I've enjoyed science fiction since I was a boy. I liked both the science (small doses of biology, physics, psychology--I learned the naturally occurring radioactive elements from the Space Patrol) and the fiction. One interesting subform in the genre is the "future history," where an author imagines what the past looks like to people in the future. Another less intentional subform is what the future looks like to people in the past. As you read works written from the 1920s through the present day, you can see different views and conventions for what the future will look like--utopian, dystopian, continuous with the present, utterly different, positively changed, or merely repeating cycles of history. Where are those flying cars everyone in the 1940s was sure would be just around the corner?
On a shorter timescale, I was reading some issues of the Harvard Business Review from late 2005, retrieved from a big office clean-out project. (Better late than never.) In this issue, there was a long article on how companies could completely control their exposure to risk and maximize their available capital through the up-to-date use of credit default swaps, hedges, and other financial innovations. It lauded the "setting free of the banks." Here is one of the pullout quotes: "The value of almost any company that sells on credit can be enhanced through the use of credit-default swaps."
It is easy to be snide--the future is hard to predict. My only certainty is that the future, like everything else, will take longer to get here than we think and probably be more like the past than we wish.
And that is my reaction to another piece, by Amy Salzhauer, in that issue--a short description of the near future of health care, called "Is There a Patient in the House?" Drawing on demographic trends that are familiar to readers of these posts--shortages of health care professionals and increases in long-lived but chronically ill "senior citizens"--she observes that in addition to the usual concern about costs of care, the US really does have a problem in the DELIVERY of care that will not be solved with increases in insurance coverage. (So far, so good.)
Ms. Salzhauer talks about the coming innovations in home-based, nonprofessionally mediated care. Like IBM's electronic pill box that calls your cell phone to let you know if you are taking your meds as prescribed. Or biomeasure tracking armbands and predictive algorithms that can "interpret volumes of medical-grade data generated by its monitors."
She also talks about The Care Product Institute (a joint venture of Kaiser-Permanente, MIT media lab, and others) looking to combine technology with social support. So your IBM pillbox might call someone else to talk about your medication use--someone who might be able to encourage you to stay on your treatment plan or otherwise "nudge" you.
I know I am a techno skeptic, but I just can't figure out how this stuff is supposed to help. Is a cell message really going to aid a patient unwilling to take meds, confused about their schedule, or unable to pay for them? Is there any evidence that this works? Is informing adult children who are distance caregivers of their aging parents' problems really going to arm us with tools to help keep diabetes, sodium, or pain in check?
To be clear, I do believe in the hardware and technology. Rockets do fly, but it is the way the human part of the equation is factored in that is so primitive that it's almost laughable. Where are the real families who are going to use this stuff to make a difference in older adults' health?
The technology sounded cool in 2005 and it still sounds cool, but it's 2009. Where are those flying cars, anyway?