Technology and health- is it time to stop chasing a unicorn?

Posted on June 12, 2015

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This is Part Two of a three part series on technology and health, with a focus on fitness. Part One started out broad discussing an overarching theme of what technological progress does to the human body. Part Two will look more at the value and costs when technology is implemented into health / fitness. Part Two will also focus some more on the digital age. Part Three will deal specifically with social media.

For this, the word technology is primarily referring to electronics, digital tools, or fairly highly complex solutions. That’s not technically the definition of technology, but it’s contemporarily what most people are referring to when using the word. Something I think is unfortunate.

luddite definition

Between part one and many of the interactions I have, I can see many dismissing me as the above. It’s all too common for someone to ask me about some health gadget or toy and for me to say don’t bother.

Because of this, I want to give some background illustrating how far I am from something like a luddite. I think this may give me a fairly unique point of view when it comes to tech and health matters. Hopefully the first section doesn’t come across as too self-indulgent.

From a technology standpoint, compared to the average upbringing, mine was about as much of an outlier as one could get, in favor of technology. My Dad was the impetus for a lot of this initially.

Both my parents worked for Digital, or “DEC” as many know it.

Digital computers

I was running cables under floors before I was 10.

I believe my parents were the first people to own a VCR out of anyone they knew. I’m pretty sure my Mom went to my Dad, “What the hell is that thing?” We were fairly early DVD adopters too.

I was always into video games. Nintendo, Sega, Nintendo 64, PC, X-Box, little PlayStation, handhelds. I played a lot of them in a variety of ways. I still play here and there on my iPhone.

I’ve been on the internet as long as I can remember. I want to say I got online ~’95, about 8 years old. I still remember going to the Victoria’s Secret page, subsequently learning the importance of the “History” bar.

We were the first household I remember getting off dial-up.

My Mom had this thing:

At ~13 I discovered Napster. A kid I hung out with up the street got on too, but I was the only one who had a writable CD-ROM drive. I also had the DSL connection, while many still had AOL dialing phone calls.

We started courting our classmates for song lists, with him doing more of the sales and me burning CDs. We would download the songs on Napster, write the CD with the list, then sell it for, I think it was $5. Eventually my neighbor got a writable drive too. One day my parents found an envelop in my room with like $250 in it. My Mom talked to my uncle, a lawyer, and they quickly shut that down.

I was the first person I knew to have a MP3 player. While I was burning CDs for friends I had stopped purchasing CDs. While not in use, I still have this in my car:

This was actually my second MP3 player.

This was actually my second MP3 player.

At 14 I started programming. My high school -a public one by the way- offered some classes, which is to this day not common. [1] I programmed in Q-Basic, Visual Basic, and Java.

In college, everyone who came to my dorm room thought it was so cool I had a computer monitor that was also a television. I would have my computer monitor on, with a picture-in-picture of a television show.

They also enjoyed the fact I could blow the doors off other rooms with these Bose speakers, which you could turn on and off with a tap of a finger.

Bose speakers minis

They still sell this model. I had it over a decade ago.

You may have thought Apple tried to sell this:

Apple Cube

But my Dad was making our family computers in a box very similar to that. Not quite as small, but the idea was the same. While everyone was using this nonsense:

Dell computer box

He was building something a third the size. He’d hand them out to our family members, while also routinely fixing my friend’s parent’s computers, cleaning up operating systems, etc.

My Dad is still working with tech, more IT stuff now, and my Mom has slowly gotten more and more into this world. Way back when she was teaching english classes. (Reading and writing.) Now she teaches schools how to integrate technology into education, and is forever frustrated at how long it takes the schools to adopt something. I believe the word technology is literally in her job title.

Finally, my brother is a double major in physics and computer science, and I think he’s going to get a minor in mathematics. He was also programming as a teenager, making some games along the way. The last time we hung out we talked at length about machine learning. I fear he may play a role in the robots taking over. [2]

Technology surrounded me growing up, yet I veered away from this stuff quite a bit. Not much programming anymore. My MacBook is five years old. My car is 14 years old. I have some mild antipathy towards Silicon Valley. Though I still have an affinity for electronics, I’m a bit of a late adopter with many technologies now. Practically every tech thing or piece of equipment people ask me about (health related stuff), I tell them save their money. What happened?

Along with all the above growing up, I was intensely interested in nutrition and exercise. You name it, and I probably experimented with it. Nearly every sport, fasting, low carb, high carb, too many supplements to remember, HIT, bodyweight only, Westside Barbell, bodybuilding, TENs machine, infomercial equipment (seriously), cortisone shots, X-Rays, MRIs, ultrasound, the list doesn’t end. I did it all. If I didn’t do it, I was exposed to it other ways. Blood sampling, EMG analysis, EKG analysis, stress tests, oxygen masks, lab research. [3]

Anybody remember these?

strength shoes

I used those.

A matter of what works

There is an expression in mathematics, .999999…. =1. Do enough of this stuff -crazy supplements, crazy diets, ridiculous equipment- and you realize, over and over…and over and over, is .999999… essentially 100% of it, is: useless, has a cheaper option, garbage marketing, or simply unnecessary.

Of course not everything nutrition and fitness related is this way, but from a percentage point of view, it very nearly is. Of all the things out there, so few of it works, or is worth it. And what you realize eventually is the fancier things are -the more tech based things are- the less valuable it likely is.

Contrast this with the technologies I encountered growing up:

  • Download songs with Napster compared to trekking my ass to Sam Goody? Napster, easy.
  • A device which holds a thousand songs and plays them? iPod all day.
  • Do I want my personal computer to be the size of a Dell box or a third that size? Or where I can carry it around with me all day, and get online? (Laptop with WiFi.)
  • I’m in a college dorm room, do I want a television and a computer monitor, or one screen that does both? Do I want to listen to someone’s crappy built in computer speaker, or do I want to make the room shake?
  • DSL connection compared to dial-up?
  • X-Box or Sega Genesis?

What works best here, what’s better, is obvious. Growing up my family wasn’t merely throwing money around, the things we were getting were better. And partially because you had to get new things in order to keep up.

From the moment I got online, it felt every six months your computer was out of date. The rate of progress was crazy. It got to where practically every year you had to shell out some money and get a new computer because the newest software couldn’t run on the older model.

Mix fitness with tech though, and things are no longer this clear.

From an exercise standpoint, people can get by without anything but their bodyweight. Throw a few pieces of metal in there shaped in a couple different ways, and you have enough. I don’t mean enough to get by, I mean enough to surpass most humans on the planet.

Performance

In the book Speed Trap by Charlie Francis, who coached Ben Johnson,

Ben Johnson side view olympics

the book is littered with example after example of how little resources they had. Not only when training Ben, but when training himself.

Charlie was a national champion in Canada. During the time he was training at a place nicknamed “Pig Palace.” The track he trained on was also used for livestock events. The track had some rubber strips laid down, but on the banks the underlying surface was wood; on the straightaways it was concrete. The entire track wasn’t even one surface type!

Charlie’s group couldn’t starting blocks at first. These things!

starting blocks

Ben also had to start out with no spikes, eventually getting a pair of used ones. Screw anything tech based. We’re talking about getting shoes here.

No big deal. 30 years later, Ben Johnson is still one of the fastest humans ever. You could make an argument for second all time. 30 years later, after all the “progress” of the digital age, only one guy has clearly run faster.

Have you ever seen where the fastest people on Earth train? Where the fastest person of all time is from? It’s Jamaica. Don’t buy into Usain Bolt’s ridiculousness you seem him doing on screen. Like this video where you can actually see the person water spraying him to make him look better.

Usain Bolt Water Spray

To get some decent info, a lot of this you have to look at before Bolt got famous (2008), as once a camera is on he wants to look good and put on a show. If you do that, you’ll find they don’t use things like parachutes, they use few machines, no motion analysis (they use their eyes and ears, not a machine), they don’t even bother with music. [4]

Check out, another very fast Jamaican, Asafa Powell’s fancy facility:

Some good info on this can be found on Charlie Francis’ forum. Here and here for instance. You can see Charlie mentioning their first med-ball was a “half-broken construction block.” The fastest people ever got there with a few pieces of steel and something half-decent to run on. (The Jamaicans do a lot on grass.)

Powerlifting consists of some of the strongest people in the world. The strongest powerlifting gym is Westside Barbell in Ohio. It’s been that way for a very long time. Here is Dave Tate describing the gym when he first got there in the early 1990s (bolding mine):

“When I showed up, Westside was in the process of changing from a commercial-type gym to a private powerlifting club. Louie had sold all the machines to Matt Dimel and took just the powerlifting essentials to a rat hole in West Columbus.

To say this place was a dump is an understatement. There were holes in the floor and the ceiling leaked. As I recall there was even some dude living in the basement.”

westside barbell gym

From EliteFts.com

It doesn’t look like they even had a full dumbbell rack. I mean, it’s Ohio, what do we expect? [5]

Let’s look at some world records in track.

Women's world records with circlesMen's world records with cirlces

All the yellow circles are world records set at least 10 years ago. This burst of technology the last decade hasn’t coincided with much increase in performance. Look at how many of the recent records are set by people from Jamaica, Kenya, Ethiopia. These aren’t highly developed countries. Technology isn’t why they’re on this list. [6] Your phone has transformed the last ten years; human performance has not.

If we look further back, we’ll see many of the records that have improved haven’t done so by much. In 1979 Seb Coe ran the 800 meters in 1:42.33 seconds. The world record currently is 1:40.91 seconds.

  • 1:42.33 = 102.33 seconds
  • 1:40.91 = 100.91 seconds

The record has improved by .014 percent, 1.4%, in 36 years. What’s especially ironic here is I picked Seb Coe because I remembered his name from reading his father’s book on distance running. His Dad actually wrote quite a bit of using high end tech equipment, and fancier methods. I just took a quick look at the book. Heart rate monitoring, body composition analysis, blood sampling, VO2 max testing, running economy, lactate threshold, iron analysis, respiratory exchange rate, meteorological balloons. There are 20 pages dedicated to lab anaylsis.

Meteorological Balloons distance running

Meteorological balloons.

The guy who currently has the 800 meter record is from Kenya. Kenyans are notorious for crude training methods, from a tech perspective. No MRI analysis, motion analysis, intense nutrition analysis (eat a lot of carbs, done), cardiology, complicated strength training (a lot of it is hill running), EKG, etc. Seb Coe did a lot of this 36 years ago; a guy who has run faster than him did not. [7]

Here is an excerpt from The Sports Gene (bolding mine):

“…as 800-meter world record holder David Rudisha sank into the couch. In the backyard is “the gym,” a single metal pole dipped in cement at both ends so it resembles a barbell.

In this documentary on Rudisha, you can see the gym his coach assembled. Here it is:

Rudisha leg press station

Close up of the barbell: [8]

Rudisha barbell

Brother Colm has coached quite a few notable track names. According to him, most of them have “rural, peasant farming” backgrounds. Not exactly advanced upbringings. Rudisha was one of these.

By 16, Rudisha had run under 50 seconds in the 400 meters. He didn’t even have spikes yet:

Rudisha barefoot

He ran the 800 meters because there were no lanes for events like the 400 meters. Before he ran his first 800 meters, a guy had to draw the starting line. A line in the dirt. With a stick.

Rudisha drawing starting line

And you can’t say “Well, what if Rudisha did do all the fancy things Seb Coe’s dad talks about? He could run faster!” You don’t think Rudisha has competitors who are doing all those things? Who are still running slower? Or, say Rudisha, the current 800 meter world record holder, is doing all those things. Say his coach is lying about his training to prevent competitors from figuring things out, or whatever. Say ALL of the improvement in his time compared to Seb Coe’s is from technological progress the last 36 years. Then it’s given him a total of 1.4%!

  • Usain Bolt 9.58s 100 meter
  • Ben Johnson 9.72s 100 meter (estimated time if he didn’t put his hand up and slow himself down)

Difference of 1.5%. These are percentages only mattering to .000000001% of the population. [9] And who knows how much of these differences are due some anomaly. Maybe Rudisha had perfect wind conditions on his fastest runs. Maybe Usain Bolt had a gust of wind that didn’t register for some reason. Maybe Usain Bolt just had a better track to run on, a springier surface more conducive to faster times. With percentages this small, over the course of decades, these things are not at all inconceivable. It’s estimated Jesse Owens, who was running in 1936, had he run on the same surface as Usain Bolt, would be within one stride!

Don’t forget how fast and strong people get with minimal resources. Don’t forget people get jacked in jail. Don’t forget how ripped people were getting over a hundred years ago.

Eugene sandow

Finally, do not forget, Rocky beat Drago. [10]

General health

Injuries go with performance. At the highest levels of performance, one is more likely than others to deal with injuries. The faster, harder you go, the more stress to the body. Yet the Jamaicans, Kenyans, etc. are doing just fine. No tech needed to stay or get healthy injury wise either. In the least, enough of them are making it through to set world records. [11]

How about other areas of health? Let’s look at the biggest one, life expectancy.

  • Costa Rica = 79.1
  • United States 78.6

I’ve been to Costa Rica. Traveled around quite a bit of it. It’s not third-world, but it sure ain’t first world from a tech perspective. I spent a good 30 minutes with my girlfriend yelling at me because of how fast I was driving on one part of the “highway,” where the cows were practically sticking their tongues through the car window. Yet Costa Ricans live longer.

If we look at the most technologically concentrated area in the world, California, the life expectancy is 80.8. Marginal improvement. I’m sure if we took a few southern states out, where I once gained 10lbs in a five day round trip, the country’s life expectancy would match California’s.

In 1980, right when Microsoft was beginning to take off, life expectancy was 73.7. In 2013, it was 78.6. Even if we say all the improvement in life expectancy was due to “technology,” five years improvement in life expectancy is what basic exercise can give.

Exercise is better than software brain games for cognitive function.

Exercise can perform as well as surgery in knee surgeryalong with rotator cuff surgery, and probably most other orthopedic procedures…

it’s not a tough reach to say the above when it was recently discovered half of surgeries examined don’t do as well as a placebo.

A few quick, non exercise areas:

-“Kangaroo care,” placing a baby skin to skin with its mother, is as effective as using a temperature controlled chamber to keep the baby warm. 

A checklist can reduce complications from surgery by 50%. Good luck achieving that type of number with another device…which probably makes the surgery more complicated…leading to a greater chance of complications.

-Compared to only aggressive treatment, if you offer considerate end of life hospice care in conjunction with aggressive treatment, people will tend to stop aggressive treatment sooner, BUT live 25% longer. That is, accepting death and getting your ducks in a row outperforms treatment to attempt to live longer. The high tech stuff can actually kill people quicker.

-Some think doctors are going to be replaced by machines. Maybe they’ll have a role in diagnosis, but how is a machine going to empathize with a person? “Who cares about empathy?” The body does, apparently. Empathy may influence diabetes, patient compliance, even the length of the common cold. [12]

-Walking can be an effective anti-depressant.

Speaking of drugs, it’s estimated the sporting performance benefit is probably at most, 5%. Charlie Francis estimated being drug free put you a meter behind a drug user. At the highest levels of sports, this matters. For 99.999999%, remember that math principle?, essentially all of us, this stuff isn’t useful.

I still take programming classes here and there. The reason I have trouble sticking with them now is the same reason I had trouble sticking with it when I was 14. Health and performance is my primary interest, and I can’t find much which seems a worthwhile application of programming. I keep looking; I keep not finding much of anything. (One exception I came up with in the spreadsheets I use.) I don’t think you’ll see computer scientists helping the Kenyans run faster.

When I came across those Kenyan and Westside Barbell photos, I had to laugh. This laughing is not at the them though. It’s at us. Who think you need much more than that.

I’m hoping someone was thinking, “That Westside photo is really before their notoriety shot up. What’s it look like now? I’m sure they’ve upgraded.” From Westside’s Instagram feed:

Westside 1

So, the walls have are whiter.

Look at the power rack on the left in the following photo. The “white” one. 1) That’s as basic of a power rack as you can purchase 2) The thing is so worn the paint is half gone 3) A separate barbell is tied to the top of the rack to simulate a pull-up bar.

Westside 2 with arrow

They didn’t even bother to buy a rack with a pull-up bar built in, despite the fact Dave Tate owns a company that makes such a thing!

Remember how I said it looks like they didn’t have a dumbbell rack when they first started? In what is one of my favorite photos of all time, here is their current, 2015, dumbbell set-up:

Westside 3

I genuinely feel the owner of Westside, Louie Simmons, posted that photo with the mental caption, “Fuck you, pretty boys.”

Here is a picture of the Kenyans’ “track facility” before Rudisha had much success:

Rudisha track This one again:

Rudisha drawing starting line

Here it is after Rudisha was a world record holder:

Rudisha kenya chalk lanes

They added some chalk lines for lanes. That’s it! Being the fastest in the world in an event is a pretty damn good moneymaker. Yet you don’t see some “state of the art” facility being erected in Kenya.

The western world, and the western side of the western world, sometimes think we’re so advanced. Yet what I see is us doing a lot of crap that has minimal, if any, value. While we may think the Kenyans, Jamaicans, Ohioans, are so caveman like, they may think we’re straight up crazy for thinking you can bypass the ball breaking work they do. That whether a barbell looks good, whether your bench is steel or wood, whether you run on a mondo or dirt surface, matters. That the more features your elliptical has, the better. That you can take a few pills and offset 23.9 hours of crappy living. That you need a body composition analysis to know whether you should lose some fat. That a phone app is how you get in shape. That you need a machine to tell you how you feel today, whether you should get up to move (yes), if five hours sleep was enough last night (no). That the one new revolutionary ingredient you add into your diet will shed fat off you. That we spend an inordinate amount of time rationalizing every conceivable reason why we’re overweight, other than the fact we eat too much. We’ll spend endless amounts of money on fancy diets, shakes, supplements, but we won’t SAVE money by eating less.

Because we do have to pay for all this shit.

A matter of cost

My girlfriend and I workout in her apartment complex gym on the weekends. One weekend I see a couple being shown the gym as part of the sales process. The seller remarked they’re in the midst of a gym renovation process where they’re going to do things like bring TVs into every piece of equipment; make the devices “smarter.” “Oooooo” go the couple. “Ahhhhh” go the couple.

While many see that as cool, I see that as unnecessarily inflating how much it costs to workout at that facility. I see a gym with all that new, shiny, exotic equipment, costing more than it should. Using more space than it needs. All for zero exchange of better results.

There is a strong probability the results will be less. Do we really think the Jamaicans or Westside Barbell would get better results with a state of the art facility? Considering their results, can you even make an argument their facilities are not already state of the art? Is it hard to conceive a more comfortable environment would make their results worse? [13]

The seller mentioned the renovation process was going to be worth around $250,000! Is the gym going to look like a castle or something? I’m trying to make it easier to workout, not harder. Lessen the barrier to entry; not increase it. And increasing the costs increases the size of the moat around this castle.

This is the inevitable clash between tech and healthcare. The moment you as a practitioner of whatever kind, move from only your personal interaction with the client / patient, to including technology, you’ve, in almost every circumstance, increased the costs to the customer. The moment you go from a few pieces of steel in a gym to adding electronics, you increase the cost. I’m not sure another industry can say this so matter of factly.

  • MRI? More money.
  • Blood pressure reading? More money. Electronic cuff? More money.
  • Power rack with all the bells and whistles? More money.
  • All radiology? More money.
  • Prescribe a drug? More money.
  • Surgery? More money.
  • Gene therapy? More money.
  • Whenever a new technology is implemented, more training is usually needed = More money.
    • This isn’t talked about enough. The longer it takes to produce a doctor or healthcare provider, the more the customer pays. Longterm, we pay for a doctor’s education. If you get out of med-school a half million in the hole, what are you going to do? Charge more to make that up. You’re not going to be 30 years old, after a grueling residency, and go “You know, I don’t deserve to make much money.” If you get out of med-school fifty grand in the hole, you don’t need to charge as much.
  • Bloodwork? More money.
  • Televisions in gym? More money.
  • Heart rate monitor on treadmill? More money.
  • Prolotherapy? More money.
  • PRP injections? More money.
  • Provide heart rate monitors to every person when they come in? More money. (Some new facilities are trying this. See footnote for dramatic cost comparison.) [14]

Healthcare spending technology shift circled

The above picture is from a discussion between Sal Khan and a doctor at Stanford. Sal noticed around 1980, again, right around when Microsoft took off, is when healthcare costs in the states started deviating from other countries. Why is this he asked? “That’s when we started transitioning to the higher end stuff.” And as they discuss in the video, the only thing that is clear is we haven’t gotten a proportional increase in health. Other countries live as long as we do, other countries have lesser infant mortality, etc.

Some of the big technologies, cars, trains, planes, computers, they’ve all gotten incredibly cheaper over time. Where healthcare has gone the other way. Not only was my family buying better technologies when we say, got a new computer, we were also getting better technology at a cheaper price! Some say an iPhone is expensive. I say a MP3 player, camera, phone, banking device, GPS device, radio, hard drive, yada yada, all for ~$700, is a bargain.

Yet seeing a physician seems to be trending towards a $1,000 an hour. I can clearly see the value of an iPhone, but with much of healthcare, it’s a labyrinth to quantify the value of some of these things. A labyrinth often finding the value isn’t there.

For fitness, it’s easier: The value is absent. TVs in treadmills don’t add anything. “But the technology of being able to watch television while on the treadmill helps me actually get on the treadmill.” To which I respond, “But you wouldn’t be concerned with the TV if the technology of TVs didn’t exist.” Regardless, the real point is the TV doesn’t make the treadmill experience more beneficial. The benefit is in your body moving; not the electronics. You’d be even better off if you went outside and saw the sun for the first time in 10 years. Like with your eyesight.

Money, from a societal standpoint, is finite. If it goes one place, it doesn’t go elsewhere. There is so much low to no value care being spent on, which really hurts other areas which could use money. A recent estimate found upwards of 30% of Medicare is spent on wasteful care. Of that 30%, more than half is on treatments known to be no value care. 30% of medicare is more than the entire K-12 budget. Clean up the waste in medicare and we could double the education budget. Or increase NASA’s budget. Or lower taxes. Whatever it is you’re for. And this is only for what we know is useless and wasteful. We’re going to find more, as what we’re doing can’t last.

From a quality standpoint, technology has struggled to help healthcare. I’d venture to say in a lot cases, more tech has caused more complications, and has any tech decreased complications by 50%? Because a checklist did. From a cost standpoint, technology has outright failed healthcare.

Maybe that’ll change. Maybe we’ll write people’s genetics and never worry about disease again. Or maybe the ease which technologists think this can be done is laughable, like so many other things they’ve inserted into healthcare.

“Electronic records will make everything easier! The sooner we go paperless, the better!” Or, you’ll help burn doctors out because of electronic records. More tech does not automatically equal better.

The unicorn

Just take a drug and your disease will be gone, right? Just clean up your knee and your knee pain is gone, right? Pop a few pills and you’re jacked in no time. Turn one gene on or off and we’ll live forever! This is the unicorn we need to stop chasing.

1) Changing the body takes work, over an extended period of time

-> I want to hammer this point, because it’s what I see the technological enthusiasts consistently miss. Changing computer hardware can happen overnight. Changing the body’s “hardware” does not work that way, no matter how hard you try, how innovative you think you are. Evolution is, so far, smarter than we are. A lot smarter. [15]

This is a good thing, from a survival standpoint. You don’t want a body that’s not robust to its environment. If the body dramatically changed every time it encountered a stimulus, it would waste a dramatic amount of energy doing so. And it wouldn’t be as robust when you didn’t want change. You might want to lose 100lbs over night…but you don’t want to gain it. You might want to kill or edit cancer genes through an injection…but you don’t want your genes edited every time a virus enters you.

Hardgainer complainers stop: The body keeps what it needs. If you tell it to not need muscle or bone, it’ll start losing it after a week, if that. If you tell it to need muscle and bone, you’re going to have to tell it for a long time. Because that’s more energy it has to garner and expend. In 2015 this might be a pain in the ass, but hundreds of years ago it’s exactly what you’d want. A gene disseminating vehicle which carries only as much energy as it needs. No more; no less. Survival > aesthetics.

Weight-loss complainers stop: You want to unlearn habits like eating too much? That takes time….Do you want to lose all the other habits you’ve learned since birth as quickly as you want to lose your eating too much habit? Chewing, walking, recognizing objects? [16]

2) We’re mortal. We have limitations. Maybe that changes one day. The best theories as to why we age say it won’t. (See Being Mortal.) As of now though, we need to accept this.

The progress of science has truly been astonishing. But the progress is not marching on like it once was. The further we push things, the harder and more expensive things get. Isaac Newton was able to revolutionize the world’s thinking in a barn, because some fruit fell and he said “Oh, shit!” To learn new things in physics we need to build something for ten years, costing billions of dollars, all to maybe inch forward. How many people even know what the Large Hadron Collider is? But I bet you know Isaac Newton.

For areas still marching on, like computers, 1) It’s also getting harder 2) How much does it even matter?

  • Download a song in 2 seconds vs 2.2 seconds? How much faster does the average person really need their internet? We’re streaming movies immediately now.
    • You click a Netflix movie and it streams, right? If the movie streams faster, it doesn’t matter because in either case the movie is playing slower than the speed at which it’s being streamed. You only care about this up until you don’t see the buffering anymore. If a movie is 90 minutes, and streaming takes 89, is that much better than it taking 1 minute? In both cases, you put the movie on, it plays without you having to wait. It doesn’t matter how far ahead the streaming is than the movie, so long as it’s ahead.
  • A million songs in my pocket or two million? Now it seems we’re at, I don’t know, 10 million vs 15 million? Does it matter anymore? How many songs do you even know?

I’ve had my Macbook for five years because everything I encounter can still run on it. This was unfathomable 10 years ago. So it’s clear why I don’t buy a new Macbook. I don’t want to spend $1300 until I need to. Or $1300 for a marginal improvement. $1300 only so I see this a couple times less a day:

The progress in these areas are starting to influence a lesser and lesser portion of the population. A millisecond is huge in the finance world of flash traders. But most of us don’t care.

We’ve gotten rid of major vitamin deficiencies, implemented a few vaccines, antibiotics, washing hands, learned about the benefits of exercise. With computers, there is still a clear benefit in say, pushing Moore’s law. We’re getting to where you can debate the how much value is there, but it’s there. For me right now, it’s $1300 I don’t feel like spending.

With health and performance, what if we’ve hit the point in which we don’t have to wait for the movie to buffer anymore? The point in which pushing things further isn’t going to matter, except monetarily? Because it looks like we probably hit this point a long time ago. Again, it’s estimated Jesse Owens might not win the 100 meters nowadays, but with training methods of 1936, he’d still be in the finals.

The Human Genome project ended twelve years ago. How many of us have been affected by it? .00000001%? I feel a lot of us think we’re going to wake up one day and boom, we’ll come across some huge breakthrough. Incremental progress? Sure. Germ theory level discoveries? I don’t know man. I can’t imagine you’re going to see a Kenyan all of a sudden break a world record by a huge margin. This is a credit to us more than anything else. Reaching your limits takes a lot of work. But acknowledging your limits can be just as hard. And everything has limits. Attempting to push past them is a recipe for problems.

Say a Kenyan does run faster, what are the physical consequences of doing so? In horses, we’ve pushed them so much their lungs are hemorrhaging. [17] We may be making matters worse. In some cases, we’ve clearly made matters worse. In other cases, the costs are more hidden.

A matter of materials

I want to make sure it’s known this is not a matter of tech vs non-tech solutions. It’s a matter of non-tech solutions doing just as well, or often better, in which case you shouldn’t bother with the tech solution. If a tech solution so clearly outperforms the non, then fair enough. But as I went through above, that’s rarely what we seeing. We’re often seeing the opposite.

What about other instances? Where perhaps the tech and non-tech solution have similar outcomes. Some may say, “So what?” Especially if the tech solution requires less effort, as it so often does. Think surgery vs a few months of physical therapy. With an arthroscope, you may feel good to go after a few days. (Rare but can happen.) With exercise, it’s probably going to take a bit of time. The surgery is more invasive, but a scope is minimally invasive as far as surgeries go. (It’s still surgery.) But we’ll take that out of the equation for the moment.

The problem here is the tech solution requires materials, where the exercise solution can require only one’s bodyweight, or materials commonly around them. A chair, wall, etc. Nothing new is needed. Nothing needs to be manufactured.

I had an idea for a different type of ab roller.

ab wheel

Instead of the regular wheel, you could make a longer roller with multiple wheels. Because of multiple wheels, the need for stability would be greater. I even made a prototype. I got this idea by having a client do ab rollouts with a wagon.

wagon

Because the two front wheels are like casters, they wobble all over the place like a shopping cart might do. This made things more difficult. The client had to really fight to keep the wagon straight.

I then scrapped the project.

I’m of the belief if you can get equal results with the non-tech solution, then one should do so. For something like my roller, I didn’t see it making enough of a difference to warrant manufacturing. Something like this is similar enough (you’re having to stabilize the side to side movement):

I can’t pull the trigger on smart watches, or FitBit like devices. First, there is the cost, but we’ll ignore that. (I actually think most are reasonably priced.) Second, I think the technology is cool as hell, but comparatively speaking, is it adding enough value? The watch can notify you to get up every certain amount of minutes. I can see that being helpful. But you could also put a post-it note in front of your computer. Put an alarm on your laptop. Use an app on your phone. No new materials needed. [18]

Say machines were just as good as free weights. Then why not use them, right? Using machines when free weights are just as good (they’re better), necessitates more materials.

The reason this matters is as soon as you make something, those materials have to come from somewhere. An iPhone, smart watch, surgical tools, other wearable tech, these things come from places.

Whether it’s CO2 emissions, air pollution, waste management, species supplantation, toxicity, slave labor, a lot of bad shit happens when you manufacture materials. Even if you got all of this down to where nothing harmful is concomitant -I’m not sure this is possible- you still have supplanted another species, and you’re still taking up land that could be for plants (who can help sequester CO2). [19] (If you don’t care about any of this then alright, you still have to consider cost, something everyone cares about.)

Solar panels help mitigate CO2 emissions for instance. However, you emit CO2 in the process of making them. Sometimes a lot. Even if you use solar energy to make the materials, to generate the heat (energy), bad things happen when you heat concrete. And you need a lot of concrete when you have a solar factory. 

That said, it’s not realistic to say let’s go back to before we had electricity. The solar, perhaps a more high tech solution than coal, has advantages. Not as much as we often think, but they’re there. So it makes sense to go with it. If you had a solution which could still provide electricity and have even less negative effects? Then you would go with that. If you had a solution which involved zero materials, it’d be beneficial to go with that.

Yet we don’t do this with the body. For most of the issues people encounter, you can get comparable results with a low tech, cheaper solution, involving less to no materials. But we over and over go for high tech, expensive solutions. Some of which entail injecting materials into our body.

most expensive surgeries to healthcare system

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS), 2011

The above is the most expensive procedures to the healthcare system. Not per procedure, but how many people get the procedure * cost of procedure.

We’ve discovered the most common orthopedic procedures are pretty futile. Such as a partial meniscectomy and knee debridementThe way we really discovered this was by doing hard research, using randomization and placebos. You know what’s sad about the above list for orthopedic procedures? Like knee replacements, spinal fusions, hip replacements? We don’t have that quality of research for these things. Nor most surgeries. [20] I’d bet a lot if we did, we’d find similar results for many orthopedic procedures. Again, it was recently found only 50% of certain surgeries beat placebos, AND those that did only did so marginally.

Let’s say we lessen spinal fusions and knee replacements by half. We’ll be generous and say quality research would say the surgeries do better than placebos, but not by much, so we still do a lot of them. Halve those surgeries and we save 6.5% on all operating room procedures. That’s only by lessening two procedures.

Get people to be in better shape and avoid a lot of those heart procedures above, and the savings start racking up very quickly. Plus, you avoid surgery! You avoid all the hell that surgery entails. You encourage calorie burning through exercise. You save on materials from not doing as many surgeries. It’s wins all around.

It can be beneficial to chase unicorns because someday you may come across one. But you can’t chase mindlessly. You can’t chase and not acknowledge the incredible costs associated with doing so, in an environment where costs are already so high. Too high.

Maybe we don’t need to stop chasing, but we need to pause. Because there are too many solutions which are cost effective, just as good, often better, less invasive, involving less materials. And we’re not taking advantage of them.

At the same time, there needs to be an acknowledgement we can’t innovate out of all problems. By innovate I mean what we commonly think of. Bill Gates, on the Mount Rushmore of techies, loves to throw around the word innovate for every problem. But even Bill Gates can’t innovate out of the fact he needs to eat less to lose weight.

A matter of an excuse

While there is a lot we can do to mitigate costs, the biggest reason healthcare costs go up is because more people use more healthcare. Does technology help or hurt this? I hit on how technology influences health in part one. What I mean here though is do technological treatments mitigate or exacerbate people’s dependency on healthcare?

I think a quote will best illustrate what I’m asking:

Client who has diabetes “My wife has been doing well with her nutrition program for diabetes. They mentioned to her if she loses enough weight, she may be able to lessen her insulin or get off it.”

Me “That’s great!”

Client “That’s not for me though. I’d rather take the insulin than try to lose weight.”

I’ll leave it with that.

[1This article says only 10% of high schools offer computer science.

[2] My sister is a little more in my domain, entertaining the healthcare field in a few different ways.

[3] If anyone is wondering, “How did he and his family do all this?” It’s not like my family was a bunch of millionaires, but we were well-off. Second, my family always spent heavily on anything education / learning based, but minimally anywhere else. Remember my Dad works in tech, so buying tech things was part of his work to a large degree. A new computer could help with school work. (And building them yourself saves money.) After 12 years old I think I stopped going on any type of vacations. My parents would still leave sporadically, but I didn’t want to miss anything sport related during the summers. (And they often were only going a couple hours away.) I spent close to ten years without leaving a ~100 mile radius.

The real high-end stuff, EKG, EMG, lab analysis, that was mainly in college.

[4] I’ve seen the no music thing at the highest levels of sport a few times. The idea is it’s a distraction. If you’re focusing on what you’re listening to, you’re not focusing on your technique as much.

[5] Now that all Ohioans hate me, Ohio actually use to be a big place for innovation. Dayton lead the country in patent applications around the beginning of the 19th century. I came across this statistic in the latest book on the The Wright Brothers, who are from Dayton. I think it’s safe to say Ohio is no longer a hotbed of technology though.

[6] See The Sports Gene for an in-depth look at this. I wrote about the book here.

[7] Although, some of Seb Coe’s training was on side streets!

Seb Coe running on street 2

[8] Something ironic about barbells and dumbbells: The simpler ones, some metal attached to metal, last longer than modern equipment. You may notice gyms nowadays with rubber coating over their dumbbells.

rubber dumbbell

I worked in a gym with these for a few years. Eventually, the rubber wears down and the metal starts sticking out. The gym eventually replaced the entire dumbbell rack. This is a huge gym, with many, many locations. That’s an enormous expense for a fitness facility. If you have the old fashioned metal dumbbells, metal plates screwed on metal bars, the things last a lifetime. They don’t look as nice, but people get over it. Either way, they’re touching the metal part!

[9] Make no mistake though, these percentages matter a great deal at the top levels of athletics.

[10] Single handedly ended the Cold War by training in a barn and the snow:

[11] I mention “enough are making it through” because there is some evidence top camps like Kenya, or the Russians back in the day, run their athletes through the grinder. Spitting out a lot of injuries, but keeping a few who make it. I’m not sure if this is a problem, or part of the reality of the training loads it takes to become world class. World class inevitably meaning many won’t make it. Don’t get it twisted though, America does this as bad as anybody. Early specializations, three day tournaments, year round play. We are no better.

[12] This may be one of the best ways to combat automation making one unemployed. Even if a computer can be programmed to empathize, we don’t seem to like knowing someone, or some thing, is empathizing for a reason other than being genuine. If you know a computer is programmed to empathize, versus a person who has the choice, I think we lean towards a person. So long as it doesn’t seem to the person is faking it, or doing it with ulterior motives.

[13] In The Sports Gene, a very successful Kenyan runner discusses how he thinks raising his kids in America made them less likely to succeed athletically, compared to Kenya. Life being significantly easier in America, with “incredible resources.” e.g. This runner ran to school growing up; his kids get a nice, perfectly climate controlled, car ride each day.

[14] This is one reason I think CrossFit took off. It was so easy to open a facility due to the limited equipment they use. You could probably open a CrossFit style gym with five grand, if that. One new gym I’ve come across, Orange Theory, uses heart rate monitors for every person who comes in. Cost to open up? $500,000. Not everyone can do that, but anybody could open a CrossFit gym due to the low barrier of entry. And then think about the difference in maintenance costs over time. I’m not a fan of CrossFit’s training, but they have gotten a lot of people to exercise.

[15] See bugs which can rewire the brain. Something we humans can’t do!

[16] Part one of this series dealt with technology making things less metabolically costly. From a fitness point of view, at some point I started going after solutions that are more metabolically costly. Surgery vs physical therapy? Physical therapy is probably better. Take a pill vs dedicated training? Training wins. One program that’s a month versus another that’s six months? Six months. It’s not how I intended to do things, but I’ve found it’s a solid bullshit filter.

[17] I still remember this conversation with a professor in college: Humans have enormous lungs relative to our overall body size, while horses do not. I believe the physiology went humans are not constrained performance wise by a lack of oxygen production from the lungs, where horses are. Because the lungs get comparatively more stressed in horses, you see this hemorrhaging, which you do not see in humans e.g. marathon runners. You do see their legs collapse though. Humans can get enough O2 production, but I believe utilization is the bottleneck.

[18] There are some other intriguing watch applications though. I had to write a paper on safety for an aerospace engineering class. One of the biggest things with aerospace safety is pilot error. The flight crash I examined dealt with pilot fatigue. One application of the watch I put forth is to monitor heart rate before take-off. You could have a continuously updated database of the person’s heart rate, say, the 24 hours before the flight. Where if a pilot has an unusually elevated heart rate -you could get baseline measurements during training- maybe they are fatigued, hungover, on drugs, were up too late the night before, etc. Rather than them tell you when they went to sleep, you can see it. (Heart rate decreases when sleeping.) The idea being you get a much more objective view of the person’s physiology compared to their subjective feedback. Subjective feedback in which they may be prone to lie to you, due to not wanting to take a day off / admit wrongdoing.

[19] This is an unfortunate reality of companies like Apple. I like Tim Cook (CEO). I think he’s trying. While to a degree it’s admirable, I’m not sure it matters how eco-friendly you try to be. When you make 75 million phone in a quarter, you’re going to have some negative impacts.

[20] I have firsthand knowledge of researchers being given a hard time for wanting to and or conducting this type of research. Many in the medical establishment do not truly want to know how much money they’re wasting, and how many bodies they’re unnecessarily traumatizing.

Update 9/27/15: Slightly modified computer programming comments.

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