Let's Place Some Big Bets

Several articles caught my attention this week.  None was specifically healthcare-related, but each, in their own way, apply.  They all were about challenging our assumptions and gambling on a different course.

Let's start with David Harrison's article in The Wall Street Journal about highways.  Yes, highways.  Most of us have grown up taking the interstate highway system as a given.  Some of us remember parts of it being built, and probably all of us have witnessed portions of it being repaired/expanded.  But too few of us remember how the original construction of many urban stretches wiped out whole neighborhoods. 

As Professor Norman Garrick told Mr. Harrison:

The freeways were put in to divide the black neighborhoods from the white neighborhoods or they were put straight through the center of the black neighborhoods and basically destroyed them.

Mr. Harrison reports how several cities -- such as Rochester (NY), Portland (OR), and Milwaukee -- are trying to reverse this by removing existing highways and reclaiming the land they occupied.  The Milwaukee planning director who oversaw the efforts there claimed:  "We’ve showed that when you take the highway out of the city it gets better. It’s that simple."

Who'd have thought?

The second article was from Laura L. Carstensen, of Stanford's Center on Longevity.  She states simply: "It’s time to get serious about a major redesign of life."  Our education, employment, healthcare, and retirement systems all still act as though we'll only live long enough for, at most, a few years of retirement.  As Professor Carstensen says: "Yet as longevity surged, culture didn’t keep up."

The Stanford Longevity Center has an initiative The New Map of Life that tries to rethink all stages of our lives.  It would require major changes.  "The challenges demand extraordinary social, scientific and educational investments," Professor Carstensen admits.  "The opportunities are even more extraordinary.... The greatest risk of failure is setting the bar too low."

As we often do.

The third and final article is from Sam Walker, also in The Wall Street Journal, on the "dying art of the Big Bet."  He uses the example, not surprisingly, of Elon Musk, with his recent electric truck, which, as Mr. Musk bragged at the truck's unveiling, "Doesn’t look like anything else." 

It's not surprising.  Mr. Musk described his approach to market research: “I do zero market research whatsoever."

Much as Elon Musk is famous for gambling on his instincts, in an era of Big Data, Mr. Walker argues, companies "don’t make bets. Before making operational changes, they run experiments to determine the outcome."  He cities the famous quote from Albert Einstein about solving problems:

Mr. Walker concludes: "Put simply, today’s geniuses study problems. Only suckers make bets." 

Call me a sucker. I'm all for rebuilding neighborhoods by tearing up highways, for redesigning the way we live, and for sometimes throwing out the data in order to place some big bets.  

When you read "highways," think hospitals and nursing homes, and when tearing them down might make the most sense.  When you think about redesigning life, think about Dr. Arthur Kleinman calling for us to change our disease-based healthcare system to an illness-based healthcare system that focuses more on "how to live a life disrupted by a disabling illness."

And when we think about market research and Big Data, think about Henry Ford's (possibly apocryphal) quote: 

Most of our healthcare innovations and reforms take the existing healthcare system as a given and try to build upon it in some way.  They add more on-ramps to the healthcare superhighway, widen its lanes, try to smooth the pavements, maybe even automate our driving on it.  But sometimes we need to tear the highway down.  

Here, in brief, are some big bets I'd like to see someone take on:

The end of medicine: Forget procedures.  Forget drugs.  Forget the practice of medicine as we know it.  Instead, we'd each have an army of nanobots inside us constantly repairing, restoring, revitalizing -- addressing most problems before they manifest and repairing ones that do.

The broader perspective: Most of our medical care is based on human anatomy and human biology, but we've come to realize that we live with a microbiome that may outnumber our cells by 10 to 1.  We can't be healthy without the "right" microbiome, so we need to totally reorient our approaches to medical care to emphasize the health of our totality, not just the "human" portion.  

Redefining healthcare professionals: We have a cornucopia of healthcare professionals.  M.D.s and D.O.s, pharmacists, dentists, nurses, optometrists, podiatrists, chiropractors, and so on.  Specialties beget sub-specialties beget sub-sub-specialties.  They're like the blind men and the elephant, only we're the elephant.  

In the not-too-distant future, though, most expertise will come from A.I. and most manual interventions will come from robots, so we should be thinking about what the uniquely human role in health care is, and how to prepare people for that role.  

Basic needs first: Amid all the debate about MedicareForAll, I want to see someone say: not one more dollar for medical care until every person has enough of the right food, lives in safe housing, has a healthy environment, has meaningful access to appropriate education, and gets the support they need for their daily activities.  

It may mean fewer of those million dollar drugs, more limits on "heroic" efforts to maintain life, and less hospital construction, but when people are starving and/or homeless literally in the shadows of new healthcare buildings, we know our priorities have gotten confused.  

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Most big bets don't pay off.  Most people like to bet on a sure thing, or at least on things that look like they have a good return.  Most people see the future very much like the present, only moreso.  But we're not going to increment our way out of the healthcare mess we find ourselves in.

So, yeah, I'm a sucker for solutions that don't look like existing healthcare solutions.  I'm a sucker for new approaches to old problems.  I'm a sucker for things that look like we borrowed them from the 22th century, rather than iterating them from the 20th.  

Any healthcare gamblers out there?