"Burn the ships; dive in" - A Three Part Series: Part 3
PublishedNovember 7, 2021
Andrew Le, MD: You mentioned healthcare, David, and obviously technology is creeping its way into healthcare. It started a bit with electronic medical record and emails, and I think it's been fast tracked during COVID. I love how you've been enabled to say, look at climate change and look at these really exciting areas of innovation, but also recognize the peripheral damage, to use your words, that we may have not come across.
To your point, there are 3.5 billion people still not on the internet. So many chapters are still to be written. Focusing a bit more on healthcare—where do you see the biggest areas of opportunity? And then if you could look into the crystal ball, what would you say are some areas for potential peripheral damage?
At Davos in 2020, Techonomy hosted a panel that I moderated on this topic of technology and healthcare and internet and healthcare. We had people from Microsoft, Phillips, Wipro and the OECD. The main theme of that discussion was that it's a crime that health systems all over the world are not taking advantage of all that technology is capable of. We've known what technology can help us do in healthcare for almost decades now, whether that’s maintaining records that are more effectively interchangeable or doing remote diagnostics—but this isn't necessarily a technological failure.
David Kirkpatrick talks with MIT scientist Andrew McAfee at Davos 2020. Image courtesy of Techonomy.
It's a systemic disinterest that had led to a lot of the problem that governments and healthcare systems—particularly in the wealthier parts of the world—which connect to their existing economic models, taking advantage of a lot of the opportunity that was quite obviously dangling right in front of them.
Like the guy from Phillips said, they just built a $2 billion hospital in some big city in the Netherlands. That money would be so much better spent for a national digital health care system that he had some design ideas for. But people still want bricks and mortar, right? That was his point. You're right; this has changed, but the pandemic has been a global tragedy and crisis. I don't think anybody any longer has any doubts that we have to go to a more digitized healthcare system.
I'm sure that many healthcare institutions in the United States are still desperately hoping to hold onto their economic structures. For example, the more digitized you get, the more it becomes self-evident that you need systems in which the insurance and the provision of care is managed by the same organization. Medicare is an example in the right direction, but it's really more like Kaiser Permanente or the British National Health Service, et cetera.
We're not really moving in that direction fast enough, but nobody denies that if we didn't have digital healthcare, we would have been totally screwed in the pandemic. The interesting thing is all these systems were more or less in place, and while they weren’t being used very much, they still were in place and were able to ramp up very rapidly during the pandemic. Almost everybody took advantage of these systems to some degree if they utilized healthcare during the pandemic—probably in any part of the developed world.
Meanwhile, I think in the developing world because the economies of scale are so obvious with digitized healthcare, that governments have seen no choice but to try to use digital tools and more scalable systems. There simply aren't enough doctors; there aren't enough hospitals; there aren't enough beds. But, they're far more likely to make progress if they do it with modern technology than to try to replicate these old physical brick and mortar systemic approaches. COVID, in this sense, has helped us leapfrog. Healthcare has made a huge, huge, positive difference in forcing us to go forward in a way we needed to be forced to go in. Do you agree with that?
"They're far more likely to make progress if they do it with modern technology than to try to replicate these old physical brick and mortar systemic approaches."
Andrew: I totally agree that COVID has forced us to move in a direction that we needed to and that a lot of countries and especially in the developing world had to leapfrog and do that urgently during the pandemic, as well. Any peripheral damage, any disadvantages to technology in healthcare that you could foresee potentially?
David: The thing that's most often discussed is the privacy problem. If institutions have too much information about people's health, they will economize by essentially abandoning them. But the biggest challenge in a digitized healthcare environment is ensuring the patient is in control of their own data—that if somebody has access to their data and is using their data, it's with their consent. HIPAA has moved in that direction somewhat in the United States, but it's a very difficult juggling act.
If governments choose to prioritize population health over individual rights, you could see some very nasty scenarios even without evil intent. You get into the issue of denial of insurance to people because of pre-existing conditions that might not have been identified if they didn't have a digital record. And then governments need to have laws that ensure that peoples’ rights are protected as we go into a much more digitally recorded healthcare landscape. In that regard, government's probably a little closer to being up to speed than they are with regulating Facebook, Amazon, and Google. All three of those companies want to get into healthcare and are getting into it in one way or another. We have to be cautious about that too.
Andrew: Then to your point—what is the potential downside to healthcare becoming more and more digitized? Yes, it makes sense that the data is used for purposes that are all either overly malicious or actually impede upon the rights of an individual. That is a very natural and potentially negative downstream effect of a digitized system. As we look at the potential upsides and downsides of technology spent the theme of our entire conversation, David, and if you could leave us with some words of wisdom so we don't repeat our mistakes, what would you say?
David: Well, it is extremely perilous to allow yourself to be afraid of technology anymore. I still know way too many people—even in my own family—who shrink away from trying to figure out certain technological things because they think they just can't get it. That's at the personal behavior level, but the same point holds at the national and global levels. Governments have to become technologized; families have to become technologized; individuals have to become technologized.
But of course, it makes sense governments should be capable of acting at the same speed and in the same manner as the rest of the economy. At the moment, in the United States we don't even have digital services online in many cases in the way we need to. I would say we are past the point when anybody can hope for an untechnologized society. We have to simply embrace the reality of where we are and work with it.
I do believe that young people mostly implicitly understand that. As they begin to have more control in society, they'll probably do a lot of things that are helpful because of their intrinsic appreciation of the technology that surrounds them. It doesn't mean everybody needs to study programming, by the way; that is actually a red herring because programming increasingly is being automated in itself. We are in an automated, technologized, digitized, connected world. It may sound a little 1984, but we essentially have to welcome the reality of this technologized world and figure out how to work within it and with it.
"It is extremely perilous to allow yourself to be afraid of technology anymore."
Andrew: I couldn't agree more. I love that message, though—that there's no going back, burn the ships, dive in. A lot of the problems that we've created we’ll also solve with technology. I completely agree that it is the only path forward.
David: I'll just share one possible contradictory point, something that I unfortunately think about more than I probably should. It is electromagnetic pulse nuclear weapons, which do exist and are very much controlled by China and Russia and are designed to basically fry electronics. If China were to invade Taiwan, which unfortunately is a real, serious possibility, that's something they might deploy to gain a strategic advantage as they're about to invade.
So that doesn't mean we won't be living in a technologized society, but technology might not always work the way we want it to. That's all. It'll come back. That's a bit of a weird aside point, but I've been thinking about it, for some reason.
Andrew: Well, just to play that out a little bit, David, would it be that we create paper or physical systems as backups, or do we create the technology to prevent that?
David: I don't know. You can shield things with lead and that sort of thing. The U.S. military and government, I think, also have a lot of things that are buried in mountains as backup systems because of this real risk. I don't know how you fight that. You just have to hope that the world is peaceful enough that no one wants to use those weapons.
It's just like nuclear weapons. It is a nuclear weapon; it's just a different kind of nuclear weapon. If anybody really sets one off, I mean the world might survive, but it would be pretty awful during the recovery period. We try to figure out how to get along with our enemies. That's another obvious corollary.
Read more about the potential uncertainties facing the tech world at https://www.theverge.com/2020/3/3/21152774/big-tech-regulation-antitrust-ftc-facebook-google-amazon-apple-youtube. Image via The Verge.
Andrew: For sure. David, this has been I think the most far-ranging but fun conversation we've had on the blog. We really appreciate your time
David: Thanks for having me. This was fun.
About the participants:
David Kirkpatrick is the founder and editor-in-chief of Techonomy Media Inc., a tech-focused conference and media company.
Andrew Le, MD, is the CEO and cofounder of Buoy Health.