Yesterday, I spoke on this topic at Anticipating 2025, an event hosted by London Futurists. [The talk was video recorded, and I will share when it's online]. The organiser, David Wood, is a smartphone pioneer, having been a co-founder of Symbian, the world’s first successful smartphone operating system.
Vinod Khosla's controversial comments back in 2012, were (and still are) very provocative, "By 2025, 80 percent of the functions doctors do will be done much better and much more cheaply by machines and machine learned algorithms."
2 years later, technology continues to advance, and we have more conferences on topics such as Wearable Tech and the Internet of Things. Healthcare is a complex & heavily regulated environment, and slow to change as the wrong decisions can cause harm to patients, and even death. The cost of healthcare, if allowed to continue rising is unsustainable. Today, it's reported that the NHS needs another £2bn. In the US, the 3rd leading cause of death is medical error, we have a shortage of 4.3 million doctors & nurses on this planet, and 1 billion people have no access to a doctor, hospital or clinic. I am always thinking, how can technology help?
Prevention of disease seems to be high up on the agenda in today's world. Well, what if all these new technologies heading our way can dramatically improve prevention? With sensors, what if our health could be monitored by the objects that are already around in our daily lives? Our phone, toilet, our shirt, our bed, our car?
How do we feel with machines knowing more about our health than either us or our doctors?
What are the ethical, legal & social implications in the future if you stick an "electronic tattoo" on the body of your elderly parent with dementia/newborn baby to monitor vitals & stream data to you & your healthcare provider/insurer when 'informed consent' is not possible?
Do we want smart vending machines that recognise who we are as we stand it front of it, knows from our medical records that we have high cholesterol, syncs with our wearable activity tracker to determine we haven't had much sleep last night and rarely exercise? When we press the buttons selecting a chocolate bar and a can of Coca-Cola, and the smart vending machine suggests we select a granola bar and coconut water, do we feel comfortable with a vending machine using our data to remind us to make healthy choices?
Last night, before going to bed, I used an AliveCor device with my iPhone to record my ECG, and paid $8 to get a clinical analysis report within 24 hours. Less than 12 hours later, I open the app to find the report has been delivered. If I can do this in 2014 with equipment available to consumers, from the comfort of my bed in my own home late at night, without going to see a doctor at a hospital, what could we do in 2025?
Cloud Computing has enabled SaaS (Software as a Service), are we heading towards MaaS (Medicine as a Service)? No need to wait 7 days to see a doctor! Get your blood analysed anywhere, anytime using your mobile device? These guys in France are working to do exactly that with their Beta-Bioled, the first hand-held blood analyzer. In Switzerland, scientists are developing a blood test performed via the screen of your smartphone.
What does this mean for physical hospitals and clinics? It's not just GPs that could be impacted. It's surgeons too. Imagine if we could take all the facilities, equipment and knowledge required to perform a successful surgery... and encode it in a single drop of saline. That's what Ido Bachelet is dreaming of when he talks about Surgical Nanorobotics at Solve for X in this video.
Today there is no profit in preventing people getting sick. The more sick we are, the more job security a doctor has. Will advancing technology cause business models to evolve? Naturally, with possibility of a seismic shift in healthcare, power, profit & prestige are at risk. The conversation doesn't have to be adversarial. We have to remember, that sometimes in life, the needs of the many, outweigh the needs of the few.
So, if technology does advance beyond our wildest expectations over the next 10 years, will the demand for doctors decline, or even disappear?
I believe we will still need humans in medicine - after all, delivering compassion & hope is not something a machine or a robot powered by artificial intelligence could do. When we are sick, we are weak, vulnerable & frightened. You need a human being to hold your hand & look you in the eye, and say "I'm here for you." Research shows that some older people visit their GP not because they are sick, but mainly because they are lonely. Will this push into Digital Health have a side effect of increasing loneliness & isolation?
Oxford University researchers published a study in 2013 where they estimated the probability of computerization of more than 700 occupations in the US. Overall, nearly 50% of occupations they analysed are at risk of disappearing. According to their model, the probability of doctors & surgeons being computerized over the next few decades is 0.4%. Not everyone in healthcare is safe though, medical record technicians are likely to disappear, and even 1 out of 5 epidemiologists.
[side note - Computer programmers are listed as 48%. It does make you wonder why governments are encouraging today's children to learn to 'code'. The infographic below is available here]
However, if much of what doctors do today gets automated, and they spend much more time delivering compassionate care, do they need to go through all that training in medical school? Does the definition of a human doctor change? Do doctors become nurses? With the explosion in data, be it genomic data or data from sensors and apps, is the doctor of 2025, a data detective?
Will the doctors who survive & prosper in 2025 be the ones that know Data Science, Computer Science, patient centred design as well as Biomedical science? A great blog post published yesterday by Kevin Wang, on how a smart washing machine helped him see the future for a safer ICU at the hospital. He's a quality and safety fellow, who wants want to integrate human-centered design into healthcare delivery and management.
Will it become easier & cheaper to produce doctors and to eliminate the global shortage? Does this mean the 1 billion people finally get what the other 6 billion have got? Access to a doctor.
If we don't manage to address the Digital Divide, will all this advancing technology simply increase inequalities in health? Will speedy diagnosis & treatment be the preserve of those wealthy enough to afford smart devices, sensors & the internet, whilst the poor have to wait several weeks to see an overworked human doctor? [Note: In Greece, a country of 11 million people, 65% of people have NEVER used the internet]
Just because we can use technology to automate tasks that humans do doesn't mean we have to do that. Despite all the promises, advancing technology isn't always used well, even by pioneers. Take Google Flu Trends (GFT), a program designed to provide real-time monitoring of flu cases around the world based on Google searches that match terms for flu-related activity. A new study shows that GFT over-predicted the prevalence of the flu in 100 out 108 weeks. This article describes the failings of Google's use of big data, and labels it, "automated arrogance."
Ultimately, technology has to serve the needs of humanity, not the other way round.
I genuinely believe we can transform the world of healthcare at a global level, but it requires taking time out of the present to actively consider our shared future, and the wide ranging implications of advancing technology. Unthinkable as it sounds, doctors could become the dinosaurs of the 21st century, given the relentless pace of automation through technology.
If your organisation is wanting to understand how to survive & prosper over the next decade in an uncertain world, do get in touch.
[Disclosure: I have no commercial ties with any of the companies mentioned in this post.]