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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.

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26 August 2012

Yoga, mindfulness, science, and human progress

Filed under: books, change, culture, Google, medicine, science, yoga — David Wood @ 12:07 am

Friday’s Financial Times carried a major article “The mind business“:

Yoga, meditation, ‘mindfulness’ – why some of the west’s biggest companies are embracing eastern spirituality

The article describes a seven-year long culture transformation initiative within business giant General Mills, as an example a growing wave of corporate interest in the disciplines of yoga, meditation, and ‘mindfulness’. It also mentions similar initiatives at Target, First Direct, Aetna, and Google, among others.

The article quotes Professor William George, the former CEO and Chairman of the Board of Medtronic, who is an intelligent fan of mindfulness. In a Harvard Business Review interview, Professor George makes the following points:

Mindfulness is a state of being fully present, aware of oneself and other people, and sensitive to one’s reactions to stressful situations. Leaders who are mindful tend to be more effective in understanding and relating to others, and motivating them toward shared goals. Hence, they become more effective in leadership roles…

Leaders with low emotional intelligence (EQ) often lack self-awareness and self-compassion, which can lead to a lack of self-regulation. This also makes it very difficult for them to feel compassion and empathy for others. Thus, they struggle to establish sustainable, authentic relationships.

Leaders who do not take time for introspection and reflection may be vulnerable to being seduced by external rewards, such as power, money, and recognition. Or they may feel a need to appear so perfect to others that they cannot admit vulnerabilities and acknowledge mistakes. Some of the recent difficulties of Hewlett-Packard, British Petroleum, CEOs of failed Wall Street firms, and dozens of leaders who failed in the post-Enron era are examples of this…

Public awareness of ‘mindfulness’ has recently received a significant boost from the publication of a book by one of Google’s earliest employees, Chade-Meng Tan. The book’s title is smart, playing on Google’s re-invention and dominance of the Search business: “Search inside yourself“. The sub-title of the book is both provocative and playful: The unexpected path to achieving success, happiness (and world peace).

The book’s website claims,

Meng has distilled emotional intelligence into a set of practical and proven tools and skills that anyone can learn and develop. Created in collaboration with a Zen master, a CEO, a Stanford University scientist, and Daniel Goleman (the guy who literally wrote the book on emotional intelligence), this program is grounded in science and expressed in a way that even a skeptical, compulsively pragmatic, engineering-oriented brain like Meng’s can process…

It’s playful, but it’s also serious. It’s a great idea to re-express the ideas of mindfulness in ways that software engineers find interesting and compelling. It uses the language of algorithms – familiar to all software engineers – to discuss techniques for improved mental performance.

(Aside: Meng has a remarkable gallery of photographs of himself alongside industry titans, leading politicians, media stars, famous book authors, and others. He’s impressively well connected.)

But does this stuff work?

Sure, these exercises can leave people feeling good, but do concrete long-term effects persist?

These are big questions, and for now, I’d like to zero in to a question that’s (marginally) smaller. I’ll leave further discussion about mindfulness and meditation for another occasion, and look now at the yoga side of this grand endeavour. Does yoga work?

My reason for focussing on the yoga aspect is that I can speak with more confidence about yoga than about mindfulness or meditation. That’s because I’ve been attending yoga classes, semi-regularly, for nearly 24 months. What I’ve experienced in these classes, and my discussions with fellow participants, has prompted me to read more, to try to make sense of what I’ve seen and heard.

I kept hearing about one particular book about yoga, “The Science of Yoga: The Risks and the Rewards“, written by Pulitzer prize-winning New York Times science journalist William J. Broad.

Broad is no newcomer to yoga – he has been practising the discipline since 1970. As he explains in the Acknowledgements section of the book, he initially thought it would take him nine months to write it, but it turned into a five-year project. The result shows – the book bristles with references to over a century’s worth of research, carried out all over the globe.

“The Science of Yoga” has received a great deal of criticism, especially from within the yoga community itself. Don’t let these criticisms put you off reading the book. It’s a mine of useful information.

The book has been criticised because of its less-than-reverential approach to many of the pioneers of yoga, as well as to some contemporary yoga leaders. The book also punctures several widespread myths about yoga – including claims made in many popular books. Some of these myths are enumerated in a handy review of Broad’s book by Liz Neporent, “What Yoga Can—and Can’t—Do: A look at the benefits and limitations of this popular, mind-body practice“:

  1. Yoga is a good cardiovascular workout
  2. Yoga boosts metabolism
  3. Yoga floods your body with oxygen
  4. Yoga doesn’t cause injuries
  5. Yoga is good for flexibility and balance
  6. Yoga improves mood
  7. Yoga is good for your brain
  8. Yoga improves your sex life

It turns out the four of these eight claims are strongly contradicted by growing scientific evidence. On the other hand, the other four are strongly supported. (I’ll leave you to do your own reading to find out which are which…)

The analysis Broad assembles doesn’t just point to correlations and statistics. It explains underlying mechanisms, so far as they are presently understood. In other words, it covers, not just the fact that yoga works, but why it works.

As well as summarising the scientific investigations that have been carried out regarding yoga, Broad provides lots of insight into the history of yoga – puncturing various more myths along the way. (For example, there’s no evidence that the popular “Sun salutation” exercises existed prior to the twentieth century. And advanced yogis aren’t actually able to stop their hearts.)

As you can see, there’s lots of good news here, for yoga enthusiasts, alongside some warnings about significant dangers.

Broad is convinced that yoga, carefully prescribed to the specific needs of individuals, can work wonders in curing various physical ailments. Broad’s discussions with Loren Fishman MD, in the chapter entitled “Healing”, form a great high point in the book. Fishman is an example of someone who immersed himself in the study of medicine after already learning about yoga. (Fishman learned yoga from none other than BKS Iyengar, who he travelled to Pune, India, to meet in 1973. Iyengar comes out well in Broad’s book, although Broad does find some aspects of Iyengar’s writing to be questionable. Full disclosure: the type of yoga I personally practice is Iyengar.)

For example, Fishman described yoga’s applicability to treat osteoporosis, the bone disease, which in turn “lies behind millions of fractures of the hip, spine, and wrist”:

Yoga stretching… works beautifully to stimulate the rebuilding of the bone. It happens at the molecular level. Stress on a bone prompts it to grow denser and stronger in the way that best counteracts the stress. Fishman said that for three years he had been conducting a study to find out which poses worked best to stimulate the rejuvenation.

“It’s a big thing”, he said of the disease. “Two hundred million women in the world have it and most can’t afford the drugs”, some of which produce serious side effects. By contrast, Fishman enthused, “Yoga is free”…

In addition to its beneficial effect on the body, yoga can have several key beneficial effects on the mind – helping in the treatment of depression, calming the spirit, and boosting creativity.

In the epilogue to the book, Broad envisions two possible futures for yoga. Here’s his description of the undesirable future:

In one scenario, the fog has thickened as competing groups and corporations view for market share among the bewildered. The chains offer their styles while spiritual groups offer theirs, with experts from different groups clashing over differing claims…

The disputes resemble the old disagreements of religion. Factionalism has soared… hundreds of brands, all claiming unique and often contradictory virtues.

Yet, for all the activity, yoga makes only a small contribution to global health care because most of the claims go unproven in the court of medical science. The general public sees yoga mainly as a cult that corporations try to exploit.

But a much more positive outcome is also possible:

In the other scenario, yoga has gone mainstream and plays an important role in society. A comprehensive program of scientific study… produced a strong consensus on where yoga fails and where it succeeds. Colleges of yoga science now abound. Yoga doctors are accepted members of the establishment, their natural therapies often considered gentler and more reliable than pills. Yoga classes are taught by certified instructors whose training is as rigorous as that of physical therapists. Yoga retreats foster art and innovation, conflict resolution, and serious negotiating…

Broad clearly recognises that his own book is far from the last word on many of the topics he covers. In many cases, more research is needed, to isolate likely chains between causes and effects. He frequently refers to research carried out within the 12-24 months prior to the book’s publication. We can expect ongoing research to bring additional clarity – for example, to shed more light on the fascinating area of the scientific underpinning of “kundalini awakening“. Broad comments,

The science of yoga has only just begun. In my judgement, the topic has such depth and resonance that the voyage of discovery will go on for centuries…

Studies… will spread to investigations ever more central to life and living, to questions of insight and ecstasy, to being and consciousness. Ultimately, the social understanding that follows in the wake of scientific discovery will address issues of human evolution and what we decide to become as a species.

I say “amen” to all this, but with two clarifications of my own:

  • Alongside a deeper understanding and wider application of yoga, improving human well-being, I expect leaps and bounds of improvement in “hard technology” fields such as genetic analysis, personalised medicines, stem cell therapy, nano-surgery, and artificial organs – which will work in concert with yoga and mindfulness to have an even more dramatic effect
  • Because I see the pace of scientific improvement as increasing, I think the most significant gains in knowledge are likely to happen in the next few decades, rather than stretching out over centuries.

Footnote: Earlier this week, William J Broad featured in a fifteen minute interview in a public radio broadcast. In this interview, Broad describes the adverse reaction of “the yoga industrial complex” to his book – “they hate this book, because it’s exploding myths… there’s an economic incentive for people to only focus on the good and deny the bad”.

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.

16 October 2011

Human regeneration – limbs and more

Filed under: healthcare, medicine, rejuveneering, risks, Singularity — David Wood @ 1:57 am

Out of the many interesting presentations on Day One of the 2011 Singularity Summit here in New York, the one that left me with the most to think about was “Regenerative Medicine: Possibilities and Potential” by Dr. Stephen Badylak.

Dr Badylak is deputy director of the McGowan Institute for Regenerative Medicine, and a Professor in the Department of Surgery at the University of Pittsburg. In his talk at the Singularity Summit, he described some remarkable ways in which the human body could heal itself – provided we provide it with suitable “scaffolding” that triggers the healing.

One of the examples Dr Badylak discussed is also covered in a recent article in Discover Magazine, How Pig Guts Became the Next Bright Hope for Regenerating Human Limbs.  The article deserves reading all the way through. Here are some short extracts from the beginning:

When he first arrived in the trauma unit of San Antonio’s Brooke Army Medical Center in December 2004, Corporal Isaias Hernandez’s leg looked to him like something from KFC. “You know, like when you take a bite out of the drumstick down to the bone?” Hernandez recalls. The 19-year-old Marine, deployed in Iraq, had been trying to outfit his convoy truck with a makeshift entertainment system for a long road trip when the bomb exploded. The 12-inch TV he was clutching to his chest shielded his vital organs; his buddy carrying the DVDs wasn’t so lucky.

The doctors kept telling Hernandez he would be better off with an amputation. He would have more mobility with a prosthetic, less pain. When he refused, they took a piece of muscle from his back and sewed it into the hole in his thigh. He did all he could to make it work. He grunted and sweated his way through the agony of physical therapy with the same red-faced determination that got him through boot camp. He even sneaked out to the stairwell, something they said his body couldn’t handle, and dragged himself up the steps until his leg seized up and he collapsed.

Generally people never recovered from wounds like his. Flying debris had ripped off nearly 70 percent of Hernandez’s right thigh muscle, and he had lost half his leg strength. Remove enough of any muscle and you might as well lose the whole limb, the chances of regeneration are so remote. The body kicks into survival mode, pastes the wound over with scar tissue, and leaves you to limp along for life….

Hernandez recalled that one of his own doctors—Steven Wolf, then chief clinical researcher for the United States Army Institute of Surgical Research in Texas—had once mentioned some kind of experimental treatment that could “fertilize” a wound and help it heal. At the time, Hernandez had dismissed the therapy as too extreme. The muscle transplant sounded safer, easier. Now he changed his mind. He wanted his leg back, even if it meant signing himself up as a guinea pig for the U.S. Army.

So Hernandez tracked down Wolf, and in February 2008 the two got started. First, Wolf put Hernandez through another grueling course of physical therapy to make sure he had indeed pushed any new muscle growth to the limit. Then he cut open Hernandez’s thigh and inserted a paper-thin slice of the same material used to make the pixie dust: part of a pig’s bladder known as the extracellular matrix, or ECM, a fibrous substance that occupies the spaces between cells. Once thought to be a simple cellular shock absorber, ECM is now understood to contain powerful proteins that can reawaken the body’s latent ability to regenerate tissue.

A few months after the surgery healed, Wolf assigned the young soldier another course of punishing physical therapy. Soon something remarkable began to happen. Muscle that most scientists would describe as gone forever began to grow back. Hernandez’s muscle strength increased by 30 percent from what it was before the surgery, and then by 40 percent. It hit 80 percent after six months. Today it is at 103 percent—as strong as his other leg. Hernandez can do things that were impossible before, like ease gently into a chair instead of dropping into it, or kneel down, ride a bike, and climb stairs without collapsing, all without pain

The challenge now is replicating Hernandez’s success in other patients. The U.S. Department of Defense, which received a congressional windfall of $80 million to research regenerative medicine in 2008, is funding a team of scientists based at the University of Pittsburgh’s McGowan Institute for Regenerative Medicine to oversee an 80-patient study of ECM at five institutions. The scientists will attempt to use the material to regenerate the muscle of patients who have lost at least 40 percent of a particular muscle group, an amount so devastating to limb function that it often leads doctors to perform an amputation.

If the trials are successful, they could fundamentally change the way we treat patients with catastrophic limb injuries. Indeed, the treatment might someday allow patients to regrow missing or mangled body parts. With an estimated 1.7 million people in the United States alone missing limbs, promoters of regenerative medicine eagerly await the day when therapies like ECM work well enough to put the prosthetics industry out of business.

The interesting science is the explanation of the role of the ECM – the extracellular matrix, which provides the scaffolding that allows the healing to take place. The healing turns out to involve the body directing stem cells to the scaffolding. These stem cells then differentiate into muscle cells, nerve cells, blood cells, and so on. There’s also some interesting science to explain why the body doesn’t reject the ECM that’s inserted into it.

Badylak speaks with confidence of the treatment one day allowing the regeneration of damaged human limbs, akin to what happens with salamanders.  He also anticipates the healing of brain tissue damaged by strokes.

Later that morning, another speaker at the Singularity Summit, Michael Shermer, referred to Dr Badylak’s presentation. Shermer is a well-known sceptic – indeed, he’s the publisher of Skeptic magazine.  Shermer often participates in public debates with believers in various religions and new-age causes.  Shermer mentioned that, at these debates, his scientific open mindedness is sometimes challenged.  “OK, if you are open-minded, as you claim, what evidence would make you believe in God?”  Shermer typically gives the answer that, if someone with an amputated limb were to have that limb regrow, that would be reason for him to become a believer:

Most religious claims are testable, such as prayer positively influencing healing. In this case, controlled experiments to date show no difference between prayed-for and not-prayed-for patients. And beyond such controlled research, why does God only seem to heal illnesses that often go away on their own? What would compel me to believe would be something unequivocal, such as if an amputee grew a new limb. Amphibians can do it. Surely an omnipotent deity could do it. Many Iraqi War vets eagerly await divine action.

However, Shermer joked with the Singularity Summit audience, it now appears that Dr Badylak might be God.  The audience laughed.

But there’s a serious point at stake here. The Singularity Summit is full of talks about humans being on the point of gaining powers that, in previous ages, would have been viewed as Divine. With great power comes great responsibility. As veteran ecologist and environmentalist Stewart Brand wrote at the very start of his recent book “Whole Earth Discipline“,

We are as gods and HAVE to get good at it.

In the final talk of the day, cosmologist Professor Max Tegmark addressed the same theme.  He gave an estimate of “between 1/10 and 1/10,000” for the probability of human extinction during any decade in the near-term future – extinction arising from (for example) biochemical warfare, runaway global warming, nanotech pollution, or a bad super-intelligence singularity. In contrast, he said, only a tiny fraction of the global GDP is devoted to management of existential risks.  That kind of “lack of paying attention” meant that humanity deserved, in Tegmark’s view, a “mid-term rating” of just D-.  Our focus, far too much of the time, is on the next election cycle, or the next quarterly financial results, or other short term questions.

One person who is seeking to encourage greater attention to be paid to existential risks is co-founder of Skype, Jaan Tallinn (who earlier in the year gave a very fine talk at a Humanity+ event I organised in London).  Jaan’s main presentation at the 2011 Singularity Summit will be on Day Two, but he briefly popped up on stage on Day One to announce a significant new fundraising commitment: he will personally match any donations made over the weekend to the Singularity Institute, up to a total of $100,000.

With the right resources, wisely deployed, we ought to see collective human intelligence achieve lots more regeneration – not just of broken limbs, but also of troubled societies and frustrated lives – whilst at the same time steering humanity away from the existential risks latent in these super-powerful technologies.  The discussion will continue tomorrow.

2 March 2010

Major new challenges to receive X PRIZE backing

Filed under: catalysts, challenge, futurist, Genetic Engineering, Google, grants, innovation, medicine, space — David Wood @ 7:16 pm

The X PRIZE Foundation has an audacious vision.

On its website, it describes itself as follows:

The X PRIZE Foundation is an educational nonprofit organization whose mission is to create radical breakthroughs for the benefit of humanity thereby inspiring the formation of new industries, jobs and the revitalization of markets that are currently stuck

The foundation can point to the success of its initial prize, the Ansari X PRIZE.  This was a $10M prize to be awarded to the first non-government organization to launch a reusable manned spacecraft into space twice within two weeks.  This prize was announced in May 1996 and was won in October 2004, by the Tier One project using the experimental spaceplane SpaceShipOne.

Other announced prizes are driving research and development in a number of breakthrough areas:


The Archon X PRIZE will award $10 million to the first privately funded team to accurately sequence 100 human genomes in just 10 days.  Renowned physicist Stephen Hawking explains his support for this prize:

You may know that I am suffering from what is known as Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig’s Disease, which is thought to have a genetic component to its origin. It is for this reason that I am a supporter of the $10M Archon X PRIZE for Genomics to drive rapid human genome sequencing. This prize and the resulting technology can help bring about an era of personalized medicine. It is my sincere hope that the Archon X PRIZE for Genomics can help drive breakthroughs in diseases like ALS at the same time that future X PRIZEs for space travel help humanity to become a galactic species.

The Google Lunar X PRIZE is a $30 million competition for the first privately funded team to send a robot to the moon, travel 500 meters and transmit video, images and data back to the Earth.  Peter Diamandis, Chairman and CEO of the X PRIZE Foundation, provided some context in a recent Wall Street Journal article:

Government agencies have dominated space exploration for three decades. But in a new plan unveiled in President Barack Obama’s 2011 budget earlier this month, a new player has taken center stage: American capitalism and entrepreneurship. The plan lays the foundation for the future Google, Cisco and Apple of space to be born, drive job creation and open the cosmos for the rest of us.

Two fundamental realities now exist that will drive space exploration forward. First, private capital is seeing space as a good investment, willing to fund individuals who are passionate about exploring space, for adventure as well as profit. What was once affordable only by nations can now be lucrative, public-private partnerships.

Second, companies and investors are realizing that everything we hold of value—metals, minerals, energy and real estate—are in near-infinite quantities in space. As space transportation and operations become more affordable, what was once seen as a wasteland will become the next gold rush. Alaska serves as an excellent analogy. Once thought of as “Seward’s Folly” (Secretary of State William Seward was criticized for overpaying the sum of $7.2 million to the Russians for the territory in 1867), Alaska has since become a billion-dollar economy.

The same will hold true for space. For example, there are millions of asteroids of different sizes and composition flying throughout space. One category, known as S-type, is composed of iron, magnesium silicates and a variety of other metals, including cobalt and platinum. An average half-kilometer S-type asteroid is worth more than $20 trillion.

Technology is reaching a critical point. Moore’s Law has given us exponential growth in computing technology, which has led to exponential growth in nearly every other technological industry. Breakthroughs in rocket propulsion will allow us to go farther, faster and more safely into space…

The Progressive Automotive X PRIZE seeks “to inspire a new generation of viable, safe, affordable and super fuel efficient vehicles that people want to buy“.  $10 million in prizes will be awarded in September 2010 to the teams that win a rigorous stage competition for clean, production-capable vehicles that exceed 100 MPG energy equivalent (MPGe).  Over 40 teams from 11 countries are currently entered in the competition.

Forthcoming new X PRIZEs

The best may still be to come.

It now appears that a series of new X PRIZEs are about to be announced.  CNET News writer Daniel Terdiman reports a fascinating interview with Peter Diamandis, in his article “X Prize group sets sights on next challenges (Q&A)“.

The article is well worth reading in its entirety.  Here are just a few highlights:

On May 15, at a gala fundraising event to be held at George Lucas’ Letterman Digital Arts Center in San Francisco, X Prize Foundation Chairman and CEO Peter Diamandis, along with Google founders Larry Page and Sergey Brin, and “Avatar” director James Cameron, will unveil their five-year vision for the famous awards…

The foundation …  is focusing on several potential new prizes that could change the world of medicine, oceanic exploration, and human transport.

The first is the so-called AI Physician X Prize, which will go to a team that designs an artificial intelligence system capable of providing a diagnosis equal to or better than 10 board-certified doctors.

The second is the Autonomous Automobile X Prize, which will go to the first team to design a car that can beat a top-seeded driver in a Gran Prix race.

The third would go to a team that can generate an organ from a terminal patient’s stem cells, transplant the organ [a lung, liver, or heart] into the patient, and have them live for a year.

And the fourth would reward a team that can design a deep-sea submersible capable of allowing scientists to gather complex data on the ocean floor

Diamandis  explains the potential outcome of the AI Physician Prize:

The implications of that are that by the end of 2013, 80 percent of the world’s populace will have a cell phone, and anyone with a cell phone can call this AI and the AI can speak Mandarin, Spanish, Swahili, any language, and anyone with a cell phone then has medical advice at the level of a board certified doctor, and it’s a game change.

Even more new X PRIZEs

Details of the process of developing new X PRIZEs are described on the foundation’s website.  New X PRIZEs are are guided by the following principles:

  • We create prizes that result in innovation that makes a lasting impact. Although a technological breakthrough can meet this criterion, so do prizes which inspire teams to use existing technologies, knowledge or systems in more effective ways.
  • Prizes are designed to generate popular interest through the prize lifecycle: enrollment, competition, attempts (both successful and unsuccessful) and post-completion…
  • Prizes result in financial leverage. For a prize to be successful, it should generate outside investment from competitors at least 5-10 times the prize purse size. The greater the leverage, the better return on investment for our prize donors and partners.
  • Prizes incorporate both elements of technological innovation as well as successful “real world” deployment. An invention which is too costly or too inconvenient to deploy widely will not win a prize.
  • Prizes engage multidisciplinary innovators which would otherwise be unlikely to tackle the problems that the prize is designed to address.

The backing provided to the foundation by the Google founders and by James Cameron provides added momentum to what is already an inspirational initiative and a great catalyst for innovation.

14 August 2009

Deadly serious changes

Filed under: cryonics, death, medicine, Uncategorized — David Wood @ 12:26 am

Who could fail to be moved by the story that emerged in Asuncion, Paraguay last weekend, of the baby boy Angel Salvador born 16 week premature?  Doctors declared the boy to be dead shortly after birth.  But four hours later, when family member Liliana Alvarenga removed the baby’s body from a cardboard box to dress it ahead of burial, the baby started crying.  The baby was not dead after all.

The baby’s grandfather, Guarani Caceres, was certainly moved.  He said of the doctors at the hospital, “they are criminals”.

Knowing when someone is “dead beyond all chance of recovery” can be a tough problem. History contains many horrific accounts of premature burials.  A short list includes:

  • The grammarian and metaphysician, Johannes Duns Scotus died in Cologne in 1308.  When the vault his corpse resided in was opened later he was found lying outside the coffin.
  • Thomas A Kempis died in 1471 and was denied canonization because splinters were found embedded under his nails. Anyone aspiring to be a saint would not fight death if he found himself buried alive!
  • Ann Green was hanged by the neck until dead – or so they thought – in 1650 at Oxford  She was found to be alive after being placed in a coffin for burial.  One kindly gentleman attempted to assist her back to the land of the dead by raising his foot and stamping her chest and stomach with such severe force that he only succeeded in completely reviving her.  She lived a long life and bore several children.
  • Virginia Macdonald was buried in a Brooklyn cemetery in 1850.  Her mother was so persistent that she had been buried alive that authorities finally relented and raised her coffin.  The lid was opened to find that her delicate hands had been badly bitten and she was lying on her side.
  • When the Les Innocents cemetery in Paris, France was moved from the center of the city to the suburbs the number of skeletons found face down convinced the lay people and several doctors that premature burial was very common.

(One source for many of these points is the book “Death: A History of Man’s Obsessions and Fears” by Robert Wilkins.)

Changes in technology are on the point of throwing a big new twist on this age-old problem. We have to bear in mind, not only the power of present-day medicine to revive someone from near-deadly diseases and traumas, but also the significantly greater power of future medicine.  The practice of cryonics is focused on preserving the body of someone who has many of the signs of death, in a state so that there is at least a chance that, at some time in the future, the body can be revived and cured of whatever disease or trauma was inflicting it.  Of course, it’s a controversial topic.

And there are at least two big legal and ethical issues that are bound to be discussed more and more often, in connection with cryonics.  These issues potentially apply to anyone who believes in cryonics and who makes provision for the preservation of their body at around the time of death.

The first issue is when medical professionals or other officials demand the right to autopsy the person following death. To quote from the website “Autopsy choice“:

Autopsy is a process of cutting open the body and removing all organs for examination. The organs are [later] placed together to the chest cavity and the wounds are sown up and the body made presentable for the funeral profession…

Advantages are that the medical profession has information for research and quality control, and the legal profession has information for research which it may be able to use in cases of crime or professional misconduct…

Nevertheless, some individuals because of religious or moral belief, would prefer not to be autopsied.

Indeed, anyone signed up for cryonics needs to give careful consideration to avoiding the risk of being autopsied in any way that significantly reduce the chances of subsequent revivification.  An autopsy that destroys the brain is particularly to be feared.  The Cryonics Insitute has a useful webpage “Avoiding Autopsy for Cryonics” on this topic.  Evidently, there’s a potential “clash of rights”:

  • The right of the state, to conduct an autopsy in order to advance knowledge beneficial to society as a whole;
  • The right of any individual, who is alive or potentially revivable, not to be treated in a way that destroys the potential for life.

Depending on the degree of credence that society is prepared to give to the possibility that future technology could revive someone who has recently died, this balance of rights is bound to change.

The second issue is if an individual wishes to start the body preservation process even before the medical profession is ready to declare them as dead. For example, someone whose brain is deteriorating under dementia may feel that their chances for eventual full mental recovery will be better if they are cryogenically vitrified sooner rather than later.

This seems close to the case of someone seeking the right to “assisted suicide“.  That’s already a hot potato!  But many of the same arguments apply for what we might term “early cryonic suspension”.

I’m expecting both these issues to receive increasing public debate.  My hope is that the debate avoids being hijacked by any claims that “death is natural and inevitable”.  If society is prepared to grant certain respect and concessions to people with a variety of religious beliefs, it should also be prepared to grant certain respect and concessions to people who sincerely believe that cyronics might be a pathway to life beyond death.

At some not-too-distant future date, if post-cryonic revival is successfully demonstrated in a laboratory, there may be many more people venting the same kind of anger expressed by Guarani Caceres, denouncing as “criminals” the people who interfered with access to cryonics procedures for their dead relatives.

Footnote: The story of baby Angel Salvador did not have a happy ending.  Shortly after his apparently miraculous recovery, he lost the fight to live.  Medical staff explained that he had now died as his vital organs were not strong enough to survive.  It’s not clear if the four hours the baby spent in the cardboard box (instead of a hospital incubator) contributed to these organ failures.

28 May 2009

The future of medicine

Filed under: cryonics, medicine, UKTA — David Wood @ 11:37 pm
  • Someone who believes in the radical transformational potential of technology, and who anticipates that technology will result in very significant improvements in the quality of life in the relatively near future – but who is willing to go beyond predictions and theorising, to roll up his sleeves and become vigorously involved in building better technology.

That’s how I’d describe Mike Darwin, the speaker at the Extrobritannia (UKTA) meeting at Birkbeck College in central London this Saturday. In other words, Mike is an eminent engineer as well as a philosopher. Specifically, he’s an engineer in the field of preservative medicine.

But there’s more. Mike appreciates that the process of refining new medical processes can be intensely messy and flawed. Just because we’re surrounded by hi-tech, it’s no guarantee that medical trials will be pain-free or mistake-free. Far from it. There are technological uncertainties, organisational impediments, and cultural hurdles. Without a willingness to embrace this ugly fact, there’s a real risk that developments in medicine will slow down.

Mike’s topic on Saturday is “Whatever happened to the future of medicine”; the subtitle is “Why the much anticipated medical breakthroughs of the early 21st century are failing to materialize”. In his own words, here’s what the talk will address:

The last half of the 20th Century was a time of explosive growth in growth in high technology medicine. Effective chemotherapy for many microbial diseases, the advent of sophisticated vaccination, the development and application of the corticosteroids, and the development of extracorporeal and cardiovascular prosthetic medicine (cardiopulmonary bypass, hemodialysis, synthetic arterial vascular grafts and cardiac valves) are but a few examples of what can only be described as stunning progress in medicine derived in large measure from translation research.

The closing decades of the last century brought confident predictions from both academic and clinical researchers (scientists and physicians alike) that the opening decade of this century would see, if not definitive cure or control, then certainly the first truly effective therapeutic drugs for cancer, ischemia-reperfusion injury (i.e. heart attack, stroke and cardiac arrest), multisystem organ failure and dysfunction (MSOF/D), immunomodulation (control of rejection and much improved management of autoimmune diseases), oxygen therapeutics and more radically, the perfection of long term organ preservation, widespread use of the total artificial heart (TAH) and the clinical application of the first drugs to slow or moderate biological aging.

So far, so good. But Mike continues:

However, none of these anticipated gains has materialized, and countless drug trials in humans based on highly successful animal models of MSOF/D, stroke, heart attack, cancer, and immunomodulation have failed. Indeed it may be reasonably argued that the pace of therapeutic advance has slowed. By contrast, the growth of technology and capability in some areas of diagnostic medicine, primarily imaging, has maintained its exponential rate of growth and, while much slower than growth in other areas of technological endeavor, such as communications and consumer electronics, progress has been impressive.

Why has translational research at the cutting edge of medicine (and in particular in critical care medicine) stalled, or often resulted in clinical trials that had to be halted due to increased morbidity and mortality in the treated patients? The answers to these questions are complex and multifactorial, and deserve careful review.

And in conclusion:

Renewed success in the application of translational research in humans will require a return to the understanding and acceptance of the inescapable fact that perfection of complex biomedical technologies cannot be modeled solely in the animal or computer research laboratory. The corollary of this understanding must be the acceptance of the unpleasant reality that perfection of novel, let alone revolutionary medical technologies, will require a huge cost in human suffering and sacrifice. The aborted journey of the TAH to widespread clinical application due to the unwillingness on the part of the public, and the now extant bioethical infrastructure in medicine, to accept the years of suffering accompanied by modest, incremental advances towards perfection of this technology, is a good example of what might rightly be described as a societal ‘failure of nerve’ in the face of great benefit at great cost. It may be rightly said, to quote the political revolutionary Delores Ibarruri, that we must once again come to understand that, “It is better to die on our feet than to live on our knees!”

Mike has spoken once before at an Extrobritannia meeting. See here for my write-up. It was a tremendous event. I’m expecting a similar engrossing debate this Saturday too. No doubt some of the discussion will focus on the main thrust of Mike’s life work, cryonics: very few people in the world are as knowledgeable about this topic.

If anyone reading this is going to be in or near London on Saturday, it would be great to see you at this meeting.

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