We Bet on Technology

We Bet On Technology

I am currently reading Steven Pinker’s book Enlightenment Now and he makes a good case for being optimistic about human progress. In an age when it is popular to write about human failures, whether it is wealthy but unhappy athletes wrecking their cars, the perilous state of democracy, or impending climate doom, the responsible message always see ms to be warning about how bad things are. But Pinker argues that things are not that bad and that they are getting better. Pinker’s writing directly contradicts some earlier reading that I have done, including the writing of Gerd Gigerenzer who argues that we unwisely bet on technology to save us when we should be focused on improving statistical thinking and living with risk rather than hoping for a savior technology.
In Risk Savvy, Gigerenzer writes about the importance of statistical thinking and how we need it in order to successfully navigate an increasingly complex world. He argues that betting on technology will in some ways be a waste of money, and while I think he is correct in many ways, I think that some parts of his message are wrong. He argues that instead of betting on technology, we need to develop improved statistical understandings of risk to help us better adapt to our world and make smarter decisions with how we use and prioritize resources and attention. He writes, “In the twenty-first century Western world, we can expect to live longer than ever, meaning that cancer will become more prevalent as well. We deal with cancer like we deal with other crises: We bet on technology. … As we have seen … early detection of cancer is also of very limited benefit: It saves none or few lives while harming many.”
Gigerenzer is correct to state that to this point broad cancer screening has been of questionable use. We identify a lot of cancers that people would likely live with and that are unlikely to cause serious metastatic or life threatening disease. Treating cancers that won’t become problematic during the natural course of an individual’s life causes a lot of pain and suffering for no discernable benefit, but does this mean we shouldn’t bet on technology? I would argue that it does not, and that we can see the current mistakes we make with cancer screening and early detection as lessons to help us get to a better technological cancer detection and treatment landscape. Much of our resources directed toward cancer may be misplaced right now, but wise people like Gigerenzer can help the technology be redirected to where it can be the most beneficial. We can learn from poor decisions around treatment and diagnosis, call out the actors who profit from misinformation, uncertainty, and fear, and build a new regime that harnesses technological progress in the most efficient and effective ways. As Pinker would argue, we bet on technology because it offers real promises of an improved world. It won’t be an immediate success, and it will have red herrings and loose ends, but incrementalism is a good way to move forward, even if it is slow and feels like it is inadequate to meet the challenges we really face.
Ultimately, we should bet on technology and pursue progress to eliminate more suffering, improve knowledge and understanding, and better diagnose, treat, and understand cancer. Arguing that we haven’t done a good job so far, and that current technology and uses of technology haven’t had the life saving impact we wish they had is not a reason to abandon the pursuit. Improving our statistical thinking is critical, but betting on technology and improving statistical thinking go hand in hand and need to be developed together without prioritizing one over the other.

Medical Progress

What does medical progress look like? To many, medical progress looks like new machines, artificial intelligence to read your medical reports and x-rays, or new pharmaceutical medications to solve all your ailments with a simple pill. However, much of medical progress might be improved communication, better management and operating procedures, and better understandings of statistics and risk. In the book Risk Savvy, Gerd Gigerenzer suggests that there is a huge opportunity for improving physician understanding of risk, improved communication around statistics, and better processes related to risk that would help spur real medical progress.

 

He writes, “Medical progress has become associated with better technologies, not with better doctors who understand these technologies.” Gigerenzer argues that there is currently an “unbelievable failure of medical schools to provide efficient training in risk literacy.” Much of the focus of medical schools and physician education is on memorizing facts about specific disease states, treatments, and how a healthy body should look. What is not focused on, in Gigerenzer’s 2014 argument, is how physicians understand the statistical results from empirical studies, how physicians interpret risk given a specific biological marker, and how physicians can communicate risk to patients in a way that adequately inform their healthcare decisions.

 

Our health is complex. We all have different genes, different family histories, different exposures to environmental hazards, and different lifestyles. These factors interact in many complex ways, and our health is often a downstream consequence of many fixed factors (like genetics) and many social determinants of health (like whether we have a safe park that we can walk, or whether we grew up in a house infested with mold). Understanding how all these factors interact and shape our current health is not easy.

 

Adding new technology to the mix can help us improve our treatments, our diagnoses, and our lifestyle or environment. However, simply layering new technology onto existing complexity is not enough to really improve our health. Medical progress requires better ways to use and understand the technology that we introduce, otherwise we are adding layers to the existing complexity. If physicians cannot understand, cannot communicate, and cannot help people make reasonable decisions based on technology and the data that feeds into it, then we won’t see the medical progress we all hope for. It is important that physicians be able to understand the complexity, the risk, and the statistics involved so that patients can learn how to actually improve their behaviors and lifestyles and so that societies can address social determinants of health to better everyone’s lives.
Healthcare Stagnation

Healthcare Stagnation

We are facing a disastrous healthcare stagnation in the United States. Our hospitals are getting older, Medical providers are aging with too few young providers to replace them, and the quality of care that many of us experience is not getting much better. Despite this, the cost of healthcare has been soaring. Healthcare expenditures, including the costs of our deductibles, co-pays, and what our insurance pays out, has been going up at a rate reliably above inflation.

 

In The Opioid Crisis Wake-Up Call, Dave Chase writes the following about our healthcare stagnation, “Unlike virtually every other item in our economy, where the value proposition improves every year, the norm in health care for decades has been to pay more and get less. Also, unlike nearly every other industry, healthcare hasn’t had a productivity gain in 20 years.”

 

Productivity is how much we produce per unit of time spent on production. A factory that makes 5,000 widgets per hour is more productive than a factory that makes 1,000 widgets per hour. Automation and new technologies have helped factories and offices become more productive, but our healthcare stagnation is evidence that we are not seeing the same gains in healthcare. Technology has improved, but not in areas that seem to produce more healthy patients given the same amount of time and effort from our medical providers. We have some new technologies, but somehow those technologies have not translated into a healthcare system that supports the same number of people with fewer resources.

 

Chase continues, “In other words, for the last two decades, there has been a redistribution tax from the working and middle class and highly efficient industries to the least productive industry in America.” 

 

As your job has become more efficient and more productive, your healthcare costs have risen. Chase equates this healthcare stagnation price increase to a tax. Factories that can work with fewer employees, software engineers, and other employees form highly productive sectors are paying more in healthcare for services that haven’t kept the same pace as the industries of the patients they treat. This is the cost of healthcare stagnation that chase wants to push back against by demanding better systems and structures from healthcare providers, insurance companies, and benefits brokers. Chase believes we can find a way to improve our healthcare system and help people live healthier lives for less cost, if employers are willing to make real investments in their employees healthcare, and are willing to hold their brokers and insurance providers accountable for the value their products provide.
Medical Technologies

The Problem with Healthcare Technology

In my last post I wrote about hidden costs of the healthcare system in America. I wrote about tax breaks for employers who offer health benefits, and I wrote about third party insurance preventing the healthcare system from working like a pure market. This post introduces one consequence of the hidden costs of our system and the ways in which our system fails to act like a market: the high cost of medical technologies.

 

In The Opioid Crisis Wake-Up Call, Dave Chase writes, “We ended up focusing on a certain type of high-technology, acute medical care – which we financially reward far more than lower-level preventive and chronic care – without regard for the quality of the outcomes or value of the care.”

 

When I took a healthcare policy and administration class along with a healthcare economics class for my graduate studies, I was surprised to see a critique of advancing medical technologies as part of the problem of American healthcare costs. I live in Reno, under the sphere of influence of the Bay Area, where technological solutions to global problems are hailed as the cure-all, deus ex machina that we need for a peaceful and prosperous world. I always thought that better medical technology saved lives, made us healthier, and ultimately reduced cost by being more efficient and precise than older technologies.

 

As it turns out, new medical technologies are incredibly expensive, and often times the benefits that patients receive are only marginally better than what existing technology offers. In some instances those marginal improvements make the difference between life and death, but in many instances, the new technologies might only add a few months of life to a terminal diagnosis, a few additional months lived in pain and fear. In other instances, the new technologies might add a little more comfort or certainty in a patient’s procedure or diagnosis, but it is fair to question whether its really necessary and worth the additional cost.

 

The quote from Chase reveals that when we are shielded from the costs of care, and when we remove market aspects from the healthcare system, we adopte a mindset that healthcare equals expensive interventions with high cost technology. I had clearly bought into this narrative prior to my graduate studies. The alternative that Chase highlights in his book, which we have underdeveloped in the United States, is to move upstream, and take care of people at a preventative level before they are sick and before they need expensive technological interventions. Developing systems, structures, and norms for healthy lifestyles will do more to reduce costs than the development of new magical cures and technological fixes. Our priorities and the focus of our system is flawed, and a as a result we focus on high cost interventions within a system no one is happy with. Rather than develop a system that actually supports healthy living, we have fished around for quick, high-cost technological solutions to our health woes.
Technology & Pain

Questioning Our Confidence in Technological Solutions

Sam Quinones interviewed Alex Cahan, a pain medicine specialist in New York, for his book Dreamland. He is quoted in the book talking about the approach that most people have toward pain and alleviating their pain. Many people want an immediate solution that comes from technology and allows them to continue living their life as they always have.

 

Quinones writes, “Cahana saw stuff [Author Note: unproven medical treatments, more surgeries, more pills, etc…] as the problem. Our reverence for technology blinded us to more holistic solutions.” The holistic approach is not one of mystic arts or managing ones energy, but is an approach focused on how we live and what health habits we have. Smoking, minimal exercise, and living with stress that we can’t regulate are all parts of our life that can make the physical pain that we experience much worse, or can lead to worsening health and pain developing from other real medical conditions. An approach to pain medicine that doesn’t consider our actual lifestyle cannot help address the root of our pain.

 

Quinones continues with a quote from Cahana, “We got to the moon, invented the internet. We can do anything. It’s inconceivable to think there are problems that don’t have a technological solution. To go from I can do anything to I deserve everything is very quick.” 

 

Cahan’s argument is that our technological innovations and the stories we tell about our scientific progress blinds us from the reality of the human body. We are not machines, we are not our own technological innovations, even if we like to believe that we can all be Iron Man. The reality is that we have to think about how we live, about the things we do, and about what could be changed, adapted, or included in our lives to help us be more healthy and experience less pain. We don’t have to believe in a mystical energy around our bodies. We don’t have to turn to medical treatments that are not proven to be safe or effective. But we do have to think about what is important in our lives, what values we hold, and how we can make changes that help us align with  those values in a healthy and reasonable way. Once we have seen where we can make changes in our actual lives and what habits can help us improve our health and reduce our pain, it is up to us to live accordingly, not up to technology to instantly solve our problems.
Disruptive Innovation

The Basics of Disruptive Innovation

In his book Deep Work Cal Newport shares a story about Clay Christensen, the Harvard Business School professor who coined the term disruptive innovation. Its an idea I like quite a bit, especially since it is a big concept in healthcare right now, and I focused quite a bit on health policy and dabbled slightly in healthcare economics during my graduate studies.

 

Newport describes the basics of disruption like this, “entrenched companies are often unexpectedly dethroned by start-ups that begin with cheap offerings at the low end of the market, but then, over time, improve their cheap products just enough to begin to steal high-end market share.”

 

In this model, Uber wouldn’t be a disruptive innovation. Uber didn’t do anything to dramatically change the world of taxis. They sidestepped a lot of entrenched thinking and decided that laws and regulations didn’t apply to them while introducing badly needed technology to the world of taxis, but they didn’t offer a new cheap version of the service to gradually build upon and improve.

 

An example of disruptive innovations that I like, that I learned about in a healthcare economics class, is Bose headphones. Bose is producing headphones that have impressive noise cancelling, noise isolating, and noise amplifying technologies. They are certainly not cheap consumer products, but compared to highly technical, very expensive, and highly individualized hearing aids, they are. They don’t do everything that a hearing aid does now, and they don’t provide quite as good of a hearing experience for someone who relies on hearing aids, but they do seem to be able to compete at the lower end of the market. For people who are currently priced out of hearing aids and people who don’t have complete hearing loss but maybe should start considering hearing aids, Bose headphones seem like they can help. They can cancel competing sounds and provide just enough amplification and isolation to improve some people’s hearing…even if hearing aids would be a better long term solution.

 

The concept is important for several reasons. If you are a business executive, you need to know what is happening in your market space, and you need to know when someone is coming along to provide a cheaper service that might one day compete with you directly, or steal your market share. Also, from a regulatory standpoint, understanding disruptive innovations and where they may be occurring is important. If people are ditching their pricey hearing aids for less effective Bose headphones, are they putting themselves at risk while driving or navigating busy environments? What happens if a disruptive innovation guts an industry, and leaves people with disabilities who relied on the high priced product’s level of support and customization without a suitable product or service?

 

We should keep disruptive innovations in mind because they can unlock new potentials (we do a lot with our phones in ways that are quicker but not always as user friendly as old standard alternatives) but can also be dangerous for individuals and markets (should we really allow anyone to use a phone to scan their eyes to get a new glasses prescription?). Thinking about disruptive innovations helps us think about current social and economic trends, and it also forces us to be more considerate of others. We have to balance and weigh the interests of business, the interests of new consumers, and the interests of vulnerable populations when we think about where a disruptive innovation could push a market.

To Wear a Sweater or Not?

There is a story that I hear from time to time in different contexts. Depending on the context, it is framed as either positive or negative, with different ideas about what our future holds and how we should behave. The story manages to hit political and social identities, aspirations and fears for the future, and concerns over self-sufficiency and parochialism. The story is about a president who encouraged us to wear sweaters during the winter.

 

I’ll start off with the negative view, one perspective of which Tyler Cowen expresses in his book The Complacent Class. He writes, “Jimmy Carter put on a sweater and urged Americans to turn down the thermostat, representing a new era of lowered aspirations. In other words, the American response to economic adversity was to seek to restore comfort more than dynamism, and Americans pushed their culture in this direction all the more in the 1980s.”

 

Cowen’s critique is that as a response to inflation and oil insecurity from foreign oil dependence, Carter suggested we accept limitations and lower expectations. Our president at the time did not encouraging Americans to find new ways to make the world the way they want it. I think this critique is fair. Instead of imagining that the world could be better, that we could be comfortably warm and energy independent through new technology, the story suggest we should just deal with some level of discomfort.

 

I’ve heard others reflect on this story in a similar way. They criticize Carter for a defeatist attitude and for thinking small. People don’t like the parochial feeling of having an elitist person tell them to be tougher and to put on another layer rather than be comfortable but use more resources. Its easy to understand why someone might have the mindset that they deserve to run the heat, even if it is wasteful, because they worked hard to be comfortable and they can afford it.

 

I also think there is value to having our top political leaders signal that we can be more and that we can use science, technology, innovations, and a sense of purpose to make the world a better place. Perhaps encouraging us to keep the thermostats where they were, but also encouraging us to, as the line from the movie The Martian says, “science the shit out of this” would have landed us in a better place than where we are now.

 

But on the other hand, perhaps Carter was right. I have heard people praise Carter for being honest and realistic with the American public. I have heard people criticize Reagan, Carter’s successor, as being an out of touch elitist wearing a suit 24/7. I think people today desire a president like Carter who would signal that they were more in touch with America by turning down the temperature in the White House, making a personal sacrifice themselves before asking others to do the same.

 

Carter’s statement that we need to conserve resources and think critically suggest that we should not just use resources in a wanton fashion. This is a sentiment that climate activists today are trying to mainstream, and perhaps if we had listened more carefully to Carter, we could have shifted our technology to be more green, less resource demanding, and less polluting. After all, who are we to decide that the world should perfectly suit us for every moment of our existence? Isn’t a little discomfort OK, and isn’t it a good thing for us to recognize that the world doesn’t revolve around us? Is it better if we turn the thermostat down, put on a sweater, and pull out a board game to play with friends and family rather than crank up the heat and stare at our screens?

 

My takeaway from this story almost has nothing to do with the story itself. Whether we decide Carter was right probably has more to do with who we want to be, who we want the world to see us as, and what is in our self-interest than it does with whether we truly believe his attitude reflected and encouraged complacency. My takeaway is that events happen in this world, and we attach stories and meanings to the events that can be understood in different ways depending on our background and context. The narrative we create and attach to an event matters, and it shapes what we see, what we believe, and in some ways how we feel about the things that happen in the world. Think deeply about your goals, what you want to achieve, and how a narrative can help you reach those goals, and you will find the ways to tie that narrative into an event. At the same time, watch for how others do the same thing, and when you have discussions with others and want to change their mind, be cognizant of the narratives at play before you go about throwing statistics and facts at someone. Maybe a new narrative will be more effective than a bunch of economics and math.

Why Tyler Cowen is Worried About Segregation and Selectionism

Tyler Cowen’s book The Complacent Class could have been called The Catered Class, and he takes a critical look at the ways we settle for simplicity and comfort in our lives rather than strive for greatness. In the book, Cowen makes the argument that the American Middle-Class (but really all of American culture) has become complacent in our approaches to life, relationships, careers, entertainment, and more. He suggest that we are seeing a slowdown in our economic advances and in productivity because we are creating tools that make us more complacent as opposed to creating tools that fuel an ambition to grow and make the world something better than what we can imagine right now. What is worse, these complacent tools cater to our desires for homogeneity, make inaction easier than action, deplete our sense of agency, and have serious long-term consequences.

 

Much of our technology today includes an algorithm to help us select more of things that we have already selected in the past. Amazon tells us to buy shoes that are similar to the shoes we previously bought, TV streaming services auto-play the next episode of the show we just watched or start a new show that is similar to the last, real estate sites help us navigate to neighborhoods based on our preferences and the characteristics of other buyers like us. These algorithms make us complacent.

 

Rather than take a chance with a title we have never heard of, we are directed to a show or book that people like us also buy if they have similar consumption patterns. Rather than try something new, Amazon pops up with available purchase options for the same things we have always had. Instead of wandering into and exploring new parts of town (maybe this isn’t so different than having a human being show you a part of town based on your race) we scope out the perfect house in the perfect neighborhood online. We have in some ways given our decision-making abilities to machines and a result is that we are actually becoming more segregated today than we have been in the past. We don’t have to interact with people who are not like us, don’t have to experience something new if we want to avoid it, and don’t have to see headlines that don’t correspond with what we want to believe.

 

Cowen writes about the dangers of this segregation in his book, “Segregation has yet another negative consequence: It leads to more intense sorting along political lines, so that both Democrats and Republicans will be more likely to live in communities of politically like-minded individuals. That would lead to more polarization in Congress and to some extent governmental gridlock.”

 

With technology that sorts us so efficiently, we become complacent and are catered to by our devices. This allows us to become more narrow minded as our catered news sources, entertainment options, and food delivery reinforce the idea that complacency is the ideal standard that everyone else should live up to. The idea that we would actively participate in making the world a better place has disappeared behind the veil that the world should be catered to our desires. Rather than working to understand things that are different from our own preferences and rather than working with others to create a world that actually improves our happiness and well-being, we prefer a world that tells us we are special and delivers the safe and comfortable things we want directly to our homes. Our complacency is catered to us, and it has serious consequences as we segregate ourselves and our interests, and as we give up a willingness to dream big about the possibilities of the world.

The Challenge of Trying to Enlarge the Pie

I often feel that we are moving so fast toward the future that we are advancing beyond our means. I think we are in some ways exceeding the capacity that we have evolved to fit, and this is creating great challenges for humans across the globe. We have new technologies, new social structures, and new understandings of our places in the world and in the universe more broadly that exceed the type of living that we evolved to succeed within.

 

A passage from Kevin Simler and Robin Hanson’s book The Elephant in the Brain highlighted this for me. They write, “Despite the fact that it’s possible to cooperate, politically, in ways that “enlarge the pie” for everyone, this is the exception rather than the rule – especially for our distant ancestors. In most contexts, for one coalition to succeed, others must fail. Importantly, however, members within a coalition can earn themselves a larger slice of the pie by cooperating – a fact that makes politics such an intoxicating game.”

 

The line about our ancestors being incapable of expanding the pie for everyone is important. Without much technology, without shared languages and translation, and in a state of constant threat from nature, it is easy to see why our early ancestors were limited to a state of competition with each other for social status, sex, and resources. There simply were too few humans, too few easily accessible resources, and too few scalable technologies for everyone to be sufficiently comfortable and connected.

 

We now live in a new world, where literally 7.5 million people in the San Francisco metropolitan statistical area are constantly thinking about ways to build new technology to scale to improve the lives of all people, not just the people they are connected with. We understand that our actions can have global manifestations, and that we need global solutions to address climate change and other existential threats. Our technology and ways of thinking have surpassed the world our ancestors lived in, and have created a new game for us to play, however, we are still stuck in the zero-sum mindset of our ancestors, asking what we can do to get a bigger share of the pie for our narrow coalition.

 

Understanding why we fall into thinking about narrow coalitions is important. Recognizing the way our brains work and why they are limited helps us see new potentials. Understanding how we can change our thoughts and how we and others will react in a world that offers so much more is key to actually living up to our new potential as a global species.

The Challenge of Trying to Enlarge the Pie

I often feel that we are moving so fast toward the future that we are advancing beyond our means. I think we are in some ways exceeding the capacity that we have evolved to fit, and this is creating great challenges for humans across the globe. We have new technologies, new social structures, and new understandings of our places in the world and in the universe more broadly that exceed the type of living that we evolved to succeed with.

 

A passage from Kevin Simler and Robin Hanson’s book The Elephant in the Brain highlighted this for me. They write, “Despite the fact that it’s possible to cooperate, politically, in ways that “enlarge the pie” for everyone, this is the exception rather than the rule – especially for our distant ancestors. In most contexts, for one coalition to succeed, others must fail. Importantly, however, members within a coalition can earn themselves a larger slice of the pie by cooperating – a fact that makes politics such an intoxicating game.”

 

The line about our ancestors being incapable of expanding the pie for everyone is important. Without much technology, without shared languages and translation, and in a state of constant threat from nature, it is easy to see why our early ancestors were limited to a state of competition with each other for social status, sex, and politics. There simply were too few humans, too few easily accessible resources, and too few scalable technologies for everyone to be sufficiently comfortable and connected.

 

We now live in a new world, where literally 7.5 million people in the San Francisco metropolitan statistical area are constantly thinking about ways to build new technology to scale to improve the lives of all people, not just the people they are connected with. We understand that our actions can have global manifestations, and that we need global solutions to address climate change and other existential threats. Our technology and ways of thinking have surpassed the world our ancestors lived in, and have created a new game for us to play, however, we are still stuck in the zero-sum mindset of our ancestors, asking what we can do to get a bigger share of the pie for our narrow coalition.

 

Understanding why we fall into thinking about narrow coalitions is important. Recognizing the way our brains work and why they are limited helps us see new potentials. Understanding how we can change our thoughts and how we and others will react in a world that offers so much more is key to actually living up to our new potential as a global species.