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30 September 2016

A declaration for radical healthspan extension

Filed under: aging, healthcare, medicine, rejuveneering, Uncategorized — Tags: , , , — David Wood @ 5:26 pm

I’m writing during a short break in the proceedings of the 2016 Eurosymposium on Healthy Ageing, which is being held in central Brussels.

The organisers have in mind that attendees could issue a declaration at the end of the event, tomorrow, Saturday 1st October – a date which happens to be Longevity Day.

Please find some draft text for this declaration. Lots of other text has been proposed too, but this is a fairly minimal version.

Before the text of the declaration is finalised, I’m interested to hear comments:

  • What should be added – or omitted?
  • What’s unclear?
  • What do people particularly like about it?
  • What improvements might be made to the language?
  • What changes (if any) would convince you to add your signature to it?
  • What’s a good way to conclude the declaration?

Please let us know!

Note: Many thanks are due to various members and supporters of Heales for suggesting text – especially Didier Coeurnelle.

(Update 6pm Brussels time 1st October – the draft text has evolved. The latest version is below.)

declaration-v3

The Brussels Declaration for Radical Healthspan Extension

The defeat of aging lies within our collective grasp. It’s time to seize this remarkable opportunity.

This 1st of October 2016, during International Longevity Day, the Eurosymposium on Healthy Ageing (EHA) meeting in Brussels proclaims the possibility and the imperative of a moonshot project to overcome all age-related diseases within 25 years by tackling aging as their root cause.

The result will be a world:

  • Where healthcare is far less expensive
  • Where human well-being can be radically extended
  • Where people place greater value on the environment and on peace, in view of their expectation of much longer lives
  • Where the right to life is more precious than ever, because life is longer.

Key steps in this initiative will include:

  • A paradigm shift stressing the need for research on aging itself, rather than only on individual diseases of old age
  • The removal of regulatory and other barriers which prevent or disincentivize companies from developing treatments for aging itself
  • An accelerated program to test anti-aging interventions on a much larger scale than anything that exists at the moment, leading to multiple human clinical trials of genuine rejuvenation biotechnologies by 2021.

These programs will require a coordinated effort at national and international level, integrating diverse existing and novel research approaches. They need to be financed by both public and private organizations, and create inclusive, affordable solutions available on equal terms to everybody.

25 May 2016

The Abolition of Aging – epublished

TAoA Cover page v11

I’m happy to report that my new book was epublished today, for Amazon Kindle. It’s “The Abolition of Aging: The forthcoming radical extension of healthy human longevity”.

You can find it on Amazon US, Amazon UK, …

It’s not a book about reprogramming our (silicon-based) devices – the kind of thing that used to be on my mind in my smartphone industry days. Instead, it’s about reprogramming our biology.

My reasons for writing this book are contained in its foreword. For convenience, I append a copy of the foreword at the end of this blogpost.

Physical copies of the book should be available from some time next month, for readers who prefer atoms to bits. I am planning to create an audio version too.

You can find more details about the book on its own website:

  • Advance praise, from people who have read pre-publication copies
  • The book’s description and dedication
  • An expanded table of contents
  • A community page, for further information about topics covered in the book.

If anyone has comments or queries about anything they read in the book, they’re welcome to raise them as responses to this blogpost.

Foreword

(This content is part of the introductory material of the book “The Abolition of Aging”.)

Within our collective grasp dwells the remarkable possibility of the abolition of biological aging.

It’s a big “if”, but if we decide as a species to make this project a priority, there’s around a 50% chance that practical rejuvenation therapies resulting in the comprehensive reversal of aging will be widely available as early as 2040.

People everywhere, on the application of these treatments, will, if they wish, stop becoming biologically older. Instead, again if they wish, they’ll start to become biologically younger, in both body and mind, as rejuvenation therapies take hold. In short, everyone will have the option to become ageless.

Two objections

The viewpoint I’ve just described is a position I’ve reached following extensive research, carried out over more than ten years. My research has led me to become a strong supporter of what can be called “the rejuveneering project”: a multi-decade cross-disciplinary endeavour to engineer human rejuvenation and thereby enable the choice to abolish aging.

But when I mention this viewpoint to people that I meet – as part of my activity as a futurist, or when I catch up with my former colleagues from the smartphone industry – I frequently encounter one of two adverse reactions.

First, people tell me that it’s not possible that such treatments are going to exist in any meaningful timescale any time soon. In other words, they insist that human rejuvenation can’t be done. It’s wishful thinking to suppose otherwise, they say. It’s bad science. It’s naively over-optimistic. It’s ignorant of the long history of failures in this field. The technical challenges remain overwhelmingly difficult.

Second, people tell me that any such treatments would be socially destructive and morally indefensible. In other words, they insist that human rejuvenation shouldn’t be done. It’s essentially a selfish idea, they say – an idea with all kinds of undesirable consequences for societal harmony or planetary well-being. It’s an arrogant idea, from immature minds. It’s an idea that deserves to be strangled.

Can’t be done; shouldn’t be done – in this book, I will argue that both these objections are profoundly wrong. I’ll argue instead that rejuvenation is a noble, highly desirable, eminently practical destiny for our species – a “Humanity+” destiny that could be achieved within just one human generation from now. As I see it, the abolition of aging is set to take its place on the upward arc of human social progress, echoing developments such as the abolition of slavery, the abolition of racism, and the abolition of poverty.

It turns out that the can’t/shouldn’t objections are interlinked. They reinforce each other. It’s often because someone thinks an effort is technically impossible that they object to any time or finance being applied to it. It would be much better, they say, to apply these resources to other philanthropic causes where real progress is possible. That, allegedly, would be the moral, mature thing to do. Conversely, when someone’s moral stance predisposes them to accept personal bodily decline and death, they become eager to find technical reasons that back up their decision. After all, it’s human nature to tend to cherry pick evidence that supports what we want to believe.

Two paradigms

A set of mutually reinforcing interlinked beliefs is sometimes called a “paradigm”. Our paradigms guide us, both consciously and unconsciously, in how we see the world, and in the kinds of projects we deem to be worthwhile. Our paradigms filter our perceptions and constrain our imaginations.

Changing paradigms is hard work. Just ask anyone who has tried to alter the opinion of others on contentious matters such as climate change, gun control, regulating the free market, or progressive taxation. Mere reason alone cannot unseat opinions on such topics. What to some observers is clear and compelling evidence for one position is hardly even noticed by someone entrenched in a competing paradigm. The inconvenient evidence is swatted away with little conscious thought.

The paradigm that accepts human bodily decline and aging as somehow desirable has even deeper roots than the vexatious political topics mentioned in the previous paragraph. It’s not going to be easy to dislodge that accepting-agingparadigm. However, in the chapters ahead, I will marshal a wide range of considerations in favour of a different paradigm – the paradigm that heartily anticipates and endorses rejuvenation. I’ll try to encourage readers to see things from that anticipating-rejuvenation paradigm.

Two abolitions

Accepting aging can be compared to accepting slavery.

For millennia, people from all social classes took slavery for granted. Thoughtful participants may have seen drawbacks with the system, but they assumed that there was no alternative to the basic fact of slavery. They could not conceive how society would function properly without slaves. Even the Bible takes slavery as a given. There is no Mosaic commandment which says “Thou shalt not keep slaves”. Nor is there anything in the New Testament that tells slave owners to set their slaves free.

But in recent times, thank goodness, the public mind changed. The accepting-slavery paradigm wilted in the face of a crescendo of opposing arguments. As with slavery, so also with aging: the time will come for its abolition. The public will cease to take aging for granted. They’ll stop believing in spurious justifications for its inevitability. They’ll demand better. They’ll see how rejuvenation is ready to be embraced.

One reason why slavery is so objectionable is the extent of its curtailment of human opportunity – the denial of free choice to the people enslaved. Another reason is that life expectancy of slaves frequently fell far short of the life expectancy of people not enslaved. As such, slavery can be counted as a major killer: it accelerated death.

From the anticipating-rejuvenation perspective, aging should be seen as the biggest killer of all. Compared to “standard” killers of the present day, such as drunken driving, terrorism, lead fumes, or other carcinogens – killers which rouse us to action to constrain them – aging destroys many more people. Globally, aging is the cause of at least two thirds of human deaths. Aging is the awful elephant in the room, which we have collectively learned to ignore, but which we must learn to recognise and challenge anew.

Every single week the rejuveneering project is delayed, hundreds of thousands more people suffer and die worldwide due to aging-related diseases. Advocates of rejuveneering see this ongoing situation as a needless slaughter. It’s an intolerable offence against human potential. We ought, therefore, to be powerfully motivated to raise the probability of 50% which I offered at the start of this foreword. A 50% chance of success with the rejuveneering project means, equally, a 50% chance of that project failing. That’s a 50% chance of the human slaughter continuing.

Motivation

In the same way as we have become fervently motivated in recent decades to deal with the other killers mentioned above – vigorously campaigning against, for example, drunk drivers and emitters of noxious chemical pollutants – we ought to be even more motivated to deal with aging. The anger that society has directed against tobacco companies, for long obscuring the links between smoking and lung cancer, ought to find a resonance in a new social passion to uncover and address links between biological aging and numerous diseases. If it’s right to seek to change behaviours and metabolism to cut down bad cholesterol (a precursor of heart disease) and concentrated glucose (a precursor of diabetes), it should be equally right to change behaviours and metabolism to cut down something that’s a precursor of even more diseases, namely, biological aging.

This is a discussion with enormous consequences. Changes in the public mood regarding the desirability of rejuveneering could trigger large reallocations of both public and private research expenditure. In turn, these reallocations are likely to have major implications in many areas of public well-being. Clearly, these decisions need to be taken wisely – with decisions being guided by a better understanding of the rich landscape of rejuveneering possibilities.

An ongoing surge of motivation, wisely coordinated, is one of the factors which can assist the rejuveneering project to overcome the weighty challenges it faces – challenges in science, technology, engineering, and human collaboration. Stubborn “unknown unknowns” surely lie ahead too. Due to these complexities and unknowns, no one can be sure of the outcome of this project. Despite what some rejuvenation enthusiasts may suggest, there’s nothing inevitable about the pace of future medical progress. That’s why I give the probability of success as only around 50%.

Although the end outcome remains unclear, the sense of discovery is increasing. The underlying scientific context is changing rapidly. Every day brings its own fresh firehose of news of potential breakthrough medical approaches. In the midst of so much innovation, it behoves us to seek clarity on the bigger picture.

To the extent that my book can provide that bigger picture, it will have met at least some of its goals. Armed with that bigger picture, readers of this book will, hopefully, be better placed to find the aspect of the overall rejuveneering project where they can make their best contributions. Together, we can tilt that 50% success probability upwards. The sooner, the better.

(If you found this interesting, you may like to read “The discussion ahead” next.)

 

15 September 2015

A wiser journey to a better Tomorrowland

Peter Drucker quote

Three fine books that I’ve recently had the pleasure to finish reading all underscore, in their own ways, the profound insight expressed in 1970 by management consultant Peter Drucker:

The major questions regarding technology are not technical but human questions.

That insights sits alongside the observation that technology has been an immensely important driver of change in human history. The technologies of agriculture, steam, electricity, medicine, and information, to name only a few, have led to dramatic changes in the key metrics in human civilisation – metrics such as population, travel, consumption, and knowledge.

But the best results of technology typically depend upon changes happening in parallel in human practice. Indeed, new general purpose technology sometimes initially results, not in an increase of productivity, but in an apparent decline.

The productivity paradox

Writing in Forbes earlier this year, in an article about the “current productivity paradox in healthcare”, Roy Smythe makes the following points:

There were two previous slowdowns in productivity that were not anticipated, and caused great consternation – the adoption of electricity and the computer. The issues at hand with both were the protracted time it took to diffuse the technology, the problem of trying to utilize the new technology alongside the pre-existing technology, and the misconception that the new technology should be used in the same context as the older one.

Although the technology needed to electrify manufacturing was available in the early 1890s, it was not fully adopted for about thirty years. Many tried to use the technology alongside or in conjunction with steam-driven engines – creating all manner of work-flow challenges, and it took some time to understand that it was more efficient to use electrical wires and peripheral, smaller electrical motors (dynamos) than to connect centrally-located large dynamos to the drive shafts and pulleys necessary to disperse steam-generated power. The sum of these activities resulted in a significant, and unanticipated lag in productivity in industry between 1890 and 1920…

However, in time, these new GPTs (general purpose technologies) did result in major productivity gains:

The good news, however, is substantial. In the two decades following the adoption of both electricity and the computer, significant acceleration of productivity was enjoyed. The secret was in the ability to change the context (in the case of the dynamo, taking pulleys down for example) assisting in a complete overhaul of the business process and environment, and the spawning of the new processes, tools and adjuncts that capitalized on the GPT.

In other words, the new general purpose technologies yielded the best results, not when humans were trying to follow the same processes as before, but when new processes, organisational models, and culture were adopted. These changes took time to conceive and adopt. Indeed, the changes took not only time but wisdom.

Wachter Kotler Naam

The Digital Doctor

Robert Wachter’s excellent book “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age” provides a dazzling analysis of the ways in which the computerisation of health records – creating so-called EHRs (Electronic Health Records) – is passing through a similar phase of disappointing accomplishment. EHRs are often associated with new kinds of errors, with additional workload burdens, and with interfering in the all-important human relationship between doctor and patient. They’re far from popular with healthcare professionals.

Wachter believes these problems to be temporary: EHRs will live up to their promise in due course. But only once people can set the hype aside. What’s needed is that designers of healthcare tech products and systems will:

  • Put a much higher priority on ease of use, simplifying usage patterns, and on redesigning the overall flow of activity
  • Recognise and deal with the multiple complexities of the world of medicine.

For a good flavour of Wachter’s viewpoint, consider this extract from a New York Times opinion article he wrote in March, “Why Health Care Tech Is Still So Bad”,

Last year, I saw an ad recruiting physicians to a Phoenix-area hospital. It promoted state-of-the-art operating rooms, dazzling radiology equipment and a lovely suburban location. But only one line was printed in bold: “No E.H.R.”

In today’s digital era, a modern hospital deemed the absence of an electronic medical record system to be a premier selling point.

That hospital is not alone…

I interviewed Boeing’s top cockpit designers, who wouldn’t dream of green-lighting a new plane until they had spent thousands of hours watching pilots in simulators and on test flights. This principle of user-centered design is part of aviation’s DNA, yet has been woefully lacking in health care software design.

Our iPhones and their digital brethren have made computerization look easy, which makes our experience with health care technology doubly disappointing. An important step is admitting that there is a problem, toning down the hype, and welcoming thoughtful criticism, rather than branding critics as Luddites.

In my research, I found humility in a surprising place: the headquarters of I.B.M.’s Watson team, the people who built the computer that trounced the “Jeopardy!” champions. I asked the lead engineer of Watson’s health team, Eric Brown, what the equivalent of the “Jeopardy!” victory would be in medicine. I expected him to describe some kind of holographic physician, like the doctor on “Star Trek Voyager,” with Watson serving as the cognitive engine. His answer, however, reflected his deep respect for the unique challenges of health care. “It’ll be when we have a technology that physicians suddenly can’t live without,” he said.

I’m reminded of a principle I included in a long-ago presentation, “Enabling simply great mobile phones” (PDF), from 2004:

It’s easy to make something hard;
It’s hard to make something easy…

Smartphones will sell very well provided they allow users to build on, and do more of, the things that caused users to buy phones in the first place (communication and messaging, fashion and fun, and safety and connection) – and provided they allow users to do these things simply, even though the phones themselves are increasingly complex.

As for smartphones, so also for healthcare technology: the interfaces need to protect users from the innumerable complications that lurk under the surface. The greater the underlying complexity, the greater the importance of smart interfaces.

Again as for smartphones, once good human interfaces have been put in place, the results of new healthcare technology can be enormous. The New York Times article by Wachter contains a reminder of vexed issues within healthcare – issues that technology has the power to solve:

Health care, our most information-intensive industry, is plagued by demonstrably spotty quality, millions of errors and backbreaking costs. We will never make fundamental improvements in our system without the thoughtful use of technology.

Tomorrowland

In a different way, Steven Kotler’s new book also brings human considerations to the forefront. The title of the book is “Tomorrowland: Our Journey from Science Fiction to Science Fact”. It’s full of remarkable human interest stories, that go far beyond simple cheer-leading for the potential of technological progress.

I had the pleasure to help introduce Steven at a recent event in Campus London, which was co-organised by London Futurists and FutureSelf. Steven appeared by Skype.

AtCampusLondon

(photos by Kirsten Zverina)

Ahead of the event, I had hoped to be able to finish reading his book, but because of other commitments I had only managed to read the first 25%. That was already enough to convince me that the book departed from any simple formula of techno-optimism.

In the days after the event, I was drawn back to Kotler’s book time and again, as I kept discovering new depth in its stories. Kotler brings a journalist perspective to the hopes, fears, struggles, and (yes) remarkable accomplishments of many technology pioneers. For most of these stories, the eventual outcome is still far from clear. Topics covered included:

  • The difficulties in trying to save the Florida Everglades from environmental collapse
  • Highlights from the long saga of people trying to invent flying cars (you can read that excerpt online here)
  • Difficulties and opportunities with different kinds of nuclear energy
  • The potential for technology to provide quick access to the profound feelings of transcendence reported from so-called “out of the body” and “near death experiences”
  • Some unexpected issues with the business of sperm donation
  • Different ways to enable blind people to see
  • Some missed turnings in the possibilities to use psychedelic drugs more widely
  • Options to prevent bio-terrorists from developing pathogens that are targeted at particular individuals.

There’s a video preview for the book:

The preview is a bit breathless for my liking, but the book as a whole provides some wonderfully rounded explorations. The marvellous potential of new technology should, indeed, inspire awe. But that potential won’t be attained without some very clear thinking.

Apex

The third of the disparate trio of three books I want to mention is, itself, the third in a continuous trilogy of fast-paced futurist fiction by Ramez Naam.

In “Apex: Connect”, Naam brings to a climactic culmination the myriad chains of human and transhuman drama that started in “Nexus: Install” and ratcheted in “Crux: Upgrade”.

RamezNaamTrilogy

Having been enthralled by the first two books in this trilogy, I was nervous about starting to listen to the third, since I realised it would likely absorb me for most of the next few days. I was right – but the absorption was worth it.

There’s plenty of technology in this trilogy, which is set several decades in the future: enhanced bodies, enhanced minds, enhanced communications, enhanced artificial intelligence. Critically, there is plenty of human  frailty too: people with cognitive biases, painful past experiences, unbalanced perspectives, undue loyalty to doubtful causes. Merely the fact of more powerful technology doesn’t automatically make people kinder as well as stronger, or wiser as well as smarter.

Another reason I like Apex so much is because it embraces radical uncertainty. Will superintelligence be a force that enhances humanity, or destroys it? Are regulations for new technology an instrument of oppression, or a means to guide people to more trustworthy outcomes? Should backdoors be built into security mechanisms? How should humanity treat artificial general intelligence, to avoid that AGI reaching unpleasant conclusions?

To my mind, too many commentators (in the real world) have pat answers to these questions. They’re too ready to assert that the facts of the matter are clear, and that the path to a better Tomorrowland is evident. But the drama that unfolds in Apex highlights rich ambiguities. These ambiguities require careful thought and wide appreciation. They also require human focus.

Postscript: H+Pedia

In between my other projects, I’m trying to assemble some of the best thinking on the pros and cons of key futurist questions. My idea is to use the new site H+Pedia for that purpose.

hpluspedia

As a starter, see the page on Transhumanism, where I’ve tried to assemble the most important lines of argument for and against taking a transhumanist stance towards the future. The page includes some common lines of criticism of transhumanism, and points out:

  • Where these criticisms miss the mark
  • Where these criticisms have substance – so that transhumanists ought to pay attention.

In some cases, I offer clear-cut conclusions. But in other cases, the balance of the argument is ambiguous. The future is far from being set in stone.

I’ll welcome constructive contributions to H+Pedia from anyone interested in the future of humanity.

Second postscript:

It’s now less than three weeks to the Anticipating 2040 event, where many speakers will be touching on the themes outlined above. Here’s a 90 second preview of what attendees can expect.

15 February 2015

Ten years of quantified self

Filed under: books, healthcare — Tags: , , , , , , , — David Wood @ 12:02 am

Ten years. Actually 539 weeks. I’ve been recording my weight every morning from 23 October 2004, and adding a new data point to my chart every weekend.

10 years of Quantified Self

I’ve been recording my weight ever since I read that people who monitor their weight on a regular basis are more likely to avoid it ballooning upwards. There’s an instant feedback which allows me to seek adjustments in my personal health regime. With ten years of experience under my (varyingly-sized) belt, I’m strongly inclined to continue the experiment.

The above chart started life on my Psion Series 5mx PDA. Week after week, I added data, and watched as the chart expanded. Eventually, the graph hit the limits of what could be displayed on a single screen on the S5mx (width = 480 pixels), so I had to split the chart into two. And then three. Finally, after a number of hardware failures in my stock of S5mx devices, I transferred the data into an Excel spreadsheet on my laptop several months ago. Among other advantages, it once again lets me see the entire picture.

20150214_084625This morning, 14th Feb 2015, I saw the scales dip down to a point I had last reached in September 2006. This result seems to confirm the effectiveness of my latest dietary regime – which I’ve been following since July. Over these seven months, I’ve shrunk from a decidedly unhealthy (and unsightly) 97 kg down to 81 kg.

In terms of the BMI metric (Body Mass Index), that’s a reduction from 31.2 – officially “obese” – down to 26.4. 26.4 is still “marginally overweight”, since, for men, the top end of the BMI scale for a “healthy weight for adults” is 24.9. With my height, that would mean a weight of 77 kg. So there’s still a small journey for me to travel. But I’m happy to celebrate this incremental improvement!

The NHS page on BMI issues this sobering advice:

BMI of 30 or more: a BMI above 30 is classified as obese. Being obese puts you at a raised risk of health problems such as heart disease, stroke and type 2 diabetes. Losing weight will bring significant health improvements..

BMI score of 25 or more: your BMI is above the ideal range and this score means you may be overweight. This means that you’re heavier than is healthy for someone of your height. Excess weight can put you at increased risk of heart disease, stroke and type 2 diabetes. It’s time to take action…

As the full chart of my weight over the last ten years shows, I’ve had three major attempts at “action” to achieve a healthier body mass.

The first: For a while in 2004 and 2005, I restricted myself to two Herbalife meal preparations a day – even when I was travelling.

Later, in 2011, I ran across the book by Gary Taubes, “Why We Get Fat: And What to Do About It”, which made a great deal of sense to me. Taubes emphasises that some kinds of calories are more damaging to health than others. Specifically, carbohydrates, such as wheat, change the body metabolism to make it retain more weight. I also read “Wheat belly” by William Davis. Here’s an excerpt from the description of that book:

Renowned cardiologist William Davis explains how eliminating wheat from our diets can prevent fat storage, shrink unsightly bulges and reverse myriad health problems.

Every day we eat food products made of wheat. As a result millions of people experience some form of adverse health effect, ranging from minor rashes and high blood sugar to the unattractive stomach bulges that preventative cardiologist William Davis calls ‘wheat bellies’. According to Davis, that fat has nothing to do with gluttony, sloth or too much butter: it’s down to the whole grain food products so many people eat for breakfast, lunch and dinner.

After witnessing over 2,000 patients regain their health after giving up wheat, Davis reached the disturbing conclusion that wheat is the single largest contributor to the nationwide obesity epidemic – and its elimination is key to dramatic weight loss and optimal health.

In Wheat Belly, Davis exposes the harmful effects of what is actually a product of genetic tinkering being sold to the public as ‘wheat’ and provides readers with a user-friendly, step-by-step plan to navigate a new, wheat-free lifestyle. Benefits include: substantial weight loss, correction of cholesterol abnormalities, relief from arthritis, mood benefits and prevention of heart disease.

As a result, I cut back on carbohydrates – and was pleased to see my weight plummet once again. For a while – until I re-acquired many of my former carb-enjoying habits, whoops.

That takes me to regime number three. This time, I’ve followed the more recent trend known as “5+2”. According to this idea, people can eat normally for, say, five days in the week, and then eat a very reduced amount of calories on the other two days (known as “fasting days”). My initial worry about this approach was that I wasn’t sure I’d eat sensible foods on the two low-calorie days.

That’s when I ran across the meal preparations of the LighterLife company. These include soups, shakes, savoury meals, porridge, and bars. Each of these meals is just 150-200 calories. LighterLife suggest that people eat, on their low-calorie days, four of these meals. These preparations include sufficient proteins, fibre, and 100% of the recommended daily intake of key vitamins and minerals.

To be clear, I am not a medical doctor, and I urge anyone who is considering adopting a diet to obtain their own medical advice. I also recognise that different people have different metabolisms, so a diet that works for one person won’t necessarily work for someone else. However, I can share my own personal experience, in case it inspires others to do their own research:

  • Instead of 5+2, I generally follow 3+4. That is, I have four low-calorie days each week, along with three other days in which I tend to indulge myself (except that, on these other days, I still try to avoid consuming too many carbs, such as wheat, bread, rice, and potatoes)
  • On the low-calorie days, I generally eat around 11.30am, 2.30pm, 5.30pm, and 8.30pm
  • If I’m working at home, I’ll include soups, a savoury meal, and shakes; if I’m away from home, I’ll eat three (or four) different bars, that I pack into my back-pack at the beginning of the day
  • On the low-calorie days, it’s important to drink as well as to eat, but I avoid any drinks with calories in them. In practice, I find drinks of herbal teas to be very effective at dulling any sense of hunger I’m experiencing
  • In addition to eating less, I continue to do a lot of walking (e.g. between Waterloo Station and meeting locations in Central London), as well as other forms of exercise (like on the golf driving range or golf course).

Note: I know that BMI is far from being a complete representation of personal healthiness. However, I view it as a good starting point.

To round off my recommendations for diet-related books that I have particularly enjoyed reading, I’ll add “Mindless eating” by Brian Wansink to the two I mentioned earlier. I listened to the Audible version of that book. It’s hilarious, but thought-provoking, and the research it describes seems very well founded:

Every day, we each make around 200 decisions about eating. But studies have shown that 90% of these decisions are made without any conscious choice. Dr Brian Wansink lays bare the facts about our true eating habits to show that awareness of our patterns can allow us to lose weight effectively and without serious changes to our lives. Dr Wansink’s revelations include:

  • Food mistakes we all make in restaurants, supermarkets and at home
  • How we are manipulated by brand, appearance and parental habits more than price and our choices
  • Our emotional relationship with food and how we can overcome it to revitalise our diets.

Forget calorie counting and starving yourself and learn the truth about why we overeat in this fascinating, innovative guide.

Three books

I’ll finish by thanking my friends, family, and colleagues for their gentle and thoughtful encouragement, over the years, for me to keep an eye on my body mass, and on the general goodness of what I eat. “Health is the first wealth”.

16 April 2014

The future of healthy longevity life extension

There’s a great deal of news these days about potential developments to increase healthy longevity. How can we decide which are the most promising initiatives? What can we do to support faster development and deployment of new treatments? If we want to enable significant increases in healthy longevity for ourselves and our loved ones, what steps should we be taking?

This whole subject – healthy longevity – is complicated by the fact that it’s clouded by a great deal of wishful thinking and misinformation (some deliberate, some unintentional). Companies have products and services they wish to promote. Whole industries have worldviews that they want to maintain. People have engrained personal habits that they wish to justify and rationalise.

And did I mention wish-fulfilment? Here’s an evocative picture posted recently by Vincent Ocasla, a healthy longevity advocate:

Anti-aging

(This picture has an interesting provenance. See the footnote at the end of this blogpost.)

Who, if they were honest, would not like to grasp the possibility of the kind of healthy age-reversal depicted here, if it could be provided ethically, for them and their loved ones? But what steps should we take, that would be most likely to accelerate the enablement of such a transformation?

Back in September last year, I organised a London Futurists “Hangout On Air” video event on that topic. This featured as panellists a number life extension activists from around the world – Franco Cortese, Ilia Stambler, Maria Konovalenko, and Aubrey de Grey. You can see the outcome here:

That ninety minute discussion covered a lot of important topics, but it’s far from providing the last word on the matter. To help continue the discussion, I’m holding an “in real life” London Futurists meetup on the afternoon of Saturday 26th April in Birkbeck College, central London. There will be a number of TED-style talks, followed by extended audience Q&A and discussion.

See here for more details about this event – and to RSVP if you’re planning to attend (this helps me to organise it smoothly) .

Meeting Image

The speakers are Phil MicansTuvi Orbach, and Avi Roy. They each have fascinating and well-informed things to say about the subject. I expect those of us in the audience will all be individually challenged and inspired, at various times in this meetup, to rethink our own personal health strategies, and/or to alter our thinking about how to change society’s presently inadequate approach to this topic.

Phil Micans is Founder and Vice President of International Antiaging Systems and Assistant Director at the British Longevity Society.

Phil has been actively involved in the antiaging field since the late 1980’s. He is currently the Editor-in-Chief of the Aging Matters™ Magazine, Chairman of the Monte Carlo Antiaging Congress, and Assistant Editor to the Lifespan Medicine Journal. He holds a masters degree in biochemistry from Canterbury.

Phil will talk about why orthodox medicine must change its approach to longevity, and the need for preventative and regenerative medicine.

His lecture will review data as issued by the US, UK and WHO authorities. It will become clear that ‘orthodox’ medicine cannot continue as-is for much longer and that a different path will need to be taken soon. The talk will also introduce the concept of the optimal health pyramid.

Tuvi Orbach is the chairman of Mindlife UK, and Managing Trustee of HELP Trust – a charity with the purpose to help and inspire people to enhance their lives.

Tuvi has a background as an entrepreneur who has established several companies integrating software, technology and “lifeware”. Products and services provided  by his companies include:

  • An interactive self-help application to cure anxiety and depression
  • Computerised health screening and prevention for long-term conditions.

Tuvi will address combining the use of technology for self-help with better internal (mind-body, optimism etc) and external lifestyle modification. He’ll also talk about the integration of new science with traditional wisdom.

Avi Roy is is a PhD student researching biomarkers of aging, mitochondria, and regenerative medicine at the Institute of Translational Medicine, Buckingham.

Avi currently writes for The Conversation and has previously written for The Guardian. His articles have also been published in the New Statesman and Business Insider.

Avi also heads up the Oxford University Scientific Society, the Oxford Transhumanism and Emerging Technologies society, and organizes talks at the British Science Association Oxford branch.

Footnotes:

The above 2014->2063 transformation picture has been adapted from (you guessed it) a similar one which portrayed the transformation in the opposite direction, 1963->2014. That earlier version was published in the Twitter stream for “History in Pictures”. So there’s at least one round of “cosmetic retouching” that has taken place. The online comments for the earlier picture suggest that it has been “faked” too.

Of course, the whole point is to find out what kind of rejuvenation technology (sometimes called “rejuveneering”) is possible, without the subterfuge of Photoshop or similar. I’ll be picking up that theme in a talk I’m giving at the Symposium of the Society of Cosmetic Scientists on May 1st. That Symposium has the theme “Face the future”. My  talk there is the closing keynote, ‘More than skin deep: radical options for human transformation, 2015-2045’:

Vision: Within 30 years, those of us still alive will have the potential to experience profound human enhancement. Detox and rejuvenation therapies that clean out internal biological damage will be able to revitalise us in far-reaching ways. Smartphone technology will be miniaturised and ready for incorporation deep inside our bodies and brains. We’ll be living alongside enchanting, witty robots and other forms of super AIs and virtual companions, who will have deprived most of us of gainful employment. We might even be on the point of merger: human with robot, biology with technology.

But which elements of this vision are science fiction, and which science fact? What factors influence the acceleration of technology? And how can we collectively mould the trajectories ahead, so that human values flourish, rather than us bitterly regretting what we allowed to happen?

19 August 2013

Longevity and the looming financial meltdown

Filed under: aging, books, challenge, converged medicine, Economics, futurist, healthcare, rejuveneering, SENS — David Wood @ 2:12 pm

What kind of transformational infrastructure investment projects should governments prioritise?

In the UK, government seems committed to spending a whopping £42 billion between now and 2032 on a lengthy infrastructure project, namely the “HS2” High Speed rail link which could see trains travelling between London, Birmingham, and six other cities, at up to 250 miles per hour. The scheme has many critics. As Nigel Morris notes in The Independent,

In an analysis published today (Monday), the IEA (Institute for Economic Affairs ) says the scheme’s cost has been vastly underestimated and had failed to take into account changes to routes and extra tunnelling because of local opposition.

Richard Wellings, its author, said: “The evidence is now overwhelming that this will be unbelievably costly to the taxpayer while delivering incredibly poor value for money.”

Supporters of this investment claim that the improved infrastructure will be a boon for business in the UK. Multi-year infrastructure improvement projects are something that the private sector tends not to attempt. Unless there’s coordination from government, this kind of project will not happen.

The BBC news website (here and here) helpfully listed ten alternative infrastructure improvement projects that might be better recipients of portions of the £42B earmarked for HS2. Suggestions include:

  • A new road motorway for the east of Britain
  • A bridge to the Isle of Wight
  • A new Channel tunnel, directly accessible to car drivers
  • Tram systems for Liverpool and Leeds
  • A tunnel between Great Britain and Ireland
  • Aerial cycle highways for London

If it were my decision, I would reallocate a large chunk of this funding to a different kind of multi-year infrastructure improvement project. This is in the area of health rather than the area of transport. The idea is to significantly promote research and deployment of treatments in preventive and regenerative medicine.

Ageless CoverThe argument for this kind of sustained investment is laid out in the book The Ageless Generation: How Advances in Biomedicine Will Transform the Global Economy, by Alex Zhavoronkov, which I’ve just finished reading. It’s a compelling analysis.

Alex will be sharing his views at a forthcoming meeting of the London Futurists, on Saturday 31st July. There are more details of this meeting here. (Note that a number of copies of the speaker’s book will be available free of charge to attendees of this meeting.)

The book contains many eye-opening pointers to peer-reviewed research. This covers the accelerating pace of medical breakthroughs, in areas such as bioartificial organs, stem cell therapies, repairing damaged tissues, fortifying the immune system, and autophagy. The research also covers financial and economic matters.

For example, here’s a snippet from the 2009 report “The Burden of Chronic Disease” (PDF) – which is written from a US point of view, though the implications apply for other countries too:

Our current economic reality reminds us that now more than ever, we need to invest in the backbone of our economy: the American workforce. Without question, the single biggest force threatening U.S. workforce productivity, as well as health care affordability and quality of life, is the rise in chronic conditions…

Further into that report, data is quoted from the Milken Institute report “The Economic Burden of Chronic Disease” (PDF)

By our calculations, the most common chronic diseases are costing the economy more than $1 trillion annually—and that figure threatens to reach $6 trillion by the middle of the century.

The costs include lost of productivity, as well as absenteeism:

The potential savings on treatment represents just the tip of the proverbial iceberg. Chronically ill workers take sick days, reducing the supply of labor—and, in the process, the GDP. When they do show up for work to avoid losing wages, they perform far below par—a circumstance known as “presenteeism,” in contrast to absenteeism. Output loss (indirect impacts) due to presenteeism (lower productivity) is immense—several times greater than losses associated with absenteeism. Last (but hardly a footnote), avoidable illness diverts the productive capacity of caregivers, adding to the reduction in labor supply for other uses. Combined, the indirect impacts of these diseases totaled just over $1 trillion in 2003…

In his book, Alex builds on this analysis, focussing on the looming costs to healthcare systems and pensions systems of ever greater portions of our population being elderly and infirm, and becoming increasingly vulnerable to chronic illnesses. Countries face bankruptcy on account of the increased costs. At the very least, we must expect radical changes in the provision of social welfare. The pensionable age is likely to rocket upwards. Families are likely to discover that the provisions they have made for their old age and retirement are woefully inadequate.

The situation is bleak, but solutions are at hand, through a wave of biomedical innovation which could make our recent wave of IT innovation look paltry in comparison. However, despite their promise, these biomedical solutions are arriving too slowly. The healthcare and pharmaceutical industries are bringing us some progress, but they are constrained by their own existing dynamics.

Alex_cover_2_smallAs Alex writes,

The revolution in information technology has irreversibly changed our lives over the past two decades. However, advances in biomedicine stand poised to eclipse the social and economic effects of IT in the near future.

Biomedical innovations typically reach the mass market in much slower fashion than those from information technology. They follow a paradigm where neither demand, in the form of the consumer, nor supply, in the form of the innovator, can significantly accelerate the process. Nevertheless, many of the advances made over the past three decades are already propagating into mainstream clinical practice and converging with other technologies extending our life spans.

However, in the near-term, unless the governments of the debt-laden developed countries make proactive policy changes, there is a possibility of lengthy economic decline and even collapse.

Biomedical advances are not all the same. The current paradigm in biomedical research, clinical regulation and healthcare has created a spur of costly procedures that provide marginal increases late in life extending the “last mile”, with the vast percentage of the lifetime healthcare costs being spent in the last few years of patient’s life, increasing the burden on the economy and society.

There is an urgent need to proactively adjust healthcare, social security, research and regulatory policies:

  • To ameliorate the negative near-term effects
  • To accelerate the mass adoption of technologies contributing positively to the economy.

Now that’s a project well worth spending billions on. It’s a vision of expanded healthspans rather than just of expanded lifespans. It’s a vision of people continuing to be happily productive members of society well into their 80s and 90s and beyond, learning new skills, continuing to expand their horizons, whilst sharing their wisdom and experience with younger generations.

It’s a great vision for the individuals involved (and their families), but also a great vision for the well-being of society as a whole. However, without concerted action, it’s unlikely to become reality.

Footnote 1: To connect the end of this line of reasoning back to its start: If the whole workforce remains healthy, in body, mind, and spirit, for many years more than before, there will be plenty of extra resources and skills available to address problems in other fields, such as inadequate traffic vehicle infrastructure. My own preferred approach to that particular problem is improved teleconferencing, virtual presence, avatar representation, and other solutions based on transporting bits rather than transporting atoms, though there’s surely scope for improved physical transport too. Driverless vehicles have a lot of promise.

Footnote 2: The Lifestar Institute produced a well-paced 5 minute video, “Can we afford not to try?” covering many of the topics I’ve mentioned above. View it at the Lifestar Institute site, or, for convenience, embedded below.

Footnote 3: The Lifestar Institute video was shown publicly for the first time at the SENS4 conference in Cambridge in September 2009. I was in the audience that day and vividly remember the impact the video made on me. The SENS Foundation is running the next in their series of biennial conferences (“SENS 6”) this September, from the 3rd to the 7th. The theme is “Reimagine aging”. I’m greatly looking forward to it!

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23 February 2013

Health improvements via mobile phones: achieving scale

Filed under: Accenture, Barcelona, Cambridge, healthcare, mHealth, MWC, partners — David Wood @ 10:27 pm

How can mobile reach its potential to improve both the outcomes and the economics of global health?

MWC13_logoThat’s the headline question for the panel I’m chairing on Wednesday at the Mobile World Congress (MWC) event in Barcelona.

MWC is an annual conference that celebrates progress with mobile technology. Last year, there were over 67,000 attendees, including:

  • More than 12,000 mobile app developers
  • 3,300+ press members representing 1,500 media outlets from 92 countries
  • CEOs from more than 3,500 companies.

This year, a larger venue is being used, and the attendee numbers are expected to be even larger. Keynote speakers include the CEOs or Presidents from Vodafone, Telefonica, China Mobile, AT&T, Telecom Italia, NTT DoCoMo, Korea Telecom, Deutsch Telekom, Qualcomm, Nokia, General Motors, CNN Digital, American Heart Foundation, Bharti Enterprises, Qtel, Ericsson, Viber Media, Juniper Networks, Dropbox, Foursquare, Deezer, Mozilla, Ubuntu, Tizen, Jolla, and countless more.

And in the midst of all that, there’s a panel entitled Health: Achieving Scale through Partnerships – which, in my role as Technology Planning Lead for Accenture Mobility, I’ve been asked to chair.

MWC as a whole generates a lot of excitement about mobile technology – and about relative shifts in the competitive positions of key companies in the industry. However, it strikes me that the subject under discussion in my panel is more profound. Simply put, what we’re discussing is a matter of life and death.

Done well, mobile technology has the potential to enable the delivery of timely healthcare to people who would otherwise be at risk of death. Prompt diagnosis and prompt treatment can spell the difference between a bitterly unpleasant experience and something that is much more manageable.

But more than that: mobile technology has the potential to address very significant financial problems in the delivery of healthcare. Runaway medical bills impact individuals around the planet. According to a 2010 report by the World Health Organisation (PDF):

When people use healthcare services, they often incur high, sometimes catastrophic costs in paying for their care.

In some countries, up to 11% of the population suffers this type of  severe financial hardship each year, and up to 5% is forced into poverty. Globally, about 150  million people suffer financial catastrophe annually while 100 million are pushed below the poverty line.

It’s not just individuals who are facing ruinous costs from healthcare. A 2011 study by the World Economic Forum and Harvard University anticipates that productivity losses and medical treatment for diabetes, heart disease and other non-contagious chronic diseases will cost economies $47 trillion by 2030. In the UK, the growing cost of treating diabetes alone is said to be likely to “bankrupt the NHS in 20 years”. In countries around the world, surging costs of healthcare treatment are exceeding the growth rates of the national economies.

In principle, mobile technology has the potential to reduce these trends in a number of ways:

  • By enabling more cost-effective treatments, that are less time-consuming and less personally intrusive
  • By enabling earlier detection of medical issues: prevention can be much cheaper than cure!
  • By monitoring compliance with treatment regimes
  • By improving real-time communications within busy, geographically separated teams of clinicians
  • By reducing barriers for people to access information relevant to their health and well-being.

The Creative Destruction of MedicineHere, the key phrase is “in principle”. The potential of mobile technology to beneficially transform healthcare has long been recognised. Success stories can indeed be found. This recent NBC news video featuring physician Eric Topol contains some excellent examples of the use of smartphones in medical practice; for my review of Dr Topol’s award-winning book “The Creative Destruction of Medicine” see my previous blogpost Smartphone technology, super-convergence, and the great inflection of medicine. Nevertheless, the mobile industry is full of people who remain unsure about how quickly this potential can turn into a reality.

Indeed, I regularly encounter people in the mobile industry who have been assigned responsibility in their companies for aspects of “mHealth programmes”, or similar. The recurring refrain that I hear is as follows:

  • The technology seems to work
  • Small-scale pilot trials demonstrate encouraging results
  • But it’s hard to see how these trials can be scaled up into self-sustaining activities – activities which no longer rely on any strategic subsidies
  • Specifically, people wonder how their programmes will ever deliver meaningful commercial revenues to their companies – since, after all, these companies are driven by commercial imperatives.

In this sense, the question of scaling up mobile health programmes is a matter of commercial life-or-death for many managers within the mobile industry. Without credible plans for commercially significant revenues, these programmes may be cut back, and managers risk losing their jobs.

For all these reasons, I see the panel on Wednesday as being highly relevant. Here’s how the MWC organisers describe the panel on the event website:

There are hundreds of live and pilot mHealth deployments currently underway across many and diverse territories, but many of these projects, both commercial and pilot, will remain short term or small scale and will fold once initial funding is exhausted.

To reach scale, mHealth systems must in many cases be designed to integrate with existing health systems. This is not something the mobile industry can achieve alone, despite operators’ expertise and experience in delivering end-to-end services to their customers, and will require strong working partnerships between mobile network operators, health applications and health IT providers.

Speakers in this session will draw upon their own experience to showcase examples of mHealth projects that have gone beyond the small scale and pilot stages.

They will seek to identify best practice in making mHealth sustainable, and will discuss the progress and challenges in partnering for mHealth.

The panellists bring a wealth of different experience to these questions:

Faces

  • Pamela Goldberg is CEO of the Massachusetts Technology Collaborative (MassTech), an economic development engine charged with charged with catalyzing technology innovation throughout the Massachusetts Commonwealth. She has an extensive background in entrepreneurship, innovation and finance, and is the first woman to lead the agency in its nearly 30 year history. MassTech is currently advancing technology‐based solutions that improve the health care system, expand high‐speed Internet access, and strengthen the growth and development of the state’s technology sector.
  • Kirsten Gagnaire is the Global Partnership Director for the Mobile Alliance for Maternal Action (MAMA), where she manages a cross-sector partnership between USAID, Johnson & Johnson, the UN Foundation, the mHealth Alliance and BabyCenter. MAMA is focused on engaging an innovative global community to deliver vital health information to new and expectant mothers through mobile phones. She recently co-lead the Ashoka Global Accelerator, focused on getting mid-stage social entrepreneurs in developing countries the support & resources they need to scale their work across multiple countries and continents. These organizations are focused on using innovation and technology to address global health issues. She recently spent a year living in Ghana, where she was the Country Director for the Grameen Foundation and managed a large-scale mobile health project focused on maternal and child health across Ghana.
  • Chris Mulley is a Principal Business Consultant within the Operator Solutions department of ZTE Corporation. He is responsible for the analysis of market and business drivers that feed into the development of cost-effective end-to-end solutions, targeted at major global telecom operators, based on ZTE’s portfolio of fixed-line and wireless infrastructure equipment and ICT platforms. A key part of this role involves informing ZTE Corporation’s strategic approach to the provision of solutions that meet the objectives of the European Commission Digital Agenda for Europe policy initiative for the wide scale adoption of ICT in the provision of e-Health, e-Transport and e-Government across Europe. Chris was instrumental in the establishment of an e-Health collaboration between ZTE Corporation, the Centro Internazionale Radio Medico and Beijing People’s Hospital.
  • Tong En is Deputy General Manager of the Data Service department and Director of the R&D center at China Mobile Communications Corporation (CMCC), JiangSu Company. He has long been engaged in the research of mobile communication and IoT related technologies, and has chaired or participated more than 10 CMCC research projects. He is a multiple winner of CMCC innovation awards, and has published nearly 20 academic papers.
  • Oscar Gómez is Director of eHealth Product Marketing in Telefónica Digital, where he leads the creation and implementation of a Connected Healthcare proposition to help transform Health and Social Care systems in the light of the challenges they are facing. Oscar has global responsibility over Telefonica’s portfolio of products and solutions in the eHealth and mHealth space. Oscar holds an Executive MBA from Instituto de Empresa, a M.Sc. degree in Telecommunication Engineering from Universidad Politécnica de Madrid and a Diploma in Economics from Universidad Autónoma de Madrid. He graduated in Healthcare Management from IESE in 2012.

In case you’re interested in the topic but you’re not able to attend the event in person, you can follow the live tweet stream for this panel, by tracking the hashtag #mwc13hlt1.

Postscript

Although I passionately believe in the significance of this particular topic, I realise there will be many other announcements, debates, and analyses of deep interest happening at MWC. I’ll be keeping my own notes on what I see as the greatest “hits” and “misses” of the show. These notes will guide me as I chair a “Fiesta or Siesta” debrief session in Cambridge in several weeks time. Jointly hosted by Cambridge Wireless and Accenture, on the 12th of March, this event will take place in the Møller Centre at Churchill College, Cambridge. As the event website explains,

Whether you attended Mobile World Congress (MWC), or you didn’t, you will have formed an opinion (or read someone else’s) on the key announcements and themes of this year’s show. “MWC – Fiesta or Siesta?!” will re-create the emotion of Barcelona as we discuss the hits and misses of the 2013 Mobile World Congress, Cambridge Wireless style…

Registration for this “Fiesta or Siesta” event is now open. Knowing many of the panellists personally, I am confident in predicting that sparks will fly in this discussion, and we’ll end up collectively wiser.

2 December 2012

Let It Be at the Prince of Wales Theatre – Beatles stream of consiciousness

Filed under: fun, healthcare, music, theatre — David Wood @ 11:03 am

“For our last number I’d like to ask your help. Would the people in the cheaper seats clap your hands? And the rest of you, if you’ll just rattle your jewelry”

These were the words used by John Lennon, on stage for the Royal Variety Performance at the Prince of Wales theatre in central London on 4th November 1963, to introduce the last number of the set played by the Beatles. The packed audience included the British royal family. Black and white archive film of the set exists:

That moment was part of a period of a few months when the phenomenon of “Beatlemania” burst into the public consciousness. As told by Beatles historian Bruce Spizer,

By September 1963, The Beatles were gaining coverage in the British press and were receiving tremendous radio and television exposure. But their big break through was a widely-watched and well-publicized television appearance on “Val Parnell’s Sunday Night at the London Palladium”, which was televised throughout the U.K. during prime time Sunday evening and was the British equivalent of “The Ed Sullivan Show”. The Beatles headlined the Oct. 13, 1963, Palladium show, which was seen by more than 15 million people. The bedlam caused by the group both inside and outside the theater caught the attention of British news editors, who elevated The Beatles from a successful entertainment act to a national news phenomenon. The Daily Mirror described the hysteria as “Beatlemania!” The term stuck.

The Beatles’ triumphant Palladium appearance was quickly followed by the Oct. 31 airport reception witnessed by Sullivan and their playing before British high society at the Royal Command Performance, also known as the Royal Variety Show. Their presence on the Nov. 4, 1963, show drew more attention than the arrival of Royal Family. The Beatles, who were seventh on the bill of 19 acts, impressed the upscale crowd with “She Loves You”, “Till There Was You”, “From Me To You” and “Twist and Show”. Prior to ripping into a rousing rendition of their closing rocker, Lennon said, “For our last number I’d like to ask your help. Would the people in the cheaper seats clap your hands? And the rest of you, if you’ll just rattle your jewelry.” While [Beatles manager Brian] Epstein viewed John’s remarks as being a bit risque, he was relieved that the crowd seemed charmed by the Beatle’s cheeky humor. Before the show, John had joked to Brian that he was going to ask the Royals to rattle their “fookin’ jewelry.”

Nearly fifty years later, the show “Let It Be”, playing at the very same Prince of Wales theatre, re-created a great deal of the same music, musicianship, and mannerisms of the original act. Including the jewelry quip.

LetItBeI had the great pleasure of viewing the show last night – and it was, indeed, a great pleasure.

There’s no plot. It’s simply a group of four musicians who look and sound remarkably similar to the original Beatles, playing a series of sets of fabulous music, interspersed (allowing the band a chance to change clothing – and wigs) with archive news footage, mock advertisements conveying a wistful sense of the 1960s, and audio excerpts of retrospective interviews by the Beatles.

The show progresses through segments (each with their own clothing and hairstyles)

  • the 1963 Royal Variety Show era,
  • a set from the 1965 Shea Stadium concert – where the Beatles had played to an audience of more than 55,000
  • a Sergeant Pepper segment
  • a flower power segment featuring All You Need is Love, Magical Mystery Tour, and more
  • a quieter section, with the group members seated for evocative melodies such as Norwegian Wood and Blackbird
  • an Abbey Road segment, culminating in a powerful rendition of The End
  • a final encore – including (of course) Let It Be, as well as a fore-taste of forthcoming solitary careers: Give Peace A Chance.

I offer a few thoughts from my stream of consciousness during the performance:

  • On either side of the stage, large screens showed images to frame the main actions. The young women who were shouting and screaming with such hysteria must in many cases be grandmothers by now – I wonder if they know their images are still delighting London audiences, nearly fifty years after their rush of blood was captured on camera
  • The vibrant twanging of Get Back mentally transported me back in time to April 1969, when I remember being enthralled, as a very naive ten-year old, by that song playing on Top of The Pop: “Sweet Loretta Martin thought she was a woman, But she was another man…”
  • The vocals to Lucy in the Sky with Diamonds and A Day in the Life were, if anything, even more trippy than in the original
  • Actually the audience seemed bemused and unsure about A Day in the Life, with many of them showing blank faces as the cacophony grew – I guess this song is nothing like as well known nowadays. And the clincher: half the audience started applauding the end of this song too soon, before that final apocalyptic multi-piano E Major chord rang out, woops
  • Perhaps another sign of the differentially fading memories of the Beatles music – the audience were happy to rise to its feet to sway along to Twist and Shout in the opening section, but when a similar request was made to stand up during Sgt Pepper Reprise, everyone sat stuck in their seats
  • A nice touch of fidelity in the Abbey Road segment – the “Paul McCartney” character was barefoot on stage – as on the Abbey Road album cover photo
  • For sheer musicianship, the guitar crescendo at the end of While My Guitar Gently Weeps was outstanding; that has always been one of my favourite Beatles tracks – particularly in its remastered version on the Love album remix – but it seemed particularly dramatic on stage this evening.

With such a rich music portfolio to choose from, inevitably many favourites have to be excluded from the two-hour show. Personally I would have missed out one or two of the tracks chosen, in order to find room for glorious stomping classics such as Lady Madonna, Hello Goodbye, The Walrus, or Back In the USSR.  For example, I’ve probably heard Hey Jude enough times already in my life, but its iconic status presumably meant it needed to be included.

Is this the show with the best set of music ever? Seeing that the competition includes Mamma Mia (with its feast of Abba hits), Westside Story (with its feast of Bernstein), and Amadeus (with its feast of Mozart), the answer is perhaps not – but it was still a tremendous occasion, providing a welcome break from thoughts about futurism, existential risk, free markets, and mobile phone technology!

Footnote: But I could not forget about mobile phone technology altogether that evening. On the way home, my companion found that her London Travel Card was being systematically rejected by tube turnstiles – again. That’s despite having bought the ticket only a few hours earlier. It’s by no means the first occurrence for her. “Is it OK to carry my travel card here, right next to my mobile phone, in this small section of my handbag?” she asked. “That is exactly the problem”, I answered – and there seems to be plenty of knowledge of this problem online. And the Beatles music faded out of my mind, to be replaced by thoughts on the health implications of proximity of mobile phones to the human body.

15 April 2012

Hope for healing healthcare

Filed under: books, change, Economics, healthcare, market failure, medicine, passion — David Wood @ 12:45 am

Within the space of the first few pages of his book “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care“, T.R. Reid had me chuckling at some of his descriptions of healthcare systems around the world. Within these same few pages, he also triggered in me a wave of anger and disbelief. He’s a veteran foreign correspondent for the Washington Post, and his writing skills shine throughout his book. Marshaling personal anecdotes from his experiences during visits to healthcare facilities in ten different countries, with historical accounts of how these healthcare systems came to have their current form, his writing addressed both my head and my heart.

Given the title of the book, it’s no spoiler for me to reveal that the episode in the first few pages that triggered my feeling of anger and disbelief was located in the USA. NY Times journalist Nicholas D. Kristof also read T.R. Reid’s book and had the same reaction as me. He retells the story in his article “The Body Count at Home“:

Nikki White was a slim and athletic college graduate who had health insurance, had worked in health care and knew the system. But she had systemic lupus erythematosus, a chronic inflammatory disease that was diagnosed when she was 21 and gradually left her too sick to work. And once she lost her job, she lost her health insurance.

In any other rich country, Nikki probably would have been fine, notes T. R. Reid in his important and powerful new book, “The Healing of America.” Some 80 percent of lupus patients in the United States live a normal life span. Under a doctor’s care, lupus should be manageable…

As Mr. Reid recounts, Nikki tried everything to get medical care, but no insurance company would accept someone with her pre-existing condition. She spent months painfully writing letters to anyone she thought might be able to help. She fought tenaciously for her life.

Finally, Nikki collapsed at her home in Tennessee and was rushed to a hospital emergency room, which was then required to treat her without payment until her condition stabilized. Since money was no longer an issue, the hospital performed 25 emergency surgeries on Nikki, and she spent six months in critical care.

“When Nikki showed up at the emergency room, she received the best of care, and the hospital spent hundreds of thousands of dollars on her,” her step-father, Tony Deal, told me. “But that’s not when she needed the care.”

By then it was too late. In 2006, Nikki White died at age 32. “Nikki didn’t die from lupus,” her doctor, Amylyn Crawford, told Mr. Reid. “Nikki died from complications of the failing American health care system.”...

Alas, the case of Nikki White is very far from being an exception. Kristof notes the estimates that “18,000 Die a Year for Lack of Insurance” each year in the US. (And numerous online responses to his blog post give other sad personal experiences.)

But here’s what I found really stomach-churning in the opening pages of T.R. Reid’s book:

Many Americans intensely dislike the idea that we might learn useful policy ideas from other countries, particularly in medicine. The leaders of the healthcare industry and the medical profession, not to mention the political establishment, have a single, all-purpose response they fall back on whenever someone suggests that the United States might usefully study foreign healthcare systems: “But it’s socialized medicine!”

This is supposed to end the argument. The contention is that the United States, with its commitment to free markets and low taxes, could never rely on big-government socialism the way other countries do. Americans have learned in school that the private sector can handle things better and more efficiently than government ever could.

In US policy debates, the term “socialized medicine” has been a powerful political weapon…  The term was popularized by a public relations firm working for the American Medical Association in 1947 to disparage President Truman’s proposal for a national healthcare system. It was a label, at the dawn of the cold war, meant to suggest that anybody advocating universal access to healthcare must be a communist. And the phrase has retained its political power for six decades…

I was reminded of the remarkable claims at the beginning of this year by would-be President Rick Santorum that the “NHS devastated Britain” and caused “the collapse of the British Empire”.

T.R. Reid had been bureau chief for the Washington Post in both London and Tokyo, and had lived in each of these cities for several years with his family. That gave him considerable first-hand experience of the healthcare systems in these two countries. The book arose from a wider set of visits, including France, Germany, Canada, India, Nepal, Switzerland, and Taiwan. He had two reasons for all these visits:

  1. To inquire about possible treatments for a shoulder injury he had sustained many years previously, but which had recently flared up again, becoming increasingly painful and hard to move. As he explained, “I could no longer swing a golf club. I could barely reach up to replace a lightbulb overhead or get the wine-glasses from the top shelf. Yearning for surcease from sorrow, I took that bum shoulder to doctors and clinics… in countries around the world”
  2. To seek, more generally, for “a solution to a much bigger medical problem… a prescription to fix the seriously ailing healthcare system” of the US.

He retells his diverse experiences with good humour and great insight. Along the way, he lists and punctures “Five Myths About Health Care in the Rest of the World” – myths that are widely believed in some parts of the US, but which have limited basis in actual practice:

  1. It’s all socialized medicine out there
  2. Overseas, care is rationed through limited choices or long lines
  3. Foreign health-care systems are inefficient, bloated bureaucracies
  4. Cost controls stifle innovation
  5. Health insurance has to be cruel

For example, on whether cost controls stifle innovation, he notes the following:

The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who’s had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

And the facts and figures throughout the book are relentless and comprehensive:

  • Average life expectancy at birth in the United States is 77.85 years. “That means the world’s richest country ranks forty-seventh, just ahead of Cyprus and a little behind Bosnia and Herzegovina, in terms of longevity. The United States is among the worst of the industrialized nations on this score; for that matter, the average American can expect a shorter life than people in relatively poor countries like Jordan”
  • “For those Americans who are uninsured or under-insured, any bout with illness can be terrifying on two levels. In addition to the risk of disability or death due to the disease, there’s the risk of financial ruin due to the medical and pharmaceutical bills. This is a uniquely American problem. When I was traveling the world on my quest, I asked the health ministry of each country how many citizens had declared bankruptcy in the past year because of medical bills. Generally, the officials responded to this question with a look of astonishment, as if I had asked how many flying saucers from Mars landed in the ministry’s parking lot last week. How many people go bankrupt because of medical bills? In Britain, zero. In France, zero. In Japan, Germany, the Netherlands, Canada, Switzerland: zero. In the United States, according to a joint study by Harvard Law School and Harvard Medical School, the annual figure is around 700,000”
  • “The one area where the United States unquestionably leads the world is in spending. Even countries with considerably older populations, with more need for medical attention, spend much less than we do. Japan has the oldest population in the world, and the Japanese go to the doctor more than anybody – about fourteen office visits per year, compared with five for the average American. And yet Japan spends about $3,000 per person on health care each year; we burn through $7,000 per person”
  • “When a Harvard Medical School professor working at the World Health Organisation developed a complicated formula to rate the quality and fairness of national healthcare systems around the world, the richest nation on earth ranked thirty-seventh… just behind Dominica and Costa Rica, and just ahead of Slovenia and Cuba…”

(For more about the WHO comparative rankings of healthcare systems, see e.g. Wikipedia’s coverage. T.R. Reid addresses various criticisms of the methodology in an Appendix to his book.)

Rising above the facts and figures, and the various anecdotes, the book provides a handy framework for making sense of the different systems deployed around the world:

“Fortunately, for all the local variations, health care systems tend to follow general patterns. In some models, government is both the provider of health care and the payer. In others, doctors and hospitals are in the private sector but government pays the bills. In still other countries, both the providers and the payers are private.”

There are four basic models:

  1. The Bismarck Model: “Both health care providers and payers are private entities. The model uses private health insurance plans, usually financed jointly by employers and employees through payroll deduction. Unlike the U.S. health insurance industry, though, Bismarck-type plans are basically charities: They cover everybody, and they don’t make a profit”
  2. The Beveridge Model: “Health care is provided and financed by the government, through tax payments. There are no medical bills; rather, medical treatment is a public service, like the fire department or the public library. In Beveridge systems, many (sometimes all) hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge”
  3. The National Health Insurance Model: “The providers of health care are private, but the payer is a government-run insurance program that every citizens pays into. The national, or provincial, insurance plan collects monthly premiums and pays medical bills. Since there’s no need for marketing, no expensive underwriting offices to deny claims, and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style private insurance. As a single payer covering everybody, the national insurance plan tends to have considerable market power to negotiate for lower prices. NHI countries also control costs by limiting the medical services they will pay for or by making patients wait to be treated.”
  4. The Out-of-pocket model: “Most medical care is paid for by the patient, out of pocket, with no insurance or government plan to help”.

Which all these systems apply in the US? The answer, surprisingly, is: All of the above – but not done in an efficient way.

Chapter by chapter, the book highlights ways in which the various medical systems keep costs lower (e.g. through having simpler administration) and deliver generally higher quality than applies in the US.

But two examples are even more important than any mentioned so far. These are the examples of Switzerland and Taiwan. Both of these are countries where significant reforms in the healthcare system have recently taken place – putting the lie to any viewpoint that complicated healthcare systems are incapable of major improvement:

Neither of these countries looks much like the United States of America… Still, both countries have important parallels to the United States. Both are vigorous democracies marked by fierce competition between political parties that look a lot like our Republicans and Democrats. Both have finance and insurance industries that are rich and politically influential. Both are ferociously capitalist places, and both have jumped aboard the digital revolution to build advanced, high-tech economies. Most important, both Taiwan and Switzerland had fragmented and expensive health care, similar to the American system – until they launched their reform campaigns.

In both countries, payment for medical care was dominated by health insurance plans tied to employment; in both significant numbers of people were left with no coverage at all. Even with large numbers of people uninsured, both countries were pouring considerable amounts of money into health care. In both Taiwan and Switzerland, as in the United States…, a growing chorus of voices began demanding universal coverage, arguing that every sick person should have access to a doctor…

In both cases, the results of the reforms have been very positive. To take the case of Taiwan:

Almost overnight, some 11 million Taiwanese who had no medical insurance suddenly had access to doctors and hospitals, with the Bureau of National Health Insurance paying most of the bill. This created a flood of new demand for medical services. The market responded with a flood of new supply: Clinics, hospitals, dentists, optometrists, labs, hostels, and acupuncture centers sprang up everywhere…

The most striking result of Taiwan’s new system is a healthier population with a longer healthy life expectancy and much higher recovery rates from major diseases. This is particularly evident in rural areas, where it was difficult or impossible to see a doctor before the new system took place…

As a system started from scratch, with uniform rules and procedures for every doctor and patient and state-of-the-art paperless record-keeping, Taiwan’s new health insurance system is the most efficient in the world. The 1994 law seemed hopelessly optimistic when it set a limit of 3.5% for administrative costs; in fact, the system has done much better than that, with paperwork, etc. accounting for only 2% of costs most years (and sometimes less). That’s about… one-tenth as high as the administrative burden for America’s private health insurers. As a result, even with explosive growth in the consumption of medical services, national health spending in Taiwan remains at about 6% of gross domestic product (as opposed to about 17% of GDP in the United States). This has kept costs low for patients…

As for the healthcare reforms in the US, under President Obama, T.R. Reid points out that they miss various elements of the reforms undertaken in both Taiwan and Switzerland:

  • Even with the reform in place, there will still be around 23 million Americans without healthcare insurance in 2019
  • American health insurance companies will still be able to get away with various practices (for denying payments to patients) that are banned in every other rich democracy
  • Much of the argumentation in favour of the reform has emphasised economics (not a bad thing in itself), but the moral and ethical drivers which were at the forefront in the debates in Taiwan and Switzerland have had a much lower profile in the US.

The final passage in the main body of the book puts it like this:

The sad truth is that, even with this ambitious reform, the United States will still have the most complicated, the most expensive, and the most inequitable healthcare system of any developed nation. The new law won’t get to the destination all other industrialized democracies have reached: universal healthcare coverage at reasonable cost. To achieve that goal, the United States will still have to take some lessons from the other national healthcare systems described in this book.

I’ll touch on four points in my own conclusion:

1. The moral argument for healthcare reform

The time I’ve spent recently reading Jonathan Haidt’s “The Righteous Mind” and watching him speak at a couple of events in London, has made me more sensitive to the fact that different people have different moral “tastes”, and can assign different priorities to six major dimensions of moral sensibility:

  • care vs. harm
  • fairness vs. cheating
  • liberty vs. oppression
  • loyalty vs. betrayal
  • authority vs.subversion
  • sanctity vs. degradation.

Failure to appreciate this fact leads of lots of bewilderment, as summarised in William Saletan’s New York Times review “Why won’t they listen?” of Haidt’s book. As T.R. Reid highlights, the current US healthcare system may well fail important moral tests on grounds of care vs. harm, and by being “unfair”. However, the arguments of people like Rick Santorum against the reform act build on different moral dimensions – e.g. liberty vs. oppression. These arguments find it particularly objectionable that, under these reforms, many people will be obliged (“oppressed”) into purchasing healthcare insurance. That’s seen as a fundamental denial of liberty.

Another insight from Haidt is that, in these circumstances of conflicting moral intuitions, reasoning often fails. One of his key summary points is as follows:

Moral intuitions come first, strategic reasoning comes second, to justify the intuitions we have already reached.

That’s not to say further discussion is pointless. As William Saletan puts it:

Haidt believes in the power of reason, but the reasoning has to be interactive. It has to be other people’s reason engaging yours. We’re lousy at challenging our own beliefs, but we’re good at challenging each other’s. Haidt compares us to neurons in a giant brain, capable of “producing good reasoning as an emergent property of the social system.”

Our task, then, is to organize society so that reason and intuition interact in healthy ways. Haidt’s research suggests several broad guidelines. First, we need to help citizens develop sympathetic relationships so that they seek to understand one another instead of using reason to parry opposing views. Second, we need to create time for contemplation. Research shows that two minutes of reflection on a good argument can change a person’s mind. Third, we need to break up our ideological segregation. From 1976 to 2008, the proportion of Americans living in highly partisan counties increased from 27% to 48%. The Internet exacerbates this problem by helping each user find evidence that supports his views…

2. A surprisingly effective example of lower-cost healthcare

So, what happened to T.R. Reid’s shoulder? Out of the all the recommendations from different doctors around the world, which was the best?

Doctors in several countries – including the US – recommended expensive, invasive, reconstructive surgery – even though all these doctors noted that there was no guarantee the surgery would be successful.

But the advice T.R. Reid ultimately found most useful involved a very different kind of technology, with roots going far back into time. That treatment was in India, and was based on Ayurdveda – which, like yoga, is derived from ancient Hindu scripture. It included

  • Eating only bland food (lentils and rice, primarily) during the course of the treatment, on the theory that the body should be under minimal strain during treatment
  • Daily massages involving hot oils and powerful hand movements (“to smooth the bodily routes that the prana needs to follow”)
  • Six times each day, imbibing “a vile assortment of herbal medicines, most of which tasted like spoiled greens or aging mud”
  • Attending a temple within the hospital grounds, “to perform poojah, or reverence, tot he Hindu god of healing”
  • Undertaking various yogic exercises
  • Accepting advice to “relax, and to forget whatever stresses and worries”
  • Reading one of the key Hindu scriptures, the Bhagavad Gita.

After several weeks of this treatment, the results were unmistakable. The shoulder had a much greater range of movement than before, and the pains were much reduced:

To this day, I don’t know why it happened. Was it the massage, the medication, the meditation…? In any case, the timing was definitely propitious. Ayurveda worked for me. I didn’t have a miracle cure; my shoulder was not completely healed. But my pain decreased, my range of motion increased, and I was definitely better – and all without the trouble or cost of a total shoulder arthoplasty…

Note that the book also describes some alternative medical treatments that were not successful – including other herbal medicines in Nepal, and acupuncture in Taiwan. And as mentioned, the Ayurveda did not provide “complete” healing. What’s more, Ayurvedic clinics increasingly incorporate x-ray machines, stethoscopes, and other western tools. But this section of the book was an intriguing reminder to me that I’d love to dig more deeply into material such as William Broad’s “The science of yoga: the risks and the rewards“.

3. Every healthcare system is under increasing financial strain

Despite the many successes of healthcare systems covered in the book, T.R. Reid was clear that all these systems are under increasing financial stress. He quotes the (somewhat tongue-in-cheek) “Universal Laws of Healthcare Systems” as articulated by economist Tsung-Mei Cheng:

  1. No matter how good the health care in a particular country, people will complain about it.
  2. No matter how much money is spent on health care, the doctors and hospitals will argue it is not enough.
  3. The last reform always failed.

As the author states,

All national health systems, even those that do their job well, are fighting a desperate battle these days against rising costs.

We live in a technological age, and technology – in the form of new miracle drugs, new medical devices (e.g. man-made shoulders) and new procedures – plays a huge role in modern medicine. This is unquestionably a good thing… but it is also an expensive thing.

But good technology, wisely applied, can reduce healthcare costs, rather than simply make them more expensive. For example, as T.R. Reid points out, suitable early tests can do wonders in preventive medicine. One place I’ve covered this topic before is in “Smartphone technology, super-convergence, and the great inflection of medicine“.

4. The good news in American medicine

Lest it be thought that T.R. Reid, the author of “The healing of America”, is unduly negative about America, or unpatriotic, let me draw attention to a 53 minute PBS documentary he has recently released: “The good news in American medicine“.

Whereas “The healing of America” gathers inspiring examples of best practice from around the globe, “The good news in American medicine” gathers inspiring examples of best practice from around the US – and draws out some important economic and moral principles along the way. (Quote: “A whole lot of this is about doing the right thing“.) Just as I recommend the book, I also recommend the video.

25 March 2012

Smartphone technology, super-convergence, and the great inflection of medicine

Filed under: books, Connected Health, converged medicine, healthcare, Internet of Things, medicine — David Wood @ 10:07 pm

You are positioned to reboot the future of medicine…”

That’s the rallying cry that rings out from Eric Topol’s marvellous recent book “The Creative Destruction of Medicine”.  The word “Destruction” is meant in the sense elaborated by Austrian-Hungarian economist Joseph Schumpeter.  To quote from Investopedia:

Creative destruction occurs when something new kills something older. A great example of this is personal computers. The industry, led by Microsoft and Intel, destroyed many mainframe computer companies, but in doing so, entrepreneurs created one of the most important inventions of the century.

Topol believes that a similar transformation is underway in medicine.  His book describes at some length what he calls a “super-convergence” of different technological transformations:

  • Genomics, which increasingly indicates connections between individuals’ DNA sequences and their physiological responses to specific drugs and environmental conditions
  • Numerous small sensors – wearable (within clothing) or embeddable (within the body) – that can continuously gather key physiological data, such as blood glucose level, heart rhythm, and blood pressure, and transmit that data wirelessly
  • Improvements to imaging and scanning, that provide clearer information as to what is happening throughout the body (including the brain)
  • Enormous computing power that can manipulate vast amounts of data and spot patterns in it
  • Near ubiquitous smartphones, which can aggregate data from sensors, host all kinds of applications related to health and wellness, and provide early warnings on the need for closer attention
  • 3D manufacturing and synthetic biology, that can create compounds of growing use in medical investigation and bodily repair
  • The adoption of electronic medical records, that allow healthcare professionals to be much more aware of medical history of their patients, reducing the number of problems arising from unexpected interactions between different treatments
  • The emergence of next generation social networks binding together patients with shared interest in particular diseases, allowing crowd-sourcing of new insight about medical conditions
  • Enhanced communications facilities, that enable medical professionals to provide advice and even conduct operations from far-distant locations
  • Improved, free medical training facilities, such as the short videos provided by the Khan Academy.

Topol has an impressive track record as a leading medical practitioner, and gives every sign that he knows what he is talking about.  Importantly, he maintains a critical, skeptical perspective.  He gives plenty of examples of where technology has gone wrong in medicine, as well as when it has done well.  His observation of the application of accelerating technology to medicine is far from a utopia.  There are two sorts of problematic factors: technology factors (including the complexity of the underlying science), and non-technology factors.

First, the technology factors.  The ways that individuals react to different medical treatment vary considerably: a drug that saves one life can have terrible side effects in other patients.  What’s more, diseases that were formerly conceived as single entities now appear to be multiple in nature.  However, the move from “population medicine” to “individual medicine”, enabled by advances in genomics and by powerful data analysis, offers a great deal of hope.  For one example of note, see the Wall Street Journal article, “Major Shift in War on Cancer: Drug Studies Focus on Genes of Individual Patients“.  The core principle is that of ever improving digital analysis of data describing individual people – something that Topol calls “digital high definition of humans” leading to “hyperpersonalisation of healthcare… fulfilling the dream of true prevention of diseases”.

But the non-technology factors are just as significant.  Instead of the complexity of the underlying science, this refers to the structure of the medical industry.  Topol has harsh words here, describing the medical establishment as “ultra-conservative”, “ossified”, and “sclerotic” – existing in a “cocoon” which has tended to isolate it from the advances in information technology that have transformed so many other industries.  Topol calls for “an end of the medical priesthood… the end of an era of ‘doctor knows best'”.  Associations of medical professionals who seek to block patients from seeing their own medical data (e.g. a detailed analysis of their personal DNA) are akin, Topol says, to the medieval priests who fought against the introduction of printing and who tried to prevent church congregations from reading the bible in their own hands.

Given such criticisms, it’s perhaps surprising to read the wide range of positive endorsements at the start of the book, from eminent leaders of the medical industry.  This includes:

  • The global president of R&D for Sanofi
  • The professor of genetics from Harvard Business School
  • The chairman and CEO of Medtronic
  • The professor and vice-chair of surgery from NY Presbyterian/Columbia University
  • The chief medical officer from Philips Healthcare
  • The executive vice president and chief of medical affairs from United Health Group
  • The president of the Salk Institute for Biological Studies

and many others.  And for a growing list of reviews of the book, including from many people deeply embedded in the medical industry, see this compendium on the 33 Charts blog.  What’s happening here is that Topol is drawing attention to structural issues inside the medical profession, which many other people recognise too.  This includes risk aversion, long training cycles that place little emphasis on information technology, funding models that emphasise treatment rather than prevention, tests that are unnecessary and dangerous, and lengthy regulatory processes.

If the problem is structural, within the medical industry, the fix is within the hands of patients.  As per the quote I started with,

You are positioned to reboot the future of medicine…”

Here’s the longer version of that quote:

With the personal montage of your DNA, your cell phone, your social network – aggregated with your lifelong health information and physiological and anatomic data – you are positioned to reboot the future of medicine.

Topol advocates patients take advantage of the tremendous computational power that is put into their hands by smartphones, running healthcare applications, connected to wireless sensors, and plumbed into increasingly knowledgeable social networks that have a focus on medical matters – sites such as PatientsLikeMe, CureTogether, and many others.

There’s an important precedent.  This is the way business professionals are taking their own favourite smartphones and/or tablet computers into their workplaces, and are demanding that they can access enterprise systems with these devices.  This trend – “bring your own device” (“BYOD”) – is itself a subset of something known as “the consumerisation of enterprise technology”.  People buy particular smartphones and tablets on account of their compelling ease of use, stunning graphics, accessible multimedia, and rich suite of value-add applications covering all sorts of functionality.  They enjoy using these devices – and expect to be able to be use them for work purposes too, instead of what they perceive as clunky and sluggish devices provided via official business channels.  IT departments in businesses all around the globe are having to scramble to respond.  Once upon a time, they would have laid down the law, “the only devices allowed to be used for business are ones we approve and we provide”.  But since the people bringing in their own personal devices are often among the most senior officials in the company, this response is no longer acceptable.

Just as people are bringing their favourite smartphones from their home life into their business life, they should increasingly be willing to bring them into the context of their medical treatment – especially when these devices can be coupled to data sensors, wellness applications, and healthcare social networks.  Just as we use our mobile devices to check our email, or the sports news, we’ll be using these devices to check our latest physiological data and health status.  This behaviour, in turn, will be driven by increasing awareness of what’s available.  And Topol is on a mission to increase that awareness.  Hence his frequent speaking engagements, including his keynote session at the December 2011 mHealth Summit in Washington DC, when I first became aware of him.  (You can find a video of this presentation here.)  And hence his authorship of this book, to boost public understanding of the impending inflection point in medicine.  The more we all understand what’s available and what’s possible, the more we’ll all get involved in this seismic patient-led transformation.

Footnote: Topol’s book is generally easy to read, but contains quite a lot of medical detail in places.  Another book which covers similar ground, in a way that may be more accessible to people whose background is in mobile technology rather than medicine, is “The Decision Tree: How to make better choices and take control of your health”, by executive editor of Wired magazine, Thomas Goetz.  Both Topol and Goetz write well, but Goetz has a particular fluency, and tells lots of fascinating stories.  To give you a flavour of the style, you can read chapter one free online.  Both books emphasise the importance of allowing patients access to their own healthcare data, the emergence of smart online networks that generate new insight about medical issues, and the tremendous potential for smartphone technology to transform healthcare.  I say “Amen” to all that.

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