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The Extinction of the Health Care Industry
Alex Steffen, 5 May 05

Bruce Sterling, WorldChanging ally #1, takes a look at the future of medicine, with four scenarios for how the sclerotic health care industry might be overturned:

Medical tourism takes off. US patients travel out of the country for everything short of visits to the emergency room. Offshore docs offer medical services that are faster, cheaper, and safer than anything available at home, obviating US doctors, clinics, pharmacies, insurers, and the federal government - just about everyone. ...

Alternative medicine gets serious. Health food stores move out of the feel-good biz and focus on efficacy and marketing. Vitamin shops partner with massage therapists, acupuncturists, herbalists, dieticians, and physical trainers. Upscale operations collaborate with paramedics, nurse practitioners, and midwives. Together, they pluck the low-hanging fruit - casual doctor visits and innocuous prescription medicines. ...

Diagnostix "R" Us. Newfangled clinics offer a galaxy of cheap, simple diagnostic tests that show people what's going on in their own bodies. Counselors dispense information, support, interpretation, and follow-up advice. Under attack from an effective populist alternative, the absurdly expensive, often unnecessary lab-test machine withers. ...

Oldsters join the extropians. Aging boomers flock to longevity spas, which dispense radical rejuvenation procedures in the guise of elder care. The neglected elderly embrace biotech research considered outré by mainstream medicine: gene therapy, stem cell-driven organ regeneration, designer drugs that restrict caloric intake. Abandoned by their best customers, GPs and gerontologists close the blinds and go home.

We're looked before at some of the implications of the last scenario: most recently in Jamais' essay a shortage of death. How long we all live, and under what conditions -- those are some of the biggest worldchanging wild card questions there are.

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Some interesting examples of this in practice already:

DNA Direct

Web MD


I fully expect to see the health care industry change radically over the next 20 years. The recent rapid increases in the cost of insurance while the quality of that insurance goes down are just the first signs of a system in deep trouble. The plight of Doctors is another - massive student debts, huge malpractice insurance and many lawsuits, and a crappy work environment all combine to make it a hard career choice to follow. Nurses have a similar problem - brutal 12 hour shifts, cronic shortage of new nurses, ever increasing expectations and duties.

The final nail in the coffin is the Baby Boomers - set to become old!

Given Clinton's failure to get a single-payer system off the ground here in the U.S., I cannot see that being the solution. Which means that private industry and innovation are going to have to step up to the plate.

How can the system be transformed from within to become the medical system we all want and need?

The answer is worth Trillions of Dollars :-)


Posted by: Eric Boyd on 5 May 05

Interesting New Scientist link today on GM mice that have had a longevity boost...

Posted by: hans samuelson on 6 May 05

I admire Bruce, but not this article. It focuses on high-tech gadgetry and systems that may, in the indefinite future, become available to perhaps 2% of the world's richest and most educated people. This is supposed to be world-changing?

Meanwhile, the not sexy, not cool, not "Viridian" work of clean drinking water, adequate nutrition, family planning and prenatal care, basic vaccinations, sewerage systems, "barefoot" doctors, etc., etc., is what will revolutionize health care for the vast majority.

That includes you and me. We are rapidly developing into a world in which none of us can be healthy unless all of us are healthy. AIDS originated because we pushed into the African interior and started eating bush meat. International trade and travel means that human-communicable Avian Flu, when it develops in Asia, will be a global pandemic. There can be no health care apartheid, and all the gene-splicing, jet flights to Ecuador, and ginseng extract in the world will not change that.

The answers we need ARE worth trillions of dollars - but not to some new techno-entrepreneurs. Those dollars will be diverted from our current medical juggernaut to more meaningful endeavors. Good health systems will be much cheaper than our current ones, not just a shift of money from one form to another. The most effective health measures are among the least expensive and least glamorous. Condoms and proper pit latrines do far more for us than MRI machines and laser surgery.

The medical scenario I would like to have seen Bruce explore is, "Cuba Without the Embargo."

Posted by: David Foley on 6 May 05

Last March (2004) in Ottawa I participated in a 3-day symposium on the future of the Canadian health care system. The symposium was hosted by the far-sighted folks at the Science and Technology Foresight Studies group at the National Research Council, headed by Jack Smith. The recommendations from the workshop went straight to Cabinet. I mention this because the symposium explored a number of scenarios for the future of health-care, some very similar to the ones Bruce proposes in his piece. I was also contracted separately in my capacity as a science fiction writer to author a "wild-card" scenario that would be based on disruptive technology or extreme lateral thinking.

The scenarios covered high-tech as well as low-tech solutions, and hybrids. My own contribution was to propose the elimination of all bureaucratic elements of the health care system, replacing them with semi-autonomous "smart" records that didn't just contain a patient's health care information but were processes that were constantly "awake" and mobile, acting as advocates and facilitators of the patient's health. Combine these with smart clothing and fridges etc. and a growing ethos of personal responsibility for one's own health, and you get a radically different vision of future medicine.

I'd encourage worldchangers everywhere to look into Canada's Foresight project. It gives reason for optimism.

Posted by: Karl Schroeder on 6 May 05

I'm with David.

Health care to include: joyous working environments, time for walks, learning qi gong and yoga.

All this will lead to better health than much high tech gadgetry.

Also, low tech (herbs, acupuncture, massage) is cheap and the health funding crisis is due to the cost of technology (machines and pills).


Posted by: Evan Hadkins on 15 May 05



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