2007: “Lifespan extension and the growing number of elderly people, once considered as catastrophic, are now viewed as an indisputable progress.”

Continuing my rather self-indulgent nostalgia trip, here is a blog post from 2007 (a decade ago!) on an then-upcoming conference. Note that I was unable to embed links!:

 

A rather melodramatic way of putting it – but that’s what the organisers of 19th World Congress of Gerontology and Geriatrics – http://www.gerontologyparis2009.com/site/view8b.php?id=119 They have two years, almost, to further encourage the “growing consensus” (and presumably take care of anyone who would dispute the progress that is lifespan extension)

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Ultra Long Term Health Effects of Slavery

This is a post I wrote on the Economics, Psychology, Policy blog, which I got involved with via rather tangential links with  the UCD Geary Institute – Liam Delaney, who I got to know then, was then  Prof of Behavioural Economics in Stirling University and the blog seems now to be part of the Stirling course – but now it seems Liam is back in UCD!

I have a weakness for sword’n’sandal type historical fiction set in Ancient Rome. One author I particularly enjoy is Steven Saylor who writes detective novels set in Ancient Rome, which manage to combine a modern sensibility – with the archetypal cynical, Sam Spadeish detective hero – with a real immersion into the foreign world of the classical past. The most recent book of his I’ve read, Arms of Nemesis, really brought home how horrific it must have been to be a slave. And it got me thinking – millions of people, possibly the majority in the classical world (as far as I recall, the number of Athenian citizens, who were of course all free males, was a tenth of the number of Athenian slaves) lived in this state of permanent insecurity, literally dehumanised and debased.

This, to say the least, can’t help but have had some profound psychological effects. And considering that, presumably, of people alive at the present moment, a good proportion have slavery somewhere, perhaps very deep, in their ancestry, perhaps this underlies many of the enduring psychological difficulties we call personality disorders. After all, we are still only beginning to realise the intergenerational effects of traumas such as the post World War II exodus and expulsions of Germans from Eastern Europe Martin’s post on the enduring health effects of 9/11 rekindled this train of thought.

Obviously in the U.S. there’s an ongoing controversy about reparations for slavery, the assets of companies who profited even indirectly during the Holocaust, and other such issues. Perhaps we should all try and lobby the Italian government for reparations from the slave holding of the Ancient Romans!

“actual clinic services with real doctors”

Again, from MobiHealthNews:

A new kind of doctor’s office opened in San Francisco this week: Forward, a membership-based healthcare startup founded by former Googler Adrian Aoun that infuses a brick-and-mortar office with data-driven technology and artificial intelligence.

For $149 per month, Forward members can come to the flagship office that features six examination rooms – equipped with interactive personalized displays – and doctors from some of the Bay Area’s top medical systems. Members are given wearable sensors that work with Forward’s proprietary AI for proactive monitoring that can alert members and their doctors of any abnormalities as well as capture, store and analyze data to develop personalized treatment plans. Members also have 24-7 mobile access to their data, rounding out what Aoun believes is a new type of preventative care.

What is interesting about this piece is that there are various other start-ups whose vision is not based on telemedicine or on “empowering consumers”, but on what is at its core the traditional surgery office except with much slicker tech. It is also interesting that Forward’s approach is based on a personal experience:

The impetus for Forward came from a personal experience of Aoun’s. When one of his close relatives had a heart attack, he found himself sitting in the ICU and realizing healthcare wasn’t quite what he thought it was. Seeing doctors having to obtain health records from multiple sources and wait days or weeks for test results and suffering from all-around communication breakdowns within their health system, he was inspired to create an alternative model – one focused on prevention, efficiency and connected tools to create a increasingly smart healthcare plans based on each individual’s needs and goals.

I took the title of this post from what I found a rather amusing aside in a later paragraph:

It also isn’t the first company to offer a hybrid of physical and digital services. In September 2016, startup Carbon Health opened its first clinic, also in San Francisco, that offers actual clinic services with real doctors

“actual clinic services with real doctors”! – sounds truly revolutionary – and quite a difference from the techno-utopian slant of the Financial Times piece I blogged about earlier in the week. At times readers may detect a certain weariness with the hype that surrounds digital health, the overuse of “revolutionary” and “transformative” and so on, the goes-without-saying presumption that healthcare is bloated and inefficient while tech is gleaming and slick and frictionless.  This is far from saying that healthcare doesn’t need change, and can’t learn from other fields – I look forward to hearing more about Forward.

“evolved strategy”: Online CBT provider Joyable lays off 20, shifts focus from direct-to-consumer to employers, providers

From MobiHealthNews:

“We let a number of talented people and friends go this week,” CEO Peter Shalek said in an emailed statement. “We did this in order to refocus our efforts on partnering with employers, insurers, and providers to increase access to evidence-based mental health care and to reduce costs. We are positioned financially to pursue this new strategy over the next several years. We’ve built a product known for having the best engagement and outcomes of any mental health-focused digital therapeutic, and we believe that our evolved strategy will allow us to reach and help the most people.”

In an interview, Shalek clarified that Joyable’s direct-to-consumer offering, an online cognitive behavioral therapy (CBT) and coaching program for social anxiety, isn’t going away completely: people currently using it will still be able to use it and new sign-ups will still be supported. But the company won’t put any more resources into developing or marketing the direct-to-consumer offering, and most of the staff involved in marketing and support for that product specifically were let go.

Shalek said that the company had always planned to go in this direction anyway and that, while they reached a lot of people, they recognized that the best way to move the needle meaningfully on social anxiety would be to help more people, which the company could accomplish by targeting populations that don’t need to pay for the service directly (the company charges individuals $23 per week for a 12-week course after a seven-day free trial).

With Joyable’s platform, first users are paired with a coach who has been trained in CBT techniques. Before starting the program, users are invited to speak to the coach for 30 minutes on a phone call about how social anxiety affects them and what they want to get out of the program. After that, the program helps consumers identify and understand their social anxiety triggers. Users must complete activities such as challenging anxious thoughts with evidence and developing alternative thoughts that are more helpful. Each activity takes around 10 minutes to complete.

From there, Joyable teaches users techniques to reduce their anxiety by putting themselves in anxious situations and working on applying the skills they learned. The coach supports the user throughout the program through text and email, and the user can also reach out for help whenever they want. The program is available online, and can also be accessed from smartphones and tablets.

One does wonder how much of Shalek’s statement on “evolved strategy” and the assurance “we always intended to go this direction anyway” masks a certain realisation that many online mental health providers are coming to: that, for all the hype and optimistic rhetoric about empowering “consumers”, ultimately engaging providers is a necessity for these technologies to actually reach the potential users who could benefit most.

Financial Times: How smartphones are transforming healthcare

This piece from last weekend’s FT magazine naturally caught my eye. It is rather techno-trumphalist narrative, with a few paragraphs of caveats on data privacy and lack of regulation in this area.However, the first and last quotations are from the CEO of Babylon an “artificially intelligent medical adviser” – the last words being:

But although we will continue to seek out physicians, it will not necessarily be because of their superior clinical skills. “If what you need is to solve a specific clinical problem, a diagnosis, then we can diagnose you better, faster, cheaper than a human doctor can,” Parsa says, with a wry smile. “Five years from now, technologically I do not believe you will have any need to see a human doctor for diagnosis… there is no scientific reason”

He would say that, wouldn’t he?

I’ve written before on the (much superior) Nature piece on “The Wild West of Health” care and have dashed off a few lines to the FT magazine on the lack of mention of the importance of clinical engagement. The piece is worth reading however, my allergy to mention of “transforming” and “revolutionising” healthcare