Clinicians and patients. Time to build.

Those most affected by healthcare are the ones who should remake it. We are happy to have the help of our friends in technology, but remember we are building for humans... all humans.

This is a truly remarkable time in human history.

We are at the inflection point of the information age. The internet has become the main avenue for business and social interaction for much of humanity, especially young people. The human social and economic realm has in many ways become detached from the human physical realm.

This is what makes medicine in this era so interesting and so important.

We are the profession that is called on when the social needs of a human body- the ability to care for oneself and others, the ability to participate in an economy, a family, and a culture— is limited or threatened by the physical reality of living in a physical body. We are the profession that enables social good through enhancing more people to effectively use their bodies and minds, beyond their perceived limitations.

Or at least, we could be.

This juncture between the physical and the social experience of life in a human body, is not unique to medicine, but medicine is uniquely situated to understand these experiences at the extremes, and by doing so build for the full variety of human experience.

We are entering an age of dissociation between our physical and social worlds, which was never possible in previous generations. Much of the digitally native generation lives their social and economic lives more through the virtual world of the internet, than the physical world of their local community.

There are amazing benefits to this interconnected world. Access to knowledge, communication with people from all over the planet, and the ability contribute to people and societies far away from where you physically reside are possible on a scale that the printed book readers and letter writers of yesteryear could not even fathom. This interconnectedness and the technological power that it enables— the immense power of AI is only possible because of the massive datasets that are a byproducts of the extreme social connectedness of the internet— accelerates human knowledge and culture to beautiful new heights, enabling whole new forms of social and economic freedom.

Yet, the old institutions of the purely physical world, remain —for better or for worse. American medicine, with its emphasis on the physical realm of the human body and all of its frailty, has built up around itself, particularly in the historical flukes of Cold War Era America, a strange mix of institutionalized social structure that currently serves neither the social needs of the digital age nor the bodies of these people (increasingly free in the digital realm, but increasingly limited in the physical one). What I mean by increasingly limited in the physical one is the environmental and health crisis of our time. The technology and knowledge of our time should be enabling the most healthy and physically free people in human history. It is in fact, but only for a very small privileged subset.

In much of the world, the scourge of death and major disability from infectious disease. particularly for children, is a distant memory. The global COVID pandemic, for a time, reminded many of us of what was commonplace for generations past— constant fear and susceptibility to waves of plagues and pestilences throughout communities. Yet the speed at which the world could respond, create a vaccine, distribute it, and see humanity through the global pandemic (with all the missteps and confusion along the way), lays further evidence that the digital era is accompanied by a time where the major threat to physical freedom of human bodies is not infectious.

On the path of vanquishing human experience of life-limiting illness, I see this order of order of conquest medical and technological conquest as this. Infectious first, then accidents and trauma (getting there), then genetic and congenital/rare (close), finally the chronic conditions of lifestyle. These conditions I will deem "environmental".

There are a small minority of people who are living longer, stronger, and more fully experiencing the fullness of life in their unique human body than ever. We see this is the extremes of longevity and personal athleticism. Unfortunately, much of this benefit has only hit the rich.

We also see people born with bodies that have genetic or congenital circumstances that in generations past would have lead to childhood death, now often times living full and long lives with the aid of medical technology. This too is a miracle that is more easily accessible if you are wealthy or born in a wealthy country.

I see the modern era of medicine as called to tackle these three remaining realms (Traumatic, genetic/congenital, and environmental) of how the physical body can limit human freedom rather than enhance it. Our knowledge and technology are incredible close, it is our institutional structures that limit this ability.

The means to this end is for more clinicians and patients to build. We need not just focus on new drugs and new medical devices, but increasingly on systems and communities of care that enable effective use of what medical science has already created. To do so more clinicians and patients should enter the so-called creator economy.... small business ownership, entrepreneurship, thought leadership, solopreneurship, and what

Greg Isenberg

describes as multipreneurship.

Medicine, as a profession and a calling as old as humanity itself, needs break the self imposed institutional shackles that keep us as a profession from helping our fellow human beings. We, clinicians, need to build.

At the beginning of the pandemic, Marc Andreessen, a technologist who has been critical to enabling the modern internet age, wrote an essay calling on America to become a nation that builds again.

We in American medicine, must also heed that call.

"Our nation and our civilization were built on production, on building.... There is only one way to honor their legacy and to create the future we want for our own children and grandchildren, and that’s to build."

Relatively recently, Daisy Wolf and Vijay Pande from Mr. Andreessen’s firm, A16Z, revitalized this call to action, but directed it towards technologists, those who built their careers at FAANG behemoths and the Silicon Valley style start-ups that hover around them.

AI generated image prompt: Health entrepreneur building a rocket ship

I have no problem with technologists building in healthcare. I welcome it. Healthcare needs all the help it can get. I’m deeply fascinated that so many incredibly experienced and talented people from this realm wish to join the cause of serving human physical and mental health.

But I have caution about calls directed at technologists, with little to no acknowledgment of what patients’ and clinicians’ role in the building process should be.

What I’m concerned about here is the implication that:

1. Technologists should be leading this building

2. A major reason to build is the size of the market potential (“build more United Healthcares”)

Patients and their caregivers, and those that spend the most time with them at the bedside— clinicians— should be leading the charge here. Those whose experience, often not of their own will, is all to connected to the physical world of living in a fallible human body, and have not yet been able to fully dissociate their social and economic experience from their physical one— are best positioned to build the healthcare that serves all.

The healthcare market, if America is to be a truly healthy society, should get smaller NOT bigger.

This newsletter will be a guide for those you deeply engrained in the clinical systems and knowledge, both clinicians and patients, on how to build.

The time is now.