The next big thing in healthcare: probably not a molecule
Some years ago, Tom Hanks went to David Letterman’s show and shared with the public a conversation he had had with his doctor some days before. The doctor had told him: You know those high blood sugar numbers you’ve been dealing with since you were 36? Well, you’ve graduated! You’ve got Type 2 diabetes, young man. (…) Look, if you can weigh as much as you weighed in high school, you will essentially be completely healthy and not have Type 2 diabetes”.
Hanks answered: “Well, I’m gonna have Type 2 diabetes.”
Tom Hanks’ diabetes is lifestyle-dependant. Optional. He can choose between changing a set of everyday habits that ultimately determine his weight, or injecting himself insulin (a molecule). And Tom Hanks chose the latter.
Is health a matter of molecules, or of lifestyle?
For decades, evidence-based medicine has turned doctors into well-trained mechanics of biological machines, predictable molecular mechanisms haunted by an inconvenient intruder: a human soul, that manifests itself in the form of a series of hurdles to treatment adherence.
This is not sustainable.
Countless studies show that the biomedical, pharmacological model of health can’t face the challenges of health and quality of life for citizens of the 21st century: chronic diseases, lifestyle-related diseases, disorders related to the ageing of the population…
Researchers have been warning for years that the current biomedical model of health must be upgraded into a biopsychosocial model that addresses the influence of social structure and lifestyle on people’s health and quality of life.
A quick example: Since the eighties, longitudinal studies have been conducted to understand the long-term phenomenon of “crack babies”, people whose mothers used crack cocaine while pregnant. When compared with general population, “crack kids” tend to have a low weight at birth, yield a worse academic performance, attain less professional success, and die younger. The puzzling thing is, when they’re compared to people born in the same socioeconomic conditions whose mothers did not use crack during pregnancy, their outcomes are virtually the same. What separates all these people from general population is not intrauterine cocaine (a molecule), but the poverty of their families, the neighbourhoods where they live, or their degree of exposure to violence. Poverty turned out to kill more than coke. It’s not the molecule — it’s the economy, stupid.
We live in a systemically sick society, a society that is sick by design. And instead of coming up with systemic solutions, we provide ourselves with symptomatic pseudo-solutions through molecules.
The food industry pumps into developed markets a bulk of calories that, divided among the population, only can cause systemic obesity. But why limiting this surplus if someone invented lorcaserin (a molecule) to help us feel fuller and manage our weight?
The pornographic-industrial complex feeds men with the reductionist doctrine that being a good lover is pumping through a 10-minute long shot without finishing, something that only makes you good at filming porn, but why renouncing that “ideal” if someone found out that the molecule dapoxetine, a failed antidepressant, happens to extend intravaginal ejaculation latency? Well, it can cause nausea, dizziness, headache, insomnia, anxiety, decreased libido, nightmares, dry mouth, and blurry vision. But hey, no pain, no gain.
The sex-gender institution tells you that if you are woman, and you want to be a professional and a mother, you must make a superhuman effort that will consume you, but, why sitting down to negotiate a more human life for everyone if your pharmacy provides you with an arsenal for the whole family to dope themselves in order to cover societal expectations?
Don’t be mistaken, I’m pharma’s biggest fan. This nonsense is the exception. The pharmaceutical industry is probably the greatest single contributor to the extension of life expectancy in the last seventy years. And it is our responsibility as a society to provide it with the right set of regulations and incentives to keep on affordably providing us with useful molecules. But there is so much more to do.
We live in a fascinating moment of opportunities for interaction designers, for service designers, for business designers, for policy designers, to improve the health and quality of life of populations by intervening where intervention is needed.
According to different studies, between 20% and 40% of the people who are into a medical treatment, fail to adhere to it correctly because of a deficient communication with health professionals. That needs the intervention of designers.
Users of the health system feel more and more helpless towards a health care system which is fragmented into specialities, technified, and faulty, in which they sorely miss the presence of an empathic actor with a holistic understanding of their health issues, who doesn’t make users feel that the only “project manager” who coordinates the system’s actions and detects/fixes its frequent errors to help them recover health are themselves. That needs our intervention as designers.
Mobile devices, wearable computing, quantified self, behavioural design, gamification, are great enabling technologies waiting to be applied in order to help people adopt healthier lifestyles. That needs our intervention as designers.
The organizational culture of most of the companies that propel our economy is systemically unhealthy. Both because of their effect on society, and because of their effect on the individuals who work on the organization itself. I’m quoting from Spanish neuroscientist Diego Redolar: “Today we know that heart disease is more prevalent amongst people who conform to the demands of Western industrialized society, with a behavioural style characterized by orientation to result rather than process; feeling rush and impatience towards its consecution, not tolerating delays to achievement; perceiving life in a hostile and competitive way; and involving themselves into work to the point of jeopardizing their interpersonal relationships and rest needs”. That needs our intervention as designers.
Urban planning, public policy, citizen participation systems, can help create a healthier society for all. That needs our intervention as designers. And as citizens, for that matter.
A massive transformation is taking place in the healthcare system. And we designers must use our increasing influence to help health industry players better achieve their foundational mission of protecting people’s health and quality of life. That involves much more than just delivering molecules in people’s bloodstream: it also involves changing their behaviour patterns, and the explicit and implicit social norms that influence them. As designers, this falls under our jurisdiction, and it’s our duty.
