Searching for Middle Futurism in Healthcare

Why are we so in love with the image of a shiny medical future?

DALL-E 2 image of a future doctor. Love the shoes.

If you go to a medical industry conference these days, you’re likely to catch a keynote presentation from a medical futurist. A seer. Usually someone selling a shiny vision for what’s ahead.

In fact, selling the shiny future of health care has become something of a cottage industry. Medical futures presentations often bring a utopian feel that suggests our best years are ahead of us. Literally.

The features of a shiny medical future

Here are some of the features of the shiny medical future:

• Everything is predicted, preempted and precise. In the future we will catch medical problems before they occur.

• Everything is immediate. Health is no longer limited to a once-a-year physical exam, but instead is a real-time affair. In some cases it’s self-managed. No more waiting.

• No one suffers. Because what hasn’t been predicted, prevented and targeted has an otherwise immediate solution.

• Technology is central to the experience. By design, a shiny future puts technology central to the healthcare experience. In fact, it would seem that we sacrifice our human connection for the promise of glossy precision.

• Exponentialism. Our shiny future of healthcare lifts us to the precipice of some exponentially better place.

• Everything is a problem with a solution. Shiny medical futures are centered in the quest for solutionism. See my letter from a couple of weeks ago.

  

  Healthcare startup Forward and their futuristic clinic

Now there’s nothing wrong with these when you consider them individually. In fact, I’m an advocate for many of these features. I mean, who doesn’t want precision when it comes to their disease? And what about a world where no one suffers? Who would have a beef with that?

But the problem isn’t wanting a better future. The problem comes when we fetishize the future. When we frame it in utopian terms. When we see our healthcare future as some kind of escape from reality. This is where the picture of future healthcare gets shiny, quiet (typically white) and a little weird.

Why do we do we like shiny futures in healthcare?

The parlor game of medical futures is big business. But why do we love these images of next healthcare?

• We love people with answers. Technology is advancing faster than we can keep up. And in uncertain times we gravitate to those who can make sense of it all. We want certainty that things will be better than they are.

• Shiny is part of Silicon Valley technoculture. This fantasy of something more perfect is what Silicon Valley sells. This promise of a clean future draws on what Jaron Lanier in Who Owns the Future calls the ecstatic, manic and irresistible feeling of being on the verge of escaping limits. This is sometimes called exponentialism.

• It offers an escape from our dystopian healthcare reality. And, of course, the shiny future of healthcare has real appeal in the face of our current healthcare mess.

So who doesn’t want these things?

The call for middle futurism in medicine

I’m not sure that I want all of it, really.

In 2019 design visionary Amber Case wrote an essay calling us to see the future as something a little more real. She wasn’t talking healthcare, but it definitely fits. Have a look — it will reframe everything you read about the future.

From Amber Case:

What’s needed, I believe, is a new approach to forecasting the future that sits between the unsustainable techno-utopianism popular with Silicon Valley, and the dystopian imagery favored by pop culture. (Which is uninspiring, and only warns us what to avoid, not what to strive for.)

Ironically, a better way for thinking about our future comes from our relatively recent past. Much of the research at institutes like Xerox PARC in the 1980s that didn’t make it into today’s collective imagination. Bringing some of this back can help save us from building a future that is brittle, high cost, and impossible to maintain.

Call it middle futurism. It draws from the thought of PARC’s Mark Weiser, who wrote this in 1991:

The most profound technologies are those that disappear. They weave themselves into the fabric of everyday life until they are indistinguishable from it…Silicon-based information technology, in contrast, is far from having become part of the environment… The arcane aura that surrounds personal computers is not just a “user interface” problem… Such machines cannot truly make computing an integral, invisible part of the way people live their lives. Therefore, we are trying to conceive a new way of thinking about computers in the world, one that takes into account the natural human environment and allows the computers themselves to vanish into the background.

Progressivism is not utopianism

Even futurist Kevin Kelly in What Technology Wants warns against the perverse concept of utopian futures:

And there will be problems tomorrow because progress is not utopia. It is easy to mistake progressivism as utopianism because where else does increasing and everlasting improvement point to except utopia? Sadly, that confuses a direction with a destination. The future as un-soiled technological perfection is unattainable; the future as a territory of continuously expanding possibilities is not only attainable but also exactly the road we are on now.

I’d like to see discussions of our healthcare future that paint a middle view where technology is invisible, and humans are back to being central to the experience. A future less about escape and perfection and more about a warmer, connected experience where the technology is nearly invisible.

Far less entertaining, more boring, but real.

DALL-E 2 image of a doctor in a future clinic

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