We Are the Ever Given

The Ever Given is free! 

Admit it: you’ve been following the story about the huge container ship stuck in the Suez Canal.  It’s about the size of the Empire State building laid flat, and somehow ended up blocking one of the busiest waterways in the world. 

As serious as this was for global shipping and all of us who depend on it, much hilarity ensued.  Memes exploded, using this as a metaphor for almost everything, healthcare included.  Once there started to be hope for getting the Ever Given free, people started new memes that it should be “put back.” 

Well, I’m a sucker for a funny meme and a good metaphor too.  Our healthcare system is that canal, and we’re the unfortunate ship.  Only it doesn’t look like we’re getting unstuck anytime soon.

Credit: Daily Mail

The Ever Given got stuck a week ago.  It is one of the world’s largest container ships, but high winds, poor visibility (due to a dust storm), and, perhaps, human error caused things to go sidewise, literally.  It got stuck on the banks.  Over 300 other ships have been blocked as a result; alternative routes add several thousand miles to the trip, making it a tough choice between waiting/hoping and rerouting. 

The Suez Canal carries about 10% of worldwide maritime traffic, worth as much as $10b daily.  It has been around since 1869 – far longer than the similarly important Panama Canal – and has been widened/deepened several times since.  Ships keep getting bigger and bigger, carrying more and more cargo, as globalization has created boom times for shipping (or, rather, shipping created boom times for globalization). 

As the wags at The Atlantic put it, “we’re going to need a smaller boat.” 

As soon as it became evident that the Ever Given wasn’t going to be freed quickly, warnings about the impacts on supply chains started, such as for toilet paper or appliances.  It was like last spring all over again, although for different reasons.  During the pandemic, we suddenly found that relying on just-in-time globalization for essential pandemic supplies like masks and other PPE, prescription drugs, or ventilators was a risky bet. 

We have so many problems, in the U.S. and in the world, and the Ever Given just seemed to typify our frustrations; thus the memes.  Travis M. Andrews summed things up in The Washington Post:

Let’s put it this way: When someone joked that we’re five minutes away from learning “all of our vaccines were being stored on the big ship stuck in the Suez Canal for some reason,” it took an uncomfortably long second to realize that’s fiction. The whole thing feels so absurd, so ridiculous, so perfectly on-brand for the state of the world that it crossed the bridge from “heinous” to “hilarious.”

If we don’t laugh, we might cry. 

We should keep in mind that, as Admiral James Stavridis (Ret.) warned in Time, the Suez Canal is not the only vulnerable chokepoint.  He cited the Strait of Malacca, the Strait of Bab-El-Mandeb, the Strait of Hormuz, the Bosporus Strait, and, of course, the Panama Canal as others.  His warning:

Last week it was the Suez canal, but in the years ahead, all of these choke points are vulnerable. Preparing now to deal with the potential challenges makes sense, instead of trying to figure it out as we stumble along as happened in the recent Suez crisis.

The pandemic took most countries by surprise.  We didn’t have the right tests, in the right quantities, and the U.S. in particular struggled to go into mass production of them.  Few countries were prepared to do the needed testing and contact tracing.  At first we didn’t have enough masks, then masks became a political flashpoint.  The FDA granted Emergency Use Authorizations (EUAs) freely, sometimes based on good data, sometimes not. 

Our underfunded public health system struggled to make headway, but a lack of a national plan, lack of needed authority, and partisan attacks weakened responses.  Many public health officials received death threats, and scores resigned due to the pressure. 

Due to good luck, good science, or Operation Warp Speed, we now have several very effective vaccines.  Despite that, scoring an appointment to get one has often seemed like The Hunger Games, and, even when we got one, there was no systemic way to track who received which type when. 

Still, vaccinations are finally skyrocketing.  We’re still a long way from herd immunity, but people are starting to feel hopeful.  Perhaps too hopeful; we’re seeing people on spring break  and states reopening as if there was no pandemic.  CDC Director Rochelle Walensky says she has a feeling of “impending doom,” admitting: “We have so much to look forward to, so much promise and potential of where we are, and so much reason for hope. But right now I'm scared.” 

We should all be.

The pandemic reminded us of the problems we have in our healthcare system.  Primary care floundered, and things got even worse for rural hospitals.  We had no good way to track or report needed data.  Our underlying comorbidities made us more vulnerable to COVID-19.  People of color were hit hardest and are trailing in receiving vaccines – less out of reluctance than availability.  Loss of jobs means millions also lost health insurance.

All of these choke points are vulnerable.  This time it was COVID-19, but none are going away even when/if COVID-19 does. 

Like those container ships, we’re getting bigger (unfortunately), and our health is becoming more complex, with most of us having chronic conditions.  Unlike the Suez Canal, our healthcare system wasn’t built in the 19^th century, but it is largely still based on its 20^th century roots (e.g., medical education, hospitals, employer-based health insurance).  It is not ready for the 21^st century.

We might like to think that COVID-19 was a once-in-a-century event, caused by some fluke winds that drove us into the banks (and aided by some human error), but the fact of the matter is that there will always be adverse winds, undertows, and bad human decisions.  We’re at risk of running aground again. 

So let’s enjoy the memes.  Let’s wear our masks and get our vaccinations.  But when it comes to our healthcare, we better take Admiral Stavridis’ admonition to heart: “Preparing now to deal with the potential challenges makes sense, instead of trying to figure it out as we stumble along.”

Enough with the stumbling along.

Nanoparticles On My Mind

Nanoparticles are everywhere!  By that I mean, of course, that there seems to be a lot of news about them lately, particularly in regard to health and healthcare.   But, of course, literally they could be anywhere and everywhere, which helps account for their potential, and their potential danger.

Let’s start with one of the more startling developments: a team at the University of Miami’s College of Engineering, led by Professor Sakhrat Khizroev, believes it has figured out a way to use nanoparticles to “talk” to the brain without wires or implants.  They use “a novel class of ultrafine units called magnetoelectric nanoparticles (MENPs)” to penetrate the blood-brain barrier. 

Credit: University of Miami

“Once the MENPs are inside the brain and positioned next to neurons, we can stimulate them with an external magnetic field, and they in turn produce an electric field we can speak to, without having to use wires,” Professor Khizroev explained.  A special magnetic helmet would communicate with the MENPs, in real-time. 

Other efforts, such as Elon Musk’s Neuralink, have been looking at using implants to achieve the brain-computer interface, but Dr. Khizroev is skeptical of this kind of approach:

Other efforts have used external instruments like microelectrodes to try to solve the mysteries of the brain, but because of its complexity and difficulty in accessing, such methods can only go so far.  There are 80 billion neurons in the human brain, so imagine how difficult it would be to attach 80 billion microelectrodes to access every single neuron. The only way to truly tap in is wirelessly—through nanotechnology.

Credit: Darpa

Professor Khizroev has been working on the technology for over a decade, and has received funding from Darpa as part of its Next Generation Non-surgical Neurotechnology (N³) program (also known as BrianSTORMs), the goal of which is “to develop high-performance, bi-directional brain-machine interfaces for able-bodied service members.”    The team got Phase II funding last November in order to build working devices. 

“Right now, we’re just scratching the surface,” Dr. Khizroev says.  “We can only imagine how our everyday life will change with such technology.”  Some of what he does imagine, though, is:

We will learn how to treat Parkinson’s, Alzheimer’s, and even depression. Not only could it revolutionize the field of neuroscience, but it could potentially change many other aspects of our health care system.

Last December, a Battelle team lead by Ping Liang, a former research partner of Dr. Khizroev, also received Phase II funding, for their work using magnetoelectric nanotransducers (MEnTs).  “Our current data suggests that we can non-surgically introduce MEnTs into the brain for subsequent bi-directional neural interfacing,” Patrick Ganzer, a Battelle researcher and the principal investigator on the project, said at the time.

Lest anyone think this is either an easy or a solved problem, Darpa points out: “N³ researchers are working to develop solutions that address challenges such as the physics of scattering and weakening of signals as they pass through skin, skull, and brain tissue, as well as designing algorithms for decoding and encoding neural signals that are represented by other modalities such as light, acoustic, or electro-magnetic energy.” 

These challenges kind of put Facebook’s new muscle movement-reading wristband in perspective, don’t they? 

But that’s not all the nanoparticle news from just this week.  In no particular order:

• Researchers from Cleveland Clinic and Chungbuk National University tested a COVID-19 vaccine (on ferrets) using antigens attached to nanoparticles.  The researchers concluded: “This approach has proven to have higher efficacy at a lower dose than traditional protein subunit vaccines,” and pointed out that it does not require cold storage. 
• Another research team, from Scripps and Temple, also tested using nanoparticles to deliver antigens for COVID-19, using three self-assembling protein nanoparticle (SApNP) platforms.  They concluded: “our study provides promising COVID-19 vaccine candidates for evaluation in clinical trials.”
• A research team at the University of Manchester used nanoparticles to discover previously unseen blood markers: “The nano-tool we developed allowed us to see deeper into the blood proteome, identifying proteins of interest that are directly associated with neurodegeneration processes in the brain, among thousands of other blood-circulating molecules.”  This might allow earlier and more definitive diagnoses of Alzheimer’s.
• A research team at the University of Science and Technology China are testing “acid-responsive nanoparticles composed solely of membrane-disruptive macromolecules” to treat pancreatic cancer.  The nanoparticles were more effective in penetrating the stroma surrounding the cancer cells. 
• Russian and Israeli researchers “have developed hybrid nanostructured particles that can be magnetically guided to the tumor, tracked by their fluorescence and pushed to release the drug on demand by ultrasound. This technology can help make cancer chemotherapy more targeted.” 

• Another Chinese research team is using nanoparticles to deliver antimicrobial peptides (AMPs) for the treatment of deep infections.  Normally AMPs are too toxic, but they believe “the development of intelligent nanocarriers can achieve selective activation and active target in the infectious sites, thus improving the therapeutic efficacy against bacterial infection and reducing the toxicity against normal tissues.”
• An international team of researchers assert: “The potential of nanotechnology in fighting this deadly disease [COVID-19] has not only been realized in context of developing a nano-vaccine but by delivering the nano-based anti-viral agents.  They propose several “nano-carriers” for various COVID-19 treatments, using “nanoencapsulation.” 
• Spanish researchers have been able to observe autonomous nanobots in vivo – inside the bladders of a living mouse -- using Positron Emission Tomography (PET).  “The possibility to monitor their activity within the body and the fact that they display a more homogeneous distribution could revolutionize the way we understand nanoparticle-based drug delivery and diagnostic approaches,” one of the researchers said. 

Nanobots in the liver over time   
Credit: Pedro Ramos, Cristina Simó / CIC biomaGUNE, IBEC, UAB

Again, that’s just this week, and only health-related nano news. 

I’m no expert on nanoparticles, or any kind of nanotechnology.  I understand that the technology has a long way to go yet.  I realize that there are risks, included unintended health effects, to using nanotechnology.  All that being said, too much of our health treatments are “shotgun” approaches that often cause as much collateral damage as beneficial impacts.  Nanoparticles offer the promise of “rifle” approaches that offer precise targeting – like using smart bombs instead of carpet bombing.   

Within my lifetime, and hopefully within the decade, we’ll have nano-delivered drugs that will greatly increase their efficacy.  We’ll have nanobots swimming around in us, for a variety of therapeutic purposes.  And we should have nanoparticle mediated brain-computer interfaces too.

Exciting stuff.   

Roblox and Healthcare's Metaverse

As neither a gamer nor the parent of a gamer, I’ve been proud that I’ve stayed even mildly in touch with the cultural phenomenon that gaming is.  I’ve written about, for example, the Metaverse, Fortnight, and e-sports.  Still, I somehow managed to be completely oblivious to the existence of Roblox, until they went public this week and was valued at $45b, larger than Electronic Arts (which I had heard of). 

Once again, I think there are lessons for healthcare.

Credit: Roblox

P.J. McNealy, CEO of Digital World Research, described Roblox to NPR as: “Minecraft meets Nintendo, which meets Lego and mobile phones enable a whole bunch of it.”  Whatever the metaphor, Roblox is booming.  It was valued at $4b a year ago, but the pandemic was very, very good for it. 

Credit: Quartz

Half of America children use Roblox.  Two thirds of its users are 16 and younger, and most of them were spending lots of time at home last year.  It is now estimated to have 37 million unique daily users, spending some 30 billion hours on the site last year.  It is available in 180 countries, in 11 languages.

What makes Roblox particularly unique is that it is not a game developer; it is a platform where users develop the “experiences”.  Roblox describes its mission thusly:

Roblox’s mission is to bring the world together through play.  We enable anyone to imagine, create, and have fun with friends as they explore millions of immersive 3D experiences, all built by a global community of developers.

It claims 8 million developers have created 20 million experiences -- and that it paid over $300 million to them.  The games are free but users can buy and spend an in-game virtual currency (Robux), which can be exchanged for actual money (Roblox shares 30% of the revenue with developers).  At least one developer made over $1 million in a single year; over 1200 made at least $10,000, with over 300 making over $100,000. 

Mr.  McNealy believes the IPO will allow Roblox significant expansion:

This money will either give them an opportunity to build more content for the for the platform or to go to adjacent platforms like music or partnering with Spotify or movie service.  That's where this is going to go.

CEO and co-founder David Baszucki isn’t content with the younger market, wondering: “So how do we make it possible for Roblox to connect with everyone in the world?”  Alex Hicks, cofounder of Roblox studio Red Manta, sees such potential, telling Polygon: “Lots of kids already know what Roblox is, but they’re just scratching the surface with the older audience.” 

In a February company blog post, Mr. Baszucki outlined some of the vision:

We see a future where tens of thousands of people can gather in a single instance to join a virtual business conference, attend a movie premier, or watch their favorite artists perform live.  We are working to make this vision a reality, innovating towards new technologies such as spatial audio and high-fidelity avatars with lifelike facial expressions.

Microsoft (Teams), Google (YouTube), and Facebook (Live) should all be looking over their figurative shoulders.  

Mr. Baszucki told Wired last year:

We will see a shift in the way people play, work, learn or simply hang out in 2021. Some of these connections will move into the Metaverse, a digital place where people seamlessly get together and interact in millions of 3D virtual experiences...[it is] arguably as big a shift in online communications as the telephone or the internet.

 Ah, the metaverse again. 

Credit: Roblox

To recap: a platform that relies on -- and rewards -- on user-generated content, thrives on shared immersive experiences, appeals to young people, and is fun.   Let’s see, which of those also apply to our healthcare system?  That’s right: none.

Healthcare is at least talking about platforms (e.g., Mayo Clinic Platform), but the closest thing the U.S. healthcare system has to a platform is probably Epic, which is renowned for poor usability and lack of interoperability.  Companies like AmWell would love to be the new platform, but are only slowly moving out from telehealth roots.  Optum is many things to many people, but not anywhere near being a platform.

Peer-to-peer support/advice is becoming more important in healthcare, but usually despite the healthcare professionals and institutions, not because of them.  Professional advice and treatment is still considered the “gold standard.”  Paying for patient-created “experiences” is unheard of. 

As for fun, well, when people use “Hunger Games” to describe what it is like to score COVID-19 vaccination appointments, it isn’t intended to convey any fun.  Healthcare may be allowing some games/gamification, but it is much too serious to take the importance of fun seriously.

Where is the healthcare platform that is built upon user-created content, paying those creators for how they engage other users in immersive 3D experiences?  “Participatory medicine” means simply allowing patients a say in their own care, which is a low bar Roblox wouldn’t even recognize.

Online gaming is a new industry compared to healthcare, but we’re already seeing the battle of its old guard and newer models.  In Venture Beat, Dean Takahaski contrasts Roblox’s IPO with Microsoft’s blockbuster acquisition of video game publisher Bethesda:

I see it as a contest between a promising part of the industry, as represented by the potential of the user-generated content of Roblox, and the old part of the industry, where Microsoft’s purchase of Bethesda is a new step in consolidation.

The way Techcrunch’s Luke Matney sees it:

The gaming industry has entered a very democratic stride as cross-play tears down some of the walls of gaming’s platform dynamics…While massive publishers have tapped cloud gaming as the trend that will string their blockbuster franchises together, they all wish they were in Roblox’s position.

Healthcare needs a Roblox.  It needs a platform that user created content and tools, among other things, can be built upon.  It needs a platform that engages users, using the latest technologies.  It needs a healthcare Metaverse. 

Such a company probably won’t come from within healthcare; e.g., Epic Games is more likely to create a healthcare Metaverse than Epic. 

I don’t know what a healthcare Roblox would look like; to be honest, I don’t really even know what Roblox looks like.  But I hope that there are some younger, smarter, more gaming-oriented people who can imagine what it might be, and that they make it happen. 

Your Health Data May Be a NFT

I must admit, after I wrote about digital currency last week, I did not expect to be writing about crypto anytime soon. Then I heard about “non-fungible tokens” (NFTs) and got a sense of the hype they were causing -- how I could I resist?

There may even be a connection to health care. 

You may have seen the Nyan Cat (pictured below), which is not new; it turns 10 in April.   What is new is that last month its creator “sold” it.  You may be thinking, wait, the GIF is everywhere, anyone can download it, so in what sense could he “sell” it?   

That’s where NFTs come in.  As you may know, “fungible” means that two things can be interchanged; one dollar is just like any other dollar, one bitcoin is like any other bitcoin, one electron is like any other electron.  Non-fungible, then, means the item in question is unique, and this is where the “token” comes in.  Basically, NFTs use digital certificates via blockchain to mark that something is one-of-a-kind, a claim of digital ownership.

Nadya Ivanova, chief operating officer of research firm L’Atelier explained NFTs to The Wall Street Journal: 

Think of it like a digital passport that comes with an asset.  They allow for this trust and authenticity to be established in a way that we haven’t been able to do before, whether it’s with physical assets or digital assets.

Artists have been using NFTs for a few years now, and auction house Christie’s is auctioning off the “First Purely Digital NFT-Based Work of Art Ever Offered by a Major Auction House,” featuring the digital artist Beeple (aka Mike Winklemann).  Christie’s promises:

…the buyer receives the artwork file containing a digital signature from the artist and all vital details including time of creation, edition size and a record of any prior sales. These details are permanently attached to the artwork, providing an enduring guarantee of value. 

NFTs have gone beyond art.  The NBA is all over this, with NBA Top Shot selling highlight clips; one of Lebron dunking just went for $200,000.  Maverick’s owner Mark Cuban is a big proponent.  “The tech is real,” he told CNBC. “The impact is real, and permanent.” 

Kings of Leon is releasing their new album as an NFT, believed to be the first group to do so.  Jack Dorsey is selling his first ever tweet as an NFT, and bids are already in excess of $2.5 million.  Singer Grimes has made $6m selling her mixed media artwork as NFTs.  Even Lindsay Lohan is cashing in. 

If you’re having a hard time discerning the underlying theme, join the club.  We’re in early days yet, and what NFTs prove best for remain to be seen.  As Kate Haun, a partner at Andressen Horowitz, admitted to NPR: "At the time the iPhone was created, nobody would've thought that one of the killer apps was going to be hailing a ride."

She went on to add:

Remember those days where people would line up for the newest Nike Air Jordan sneakers at the physical store? This is the new digital equivalent.  It's everything that brings together culture, and it's also a bet on the future of e-commerce.

Luke Heemsbergen, a professor at Deakin University. wrote in The Conversation:

NFTs are a cultural answer to creating technical scarcity on the internet, and they allow new types of digital goods… [they] bring code and culture together to create a form of control that doesn’t rely on the law or sabotaging existing systems. They create a unique kind of “authenticity” in a[n] otherwise shareable world.

All this means that NFTs are potentially revolutionary.  Bloomberg’s Leonid Bershidsky points out:

You could also see it as a new concept of property, which communist dreamers of centuries past would have found to their liking: It’s communal in all practical applications even as it feeds the creator and honors the supporter.

Anybody hooked by the news of (pretty unremarkable) videos and collages selling for lots of money will quickly find out that the NFT concept can be applied to property rights on everything under the sun (or, as the community would hope, that Bitcoin moon).

 A new concept of property, applied to property rights on everything…yeah, I’d call that revolutionary.

What makes NFTs even more intriguing is that some content creators are specifying that, as the NFT is resold, they get paid, giving them a future revenue stream and a share in any appreciation in value. 

So, what might this have to do with healthcare?

There are undoubtedly lots of potential applications, but my thoughts immediately went to health data.  It has long been a bitter fight in healthcare: whose data is it, anyway?  Patients believe it is theirs, but they don’t hold it, don’t always have access to it, can’t control it from being shared or even sold, and generate no economic value from it even as it produces real economic gains for companies using it.   

All of that is maddening, yet not much of it is likely to change under the existing paradigms.     

If our health data was an NFT, we could have more control when it was shared.  We could auction it off.  We could ensure that we benefit financially as others use it or resell it.  And, by the way, all the parties using it could have more assurance that the data was authentic.

There has been much talk about use of blockchain in healthcare, as in many other industries.  Mr. Cuban says, speaking specifically in reference to NFTs, “[B]lockchain and smart contracts and marketplaces are here to stay.”  NFTs could be blockchain’s killer app in healthcare.

A big drawback to NFTs, as with blockchain and cryptocurrency more generally, is that they require a lot of computing power.  NPR points out: “By some estimates, one crypto transaction could gobble up more power than the average U.S. households uses in a single day.” 

But, as Dr. Heemsbergen points out: “Other than their tonnes of CO₂ emissions, what’s real about NFTs is how their creation of technical scarcity enables a new cultural agreement about how something can be authentic and who controls that authenticity.” 

We can use NFTs to do that with digital art and dunk highlights, or we can do something meaningful by applying them to our health data.  If anything needs a “new concept of property,” it’s health data. 

Wanna Buy Some Bitcoin

To healthcare organizations, digital currency is the thing you’re forced to deal with when your systems are held for ransomware.  To the rest of the world, it’s increasingly starting to look like the future.

Credit: Getty Images

Tesla caused somewhat of a stir last month when it disclosed that it had bought $1.5b of bitcoin.  It also said it would start accepting bitcoin payments for its cars.  CEO Elon Musk added to the furor, saying: "I do at this point think bitcoin is a good thing. I'm late to the party, but I am a supporter of bitcoin.” 

Most of us are late to the digital currency party. 

Credit: FamZoo Staff

Bitcoin’s market cap hit $1 trillion in mid-February, although it now hovers just over $900b, with Ethereum another almost $200b.  Tesla is making more money from its bitcoin investment than from its core businesses.  In the scheme of global financial markets, digital currencies are still small, but are not something any CFO should be ignoring.   

Tesla is not the only major company accepting digital currencies; Overstock, Starbucks and Twitch do, as three wildly different examples.  Twitter is thinking about paying vendors or even employees with bitcoin.  Facebook expects to launch its own cryptocurrency this year. 

I’m not aware, though, of any major healthcare companies accepting or paying with digital currencies.  No Tesla-type breakthroughs in healthcare.   

Banks recognize the threat that digital currencies could pose to them.  Just today, Citi allowed that bitcoin could “become the currency of choice for international trade.” Its research note went on:

Bitcoin’s future is thus still uncertain, but developments in the near term are likely to prove decisive as the currency balances at the tipping point of mainstream acceptance or a speculative implosion.

Bank of New York MellonCorp announced last month that it would hold, transfer and issue bitcoin and other cryptocurrencies for its asset management customers.  “Digital assets are becoming part of the mainstream,” said Roman Regelman, chief executive of BNY Mellon’s asset-servicing and digital businesses.  JP Morgan isn’t there yet, but last week said it would allow investors to hold up to 1% of their portfolio in cryptocurrencies. 

PayPal announced last October: “Beginning in early 2021, PayPal customers will be able to use their cryptocurrency holdings as a funding source to pay at PayPal's 26 million merchants around the globe.”  Dan Schulman, president and CEO, said:

The shift to digital forms of currencies is inevitable, bringing with it clear advantages in terms of financial inclusion and access; efficiency, speed and resilience of the payments system; and the ability for governments to disburse funds to citizens quickly.

Mastercard and Visa are also already bowing to that inevitable. 

One of the aspects of bitcoin and other cryptocurrencies that holds much appeal is that they bypass central banks, unlike so-called “fiat currencies” issues by nations’ central banks.  Those central banks are recognizing that they risk being left out of the future, and are determined to have their say. 

Credit: Ledger Insights

A recent Bank for International Settlements survey found that more than 86 central banks were exploring a central bank digital currency, with more than 60 countries already testing the concept.  Countries like the Bahamas (Sand Dollar) and Sweden (e-krona) are already far along in their testing; the Swedish central bank (Riksbank) wants making e-krona payments to be “as easy as sending a text.”

Even the U.S. is finally coming around to the idea, with Treasury Secretary Janet Yellen allowing that digital currency was “absolutely worth looking at” because it “could result in faster, safer and cheaper payments,” although she also expressed some concerns.  Fed Chairman Jerome Powell told Congress that such a currency is a “high priority project for us…This is something we're investing time and labor in, across the Federal Reserve system”

But, as Frederick Kempe, President & CEO of the Atlantic Council, wrote in a CNBC op-ed: “Yet while the Fed consults, China executes.”

China is, indeed, not late to this party.  It is aggressively working on a national digital currency.  The New York Times reported: “no major power is as far along as China. Its early moves could signal where the rest of the world goes with digital currencies.”   

Mr. Kempe worries:

Chinese officials have made no secret that their greatly accelerated efforts at introducing and distributing the digital yuan are an opening move in their long-term strategy to undermine the dollar’s global supremacy and expand their influence.

If the U.S. loses the high ground of financial technological innovation, combined with a weakening of the dollar’s global dominance, the benefits for Beijing would be considerable.

An article in the magazine of China’s central bank admitted: “The right to issue and control digital currencies will become a ‘new battlefield’ of competition between sovereign states.” 

I’ve written before about how China is threatening America’s lead in emerging technologies, social media, and AI healthcare, but I hadn’t thought much about losing “the high ground of financial technological innovation” to China as well.  It’s a battlefield we’re not prepared for.

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In the best case, digital currencies could make payments “as easy as sending a text,” as Rikbank hopes.  They should make processing those payments faster, more secure, and less impacted by national boundaries.  They’d open up electronic payments to the unbanked; anyone with a smartphone could use them. 

KHYLIN WOODROW/BLOOMBERG BUSINESSWEEK

In the worst case, though, they could further erode privacy; all those anonymous cash or bitcoin payments could be tracked, such as through a central bank.   Yaya Fanusie, a fellow at the Center on Economic and Financial Power, told The New York Times:  “This is about more than just money.  It’s about developing new tools to collect data and leverage that data so that the Chinese economy is more intelligent and based on real-time information.”   China won’t be the only country with such interests.

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The Digital Currency Initiative at MIT Media Lab says its mission is “to create a future in which moving value across the Internet is as intuitive and efficient as moving information.”  That just makes me smile; when it comes to healthcare, moving information is still neither intuitive nor efficient.   

Healthcare has lots on its plate right now, with a host of legacy issues that have only been exacerbated by the pandemic.  I get that.  Incorporating digital currencies is not on the front burner.  But ignoring them won’t make them go away; it will only make the “inevitable” transition harder.