The Creative Destruction of Medicine: How the digital revolution will create better health care by Eric Topol
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The Future of Remote Healthcare
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 beginning of the end for oil in Saudi
I was talking with someone in Dubai yesterday and they pointed me in the direction of a great statistic, which is that by 2040 Saudi will be a net importer of oil. It’s so good in fact that if you Google: “By around 2040, Saudi Arabia will be a net oil importing nation”, Google tries to correct your search by changing “importing” to “exporting”.
Source of the graph is Chatham House (Burning Oil to Keep Cool: The Hidden Energy Crisis in Saudi Arabia by Glada Lahn and Paul Stevens) but IMF has also referred to this forecast.
Monday Statistic
According to the UK Office of National Statistics, there will be more than 500,000 people in Britain aged 100 + by the year 2066. There are currently just 12, 640 people aged 100 or more (itself a 500% increase on 1980).
The Nature of Consciousness
Following on from my last post about the fabric or reality here’s another in a similar vein. Both are from the cutting room floor in the sense that I’m doing a second (and hopefully final) edit of one of my new books (The Future: 50 things you really need to know) and these didn’t make the cut for one reason or another.
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Consciousness is difficult to get your head around. It’s essentially thoughts, or awareness, generated by the interaction between the human brain and the outside world, although some might argue that it’s your mind not your brain doing this. Perhaps it’s simply awareness of self or of one’s own thinking.
Consciousness is somewhat problematic in that we cannot currently define it let alone understand exactly how it works or replicate it. Where, for example, does consciousness reside? Is the brain separate from the mind, and if so, how is it separate? Until we can answer these questions, we will never be able to create an artificial intelligence (AI) that will truly rival human beings. Machines are already very smart, but they are a very long way away from being able to criticise their own thinking or create their own problems. In short, can a machine ever really be described as intelligent if it does not really think in the true sense of the word?
Thinking about this issue in a slightly different way, perhaps new forms of intelligence will emerge from new forms of chaos. For example, think of the way that shoals of fish move around or swarms of bees interact. Maybe, the wisdom of crowds will evolve into something resembling a ‘hive’ consciousness – billions of human brains unknowingly connecting with each other to create a superior form of instinctive intelligence.
In a book about the future, and the fringes of current thinking, it is worth probing two areas that relate to human consciousness, both of which are somewhat metaphysical and philosophical. The first is how do we know that what we currently understand as consciousness (i.e. being alive) is not merely a Matrix movie-like dream or simulation? How do we know that we even exist? If you are interested in this I would recommend another book in this series, which is 50 Philosophy Ideas You Really Need to Know. That’s a cheap way of digging myself out of a large hole.
The second thought is whether or not it could be possible for human consciousness to reside or move outside of the human body. This will sound a little crazy, but we need to consider this for two reasons. First, this could link to discussions about a human soul, which links to various spiritual and religious ideas. Second, if we are trying to turn ourselves into immortal beings (transhumanism) or build true thinking machines (AI), this could lead to the development of devices that could ‘hold our souls’ – or at least an individual consciousness.
Some religions, of course, may argue that this happens already. Some faiths, for instance, believe that after a person dies, their spirit or soul leaves the old body and passes to that of another animal or even a plant. Maybe one day it will be discovered that this is true or that it is possible for a soul to pass into, or somehow inhabit, inert objects or materials such as rocks. Or that consciousness contains some kind of unknown energy that can be housed in things such as buildings or disrupt other unknown energy fields.
And what of animals? They have brains, but do they possess consciousness? This is an ethically charged area, not least because if you deny animals consciousness (or knowledge of their own existence) this can be used as a justification for killing them.
And what of plants? Could we one day discover that they possess some kind of limited consciousness? It’s not impossible that consciousness is actually a continuum and that all living things have some level of self-knowledge.
And if you think that’s a bit unlikely I have another idea for you. What if it were one day possible to introduce, or remove, memories from the head of an individual via pharmacological intervention. You could then make people believe that something had happened to them even when it had not or, conversely, remove the memory of real experiences. And, of course, the individual could be made unaware that such an intervention had ever taken place. The military would have an obvious interest in what could perhaps be termed ‘pharmaceutical reality’ due to Post Traumatic Stress Disorder (PTSD), and so to would some victims of serious crime. But what if governments or corporations (or even parents) started to alter reality in this manner? Perhaps it would start, innocently enough, with a desire to remove the stress and strain of everyday living via neural implants, but who is to say that it would stop there?
The Fabric of Reality
The traditional, classical, view of reality is that something only exists in one place, but what if objective reality was found not to exist? What if an object could be in more than one place at once? What if particles billions of miles away could communicate with each other faster than the time it takes for light to travel between them – or what if time could move in more than one direction?
Albert Einstein stated that if someone travelled into space at a sufficiency high speed and came back to Earth, they would experience less time than someone who stayed at home. So time, essentially, is relative, even at slower speeds.
There are limits to this theory because Einstein believed that nothing with mass could travel faster than light, but what if he was wrong? Could someone get back before they had left (time travel). It’s a bit like flying from London to New York on a supersonic jet and getting to the Big Apple before you’ve left old London town. Keep this thought in your head, but also consider another one.
In the 1920s it was thought that memories were stored in very specific locations in the brain. But in 1977, Karl Pribram, a Stanford University neurophysiologist, came to the opposite conclusion, namely that memories were not to be found in specific brain cells, but were more widely distributed throughout the brain. This didn’t make a whole lot of sense until he started to think in terms of holograms. Perhaps the human mind was functioning in a similar way?
If you are not familiar with holograms they are made by splitting a laser beam into two. One beam is bounced off an object and the second functions as a reference beam. If you cut a laser image of an object in two, each piece would contain the complete image, albeit at a slightly lower resolution. Hence, the possibility that each brain cell might be able to contain the same memory. If you think this is impossible, consider the fact that holographic storage is one way that computers could progress in the future. Quite what a neural equivalent of a laser reference beam could be is anyone’s guess, as is the ultimate nature of what the brain is perceiving.
In 2011 a Nobel Prize was awarded to work in relation to Dark Energy. This is a force believed to be responsible for the fact that the universe is expanding at an accelerating rate. Link this to some other astronomical ideas (for example, the belief that the universe is infinite) and you might arrive at the idea of a universe containing every conceivable combination of matter, which could mean other permutations of you reading this book. In other words, our universe is actually a multiverse. The universe is not the only one and neither are you. This idea is probably a bit of a stretch, partly because it’s unknown whether the universe is infinite or not and because there’s a big difference between a situation where everything must happen and one where anything could happen. Nevertheless, it’s an interesting way to give yourself a headache, a bit like trying to think about what infinite space – or it’s converse – or no outside beyond the universe would look like.
Going even further ‘out there’, perhaps there are not only things we cannot see, but there is another dimension hidden from human awareness. This takes us to the fringes of physics and into mainstream science fiction but, as we’ve seen, the two do sometimes collide. Take Black Holes, for instance. Technically nothing can escape from a Black Hole because to do so would require movement faster than light. But what if things could move far faster than light? Indeed, what if there was a tiny black hole inside every atom? What if travel, not only in time, but also between different universes, were possible? Perhaps the world really is inside a grain of sand.
As usual, someone has already thought of this and other strange possibilities.
For example, in Fritz Leiber’s book, The Big Time, war is waged across time. Perhaps inter-dimensional travel explains ghosts, although if this were the case, why do people only ever see visions of people from the past and never people from the future? What if memories were real and could exist outside of the brain or what if cracks in parallel universes allowed things to leak out? Maybe this would explain premonitions or deja vu? Indeed, what if nothing really exists? What if everything is just nothing except oscillating energy of various kinds that can exist in all places simultaneously?
Maybe our dreams or our intuitions are as real as reality ever gets.
Libraries
I had an 11-hour flight yesterday so I managed to polish off something called the Library Book (Profile Books). It’s a collection of short essays by people that are passionate about and wish to protect public libraries, including Julian Barnes, Caitlin Moran and Seth Godin. There wasn’t anything inside that I didn’t already know about in a sense, but it was good to have some key thoughts confirmed – such as not reducing the value of a library to the sum of the books on its shelves.
The book is full of good quotes but one I especially liked is this one by Caitlin Moran:
“A library in the middle of a community is a cross between an emergency exit, a life raft and a festival. They are cathedrals of the mind; hospitals of the soul; theme parks of the imagination. On a cold, rainy island, they are the only sheltered public spaces where you are not a consumer, but a citizen instead. A human with a brain and a heart and a desire to be uplifted, rather than a consumer with a credit card and an inchoate ‘need’ for ‘stuff’.
BTW, a fun aside was that the in-flight entertainment system broke down three times and some of the passengers almost had heart attacks at the thought of eleven hours with no access to a screen. What were they supposed to do? Should have brought a book I guess.
One final thought just in via email – a great list of 10 ways we can expect libraries to change in the future. Click right here (thanks Kaitlyn).
The Russians are coming
I’m lying face down in the Indian Ocean wondering where all the Chinese have gone. To be more precise, I’m in a bungalow on slits lying on a massage table at one end of which is a hole through which you can put your head and through which you can see the remnants of a coral reef and a few fish thanks to a glass plate inserted into part of the wooden floor. Did I mention I’m wearing black nylon women’s underwear? (I’ve had a few massages in my time, but I’ve never before been asked to wear nylon knickers under my towel, which is really pants if you know what I mean).
Anyway, the point of this story is that at the end of the massage the woman leans over and says “Good, but ouch.” I think she was referring to the strength of her massage technique and the fact that I’ve done something to the muscles in one of my arms, but perhaps she was referring to the world economy over the next couple of decades.
I’ll use that line somewhere one of these days.
Other observations. The resort – in the Maldives – is a real melting pot of nationalities, especially Indian’s, Arabs and a few Europeans, but at least one third of visitors are Russians, many of whom are the colour of freshly fallen snow. In the evenings, a local band plays traditional Russian folk songs. There are no American tourists anywhere to be seen.
I spoke to one of the resort staff and he said that before the 2012 coup, 80-85% of tourists were Chinese. I’m probably reading too much into this, but perhaps the Russians are a little more used to political turmoil?
And no, there are no pictures of my knickers.
Books (and a stat)
Two books I like the sound of. The first is Quiet: The Power of Introverts in a World That Can’t Stop Talking by Susan Cain. Essentially this is about the transition from an age of character (actions) to one of personality (style) where the pressure to entertain and sell oneself (and never to be nervous or unsure about oneself) is growing rapidly. Here’s the central idea of the book: “Introverts living under the extrovert ideal are like women living in a man’s world, discounted because of a trait that goes to the core of who they are.”
The second is It Was a Long Time Ago and It Never Happened Anyway by David Satter. This is about Russia, its lost utopia, its nostalgia for community spirit, its demographic crisis and the rise of Putin. My take from reading a review of this book is that Russia is now primarily about lost empire and a desire to be feared.
A stat from the book (could have been another one on Russia, I can’t remember): When the Soviet Union fell apart its population stood at 150 million. By 2025 it will be between 121 million and 136 million according to the UN.
Precognition
This is fun – and slightly mind popping if true. A handful of psychologists, notably Michael Frank at the University of California (Santa Barbara) and Daryl Bem, at Cornell are conducting experiments into peoples’ ability to foretell the future or, more precisely, whether it’s possible for the future to influence the present.
In one experiment Bem asked people to briefly look at a list of words and remember them. They were then given an edited selection of the same list of words, which they were also asked to memorise. Weirdly, people were more likely to remember the edited selection of words during the initial test. In other words, later events appeared to influence earlier behaviour. Several studies have tried to repeat these results, one study succeeded but six others failed.
Source: New Scientist, 14.1.12 pages 39-41.