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Metaverse and Health Care – A View From 50,000 Feet

by MIKE MAGEE

dystopian

[disˈtōpēən]

ADJECTIVE

1. relating to or denoting an imagined state or society where there is great suffering or injustice.

NOUN

1. a person who imagines or foresees a state or society where there is great suffering or injustice.

There are certain words that keep popping up in 2021 whose meanings are uncertain and which deserve both recognition and definition. And so, the offering above – the word “dystopian.” Dystopian as in the sentence “The term was coined by writer Neal Stephenson in the 1992 dystopian novel Snow Crash.”

One word leads to another. For example, the above-mentioned noun, referred to as dystopian by science fiction writer Stephenson three decades ago, was “Metaverse”. He attached this invented word (the prefix “meta” meaning beyond and “universe”) to a vision of how “a virtual reality-based Internet might evolve in the near future.”

“Metaverse” is all the rage today, referenced by the leaders of Facebook, Microsoft, and Apple, but also by many other inhabitors of virtual worlds and augmented reality. The land of imaginary 3D spaces has grown at breakneck speed, and that was before the self-imposed isolation of a worldwide pandemic.

But most agree that the metaverse remains a future-facing concept that has not yet approached its full potential. As noted, it was born out of science fiction in 1992, then adopted by gamers and academics, simultaneously focusing on studying, applying, and profiting from the creation of alternate realities. But it is gaining ground fast, and igniting a cultural tug of war.

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I am Dr. Groot

By KIM BELLARD

The healthcare world is abuzz with Dr. David Feinberg’s departure from Google Health – another tech giant is shocked to find healthcare was so complicated! – while one of those tech giants (Amazon) not only just surpassed Walmart in consumer spending but also is now planning to build its own department stores.  Both very interesting, but all I can think about is robots. 

Most of the recent publicity about robots has come from Elon Musk’s announcement of the Tesla Bot, or the new video of Boston Dynamic’s Atlas doing more amazing acrobatics, but I was more intrigued by Brooks Barnes’s New York Times article Are You Ready for Sentient Disney Robots? 

Like many industries that serve consumers, healthcare has long been envious of Disney’s success with customer experience.  Disney even offers the Disney Institute to train others in their expertise with it.  Disney claims its advantage is: “Where others let things happen, we’re consistently intentional in our actions.”  That means focusing on “the details that other organizations may often undermanage—or ignore.” 

You’d have to admit that healthcare ignores too many of the details, allowing things to happen that shouldn’t.  

One of the things that Disney has long included in its parks’ experience were robots.  It has had robots in its parks since the early 1960’s, when it introduced “audio-animatronics” – mechanical figures that could move, talk, or sing in very life-like ways.  Disney has continued to iterate its robots, but, as Mr. Barnes points out, in a world of video games, CGI, VR/AR, and, for heaven’s sake, Atlas robots doing flips, its lineup was growing dated. 

Mr. Barnes quotes Josh D’Amaro, chairman of Disney Parks, Experiences and Products, from an April presentation: “We think a lot about relevancy.  We have an obligation to our fans, to our guests, to continue to evolve, to continue to create experiences that look new and different and pull them in. To make sure the experience is fresh and relevant.” 

Enter Project Kiwi. 

In April, Scott LaValley, the lead engineer on the project, told TechCrunch’s Matthew Panzarino: “Project KIWI started about three years ago to figure out how we can bring our smaller characters to life at their actual scale in authentic ways.”  The prototype is Marvel’s character Groot, featured in comic books and the Guardians of the Galaxy movies (he is famous for only saying “I am Groot,” although apparently different intonations result in an entire language). 

By 2021, they had a functioning prototype:

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Yes, Shit

By KIM BELLARD

The Conversation had a provocative article by Stanford professor Richard White about how America has a bad pattern of wasting infrastructure spending.  In light of the surprisingly bipartisan $1 trillion infrastructure bill recently passed by the Senate, this seems like something we should be giving some serious thought to. 

I’ll posit that we’re doing it again, by not adequately addressing the potential that our excreta, to be polite, offers to detect health issues, including but not limited to COVID-19. 

No shit: excrement can be an important tool in public — and personal — health. 

Take wastewater monitoring.  It is not a new concept – for example, to track polio – and has been used during much of the current pandemic.  According to the COVIDPoops19 dashboard, run by UC Merced’s School of Engineering, there are 55 countries with 89 dashboards monitoring the wastewater in 2,428 sites for signs of COVID-19.  The project even has its own Twitter handle (@CovidPoops19). 

According to Kaiser Health News, the University of California San Diego’s program has identified 85% of COVID-19 cases over the last year, using a largely automated monitoring system.  Infected people shed virus particles long before they show symptoms, allowing such programs to act as an early detection system. 

“University campuses especially benefit from wastewater surveillance as a means to avert COVID-19 outbreaks, as they’re full of largely asymptomatic populations, and are potential hot spots for transmission that necessitate frequent diagnostic testing,” said UCSD study first author Smruthi Karthikeyan, PhD.  Any university debating vaccine or mask mandates in order for students to return to campus should seriously be considering this kind of monitoring mechanism.

Similarly, the University of Minnesota has been sampling the wastewater of 65% of the state’s population, and has correctly predicted the rise and fall of each of the three waves in the last year.   North Carolina has also had success. 

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Health Care You Do Not See

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By KIM BELLARD

Within a mile from my home in one direction, there are two pharmacies and a primary care office.  In another direction, there’s a multi-specialty physician practice, complete with lab and pharmacy.  And in a third direction, an urgent care center.  Widen the circle another mile, and there are more physician offices, a plethora of other health care professionals, another urgent care, a retail clinic, and an imaging center.  Add a couple more miles and hospitals – plural – to start show up.

I’m not sure that’s a good thing.

Admittedly, not everyone has so many options.  If you live in a rural area or a disadvantaged neighborhood, there may not be so many choices.  Chances are, though, even in those places, whenever you find retail activity, some portion of it is probably healthcare-related.

Retail clinics helped blur the lines between retail and healthcare, and early moves by retail giants like Walmart or Kroger to incorporate first pharmacy, then primary care, into their stores made getting care easier for millions.  All in all, probably a good thing.

Still, though, you know when you’ve gone from shopping for home goods or groceries to getting your healthcare.  You know because there’s more waiting.  You know because there are more forms to fill out.  You know because you don’t know what will happen to you. 

And you definitely know when you are getting health care services.  You get an injection, you take a pill, you have an image taken, your body is invaded by a tube or a scalpel.  That’s why we go, isn’t it?  We go because we fear something may be wrong and we want someone to do something about it.  Advising us to make lifestyle changes is all well and good, although usually not effective; we want some concrete treatment.

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Let’s Meet in the Metaverse

By KIM BELLARD

I really wasn’t expecting to write about the Metaverse again so soon, after discussing it in the context of Roblox last March, which itself followed a look at Epic Games CEO Tim Sweeney’s vision for the Metaverse last August.  But darn that Mark Zuckerberg!

Not many noticed when Mr. Zuckerberg told Facebook employees in June that the company would become focused on building a metaverse, but he got some attention when he expanded on his vision for The Verge in late July.  Then last Monday Andrew Bosworth, Facebook’s head of AR/VR, confirmed a product group had been formed to bring it about.  And, finally, in an earnings call last Wednesday, Mr. Zuckerberg and his executive team couldn’t stop gushing about the importance of the metaverse to the company, and the world.

So, yeah, the metaverse is in the news.  And, once again, I worry healthcare is going to be late to the party. 

I won’t go into too much detail about what the metaverse is; for those who want a deep dive, there’s Matthew Ball’s nine part primer, or you could just read Ready Player One.  Mr. Zuckerberg described it to The Verge as follows: “you can think about the metaverse as an embodied internet, where instead of just viewing content — you are in it.”  In the earnings call, he clarified: “The defining quality of the metaverse is presence – which is this feeling that you’re really there with another person or in another place.” 

Depending on your age/preferences, the concept of “an embodied internet” is either chilling or thrilling.  Maybe both.   

It’s potentially a big deal.  Gene Marks, writing in Forbes, says, “business interactions will forever change.”  The Conversation’s Beth Daley goes further, stating “creating a virtual world for users to interact with their friends and family is not just a fancy vision, it is a commercial necessity.”

It’s not VR, it’s not AR, it’s not 3D internet, although all those may be part of it.  It’s not gaming, it’s not entertainment, it’s not social network, although all of those will be part of it too.  Mr. Zuckerberg promises: “It’s going to be accessible across all of our different computing platforms; VR and AR, but also PC, and also mobile devices and game consoles.”  Not to overstate it, but he sees the Metaverse as the “next generation of the internet.”  Mr. Zuckerberg also described it as “the next computing platform.”

He is openly telling people that the goal is for Facebook to transition to a metaverse company, “within the next five years or so.”  Analysts on the earnings call pressed Facebook to confirm an estimate of a $5b investment, but only got an admission that, yes, the investment was “billions.”

Significantly, for Facebook, Mr. Zuckerberg believes: “this is going to be not something that one company builds alone, but I think it is going to be a whole ecosystem that needs to develop.”   As Mr. Zuckerberg said in The Verge interview, “Hopefully in the future, asking if a company is building a metaverse will sound as ridiculous as asking a company how their internet is going.”

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#Healthin2Point00, Episode 225 | Amwell acquires SilverCloud & Conversa – plus more deals

Today on Health in 2 Point 00, we have a deal so big it’s brought me out of vacation just for this episode! Amwell acquires not one, but TWO companies – DTx mental health company SilverCloud Health and chatbot company Conversa Health for a combined $320 million. In other news, mental health company Sondermind raises $150 million, bringing their total to $188 million, and femtech company Elvie raises $80 million, bringing their total to $133.9 million. —Matthew Holt

The Most Important Thing

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By KIM BELLARD

Jack Dorsey has some big hopes for bitcoin.  In a webinar last week, he said: “My hope is that it creates world peace or helps create world peace.”  The previous week Mr. Dorsey announced Square was starting a decentralized financial services (DeFi) business based on bitcoin, joining the previously announced Square bitcoin wallet.  

None of this should be a surprise.  At the Bitcoin 2021 conference in June, Mr. Dorsey said: “Bitcoin changes absolutely everything.  I don’t think there is anything more important in my lifetime to work on.”

I’m impressed that someone with as many accomplishments as Jack Dorsey picks something not obviously related to those accomplishments and decides it is the most important thing he could work on.  So, of course, I had to wonder: what might accomplished people in healthcare say was the most important thing they wanted to be working on?

For many these days, of course, it is the COVID-19 pandemic.  Not much has had a higher priority.  Highly effective vaccines have been developed, COVID-19 treatments have greatly improved, supply chains have been adjusted and readjusted, and countless public health measures have been tried.  Healthcare professionals have worked themselves to extremes.

For others, perhaps, it would be to address the extreme financial hardships the U.S. healthcare system can cause.  A new study in JAMA confirmed what is hiding in plain sight – hundreds of billions of medical debt.   Debt continued to rise despite ACA, especially in states that perversely chose not to expand Medicaid.  Efforts such as requiring hospital “price transparency” have largely failed.  Many large hospital systems continue to sue patients who can’t pay.  These hardships are unfair, immoral, and unique to the U.S.; addressing them should be important.

However, both the pandemic and financial obstacles contributed to, but did not cause, the big health inequities in the U.S. healthcare system.  People of color, people in lower socioeconomic classes, even women all face numerous inequities in the health care they receive and in the health they achieve.   These may reflect broader social inequities, but no one in healthcare should look at these without wanting to address them. 

Digital health has never been hotter. The pandemic reminded people how valuable telehealth can be, and investors are pouring money into digital health at astounding levels – some $19b in the first half of 2021 alone.  We may be in bit of a manic phase right now, but few doubt that digital health is going to be a big part of healthcare’s future. 

Then there’s artificial intelligence (A.I.).  No industry in 2021 can be ignoring it. Some well-publicized mishaps with IBM’s Watson or Babylon Health notwithstanding, A.I. in healthcare has already made impressive strides, such as DeepMind’s recent protein predictions or its successes in imaging.  A.I. is going to be built into our health care in the future, either in a supporting role or directly, and working on it has to be on many people’s wish list.  

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Health Care Should Go (Micro) Nuclear

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By KIM BELLARD

I think of hospitals as the healthcare system’s nuclear power plants.  They’re both big, complex, expensive to build, beset with heavy regulatory burdens, consistently major components of their respective systems (healthcare and electric generation) yet declining in number.  Each is seen to offer benefits to many but also to pose unexpected risk to some.

Interestingly, there’s a “micro” trend for each, but aimed towards different ends.

Micro hospitals have been with us for several years.  They usually have only around ten beds, along with an emergency room, lab and imaging.  Dr. Tom Vo, CEO of Nutex Health, says: “We position ourselves between urgent care and a big hospital.”  A micro-hospital Chief Medical Officer admits: “We still partner with our larger hospital partners for patients who might require surgery or intensive care.” 

They’re not trying to reinvent hospitals so much as to support them and offer more convenience to patients.  Not so with micro reactors; they’re looking to revitalize their industry, which is in trouble.

According to the U.S. Energy Administration (E.I.A.), there are 94 U.S. nuclear reactors, at 56 nuclear power plants, in 28 states.  Only one new reactor has gone active in the U.S. since 1996, while almost two dozen are in various stages of decommissioning and only two new ones are under construction.  Overall, the U.S. gets about 20% of its power from nuclear reactors, while 13 countries get at least a quarter of their electricity from nuclear, with France leading the pack at 75%.     

We talk a lot about transitioning away from using fossil fuels to generate electric power, but none of the renewable options currently offers a realistic path towards replacing them.  Nuclear power is the proven alternative, but, as Dan Van Boom wrote in CNET, nuclear power has a PR problem.  No one wants a nuclear power plant in their backyard, no matter how big that backyard is.

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Up, Please

By KIM BELLARD

When I think of elevator operators, I think of health care.

Now, it’s not likely that many people think about elevator operators very often, if ever.  Many have probably never seen an elevator operator.  The idea of a uniformed person standing all day in an elevator pushing buttons so that people can get to their floors seems unnecessary at best and ludicrous at worse. 

But once upon a time, they were essential, until they weren’t.  Healthcare, don’t say you haven’t been warned. 

Elevators have been around in some form for hundreds of years, and by the 19th century were using steam or electricity to give them more power, but it wasn’t until Elisha Otis debuted the safety elevator that they came into their own.  New engineering techniques such as steel frames made skyscrapers possible, but safe elevators made them feasible; no one wanted to climb stairs for 10+ stories. 

Those generations of elevators weren’t quite like the ones we’re used to.  The speed and direction had to be controlled manually, the elevator had to be carefully brought to a stop at a floor, and the doors had to be opened and closed.  Managing all this was not something that anyone wanted to entrust to passengers.  Thus the role of the elevator operator.

But, of course, technology evolved, allowing for more automation.  According to elevator engineering expert Stephen R. Nichols:

Elevator buttons were introduced in 1892, electronic signal control in 1924, automatic doors in 1948, and in 1950 the first operatorless elevator was installed at the Atlantic Refining Building in Dallas. Full automatic control and autotronic supervision and operation followed in 1962, and elevator efficiency has steadily increased in other ways.

Elevator operators gradually transitioned from being mechanical operators to concierges, helping passengers find the right floors and making them more comfortable.  A 1945 elevator operators strike in New York City had a crippling effect.  As Henry L. Greenidge, Esq. wrote on Linkedin, “The public refused to go near the controls despite having watched the operators work the levers numerous times. The thought that a layperson could operate an elevator was simply an outrageous thought.” 

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Go Ahead, AI—Surprise Us

By KIM BELLARD

Last week I was on a fun podcast with a bunch of people who were, as usual, smarter than me, and, in particular, more knowledgeable about one of my favorite topics – artificial intelligence (A.I.), particularly for healthcare.  With the WHO releasing its “first global report” on A.I. — Ethics & Governance of Artificial Intelligence for Health – and with no shortage of other experts weighing in recently, it seemed like a good time to revisit the topic. 

My prediction: it’s not going to work out quite like we expect, and it probably shouldn’t. 

“Like all new technology, artificial intelligence holds enormous potential for improving the health of millions of people around the world, but like all technology it can also be misused and cause harm,” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said in a statement.  He’s right on both counts.

WHO’s proposed six principles are:

  • Protecting human autonomy
  • Promoting human well-being and safety and the public interest
  • Ensuring transparency, explainability and intelligibility 
  • Fostering responsibility and accountability
  • Ensuring inclusiveness and equity 
  • Promoting AI that is responsive and sustainable

All valid points, but, as we’re already learning, easier to propose than to ensure.  Just ask Timnit Gebru.  When it comes to using new technologies, we’re not so good about thinking through their implications, much less ensuring that everyone benefits.  We’re more of a “let the genie out of the bottle and see what happens” kind of species, and I hope our future AI overlords don’t laugh too much about that. 

As Stacey Higginbotham asks in IEEE Spectrum, “how do we know if a new technology is serving a greater good or policy goal, or merely boosting a company’s profit margins?…we have no idea how to make it work for society’s goals, rather than a company’s, or an individual’s.”   She further notes that “we haven’t even established what those benefits should be.”

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