I don’t remember how I acquired my copy of Adam McHugh’s wine memoir, Blood From A Stone. It was published last fall, and it’s possible his publisher sent it to me, or maybe their Canadian distributor. I used to review food and wine books frequently and was on lists to receive review copies, or at least catalogues of new books from which to request one.

I suspect I bought it myself, though. Karen MacNeil, the California-based wine writer, reviewed it glowingly on her blog in January. I have a vague, though probably not false, memory of ordering it on a whim after reading MacNeil’s post. January was a crazy-not-in-a-good-way month, in what has turned out to be a crazy year in my house and with my family. I must have been distracted by events and forgot about the book in the pile at the corner of my desk.

I found Blood From A Stone just in time for a couple of weeks’ holiday in July, and the timing couldn’t have been better. After the trying winter and spring, I was ready for it. The book is about how McHugh changed his life from being a hospice chaplain to being part of the wine trade in Central California, coming to terms with loss, and re-imagining one’s self and circumstances.

Much of the book is about wine, generally: science, history, culture, all of it. If McHugh’s reader is already a wine nerd, then he tells some familiar stories in a novel and amusing way. If McHugh’s reader is not already a wine nerd, then he provides an excellent introduction to the subject. Though it sometimes touches on dark subjects, it’s a fun and witty read.

One of the things that Blood From A Stone is really about is change, welcome or otherwise. Through the book, McHugh makes connections between events in his life and the processes, whether chemical or cultural, that make wine. 

Wine is also really about change. The winemaker turns sweet grapes into dry alcoholic wine. Or at least they guide the natural process of change. The same might be said of any cooked food or alimentary product. But what separates a bottle of good red wine from a bottle of Coca-Cola is that it is, at least notionally, alive and prone to change as it sits in the cellar or opened on the counter.

Another California wine writer, Alder Yarrow, published a kind of interview last week on his website, Vinography, with the French bio-dynamic winemaker pioneer, Nicolas Joly. In it, Joly suggests the true test of a well-made wine is time after the bottle has been opened and the wine exposed to oxygen.

He tells Yarrow: “Here’s is the test of truth. You follow the wine. You drink a glass, another glass, and then you wait and have another glass three days later. In summer, all true wines will improve for 8 or 9 days.”

This seems extreme, though having met the man, I have no doubt that he does it regularly and that his Loire Valley wines, made with organic Chenin blanc grapes grown on land that has been under vine for centuries, are up to the challenge. Less dramatically, I have returned from a week away to find a perfectly good half bottle of wine waiting in my fridge. Whether it had improved or not, I couldn’t say.

Most wines today don’t need to be opened well in advance of being served or to be decanted to encourage more contact with oxygen in the air. Modern, temperature-controlled wineries make stable wines, which don’t require heavy tannins, from grape skins, stems, or new oak barrels, to keep them from spoiling.

Producers still make wines that are meant to age, but today they don’t have to, and the great majority of wine is meant to be drunk within a year or two of being bottled. This summer I am regularly pouring a white wine from the North of Italy: the 2021 Zenato San Benedetto Lugana. Lugana is a DOC designation for white wine that holds the distinction of being stretched between two political regions: Lombardy and Veneto on the south shore of Lake Garda.

The Zenato Lugana is just under $20 in Ontario, and there is enough of it sent here that it is relatively well distributed across the provincial liquor retail monopoly. Apart from the twin virtues of being well-priced and fairly easy to find, the Zenato Lugana is also a fruit-forward crisp sipper with some weight in the mouth. It’s not terribly complicated, but it’s a pleasing refreshment that’s easy to sip as an aperitif.

But here’s the problem: I am not sure exactly what it tastes like. When I first tried it, I made a note that I was receiving tangerine. The second time, I was convinced it was peach. By the third, it was grapefruit and apricot. Now, when I open a bottle, I wonder which version will end up in my glass.

Taste is, of course, subjective. I write my tasting notes independently, but then I like to compare them against other wine writers I respect. They’re never exactly the same, but often similar, especially if I have resorted to vague descriptions like “red fruit”. And sometimes they are as different as tangerines and peaches. When that happens, I’ll look up a third and a fourth review, only to be further confounded by a lack of sensory consensus.

Wine is, of course, itself subjective. Any number of variables, from temperature to oxygen exposure or the shape of the glass a wine is poured into, will affect taste. Many (like me) believe the weather can change how a wine tastes and distinguish between “fruit days” and “root days.” The best explanation for this phenomenon that I have heard is that day’s barometric pressure affects the volatility at the surface of the glass of wine, which changes how many aromatic molecules will reach the taster’s nostrils.

In the end stone fruit notes from the Verdicchio grapes that make the Luagana are winning over the citrus ones. But I like that that could change with the next bottle. It might also change when the 2022 vintage replaces the 2021. Wine like most good things is about being in the moment and never really knowing what’s coming next.

This article is the first installment in a four-part series, “Hope in Health Care“, exploring how we can modernize and adapt our health systems for the future.

Where have you gone, Harold Johns?

For some (including Simon & Garfunkel), it’s Joe DiMaggio. For others, it might be Jean Beliveau, Julie Andrews, or Rosa Parks. Whether you lived in the era or not, you likely regard the mid-twentieth century with some romanticism—and its cultural figures with heroic esteem. The age of moonshots and microwaved dinners was a moment of transition and growth, while also being a time of boundless optimism. The world moved in giant steps. And almost everyone appeared convinced that, if given the chance, they could keep up.

In one corner of our country, an enterprising physicist by the name of Harold E Johns was convinced that Canadians could beat cancer. And then he proved himself right.

While the Tommy Douglas types were mapping out the future of health-care administration, big brains such as Johns were overhauling medical science itself. More specifically, Johns and colleagues at the University of Saskatchewan were doing pioneering work in the emerging field of radiation therapy. They channeled a frenzy of activity in nuclear research into the first ever accurately calibrated dose of a life-saving treatment. In 1951, a Saskatchewanian mother of four with cervical cancer became the first patient in the world to benefit from this breakthrough. She lived another 47 years.

In his harnessing of a novel science, Johns turned technological uncertainty into something truly wonderful. He stood on the precipice and saw the mountain peaks ahead. He did something that brought hope and healing to an estimated 70 million patients across the globe. And in the decades that followed, countless successors have built on the legacy of Johns and others by forging further breakthroughs in radiation therapy, advancing the field far beyond its position in 1951. 

And, thus, in our own moment of rich technological potential, with a mix of nostalgia and confidence, our health-care leaders might ask: Where have you gone, Harold Johns? Or, perhaps more appropriately, what should we be doing to support the “Johns-ians” among us today? What would Harold Johns do amid lively debates on artificial intelligence in health care, for example? What support would he need to bring his ideas from the laboratory into patient care?

On the issue of AI in health care, I’d like to think that Johns would be bullish on the convergence of new technologies and public policy. I think Johns would find common cause with present Canadian luminaries David Naylor and Geoffrey Hinton (yes, that Geoffrey Hinton) who suggested in 2018 that appropriately managed deep learning had the potential to transform health-care delivery (although Hinton has since added cautionary notes to his earlier championing). I think Johns, backed by a lifelong commitment to higher education, would encourage our generation of researchers to do the hard work of seeking and scaling the next mountain range, yet again making Canadian science and technology a marvel of the medical world.

Of course, one could (and should) argue that this call to action is more than a mere thought experiment. It’s, for many, a present reality. At the University of Toronto, where Johns founded the Department of Medical Biophysics following his time in Saskatchewan, there are already researchers setting the pace for AI in health care, testing interventions such as the use of patient voice and machine learning to diagnose disease. At the Princess Margaret Cancer Centre, another organization shaped by Johns’ legacy, researchers are finding ways to leverage data and digital technologies to enhance triage and better match patients with clinical trials. More broadly, AI is proving to be a valuable tool for improved detection of breast cancer as well as enhanced risk assessment for pancreatic cancer, among various other promising interventions. 

In other words, Harold Johns hasn’t gone anywhere. His pioneering spirit remains central to Canadian health research and technology.

But, is an ethos of transformation also evident as we migrate from science and technology to public policy? What happens when one moves from academic journals to venues of care for patients? Are we getting the full benefit of technological progress in our day-to-day experiences of health care? Are health-care policymakers responding to the complexities of AI with creativity or constraint? If the latter, which policymakers are willing and able to roll up their sleeves and break through the (ana)log jam? After all, what would Johns have done if then Saskatchewan Premier Tommy Douglas didn’t do the tedious work of prioritizing cancer care; or if the Leslie Frost government in Ontario hadn’t established the Ontario Cancer Institute? What if the vigor of technologists wasn’t met with the thoughtful planning of our political leaders?

Folks smarter than I have observed that data readiness, valid concerns around inequities, regulatory frameworks, and human resources—among other factors—can slow the progress of AI in health care across Canada. Indeed, predictions of AI-type technologies significantly reducing health human resource pressures are now decades old, yet parts of our health system are lacking in their propensity to adopt latest and greatest technologies—contributing to stories of long wait times and burnt-out health-care providers. So, it’s fair (and understandable) to say that our systems have room for improvement. And it’s also fair to say that fundamental governance changes in the midst of a technological inflection point are difficult to navigate. 

And therein lies the rub. Health-care policy systems that aren’t already purpose-built for transformation—that have yet to make a habit of developing, assessing, adopting, and scaling technological innovation, as well as its various supplements (e.g. high-quality data, and agile training programs)—are at risk of not fully capturing the enormous potential that is AI in health care. Our current policy ecosystems may become disoriented—to the point of static—if mega-opportunities, including but not limited to AI, are not systematically calibrated with our rightly complex health-care institutions.

In the case of AI in health care, some important first policy steps toward such alignment could include: credentialing that results in better training for health-care professionals in the use and management of emerging technologies; acceleration of electronic health implementation in a way that makes data voluminous, higher-quality, and more usable across providers; greater resourcing and scaling of localized problem-solving; and creating increased capacity within administrative apparatuses for true value-based procurement—inclusive of more rapid assessment and adoption of leading-edge technologies. If we can capitalize on these reforms (as starting points), we will continue to foster an environment where health-care entrepreneurs can thrive, and where patients can get the best care in the world.

So, for every ounce of legitimate public policy reactiveness and administrative complexity we inject into our health-care systems across Canada, we should inject equal parts public policy foresight. We should view an “AI in Cancer Care Moonshot” not as a possible science-fiction title, but as a practical necessity. As often as we query provincial comparisons on wait times, we should ask which province will lead the country, or even the international community, in defining the future of medical technology. The impulse toward this kind of virtuous competition is discernable in initiatives like Ontario’s Innovation Pathway, or Alberta’s new Chair in AI in Health, or Nova Scotia’s Health Innovation Hub. But more is needed. Fast.

For the past three years, many of us have felt a degree of anxiety about our health-care systems. We’ve tried to avoid getting sick. We’ve strained to hold up frayed processes of diagnosis and treatment. And we’ve grown exhausted sorting facts from fiction in popular medical discourses. 

Yet, there is another path. A more positive and aspiring path. A path that is both newer, and older. It’s the Harold Johns path.