Being Human

This is the most difficult blog post I’ve ever had to write. Almost 3 months ago, my sister passed away unexpectedly. It’s too painful to talk about the details. We were extremely close and because of that the loss is even harder to cope with. 

The story I want to tell you today is about what’s happened since that day and the impact it’s had on how I view the world. In my work, I spend considerable amounts of time with all sorts of technology, trying to understand what all these advances mean for our health. Looking back, from the start of this year, I’d been feeling increasingly concerned by the growing chorus of voices telling us that technology is the answer for every problem, when it comes to our health. Many of us have been conditioned to believe them. The narrative has been so intoxicating for some.

Ever since this tragedy, it’s not an app, or a sensor or data that I turned to. I have been craving authentic human connections. As I have tried to make sense of life and death, I have wanted to be able to relate to family and friends by making eye contact, giving and receiving hugs and simply just being present in the same room as them. The ‘care robot’ that had arrived from China this year as part of my research into whether robots can keep us company, remains switched off in its box. Amazon’s Echo, the smart assistant with a voice interface that I’d also been testing a lot also sits unused in my home. I used it most frequently to turn the lights on and off, but now I prefer walking over to the light switch and the tactile sensation of pressing the switch with my finger. One day last week, I was feeling sad, and didn’t feel like leaving the house, so I decided to try putting on my Virtual Reality (VR) headset, to join a virtual social space. I joined a virtual computer generated room where it was sunny and in someone’s back yard for a BBQ, I could see their avatars, and I chatted to them for about 15 minutes. After I took off the headset, I felt worse.

There have also been times I have craved solitude, and walking in the park at sunrise on a daily basis has been very therapeutic. 

Increasingly, some want machines to become human, and humans to become machines. My loss has caused me to question these viewpoints. In particular, the bizarre notion that we are simply hardware and software that can be reconfigured to cure death. Recently, I heard one entrepreneur believe that with digital technology, we’ll be able to get rid of mental illness in a few years. Others I’ve met believe we are holding back the march of progress by wanting to retain the human touch in healthcare. Humans in healthcare are an expensive resource, make mistakes and resist change. So, is the answer just to bypass them? Have we truly taken the time to connect with them and understand their hopes and dreams? The stories, promises and visions being shared in Digital Health are often just fantasy, with some storytellers (also known as rock stars) heavily influenced by Silicon Valley’s view of the future. We have all been influenced on some level. Hope is useful, hype is not. 

We are conditioned to hero worship entrepreneurs and to believe that the future the technology titans are creating, is the best possible future for all of us. Grand challenges and moonshots compete for our attention and yet far too often we ignore the ordinary, mundane and boring challenges right here in front of us. 

I’ve witnessed the discomfort many have had when offering me their condolences. I had no idea so many of us have grown up trained not to talk about death and healthy ways of coping with grief. When it comes to Digital Health, I’ve only ever come across one conference where death and other seldom discussed topics were on the agenda, Health 2.0 with their “unmentionables” panel. I’ve never really reflected upon that until now.

Some of us turn to the healthcare system when we are bereaved, I chose not to. Health isn’t something that can only be improved within the four walls of a hospital. I don’t see bereavement as a medical problem. I’m not sure what a medical doctor can do in a 10 minute consultation, nor have I paid much attention to the pathways and processes that scientists ascribe to the journey of grief. I simply do my best to respond to the need in front of me and to honour my feelings, no matter how painful those feelings are. I know I don’t want to end up like Prince Harry who recently admitted he had bottled up the grief for 20 years after the death of his mother, Princess Diana, and that suppressing the grief took him to the point of a breakdown. The sheer maelstrom of emotions I’ve experienced these last few months makes me wonder even more, why does society view mental health as a lower priority than physical health? As I’ve been grieving, there are moments when I felt lonely. I heard about an organisation that wants to reframe loneliness as a medical condition. Is this the pinnacle of human progress, that we need medical doctors (who are an expensive resource) to treat loneliness? What does it say about our ability to show compassion for each other in our daily lives?

Being vulnerable, especially in front of others, is wrongly associated with weakness. Many organisations still struggle to foster a culture where people can truly speak from the heart with courage. That makes me sad, especially at this point. Life is so short yet we are frequently afraid to have candid conversations, not just with others but with ourselves. We don’t need to live our lives paralysed by fear. What changes would we see in the health of our nation if we dared to have authentic conversations? Are we equipped to ask the right questions? 

As I transition back to the world of work, I’m very much reminded of what’s important and who is important. The fragility of life is unnerving. I’m so conscious of my own mortality, and so petrified of death, it’s prompted me to make choices about how I live, work and play. One of the most supportive things someone has said to me after my loss was “Be kind to yourself.” Compassion for one’s self is hard. Given that technology is inevitably going to play a larger role in our health, how do we have more compassionate care? I’m horrified when doctors & nurses tell me their medical training took all the compassion out of them or when young doctors tell me how they are bullied by more senior doctors. Is this really the best we can do? 

I haven’t looked at the news for a few months and immersing myself in Digital Health news again makes me pause. The chatter about Artificial Intelligence (AI), where commentaries are at either end of the spectrum, almost entirely dystopian or almost entirely utopian, with few offering balanced perspectives. These machines will either end up putting us out of work and ruling our lives or they will be our faithful servants, eliminating every problem and leading us to perfect healthcare. For example, I have a new toothbrush that says it uses AI, and it’s now telling me to go to bed earlier because it noticed I brush my teeth late at night. My car, a Toyota Prius, which is primarily designed for fuel efficiency scores my acceleration, braking and cruising constantly as I’m driving. Where should my attention rest as I drive, on the road ahead or on the dashboard, anxious to achieve the highest score possible? Is there where our destiny lies? Is it wise to blindly embark upon a quest for optimum health powered by sensors, data & algorithms nudging us all day and all night until we achieve and maintain the perfect health score? 

As more of healthcare moves online, reducing costs and improving efficiency, who wins and who loses? Recently, my father (who is in his 80s) called the council as he needed to pay a bill. Previously, he was able to pay with his debit card over the phone. Now they told him it’s all changed, and he has to do it online. When he asked them what happens if someone isn’t online, he was told to visit the library where someone can do it online with you. He was rather angry at this change. I can now see his perspective, and why this has made him angry. I suspect he’s not the only one. He is online, but there are moments when he wants to interact with human beings, not machines. In stores, I always used to use the self service checkouts when paying for my goods, because it was faster. Ever since my loss, I’ve chosen to use the checkouts with human operators, even if it is slower. Earlier this year, my mother (in her 70s) got a form to apply for online access to her medical records. She still hasn’t filled in it, she personally doesn’t see the point. In Digital Health conversations, statements are sometimes made that are deemed to be universal truths. Every patient wants access to their records, or that every patient wants to analyse their own health data. I believe it’s excellent that patients have the chance of access, but let’s not assume they all want access. 

Diversity & Inclusion is still little more than a buzzword for many organisations. When it comes to patients and their advocates, we still have work to do. I admire the amazing work that patients have done to get us this far, but when I go to conferences in Europe and North America, the patients on stage are often drawn from a narrow section of society. That’s assuming the organisers actually invited patients to speak on stage, as most still curate agendas which put the interests of sponsors and partners above the interests of patients and their families. We’re not going to do the right thing if we only listen to the loudest voices. How do we create the space needed so that even the quietest voices can be heard? We probably don’t even remember what those voices sound like, as we’ve been too busy listening to the sound of our own voice, or the voices of those that constantly agree with us. 

When it comes to the future, I still believe emerging technologies have a vital role to play in our health, but we have to be mindful in how we design, build and deploy these tools. It’s critical we think for ourselves, to remember what and who are important to us. I remember that when eating meals with my sister, I’d pick up my phone after each new notification of a retweet or a new email. I can’t get those moments back now, but I aim to be present when having conversations with people now, to maintain eye contact and to truly listen, not just with my ears, and my mind, but also with my heart. If life is simply a series of moments, let’s make each moment matter. We jump at the chance of changing the world, but it takes far more courage to change ourselves. The power of human connection, compassion and conversation to help me heal during my grief has been a wake up call for me. Together, let’s do our best to preserve, cherish and honour the unique abilities that we as humans bring to humanity.

Thank You for listening to my story.

An app a day keeps the doctor away?

An app a day keeps the doctor away may very well be what our children hear as they grow up in the 21st century. During my research, I found that the origin of the familiar phrase, "An apple a day keeps the doctor away", may have originated 148 years ago in Wales, UK

A Pembrokeshire proverb. Eat an apple on going to bed, And you'll keep the doctor from earning his bread.

Before I talk about apps replacing apples, I'd like to share some of the feedback that's been generated from my last blog post on tech making doctors unemployed. It's triggered a healthy debate within & outside the medical profession. I'm not sure doctors like me anymore! 

I've had docs email me saying stop pushing this kind of talk, I need to put my kids through college. Some of the younger doctors have responded positively, understanding that they might benefit by having digital skills as a doctor. Many older docs seem to be terrified, and some docs of all ages seem to be responding to the threat with at attitude of "Bring it on!"

All of this has really made me think deeply about the choices we face in society in this increasingly automated world. A visit to a London supermarket this week compelled me to ask this question. 

Whilst some doctors may be outraged that I have the audacity to even challenge the notion that their work cannot be automated by machines, there are deeper questions facing ALL of us in society. This recent Guardian article which has the headline, "When robots take our jobs, humans will be the new 1%. Here's how to fight back."

Even much of the work I've done for the past 20 years, in the realm of data analytics, is being handled by machines and software now. In fact, as a Futurist, I may be joining the doctors at the unemployment office in 2025, given that robots are now writing news stories, and some believe that 90% of the news could be written by computers by 2030.

Is the future that we're heading towards really the future we desire? If it isn't the future we desire, whose responsibility is to intervene? Should governments create policies that encourage institutions to retain human workers, even when the human is more expensive than the machine? Should the CEO of a corporation also wear the hat of Chief Ethics Officer? 

Will getting an app on prescription become the norm?

Many people including patients in rich countries may roll their eyes at using their mobile phone for healthcare, but patients in low and middle income have been using mobile phones in healthcare for several years, frequently using text messages with more basic phones, not apps with smartphones.

In fact, Africa is home to the largest number of mHealth projects in the world. A list with examples of projects can be found here. Patients in the US during 2014 will be able to download the world's first doctor prescribed app, Bluestar, for helping them to manage Type 2 Diabetes. This is a massive step, and could it be a signal of times to come? 

Well, a recent poll of physicians in the US revealed that "37% have no idea what apps are out there."

According to research conducted by Digitas Health in 2013, 90% of chronic patients in the US would accept a mobile app prescription from their doctor. Do you know what proportion of those patients said they would accept a prescription of medication? Just 66%!

So, this is the future, right? Well, doctors have a right to be wary of apps. In a previous blog post, I mentioned how a certification program for health apps allowed an app to be certified which had flaws relating to protection of data in the app. We are heading into uncharted waters, and mistakes are to be expected. Looking beyond the hyperbole, the key question for me (and the regulators) is, do the benefits outweigh the risks? 

Source: Pew Internet Research Project

Source: Pew Internet Research Project

The conclusions of the first ever cross-stakeholder Pan-European seminar on Health Apps & how patients, policy-makers, healthcare professionals and industry see the future was recently published in a white paper. What I find encouraging in the paper is the that EU has made it clear that it does NOT want to discourage the burgeoning market for health apps by producing excessive red tape.

As Digital Health becomes more prevalent, the scenario of doctors everyday weighing up whether to prescribe an app or a medication to a patient is entirely possible in just a few years. However, as this recent paper in JAMA remarks, we will need an unbiased review & certification process for health apps, if this is to happen.

Exciting stuff, but I can't help but also wonder, exactly how much of an impact will prescribing of apps really make on healthcare, given that just 18% of Americans aged over 65 own a smartphone? That figure drops to 8% for those over 65s with annual household income of $30,000 or less!

Should we be asking innovators to focus their energy on technologies that solve the problems of the biggest users of healthcare, those aged over 65? Will many basic problems in healthcare remain unresolved, as the 'worried well' develop amazing technology, to be used primarily by the 'worried well'?

What role will community pharmacies play in public health if prescribing of apps takes off and fewer people actually walk into a physical pharmacy? Will apps cause pharmacists to also become unemployed in the long term? 

What is the impact on the future of the pharmaceutical industry which is not just slower than other sectors to adapt, but also employs considerable numbers of people around the globe? IMS Health, the world's largest health data broker, has launched AppScript, a platform that offers doctors easy, secure and evidence-based app prescribing.

What about absurdly simple problems, such as being prescribed an app, but your smartphone's battery barely lasts the whole day, and the battery could die just as you really need to use the app to manage your condition. A tablet doesn't need a power source. 

What about the impact on our eyes? Opticians have recently warned that overuse of smartphones may damage your eyes.

What's the impact on the fabric of our society if in the future, we can both be diagnosed & treated from the comfort of our own home just using a our smartphone combined with an app & a tricorder?

Scanadu Scout  

Scanadu Scout 

Not long to wait to answer that question! The combination of the long awaited Scanadu Scout and their app on Monday may indeed make the phrase, an app a day keeps the doctor away, part of our everyday vocabulary. The latest blog post from Scanadu, mentions "placing it over the forehead to take a composite, multi-parameter biometric signature that pulls in several vital signs in seconds: diastolic and systolic blood pressure, body temperature (core temperature is coming in a couple of weeks), SPO2 (blood oxygenation), and heart rate." 

I should be getting my hands on a unit soon, and look forward to sharing my feedback with you!

One more thing, what if the apps in our cars in the future 'prescribed' us a different route home to improve our health? Given Apple's development of CarPlay, I mocked up a possible scenario of the world we could be heading towards. The question again - is this a desirable world?

Asking Siri to navigate home may never be the same again.

My next talk - Boston!

I'm going to be passing through Boston, MA in 2 weeks time. It's last minute, but I'm hoping to be able to give a talk there on whether tech will make doctors unemployed and also share some of my ideas & thoughts on how the medical profession could adapt to this rapidly changing world of Digital Health. As soon as it's confirmed, I'll share the details on Twitter. If whilst I'm in Boston, your organisation wishes to book me as a speaker, please see my Public Speaking page.

[Disclosure: I have no commercial ties with any of the companies mentioned above]

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Healthcare in the future: Will advancing technology make doctors unemployed?

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

Sources: University of Oxford, Carl Benedikt Frey and Michael A. Osborne  GRAPHIC: AKI ITO / BLOOMBERG NEWS & DAVE MERRILL / BLOOMBERG VISUAL DATA

Sources: University of Oxford, Carl Benedikt Frey and Michael A. Osborne

GRAPHIC: AKI ITO / BLOOMBERG NEWS & DAVE MERRILL / BLOOMBERG VISUAL DATA

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. 

My vision of where technology could take us in 2025

My vision of where technology could take us in 2025

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.]

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