Without Relevance, Evidence Has No Purpose

How does technological progress affect medicine and public health? Florian Guckelsberger and Lars Mensel sat down with Thomas Goetz, Executive Editor at WIRED Magazine, to talk about the prospect of old age and the costs of drugs.

The European: Mr Goetz, how old do you want to become?
Goetz: This is a good question. In fact, I have thought about that a lot and I think it’ll be one hundred years.

The European: Why exactly one hundred?
Goetz: It’s a good round number. For me it’s the combination of a fruitful life without getting life extensions that make us prolong lives that we don’t actually want to extend.

The European: You have a good chance to become much older. Thanks to medical and technological progress, we will see fewer car accidents, we will live healthier and optimize our lifestyle. You describe this as a feedback loop. How would society be affected by it?
Goetz: We often make mistakes in life. We have all these opportunities and decisions that we make, little decisions: where we park our car, how far we are going to walk. In all these decisions we make mistakes since we base our judgment on short-term considerations rather than long-term evaluations. I think the idea of the feedback loop is to help to remind us of the long-term effects of our decisions. It reminds us of the longer goals that we have. I hope that if we add up all the consequences of small thoughtful decisions it will pay off one day and we live not only a longer but a healthier life.

The European: We frequently commit mistakes and then opt for another way to go about a certain problem. Do we need this trial and error mechanism?
Goetz: A feedback loop and the idea of trial and error are the same thing. Trial and error means trying something, learning from your decision and the outcome it produces, and then trying again. And that idea of trying again is a feedback loop. So it is very much the same, but the goal is to actually learn from our mistakes. If we only keep on trying without taking some measurement or thoroughly observing what we could have done differently, we will reach no results. We have to be more conscious of our decisions. It is not necessarily another way of thinking, it’s just about being a little bit more conscious of what we are doing.

The European: You have presented a number of devices that are supposed to raise our standard of living through data-based analysis of our lives. For instance, there’s the alarm clock bracelet which tells us when to wake up. Who sets the standards for these health recommendations? How do you ensure that we do not become all too homogeneous?
Goetz: I think the idea is not to dictate one overall standard but to let people personalize their decisions, so they can be acting on what works for them. These devices you mentioned are tools that will allow us to be more conscious of what we are doing and why it may work for us or not. They don’t prescribe some standard generic response. In medical research, what counts is often the mean, the statistical average. But very few people actually hit that average number. What we want to understand is where we are on the plot and where we are on the bell curve for any given decision or any given nation. With sleep, it turns out that people who say that they can live with four or five hours of sleep actually need more. If you put these people into a sleeping lab and test how their sleep duration deviates from other people you hardly notice a difference. It is around eight and a half to nine and a half hours. That is under perfect conditions without clocks or outside light. If we can create perfect settings and measure a relatively small deviation, we can say that we all really need eight or nine hours of sleep.

The European: Something that is always surprising is how little consumers know about the costs of medicine. We don’t usually make rational choices about medicine. How can the reality check of a feedback loop be integrated into our health care system?
Goetz: The fact that people do not know the cost of medical products is good and bad. It is good in the sense that subsidies help to let people consume pills that they need but could otherwise not afford. If you look at it globally, you notice that pharmaceuticals are far more expensive in the United States than in developing countries. We actually subsidize medicines in those countries. Some people who complain about the cost of medicine in Western countries feel that they are being exploited. However, as it turns out, if the pharmaceuticals were not that expensive in Western countries, then people in the developing countries would not receive them at all. So it is always hard to find the true costs for drugs – therefore transparency is important. But I am not only concerned with drugs but also with how people are ignorant of the costs and outcomes of treatments, procedures and surgeries. Ignorant not in terms of „does it work?“, but in terms of „what will this procedure require of me in terms of rehabilitation and in terms of visible therapy?“ We often do not think about those things, and we are often not told about them either. The more we learn about these things, the more likely we are to avoid surgery. Often, small behavioral changes are a better way to fix our health than going under the knife. I think that is another layer of transparency that we need to establish: Transparency in relation to what is required of us. And it all goes back to the idea that we must try to get individuals to change the way they live their lives from day to day rather than trying to find somebody else to fix them.

The European: Collecting data can obviously help along this process. But is there a point at which we have too much data and no longer trust our gut? Goetz: Well, when you are talking about data, you do not want to be overwhelmed by information all the time because that would be only noise. So you need to make sure that we have good filters. This is true for health care in particular but also for information in general. We need effective filters that personalize information for us so that we can calibrate the amount and specificity of information that we require. Gathering the data is only the first part. The second part is finding the relevance and depicting it. Without relevance, evidence has no purpose. Therefore the design or the interface that represents data to the people is probably the most important part. People need to understand what information means to them.

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