11 October 2007

Still scratching

I have received comments, one of them lengthy, from two individuals who appear to be involved in the creation of the video A Brief History of Medicine, which I lambasted in my post of 4 October, Scratching an itch. I replied rather tartly to "matthew" in the comments section, but this longer reply to Bungle M (who signs as "michael") deserves its own separate post. Besides, I haven't figured out whether it's possible to add illustrations to comments in this software. And I like illustrations.

Dear Michael (or is it Bungle M ?),

I seem to have caused a bit of a flap in the ScribeMedia pigeon loft with my blog post of 4 October. How else to account for the rush to reply to a satirical morsel of invective by an obscure, curmudgeonly hospital librarian in a remote Canadian outpost? Have you no sense of humour? Have you no sense of perspective? It's just a video after all; and I'm just a library guy who isn't always on top of every trend but who nevertheless has an axe to grind when the trend is rightwards. At least for my generation, short videos such as yours are at worst a vexing irritant and at best a trifling entertainment, not unlike
radio jingles, urinal advertisements, movie trailers, and elevator music. I have observed with interest and some alarm the growing importance of videos as a means of communication for a new generation less interested in the printed word. YouTube up, library circulation down. It's not that I object to the short video on principle. Videos can be brilliant, inventive, disturbing, and informative. I enjoyed Web 2.0 … The Machine is Us/ing Us, whose style you so studiously copied. I just didn't think your video was all that good, in contrast to the fawning comments in praise of its awesomeness. And that infernal soundtrack! I'm still scratching. But, as you say, we won't get anywhere arguing about video and audio aesthetics.

I accept your claim that you did not intend to be partisan. I, on the other hand, freely admit to being one, although of the World War II variety I take no prisoners. I didn't call anyone a Clintonite. I just thought it somewhat humorous that the Clintons got the good visuals in the video while nary a Republican was to be seen. Believe me: I am the last person to be making accusations about a "liberal agenda." The very term is foreign to Canadians, but I could fairly be labelled as having one. We actually like liberals up here, and frequently elect them to Parliament and to provincial legislatures. What I did appreciate about your video was its attempt at a statement of liberal values around health. Something goes terribly wrong at the end, however, when, as I have noted, the acme of health care is touted as a series of lavishly designed and highly remunerative websites.

To restate my point, what I chiefly object to about A Brief History of Medicine is how it allows itself to become a shill for a gathering of plutocrats and entrepreneurs who see the web as a means to make a killing in the health care biz. I would object to the use of the word "cabal" to describe such a group. This is not a conspiracy in the usual sense of the word. I'm sure they see themselves as good corporate citizens simply responding to consumer demand. They are only doing what any business would do when given the opportunity. That is the problem. It's all arranged; the market is targeted; the strategies for growth are being discussed in oak-lined boardrooms and on thousands of humming Blackberries. I would dearly love to be proven wrong in my suspicions. I would really like to be assured that Google's Product Marketing Manager, Kaiser Permanente's Senior Advisor [sic] & Medical Director, and Medstory/Microsoft's CEO have only the best interests of the public at heart, that they truly care about US. But I remain unconvinced. As George Eliot remarked in her novel Felix Holt, "the foxes have a sincere interest in prolonging the lives of the poultry."

For all its enfolding and rhapsodic idealism, your video actually does end up being partisan. Certainly, it seeks to avoid politics by emphasizing the personal; but the personal is political also. So, for example, the vacuous inclusiveness you praise in the video's self-congratulatory summing-up, "Health Is... Men. Women. Children. Mothers. Fathers. Brothers. Sisters. Doctors. Patients. Caregivers. You... Health is US," acknowledges despite itself the unmentionable yet clamorous need for all these atomized individuals to work together for a political solution to soaring health costs, the plight of the uninsured, unethical practices, and the general plunder and pelf of a corporatized health care system.

I recognize that when it comes to health care the United States has a particularly difficult set of circumstances. As you state yourself, American politicians and "thoughtleaders" have not been willing or able to offer solutions that would bring real change. But it is not my intention to launch a political critique of the American system. There is plenty to criticize in my own country. I simply maintain that universal, sustainable, not-for-profit health care, however infinitely debatable its successes and failures, is a workable solution with measurable outcomes. (For a good example of what I mean, see the much-praised but regrettably neglected Romanow Report of 2002, Building on values: the future of health care in Canada.) Yet such a notion beyond liberal, even "socialist" in the view of many is incompatible with and cannot even be easily articulated within the specific form of discourse around health that is dominant in the United States and growing in strength on this side of the border (see my discussion of the latest salvo from the Canadian Medical Association).

Would you not agree, my dear michael, that it is a sign of just how bad things are when even the modest proposal that everyone has a right to decent health care brings on howls of righteous indignation and mindless red-baiting? What is all the commotion about? Only extremists could argue against the equitable provision of health care to all, just as only extremists could endorse a global economic system that condemns billions to lives of poverty and desperation. Who are the real reds under the bed? Who are threatened with the loss of wads of money if universal health care is adopted? The peddlers of Health 2.0 and their ilk are counting on the continued survival of privatized medicine, gambling with some confidence that it's too good a show to shut down. They're itching for action.

Finally, in defence of my position I submit the agenda of the Health 2.0 Conference (San Francisco, 20 Sept. 2007), cut and pasted from the conference website itself. The presenters and panelists: almost exclusively company CEOs, COOs, VPs and Presidents. Their purpose: "to confront the decision of how to interact with ... new technologies and networks, and potentially adopt and integrate them into their strategies for growth." Translation: to figure out how to make money and then to make more money.

I submit that health for these "stakeholders" is a commodity like any other, to be packaged and sold for profit. My purpose in the blog post, aside from having a bit of fun at your expense, was to lift up a corner of the sequined curtain of Health 2.0 and expose what Ambrose Bierce described as the strife of interests masquerading as a contest of principles, and the conduct of public affairs for private advantage. I would be quite happy to see the Health 2.0 meme scratched off the parchment, now that it has been appropriated by the entrepreneurial seigneurs of the new feudalism.

Pruritically yours,


Health 2.0 User Generated Healthcare Conference Agenda

8:00-8:30 INTRO Health2.0: User-Generated Healthcare
Matthew Holt/Indu Subaiya

8:30-9:30 OPENING PANEL:
The Role of the Consumer Aggregators
Missy Krasner, Product Marketing Manager, Google
Wayne T. Gattinella, CEO, WebMD
Peter Neupert, VP Health Solutions Group, Microsoft
Bonnie Becker, Director, Health Category, Yahoo!
Moderator: Jane Sarasohn-Kahn, THINK-Health

Special Perspective from: David J. Brailer
Former National Health IT Coordinator
& Founder, Health Evolution Partners

9.30-9.40 STRETCH BREAK, Bio Break & Coffee refill

9.40-10.40 DEMO PANEL & Discussion: Search in Healthcare
Alain Rappaport, CEO, Medstory/Microsoft
Venky Harinarayan, Co-Founder, Kosmix
Tom Eng, President & Founder, Healia/Meredith
Dean Stephens, President & COO,Healthline Networks
Moderator: Jack Barrette, CEO WeGoHealth (ex-Yahoo)

10.40-11.15 NETWORKING Break with Demonstrations

11.15- 12.15 DEMO PANEL & Discussion: Social Media for Patients
Ben Heywood, CEO, Patients Like Me
Doug Hirsch, CEO, Daily Strength
Steve Krein, CEO, OrganizedWisdom
Karen Herzog, Founder, Sophia's Garden
John de Souza, CEO, MedHelp International
Brian Loew, CEO, Inspire
Moderator: Amy Tenderich, Blogger/Journalist DiabetesMine

12:15-1:00 REACTOR PANEL Payers, Providers, & Pharma….and Health2.0
Paul Wallace, Senior Advisor & Medical Director, Kaiser Permanente
Joe Gifford, Chief Medical Officer, Regence BCBS
Jeff Rideout, Managing Partner, Ziegler HealthVest Fund
Bruce Grant, SVP, Digitas Health
Ted von Glahn, Director, Performance Information and Consumer Engagement, PBGH
Moderator: Doug Goldstein, eFuturist

1:00-2:00 LUNCH with "Unconference" issue tables
& more demonstrations

2:00-3:00 DEMO PANEL & Discussion: Tools for Consumer Health
Mike Battaglia, VP Healthcare Strategy, Intuit
Marlene Beggelman, CEO, Enhanced Medical Decisions
Dave Hall, VP of Innovations, HealthEquity
Joseph Villa, COO Employer Division, Revolution Health
Ryan Phelan, CEO, DNADirect
Moderator: Scott Shreeve, CrossOver Healthcare (founder Medsphere)

3:00-3:30 NETWORKING Break with Demonstrations

3:30-4:30 DEMO PANEL & Discussion: Providers and social networks
Daniel Palestrant, CEO, Sermo
Lance Hill, CEO, Within3
Chini Krishnan, CEO, Vimo
Gale Wilson Steele, Founder/CEO, Careseek
Patricia Ball, VP Product Development Consumer Aware/BCBS Minnesota
Doug Goldstein, eFuturist & President, Medical Alliances
Moderator - Enoch Choi MD, MedHelp/PAMF

4:30- 5:30 CLOSING REACTOR PANEL: Health2.0 - Looking Ahead
Lee Shapiro, President, Allscripts
David Kibbe, American Academy of Family Physicians
Bob Katter, Senior VP, Relay Health (McKesson subsidiary)
Jay Silverstein, Chief Imagineer, Revolution Health
Steve Brown, Founder Health Hero Network, Entrepreneur in Residence, Mohr Davidow Ventures
Esther Dyson, EDventure
Moderator: Marty Tenenbaum, Commercenet

5:30- 5:45 Wrap-up - Matthew Holt/Indu Subaiya

5:45- 6:45 Wine and Cheese Networking