McKinsey – from the from lines of implementing analytics

Key issues highlighted:

  • Hype – need to manage internally
  • Privacy – flipside is improved health outcomes. the remedy is to provide consumers with more control of their data and building trust is the way forward. Opt-in. Company behaviour. Reinforce benefits.
  • Talent – short supply of analytics and IT professionals. Also short on “translators” – people whose talents bridge the disciplines of IT and data, analytics, and business decision making. These translators can drive the design and execution of the overall data-analytics strategy while linking IT, analytics, and business-unit teams. Without such employees, the impact of new data strategies, tools, and methodologies, no matter how advanced, is disappointing.
  • Centre of Excellence –  To catalyze analytics efforts, nearly every company was using a center of excellence, which works with businesses to develop and deploy analytics rapidly.
  • Adoption – Automation & Training

 

  •  combine proprietary data with open data sources to boost richness, improve models and business outcomes
  • Establishing priorities wisely and with a realistic sense of the associated challenges lies at the heart of a successful data-analytics strategy.
  • Start with an portfolio/ensemble pilot effort with clear rules for making go/no go decisions from shift from exploratory to production

PDF: McKinsey_ViewsFromTheFrontlinesOfTheDataAnalyticsRevolution

http://www.mckinsey.com/insights/business_technology/views_from_the_front_lines_of_the_data_analytics_revolution

Views from the front lines of the data-analytics revolution

At a unique gathering of data-analytics leaders, new solutions began emerging to vexing privacy, talent, organizational, and frontline-adoption challenges.

March 2014 | byBrad Brown, David Court, and Tim McGuire

This past October, eight executives from companies that are leaders in data analytics got together to share perspectives on their biggest challenges. All were the most senior executives with data-analytics responsibility in their companies, which included AIG, American Express, Samsung Mobile, Siemens Healthcare, TD Bank, and Wal-Mart Stores. Their backgrounds varied, with chief information officers, a chief data officer, a chief marketing officer, a chief risk officer, and a chief science officer all represented.1 We had seeded the discussion by asking each of them in advance about the burning issues they were facing.

For these executives, the top five questions were:

  • Are data and analytics overhyped?
  • Do privacy issues threaten progress?
  • Is talent acquisition slowing strategy?
  • What organizational models work best?
  • What’s the best way to assure adoption?

Here is a synthesis of the discussion.

1. Data and analytics aren’t overhyped—but they’re oversimplified

Participants all agreed that the expectations of senior management are a real issue. Big-data analytics are delivering an economic impact in the organization, but too often senior leaders’ hopes for benefits are divorced from the realities of frontline application. That leaves them ill prepared for the challenges that inevitably arise and quickly breed skepticism.

The focus on applications helps companies to move away from “the helicopter view,” noted one participant, in which “it all looks the same.” The reality of where and how data analytics can improve performance varies dramatically by company and industry.

Customer-facing activities. In some industries, such as telecommunications, this is where the greatest opportunities lie. Here, companies benefit most when they focus on analytics models that optimize pricing of services across consumer life cycles, maximize marketing spending by predicting areas where product promotions will be most effective, and identify tactics for customer retention.

Internal applications. In other industries, such as transportation services, models will focus on process efficiencies—optimizing routes, for example, or scheduling crews given variations in worker availability and demand.

Hybrid applications. Other industries need a balance of both. Retailers, for example, can harness data to influence next-product-to-buy decisions and to optimize location choices for new stores or to map product flows through supply chains. Insurers, similarly, want to predict features that will help them extend product lines and assess emerging areas of portfolio risk. Establishing priorities wisely and with a realistic sense of the associated challenges lies at the heart of a successful data-analytics strategy.

Companies need to operate along two horizons: capturing quick wins to build momentum while keeping sight of longer-term, ground-breaking applications. Although, as one executive noted, “We carefully measure our near-term impact and generate internal ‘buzz’ around these results,” there was also a strong belief in the room that the journey crosses several horizons. “We are just seeing the tip of the iceberg,” said one participant. Many believed that the real prize lies in reimagining existing businesses or launching entirely new ones based on the data companies possess.

New opportunities will continue to open up. For example, there was a growing awareness, among participants, of the potential of tapping swelling reservoirs of external data—sometimes known as open data—and combining them with existing proprietary data to improve models and business outcomes. (See “What executives should know about open data.”) Hedge funds have been among the first to exploit a flood of newly accessible government data, correlating that information with stock-price movements to spot short-term investment opportunities. Corporations with longer investment time horizons will need a different playbook for open data, but few participants doubted the value of developing one.

2. Privacy concerns must be addressed—and giving consumers control can help

Privacy has become the third rail in the public discussion of big data, as media accounts have rightly pointed out excesses in some data-gathering methods. Little wonder that consumer wariness has risen. (Data concerns seem smaller in the business-to-business realm.) The flip side is that data analytics increasingly provides consumers, not to mention companies and governments, with a raft of benefits, such as improved health-care outcomes, new products precisely reflecting consumer preferences, or more useful and meaningful digital experiences resulting from a greater ability to customize information. These benefits, by necessity, rest upon the collection, storage, and analysis of large, granular data sets that describe real people.

Our analytics leaders were unanimous in their view that placing more control of information in the hands of consumers, along with building their trust, is the right path forward.

Opt-in models. A first step is allowing consumers to opt in or opt out of the collection, sharing, and use of their data. As one example, data aggregator Acxiom recently launched a website (aboutthedata .com) that allows consumers to review, edit, and limit the distribution of the data the company has collected about them. Consumers, for instance, may choose to limit the sharing of their data for use in targeted Internet ads. They control the trade-off between targeted (but less private) ads and nontargeted ones (potentially offering less value).

Company behavior. Our panelists presume that in the data-collection arena, the motives of companies are good and organizations will act responsibly. But they must earn this trust continually; recovering from a single privacy breach or misjudgment could take years. Installing internal practices that reinforce good data stewardship, while also communicating the benefits of data analytics to customers, is of paramount importance. In the words of one participant: “Consumers will trust companies that are true to their value proposition. If we focus on delivering that, consumers will be delighted. If we stray, we’re in problem territory.”

3. Talent challenges are stimulating innovative approaches—but more is needed

Talent is a hot issue for everyone. It extends far beyond the notoriously short supply of IT and analytics professionals. Even companies that are starting to crack the skill problem through creative recruiting and compensation strategies are finding themselves shorthanded in another area: they need more “translators”—people whose talents bridge the disciplines of IT and data, analytics, and business decision making. These translators can drive the design and execution of the overall data-analytics strategy while linking IT, analytics, and business-unit teams. Without such employees, the impact of new data strategies, tools, and methodologies, no matter how advanced, is disappointing.

The amalgam is rare, however. In a more likely talent scenario, companies find individuals who combine two of the three needed skills. The data strategists’combination of IT knowledge and experience making business decisions makes them well suited to define the data requirements for high-value business analytics.Data scientists combine deep analytics expertise with IT know-how to develop sophisticated models and algorithms. Analytic consultants combine practical business knowledge with analytics experience to zero in on high-impact opportunities for analytics.

A widespread observation among participants was that the usual sources of talent—elite universities and MBA programs—are falling short. Few are developing the courses needed to turn out people with these combinations of skills. To compensate, and to get more individuals grounded in business and quantitative skills, some companies are luring data scientists from leading Internet companies; others are looking offshore.

The management and retention of these special individuals requires changes in mind-set and culture. Job one: provide space and freedom to stimulate exploration of new approaches and insights. “At times, you may not know exactly what they”—data scientists— “will find,” one executive noted in describing the company’s efforts to provide more latitude for innovation. (So far, these efforts are boosting retention rates.) Another priority: create a vibrant environment so top talent feels it’s at the cutting edge of technology change and emerging best practices. Stimulating engagement with the data-analytics ecosystem (including venture capitalists, analytics start-ups, and established analytics vendors) can help.

4. You need a center of excellence—and it needs to evolve

To catalyze analytics efforts, nearly every company was using a center of excellence, which works with businesses to develop and deploy analytics rapidly. Most often, it includes data scientists, business specialists, and tool developers. Companies are establishing these centers in part because business leaders need the help. Centers of excellence also boost the organization-wide impact of the scarce translator talent described above. They can even help attract and retain talent: at their best, centers are hotbeds of learning and innovation as teams share ideas on how to construct robust data sets, build powerful models, and translate them into valuable business tools.

Our participants agreed that it’s worth creating a center of excellence only if you can locate it in a part of the company where data-analytics assets or capabilities could have a dramatic strategic impact. For some companies, this meant IT; for others, marketing and sales or large business units. At one company, for instance, the analytics agenda is focused on exploiting a massive set of core transactional data across several businesses and functions. In this case, the center of excellence resides within IT to leverage its deep knowledge of this core data set and its role as a shared capability across businesses.

The goal should be for these centers to be so successful at building data-analytics capabilities across the organization that they can tackle increasingly ambitious priorities. One executive suggests that as businesses build their analytics muscle, centers of excellence will increasingly focus on longer-term projects more akin to sophisticated R&D, with an emphasis on analytics innovation and breakthrough insights.

5. Two paths to spur adoption—and both require investment

Frontline adoption was the most important issue for many leaders. Getting managers and individual contributors to use new tools purposefully and enthusiastically is a huge challenge. As we have written elsewhere,2 companies simply don’t invest enough, in time or money, to develop killer applications that combine smart, intuitive design and robust functionality. However, our participants see two clear paths leading to broad adoption.

Automation. One avenue to spurring adoption works for relatively simple, repetitive analytics: creating intuitive end-user interfaces that can be rolled out rapidly and with little training. For example, a mobile application on a smartphone or tablet might give brand managers instant visibility into volume and sales trends, market share, and average prices. These tools become part of the daily flow of decision making, helping managers to figure out how intensely to promote products, when tactical shifts in pricing may be necessary to match competitors, or, over time, where to begin pushing for new products. According to one executive, “Little or no training is required” with simple tools like these. Provided they are “clear and well designed, with strong visualization qualities, end users will seek them out.”

Training. A second path requires significant investments in training to support more complex analytics. Consider a tool for underwriting small and midsize business loans. The tool combines underwriters’ knowledge and the power of models, which bring consistency across underwriting judgments, clarifying risks and minimizing biases. But underwriters need training to understand where the model fits into the underwriting process flow and how they can incorporate what the models and tools say into their own experience of customer characteristics and their business priorities.

Whichever path is chosen, it should start with pilot efforts and clear rules for making “go/no-go” decisions about the shift from exploratory analytics to a full-scale rollout. Some models don’t end up being predictive enough to deliver the desired impact; better to shelve them before they become investment sinkholes and undermine organizational confidence in analytics. Executives need to be willing to press “pause” and remind the organization that the failure of some analytics initiatives to materialize is nothing to worry about; in fact, this is the reason for pursuing a portfolio of them. The combination of success stories and hard-nosed decisions to pull the plug is all part of creating a climate where business units, functions, top management, and frontline employees embrace the transformational possibilities of data analytics.

About the authors

Brad Brown is a director in McKinsey’s New York office, David Court is a director in the Dallas office, and Tim McGuire is a director in the Toronto office.

The authors would like to acknowledge the contributions of Brian Tauke and Isaac Townsend to the development of this article.

Saying Goodbye to the Old World of Healthcare

Powerful op ed by Toby Cosgrove on the way things will need to be…

http://www.linkedin.com/today/post/article/20140305130248-205372152-saying-goodbye-to-the-old-world-of-healthcare

Saying Goodbye to the Old World of Healthcare

March 05, 2014

It’s a whole new world. The old way of practicing medicine is just that- an old way of doing things. While it took us a while to get to this point, I can say confidently this new world of healthcare will be better for all of us: doctors, patients and the people who pay for healthcare services.

Many of us got into medicine to be independent, to make our own decisions based on our own best judgments and now we’re being asked to join group practices, follow protocols, and take advice from a computer. We’ve always treated sick people, but now we are trying harder than ever to keep them well. We used to bill for single services, but now we have to look at the whole continuum of care. Things have changed.

For the first time in human history, we have the science and computational power to help physicians quickly sort through vast troves of medical literature to determine what actions are best for each patient at each stage of diagnosis and treatment. It would be virtually unethical not to put these tremendous resources to work to improve care and lower costs.

For doctors, it means extra time at the computer, but with each keystroke we are adding to the informational treasure of our patients, our offices, and medical researchers for generations to come. Information technology is helping us to control and direct the cost revolution that is coming to healthcare as surely as it had already come to manufacturing, retail, airlines and other industries.

What will the future look like? We will have a leaner, more efficient, and more integrated system. Large networks of providers will share comprehensive, evidence-based guidelines and provide personalized healthcare services in patient- and family-friendly settings, under the direction of the highly skilled and compassionate medical professionals. It’s a future we can all look forward to with confidence.

 

Photo: oksana2010 / shutterstock

Vitality lands in Australia in the form of a life insurance product…

Interesting to see Vitality land in Australia as a life insurance product. Interesting model, perhaps looking to cancel out the moral hazard of life insurance?

Interview with Fran Kelly:

Health expert Dr. Kevin Volpp joins RN Breakfast to discuss how incentives can encourage healthier behaviours and combat Australia’s rising obesity rates.

Program page:
http://www.abc.net.au/radionational/programs/breakfast/how-incentives-can-change-unhealthy-behaviour/5301962

The Conversation:
http://theconversation.com/should-we-pay-people-to-look-after-their-health-24012

https://www.aiavitality.com.au/vmp-au/

As the real life company, AIA Australia introduces AIA Vitality, the science-backed wellness program that works with you to make real change to your health. We keep you motivated by adding up the benefits of every healthy choice you make, however small. So, you can live a healthy life that’s rewarding in every way.

All you have to do is know more about your health, work towards improving it and get rewarded along the way.

NHS data might save lives

Numbers in medicine are not an abstract academic game: they are made of flesh and blood, and they show us how to prevent unnecessary pain, suffering and death.

Tim Kelsey is the man running the show: an ex-journalist, passionate and engaging, he has drunk more open-data Kool-Aid than anyone I’ve ever met. He has evangelised the commercial benefits of sharing NHS data – perhaps because he made millions from setting up a hospital-ranking website with Dr Foster Intelligence – but he is also admirably evangelical about the power of data and transparency to spot problems and drive up standards. Unfortunately, he gets carried away, stepping up and announcing boldly that no identifiable patient data will leave the Health and Social Care Information Centre. Others supporting the scheme have done the same.

This is false reassurance, and that is poison in medicine, or in any field where you are trying to earn public trust. The data will be “pseudonymised” before release to any applicant company, with postcodes, names, and birthdays removed. But re-identifying you from that data is more than possible. Here’s one example: I had twins last year (it’s great; it’s also partly why I’ve been writing less). There are 12,000 dads with similar luck each year; let’s say 2,000 in London; let’s say 100 of those are aged 39. From my brief online bio you can work out that I moved from Oxford to London in about 1995. Congratulations: you’ve now uniquely identified my health record, without using my name, postcode, or anything “identifiable”. Now you’ve found the rows of data that describe my contacts with health services, you can also find out if I have any medical problems that some might consider embarrassing: incontinence, perhaps, or mental health difficulties. Then you can use that information to try and smear me: a routine occurrence if you do the work I do, whether it’s big drug companies, or dreary little quacks.

http://www.theguardian.com/society/2014/feb/21/nhs-plan-share-medical-data-save-lives

The NHS plan to share our medical data can save lives – but must be done right

Care.data, the grand project to make the medical records of the UK population available for scientific and commercial use, is not inherently evil – far from it – but its execution has been badly bungled. Here’s how the government can regain our trust
The Guardiandoctor looking at medical data
‘If the government gets it right, they can save a vital data project, and allow medical research that saves lives on a biblical scale to ­continue,’ writes Ben Goldacre. Photograph: Hans Neleman/Getty Images

Everything would be much simpler if science really was “just another kind of religion”. But medical knowledge doesn’t appear out of nowhere, and there is no ancient text to guide us. Instead, we learn how to save lives by studying huge datasets on the medical histories of millions of people. This information helps us identify the causes of cancer and heart disease; it helps us to spot side-effects from beneficial treatments, and switch patients to the safest drugs; it helps us spot failing hospitals, or rubbish surgeons; and it helps us spot the areas of greatest need in theNHS. Numbers in medicine are not an abstract academic game: they are made of flesh and blood, and they show us how to prevent unnecessary pain, suffering and death.

Now all this vital work is being put at risk, by the bungled implementationof the care.data project. It was supposed to link all NHS data about all patients together into one giant database, like the one we already have for hospital episodes; instead it has been put on hold for six months, in the face of plummeting public support. It should have been a breeze. But we have seen arrogant paternalism, crass boasts about commercial profits, a lack of clear governance, and a failure to communicate basic science properly. All this has left the field open for wild conspiracy theories. It would take very little to fix this mess, but time is short, and lives are at stake.

The care.data project was promoted in two ways: we will use your data for lifesaving research, and we will give it to the private sector for commercial exploitation, creating billions for the UK economy. This marriage was a clear mistake: by and large, the public support public research, but are nervous about commercial exploitation of their health data.

Now the teams behind care.data are trying to row back, explaining that access will only be granted for research that benefits NHS patients. That is laudable, but potentially a very broad notion. It’s one we would want to unpack, with clear, worked examples of the kind of things they would permit, and the kind of things they would refuse. But that’s not possible because, bizarrely, the specific principles, guidelines, committees and regulations that will determine all these decisions have not yet been clearly set out. This poses several difficulties. Firstly, the public are being asked to support something that feels intuitively scary, about the privacy of their medical records, without being told the details of how it will work. Secondly, the field has been left open to conspiracy theories, which are hard to refute without concrete guidance on how permissions for access really will work.

That said, many criticisms have been absurd. There has been endless discussion around the idea of health insurers buying health records, for example, and using them to reject high-risk patients. Call an insurer right now and see how you get on: within minutes you will be asked to declare your full medical history, waive confidentiality and grant access to your full medical notes anyway.

Many have complained about drug companies getting access to data, and this is more complex. On the one hand, arrangements like these are longstanding and essential: if medicines regulators get a few unusual side-effect reports from patients, they go to the drug company and force them to do a big study, examining – for example – 10,000 patients’ records, to find out if people on that drug really do have more heart attacks than we’d expect. To do this, the UK health regulator itself sells industry the data, in the past from something called the GP Research Database, which holds millions of people’s records already. This needs to happen, and it’s good. But equally, people know – I’ve certainly shouted about it for long enough – that the pharmaceutical industry also misuses data: they hide the results of clinical trials when it suits them, quite legally; they monitor individual doctors’ prescribing patterns to guide their marketing efforts, and so on. The public don’t trust the pharmaceutical industry unconditionally, and they’re right not to.

Trust, of course, is key here, and that’s currently in short supply. The NSA leaks showed us that governments were casually helping themselves to our private data. They also showed us that leaks are hard to control, because the National Security Agency of the wealthiest country in the world was unable to stop one young contractor stealing thousands of its most highly sensitive and embarrassing documents.

But there is a more specific reason why it is hard to give the team behind care.data our blind faith: they have been caught red-handed giving false reassurance on the very real – albeit modest – privacy threats posed by the system.

Tim Kelsey is the man running the show: an ex-journalist, passionate and engaging, he has drunk more open-data Kool-Aid than anyone I’ve ever met. He has evangelised the commercial benefits of sharing NHS data – perhaps because he made millions from setting up a hospital-ranking website with Dr Foster Intelligence – but he is also admirably evangelical about the power of data and transparency to spot problems and drive up standards. Unfortunately, he gets carried away, stepping up andannouncing boldly that no identifiable patient data will leave the Health and Social Care Information Centre. Others supporting the scheme have done the same.

This is false reassurance, and that is poison in medicine, or in any field where you are trying to earn public trust. The data will be “pseudonymised” before release to any applicant company, with postcodes, names, and birthdays removed. But re-identifying you from that data is more than possible. Here’s one example: I had twins last year (it’s great; it’s also partly why I’ve been writing less). There are 12,000 dads with similar luck each year; let’s say 2,000 in London; let’s say 100 of those are aged 39. From my brief online bio you can work out that I moved from Oxford to London in about 1995. Congratulations: you’ve now uniquely identified my health record, without using my name, postcode, or anything “identifiable”. Now you’ve found the rows of data that describe my contacts with health services, you can also find out if I have any medical problems that some might consider embarrassing: incontinence, perhaps, or mental health difficulties. Then you can use that information to try and smear me: a routine occurrence if you do the work I do, whether it’s big drug companies, or dreary little quacks.

This risk isn’t necessarily big, but to say it doesn’t exist is crass: it’s false reassurance, which ultimately undermines trust, but it’s also unnecessary, and counterproductive, like hiding information on side-effects instead of discussing them proportionately. To the best of my knowledge, we’ve never yet had a serious data leak from a medical research database, and there are plenty around already; but then, we are standing on the verge of a significant increase in the number of people accessing and using medical data. There are steps we can take to minimise the risks: only release a subset of the 60 million UK population to each applicant; only give out the smallest possible amount of information on each patient whose records you are sharing; suggest that people come to your data centre to run their analyses, instead of downloading records, and so on. But, while the care.data project might be planning to do some of those things, the ground rules haven’t been properly written out yet.

In any case, even safeguards such as these can be worked around. There are companies out there operating in the grey areas of the law, aggregating data from every source and leak they can find, generating huge, linked datasets with information from direct marketing lists, online purchases, mobile phone companies and more. Who’s to know if someone will start quietly aggregating all the small chunks of our health data?

This, of course, would be illegal. As Tim Kelsey and others are keen to point out, re-identifying or leaking data in any way would be a “criminal offence”. But as this project lands, we’re all becoming rapidly aware that incompetence, malice and creepiness around confidential data is policed with a worryingly light touch. Private investigators have little trouble obtaining confidential data from staff in the police force, banks and tax offices, for example.

Here’s why: it took a long time for anyone to realise that Steve Tennison, a finance manager in a GP practice, had accessed patients’ records on 2,023 occasions over the course of a year, although this was relevant to his work on only three occasions. The majority of records he snooped on belonged to young women: he repeatedly accessed the record of one woman he had gone to school with, and that of her son. The maximum penalty for this is a fine, with a ceiling of £5,000 in magistrates courts. Tennison was fined £996, in December 2013. This is why the public feel nervous, and this is what we need to fix.

It’s painful for me to write critically about a project like care.data, because I love medical data, and I know the good it can do. We have a golden opportunity in the UK, with 60 million people cared for in one glorious NHS. Opt-outs would destroy the data, and the growing calls for an opt-in system would be worse: opt-in killed people by holding back organ donation, and more than that, it would exacerbate social inequality around data, because the poorest patients, those most likely to be unwell, are also the least engaged with services, the least likely to opt in. They would become invisible.

So here’s my advice: if you’re thinking of opting out – wait. If you run care.data – listen. There are three things the government can do to rescue this project.

Firstly, make a proper announcement about what you will do in the six-month delay. You cannot rely on blind trust when it comes to sharing private medical records, so explain that you’ll be coming back soon with a clear story. Sort out the governance framework, present unambiguous rules and principles explaining how data will be shared, list the specific clinical codes you’re proposing to upload, then give real-world examples of the kind of access applications that would be approved, and the kind that would be rejected. This is fair, and sensible.

Secondly, show the public how lives are saved by medical research. This needs examples, from the vast archives of medical research on cancer, heart disease and more. Alongside that, give a clear nod to the small risks, and an explanation of how they will be mitigated. Never be seen to give false reassurance on these risks; if you do, you will lose patients’ trust for ever.

Lastly, we need stiff penalties for infringing medical privacy, on a grand and sadistic scale. Fines are useless, like parking tickets, for individuals and companies: anyone leaking or misusing personal medical data needs a prison sentence, as does their CEO. Their company – and all subsidiaries – should be banned from accessing medical data for a decade. Rush some test cases through, and hang the bodies in the town square.

If the government do all this, they have a good chance of saving a vital data project, and permitting medical research that saves lives on a biblical scale to continue. If the government try to fudge – with half measures, superficial PR and false reassurance – then care.data will fail, and it might well bring down other sensible public health research with it. Lives are at stake. This cannot be left to the last minute in the six-month pause, and time is precious. It’s February. If you’re thinking of opting out, please don’t. But mark your diary for May.

A clear head shot from Jeffrey…

Not one stakeholder group left untrashed…

Great Einstein quote – the original definition of insanity presumably:

‘The significant problems we face cannot be solved at the same level of thinking we were at when we created them’

PDF: Braithwaite Delusions of health care JRSM 2014

The medical miracles delusion

Army ants subscribe to a simple rule: follow the ant
in front. If the group gets lost each ant tracks
another, eventually forming a circle. According to
crowd theorist James Surowiecki, one circle 400m
in circumference marched for two days until they
all died.1
Humans are not ants, but we often trudge together
along the same trail, neglecting to look around for
alternatives. Mass delusions involve large groups
holding false or exaggerated beliefs for sustained periods.
Humanity has a long, sorry list of these shadowthe-
leader epidemics of collective consciousness which
appear obviously wrong only in hindsight. Some last
for centuries: early alchemists intent on transmuting
base metals into gold and the Christian Crusades of
Europe’s middle ages, for example. Others have correlates
which resurface decades or centuries later:
McCarthy’s persecution of alleged communists in
the 1950s harked back to the Salem Witch hunts of
16th century America just as the 2008 Global
Financial Crisis had much in common with the
‘South Sea Bubble’ which slashed 17th century
Britain’s GDP.
In the educated 21st century, too, we blithely trust
in economic and political systems which are stripping
the earth’s resources, altering the climate and facilitating
wars. Are we then similarly mistaken, en masse,
about the capabilities of the health system?
Most of us believe in the miracles of modern medicine.
We like to think that the health system is
increasingly effective, that we are implementing
better treatments and cures with rapid diffusion of
new practices and pharmaceuticals and that there is
always another scientific or technological breakthrough
just around the corner promising to save
even more lives; all at an affordable price.
We maintain the faith despite multiple contraindications.
Modern health systems consistently deliver
at least 10% iatrogenic harm.2 Despite very large
investments and intermittent but important interventional
successes, such as checklists in theatres3 and
clinical bundles in ICU,4 there is no study showing
a step-change reduction in this rate, systems-wide.

Only half of care delivered is in line with guidelines,5
one-third is thought to be waste,6 and much is not
evidence-based,7 notwithstanding concerted efforts to
optimise that evidence and incorporate it into routine
practice.8
The reality is that progress is slowing, and medicine
seems to be reaching the limits of its capacities.
The potentially disastrous problems of antibiotic
resistance, for example, are yet to play out. This is
only one point among many. New technologies such
as the enormously expensive human genome project
have provided only marginal benefits to date. We still
do not have the answers to fundamental questions
about the causes of common diseases and how to
cure them. Many doctors are dissatisfied and increasingly
pessimistic.9,10 It must also be remembered that
although death is no longer seen as natural in the
modern era, everyone must die. Yet, we inflict most
of our medical ‘miracles’ on people during their last
six months of life. Le Fanu describes this levelling off
and now falling away of health care progress in The
Rise and Fall of Modern Medicine.11
Every major group of stakeholders has its own
specific delusion which acts to augment the metalevel
medical miracles delusion. Thus, the overarching
delusion is buttressed by a set of related ‘viruses
of the mind’, to borrow Richard Dawkins’ evocative
phrase.12
Although politicians think and act as if they are
running things, modern health systems are so complex
and encompass so many competing interests that no
one is actually in charge. Then, bureaucrats – acting
under their own brand of ‘groupthink’ – assume their
rules and pronouncements provide top-down stimulus
for medical progress and improved clinical performance
on the ground. Yet coalface clinicians are relatively
autonomous agents, so there can only ever be
modest policy trickle down.13,14
Researchers, too, support the medical miracles
industrial complex. The electronic database
PubMed holds some 23 million articles and is growing
rapidly. Every author hopes it will be his or her
results that will make a difference, yet there is far less

take up than imagined and comparatively little
investment in the science of implementation8 – translating
evidence into real life enhancements.
Nor are clinicians or the patients they serve
immune. While frontline clinicians strive to provide
good care, many myopically assume their practice is
above average; the so-called Dunning-Kruger
effect.15,16 Of course, statistically, half of all care clinicians
provide is below average. And notwithstanding
decades of public awareness, patients believe modern
medicine can repair them after decades of alcohol,
drugs, sedentary lives and dietary-excesses, despite
evidence to the contrary.
Meanwhile, the media’s unremitting propensity to
lend credibility to controversial views and to hone in
on ‘gee whiz’ breakthroughs – while ignoring the
incremental and the routine – fuels unrealistic expectations
of what modern medicine can deliver.
Throughout history, mass delusions have been
aligned with mass desires for favourable outcomes.
In the pursuit of medical miracles all of our interests
line up in a perfect circle. We seem more like army
ants than we think.
Just as the Global Financial Crisis was a wake-up
call for the serious consequences of blind fiscal faith
we must begin to manage our expectations of the
health system. Progress is always in jeopardy when
the real problems are obscured.
The challenge is to harness the tough-minded
scepticism needed to tackle this widely held ‘received
wisdom’. One realistic way forward is to encourage
stakeholders – politicians, policymakers, journalists,
researchers, clinicians, patients – to first consider
that their own and others’ perspectives are simply not
logically sustainable. This may be achieved through
genuine inter-group discourse about the health
system, where it is at, and its limitations.
As is so often the case, Albert Einstein said it best,
in a typically neat aphorism: ‘The significant problems
we face cannot be solved at the same level of
thinking we were at when we created them’.17 If we
can humbly accept that we need new perspectives
for healthcare – and radically different ways of
thinking – we will be better placed to free ourselves
from the hold of these peculiar viruses of the mind.