by Andrew Thorn
So. Here for that COVID content, are you? Dig it. It’s what is on everyone’s minds. And who can blame us? We are all looking for a little sense of control. It’s basic behavioral science, is it not? Most people would prefer to believe that they have a personal agency. Are we making things happen, or are things just happening to us? The less we know, the more threatened we feel. Lack of knowledge means we don’t know what we need to know to protect ourselves. This equates to a lack control over health and safety, life and death. The future serves as an opportunity to vent our worst fears and project our greatest hopes. Futurism is a riddle, and the ability to solve it seems limited to those with special powers. Prophets, geniuses, or Michael J. Fox.
One of my favorite writers is Isaac Asimov. Well known for his futurist science fiction. He was writing about the singularity, before it was cool. He once complained “predicting the future is a hopeless, thankless task, with ridicule to begin with and, all too often, scorn to end with.” So why do people make predictions over and over? Well, Asimov was not entirely correct. It is a thankful task as there are potentially big rewards for people who make and get right predictions. But there is little punishment for making bad predictions. They are immediately forgotten. Even in the age of the internet and cancel culture. Unless you are Elon Musk. Then someone creates a website called Metaculus.com that keeps track of them.
The multiplying of predictions would be harmless were it not for the fact that we are so bad at it. And experts, by the way, are worse. In 1984 the psychologist Philip Tetlock performed a study. He put predictions—specifically political and economic—under a microscope. In the end, experts were horrific forecasters. Now, to be fair I am the son of a noted historian and am more predisposed to look backward than forward. For my 6th birthday I wanted a bike, and a G.I. Joe with the Kung-Fu grip. He got me a framed print of the Santayana quote “Those who cannot remember the past are condemned to repeat it.” For my 7th birthday I again asked for a bike and the G.I. Joe. He got me a framed print that read “Do you not remember what I got you last year?”
I joke. However, he did get me hooked on studying history. Yale historian Paul Sabin wrote a fascinating book called “The Bet.” In it he detailed the 30-year debate between two experts, Julian Simon and Paul Ehrlich, and about their ideas of the future. Great read. Ehrlich and Simon are examples of what Tetlock termed “hedgehogs‘ in his study. Hedgehogs are highly specialized and know one big thing. In comparison, the “integrator foxes” knew many little things. Incredibly hedgehogs performed especially poor on long-term predictions within their specialty. The more credentialed, the worse the predictions. Foxes were intelligent people with no specific expertise, but expansive reading habits. They, in comparison, blew away the hedgehogs. They also exhibited qualities that made them effective collaborators.
This notion informs the one certainty I’d like to offer about navigating this global pandemic— be a fox. Foxes are curious about everything. They get outside of their comfort zone and cross disciplines. Do not view your teammates as peers who need to be convinced of your point-of-view. Instead, consider them to be sources of learning.
What will the world look like post-pandemic? Since the Renaissance, science and technology has dominated our view of tomorrow. As we look back many predictions have come true, but generally technology has moved even faster than anticipated. Another one of my favorite authors is H.G. Wells. He nailed many technologies (movies and air conditioning) well before they were invented. But he underestimated by a factor of 5× how long it would take to get there. So, please keep this in mind when considering the future of telehealth, wellness technology (i.e., in-home monitoring), and online channels of communication. Not only are they coming, they will be here even faster than you thought. Get on board the all-digital train as fast as you can.
Historically, though, the most egregious errors in prognostication have been the failure to anticipate major social change. Futurist bias toward predicting technological versus social progress has been an Achilles heel. Baseball legend Hank Aaron passed this year. When considering his legacy, it’s painful to remember the hate directed at him, but it is intrinsically linked to the happiness he brought to so many others. And it is far more important.
The pandemic has accelerated the inception of all sorts of gadgets and gizmos. They are all fun to talk about. But, while technology can assist as it becomes more pervasive, the existing technology gap exposes even greater health disparities.
The number of Americans without broadband access is well over 40 million. And that doesn’t account for people who live in areas with broadband infrastructure, but who can’t afford it, which adds another level of socioeconomic concern. The technological disparity is even more alarming when overlaid against the record numbers of patients for whom insurance, and therefore medical access, is an unscalable barrier. This population may be those completely without insurance— which COVID has seen climb to record numbers. Or, it may be those with limited insurance who are not actively seeking care or have insurance lapses that affect care. Even before the pandemic, research showed that more than one-half of Americans with employer-sponsored health insurance had delayed or postponed recommended treatment because of cost. This is particularly alarming when considering patient populations with oncological conditions where delay can have dire consequences. Consider that both Blacks and Hispanics are much less likely to be diagnosed with many cancers at an early stage and undergo curative treatment than Whites.
It would seem that the pandemic has cast a spotlight on important issues that affect the patient population as a whole. But these issues even more acutely affect those who go underdiagnosed and undertreated due to socioeconomic and technologic inequities.