Bruce Mau, CEO, Massive Change Network
How can we use fact-based optimism to design a new healthcare system? Internationally renowned designer Bruce Mau imagines an intelligent ecosystem of life and health with a diverse ecology that integrates market and social methods. He shares that design goes beyond medical innovations, and can be applied in developing solutions to health disparities, creating health care accessibility and regulating artificial intelligence.
Bruce Mau is a brilliantly creative optimist whose love of thorny problems led him to create a methodology for whole-system transformation. Across 30 years of design innovation, he’s collaborated with leading organizations, heads of state, renowned artists and fellow optimists. A serial entrepreneur since the age of 9, he became an international figure with the publication of his landmark S,M,L,XL, designed and co-authored with Rem Koolhaas. He is the author of MC24, founder of Bruce Mau Studio and co-founder and CEO of Massive Change Network, a holistic design collective based in Chicago.
Show Notes
Bruce Mau shares his background in implementing design to solve problems. [02:11]
Health care will be fundamentally reconceived based on a series of structural challenges. [03:01]
The all powerful doctor era is over as the patient becomes more empowered. [05:13]
Most of health care is routine knowledge that could be run by artificial intelligence. [07:09]
We need design applied to a new level of artificial intelligence governance and regulation. [09:26]
Using fact-based optimism in solving health care issues. [10:44]
How do we solve health disparities both within and between countries? [12:23]
How do we create accessibility for new health care innovations? [14:42]
How should we fund scientific research in the future? [17:04]
How do we solve health care challenges as our world population grows? [18:33]
What are the impediments to change? [20:54]
How do we normalize change? [21:42]
How will we use the opportunity to advance quickly? [22:53]
Transcript
Jason Helgerson: I'm Jason Helgerson, and you're listening to Health 2049.
Bruce Mau: For me, it's a diverse ecology. It's not a monoculture. It's not about a singular solution. We can see innovation and contribution and development using market methods, and we can see innovation and development using social methods. There's a new kind of axis developing that is not about left and right. It's not about social versus market. It's actually about forward and backward, an advanced world and a world that is moving forward or retrograde and moving backward.
Jason Helgerson: [01:46] This week, we'll be talking to someone whose optimism and big ideas know no bounds. This week we challenge internationally recognized designer Bruce Mau to think creatively about the state of healthcare 30 years into the future. So without further ado, let's meet Bruce Mau. Bruce, welcome to the show.
Bruce Mau: [02:04] Thank you, Jason. Delighted to be here.
Jason Helgerson: [02:06] So, Bruce, please tell our listeners a bit more about your extraordinary career.
Bruce Mau: [02:11] Well, I'm a designer. I started over 30 years ago as a graphic designer, so I have some perspective. But over those decades, my work has expanded really to design outcomes of all kinds. So I've designed cities and carpets, brands and businesses, social movements and institutions. I've really applied the power of design to solve problems of all sorts.
Jason Helgerson: [02:38] And I know one of your major projects in your career was coming up with a 1000 year plan for Mecca. So if there's anyone qualified to talk to about what healthcare could and should look like 30 years in the future, I think it's you, Bruce. We're so pleased to have you here today. So I'm going to start out with the same question we ask all of our guests what does healthcare look like in 2049?
Bruce Mau: [03:01] I think healthcare will be fundamentally reconceived based on a series of structural challenges that apply to every healthcare system, whether that system is market-based like we have in the US or socialized like most of the rest of the world. Every year we add new capacities and possibilities, new drugs, new products, procedures, new technologies, new replacement parts, we add, and we never subtract. The potential for intervention is ever expanding. The status quo is under constant attack. At the same time, technology is working to miniaturize or dematerialize everything, driving down cost and connecting every device to the Internet of things.
On top of that, we're developing an AI functionality that will take much of the conventional knowledge requirements out of the practice of healthcare. Embedding the knowledge in the devices themselves. As the cost of genetics decreases, healthcare will become increasingly personal and individual. Additionally, with all of that connectedness comes a new potential for data analytics, where we really can learn from tracking our behavior and our genetics to produce health outcomes that we want and need socially, economically and ecologically, using a much more consumer facing interface.
Finally, there will be a lot more of us. We'll be approaching 10 billion people on the planet, and the stress on the ecosystem will challenge us everywhere to change everything and live differently. So I imagine a much more interconnected, intelligent ecosystem of life and health rather than the medical system as we know it today.
Jason Helgerson: [04:36] Interesting. So, as I said up front, Bruce, you are a man of big ideas, and your idea for healthcare in 2049 encompasses the entire system on a global basis. But I'm hoping that maybe you can take us down from say, that 50,000 foot level down to the ground floor and describe for the audience an experience I think we all have. We all know what it's like to go to a doctor's office. And so I'm wondering what you think that experience will be like in 2049, given your overall system changes that you see coming our way.
Bruce Mau: [05:13] Well, I think that depends very much on where you are. I think overall, the biggest difference will be an empowered citizen. If you think about what is happening globally in our possibility, we're really shifting power to the citizen to the individual. I remember reading a book called "The Pearl," I think it was by Steinbeck when I was in high school and it was about a doctor who was all powerful. That era is over. What we're really seeing is the distribution of power to the individual.
Suddenly the individual really has access to knowledge in a way that was really impossible for most of history. That changes the experience pretty fundamentally, where more and more of the potential for intervention in the health experience is actually resting on the patient, on the citizen and the healthcare doctor's office experience is much more of a collaborative experience than it is today.
Jason Helgerson: [06:14] Interesting, in healthcare we often talk about this concept of patient-centered or person-centered care, but yet least in my view, has always been that it couldn't be farther from the truth that whether it's a doctor's office, a hospital, or almost any other mode of delivery of care is almost all built around the provider of the service and services provided at the convenience of the provider. But the world you're describing is one where the patient, the person is the center, they're an empowered decision-maker.
So one, I think your vision is exciting. But my only question for you is it's doability. We look back in my lifetime, 50 years on the planet, the mode and the method of healthcare and the relationship between the doctor and patient hasn't fundamentally changed in my lifetime. What gives you confidence that the fundamental relationship between the doctor, the system and the patient will fundamentally change over the next 30 years?
Bruce Mau: [07:09] I think, mostly because it's already happening, even though I think you're right that the kind of status quo is holding on. But there is a tsunami of massive change happening. Most of what I described is already here. It's just not implemented yet at mass scale. So it's not accessible. But over a decade ago, I did a project called Massive Change, and we did 20 person years of research to try to understand how our capacity to design the world is changing. And what we discovered is so profoundly optimistic that it is really stunning that we don't believe what we are capable of and what we are, in fact, doing. According to Ray Kurzweil, living in the 21st century will be like living through 20,000 years of human progress.
So the kind of change that is coming and is already happening, I think, is really profound. If you think about what just happened with the coronavirus. The Pfizer vaccine was designed in two days. AI is already making all sorts of routine knowledge actionable on an everyday basis, and most of healthcare is routine knowledge. Now there's a lot of friction to let go of that, because so much status and economy is attached to it. But that's an inevitability. I mean, that is just happening. And like it or not, that's really what we're going to experience.
Jason Helgerson: [08:32] Interesting. And I know there's been a lot of talk about the potential of AI in healthcare. I think not quite yet realized to the degree to which particularly the advocates for the new technology would like. But certainly we already have examples of artificial intelligence being able to diagnose certain conditions or to read, say, imaging more effectively than human beings. Do you see that as a major development here in the sense of really empowering patients when they don't have to see the doctor as this all powerful omnipotent or omniscient individual, the super scientist who has to answer the questions that no one else can answer and that they'll be able to access technology to get some of those answers themselves. Is that what you see is sort of will really change the power dynamic here?
Bruce Mau: [09:26] I think that's a big part of it. I think that when you distribute that possibility, when it's really accessible, when it's really fully developed. For me, AI has a kind of two sided. On the one hand, I think the opportunity to do what you just described is really important and would be profound in transforming not only the experience, but the economy of healthcare.
The other side is that I think AI and data should not be used by the existing system. We need a new level of governance and regulation that currently really doesn't exist. Our crisis in governance is holding us back in profound ways, and so we need design applied to governance as much as it is applied to the experience and the technology.
Jason Helgerson: [10:13] Interesting, because there are certainly while there are many advocates for these new technologies and tremendous excitement about their application in healthcare, there are also those who have serious reservations and concerns. And I think you have begun to highlight some of those the fear of how this new technology could be used to discriminate against people to exacerbate the inequalities that exist in healthcare access and outcomes. But it sounds like you're more optimistic.
Bruce Mau: [10:44] Absolutely. That's fact based optimism. One of the projects that I just published in MC 24 by a man named Max Roser from Our World in Data, looks at the last 200 years and represents that by 100 people over that time. In other words, if you look 200 years ago, if you look at the important metrics like poverty, extreme poverty 200 years ago, only 6% of the world did not live in extreme poverty. Now only 10% still do.
Now, when I say only 10%, it's still a huge number, but what's interesting, when you really look at the data, when you look at the graphs that Max Roser did, you can see very clearly where that line is going and it's going inexorably in the right direction. The same is true of infant mortality, of basic education, of vaccination, which 200 years ago was zero. Today, it's 86%. So you can see what we're accomplishing. And it's clear that globally we are already doing it and already committed to that.
Jason Helgerson: [11:47] Interesting. So I'll push back a little bit on your optimism in this sense is that disparities exist both within countries and between countries in terms of many of the outcomes that you mentioned. While I agree with you that we've made significant progress and don't dispute your statistics, we still have very significant disparities. What gives you confidence that those disparities exist today will no longer be a salient factor in the healthcare system of 2049? You seem to be quite confident that all boats will rise.
Bruce Mau: [12:23] That is optimistic perspective, but again, it's fact-based optimism. In other words, we've been doing that all along, and we continue to do it, and we will continue to work on smaller and smaller pockets of extreme challenges that we face. And I think that's clear. For instance, just a few weeks ago, at the beginning of this year, Plan S was declared. And Plan S is a commitment by a large group of major funders of scientific research that all of the science that they fund will be accessible on an open platform without cost.
So no more will the science be behind paywalls. And what that does is it broadly distributes possibility in a way that hasn't happened in the past. And I think that that's just part of the global movement that we call massive change. It passed without notice, for most people, they were not aware of Plan S, but it is a profound structural, fundamental change in the knowledge culture of the world. And it means that everywhere anyone can gain access. And that really is the revolution that we're living through.
Jason Helgerson: [13:40] Yeah, that is super interesting and I think massively underreported because I think that the healthcare world is used to new technologies, new treatments, new drugs being patented. And as a result of those patents, that gives the maker of those new treatments, those new devices, those new drugs the opportunity to charge quite high prices for those treatments. And I'm not going to argue that they did not incur costs, R and D costs and development. But the system that we have today, at least at its bedrock, is this concept, that innovation is rewarded through these patents.
And I think what you're suggesting is a pretty fundamental change and move away from that in which those technologies, those new treatments would not be reserved for that length of time. And as a result, the prices would come down and would be more widely available. But I'd say, Bruce, that's a pretty significant change from what we're seeing today.
Bruce Mau: [14:42] Absolutely. And it's something that I've been troubling about for several years. I was trying to think, how do you distribute access if you think about the scientific project, the kind of real genius and transformation of the scientific project is that it was egalitarian. It was accessible to anyone. Anyone could write a paper invent something, prove something and contribute it to the scientific literature. And your status was not a determining factor in its success. Now, the status and the kind of prejudice was still built into the culture. So you didn't escape that, but you could contribute.
And I think that is now coming to full fruition. And I think that kind of a future accelerates impact. I like to say that Einstein's are evenly distributed, but they're not evenly supported. And the more that we can support access to possibility, the more great contributions we will have. That's why I'm confident think about 100 design teams working on vaccines simultaneously. That's how we're going to beat this thing. And that really is a new era that just wasn't possible even 50 years ago.
Jason Helgerson: [15:59] Agreed. Although I would say about that, though, is that obviously those design teams, which are a mix of government funded and private, although the Pfizers, the Modernas are private companies, some of those receiving government money, others not. But a lot of those companies had the resources, had the ability to focus on the current crisis because they were profit maximizing, because they had generated profits from previous discoveries they were able to capture those economic rents. And so, in essence, the Pfizers of the world are creatures of that system that I had previously described.
But the world you're describing is a very different one. How do you envision that that research is financed in the future? Do you see it as a government function? Because my concern would be is that if you take away some of the profit-making potential of these developments by making them more widely available and less of a proprietary nature, that you're going to get less investment in that. Unless, of course, the government comes in and makes up for it.
Bruce Mau: [17:04] Of course, I think you're absolutely right. And that's why, for me, it's a diverse ecology. It's not a monoculture. It's not about a singular solution. We can see innovation and contribution and development using market methods, and we can see innovation and development using social methods. We can use social institutions to advance the world and we can use market methodologies and incentives to advance the world.
What we saw really, when we did massive change was that there's a new kind of axis developing that is not about left and right, it's not about social versus market. It's actually about forward and backward, a 90 degree axis that is about an advanced world and a world that is moving forward or retrograde and moving backward. And I think that's a more important access than the left and right.
Jason Helgerson: [17:57] Interesting. So let's talk about what I would consider potentially a threat or opportunity that the world you described presents, which is that as the technology advances, there will be opportunities for all of us to live longer, including people listening on to this podcast right now. But with that, as you had mentioned earlier on, the population of the world will continue to grow. And so my first question is, do you see those longer lives and the growth in the population as a threat or an opportunity or both?
Bruce Mau: [18:33] I wouldn't frame it as threat or opportunity. I think it's a challenge. There are going to be more of us and we're going to live longer. Those two facts seem inexorable, and that produces a new kind of challenge, because that means we're going to have to reconceive practically everything that we do. I mean, the way we do almost everything today is designed for the short term. It's designed for the top billion people. We leave the bottom 7 billion to their own devices.
CK Prahalad wrote a book called "The Fortune at the Bottom of the Pyramid." And what he describes in the book is that if you really look at the bottom of the economic pyramid in the world and you go down there and you solve those problems. Often you revolutionize the top of the pyramid. And what he showed is that almost no design application is being directed to that bottom of the pyramid.
And when we do direct it, if you look at the work of Rebecca Richards-Kortum at Rice University, what she did that was so stunning, is she said, look, I want to take a contemporary doctor's office and put it in a backpack and take it off the grid. So I want all the functionality that I have in a modern doctor's office in Chicago, and I want to carry it into the jungle in Guatemala. That means everything has to be miniaturized. It has to have low power needs, because we're going to use solar power and it has to be low cost. And what she did with her team at Rice was they went systematically function by function and put those functions into the backpack. And one of the devices took a $4000 piece of equipment and made it accessible for under $100.
Now, if you're the maker of that $4,000 piece of health care equipment, it's a bad day for you, but that's possible because we're solving the problem of gaining greater and greater access to possibility. That's an inexorable movement, that's not going to stop. We're going to keep making things lighter, cheaper, easier, smarter, more connected, more intelligent. And all of that is going to make healthcare more accessible.
Jason Helgerson: [20:48] What do you see as the biggest potential impediment to this positive vision of the future becoming reality?
Bruce Mau: [20:54] I would say the status quo. It's the stopping power of inertia, combined with the staggering amounts of money and status that are involved. In other words, there are a lot of people right now who have a pretty sweet deal and a very good life and kind of standing in the community under the existing regime. But the sand on which that edifice is constructed is really shifting underneath them. And I think a lot of those people are going to do everything they can to hold on while the world changes. And that, I think, is true of almost everything.
Jason Helgerson: [21:30] So in terms of overcoming that, it sounds like you're quite optimistic that despite that status quo as being a challenge, that humanity will overcome it within the next 30 years.
Bruce Mau: [21:42] Yeah. I have no doubt about that. You think about everything else that we've done. I think one of the most extraordinary things about the human animal is how quickly we normalize what we change. Think about how short a time we've had the iPhone. I started in the design business when we were still using hot metal type. I started in the Gutenberg era, and the change that I've seen is absolutely staggering. I can't remember how we did things. I can't remember how we did things before the computer was the way that we work.
But we did. We managed to produce things every day of the year, so we normalize how staggeringly inventive and creative and transformational we really are. We somehow project that backwards and forwards. We think, oh, it's always been like this and it's always going to be like this. No, it actually hasn't been like this. It's never been like this. And it won't be like this in the future.
Jason Helgerson: [22:45] Great. So one final question, Bruce, and appreciate you being on the show here with us today. What question didn't I ask that I should have?
Bruce Mau: [22:53] That's a great question. I think the question that I really don't know the answer to is whether we will use all this possibility to advance things quickly or whether we will hold on to the very last minute. I mean, I think that it's inexorable at the same time, the big question that we have to answer is, are we willing to move quickly because lives are at stake?
Jason Helgerson: [23:21] Well, thanks, Bruce. That was absolutely fantastic. Thank you so much for coming on our show. Well, folks, that was internationally recognized designer and big thinker Bruce Mau, who was gracious enough to share his positive vision for health and wellness in the year 2049. As always, thank you for listening to Health 2049. If you enjoyed what you heard, please subscribe to us and share this podcast with a friend. Thank you and see you next time.
