The Fourth Turning

We are in a Fourth Turning, in case you care. What does that mean? It means you feel unsettled and anxious, as if all our institutions are failing and we the people are left to our own devices. Literally.

Bad joke. The Fourth Turning is a cyclical representation of history introduced in the 1997 book The Fourth Turning: An American Prophecy by William Strauss and Neil Howe. The book describes a repeating 80-to-100-year pattern of four distinct 20-year generational eras called “turnings”: the High, the Awakening, the Unraveling, and the Crisis. As Americans, we’ve had several “fourth turnings” before, like the American Revolution, the Civil War, and the Great Depression/World War II. Yes, this is a metaphorical way to refer to historical periods, but it’s no sillier than Boomer, GenX, Millennial, and Gen Z.

This time the “turning point” is the AI Revolution. We have a few years of uncertainty and anxiety left before we get into the next rebirth, which will begin a new High, in which institutions are reborn and there’s a time of confident expansion.

In the meantime, console yourself by getting prepared for the beginning of the next cycle. Learn the new tools. Be part of what’s coming. It doesn’t take much.

Learning to use AI is pretty passive. Just as you are, you are a mini-data center. So am I. Individuals with decent educations and enough money to afford Apple watches and iPhones or the analogues in the Google ecosystem are gathering their own health data every day. We are all like little portable ICUs with beeping monitors. The data is being collected, although most of it isn’t being read.

But AI is almost at the point where it will make that data useful. We can all be walking health exams. My vitals are detectable from my smart phone. If something is out of range, either my phone or my watch can report it to either a physician or me. I also have an Oura ring and an Apple Watch, in addition to my iPhone. Everything I wear or carry is tracking me all day long. Steps, calories, blood pressure, blood sugar -- it’s all available on a wearable. There was never a time in history when a doctor could know more about a patient.

However, most of this data goes unmonitored, unread, unstudied. That will all change during the next High, when I can feed my data into a dedicated AI for healthcare and ask for a diagnosis or a trend. Am I heading in the right direction with my diet, my sleep, my exercise? Are my values out of range? There’s an AI for health care that physicians use today called Open Evidence, which is trained on medical articles and research papers, but only doctors can use it.

What will be the need for physicians in the future?

I have labile high blood pressure. I’ve had it for 30 years. The readings can be anything from totally normal to hypertensive crisis. But I’ve been on medication, and so far I have had no consequences from it. The worst consequence has been the fear that it is out of control.

I’ve tried meditating, exercise, no salt diets, and many other supposed remedies. Unfortunately, what works for me best is big doses of big pharma blood pressure medications. I take three blood pressure pills. I have also tried to give my doctors information about my home readings, but there was no systematic way to do that until last year, when my cardiologist’s practice finally got into remote patient monitoring, which I’ve known about since 2007, when the Health 2.0 initiative got going in Silicon Valley.

Future physicians will be in charge of interpreting the data we are collecting and sharing their trained interpretations with us.They might need different personality characteristics and different skill sets to meet our needs, however. These skill sets used to be called a “bedside manner.”