“Anything that you can conceive of as a supply chain, blockchain can vastly improve its efficiency—it doesn’t matter if its people, numbers, data, money.” —Ginni Rometty, CEO IBM
Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA
Well, we enjoyed five decent days in 2021 before the Jan. 6 insurrection; I guess we should hope for better in 2022. I am paraphrasing a statement I heard on social media (I am sorry that I do not have the original source). I feel like 2020 is analogous to a drunken college roommate who has been out all night involved in some unspeakable debauchery and comes home to vomit on your floor in the morning (true story). Fear not, dear reader, I am not investing another editorial lamenting the pitiful state of our democracy. If anything, I am more hopeful than in 2020, because our Constitution has weathered this latest attack on the seat of the American government. The U.S. president has been impeached a second time for inciting the insurrection. A fitting conclusion to the worst American reality show series in history that has run for four seasons. Despite this rough start, I am cautiously optimistic about our collective future in 2021.
One positive outcome from 2020 was my personal reeducation on blockchain technology’s promise in our society’s evolution. Before I proceed, I need to state that I will be mentioning some financial organizations and/or products as examples of blockchain technology. Neither U.S. Medicine nor I am related, endorsing or recommending anything. In fact, to ever take financial advice from a tired, old Army anesthesiologist like me would be the height of economic folly worthy of seeking professional help. You have been warned.
Merriam-Webster defines blockchain as “a digital database containing information (such as records of financial transactions) that can be simultaneously used and shared within a large decentralized, publicly accessible network.” The key terms are ‘decentralized’ and ‘public.’ Your bank represents the standard centralized database or ledger we all depend on for regular banking services. In this traditional system, you must trust the banker (third party) to be an honest broker for your money as you trade fiat dollars for goods and services. A quick jaunt through the headlines regarding bank malfeasance (remember the housing bubble or Wells Fargo?)1 and one begins to understand that the individual is at a severe disadvantage when it comes to the bank’s potential for maliciously manipulating your finances. Blockchain’s fullest expression in our society thus far has been in the cryptocurrency industry. Bitcoin is perhaps the best-known use case for blockchain technology. The cryptocurrency has been on a bit of a tear lately. Unlike the U.S. dollars (mostly electrons just like bitcoin) that you are presently paid in, bitcoin exists as a distributed, decentralized ledger maintained on the internet. It does not rely on a centralized authority. Transferring value using bitcoin does not require a bank but rather is peer-to-peer. Millions in bitcoin can be exchanged over the internet instantly for little cost. Bitcoin also has a limited supply (there will only ever be 21 million), and no government can create more (deflationary). Many huge financial institutions are betting on bitcoin to preserve their wealth in the face of government money printing and unchecked inflation. Recent institutional buying of bitcoin has been remarkable.
A friend and anesthesiologist colleague, Alex Cahana, MD, tried to educate me on the social and financial advantages of emerging blockchain technology more than 10 years ago. Alex is a true visionary, but his superb arguments could not overcome my skull’s density at that time. Had I been smart enough to listen and purchased $1,000 of bitcoin back then, I would be writing this editorial from the Bahamas on my live-aboard sailing catamaran, sharing a rum-something with my lovely wife. I digress. The financial use cases of blockchain notwithstanding, I have learned from Alex that blockchain technology has the potential to revolutionize medicine and public health. Alex, in his editorial, “How blockchain will transform healthcare,”2 describes how blockchain adoption will create “a sustainable and resilient business-ecosystem, where all stakeholders share a common mission, taxonomy and sense of purpose.” The business ecosystem that Alex is describing is a decentralized (no central point of failure) and incentivized system where governments or companies can influence healthy behaviors (stop smoking, for example) in exchange for something of economic value. The decentralized ledger system’s power is it does not require the user to trust the government, company or central bank authority since the trust is embedded in the blockchain technology. Yes, I realize this is confusing, and a fuller understanding will require some effort. I have been down the blockchain rabbit hole for most of 2020 (it has been a nice distraction), and the internet is a great place to start with the search word “blockchain.”
One example of blockchain technology that I have been using is an app on my cellphone called Coin (my referral link is https://coin.onelink.me/ePjg/f9b5862b if you want to check it out). The Coin app allows your cellphone to become part of a geospatial network of location data. Confirmation of your location through your cellphone device, as part of the network, has value. Real-time tracking of packages is a use-case example for this data. Users are incentivized to participate through the allocation of XYO tokens as you travel around. The XYO tokens can be exchanged for currency or other items (an iPad, for example). I enjoy walking, a healthy activity and now I get paid to do so.
Other blockchain projects can help individuals provide benefits on a global scale. I am involved in a regular purchase of UPCO2 tokens (https://universalcarbon.com/) monthly. UPCO2 is a blockchain tokenized carbon credit, usually only available to major corporations, allowing me to buy REDD+ (reducing emissions from deforestation and forest degradation in developing countries —a UN program) carbon credits to support reforestation projects around the globe. I calculated my household’s carbon footprint using Conservation International’s tool (https://www.conservation.org/carbon-footprint-calculator#/), and I purchase UPCO2 monthly to offset my family’s carbon footprint. While I do not think this is a good investment, it is a charity I can support that is also in my family’s self-interests. I am contributing to developing a carbon economy that will incentivize inhabitants of countries containing the world’s rainforests to not burn them down. I enjoy the air I breathe and the economic advantages I have. It seems reasonable to share in the cost of preserving those areas of the Earth critical to our collective survival.
Another example of blockchain financial incentives that I have invested in is Cardano (ADA) cryptocurrency. This blockchain company is focused on Africa and the millions of humans who are “unbanked,” meaning they do not have access to the financial services we take for granted in the United States.3 Although many Africans do not enjoy banking services, many have access to the internet through modern cellphone technology. Using Cardano’s blockchain technology, African cellphone users can become their own bank stimulating economic activity and solving local market issues regarding trust between the population, governments and industry. This effort can bring many African communities out of poverty through blockchain supported economic development while simultaneously opening substantial new markets for investors. One example is the Ethiopian coffee industry, where Cardano’s blockchain is being used to incentivize coffee farmers to adopt more productive and sustainable farming practices, which will have tremendous social benefits for the country.
My personal exploration into blockchain technology and the potential benefits for a healthier, more harmonious world has been a bright spot in an otherwise lamentable 2020 (thank you, Alex Cahana). I offer these ideas up today because blockchain will be as consequential to the healthcare industry globally as bitcoin has been to financial markets. As a healthcare provider, you need to understand the implications, positive and negative, these changes will bring. The use of the dark web or Silkroad for trafficking in drugs and arms is undoubtedly an example of unsavory uses of blockchain technology. Nevertheless, this technology is here and will not be ignored. I prefer to focus on the many positive aspects blockchain technology can bring to the people and the planet’s health. In that regard, with all we have been through as a nation, I feel we all could use some positive news.
- R. Cooper. “A brief history of crime, corruption, and malfeasance at American banks.” The Week. Oct. 9, 2017.
- A. Cahana. “How blockchain will transform healthcare.” HealthManagement, Volume 19 – Issue 1, 2019.
- https://emurgo.io/en/blog/cardano-strategy-africa. Accessed Jan. 14, 2021.