the text boxes according to which section of the graphic they dealt with, but it was A) garish and B) not that helpful. In this version I also did some gradient work as I was back in CS5.5 with the proper gradient tool - so I fixed the earth pillar in "ground water", and the gradients for all the pipe corners. And finally sorted out the visibility of that arrow head from "leachate" to "ground water".
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A quick typeface change, a few minor tweaks and the addition of the digger that made it through all the way from my original sketch, and that brings us up to my current version (version 149 for what it's worth):
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I toyed briefly with the idea of putting in more details like the digger - people and cars on the streets, trees, bushes, etc (you'll notice some of these details on the final pencil sketch). This would have had the advantage of making it look more like a city that people would want to live in, rather than an industrial wasteland. However, as the diagram was already very complicated, I decided that what little white space (green space?) that there was should probably be left that way.
This is the final version for now, and I've submitted it to the AAAS/NSF science and engineering visualisation competition. However, we have some plans for it in the future: Taking the text off and using it as a discussion tool at a policy-focussed conference; using it as a teaching aid to get dental / medical students thinking about prescribing practice; and maybe even using it as the basis for a study, to see what effects it has on prescribing practice for student / early career medical professionals. During the course of those uses, I'm sure it will be altered and adapted, and if so I'll try to find time to write up on here too.