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Nathan: I'm very lucky to be chatting with a person whom I really respect and admire Dr. Alex. Cahana. I've had the honor of working with him since 2017. During the ICO craze we met at ARK invest, Friday round table discussion many years ago, ARK, standing for active research and knowledge, is an investment manager founded by Cathy Wood in New York City that invest in disruptive technology, including a genetic revolution, autonomous tech and robots, FinTech revolutions mobility as a service, space exploration, 3D printing, big shout out to ARK here. Alex and I got to work together on a lot of emerging projects and we got to design a federated learning system back in 2017, which he is now deploying a ConsenSys Health.

So trying to describe, Dr. Cahana's background is a bit like the fable of three blind men who each touch a different part of an elephant. So he is a crypto-health Sherpa, which is on his LinkedIn, which basically means that he is hired to take inexperienced people up the Everest of understanding the inner workings of blockchain as it relates to healthcare. I guess that means he brings along the oxygen tanks and cleans up after people realize that they're building open source software in a capitalist business model. He is the chief medical officer and EMEA lead for ConsenSys Health. EMEA stands for Europe, Middle East, and Africa, where he is working on federated learning.

He's a blockchain expert in healthcare for the UN to promote cooperation between private enterprises and governments. Here is a list of his experiences from LinkedIn. His bio and resume is super extensive and takes a couple of minutes for LinkedIn to even load it. So if I've left something out, check him out on LinkedIn.

Medical attache, and founding member at the Internet Foundation, member of Top Tier Impact, a group that solves big problems that requires expertise in impact and sustainability for the betterment of our planet. Strategic Advisor for Global Blockchain Ventures, advisor at Crypto Oracle, a theme developer for ARK Invest, subject matter expert for Defense and Veterans care for Integrative Pain Management; at University of Washington, he was the Endowed Professor and Chief of Pain Medicine for five years, which essentially meant he overhauled their entire pain management department. And he was the head of interventional pain program at the University of Geneva. He also served in the Israeli Defense Force for many years.

So this is all to say that Dr. Cahana has an extensive understanding of the treatment and management of pain, which is why he's the most sought after advisor for health care companies and governments that want to use blockchain technology.

He speaks at six languages fluently, I think which means he can quote lines from movies and books that I do not understand in the native tongue. Most recently he told me he was reading a French essay on crypto capitalist, Marxism existentialism, and then I blacked out.

Doc, I appreciate your time on this. On this podcast. And I think that it's best for us to start this conversation with the large scale topics that you work on and then focus into micro ideas.

Our podcast is mostly focused on blockchain data, but, and I'd like to get around to that as it relates to your current work. But I suspect that will get lost in the weeds unless  we give ourselves some, orientation. I want to start for your most recent medium article, which was called the road from COVID disparity to COVID dignity goes through blockchain. And you said "racism is nothing short of a public health crisis." Maybe you can work on an elaborating that for us.

Alex: Yes. Yes. Thank you. Thank you so much, Nathan . And thank you for the very kind introduction. It was the best. I've heard it since my bar mitzvah, and I would say that, I always say I lived four life was in one, which means not only that I'm old, but I know the dirty little secrets of every life. So I think that helps us have both a macro and micro view of things. And, really this whole idea of, dignity and disparity is a key theme in understanding technology.

I'd like the audience to appreciate and understand that what we're experiencing now is not because the system is broken. Actually, the system is doing exactly what it was designed for. And I'm not just talking about healthcare, I'm talking about the social determinants of health and the economic engine that is behind healthcare. And mother nature in its infinite wisdom has simply stopped us in our tracks and, gave us an opportunity to stop and really rethink.

And that not recover, which means to recover it, to cover again, but really rethink and redesign, the system, to be resilient and to be sustainable. And all the listeners who are involved in developing technologies, that everyday think about "the how"" I would love that this hour would be in the conversation about "the why."

Why are we where we are? We need to know history and anybody who understands open dynamic ecosystems and understands the importance of historicity and, also understand, what are next steps. Try to figure out how do we redesign a, resilient, non-rivalrous sustainable ecosystem inspired by, I would say, nature, which is probably the strongest and the most resilient ecosystem that we've lived through.

Nathan: Do you, do you want to elaborate on how you view racism as a public health crisis?

Alex: I think that, it dawned on me when I was looking at various maps. the CDC does a very good job and the WHO do very good jobs on mapping different diseases. It could be communicable diseases like outbreaks and, it could be noncommunicable diseases like mental health, drug addiction, anxiety, depression, HIV, unwanted teen pregnancy.

And when I started looking at these maps and I started also to look at the maps of poverty, immobility, joblessness, food desert, gun violence, domestic violence, police violence, all the things that we talk about, they completely overlapped. So it really pointed out that, although traditionally, especially among the privileged and those who suffer from "affluenza" in the United States, because everything is available and convenient and accessible, that social determinants of health, are the most important factors to determine, your wellness and wellbeing.

And that is a topic that I've been discussing a lot, not only when I was practicing pain management and basically saying to people, the best thing to do is to eat well, sleep well, exercise and meditate, but also you saw the side side effects of medicalizing human suffering of over-treatment with medications, with tests, with surgery. And racism or any ism for that matter, which results in inequity, which results in a lack of opportunity, really doesn't only disrupt our wealth, but also disrupts our health. And that's something that, even though it's totally understandable, it is very much underscored and not explicit enough.

And the way I explained it, and I even explained it when I testified in Congress, when they were asking me, Dr. Cahana, how can we fix the Healthcare system in the United States? And I said, how long do I have? And they said, 90 seconds. The answer that I chose was that I asked them, what is the opposite of health?

And that wasn't a trick question. And obviously everyone answered just, I'm sure that your listeners are answering. You're answering to yourself right now that the opposite of health is disease and illness. And I argued that is an incorrect answer. That because we think that the opposite of health is disease is why we have a disease management system and that not a health care system.

And I wanted to argue for a second that the opposite of health is not disease, but rather isolation. That through disease and illness, we become isolated in our world contracts and become smaller and smaller to the point that one day we wake up and we feel so alone, which by the way, it can be true or not, but we feel alone. And then we take a Xanax, we take an Oxycontin, maybe a single malt or a beer or Chardonnay, and we die. And that happens 150 times a day. And it has been having like that for the last 15 years. So if we agree that the opposite of health is isolation, then the journey back to wellness is to connectedness.

And that connectedness is to be connected to yourself, to your data, to your family, to your friends, to your social network, to your community, to your planet. So if anything, what COVID emphasized is really our thirst or hunger for that connectedness. And so when policy makers make policies or when technologist produce technology, we have to ask ourselves, how does that contribute to our connectedness?

Because if you take the "I" out of illness and replace it with, "we", you get wellness. So it's what we do fortifies the "we" increases the "we", makes the "we" trustful and fair, then we have a solution that is not only healthy, but also sustainable.

Nathan: How much of our current policies are focused on isolation rather than connectedness?

Alex: I think, and it may not come to a surprise to anyone that the healthcare system is not doing any of what I described. It is a friction-full, data-full, heavily regulated environment that is designed to self serve itself to serve its stakeholders.

Which means that those that need it the most don't benefit from it. I think that the younger generation sees the futility in accessing healthcare and that not just in terms of its cost, but also in terms of its value of what it brings. So yeah, the policies do not support it. The policies, do not support, I would say the idea that data belongs to you, you should be self-sovereign. In the US for example, 49 out of the 50 States the heath data doesn't even belong to you. It belongs to the Institute that generated that data. We live in an economy where we are the product. And data is monetized by third parties without your permission, without your explicit permission, maybe with some type of contract that you don't understand, what's written on page 49, but clearly it's not designed to benefit you. And this is important. This is important because you are your actions and your actions are captured by your data. And so you are your data. And so if a third party takes that data and uses it or loses it or abuses it as part of capitalism or surveillance capitalism, or just pure predatory practices, they take a piece of your dignity, they take a piece of you.

And if anything, from the long story that you told about my life, dignity is a center piece of it. I unfortunately experienced the battlefield for many years, multiple times, and saw that pain strips us from our dignity. That's why I decided to dedicate my life for over 26 years into practicing pain management. And then after that, deciding that maybe instead of helping one at a time, I can help millions at a time by creating technologies that empower, not only the health, but also the wealth of the people that are using these technologies.

And that's why I'm so excited about decentralized distributed web 3.0 tools because they encapsulate in themselves, not policies who protect centralization, who are security-vulnerable,  collusion-vulnerable, censorship-vulnerable, but really the web 3.0 tools that really enhance our ability to be the masters of our life.

Nathan: And where do you see a company like Facebook when it violates those, privacy agreements, those data agreements, the agreements that say that we own our data, when they get fined $5 billion and they, their stock goes up, what do you make this mean?

Alex: I think that not only Facebook, but any organization when it centralizes and becomes a large and powerful entity, at that point lose their sense of purpose.

And this something that is very subtle, it's something very insidious. And this is where representative democracy has failed us. The idea of representative democracy, in the last 150 or 200 years after the industrial revolution, was to say that, "life is so complex we need trust agents that can help us navigate through this life."

Because once upon a time, we were all holocratic. Once upon a time, we all had self agency and self actualization. We did everything, but then life became a little bit more complicated. And you started to need people that you trusted the teachers, you needed doctors, you needed, wise people in the community to ask questions, scientists, if you wish. And that was good because that created an economy that created people that could dive deep and become those trusted agents. And so then we suddenly start to have merchants and we still like to have traders, and we started that, investors, and bankers and brokers, and we started to develop all this.

And so in healthcare, the way it looks like is that once upon a time there was a doctor on a patient that was it. You know what come to me and talk to me about the most secret things that you feel, and I, with my infinite wisdom would sit and help you, and it was a peer to peer transaction of knowledge. And suddenly, the world became complicated and I needed more and more advice, and I needed specialists and I needed algorithms and I needed scientists and I needed research, and we've created suddenly all these brokers in between. And then you have to pay for it, but it couldn't be a direct payment. So there had to be some brokers and third parties, and then there were medications and then there was pharma, and pharmacy benefit managers, and general purpose organization, and suddenly you have on every one, doctor seven administrators that are diluting, infringing, and impinging on the pure one-on-one conversation.

And so what happened was that all these trusted agents stopped taking care of me, the patient, the person, the user, and started taking care of himself in a very insidious way. So let's say all doctors are evil or all insurers are evil. All brokers are not at all, but as life goes on and when you become bigger and you have more and more responsibilities, your vantage point is forced to change.

And suddenly we dehumanize the conversation suddenly it's no more a person, it's a case. It's a number, it's a statistic. And yeah, I can definitely imagine facebook from the time that the guys were sitting in their dorm, the one in Harvard, figuring out all the things and how would develop to become one of the biggest economies in the world, they lost their way because representative democracy has failed us. Our trusted agents have become untrustworthy. And the whole idea of decentralizing or distributing or giving trust to the code and creating a trustless environment that doesn't require an intermediary is exactly to solve that problem.

So when people ask me, what is blockchain? I don't go around using the words that people never heard of saying, it's a distributed ledger or append only non-tech people don't understand these words. I say it is the software solution for the social problem of trust. We now trust absolutely nothing.

I want to trust Facebook, but I can't. I want to trust that what I'm eating at the restaurant is really a salmon, but I don't know, maybe it's some pink fish that came from I don't know where, and we have no sense of what is the supply chain, no sense of what the value chain is, centralized government doling our money in a way that no one knows who gets what, why, when, and it's just this huge, a mess. A cognitive mess that even the most optimistic amongst us have very hard difficulty to make what is sense, what is real and what is fake. And that's that is "the why" behind all "the how", and going back to the question of Facebook, I don't attribute a priori any malice to anyone. But it is true that thanks to technology today, we are in a unique time in human history where things that we do wrongfully are not attributed to ignorance, but to ineptitude. If we, bled to death, George Washington, because he had a bad yogurt, that there was no malice. We really thought that leaching and bleeding patients was the way the treatment.

But today the practices that we do by omission and by commission are really a sense of ineptitude because we know what you're supposed to do, it's not complicated. We know what's right to do. It's not complicated, but we still opt for whatever reason not to do it.

Nathan: The way that specifically the US has treated COVID  how do you see our ability to treat this disease as a larger framework to treat some of these other issues we're talking about?

Alex: Yeah, that's an excellent question. I get a lot of calls from my European friends and my Israeli friends will say to me, what the hell is going on there in the US? Because it's not that we are treating it poorly, it's almost a sense that we gave up, we're just not treating it. And it's multifactorial. Of course it's not true that people on the front line, as we speak are doing everything and anything they can to save lives. I don't want to come across, dismissive of the amazing work that has been done. But I think that they are, three elements, that are here, that contribute to why the US is behaving the way it's behaving. And these are a little bit more nuanced than saying, "Oh, we're polarized or politicized." I want to take a step back and say, how is it, how could have we predicted that this would happen?

So the first thing is really this ethos of individualism that is very strong in the United States,

Nathan: which gets into your isolation point.

Alex: Yep. And isolation, exceptionalism, and nothing good has happened in human's history by thinking that you're special because when you say you're special by proxy, you're saying I'm not, and that's where racism comes in. And again, it doesn't have to be explicit it's just by the definition.

And so when people are ask me, what is the translation of the word unique? Everybody says special or exceptional. I say, no, you mean comes from the Latin word unum, which means one, not the one. One. So I'm unique and you're unique and everyone who's listening is unique. And that's what is actually common, what is common between us as living creatures are that we are unique and, not special. So this is this quest of individualism or this fantasy of self agency. This idea that, I can do everything alone and discount all the contribution of the people that were before you and around you, the silent partners that have raised you on the wave of success, is causing us not only to fail, but also to disrespect and to negate all those were not similar to us. So that's the ugly face of individualism that is simply failing us.

The second is skepticism. There's an excellent book. I think it was two 2017, Kurt Anderson came out with called "Fantasy Land", great book,

Nathan: This was the orthodoxy of charlatanism in America.

Alex: I just loved it. I wasn't familiar with it. I didn't go to school here in the US so all, a lot of things that maybe everybody understands anywhere between, snake oil and Barnum and Bailey circus with all their freak shows and, Disney telling, in a fun way, a history that never existed, for me, it was fascinating. And on one hand and there are two sides  to the skepticism. One side it's really the scientific thinking; a good scientist is a skeptic and has no problem if science says, that one day you shouldn't wear a mask, but the next day you should wear a mask.

Or one day we thought it was aerosol and the other day, we thought that it was airborne, because data accumulates, that's why we do A/B testing and iteration and we test and we correct, and we move forward. But the ugly side of that skepticism is the opposite of scientific thinking and that is gullibility is to believe in non-scientific or nonsensical things.

It's not to have the tools of critical thinking to actually analyze the situation. And this is compounded by a time where we are suffering from cognitive overload at a time where we're suffering from the difficulties in distinguishing between a truth and a fake. And it will be only worse with deep fakes. And so we are, as human beings are not litigating life as scientists saying, "I will observe, and according to my observations, I will decide." But rather more like lawyers, "I have a story to tell a case to prove, and I will cherrypick. I will cherrypick all kinds of ideas that suit me. I will conveniently ignore things that don't fit in this narrative, and I will create, for me, a very cozy airtight echo chamber, an alternative world that will comfort me." And I understand that as a doctor and they said people require solace. and when I would treat patients with pain, and I remember once I was in one of my interviews that was asked, "how did you know if your treatment would work?" I always said it was very easy if the patient said, "aha, I get it." So when there's this cognitive congruency of "yes, now I understand it," then we find that peace and that ability to heal.

The US is failing because it doesn't understand that the easy questions that they think they're asking are actually really hard.

That when someone says to me, how many ventilators do I need? Or, how much, hand sanitizer is left, these sound like easy questions. When is COVID going to be over, how many are going to die? Okay. These are very hard questions and they're hard because they're big, they require a lot of data. They are expensive because you need to standardize the answers and you need to harmonize the answers and you need to label the answers, which I'm sure that your listeners will appreciate, which is very expensive because you want to make sure that everybody's speaking the same language and the comparisons are correctly weighted. And the third one is that they're very sensitive. There's a lot of data out there that is very sensitive. So we spoke a little bit about self sovereignty, but the other thing that we want to talk about is privacy. And so again, what is exciting for me in this time is that there are now actually technologies that can, I would say, incentivize motivate, create conditions of good behavior through consensus that could create large coordinated, analytics through federated analytics and federated learning and can maintain or preserve privacy, be it any type of verifiable compute can be zero knowledge proofs, homomorphic, encryption, trusted execution environments, it doesn't matter if it's a hardware, software solution. But the point being that, we are living in a time that I'm sure many of your folks are actively working on as pieces of the puzzle to create a, I don't know, post-trust era. Where we're when I say that I trust you, I don't have to say, "Oh, I trust you because you're a nice guy," I can say, I trust you because there's the computational trust in it. There's the proof in it that I know that it's true.

The third is, I would say, the way we interact with each other, through an economic markets. And I don't want to say capitalism because they don't want to come across as an anticapitalist because I'm not. But the practice that we have right now in the current economy is a non-sustainable practice. It's not really Adamsonian capitalism, because Adams talked about when you gain, that gain goes back into the development of the company that goes back into the development of the entity that you invested in. And this is not what's happening now. Markets are now centralized. They are manipulated, there are behind the scene deals that are happening. It is exclusionary; it is not the way it was designed, no more than socialism was practiced the way it was designed.

Nathan: Would you say that t's functioning as it was designed, or we said the system is not broken, it's working as designed.

Alex: It is except that we're not practicing capitalism in its pure form or we're practicing something else. Just like we're not practicing democracy, representative democracy as designed. I don't know what exact names I can give them without sounding, inflammatory.

I don't know, if we should call it "Peacock-cracy or "Kakistocracy", where we're the worst, our ruling, I don't want to say that it's crony capitalism or, it is predatory or vulture capitalism, because people who are working in it rightfully so will get offended.

What I'm saying is that just like doctors, don't exactly practice medicine the way they want, because there's a whole bunch of externalities that are forcing them to, practice differently. I think that is true for every single profession. I think that journalists are not reporting the way they would want. And advertisers are not advertising the way they want. And even politicians, even honest, politicians are not politicking the way they want, but there are so many artificial forces, artificial economic forces, that we have embraced for no reason. Nobody said, for example, that we need a, "just-in" supply chain, nobody said, "Oh, just in time supply chain, Oh, I just need exactly the amount of ventilators because having a couple in reserve is too expensive."

We have imposed on ourselves these rules of transaction between each other, which we think that is the secondary to how the system is, but it's not true. it's man-made and it can be also man-fixed. So I think that the third part is, we have created a malaligned economic system that if I think specifically in healthcare, I would say that for me, for a hospital, the last thing you want is someone to be healthy because if they're healthy, then they're out of luck. So why would I want you to be healthy? I don't want you to be super sick cause that's expensive too, so I want you to keep you like on this chronic condition, have this kind of dysfunction that you come and see me a couple of times a year and I give you maybe a pill that's not too expensive and it's not really hard to manage , and that's wrong. We can create a system, that actually the incentives are to keep you healthy. That incentives are to encourage you to stay away. But then what we do, what doctors do, what teachers do, what law enforcement does, what diapers do will be different. And this is why we're stuck. This is where lack of imagination when we say, "Oh, we have to do things differently."

Nathan: And specifically in healthcare, how we want to keep people in a chronic condition, what are some of the solutions that you and ConsenSys Health are proposing it? Could you elaborate on your federated, data learning model?

Alex: Sure. Sure. So I would say the, web 3.0 tools for healthcare is extremely exciting.

And, I know I'm biased, but I dare say that out of all, the industry verticals, healthcare is actually the most amicable to benefit from these types of tools, because healthcare is a system that relies on large scale cooperation and coordination and suffers most from centralization and, ConsenSys Health, which is a spin off well ConsenSys.

We are our own company, we of course enjoy, the ecosystem, the technological environment that ConsenSys has to offer. But we believe that healthcare really requires an in depth expertise that is beyond the creation of solutions and platforms and platforms as service. And so the way I explain what ConsenSys Health is doing is almost like, there's a legacy system out there that we can't and we shouldn't ignore; electronic health records there are health information exchanges, there is a whole universe of data commerce that exists in healthcare. That's on the bottom, on the top, you have all these great innovations, these apps, these light bulbs I would call them. "Oh, I have, this way to monitor temperature from far away, or I have a swab that can measure your COVID and have a taste of coffee. I have this app that can tell me if you're sick or not, by telepathy." Doesn't matter. But the point being is that there are tons of apps and none of these apps can become killer apps because just like the light bulb became a killer app only when there was an electrical grid.

So the way I would like people to think about ConsenSys Health is like a utility company. It's like the ConEdison of web 3.0 solutions for healthcare. In other words, like ConEd doesn't own electricity, just to make sure that the electricity comes from clean sources and that it is distributed, honestly, equitably accessibly, reliably 24/7 to people who opt in to use it as a utility and not as a commodity, that is what we do. And we replace the word electricity or energy if you wish with data. And so for those who are not familiar with federated learning, The way I would explain it is that as opposed to other machine learning or other kinds of learning algorithms being in deep reinforcement or whatnot, usually the data needs to be copied, needs to be transported and it needs to be sent to a centralized repository for the algorithm, to receive the input, to apply it. And then to return, the output through a query.

Federated learning the way I explain it is that instead of the data coming to the algorithm here, it's the algorithm comes to the data. So I apologize to any of the federated learning aficionados that are out there that think that is a simplistic or dumb explanation- but it almost sounds to me, like instead of me going to the hospital and with all the expenses and the risks, getting sick or anything bad or malicious or corrupted that can help me help happen to me on the way, it's more like I am doing house visits. And every time I visit another patient, I become smarter and smarter.

So federated learning has an ability to analyze information insight behind the fire wall, combined with privacy, preserving technologies or verifiable compute, which is perfect for sensitive patient information, governed by smart contracts that are incentivized by tokenization, be it monetary or non-monetary, is really the fabric of how a utility works. And obviously the participation in this Federation is totally opt in, and we are working, in the US and also outside the US in markets, and it's very interesting to see the difference between these markets. And I think that is how healthcare would look like. Instead of these giant consortias that are selectively deciding what they're sharing with because they're worrying about their IP, here is a new, not only compute model, but also an economic model that can be architectured based on these web 3.0 tools.

Nathan: What application are you guys specifically working on with your federated learning right out of the gate?

Alex: So obviously on everyone's mind is Covid, so we are working on COVID-related information. I specifically am working in Africa on a Federation of hospitals there. There are already multiple consortias in the US that are working to solve the COVID problem. The only, I would say problem with these consortias, or data aggregates is that there's really no economic model.

Behind the  collaboration or collaborative, besides the, I would say goodness of the heart of all the people involved, understanding that, if we won't work together, then we won't be able to generate those hard answers for the hard questions. But the data structure itself has not changed. When a vaccine will be found, its distribution will not be fair or equitable. The data will not be shared in a transparent way. We see by the way, how states are manipulating their information in order to look better. Again, all the listeners are in this world for a reason, they understand the vulnerability of centralizing data, both from a security perspective, both from a censorship perspective and also from a collusion perspective.

I think that the mainstream world, especially in healthcare, which was very, very conservative. I speak all the time to very smart people, by the way; policy makers, it CSOs, people who really know what they're doing. And they're simply unfamiliar with the technologies that I'm talking about, or if they are familiar with a technology, they do not see the connection of how that would relate to other technologies to create a holistic system, which is anti-fragile. So that's where we are right now.

I think that specifically for Africa, they are poised to leapfrog. I think that the web 3.0 tools are actually way more appropriate for environments that have little to no resources, little to no data, little to no interoperability. And what they do have is a lot of hardship, daily hardship. And so they understand something that we don't understand in the United States. Maybe that I should have said that earlier, when you asked me about what is it, why is it that we're failing so bitterly, is that we think of this COVID story, or we think of this world as a Hollywood story, good guys or bad guys, when actually this is not a Hollywood story; this is a Greek tragedy. Either we all win or we all lose. And what COVID has taught us is not only that, what we do impacts the wellbeing of people who live far away, which you really don't care that much. We don't care that our plastic bags are polluting South Pacific islands that we don't even know exist. We still think that Sweden and Switzerland is the same or Austria and Australia are the same places in the world. But what now Covid has shown us is that people from far away countries actually impact us. So we suddenly recognized the interdependence of this world, which forces us to question again, the idea of individualism exceptionalism and if anything, this is a very humbling experience. And in many cases, in a positive note, has opened people to the notion that something needs to give. And when people ask me, so Alex, what's the difference ever since Covid started and they expect me to say, "I'm virtual, I'm not eating out." I actually say, what really is different? Is that now suddenly, people are saying, "Alex, what was that thing you'd been working on these last five years? I want to learn more." So if anything, there is an appetite for people to acquaint themselves with what is distributed ledger technology? What is verifiable computing? What is federated learning or federated analytics and federated learning

Nathan: And, specifically in Africa, what's the name of the company or would you like to share what the name of the company that you're working with over there is, and what they're working on?

Alex: Sure. Sure. There are multiple companies that I'm working with. I'm always worried to give names because I don't want to hurt the feelings of others, so by no means does that attest to the robustness of all the companies that I'm working with, but I'll mention two, for the sake of fairness. One, for example, they're called Afya Rekod, which in Swahili means "health record." And Afya Recod started in Kenya, it's now in multiple countries in East Africa. And if anybody knows a little bit about Africa, there's a concept called the East African Federation, which, consists of six countries, Kenya, Uganda, Burundi, Rwanda, South Sudan, and Tanzania. And they are working towards a common currency. Right now, each country has their own currency, which is called the shilling, but have different trading rates. But if they all opt and it's something in the works, for a Federation of States, almost like a mini United States or a mini European Union. They have a very rudimentary healthcare system. Most of the people live with the lack of access to what we would think are university-based or urban-based facilities. And although many of them live in cities, the infrastructure is lacking and we are working with a self-sovereign, tokenized, electronic health record that also ports, a decentralized identity, which, allows people, to be incentivized when they do the right thing.

So when mothers boil their water, or bring their babies for vaccination, or men adhere to their HIV treatment, they get compensated for and rewarded as well as health records. And these are all microtransactions. So if you boil water before you drink it and you make 25 cents, for someone who makes a dollar 25 a day, that has a lot.

And so this is work in progress; it is exploding. We are now at the inflection point of where we're having millions of new citizens onboarding every week. And so that's one exciting project.

And the second exciting project is also similar in the sense that it is about decentralized identification, but for providers. It's a company called Alchemy it's in Johannesburg.

And again, it's a coalition of five States in the Southern part of the continent: South Africa, Lesotho, Zimbabwe, Botswana, Namibia. And we are working with them on a provider directory on a distributed ledger, because what they're struggling with is fraud and the need for certification to make sure that doctors are really doctors and their charges to health insurance plans are correct.

There are similar solutions that are developed in the US that are not widely used for obvious reasons. And so when I see something happening in Africa that just is adopted with such, not only ease but also enthusiasm, that is something that is very rewarding and is very discouraging to talk here to regulators, to investors, to technologists, to other companies about innovation, and changing the system when always what's on the mind is, what about the HIPAA compliance and how much money am I going to make? What about that company? And, but their competition. It's just a different mindset there; how can we help Africans?

And, they're going to leapfrog us unless we change our mindset. And unless we start asking the same questions of how are we going to help the other, not just ourselves, they will definitely leap forward.

And I am very cautious and very vigilant to make sure that not only will they not suffer from technological colonialism, where large companies are going to come in and appropriate what they're doing, and simply either take it or steal it or bastardize it, but also to make sure that they will be able to be technology exporters to other parts of the world. And right now we're seeing how their things can be used in South America.

Nathan: That's amazing. Can you go into how they're rolling out a decentralized identity, like on what platform on what phone?

Alex: Without going too much in the weeds, and people can reach out to you and you can reach out to me or they can reach out to me directly, There are three versions of the health record. There is one on a smartphone, there is one on a stupid phone, which is a USSD channel that works through text messaging, and there is one that is basically on a plastic card with NFC and transfer of information through information packets that don't even require internet. So the technology solutions are there that's not the challenge. I think that where we need to be strategic is really the rollout.

How do you make sure that many people that speak different languages that live in different environments that represent different markets can actually flourish and can benefit from this type of service. That's really what we find on an everyday basis that when we hit a technology hurdle, it's not complicated. We asked folks, what do you think we do this? There's reiteration a course correction, and that's it. But it's really about how do you make people feel that what we are giving them is actually helpful and that they get excited and they become your ambassador. And obviously this is the beginning, this is not something that we're saying, okay, we're at the end of this marathon, this is just, we are at the first chapter of the book. But you can imagine how by creating all these non monetary incentives, you create ambassadors and voices within healthcare. Into what we call an urban network or a societal network, where there are leaders that take upon themselves the voice to make sure that not only I go and take my vaccination, but also that my community takes this vaccination. So whereas the US we are in this conversation of are vaccinations real, or is climate change real, they're like, yeah, we need to vaccinate because if not, then we all get sick. And the repercussions of climate change are real.

So we need to do environmental friendly activities and put in place conservation policies. So for me it's just striking. And maybe it's just a personal decision to stop arguing with people about the veracity of things. And actually go out to places where people want to do this. And what they appreciate most is that we don't come to help. Okay. Then we don't come in a disguise to insert our values, but that we are, and I can say, I personally am honored. That they see me as a partner, as a part of their community and allow me to be amongst them.

And before the travel restrictions were on, I traveled, I was there a whole month in Uganda, Tanzania, and Kenya, and it was just amazing. It was just amazing: the friendship, the emotional attachments, and the ability to see a difference on a daily basis from real technology.

Nathan: That's amazing. Thank you for sharing that.

Is there something that you, you'd like to discuss about about your, about how your experience, in the hospital systems, or let's say University of Washington is guiding your choices now in places like Africa or with the VA?

Alex: Yeah, I think it's an excellent question. And I have to say that. I've never experienced something that I was sad that I experienced. I might've said at the end "whew I'm never going to do this again," but I've always learned something. And working at the University of Washington, perhaps for your listeners that are not familiar with the University of Washington, Seattle, Washington is a, regional hospital, four, five States called WWAMI; Washington, Wyoming, Alaska, Montana, and Idaho. So when people would ask me, when my European friends would ask me, what are you doing? I would say, I'm the pain doctor for 25% of the United States territory. And it is true that I would have find myself many times travel to Alaska all the way up to Nome Alaska, as well as to the other rural parts of the other states. And it is clear that when you work in academia in a collaboration with the private practices in the city, you learn the actual business of healthcare.

And that helped me a lot to understand the stakeholders and to understand their vantage point and where they're coming through in maintaining, I would say, the system. And, that's also where I got it acquainted with the veterans administration in 2009, the National Defense Authorization Act. Basically Congress came up with a law saying to the Department of Defense and the VA, "there's too much pain among service members and their families get a grip on it, fix it." Okay. And so they created a pain task force then reached out to large practices, civilian practices, and they came to the university of Washington.

And we were the first pain clinic in the world back from the fifties. So there was a lot of experience. And during my tenure, we put a lot of new technologies in there. We started telehealth, we are one of the first that started tele-health back in 2007. We used desktop interfaces for patient reported outcomes. Bottom line, they came to visit us. They said, Alex, Dr. Cahana will you be a subject matter expert for us? For the DOD and the VA. What I learned from that not only brought back memories of my soldier days, but it also brought back what it is to work with vulnerable populations.

And so I personally have been fortunate to experience multiple environments that allow me to understand things from different points of view. So I'm not saying that I don't have blind spots, but what I am saying is that I have been a coalition builder and have been capable of understanding the corporate mentality, the academic mentality, the regulatory mentality, the patients point of view when they are financially secure and patients view where they are financially insecure. And that all that allowed me to shape in my mind what are the essential ingredients necessary for a system not only to be viable, but to be sustainable?

You mentioned Ark investment and Chris Berniske at the time was there an analyst and because of him, I got bit by the blockchain chain bug. I met you there, Nathan. And since then, we've been working on tons of stuff. It was there I learned, technology does nothing. It's what people do with technology.

And I think that when you understand people, you can design and you can create the right tools to enable people or help them facilitate the good things that they want to do. And so for me, I wouldn't have been able to be the University of Washington without the military. I wouldn't have been able to understand technology without the University of Washington and you mentioned, Crypto Sherpa. I just, people were calling me on the crypto health influencer and I jokingly said, I feel more like a Sherpa schlepping everybody's stuff, nobody knows my name. And I think it's really about schlepping a lot of stuff. And if we don't have that mentality of service of humility, and selflessness combined with curiosity and rigor, we have to have those characteristics in order to succeed.

Nathan: thank you for sharing that. We're coming up on almost an hour and a half here. Is there something that you'd like to cover about what your currently working on that you'd like other people to know? Or do you feel like it's a pretty good point to stop, what would you, what else would you like to discuss?

Alex: I think maybe we covered a lot. I think the Africa and the VA project that I'm working with in ConsenSys Health is currently preoccupying my conscious space while still leaving time to read books like you said, in many languages, like a crypto communism, which wouldn't be a book that is written or translated to English.

But what I hope your listeners, leave with, first of all they can all reach out to me, Alex dot Cahana[at] So that's a first with the first, but the second is that they hope that they leave encouraged, inspired. That they realize that, there's an opportunity here not only to do right things, but to do the things right. And this is where we are right now.

We have to step back from the COVID, understand the pain points of our system, and think not only about the gaps or what can be fixed, but understand what are the forces that are maintaining the current weaknesses? Why is it that we're behaving the way we are behaving? And it's only after we understand where the positive and negative feedback loops that are maintaining these type of negative behaviors, then we can start to engage in real solutions. And as long as we don't solve racism, as long as we don't solve the problem of understanding that exceptionalism is not a blessing, but a curse, as long as we don't understand that uniqueness is something common and not something special, as long as we don't understand that none of us is as good as all of us, then we will continue this way.

And that's the message I want to leave that I'm sure that there are way smarter people on this call than I am, but none of us on this call are better than all of us. And that's the connectedness I was coming from.

Nathan: Thank you so much for your insights and your time. I'd love to get back together with you and dive more into this, especially as things develop in Africa and also domestically here. I want to thank you so much for your time. we'll post your email in the show notes. We'll post a, transcription for reading, but I appreciate all your time, Doc. Thank you so very much.

Alex: Thank you, thank you. It was a pleasure, Nathan.