History of Health

• What is Health?
• Stone Age (5000+ BCE)
• Bronze Age (5000-3000 BCE)
• Iron Age (1000 BCE-1500 AD)
• Medieval to Early Modern Age (14th-17th century, aka Renaissance)
• Modern Era
• Industrial Revolution (1800s)
• 20th Century (1900s)

What is Health?

Health is one thing:

1. maintain harmony
1. by fighting entropy

It is an infinite battle for harmony all the way down, at every level.

This begs the question- what exactly is life? What does it even mean to be healthy?

It means to be in harmony.

According to Nick Lane, life is "a self-sustaining chemical system capable of undergoing Darwinian evolution.” This means that it is an anti-entropic system in the beginning, that outputs entropy back into the universe, until it itself becomes victim of entropy. It is a system that maintains order (control), then grows beyond itself after a specific amount of time.

A healthy organism, that is alive, is one that is able to maintain a state of balance or homeostasis, despite external and internal challenges. This means that the defining characteristic of life is adaptability- not only can this life-form keep balance internally, but it can also respond to external stimuli effectively.

So what characteristics of a self-sustaining system need to exist?

• resist and fight off things that want to consume it
• repair itself, internally and externally
• efficiently metabolize external chemicals internally to prevent disorder/decay/entropy (for repair)

Basically, it is a system that is constantly fighting off entropy, until eventually, there is so much chaos internally that the system itself degrades. We grow to our max size, which (hopefully) our genome can then reproduce at, then we overstay our welcome and try to enjoy the rest of life, until we become victims of entropy.

Side note: I would bet that this entropy consumption follows a power law as well. When I was a kid, I remember my grandmother dying very quickly from cancer. She was diagnosed with stage 4 colon cancer, and within two weeks, bedridden, and within a few days after that, dead. Entropy consumes your body so quickly, that I would imagine it follows the same power laws that markets, technologies, and media follow in the real world. Once past the tipping point, just like Amazon or Apple consume almost all available cash flows (energy) in a market, so too does cancer consume all of the available energy that someone ingests.

So what?

Ok, so we have established that life is basically just fighting off entropy, giving us enough time to pass on our genome so that it can adapt to new environmental changes that are externally created. Like temperature and geographic changes driven by the Earth’s evolution, distance from the sun, and available particles in the air (Oxygen, Nitrogen, whatever- including bad stuff). Our species has become so successful, however, that we are now controlling our immediate environment, and who knows- that might change our breeding habits. But, I digress.

Even early humans, from millions of years ago, were practicing this. Using herbs and materials in the environment, we have sought to fight disease and injury, to keep this balanced state in tact for as long as possible. This is the exact same system we use today, but because of risk math (insurance) and government intervention, it has become totally fucked up. So let’s dive into it.

What is an efficient economic system?

An economic system is simple- it is when you have asymmetric skills, and a medium of exchange that lets people trade more effectively. If there is a person who can sew clothes, someone who can make baskets to catch fish, and someone who can make flint, then you have three people who can trade skills, using something of value to exchange among each other. Their information is valuable to each other, but only at points of relevance.

This is supply and demand- people pay a premium for skills and services when they need it the most. And when do people need things the most? When they are getting closer to entropy- meaning pain. People pay the most when they are in the most pain (pain can also mean FOMO- getting us further away from being the “it” tribe, meaning we are getting further away from reproducing with a healthy mate. Just look at crypto/AI terms sheets during the bull run, or fashion piece prices during “hot” times).

To be honest, humans are dumb- we are literally no different than the single-cell, chemical-trail following ancestors that we had billions of years ago. However, we do have the ability to learn. So why, then, do we only respond in periods of extreme pain?

Before 2008 we knew the incentives for CMBS’s were wrong, but we assumed the housing market would never crash because it never had. We also knew that population density was eventually going to cause a virus to spread rapidly, but we didn’t see its effects until 2020. There was no plan, no preparation. Because that is exactly how our body fights off entropy.

We don’t allocate energy to problems that are not immediate and life-threatening. That’s just how our genome has set us up. If there is no crazy threat that can cause us to die immediately, then we don’t plan. Does our body store the reading of RNA from a virus before it enters our body and causes harm? No, that’s why we created vaccines. We aren’t good at planning. We’re good at responding. We’re good at adapting, especially to changes in our external environment.

What does this have to do with the history of health?

Everything. This is the history of health and the technologies that helped us fight entropy. For now, we will cover the history of health technology, finance (money, which just represents energy and value), and law. Let’s begin.

I like to define our history by ages- they really blend together, but they are driven and defined by technologies. And as we have learned from business, technology is the only thing (and derivative innovation) that creates new ways of doing things. You can’t create a new market, or a new way of doing something, without first inventing the new medium to do that thing. The technologies throughout the ages are also driven by external conditions- again, we respond and adapt to our environment.

Stone Age (5000+ BCE)

Health problems that required technology:

• injuries from defending home/taking resources from other tribes
• food that made our tribe healthier
• disease- viruses and bacteria that hurt our internal system
• genomic deficiencies- attributes that made us less effective members of our tribe (aka less take more resources than give to tribe)

Technologies

• natural bandages for external wounds- mud, ground plants and spices, manure
• remedies for internal disease- herbs and spices
• spiritual- prayers and vibrations from human vocals
• trepanation (relieve brain of pressure by creating a hole)
• animal skins for warmth

Bronze Age (5000-3000 BCE)

New health problems that required technology:

• denser tribe populations
• warfare with metals
• more burns and injuries from working with metals
• agriculture- the domestication of animals and mastery over crops

Technologies that created new ways of healing:

• written records- patient information, medical information, and practices could be written down to become systems
• meaning medicine now becomes repeatable, with marginal improvements per generation of physicians
• metals allowed for the creation of sharp medical tools to pierce the body and provide rigidity during operation: scalpels, forceps, and clamps to perform surgical procedures
• alcohol for putting patients under and making surgeries less painful
• herbal medicine continues- Ayurveda is an example
• agriculture advancements allowed people to grow medicines (industrialization of medicine). Corporations didn’t exist- it was still healers
• public baths and drainage of used water (Indus Valley)
• use of heat

Iron Age (1000 BCE-1500 AD)

New health problems that required technology:

• iron-deficiency anemia- lack of iron in diet (more iron going to tools), which led to fatigue and weakness
• dental problems- because of the success of agriculture, grains and other processed foods caused faster tooth decay
• infectious disease- tuberculosis and cholera (and STD’s) started spreading more because of trade and city networks

Technologies that created new ways of healing:

• surgical tools are made sharper and stronger, replacing copper and bronze with iron
• herbal medicine continues to improve
• medical texts (from paper improvements) continues to increase
• Charaka Samhita (Indian medical text)
• Hippocratic Corpus (Hippocrates, 5th century BC)
• public health measures- states attempt to restrict disease by implementing laws
• Romans and Indians improve on drainage systems

Medieval to Early Modern Age (14th-17th century, aka Renaissance)

New health problems that required technology:

• disease, like crazy. These are all just random mutations that end up fucking up one part of the genome of a human that is so generalizable that it wipes out an entire portion of our population
• Black Death (14th century, kills ~25M people)
• Syphilis (late 15th century)
• Smallpox (killed a lot of Native Americans, including those in South America. European genomes had passed on anti-viral information through their genomes, but Americans had not ever experiences the disease before)
• side note: human genome is just getting tougher and tougher over time. we constantly update our state to defend against random mutations from external life forms/niches

Technologies that created new ways of healing:

• printing press in 15th century made medical information available to way more people- this meant that not only doctors could have access to medical text
• more skilled people in medicine, people who found a passion in it from childhood
• De Humani Corporis Fabrica by Andreas Vesalius (1543)- made it easy and accessible to differentiate normal medical state of a body vs abnormal, so people could find answers to what was wrong with them. Like an early WebMD, pre-chatGPT
• The English Physician by Nicholas Culpeper (16th century), book for herbal remedies and treatments
• De Plantis by Andrea Cesalpino, plant classification and medicinal properties
• apothecaries become business people
• first biopharma, technically
• quarantine
• 14th century, Venetian “Trentino”- ships had to anchor for 40 days off the coast before stepping onto land, coming from plague-ridden places
• messages were still delivered overseas by hand, where the deliverer could be carrying that disease
• 1663, London passed the Quarantine Act, inheriting the same practice from Venice
• ligatures are used to stop bleeding on battlefield wounds (invented by Ambroise Paré, a French surgeon, in the 16th century)

Modern Era

Key innovations:

• germ theory (19th century, scientists like Louis Pasteur and Robert Koch)
• vaccination (19th century, Edward Jenner and Louis Pasteur)
• modern surgery (invasive)
• pharmacology (20th century)- target more specific diseases in the body
• chemo- wash the entire body in chemicals, rather than precision
• radiation
• medical imaging

Industrial Revolution (1800s)

New health problems that required technology:

• respiratory diseases from factory work
• asthma
• bronchitis
• cancers from chemical exposure
• humans were consolidating chemicals our bodies aren’t used to into massive, concentrated sources for manufacturing and distribution
• processed foods led to nutritional deficiencies, thus disease
• scurvy
• rickets

Technologies that created new ways of healing:

• written text
• De Morbis Artificum Diatriba by Bernardino Ramazzini (1743), discusses occupational health hazards faced by miners, metalworkers, and printers (industrial workers)
• it’s because they’re exposed to chemicals in quantities our bodies are not suited for- we are suited for nature
• epidemiological methods for tracking outbreak sources (tracking disease source)
• John Snow used mapping and statistical analysis to identify a contaminated water pump as the source of a cholera outbreak in London (1854)
• occupational health becomes a real field of study- quite literally created by humans
• anesthesia
• William Morton (American dentist) used ether for surgery on a patient (1846)
• leads to chloroform, novacaine, cocaine as anesthesia
• nutrition
• scurvy can be treated with some oranges- leads to discovery of Vitamin C
• side note: you really need to just go into uncharted territory and make discoveries to really make changes to humanity. imagine if Musk didn’t want to explore traveling to Mars, or Ford wanting to automate farming and clearing trees
• X-rays
• German physicist Wilhelm Conrad Roentgen discovered electromagnetic radiation that could pass through solid objects and produce images of internal structures (1895)
• discovery is used in CT, MRI, and PET scans
• CT: diagnose body injuries
• blood vessels
• MRI: diagnose brain and spine injuries
• usually soft tissue
• PET: cancer, heart, and brain
• radiation therapy planning

** is the entire health industry business model dependent on insurance?

20th Century (1900s)

Ok, so this is where medicine started to really take off, especially because of technology getting smaller. The 21st is obviously more advanced, but this is where medicine starts to become a major source of technological advancement.

Driven by:

• wave discoveries in physics that could be used for medical purposes
• disease from increased density
• surgical techniques getting smaller
• systematic manufacturing of chemicals (Haber-Bosch process, mid-20th)
• IVF and other synthetic growing-human processes

interestingly enough, not a lot of DNA stuff yet (21st century thing)

New health problems that required technology:

• WW1 and WW2
• Holocaust
• major urbanization
• suburbs
• mental health

Technologies that created new ways of healing:

Observations:

• a lot more energy (money) put into cures, rather than prevention. This makes sense since:

pain → reproduction we want to get away from pain, towards reproduction, and will put more resources towards more immediate threats.

• opportunity in internal monitoring devices with prevention built in
• innovation has predominantly come from research (?)

Health Insurance

• innovation in commercial companies before health insurance
• major laws that changed health, and also the economies and technologies available at the time

History

• Early History: religion, magic, and superstition
• Middle Ages: religious and traditional
• Renaissance: anatomy and physiology, accurate diagnosis and medical literature
• Industrial Revolution: vaccines, anesthesia, surgery (health insurance introduced in 1890)
• 20th century: government-funded healthcare system, antibiotics
• 21st century: telemedicine, patient data, hospital and accident data sources, personalized medicine

Before the industrial revolution, health was paid for out of pocket and by charitable organizations. My assumption is that the charitable organization was built to pay for poor people and their access to health services. They charged higher fees to wealthier people and lower fees to poorer people. This is an inherent problem- Amazon does not charge premiums to rich people. This resembles the services industry. How is there no Ford for the healthcare industry?

The first health insurance policy was sold in 1890 by Franklin Health Assurance Company of Massachusetts. It was started by cotton business owners who wanted to spread out injury risk among their employees. This covered steamboat and railroad accidents.

They offered policies that covered medical expenses for a fixed monthly fee, premiums based on age and occupation. They charged employees for a fixed monthly fee and a premium. This is where the W2 paycheck deductions come from.

Ah, now we’re getting into the bullshit. So in 1935, the National Labor Relations Act was passed, and the tax exemption for employer-sponsored health insurance was added in 1943. Let’s think about where this came from. Health insurance providers paying off lobbyers to incentivize all employers to provide health insurance for companies. Wonder if it’s always as a tax advantage first (so low risk), then they make it legally required for employers to provide insurance**.

By making it more affordable for employers to offer health insurance benefits, the tax exemption has encouraged the use of comprehensive insurance plans that cover a wide range of medical services, which can be expensive.

Economics

• contractions and expansions in health- just like the economy (more companies are acquired to form mega corps when undervalued (bad market), they are then sold in overvalued markets (good market))
• trends in health- past, present, what comes next? is it like the luxury goods industry?
• where do you even spot trends? what data is required to see what is going to be a trend?

Actually getting a medical device to market

how much money goes into it every year:

how much money is produced from the sales of these devices:

• phase 1 clinical trials:
• success: 63%
• phase 2 clinical trials:
• 30%
• phase 3 clinical trials:
• 25% for cancer drugs, 50% for normal biopharma
• FDA clearance for medical devices is 80%

Biology research industry

precision instruments

• x ray crystalography
• microscopes
• balances
• pH meter

animal facilities

• fish tanks for zebra fish
• animals
• veternary management for experiments

plastics

• pipette tips
• petri dish
• gloves

lab building real estate development

• food
• benches
• water management
• coldrooms
• electricity (increased demands)

office equipment

• whiteboards
• conference room projectors
• glass (doors, windows, panels)

lab safety equipment

• hoods
• biosafety cabinet
• clothing
• cold/hot gloves
• badges

experimental equipment

• beakers
• pyrex
• centrifuges
• incubators
• vortexer
• shakers
• minus 80 fridges
• hot plates
• pipetes
• pipette tips
• refrigerators

biological tools

• antibodies
• viruses
• bacteria

lab chemicals

• media, agar
• gases
• buffers
• pure chemicals (ethanol, salt, whatever)

maintenance

• cleaning
• disposal of hazardous waste
• maintainence of specific equipment (warranty, insurance)
• autoclave (giant pressure cooker)

computer

• storage
• compute hardware
• virtualization software
• licensed software
• cybersecurity

DNA

• dna/rna synthesis
• dna/rna sequencing

legal:

• licensing/permits
• animal regultions
• HIPAA compliance

clinical trials

• data collection mechanism
• staff to manage the people

needs to part of humans daily habits every day for decades, you are building a market for a new customer experience