Monday, February 18, 2008

Moses, Linearity & Singularity: Here It Comes!

Given the season, this is a good time to consider this Bible passage from the 34th Chapter of Deuteronomy:

“Then Moses climbed Mount Nebo from the plains of Moab to the top of Pisgah, across from Jericho. There the LORD showed him the whole land……Then the LORD said to him, "This is the land I promised on oath to Abraham, Isaac and Jacob when I said, 'I will give it to your descendants.' I have let you see it with your eyes, but you will not cross over into it."

It’s telling because it portrays a critically important insight about human existence. At that time, most of humankind lived and thought “circular.” It fit nicely with the eternal cycling of the seasons and the motion of the stars. If Simba needed knowledge, it could be found by looking to the past; if an answer couldn’t be found, the right question wasn’t being asked. The upstart Jews adopted a radically novel point of view: they discovered human existence was linear and, what’s more, led to a richer future that mattered a great deal – if not to us, then to our descendants. This is one of the greatest intellectual achievements in history and it is still with us today. Some would argue it must have been a divine gift.

Fast forward to the present day portrayed by a “Blue Man Group” concert. If you have a chance, this PVC-pipe percussionist spectacle is well worth the price of admission. However, I was drawn to its portrayal of a virtual “post-biologic” hyper-tech world that was not only humorous but starkly linear. The Blue Men reminded the audience that we are still very preoccupied with the future.

In fact, our race to reach it may soon result in what futurists have described as “singularity.” Increases in processing speed, access to huge stores of information, rates of new discoveries in energy, transportation, education and yes, health care, will have profound implications for our sense of self, roles, social status, interests and occupations. When the doubling cycle for the rate of change shortens to zero, change will become infinitely rapid and permanent. It is possible that that point could occur sometime in the next ten years.

What does this have to do with disease management? Well, my blog, so I can still post whatever comments I want. But seriously, the disease management sector in health care is not immune and could help lead the way. The field is getting wider, encompassing more conditions, as well as deeper, using new approaches to identifying populations, quantifying their risk, incenting change and deploying interventions. As change accelerates, it will become even more difficult to run clinical trials: results will be antiquated by the time the trials are completed. In fact, print journals themselves will become obsolete (and blogs will become more important). Consider the possibilities that traditional face-to-face provider visits will become virtual and old fashioned telephony much richer. In fact, access to organized information has huge implications for the role of a physician, which is largely dependent on unequal access to medical knowledge. I don’t profess to know just where disease management will fit in the future, but it seems the possibilities are infinite.

Scary stuff. Those Jews must have felt the same way about their Promised Land.

Later this week, I'll touch on another Bible passage.

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