Monday, May 21, 2012

Free-range thinkers create Foo for thought

I cite this favorite quote from Max Planck in my book (and every chance I get):
A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.
I think this applies to all walks of life, not just science. Yet sometimes an argument so compelling comes along that, though reluctantly at first, one by one the old guard drop at its feet. This is what happened to me this weekend at the Health Foo Camp in Cambridge, MA.

First, what is Health Foo? Well that was my first question when I received an invitation to attend this strangely named meeting. A Foo Camp is something put together by O'Reilly, the pioneering digital media group. Started 12 years ago, these meetings are thematic gatherings of "Friends of O'Reilly," hence "Foo," intended to bring together a diversity of thought about a specific field. The camp that I attended was the second such gathering in the healthcare space, supported in part by the Robert Wood Johnson Foundation, and held at Microsoft's New England Research and Development Center in Cambridge. How can I ever thank O'Reilly, RWJF and Microsoft for this mind-shifting event?

As I mentioned in my previous post, the attendee roster was so full of luminaries that I frankly wasn't sure that the invitation had not ended up in my Inbox by mistake. But mistake or not, what a privilege to attend! I spent the weekend getting to know the faces and the substance behind such familiar names as Regina Holliday, Paul Levy, Alan Greene, Ted Eytan, Susannah Fox, Gilles Frydman and others. And what still has my mind spinning is my conversations with people I don't normally interact with -- computational scientists, game designers, food advocates and international public health movers and shakers.

The most risky aspect of this meeting was the very essence of its success: we were to free-range. No agenda was set; space, food and company were provided. The resulting sessions ran the gamut from the usual nerd porn of probability to such far-reaching topics as memory and the role of faith, poetry and the arts in medicine (my personal favorite, where I got to play in the sandbox of participatory painting led by Regina. Take that, left brain!)

I have to say I spent a part of the weekend in a bit of a fog. What is gamification of medicine? What does "deep modularity" mean? But the full impact of such diversity of knowledge did not hit me until I was heading West on the Turnpike away from the meeting in the direction of home. It felt like a deep air pocket, and for a moment I couldn't catch my breath.

My epiphany was this: I have been sitting in my office and analyzing, writing and thinking about how to slow down this juggernaut of digitalization in healthcare. My logic has been to identify the problems, particularly the overdiagnosis and overtreatment and the attendant harm, all in the context of an obscene price tag, and to say that not only does medicine not need the radical digital revolution that is being imposed on it, but the very definition of medicine needs to change. What I failed to consider is that medicine is a module that needs to fit into the rest of what we call our modern life. So, slamming on the brakes in hopes of stopping this locomotive before it squashes the medical system is the wrong approach.

I can hear what you are thinking. "There goes another one." "She drank the Kool-aid." "If she gets all starry-eyed about technology, there is no hope for the rest of us." Well, I am not a fan of Kool-aid, but I do like Shakespeare. My realization is as follows: If we don't start thinking about what we want medicine to be, we will continue getting medicine that looks and works like a Rube Goldberg machine, a conglomeration of unrelated levers that may or may not achieve the desired results. The stakes are too high, stakeholders too many, and the resources being used staggering.

The digital revolution will continue its break-neck pace regardless of my opinions. In its quest to take over the world, it will continue to advance into every aspect of medicine. But instead of positioning it as a confrontation between Godzilla and King Kong, I have decided that a more constructive way is to start to imagine what medicine can and should be in the future. The current model is moribund, if not altogether dead. Nature abhors a vacuum, and unless we fill it with something that heals and nurtures that has come out of a concerted multidisciplinary blueprint, it will continue to grow into a hydra that will eventually swallow us.

I know, I miss the slide rule too. But we did not get to be on Twitter by chaining ourselves to the old paradigms. Regina Holliday taught me, among so many other things this weekend, the word "chaordic." It is a neologism that combines the ideas of chaos and order into one force of nature. I think there has been enough chaos in the relentless penetration of technologies into medicine. I am tired of screaming at at the back of the digital monster like a crazy lady. We need to get ahead of it with an open mind and even some excitement, and start imagining where we can direct it for the better health of the public. Our magical thinking will not change the fact that this tidal wave will destroy us if we lack the imagination to ride it. A gathering like the Health Foo Camp is what fuels that imagination. Let's grow and harness it!

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  1. Great post! I think you will like this:

    A toast to data, technology and Shakespeare!
    - Regina Holliday

  2. I am sitting here and smugly thinking: Thank goodness Marya Z. is my DIL.

    But I'm beyond lucky.

    Many, no make that millions, of older folk who need her forward-thinking advice don't have access to it. They don't have computers or don't know how to find stuff they need to find out about. They rely on their primary-care docs who may not be up-to-date on the latest studies and medical information because they're too busy coping with an overload of patients. I have a friend whose medical issues are legion. She has a dozen different docs for a dozen different problems, along with a dozen different meds.

    Do they play well together?

    This is what we need to find out.

  3. Regina, thanks for visiting and sharing that wonderful slide deck -- love the graphic explanations of what the numbers add up to!

  4. Maggie, such kind words, thanks (she is definitely biased, folks, but it only alters the effect size, not its direction :))

  5. Thought provoking post, thank you. I hope you met my cousin, Sara Winge, a FOO camp organizer and an O'Reilly Radar VP (and a wonderful singer, thinker and citizen).
    Your post again reminds me of the wrongful direction of medicine at a strategic level, where no one person or phenomena is in charge. I sometimes compare it to my experience in Vietnam where we were tactically superior and "victorious" but aligned with the wrong strategy (counterinsurgency) which ended in disaster. Medicine needs strategic direction and leadership.
    Can it happen?
    The human interface with the medical technology provides a sociotechnical neighborhood where the human element is critical. Can humans win? FOO camp is the type of assemblage of thought leaders that gives hope for new strategic direction for medicine.

  6. Pat, thank you for your comment -- as always, right on target. I did meet Sara, and she is wonderful.

    The Foo was fantastic in terms of seeding new ideas. What we need now is some integrated thought about what we think medicine can and should be in 10, 20 and 30 years. We cannot leave this, yet another, catastrophe for our children to clean up.