by Roger Bourke White Jr., copyright February 2016
Health care is both ancient and currently undergoing dramatic changes. The dramatic changing is going to continue for the next few decades.
This means it is going to be influenced by a potent mix of new technology and instinctive thinking.
This essay is about how new technology, instinctive prescriptionism, The Curse of Being Important, and the newly emerging Total Entitlement State (TES) lifestyles are going to be mixing it up in health care in 2050.
The changes in health care are going to be big and dramatic. Mix new kinds of pills with better understanding of DNA, nano tech, and wearables that can both monitor and directly adjust things and... wow! Lots of changes!
Even fewer people will get sick than today and the incurable diseases and disorders will become few and far between. This will mean routine century-long lives, and a lot of really frail-but-healthy people wandering around because bodies will still age. Sadly, getting people back into twenty year old body equivalents will come much later than curing ailments.
In theory, health could become something that people no longer pay attention to, just as people rarely pay attention to running water in a house. A person's wearables plus pervasive surveillance will be doing all the important attention paying.
But this is an unlikely outcome. Because it is unlikely, what will be paid attention to will be mostly urban legend. People will still be paying a lot of attention to health, but because understanding harsh reality is becoming so irrelevant to how people live, making rational choices about health issues will become less and less common. Instead, fads and urban legend will dominate.
Right along side the issue of what are good and bad practices is the issue of who is paying?
This who is paying business is a heated and chronic issue in the 2010's, and the heat and chronicness are unlikely to subside by the 2050's. But the health environment will have changed so much that these chronic arguments will change their nature as well.
As an example, many people, politicians and organizations will be arguing constantly over who pays for what. The 2010's equivalent is the arguing that goes on between the health care providers, Big Pharma, FDA, AMA, health insurance companies and other healthcare paying systems such as Medicare and Medicaid.
In 2050 these arguments will revolve around who is paying for what in the various TES communities. Who is setting the rules? Who are they setting them for? The issues of what is "basic care" and should be paid for automatically by the government, or by the individual using their Necessity Money, as versus what is "discretionary care" and should be paid for by the individual using their Luxury Money, will still be a hot one and the answers will change with the political winds of the day.
Very much related is what will people want to pay for? In the 2010's much effort is made to be scientific about what gets approved and what gets rejected. But, again, with people becoming more detached from rational and scientific understanding of the world around them, this effort to be scientific is going to be diluted by efforts to support urban legends and personal expression.
So... will voodoo witch doctors see a revival? Think Tattoos and T-Shirts on this: How much personal expression will permeate the health care environment? (Hint: There will be a lot.) This means that while wearables take over much of the heavy lifting in terms of diagnosing and treating, people will still want to engage in, and pay for, older rituals that have lots of personal expression wrapped up in them -- which is why I bring up the witch doctors.
Beyond Tattoos and T-Shirts issues, here are some other big questions:
o Who gets access to what of these upcoming medical changes? And in what order? Just as things are in the 2010's: Some will be cheap and easy, some will be difficult and really expensive, and many will be mucked up in instinctive feelings and rituals of various sorts. The Curse of Being Important can't get any stronger than it does in health care issues.
o Who has control over what are "right" and "wrong" medical techniques? What will medical guilds such as the AMA and FDA evolve into? What will be their role? Example from above: If a person wants to get treated by a voodoo witch doctor, should this be considered "wrong" and something that is either not paid for, or flat-out illegal, or both? Conversely, should it be tolerated because the treatment makes the patient feel better -- why it does so is not important. Who decides? Will the medical profession guilds be just as prescriptive as now? How will cyber giving advice influence this prescriptiveness?
o There will be constant agitating for more health practices to be considered "a right" and therefore covered under TES necessity spending. But which practices and devices get high-profile, and thus more in demand to become a right? This will be determined more by instinctive thinking than by cost-benefit analysis. "This will be faddish," is another way of putting it.
o Because of The Curse, letting rational people or cyber decide these things is going to be hard to implement. It will take a revolution of some sort. The mildest sort will be concocting some kind of distraction that takes human attention away from "real" health care issues and puts it on low cost faddish and meaningless issues that urban legend wishes to support. Much lower profile will be the good science solutions being enacted by quietly enhancing the performance of drugs and wearables. Then The Curse can have its pie, and good science can be practiced as well.
Mixing in with this arguing over rights versus luxury spending will be constant improvements that are first covered with luxury spending. Some of these will be scientifically rigorous-based inventions, but not all. There will still be fads. And, with time, as people become on the average more delusional, the fads will gain in attractiveness. Then a big issue becomes which fads to support, and how much luxury/necessity money should be spent to support them? And how will the fads interact with the "real care" being handled unobtrusively by the wearables?
To say it again, as time goes on, most people will become so ill-versed in science that humans will be unable to make good choices based on scientific evidence. It will be cyber, not humans, who use scientific evidence to make choices. So the question then becomes: Which humans will rely on cyber for their choices? And related: If they do, will they become seriously shamed, or even outlawed, by those who want to use urban legend to decide medical practices?
Somewhat related is genetic engineering (GE) of humans and domesticated animals, including pets. Somewhat related because the scope of the GE is usually about upcoming progeny, not existing bodies... but there will be exceptions to this. The CRISPR editor that I have started reading about in 2015 seems to be able to do the basic "word processing" functions in the world of gene editing -- cutting and pasting code in various places on the gene. This tool means steadily gaining the ability to get smarter about the editing process, getting real reliable, and building new genes from scratch to insert in already alive and grown organisms may be coming soon.
As it does, who gets to indulge? An example of where this question can lead is: Which parts of CRISPR/gene editing become do-it-yourself (DIY) activities? When do school kids on science fair projects get to do gene editing?
Health care will undergo many deep technical and social transformations over the next thirty years. How it evolves will be determined by a swirling mix of new technology possibilities, ancient instinctive thinking, The Curse of Being Important, and how healthcare institutions and rituals evolve in the TES lifestyle environments.
There are going to be lots of surprises, some rational ones, many delusional ones.