Health technology assessment (HTA) is an interesting scientific field. The new digital opportunities allow people to participate in medical and medication trials in their homes or even in bed. Their health data and the administration of medication is also encouraged and sometimes supported through digital devices. The pharma and health industries have many devices ready to go. The differences to the traditional forms of medical trials, however, is an issue as we want to compare the results from both kinds of trials. Participants of trials, might prefer or struggle with these novel kinds of study designs. In any case the results will be impacted in several forms (Study Link). In the best of all worlds for the researcher the effects will cancel out each other, but is rather unlikely. Some participants will reach more positive effects with the use of digital tools, whereas others are challenged and might even abandon during the trial. Monitoring during the study (for example through digital inhalors) is another advantage of such distributed trials. Rather than taking adherence to a trial medication for granted, digital tools allow a more precise monitoring of subgroups as well. Data and effort invested in the trial is preserved through the easier access to person’s information, assuming continuous readiness to stay on in the trial.
Our own smartphones are still underexploited in terms of health monitoring and use in research designs. The possibilities to link data to other external data sources shall further advance the research potentials in many interesting ways. Data protection and data security become even more important with the ever smarter phones and connected devices.
Health data
2025 will be a crucial year for health data across the EU. Germany introduced the electronic patient card, which can store basic information to then access data in the health insurance cloud for medical doctors, hospitals and other related health services. Potentially this is a great step ahead as some tests do not have to be repeated if they had been completed recently before already.
In pseudomised form, research may draw samples from such databases to enhance our science based understanding of disease. The evaluation of public health interventions becomes easier and medium and long term efficiency of measures can be assessed in many instances.
The Belgian research using health data has met to discuss the potential and limitations to link health data to other data sources to allow more complete and more complex analyses of health and disease processes. Another extensive data source sits on our smartphone. Collection of steps walked, sleep patterns or heart beats give valuable insights into a person’s own contribution and care about personal health. Although data are frequently incomplete, researchers are used to estimate missing data on the basis of existing or comparable person’s data. The basis for improving health for all are quite promising, data handling and linking them will be a challenge to the competence of all stakeholders and everyone involved in better health. It will be stressful before it becomes a routine. 
Sociolegal Circularity
At times legal systems feel like going round in circles. Legal procedures move from one stage to the next and they may get referred back to the previous instance to resolve a particular issue or restart the procedure. This has good reasons with the aim of “doing justice”. Sociolegal circularity, however, begins before the, right at the beginning and negotiation of legislation on which all legal systems are based in democracies, that is. Hence, the legal definition of waste, recycling as part of the circular economy and society is rather crucial.
Circularity is a complex sociolegal issue as the example of PFAS in plastics demonstrate. In economic theory the existence of externalities invites profit seeking of the kind like: “the sea in large part is owned by us all and there is no price attached to the (ab)use of it. Dumb PFAS into the sea, because the costs of cleaning up will be shared by all of us”. In order to limit the extent of this economic logic, we have to rely on sociolegal processes. The precise definition of property rights and liabilities beyond the PFAS issue have to be well-defined. It is an intergenerational topic as well, not only in view of deferred payments.
Parliaments have to be rather competent to look through all the complex issues of producing and recycling of materials to make sound provisions in law including future generations. Going round in circles in parliament is yet another element of necessary condition of circularity in a rather broad sense.
The air we breathe and the water we drink have become part of this “economic externality”, which is a very internal, inside of our body kind of sociolegal affair. Who is responsible for the bad air we breathe and the contaminated water we drink? Air and water have for a long time become marketable products. The more your local water is polluted, the more we are forced to buy water. The more the air in inner cities is filled with fine dust particles, the more medical doctors, hospitals and rehabilitation facilities we need to construct.
For GDP calculations these are win-win-win situations, although they make us all worse off. Society and politics are in charge to define and redefine (yes, circles again) the legal basis with a lot of precision and scientific detail. Sociolegal circularity is key. You just have to turn it in the right direction.
(Image, Palais de Justice, Brussels view from Forest district).
Cupid at Work
The last 11 entries in this blog focus on conceptual thoughts as a contribution to the history of ideas with an extension to modern concepts. Our societies, management of companies and personal development are conceived under the conceptual framework of these concepts. Take the 1st letter of each term and it reads like “cupid at work“, easy to remember and enumerate.
Take each term as a prism through which you frame your life course, an enterprise or a society. The 3 levels by 11 concepts matrix is a starting point to scan empirical examples for substance.
Complexity, Uncertainty, Plurality, Intersectionality, Dosage.
Woke-ability, Organics, Resilience, Keys,
(Image: Peter van Lint, Jupiter embraces Cupid, 1636, MRBAB 2024) 
On Keys
Keys may open multiple doors. Even a single key can open many locks, if constructed in the appropriate way. The obverse of key is also key, at least in the function of keys to lock doors. Hence the trick of the key is its dialectic function (open/close) of access. We practice the functioning of this binary thinking (1= open, 0= closed) several times a day. Even binary thinking can become very complex in case you consider a bunch of keys or organized as a ring of keys. With a plurality of locations or rooms (home, work, leisure) the uncertainty to have the fitting key to the lock in question at your disposable becomes a bit of a puzzle. Here we are, trial and error enter the stage for most of us. Don’t worry, there are digital tools to solve the problem for you, but then the whole issue of trust comes into play more forcefully. Sharing is not only caring, but also daring. Transponders replace keys and passwords have become the new “passe partout”. This leads to the brave new world of encryption as the keyfactor for security. Encryption is key. Are you already encrypting or still turning keys?
Keys are key to understanding as well. Artists in Berlin-Schöneberg combined the portraits of persons and their bundles of keys next to each other. Keys seem to reveal key personality traits of a person. Life course researchers may investigate the “first ownership” of a key to a room, an apartment or the family home as a factor of independence, even freedom to move. Handing over the keys of a car or your home to a significant other may mark looming restrictions due to health issues.
Anyway, what is your favourite key in music? More a fan of serial music or 12-tone music? 
On Resilience
There are at least 2 definitions of resilience: (1) a material definition points at the “ability to return to an original form or position after being compressed, extended or curved, and (2) a immaterial or psychological definition. The latter one describes the ability to recover, be happy or successful anew having overcome a bad or challenging experience. The American psychological literature defines resilience in the shortest form as “positive adaptation despite adversity”. The psychological construct is linked to a positive life span perspective of personal development. Other areas of application range from “resilient investments”, “resilient industries” to single resilient societies or intergovernmental organizations like the European Union or NATO.
The challenges to resilience increase with complexity of societies and social as well as technical systems. As supply chains have become longer in time and travelling longer distances as well, the improvement of resilience has become a steep challenge for globalization. Reorganizing supply chains with “own sourcing” as in countries which are cut-off from international trade will have huge consequences on sending and receiving countries.
Last, but not least, countries like Ukraine demonstrate the fact and virtue of resilience after more than 1000 days of the massive Russian invasion of its country, which threatened its survival. Resilience works best in networks of organizations and countries. Solidarity is a fundamental building block of resilience as well. Donations and funds support activities that foster resilience. 
On Organics
Organics are the new hype. Organics are everywhere. It is true in organic chemistry, biochemistry or pharmaceutical biochemistry we start from organic compounds as the basis for various forms of classification systems, structures and reaction chains. A search for organics brings you to Organic Farming and to lots of other applications of organic production as well as organic design.
The extended definitions highlight the foundation in biology and chemistry to then include any processes which integrate cyclical reproduction or resources and conservation of biodiversity. Based on the plurality of forms and connectivity of organic compounds this leads to a vast and diversified basis of carbon- and hydrogen-based life on earth. The ensuing complexity (variety of species) has been the basis for mankind to come into being. It is likely to determine also our survival in the long run. Organics is based on open as well as closed forms and therefore has an encompassing nature. Depending on time and space constellations (temporality) evolution has taken one or the other path. We are certainly not at the end of this evolution, although we through the loss of biodiversity we narrow down new potentials in an unprecedented way. Rethinking life on earth from a cell-based perspective of plastics and chloroplasts is a challenge, but it will lead us on towards the “organic turn” in the 21st century. 
On Temporality
Time is passing, or is it? We tend to confound time, with passing of time or an occurrence at a specific point in time. Time has a static use, which refers to a date of birth or date of death. Time refers to durations like the lifetime or time in office of a person or a political leader. In most such cases time is considered as a continuous and linear process. The concept of temporality questions these common perspectives on time to allow additional time perspectives in the description and understanding of time.
Temporality is linked to a more flexible view on the periodization of history. The time before and after the 12 years of Nazi-terror will then be part of the extended periodization of the Nazi-Regime in Germany and Europe. Similarly, temporality widens the perspective on social phenomena by linking historical events to the time before and maybe even to what follows, seen as a consequence of the temporal and spacial co-evolution.
A deviation from the static view of time and a rigid periodization of fascism allows to study the Russian male dominated political authoritarianism as a new wave of fascism in Europe, which negates the right of existence of the state of Ukraine in its neighborhood.
Temporality expresses the need to go beyond a simplel periodization to include a spacial dimension in the defintion of time, much like modern physics does in relativity theory. Temporality, therefore, opens up a “thought space” beyond just the timing of events, which may challenge many of our day-to-day experiences. Cultures with a different understanding of time or the pace of time become a “sound board” for our way of considering and being captured in a time space. Probably many artists are forerunners in playing with time and the way time is “treating” them. Most of them face(d) hardship during their lifetime, but have an extended “after life” in terms of reputation. Some contribute to the perodization in the arts and of their time. They all shape(d) temporality.
(Image: extract from Hans Bol, 1593 Ring Jousing in front of a pond inan imaginary city, MRBAB, Brussels)
On ambiguity
Ambiguity is defines as something which can have more than precisely defined meaning. In legal affairs or other domains this may cause confusion and invites discussions or clarification. It has become even a personality trait and a competence to endure ambiguity. If a manager distributes tasks, ambiguity creates a potential for misunderstanding. However, ambiguity may also leave room for self-organization that people might like or be afraid of. Hence. handling of ambiguity is something of a skill that you are able to operate in less well or even undefined situations or circumstances. In such cases you have make decisions yourself and take responsibility later on for your decision. Creating ambiguity or ambiguous situations is a technique in art as well. To throw into doubt what previously was the received wisdom challenges people and institutions. The ways to handle ambiguity become a challenge to the performance of individuals or institutions. In dialectic thinking you think of something as well as the opposite. The result is an ambiguity which you might want to resolve. Quantum physics created a similar challenge to classical physics as more than one kind of behavior of particles is possible. Ambiguity might be more the rule than the exception despite our continuous efforts to disentangle ambiguity. 
On Dosage
- Dosage is key. We all know it from everyday expériences. Certainly from drinking alcohol we know the tricks that dosage can have on us. Consumption in small doses is fine and enjoyable, but larger amounts cause all sorts of trouble. In pharmacology the effect of dosage is applied with particular virtue. Small doses even of a poison can have beneficial effects. More of rhe same might well kill you. The same rationale applies to other fields as well. Physiological training effects depend a lot on the right amount of training and the timings or intervals between training sessions. In managerial, economic or social applications the question is not only about what is the right remedy, but also how much of it. The interest rate decisions of central bankers are mostly concerned with dosage rather than « whatever it takes ». A minimum wage increase is equally about dosage and we all have additional examples.
Even in art, take painting or music, dose and pose, that is the question. It is quite surprising that such an overarching issue has received rather little attention, comparatively or only among specialists in each field.
It appears strange, but it is possible to have only a little bit of war, as opposed to comprehensive conflict. The applications of dosage are manifold.
Learning about dosage might prevent binge learning at first and binge viewing later on. In the age of tiktok and social media, dosage has become a key competence. (Image Extract of Gustave Courbet Die Welle 1870, Alte Nationalgalerie Berlin).