Sunday, March 11, 2018

Kate Johnston and Public Health

I was really happy to have Kate Johnston, an expert on public health issues, on the show to talk about them. Public health is a really important issue to think about in worldbuilding, and I don't see enough of it. As Kate said, not many people think about it on a holistic level, beyond inventing "a gizmo" for a plot device. Often even when a gizmo gets invented, the implications of its invention don't get explored.

She mentioned how in The Windup Girl by Paolo Bacigalupi, people had a pressure osmosis filter that allowed them to filter urine. Kate asked, "Where is that in the rest of society?" Why wouldn't people filter seawater? Why wouldn't they use the technology to create desalination plants? And what effect would that have on the ocean as it got more saline?

New technologies expand through society. One example she gave was GPS. David Gerrold imagined it, but didn't imagine that you would carry a GPS device in your pocket.

It's very hard to look forward into the future.

Kate talked about John Snow, a doctor who tracked down the source of a cholera epidemic to a public well. He couldn't get people to listen to him, so he removed the well's handle and stopped the epidemic.

Kate also urges us to consider the public health implications of climate change, such as the expansion of malaria and other mosquito-borne diseases. She calls the CDC "toothless" on many issues.

Will we have a global medical infrastructure? Might that become so pervasive and important that it could function like a world government?

If you are going to invent a health-related MacGuffin, think about how its invention would resonate. What would be the positive and negative effects? Kate thinks Julie Czerneda and Lois McMaster Bujold do a great job with such questions. Cultural change can come about via medical appliance.

Right now, as Kate puts it, medicine has been "pre-personalized" to white males. Real personalized medicine will expand quality of care to other groups. Kate doesn't think we're going to crack the question of life extension, which will restrict our ability to travel deep into space.

Insulin monitoring tattoos and implants might become possible and widespread, and would affect quality of life.

What happens if the corn belt becomes a savannah due to climate change? How does that change farming? What happens in areas where the land is shrinking? Stephen Baxter took on these questions in Flood. Marginalized people don't have the ability to move to another house. How do you move a huge population while keeping them healthy and safe?

The CDC and FEMA have a medical stockpile for emergencies that they keep rotated so it can be moved out quickly... but we have never used it.

We also spoke about vaccinations. Right now we are starting to have vaccines for types of cancer. Will we get them for other things? What if there were a vaccine for Alzheimers? Who gets such a vaccine? How do they pay for it? And what happens then, if people aren't dying?

DNA is a lot more complex than people thought, especially as it's portrayed in elementary genetics. Kate says it's not "the magic LEGO block." We know that a child's DNA changes the DNA of the mother. We're also learning about epigenetics, and the interface between body, mind, and environment.

You could write a story about whether you get vaccinated or not. Would a person skirt regulations ot save their own child?

We may learn to regrow teeth and restore bone mineralization due to research done for the space program. The space program has had an enormous influence on society because of the larger implications of innovations made for space, like velcro, synthetic motor oil, and anti-vibration mechanisms. You have to be very creative when you can only use one size bolt because you only have one wrench. That last part is changing a bit because of 3D printing technology.

Medical technology is already printing tissue. What will we achieve in building on this?

We've already done things like add micronutrients to bread and milk. This leads to people thinking you don't get scurvy any more because people are just better, when in fact they are getting necessary nutrition from things like Wonder Bread.

Accessibility to medical treatments is a huge issue in our world, and would be in other worlds also.

The curb cuts mandated by the Americans with Disabilities Act benefit everyone, not just the disabled.

What are the consequences of gene editing by CRISPR? People are already self-injecting this, performing dangerous experiments on themselves.

Things that do harm are easy to access. Things that help are harder to access.

When Craig Venter decoded his own genome, it was considered an enormous accomplishment. Now, though, you can get your DNA analyzed by mail.

Sometimes the progress of technology has randomness built in, as when clocks started all going "clockwise" simply because that became the trend in their manufacture. There was a time when you could find cars with doors that opened toward the front (these were called "suicide doors" for a reason). 8-track tapes were more effective than VHS tapes, but didn't end up being used widely enough to be maintainable.

There is a trend toward online psychotherapy. This is very helpful because of the difficulty of doctor access in small towns and rural areas. Morgan told us how far she lives from certain services, six miles from "the village" and ten miles from Ithaca.

We talked about vectors, or how diseases spread. This is a question often ignored by lawmakers. Kate says that people who have not grown up around animals do stupid things like kiss a chicken and get salmonella. She mentioned the Oregon woman who got cattle worms in her eye. She encourages more people to write SF/F about parasites, because "we haven't had a good parasite since Alien."

When refugees show up in a place, what kind of diseases do they carry?

We are living in the midst of a microbe world we hardly know anything about.

Why couldn't you have multiple elective surgeries at once, to save money on anesthesia?

A new trend in operating rooms is for the doctors to write their specialties on their hats so that everyone knows who the anesthesiologist is.

Kate said that if you want to look at an example of actual cooperation under pressure, you should look at an emergency room. She and I both recommend this article, which talks about very effective emergency room management during the shooting in Las Vegas, Nevada.

It's worth giving some thought to how communication works in a medical setting.

Kate suggests a thought experiment, where we imagine that health care providers are all fully staffed to the level they need to provide good care. What kind of economic effects would that have?

What is the status of doctors and nurses in a society? Differences there can impede communication and cause harm in our world; what would happen in a fictional situation? How would doctors deal with marginalization, or with trans identity? There are both social and physical aspects to these questions which can have dire impact on individuals. Who falls through the cracks?

Where is birth control in the future? Are women still denied tubal ligations in the name of future fertility they might not want? Are there condoms in the future?

What provisions are made for mental health? Who is providing help during the 2am-5am period when mental health crises are most common?

Would there be side effects to controlled breeding in humans the way there are in dog breeds?

What will the next Great Death be? The black plague was catastrophic, but we haven't had a serious epidemic in a long time, with the exceptions of the 1918 flu and the AIDS epidemic.

The current 2018 flu is killing a lot of people, particularly people with less health support.

My heartfelt thanks to Kate for coming on the show to discuss these important topics. This week, Dive into Worldbuilding will meet on Tuesday, March 13th at 4pm Pacific Daylight Time to discuss Personal Weapons. I hope you can join us!