Soul Searching and Deep Thinking – A Socratic Moment

Posted on | September 28, 2017 | Comments Off on Soul Searching and Deep Thinking – A Socratic Moment

Mike Magee

You can say what you want about America’s current trajectory, but one thing’s for sure – there’s a lot of soul searching and deep thinking going on. Just this morning, I came across three different pieces – in The New Yorker, the New England Journal of Medicine, and the The New York Times – all deep, deep, deep!

I also came across the following quote attributed to Socrates in the April 28, 1927 issue of The Boston Medical and Surgical Journal (to become the NEJM one year later) : “Men of Athens, I have never yet studied medicine, nor sought to find a teacher among our physicians; for I have constantly avoided learning anything from the physicians, and even the appearance of having studied their art. Nevertheless I ask you to appoint me to the office of a physician, and I will endeavor to learn by experimenting on you.”

The New Yorker piece was written by Atul Gawande who cued up the question: “Is Health Care A Right?” Atul, a physician and public health expert, had traveled back to his conservative, bedrock American home of Athens, Ohio, to track down childhood friends for answers to his existential query. Here are a few of the honest revelations/biases/beliefs/insights.

From The New Yorker (Atul Gawande):

“One person’s right to health care becomes another person’s burden to pay for it.”

“Everybody has a right to access health care, but they should be contributing to the cost.”

“I am becoming more liberal. I believe that people should be judged by how they treat the least of our society.”

“A right makes no distinction between the deserving and the undeserving, and that felt perverse.”

“Here self-reliance is a totemic value.”

“The notion of health care as a right struck her as another way of undermining work and responsibility… ‘I’m old school, and I’m not really good at accepting anything I don’t work for.’ ”

“But then we talked about Medicare, which provided much of her husband’s health care and would one day provide hers. That was different. ‘We all pay in for that,’ she pointed out, ‘and we all benefit.’ … There is genuine reciprocity.”

“Medicare was less about a universal right than about a universal agreement on how much we give and how much we get.”

“…rights are as much about our duties as about our freedoms.”

“…‘basic rights’ are those which are necessary in order for us to enjoy any rights or privileges at all…. basic rights include physical security, water, shelter, and health care… the critical question may be how widely shared these benefits and costs are.”

“…everyone has certain needs that neither self-reliance nor the free market can meet… When people get very different deals on these things, the pact breaks down.”

“ ‘I think the goal should be security,’ he said of health care. ‘Not just financial security but mental security—knowing that, no matter how bad things get, this shouldn’t be what you worry about.’ ”

“We don’t worry about the Fire Department, or the police. We don’t worry about the roads we travel on. And it’s not, like, ‘Here’s the traffic lane for the ones who did well and saved money, and you poor people, you have to drive over here.’ ”

“What we agree on, broadly, is that the rules should apply to everyone.”

From the New England Journal of Medicine (Ziad Obermeyer, M.D., and Thomas H. Lee, M.D.):

“The complexity of medicine now exceeds the capacity of the human mind…”

“Every patient is now a ‘big data’ challenge…”

“The first step toward a solution is acknowledging the profound mismatch between the human mind’s abilities and medicine’s complexity.”

“If medicine wishes to stay in control of its own future, physicians will not only have to embrace algorithms, they will also have to excel at developing and evaluating them, bringing machine-learning methods into the medical domain.”

“Machine learning has already spurred innovation in fields ranging from astrophysics to ecology… but experts in the field — astrophysicists or ecologists — set the research agenda…”

“Algorithms that learn from human decisions will also learn human mistakes, such as overtesting and overdiagnosis, failing to notice people who lack access to care, undertesting those who cannot pay, and mirroring race or gender biases.”

From the New York Times (Thomas L. Friedman) :

“We’re… going from an interconnected world to an interdependent one… a world of webs where you build your wealth by having the most connections to the flow of ideas, networks, innovators and entrepreneurs.”

“… connectivity leads to prosperity and isolation leads to poverty.”

“We’re moving into a world where computers and algorithms can analyze….optimize….prophesize…customize…digitize…automatize.”

“Any company that doesn’t deploy all six elements will struggle, and this is changing every job and industry.”

From me:

I’ll spend the rest of the day considering how these three pieces inform each other.