Role of B.S. in Advanced Society

B.S. is a deeper philosophical topic than it might seem at first glance. Two interesting books contemplate the matter: B.S. and Philosophy (2006) and On B.S. (2005).

What is the role of B.S. in advanced society? Since it exists, it must have some role, possibly related to conflict reduction and social lubrication. A second reason for B.S. could be the complex values hierarchies in which individuals and societies operate. Social pressure and belongingness may trump truth as values. When someone is asked a question, the presupposition is that he or she may be able to answer and the inclination of the person asked is to try to respond even if a misrepresentation, e.g.; B.S., occurs.

These authors and others agree that B.S. has proliferated from the past to the present. Given that, what could be said about the future, is B.S. likely to increase or decrease? In the short term it will probably continue to increase but could then be reduced in the longer term with the advent of more advanced technology.

Personalized hypertargeted B.S.
On one hand, technology is increasing the detectibility of B.S., suggesting that B.S. could go down in the future. On the other hand, information is continuing to explode, providing more potential venues for B.S., suggesting that B.S. could go up in the future. B.S. is like spam or commercials, growing, but simultaneously control mechanisms are also growing to mediate interactions. Although B.S. could be more insidious, less detectible and even desirable when it is highly personalized and hypertargeted such as marketing is starting to be now.

Politicians replaced by Artificial Intelligences
Considering fields ranging from science, with a zero-low tolerance for B.S., to politics, with a high tolerance for B.S., it is possible in the future that it would be desirable to replace people in high-B.S. professions with Artificial Intelligences. This would solve the agency problem and special interests control overnight. Policy debates could be resolved by running a million different permutations via virtual simulation varying every parameter of a given policy change such that overall utility is maximized.

Affinity Capital

A key concept in the 2.0 Economy is affinity capital. Deeper levels of information about every economic transaction are starting to be available such that individuals, businesses and communities can be very specific in directing and democratizing their capital. In many cases, products can be chosen that are organic, recyclable, fair trade, made from sustainable materials and made by companies with fair labor practices or whatever affinities or attributes the buyer cares about.

Affinity-directed capital can influence both cash inflows and outflows. Affinity inflows are the money earned. Earners can now be more selective by checking Corporate Social Responsibility reports if thinking of working for large companies, by being entrepreneurs and contractors, finding projects on website marketplaces like TopCoder (software programming), oDesk (professional services) and 99 designs (graphic design) or by having clients seek them directly through their web activities and content. A taxonomy of affinity capital marketplace links is available here.

Affinity capital influences capital outflows too: investing, donating and purchasing. In investing, socially-responsible investing (SRI) mutual funds have been available for several years, and now peer-to-peer lending and social venture capital platforms allow investors to direct capital into these asset classes too. Philanthropy is merging with investing in cases like Kiva where investors find a lower or blended financial return is acceptable when social outcomes can also be achieved. The SocialCapitalMarkets conference has continued to draw several hundred worldwide social entrepreneurs to talk about how to bring social change with economic transactions at their annual September conference in San Francisco. The organization also sponsors The Hub, twelve worldwide physical spaces for social capital markets collaboration.

Affinity purchasing, voting with dollars based on product attributes, is another way of democratizing capital as consumers and businesses check websites like ClimateCooler, the Fair Trade Federation and others to see how socially and environmentally friendly products are before buying or purchasing directly from green product websites like GreenHome or other affinity-based marketplaces.

Socially-responsible and environmentally-friendly are some of the biggest affinity attributes but the key point is that deep attribute knowledge means that capital can be directed granularly to ANY affinity attribute.

FutureThink: the Mindset of the Future

To think strategically about the future, it is necessary to realize that the mindset of today may be outdated for appropriately contemplating the future. The inadequacy of current human minds is sometimes given as a possible reason that humans may not be able to understand the full physics of the universe (multiple dimensions, multiple universes) or design artificial general intelligence.

One technique to improve the current mindset is to try deriving future intellectual norms from historically trending principles.

There are other examples of this concept. Successful athletes do not move to where the ball is now but where it is going to be. Ray Kurzweil exhorts not to invent a future object based on today’s technology, but rather where the technology will be in the future.

Three key principles and one meta-principle are discussed below.

1. Increase in humaneness: The first historical principle that can be identified is an increase in humaneness. Over time, there are new tiers of behavior that are deemed inhumane and become unacceptable. For example, slavery was acceptable in past eras but is not now, many societies have moved away from capital punishment and diminished discrimination is ongoing. Some contemporary issues are the rights of homosexuals, and noise and light pollution. In the future, it could be seen as inhumane to keep people waiting, or bored, or under-actualized, or without personalized-temperature control, or exposed to air pollution or disease toxins emitted by others.

Medicine and dentistry are obvious fields of increased humaneness. Today state-of-the-art treatment from 100 years ago seems primitive and barbaric. When seen from the lens of the future, it is easy to contemplate a time where people would be shocked to be operated on with a knife; we are already starting to see this now as da Vinci robotic surgery is 90% less invasive than traditional methods.

2. Increase in choices: A second historical principle is an increase in choices. For example, in music, with the advent of records, industry insiders were afraid that people would stop listening to the radio, however there was a boom in both as they reinforced each other and expanded music-listening as a category. If a new concept provides value, it helps to refine, stratify and expand the whole market. Contemporary examples are TiVo, YouTube and free e-books spurring traditional sales.

3. Decrease in limitations: The third idea is related to the second, not just are there more choices but there are new choices. For example, population growth may be a problem if only certain areas of the Earth can be inhabited and if resources are constrained, but FutureTech may open up living in places that were formerly uninhabitable (for example, the Seasteading Institute is investigating the feasibility of water-based settlements). Resources could become more abundant such as is happening now with solar and wind energy and the possibility of repurposing of cellulosic plant waste for fuel or food with synthetic biology. A significantly higher population could be supportable on Earth. Today’s constraints will not be tomorrow’s constraints.

Meta-principle: Abundance
These three principles, increase in humaneness, increase in choices and decrease in limitations are all aspects of the overarching principle of abundance. With abundance, there is more in every dimension, not a world of either/or scarcity. For example, a classic futurist thought experiment is whether someone would forsake their embodied form by uploading their mind to a computer. This is a perfect example of the fallacy of applying current thinking, e.g.; today’s resource scarcity mindset, to future scenarios. A future seems much more likely where many options would be possible. People may have many digital backup copies of their mind files, possibly multiple copies engaging in different activities, as well as one or more embodied forms, rather than an either/or choice of identity representation. An increase in options in existing and new possibility spaces, physical, intellectual, emotional and philosophical, is the hallmark of abundance thinking about future scenarios.

Preventive Medicine and Docs vs. Genomics

Despite NIH Director Francis Collins’ strong support of personalized genomics (he claims he lost 15 pounds after finding out through direct-to-consumer genetic testing that he is at higher risk for Type 2 Diabetes) and noting that the only way to successfully transition to the genomic era is with a skilled professional work force, doctors are taciturn about embracing genomics, and rarely try it even when it is made available to them and their patients for free (less than 5% uptake in a recent example with El Camino Hospital and DNA Direct making genomic testing available to 1000 physicians).

Top 10 reasons doctors will probably not be the ones implementing genomic data in patient care, in rank order. Physicians...

1. think they have to be the domain experts of any health area they direct for patients and are too constrained, unwilling or unable to be a genomics domain expert
2. do not see the clinical utility of genomics
3. have the attitude that genomics is optional, not required
4. have a precedent for non-adoption of preventive medicine tools as evidenced by slow uptake of molecular diagnostics
5. driven by liability, malpractice fears
6. self-direct per insurance non-reimbursability
7. believe genomics overconsumes scarce medical resources
8. are already cost, time, new knowledge acquisition constrained
9. are resistant to change and enjoy autonomy in directing their own practices
10. do not have specific tools for implementing genomics in their practices

Number one reason physicians would adopt genomics:

1. if their peers did

Physicians are intelligent and could easily adopt genomics
In reality the way that genomics adoption unfolds in the traditional health care system could be straightforward. Once regulated, physicians would have no choice but to adopt. Whole human genomes would be on file in patient Electronic Medical Records (EMR) and genomics tests could be a few more items on the standard blood test menu where primary care physicians interpret results within quantified ranges. Even though physicians are spending on average only 12 minutes with each patient per year in the US, they are required to spend 100-200 hours per year on Continuing Medical Education, and being quite intelligent, could easily master the basics of delivering genomic medicine.

Best quotes from the September 2009 National Coalition for Professional Education in Genetics (NCHPEG) meeting:

• “Not only is genomic data useless, educating physicians about genomic data is useless”
• “Learning about genomics might be useful to my practice, so would speaking Spanish, but I’m not going to do it”

Solution: new care provider tier for Preventive Medicine

The disincentives to physician adoption of genomic medicine are really part of the bigger issue of how societies are going to shift to preventive medicine in general.

The traditional health care model of physicians and insurance companies is probably not going to deliver preventive health, a new tier of care providers, entrepreneurs, is.

Figure 1. Future Health

Image: MS Futures Group, Oct. 2009

A model for the future of health care is presented in Figure 1. The patient is at the center, increasingly taking responsibility for managing their own health. Easy-to-use tools, both devices and web-based software, could provide the first shell of actionable health information to individuals. Over time (decades), there is no reason that the primary care provider could not be superseded by automated health monitoring tools.

New Era Preventive Care Specialists: the Health Advisor
The next preventive medicine shell is the new tier of health care providers. When consumers say “I have my genomic data, now what?” traditional doctors say, “I have no idea what to do with that” or “That is not clinically useful,” but the New Era Preventive Care Specialists do not. They show what to do with personalized data by using genome-in-the-cloud browser tools to make genomic data intelligible and actionable. They incorporate genomic data, together with family history and current phenotype and biomarker data into an overall care plan (when is Keas finally going to launch? what about Omicia?), with a systemic approach (when will Entelos license their virtual patient technology to consumer-pointing applications?).

The Health Advisor (analagous to the Financial Advisor) could be one of the fastest growing new job areas. The business model may be traditionally trained experts in general medicine, genomics, nutrition and sports medicine coming together in private clinics to work in the new paradigm of exploding volumes of digitized health data (both health metrics collected daily and genomic, transcriptomic, etc. data) together with EMRs. One first service could be EMR assembly where patients own and control the data. Other services could include all manner of personalized health plan creation and monitoring. Anti-aging treatments would be another logical area for inclusion.

Health Savings Account (HSA) Dollars
Accustomed to the third-party pay model, consumers may object to paying for medical services (although they do shell out several billions of dollars per year for weight-loss products) but instead of paying directly out-of-pocket, it is quite possible that preventive care services could be purchased with pre-tax HSA dollars, as more than half of U.S. large-company plans may be offering as an insurance option. This marketing point that should not be lost on the new era of preventive health providers.