The Present and The Future

Howard Lindzon has been asking people to think about The Next Ten Years. He says:

Few of us are thinking of the next TEN years. It’s hard not to get excited and short term distracted with Twitter, Groupon and Facebook adding billions in value as private companies in just a few years.

Thinking about the future is what VCs and entrepreneurs must be doing. Focusing on what is working now is not the way to join that billion dollar club in the future.

Last week I wrote a post about mobile OS market share and where developers should be focusing. It generated a great discussion in the comments and led to a number of posts in the blogs and traditional media. Many of those who disagreed with my conclusions focused on what is working in iOS today. And my counter to them is what is going on today will not be going on a year from now and certainly not five years from now.

If there is any certainty in the tech business, it is things are going to change. What we should all be doing is thinking about how those changes will develop, what forces are at work, and what new directions things will head in.

This blog is a big part of how I do that kind of thinking. And I am not the only VC who is thinking out loud. Mark Suster wrote a great post this past week where he lays out his vision of how the cloud stack is getting built out. Maybe Mark is right and maybe he is wrong. Maybe I am right about Android and iOS and maybe I am wrong.

The most important thing is that we are all thinking about where things are going and making bets about the future. Because betting that things will stay the same is a bad bet. I am sure of that.

#VC & Technology

Comments (Archived):

  1. William Mougayar

    Alvin Toffler once said “We’re all futurists”. And he meant each of the 6.7 billion people living on earth.The thing that is worrisome and where you will find disagreement around is the speed of getting there. Those people that are hyping things want this future to be around the corner, and they might crash while getting there. The wiser people will do so at the right speed, so that, as they build bridges into the future, they are also securing the bases. That’s the most sustainable future we can hope for.We also need to think about the future in a non-tech context. At AVC, we’re all so obsessed with technology and make it a central part of everything, but it’s also healthy to put technology aside once in a while, and think about the non-tech related future.

    1. JimHirshfield

      So true William. Human and business needs, that’s the ticket. What are the future needs?

    2. David Noël

      Great comment, William. I think that what’s happening in tech today (exchange of information and communication, commerce) can fuel the traditionally non-tech changes and progress of tomorrow: the way we fundamentally interact socially, behavior towards the environment, energy, education, politics, just to name a few.There are many bigger issues to tackle in the future, especially as the world grows even more flat – the good thing for us (read: the AVC community), is that technology will play an important role.

      1. Dave Pinsen

        Agreed that it’s a great comment, but I think techies have a tendency toward utopian sorts of predictions sometime. Looking at current trends and extrapolating from them over the next decade, it’s hard not to see us as a Brazil without Brazil’s trade surplus, primary budget surplus, strong currency, or sunny “tudo bem” mentality. I see greater inequality, less upward mobility, and a more hollowed-out middle class. What business opportunities does that suggest? Thinking about what Brazil has that we don’t: – More violent crime. – A greater emphasis on personal security among the wealthy. – More informal, third world-style entrepreneurship among the poor (e.g., young men trying to sell you water bottles when you’re stuck in traffic in your car). – More informal, third world-style housing arrangements (particularly if fiscal challenges lead to slashed subsidies for housing here)..So it might pay to think about what technologies would work in that sort of future and which wouldn’t. One example that immediately leaps to mind is all the new location services we have today, where multimillionaire venture capitalists tell the world where they are eating lunch, or post a map of where they are biking by themselves. Seems like that would be risky to do in São Paulo today, and maybe in major American cities in ten years as well.

        1. William Mougayar

          One piece of advice for the US, pertaining to the next 10 years & mortgaging its future: Get rid of the deficit, and stop delaying dealing with it or ignoring it.

          1. Dave Pinsen

            A statesmanlike, responsible approach President Obama could have taken would have been to propose that the Bowles-Simpson Commission recommendations be made law on Jan 21st, 2013, if no alternative plan meeting the same deficit reduction goals were passed before then. That would have set the stage for a national debate between now and the elections in 2012 over the best way to rein in the deficit, with presidential candidates running on their own plans. By November, 2012, it would be decided, negotiators could put the final details on it afterwords, and the new president could sign it into law right after his inauguration on Jan 20th, 2013.Had Obama done that, and gotten leading Republicans to agree (easier, probably, than getting some members of his own party to agree to rein in the deficit), that agreement would probably have provided a boost to the economy today, by assuaging concerns about yawning future deficits and the steeply higher future taxes and interest rates they imply.

          2. fredwilson

            great point Davei sense that we don’t agree on that much politicallybut i believe that deficits are at the heart of our country’s ills and i want them eliminated

          3. Dave Pinsen

            Thanks. I get the sense if that if you follow where your view on deficits leads, you may find we agree on more than you think.

        2. Matt A. Myers

          But we do know a lot of the leading metrics for what causes crime to be higher.Good points though, especially on privacy and feeling safe. Really though there’s no reason this information isn’t already starting to be used against people – financially or for violence. There’s just not way to track or link to it – in most cases. How many people are more easily stalked? How do you lower this? You take care of people and give them enough enjoyment and love in their life where they don’t want to throw it away, where it’s not worth throwing it away. And there are leading metrics for dictating this as well.

          1. ShanaC

            You know, I’m going through a slight stalking problem right now (why me….)As a back note, this would be the second time I’ve developed a stalking problem, about 8 years ago, over AIM.It’s a lot easier in some ways to deal with a stalking problem. I offset parts of my phone to places like google and youmail. I can block people on Facebook. Twitter seems a bit more difficult.People also seem to be more likely to ID themselves. Most people if I had to couldn’t find me.OTOH, I do know of someone who had an abusive ex, changed her phone number, deleted her facebook, moved. The answer seems largely to be accessible, but not too accessible. Don’t put your address online in an easy place to view for example. Be able to offset services that make you more traceable.

          2. Tereza

            Stalking is a quite prevalent problem. They report 8% of women in the US are stalked but it’s probably much higher because we don’t report it. They report 2% of men are stalked.The problem with stalking is there’s so little you can do about it.This is an unspoken fear among many women and I’m quite certain it accounts for a portion of why we venture a little later into soc nets (though then when the waters are deemed relatively safe, we dive in). The notion of physical safety is always on our minds. We’re biologically wired for this.

        3. ShanaC

          Trust me, I’m far from utopian -though I do think that people will avoid whenever possible violent means if they can get what they want in some other ways. What is really interesting about the internet is that it actually helps that process.I do think we’re going to see certain forms of social polarization. Very traditional lifestyles can’t handle the new media age. I already have seen these sorts of issues based on the way I grew up…

        4. Mark Essel

          So are you considering moving? Is this the type of future you want to raise a family in, I don’t. What can be done to change that future? That’s more important to me than how to profit from/in it.Even from a wealthy perspective that type of society with a handful of very rich versus a majority of struggling is pretty dark.

      2. Tereza

        I think that’s all true, David. I do think, though — and no offense, folks — but that techies are often a bit underdeveloped on the emotional side.At some point that bites us in the ass.I wrote in my comment above but think it’s worth saying it here….I expect much more emotional awareness being baked into web experiences.

    3. Matt A. Myers

      I look at where my world is going and where I am hoping it will go, and I base my decisions off of that. Everyone around me who I explain how I see things and want things support and believe what I believe. This may be a bubble because of the people I associate with are more conscious of what I’m speaking about (similarly can occur in the tech area – where because we’re exposed and absorbing and aggregating information we can better see where things can go).However things like the WikiLeaks releases – this scares me some but is exciting at the same time. Will there be a large social revolution? Will it be violent (is it already violent towards the people, people versus the state)? Will it be guided and created by businesses and supported by people because these businesses are founded by good people with good hearts and are transparent and open? Or will big business who’s drive is profits, and who have the profits to spend on grabbing reach and attention before others, will they continue to dominate the landscape and become ever-richer without being holistic and helping the whole of society and the world?I know what I want my future to look like. I know what it needs to look like and what needs to be in place to create a sustainable environment, a sustainable society. The reason I naturally flowed into business was I understood at a young age that you needed money (at least some) to make or reach people to guide change. And I understood business (or another name being organization) was the most efficient way to get things done because business has discovered and teaches said efficiencies.This is one reason Fred Wilson is a regular thought of mine. Boutique-style versus large democratic organizations which are slow. Low burn rate so you are careful to know and test and find leading metrics and don’t waste before you spend the King’s share to expand, and having founders who are capable of the meticulous work and focus and are passionate to create and learn — who understand already what they’re doing and working towards. It makes things easier, clears up inefficiencies, and makes for a team that’s all on the same page. A good base, a strong foundation.Anyway, back to topic, I conclude saying I am working towards creating this foundation to help and be apart of leading the world, or at least my little part of it, to be where I see it needing to go for all of the society to be better off – healthy, happy, productive.

      1. Matt A. Myers

        Thanks for the likes Mark and Shana. 🙂 I <3 you two too! 🙂

    4. Dave W Baldwin

      Be careful trying to ‘down’ those that can make a difference. For the structures holding those bridges up are being built and the bridges are beginning to connect.What is funny is the age group everyone saw go ‘text’ seeming to be in their private worlds… yet the improvements being made/enhanced ‘sooner than later’ will lead to people having more time to be ‘face to face’.

    5. fredwilson

      the gotham gal says that “tech is a given” and that all businesses are tech businesses

  2. Jesper Bergmann

    Excellent point. And because it has been shown so many times that managers of large incumbents are not very good at this, I’m sure a lot of entrepreneurs and new-comers will continue to upend larger and older firms.Gary Hamel and C.K Prahald has written a great book called “competeing for the future” where they show multiple examples of this and give examples of questions about the future that top management should think about. It should be required reading for big co executives.

  3. RichardF

    As the saying goes “you have to skate to where the puck is going” (Mark Suster had a post called that a while back I think)I think you do have to look ahead as an entrepreneur but getting the timing right is also important. There’s no point in developing something that the market is not ready for or capable of supporting.There’s nothing really new about Groupon, I can remember 10 years ago, consumer group buying sites that never took off because in my opinion consumer internet broadband penetration was not high enough. Those companies just folded, there was no way their VC backers were going to keep on investing because the market might be ready for them in ten years time.Having said that Shazam is a great example of a company that did what it needed to do (those guys have been around for years) to keep going until the arrival of the iPhone, at which point their growth has exploded (They’ve reached 100m users)It’s a difficult balancing act.


      Yes! I agree 100%, Timing is incredibly important. It is often the deciding factor between success and failure. Its a whole lot easier to say what things will happen, and far far harder to say when.


    A bit about my futuring technique: Like Einstein and many other great men. When thinking of the future, it is best to think in terms of extremes. It is at these limits where innovation is necessary and will happen. For example, the movement from 2D lithography to 3D lithography when 2D lithography hits its eventual limits. Another interesting point is that when one dimension is saturated, or nearly saturated, another dimension tends to show its face. This is quite simple when you look at 2D to 3D lithography, but gets more abstract when you look at other mediums which have vague dimensions. To extract the dimensions in a abstract domain, you again need to look at the extremes contained in it that are uniquely separable. Once you extract the separable dimensions, then you can measure them and make some determinations about where the future is headed in a particular domain. Its not easy, and subject to human error, but its better than not knowing anything about the future.

    1. William Mougayar

      But it is wrong to assume that the future will happen linearly. You have to assume that there will be certain events/developments that will break any patterns. You have to think in scenarios.


        Of course, another world war, meteor hitting the planet, plague, or other things would cause many significant disturbances in practically everything. But you can’t really control that or know when it would happen. These “wild cards” happen all the time (but in less severe cases). You have to plan for them, but they all won’t happen at the same time (hopefully!). The futuring technique is still valid however, and to date, its been the most accurate for me personally.

        1. William Mougayar

          Scenario planning allows you to think about various possibilities, and what to do about them.


            Absolutely, its an important and critical part of any strategy. No arguments there.

  5. Tutor Sentih

    True.What’s hard as operating managers is freeing yourself from day to day tasks so you can work on the future!

    1. Noname

      Innovator’s dilemma

  6. Rahul Chaudhary

    Fred, are you going to write a post about where the puck is going to be in next 5-10 years? It would be interesting to know your thoughts on what are the specific areas that you are focused on for the future.

  7. Cindy Gallop

    Very cheering post. My startup represents my personal bet on the future: on what I believe will be the future of business, the future of advertising, the future of human nature. Like, tweet, act (we’re the third bit). Our business model was designed as a bet on the future – that the future of business is about doing good and making money simultaneously; not in the old world order way (make money + do good by writing checks to causes to clear your conscience) but in the new world order of making money BECAUSE you do good. And we’re out to prove our own business model. A future-forward concept that encounters all the usual obstacles any future-forward concept does, and with everyone focused on Twitter/Foursquare/Groupon templates, working on something aimed out beyond that with a commitment to the longer term can get pretty discouraging and demoralizing. Very encouraged to read this and will share with my team. Many thanks.

  8. Dan Lewis

    What about the past, though?I’m openly enamored with email newletters as a content vehicle, e.g. Thrillist or Jason Calacanis’ JasonNation. The medium is anachronistic. Ten years ago, it gave way to blogs. But now? A lot of really great ideas for blogs would be better off as newsletters. (Or, at least that’s what I thought when I started mine in June.)What other “old” things are going to be relevant again?

    1. Aaron Klein

      Leisure suits and bellbottom pants?Oh wait, that already happened.

    2. fredwilson

      i don’t understand why anyone would produce or read an email newsletter

      1. Dan Lewis

        Relationship between reader and publisher is stronger, I think.Calacanis has said similarly and CPMs suggest that’s right. Plus it’spassive delivery for the reader, but that may play into the firstpoint.Part of the reason that I comment on your blog is bc (a) you replyoften and (b) those replies get delivered to me — via email — w/o mehaving to go back and check the original post. That’s powerful forpublishers.

  9. ryan singer

    I think it’s hard to predict. When blogging boomed there was speculation it would peak and then end. That prediction was way wrong, in fact there are more blogs now than ever. Things won’t stay the same just like our earth is ever changing.

    1. Dave Pinsen

      But how many of today’s blogs are written or read by anyone on a regular basis? Remember the arc of a typical blog.

      1. ryan singer

        Hmm Good question. I can only speak for myself as I’ve found a good balance to things in my life.I do frequent the same 3-5 of blogs for the past 3 years. I also follow less than 20 people on twitter and have a good balance doing things I love, spending time with my wife and kids, and have a regular group of friends I hang out with on a weekly basis.Going back to my original comment about things changing and being unpredictable, in general people find what works for them and typically stick with it. Although this statement is true I can also contradict this by saying I’ve been an iPhone user for a long time looking forward to moving on after july when our family contract is up. At that point I will see whether I go Windows Phone 7, Android, or is HP ever does anything exciting with Palm’s WebOS.. My bet is on some future Android option, but who knows?! Point is we don’t. So for the developers out there I agree with Fred that you can’t count on anything so do a little of each and you’l stay in the running. Technology comes in waves and there is always a new break after one has passed. All you have to do is wait a little to catch a new one..IOS may need to disappear as most technologies do. People have spent plenty of money in Apps, movies, games, etc.. But once they feel like they’ve thrown good money after bad enough then they should see it reasonable to jump ship for the latest and greatest. Apple just needs to keep innovating and every so often reinvent themselves as they have been and they will stay afloat as a company. IOS might be a passing phase.. who knows?!

  10. Kate Huyett

    “genius in the 21st century will be attributed to people who are able to unplug from the constant state of reactionary workflow, reduce their amount of insecurity work, and allow their minds to solve the great challenges of our era.” – Scott Belsky.Found this quote via Bryce at OATV, who wrote a post earlier this week saying that he doesn’t believe that “we, collectively, aren’t tackling big enough problems because we’re not allowing ourselves to think deeply enough about big solutions.” Part of Bryce’s solution was to essentially create that time by devoting one day a week to being largely offline.That discipline to taking the time to think (and to write) feels like part of the solution. Events like TED and Y+30 are probably another piece of the puzzle.One question for Fred: do you think the relatively low cost of starting new ventures coupled with robust funding environment is discouraging longer-term thinking?

    1. fredwilson

      yes, to some extent

  11. Sebastian Wain

    I find easier to think in the future than in the present.Some thoughts:MOBILE- Commoditized mobile hardware (waiting ASUS, MSI, etc) If the mobile market (in terms of units sold and early unit replacement) is bigger than the PC market then multi-touch, multi-core, gps, accelerometers, etc will be commoditized. May be Apple will find other advantages (3D mobiles?, better design) but the competition will be between smartphones, not Nokia 1100 models.- More Android competition: New Linux distributions oriented to mobiles (not Maebo), paying attention to: webkit based browsers (not gecko), excelent UI (not x-windows variants), good development tools (IDE). Again, I believe that Microsoft will have more mobile market share.- A new kind of programming tools to develop within the mobile quick applications. The calculators of the future (probably related to web mashups).- I am not sure about mobile virtualization, seems like a buzz right now.WEB- Keyword Exchange Markets- APIs carrying advertising.- Movie/Video rorrents with advertising inserted automatically based on location/zones.- Long on Visualization/Analytics tools- Browsers will support a variety of programming languages (with a new VM) instead of only Javascript.- A MVC (model, view, controller) like web. Better APIs and more separation between the representation and the data.- I don’t buy the (complete) P2P social network idea, it’s very difficult to do mining in distributed information.- Google will be the pioneer in video/image/audio pattern recognition.- Long on Web Augmentation.- VC will search for opportunities outside main economic cities/countries- I reserve two for the next 5yrs- A revolution in education: high level interactive education material with automatic adjustment of problems/puzzles to the learner.

    1. Mark Essel

      Interesting thoughts.On p2p social networks, is the goal of networks mining or enhanced communication? For systems which have the former design motivation I agree, but I tend to favor the latter need for social network evolution. Phones weren’t good enough, we want new comm networks.On education: I receive the vast majority of information from screencasts, web docs, tutorials and working people that love what they do. Education has already been hacked from my perspective.

      1. Sebastian Wain

        One of the goals of P2P is enhanced communication, but to improve the communication you need to do some mining and it’s complicated to run algorithms with distributed data (not in theory).On education: what I am not seeing is a place to do a complete career in a more automated way. For example in math it’s very possible to achieve it but it’s necessary to give adaptive exercises based on the learner feedback (exercises results). What we have now is the education material but not the guide. The learner needs a lot of self discipline to progress and organize all those things. Adaptive exercise work like games and helps in self discipline. BTW I think that self discipline is the difficult skill, not the lack of resources.

          1. Sebastian Wain

            I think it’s fine, Stack Overflow’s like Q&A has an excelent impact depending on the community involved.But what I mean is something like an “automated teacher”, chess players train with software so I expect that some careers (mainly math) can be studied semi-automatically. Obviously Q&A, open coursewares, forums, etc support the education process but it will be interesting to “play learning”. Imagine having fun and competing with other “players/learners” at your level. Again, I think what happen with Internet chess is part of the model, where you can play against people within your same ELO, because playing against Kasparov(s) is not fun for most of us :-)Following your mobile/education past threads, I see mobile + some-kind-of-automated-education having a bigger impact on poorer communities where mobile phones are more omnipresent than computers.

          2. fredwilson

            ah, got iti’ll look for that

          3. Udo Szabo

            Have a look at the “MoMaths” project. Backed by Nokia in South Africa it deliver maths lessons to students via mobile phones. The results from the 2010 project has shown a 14 percent rise in maths competency. We have seen similar results from english learning programs in China. Its truly amazing what the combination of community, mobility and education can create.

    2. fredwilson

      great list!i am with you on most of this

  12. Jonathan Cohen

    yup, exciting times ahead. the pipes are set. now, what to fill them with…

  13. Dan Ramsden

    I think in addition to making bets, it may be possible now for those who are in a position of influence, who can have an impact on direction and changes, to do so proactively and on the basis of a vision for betterment. New widgets, new toys, new and improved apps, are nice, but once the novelty wears off (and after 15 years of Internet evolution, the novelty factor is diminishing) what may be even better is a long-term approach towards real solutions.The recent investment by USV in the field of education may be a good example – as the web offers tools to also teach in improved ways, not only to diminish attention spans. Another example may be the effort that Peter Thiel is making – whether or not you agree with his perspectives – to think about the types of innovations needed for societal benefit.From a purely capitalist perspective, it should in fact prove to be a better approach to invest with that sort of vision in mind, rather than scattershot bets on new “stuff,” because new stuff becomes old stuff quickly. Things of true value remain.

  14. William Mougayar

    Pertinent article by Vinod Koshla “Long Shots: Why throwing money at today’s clean-energy technologies could keep us from discovering tomorrow”…Quote “What matters isn’t just technology investment, but also the kind of technology investment.”

    1. Dave Pinsen

      And, a cynic might add, what sorts of technologies you can get the government to subsidize.

  15. Bijan Salehizadeh

    As a healthcare VC, I’m biased, but I think medical innovation, healthcare IT and cloud-based health services will be a massive growth area for the next 10 yearsI wrote a post this week talking about why I am so bullish about healthcare investing over the next decade – it’s tough to fight demographics. (Little known fact: healthcare VC returns have crushed IT/internet returns in the past 10 years as well).…Without being self serving, one quote from my post which may seriously impact the next decade:”The fastest growing segment of the US population over the last 10 years and projected to be the fastest growing over the next 30 years is people over the age of 100. That 100+ group has grown 40% in the last decade and is expected to grow by 650% over the next 30 years.By comparison, the # of people in their 30s has actually shrunk by 6% in the last decade and is expected to remain flat at best over the next 30 years.”Lots of opportunities will be created here – but there is a massive dearth of web-savvy entrepreneurs attacking major healthcare problems today.

    1. Dave Pinsen

      If low-skilled immigration is ever restricted in this country, I could see some of Japan’s labor-saving health care/elderly care technologies taking off here.

    2. Tereza

      So glad you wrote this as I read the post but didn’t have time to comment until now.I was reflecting that with the aging boomers, we will be hit with a tidal wave of elder care.So indeed, along the lines of what you are saying, healthcare broadly, I totally agree.One area where I see little if any talk is around care for caregivers. Unfortunately my life took me to hell and back on that one, and I anticipate that many people will fall into this and need massive support…and possibly businesses which can help.While we have children later than our parents and grandparents — in our 30’s and 40s — and our parents had us at this same age, this means that our parents become old and sick at exactly the same time we are hitting extremely intense years of parenting. This is called the “sandwich generation” and in 10 years we’ll start seeing a tidal wave of that life experience.By the way, these years also happen to correspond with very critical years career-wise, when if a jump from middle to senior management is going to happen, it happens in the 30’s/40’s as well.It used to be — have kids in your 20’s, grow the career in the 30’s + 40’s, care for aging parents in your 50’s.Also what people who haven’t been through elder care don’t know, it’s very tough in large part because you never know how long that intense period may last. You dad could suffer from Alzheimers for 10 years. That can be radically stressful. And that affects your ability to be productive.Anyway, we’re seriously not set up to support the people who have to support the people who are aging. And I tend not to see many internet plays that give much respect or credence to the aging population. There are some not-for-profit and for-profit sites that help with various pieces of it. But by-and-large it’s an extremely fragmented, hyper-stressful experience.Someone needs to hack that.Separately, let’s talk education.I think in 10 years we’ll see how f-d up our education system got with all the low-value testing, and I see a huge shadow system running in parallel to the public school system that is web-, tech-, mobile- and extremely game-driven. Because I’m seeing kids and teachers being turned off by the testing more than their being energized by ‘higher standards’ (which are lower than the standards they had when they were left to their devices). And I think technology will definitely be providing teachers more leverage in the classroom — some legitimate ability to be teaching 24 kids at a time.Finally, let’s talk about ourselves as human beings. This may be more of a 5-year than a 10-year thing, but I and a few women I know here in NY are talking about what we see as a next generation of the web which I call a web 3.0 of the “emotional web”.I contend that the way much of web 2.0 interactions have been wired up, they follow fundamentally male-type thinking. A lot of massive data mining and analytics, scale, getting us in touch with as many people as possible, as quickly as possible. All that is great and important. But it’s not addressing problems that I think about every single day. How do I become a better person? How do I become a better mother/daughter/friend? How do I become happy? Satisfied with my life? How do I take the relationships that matter to me the most, and enrich them. I see it as a phase of *enriching* our online and offline lives, not just making it faster/cheaper/smarter. There is science that understands this. It can be baked into our online experiences, but it hasn’t happened much yet.To say it another way, if there is a Mazlow’s hierarchy of needs applied to the web, we’ll see more movement up that pyramid within our online experiences.

      1. Mark Essel

        I was thinking of the same issue (elder caregivers) while reading Bijan’s comment. Excellent comment Tereza. The foundation for network systems has been built and will continually get rebuilt, while higher level vertical support (emotional, inspirational) is layered on top. We all see the Internet differently, it’s current offerings, it’s potential as a communication hub. Even brilliantly designed search tools miss human extra-net relationships, which showed us the value in social weighting/filtering (Facebook, twitter).

      2. Dave W Baldwin

        There will be an additional element in this realm that will help with emotions while at the same time enable people to spend 1 on 1 time together.

    3. awaldstein

      Thanks for this comment.I’ve thought a lot about the disparity between the scientific advances that let us live longer and be more productive, and the dearth of social web infrastructures which have the enormous capability to eliminate isolation and increase productivity as the body ages.This struck home to me right after my mother’s 91st Bday. I tried to capture this in a post last summer.”Thoughts on social networks and aging” @

      1. Donna Brewington White

        I read that post a while back. Poignant and I think important. Not hearing/seeing a lot of this kind of thinking — glad you put this out there.

    4. fredwilson

      we are a case in pointwe know this is truebut we have not been able to find a model to invest in healthcare that fits our investment thesis

  16. msuster

    Thanks, Fred. Appreciate it.It’s true that if you have a “long view” many people will disagree as I found out when I wrote my “App is Crap” article advocating for the future of “the mobile web” and not the “mobile app.”My version of of your post here is the one I call, “Skate Where the Puck is Going”

    1. Donna Brewington White

      Great minds…

  17. howardlindzon

    I am working on some great interviews and medical as much as it freaks me out because of my lack of knowledge is impossible to ignore. Russia has the most excited for fat pitch opportunities as well.I am going to head there this summer and check it out.Thanks for the friendly link.

    1. William Mougayar

      Gee, you’re getting exotic. I wonder if Russia has world-class falafel.

  18. Vladimir Vukicevic

    There will be a lot more Treadpads in use.

    1. William Mougayar

      Definitely! But will we see a Velcro option in the iPad2…

  19. LIAD

    Ronald Cohen the founder of Apax Partners,a private equity firm with bazillions under management wrote a book a few years back called ‘The Second Bounce of the Ball’In the same vein as Wayne Gretsky’s puck quote, his sentiment was that everyone can see the ball’s first bounce, the riches are in working out where it’s second bounce will be. To do so though, he says you need to have really deep domain expertise.He also says “risk is an emotive word that masks the value of uncertainty” and that “exploiting uncertainty is the essence of entrepreneurship”

  20. Michael Bonner

    The last 10 years of VC returns have been negative – at least as an industry. Does this drive any appetite for VCs to rethink their business models?For instance – Is it better to imagine where the puck will be or would the VC actually deliver the innovation they tout in their brochures by doing the hard, risky work of eliminating the toughest problems one by one? How many of today’s biggest pucks improve any aspect of business or personal life? Which pucks actually distract from efficiency or personal relationships? Are they more answers in search of a question nobody asked?10 years ago we might have been told that Twitter would be a puck. The press wants to call it a puck. Pew looks at this monster puck and finds that the usage evidence is nowhere near the media perception.The Cloud is filling with detritus. What helps cut through the dross? What delvers order? Where are we getting better? Where are VCs reinventing wheels in hopes of getting ‘share’ in a market they don’t understand but think might be where the puck might go?What would happen if all the buzz and investment that drives the fluffy pucks to prominence were devoted to issues that focused on education? Underemployed 20 and 30-year-olds – as well as 50 year olds that may never work again? Health-enhancement instead of disease treatment? Politics as a cooperative solution rather than bloodsport entertainment? Information that exists to distract from and minimize wisdom? The buddhists have warned us for centuries that our thoughts are our future. Perhaps VCs will be freed when the focus isn’t first on the shortest route into the next guy’s wallet. History shows that the wallets will open to true solutions anyway.

    1. Mark Essel

      On the optimistic side, many of the real problems you discuss are being tackled. Their nature results in investments and social payouts with much longer horizon than VC funds, and far longer than political terms.Where’s the financial benefit of matching un/underemployed with challenging and meaningful work when company profit and quarterly shareholders determine decisions? I see a social benefit to this and paying down/off debt but my nations fiscal and political engines do not.

  21. raheeln

    Never trust a futurist. (or scenarist, technologist or any other type of oracle). You can trust speculative fiction writers a bit, science fiction writers a bit more. Black Swan taught us to never trust an expert. If you want to have a real nosey then l I’ve found JG Ballard – dead on. Frighteningly so. The only future that you can say anything deliberate about is the one that you will build.

    1. Dave Pinsen

      From Eric Falkenstein’s review of the Black Swan:To be popular it is helpful to make people think they are learning something new about something novel and important. Yet the masses do not really like novelty, they like affirmation of their inchoate prejudices. Thus, a reader can leave The Black Swan thinking that any expert is either a charlatan or a fool except Taleb and those smart enough to appreciate him, a group that prides itself on knowing what they don’t know, that any specific model is imperfect and therefore evidence is naive Platonism.[…]To the degree The Black Swan has arguments about the essence of risk they are at least a generation old, even if many are pleasantly introduced to them for the first time (fat tails see Mandlebrot (1962), nonquantifiable risk see Knight (1921), for various cognitive biases see Kahneman, Slovic and Tversky (1982) which was a compilation of papers mainly done in the 1970’s), and these books have spawned, or are clearly referenced, by literally thousands of books. The Black Swan may popularize the concept of low probability events, what were called ‘peso problems’ (see Rietz 1988), and that would be a good thing. But ultimately, the bumper sticker “shit happens” is kind of funny, kind of true, but hardly profound.

    2. fredwilson

      we are big fans of science fiction at USV

  22. Aaron Klein

    This is really one of the key factors that separate the innovators from the imitators.Like the 35 people who have decided they’re going to build a dating site with social virality, game dynamics and daily deals with location-based check-in.Nothing wrong with having a few of those things be elements of your startup, but for an idea to fly, you have to have a unique idea about the future that you’re going to solve.I’ve got a theory on one of those right now that’s developing. Sure, it utilizes social and gaming concepts in some interesting ways, but the value is in the core idea, and if the future develops the way I think it will, this will be a great solution to a couple of multi-billion dollar problems.The core idea is such that quite a few people think it’s crazy and will never work.That’s what makes me think it just might be perfect.

  23. robotchampion

    I bet that twitter is dead. I predict it will go the way of myspace and be bought by a large company only to lose market share to a new competitor. They are leaving themselves open since the market is proven and the tech is imitable. Facebook is taking them over while simultaneously bringing the status update to so many more non typical demographics. The only way twitter can survive the decade is to expand into an empire, add in threaded comments, host photos, and seriously start competing with Facebook.In 10 years the microblogosphere will be as diluted as the blogosphere is. With many tools, custom sites, open source projects, and allegiance to any site lost.Steve Mandzik – 1×

    1. fredwilson

      that is certainly a fearbut i think competing with facebook would be a huge mistaketwitter is different and must become even more different

  24. paramendra

    “This blog is a big part of how I do that kind of thinking.”Love your blog.

  25. ShanaC

    I think certain things will not change: People will be born, people will die, there will be important discoveries and new ideas about the way the world works across the earth. Humans will still like stories, we will still like to relate to each other in a variety of ways. Those are things you can always count on being true.What will happen is that we will change the way we process our lives. I think Medicine will change radically, in a Gary Shteyngar/Super Sad True Love Story kind of way, except for the postscript.(I suggest people read that book, there are certain truths about the way we live in it.) I think education will change, in some ways for the better, in some ways for the worst. It will be m,ore accessible, but I think parts of the humanities that are important (say philosophy) might die off except among a very small crowd.I think our conception of countries, localities, and politics will change. We’re moving back to an era of Supercities and easy ways of traveling between them. (I think that even with peak oil issues, a very strict sense of economics state that we will find a replacement, and the replacement will become dominate. I do think that process will take some time,but I also think whatever that replacement is, it will help cities dominate). In some ways I feel more tied to my nearest city than I do to my state, and somewhat to my country for a bunch of various values. I think that attitude will become much more predominant as time goes on.I think in the West we will have less kids. It’s more time and money intensive than ever before, and we’ve mostly stopped have kids for adding to family wealth reasons. It will change our notion of gender.Finally, I think we’re going to move into an era where one will need image literacy as well as math/science literacy and reading literacy. I think this is largely because we will be seeing and interacting with more objects that are or are like images (see your post yesterday). It requires a really different sense that can be extremely sophisticated when you have to use images to explain content as opposed to words.

    1. fredwilson

      image literacy is one of the special aspects of tumblr

  26. Harry DeMott

    Based on yesterday’s press conference – Bill Clinton should just about be finishing his 4th terms as president!

    1. fredwilson

      i love the idea of Bill as the elder statesman in Obama’s cabinet

      1. Harry DeMott

        Or Obama could just clear out of the office and let Hilary and Bill get onwith it!

  27. Dave W Baldwin

    The marriage of Nanotech and Biotech matched with attaining measurable goals along the path to AGI will do much more than most imagine.Yes, the reading of images will be important, but we will adapt since our neurons truly are image anyway (not text) and that will enable the faster exchange of news/ideas for we will not feel so compelled to write (what we feel) needed explanation.Toward 2018, true advancement toward affordable and friendly BCI will be happening (it won’t be text) and most things we take for granted around us today, from the raw materials to products in our homes will be completely different….and will be full of information.Remember there are some of these things we can do in a fashion that will speed the improvement needed in other parts of the world and grow economies (including our own) to the needed level matching the monies spent recently. Good post!

    1. fredwilson

      can you explain AGI and BCI to the AVC community in a few sentences each?

      1. Dave W Baldwin

        AGI- Artificial General Intelligence. Simply means AI being cognitive enough to think independently, create storyline to solve issue at hand and so forth. There are those that will claim big things seeing if they can fool people and have them believe the machine is smart, though it is truly programmed to fit the wishes of the developers. Otherwise, there are those of us playing straight up.BCI- Brain Computer Interface. Some of your readers are thinking right regarding images…for if you were to command your kitchen attendent at home your wish for Surf & Turf, you would be transimitting the image of the meal, not spelling out to text. A safer date would be more like 2022, but as some of us roll faster, we can push that back.For those who want to attack from the “Smart machines will kill humans” or “Privacy issues involving the process of doing BCI”, don’t be stuck so much in the present and/or Hollywood.

  28. J.R. Sedivy

    Mark Suster’s “Skate Where The Puck Is Going” article also comes to mind!

    1. vruz

      Ten team points! That was a great post.A must read for anyone interested in these topics:http://www.bothsidesoftheta…Too many actors in the industry (entrepreneurs, VCs, technologists too) are sometimes too pragmatic, too unimaginative focusing on the right here right now.Right now is often too late.

      1. J.R. Sedivy

        Definitely one of my favorites which helped put things in perspective. Although with start-ups taking care of right now is often critical to ensure you make it to tomorrow – Without the clear vision of where things are going and a drive to get there a business will only keep pace at best.

        1. vruz

          Yep. It’s hard to strike the right balance.In an extreme case, that’s what the Innovator’s Dilemma is all about really.We could write entire new books about this topic.

  29. Bala

    Well said..

  30. vruz

    To all of you doing futurology: think of the things we were betting on 10 years ago.Think which of them you placed your bets on, considered or even imagined 10 years ago.In that worldview, there was no Youtube, no iTunes, no Facebook, and no Twitter, no Firefox, no Cloud, no iPhone, no Skype, no Wikipedia,Yes you could have placed some bets on VOIP and MP3 trends (Napster! the Satellite music downloader! the original IPHONE application!) but chances are you were absolutely hopeless about specific products and also most trends.Science Fiction writers know this phenomenon pretty well, we’re always more or less clever about great trends and waves of innovation, but it’s impossible to know beforehand what the specifics will look like.And sometimes not even that, or by now we’d be living like The Jetsons.Possible exception: smartphones are more and more like Star Trek tricorders combined with the Junior Woodchucks Guidebook.I never for the life of me thought that could ever be technically possible.…If you think you know what’s going to be like in 2020, think again, you are absolutely wrong.

    1. Dave W Baldwin

      I like the App Voodoo post from the Spring. Back when one Smartphone’s mantra was the number of apps in the store compared to the rival’s, I explained to people that you can have 1m apps and you will be overloaded with 990k pieces of shit.

      1. vruz

        Sorry I wasn’t talking about the Apple iPhone, but about one of the first commercially available VOIP desktop applications of the same name, circa 1999.Cisco later bought the IPHONE company, and Apple bought the trademark from Cisco.

        1. Dave W Baldwin

          I know…was just using that as an example…the main thing people need to start thinking about is moving thru this decade, the different pathways will all be accelerating and begin to merge. So it goes beyond building an app appealing to a niche that the evangelist claims is bigger than that niche.In other words, the exponetial meets the tier.

    2. Mark Essel

      Funny that you mention smart phones and science fiction. One of the chief technologies we described in an rpg we’ve written/playtested off an on over a decade were Globals. Interconnected personal computing and communication devices that gave everyone access to a galactic network. It’s the sales pitch my co-author Aakin (“dude, it’s a global”) used to get me to pony up the money for the original iPhone when I was happy with a low-fi old school phone.

      1. vruz

        A lot of what we use without much thought today was already roughly described in some form in Sci/Fi books.The keyword here is “form”. The function has been described in the past, but the exact form it takes in the future and the magic that really makes things work can’t be known with certainty.Possible exceptions: Arthur C. Clarke’s idea of geostationary satellites long before they became a reality.Some guys closer to the science of things can make more accurate predictions about both form and function. In the case of satellites, the function involves relatively simple classical physics.Complex systems like human societies, human psychology and user interface design make the right form which correctly addresses the form problem more difficult to anticipate.Sometimes in some exceptional cases like the iPhone, we have problems we didn’t even know we had, much less the right answers, or any answers whatsoever.

    3. fredwilson

      maybegeocities fortold myspace, facebook, and tumblr

      1. vruz

        Well yes and no.Geocities fortold all those in the same way Chuck Berry fortold The Rolling Stones, to use a musical analogy :-)You can tell where the lineage goes on hindsight, but it’s really not totally true the other way around.

        1. fredwilson

          keith richards basically said that chuck berry begat the stones

          1. vruz

            I think what i’m getting at is that it was obvious possibly only to Chuck Berry and to the Stones themselves, but most of the rest of us learnt that on hindsight, much later and after the fact.

      2. vruz

        Mark’s was actually much much closer to Facebook.He just didn’t find a good business model fast enough, and he didn’t have a strong technology to back him, but he was *this* close, very correct directionally.It’s not a mere coincidence that he had the right instincts already when Facebook built out the platform.He didn’t have to build the platform but he already knew what he had to do socially.

  31. Hayden1059

    I see 2 forces moving in opposite directions.1. The American economy has been seriously crippled and despite all kinds of hype about things getting better soon, I foresee America in a depression for a number of years.2. Using a ballpark guess, say 75% of the population has the willingness and the drive to actively create energy. Continuing in our current economic model keeps us depressed in spite of the willingness of a majority to willingly desire to generate activity.Suppose there was an electricity generating machine that consisted of a bicycle chain, seat and pedals that could be placed in the home and plugged into a central coordinator, that would create a considerable amount of energy that we don’t have.The bicycle energy is only an image to suggest what could happen. A program that weans people away from the standard job approach and into 2 groups: those who need/want something and those who can perform those services (obviously in the same region) and that includes fresh means of rewarding those services – that’s my prediction for a vital new approach to help us emerge from this disaster.

  32. Mark Harai

    It’s the unsolved problem, or need that is currently unfilled that will be the next Twitter, Groupon or Facebook. Funny, when one of these uber cool technologies/companies/ hit, everyone somehow believes it’s the holy grail. Next you have copy cats – or those who build on the vision of those original business models. Nothing wrong with this mind you – there are many successes that come from extending these applications/ platforms/ models.However, the next Facebook, Twitter or Groupon will come from a completely original viewpoint and if recent history teaches us anything, it will more in likely come by accident.

  33. Terry J Leach

    I totally agree with betting on the future. Call it having a “Vision”. Too often developers become enamored with a technology rather than more business like and looking at the numbers. Here are some numbers announced just this week “300,000 Android phone activation per day” that’s more than the iPhone and Blackberry combined and it surpasses Nokia phone activations. The future is not so distant and HTML5 will be mobile application foundation. Check out the PhoneGap framework it uses HTML and Javascript to build mobile apps that work in a variety of mobile platforms.On a personal note I’ve had a vision of data for very long time and next year we will launch a startup focused solely on adding value to the data stack. It’s great to see Factural getting funded. 🙂

  34. Prokofy

    Do you think the cloud thing is going to go on being so popular after WikiLeaks?Dave Winer wants to build a new Darknet sort of thing separate from the commercial Internet because he says you can’t save anything and can’t trust anything. I think he’s being hysterical and dramatizing the victimhood of WikiLeaks, which in fact wasn’t censored, but it’s an opinion some tekkies will have.

  35. Alex Murphy

    Yesterday, we took my older son into DC for the day for his 7th Bday and sang Happy Bday at the top of the Washington Monument at the minute he was born. It was really cool.While we were there, I was struck by a quote from George Washington himself:”My first wish … is to see the whole world in peace, and the Inhabitants of it as one band of brothers, striving who should contribute most to the happiness of mankind.”Talk about a visionary.In the next 10 years, I hope that we will see a world that more closely resembles Washington’s wish than it does today.

  36. Rahul Chaudhary

    How so?

  37. Matt A. Myers

    That covers a lot. 🙂

  38. William Mougayar

    Agreed 200%.Charlie C for Treasury Secretary!

  39. Dave Pinsen

    You can’t close the deficit without reining in social spending, and/or raising taxes on everyone, not just the top 2% of earners. Social Security, Medicare, Medicaid, plus unemployment/welfare comprise about 57% of the federal budget, and Medicare spending in particular has been growing at about 3x our trend GDP growth rate. About 19% of the federal budget goes for defense (the supplemental spending on the wars adds maybe another 3%).

  40. Dave Pinsen

    Health care financing isn’t that simple. You need to combine a profit motive to spur innovation with social insurance so that no one gets denied treatment for lack of ability to pay. I don’t think we have the right balance currently. One thing I think we should do is demand that other first world countries take on more of the costs of R&D. Canada, for example, is a big free-rider on our medical R&D.What Bush did was make the federal income tax system more progressive than it was under Clinton, shrinking the tax base. Other than lowering the top marginal income tax rate a little (to a level higher than where his father had raised it to), Bush 43’s presidency was like a scaled-down version of LBJ’s: guns, butter, war, and new entitlements.And what Clinton did yesterday was say, essentially, that our economy is at risk if we go back to Clinton-era tax rates. Which was somewhat disconcerting to see. Why are Democrats so intent on extending almost all of Bush’s tax cuts?

  41. Aaron Klein

    unless you believe this particular puck can soar into eight-dimensional hyperspace…

  42. Mark Essel

    it’s relative.the world moves around the puck offering it different trajectories or opportunities. Self propelled pucks are more interesting than those that need a hockey stick to get them going. but the puck craves speed. damn adrenalin junkies ;)On restrictions: Horse blinders are a limitation, but they keep the horse’s attention forward. I prefer life without them.

  43. Aaron Klein

    sorry, should have said “multi-dimensional hyperspace” 😉

  44. ShanaC

    Actually, I think Obama’s mandate to digitize healthcare would be helpful in bringing down costs enormously. I can fax or send certified mailed my application, but get the internals of my healthcare provider to use the web to efficiently get my application going – nope. As a result, it is so damn bureaucratic. Plus, healthcare could keep us on top of our spending for things like drugs, or start providing sensors so that we get healthy because we can see how these things affect our health and healthcare costs…Meanwhile I’m waiting to just be able to properly send my application and cut out middlemen…

  45. Fernando Gutierrez

    A few thoughts on health care:-Here in Europe most countries have a public health care system that covers everyone for almost everything. There’re also some private insurance companies and a few private practices. The cost is completely out of control and it has to be reformed. Soon.-When you have public health care life is difficult for small businesses. I know well. I own a business there. You can compete with free, but it’s a tough game.-You can’t take out insurance companies from health care unless you have public system that covers everything. Medical expenses can be very high and impredictable, so individuals need insurance to make it regular. I agree they kill innovation, but so do public sector. Profit drives innovation, but I understand that in a complitely private system there are many losers. Difficult equilibrium.-Recently I’ve had some contact with the American health care system. My knowledle is limited in depth and coverage (just the Boston area, I don’t know if it’s the same everywhere), but I think you could get instant savings just limiting litigation. Some doctors explained me the cost of their insurance and it’s crazy. Negligence must be punished, but there has to be some limits.

  46. Tereza

    We spend an inordinate amount of money on end-of-life treatment.Americans are ridiculously naive in thinking we won’t die. We think it’s our right to heroically extend the lives when what they need is dignity in dying. This happens in every hospital every day.Doctors are scare sh*tless to *not* treat heroically so they don’t get sued.When my mom was dying I was very lucky that she was lucid and could said full-on to the doctor “do not give me a cardiac difibrillator. I want to die.” It didn’t matter that she had a fully papered DNR. They needed to hear her say this. It was insane. And because my sister didn’t want mom to die even though mom put in writing that she wanted to die, they would have undertaken ‘heroic’ (read: insanely expensive) means so it would appear they’d done everything — again, to avoid a lawsuit.If I were to hack at healthcare, the first thing I’d do is mandate end-of-life planning and not allow doctors to vacillate from those plans. Because that’s where all the wasted care goes.

  47. Dave Pinsen

    “We spend an inordinate amount of money on end-of-life treatment.”That gets repeated a lot, but it’s sort of a content-free statement. First, you don’t always know when a patient’s life is about to end, and patients are often the sickest just before they die. So it doesn’t seem “inordinate” to spend the most money on the sickest patients (excepting cases such as your mother’s, where the patient doesn’t want the treatment).Another point that gets overlooked is that there is often overlap between what is palliative and what is curative care. I’ll give you a personal example. When my father was terminally ill with cancer, he had a mass pressing against his esophagus that caused him a lot of discomfort. In his case, the palliative treatment was radiation that shrunk the cancer. I’m glad he was able to get that treatment, and I don’t consider it to have been “wasted care”. He had dutifully paid his health insurance premiums for years precisely to cover that sort of treatment.Another example was one President Obama brought up during his campaign, one which I’m surprised no one called him on. At the time, his grandmother was still alive, and he said that if she broke her hip, then maybe she should just get “a pain pill” instead of getting it fixed. Shortly before he passed away, my father broke his hip (which, we were told at the time, wasn’t too uncommon: steroids given during cancer treatment often weaken the bones). My father was about to get discharged from the hospital when this happened, and he was put on a morphine drip while they trooped in the various specialists to sign off on surgery to repair his hip. The pain from the broken hip was excruciating; morphine barely dulled it. No magic “pain pill” can ameliorate the pain of an injury like that.In the end, my father was approved for the hip operation, but his condition deteriorated before the scheduled operation, and he passed away a few days later. But had he gotten that hip operation, I wouldn’t have considered it “wasted care” either.

  48. fredwilson

    we are going through this right nowand you are so right about this

  49. fredwilson

    yupwe have to tell our citizens that they are going to have to pay more and get lessit’s simple to see but maybe impossible to do

  50. fredwilson

    they do, but not well

  51. Tereza

    Sorry to hear about that.Unfortunately, sooner or later, everyone will go through it.It’s a bitch, any + every way you slice it.

  52. Tereza

    The worst part is you hustle your ass to get them comfortably to the finish line, if you will. But when it’s done, it’s not a celebration. It’s just sad and depressing.Who celebrates the caregivers and makes them feel better?Need an app for that.

  53. Blsavini

    What happens when the citizens have no more to give?

  54. Dave Pinsen

    I don’t think it’s impossible if you level with people about what’s at stake instead of pandering to them. Chris Christie strikes me as a rare politician who has the courage and articulateness to do that. Check out this example of him laying out the budget facts to a public school teacher:

  55. fredwilson

    well we have to cut toobut sadly cutting will also take money out of the citizens pocketsbecause it is entitlement spending that has to be cut the most

  56. fredwilson

    he is most certainly someone to keep an eye on

  57. Tereza

    I’m not going to judge what was a waste for your dad or not, nor am I saying there should be no palliative care. I think we need really strong palliative care. I’m for dignity i death and pain-free dying.But there are some lines that we cross. For example I was repeatedly warned not to move mom to a respirator. Because then it puts you in a situation where they’re only alive because of the respirator and then you have to choose to pull the plug. And people (naturally) struggle to choose to pull the plug. Lots of siblings get into wars over that decision. You lose control by having more control.

  58. Dave Pinsen

    “nor am I saying there should be no palliative care. I think we need really strong palliative care.”You have elided my point about the overlap between palliative and curative care sometimes. Everyone’s in favor of palliative care. It’s cheap. But sometimes the only truly palliative care requires aggressive treatment, and isn’t cheap. It depends on the situation. A close family friend passed away from an awful pulmonary disease where the only form of treatment, palliative or otherwise, was morphine. And that’s what she got, and passed away at home with visiting hospice assistance.”Because then it puts you in a situation where they’re only alive because of the respirator and then you have to choose to pull the plug.”Not necessarily. People are perfectly capable of dying while on respirators. Again, my father’s case was a counterexample. He passed away within a few days of being placed on one (infection leading to kidney failure leading to heart failure). The way to avoid sibling wars is to establish a living will ahead of time, which is what my father did. He made the decision to be put on the respirator, but he had given instructions about what to do and who to consult with if he were incapacitated. After it became clear he had little to no chance of recovering from the infection (which wasn’t obvious at the time he was put on the respirator), the decisions to eschew dialysis and not try to resuscitate him were consistent with my father’s living will.

  59. Tereza

    Dave, there’s such a long list of reasons why it would be totally inappropriate for me to adjudicate on your father’s sickness and death.It does sound, though, like his care was consistent with what he wanted, and what you (the family) felt was right, including the respirator. And that is as it should be. I’m also guessing that you (meaning the family) had the resources to enable the care that would relieve his pain, whether labeled Palliative or Curative. And perhaps the definition of Palliative should be broader than it is today. Look, neither of us are doctors — we’re relating to our own very personal experiences here. And in both cases, the experiences were awful.In my mother’s case, her tumor caused her to suffocate to death. The respirator would have slowed down a process that was irreversible. The slower rate would have falsely represented hope, when there was none. Tough times create irrational decision-making. In our case, a respirator was a bad decision one of my family members was very eager to make. Luckily mom said Hell No. They literally made my mom repeat the words “I want to die” in front of multiple doctors and hospital personnel, when the woman could gasping for breath. She turned to me and said — how many times do I have to tell these people that I want to die? So I ask — Where’s the dignity in that?My point was this. Even with a living will in place, I experienced that the medical establishment can resist following those instructions. And the primary driver is they don’t want to get sued by the next of kin who wants to fight it to the finish line, and in an emotional state don’t want to think about dollars. (the second is they’ll get paid for the expensive treatment anyway). It quickly can become an arms race for more and more expensive treatment.My husband works in a senior position in one of the massive healthcare consulting firms and their current focus is exactly this….the inordinate costs spent at end-of-life care. There is a lot of data on this and more is emerging.But Dave — clearly, every such decision is unique.And by the way, I’m terribly sorry about your dad.

  60. Blsavini