"There is a time for putting together
And another time for taking apart."
— Chuang Tzu
阿尔弗雷德·杰·福天博士
Welcome to my blog. I'm your host, Alfred J. Fortin PhD (阿尔弗雷德·杰·福天博士), writing from Honolulu, Hawaii. You can read more about me, or email me at contact@ajfortin.com.
This blog covers health care challenges in the U.S., China and the Third World, with an emphasis on politics, political theory, culture and globalization. To get oriented, you may want to check out the Suggested Reading page.
It may be sacrilegious to say this in a health policy journal, but the greatest lesson of the failure of the Clinton health plan is that reformers pay too much attention to policy and too little to politics. If real estate is about location, location, location, health reform is about politics, politics, politics.
And Hacker’s lament: “Why did such smart people get the politics so wrong?”
Why indeed, why indeed and will we repeat the Clinton herstory?
SB: Is it the scientists who are putting them down?
FD: Yes. There is this snobbism among scientists, especially the academic types.
SB: Are there other kinds?
FD: There are scientists in industry who are a bit more broad minded. The academics look down on them, too.
SB: Is that a weird British hangover?
FD: It’s even worse in Germany. Intellectual snobbery is a worldwide disease. It certainly was very bad in China and probably held back development there by 2,000 years.
SB: How would you stop this intellectual snobbery?
FD: I would abolish the PhD system. The PhD system is the real root of the evil of academic snobbery. People who have PhDs consider themselves a priesthood, and inventors generally don’t have PhDs.
SB: Are those getting PhDs rewarded in any other way than as an honor?
FD: It’s much more than an honor. It’s a ticket to a job.
SB: So is anybody buying this? Are PhDs being abolished or disregarded?
FD: No. The stranglehold has gotten even tighter over the years. It’s become essentially like the MD - with much less justification. It’s simply a barrier you have to climb over before you can make a career, and it’s being imposed on more and more jobs. At even the smallest liberal arts college, nowadays, they say with pride, “All of our faculty have PhDs.” Many of the best teachers are thrown out because they don’t have a PhD. It’s a paper qualification that poisons the whole field.
Fareed Zakaria argues in his new book “The Post-American World“, that the problem America faces in the new emerging international sphere is not so much domestic decline, but rather more “the rise of the rest.” By this he means that countries all over the world “have been experiencing rates of economic growth that were once unthinkable.” This is resulting in shifting of the balance of power, the movement from a unipower world with America at the center, to a world of “many actors, state and non-state” where there is no center. The challenge in such a world, according to Zakaria, is “how to stop the forces of global growth from turning into the forces of global disorder and disintegration.”
In this new “Post-American World”, Zakaria asks “will international life be substantially different in a world in which the non-Western powers have enormous weight?” Will Washington be able to “adjust and adapt to a world in which others have moved up?” And can we thrive in a world we cannot dominate? In America, “new thinking about the world is sorely lacking” and our isolationism has left us quite unaware of the world beyond our borders.
We also suffer from a “dysfunctional politics”, Zakaria writes, one characterized by gridlock and partisanship, which prevents us from beginning “a generous effort to engage the world.” The future is already here.
The task for today is to construct a new approach for a new era, one that responds to a global system in which power is far more diffuse than ever before and in which everyone feels empowered.
And organizing coalitions has become a primary form of power. Real solutions require,
creating a much broader coalition that includes the private sector, nongovernmental groups, cities and localities, and the media. In a globalized, democratized, and decentralized world, we need to get individuals to alter their behavior.
Now here is where health care begins to enter into the “Post-American” picture.
While Zakaria complains that health care costs “have risen to point that there is a significant competitive disadvantage to hiring American workers,” — and will not be an easy fix — he strongly believes that “America will remain a vital, vibrant economy, at the forefront of the next revolution in science, technology and industry — as long as it can embrace and adjust to the challenges confronting it.” The United States “has been and can be the world’s most important continuing source of new ideas, big and small, technical and creative, economic and political.”
In fact two of the industries he cites as examples are nanotechnology and biotechnology.
So where does Zakaria’s analysis leave those of us in health care. Here are a few thoughts.
Health care reform in the US is not just a domestic priority but an international one as well. It is both part of the problem and part of the solution to America’s future position in international affairs.
As I have argued a number of times before( here, here, and here ) American health care can become a stronger component of our international ’soft power’ because it is a valuable and desired center around which international coalitions can be formed.
The world (and the US) has yet to full advantage of the emergence and development of Health 2.0. What an opportunity for a technology which emphasizes social networks to bring the world a bit closer together around a major concern of all countries– health care.
The time to bring America’s involvement in world health care to the next level is now.
Health care can help to renew America’s legitimacy to act, in Zakaria’s words as an “honest broker’ in world affairs. It is time for US health activists to think global and take leadership in this important challenge.
We keep adding to the 101 uses of mobile phones in health care I alerted readers to recently. An article in the recent edition of The Economist alerts us to the use of mobile phones as microscopes. From a research team led by Dan Fletcher, a professor of bioengineering at the University of California, Berkeley, comes
a cheap attachment to turn the digital camera on many of today’s mobile phones into a microscope. Called a CellScope, it can show individual white and red blood cells, which means that with the correct stain it can be used to identify the parasite that causes malaria. Moreover, by transmitting an image directly over the mobile network, the CellScope could greatly help with the remote diagnosis and monitoring of many illnesses.
In addition, some reader comments on other possible uses:
Great list from Wireless Healthcare, but I do not see baby monitoring working? Maybe from a video phone to a monitor? If you are interested in learning more about SMS, email and voice messaging for healthcare, please visit my company’s website, http://www.intelecare.com.
Intelecare is a healthcare technology company focused on enhancing medication adherence. We have developed a proprietary messaging platform that sends user created reminders for daily medications, prescription refills, doctor’s appointments and vitals monitoring - all delivered how and when the user wants them.
Our service is free on our website, and we license our technology to industry as a hosted or enterprise solution. If you would like to learn more or sign up for your free medical reminders, please visit http://www.Intelecare.com.
With 3G networks launching in the USA soon you could also add a couple more including:
“Remote Video Consultation” and “Creation, Management and Sharing of your important health infomation”. For more information on these please visit http://www.3gdoctor.com
John Brohan Says: I think this list of 101 things is very interesting. I am willing to modify it to allow the “things” to link to the various websites where the application is available. Mine is wound healing for example http://www.woundfollowup.com.
This is the question that Wireless Healthcare, a Cambridge UK firm addressed in a recent report ($$) it issued. (Thanks to NWMD for the heads-up). The key point here, as NWMD observes is this: “The report notes that the barriers to entry are lower for vendors targeting the remote care market whereas there is often strong resistance to change within hospitals.” Put in a broader context, will hospitals and other health care institutions, due to their slowness and inability to adapt, be stripped of those functions than can be done better, more simply and at less cost than is currently the case? Will technology, and the accompanying social change that it drives, put hospitals, as we now know them, out of business? The notion of ‘patient monitoring centers‘, for example, is intriguing to say the least.
It would be easy to argue that the transformative energy to change the hospital will not come from within the institution itself. But that does not mean such fearsome change will not happen. Just like the phenomenon of Wikipedia did not come from the university (as Charles Nessonrecently noted), the new models of health care may not come from the hospital.
This list, with many kudos to Wireless Healthcare, shows the kinds of health care options that can come with the creative use of cell phones.
1 Appointment Reminders (SMS)
2 Patient Support (SMS)
3 Medication Reminders (SMS)
4 Appointment Booking
5 Medical Data On SIM Card
6 Patient Information For Relatives
7 Peer Support For Patients
8 Post Cardiac Surgery Support
9 Accessing Patient Records
10 Access To Dietary Information
11 ePrescribing
12 Patient Paging In Outpatient Clinics
13 Support For Alzheimer Patients
14 Support For Diabetes Sufferers
15 Clinical Trials
16 Support For Dementia Sufferers
17 Support During Rehabilitation
18 Support For The Deaf
19 Support For The Chronically Ill
20 Support For Addicts
21 Support For STD Sufferers
22 Baby Monitoring
23 Suicide Watch
24 Support For Children
25 Food Product Dietary Information
26 Allergy Alert Services For Asthmatics
27 Doctor At Home
28 Self Diagnosis
29 Patient Data For Overseas Travelers
30 Data Capture From Medical Instrumentation
31 Smart Card Applications
32 Monitoring For Asthma Sufferers
33 Blood Glucose Monitoring
34 Temperature Measurement
35 Weight Measurement
36 Medication Compliance Monitoring
37 Voice Pattern Analysis
38 Analysis Of Breath
39 Heart Rate Monitoring
40 Smart Homes For The Elderly
41 Patient Diaries For Clinical Trials
42 Collecting Data From Pacemakers
43 Fitness Monitoring
44 Real Time Patient Assessment
45 Sleep Monitoring
46 Collection of Data From Wearable Sensors
47 Collection of Data From Implanted Devices
48 Diabetes Monitoring In Chiropody
49 Detection Of Septic Episodes
50 Remote Antenatal Care
51 Telehealth Gateways
52 Patient Location
53 Pulse Oximetry
54 Personalized Diagnosis
55 Early Detection Of Cardiological Syndromes
56 Appointment Scheduling
57 Access to Patient Data For Domiciliary Workers
58 Diagnosis Support For Domiciliary Workers
59 Personal Attack Alarm Services
60 Clinician Identification
61 Asset Tracking (RFID)
62 Stock Control (RFID)
63 Patient Identification (RFID)
66 Dispensing Support
65 Locating Staff
66 Conferencing During Emergencies
67 Accessing Training Material
68 Accessing Laboratory Results
69 Blood Bank Support Services
70 Locating Blood Donors
71 Locating Organ Donors
72 Support For A&E (accident and emergency services)
73 Tracking Surgical Instruments
74 Controlling Insulin Patches
75 Billing
76 Patient Consent
77 Drug Authenticity Verification (RFID)
78 Patient Entertainment And Communication
79 Patient Notes Dictation Systems
80 Administration At The Point Of Care
81 Linking Emergency Services To A&E
82 Access To X-ray Images
83 Skin Cancer Monitoring
84 Remote Consultation (Telemedicine)
85 Data Collection From Capsule Endoscopes
86 Conventional Endoscopes (Picture Phones)
87 Nutrition Coaching
88 Monitoring Wound Healing
89 Support For Neurosurgeons
90 Breast Cancer Screening
91 Context Sensitive Medicine
92 Disease Monitoring
93 Food Contamination Alerts
94 Environmental Contamination Alerts
95 MRSA Detector
96 Telecare In Rural Areas
97 Telecare In Developing Countries
98 A&E Field Support
99 Wireless Stethoscope
100 Support For AIDS Sufferers
101 Call Center Supported Health Services
Lawrence Lessig wrote in Free Culture, that “privacy was assured because of the inefficient architecture for gathering data and hence a market constraint (cost) on anyone who wanted that data.” Privacy was guaranteed to us by a kind of economic “friction” and system inertia. Today that friction has all but disappeared and the privacy protection it once offered along with it.
Given that health care is a late bloomer to new media and the Web 2.0, some of the friction Lessig talks about may still be helping to secure private health information. Since this confidential information predominately resides today in slow moving, conservative institutions that dominate health care delivery, there is still time to consider the threats to privacy that Jonathan Zittrain outlines in his new book, The Future of the Internet (and how to stop it). He writes:
Cheap sensors generatively wired to cheap networks with cheap processors are transforming the nature of privacy. . .
The heart of the next-generation privacy problem arises from the similar but uncoordinated actions of individuals that can be combined in new ways thanks to the generative Net. Indeed, the Net enables individuals to compromise privacy more thoroughly than the government and commercial institutions traditionally targeted for scrutiny and regulation. . .
The essence of Privacy 2.0 is that government or corporations or other intermediaries need not be the source of the surveillance. Peer-to-peer technologies can eliminate points of control and gatekeeping from the transfer of personal data and information just as they can for movies and music. . .
Peer-leveraging technologies are overstepping the boundaries that laws and norms have defined as public and private, even as they are also facilitating beneficial innovation. . .
The slippery slope that privacy now sits upon is coming to health care.
Most of the privacy debate we see now in health care is focused on what Zittrain would call Privacy 1.0: how to impose rules and sanctions regarding things like disclosure, notice, encryption etc. upon recognized institutions, professional groups and medical workers. And while we hear calls for a new national privacy framework that will apply to the information technology industry (Google, Microsoft) it centers on the protection and control of electronic or personal health records. Again the emphasis is on formal records and institutions.
Privacy 1.0 is still a necessary front to secure if we are to modernize the health care system. But it does not get at the threats to privacy that Zittrain contemplates.The recently touted Congressional bill S 1693, the “Wired for Quality Health Care Act’ may, if passed, provide various forums for discussion of Privacy 2.0, but the bill itself seems oblivious to the implications of these kinds of issues.
So how do we manage ‘consent’ when it comes to private health information in this social media environment? This is one hell of a key question that needs to be addressed, and one that many are afraid to ask less it result in some draconian measures applied to all social media.
Do we have to accept a diminished private space to gain the benefits of social media? Will confidential health information become the entertainment for the ‘monitorial citizen’, part of the banal collective din of spectators who are fast becoming the new surveillance force in contemporary society? The values that are “animating our concern for privacy” are changing according to Zittrain, noting the age gap between those who use social media and those who shun it.
Zittrain does pose some ideas at least on how to signal the ‘intent’ of patients when it comes to their health information through tags, and embedded codes. But they pale in comparison to the zero-tolerance controls now demanded by US laws and regulations.
Nicholas Carr argues in The Big Switch, that contrary to popular sentiment, the technologies that make up the Internet are not those of emancipation, but are at core “technologies of control.” As social media begins to invade health care we will be able to test the capability and nature of that control. So hang on.
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. . . Conversions will occur a few at a time until, after the last hold-outs have died, the whole profession will again be practicing under a single, but now different, paradigm.
Paradigm shifts, in other words, whether it be scientific, or by extension technological, don’t really gain a hold on a society until the old geezers meet their maker. I was reminded of this by-now fairly common, if not depressing insight, in coming upon the very last paragraph of Nicholas Carr’s new book, The Big Switch: Rewiring the World, from Edison to Google where he seems to be channeling Kuhn but with an interesting twist. Carr writes:
All technological change is generational change. The full power and consequences of a new technology are unleashed only when those who have grown up with it become adults and begin to push their outdated parents to the margins. As the older generations die, they take with them their knowledge of what was lost when the new technology arrived, and only the sense of what was gained remains. It’s in this way that progress covers its tracks, perpetually refreshing the illusion that where we are now is where we were meant to be.
As one of those being slowly dragged by the pace of technological change to the intellectual iceberg , I’ve yet to give up the good fight. But Carr in his own way has issued yet another implied challenge to the boomer generation in addition to just ‘keeping up’, namely, what can we learn from what is being lost in this maelstrom of shifting mentalities?
We see this paradigmatic tug-of-war going full tilt in health care. Whether it be the ‘demographic’ battle over Health 2.0, or what it means to live in the postgenomic material world, health care is becoming the poster child for these generational mashups. And maybe that’s just the term for what we are seeing and what we should see more of in the future: inter-generational cultural explorations, something essential to realizing the best in technological change.
Technology critics, such as Cass Sunstein, often point to the polarizing and narrowing effects of the internet world and its possible impact on democracy. Maybe those raised in pre-internet times, having read pre-citizen journalist newspapers, and having lived in a pre-web world have something to offer after all. By helping to capture what is being lost, maybe in time it will re-covered, re-thought and re-spected for the human value it re-presents.
From the China Digital Times on the arrest of Wu Xin and others concerning a public protest of a petrochemical project in the city of Chengdu:
The police seriously urge people to be aware of national laws and regulations and to observe them, not to create or disseminate rumors through the Internet or through cell phone text messages, otherwise the police will carry out strict monitoring and control mechanisms. We will carry out punishment according to law for each case we discover; absolutely no soft treatment will be granted.
The police severely warn those who intend to disturb social stability by instigating unrest and organizing illegal assemblies to stop their criminal activities.
For the past decade, China’s “soft power” has helped fuel Beijing’s rise by attempting to assuage fears of an expansionist China. Whether it be the establishment overseas of hundreds of language-teaching Confucian Institutes (there are more than a dozen in the US), the pay-out of millions of dollars to favored academics, preferential trade deals, or smart financial and foreign policy, China’s “soft power” has been a key cog in the wheels of Chinese diplomacy. . .
But given recent events over the past year, Pomfret declares we are witnessing the end of the era of China’s soft power. Well, given the reputation of the US in the international community today, this may be one unfortunate trend that we share with the Chinese.
