Losing our brains with disruptive technologies (XXII): Curing the healers?
Today´s post is about establishing the essence of the bottom-line medical profession dilemma when it comes to disruptive technologies applied to the “CURE” activities. Regardless if we are constantly sick, we keep a health impairment for life, we deliver babies in a medical institution or if by destiny we are harmed by accident; at one point or another we will end up visiting a doctor or a hospital. In addition, as individuals, the “cure” activities squeeze a significant part of our average salary.
Let´s start:
What is the meaning of cure? The word cure means to restore health, recovery of any disease. It is also defined as a process, a method or course of medical treatment utilized to restore health. In general, the verb cure is used when we proceed to do something that relieves a harmful or disturbing condition or situation. Synonyms of this linguistic word “care” are to heal, to care, to remedy. To set right and recover from an undesirable or unhealthy status.
Cure Activities observed through a new pair of lenses. A close-up piece of watercolor “Le petite fille verte”. Eleonora Escalante 2020.
The health professions signify an important part of social life. Those who are related to the word “cure” are linked to the health industry. Beyond the M.D. doctors, there are other areas (economic sectors and sub-industries of the healthcare industry) outstanding. All are connected in between in global value chains. Some of these participants are pharmaceutical manufacturing companies, pharma retailers, medical research organizations, health-care information technology providers, medical providers as hospitals and clinics, health-care payers, healthcare delivery systems, university medical research centers, etc. Drug companies are among the top corporate giants which drive the whole industry; meanwhile, hospitals, doctors, nurses, elders and children medical care and medical insurance take a significant part in it.
The medical profession dilemma. Today I will use some of the premises of Professor R. T. de George when it comes to explaining the key issue that is driving nuts the healthcare industry when it comes to disruption technologies. Professor T. de George wrote about professionalism and the profession’s dilemma in the 90s. This paradigm is now more distinguished than ever. If you wish to read about this dilemma in detail, please do it on chapter 17 pages 454 to 470 at his book “Business Ethics”, 4th edition. What I will do is apply the rationale from Professor T. de George to the health-care industry disrupted by the new innovations in matters of nanotechnology, robotics, artificial intelligence, quantum processing and the Internet (NAIQI technologies as I have baptized the combo of them for the purpose of this saga).
A historic background. The field of curing was always in the hands of “physicians curadores” or physicians who learned by practice. Physicians in the past were kind of the witch-doctors, (called “curador” in Spanish) or the shamanistic healers who practiced the art of botanical magic to cure the sick. Independently of the culture or society, “A witch-doctor had arcane knowledge, he controlled access to that knowledge and initiated his successor(s) or pupils to his role”. The magician-doctor performed an important service to his society, he commanded respect, fame, and prestige. The doctor was a designated profession appreciated by society.
“The Anatomy Lesson of Dr. Nicolaes Tulp” is an 1632 oil painting on canvas by Rembrandt. It is housed in the Mauritshuis museum in The Hague, the Netherlands.
With time we have evolved to become “modern societies” with specialization obliged. As time passed by, the role of the witch-doctor evolved from the kind of sorcery expertise healing to the formal classroom. In order to be a doctor, a general degree at the university and several years of merit work with specialization practice were required. After WWI, M.D. Practitioners have segmented themselves in different groups of specialties professions dedicated to curing each body part separately. By now, in the United States there exist 24 different groups of specialty physicians, under the umbrella of the American Board of Medical Specialties (ABMS). That is why the USA has ended with the following American Boards:
- American Board of Dermatology
- American Board of Obstetrics and Gynecology
- American Board of Ophthalmology
- American Board of Otolaryngology-Head and Neck Surgery
- American Board of Orthopaedics Surgery
- American Board of Pediatrics
- American Board of Psychiatry and Neurology
- American Board of Radiology
- American Board of Urology
- American Board of Internal Medicine
- American Board of Pathology
- American Board of Surgery
- American Board of Neurological Surgery
- American Board of Anesthesiology
- American Board of Plastic Surgery
- American Board of Physical Medicine and Rehabilitation
- American Board of Colon and Rectal Surgery
- American Board of Preventive Medicine
- American Board of Family Medicine
- American Board of Allergy and Immunology
- American Board of Nuclear Medicine
- American Board of Thoracic Surgery
- American Board of Emergency Medicine
- And the last one, operating since 1991, the American Board of Medical Genetics and Genomics
The descriptions of the specialty member boards and their 87 subspecialty areas are described in the link below. Each of these areas is considered a profession. Click here: https://www.abms.org/media/257905/abms-guide-to-medical-specialties-2020.pdf.
Why did I decide to share the list of the medical professions segmented by American Boards? Let´s discover it.
In the contemporary world, one of the top paradigms of the professions is the medical profession. A profession is more than an occupation. The doctor, from ancient times to the present, has performed a needed service for the society. As mentioned previously, the M.D. has controlled and had access to specialized knowledge and has been given a status, prestige, and recognition by society. Nevertheless, with time, the “medical professions”, ultimately are also seeking for wealth beyond the recognition to cure. The “magic to cure” is not enough anymore. Physicians have joined different efforts to make a living, and one of them is the medical and digital technologies applied to the healthcare industry.
According to Deloitte, the Global Health Care spending will reach more than USD $ 10 trillion by 2022
The pharmaceutical industry. After the First World War, the advent of antibiotics triggered a colossal pharmaceuticals’ new industry. The pharma industry which was a disruptive technology for that epoch, supported by the miracles of the penicillin; endeavored a new mental framework for doctors. With the art of chemistry, manufactured drugs emerged. Doctors shifted to rely on their traditional natural remedies to total faith in the pharmaceutical new technologies and products. Everything started to be cured through man-made drugs offered in injections, pills, etc. Suddenly it was big business to create and produce massive amounts of medicines for each disease, and chemistry researchers/engineers were required and flourishing at its best.
The botanical remedies or bio-medicine used by the traditional “old fashion” doctors were disrupted at its roots and 6,000 thousand years of knowledge were thrown to the wastebasket. The miracles of the pharmaceutical emerging industry disrupted the past wisdom from the traditional doctors, and many natural botanical remedies were dismissed. More than 6,000 years of natural medicine were considered “old fashion”, expensive, slow, not enough, not effective and not practical. Our physicians substituted the old wisdom of botanical herbs and food nutrition healing, with the new pharmaceutical products. The “profession that traditionally carried prestige, respect, social status and autonomy” started to lean on the pharmaceutical giants’ movers and shakers of the industry.
Physicians’ minds also shifted. Doctors extensive years of education at the university and the connection between the pharmaceutical industry and the healthcare decision making were established during the last 75 years. Doctors have been regarded as well-paid occupations in developed nations. In addition, doctors were educated to cure diseases, but not to prevent them by using integrative food as medicine. Hand by hand with pharmaceuticals and more recently with medical technology companies, physicians decided to use the ample great autonomy of their professions, to try and test whatever new technology and drug available has come into the horizon. Doctors as a profession, have always had an infinite territory to test new stuff for the sake of curing. The urgency to find new solutions to heal the sick was also driven by the pharma companies’ interests. Today, new technology solutions are a new trend in the healthcare sector. Mckinsey has shared a market map of the tech applications.
The Medical Industry pioneers of each specialty are always tempted to use disruptive technologies. But where are the boundaries and professional ethical codes? It is not a surprise that the health-care industry wishes to use the ample range of its autonomy profession to try and test the emerging NAIQI technologies, particularly in the genetics and genomics fields, when it comes to diseases. But also, disruptive technologies have a spot in each substantial component of the healthcare value chain. Be aware that the health-care industry is now segmented in several economic sectors, which are robust too.
This graph shows the different players in the global healthcare profit pool. Source: Bain Analysis.
- The medical professions´ interests, traditionally set by each AMBS, are now blurry and affected by the rest of the healthcare players. The physicians are not leading the “cure” baton alone as when they were the witch-doctors of XIX century: There are strong pharma, delivery, insurance, and now tech new players involved. The emergence of other participants and related, Healthcare Payers, Medical Insurance, pharma, and Delivery Systems are and will continue putting pressure on American Boards of Physicians. The American Boards created for doctors and hospitals, are now obliged to consider these new players’ economic´ interests too? Which of these new players is driving the healthcare industry? Do you think the leaders of the healthcare industry are ONLY the Medical Boards of Specialties? or the new venture capitalists (with zero medical background) which have invested in health-care through private equity deals massively since the last financial crisis during the Obama administration? Who is behind the physicians ruling their decision-making activities when it comes to disruptive tech?
- Doctors as members of a profession board have enjoyed autonomy. As an instance, in the USA, members of AMBS professions (each of the AMBS listed) set their own standards, regulate entry into the profession, discipline their own members and function with fewer restraints than other professions. Physicians or Medical professions at each Board of Specialty have autonomy: they set their own tasks, are not closely supervised and do not punch time clocks. In return for such expanded autonomy, however, they properly are expected to serve the public good with no schedules, to set higher standards of conduct for their members than those required of other professions, and to enforce a higher discipline on themselves than others do.
- The trade-off granted by society to the medical profession is that it imposes less social control to them, on the condition that the profession will be self-regulating and self-disciplinary. The standards, to which each member of a profession is to hold themselves, are usually expressed in professional codes, most often called ethical codes of conduct, promulgated and enforced by each board organization. What happens when the ethical professional code of physicians doesn´t rule the whole industry or the rest of the new “kids on the block” players? What happens when clinical tests acceleration is forced for the sake of “making money” despite the efforts of each AMBS board to keep them with high standards? What happens when the combo of NAIQI technologies are not covered by the ethical code of the medical profession? This is the crucial reason why we are here writing this saga. This core dilemma is the essence of the outstanding issues related to the utilization of disruptive technologies in the health care industry.
Now let´s see what occurs when we apply this background to analyze the current coronavirus global plague.
To be continued…
Sources of reference utilized to write this article:
https://www.abms.org/about-abms/
Disclaimer: Illustrations in Watercolor are painted by Eleonora Escalante. Other types of illustrations or videos (which are not mine) are used for educational purposes ONLY. Nevertheless, the majority of the pictures, images or videos shown on this blog are not mine. I do not own any of the lovely photos or images posted unless otherwise stated.
Thank you for reading to me.
Eleonora Escalante Strategy 