Since it’s day one of a new year, I’m going use the occasion to explore some ideas about the future (otherwise known as Wild A** Guesses, WAGs). What attracts my attention is big general trends that have effects in the long run but of which there may be only quick glimpses on any given day. There’s a lot of noise in daily events from things that seem sort of important, but a lot of stuff seldom has more than transient impact on how lives change over time. So there’s three things I’d like to focus on that I think have great impact: globalism, information flow, and the intricacies of knowing cancer.

#1, Globalism
I can no longer view much that’s happening outside the context of globalism. Economics, technology, health, politics, social values: it’s all going global now. National and even community specifics in these areas affect and are affected by activity taking place all over, and I, at least, can’t see a lot of benefit in separating things out by geography or national boundaries. That’s not to say that globalism is by any means complete. It started when the first knuckle-draggers wandered out of some gorge in Africa and started exploring the Earth’s surface. My guess is that what’s happening now is ~20% or 25% of what will be happening by the end of the century, but the effect is significant now.

I mean, who could be more surprised than the President George W Bush at the degree to which his administration has had to be about events around the world? And I don’t just mean terrorism. By all accounts, he was not going to focus on places like the Middle East, but there has been no escaping it. International relation-building, trade have taken up a lot of his time.

One of the things I expect to see in 2004 is the incursion into US politics by people from all over the world to a degree not seen before. Terrorists are likely to try to play a hand in the next election, and many commentators are going to have their say about Bush and “the other candidate” as the world watches the election. Being the US president is no longer just being the executive of America; it is a world leadership job and more and more people want to have a say about who does it whether they can vote or not . (The same is true for head of state of any powerful country.) Increasing flows of news and political commentary through the Internet is extending the channels of influence beyond traditional TV. I wonder what the rules are about raising campaign contributions overseas?

Another globalism issue that I’ve gone on about at length is The Economy. To me The Economy is the worldwide circulation of capital, goods, services and skills. The redistribution of IT jobs is really the extension of trends that have been going on for some time and will be going on to a much greater degree from here on.

A recent study by The Yankee Group is informative. They assert that a lot of the IT skills going overseas have to do with old legacy applications written in stone-age languages like COBOL. They have to be some of the oldest programs known to man. More sophisticated IT functions like systems design and business process automation in the US are pretty safe…for now. So, if you write old code your job’s at risk like guys in the infamous “rust belt.” If you design systems you better look over your shoulder, and if you create new ways to do new business you should be in good shape. But the companies that are employing people in India are getting better at managing and interfacing projects and at quality control. They will get more competitive at all levels over time.

But this isn’t just about IT. Similar trends will apply in many other areas. If you make your living sitting in front of a computer plugged into a network and churning information, it better be cutting-edge work if you expect to command much of a salary. (One study estimates 14 million US jobs are of this type.) There are many well-educated hands around the world that can handle vin ordinaire.

But to me the most telling thing about the Yankee study is the way they refer to the skills issue: they call it “sourcing.” Corporations of any magnitude these days are global. They don’t necessarily call it “outsourcing” because there is no “out.” If you’re a US worker and a company decides to move the work you’ve been doing to India, it looks like “out” to you. But to company managers who already have employees in a dozen places around the world, it is just looking for the source of a skill at lowest cost. Many companies say, “The sun never sets on our company. We’re just serving our customers around the world.” To me that’s a perspective that is becoming a mindset for pretty much any enterprise and will become a universal value during the 21st century.

It’s going to be interesting during 2004 to see what happens to the US “recovery.” Purse strings of companies based in the US are starting to loosen. Until now it has been called a “jobless recovery”—to me a blatant oxymoron. But supposedly the growth rate is enough now to stimulate hiring and job creation. But what jobs, where? Will more jobs be created in the US or in China? Will they be high-paying jobs or jobs with salaries cut by 30% to compete with overseas wage-earners? Will they be jobs for higher-skilled US workers, or jobs that are tied to a specific geographic location? It seems to me the next 12 months will see how much The Economy materializes in specific ways in the US.

And what about the ACS in the world? An interesting thing happened during the 1940s and ’50s. The categorical health agencies that took shape at that time mostly put the nation in their name: the American Cancer Society, the American Heart Association, the American TB Association, etc. It looks to me like they’ve all stuck to that designation and that scope of effort.

I wonder what we’d be today if we’d adopted the name, The Cancer Society? The national designation seems to me something that has limited the Society’s concept of what should be done and it’s perception of the scope of the problem. True, many countries around the world are still dealing primarily with basic communicable disease problems, but the magnitude of the world cancer problem seems to be emerging more into public consciousness, especially the consciousness of worldly, wealthy potential donors. It’s encouraging to see the things like ACSU that involved Asians during 2003, but it doesn’t seem to me to mark a significant shift in perspective. I told June Chan that I thought that if a Hong Kong real estate billionaire donated a big chunk of money to the ACS that would get people’s attention. Money always does. But why would someone in China donate to the American Cancer Society?

[p.s.: 1/2/03 Another aspect of globalism I find encouraging is the wide spread development of science around the world. It’s reassuring that there are efforts everywhere to develop education and economic underpinnings from science. Having participation in science in many places is reassuring.] #2, The Flow of Information

In many ways it’s difficult to draw a line between globalism and information flow. A large part of globalism is a result of advancing information technologies and the resulting flow of information around the world. It has enabled an integration of economy, culture and even politics to a level greater than the past. That trend is only going to accelerate.

But information flow is much broader in implication than just human direct communication. Just about anything you see about electronics or nanotechnology points to continuation of smaller, faster and much cheaper. Sensing, detecting, storing, processing and transmitting information—words, twitches of atoms, sequences of DNA and proteins, pulses of objects on the other side of the cosmos—continue the ride we’ve been on of doing much more at less cost. The consequence is that information processing—broadly defined—continues to be transformative because it enables and makes practical in the world things not even dreamed of just a few years ago. There is no end in sight (despite the predicted end to Moore’s Law in 10 or 15 years) to the minuteness and scale of this process.

The march toward “ubiquitous computing” continues apace. This idea suggests that a processor of some kind will be in every manmade thing. It also implies that the processor will report to a network or to the unbounded Internet. It’s kind of amusing to see articles like one that appeared the other day on BBC.com advising that information accumulation everywhere is nearly upon us and that: “We should reflect on how we use technology.”

Yeah, yeah, let’s talk about it. So what? You can only conjecture about what’s going to happen, and what its “unintended consequences” will be is totally unpredictable. We can debate it, but in the long run I think it’s a juggernaut. We’ve been expanding our information capacities since somebody first scrawled on a cave wall with charcoal. There’s nothing that will stop it now.

Let me go out on a limb just a little here and conjecture that this capacity is going to change the nature of life itself. What’s happening is part of a continuum that has driven evolution itself. Living things emerged from simple chemical information systems that built layer upon layer of informational supra-systems enabling greater capability with each jump. We moved from animated goo to cells to multi-cellular organisms, all on information linking. The rest is history, literally. That’s pretty much what humans have been doing all along with new information technologies. Now we’ve reached an inflection point, the crook in the hockey stick-like graph of information generation and communication, where the process is going nearly straight up.

My guess about “ubiquity” is that devices external to people are just the beginning. Starting with medical devices, I think sensors, processors and transmitters will invade our body spaces to monitor all of our vital sub-systems or to monitor what we’re doing. Even our molecular self—DNA, gene expression, etc.—will be part of an extended informational self and embedded somewhere in the vast “system.” We’re going to get wired. Or maybe not wired exactly; probably Wi-Fied. We—data creators and transmitters—will move through an electromagnetic environment filled with other sensing and processing devices.

The degree of informational integration between us as individuals and with everybody else worldwide will be far greater than it is today within a few decades. What it means to be an “individual” will be different. What “society” means will be very different too. Tighter and tighter informational integration and interdependency enables social complexity and functionality beyond what we know today, just as advances in communication and transportation have transformed human culture many times in the past. Today’s lifestyles will seem as quaint and strange in the future as living in a sod house on the prairie of 150 years ago seems strange today.

What comes out of all of this will not be a grand design. New things—many of them totally unexpected—will emerge over time. There will be controlled intervention, for sure, but the untended and unexpected outcomes will match the purposeful ones in significance. As the wise philosopher said, we have to live prospectively but we only understand life retrospectively. I think that’s true of the sweep of history as well.

#3, The Intricacies of Knowing Cancer

This is a very exciting time in the exploration of the life-process-gone-awry we call cancer. At the same time we seem to both know more and more and less and less. To put it another way, the more we know the more we know there is to learn. What’s gone is the notion that there is any simple solution to cancer, i.e., THE CURE. That’s not the same thing as saying risk can’t be reduced, detection made more sensitive and specific, and effective treatments devised. But it seems to me the notion of simplicity is being supplanted by indicators of complexity in cancer. The more we dig the more variables and alternatives for how cancer develops and varies from person to person are found.

There’s a whole new and growing lexicon in bio-medicine—genomics, proteomics, epigenetics, molecular medicine, personalized medicine—and all of these are ways of making a positive contribution to unraveling the details needed to grind cancer down to a nubbin. But a nubbin will remain, because cancer is an inherent risk of being a living, complex organism.

To be alive an organism must start from a single fertilized cell and create a finished product that—in the case of humans—has 100 trillion living constituents. Along the way the organisms’ cells must multiply, differentiate, replace damaged members, divide at appropriate times, stop at other appropriate times and even self-destruct at appropriate times. The “appropriate” thing is not governed by some global consciousness or intention; it is the outcome of moment-to-moment interaction of molecules responding to fundamental physics and chemistry. The process keeps going remarkably well by way of a vast system of information flow within and among cells at every living moment. From that “appropriateness” emerges.

The whole darn thing is phenomenally well worked out by literally billions of years of evolution. But still there’s non-negligible risk at all times that things can go awry. During the course of an 80-year lifetime the 100 trillion cells is multiplied by another 100 divisions per cell, on average. Even in the best, well-oiled machine, that’s a fair chance for problems.

So around every new turn in the road to knowledge about cancer there seems to be more surprises. Good surprises, really, that answer some ambiguity on the one hand and raise another question on the other. Great research programs in all the areas mentioned above and new syntheses of tools and techniques are in the works. In fact, cancer knowledge is perhaps the greatest beneficiary of the explosion of what’s often referred to as “post-genomic” science. But the mountain of detail remains enormous. And the application of refinements to individuals—to identify their cancer risk or to detect the presence cancer or to specify more precise treatment—will remain a daunting and expensive task for some time. Many of the emerging disciplines are a long way from everyday application in medicine. Even the existing medical care system is not geared up to accept new developments as they emerge. Some expect it will take a new generation of doctors to absorb the new knowledge and treatment practices emerging at this time before the greatest benefit is seen.

And what of the ACS in the foreseeable future? I expect the Society to stay pretty much the way it has been for decades. It’s foundations in middle-class volunteerism and 20th century community public heath has been a very viable niche. The Society is downstream from science and from medicine and has the opportunity to work out reactions to developments when they occur. There doesn’t seem to be much that would bring about significant change.

[p.s., 1/2/04: The traditional prevention/behavior-change message of the ACS has a lot of maileage left since it is both cost-effective and since many of the medical advances promised by new bio-medical knowledge will be some time coming.]