Here we go. A new series of posts about social innovation – sometimes from a technological starting point - based on weekly talks in my Rotary Freshstart club. I should have started blogging about these talks a long time ago, but never got myself going.
 
Oscar Sum, an expert on artificial intelligence in dental health care, spoke on September 20th about how AI can help China to solve its shortage of qualified dentists and explained how AI dental diagnosis and treatment planning will revolutionize his profession. He graduated from one of the world’s top dental programs at King’s College London before moving to Shanghai to become dental director of Global Healthcare China. As a pioneer in applying AI to dental care he created his own company Aidencare.
 
Dentists and lawyers are supposedly the main stock of Rotary members: a bunch of conservative and well-off folks who gather in closed clubs to build and cement their social networks. Oscar made therefore a good point by asking what we associate with dentists: pain, expensive, yacht, beauty, tooth fairy, demon dentist, headache, fear, were some of the words that came the audience to mind.
 
Dr. Sum explained that there is a dark side to the profession which is rarely discussed in public. While some dentists might own yachts and drive Ferraris, many suffer from back injury, debt, isolation, and depression. Dentists do have a far above general population suicide rate which might be the consequence of before mentioned issues.
 
Taking the perspective of the patient, dentistry seems to be a scarce or at least not sufficiently applied treatment. 94% of China’s population is diagnosed with a dental disease, ranging from periondititis to serious caries. Oscar explained such poor dental health with a general lack of awareness in regard to dental hygiene and a rampant shortage of dentists. While countries like Germany or Sweden count around 800 dentists per one million inhabitants, China has only around 50, which are mostly insufficiently educated. China’s dental training has not yet undergone a standardization as in the west and quite often a vocational training is sufficient to get a license to practice.

The state of the dental industry is nevertheless all but good in the West. A look into the history of dental health care demonstrates that dentists work with technologies which have not changed much during half a century. Latest innovations like invisible braces and 3D printing of fillings have brought only insignificant improvements for patients and practitioners.
 
It’s interesting to note that invisible braces empower regular dentists to prescribe braces, a treatment which was prior to their invention limited to specially trained dentists, called orthodontists. This example shows that technological improvements can disrupt established procedures and ossified education and treatment standards.
 
With such disruption comes the fear of those who have spent half of their life and (in the case of the US) up to half a million USD for their training and degrees – a human obstacle to technological innovation, which will also affect the application of AI in dental health care. How much are those who manage professions and industry standards willing open themselves to a technology induced transformation?

If AI is to be viewed as an aid rather than a menace to those who have built their careers around a specific subject, we need to start an open discussion about the status quo and what it takes to transform an industry towards better conditions for both ends of the system – in the case of dentistry: practitioner and patients.
 
Dr. Sum explains that dentists in Shanghai process between 80 and 160 patients a day, which effectively means that they can’t spend more than three minutes with a patient. While China’s enormous population drastically points at a core problem of generally far too low dentist-population ratios, the situation is only relatively better in the West where public health system dentists treat e.g. in the UK 30-40 patients a day.
 
While patients desire qualified dental care at an affordable price or - even better - free of charge, a dentist wants a decent remuneration for his services and her up to 20 years of expensive training.  It is a law of the free market that scarcity increases profit. The dental health care establishment is therefore interested in making access to the industry as difficult as possible to prevent cascading market prices and is biased against AI like 18th century Luddites wanting to trash algorithms now like weaving machines then.

A sober analysis of the dental profession reveals though that it consists of three significantly different competencies which each consume in every treatment time and effort. A good dentist requires an academic medical training which enables him to assess a disease and choose a treatment. Like only few other white-collar jobs, a dentist needs in addition a high degree of manual dexterity similar to a surgeon or welder. And quite different to many solitary professions in which one spends much time interacting only with a screen or other objects, a dentist requires an advanced interpersonal intelligence to make his patients feel heard and comfortable.
 
It is therefore no exaggeration that the dental profession could serve as a blueprint of how to deal with an AI induced technological transformation. Dr. Sum showed us that his software automates and improves the diagnosis part of his profession – the one which requires most of the academic training and related memory - giving practitioners the opportunity to focus on manual treatment and more time to listen to their patient’s needs.
 
Whether they will use their additional time to give themselves and their customers a better experience or stay stuck in the rut of dealing with as many as possible cases a day to increase their dental practices revenue, we will see. If medical schools will reduce the length of their training programs and thus give away big chunks of revenue, we will see. In the long run, the assumption with which I started this blog, namely that our labor markets will increasingly demand a combination of manual crafts and interpersonal intelligence, will be confirmed.
 

To be, or not to be, that is the question:
Whether 'tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take Arms against a Sea of troubles,
And by opposing end them: to die, to sleep;
No more; and by a sleep, to say we end
The heart-ache, and the thousand natural shocks
That Flesh is heir to? 'Tis a consummation
Devoutly to be wished. To die, to sleep,
perchance to Dream; aye, there's the rub,
For in that sleep of death, what dreams may come,
When we have shuffled off this mortal coil,
Must give us pause. [...]

Dr. Susan Schneider explores a post-modern version of Shakespeare's Hamlet in a brand new Nautilus article. A must read for everybody doubting Elon Musk's Neuralink plans and other transhumanist ideas on making the human being obsolete. I maintain that mindfulness is our only light at the end of a dark and gloomy tunnel and still ask how 10 billion people can compress the experience of life-long meditation masters into their information overloaded little nutshells.

Chai Jing's 2013 documentary Under the Dome kicked it all off in China: the obsession with air pollution – the visible testimony to how we treat our environment. Beijing’s air pollution index went viral in January 2013 topping PM 2.5 900µg and Shanghai’s reached in December 600µg. One was able to slice the air. So thick it was. I have never cared too much about air pollution. Expats fidgeting on their smart phones and constantly discussing the PM rating, were people I tended to avoid. There are more important things to be anal about, I told myself.
 
Since December 2016 I have joined the crowd, but more for the sake of our children than for myself. We still don’t wear face masks, but I watch the US consulate rating before we decide if outdoor activities are advisable for our family. 16 of the world’s most polluted cities are said to be located in China. A rough, gut-felt estimate on the sources of air pollution: 1/3 traffic, 1/3 industry, 1/3 building operation. But all air pollution is rooted in China’s deadly energy mix with more than 60% based on thermal power plants which burn domestic and imported coal to fuel the GDP growth machine … leaving China’s residents with healthy carbon dioxide.
 
Back in 2014 air pollution was one of ten top reason's to leave China. Our choice was to stay despite many befriended families moving out. 2016 was a year with outstanding AQI values and I repeated myself many times saying that this is the best year we had in Shanghai since our arrival in 2009. But as every year the regional weather conditions are worst from November to February and our expectations were not disappointed that year, neither were they this winter. Shanghai residents suffer during the cold season frequently from PM 2.5 values around and beyond 150 µg.
 
Many schools have implemented strict regulations based on a national Air Quality Index (AQI) e.g. no outdoor activities if AQI higher than 120. Understandably so. One is concerned with the health of those who have been put in one’s care. Thomas Thalhelm, founder of Smart Air, the company who provides DIY kits for indoor air purification, writes that he quit using AQI and relies entirely on PM 2.5 data, because its independent from national standards. But does it make any difference which measurement of air pollution we follow?
 
WHO writes in the first paragraph of its fact sheet on air quality that air pollution is a major environmental risk to health. By reducing air pollution levels, countries can reduce the burden of disease from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma. Our obsessive focus on air quality generates however a certain blindness to other health risks; and it conspires with our increasing addiction to screens which keep us indoors, sealed off from the “harmful” outdoors.

One such underestimated health risk is summarized under the umbrella term nature deficit disorder, which was coined in 2005 by author Richard Louv in his book Last Child in the Woods. Louv argued that the alienation from the natural world leads to a plethora of problems. So while parents might keep their children safe from toxic emissions they inflict upon them other ailments.
 
The Children & Nature Network, a non-profit which is dedicated to reconnect children with the natural world, lists in its research section a number of scientific studies which confirm that limited exposure to nature leads to an increased probability of

• Attention disorder
• Hyperactivity disorder
• Obesity
• Depression
• Slowed cognitive development
• Reduced creativity

 
It seems therefore that parents face a tough choice: either protect their children from the toxic emissions of our industrial and urban environments or expose them to the dulling and debilitating conditions of indoor life. The truth is though simple and there is no choice. Richard Louv believes that the effects of nature deficit disorder on our children will be an even bigger problem in the future. An increasing pace in the last three decades, approximately, of a rapid disengagement between children and direct experiences in nature…has profound implications, not only for the health of future generations but for the health of the Earth itself.
 
If we want to save our children, we need to connect them to nature; and the more we connect to nature the more likely it is that we clean up the mess we have created. That’s most likely what Victorian poet Mary Anne Evans aka George Eliot anticipated when she wrote in the 19th century: We could never have learned to love the earth so well, if we had had no childhood in it.
 
Further reading:

Our November Family Film screening, Captain Fantastic, made me look deeply into what parenting means today and why it has become such difficult task. Part of the answer is the perspective we take and my conclusion is that we need to shift away from the nuclear family and towards "tribal" parenting.

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Ben Hewitt, author of Home Grown, writes in a recent essay that modern parents too often do a poor job of distinguishing between responsibility and control. What responsibilities do we have as parents? How much control are we entitled to exert? Hewitt’s book is a beautifully written account of one family's unschooling journey in rural Vermont. It is – as a goodreads review summarizes - a kind of love letter to nature and the rhythms of life more than it is a book about unschooling - but that is precisely the point: For Hewitt and his family, life, nature, and education are intimately intertwined and inseparable.
 
Hewitt is to a certain extent the real life character on which director Matt Ross modelled his 2016 movie Captain Fantastic, which features Lord of the Rings star Viggo Mortensen as a father who raises his six children in the forests of (presumably) Washington State far away from any contact with civilization. Captain Fantastic is a modern family tale based on the Greek philosopher Diogenes of Sinope (414-323 BC) who argued that civilization is regressive and insisted that morality implies a return to the simplicity of nature, because wisdom and happiness belongs to the man who is independent of society. The film captures in an outstanding work of art the American education crisis and the nationwide if not global discussion about pros and contras of homeschooling. Ross succeeds to highlight some core truths about our societies with a narrative of extreme exaggeration similar to the 2006 film Idocracy, but on the very other end of the intellectual spectrum.

Download pdf to read entire review.