BY KIM BELLARD

I saw a great quote by Alfred North Whitehead the other day: “It is the business of the future to be dangerous.”

Now, I was a math major many years ago, so I know who Alfred North Whitehead was: the coauthor (with Bertrand Russell) of the Principia Mathematica, a landmark, three-volume treatise that proved – in excruciating detail — that all of mathematics (and thus, arguably, all of science) can be reduced to mathematical logic.  I always thought Lord Russell was the eloquent one, but it turns out that Professor Whitehead had a way with words too.  

So, of course, I want to apply a few of his particularly pithy quotes to healthcare.

Few looking at the future of healthcare wouldn’t say it was dangerous.  Our current pandemic has illustrated that no country’s healthcare system was really prepared for it; each struggled.  Sure, we developed vaccines in record time, and our healthcare workers proved, yet again, that they are capable of being heroes, but we also showed that we’re capable of throwing money – lots of it – at healthcare problems without actually solving them. 

Even worse, our blithe resistance to following public health/medical advice, and our credulity for misinformation, aren’t unique to the pandemic but are endemic to our attitudes towards health generally. They help account for why our health is getting worse despite all the health care we’re getting and all the money we’re spending on it.  

There’s not going to be enough money for all our health care needs, there’s not going to be enough health care workers to give us the care we want, and the Western lifestyle is gradually undermining our health, assuming climate change and/or microplastics don’t get us first.  The future sure looks dangerous.

Yet we’re not panicking.  We’re not making wholesale changes to our healthcare systems or the way we live.  We’re relying on the familiar institutions to take care of us.  Which brings to mind a second quote from Professor Whitehead: “Familiar things happen, and mankind does not bother about them. It requires a very unusual mind to undertake the analysis of the obvious.”  In fact, he says, “It takes an extraordinary intelligence to contemplate the obvious.”

It is obvious that our current healthcare systems, and our approaches to heath, do not work and, indeed, have never worked.  We got lulled into complacency by some admittedly spectacular medical advances over the years, and grew to assume that, whatever was wrong with us, we would just take a pill or get a procedure to make us better.  

Sometimes, maybe even many times, those pills and those procedures worked, mostly, but we weren’t paying enough attention to the times they didn’t, or to the costs and consequences of them. We weren’t paying enough attention to the opportunity costs, to all the things we weren’t doing because we were doing the “familiar” healthcare things.  

E.g., making sure people don’t live in poverty.

There have been lots of proposals for changing our healthcare system(s), from lots of very smart people, but I’m not sure we’ve had the right “unusual minds,” with the necessary “extraordinary intelligence,” really contemplating the obvious.  We’ve yet to see the breakthrough suggestions about how to change the familiar about healthcare into something that works the way it could/should.

The trouble will be is that, when those suggestions come, we may not recognize their value.  Professor Whitehead warned us: “Almost all new ideas have a certain aspect of foolishness when they are first produced.”  The ideas that we’re going to need aren’t going to be clear solutions at first.  As is usually true with new ideas in science as well, we’ll laugh at them initially, deride them for being foolish, and only over time will they prove their worth.

It starts, as most things do, with asking the right question.  Professor Whitehead’s words of wisdom on this are: “The silly question is the first intimation of some totally new development.”  If we’re not asking “silly” questions, we’re not going to make quantum leaps; we’re just going to keep iterating the present.  That may be safe in the short term, but is doomed to failure in the long term.

People say they like progress, but the truth is that we don’t really like change.  Change upsets our routines; change requires us to do things differently.  “The art of progress,” Professor Whitehead believed, “is to preserve order amid change and to preserve change amid order.”  

We often have to try to preserve order amid change, as change is sometimes forced upon us, but it’s harder to preserve change amid order.  When things are going well, when it seems things are working well enough, we don’t usually go looking for change.  But for there to be progress, we must.  

I have to confess that when I introduced Professor Whitehead’s first quote, I truncated it.  The full quotes is: “It is the business of the future to be dangerous; and it is among the merits of science that it equips the future for its duties.”  Science doesn’t ensure progress, but it enables it, and the changes it brings about are what makes the future dangerous.

So be it.  The technologies that will be pervasive in 2050 are already here — somewhere, in some form.  It’s the familiar William Gibson (supposed) quote: “the future is already here – it’s just not evenly distributed yet.”  The hard part about envisioning healthcare’s future is not predicting the technologies but in figuring out how we integrate them into our lives, and pay for them.

Me, I don’t see a healthcare future that looks much like today, with huge costs, armies of workers, bloated bureaucracies, numerous middlemen, and oft-ineffective interventions.  It’s obvious that those cannot persist. I just lack the “extraordinary intelligence” to say what comes next.

So, if you’re in healthcare, spend more time contemplating the obvious, and get some really, really bright people to help with that. Ask more silly questions.  Don’t laugh at answers that appear foolish upon first blush.  And make sure that your organization is working at least as hard to preserve change as it is to preserve order.

Yes, the future is going to be dangerous. Bring it on.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

BY KIM BELLARD

I find myself thinking about the future a lot, in part because I’ve somehow accumulated so much past, and in part because thinking about the present usually depresses me.  I’m not so sure the future is going to be better, but I still have hopes that it can be better.  

Two articles recently provided some good insights into how to think about the future: Kevin Kelly’s How to Future and an except from Jane McGonigal’s new book Imaginable: How to See the Future Coming and Feel Ready for Anything―Even Things That Seem Impossible Today that was published in Fast Company.

I’ll briefly summarize each and then try to apply them to healthcare.

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Mr. Kelly – a founding Executive Editor of Wired (and now “Senior Maverick” there), editor/ publisher of Cool Tools – posits that futurists need to look at the past, present, and future.  “They look carefully at the past because most of what will happen tomorrow is already happening today,” he notes.  “The past is the bulk of our lives, and it will be the bulk in the future.”  

As for the present: 

It is often said that most futurists are really predicting the present. It turns out that the present is very hard to see…So a good futurist spends a lot of time trying to decipher the present and to try to see it through the mask of present-day biases…I sometimes think of “seeing the present” as trying on alien eyes; looking at the world as if I were an alien from another plane.

As for the future, he says, “I find it helpful to unleash the imagination and trying to believe in impossible things…there is an art to believing in impossible things well. It’s more like being open to possibilities, to listening to what is possible.”  

Mr. Kelly suggests trying to picture the “history” of an imagined future, the steps required to get to X in year YYYY, so that we can understand “What kinds of technology and laws and social expectations needed to be in place year by year in order to arrive at that state.” However, he warns: “Most important, the main job is to think about the consequences of X arriving. What would we do if X was true? How do we manage it? How do we regulated it? How does it change us as humans?” 

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Dr. McGonigal – a game designer, Director at The Institute for the Future, and co-founder of health app/game SuperBetter – shares five tips for imagining the future:

Take a Ten Year Trip to the Future: “Ten years because that is enough time for society, and your own life, to become dramatically different. It’s enough time for new technologies to scale up and achieve global impact. It’s enough time for social movements to achieve historic victories. It’s enough time for big new ideas to take root, gain traction, and change the world.” 

Be Ridiculous – At First: “Any useful statement about the future should at first seem ridiculous…We need to prepare our collective imagination for “unimaginable” possibilities…If something feels unimaginable, that’s the tip-off that it is an essential future to start thinking about.”

Look for Clues: “To find future clues, you need to develop a way of observing the world in which you spot weird stuff that others overlook.  You must constantly home in on things you haven’t previously encountered, things that make you say, “Huh…strange,” and “I wonder why that’s happening.”

Turn the World Upside-Down: “If your imagination feels stuck in the present, then rewrite the facts of today. Make a list of up to a hundred things that are true today, then flip them upside-down…Turning the world upside-down can help clarify what changes you want in society and your own life.”

Build Urgent Optimism: “Urgent optimism is a highly motivating, resilient mindset made up of three key psychological strengths: mental flexibility, realistic hope, and future power.’

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In healthcare, the past is, for better and for worse, always with us.  For example, the central role of hospitals and doctors is certainly over a century old, that of pharmaceutical companies almost that old; the pervasive presence of employer-provided health insurance goes back to the 1940’s and that of Medicare/Medicaid to the 1960’s.  None of them seems likely to go anywhere anytime soon. 

The present of our healthcare system is, as Mr. Kelly warns, is harder to see.  It has proved dangerously fragile in this pandemic.  It never has offered equal care, or even equal access to care, to everyone.  And, most scary of all, in 2022 it turns out that we still don’t know if most medical treatments work, much less cause harm.  

It’s not a “system” in any meaningful way, and I’m honestly hard pressed to think of for whom it works well; even the people getting ridiculously compensated by it complain.  “Alien eyes” looking at it might not even recognize it as health care, especially considering we keep paying more and more yet are increasingly in worse health.

So we need to think of ridiculous futures, filled with impossible things.  We need to turn healthcare upside-down, as Dr. McGonigal might say.  Ten years isn’t going to be enough; we need to be thinking about 2050, or 2100.  

In my upside-down healthcare world, we don’t have doctors and hospitals.  Care is done at home, supported by assistive/supportive technology and overseen by artificial intelligence.  Health is monitored in real-time and any necessary adjustments are made almost as quickly, such as through the nanobots swimming within us or in the medications/devices we 3D print at home.  Care decisions and treatments are based on evidence, collected and analyzed on an ongoing basis, not on intuition, tradition, or personal preferences.  Technology has lowered costs so much that insurance is not necessary.

We acknowledge that health starts with how we live – what we eat, where we live, what we breathe, how much income we have, how we earn our living, to name a few.  We need massive savings in healthcare to invest in those.  

Where are all the healthcare workers in this future?  I don’t know, but healthcare isn’t supposed to be a jobs program.  It’s supposed to be about maintaining/improving our health.

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Sound ridiculous?  Good; that’s how we know we’re trying hard enough.  

I’m going to keep looking for clues to that future, be they improvements in AI, turd robots, or RNA computers – “weird stuff that others overlook,” as Dr. McGonigal says.  I want to be open to the possibilities that healthcare can become, not limited by our expectations about what it is now.

We need more urgent optimism about fixing healthcare.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

Episode 14 of “The THCB Gang” was live-streamed on Thursday, June 18th. Tune in below!

Joining Matthew Holt were four regulars: health futurist Ian Morrison (@seccurve), writer Kim Bellard (@kimbbellard), MD turned leadership coach Maggi Cary (@MargaretCaryMD), Consumer advocate & CTO of Carium Health Lygeia Ricciardi (@Lygeia), and two guests: Emergency Room MD, IT consultant and so much more Medell Briggs (MedellBriggsMD), and patient advocate CEO of Patient Orator, Kistein Monkhouse (@KisteinM). It was a very thoughtful conversation about patient care, the role of social movements, what to do about structural racism in health care, and what new legislation might come from the federal level. You can watch below right now.

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan