{"id":390,"date":"2026-09-12T00:30:44","date_gmt":"2026-09-12T07:30:44","guid":{"rendered":"https:\/\/asoneone.com\/?p=390"},"modified":"2026-09-12T00:32:31","modified_gmt":"2026-09-12T07:32:31","slug":"from-trial-and-error-to-a-learning-healthcare-system","status":"publish","type":"post","link":"https:\/\/asoneone.com\/index.php\/2026\/09\/12\/from-trial-and-error-to-a-learning-healthcare-system\/","title":{"rendered":"From Trial and Error to a Learning Healthcare System"},"content":{"rendered":"\n<h3 class=\"wp-block-heading\"><strong>Personalized and Precise Medicine<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The more I thought about the problem of psychiatric medications, the more I realized that the solution might require something much larger than a better antidepressant.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It might require a different kind of healthcare system.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Today, a patient&#8217;s medical information is often scattered across different hospitals, clinics, pharmacies, laboratories, insurance companies, and electronic health-record systems. One healthcare organization may know what medications a patient has taken, another may have laboratory results, another may have genetic information, and yet another may have records of previous hospitalizations.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The patient is the common denominator, but the information is often fragmented.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What if we could connect these pieces while allowing the patient to remain in control of the data?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This is where the idea of a <strong>decentralized health-data network<\/strong> becomes interesting.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">I do not envision a giant database containing the genomic information of every person on Earth. Such a system would create an enormous concentration of sensitive information and would present obvious security and privacy risks.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Instead, I imagine something more like a decentralized network.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Each person could have a secure digital health-data identity or personal health-data vault. Their information could include medical records, laboratory results, medication histories, adverse drug reactions, treatment outcomes, wearable-device data, and, if they voluntarily choose, genomic information.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The data would not necessarily need to be stored directly on a blockchain.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Blockchain-like technology could instead be used to establish <strong>trust, consent, identity, provenance, and an auditable record of who has been authorized to access particular information<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The actual medical and genomic data could remain encrypted and stored in secure systems controlled by patients, healthcare organizations, research institutions, or trusted data custodians.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In this model, the patient becomes more than a passive recipient of healthcare.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The patient becomes a participant and potentially an owner of the information generated by their own healthcare journey.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Imagine that I take an antidepressant.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Instead of that event disappearing into a medical record that may never be meaningfully connected to anyone else&#8217;s experience, I could voluntarily contribute information to the network:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Which medication I took<\/li>\n\n\n\n<li>The dose<\/li>\n\n\n\n<li>How long I took it<\/li>\n\n\n\n<li>Whether my symptoms improved<\/li>\n\n\n\n<li>What adverse effects I experienced<\/li>\n\n\n\n<li>Why I discontinued the medication<\/li>\n\n\n\n<li>Other medications I was taking<\/li>\n\n\n\n<li>Relevant laboratory measurements<\/li>\n\n\n\n<li>And, if I consented, genomic information<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Now imagine millions of people doing the same thing.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The system would gradually accumulate something extraordinarily valuable: <strong>real-world longitudinal evidence about how different people respond to different treatments.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This is where artificial intelligence could become transformative.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An AI system could analyze enormous numbers of treatment histories and identify patterns that would be almost impossible for an individual physician\u2014or even a large research team\u2014to recognize.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Instead of simply asking whether an antidepressant works on average, we could begin asking much more sophisticated questions:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Who is most likely to benefit?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Who is most likely to experience a particular adverse effect?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which genetic characteristics are associated with differences in drug metabolism?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Does a patient&#8217;s previous treatment history predict their response to the next medication?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>How do genetics interact with age, medical conditions, other medications, and environmental factors?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The result could be a continuously learning system of personalized medicine.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A physician might eventually be able to enter a patient&#8217;s clinical information into an AI decision-support system and receive something like:<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p class=\"wp-block-paragraph\">Based on this patient&#8217;s clinical characteristics, previous medication history, laboratory data, and\u2014where appropriate\u2014genomic information, these treatment options have the highest estimated probability of benefit and the lowest estimated probability of particular adverse effects.<\/p>\n<\/blockquote>\n\n\n\n<p class=\"wp-block-paragraph\">That would still be probabilistic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It would not be:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>&#8220;This patient has gene X, therefore prescribe drug Y.&#8221;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Human biology is far too complicated for that.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Instead, it would be a sophisticated calculation of probabilities based on evidence from thousands or millions of comparable patients.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In other words, medicine could gradually move from <strong>population averages toward individualized probabilities<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">The Role of Universal Healthcare<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">But there is another piece of this puzzle.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Personalized medicine is difficult to achieve if access to healthcare itself is highly fragmented.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A patient who changes insurance plans may change doctors. A patient who moves to another state may enter a different healthcare network. A patient who cannot afford a medication may never generate the treatment-response data that the healthcare system needs to learn from.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This is where universal healthcare could potentially become an important part of a learning healthcare system.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A universal healthcare system could provide a common foundation through which people receive continuous healthcare regardless of employment status, income, or changes in insurance coverage.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That continuity matters.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Imagine following a person&#8217;s health for thirty, forty, or fifty years rather than seeing disconnected episodes of care.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">We could potentially observe the entire trajectory:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>genetics \u2192 childhood health \u2192 medications \u2192 laboratory results \u2192 diseases \u2192 treatments \u2192 outcomes \u2192 aging.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That longitudinal information could be extraordinarily valuable.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It could allow healthcare to become less reactive.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Instead of waiting for someone to become seriously ill and then treating the disease, AI systems could potentially identify patterns associated with increasing risk and encourage earlier intervention.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The system could become increasingly predictive.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">And this is one of the reasons I believe universal healthcare and personalized medicine are not necessarily opposing concepts.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">At first glance, personalized medicine sounds like something available only to wealthy individuals who can afford expensive genetic testing and specialized physicians.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">But it could become the opposite.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If healthcare were universally accessible and a secure data infrastructure allowed people to voluntarily contribute their health information, personalized medicine could eventually become <strong>a population-level resource rather than a luxury product<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The more people who participate, the more representative the data could become.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That matters because medical research has historically struggled with underrepresentation. If the data come primarily from wealthy or narrowly defined populations, AI systems may perform well for some people and poorly for others.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A truly useful personalized-medicine system would therefore need diversity\u2014not simply enormous amounts of data, but data representing different ages, ancestries, socioeconomic circumstances, environments, and medical histories.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">The Patient as a Data Contributor<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">There is another philosophical change hidden inside this idea.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For centuries, medicine has generally viewed the patient as the recipient of medical knowledge.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The physician possesses the knowledge.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The pharmaceutical company develops the medication.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The researcher conducts the study.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The patient receives the treatment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">But the patient also generates knowledge.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Every time a person takes a medication, experiences an adverse effect, responds positively, fails to respond, or changes treatment, they generate information.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Historically, much of that information has remained locked inside individual medical records.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Artificial intelligence gives us an opportunity to change that.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If patients voluntarily contribute their information to a secure network, their experiences could become part of a collective intelligence.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One person&#8217;s experience may be anecdotal.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A million people&#8217;s experiences can become data.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">And billions of observations, analyzed carefully, could potentially become a new source of medical knowledge.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">The Blockchain Analogy<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This is where I see an analogy with blockchain.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The most important concept behind blockchain is not cryptocurrency.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is <strong>distributed trust<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Rather than requiring everyone to trust a single central institution, blockchain technology can create mechanisms for verifying transactions and maintaining a shared record without relying entirely on one central authority.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Healthcare could potentially borrow some of these concepts.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A decentralized health-data network could record permissions, consent, access, and data provenance in a way that is transparent and auditable.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For example, a patient could authorize a research institution to analyze a particular category of data for a specific purpose.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The system could record:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Who requested access?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>What information were they authorized to use?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>For what purpose?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>When was access granted?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>When did it expire?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Was the data subsequently used in an approved research project?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The patient would not necessarily need to understand the technical details.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The infrastructure would operate underneath the healthcare system.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The fundamental principle would be simple:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>My health data should work for me, while also helping society learn\u2014if I choose to participate.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">AI as the Intelligence Layer<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">If decentralized health data represents the infrastructure, artificial intelligence could become the intelligence layer.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Genomics provides one type of information.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Electronic health records provide another.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pharmacy records provide another.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Laboratory testing provides another.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Wearable devices can provide continuous physiological information.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patient-reported outcomes provide something that traditional medical records often miss: the patient&#8217;s own experience.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">AI could potentially integrate these different sources.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Instead of analyzing each piece of information independently, an AI system could search for relationships across them.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Perhaps a particular genetic profile is associated with a higher probability of adverse effects from one medication.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Perhaps a certain combination of previous medication failures predicts response to another treatment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Perhaps changes in sleep, activity, heart rate, or other measurable variables occur before a patient&#8217;s symptoms worsen.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Perhaps subtle patterns in thousands of patients reveal a previously unknown relationship between a medication and an adverse effect.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The system would continually learn from new evidence.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That is why I think of the future healthcare system as a <strong>learning healthcare system<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The healthcare system would not simply treat patients.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It would learn from every treatment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It would continuously update its understanding of what works, for whom, under what circumstances, and with what risks.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">From Personalized Medicine to Participatory Medicine<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Ultimately, my vision is not simply for personalized medicine.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is for <strong>participatory medicine<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients would participate in their own care.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">They could decide whether to contribute their genomic and clinical information.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">They could decide which researchers or organizations could access it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">They could potentially receive information about how their contributions are being used.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">And, most importantly, their experiences could help future patients.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Someone taking an antidepressant today could benefit from the experiences of people who took that same medication ten years earlier.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">And that person&#8217;s experience could help someone else ten years from now.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This creates a powerful feedback loop:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Patient \u2192 Data \u2192 AI \u2192 Knowledge \u2192 Better treatment \u2192 New patient data \u2192 Better AI.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The cycle continues.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Perhaps that is the real promise of the AI era in healthcare.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Artificial intelligence alone will not create personalized medicine.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Genomics alone will not create personalized medicine.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Blockchain alone will not create personalized medicine.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">And universal healthcare alone will not create personalized medicine.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">But together\u2014with appropriate privacy protections, scientific validation, ethical governance, patient consent, and equitable access\u2014they could form the foundation of a healthcare system that is capable of learning from the people it serves.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">My original question was simple:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Why does the same medication help one person but fail another?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Perhaps the answer will never be completely predictable.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">But perhaps we can become much better at predicting it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">And if we can, then the painful trial-and-error process that so many patients experience today may eventually become less painful, less wasteful, and more personalized.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That is the future I imagine.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A healthcare system in which every patient is not merely a recipient of treatment, but a participant in a continuously learning network of human health.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A system in which our collective experiences become part of the medicine of the future.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">And perhaps, in the age of artificial intelligence, that is how we finally begin to move from <strong>trial-and-error medicine toward truly personalized medicine<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Personalized and Precise Medicine The more I thought about the problem of psychiatric medications, the more I realized that the solution might require something much larger than a better antidepressant. It might require a different kind of healthcare system. Today, a patient&#8217;s medical information is often scattered across different hospitals, clinics, pharmacies, laboratories, insurance companies, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-390","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/asoneone.com\/index.php\/wp-json\/wp\/v2\/posts\/390","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/asoneone.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/asoneone.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/asoneone.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/asoneone.com\/index.php\/wp-json\/wp\/v2\/comments?post=390"}],"version-history":[{"count":2,"href":"https:\/\/asoneone.com\/index.php\/wp-json\/wp\/v2\/posts\/390\/revisions"}],"predecessor-version":[{"id":392,"href":"https:\/\/asoneone.com\/index.php\/wp-json\/wp\/v2\/posts\/390\/revisions\/392"}],"wp:attachment":[{"href":"https:\/\/asoneone.com\/index.php\/wp-json\/wp\/v2\/media?parent=390"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/asoneone.com\/index.php\/wp-json\/wp\/v2\/categories?post=390"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/asoneone.com\/index.php\/wp-json\/wp\/v2\/tags?post=390"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}