As the stuff of science fiction starts to seem possible in the world of healthcare — from reversing aging to microscopic body monitors — Zócalo asked five doctors, humanists, and medical experts what single technology will most revolutionize the practice of medicine. Their answers include what we already have — apps and electronic records — to the ultimate shift, defeating death.

How the iPhone has doctors beat

Certainly technological interventions have transformed medicine: the stethoscope, penicillin, polio vaccines, and anesthesia being at the top of my list. In other instances, technologies that have made the biggest impact have been simple, human communication strategies: patient-centered communication to assure tailored decisions and the recent “checklist manifesto” that can assure consistent quality care. In many ways, our intervention-based technologies have gotten in the way of sane healthcare, and the more we can stay out of the medical center, the better. Mobile health technology is actually working to direct patient-centered messages that can support people and community-based care providers in preventing and managing illnesses. In the U.S., one of the top-selling iPhone applications is directed at counting calories and weight-management targets. This 99-cent innovation significantly impacted diet and exercise behaviors – arguably the area that hurts us most in the North – in a time when medicine has long since given up on being able to change behavior and moved to simply prescribing pills instead. Developing communication strategies (interpersonal as well as mobile-technology enabled) could be the best technology medicine can use to guide people toward healthy choices and contribute to positive health impacts.

–Kelly Edwards is an Associate Professor in the Department of Bioethics and Humanities at the University of Washington School of Medicine.

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The end of death?

The single most technological advancement that will revolutionize the practice of medicine, and for which doctors are most unprepared, is the possible defeat of death.

During the past 40 years significant changes have occurred in relation to the way in which we think about death. Previously, death was thought of as ordained by God, part of the divine order.  More recently, in a fully naturalized world, death was thought of as inevitable, a fact that follows from the way we are biologically constructed. If it was not the case that a divine order underlay the world, at least the natural world had its own order. Even more recently, the idea that death is “natural” began to be interpreted as death is “inevitable.” There is, simply, no way to avoid it.

Interestingly, there is a certain comfort in all these perspectives. Death is part of the divine order (God is in charge), death is part of the natural order (at least nature is predictable), and then finally death is inevitable (at least we can make our peace with it).

But what is death? Increasingly, it seems, death is understood as the wearing out of body parts, or organs, or biological systems. If one looks through the obituaries of the past 40 years one will see a very significant change. At some point, it became a requirement that the cause of death be clearly indicated. The result is that one can read an obituary and think, “If I only avoid what he or she died of, I can avoid death.”

Ultimately, then, we are getting closer and closer to the point where death might end up being a choice.  How will doctors counsel patients about this possible choice? This would be a very unsettling development for which we are entirely unprepared, and to which physicians have given no attention at all.

–Mark Sheldon is Distinguished Senior Lecturer in Medical Humanities & Bioethics at Northwestern University, and a former policy analyst for the American Medical Association.

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We already have the most revolutionary technology

Interestingly, one of the technologic advancements that will revolutionize health care has been around for many years but not utilized widely: electronic medical records. In the coming years, EMR will play a key role in advancing the quality of patient care by providing the data required to track performance and therefore implement continuous improvement. It will help ensure that evidence-based medicine is implemented for patients through decision support tools, such as checklists. EMR will help promote patient safety through programs that check medication interactions and alert providers about critical patient conditions. Lastly, EMR will enable providers to effectively communicate with each other regarding various patient care issues.

Currently, only one in 10 providers uses EMR. Providers rely on paper charts for communication, which often vary widely and are incomplete. This lack of standardized process leads to significant variations in communication, as well as the care delivered. At a time when decision-making should be based on the most up-to-date information, it is quite challenging to collect all the relevant information for one patient from the various providers involved in the care. These features of EMR will help create a standard, as well as accountability, for care. The future of medicine is providing the highest quality of care, in the safest manner possible. EMR will help accomplish this.

–Nasim Afsarmanesh is Director of the Hospital Medicine and Neurosurgical Clinical Quality Programs at Ronald Reagan UCLA Medical Center.

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Trekkie tech

It may seem too far-fetched and, for “Trekkies,” too familiar, but I think we’re not far from seeing something like a “tricorder” being used in medicine. Just as cell phones evolved from bulky bricks into flip phones resembling “communicators” in the same series, early tricorder prototypes will barely resemble the real McCoy – as it were.

Early prototypes will rely on blood and tissue samples – ouch! – and they will not be stand-alone devices. Interconnectivity will be a critical and enabling component, since these devices will need to have access to massive amounts of intelligently organized, personalized and analyzable data. By integrating many advances in cloud computing, search technology and bioinformatics, early tricoders will reach the level of artificial intelligence we need to meaningfully process a flood of person-specific data – a complete cataloguing of an individual’s proteins at the time of assessment. The protein and metabolite information generated by analyzing blood and tissue samples will then be connected to the entire medical history of that patient which will, of course, include their genetic template and epigenetic idiosyncrasies.

This type of technology has the promise of detecting incipient cancers when they are at their earliest stages. With other advances in nanotechnology and biomimetic electronics, new targeted treatments will be able to nip these cancers in the bud. Learning that pancreatic cancer, for example, takes an average of 15 years to develop before any symptoms are noticed underlines the importance of early detection coupled with targeted treatment. Our first generation of tricorders will be limited to early detection of a handful of diseases for which there are treatment options. They will serve as a rapidly-developing platform technology where advances in detection and treatment processes can be incorporated.

The introduction and evolution of tricorders will revolutionize the practice of medicine by making information and decisions more transparent to all involved. The practice of medicine will become, more and more, a shared and coordinated set of interventions. Who, when and what to do will be determined by a comprehensive, system-level understanding of biological processes enabled by technology.

–George Tolomiczenko is the Administrative Director of the HTE@USC program, a joint effort between USC’s Keck School of Medicine and Viterbi School of Engineering to teach medical students and engineering students how to work together to create innovative solutions to healthcare issues.

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Monitoring our elders

As other advances in medicine, health and nutrition prolong life, the elderly population will grow disproportionally. Monitoring the health of this population in the traditional healthcare environment is not going to be feasible.  Many patients whose routine care is traditionally managed in the hospital or clinic will have to be connected to their providers remotely, from their home.

Non-invasive, wearable sensors that measure and monitor physiological, chemical and physical variables will therefore revolutionize the practice of medicine the most in the coming decades.

It’s already possible to measure non-invasively certain physiological variables – heart rate, blood pressure, oxygen saturation, respiratory rate and volume, blood glucose concentration, hemoglobin concentration. Today, small monitors such as those in mobile phones can provide information on environmental conditions such as location, speed, acceleration, and elevation, and can provide audio and video transmission. Future advances in sensor technologies – enabling breath analysis and accessing small blood vessels in the inner eyelid – coupled with secure transmission of information over the Internet will allow a large battery of variables to be measured and relayed to virtually attending physicians in real time.

These devices will not only ensure close monitoring of patients’ conditions, but also have the capability of providing feedback to the wearer – such as “your heart rate is too high,” or “your blood sugar is too low.” Physicians will also have the option of remotely effecting treatment through these wearable technologies such as adjusting insulin doses or pacemaker variables. These remote monitoring and intervention capabilities will dramatically reduce the number of visits to healthcare facilities and streamline healthcare for elderly and chronically ill persons, ensuring high quality care despite heightened demands for efficiency.

–Selim Suner is Associate Professor of Emergency Medicine Surgery and Engineering at Brown University.

*Photos courtesy the participants. Photo of a Star Trek tricoder replica courtesy David July.

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Many of us already go online to seek healthcare, and not just to Google symptoms. Online support groups, healthcare systems that allow for online communication between patients and doctors, and other innovations are making the web a crucial part of car. Ahead of our panel asking doctors and bloggers to discuss the dangers and opportunities of online care, we asked UCLA’s Molly Coye, Kaiser’s Kate Christensen, and UC Davis’ Peter Yellowlees to tell us what online healthcare will look like in five years.

Building trust and easing pain online

What do we really expect from online healthcare? In the first wave of online services, we used the internet to find sources of information. In the second wave, online communications replaced some of the most tedious parts of healthcare – allowing us to send information to the doctor’s office, make appointments, refill prescriptions, and avoid endless missed calls by emailing our doctors. At the same time, some health providers started using telephone and then Internet-enabled devices to monitor our blood pressure, weight, and other indicators of our health. These functions make our lives easier and (at least in theory) should make healthcare less expensive. When Kaiser Permanente offered members the chance to email with their doctors, for example, the need for clinic visits was reduced by 25%.

But the most promising aspect of online healthcare is emerging as consumers and patients and physicians discover the power of the Internet to foster relationships. Relationships of trust, learning, support and mutual benefit are the long-term platform for successfully managing our way through the potholes and bumps of parenthood, the advent of chronic conditions and those rare acute crises that galvanize our entire network.

The idea that relationships – especially networks as communities – can support individuals to change their lives is not new. When Kate Lorig asked groups of arthritic patients to meet in groups – without a provider present – in order to talk about managing their pain and disability, she found that their pain and disability decreased and their need for pain medication stayed lower than expected for several years after they participated in the group. That was in the 1990s. Today, this approach has been reformulated for the web, and groups of patients are advising and supporting each other and forming their own communities in order to manage their health. The National Health Service in the UK and large health systems in the US have adopted Lorig’s program.  And patients, or consumers, have found their own platforms: on PatientsLikeMe, individuals are sharing their health data, exchanging information about diagnoses and treatments, and forming online support groups without any sponsorship by health providers.

–Molly Joel Coye, MD, MPH, is Chief Innovation Officer of the UCLA Health System.

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The Internet can make us healthier

As an old-school Internet user, with children in their 20s, I see a clear trend between those older folks with health issues who are deeply engaged in using the Internet from their computers for health matters, and those young ‘uns who live on their mobile phones.  That trend and the distinctions it creates will accelerate over the next 5 years.  According to a recent California HealthCare Foundation Survey, “40% of respondents with two or more chronic conditions that use PHRs [online Personal Health Records] did something to improve their health vs. 24% of others interviewed.”

About 44% of registered users of the Kaiser Permanente Web site kp.org, and its ‘My Health Manager’ Personal Health Record, are over 50.  This makes sense, because they have greater health care needs than most younger people.  They use it to make appointments, request refills, research conditions, check their test results, and email their doctors.  In five years, us AARPers will participate in even more health interactions with Web visits, online chat or email with providers, prescribed WII Fit exercises, online health coaching, and digital monitoring of activity and biometrics like blood pressure and blood sugar.  All of these capabilities are in use now, but have not yet become mainstream and are not yet integrated together into a coherent experience.  When the technology is cheap and ubiquitous, platform agnostic, and integrated and the incentives for all are aligned, it will be commonplace to see digital monitoring in the homes of older Americans, as well as in the homes of younger people with hypertension or diabetes.  (The fitness enthusiasts are already tracking their pulse rates and mets burned any way they can).  In five years, we will also be seeing more integration between the information I track in my home and the information my doctor tracks for me.  This will give rise to new opportunities as doctors are able to see data about patients’ real lifestyles (if they’re willing to share) and how they integrate with in-the-moment problems.

Members of my kids’ generation use their mobile phones mostly for texting (using a phone to talk on is so lame!) and Internet searches and transactions, like music downloads. Online health for them will look like text reminders and notifications, with a Web cam visit, digital photo or video upload when needed.  They will expect to be able to complete transactions on their phones, like making appointments or requesting refills, with a high degree of usability.  There will have to be an app for that, for most anything they want to do. In addition, there will be opportunities to integrate the data from all of the disparate sources and transactions in a unified whole, and once this is commonplace, we’ll wonder how we ever got along without it.

–Kate Christensen, MD, is Medical Director of the Internet Services Group for Kaiser Permanente.

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The tipping point for online care

Online healthcare is becoming more accepted by both patients and doctors and is, I believe, at a tipping point in 2010.  The remarkable changes in internet based technologies are allowing us to rapidly implement new clinical practices that support patient focused and individualized care. By 2015 online communication between patients and doctors and the routine use of multimedia information will be the norm.

Patients will still be seen in person but our improved capacity to communicate electronically is, as CM Christensen, JH Grossman, and J Hwang put it, “a disruptive innovation”  that will revolutionize healthcare delivery. Providers will be routinely using new technologies, such as email, telemedicine, electronic records, social networks, and wireless mobile applications with patients. This will make healthcare more affordable, accessible and efficient.

These changes will be supplemented and strengthened by the availability of multimedia data. Electronic clinical information will be more freely available than today for both patients and doctors to review, comment on, pass to others for second opinions, and compare with clinical databases and disease registries. This data will be in multiple electronic formats–numeric, text-based, audio, digitized still pictures, video, radiologic, genomic and 3D streams. It will include data emanating from multiple medical monitoring and diagnostic devices as well as from ubiquitously available consumer devices such as cell phones. Patients and physicians will have to learn to navigate a “sea” of data, using new techniques to evaluate and analyze the relative importance of specific data points and elements of clinical information.

These two changes will mean that by 2015 the relationship that many patients have with their doctors will have expanded beyond the in-person interaction of today, and will increasingly occur literally anytime, anywhere in both online and in person environments.

-Peter Yellowlees, MD,  is Director of the Health Informatics Graduate Program at UC Davis and author of Your Health in the Information Age – How You and Your Doctor Can Use the Internet to Work Together.

*Photos courtesy the contributors. Photo of desktop courtesy Chris Jagers.

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Bad lighting, windowless walls, low ceilings, and dull furniture are the hallmarks of many an office, hospital, care center, or any place aiming for cost-effective function over beauty. But good-looking environments matter. Before Zócalo presents next week’s panel on what healthy design does for us, we asked five architecture experts – writer Alain de Botton, KCRW’s Frances Anderton, interior designer Lynnette Tedder and architects Roger Sherman and Victor Regnier – whether good design improves our well-being. Their answers, drawing on everything from the Ronald Reagan UCLA Medical Center to KCRW studios to offices and homes, follow.

Good buildings are like good people

Good design has a huge role to play in altering our mood. When we call a chair or a house beautiful, really what we’re saying is that we like the way of life it’s suggesting to us. It has an attitude we’re attracted to: if it was magically turned into a person, we’d like who it was. It would be convenient if we could remain in much the same mood wherever we happened to be, in a cheap motel or a palace (think of how much money we’d save on redecorating our houses), but unfortunately we’re highly vulnerable to the coded messages that emanate from our surroundings. This helps to explain our passionate feelings towards matters of architecture and home decoration: these things help to decide who we are.

Of course, architecture can’t on its own always make us into contented people. Witness the dissatisfactions that can unfold even in idyllic surroundings. One might say that architecture suggests a mood to us, which we may be too internally troubled to be able to take up. Its effectiveness could be compared to the weather: a fine day can substantially change our state of mind – and people may be willing to make great sacrifices to be nearer a sunny climate. Then again, under the weight of sufficient problems (romantic or professional confusions, for example), no amount of blue sky, and not even the greatest building, will be able to make us smile. Hence the difficulty of trying to raise architecture into a political priority: it has none of the unambiguous advantages of clean drinking water or a safe food supply. And yet it remains vital.

–Alain de Botton is the author of The Architecture of Happiness and more recently The Pleasures and Sorrows of Work.

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Design isn’t everything

If by good design we mean environments that provide fresh air, natural light, soothing natural materials and pleasing colors, with sounds and sights of nature outside, then I would say yes, absolutely, good design provides a sense of well-being, and might even actually improve health. Indeed, hospital design is moving in that direction, after several decades of highly functionalist buildings that have proven far from life-enhancing for the patient (hear more on this DnA). Furthermore, for the person who is highly sensitive to the aesthetics of their surroundings, an environment that is designed in a style that pleases the patient could also improve spirits.

However, there are other social contributors to well-being that have nothing to do with design, and may even counter the points made above. I speak from experience. When I first went to volunteer for KCRW, I visited the station in its famous basement and was horrified to find it had almost no natural light nor cross-ventilation, bright fluorescent strip lighting, and only the clatter of other people’s computers and phone conversations as background noise. But I was so keen to work at the station that I suppressed my desire for a more pleasant environment. The station, because of its staff and its goals, proved to be the most stimulating, interesting and fulfilling place I’ve ever worked, suggesting something that, as an advocate of the benefits of good design, I say with reluctance: good design is not all-important.

Having said that, I did get headaches in the basement and was relieved when our production team was given an above-ground office with natural light and air, meaning we could enjoy both a decent environment and KCRW’s social well-being.

–Frances Anderton is host of KCRW’s DnA: Design and Architecture.

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Healthier hospitals

As a healthcare designer, I believe well-designed healthcare environments have a positive impact on patient experience and outcomes. Fundamental to this tenet is an understanding of the relationship between humans and the built environment. For every facility, healthcare designers study how staff interact, how services are delivered, what safety and maintenance requirements need to be met, and other critical issues that inform how facilities should be planned. We then implement design strategies with the goals of improving patient care and increasing user satisfaction.

One notable area where we can have an impact on patient care and safety is the design of caregiver zones. When these areas are well defined, with quick access to hand washing and to support items, the likelihood of infections can be reduced as well as the instance of medical errors. The selection of materials can also have an extreme impact on infection control and safety by reducing the transfer of airborne pathogens, growth of bacteria, and the presence of slipping hazards. How these materials affect the overall ambiance of a space through their color, texture and reflection also are important considerations. A designer’s ability to achieve a balance between aesthetics and high-tech materials, while specifying a sustainable solution, is one of the strongest influences design can have on health.

The Ronald Reagan UCLA Medical Center is a local example where we applied these design principles. Since the facility opened in 2008, the feedback from patients, staff, and administrators, has been very positive. We’re confident that this high level of patient and caregiver satisfaction will contribute to better outcomes.

–Lynnette Tedder is a Senior Interior Designer at Perkins+Will.

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Good for whom?

Taking the issue of “goodness” out of the equation for a moment, that there is a relationship between design and health is clear. What is perhaps less clearly understood – and most worth discussing – are the means of measuring and evaluating their connection, in order to better define what is indeed meant by “good” or “poor” when it comes to design.

Is it merely the aesthetic or visual impression a space or building makes? Or does it pertain more to what architects like to call performance, such as the provision of natural versus mechanical ventilation and lighting? Is it the quantity of unprogrammed common space that matters, or the quality of those spaces with more defined purposes? Is it the way in which a building encourages people to walk between destinations, as opposed to taking the elevator? While some might argue this is simply inefficient, convenience is not always synonymous with either the health of the city or its citizens. This was made clear recently in a local debate over whether County office buildings should house cafeterias or close them in an effort to get employees to walk and to use the new civic park.

These questions are not so easily parsed. Nor, for that matter, is the associated question – one of social justice – that asks whose health should benefit first or most from design. Is it urban residents at large, or only the building’s users? In a perfect world, good design is the rising tide that floats all boats, but in today’s economically- and politically-constrained environment, these are often choices, and difficult ones at that.

–Roger Sherman is Principal of Roger Sherman Architecture and Urban Design Co-Director, cityLAB.

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Making senior homes livable

Having nearly 40 years of experience evaluating housing with services for mentally and physically frail people, I am totally convinced that environment makes a huge difference in quality of life.

So many older people and their families take cues from the environment when assessing their ability to maintain independence. Environments affect staff as well – working in an institutional setting, like living in one, is depressing. Simple things like not having control over who enters or exits your room, or whether or not you can bring your own possessions with you, are very important.

The best northern European models have always responded to this by keeping people in residential environments and “ramping up” services for them as they need more assistance.

European service houses and what the Dutch call “Apartments for Life” are designed to connect housing and services rather than bundle them together and call them assisted living or nursing care. These settings operate in conventional communities. They deliver health and supportive services and any necessary home repairs, allowing residents to remain independent and live in their own homes.

Whether for appearance or function, environments make a huge difference in supporting the independence of older frail people.

–Victor Regnier is a Professor of Architecture and Gerontology at the University of Southern California.

*Photos of Alain de Botton and Roger Sherman by Aaron Salcido. Photos courtesy Frances Anderton, Lynnette Tedder, Victor Regnier. Photo of dam courtesy Tim Caynes.

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Spencer Wells, a geneticist and anthropologist, had studied the genetics of indigenous human populations for years when, after working on the PBS documentary about the Y chromosome, “The Journey of Man,” he found a home at National Geographic. “They said, ‘This is fascinating stuff. Now that you’re done with the film, what would you like to do next?’ It’s a great question to be asked,” said Wells, who is now the “Explorer-in-Residence” for the magazine. His work took him around the world and ultimately toward writing Pandora’s Seed: The Unforeseen Cost of Civilization, which, as he discusses below, argues that the switch to agriculture 10,000 years ago is the root of many a modern problem, from obesity to religious fundamentalism to social anxiety.

Q. What did you learn from the time you spent in hunter-gatherer societies?

A. As a relatively affluent, middle-class American going to visit these people who have virtually nothing, the first thing that strikes you is, how can they live like this? They must be so unhappy. But as you spend more time with them, you unwind from the Google and mobile-filled world and you realize they’re incredibly happy and have a wonderful lifestyle, though it’s increasingly under threat. Left to their own devices, they would be completely fulfilled. So you have to ask, why is everyone in the world today an agriculturalist? Ninety-nine point nine percent of us rely on agriculture rather than hunting and gathering. That led me to do some research, to ask, what led to that transition, and what effects did that transition have on us, physically and mentally? The early agricultural populations were less healthy than hunter-gatherers, so why did their way of life lose out?

It’s because with agriculture, you can grow more people, even if they’re not happier or healthier. That set in motion a lot of forces that I trace in the rest of the book.

Q. When did the transition from hunter-gathering to agriculture happen, and what effect did it have on humans?

A. Around 10,000 years ago. The world was coming out of from the last Ice Age, conditions were improving, the world was warming up and the human population started to expand somewhat in certain locations. People started to specialize in gathering particular grain species – wheat and barley in the Middle East, rice in China and India, corn in Mexico. They started to settle down into villages. Then an ice dam melted in North America. The water of Lake Aggasiz, which had been created by the melting of the Laurentide ice sheet, was released into the North Atlantic.  This killed the Gulf Stream, which brings warm water into the North Atlantic. It plunged western Eurasia back into Ice Age-like conditions, but population density had by that point increased beyond the ice age carrying capacity. So people had to innovate, and the innovation was agriculture.

We survived. It made complete sense at the time to develop agriculture. The sting in the tail was that as population density increased, we overhunted the animals we survived on. So we had to domesticate some species. Most major infectious diseases that afflict humans were introduced then, from these domesticated animals. There was also a shift in the human diet away from a diverse gathered group of plants. Hunter-gatherers in the Middle East were eating over 150 plant species – fruits, nuts, berries, tubers as well as grains. Once they made the transition to agriculture, it went down to about eight plant species, with most calories coming from wheat and barley. Even today, 60 percent of the world’s calories come from wheat, rice and corn. Consumption of starch and simple sugars increased, and there was a massive increase in cavities right away, no matter where the population was – the Middle East, Asia, the Americas. As soon as people transitioned to agriculture, cavities quintupled. It’s an early sign that we were maladapted to the new way of life. That continues today – the obesity epidemic is an extension of that.

Q. Why did we evolve this way if it seems to have been bad for us?

A. Evolution is all about reproduction. In a Darwinian sense, agriculture was real winner. It produced more people. But of course, it’s not just about making more people, it’s a question of choosing the lifestyle that’s right for us. We’re still in the course of adapting to this radical cultural shift. For instance lactase, the gene that codes for the enzyme that digests lactose, the sugar in milk.  Certain populations that  domesticated sheep, goats, and cattle, and started drinking milk beyond childhood were selected to retain that ability.  As a result, most Europeans today have it. You can see evidence of this sort of culturally-driven selection in the human genome.

Q. What other modern problems came about because of our transition to agriculture – what were the mental impacts in particular?

A. There is some mental fallout. The predicted ideal human group size is around 150 people, according to the British evolutionary psychologist Robin Dunbar. That’s what the neocortex, which governs the ability to form social relationships, can handle. He predicted we should be living in groups no larger than 150. It remains an important figure – it’s the size of army companies, the size of traditional Hutterite farming communities in Canada (they are a bit like the Amish). Once you go beyond 150, the group fissions. If a group size exceeds 150 people, you need to create some sort of bureaucracy, a government, because otherwise you can’t keep track of all the social relationships.

Today, we’re living in cities with thousands and millions of people. But we’re actually disconnected from most of them. Imagine you’re in an elevator – you’re not chatting with anybody, you’re checking your Blackberry, perhaps, or staring at the floor numbers. You’re crowded, but disconnected. I argue that this creates unease.

We actually do see rising rates of mental illness. The World Health Organization predicted that by 2020, mental illness will be the second leading cause of death and disability after heart disease. Antidepressants are the most widely-prescribed class of drugs today. As I say in the book, for the first time in human history, we have to drug ourselves to feel normal. We used to do it, with shamans, for instance, to get out of the normal state of existence, to enter a mystical trance.  Now we do it to make it through the day.

Q. You discuss in Pandora’s Seed how fundamentalism can be traced back to these problems as well – can you elaborate?

A. Most think only of Islamic fundamentalism, but there is also Christian fundamentalism, particularly in the U.S. I argue that both are the product of the last 50 years or so, and are in part due to a sense that some people have that they’ve lost their purpose, a religious purpose, the overarching sense of what is ethical, in all-out race to create novelty and material wealth. Religious fundamentalism is perhaps a backlash against that, along with the increasingly secular world we live in. It’s an effort to go back to an earlier time, where mythos – received truths and traditions – was more important than logos, than rational thought.

Q. How can we repair some of these problems?

A. It’s not going to be easy – we have a lot of crises facing us in the 21st century.  We should, I argue, take some cues from surviving hunter-gatherers, and our distant ancestors, and try to want less. Look at the Gulf of Mexico oil spill, for instance. There are proximal causes to that – errors made by BP, perhaps coupled with a lack of regulation and oversight. But ultimately, the root cause is that we all need cheap gasoline. We as a society are ultimately to blame. Everyone is ringing their hands about climate change and so on, but really, part of the solution is simply to learn to want less – to live more efficiently, recognizing that there are limits to our previously unchecked growth.

Q. Is that enough, given that the problem seems part of our genes?

A. That is something that needs to underlie everything else we do. We also need to come up with better, cleaner sources of energy, pursue material wealth less, and develop better farming methods. I think all of that comes down to wanting less. What’s going to happen over the next half century, for the first time in 70,000 years, is we will be living in a population that’s no longer growing. The UN is predicting around 9.5 billion people by mid-century. That’s a lot of people, especially people who want to live the way the average American lives today. It’s simply untenable to imagine that. I think for all of us to survive, we have to get by on less and be more efficient with the resources we use.

Q. Are you optimistic about our ability to change in this way?

A. There is hope – that’s why I called it Pandora’s Seed. The myth of Pandora is that she opens the box, and all these plagues for humanity fly out. But she claps down the lid and saves hope. Hope lies in our remarkable ability to innovate. It’s what saved us time and time again throughout history. I think it’s going to allow us to create solutions, once we see the consequences of what we’re doing. We are fairly short-sighted as a species. But we’re at a point in our social evolution where we need to think longer-term in order to see the true costs, the unintended consequences of our actions.

*Photo of Spencer Wells by David Evans. Photo of wheat courtesy bernat….

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Marian Mulkey is director of the California HealthCare Foundation’s Health Reform and Public Programs Initiative, which is working to support the implementation of national health reform in California and advance the effectiveness of public coverage programs. Before chatting about health reform’s implications for California, she took our Green Room Q&A.

Q. Where would we find you at 10 a.m. on a typical Saturday?

A. At the grocery store, stocking up for the week.

Q. What do you wish you had the nerve to do?

A. Travel extensively and leave work behind a little more often.

Q. What music have you listened to today?

A. Some hip hop in the cab on the way over.

Q. When do you feel most creative?

A. Early in the morning.

Q. What is your favorite word?

A. Depends on the occasion.

Q. Who is your favorite fictional character?

A. I just reread To Kill a Mockingbird because my son’s reading it, and I have to say, Scout is a winner.

Q. When you were a child, what did you want to be when you grew up?

A. I was never clear. I wanted to be lots of different things.

Q. What profession would you like to practice in your next life?

A. I’m enjoying this life pretty well.

Q. What is the best advice you have ever received?

A. Find something you really like to do and do it as well as you can.

Q. If you could take only one more journey, where would you go?

A. The South Pacific.

To read more about Mulkey’s panel, click here.

*Photo by Aaron Salcido.

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Lucien Wulsin is the project director of Insure the Uninsured Project and is working on approaches to expand coverage for uninsured working Californians. He is the author of “California at the Crossroads: Choices for Health Care Reform,” a study on California’s options to redesign its health care system. Before chatting about health reform’s implications for California, he took our Green Room Q&A.

Q. Where would we find you at 10 a.m. on a typical Saturday?

A. Hiking up in the Santa Monica Mountains with my dogs.

Q. What do you wish you had the nerve to do?

A. Jump out of an airplane with a parachute.

Q. What music have you listened to today?

A. Not a note.

Q. When do you feel most creative?

A. First thing in the morning until roughly 11 or 11:30, or when I’m in the mountains or on a boat.

Q. What is your favorite word?

A. Uh.

Q. Who is your favorite fictional character?

A. The Brothers Karamazov – all of them.

Q. What is your favorite thing about Los Angeles?

A. My house.

Q. When you were a child, what did you want to be when you grew up?

A. A baseball player, and then a singer. Eventually I realized I can’t sing and my baseball skills are not that great.

Q. What is your greatest extravagance?

A. When we go out to eat.

Q. What profession would you like to practice in your next life?

A. Supreme Court Justice.

Q. What is your most prized material possession?

A. I don’t know that they’re material possessions, but, my dogs.

Q. Who is the one person living or dead you would most like to meet for dinner?

A. Abraham Lincoln and Barack Obama, together. I’d just listen to them talk.

To read more about Wulsin’s panel, click here.

*Photo by Aaron Salcido.

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John Arensmeyer is the founder and CEO of Small Business Majority, a California-based, national, nonpartisan organization. Prior to starting Small Business Majority, Arensmeyer was the founder and CEO of ACI Interactive, an award-winning international e-commerce company. Before chatting about health reform’s implications for Californians, he took our Green Room Q&A.

Q. Where would we find you at 10 a.m. on a typical Saturday?

A. Unfortunately, since health care reform passed, in the office.

Q. What do you wish you had the nerve to do?

A. Not go into the office at 10 a.m. on a Saturday.

Q. What music have you listened to today?

A. Nothing that stands out.

Q. When do you feel most creative?

A. When things are extremely intense.

Q. What is your favorite word?

A. Empowerment.

Q. Who is your favorite fictional character?

A. Huck Finn.

Q. When you were a child, what did you want to be when you grew up?

A. Some kind of a political leader.

Q. What profession would you like to practice in your next life?

A. Architect.

Q. What is the best advice you have ever received?

A. To look at everything pragmatically, and to not have any fixed ideological frame.

Q. What is your most prized material possession?

A. An original Mickey Mantle signature I got when I was seven years old, when I met him on a train.

Q. What comforts you?

A. An interesting evening with good food and good friends.

Q. Who is the one person living or dead you would most like to meet for dinner?

A. Franklin Roosevelt.

To read more about Arensmeyer’s panel, click here.

*Photo by Aaron Salcido.

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Jan Spencley is the Executive Director of San Diegans for Healthcare Coverage. Jan is also a health care consultant with over 35 years in the industry, including 25 years at UCSD Healthcare.  Before chatting about health reform’s implications for California, she sat down for our Green Room Q&A.

Q. Where would we find you at 10 a.m. on a typical Saturday?

A. In metalsmithing class, or working.

Q. What music have you listened to today?

A. A mélange of music in a restaurant, old and new. I loved it.

Q. What do you wish you had the nerve to do?

A. Parasail. I want to fly.

Q. What do you do to clear your mind?

A. Meditate.

Q. What is your favorite word?

A. Empowered.

Q. Who is your favorite fictional character?

A. Bilbo Baggins.

Q. When you were a child, what did you want to be when you grew up?

A. A princess.

Q. What is your greatest extravagance?

A. Travel.

Q. What is the best advice you have ever received?

A. Slow down, be patient.

Q. What is your most prized material possession?

A. A locket from my mother.

Q. Who is the one person living or dead you would most like to meet for dinner?

A. Mother Teresa.

To read more about Spencley’s panel, click here.

*Photo by Aaron Salcido.

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Zero Decibels: The Quest for Absolute Silence
by George Michelsen Foy

–Reviewed by Swati Pandey

George Michelsen Foy’s search for silence starts in a burst of noise. Generally the wish of scolds and New-Agers, the very religious or the somewhat mad, silence captivates Foy after a particularly “thundering shrieking roaring” eruption of New York subway trains at the 79th street station.

It makes sense for the study of a subject most often defined, as Foy puts it, “almost wholly as an absence, a withholding or subtraction from a presumed normalcy of sound.” Foy, a lifelong urban dweller who admits despising those “milquetoast” subway riders who shudder at noise, seeks by ear or by gadget “silence wherever it might live,” and more often than not comes across sound along with it. His quest takes him from the city to the country, from headphones to flotation tanks and anechoic chambers, and from the most expansive place – space – to the most intimate, the pause between heartbeats.

Foy sets off with decibel meter in hand – stoking mass transit paranoia and more than one TSA manhandling – to search for quiet places. He finds that the city rarely gets softer than 40 decibels. The subway platform peaks at higher than 100 decibels, “well over the volume of a fully revved-up chainsaw held at arm’s length.” Shrieks like these, Foy notes, and the “toxic noise” that 30 million Americans suffer, can cause higher blood pressures, heart problems, stress, low motivation, and at its worst, headaches, nausea, fatigue and even death. By Foy’s count it’s enough to make a movement. But the closest we’ve come are laws prohibiting noise, which have been with us since at least Julius Caesar, who outlawed late-night chariots.

And New York today, even at its quieter moments, has a hum, one that Foy can hear underwater and underground. He anatomizes it with poetry and precision as the combination of engines roaring, drunk students whooping, air conditioners, cars, “the fizz of TV and radio…someone talking in her sleep, and a disturbance of sparrows, and the lisp of locust leaves in the breeze off the Hudson, the pat of rats going about their business.”

Sound seems inescapable, definitive of eras and places, Foy writes. The ringing of church bells defined territories – their inaudibility meant one was exiled – and the clamor of industry sent London and Paris writers and artists into fits. Young American female factory workers screamed from the shock of silence after 12-hour shifts at the dawn of the last century. The “war cry”, from primitive whooping to devastating sonic weapons, delineated allegiances and enemies.

The constancy of sound makes Foy seek absolutes of scientific and religious silence, only to find that our relationship to silence is a paradoxical one. Space seems to hold a promise of silence (and the quietest place on Earth turns out to be a lab searching for dark matter). But as an astronaut tells Foy, silence in space means the oxygen flow isn’t working. While many faiths and cultures idealize the pursuit of quiet, others see in silence death, disappearance, evil, or at least dullness. This split is apparent in less rarefied realms, too: Movies idealize the strong silent cowboy while still canonizing the creepiness of silence: “It’s quiet. Yep, too quiet.”

Foy wonders if hearing is too intrinsic to life to be undesirable. Our sense of sound evolved along with our sense of balance, that is, with our ability to act. Silence for an early human meant the absence of prey as much as the absence of predators. And as Foy finds when he interviews a man who can remove the implants that allow him to hear, the brain “invents what it longs to hear.” One of three men, including Foy, and two of three women make otoacoustic emissions from the inner ear, hearing things even when there’s nothing to be heard.

Perhaps the silence – or relative silence – we’re most comfortable with is the kind we rarely notice, to which Foy devotes a slim middle chapter. This is the silence between words and notes, or between set-up and punch line, the silence that make rhythm possible. It’s perhaps fitting, then, that the quietest place in New York, by Foy’s measure, is deep in the old apartment of the newspaperman and endower of prizes for those who best manipulate silence and noise to tell stories – Joseph Pulitzer, whose specially-designed sound-proofing chamber comes in at 37.1 decibels.

Excerpt: “A fellow I think of as ‘Glory Man,’ an ancient black guy in a neat suit and homburg hat, walks past, clutching his Bible, bellowing, ‘Glo-ry! Glo-ry! Jesus loves you!’ He laughs in not very sane fashion. Though I don’t share his belief system, I have always admired Glory Man for his commitment to an ideal that seems significantly different from what powers most people in this lucre-crazy town. Glory Man’s voice is hoarse from shouting, but at close range he still tops 85 dB. Once he has passed, and the traffic is stopped by a red light, with the windows rolled down on 103rd Street the hum is clearly audible, and louder even than it was this morning, more like a faraway roar. But it carries no clear tone, and no more directional dimension than before. It seems to come from everywhere and nowhere. It lives in a special dimension of the city itself, the frequency of New York.”

Further Reading: Silence: Lectures and Writings by John Cage and World of Silence by Max Picard

*Photo above courtesy Hckyso; homepage photo courtesy ecastro.

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Elaine Tyler May has a professional and personal connection to the birth control pill. She’s a historian at the University of Minnesota who has long studied family and sexuality, particularly the intersection of private life and public policy. And her parents both helped bring the pill to being – her father was a clinical researcher who worked on the development of the pill, and her mother was a birth control activist. “The pill was a really obvious choice for me to take a look at, 50 years after the FDA approved it,” said May, author of America and the Pill: A History of Promise, Peril, and Liberation. Below, she chats about the great expectations for the pill at its introduction, how it transformed women’s lives along with the medical and pharmaceutical industries, and why it still remains inaccessible for many women.

Q. What was the political and cultural atmosphere when the pill was approved 50 years ago – and where were you then?

A. I was 12 years old when the pill was approved. It was very exciting. At the time, that excitement seemed to be part of the belief in progress that so many felt in those early postwar years – that science and technology and medicine were going to solve the problems of the world and cure diseases. There were a lot of high hopes attached to what science could bring to the world. It was also the time of the Cold War. There was a lot of anxiety about communism, about unrest around the world, about the possibility of atomic war, the possibility of war and conflict breaking out around the world.

The pill fit into all of these large global concerns in a number of ways. Its advocates and developers believed it would help bring down the population in the overcrowded and overpopulated areas of the developing world, and that by bringing down the population and helping to alleviate poverty there would be less social unrest and misery. Those countries would be less likely to turn to communism. They would embrace capitalism because they could afford goods and provide markets for the West and allies for the U.S. At the same time there were these geopolitical hopes, within the U.S. I guess you could say there was an idealistic optimism that the pill would put an end to unwanted pregnancy and unwed pregnancy, and would alleviate the pressure on married couples who were worried about having too many children. If they could control their fertility, women could enjoy sex more and be happier in their marriages. As a result the divorce rate might decline and children would be well-adjusted and contented.

So there were a lot of goals centered on individual happiness and well-planned families and a kind of rational social order. At the same time, there were some anxieties – some feared that the pill would unleash sexual chaos and single women’s promiscuity, and unravel the social order and damage or destroy the family. There were the naysayers and those who were afraid of the pill. Either way, whether the predictions were positive or negative, it turned out that they were all pretty much wrong.

Q. How did the predictions go wrong, and when did it become clear that the pill wouldn’t have all these effects?

A. It became clear pretty quickly that the pill would not have a real impact on the population around the world in most places where populations were growing at the highest rate, people were poor. They didn’t have access to clinics and medical professionals to get prescriptions and have check-ups and get refills. It just wasn’t practical. At the same time, it wasn’t just the availability of contraception that would allow women to get a handle on their fertility – it required women’s education and empowerment. They had to have some status and equality in their communities to be able to take advantage of contraceptive products.  In very traditional patriarchal communities, even if there were contraceptives available, they wouldn’t be able to take advantage. So the pill itself didn’t have any impact on populations in the developing world until many years later.

At home, as we know, the pill didn’t suddenly change cultural values. The pill, as we know now, had no impact on the sexual revolution. Single women didn’t really have access to it – it was very difficult to get. Even married women had trouble for some time. Twenty-two states prohibited contraception being prescribed to anyone. Between the double-standard and the stigma and the need to have a plan and be bold to get the pill, it was very unlikely that a single woman would suddenly decide that since the pill was available, she should go get it and then have sex with someone.

Q. How did the pill interact with the budding feminist activism of the time?

A. That’s really where the pill had its biggest impact. It’s a coincidence, really, that the pill arrived just as the feminist movement began to gain momentum. It’s really because of the feminist movement that the pill became a truly revolutionary tool for women. As the feminist movement pushed open doors for women to join graduate programs, professional programs, to get training for careers and opportunities in public life, the pill made it possible for married women to control their fertility predictably, and effectively to take advantage of those opportunities. If there hadn’t been a feminist movement, and if opportunities for women were confined either to the home or to very limited kinds of job opportunities, then the pill would have still been important because it put contraception in the control of women. It just would not have been revolutionary in the way it was.

So the pill coincided with the feminist movement and the women’s health movement, allowing women to control their lives. The pill also became a tool for challenging institutional authorities. Women demanded, for instance, that pharmaceutical companies provide information with each prescription – they ended up getting Senate hearings, and public policy eventually mandated that information packets come with every prescription of the pill. Women also demanded prescriptions – the situation was no longer one where a woman would go to a doctor and be told what to do.

Women also challenged laws that prohibited contraception. In 1965, the Supreme Court ruled that states could not prohibit married women from gaining access to contraception, and in 1972 the Court extended that right to unmarried women. The Catholic Church is another great example. Even though it came very close to approving the pill before the Pope decided to reinforce and confirm the ban on contraception, pretty soon Catholic women were taking the pill at the same rate as other women. It ended up forging a wedge between church authorities and Catholic women – they just did what they wanted to do regardless of what the church said they should do. You have a whole range of ways in which the pill was a tool for women, both in their personal lives and also in terms of challenging these larger institutions.

Q. Did activism around the pill change the pharmaceutical industry and healthcare generally?

A. It was certainly the first time women would interact with doctors in that way, and probably in general, the medical profession was set up in such a way that doctors were sort of gods. Also I think particularly in the 1950s and early 1960s there were very few women doctors, so when a woman went to her doctor, it was likely that she would be interacting with a man. The pill was a vehicle for changing those power relationships.

Q. What other contraceptives were available at the time, and why was the pill different?

A. The diaphragm had been around a long time. It was effective if used properly. So the pill wasn’t the first contraceptive available. What made the pill different was that it completely separated the practice of contraception from the sex act. The pill was the first to do that, and that was very remarkable. It was also remarkable because it was the first time women could actively take care of contraception without their sex partner’s participation or cooperation or even necessarily his knowledge. It put a lot of control into the hands of women.

Q. Is it still difficult for women to access the pill today?

A. That’s one of the things I found most striking taking a look at the pill in the 50 years since it was approved. There are still very real barriers to access and affordability and availability. I did an Internet survey and heard back from more than 100 young women talking about their experience of the pill – some loved it, some hated it, some had been on it for years, others only tried it for a short time. Whether they wanted it or liked it or not, overwhelmingly, the message was one of frustration that the pill and other legal contraceptives were not available to them. There were various restrictions – either it was too expensive, and subsidies were removed from many college campus clinics, or conscience clauses meant pharmacists could deny these women a prescription. The morning after pill – Plan B, emergency contraception – was not available to them when they needed it. We’ve seen a backlash against the reproductive rights movement that has made it in many ways more difficult to access affordable contraceptives. The women I surveyed also complained about abstinence-only sex education, where they could not get the knowledge they needed to make decisions about their healthcare.

Q. Has the recently passed healthcare legislation limited or improved access to contraceptives?

A. I think that remains to be seen, whether anti-choice politicians are going to implicate contraceptives in the same way they have implicated access to abortion. The effort to collapse the two into one issue posed some very serious challenges. I think it remains to be seen if insurance will continue to pay for contraceptive and provide prescriptions.

Q. How is access in the developing world today?

A. The pill is taken by millions and millions of women around the world. U.S. participation in that has to do with whether or not the pill – or contraceptive products at all – have been part of foreign aid. That has been a political football since the Reagan administration. Reagan cut off all aid to foreign clinics that provided any kind of information that might lead to a woman having an abortion – even if the clinics weren’t funding abortion services. They would then refuse to make contraceptives available to those countries, and that was devastating. It just goes back and forth between Democratic and Republican presidents. Within the first week of Clinton’s presidency, he reversed it, and within the first week of the George W. Bush administration, he reinstated it. I think the second day of the Obama administration, he reversed it again. So unfortunately women around the world are held captive in some ways to American political swings.

Q. Where do you see the future of the pill going? Will it ever reach the expectations set when it was first approved?

A. I think that depends where the country is moving in the future. I don’t know. It’s worrisome. I would like to think that we are as a nation increasingly affirming of women’s autonomy and personal choices. But that’s not universally something that people in this country hold dear.

*Photo courtesy JackelynAnn.

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