Health care: Information tech must catch up to medical marvels
Michael Dowling, Northwell Health's CEO, believes we're entering the age of smart medicine.
- The United States health care system has much room for improvement, and big tech may be laying the foundation for those improvements.
- Technological progress in medicine is coming from two fronts: medical technology and information technology.
- As information technology develops, patients will become active participants in their health care, and value-based care may become a reality.
In his book Health Care Reboot, Michael Dowling, Northwell Health's CEO, argues that "[the United States] is constructing a solid foundation upon which the new American health care is being erected." To those steeped in news of health care's administrative bloat, under-performing primary care, and low levels of insurance coverage, such a thesis may seem bold, wishful, or downright delusional.
But Dowling does not ignore the health care system's need for improvement. Rather, he believes that contemporary trends can foster such improvement if we recognize their value. He cites advances and disruptions in areas such as consolidation, education, payment reform, and mental health to support his progressive view that "better, safer, and more accessible care" is coming.
Among those trends is big tech's move into health care, or as Dowling puts it, technology may soon move us into the age of smart medicine.
Medical tech marvels
Dowling sees big tech's stride into health care as coming from two fronts: medical technology and information technology. On the medical technology front, the technology available to doctors has accelerated at an unprecedented pace, resulting in tools and techniques that are "the stuff of Star Wars."
"Some of the most advanced technology tools ever developed in any field are in use to care for patients. Look at any modern operating room or intensive care unit, and the technology to treat patients and keep them alive is remarkable," writes Dowling.
To pick one of many examples, Northwell Health's Cohen Children's Medical Center was the first pediatric program on Long Island to institute ROSA, a "robotic operating surgical assistant." Before ROSA, children suffering epilepsy would have to undergo a full craniotomy to target and monitor areas of seizure activity. With ROSA's assistance, surgeons can get the same results through a minimally invasive procedure, reducing the risk of infection and strain on the patient.
Even technology not designed for therapy has been co-opted to play small, yet supportive, roles in quotidian treatment. A study out of the Children's Hospital Los Angeles found that virtual reality can help reduce a child's anxiety and stress during basic procedures such as a blood draw.
Information tech plays catch up
Photo: Sisacorn / Shutterstock
Dowling characterizes the information technology front as "less impressive," pointing to the well-known difficulties of onboarding electronic health records. Beyond concerns of cybersecurity and interoperability, such systems have caused widespread burnout and dissatisfaction among practitioners thanks to their time consumption and complicated workflows.
But progress is being made. Apple recently added a Health Records app to its iPhone, giving patients from 39 health systems access to their medical records.
"This existing new reality is that a fat file, that until recently was stored away unavailable to the patient, now sits in its entirety on the patient's phone," writes Dowling. "For patients with chronic conditions who make frequent use of medical services, this leap forward enables them, whether a mile from their doctor's office or a thousand miles, to track and share with their doctor essential data on blood pressure, heart rate, glucose levels, and scores of other important clinical markers."
But to succeed, this information must be gatherable, accessible, and understandable to any patient. Big tech will need to streamline such systems for maximum user-friendliness, all while keeping operations on a device with which patients and practitioners are intimately familiar.
That device will be the smartphone and tablet. 77 percent of Americans own smartphones. Among Americans over 65 years of age — the demographic most in need of such advancements — 46 percent own a smartphone, a number that is likely to climb.
Big tech's vision of integrating information technology with health care is some ways off. Much experimenting must be done, and big tech needs to better collaborate with traditional health care stakeholders. Even so, these incipient steps may lead to a framework where practitioners can gather more data more quickly and with greater ease, while patients become partners, not passive recipients, of their health care team.
Accelerating value-based care
In the United States, value-based health care exists today as a should-we, could-we debate topic. Big tech's entry into the field could push value-based care closer to practice. As noted on the health care blog Tech Prescribed, integrating improved data acquisition with AI-powered platforms could turn value-based care into a manageable venture.
"As a result, we will see the move to VBC accelerate even further as more firms turn a profit through this business model. Good news for docs — this will make you the primary customer for provider technology and really improve your user experience as a side effect," writes Colton Ortolf of Tech Prescribed.
The Northwell Health entity Pharma Ventures was created both in response to collaborating with big pharma and as a means to promote value-based care. Pharma Ventures was designed "to link drug prices to drug performance" and "to serve as a super-site for clinical trials." The goal is to drive down costs while simultaneously improving patient experience. Such an initiative is only possible due to Northwell's integrated systems and system-wide electronic health records.
Entering the smart age of medicine
For Dowling, health care in the United States is laying an important foundation for the medicine of tomorrow. We're moving away from the view that health care is something the patient receives at a medical facility. Soon, health care will see the patient take an active role alongside a team of health care providers.
"The new American medicine is proactive and has physicians working in teams with nurses and other caregivers to reach out to patients and guide them along a pathway to health and wellbeing," writes Dowling.
By creating new machines, proliferating information, and making that information easier to obtain, big tech's dive into health care will be a fundamental element in this upcoming paradigm shift.
The Inglehart-Welzel World Cultural map replaces geographic accuracy with closeness in terms of values.
- This map replaces geography with another type of closeness: cultural values.
- Although the groups it depicts have familiar names, their shapes are not.
- The map makes for strange bedfellows: Brazil next to South Africa and Belgium neighboring the U.S.
Some countries value self-expression more than others.Credit: Robyn Beck / AFP via Getty Images
Question: On what map is Lithuania a neighbor of China, Poland lies next to Brazil, and Morocco and Yemen touch?
Answer: The Inglehart-Welzel World Cultural Map. To be precise, the 2017 map. Because on the 2020 version, each of those pairs has drifted apart significantly.
These are not, strictly speaking, maps but rather scatterplot diagrams. Each dot represents a country, the position of which is based on how it ranks on two different values (discussed below). The dots are corralled together into geo-cultural groups:
- Catholic Europe, which comprises countries as diverse and far apart as Hungary and Andorra■ Protestant Europe, taking in both Iceland and Germany
- The Orthodox world, from Belarus all the way to Armenia
- The three Baltic states
- The English-speaking world, including both the U.S. and Northern Ireland
- The huge African-Islamic world, ranging from Azerbaijan to South Africa
- Latin America, which goes from Mexico to Argentina
- South Asia, which comprises both India and Cyprus
- The Confucian world, encompassing China and Japan.
The placement of the dots indicates cultural proximity or distance. Some countries from different groups can be more similar than other countries in the same group.
See the examples indicated above: cultural neighbors China and Lithuania belong to the Confucian and Baltic groups, respectively. Poland is part of Catholic Europe; its 2017 neighbor Brazil is in Latin America. Morocco and Yemen are closer culturally to Armenia, in the Orthodox group, than they are to Qatar, despite all belonging to the African-Islamic group.
The 2017 version of the map places Malta deep inside South America and lets Vietnam, Portugal, and Macedonia meet.Credit: World Values Survey, public domain.
Creating a culture map
So, what exactly are the criteria used for plotting these dots in the first place?
These maps are part of the World Values Survey, first conducted by political scientist Ronald Inglehart in the late 1990s. With his colleague Christian Welzel, he produced an update in 2005. The WVS has been revised several times since, most recently in 2020.
The WVS asserts that there are two fundamental dimensions to cross-cultural variation across the world. These are used as the axes to plot the various countries on the diagram.
- The X-axis measures survival versus self-expression values.
Survival values focus on economic and physical security. There is not much room for trust and tolerance of "others." Self-expression values prioritize well-being, quality of life, and self-expression. There is more room for tolerating ethnic, religious, and sexual minorities.
- The Y-axis measures traditional versus secular-rational values.
Traditional values include deference to religion and parental authority as well as traditional social and family values. Societies that score high on traditions typically also are highly nationalistic. In more secular-rational societies, science and bureaucracy replace faith as the basis for authority. Secular-rational values include high tolerance of things like divorce, abortion, euthanasia, and suicide.
As indicated by the significant changes on the 2020 map, the cultural values of nations are not static:
- Countries that move up on the map are shifting from traditional to more secular-rational values.
- Countries that move to the right on the map are shifting from survival values to self-expression values.
- And, of course, vice versa in both cases.
According to the authors of the map, changes in cultural outlook can be the result of socioeconomic changes — increasing levels of wealth, for example. But the religious and cultural heritage of each country also plays a part.
The world's cultural landscape is dynamic — you could even say promiscuous, producing new bedfellows every few years.Credit: World Values Survey, public domain.
Some notable features of the 2020 map:
- The Baltic group has been dissolved; Lithuania is now part of Catholic Europe, Estonia a lone Protestant island in a Catholic sea. More worryingly, Latvia seems to have dissolved completely.
- In general, survival values are strongest in African-Islamic countries, self-expression values in Protestant Europe.
- Traditional values are strongest in African-Islamic countries and Latin America, while secular values dominate in Confucian countries and Protestant Europe.
- The United States is an atypical member of the English-speaking group, scoring much lower on both scales (that is to say, lower and more to the left). In other words, the U.S. is more into traditional and survival values than the group's other members.
- Shifting attitudes don't just separate; they also unite. Belgium and the U.S. are now culture buddies, as are New Zealand and Iceland. Kazakhstan is virtually indistinguishable from Bosnia.
The Inglehart-Welzel map is not without its critics. It has been decried as Eurocentric, simplistic, and culturally essentialist (that is, the assumption that certain cultural characteristics are essential and fixed, and that some are superior to others). Which is, of course, a very self-expressive thing to say.
For more on these maps, on the WVS surveys, and on the methodology used, visit the World Values Survey.
Strange Maps #1098
Got a strange map? Let me know at firstname.lastname@example.org.
A study finds that baby mammals dream about the world they are about to experience to prepare their senses.
- Researchers find that babies of mammals dream about the world they are entering.
- The study focused on neonatal waves in mice before they first opened their eyes.
- Scientists believe human babies also prime their visual motion detection before birth.
Imagine opening your eyes for the first time as a brand new baby. The world is so mysterious, full of obstacles and strange shapes. And yet it does not take babies all that long to get their bearings, to latch on to their parents, and to start interacting. How do they do this so quickly? A new study published in Science proposes that babies of mammals dream about the world they are about to enter before being born, developing important skills.
The team, led by professor Michael Crair, who specializes in neuroscience, ophthalmology, and visual science, wanted to understand why when mammals are born, they are already somewhat prepared to interact with the world.
"At eye opening, mammals are capable of pretty sophisticated behavior," said Craig, "But how do the circuits form that allow us to perceive motion and navigate the world? It turns out we are born capable of many of these behaviors, at least in rudimentary form."
Unusual retinal activity
The scientists observed waves of activity radiating from the retinas of newborn mice before their eyes first open. Imaging shows that soon after birth, this activity disappears. In its place matures a network of neural transmissions that carries visual stimuli to the brain, as explained by a Yale press release. Once it reaches the brain, the information is encoded for storage.
What's particularly unusual about this neonatal activity is that it demonstrates a pattern that would happen if the animal was moving forward somewhere. As the researchers write in the study, "Spontaneous waves of retinal activity flow in the same pattern as would be produced days later by actual movement through the environment."
Crair explained that this "dream-like activity" makes sense from an evolutionary standpoint, as it helps the mouse get ready for what will happen to it after it opens its eyes. It allows the animal to "respond immediately to environmental threats," Crair shared.
Retinal waves in a newborn mouse prepare it for vision www.youtube.com
What is creating the waves?
The scientists also probed what is responsible for creating the retinal waves that mimic the forward motion. They turned on and off the functionality of starburst amacrine cells — retinal cells that release neurotransmitters — and discovered that blocking them stopped the retinal waves from flowing, which hindered the mouse from developing the ability to react to visual motion upon birth. These cells are also important to an adult mouse, affecting how it reacts to environmental stimuli.
Graphic showing the origin and functionality of directional retinal waves.Michael C. Crair et al, Science, 2021.
What about human babies?
While the study focused on mice, human babies also seem to be able to identify objects and motion right after birth. This suggests the presence of a similar phenomenon in babies before they are born.
"These brain circuits are self-organized at birth and some of the early teaching is already done," Crair stated. "It's like dreaming about what you are going to see before you even open your eyes."
The non-contact technique could someday be used to lift much heavier objects — maybe even humans.
- Since the 1980s, researchers have been using sound waves to move matter through a technique called acoustic trapping.
- Acoustic trapping devices move bits of matter by emitting strategically designed sound waves, which interact in such a way that the matter becomes "trapped" in areas of particular velocity and pressure.
- Acoustic and optical trapping devices are already used in various fields, including medicine, nanotechnology, and biological research.
Sound can have powerful effects on matter. After all, sound strikes our world in waves — vibrations of air molecules that bounce off of, get absorbed by, or pass through matter around us. Sound waves from a trained opera singer can shatter a wine glass. From a jet, they can collapse a stone wall. But sound can also be harnessed for delicate interactions with matter.
Since the 1980s, researchers have been using sound to move matter through a phenomenon called acoustic trapping. The method is based on the fact that sound waves produce an acoustic radiation force.
"When an acoustic wave interacts with a particle, it exerts both an oscillatory force and a much smaller steady-state 'radiation' force," wrote the American Physical Society. "This latter force is the one used for trapping and manipulation. Radiation forces are generated by the scattering of a traveling sound wave, or by energy gradients within the sound field."
When tiny particles encounter this radiation, they tend to be drawn toward regions of certain pressure and velocity within the sound field. Researchers can exploit this tendency by engineering sound waves that "trap" — or suspend — tiny particles in the air. Devices that do this are often called "acoustic tweezers."
Building a better tweezer
A study recently published in the Japanese Journal of Applied Physics describes how researchers created a new type of acoustic tweezer that was able to lift a small polystyrene ball into the air.
Tweezers of Sound: Acoustic Manipulation off a Reflective Surface youtu.be
It is not the first example of a successful "acoustic tweezer" device, but the new method is likely the first to overcome a common problem in acoustic trapping: sound waves bouncing off reflective surfaces, which disrupts acoustic traps.
To minimize the problems of reflectivity, the team behind the recent study configured ultrasonic transducers such that the sound waves that they produce overlap in a strategic way that is able to lift a small bit of polystyrene from a reflective surface. By changing how the transducers emit sound waves, the team can move the acoustic trap through space, which moves the bit of matter.
Move, but don't touch
So far, the device is only able to move millimeter-sized pieces of matter with varying degrees of success. "When we move a particle, it sometimes scatters away," the team noted. Still, improved acoustic trapping and other no-contact lifting technologies — like optical tweezers, commonly used in medicine — could prove useful in many future applications, including cell separation, nanotechnologies, and biological research.
Could future acoustic-trapping devices lift large and heavy objects, maybe even humans? It seems possible. In 2018, researchers from the University of Bristol managed to acoustically trap particles whose diameters were larger than the sound wavelength, which was a breakthrough because it surpassed "the classical Rayleigh scattering limit that has previously restricted stable acoustic particle trapping," the researchers wrote in their study.
In other words, the technique — which involved suspending matter in tornado-like acoustic traps — showed that it is possible to scale up acoustic trapping.
"Acoustic tractor beams have huge potential in many applications," Bruce Drinkwater, co-author of the 2018 study, said in a statement. "I'm particularly excited by the idea of contactless production lines where delicate objects are assembled without touching them."
SMARTER FASTER trademarks owned by Freethink Media, Inc. All rights reserved.