A War on Science Is a War on Us

 We’re in the midst of a major U.S. election, as well as hearings on a Supreme Court vacancy, so people are thinking about litmus tests and single issue voters – the most typical of which is whether someone is “pro-life” or “pro-choice.”  Well, I’m a single issue person too; my litmus test is whether someone believes in evolution. 

I’m pro-science, and these are scary times.

Within the last week there have been editorials in Scientific American, The New England Journal of Medicine, and Nature – all respected, normally nonpartisan, scientific publications – taking the current Administration to task for its coronavirus response.   Each, in its own way, accuses the Administration of letting politics, not science, drive its response. 

SA urges voters to “think about voting to protect science instead of destroying it.”  They cite, among other examples, Columbia Law School’s Silencing Science Tracker, which “tracks government attempts to restrict or prohibit scientific research, education or discussion, or the publication or use of scientific information, since the November 2016 election.”  Their count is over 450 by now, across a broad range of topics in numerous federal agencies on a variety of topics.   

The SA authors declare:

Science, built on facts and evidence-based analysis, is fundamental to a safe and fair America. Upholding science is not a Democratic or Republican issue.

Similarly, NEJM fears:

Our current leaders have undercut trust in science and in government, causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.

Jeff Tollefson, in Nature, warns:

As he seeks re-election on 3 November, Trump’s actions in the face of COVID-19 are just one example of the damage he has inflicted on science and its institutions over the past four years, with repercussions for lives and livelihoods. 

“This is not just ineptitude, it’s sabotage,” Jeffrey Shaman, an epidemiologist at Columbia University, told Mr. Tollefson about the Administration’s pandemic efforts.  “He has sabotaged efforts to keep people safe.”  Christine Todd Whitman, former New Jersey Governor and EPA head, added: “I’ve never seen such an orchestrated war on the environment or science.”

The Administration likes to tout the admittedly remarkable progress that pharmaceutical companies have made in therapeutics and vaccines – Operation Warp Speed! -- but the constant battles with both the FDA and the CDC (EUAs for everything!) have left the American public skeptical of supposed breakthroughs.  In the wake of President Trump’s recent embrace of monoclonal antibodies, The Washington Post lamented:

This has been the 2020 pattern: Politics has thoroughly contaminated the scientific process. The result has been an epidemic of distrust, which further undermines the nation’s already chaotic and ineffective response to the coronavirus.

 A Pew Research survey found Americans evenly split between those who would definitely/probably get a vaccine as soon as it was available and those who would not – and the percent willing has dropped from 72% in May.  Almost 80% fear the approval process will move too fast; in other words, that the science will be trumped by political concerns. 

“Warp speed really isn’t something I want from my medications, especially not ones for my children,” one physician told Alexandra Feathers in Slate.

A separate survey, from Axios/Ipsos, found that only 8% of Americans now have a “great deal” of faith in the FDA to look out for their best interests; only slightly more than half even had a fair amount of faith.  Trust in the CDC has also fallen. 

Science is losing. 

As tempting as it is to blame the current Administration for this war on science, it is a symptom of the problem, not the cause.  Some examples:

• One in four Americans believe the sun rotates around the earth. 
• Depending on how the question is asked, between a fifth and a third of Americans don’t believe in evolution at all, with another third believing in evolution “directed” by God. 
• Only three-fourths are Americans believe climate change is happening, with smaller percentages believing any such change is due to human actions. 
• Anti-vaccination beliefs had been growing steadily even prior to COVID, for well-understood, highly effective vaccines.    
• American school children continue to rank mediocre in science and math; adult Americans get a gentleman’s “D” for their science knowledge. 
• Only 73% of Americans think science has, on balance, had a positive impact on society; only 35% have a “great deal” of confidence in scientists to act in the public interest (although 51% had “fair” confidence). 

Politicians can get away with downplaying science because we let them; we let them because some of us don’t know enough, and others among us don’t care enough.  Anti-vaxxers were initially seen as an aberration, too small to worry about, but became a problem.  Now people not getting a COVID vaccine could be the difference between months of pandemic and years of pandemic.

Cultural wars have become wars on science.  Experts agree that wearing a mask and social distancing are the keys to our battle against COVID for the next many months, yet to many wearing a mask is a “personal choice” -- even when not wearing one is a risk not just for the person not wearing one but to them people around them. 

We should listen to the science.

It’s easy to get caught up in partisan politics about all this, but that’s wrong.  Science doesn’t care about your politics.  COVID doesn’t ask who you’re going to vote for.  Climate change doesn’t stop if you refuse to believe in it.  As writer Valorie Clark tweeted:

Stop asking candidates if they “believe in” climate change and start asking if they understand it. It’s science, not Santa Claus.

We should stop allowing candidates to tell us there’s a metaphorical Santa Claus and start demanding fact-based decisions. We should stop thinking science is something only scientists care about and start accepting that our lives depend on science, so we better understand how. 

Many might claim they are bad at science, but I think about what mathematician Paul Lockhart wrote many years ago in A Mathematician’s Lament.  If music was taught like math (or science) is, few would enjoy listening to it and even fewer would play it. It’s incumbent on scientists and educators to make science more accessible and understandable for the rest of us. 

We’ve failed the science test so far when it comes to COVID, and it has literally cost us hundreds of thousands of lives.  It’s not the first such test we’ve failed, but we can, should, and must do better – starting now. 

Attention, Walmart Patients

When Walmart announced earlier this summer that it was opening an insurance agency to sell Medicare-related products and services plans, I thought, “that’s it?”  When Walmart announced later in the summer that it was partnering (first with Microsoft, then with Oracle) in the bid to buy TikTok, I thought, “well, isn’t that interesting?”  And when Walmart announced a few days ago that it was partnering with Clover Health to offer Medicare Advantage plans, I thought: “it’s about time.”

You know Walmart.  265 million people (worldwide) shop at its stores each week.  Ninety percent of Americans live within 10 miles of a Walmart store.  It is estimated that 95% of Americans shop at Walmart during the year.  In over 200 U.S. markets, it accounts for at least 50% of grocery sales.  It is the fifth largest pharmacy chain by revenue. 

And Walmart has been shaking up healthcare for some time.  Way back in 2006, it introduced its $4 Prescriptions program that upended pharmacy pricing.  In 2008, it started offering in-store retail clinics, initially in partnership with hospitals and now operates on its own. 

Last year it started offering standalone clinics – Walmart Health – that went far beyond typical retail clinics.  They feature primary care, dental, lab and imaging, plus vision and audiology, and are starting to rapidly expand their footprint, aiming for 22 locations, in multiple states, by the end of 2021.  Patients can go online to view prices of services and book appointments. 

Then-President of Walmart U.S. Health and Wellness Sean Slovenski declared, “We're bringing people into the health care system that have not traditionally been in it and identifying their needs.  We're kind of creating an entire new market of customers."  Commenting on the clinic’s low-cost, disclosed-in-advance prices and all-in-one services, Mr. Slovenski said: “We didn’t set out to disrupt healthcare. We set out to meet the needs of our customers at Walmart.”

To help its customers use technology in their health care journey, earlier this year it acquired technology from CareZone that “helps individuals and families manage medicine and chronic illness for each member of the household.”  They can also scan insurance cards or prescription drug labels. 

Walmart is beefing up its clinics by a new deal with Oak Street Health.  Marcus Osborne, Senior Vice President, Walmart Health said: “As we grow Walmart Health locations in other markets, we think Oak Street Health’s innovative value-based healthcare model will help us continue to deliver on our live better promise at these locations.”

Not to be outdone, Walmart subsidiary Sam’s Club just announced it is going nationwide on a collaboration with telehealth provider 98point6 that it piloted in September 2019.  It offers a subscription service that features unlimited $1 telehealth visits.  “Offering access to telemedicine was on our roadmap in the pre-COVID world, but the current environment expedited the need for this service to be easily accessible, readily available and most of all, affordable,” said John McDowell, Vice President, Pharmacy Operations and Divisional Merchandise, Sam’s Club. 

Walmart hasn’t been content to just offer health care services; it has been active on the payor front too.  In 2010, it partnered with Humana to offer a Medicare Part D plan, which it still offers.  For its own employee health program, it has had a Centers of Excellent program for over twenty years, and has tested ACOs, bundled payments, and value-based purchasing.  A couple years ago there was much discussion about a Walmart-Humana merger/acquisition, which did not pan out – yet. 

Which brings us to the Clover Health partnership, called LiveHealthy.  Clover Health President & CTO Andrew Toy said:

The Walmart brand is synonymous with the best value and low prices, and that's exactly what we're doing at Clover.  By offering affordable insurance plans with an open network  of doctors and hospitals, we are democratizing high-quality care and bringing it to individuals and communities that have previously been overlooked by other insurers.

LiveHealthy will start out in eight Georgia counties, with a network of 31 hospitals and 8,000 clinicians – including Walmart Health locations.  The plan is being billed as “Clover-powered,” but follows the Walmart value approach – zero premium, “free” primary care visits, lab tests, and preventive dental services, not to mention $100 every quarter to spend on OTC items at Walmart. 

In the scheme of things, Clover Health has a small membership/footprint.  Its main strength is its technology, specifically Clover Assistant that “gives your primary care doctor a complete view of your overall health and sends them care recommendations that are personalized for you, right when you're in the appointment,” using “data, clinical guidelines, and machine learning to surface the most urgent patient needs.”

I’ve always wondered why Walmart hadn’t pursued partnerships with/acquisitions of managed Medicaid plans, such as Centene or Molina Healthcare (both of which are actively pursing their own acquisitions).   Clover Health’s website says: “Clover proudly serves many low-income and often overlooked communities, which is core to the company’s mission of bringing healthcare to people who are most in need and commonly ignored by other insurers.”  That dovetails quite nicely with serving a Medicaid or dual eligible (Medicare and Medicaid) population. 

Lest anyone think Walmart is solely focused on healthcare, there is:

• The aforementioned interest in TikTok, which Walmart believes “will provide Walmart with an important way for us to expand our reach and serve omnichannel customers as well as grow our third-party marketplace, fulfillment and advertising businesses.”  It would especially boost Walmart’s presence for younger audiences.
• The introduction of Walmart+, it’s answer to Amazon Prime that some analysts think could lead to 10 million subscribers by the end of 2021.  It includes unlimited free delivery on more than 160,000 items.
•  Its surging online sales, which have nearly doubled in the last quarter, especially for online groceries.  “You see Amazon following behind Walmart on this,” Edward Yruma, a retail analyst at KeyBanc Capital Markets, told The New York Times.

 Walmart U.S. CEO John Furman believes: “The demand definitely tells us that Americans are looking for access to quality care, and we think Walmart — its footprint — should be a part of that.”  Maybe “Walmart” doesn’t carry the same cache as, say, “The Mayo Clinic” when it comes to healthcare, but its brand for value and convenience is hard to match, and that may be enough to make it a force in healthcare. 

Pundits spend a lot of time wondering what Amazon will do in healthcare, when.  It is, indeed, taking some interesting steps, but no one should be overlooking what Walmart is doing. 

Or soon will be.

Making AI Less Squirrelly

You may have missed it, but the Association for the Advancement of Artificial Intelligence (AAAI) just announced its first annual Squirrel AI award winner: Regina Barzilay, a professor at MIT’s Computer Science and Artificial Intelligence Laboratory (CSAIL).   In fact, if you’re like me, you may have missed that there was a Squirrel AI award.  But there is, and it’s kind of a big deal, especially for healthcare – as Professor Barzilay’s work illustrates. 

The Squirrel AI Award for Artificial Intelligence for the Benefit of Humanity (Squirrel AI is a Chinese-based AI-powered “adaptive education provider”) “recognizes positive impacts of artificial intelligence to protect, enhance, and improve human life in meaningful ways with long-lived effects.”  The award carries a prize of $1,000,000, which is about the same as a Nobel Prize. 

Yolanda Gil, a past president of AAAI, explained the rationale for the new award: “What we wanted to do with the award is to put out to the public that if we treat AI with fear, then we may not pursue the benefits that AI is having for people.”

Dr. Barzilay has impressive credentials, including a MacArthur Fellowship.   Her expertise is in natural language processing (NLP) and machine learning, and she focused her interests on healthcare following a breast cancer diagnosis.  “It was the end of 2014, January 2015, I just came back with a totally new vision about the goals of my research and technology development,” she told The Wall Street Journal. “And from there, I was trying to do something tangible, to change the diagnostics and treatment of breast cancer.”

Since then, Dr. Barzilay has been busy.  She’s helped apply machine learning in drug development, and has worked with Massachusetts General Hospital to use A.I. to identify breast cancer at very early stages.  Their new model identifies risk better than the widely used Tyrer-Cuzick risk evaluation model, especially for African-American women. 

As she told Will Douglas Heaven in an interview for MIT Technology Review:  “It’s not some kind of miracle—cancer doesn’t grow from yesterday to today. It’s a pretty long process. There are signs in the tissue, but the human eye has limited ability to detect what may be very small patterns.”

This raises one of the big problems with AI; we may not always understand why AI made the decisions it did.  Dr. Barzilay observed:

But if you ask a machine, as we increasingly are, to do things that a human can’t, what exactly is the machine going to show you? It’s like a dog, which can smell much better than us, explaining how it can smell something. We just don’t have that capacity.

She firmly believes, though, that we can’t wait for “the perfect AI,” one we fully understand and that will always be right; we just have to figure out “how to use its strengths and avoid its weaknesses.”   As she told Stat News, we have a long way to go: “We have a humongous body of work in AI in health, and very little of it is actually translated into clinics and benefits patients.”

Dr. Barzilay pointed out: “Right now AI is flourishing in places where the cost of failure is very low…But that’s not going to work for a doctor… We need to give doctors reasons to trust AI. The FDA is looking at this problem, but I think it’s very far from solved in the US, or anywhere else in the world.” 

A concern is what happens when A.I. is wrong.  It might predict the wrong thing, fail to identify the right thing, or ignore issues it should have noticed.  In other words, the kinds of things that happen every day in healthcare already.  With people, we can fire them, sue them, even take away their license.  With A.I., what we do to whom/what is not at all obvious.

“This is a big mess,” Patrick Lin, director of Ethics and Emerging Sciences Group at California Polytechnic State University, told Quartz. “It’s not clear who would be responsible because the details of why an error or accident happens matters.” 

Wendall Wallace, of Yale University’s Interdisciplinary Center for Bioethics, added: “If the system fails to perform as designed or does something idiosyncratic, that probably goes back to the corporation that marketed the device.  If it hasn’t failed, if it’s being misused in the hospital context, liability would fall on who authorized that usage.”

“If it’s unclear who’s responsible, that creates a gap, it could be no one is responsible,” Dr. Lin said. “If that’s the case, there’s no incentive to fix the problem.”  Oh, great, just what healthcare needs: more unaccountable entities.

To really make AI succeed in healthcare, we’re going to have to make radical changes in how we view data, and in how we approach mistakes.

AI needs as much of data as it can get.  It needs it from diverse sources and on diverse populations.  All of those are problematic in our siloed, proprietary, one-step-from-handwritten data systems.  Dr. Barzilay nailed it: “I couldn’t imagine any other field where people voluntarily throw away the data that’s available. But that’s what was going on in medicine.” 

Despite our vaunted scientific approach to medicine, the fact is that we don’t really know what happens to most people most of the time, and do a poor job of counting even basic healthcare system interactions, like numbers of procedures, adverse outcomes, even how much things cost.  As bad as we are at tracking episodic care, we’re even worse at tracking care -- much less health -- over time and across different healthcare encounters. 

Once AI has data, it is going to start identifying patterns, some of which we know, some of which we should have known, and some of which we wouldn’t have ever guessed.  We’re going to find that we’ve been doing some things wrong, and that we could do many things better.  That’s going to cause some second-guessing and finger-pointing, both of which are unproductive.

Our healthcare system tends to have its head in the sand about identifying errors/mistakes, for fears about malpractice suits (justified or not).  Whatever tracking does happen is rarely disclosed to the public.  That’s a 20^th century attitude that needed to be updated in an AI age; we should be thinking less about a malpractice model and more about a continuous quality improvement model.

“The first thing that's important to realise is that AI isn't magic,” David Champeaux of Cherish Health said recently.  It’s not, but neither is what we already do in healthcare.  We need to figure out how to demystify them. 

WeChat to Many, But WeDoctor to Some

You’ve probably heard about TikTok, especially lately.  President Trump wanted a ban on it, and seems to have endorsed a deal for a U.S.-based version of it.  The hundred million U.S. users, and probably their parents, are undoubtedly watching the sequence of events with mixed amusement and concern. 

But you may have paid less attention to what’s been going on with WeChat, another China-based app.  WeChat was part of the original proposed ban, which a federal judge blocked this weekend, hours before it was due to go into effect (the Commerce Department plans to appeal).  The ban is on “transactions,” which, in WeChat’s case, covers a lot of ground. 

TikTok was overlooked by authority figures for a long time because it was mostly used by young people and mostly for what seemed, to them, to be trivial purposes.  Not so with WeChat; it is deeply engrained in users’ lives, including for their health.   

WeChat is owned by Tencent Holdings, one of China’s internet giants.  It has been described as a “Swiss Army knife” app, able to do many tasks – not just messaging and social networking, but also games, shopping, and payments.  You can order food or book travel.  For many users it is a primary source of news, which is part of the problem. 

It is also important to users’ health.  WeChat is, according to CMI Media, “fast becoming the #1 online healthcare destination in China.”  It offers, among other things, health content (some in partnership with U.S. firms), health products, telehealth, a network of “trusted” doctors, a form of health insurance, and WeDoctor.  The latter “provides online health enquiry service, psychological support, prevention guidelines and real-time pandemic reports,” and is free to the user.  It is available “24/7 for people all over the world.”

Most notably, WeDoctor is preparing for an IPO for late this year/early 2021, which could value it as high as $10b.  I would again note the “24/7 for people all over the world.”

If we’re worried about what information China might glean from the video-watching habits of teenagers, think about how worried we should be about China having access to what health information users sought, what medical advice they got, and what health products they ordered.

China is famed for its “Great Firewall,” which restricts which outside internet platforms – like Google or Facebook – can be used within its borders.  Equally important, the Chinese government monitors what happens on WeChat and other internet platforms/apps, and does not allow news or opinions it finds objectionable, or subversive.  You might think you are in your own Facebook or Twitter bubble in the U.S., but in China – or on WeChat – that bubble is shaped and controlled by the government. 

As a result, Politico reported, “Now young online Chinese, once conduits for new ideas that challenge the power structure, are increasingly part of Beijing’s defense operation.”  Even U.S. users find their worldview shaped by the content they are allowed to see.  As The New York Times said, “it has helped bring Chinese censorship to the world.”

“All of a sudden I discovered talking to others about the issue didn’t make sense,” one user told The New York Times.  “It felt like if I only watched Chinese media, all of my thoughts would be different.”

There are estimated to be 19 million U.S. users, out of WeChat’s 1.2 billion users; most are people with family or friends in China, who rely on the app to stay in touch.  The U.S. may argue it is worried about what financial and personal information might be going to the Chinese government, but it should be equally worried about what “information” is being served to U.S. users. 

Think, for example, what it might tell U.S. users about COVID-19 vaccines.

The U.S. moves make some worry that we’re becoming more like China, leading to the “splinternet” where, as Vox explained, “your experience of the internet increasingly depends on where you live and the whims of the ruling parties there.” 

Vox goes on to note:

Nations are increasingly pursuing various forms of internet sovereignty, from Russia building a walled-off intranet to India regularly shutting down the internet in areas of social unrest to some European nations introducing a right to be forgotten from search engines.

It is the opposite of the open access, no borders version of the internet that most of us have believed in for the past thirty years.  Aaron Levie, CEO of cloud-computing company Box Inc, warned in The Wall Street Journal: “U.S. tech companies have far more to lose if this becomes a precedent.  This creates a Balkanization of the internet and the risk of breaking the power of the internet as one platform.”

One Congressional official told Wired:

We are finally having the debate China had two decades ago, when it put in the Great Firewall because it found foreign technology threatening its political system. Only now is America catching up with foreign technology that is a direct threat to our open system.

But Jason Healey, an expert on cyber conflict, competition and cooperation at Columbia University, told The New York Times: “The vision for a single, interconnected network around the globe is long gone. All we can do now is try to steer toward optimal fragmentation.”

Somehow, “optimal fragmentation” isn’t how I want to think of my internet experience; I suspect that fragmentation won’t be so optimal.

Even if some version of the ban on WeChat goes through, it’s not clear how effective it would be.  Options like using VPNs or downloading the app from non-store channels may allow users to continue to use it.  In any cases, The Washington Post reported that “the administration does not intend to prosecute anyone for finding new ways to use the apps.” 

In discussing the effect of potential WeChat bans with The New York Times, Fang Kecheng, a professor at the Chinese University of Hong Kong, said: “Information is like water. Water quality can be improved, but without any flow, water easily grows fetid.”  He didn’t carry the analogy further, but I will: information is like water, in that, eventually, it will get to where it wants to go. 

We don’t have a U.S. platform as versatile as WeChat; we don’t even have a health platform as capable as WeChat’s health capabilities.  But, if we’re not careful, WeChat might become that platform.   

Healthcare Can Learn from Chess

 Oh, gosh, two of my favorite things are in the news together: Twitch and chess. 

Just kidding.  I barely know what Twitch is, and the last time I played chess was, well, not in this century (and, even then, not well).  But I’m not kidding about their convergence.  Chess has become a big hit on Twitch, especially in these COVID times. 

I figure, if two such seemingly divergent things are meshing, there must be some lessons there, even for healthcare. 

For those of you over, say, fifty, Twitch is an online service that facilitates livestreaming, particularly of gaming.  That is, people watch other people playing games, such Fortnite or League of Legends. 

E-sports, as this is known, have become a big thing; colleges are even giving out scholarships for e-sports.   Major news outlets, such as The New York Times and The Washington Post, reported on Twitch re-signing video game star Tyler Blevins, a.k.a “Ninja,” much as they might have reported an NFL team signing a star player. 

As I write, 2.7 million people are livingstreaming on Twitch.  Its all-time concurrent viewers peak is just over 6 million.  There were 1.6 billion hours watched in August, with over 11 billion year-to-date.  It draws more viewers than network television hits. There are 93,000 live channels at this moment. 

Some of those livestreams are watching chess.  Analytics website Sullygnome reports people watched 45 million hours of chess on Twitter in 2020.  In June an amateur chess tournament was (briefly) the top-viewed Twitch stream. The convergence of streaming and chess has created a “giant chess bonfire,” Marcus Graham, Twitch’s head of creator development, told The New York Times. 

The biggest Twitch chess star is grandmaster Hikaru Nakamura, who accounted for 10 million of those 45 million hours watched.  Last month esports organization Team SoloMid signed Mr. Nakamura to what is believed to be a six figure deal; he is not the only chess player signing such deals, nor is it the only such organization signing them.  Other key players include Alexandra Botez, Eric Hansen, and Felix “xQc” Lengyel (who is more famous for other games). 

Mr. Nakamura has over 500,000 Twitch followers, drawn as much by how he engages viewers as his chess expertise.  “He draws people because he’s so good, but also, there are other top players on Twitch that are not as engaging as he is, not as funny, not as in tune with the sort of Twitch culture,” one viewer told The Times.

Mr. Nakamura’s appeal is, in part, because he helps demystify the game; “Fans love when he loses his mind at a poorly thought-out move.”  One fan told The Times:

When I was growing up, high-level chess was secreted behind closed doors, played by the privileged, moneyed people in society.  Realizing that I could see chess being played at the highest levels and seeing the players on Twitch communicate their thoughts with the community really resonated with me.

In an interview with NPR. Mr. Nakamura acknowledged the conflict: “So there are people who feel very much that chess, as it is, should stay that way as opposed to, say, in a sense cheapening the game by trying to make it more popular.”  His goal is to help break down those barriers.

As The Times asked, “If Serena Williams and Usain Bolt showed off their unique abilities every day on a livestream, wouldn’t you watch?” 

Lest we think this is entirely about Twitch, I’ll point out that Chess.com is the world’s third largest gaming website, with 42 million members and an average of over 9 million regular viewers.  It claims to be adding over 1 million users per month.  Chess is adapting to the times.

Twitch isn’t just focused on games, much less on chess.  It has signed musicians and other creators.  It livestreams sports and concerts.  It uses its connection to Amazon Prime to host Watch Parties, so users can “watch, react, and discuss any movie or TV show that is available with their Amazon Prime or Prime Video subscription, directly on Twitch.”  YouTube and Netflix should be worried. 

I actually wrote about Twitch several years ago, just after Amazon acquired it for close to a billion dollars, noting at the time:

I'll posit this: if you didn't know what Twitch was, or are still puzzled at its appeal, your organization is going to have a tough time competing over the next couple of decades.

That’s even more true today than ever.

As with TikTok, Twitch users are predominately young.  Forty-one percent of its users are 16-24, with another 32% 25-34.  Only 3% are 55-64; users over 65 don’t even count as a rounding error.  It is the converse of our healthcare system’s current users, but it is the generational wave that is coming. 

I’ve written before about how healthcare has lessons to learn from disparate platforms like TikTok or Fortnite, as those platforms have extended their reach (e.g., social justice and the Metaverse, respectively).  As best I can tell, Twitch hasn’t paid any attention to health or healthcare.  Then, again, gaming/gamification are still struggling to gain a foothold in healthcare. 

Healthcare likes its traditions – white coats, anyone? – and claims to value our privacy so much that it often makes it hard for us or our caregivers to get access to our information.  “Games” or livestreaming to a participatory audience seems like the remotest thing for healthcare.

But if the staid, traditional-laden of chess can thrive in a Twitch environment, there have to be ways that healthcare can take advantage of it as well.  Too much of what goes in healthcare is “secreted behind closed doors,” as the one chess fan said about chess.  We need to open those doors.

I’m not talking about easy uses like yoga classes or even medical lectures; I’m talking about more things like livestreaming surgeries, as Tokyo Women’s Medical University does – in VR.   COVID-19 is prompting some medical schools to do the same.  There are uses we have not yet thought of, but should.  It just probably won’t be healthcare’s largely Baby Boomer leadership that will come up with them. 

What healthcare organization or professional will have the first breakout Twitch channel?  

A New Kind of Labor Day

This is probably the strangest Labor Day in decades, perhaps ever.   Tens of millions of workers remain unemployed due to the COVID-19 pandemic.  Many of those who are still working are adapting to working from home.  Those who are back at their workplace, or never left, are coping with an array of new safety protocols. 

Those who work in the right industries – like the NBA – may get tested regularly but most workers have to figure out for themselves when to quarantine and when to get tested.  For many workers, such as health care workers, people of color, and workers with underlying health issues, going to work is literally a life-or-death calculation. 

No wonder that experts, like Dr. David B. Agus, are calling for companies to have Chief Health Officers. 

Labor Day was originally intended to celebrate the labor movement, but these days labor unions don’t have much to celebrate.  Only around 10% of U.S. workers belong to a labor union; both the number and the percent of unionized workers has been in steady decline over the past few decades. 

Now Labor Day is mainly an extra day off for most, the unofficial end to summer, and, this year, possibly the springboard to a new surge in COVID-19 cases, due to holiday celebrations.  Dr. Anthony Fauci warned:

We don’t want to see a repeat of the surges that we have seen following other holiday weekends.   We don’t want to see a surge under any circumstances, but particularly as we go on the other side of Labor Day and enter into the fall.

Eleanor Murray, an assistant professor of epidemiology at the Boston University School of Public Health, explained to The New York Times:

People are getting tired of taking these precautions and of having their lives upended.  They’re missing their friends and family, and everyone wishes things were back to normal. That’s totally understandable, but unfortunately we don’t get a say, really.

Las Vegas Labor Day party

It doesn’t help that many schools have reopened, with colleges and universities already seeing mass outbreaks.  One estimate found at least 25,000 such cases, in 37 states.  Labor Day parties and gatherings could send that number soaring.  No one is going to be surprised by photos of swarms of beachgoers, pool parties, and crowded bars, and no one can be surprised if this fall sees the consequences of that in more COVID-19 cases, hospitalizations, and deaths.

Many wonder if the nature of work will change as a result of the pandemic.  Most companies have been pleasantly surprised to find that productivity hasn’t suffered by work from home.  A survey by Mercer found that 94% of employers said productivity was the same (67%) or even higher – and 73% said they expected at least a quarter of their workforce would remain working remotely. 

Workers are generally happy too.  For one thing, they’re saving the equivalent of “billions” of dollars in avoided commuting time, not to mention actual costs such as gasoline, parking, and mileage.  Some see “digital nomads” as the future.  A June PwC survey found that, even post-pandemic, 83% of office workers wanted to work at least one day a week from home, and 55% of employers thought most of their workers might do so. 

Not everyone is a fan of remote work.  Reed Hastings, founder and co-CEO of Netflix, called it a “pure negative,” citing the benefits of getting together in person.  Still, even he concedes the new balance might be four days in the office, one day virtual. 

Mr. Hastings is not alone in his concerns about the benefits of in-person interactions, the so-called “water cooler” or “hallway” effect – serendipitous encounters that have been linked to creative thinking.  “These ties are critical to our well-being because they end up giving us the opportunity to vent, confide, brainstorm, and discuss things that we think are important,” says Mario Luis Small, a Harvard sociology professor. 

"The water cooler as a place to build relationships just evaporated when everybody went remote,” Dan Manian, CEO of Donut, told The Wall Street Journal.  Professor Eddie Obeng also told The Wall Street Journal, “employees are using tools and methods that weren’t designed for the current world in which we are living.”  Donut is one of the companies trying to provide solutions for this problem. 

Slack, Microsoft Teams, and Zoom are also trying to do the same, as are less well known companies like Hallway, Miro, Qube, Sidekick, and Spatial.  .

We need to be thinking bigger.  As Dr. Agus said in a May interview with Salesforce:

I want companies to have a program where they think about their employees’ productivity and health every day. And, then, if they're customer-facing, how do they convey that same message to the individual customer? We have to think differently in that way.

Some companies and other organizations are starting to take Dr. Agus’s suggestion seriously, such as Bowling Green State University.  Cambridge Health advisors, which aims at retailers and restaurants, urges: “New C-level leadership, a chief health officer, is needed to establish a vision for chainwide public health and to ensure store level initiatives are executed timely and effectively.” 

Adam Aron, CEO of AMC Theaters, says frankly:

The single biggest issue facing businesses in the United States is how do we manage our way through the coronavirus crisis.  The CEO of every major company in the country is going to have to make public health the single top vision of the company.”

Imagine that.

It shouldn’t have taken a pandemic to greatly increase remote work.  It shouldn’t have taken a pandemic for companies to think about their employees’ productivity and health every day (and to weigh those at least equally).  It shouldn’t have taken a pandemic to make public health top-of-mind for CEOs of every major company.  But it has, and, even now, it’s not clear how many companies will actually change long term.

It’s been about six months now since the restrictions/quarantines/lockdowns started, with the resulting job losses and economic havoc.  We’ve learned a lot, at a terrible cost, but it’s anyone’s guess about what the next six months will bring (especially as flu season is about to start).

So, let’s celebrate Labor Day – responsibly! – and hope that we’ve learned the right lessons.