Future Shock and Medicine

Future shock…the shattering stress and disorientation that we induce in individuals by subjecting them to too much change in too short a time.

Alvin Toffler (1928-2016),  Future Shock (1970)

Alvin Toffler, the futurists’ futurist,  has died in Los Angeles at age 87

In a trilogy of books – Future Shock (1970), The Third Wave (1980), and PowerShift (1990), Toffler described the transition from the industrial age to the information age in these terms

“ The Second Wave Society is understood and based on mass production,  mass distribution, mass consumption, mass entertainments, and weapons of mass destruction.  You combine these things with standardization, centralization, concentration, and synchronization, and you wind up a style of organizations we all call bureaucracy.”

This is  precisely what is occurring  medicine and the health reform.   The forces of managed care in the form of HMOs, PPOs, and integrated large organizations and of government, as exemplified by ObamaCare have sought to standardize, centralize, concentrate, and synchronize health care  into organizational and  governmental bureaucracies.  To a large extent, these forces have succeeded.

Toffler predicted these changes:

·         Cloning

·         The influence of personal computers

·         The coming  of the Internet

·         Cable television

·         Telecommunication

·         Interactive medial

·         Online chat rooms

·         Virtual reality

·         The shift of mass manufacturing and marketing to a computerized information society

Along the way,  Toffler coined these phrases  “A roaring current of change, “information overload,” “confusional breakdown,” “the information age.”

And he predicted displacement of workers who did not have the time or inclination to learn the skills of the information age,

“The illiterate of the 21^st century will not be those who cannot read, but those who cannot unlearn, and relearn."

“Our technological powers will increase, but the side effects and potential hazards will accelerate.”

“One of the definitions of sanity is the ability to tell real from unreal.  Soon we’ll need a new definition.’

Toffler was on target. The information age  has accelerated change,  we are overloaded with Internet information, millions of workers  have been displaced and replaced by the computer,  many of these workers have been unable to unlearn the old way and to relearn the new ways,  the side effects and hazards are becoming evident, and virtual reality has arrived

Changes are medicine include:   consolidation and absorption of individual  patients  and physicians into large organizations;  the transition from fee-for-service payment based on clinical judgment  to  “value” payment based on data;  the decline of private practice;  the electronic revolution with its reliance on data rather than clinical judgment;  and physicians’ rush to become hospital employment for economic security or do cash only practices to escape 3^rd party mandates and restrictions.

Toffler foresaw  “information confusion” and “information overload.”  He did not foresee how  these factors will play out.    Will an overreaching global  bureaucracy, i.e., the establishment,  call the shots?  Or will those advocating national and individual sovereignty and liberty, emerge as victors?   The European Union,   Brexit, Clinton, or Trump?