I cite this favorite quote from Max Planck in my book (and every chance I get):
A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.
I think this applies to all walks of life, not just science. Yet sometimes an argument so compelling comes along that, though reluctantly at first, one by one the old guard drop at its feet. This is what happened to me this weekend at the Health Foo Camp in Cambridge, MA.
First, what is Health Foo? Well that was my first question when I received an invitation to attend this strangely named meeting. A Foo Camp is something put together by O’Reilly, the pioneering digital media group. Started 12 years ago, these meetings are thematic gatherings of “Friends of O’Reilly,” hence “Foo,” intended to bring together a diversity of thought about a specific field. The camp that I attended was the second such gathering in the healthcare space, supported in part by the Robert Wood Johnson Foundation, and held at Microsoft’s New England Research and Development Center in Cambridge. How can I ever thank O’Reilly, RWJF and Microsoft for this mind-shifting event?
As I mentioned in my previous post, the attendee roster was so full of luminaries that I frankly wasn’t sure that the invitation had not ended up in my Inbox by mistake. But mistake or not, what a privilege to attend! I spent the weekend getting to know the faces and the substance behind such familiar names as Regina Holliday, Paul Levy, Alan Greene, Ted Eytan, Susannah Fox, Gilles Frydman and others. And what still has my mind spinning is my conversations with people I don’t normally interact with — computational scientists, game designers, food advocates and international public health movers and shakers.
The most risky aspect of this meeting was the very essence of its success: we were to free-range. No agenda was set; space, food and company were provided. The resulting sessions ran the gamut from the usual nerd porn of probability to such far-reaching topics as memory and the role of faith, poetry and the arts in medicine (my personal favorite, where I got to play in the sandbox of participatory painting led by Regina. Take that, left brain!)
I have to say I spent a part of the weekend in a bit of a fog. What is gamification of medicine? What does “deep modularity” mean? But the full impact of such diversity of knowledge did not hit me until I was heading West on the Turnpike away from the meeting in the direction of home. It felt like a deep air pocket, and for a moment I couldn’t catch my breath.My epiphany was this: I have been sitting in my office and analyzing, writing and thinking about how to slow down this juggernaut of digitalization in healthcare. My logic has been to identify the problems, particularly the overdiagnosis and overtreatment and the attendant harm, all in the context of an obscene price tag, and to say that not only does medicine not need the radical digital revolution that is being imposed on it, but the very definition of medicine needs to change. What I failed to consider is that medicine is a module that needs to fit into the rest of what we call our modern life. So, slamming on the brakes in hopes of stopping this locomotive before it squashes the medical system is the wrong approach.
I can hear what you are thinking. “There goes another one.” “She drank the Kool-aid.” “If she gets all starry-eyed about technology, there is no hope for the rest of us.” Well, I am not a fan of Kool-aid, but I do like Shakespeare. My realization is as follows: If we don’t start thinking about what we want medicine to be, we will continue getting medicine that looks and works like a Rube Goldberg machine, a conglomeration of unrelated levers that may or may not achieve the desired results. The stakes are too high, stakeholders too many, and the resources being used staggering.
The digital revolution will continue its break-neck pace regardless of my opinions. In its quest to take over the world, it will continue to advance into every aspect of medicine. But instead of positioning it as a confrontation between Godzilla and King Kong, I have decided that a more constructive way is to start to imagine what medicine can and should be in the future. The current model is moribund, if not altogether dead. Nature abhors a vacuum, and unless we fill it with something that heals and nurtures that has come out of a concerted multidisciplinary blueprint, it will continue to grow into a hydra that will eventually swallow us.
I know, I miss the slide rule too. But we did not get to be on Twitter by chaining ourselves to the old paradigms. Regina Holliday taught me, among so many other things this weekend, the word “chaordic.” It is a neologism that combines the ideas of chaos and order into one force of nature. I think there has been enough chaos in the relentless penetration of technologies into medicine. I am tired of screaming at at the back of the digital monster like a crazy lady. We need to get ahead of it with an open mind and even some excitement, and start imagining where we can direct it for the better health of the public. Our magical thinking will not change the fact that this tidal wave will destroy us if we lack the imagination to ride it. A gathering like the Health Foo Camp is what fuels that imagination. Let’s grow and harness it!
Marya Zilberberg, MD, MPH, is a physician health services researcher with a specific interest in healthcare-associated complications and a broad interest in the state of our healthcare system. She is the Founder and President of EviMed Research Group, LLC, a consultancy specializing in epidemiology, health services and outcomes research. She is also a professor of Epidemiology at the University of Massachusetts, Amherst. Dr. Zilberberg blogs at Healthcare, etc.
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Bruce, thank you for your comment — I think you have read my argument exactly the right way. Here is the post I did the day after this one; it is exactly along the lines of what you said.
Marya, thank you for demonstrating a growth mindset. We all need that. But I think you also had that resistance to the digital revolution in healthcare for some good reasons. Not that it should not happen, but in and of itself it is not the solution. Without a system structural change in how we deliver care (which I think should be the focus of healthcare innovation), we will continue to use electronic health tools poorly. Until we end the fragmentation, all of the parts in healthcare (payers, hospitals, physicians, etc.) will continue to function for their own optimization, and I think the patients will continue to suffer despite the escalating technology.
Beautifully put, Marya. Thanks for such a great summation.
Thank you, Paul.
Pure joy of learning aside (sorry academs), science is fulfilled in its application to the real world. The same holds true for assessments of our system. The ultimate questions we must ask are: “so what?” and “now what?” It is far easier to analyze and criticize than it is to come up with what it should become. The unfortunate reality is that making medical care into a system invites making it political (which it does), once theory becomes a vision it too becomes political. The only way to overcome this, in my opinion, is to make something good enough that resisting it seems silly and stupid. Bank tellers may have been against ATM’s for a while, but it was just too convenient compared to the alternative. I think that’s known as the “duh” factor.
I am jealous of your opportunity to think ahead. I also think the word “Foo” is pretty cool.
Rob, I love your comment — this is exactly the discussion before the discussion that should be happening. I realize that “planning” is a little bit anathema to market economies, yet perhaps that is exactly what needs to be happening. And yes, it is political, but if we agree that the current non-system is the result of haphazard piling on of stuff, then what other reasonable solutions are there? We conducted the experiment. It failed. Not time to try a new approach.
Shall we start our own virtual Health Foo?
Count me in, if only for being able to be part of a foo.