I’m a sucker for underdog stories. I love unconventional wisdom overthrowing conventional wisdom. I’m deeply suspicious of Big Tech, Big Oil, and big health. I know unfettered competition is not always to my benefit but get nervous when I don’t really have many options.
So when I read that Google is starting to worry about a threat to its search dominance and that TikTok and other social media giants are scared of a rival start-up, well, count me in. I just wish it was health care goliaths that were worried.
Epidemics don’t appear in isolation of geography, social status, race or economics.
In a recent Kaiser Family Foundation article, the authors reviewed case numbers and death rates organized by race/ethnicity. It will come as no surprise that the most vulnerable populations death rate is nearly three times greater than the least vulnerable. But what may surprise you is that the population at greatest risk was neither self-identified as Black or Hispanic, but Native American.
Sadly, this is not a new story, but in the analogs of American history, it has been papered over by a partially true, but incomplete, narrative. That storyline was largely popularized by the book, “Guns, Germs, and Steel.” Published in 1997, author Jared Diamond explained that European colonists, arriving in the Caribbean islands in the late 15th century, carried with them a variety of diseases like smallpox and measles, and transmitted them to indigenous people that had no prior exposure to these deadly microbes.
When my siblings and I were young, we were fascinated by my father’s Uncle Byron. Handsome and confident, he drove a big, 1960s-era Chrysler Imperial, had a glamorous job — an executive at a Baltimore radio station — and radiated panache.
He also was part of a small family mystery. His father, Louis, was married three times, and Byron was raised by Wife № 3. But he was the biological child of Wife № 2, who died just a few years after his birth from an unknown cause.
Thanks to some persistent genealogical research, I recently discovered that cause: Annie Millenson had a botched abortion, and it killed her. It also destroyed her surviving family.
Our rural health care system has suffered badly during the COVID-19 pandemic. It entered the pandemic with severe structural weaknesses, including magnified health disparities and inequities, lower rates of vaccination in the general population, and high risk of rural hospital closures. Beginning with these challenges, rural providers have been harder hit by the pandemic than just about any other health care sector.
Juxtaposed against this struggle is the optimism for digital health – one of the few bright spots of the pandemic. We have witnessed a veritable digital health revolution – record capital infusions of $37.9 billion to digital health companies in 2021, a proliferation of digital health companies (11,000 by some estimates), a wave of healthtech IPOs (29), and an unprecedented talent migration of Silicon Valley programmers, technologists, and engineers into health care. With this investment and talent boom comes staggering growth in new digital health tools. From telemedicine to remote diagnostics to the delivery of medications directly to a patient’s home, it seems that for every health care access need there is a digital solution.
A recent CNN article discusses approval of the Moderna Covid-19 vaccine for people ages 6-17. The CDC director acted after its vaccine advisers on the Advisory Committee on Immunization Practices voted unanimously to support the two dose Moderna COVID-19 vaccine for kids in this age group. The goal per CDC director Walensky was to “protect our children and teens from the complications of severe COVID-19 disease”
The New York Times had an interesting set of op-eds last week under the theme “I Was Wrong.” For example, Paul Krugman says he was wrong about inflation, David Brooks laments being wrong about capitalism, and Bret Stevens now fears he was wrong about Trump voters. Nobody fessed up about being wrong about healthcare, so I’ll volunteer.
I’ve been writing regularly about healthcare for over a decade now, with some strong opinions and often with some pretty speculative ideas. I’ve had a lot to be wrong about, and I hope I will be wrong about many of them (e.g., microplastics). Some of my thoughts (such as on DNA storage or nanorobots) may just be still too soon, but there are definitely some things I’d thought, or at least hoped, would have happened by now.
I saw a great quote by Alfred North Whitehead the other day: “It is the business of the future to be dangerous.”
Now, I was a math major many years ago, so I know who Alfred North Whitehead was: the coauthor (with Bertrand Russell) of the Principia Mathematica, a landmark, three-volume treatise that proved – in excruciating detail — that all of mathematics (and thus, arguably, all of science) can be reduced to mathematical logic. I always thought Lord Russell was the eloquent one, but it turns out that Professor Whitehead had a way with words too.
So, of course, I want to apply a few of his particularly pithy quotes to healthcare.
It’s July 4th – Independence Day for those of you who remember your U.S. history. There’s already too much talk about loss of rights, political tyranny, militias, even succession, and I don’t want to wade any further into those troubled waters. But I thought I could at least try to reimagine what a Declaration of Independence might look like if it was aimed at the American healthcare system.
Well, they did it. We had a warning they were going to do it, from the leaked opinion in May, but it still was a blow to well over half the country when the Supreme Court struck down Roe v. Wade in its ruling on Dobbs v. Jackson Women’s Health Organization. It didn’t rule that abortion was unconstitutional – as Justice Kavanaugh wrote. “On the question of abortion, the Constitution is therefore neither pro-life nor pro-choice” – but, rather, left it to the “voters,” i.e., the states, to decide. And, boy, the “pro-life” states have been deciding and are ready to do a lot more deciding.
There has been lots of outrage, many protests, and calls for the Senate to pass a federal law explicitly granting a right to abortion (although that would require changing the filibuster rules). Aside from the fact that the Democrats probably don’t have the votes to do that, even if they did, as soon as the Republicans retook Congress and the White House, they’d just repeal it and perhaps pass a law outlawing abortion everywhere. So it goes.
There are going to be many fights about abortion in Congress and in the states, but I think it’s time for a new strategy. It’s time to amend the Constitution.
I find myself thinking about the future a lot, in part because I’ve somehow accumulated so much past, and in part because thinking about the present usually depresses me. I’m not so sure the future is going to be better, but I still have hopes that it can be better.
Two articles recently provided some good insights into how to think about the future: Kevin Kelly’s How to Future and an except from Jane McGonigal’s new book Imaginable: How to See the Future Coming and Feel Ready for Anything―Even Things That Seem Impossible Today that was published in Fast Company.
I’ll briefly summarize each and then try to apply them to healthcare.