Watch out if you're overweight in Japan: the government is starting a new initiative to measure their citizen's waistlines in order to combat obesity. The government will be measuring all Japanese between the ages of 40 and 74, and, believe it or not, actually now has state-legislated guidelines on how large your waist should be. For men, it's 33.5 inches, for women, 35.4 inches.

What happens if your waist isn't as slim as the government wants? The individual recriminations are mild: dieting guidance and health classes. However, Japan is making employers responsible for their employee's health, and businesses will face financial penalties if their employees' waists don't measure up.

This is all in an effort to reduce Japan's obese population by 10% in the next four years and 25% in the next seven years. It all seems a bit much, no? Japan's population is already much less obese than other World 1 countries--only 3.2% of Japanese are considered obese.

Image: Omid Tavallai (Flickr)

As part of our Technology Foresight program, Social Technologies conducted a virtual, global focus group of experts in technology, innovation, and business strategy to determine the top 12 areas for technology innovation through 2025. Personalized medicine is the first innovation area in the series.

Personalized medicine: "one drug for all" to "one drug per case" 

Personalized medicine includes the use of gene therapy, pharmacology and information technology to treat each patient individually. The ultimate goal of personalized medicine is the use of a person’s genome to move medicine from a reactive to a preventive stance, fixing a potential problem before it occurs rather than after it manifests. Changes in the medical and healthcare sector will give consumers more information about the interplay of disease and their own genomes, providing them the opportunity to take greater control of their healthcare and enable treatments tailored to specific genomes, which will thereby move medicine from “one drug for all” to “one drug per case.”

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On February 15th, the National Academy of Engineering unveiled its Grand Challenges for Engineering. Over a year in the making, the list was crafted by an international committee with members like Ray Kurzweil, William Perry, and Craig Venter. The group came up with the following list of challenges:

• Make solar energy economical
• Provide energy from fusion
• Develop carbon sequestration methods
• Manage the nitrogen cycle
• Provide access to clean water
• Restore and improve urban infrastructure
• Advance health informatics
• Engineer better medicines
• Reverse-engineer the brain
• Prevent nuclear terror
  
• Secure cyberspace
• Enhance virtual reality
• Advance personalized learning
• Engineer the tools of scientific discovery

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Recently, I've been immersed in reams of data on India, while helping to assemble S)T's field guide for our upcoming Futures Expedition to Hyderabad, India. It has been fascinating work, and some of the discoveries have been downright startling, providing stark examples of the challenges India faces as it tries to balance growth with stability and environmental concerns.

I've read about the growing problems surrounding car emissions and air pollution, such as smog so thick that it routinely forces airplanes to divert from major airports. Researching India's infrastructure, I discovered how urban areas often use their major rivers as primary drains--New Delhi alone pours almost 1 billion gallons of raw sewage water into the Yamuna River each day.

While these are major problems, they are not unmanageable: with time and investment, India can clean up its environment and build out its infrastructure.

No, what really worries me, in fact, was one statistic I came across while investigating the effects of urban pollution. According to estimates by doctors at St. John's Medical Center in Bangalore, more than 50% of urban Indian children under the age of 12 have lead poisoning. Lead poisoning can cause severe brain damage and up to a 20% loss of IQ.

India's infrastructure and environmental clean-up issues seem relatively trivial in comparison--that India's development may be literally crippling its rising generations is a much more worrisome possibility.

Image: Joooule [ Programme sensible ] (Flickr)

What will likely be the most important scientific and technological breakthroughs with significant commercial value and impacts on the lives of consumers out to 2025?

To begin to answer that question, S)T's Technology Foresight program conducted a virtual, global focus group of experts in technology, innovation, and business strategy. The group included experts from the Association of Professional Futurists, Tekes, Duke University, Hasbro, Worldwatch, General Motors, Shell, Johnson Controls, and Oxford University, among others.

After consolidating input from the expert panel and analysis by Social Technologies' futurists, what emerged was our list of top 12 areas for tech innovation through 2025:

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Your new best friend? Image: Scott SmithA recent one-day "snapshot" of global health indicates that obesity is becoming a global problem, not just one concentrated in a few Western countries. A study of 168,000 people in 63 countries worldwide found that more than half--in some cases up to two-thirds--of men and women in those countries are obese.

The project, called the International Day to Evaluate Obesity, looked at both waist circumference and a calculation known as Body Mass Index, which measures weight and height to establish whether someone is overweight. A BMI of 25-29 is considered overweight, and over 30 obese. The study found the average BMI for Latin America for both men and women is 28. More surprisingly, 38% of women in the Middle East were found to be obese. Only East Asia shows some signs of resistance to the trend at the moment, with just 7% of the studied population considered obese.

Another recent study in Britain blamed a cocktail of cheap, energy-rich foods, labor-saving devices, less costly motorized transportation, and less active lifestyles as contributing to the problem of obesity. One UK minister declared obesity on par with the impact of climate change in that country, and there are early indications of the same reasoning (i.e. economic costs/impact) being applied to obesity as has been applied to climate issues.

Will playing the environmental card be the trick that slows or reverses climbing rates of obesity? It's too early to say, but some government economists around the world are starting to count the cost of the obesity "pandemic" in dollars and cents, putting it in a new class of "meta-issues" (such as aging and climate change) that are on the radars of world leaders. Will global obesity be on the agenda at Davos this year? Will there be a worldwide series of  "Stop the Fat" concerts worldwide next summer? In the next few years, it could happen.

© 2007 Jupiterimages CorporationIt looks like the whole issue of health insurance in the US is about to get really, really hot. Not only do we have presidential candidates weighing in, but some powerful forces in American society are also starting to take on the issue.

The American Cancer Society recently started a campaign that includes hard-hitting TV ads and an extensive website promoting universal access to quality cancer treatment.

"Fighting cancer is tough enough without having to fight for the care you need; but many uninsured and underinsured Americans are facing this difficult situation. This site will show you what we're doing and how you can help. Because winning the fight against cancer depends on improving access to quality cancer care," the society says on its webpage.

Having the American Cancer Society weigh in on an issue like health insurance is highly significant, but there is more. There also seems to be a major shift happening in business. Health insurance was a major issue in the recent GM strike. One blogger who watches the auto industry noted that health care was "the key item that affects the future viability of (General Motors)." A lot of other companies are feeling the pinch; premiums keep going up and benefits are slowly ratcheted down.

In the October 2007 issue of the Harvard Business Review, an article called "Realizing the Promise of Personalized Medicine" states that while over the past decade there have been numerous advances in the diagnosis and treatment of many diseases, the healthcare system itself is not functioning efficiently and effectively. It advocates moving to personalized medicine--using more refined diagnostic techniques to tailor treatment to each patient's unique physiology. However, the article notes that "obsolete business models, regulations, reimbursement systems, and physician behavior stand in the way but can be overcome."

When business, non-profit organizations like the American Cancer Society, and politicians converge on an issue, you can bet it's going to be a moved to the front burner and things are going to heat up.

This summer I've made the trek from LAX to Orange County and back a number of times while working on an interesting project that touches on urban lifestyles. My path, and some occasional spare time, has allowed me to meander around parts of Los Angeles I might not otherwise check out--parts of South Central LA in particular. This same project has taken me back to my home town of Atlanta, as well as to some declining Detroit suburbs.

One common factor in all of these locations is the high density of fast food joints. In LA, it's fast burgers, a profusion of donut shacks and taquerias. In Atlanta, plenty of fast food chains (many run down) and cookie-cutter fast-casual outlets surround the big malls. In Detroit, food courts and liquor stores. The common theme? Lower-income areas seem chock-a-bloc with brightly colored, cheap, but dubious gastronomic choices. Within a few hundred yards of a resident's front door, one can find any manner of fried, spicy, or triple-decker meal, often for under $5 or so.

In much the same vein as some public schools' removal of junk food from cafeteria's and vending machines, the LA City Council is mulling a motion to place a two-year moratorium on new fast food outlets--but only in South Central, one of LA's poorer neighborhoods. The move goes a step beyond similar movements in places such as New York City, by attempting to make enact a law, rather than limiting things to a call to action. The moratorium's supporters say the urban poor have few healthy food choices that are affordable. Detractors say the big fast food chains do provide some access to healthy choices, but also provide a "safe" area in often-dangerous neighborhoods, as well as critical jobs, and that most important American value, convenience.

Regardless of how the moratorium vote goes, this move represents an indicator--an early hint--of new ways the nutrition and obesity battles may be cast: jurisdictions singling out particular geographies for intervention. Will Whole Foods get a tax break for moving into inner city neighborhoods to fill the perceived nutritional vacuum? Watch this space.

Eukanuba’s “Feed the Breed” website gives adoring dog owners customized food recommendations based on 3 breed sizes, 3 lifestage options (puppy, adult, senior), 4 activity levels, and 3 weight profiles (ideal, under, over).

There are also other variables that play into the recommendation. Is your puppy going through the weaning period? There is a food for that. Is your dog active? The “active” mix has “Glucosamine and Chondroitin Sulfate for healthy joints and mobility.” Do you have a sporting dog? If so, the sporting mix has “highly digestible carbohydrates to help support a short exercise recovery time…and is rich in Omega-3 fatty acids to help promote a good nose and scenting ability.”

Basically, we’re talking about functional foods for dogs. This got me thinking about the food I eat, and wondering where all the functional foods for people are.

Well, we’re starting to see them hit the shelves, too.

• DanActive, the probiotic drink from Dannon, has reached sales of over $100 million already, according to this article.
• Tropicana is about to release an orange juice with omega-3 described here.
• And Groupe Danone is about to launch a yogurt in Spain and France that claims cosmetic benefits. As reported in the LA Times, the yogurt will supposedly “improve the health of the skin of people who eat it for at least a month.”

This is a start, for sure, but I’m waiting for the day when my diet can be as tailored as those offered by Eukanuba, and eventually that will be the case.

At least that’s what research from the Institute of Food Technologists suggests. We’ve profiled some of their research in our Technology Foresight project and it indicates that as researchers learn more about the biochemical effects of nutrients and gain an understanding of the differences among different sub-groups of people at the genetic level, recommended dietary allowances will be tailored to specific populations—giving us highly customized diets too.

This could have several effects, from reducing chronic disease risk to allowing consumers to choose optimal diets based on activity or lifestage (e.g., adolescence, pregnancy, athletic goals, stress level, job activities, etc.). In the meantime, your dog can have a breed-specific meal and you can check out the full report from the Institute of Food Technologists, Functional Foods: Opportunities and Challenges.

Image: Social Technologies 

A phenomenon dubbed Morgellons may be the first "socially transmitted disease" in which the "vector" is the Internet. According to news reports, some people start experiencing Morgellons-like symptoms only after reading about it on the Internet -- where it was first described and named in 2001 -- and the Internet has given rise to an active community of self-diagnosed sufferers, researchers, and conspiracy theorists around the condition.

The question is whether the condition is physical, as its sufferers insist, or purely psychological, as most medical practitioners maintain. How we deal with this kind of question can have profound implications for the future.

The history of dealing with new medical disorders during the latter part of the 20^th century has a checkered track record. Health problems caused by Agent Orange and dioxin poisoning in Vietnam veterans, exposure to toxic chemicals at places like Love Canal, chronic fatigue syndrome, and other serious health problems have often been initially dismissed as a psychological problem experienced by the victim.

The societal reaction to AIDS/HIV in the early years of its emergence, when moral and political issues interfered with medical research, was also a telling indicator of how emerging diseases can go unrecognized.

Typically, the fewer easily observed physical manifestations there are, the more likely the victim’s complaints are to be dismissed. Even when there are physical symptoms, there is a tendency to minimize them or attribute them to some other, more “conventional” disease. Dismissing emerging medical disorders and health issues is common, particularly when the first victims are among society’s disadvantaged.

Morgellons’ symptoms cluster around a sensation of millions of tiny insects crawling under the skin. Sufferers often feel their lives are dominated by constant itchiness and pain. The only visible symptoms, however, are persistent skin lesions—which may result from sufferers’ own scratching or other ordinary causes.

Although Morgellons sounds like science fiction, in a world in which genetic engineering and nanotech are becoming widespread, it becomes increasingly important for organizations like CDC be able to move quickly to identify the true nature of weird medical conditions.

A recent History Channel documentary on the Black Death was both enlightening and frightening in its depiction of the profound destruction epidemics can wreak. It is humbling to think how all that we have built could be swept away as quickly as the social, political, and economic structures of 14^th century Europe.

Morgellons may be nothing more than a product of the fevered minds of an active Internet community of self-diagnosed sufferers. Let’s hope it is. The danger is that if the CDC finds no medical basis to Morgellons, criticism from naysayers and “told-you-so-ers” will discourage future investigations of other weird and fantastic ailments, hindering the early warnings that we will need when the real thing emerges.

American pediatricians are starting to circle the wagons against the growing number of in-store health clinics opening up in malls, big-box stores, and pharmacies across the nation. As described in a recent Global Lifestyles brief on Medical Mini-Marts, these clinics, most staffed by nurse practitioners or physician’s assistants rather than doctors, offer a limited menu of health services—flu shots, vaccinations, strep tests and other cultures, sports physicals, etc.—offered at low cost to walk-in patients. By the end of the decade, several thousand more retail-based clinics will have opened throughout the United States.

Responding to this threat, the December 2006 issue of Pediatrics features a policy statement on retail-based health clinics developed by a special panel of the American Academy of Pediatrics. Among the concerns the pediatric panel cites are fragmentation and other possible effects on quality of care, the lack of central health records for individual patients, problems in identifying and addressing chronic conditions or long-term issues such as obesity, and the possible spread of contagious diseases by bringing patients into a commercial retail environment.

In attempting to defend their turf, however, the AAP ignores a basic fact: For the most part, in-store clinics are not taking business away from pediatricians and other general practitioners. By and large, in-store clinics draw their customer base from two groups: the 46 million Americans who lack health insurance and cannot necessarily afford a $150 doctor’s visit; and insured but time-pressured patients who might be able to afford the monetary cost, but choose to avoid spending the time and trouble of visiting a doctor’s office until a health problem becomes severe. The advantages retail-based clinics offer—low cost, short wait times, convenience, and seven-day-a-week availability—cannot be matched by general practitioners, at least the way most American doctors operate their practices today.

In voicing their concerns, the AAP wrongly assumes that most of the patients who walk into these clinics have the alternative of seeing their primary physician. But 30% of Americans have no primary physician. And given the choice between spending $150 for a pediatric visit, $300 for emergency-room care, or $25-60 at an in-store clinic, those with no primary physician—especially if they have no insurance—would be wise to visit one of these clinics.

A colleague who has used these clinics three times over the past year loves them. He recognizes that they aren’t as good as a doctor’s office, but they offer fast, cheap service without the hassle of insurance and referrals, they are open late and on weekends, and they will refer you to a physician if you need treatment beyond their limited services. (Host stores that value their reputations will make sure that clinics behave reputably in this regard.)

The number of in-store clinics will expand rapidly in coming years. They will open not only in pharmacies, Wal-Marts, and malls, but perhaps in health clubs, gyms, and high-end vitamin stores that want to reposition themselves as wellness centers. Medium-sized employers may join universities, hospitals, and other large employers in establishing their own employee health clinics following the in-store clinic model.

Rather than rail against this rising tide, the AAP and other physicians would be better off examining these clinics to see how they serve their market. Perhaps a change in the way doctors operate their practices—remaining open on some evenings or on weekends, for example—might draw some of these healthcare consumers to their offices.

(Image: Social Technologies)

Unless you have been under a rock, if you live in the US, you probably know by now that two major video game systems have been released in the past week, Sony's Playstation 3 and Nintendo's Wii. I say "probably" because video games have become such a part of pop culture, and their marketing so widespread, that the importance attached to these two new devices has reached the level of a major cultural event, with attendant marketing and news coverage. With some 60 percent of Americans playing video games, according to the Entertainment Software Association, digital play is as mainstream as any other media behavior at this point.

With the video game industry maturing, the time has come for the three major players, Microsoft, Sony and Nintendo, to differentiate or disappear. Microsoft's Xbox, released last year, emphasizes connectivity, while Sony's new Playstation is all about a rich digital entertainment experience. Nintendo, however, has taken what one marketer called a "left turn," opting to change the direction of video game development and address several emerging trends among its users and its larger potential markets.

As I pointed out to my colleagues last year when news of it first broke, the main gamechanging element to Wii is the controller, which is untethered, somewhat like a TV remote. It is motion-sensitive and delivers physical feedback as well, essentially allowing the player to break free from the sit-down play experience and physically get into the game -- swinging the controller like a tennis racket, bowling it like a bowling ball, and acting in other new ways that allow the game to become a stand-up, immersive experience.

This allows Nintendo to enter, or even define, the realm of what is being called "exergaming," a topic on which we are issuing a forthcoming Global Lifestyles brief. Why is it important? Exergaming's emergence points not only to a need to break out of commoditized play and deliver a richer experience, which consumers demand in many other leisure pursuits today in World 1, but it also allows broader demographics -- older, younger, female, family -- to be participate comfortably in digital play. Nintendo hopes to tap consumers who want to get fit at home and become more physically engaged in this mixture of exercise and entertainment.

Drawing in new players will inevitably change the nature of games. Nintendo has taken steps to redefine what a game is, through such innovations as Brain Training, aimed at older players' mental acuity, and Elektroplankton,  a visual musical tool, both part of the company's Touch Generations initiative to expand modes of play generationally as well as in format and mode.

It will be interesting to see which platform has the biggest impact of the three big game consoles. I suspect the Wii has the greatest potential to change the definition of gaming and play for more consumers. Meanwhile, get some sweatproof carpet and move back the furniture a few inches. For many people in World 1, the home will have to adjust to new kinds of play.

Some big baby news came out of Britain last week. First up, Louise Brown, better known as the world’s first test-tube baby, announced that she was pregnant. She is not the first test-tube baby to bear children—that honor apparently goes to her younger sister Nicole, a mother of two. Given the furor caused by Brown’s birth 28 years ago, it is remarkable how little notice there is of this event. It is a measure of a society’s ability to normalize a technology that in-vitro fertilization is now looked upon as a legitimate medical procedure to treat infertility.

The acceptance of IVF today provides some perspective on the other baby news from Britain. The British government is moving forward with plans to ban preimplantation genetic diagnosis (PGD), so-called embryonic sex-selection. In discussing the ban, Health Minister Caroline Flint said that sex selection of children “could be the start of a ‘slippery slope’ to designer babies.” Interestingly, many of the same objections to IVF are being raised regarding so-called sex selection, including the creation and disposition of unused embryos.

Though the issues are not strictly comparable -- sex selection can have serious effects on a society -- opposition to both IVF and PGD have used some of the same arguments, and yet IVF is now considered a legitimate medical practice. The evolution of society's attitude toward IVF illustrates the point that popular views on medical ethics are not unchanging.  The recent American debate over stem cell research further highlights this point.

At Social Technologies it is not our job to weigh in on either side of the sex selection debate, but rather to look for indicators of change. Whether PGD gains societal acceptance is a question that remains open, but partisans on both sides of this issue would do well to study the case of IVF.

In preparing for an interview with the newly minted American Nurse Magazine, I came across a story about a class-action suit being brought against hospitals by a group of nurses; the gist of the complaint is that hospitals are colluding to keep wages low despite the ongoing nursing shortage. The shortage leads to long 12-hours shifts and lots of mandatory overtime. Nurses are also increasingly handling more sophisticated tasks, as the prerogatives of the health cares system require doctors to minimize their expensive time with patients. In sum: relatively low wages, long hours, and unrewarded greater responsibility. Gee, do we wonder why there is a shortage?

What might change this situation as we look into the future? Several trends suggest there may be an opportunity for nurses to improve their situation. We know there is a long-term shift in the location of care away from the institution and toward retail and the home. This is driven by the aforementioned cost-cutting pressure from the health care system. At the same time, we know that Boomers, as they approach retirement and seniorhood, are going to fight aging and any appearance of being old and incapacitated – they are not going to want to be institutionalized! They will want to care for themselves, but they will need help.

Getting the picture? There looms a great opportunity for nurses capable of increasingly sophisticated care to provide it to the aging Boomers (and others) who would prefer to receive care outside the institution and in their home. Sounds like a house call! Nursing students, use those electives on business courses.

The recent news that Nestlé, the Swiss food giant best known for its chocolates, plans to buy weight-loss company Jenny Craig provides another illustration of the increasingly dialectic nature of the food and beverage industry. On the one hand, leading food and beverage companies want to give consumers what they want—and sales of products high in sugar and/or fat content show that they still want lots of “junk food.” On the other hand, increasing awareness of the rise in overweight and obese adults and, even more alarmingly, children in World 1 and World 2 countries has begun to transform public opinion: more and more, food manufacturers are in danger of being seen as pariahs.

In an attempt to avoid the situation faced by—and comparison with—cigarette companies, many food purveyors are doing their best to burnish their public image. McDonalds introduced an array of salads to their menu and added apple slices and milk to its Happy Meals. Kraft promised to stop advertising less nutritious fare to children under age 12. Coke, Pepsi, and Cadbury Schweppes have agreed to remove sweetened drinks from school cafeterias and vending machines over the next three years. And now Nestlé buys Jenny Craig.

Nestlé recognizes that when it comes to their own diets, many consumers are beginning to resemble the Sneetches in the Dr. Seuss story who run from the Star-On to the Star-Off machine and then back again to the Star-On machine. I think we’re going to see more and more food and beverage companies hedging their bets by offering both Weight-On and Weight-Off products and programs—the latter the outgrowth of either R&D or acquisitions—over the next decade and beyond. The smart money in the food and beverage industry recognizes that consumers in World 1 and increasingly in World 2 have a love-hate relationship with food: they love to eat sweets and fatty foods, but hate what eating these foods can do to their bodies and their overall health.