The Most Important Thing

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.  

These, and other initiatives, are all important and I sure hope people are working on them.  However, I think about some other things that Mr. Dorsey discussed in the webinar.

We have all these monopolies off balance and the individual doesn’t have power and the amount of cost and distraction that comes from our monetary system today is real and it takes away attention from the bigger problems…You fix that foundational level and everything above it improves in such a dramatic way.

Mr. Dorsey said he’s inspired by the bitcoin community: “It's deeply principled, it's weird as hell, it's always evolving,” reminding him of the early days of the internet.  I always, always, think about Steven’s Johnson’s great quote from his book Wonderland: “You will find the future where people are having the most fun,” and that certainly has to be part of what Mr. Dorsey sees about cryptocurrency.

Credit: BiotechScope

So, for me, the most interesting future for healthcare has to be synthetic biology, including biohacking.

Synthetic biology, in case, you didn’t know, is “redesigning organisms for useful purposes by engineering them to have new abilities,” and biohacking is doing that to your own body, usually to optimize or improve its functioning. 

Observers seem to think that synthetic biology seems to draw an edgy, counter-cultural crowd.  It’s on the cutting edge, and it, too, is getting record funding.  Former Google CEO Eric Schmidt said, at a 2019 synthetic biology conference: “What is changing the fastest right now? Because whatever that is determining the history of next year. There’s lot of evidence that biology is in that golden period right now.” 

Credit: Biohack the Planet/Indiegogo

Biohacking caught my attention a couple years ago because it seemed like “hacking” in the early days of PCs and the internet – not cybercriminals but amateurs just having fun exploring the medium; in this case, the medium is us.  Sure, biohacker have pulled some crazy stunts, but the #WeAreNotWaiting movement , among others, has done amazing, impressive, and important work.

When we start talking about “programming biology,” well, if that isn’t “weird as hell,” I don’t know what is.  That’s fun, and that’s the future.

The theme for me is to solve health issues at the source code level.  Not to take a pill that may or may not address my condition but probably will have side effects, or to have a surgery that will assault my body along the way, but to fix the errant cells/genes/structures at the root level.  Fix things, as Mr. Dorsey said about bitcoin, “at the foundational level.”

Mike Brock, who will head up Square’s DeFi business, tweeted: “Technology has always been a story of decentralization. From the printing press, to the internet to bitcoin – technology has the power to distribute power to the masses and unleash human potential for good, and I’m convinced this is the next step.” 

I want the same for our health – use technology to decentralize, and to distribute power to the masses.  That offers the promise of taking control from the traditional healthcare structures – not relying on hospitals, health insurance companies, or even medical professionals. 

As Mr. Dorsey thinks about bitcoin, “I don’t think there is anything more enabling for people around the world.”