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Why Crypto needs a Doctor and Medicine needs Blockchain Technology — It’s not what you think…

Earlier this week at CryptoMonday I noticed that when I introduced myself as Dr. Alex Cahana, many responded with surprise and asked:

“What? You are a doctor? What the hell are you doing here”?

I then realized that during these last Mondays I have met well over one hundred crypto-enthusiasts and not one of them was a medical doctor. (Actually two started medical school but then felt it wasn’t for them and left).

So I have decided to start and post regularly, to attract more of my colleagues to join the crypto-space and I will start my first post with two simple questions:

  1. Why isn’t there a doctor in the house?

2. Why does it matter?

1. Why isn’t there a doctor in the house?

First reason: MD’s hate HIT (health information technology)

As much as medical doctors consider themselves data scientists and love medical technologies (what would we do without our MRI’s, coronary stents and laparoscopic surgery?), we are at best very suspicious of health information technology, most notably our Electronic Health Records (EHRs).

After now a decade of mandatory use of EHR (thank you Affordable Care Act, HITECH 2009), most physicians feel that they have distracted us from patient care and have not delivered on the promises of better patient experience, lower costs and better outcomes. Furthermore, our concerns of reduced productivity, lack of data interoperability, security breeches, increased medical liability and simple burnout, have brought many to regard EHR as no more than a ‘glorified’ billing program used to ensure an otherwise low reimbursement.

Source: Medical Economics — 2017 EHR Report

And so it is not surprising that the idea of solving these problems with EHRs versions 2.0, 3.0 equipped with machine learning features, NLP or blockchain technology seems to many of us hype and a simple waste of time and money.

Second reason: Most MD’s have no idea what Blockchain does, let alone what it IS

Most of my friends and colleagues have no clue what blockchain is (or what I do) and beyond the sensational press on hacks, investigations and currency volatility, crypto-publications still have a lot of educating ahead. Despite excellent articles here and here and here, blockchain jargon is confusing, inconsistent and at times outright counter-intuitive.

Just like in Medicine where having all your tests ‘negative’ is good, but having a ‘positive’ finding is bad, the terms open, public and trust-less are not intuitively clear or synonymous with what the general public understands as meaning private, secure and trust-worthy.

We need to do better. (Thank you @Preethi Kaireddy!)

It is not surprising that even the most tech-savvy in healthcare, top executive CIO’s, do not fully understand the potential role of Blockchain in Healthcare and believe they are over-hyped compared to other competing technologies. (I have yet to find an institutional strategic plan that includes distributed ledger technology).

2. Why does it matter?

Healthcare needs blockchain technology and it’s not for the reasons you think!

For 25 years I used to prescribe pain killers (mostly opioids) for chronic non-cancer pain because it helped my patients, or that’s what I thought and that’s what I was taught. Then I stopped prescribing opioids because I learned it didn’t help patients, or that’s what I thought and that’s what the CDC opioid prescribing guidelines say now.

But what I really found out was that I was as Voltaire said:

[a man] who prescribes medicines of which [I] know little, to cure diseases of which [I] know less, [to] patients of whom [I] know nothing [of]…

so, I started to study ways on how I can get to know and understand better my patients and help them, help themselves.

This journey took me through Pain Medicine and cognitive neuroscience, phenomenological investigation, and behavioral economics, finally leading me to systems thinking and my interest in blockchain distributed ledger technologies.

Now I review every week at least half a dozen crytpo-health solutions that hope to solve problems and save healthcare, which makes sense. Healthcare is a multi-stakeholder, mal-aigned, friction-full, opaque, heavily-regulated, lacking-of-trust, data-rich environment that does lend itself to a spectrum of blockchain-based platforms.

Having said that, I do however think there is really only one reason why blockchain will be disruptive in healthcare.

But before I say it I must ask you:

What is the opposite of health?

If you answered disease, then you are wrong (don’t worry everybody answers disease or illness). But this is why we have a disease management system instead of a Healthcare system.

I will argue, and please bear with me, that the opposite of health is not disease but rather ISOLATION. That as we get sicker, our world contracts, gets smaller and smaller until one morning we wake up take a Xanax, an Oxycontin, drink a Chardonnay (or beer if you prefer) and overdose.

This isolation, these ‘deaths of despair’ has been claiming a life in the US every 10 minutes for over a decade!

CDC, 2017

And so, if we agree for moment that the opposite of health is isolation, then the journey back to Wellness is by connectedness — and this is where blockchain enters — as a decentralized, distributed network, empowering individuals in a community (ecosystem) to modify their behavior (token economics) for the betterment (health, wealth) of all.

So before we talk about PoS, PoW, DAG’s, Forks and Sharding, let us spend more time to explain how blockchain technology can change behaviors, encourage sustainable practices and reign in the disproportionate power incumbents have on predatory practices. #blockchain matters

Like Lou Kerner I believe that Crypto is the biggest thing to happen in the history of mankind.

Look out for my future posts that will include: The Good, the Bad and the Ugly in Health Crypto-solutions; Pain, Pain Killers and Blockchain; What’s good for me may not be good for you and how to change it.

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