Tuesday, January 29, 2008



Apologies for the very long URL but it's a good one from today's New York Times. The article is concerned with the the ups and downs of working at home. This is a topic I can speak with authority on since I've spent over a year now firmly planted in my home office in the back yard. My office, or the 'Little House', sits all by itself about 10 steps from the 'Big House' as me and my dog have come to call the place where we all live. I spend most of my working days in there and have heating, cooling, technology and scented candles. With windows all around, I feel like I am actually in the garden.

So what does this have to do with future health trends? Well, according the NYT article, there are more and more people working from home and a good portion of these folks feel at increased risk of social isolation (obvious) and depression (less obvious). Personally, I have experienced neither in my year at home but then I've always liked being by myself. I do the odd lunch to keep in touch with friends and ex-colleagues, and I network on line like a mad woman. I miss certain old friends of course, but not enough to consider going back to the office environment.

A second issue for homies, is that they have trouble organizing their day without the enforced rules of the corporate office. Now this I identify with. There are some days when I cannot seem to get anything done and others where I work like there is no tomorrow (sometimes, there isn't....deadlines being what they are). However, I do find this work easier than any I have ever had to face in the past. Probably because it is my choice to do it for the most part, and also because I actually enjoy it. The hours in meetings at my previous work places, while neat and well-scheduled, were often tedious and non-productive in a real-world sense. Now, I do feel guilty when I am not working sometimes, perhaps because somebody else did not sanction it. It can be hard to justify a day off, or even an hour off, when there is work to do and no boss to say--go ahead, relax, you deserve it. Such is our conditioning that we feel we must work an 8-hour day no matter what (see 'The 4-hour workweek' by Timothy Ferris-an excellent read on this topic).

The home-office worker has to be disciplined but the self-employed have to play many roles themselves. Deciding how to structure the day is a challenge I did not see coming when I left the corporate office. I actually missed the structure at first. I think I grieved for it a bit. It was like an old friend providing security and easy gratification. If all else failed, I knew I had to be there at x o'clock, ready for the next strategy meeting/performance review/IT meeting/etc/etc. Just being there on time and prepared garnered a sense of achievement that I didn't recognize as such at the time. Now I have to be the meeting organizer, the confidante (no, I'm not schizophrenic and I don't have multiple personalities (although some might beg to differ on the latter), but I do have to talk to myself, if only to get to the truth of what I am feeling), the sanctioner of 'off-time', the patter of the back when things go well, as well as the actual decision maker on what to do. It's a lot to fit into a day.

So back to the future of health. There are some downsides to working at home and the article referenced above articulates them well. I've thought of a couple of others too. What happens if you have a heart attack in your home office and there is no-one to revive you? Worse still, if you live alone, it may be days, nay, weeks, before you are missed! Add that to the depression that can go with isolation, and the stress of having to make your own plans every day-and stick to them- then working at home does come with potential health issues. As more of us do it, will we get better at dealing with them? Support groups for the lonely home worker anyone? Government subsidized work conclaves so people can cheaply rent communal office space to get their social fix a couple of times a week without losing work time? Or maybe the three day weekend (that should surely be just around the corner for an advanced civilization such as ours) will take care of it when it gets here.

In the meantime, I will continue my occasional morning coffee/lunch with friends, and make sure if I'm having any chest pain, that I leave the office and hang out in the front garden until it goes away. Just in case...

Monday, January 21, 2008

Family doctors, or cyber health?

Several friends of mine have, or have had, cancer.  Some of them are freshly diagnosed while others are old hands.  One recently died.  All these friends have something in common, besides their cancer.  They struggle for answers.  What does my diagnosis mean? What should I do about it? Should I take the surgery right away? I feel like I've been hit with a sledgehammer-do I have time to step back and think?  Who is the best doctor for what I've got.  What have I got anyway?

Some of my friends come to me with these questions.  They know I am a net maven, and they know I'm something to do with the medical field, if not an MD.  Many folks can find information, but they have a hard time sifting through it to find what's relevant.  The stories I hear are amazing.  One doctor says one thing, another says something else, and the web tells a whole different story.  With a little context I can often offer some clarity, but it's also a matter of what people are ready to hear.  They know it's not a good situation when they hear the C word, and sometimes they like to take things a step at a time.  Is there room then, in the future, for a better way to help patients make sense of health information, whether it is preventative care, tending to a kid's bruised up knees, or the decisions that need to be made after the big C diagnosis.  Can our questions be shaped in such a way that the answers are more immediately relevant?  Can our data retrieval systems be such that the solutions coming back actually make sense without having to find a friend who is the the trade, so to speak, to help us understand what the doctor and the internet could not? Can we get better answers by just pushing the right buttons?
The answer, I think, is no.  The singularity is near, Ray Kurzweil tells us in a recent book of his. The time when machines become smart enough to replicate themselves in smarter versions that humans themselves.  If that were true then, for these entities, the interpretation of such complex factors as a medical diagnosis in the setting of our own unique contexts would be child's play.  It would be just a matter of engaging the right algorithms and acting on what comes out the other end.  I think Ray is off the mark though.  Machines can only deal will attributes and relationships that we put into them.  They are no good at predicting the future of an action any more than they are any good at feeling an emotion.  It is only through predicting the future that we can act in circumstances that have never been encountered before.  We can't search our memories for this exact moment because it hasn't happened yet.  However, we can search for similar moments and approximate our response based on that.  This requires a prediction of what might happen if we do 'x' so that we can engage the appropriate action for the situation.  This is one of the research topics at the Redwood Institute in California and suggests that artificial intelligence is not so intelligent after all.  At least, not yet.

So, the future of medicine, probably does not include replacing doctors with artificial diagnostic intelligence, and bedside robots at least for the moment.  My cardiologist and I discussed recently the phenomenon of a doctor's intuition.  We agreed it is hard to explain and even harder to teach.  This is an element of medical practice that all those cancer patients I talked about could really use; an empathic doctor who will use his intuition to engage with the patient and work through the data with them to find the truths they seek.  Often, there are gaps. Always, there are uncertainties.  But what patients need most of all at times like these, is a trusted individual to tell them what they need to know.   Someone to validate their fears, and guide them through the options for treatment and beyond.  In other words, an old fashioned family doctor.  
Perhaps the future will see a return to the past with the family doc acting not just as the first person to go to with symptoms, but as a sympathetic infomediary that interprets and guides in the midst of all those specialists. An internet whiz who can seamlessly bob and weave through the paper and the ether to give us the confidence that while we may not know how it's all going to end up, we can make the best of what we've got given what's known.

Wednesday, January 16, 2008

Mac Magicians

Not exactly the future of health, but it could be.  Who knows when the fingerprint pulse-ox widget will become available and allow us to check our oxygen saturation on our iphone?

They have done it again. The Mac Air was unveiled yesterday and I want one. It is geared for light, wireless working anywhere and everywhere. While not exactly sorcery, it may as well be to me. I don't know what goes on under the keyboard and contrary to my husband who builds his own computers and scoffs at Macs, I don't care. All I know is, I want a light, portable, durable, connected machine and the Air looks like it is it. At almost 2K I'll have to wait though. As if revealing the Air was not enough, I also discovered the latest iphone update today. It lets me customize my home screen among other things, as well as pin my home address to my maps for ready directions anywhere I want to go. The iphone is remarkable. I don't know how anyone will catch up. Then there is the iTunes latest that allows movie rentals for 30 days after which they miraculously disappear to free up hard drive space and make way for the next batch. I love it all. To me it's sorcery and science in perfect synergy

Sunday, January 13, 2008

Dem old bones

Shortness is related to arthritis, the latest news tells us. Too tall, or too short, it seems we are at risk of osteoarthritis if we are anything other than average when it comes to height. The reasons are not clear but this news is quite exciting to researchers as there are so few genes for osteoarthritis, whereas there are a great many for height. Careful digging into the genetic and environmental causes of both may shed light on the increased risk. If short people get arthritis, what does this mean from an evolutionary perspective? Often, a genetic disadvantage in this day and age, may have been a significant advantage in years gone by.
I'm short, so I should perhaps be concerned. Or maybe not. I could have a gene test; a gene for Growth Differentiation Factor 5, or GDF5, has been associated with the development of cartilage, and also with arthritis susceptibility in Europeans and Asians. If I have the risk variant, what would I do about it? Nothing, because there is really nothing that can be done. I have no family history, although my son does appear to have somewhat mobile joints. Perhaps I passed a dicky gene on? To understand my genetic risk is becoming easier for bones and lots of other pending problems. Gene testing is relatively cheap and beginning to offer significant information, albeit un-validated for the most part. The HapMap, a complete map of human genetic variation, is about to be released in the journal Nature Genetics (online, Jan 13th 08). For sure, as these types of sweeping tests become more popular, doctors, diagnostics companies and drug companies will have to start coming up with ethical responses to the questions that will arise when folks begin to see they have genes rendering them susceptible to dementia, cancer and the like. How will we deal with the knowledge of the risk, with no preventatives to soothe us while we wait for the inevitable? Dangerous and heady times are ahead. But what an amazing time to be alive, and what a great opportunity for those of a business mind-set.

Saturday, January 12, 2008

Welcome to the Future Health Trends Blog

Our health environment is changing as information becomes more available about diseases, treatments and the effects of our own body's characteristics on the effects of both.  There is so much information out there, in fact, that we can get bogged down answering even the simplest of questions when we turn to the internet, the TV or media.  The problem with the ubiquity of information is that not all information is relevant to each one of us, and the trick is to understand what is meaningful in our own context, and what is not.
Science and technology has been quite reductionist for a while. For several centuries in fact.  Now, however, we are recognizing that the power of science and technology can only be increased by integrating with the arts and the humanities. It is at the intersections of art and science that true discoveries are often made. This blog is intended to explore the future of health and medicine from the perspective that integrative approaches to health and wellness are better than linear, discipline based approaches.  We will also report on key developments that stand to improve access and effectiveness of diagnostics and treatments based on the understanding of individual physiological, psychological and socioeconomic characteristics.