Will machines will help to cure us or help to kill us in the future. I think the answer is probably a bit of both. First the good news.
I was in Poland doing a TEDx talk a while ago and met someone that had created a mobile application called Life Circle. This is essentially a way of using mobile phones to increase the supply of blood and, in particular, to solve the issue of short-term blood supply problems. Basically, if I’m a blood donor with a smart phone I register with a local blood bank and they take my smart phone number. If they have an emergency and need my blood type in a hurry they can instantly find out how close I am to them and ask me to come in. What’s more other blood banks internationally can be linked into the same system.
But there’s more. The mobile app can link with social networks, so users can tell their friends about the idea, talk about blood donation or even – and you’d have to be rather careful with this – compete with each other online over how much blood they’ve donated recently.
It’s a great idea, but it’s not the only one out there. 23andMe is brilliant too. For $150 I can find out what I’m likely to get seriously sick from in the distant future and try to adjust my lifestyle so that perhaps I don’t. I can sign up for the latest news about my specific condition too.
Other great ideas I’ve come across recently include a Kettle in Japan that knows when its usually pickled up in the mornings and will send an SMS to a carer when its not.
I’ve seen clothing in Singapore that knows if the wearer has fallen over, and possibly why, and calls for help if needed.
I’ve seen a virtual role playing game (SPARX ) that helps teenagers deal with depression and boost self confidence, robotic teddy bears that teach kids with diabetes to manage their condition, cutlery that tells you if you’ve got too much salt on your food, a personal DNA sequencer that’s the size of a USB memory stick (MinION) and a computer the size of a grain of sugar (with a microprocessor, solar panel, pressure sensor and wireless connectivity).You stick the computer in your eye to measure the pressure of liquid on your eyeball and the data is sent to your doctor – for people with Glaucoma. And let’s not forget what’s on the horizon in areas such as regenerative medicine, user-generated medicine, robotics, nanotech and data mining.
In short, everything is getting smarter, cheaper, smaller and linked together with the result that we are generating huge mountains of data that can be used to observe things that were previously invisible and to predict things with increasing degrees of accuracy. This means that information is getting cheaper, its reach is being extended and its uses are increasing rapidly. Moreover, power is shifting from institutions to individuals (i.e. from doctors to patients), hopefully with the result that people will be empowered to look after themselves a bit more and challenge the powers at be when the powers at be seem to be wrong with their diagnosis or opinions. The transparency and collaborative nature of websites like Patientslikeme is just the beginning.This isn’t utopia by a long shot, but things are moving in a good direction.
But there’s also a darker side.
Connectivity is destroying privacy. Connectivity is fuelling cyber crime (including medical identity theft and fraud in the US), is destroying intellectual property, is shortening attention spans and, most worrying of all, perhaps, is allowing individuals to shut themselves off from the rest of the world, or at least shut themselves off from the views and opinions of those that contradict what they believe. As for ‘The Cloud’, that’s a great development, but I do still worry about overall security and whether the companies that are controlling my data will still be around over the longer term and whether they can be trusted to do what they say they’ll do in terms of access.
And let’s not forget about Internet addiction either – between 2% and 20% of all users from the studies I’ve seen, but who really knows yet. Interestingly, if you plot the uptake of mobile devices by children in the UK against Ritalin prescriptions there appears to be a correlation, although perhaps that’s just a coincidence. Maybe you’d get the same result plotting Ritalin against scooters sales or visits to Gregg’s bakers.
But maybe not. Scientists at the University of California (San Diego), for example, claim that constant exposure to digital information means that there is no longer enough time available for what has been termed ’emotional processing’. In short, digital devices are not only making us impatient, they are leading to a loss of empathy.
Another study wonderfully titled ‘Ego Inflation Over Time: A Test of Two Generational Theories of Narcissism Using Cross-Temporal Meta-Analysis’ (I love that!) has found a marked increase in narcissism among US students since 1982. The 40-question survey attracted 16,475 respondents and found more individuals than ever agreeing with statements like “I think I am a special person.” One explanation put forward by researchers to explain the increased focus on the self is Web 2.0 and sites like YOUTube and MYSpace. There seems to be an explosion of ‘Me-ism’ out there and Web 2.0 and mobile technology seems the most likely culprit.
My other main concern here is that while some commentators say that power is transferring from institutions to individuals, the exact opposite may be occurring. Google knows a lot about me. So does my mobile phone company. If I were on Facebook, which I’m not, they would know even more. As for governments, at the moment they’re relatively stupid. I know that they able to intercept certain things I say and observe certain patterns of behaviour, but mostly I’m left alone – for now.
But what happens when governments really wake up to the potential of the data that we now broadcast almost every hour of the day thanks to our addiction to mobile phones, digital money, online shopping and social networks?
One thing is for sure. If governments are short of money, which they often are, they’ll start to ration access to certain services based upon observed behaviour and choices. Free dental care? Not if I’m seen to be addicted to Cadbury’s Fudge bars.
A new heart? I doubt it, not unless I’m seen to be walking more and spending less time in KFC. I know this happens already to some extent, but we’ve not seen the start of it in my view. Moreover, who is to know whether I really need those Fudge bars?
Perhaps they calm me down and stop me from becoming an axe murderer!
What’s clearly happening here is that behaviour (even attitudes) that were once private and hidden from view are becoming increasingly public – or at least visible to certain parties. Do this matter? I think it does. Firstly, whose data is this? Does it belong to the individual that’s generates it, the people that own the device that captures it or someone else? Should people that generate this data be able to sell it to others and if who exactly should be allowed to see it?To me these are big questions and we’ve not even started the debate yet.
I’m something of a tragic when it comes to collecting statistics and two that caught my attention recently were that around 50% of America’s medical budget is consumed by around 5% of the US population. The other one is that in Australia, between 27% and 31% of lifetime Medicare expenditure is spent in the last week of a patient’s life.
Again, I don’t know how true these figures are, but if they are even remotely correct then two thoughts enter my head. The first is that governments are going to find out one way or another who the heaviest users of healthcare are and do one of two things. Either they are going to limit expenditure by individual patients with some kind of lifetime maximum or they are going to ration the availability of healthcare based upon observable behaviour. How are they going to do the latter? With technology and with information.
Two other thoughts.
The first is that healthcare is going to become much more targeted or personalised based upon information about individual patients. How with we do this? Technology again.
The second thought is that one highly plausible future is a somewhat uncomfortable mixture of high-technology and austerity. We will invent the most incredible new medical technologies, but we’ll have to ration them due to cost, either because governments don’t have enough money to deploy them or because they will cost too much to use. I’m referring to things as prosaic as energy costs Many of these machines use a great deal of energy to operate and so too do supercomputers, networks and clouds. We may solve this in the future with quantum computing but don’t bet in it, especially in the shorter term.
So, overall, am I optimistic or pessimistic? Will machines free us or enslave us? I don’t know the answer to this question yet. But I do know that ultimately the answer is in our hands. I do not agree with the thought that technology is neutral. It isn’t. Technology sets boundaries, rules, about what can and can’t be done the minute it comes into contact with human minds and human hands.
But it is up to us whether we accept these rules. Our present choices and actions shape the future and what I’d like to see is more debate about the social impacts of certain technologies.
Technology has played a role in medicine for hundreds if not thousands of years. But so too have people. You can automate, virtualize and cost-save your way to a future where doctors and nurses are almost redundant. But in my experience what people that are sick want, apart from being better, is human contact.
Last year I hear that someone made the comment that if you removed 1% of human interaction from the NHS and relied instead on machines, the NHS would save £250 million. That’s great. £250 million to spend on improving healthcare and saving lives elsewhere. But taken to the extremes, the cost saving mentality is almost as dangerous and the idea that all human interactions should be replaced by machines for reasons of speedy or efficiency.
To me the whole point of technology and the data that it can produce is to enhance human thinking and contact. If it replaces them we are all in serious trouble.
The 1918-19 flu pandemic killed somewhere in the region of 50-100 million people. Whatever the figure it was almost certainly greater than the number of people killed during World War 1. Most experts agree that another epidemic is overdue, possibly not on the same scale, but devastating to at least our mental state nevertheless. On a slightly related note, expect to see a return to some old-fashioned diseases and conditions in the future — gout and rickets for example.
The flip side of the happiness trend is unhappiness, and in particular loneliness and depression. And depression is linked to all kinds of other problems. For example, a study by Brown Medical School (US) found that men who suffer from depression increase their risk of heart disease by 12% (and if they’re pessimists, the risk increases by 18%). Is this a real trend caused by the likes of individualism, living alone, and social exclusion (lack of community) or is it just that people have got time to think about themselves too much these days? Once upon a time depression was just part of the human condition. In the future it will, increasingly, be treated as an illness.
In the future, patients will demand 24/7 access to their full medical records. In some cases they will even carry them around on their person (i-Pods for your medical history?). Links with the growth in mobile medical devices.
The ageing trend is a megatrend that will have enormous influence on healthcare in the future as people not only live longer (life expectancy is expected to be 100+ by 2020 for many countries) but expect to be well for longer too. Obvious impacts include higher expenditure on pharmaceuticals and care for the elderly which are already at record levels in the US (healthcare spending in the US was US $1.7 trillion in 2003), but the type of diseases we’ll see will also change. We’ve already seen voice lifts and other forms of anti-ageing surgery. Expect to see more R&D dollars put behind things like memory recovery and enhancement and the replacement of body parts. Also expect to see more debate about subjects like euthanasia.
Increasing hospitalisation and treatment costs, together with developments in remote monitoring and wireless communications, will create a boom in home based monitoring, diagnosis and treatment. This trend will also be driven by the rise in the number of people aged 65+ that are quite literally clogging up hospitals (there has been a 155% increase in the number of Americans being treated for heart failure in the US, not because of an increased disease rate but simply because people are living for longer). A good example of such self-diagnosis or treatment is the Philips Heart Start Automatic External Defibrillator (AED). That’s right, your very own personal defibrillator available from amazon.com for US $ 1,495. The price might give a few people a heart attack but at least they can treat themselves.
It looks increasingly likely that we will be able to model biological systems and processes using computers and then use computerised models and simulations to design and test new drugs. It currently costs around US $900 million and fifteen years to design and launch a new drug, so the cost savings could be significant. Some observers put potential savings at around US $200 and three years. How far are we away from this? Most experts say at least 10-15 years given that we still don’t know how many physiological processes work.