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At the 25th annual TEPR+ conference in Palm Springs on Feb. 2, Alan Greene ( gave the opening address. It was inspiring – I wish we had a video of it. Too bad so many attendees opted to skip the keynotes and fly into town late! Like, did you guys think the conference was worth attending for learning purposes, or were you just phoning it in??

Alan’s talk about Jefferson was great. He recapitulated what he’d said in his October post here, but beyond that, he talked about the “healthcare bubble.” It was superb and powerful; in light of today’s economic reality it was compelling. He said the attributes of a bubble are:

  • Trade in high volumes, at prices that are considerably at variance with intrinsic values
  • A situation where market prices are unsustainably high
  • Causes misallocation of resources into non-optimal uses
  • Comes to an end

This is important. Healthcare as we know it today is dysfunctional – neither party (the patient nor the clinician) is getting from the relationship what they came for. This shall end. Alan laid out the economic forces that foretell the collapse, and participatory medicine (especially with do-it-yourself patient-generated solutions) is the force that will disrupt it.

Speaking of disruption, just the day before, the New York Times had run a piece titled Disruptive Innovation, Applied to Health Care that brought to healthcare the thinking of Harvard Business School professor Clayton Christensen. (If you don’t understand disruption, you should; it’s important and real. The Wikipedia article is good, except that it only talks about price as the motivator. In healthcare that’s a factor, but a more potent one is that healthcare isn’t even getting the job done as effectively as it should, regardless of cost.)

Our thinkers (e.g. our science editors) have a ways to go before they understand disruption: the photo on the Times piece shows someone using a tablet computer, and new tools have nothing to do with disruption. Disruption involves a large number of people fundamentally rejecting the values of a dominant establishment, which isn’t giving them what they need. See Bubble, above.

My take: This industry (American healthcare) is generally blind to solutions that are already well implemented in other industries. While we want to support the establishment in evolving, we should not wait. We ought to augment the superb, cost-efficient patient support communities and platforms that already exist – ACOR cancer communities, diabetes blogs and communities, and many others (shout ’em out in the comments!) – by funding them, expanding them, empowering them, give them access to database tools to evolve their own knowledge.

Think that’s crazy or unworkable? You’re years out of date :-) … see Chapter 5 of E-Patients: How They Can Help Us Heal Healthcare, E-Patients as Medical Researchers, or even Chapter 4, The Surprisingly Complex World of E-Communities. We been doin’ it for years, peoples. :)

Another angle on this comes from another speaker who followed Alan that morning, Adam Bosworth of Keas. Not everyone agrees with Adam’s message, but to me, the measure of a future-predictor is whether s/he has a record of knowing what things succeed. Adam has some chops on that – more than I do, and probably more than you: he developed the Quattro spreadsheet, MS Access, he was one of the XML founders, and was the head of Google Health.

And what did Adam say about disruptive social change? “When the consumers all leave, sooner or later the laggards have to follow or die.”

Check that definition of bubble again, and you can see why I recently reached the conclusion that the Thousand Points of Pain give us additional motivation to get to work on our own solutions – while doing whatever we can to bring the establishment along with us.


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