I read this heartbreaking story today about the U.S.’s current opioid epidemic. The surgeon general was having dinner with a friend, a cardiologist. Then this happened:
“I was having dinner with him and I said, ‘Can you believe that we were taught that these opioid medications weren’t addictive in our training?’ ” Murthy told a group at the Aspen Ideas Festival in Colorado in June.
“And he put down his fork and he looked up at me and he said, ‘Wait, you mean they are addictive?’ ” Murthy added.
Like many doctors, his friend, a cardiologist in Florida, learned in medical school and in residency that opioids weren’t addictive as long as a patient was truly in pain, Murthy said.
“He’s trained at some of the best institutions in the country. He’s one of the most compassionate doctors that you’ll ever meet,” he said.
I know that they’ve been proven addictive for quite some time now (in more than edge cases). You know that, I hope, by now. Experts know that. Professional boards and state committees know that.
The doctor: he had no clue. It so shocked the Surgeon General that he is writing a letter on opioids and sending it to every doctor in America.
But look deeper into that story and you’ll see the big problem:
Like many doctors, his friend, a cardiologist in Florida, learned in medical school and in residency that opioids weren’t addictive as long as a patient was truly in pain, Murthy said.
“He’s trained at some of the best institutions in the country….
What we come up against here is the idea that four years or six years or eight years of education is sufficient to what we do. But unless we graduate our students into a professional learning network that can get the right information to them as our knowledge evolves, tragedies like this will happen time and time again.
This is why we have to move past the infotainment model of Facebook, Twitter, Reddit, and the like and build some real fricking professional systems that let important information and insights flow from point A to point B in stigmergic ways. Our current model, based on advertising dollars, couldn’t give a crap whether your cardiologist is tweeting the latest Clinton Body Count conspiracy or important updates to prescribing guidelines, as long as effective adverts get shown.
But we care. We care a lot.
Anyway, *this* is what drives me. This sort of story where having a simple piece of information or making a simple connection between two ideas could make us smarter and better people, in ways both small and large, with impacts big and small.
I wish I could say we’ve gotten better at building media that expands the mind in the past decade or so. But we’ve gotten worse at this.
Ten years ago I co-founded a community for progressives in New Hampshire, mostly for one reason: I knew very little about New Hampshire politics and wanted to change that. While the “blogging community” format had its challenges, it was a life-changing experience for me, where we found ways to truly tap into the power of networks to raise the collective intelligence of people, and make them better informed about their state: the political structure, the bills sitting before the legislature, the crucial races, and the history of various state debates. We taught each other and it was beautiful.
For various reasons we pulled the plug on it a couple years back, after over 10,000 blog posts by members and 100,000 comments (actually probably more than that — those are 2010 numbers). There were many reasons why the site eventually petered out. But one issue was it was already in decline was because by 2012 people had moved to Facebook for their political community needs.
And as a recent NYT article describes, that’s a huge problem. Because Facebook is not a learning community in any sense of the word. It’s an identity factory:
[T]ruly Facebook-native political pages have begun to create and refine a new approach to political news…This strange new class of media organization slots seamlessly into the news feed and is especially notable in what it asks, or doesn’t ask, of its readers. The point is not to get them to click on more stories or to engage further with a brand. The point is to get them to share the post that’s right in front of them. Everything else is secondary.
….
From a user’s point of view, every share, like or comment is both an act of speech and an accretive piece of a public identity. Maybe some people want to be identified among their networks as news junkies, news curators or as some sort of objective and well-informed reader. Many more people simply want to share specific beliefs, to tell people what they think or, just as important, what they don’t. A newspaper-style story or a dry, matter-of-fact headline is adequate for this purpose. But even better is a headline, or meme, that skips straight to an ideological conclusion or rebuts an argument.
I’m not quite sure where I’m going with this, except maybe to say that these two issues — the opioid crisis and America’s conspiratorial, Facebook-fueled political turn depress the hell out of me, rip my heart out and stamp on it cartoon-style until dust clouds billow out of it and it just expires.
I care about most of the things my readers do — corporate encroachment of education, a desire for “free-range” education, emergence, creativity, what-not. But at the root of all of it for me is a simple dream I had that we all shared, that we could use technology to make ourselves smarter and better people. And it seemed for a while like we were heading there, until the current interests took over and turned technology into Skinner boxes for advert agencies.
I’ll tell you the truth. I don’t even give so much a crap about all Google’s data mining and analytics. I’d deal with it, if Google could just get that one fricking cardiologist a Google Now message that says “Hey dude, update: Opioids are addictive.”
But Google Now is not going to do that, because the dream of Google is not the dream of Engelbart or Kay. Those inventors wanted a world where we became better people, better doctors, better citizens, better architects. Google Now doesn’t give a crap about any of that. Google Now doesn’t want to make you a better doctor or a more compassionate human. It just wants to get AI down enough that it can sell you a Starbucks on your morning commute. And eventually, maybe opioids for your back pain too. Because it’s all just data, right?
Good job everyone. Welcome to the future.
Sorry, I’m legit sick to my stomach right now, and I have to sign off.
Hapgood 
As one who comes from a family of medical doctors (but isn’t one) I feel compelled to say that of all the people I know, they are the most ppl who recognize the need to never stop learning or staying up to date with their field. Really. However, as practitioners, they will occasionally miss out on updates that are peripheral or tangential to their specialty areas (i can’t say for sure how often cardiologist prescribe opioids vs say oncologists – I can say for sure that I know they’re addictive so I am unsure how he missed that update, but I assume oncologists know but since their patients are often terminal this is less of a consideration? I don’t know).
I don’t know upon whose values or choices any software would update a doctor on what is deemed most important. They have conferences. They have professional organizations. They have in most countries some form of continuous professional development. Private practitioners and esp surgeons may focus more on their daily practice and have less time for all that. They may learn of new meds only thru medical reps of companies who forget to tell them how prohibitively expensive a new drug is. Or how badly it interacts with another drug some patients may take. It’s a complex issue and they make huge mistskes that way. I don’t know if there’s a solution to all this…but somehow I don’t think it was ever technology that was the problem or the solution. These doctors could all use technology to help them do their job better – I just don’t know that in every instance of decision-making they will/do.
What drives me nuts is when they get pissed off at the patient for looking stuff up on the internet.
I have to say, though, that my daughter’s doctor (my girl has a chronic illness) respects my online reading and updates me on the latest in the field. Her non-specialist doctors’ eyes glaze over when I mention her syndrome because they really don’t know what it is all about. It’s just too much for them…not their specialty. In the same way cognitive neuroscience and data analytics aren’t my specialty, you know?
You make several really good points. My mom was a pediatric nurse, and I agree, doctors do have professional training (and so do nurses) although from what I’ve seen a lot of it will rely too heavily on a single conference in a year. I think in other areas we’ve come to realize that a more daily low-investment interaction can pay better dividends. Technology might not be the way to solve it, but as a technologist looking to make things better it seems like a fertile area.
Your other point intrigues me — there already is a network that doctors can learn from that they interact with every day — their patients. Jon Udell used to write about this. Again, I know this may be a hammer-nail problem but I can’t help but wonder whether designing online communities that better bring together patient and doctors to teach one another might be a worthy goal. There’s a lot of examples of this (or there used to be), and maybe that’s one way to find promise in a rather dismal landscape. (A friend of mine is actually trying to put together such a thing for autism, a sort of MOOC that brings doctors and patients together, but I don’t know if it will get funded.)
Do you know about ePatients via Virtually Connecting? That’s what Rebecca Hogue and some others are trying to do. Bring patients and doctors together 🙂 it’s currently focused on hangouts but i understand Rebecca’s hopes are to be more than that.
About 3 years ago, my husband, healthy, no blood pressure issues, ideal weight, fit, mid 40’s, no cardiac issues, no cholesterol issues had a carotid artery dissection while out running in Zurich where he was on a business trip.
with a blinding headache (he has no history of migraine or headaches) and vision problems in one eye, he went to the emergency of the main hospital there. They checked him out (missed the fact that one eye was dilated with Horner syndrome), sent him back to the hotel with migraine tablets and said he was fit to fly back to Singapore (12 hour flight) the next day. He got home, went to bed still complaining of headaches and “jet lag”, went to work the next day, had 6 TIAs and asked a colleague to take him to a hospital here. Fortunately here they did all the scans and he ended up in hospital, his artery too collapsed for surgery on bed rest for over a week with blood thinners and then home for about 3 months, most of which were spent sleeping.
Now the point is, this happens so seldom in men with his profile that another cardiologist in the Netherlands (our home country) who we saw trying to understand his chances of ever regaining functioning in both arteries, as one remained blocked for nearly a year), that it was actually amazing it was diagnosed at all, because the average doctor, let alone cardiologist / neurologist never sees this. The whole time during his treatment, and my googling, I had the feeling we were doing little besides giving him rat-poison (the blood thinners) and throwing some metaphorical bones. The Dutch cardiologist said if every doctor who came across these symptoms would only just log it in some kind of database, and patients could be signed up to some kind of global follow-up / tracking system we could advance so much in our understanding of the problem, its causes, and most important to patients and their families – the outcomes – long term and short term, and the best course of action.
But it seems many doctors, if at all they participate in collaborative learning, it is regional or national, and that will miss out on the extremely rare incidents.
Mike,
I absolutely feel you on this and absolutely share your disdain for what mainstream computing has become. If it’s any consolation, you’ve had a major, positive effect on this young computerist. That gives me hope that although the blog format (which as you say, isn’t *the* ultimate medium, but is better than social media drivel) seems to be waning, it *does* still have a pulse.
One thing I’ve realized is the “web is democratic” conceit is misleading. The web isn’t really democratic (if anything, it’s kind of anarchy), and so it’s relatively easy to have these power inequities where major companies like Facebook and Google can effectively strangle computing for the rest of us. I don’t know what to make of that quite yet.
Please keep up your great work! and know you are reaching people who care and share the same dreams, who are also sick of what much of mainstream computing gives us, and who aren’t done fighting for the dreams either.
Wow, thank you! I looked at some of your stuff, and it’s really neat. Maybe I’ll get to look deeper this weekend.
In the end we need a new generation of technologists to swing the pendulum back to the idea of “augmenting human intellect and capability” and other ideas. And maybe we’ll get that. My one worry would be that the last generation did that on government grants that don’t exist any more. So there’s that 😦
I despair that the new generation has been sucked in whole sale into the immediate gratification that social media offers. Never even mind the hard to search, hard to use, closed Facebook platform – they’re on snapchat. Never mind opioid addiction – this is far worse for far more people – our youth.
I don’t see them embracing all that open platforms have to offer, only embracing memes and stupid youtube videos.
How could anyone discover a passion (except through tinder, haha) for an intellectual area this way?
Mike,
Thank you for the kind words, I’m glad you liked my stuff!
I definitely agree about needing a “a new generation of technologists to swing the pendulum back to the idea of “augmenting human intellect and capability” and other ideas” and that’s why I think blogging is one very important thing we can do. Evangelism of optimism and realism, I guess?
So many in my generation follow the Hacker News lifestyle (temporarily embarrassed start-up-exit millionaires), or what Alan Kay would probably call the Computer Science pop culture. A lot of people are convinced they’re creating the future when most are recreating a shoddy past. But again, this is where blogging, talks, never-shutting-up about the actual, true important ideas of computing is important. The more people who get the message, the better.
Alan and folks have a new research initiative through the Y-Combinator folks, and I can’t quite tell if this is good or bad 🤔 but at least it’s a research-funding-possibility for the Hacker News generation.
I just helped a doc friend of mine figure out Powerpoint so she could present about this and yes, I wondered things like whether the docs listened to NPR … but if they were *trained* with the outdated information it makes sense she’s got to share whatshe knows (as an addiciton specialist).
… and I agree that … it would behoove us to try to steer social media from Algorithm Central, for LOTS AND LOTS of reasons.
Really great post, Mike. About a third of the way through, I thought for sure you were going to connect the opioid epidemic to a metaphorical addiction to specific and desired information streams, a la selective exposure theory — especially in light of the article you recently cited on diversity of thought in Twitter networks.
Thanks Mike. I totally agree that the mega-computing brands (Facebook, Google, Twitter, LinkedIn, etc.) do have a large part in the dummying down of social media but I also think there is a major issue of the general public being behind the curve on what any of these tools mean and how to better their lives through them. As an early blogger as well, I do recall the days when there were thousands of us united in our vision of a networked consciousness. Now there are millions of us, most with very limited understanding of what they want and need to know, let alone how to use any of these tools to seek it.
Being the “resident social media guy” amongst my friends and family, I constantly get the blank stare when they tell me they have a Facebook account but don’t know what they are supposed to do with it. Or they have been retweeting Tweets, but they don’t know why. So they end up looking for what they are already familiar with and focus on that. It amounts to something akin to distracted driving. Is the car to blame when a salesman plows into a stopped vehicle because he was on his cellphone arguing with his business analyst over the price he needs to close a big deal?
While refocusing technological efforts will help, a major part of the solution needs to be aimed at getting people to pay attention to what they are doing. The most expertly crafted hammer won’t work if you don’t realized you need a nail as well.