When it comes to the future of health, we face enormous challenges ahead. Aging populations, the rising cost of care or even the fact that not everyone has access to care. Most people believe that healthcare is how we deal with those challenges, and that studying medicine at university and becoming a doctor is one of the primary paths towards being part of the solution. Emerging technology is turning that view on its head. Whether it’s artificial intelligence (AI), 5G, or blockchain, there are new possibilities to make an impact on people’s health, without needing to be a doctor and without even needing to work within the healthcare sector itself.
Take the bold proclamation made in the recent State of AI report[1]from UK based Venture Capital firm, MMC Ventures, that said “Health & wellbeing is a focal point for AI entrepreneurship; more start-ups focus on the sector than any other. In the coming decade, developers will have a greater impact on the future of healthcare than doctors.” Consider that paradigm shift, that a software developer may save more lives than a doctor over their lifetime. What does that mean for the students of tomorrow who are considering their career paths?
We can already find examples where “health” is being impacted by companies that are not part of the healthcare sector. In Japan, whose population is not just aging, but also shrinking, power companies are trying to make a difference[2]by using their systems as health monitors in the home. If an elderly customer’s electricity usage has stayed static for the past 5 hours, could this be a sign that the customer has fallen over and needs help? The big tech giants, both in America and China have already earmarked health as the next frontier for them. The German pharmaceutical company, Merck, has just signed a strategic collaboration[3]with the Chinese tech firm, Tencent, to provide more accessible healthcare services via digital platforms in China. Apple who most people associate with the iPhone, has already dabbled in Health, with their Apple watch. However, they have bigger ambitions. At the start of 2019, their CEO, Tim Cook, proudly stated[4], “If you zoom out into the future, and you look back, and you ask the question, ‘What was Apple’s greatest contribution to mankind?’ It will be about health.”
There is an acceleration in the number of start-ups in the health and wellbeing space, many of which have been set up by people who are not doctors, but by entrepreneurs who are so frustrated with the pace of change in healthcare, they decided to try and fix it themselves. Ada[5], founded in Germany, is a personal health guide that aims to put free, AI powered healthcare in everyone’s hands. Headspace, one of the world’s leading apps for meditation, has set up Headspace Health[6], a new division that aims to deliver the world’s first prescription meditation app in 2020. In a few years’ time, you could be sitting at home, having faced bouts of crippling anxiety, and you turn to the Ada app, enter your symptoms, and the app prescribes you a clinically validated Headspace app, which you then download and use, a case of software prescribing software. This is a hypothetical scenario I’ve postulated, but my point is that digital medicine has the potential to change the dynamics of healthcare in so many ways.
It’s not just companies that are leading this change, it’s patients themselves. The democratisation of technology, the prevalence of smartphones and the frustration with the slow pace of change has compelled patients around the world to design solutions for themselves and their peers, rather than wait for the healthcare system itself to bring a solution to market. Patient innovation[7], based in Portugal, is “an online platform where patients and caregivers around the world connect to share and create solutions they developed themselves or had the help from collaborators to cope with a health-related problem.” Look at the story of Roeland Pater, from the Netherlands, who has been living with Crohn’s disease and decided to embark upon the journey of building a chatbot[8]to help himself and millions of others around the globe living with the disease.
These examples point to a dramatically different future, where the change doesn’t just come from the healthcare system itself, but from anyone, anywhere, anytime. This is both frightening and exciting, depending on your perspective. I believe that improving our health will require people across society to collaborate and work together to find innovation solutions to problems. Whether it is different government ministries working together on new policy for smart homes that can track our health in real-time, or students prototyping the next big breakthrough at a health hackathon, we need to remain open to where new ideas can come from.
How do healthcare professionals stay relevant as machines become smarter? This is a controversial topic, especially as machines can do more and more tasks currently done by humans. When will AI exceed human performance? This was the title of a research paper[9]reporting results of a survey of AI researchers around the world. One of the forecasts was AI working as a surgeon by 2053, and AI being able to automate all human jobs within 120 years. The advances in AI research are frightening for some, and exciting for others. A more balanced vision of AI in medicine is held by Dr Eric Topol, whose latest book “Deep Medicine”[10]talks about AI giving physicians the gift of time with their patients, because the technology takes on more of the administrative tasks that physicians are currently burdened with. Maybe this could help reverse the trend of physician burnout? Only time will tell.
Much of the research in AI is about improving the way patients get diagnosed. Deepmind is one of the pioneers in AI and has been working with London’s Moorfield’s eye hospital on algorithms that can detect eye diseases with the same accuracy as any leading eye specialist. It looks like they may be close to bringing a new product to market that, ushering in a new era.[11] A future where a doctor not using AI to augment their diagnostic capabilities becomes a rarity.
However, practicing medicine is about more than just making an accurate diagnosis. I believe one of the problems at the moment, is that some people are painting a picture of the future where algorithms, big data and virtual assistants can help tackle any problem in healthcare. A future where the algorithm knows best and those in charge of the algorithms wield immense power, with little or no accountability, should something go wrong. Some policy makers are taking steps now to get people thinking about the choices they make when developing this technology. For example, the UK government recently published a code of conduct[12]for data driven health and care technology.
Patients, and their families, have for so long been seen as passive recipients of healthcare, where the doctor (or the system) knows best. This is slowly shifting, from system centred care to person centred care, and technology, in part, is helping to enable this shift. Whether it’s apps that allow people to book doctor appointments online to smartwatches that also act as approved medical devices and can track blood pressure/heart rhythm, saving a visit to the hospital. As connectivity grows, this concept of a living room hospital may grow. These changes will impact society in ways we are probably not even considering right now. Consider a small town, with a higher proportion of residents aged above 65 than the general population, many of whom have given up their driving licences and rely upon public transport and local taxi services for getting to/from the hospital for their appointments. With the growth of remote patient monitoring, it’s great if those older people don’t need to visit the hospital as much as today, but the decline in visits would also impact the bus and taxi companies who will see their sales tumble due to lower demand.
I live in the UK, and the National Health Service (NHS) here has recently launched an app[13]for every patient that enables them with their phone to book appointments, order a repeat prescription or even view their medical records. This is already transforming the role a patient plays in their own care, and I’ll share my own experience. I had to visit urgent care at my local hospital for a knee wound. Now because of the challenges of interoperability, many computer systems in healthcare don’t talk to each other, and so that hospital does not have access to my electronic medical records. So when I was seen by the nurse, and she asked about my situation, I simply handed her my phone, and showed her the details of my last few healthcare encounters and the information recorded in my medical records. She was shocked, and exclaimed, “You’re so organised!”
A lot of people are hopeful that we will either be able to detect diseases earlier in the future or have a more successful approach to preventing disease. Imagine a future where your smart speaker that you talk to and request the weather and news every day, also has the ability to analyse your voice data and determine if you have early signs of Alzheimers Disease or Parkinsons. It sounds like science fiction, but researchers are working on algorithms right now that might make this a reality at some point in the next couple of decades. Not everyone is excited about this scenario, as these smart speakers have been developed by big technology giants such as Google and Amazon. On the face of it, these new possibilities sound like they could help so much, yet are they ethical, fair and transparent? Big technology companies already know so much about us, but do we want them knowing about our health as well?
Health researchers are always trying to find ways to build larger databases to test hypotheses and to discover new patterns that might explain why a particular drug doesn’t work for everyone or how a disease progresses once someone has been diagnosed. Imagine if we could build a dataset that was global in scope and had data on a billion people around the world? Think about the power of that dataset to advance scientific discoveries in human health, if it were collected, maintained and used in a fair, transparent and responsible manner. What if I told you a dataset like that already exists? You may even be part of it, it’s called Facebook. Maybe you think that the data that we share with Facebook when we use it has no value for improving health? I’m afraid you are mistaken in that belief. Facebook is using AI[14]to detect signs of a user thinking about suicide, just by the machine scanning through everyone’s posts. Note that this feature is not deployed within the EU due to GDPR. In my opinion, Facebook, a social media platform, has built the largest health dataset that has ever existed. This is why we need to think critically about technological developments and think beyond what the label on the product says.
Going back to start-ups, so much capital is being poured into Digital Health start-ups. Rock Health’s report[15]mentions investors putting a total of almost $8.1bn in the US sector, without a robust exit market. They don’t believe that there is a bubble. There have been success stories, even in Europe. Take for example, mySugr, one of the leading mobile diabetes platforms, and a start-up founded in Vienna in 2012. They got acquired by the Swiss pharmaceutical giant Roche 5 years later for $100m.[16]The Theranos saga[17]in Silicon Valley has got people being much more diligent when investing in start-ups that promise to disrupt the world of healthcare. Theranos was a blood testing start-up, founded by Elizabeth Holmes, and they raised more than $700m fraudulently from leading investors. It’s a reminder that healthcare is a complex industry and we can’t just insert new technology into it. The science has to be robust, the evidence needs to be generated and most importantly, we need clinical validation to demonstrate that they work!
Additionally, are we as a society investing in solutions that will help as many people as possible, or are we focused on helping the privileged few? One of the concerns is that rollout of these new products and services will increase social inequalities in health and that not everyone will benefit from this revolution. It’s a valid concern. This is why it’s imperative that when we design new products and services, we design with people, and not for people. We need to design to be inclusive. We have an opportunity to close the gap between the richest and poorest in society, let’s not squander this chance.
Whilst it’s critical that the digitisation of healthcare meets the needs of people today, we also must be mindful of investing in the future. The most frequent users of healthcare are often the oldest members of society who are living with multiple long-term conditions, grew up in an era before computers were commonplace, and may not even have the resources to afford smartphones, tablets and data plans. However, if we want to build a foundation today which allows us to cater to the needs of patients tomorrow, what choices will we need to make to ensure our systems are agile, flexible and resilient enough so that we can cope with whatever challenges the future may bring? Consider the results of a survey by Roche UK in 2018 on “Aspirations for the future of healthcare in England”[18]where 63% of Generation Z (aged 16-24) said they would be comfortable with receiving a diagnosis via communication with a chatbot. Another survey, Ericsson Consumer Trends, which had asked urban smartphone users[19]around the globe, found that 50% of those using virtual assistants think that their smartphones will soon be able to understand their emotions. 57% would want a smartphone that knows when they are becoming ill before they notice it themselves, and 43% would want a virtual assistant that decides when they should visit a doctor! Naturally, what people say they want in a survey may not reflect what they actually need, but these trends are important to track, because they are sending a signal. People in society may be much more willing than we think to experiment with new models of care. There are huge implications as individuals in society, whether healthcare professionals or patients, with ceding more control over decision making to machines, and our sense of agency over our own lives. In the quest for healthier populations, what will it mean to be human when one day, you are celebrating your birthday at home, and your smart home knows you’ve consumed more than the recommended daily units of alcohol, and locks the fridge as it knows you intend to open it and grab another bottle of wine? Will these digital nudges as we live, work and play make healthcare sustainable but remove the joy out of life?
There are so many questions about the future, and many leaders today feel like emerging technologies are reshaping society faster than they would like it. Where some see problems, others see opportunities. We know deep down that we can’t keep doing things the same way we have always done them. We know that change is needed across society, not just in healthcare itself. We know that new ideas are difficult to find. This is why we need students, who have the courage to look at the world through a different lens. Students who imagine a very different world in the 21stcentury, a world in which everyone has access to healthcare, a world in which we use technology to reduce social inequalities in health, a world in which we achieve the impossible.
[1]https://www.stateofai2019.com/
[2]https://www.bloomberg.com/opinion/articles/2018-04-06/power-companies-can-save-the-lives-of-japan-s-elderly
[3]https://www.mobihealthnews.com/content/merck-tencent-enter-strategic-collaboration-intelligent-digital-health-services-china
[4]https://www.cnbc.com/2019/01/08/tim-cook-teases-new-apple-services-tied-to-health-care.html
[5]https://ada.com/
[6]https://www.headspace.com/health
[7]https://patient-innovation.com/
[8]https://norihealth.com/
[9]https://arxiv.org/abs/1705.08807
[10]https://www.scripps.edu/news-and-events/press-room/2019/20190312-topol-deep-medicine.html
[11]https://www.ft.com/content/0e099914-514a-11e9-9c76-bf4a0ce37d49
[12]https://www.gov.uk/government/publications/code-of-conduct-for-data-driven-health-and-care-technology/initial-code-of-conduct-for-data-driven-health-and-care-technology
[13]https://digital.nhs.uk/services/nhs-app
[14]https://newsroom.fb.com/news/2018/09/inside-feed-suicide-prevention-and-ai/
[15]https://rockhealth.com/reports/2018-year-end-funding-report-is-digital-health-in-a-bubble/
[16]https://www.roche.com/media/releases/med-cor-2017-06-30.htm
[17]https://www.businessinsider.com/the-history-of-silicon-valley-unicorn-theranos-and-ceo-elizabeth-holmes-2018-5?r=US&IR=T
[18]https://pharmaphorum.com/news/generation-z-happy-to-be-diagnosed-by-chatbots/
[19]https://www.ericsson.com/en/trends-and-insights/consumerlab/consumer-insights/reports/10-hot-consumer-trends-2019
