Who Owns the Future? (15 page)

The economics of elder care reflects the destruction of middle-class levees and the rise of Siren Servers just like any other sector. There’s a tremendous drive to hire staff without benefits, since paying for someone else’s health care is an unbounded liability in an
era when insurance is run by Siren Servers (this will be discussed in an upcoming section).

There’s also fear of litigation. In the network age, lawsuits can be organized with network effects. Litigants can be gathered online into swarms. This creates an unfortunate paranoia. I have run into problems trying to get Internet connectivity into elder-care facilities, and the problem is often fear that a webcam will capture a small infraction that turns into an insanely amplified liability. Maybe someone will slip on a wet floor, and then there will be hundreds of thousands of dollars of legal bills to pay.

If you go to a tolerably decent elder-care facility, almost every resident will be the beneficiary of some form of levee. Almost none will have simply saved cash for old age. There is almost always a pension, or government programs like Medicaid. In every case, the institution that is providing these benefits is being crushed by the obligation.

Go visit places where residents don’t benefit from levees. It’s not pleasant. The facilities for those left hanging are more smelly and wretched than you’d expect things to be in a rich country. Seriously, go visit the public elder-care facility of last resort where you live. That would be better than me describing them.

It’s not that the robots will necessarily be cheaper in an immediate sense. There might be significant expenses associated with the goops needed to print them, if they’re printed, or with manufacturing and maintaining them if they are not. But the expenses will be more predictable, and that will make all the difference.

Hiring a human nurse will mean paying for that person’s health insurance, and taking on unpredictable legal liabilities for the mistakes that person might make, like leaving a floor wet. Both of these drags on the ledger will be amplified by network effects, just as has happened with mortgage risks.

Insurance companies will use computers to weasel out of liability
and
to extract ever-larger payments. The whole world’s lawyers will be circling online. The liability side of having an employee will be copied and amplified over a network, just like a pirated music file or a securitized mortgage. It will eventually become less risky to choose a robot. When you turn action into software, then no one gets blamed for what happens.

Humans will always do those jobs that a robot can’t do, but the tasks might be conceived as being low skilled. It might turn out that robots can give massages, but can’t answer the door. Maybe robots will be good at catching patients who fake the ingestion of medicines, but ineffective at soothing patients so that they’ll take them voluntarily.

The key reason to avoid acknowledging that there’s real skill in doing what robots can’t do—and hiring people for real jobs—will not be to keep the immediate expenses low, but to reduce the amplified liabilities of the network age. So there will be plenty of dead-end jobs without security or benefits.
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This will be despite the fact that the humans in the caregiving loop might be absolutely essential to the well-being of those being cared for.

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This is being written in America, in advance of the 2012 election. It is possible that “Obamacare” will stand or fall, but in either case, the larger pattern described here will persist unless it is addressed more fundamentally than by health-care finance reform.

Meanwhile, the programming of caregiving robots will be utterly dependent on cloud software that in turn will be dependent on observing millions of situations and outcomes. When a nurse who is particularly good at changing a bedpan feeds data to the clouds—such as a video that can be correlated to improved outcomes, even if the nurse never is told about the correlation—that data might be applied to drive a future generation of caregiving robots so that all patients everywhere can benefit. But will that nurse be compensated?

If present online patterns continue, the answer will be no to the nurse, who will be expected to “share” her expertise and to forgo proper compensation for it.

A Pharma Fable That Might Unfold Later in This Century

The examples given so far are part of a standard set of anticipations in Silicon Valley. The pattern can be applied to almost any industry
that isn’t yet fully software-mediated in the way that recorded music already is. Here I’ll tell a tale of how the pattern might be realized in the pharmaceutical industry:

It was 2025. It all started in a Stanford dorm room. During a party someone knocked a bottle of vitamins to the floor and it shattered. “Dude! My vitamins.” No one had a car, and it was miles to the nearest drugstore.

“Hey what about those reaction chips we use in chem?” Reaction chips were tiny chemistry experiment stations on a chip. Layers of gossamer shape-changing surfaces were puckered by charges from transistors in the top layer of an inch-squared chip, creating any desired architecture of chambers. Chambers could be manipulated to form tiny pumps, pressure chambers, or even itsy-bitsy centrifuges. The contents of a transient microchamber could be mixed, heated, cooled, or pressurized. Sensors of many kinds were also distributed on the chip’s surface. Every spot on the chip was monitored for temperature, color, conductivity, and many other properties.

Tiny drops of antecedent chemicals were added to inlets at the surface of the chip by robotic eyedroppers within a desktop chip-filling station. Instead of spending hours to perform dozens of steps to synthesize a chemical at a bench, you could set up a chip to perform tens of thousands of steps while you went on with your life. More important, you could set up thousands of chips to perform variations on synthesis experiments in parallel. Chemistry finally merged with big data. A single typical senior project might test a million synthesis sequences to evolve a better one, or might test dozens of variations of an experimental material.

The most fun thing was to watch a chip under a microscope while it was carrying out chemical synthesis. It looked like the world’s smallest Rube Goldberg device, squeezing, spinning, boiling, and squirting out tiny amounts of experimental substances. YouTube videos of chips in action drew a cult following. The ones where chips blew up were the most popular. T-shirts with the words
CHIP FAIL
became popular in chemistry departments everywhere.

Anyway, back at the dorm room, one of the guys said, “Just get a chip to make your vitamins, dude. It’s stupid to go spend all that money at a store.”

So a few chips went missing from the lab that night.

It turned out to be a pain to keep chips in a dorm room drawer. The first one that made vitamins got lost in a bundle of underwear. But a roommate said, “Dude, you should visit the wearable computing lab. We should be wearing these chips.”

Where to wear them? Chips started showing up in tattoos, like gold accents in a Klimt canvas.

Amazingly, it took months for the administration to realize chips were being pilfered. First came the stern lecture, then, without even time to pee, a visit to Stanford’s intellectual property lawyers for the patent drafting.

All the usual suspects in Silicon Valley put angel money into the startup, which was called VitaBop. The slide set at the first investors’ gathering showed skiers and a winner of a dance competition with VitaBop tattoos. An Olympic sprinter came up on stage and showed off his Bop Tat. Everyone with a Bop just exuded health and vitality. Of course they were all twenty-two.

VitaBop created a no-hassle “fill-up station.” You’d press your chip up against the station to get a refill of antecedent chemicals. The chips also gained an ability to monitor the blood and vital signs.

VB stations appeared at every café in Palo Alto. You could get a fill-up of the standard antecedents. Furthermore, a café might offer something exotic as a promotion. You could spend ten bucks to be part of a Bopathon, where everyone in the café would let the special chemistry of the day take hold. Despite all the hype, the active ingredient always turned out to be caffeine.

Culture pundits remarked that at least people at Bopathons were looking at each other instead of at gadgets, because everyone was curious what the recipe would do to you. In a strange way, Boppers were more physically aware of each other than non-Boppers. The chips became a social gateway. If you didn’t have one, you became kind of invisible to someone who did.

VitaBop grew like crazy. The chips were basically given away. It turned out that the thousands of tattoo shops, which had been going a little out of fashion, provided a ready retail network for
VitaBop installs. The startup enjoyed a friction-free magic carper ride.

Oh yes, the business plan. Well, there was a “recipe store” where you bought formulas that could be run on your Bop. Venues could pay to entice people to VB stations that would provide supposedly special formulas. Advertisers, insurance companies, and all kinds of other third parties paid for access to the amazing database VitaBop was building about what was going on within the bodies of Boppers. Privacy advocates worried, but the company assured everyone that only “aggregate” data was available.

Revenues flowed in, though only a trickle compared to what was earned by the industries VitaBop might kill. Many took pleasure in seeing the Big Pharma companies scared out of their wits, but at the same time it was sad to see the coffee business shrivel. Some cafés survived, as Bopper dens, but there were heartrending stories about how all those hard-fought battles to create fair-trade coffee plantations in the developing world had come to bankruptcy.

But back in Silicon Valley, all was well. It was to be expected that the shrinkage of old industries would be greater than the expansion of new industries. After all, making things more digital was all about efficiency.

Somehow professional chemists and pharmacologists were surprised. The jobs were going away. Sure, if you got a gig at VitaBop itself, especially early in the game, you’d do great. But chem and bio graduates from campuses far from Stanford started noticing a drop-off of available jobs. At one school in Idaho, the head of the journalism school consoled the head of chemistry. “I’ve been there, my friend.”

Somehow it took almost a year after the insane, ultraquick IPO before the culture wars discovered the world of Bopping. In theory there was an oversight board comprised of distinguished physicians and professors of public health who approved every program that could be distributed on the VitaBop store.

However, what was purported to be a hacking site in New Zealand soon posted a method to “root” or “jailbreak” VBs to gain access to the entire spectrum of their functions, not just those
approved by the manufacturer. Now wearers could enter any program into a VB. Anti-abortion groups were horrified that a young woman could synthesize a morning-after pill without anyone knowing. Sports medicine was thrown into turmoil. Efforts to ban Bops in college and pro sports sputtered and ultimately failed.

If you have the luxury of programming tens of thousands of steps, you can synthesize an awful lot of results from commonplace antecedents. The psychedelics came first. An interesting feature of VitaBops was that smaller doses were needed than for what came to be known as “stuffing,” or old-fashioned drug taking. You could titrate measured amounts directly into the bloodstream, controlled by how the body was responding at that moment. At first, police couldn’t figure out how to prove a VitaBopper had programmed an illegal substance.

Boppers argued that you couldn’t overdose off a Bop. This was a device measuring what was going on with your body millisecond to millisecond, after all. It wasn’t like stuffing an illicit substance to see what would happen. Somehow, the staid pre-Bop society wasn’t quite ready to hear that argument.

A youth culture around rooted
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Bops was all about recreational substances, but Bops were also squirting out therapeutic drugs. It took about a month after a huge bust of Bop rooters at the University of California, Berkeley for an organization called the Granny Boppers to distribute recipes over the same file-sharing sites that had recently been conduits for pirated movies and TV shows. Legit pharmacy sales of drugs for diabetes, blood pressure, migraines, and erectile dysfunction suddenly sank.

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A rooted device is typically a phone or tablet which is no longer governed by the company that sold it, but instead by the owner who bought it. For instance, a “jailbroken” phone can load unapproved apps.

Talk about lawsuits. All the pharmas and medical device companies ganged up on VitaBop.

VitaBop argued before the U.S. Supreme Court that it had done nothing wrong. It was only a neutral channel that its users acted within, and furthermore, it had absolutely no jurisdiction over the
bodies of Boppers. For it to even attempt to eavesdrop on or influence what Boppers were up to would put it in violation of medical privacy laws.

VitaBop was for the most part able to survive legal scrutiny. People liked having the ability to control more about what went on in their own bodies. But at the same time, the economy was shrinking. Amazingly, fresh graduates in medicine and chemistry sometimes had to rely on their parents for even basic support, like getting the latest VitaBop.

Bops were still cheap or free, but the overall cost to use them seemed to be going up and up. You could try using aftermarket antecedent chemicals, but somehow they never quite worked. Something fishy was going on with the pricing of official antecedents; they gradually became more expensive for no good reason. Antitrust regulators had a hard time tackling VitaBop. After all, traditional pills were still available. VitaBop argued it existed in a competitive, dynamic environment. Plus, the company pointed out, what the government really should be worried about is the illegal trade in rooted Bops.