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Contextual Health vs The Elephant in the Hospital

This article is more than 10 years old.

NOTE: I am writing a book with Robert Scoble called Age of Context. I have been posting a good number of excerpts. We thought it might be a good idea to post an entire sample chapter to give people a full sense of what the whole book will be like in October when we will publish it.



In Michael Crichton’s 1972 novel Terminal Man, the central character commits violent acts during blackouts. To cure him, a medical team inserts electrodes into his brain, wiring them to an atomic-powered computer attached to his shoulder.

Of course, the experiment runs amok. The patient escapes and goes on a killing rampage.

It’s a Crichton formula that runs through several books such as Jurassic Park and The Andromeda Strain. Well-intentioned scientists invent something to make a better world. It runs out of control: people die. The theme goes all the way back to Shelley’s Frankenstein.

Sometimes reality turns out to be less freaky than what people feared. Crichton’s vision of electrodes, wires and nuclear-powered strap-on devices has evolved into tiny sensors, communicating by Wifi to mobile devices, or even running on electricity produced by the body.

They don’t incite people to become homicidal maniacs. Instead they help people become healthier and fitter. Even though this new era of contextual health has just begun, millions of people are already enjoying its benefits.

While all five forces play a role in contextual health, sensors enjoy a starring role. They are doing everything from helping people lose weight to arming doctors in the fight against cancer.

This is all new. We could find no data on the size of the health sensor market in 2008 yet, projections are that by 2017 health sensors will be a $5.6 billion market. It will be well worth it many times over in terms of lives improved and saved.

Sensors will reduce emergency room visits, many invasive diagnostic tests will become unnecessary, and some terminal diseases may be stopped before they claim their victims.  Sensors will provide people with greater knowledge of their own bodies than ever imaginable and the data can be shared with medical caregivers who are willing to become unstuck from their old ways.

Sensors on Pills

Proteus Digital Health is one of several pioneers in sensor-based health technology. It is an early-phase company based in Redwood City, California. They make a silicon chip the size of a grain of sand, which is embedded into an easily digested pill and swallowed.

When the chip mixes with stomach acids, the processor gets powered by the body’s electricity and data to a patch worn on the skin. The patch transmits data via Bluetooth to a mobile app, and then transmits data to a central database where a health technician can determine if a patient his taken her medications.

This is a bigger deal than you may think. In 2012, it was estimated that people not taking prescribed medications cost $258 billion in emergency room expenses. An average of 130,000 Americans die each year because they don’t follow their prescriptions closely enough.

Currently, most doctors simply ask patients if they are taking their meds as directed. The problem is that patients sometimes get confused and often lie.  One doctor told us not only do patients forget to take their pills, but to cover up their forgetfulness, they throw them out, so that pharmacists can’t tell there are lapses based on reorder rates.

The Proteus solution gives doctors realtime irrefutable data on when pills are taken or skipped. In April 2012, the FDA approved placebo testing. Barring surprises, sensor-pills will come to market in 2015 or 2016.

The sensor-pills also measure heart rate and physical activity, reporting key data to healthcare givers as well as tracking adherence to medication regimens.

Proteus CEO Andrew Thompson says the system has far greater potential. It was successfully tested  for tracking tuberculosis, mental health, heart failure, hypertension, and diabetes.

Currently, Proteus is the only company to receive FDA approval for sensor-pills. Other pioneering contextual health companies are working on tiny ingestible devices that could eliminate the sort of tests we hate, such as colonoscopies and prostate examinations.

This is heartening. In our years of following leading-edge technology, health has consistently lagged behind most other sectors. Something has changed. While the institutional healthcare industry continues to move like a Luddite with a limp, there is a bottom-up movement changing things exponentially. Contextual entrepreneurs rather than Washington-based policy makers drive it.

But progress remains uneven. The health category is divided into two areas:

[1] Fitness and Prevention—In this area we found an increasing amount of activity spearheaded mostly by sensors and data.

[2] Healthcare and Treatment—This is the purview of healthcare providers, insurance carriers and government regulators who enforce HIPPA. Here we see reason for hope—but also formidable barriers.

Wearable for Health

Our opening chapter on Google Glass and digital eyewear makes clear how important we believe such devices will be. But there are only a few thousands devices being used today and few of them are being used for health-related applications.

But there are other wearable devices and millions of them are helping people be fitter. In fact, health is the largest of all wearable applications today.

Fitbit™ and Nike+ Fuelband™ are among the most popular.

FitBit calls its $99 clip-on device ‘the One™,’ but most everyone else just calls it FitBit. It measures movement, distance, calories and sleep cycles.

It is also a motivational tool; it helps you set goals by sending you cheery little congratulatory messages when you reach milestones. Men complain because it’s easy to lose. Women prefer them because it’s easy to clip on to a bra strap where, we are told, it is virtually invisible through clothing.

Nike+ Fuelband costs about $150 and is worn on the wrist. It is a flagship for Nike’s growing family of sensor-enabled products branded by the +.  Other + offerings include running shoes that tell you when to replace them and basketball shoes that record how high you jumped, dunked or tried to.

All + products talk with Fuelband which creates a personal health private network.

We think Fuelband is a particularly attractive device with an elegant Applesque design. It contains an accelerometer and tracks exercise, calories, walking etc. Some people question how accurate it is as a pedometer because it measures arm instead of leg motion.

It can be worn in the shower but not in a pool, just like Google Glass, as Scoble so famously demonstrated. The only criticism we heard was that there is no warning before the battery dies, an easy fix.

Users praised the Nike+ site analytics as simple and easy to understand. This is an important factor. Many of the new devices are heavy on analytics, but for everyday users who just want to track essential exercise data, less may be best.

Nike says its + family of sensor-enabled gear had six million users in May 2013. It is backed by the athletic gear company’s strong marketing campaign.

Quantified Self

The very high end of these health-related wearable devices is the $250 Basis™.  Designed for “wellness and fitness,” it looks like a digital watch, one that Bill Gieser, our digital watch fashion maven, would probably like. Basis even tells time, but with five sensors inside, it does a lot more: measuring pulse, perspiration rate, activity and body temperature as well as sleep quality.

It provides enough data to satisfy an astrophysicist. The site lets users drill deep into personal data mines of stats, charts and graphs.

Basis is a particular favorite of a growing movement called The Quantified Self, comprised of people who believe the more data they have, the better they can understand their own bodies and thus stay healthier.

They track and graph their behavior, exercise, location, biology, genes, and anything else that interests them, in the belief that the more they understand, the more they can adjust their fitness habits.

Many Quantified Selfers are serious athletes such as Olympic trainers, triathletes, professional performers and competition runners.

Some believe they can ultimately reach a point where they just won’t need a doctor.

Loic Le Meur, producer of LeWeb, Europe’s largest tech conference, is an ardent fitness enthusiast and Quantified Self proponent. In August 2010, he suggested in a blog post that, as people and mobile devices work together to provide highly personalized data, the human body itself becomes an Application Programming Interface [API], meaning that developers are now offering personalized mobile apps for each individual by letting their computer codes talk with each other.

From that perspective, perhaps we are becoming Terminal Men, but the picture looks far more positive than Crichton painted it.

As Le Meur demonstrated in his blog, Quantified Self data can build a personal anticipatory system. You can see patterns in your exercise and diet. You can detect correlations between the two, plus sleep and understand when you get sick or have just experienced an off-pace run.

Le Meur studied his personal patterns. He got stouter and leaner at about the same time each year. By seeing it, he understood how to break the patterns and perform better.

We don’t know if the day will actually come when people don’t need doctors, but we do know this: the day has already come when there are devices that will help you stay healthier and fitter.

The more that happens, the less burden there will be on the American healthcare system.

Social Fitness Networks

Wearable devices, sensors and data are weapons in a holistic war that must be fought on multiple fronts, including the workplace and home, in children, the aging and the chronically ill.

All contextual forces are of course involved. But so is Andreessen’s free ice cream in the guise of competition, gamification, rewards, or plain old-fashioned bribes.

Endomondo Sports Tracker uses your phone as a wearable device. It employs social networking and competition to make users fitter.

You strap your phone onto your upper arm during workouts, races, kayaking, cycling and other strenuous sports. It automatically uploads your personal data to its online community site, which analyzes your results and progress.  You can add music, route maps and heart rate monitors.

It also allows you to create a social network of your friends, or you can join others who share your activity interests. Participants compete or encourage each other as they see fit.

Founded in 2007, Endomondo reports it has a total of 12 million users and touts itself as the first Social Fitness Network.  Users we talked with on Facebook and Twitter expressed love and loyalty to it, sometimes calling it a ‘life-changer.’

But Endomondo is for play. Employee fitness and health is a serious business issue and there are apps to address that as well.

Adam Bosworth’s Keas is an early-phase company based in San Francisco. He describes it as a fitness social network that helps employers motivate workers to get healthier.

Prior to Keas, Bosworth, a respected industry veteran, started and ran Google Health, an ill-fated attempt to aggregate, store and make available all medical records via a secure cloud storage system.

While he was at Google, Bosworth had to deal with some family healthcare issues. “I learned that just giving people access to their health information wasn’t enough to change behavior,” he said.

To help people develop better health habits, he founded Keas in 2008. It provides a motivational fitness system for employees of large organizations such as Microsoft. While Keas sell its service to HR departments, it uses word-of-mouth grassroots techniques to spur adoption, rather than the traditional corporate memo.

Keas recruits a few employee evangelists, who tell a few friends, who then reach out to other peers until eventually it goes across the entire enterprise.

Bosworth said the Keas system is comprised of four elements: inspiration, motivation, information and—most important—team competition.

Employees form groups of six members or less. They challenge other teams and then compete for points. The employers award winning players with modest prizes, perhaps cash, a day off or a free dinner.

Players earn points by reaching health-related milestones: weight loss, exercise a certain number of times or distances run. So, being the fittest is not necessarily the most important asset. It’s at least equally valuable to just meet your personal improvement milestones.

Not only do employees get motivated through competition, they also understand that teammates count on each other to reap award benefits.

After five years of trial and error, Bosworth says, he has three key lessons learned:

Be positive and simple. Tell an employee how much weight she’s lost, not how many pounds overweight she is. Keep the data simple, so that anyone can understand it.

Six is optimal. Bosworth doesn’t know why, but trial and error has made six the perfect team size.

Social pressure matters. Keas data is shared in an internal social network that is culturally strong on competition. The pressure on individuals focuses less on meeting personal goals so much as contributing to a team effort.

There is one more aspect: You can’t cheat.  Patients may lie about drugs to their doctors, but you cannot lie to your coworkers about the weight you’ve lost: they can see the results for themselves.

Keas has effectively created what is known as a serious game—one designed to achieve a real purpose rather than just to entertain. There are many serious games being played based on contextual technologies, many of them in health-related areas.

Bribes, lies and diabetes

There are about 25 million people with diabetes and more than twice that number have what doctors call pre-diabetic conditions.

The costs in healthcare and life each year are incalculable because both diseases contribute to so many other terminal afflictions such as heart disease, blindness, amputations and organ failures.

It is particularly cruel to children.

While institutional approaches have not changed much in recent years, a good deal is happening on the front lines, where doctors, parents and patients use contextual technologies to help kids fight the disease more effectively.

Dr. Jennifer Dyer, a child endocrinologist in Columbus, Ohio revealed the key to her successful practice:

“Bribes,” she told us.

She doesn’t take them; she gives them to teen-aged diabetic patients. She uses incentives to motivate adolescents while simultaneously providing them with  a mobile app she developed that aggregates data that can help her provide better treatments.

She had been working on her system for five years when we spoke with her in April 2013. After much tweaking, she had started  achieving consistently high success levels. What she does in her practice, she believes is replicable through a reward-based mobile app. Like Keas she has incorporated serious game as a system component.

Called EndoGoal, it was expected to be available in summer 2013.

A teen participating in Endogoal earns points every time he confirms on the app that he took his meds, ate right or exercised. The app features a cute virtual pet dog— Cooper-- who receives a treat whenever the patient takes appropriate action--but whines when he doesn’t.

Reaching milestones leads to real-life rewards in the form of an iTunes song, prepaid visa cards, or retail gift certificates. Local stores can contribute incentive rewards.

“EndoGoal is really just a social business model. It works just like a Girl Scout Cookies drive. Instead of getting a prize for selling cookies, EndoGoal rewards patients for checking blood.”

As a doctor, Dyer personalizes the rewards in her private practice when she can. “If I find out a patient likes bowling, I take the time to learn about bowling and try to arrange for a related reward.”

In return, she gets data that helps her customize each kid’s program.

Like patients who lie about taking pills, hers can be deceptive—but kids these days also know how to be duplicitous with tech. Many of her teen patients know how to hack a glucose meter to make it look like their blood sugar levels are consistent and healthy when they are not.

So, Dyer keeps an eye out for corroborating evidence.  If the meter says that a patient had perfect and consistent glucose measurement scores every day for a month, but the scale says she lost five pounds in that same period, the evidence would imply there was an eating disorder that had been covered up by hacking the meter.

Endogoal, Dyer said, makes it easy for a doctor to catch such deceptions and thus offer a chance of helping the patient. The app lets doctors anticipate the patient’s direction and doctors will be able to adjust treatment accordingly.

A parent’s best helper

Not all doctors are as tech-aware as Dyer, who seems to understand how contextual technologies can help patients run on ahead even if the health industry stands still.

There are also parents who understand how to take the lead—while doctors remain set in their old ways. Instead of the formerly all-knowing doctor, Vivienne Ming’s best friend for her son is data-driven technology.

She is not your typical parent when it comes to understanding technology’s new capacities. A neuroscientist, with a PhD from Carnegie Mellon University and a visiting scholar at University of California, Berkeley Ming is chief scientist at Gild, a San Francisco big data company that helps recruit tech sector talent. She was among the first Glass wearers.

Both Ming and her partner are big data experts. Ming’s work has previously involved modeling the human brain.

When their son, Felix showed symptoms of child onset diabetes, they did what they knew best: they started collecting every bit of data they could on Felix’s eating, exercise and behavior.

The two also researched the most advanced technology for managing the disease. They opted for a wireless Omnipod Insulin Pump that would work with a wireless Dexcom 4 continuous glucose monitoring system. The system, Ming said, is ten times more precise than a standard measuring and dosing system, which automatically adjusts to changes in blood sugar levels.

They also purchased a Basis watch, which they strapped around Felix’s ankle: his wrists are too small.  That provided them with even more data.

When the time came, they gathered up their small data mountain and went to the endocrinologist’s office.

“At the appropriate time, we showed the doctor and nurse all the data we had gathered, the data that told Felix’s story. They refused to take it from us. Instead, they gave us a paper form containing blanks for hand entering just three numbers every day.” She recalled.

“They wanted us to record those numbers for one random week, over the three-month period between visits  and then enter those numbers into the printed form. When we did, they leaned over the sheet, squinting at the numbers for a while, then handed it back to us.”

Ming insisted that these were capable practitioners. “This is what they do. They just don’t know how to handle extra data.”

So the parents complied for the practitioner’s satisfaction. Meanwhile, the couple has developed their own app for recording far more comprehensive data. It has proved helpful.

For example, they discovered that Felix’s blood sugar spiked each school day morning, but not on weekends. The Basis revealed a simultaneous reading via Galvanic skin response, indicating anxiety.

Kindergarten was making little Felix nervous.

Anxiety causes adrenaline to spike, which in turn, elevates glucose. A simple insulin adjustment solved the problem—one that the doctor, just looking at numerical averages, would never be able to catch.

Ming simply created a small anticipatory system that toggled insulin doses up on school days but not on weekends.

How big of a deal is this for Felix? It’s life changing, according to Ming. Elevated or lowered blood sugar levels cause children to misbehave in school. If it is high, a child’s behavior can be wrongly diagnosed as indicating ADD; if it is low, teachers can mistakenly assume the child is suffering from depression.

“Our little predictive app allows our son to have a normal life. He can play with other kids, do chores, and take a few piano lessons. He can have really normal kid experiences. This would not have been possible without our little app,” Ming told us.

Ming shared her experience in a talk at a Woman 2.0 conference in early 2013. Afterward, an attendee approached her saying she was starting a company to create similar predictive systems to manage a blood-clotting disorder. She asked Ming to join the board.

“The point is that technology is being under-utilized in healthcare. So many people’s lives are being wasted because they have uncontrolled diseases that could be controlled with available contextual technologies,” she told us.

Breathing in Place

Like diabetes, there are about 25 million Americans who suffer from asthma, a chronic disease that inflames and narrows the airways causing wheezing, shortness of breath, and coughing. Also, like diabetes, about one in four people with the disease is a child who very often suffers more than an adult.

Asthma takes the lives of about nine people in the United States every day and accounts for one-fourth of all emergency room visits. The cost of treating each asthma patient is about $3,000 annually—about $50 billion. Improved asthma control would measurably reduce the cost of medical visits.

Causes of these painful, and occasionally terminal wheezing attacks are most often airborne factors such as pollen and pollution. For decades, treatment has involved inhalers and allergy shots—lots of them.

But now, a Wisconsin-based, early phase company has started taking a contextual approach to fighting asthma. Instead of just looking at what was in the air, it is looking at what’s on the ground.

It is using location-based data to alter asthma sufferer patterns, thus preventing attacks and reducing both medication needs and emergency room visits.

Of course, sensors, data, and mobile technologies are involved. The way it works is that a little cap-like device containing a GPS sensor snaps on to the top of the inhaling devices that asthmatics carry.

When an attack comes, and the patient uses the inhaler, the device records time and place, then transmits the data to a website where physicians and public health officials share access.

Data is collected from all users in an area and aggregated to reveal usage patterns and to identify geographic asthma hot points.

That provides a very simple solution: avoid the place and you avoid an asthma attack.

An example of how simple the solution can be is the case of a group of asthmatic children at a particular New York City school who participated in an Asthmapolis beta test.

The data revealed that kids seemed to use inhalants at the same place en route to and from school each day. It turned out they were passing a refinery where air pollution was high. By rerouting the kids a single block, they no longer needed to take two doses on every school day.

Asthmapolis provides an unprecedented and inexpensive hope of bringing relief where nothing new has happened for generations.

Public Health officials in Louisville Kentucky, a city with higher-than-average air pollution, partnered with IBM’s Smarter Cities and Asthmapolis to create a test project.  The city distributed 500 Asthmapolis sensors to patients. Then it collected data to pinpoint previously undetected asthmatic hotspots.

Louisville could then inform local people with respiratory issues of places to avoid, thus reducing suffering and public health costs.

How does this impact the lives of 25 million people afflicted with the disease? We talked with just one.

Whitney Zatzkin, a member of the TedMed Conference production team has had asthma since she was a child. She is an early Asthmapolis beta user. “It helped me be a better patient,” she told us. The geographic information let her use medications more wisely and perhaps see doctors less frequently.

Places for Heart Attacks

Asthmapolis is part of a nascent—but growing—approach to health solutions: geomedicine, which looks for a correlation between geography and health.

It is spearheaded by Bill Davenhall, global manager for health and human services at ESRI, a leader in geographic information systems. He grew curious about the relationship between health and location after he suffered a “surprise heart attack.”

It turned out that Davenhall had unwittingly resided all his life in places where environmental factors were known to increase heart attack. Despite the apparent connection, no doctor ever asked him a single question about where he had lived.

There are tons of data that link location with such afflictions as heart disease, cancer, respiratory disorder, diabetes, and other lesser ailments, yet the medical establishment has historically ignored location as a medical factor.

Geomedicine is a form of contextual medicine. From location-based technologies, doctors can predict what diseases you are likely to face down the line.

Geo medical practitioners can personalize their medical advice, pointing out adjustments you can make based on where you have lived.

A few examples:

  • If you lived in the mountains where ozone layers are thin, cancer is an enhanced threat;
  • Near polluted rivers? Watch out for internal disorders.
  • Coal mines? Then you face a higher than average likelihood of emphysema.

Wearables for Seniors

Wearable Technologies magazine, our favorite resource for finding such technologies, has also reported on numerous wearable health-related products targeted to the growing number of senior citizens who use wearable devices to maintain independence.

A common feature of all these devices  is extreme ease of use, as some seniors have never become comfortable with personal technology and others suffer from cognitive diseases such as Alzheimer’s, which causes confusion.

Among the devices that impressed us was the Vega Everon™ bracelet that uses GPS sensors to set up a ‘safe zone’ so that people with cognitive disorders can walk freely on their own. It also alerts the service if a patient wanders out of the zone.

Likewise, Tunstall is a home patient tracking device, with a base station that lets patients press one button if there is an emergency situation, and another if they have a question. The wearable component is a pendant embedded with a sensor that sends an alert if the patient falls.

BodyTel™ is a system that combines devices for glucose, blood pressure and weight monitoring, and can communicate with a smartphone. Grandcare offers a tele-health system for patients in independent facilities that use sensors to report the patient’s motion, activities and vital signs. The site serves as a portal for family and healthcare providers to track patient data.

For Whatever Ails You

We were surprise and pleased to discover, even at this early stage, the health landscape is rapidly filling with a variety of devices helping people of all ages with solutions to a plethora of health-related solutions.

To get some sense of what we found, consider these:

  • PeeCheck. We found a 99-cent iTunes app called uChek that lets you pee on a strip in the comfort of your own home, then snap a photo and upload it to a mobile app for analysis. Sessions in health facilities involving restrooms and plastic bottle can be a thing of the past.
  • Mesh tattoos. Researchers at the University of Illinois Champagne Urbana are working on a tattoo-like electronic mesh. Comprised of sensors, electrodes, power and Wifi, the mesh is stamped onto the patient’s skin following surgery, where it measures and transmits vital statistics such as skin hydration and body temperature. It self-dissolves in about two weeks.
  • Handing it to her. A University of Pittsburg experiment is studying how brainwaves can operate non-connected prosthetic devices. A quadriplegic woman reportedly used an unattached artificial hand to feed herself chocolate. Hopefully she is not a diabetic.

Sensing decay. Some apps improve pragmatic hygienic necessities. At least two companies, Beam and Phillips are shipping sensor-enabled toothbrushes.

Beam’s device focuses on using sensors to get kids to brush more. Phillips, we were told, was in the latter stages of developing a sensor-enabled toothbrush that will sense tooth decay and send text messages to the user as well as the family dentist.

Clean-hands-save patients. There is now a sensor that attaches to washbasins in hospitals. It reports which employees don’t wash their hands.

Dr. Paul Levy, CEO of New England Deaconess Hospital in Boston, posted on his well-followed blog several cases where hospital staff not washing their hands has spread bacteria. In one case, the behavior directly resulted in the deaths of two newborn infants.

We think the intelligent approach is to use the device, but make it clear to all hospital employees that it is there and why it is being used.

Predicting heart attack. A Swiss medical team has developed a tiny sensor-crammed implant. Currently in the experimental stage, the tiny, Bluetooth-enabled device monitors blood chemistry. Researchers believe it will predict a heart attack hours before it occurs and be able to alert hospitals as well as the user.

FAST Fights Cancer

Of the many medical projects we examined, nothing showed us more promise than something called FAST [for Fiber Optic Array Scanning Technology], which we saw during a highly informative and exciting tour of SRI International in Silicon Valley—perhaps the world’s most accomplished facility for research and development for government and business.

We knew SRI as a mecca for tech innovation. Ever since the computer mouse was invented there, SRI has been developing useful technology innovations such as SIRI, the voice interactive personal assistant now owned by Apple.

We didn’t expect to see anything that might stop cancer in its tracks, but that is precisely what FAST promises to do. They expect to do it soon and, the earlier it is detected, the less devastating the treatments to purge it will be.

FAST is a machine about the size of a lateral file cabinet. It enables a two-step process that allows sensors to search a biopsy sample at amazing speed. It can detect one or two cancerous cells in a batch of 50 million and can do it in less than two minutes.

These cells are tagged with markers so they can be found again. Then technicians try various forms of treatment and determine which one works best against the cells being examined.

Armed with this information, just one treatment needs to be used on a patient, eliminating massive chemo assaults mixed with radiation. The body does not have to suffer the massive assault currently used as standard practice.

While the process will be used against several kinds of cancer, we were told FAST will take on breast cancer first.

The machine was in clinical testing in May 2013. SRI told us they were planning to spin the venture into a business before year-end. A production version could be available by the end of 2014, depending on FDA issues.

SRI expects that in 3-5 years FAST will be about the size of a home printer and cost less than $10,000.

“We are hoping this will be in doctor’s offices within the next 36 months,” Nathan Collins, executive director of SRI Biosciences, told us. So are we.

The Elephant in the Hospital

The word health covers two sides of a well-known equation: prevention and healthcare. We found dozens, perhaps scores of examples of how mobile, social media, data, sensors and location-based technologies are helping millions of people. In the areas of prevention and fitness,  solutions abound.

We think there is a healthcare maker movement taking form, such as we discussed in our Contextual Cities chapter. There is great reason to hope that such efforts as we have reported here will reduce suffering and save lives and, along the way, save people and institutions billions, if not trillions of dollars.

But there is a very large elephant sitting in the middle of the hospital lobby. It is large, curmudgeonly and–worse–dangerous.

The elephant is actually part of a herd, comprised of regulators, insurance carriers and medical facilities run not by doctors, but by administrators who seem more focused on profits than patients.

Why should they change systems, when those systems work perfectly well for them and their shareholders? Why develop pills that can eliminate colonoscopies and prostate exams when there is so much money to be made performing such tests? Why should elected officials pass healthcare reforms when fighting about them produces so much political fodder?

We like the way T.A. Barnhart said it in BlueOregon, his personal blog:

“We do everything …  to reform America’s healthcare but shut up and remember that this is not about government, not about philosophy, not about politics, not about money.

“It is about people and the quality of their lives.”

It seems so simple and clear, but history has taught us otherwise.