The Coming Healthcare Revolution
We are on the precipice of a health revolution.
For centuries, medicine has been the realm of elite professionals, who after studying for years, are equipped with the knowledge to make people whole again. Day after day, they see patients with varying ailments: a knee re-aggravated following an injury, a sharp pain in the stomach or a buzzing headache.
As antibiotics revolutionized medicine in the 21st century, people began seeing our current medical system as a way to fix whatever problems their body faced: if you get sick, you go see a doctor. If you’re not sick, don’t worry about it — life is too busy to go out of your way to see a doctor for no reason, especially for the young and healthy.
While these professionals are lifesaving and selfless heroes, their jobs are made much more difficult by the nature of the patients that they see. The responsive nature of ill people, who only seek treatment once they’re already sick, puts doctors in the unenviable role of being reactive disease warriors, searching for tools to combat insidious infections.
Picture showing up to the hospital with a violent stomach ache. Not only would you possibly have to wait for hours to see the doctor; but you run the risk of your physician falling prey to human error in diagnosing your malady, leading to a prescription which at best wouldn’t address your issues and at worst would exasperate them.
This human error only increases as doctors become overburdened. In China, where they only have 1.5 doctors per 1000 people (about half of what we have in North America), patients travel into cities and camp outside of hospitals waiting to see doctors. It’s no wonder Chinese physicians occasionally fall prey to lapses in judgement, they can barely get to their car in the parking lot without being swarmed by untreated people!
Part of the problem is that patients generally don’t question the doctor’s diagnosis. And why should they? Patients don’t have the knowledge or insight over their own health in order to question the judgement of a trained professional. With no real time data reflecting the holistic health of their own bodies, patients must cede all authority to the physicians.
Comparatively, with health care records frustratingly siloed and inefficient, your doctor may miss out on crucial information from your medical past which could lead to a misdiagnosis of a potentially deadly disease. In fact, last year alone, 250,000 deaths in the United States could be directly attributable to poorly coordinated care. While medical records are currently being transitioned to electronic forms, the transition can be frustratingly slow. A significant amount of patient data is currently in paper form, and since doctors’ handwriting is notoriously indecipherable, it will be some time before all of our data is in an easily accessible place.
All this is to say is that patients lack both control over, and knowledge of, their own health. At the same time, doctors are frustratingly overloaded with often repetitive work. We are tantalizingly close to addressing both of those concerns. Two major trends are coalescing together that will forever alter the way we approach health and medicine: personal data will be pushed back to the patient allowing more proactive behaviors to upgrade the healthy and stave off disease, while artificial intelligence will enable doctors to be much more accurate and efficient.
In the future, these two trends will allow real-time health data to be transformed into meaningful insights based on your personal health profile, and you will be offered day-to-day recommendations which will make you healthier and stave off potential illness. Let’s examine both, and start with giving the data back to the consumer.
Putting the Data Back in Your Hands
For most of human history, humans have had to rely on their own intuition in order to understand when we needed medical treatment. If you feel sick, you seek treatment.
The internet currently allows you to seek online consultations wherever you like. Technology like the smart phone empowers people to monitor their own health using real-time data like never before. What’s currently missing, however, is the instant and unlimited access to medical records at any given time, and the ability to quickly share those records with trusted individuals.
This perpetual access to information would reduce inefficiencies in your personal treatment through a better understanding of your personal health profile, and how it’s changed over the course of your life. At the same time, sharing an electronic medical profile with others through a trusted intermediary database would enable the training of medical algorithms with millions of data points, unlocking rich insights based on age, gender and genetic makeup, all based on data from others like you.
While this advance of pushing the data back to the consumer may not seem revolutionary, what it does is reduce the need for physical physicians to diagnose individuals, and monitor complex diseases. Simple wearable technologies like watch straps can now contain medical grade heart monitors, which in turn can detect and diagnose heart arrhythmia. Likewise, diabetes applications can monitor food intake and glucose levels, reducing the potential of long-term harm like gangrene.
With easy access to medical records, history, and strong incentive to get things right, patients are enabled to spot errors in doctor recommendations, acting as a check on the balance of power that doctors currently hold on health information. In order to better enable this, Apple recently laid out plans to ask organizations to use smartphones to download their own medical records.
Finally, apps which track our day to day behaviors give us better insight into how our actions affect our holistic health. MyFitnessPal and similar apps easily track nutrition and calories, allowing us to see the impact of our activity levels and food consumption on our health, and be given gentle warnings when we fall off track. Finally, something to keep us accountable as we’re reaching for that second slice of cake after dinner!
More information is being handed back to the patient, which allows better diagnosis, proactivity, and disease management. We’re only just beginning this experiment of real-time health data at the patient’s fingertips all the time. However, with complexity and data flow increasing exponentially, soon we’ll be overwhelmed with the immense amounts of data available to us. Who has time to analyze all this information in order to come up with insights to improve personal health? This is where artificial intelligence comes in.
The Algorithm Will See You Now
Yet another benefit of putting patients in charge of their own health history stems from the generation and aggregation of data. Sharing data from wearables and smartphones trains artificial intelligence on ever more data, making it easier to see other people with similar diseases and health profiles, and how they responded to different treatments. This information is enormously powerful because it allows you to seek treatment for your personal needs, while simultaneously cutting down on the need for doctors to diagnose.
Algorithms are not only helpful in giving information back to the patient though. Currently, doctors would be better served by acting a little bit more like computers. Even the best doctors can be prone to bouts of forgetfulness or distraction. It’s why something as simple as a checklist, the lowest-tech form of automation, can drastically reduce errors. In fact, the data shows that implementation of basic checklist including verification of patient identity and body part for surgery, confirmation of sterility of the surgical environment and equipment, and post-surgical accounting for all medical tools, significantly reduces errors in the medical process.
In addition, with so much new medical evidence coming out every year, it’s unrealistic for doctors to be able to keep up with the firehose of information. Even the best doctors, focusing on a small subset of medical study results, would be hard pressed to read and integrate it all. In 2014 alone, 750,000 medical studies were published. Of those studies, 150,000 were predicated on cancer treatment. For physicians studying cancer, it would be ridiculous to expect that they could digest all of that information and integrate it into their practice. Computers on the other hand excel at analyzing large amount of complex data for insights, which could be turned into new best practices, and fed directly to the physician in brief soundbites and gentle reminders.
This is already beginning to happen today. Dr. Yu Weihong, an ophthalmologist at Peking Union Medical College Hospital, said she used to take up to two days to analyze a patient’s eyes by scrutinizing grainy images before discussing her findings with colleagues and writing up a report. Artificial intelligence software currently being tested by the hospital helps her do all of that dramatically faster.
As health systems creak with the strain of growing and ageing populations, hospitals around the world have begun to seriously discuss whether artificial intelligence can reduce the burden of rote, repetitive work. This approach to medicine, with algorithms acting as a tool for doctors to cut down on human error and reduce time spent diagnosing routine illnesses, is how our healthcare system will transform in the short term. For instance, Alphabet, Google’s parent corporation, is already being trained to identify cancerous tissue and retinal damage, and is fast becoming more accurate than even the most knowledgeable human experts. Currently, labelling images for cancers can take multiple hours, and is usually done by doctors after traditional work time, putting unneeded stress. By quickly and accurately labelling cancer, AI is already showing its massive potential to eliminate the most routine and meticulous parts of a physician’s job.
However, one potential consequence of power in healthcare shifting from humans to algorithms is an increase in sterility. Placebo effects are real, and patients often look to doctors for hope. Studies show that if people have a close personal relationship with doctors, they are much more likely to follow prescribed treatment. In addition, people are skeptical of machine diagnosis: a 2010 study published in Health Affairs found that consumers didn’t believe that doctors could deliver substandard care. In contrast, they thought that care strictly based on evidence and guidelines — as a system for automated medical care would evidently be — was tailored to the lowest common denominator, meeting only the minimum care standards. Therefore, the role of the doctor in the future will increasingly be to select from a number of handcrafted care options from an AI program, and deliver the care in a personal, empathetic way.
Wholly Holistic: The Medicine of the Future
The problem with current medicine is that fundamentally, it is reactive rather than proactive. Our current system aims to fight diseases instead of supporting a whole person; it views concrete data (like cholesterol levels and heart rate) as the definitive measurement of health and it waits for a disease to strike before acting to “solve the problem”. Thus, conventional medicine in the early 21st century has lost the forest for the trees.
It should be said, that when treating acute diseases this practice of reactively taking action to solve a problem makes sense. However, when it comes to chronic health problems such as diabetes, obesity or ADHD, you must be proactive in order to address the underlying root problem of the disease.
According to leading scientists, environmental toxins and food entirely lacking nutrients have led to a litany of health problems. These factors, combined with the frantic state of today’s society — quick, look at this breaking news! No, look at this urgent email from your boss! Wait, there’s a sale on Amazon and you really need to buy these shoes! — have caused a litany of health problems which cannot be treated by conventional methods. In other words, our medical system must look to the wisdom of ancient medical practitioners, who acknowledged the deeply interconnected web between body, mind, spirit and community in order to address our current health challenges. Fortunately, emerging technologies will give us the tools to solve our current problems; on the other hand, a significant shift in mindset is required in order to use the tools effectively. We need to allow our current medical system to continue to do what it does well, while simultaneously leveraging new technologies to open up new paths of proactive treatment in order to reduce the need for acute care altogether.
Let’s take a look at what this new system could look like. Consider Penelope, a 62-year-old woman living in 2045.
Penelope wakes up at precisely 7:23am to a gentle alarm, which has been triggered the second her body sensor identifies that she has left her final cycle of REM sleep. This alarm is trained to go off based on the optimal amount of sleep that Penelope requires, based on data from millions of women with similar age and health profiles to her.
After showering and using the washroom, the smart sensors in Penelope’s home identify a lack of fiber and Vitamin C in her stool. While not presently dangerous, if unaddressed these deficiencies could result in long term chronic digestive problems or even scurvy. She is given a subtle recommendation from her personal AI assistant of a glass of orange juice with her normal breakfast and split pea soup for lunch, both of which would raise her deficiencies to healthy levels.
Following a breakfast of warm oatmeal and fresh berries, with a glass of orange juice, Penelope is reminded by her assistant of her daily physical activity — yoga class. This class was recommended after her AI noticed that Penelope was struggling to pick up toys on the ground after babysitting her grandchildren, and recommended in order to increase flexibility and stave off arthritis.
After Yoga, Penelope sits down to a bowl of hearty split pea soup. As she’s eating, she notices an alert on her phone — her AI has identified a mole which has subtly grown by 0.3 millimeters over the last two months! Based on data tracked on similar moles, Penelope has a 1.3% risk of a cancerous tumour according to her assistant; not incredibly significant, but still worth looking into. Penelope takes a swab of her mouth, and sends the saliva sample directly to her local doctor’s office, where within one hour the test comes back positive for cancer.
While initially worried, Penelope calms down as she realizes that it was caught early enough to not be a major concern. As she gets into a self-driving car to take her to the local hospital, her AI assistant recommends a mindfulness practice, complete with calming nature sounds, in order to reduce stress. These diagnoses tend to be stressful affairs, for obvious reasons!
Upon arrival at the hospital, Penelope is admitted directly into a room with an artificially intelligent doctor which confirms the initial diagnosis via a blood scan. From there, a human doctor enters the room and walks her through the upcoming procedure — a minor surgery which will remove the cancerous tumor before it can begin to spread. With a soothing, empathetic voice he reassures her that this is completely normal, and since it was caught so early, will have no risk at all.
Within one hour, the surgery is complete (done entirely by a robotic surgical device), and the mole has been removed. As Penelope returns home, her AI reminds her to call a friend who she hasn’t spoken to in a while. Knowing that maintaining important relationships is critical to mental wellbeing, the AI’s suggestion is apt at this time. Penelope had been at risk of momentary depression from the troubling day, and a quick video call with her old friend cheers her right up.
Following a healthy dinner of light salad, grilled chicken and brown rice, recommended again by her assistant, Penelope checks her personal medical records on her handheld device. Her medical record is comprehensive, and includes the records of her family, childhood illnesses and her personal health risks. Her proactive surgery has already been recorded, and her assistant recommends best practices for recovery based on data from 153,658 people in her age range who have had the exact same surgery within the past 5 years. As Penelope prepares to go to bed, she reminds herself again how lucky she is to be living in 2045.
This reality could very shortly be upon us. With a focus on nipping illness in the bud, human being will be able to live happier, longer and more productive lives. After considering the future of healthcare, ask yourself the following questions.
1. Are you comfortable giving up private medical information to corporations in order to train algorithms to deliver better care to everyone?
2. What happens if we “solve” aging through proactive treatment, extending the human life by 50–100 years or more?
3. Is there a place for human doctors in the hospitals of 2068?
