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James Davis
James Davis

New Technologies Let Patients Wrest Control From Doctors


The move from selling products to managing a permanent customer journey has required mastering the four capabilities that all companies will need to compete: automation (in this case, the ability to control the cooker from an app); personalization (offering tailored recipes); contextual interaction (changing the app interface as customers move from purchasing ingredients to cooking); and journey innovation (adding new recipes, online purchase capabilities, and community).




New Technologies Let Patients Wrest Control From Doctors



Masayoshi Son, billionaire head of SoftBank Group Corp., may have heaved a sigh of relief after wresting control of the Chinese venture of British semiconductor designer Arm Ltd. back from its wily CEO.


Specifically, as communications technologies make workers ever available, they allow one role in our lives to invade another. Role stress is something we have all felt at one time or another, as role stress arises from the conflict between responsibilities across different spheres of our lives.


The digital revolution, beginning in the second half of the 20th century, is now having similar effects on the global system. The Internet has redefined the modern economy, enabling the growth of software, global supply chains and modernized manufacturing processes. And the revolution is far from finished. Emerging technologies such as smart grids, additive manufacturing, artificial intelligence and intelligent industrial robots are all poised to make a significant impact in the coming decades.


But this transformation is occurring in a world fundamentally different from that of previous revolutions. Worldwide, the United States sits at the heart of financial institutions, controls the oceans and undisputedly leads in technology development. At the same time, Europe's economy has been surpassed by China's and India's for the first time since the Industrial Revolution began. Not since before it perfected deep-water navigation has Europe lacked the wealth and the political control of Asia.


Improving the performance of our health-care system is without a doubt one of the most important challenges that our nation faces. In recent decades, improvements in medical knowledge and standards of care have allowed people to live healthier, longer, and more productive lives. New medical technologies and treatments promise more and better to come. From a social point of view, we hope as many people as possible benefit from these advances. But health care is not only a scientific and social issue; it is an economic issue as well. The decisions we make about health-care reform will affect many aspects of our economy, including the pace of economic growth, wages and living standards, and government budgets, to name a few.


Inconsistent use of best practices by doctors and hospitals is also surprisingly widespread. For example, numerous studies have pointed to the lack of adherence to evidence-based guidelines for the treatment of heart attacks. In particular, it has long been well established that restoring blood flow to the heart and using aspirin, beta blockers, and ACE inhibitors at the appropriate times significantly reduce deaths resulting from heart attacks.8 Yet studies show that the dissemination of these treatments occurred only slowly.9 More widespread application of evidence-based medicine could help health-care workers make better use of the medical knowledge they already have to improve patients' outcomes.


That said, the evidence also suggests that the cost of health care in the United States is greater than necessary to allow us to achieve the levels of health and longevity we now enjoy. I have already mentioned research that finds large regional differences in the cost of treating a given condition, with high-cost areas showing no better results. The slow diffusion of the use of aspirin and beta blockers for treating heart-attack patients shows that cheap, effective treatments are not always used, potentially leading to higher costs and worse outcomes. Moreover, because insurance companies and the government play such prominent roles in financing health care, patients and doctors have far less incentive to consider the extra costs of optional tests or treatments. But, as we all know, although testing and treatment decisions may be undertaken on the presumption that "someone else will pay," the public eventually pays for all these costs, either through higher insurance premiums or higher taxes.


Efforts to improve the quality of health care are a vital component of comprehensive reform and are likely to yield high social returns. Additional research and experimentation can help us address difficult questions such as how best to measure quality and cost-effectiveness in health-care delivery and how to give doctors and hospitals incentives to adopt best practices and improved information technologies.


Knowledge of the costs of alternative approaches is likely to be insufficient by itself. Patients, doctors, and hospitals must also be given incentives for choosing cost-effective approaches. However, the questions of how to structure incentives and monitor performance are hotly debated. For example, advocates of "consumer-driven" health care argue that, given appropriate information and incentives, patients--or in some cases, private insurers acting on their behalf--can effectively impose at least some degree of market discipline on health-care providers. Others see an inevitable role for government in setting standards of care and in measuring performance. Professional associations, hospitals, medical researchers, and other stakeholders may also have a role to play. At the heart of the debate are the fundamental social questions of how we determine when various medical services are worth their cost and how we measure and reward good performance by providers.


Election analysts say vote counts in the remaining 14 contests give Republicans plenty of opportunities to pick up one more seat and likely additional ones to wrest control of the chamber from the current Democratic majority.


Nonetheless, a Republican majority in the House is likely to give Biden opponents an entrée to launch investigations of his administration's missteps during his first two years in the White House, such as last year's chaotic U.S. troop withdrawal from Afghanistan and the lack of control of the influx of thousands of migrants across the U.S. border with Mexico.


By 1786 the old chief Kahekili, king of Maui, had become the most powerful ali'i in the islands, ruling O'ahu, Maui, Moloka'i, and Lana'i, and controlling Kaua'i and Ni'ihau through an agreement with his half-brother Ka'eokulani. In 1790 Kamehameha and his army, aided by Isaac Davis and John Young, invaded Maui. The great chief Kahekili was on O'ahu, attempting to stem a revolt there. Using cannon salvaged from the ship, the Fair American, Kamehameha's warriors forced the Maui army into retreat, killing such a large number that the bodies dammed up a stream. However, Kamehameha's victory was short-lived, for one of his enemies, his cousin Keoua, chief of Puna and Ka'u, took advantage of Kamehameha's absence from Hawai'i to pillage and destroy villages on Hawai'i Island's west coast. Returning to Hawai'i, Kamehameha fought Keoua in two fierce battles. Kamehameha then retired to the west coast of the island, while Keoua and his army moved southward, losing some of their group in a volcanic steam blast. This civil war, which ended in 1790, was the last Hawaiian military campaign to be fought with traditional weapons. In future battles Kamehameha adopted Western technology, a factor that probably accounted for much of his success.


Kamehameha spent the next three years rebuilding the island's economy and learning warfare from visiting foreigners. Upon Kahekili's death in 1794, the island of O'ahu went to his son Kalanikupule. His half-brother Ka'eokulani ruled over Kaua'i, Maui, Lana'i, and Moloka'i. The two went to war, each seeking to control all the islands. After a series of battles on O'ahu and heavy bombardment from Brown's ships, Ka'eokulani and most of his men were killed. Encouraged by the victory over his enemies, Kalanikupule decided to acquire English ships and military hardware to aid in his attack on Kamehameha. Kalanikupule killed Brown and abducted the remainder of his crew, but the British seamen were able to regain control and unceremoniously shipped Kalanikupule and his followers ashore in canoes. Recognizing his enemy's vulnerability, Kamehameha used his strong army and his fleet of canoes and small ships to liberate Maui and Molaka'i from Kalanikupule's control.


It was a curious coincidence that the pandemic arrived on the heels of the technology wars because it carried the same lesson. Faced with a natural, existential threat, the main state actors had to consider how to build a secondary world protected from the unexpected intruder. Rules, policies, and technologies such as digital surveillance or vaccines were quickly developed for this purpose. They were insufficient, but this is just the beginning. The important point is that different state actors aimed to free us from the old natural world of material needs upon which we still relied.


Think about it as a clash between two versions of the world. Or, more graphically, imagine a simulated landscape in which two or more computer programmers are fighting to redesign what appears on the monitor. The pixels keep changing from moment to moment. One second, the landscape looks like a mountain scene; then the mountains grow smaller and smaller until the landscape becomes a grassy plain. Some back and forth ensues until one of the programmers gives up and the other vision wins. Geopolitics is the struggle not to control territory but to create the territory. As we enter an age of climate change, the meaning of terraforming becomes increasingly vivid and even literal.


Much in the American panic about Huawei and other Chinese companies reflected simple anxieties about economic decline, but it also revealed a new, existential fear about a specific technological singularity. What happens to geopolitical competition when we enter the Anthropocene? What happens to war and conflict when the battlefield is no longer natural but technological? As Helberg puts it, if the Chinese wrest control of global telecommunications systems, if they can steal our information, manipulate it, monitor it, and redirect it, then any level playing field for system competition is gone: they will have the ability to extend and enforce their influence around the world.


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