Mythical magic munitions

By Robert Hickson 11/03/2014


There may be still a few discoveries and technologies out there, or yet to see the light of day, that will be “magic bullets” which will solve a pressing problem. As, for example, penicillin once did. In parts of Silicon Valley that hope probably still springs eternal, at least if you can develop an app from it.

Think of all the problems that would be “eliminated” if we could upload your mind to a robot, or take a pill to live longer.

But as we develop a better understanding of the complexities of our world, that seems like a mythical, more simpler place.

This is well illustrated in a poignant article in the New Yorker about children with complex life-threatening medical conditions [Subscription required to read whole article]. Jerome Groopman notes that as medicines get better in prolonging lives, there is a need to change how healthcare operates to meet the increasingly complex needs of the patients and their families.

The article describes the role that Pediatric Advanced Care Teams are now playing in helping coordinate healthcare for a patient, but also the way in which they help the family better navigate the health and social systems and assist the family in making difficult decisions about treatments.

The last point is the most important. It’s not just about coordinating and wrapping around services, but enabling the patient or family to have some control and choice. In many cases there isn’t a simple linear path from surgery/medicines to a fully healthy life.

Just providing more health-care robots and simple brain fitness apps won’t be enough to handle the potential senile tsunamis many developed countries may face as their post-retirement populations metastasize.

The bringing together of multidisciplinary teams of broader groups of interested parties to solve problems is becoming more common outside of medicine too. We are starting to see examples in water (or other resource) allocation, in some areas of social services, and energy supply. We’ll need many more of them.

They can appear slow, chaotic (at times), and the benefits can be slow to appear. Not a situation that sells itself to impatient policy makers of technocrats. But as the New Yorker article notes, the new approach can not only improve the quality of life of the patients and their families, but also provide big savings to the healthcare system by reducing readmissions and ineffective surgery or other treatments.

Deloitte is promoting a similar approach to government in their “GovCloud” report on the future of government work. Once many bureaucratic processes are automated you can, in Deloitte’s view, radically cut back the public service and have diverse teams of creative bureaucrats coalesce around particular policy problems, provide a solution, dissolve and reform into new teams for the next problem.

This is being done, at a small scale at least, in some places. Notably the UK’s “nudge” unit. [I don’t think nudging is a panacea, and much still needs to be done to demonstrate long term effectiveness. Paul Walker earlier this week at The Dismal Science blog linked to a libertarian critique  about nudging]

While aspects of Deloitte’s proposal appeal, I can see it going badly wrong if you just bring in a bunch of general policy wonks and consultants who have little understanding of the particular issue, propose a simplistic solution, and then move on without any accountability. We’ve all seen that before.

But the notion that we need to approach issues and problems differently now is critical. Magical thinking shouldn’t continue when we don’t have magic bullets anymore.