Danger Ahead. Good.

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.