Friday, September 10, 2010

Health Care Innovation: No Miracles Among Friends

These days I find myself looking more at the spiritual and humanistic side of medicine than the technological. This could be maturity. It could be because I have a son, a nationally known poet, who is about to be ordained as an Episcopalian priest.

Or it could be because one of my favorite books is No Miracles Among Friends, a 1959 book by Sir Heneage Ogilvie, an English surgeon who organized an international surgical group called the Surgical Travellers. The group’s motto was “No miracles among friends. “

In his book, Sir Ogilvie tells the story of St. Peter and St. Paul who arrived at an inn in Jerusalem, weary and footsore. After wine and a meal, they disputed who should pay the bill. Peter suggested throwing dice to settle the argument. Paul fetched the dice, shook the box, and threw a four and a five. Peter shook, and threw two sevens. Paul gave him a long look, and said, ”Peter, old man, no miracles among friends, please.”

We live in an age of expectations of miraculous health reform, of Internet –based information technological miracles, of belief in stem cells as a cure all for chronic diseases. Enthusiastic advocates of these things expect somehow to throw two sevens, but personally I do not anticipate any miraculous transformations – any dramatic health care reforms, any IT Holy Grails, any immediate stem cell breakthroughs. These are evolutionary not revolutionary concepts, they are worth working on, but they will take time and human acceptance or resistance.

We live in a high tech/high touch world, and as human beings, we expect both. We want more scientific progress, but at the same time, we want more human warmth. Our response to high tech is a more personal value system to compensate for the impersonal nature of technology.

We expect health reforms, but reforms that do not disrupt our current health plans and do not cost us too much or deviate too much from our current routines. We welcome instantaneous and immediate electronic communications with access to the latest medical information, but not at the cost of privacy, economic security, intrusions into our personal habits, or changes of our culture. We want and expect stem cell research and other genomic developments to cure degenerative diseases and personalize individual care, but not through the wholesale use of human embryos or at the price of perverse genetic engineering that turn normal human reproductive processes and relationships upside down.

My own attitudes towards these seemingly profound, and potentially revolutionary innovations are these. Listen to the markets, listen to the people, listen to the voters. They will vote with their pocketbooks, they will embrace technologies that benefit them, and they will resist changes that offend them.

I close with a quote from John Naisbitt, author of Mind Set! and a believer that with the human species , almost all change is evolutionary not revolutionary and that all things take time – almost always more time than we expect.

“Do not underestimate people. When they resist change – change you think they ought to readily embrace – you have either failed to make benefits transparent or there are good reasons to resist. In that case, instead of lamenting the resistance, look for their reasons for resisting.”

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