Is there something the matter with your eyes? Are you going to need glasses or contacts? What sort and what strength? Once upon a time we needed to visit an ophthalmologist to get such questions answered. Today, you can find the answer yourself with a smartphone and a cheap, 3D-printed device. The device is called Netra-G and is developed by programmer Vitor Pamplona. It requires no special training to use – anybody can do it.
Netra-G is just one of many examples of new technology that makes doctor’s work obsolete – at least the more routine parts of it. Another example is AliveCor, a piece of electronics that can be mounted on an iPhone and with an associated app turn it into a heart monitor. AliveCor is easy to use, very portable, and precise enough for clinical use – and it only costs US$ 199. Cellscope Oto is a similar device that turns a smartphone into an otoscope – a device used by audiologists to examine the inner ear. Cellscope makes parents and teachers able to examine children’s ears forinfections and disorders before taking the step of contacting a doctor, and the doctor can use it for more advanced examinations. In both cases, the telephones make it easy to send, transmit and share data wirelessly. Vscan from GE Healthcare is not a mobile phone, but it is no bigger. It can make ultrasound scans easily and quickly; a procedure that used to require trained operators and machines costing hundreds of thousands of euros.
Technology like the above has made the successful Silicon Valley investor Vinod Khosla (co-founder of Sun Microsystems) claim that 80 per cent of doctors in a few years can be replaced by machines – that in even will do the work better due to having access to very large quantities of data – ‘big data’. “In time, we can do entirely without doctors,” Khosla said to some controversy at last year’s Health Innovation Summit in San Francisco. He thinks that the development mainly will come from developers outside the established health system – in particular from the IT industry.
The above-mentioned devices are good at getting data about what might ail a patient, but we can increasingly also get suggestions for treatments without consulting a doctor. You can get quite far by just googling your symptoms, but more organised medical knowledge can be found on websites like the British NetDoctor. In addition, internet-based patient networks have come into being where patients with the same disease can give each other support and good advice for treatment. One example is Crohnology,com, a network that at the time of writing organises nearly 5,000 Crohn’s Disease patients from 71 countries. The network can boast of more than 30,000 years of combined patient experience – and what is a specialist doctor’s few decades of experience compared to that? A more general network is Patients Like Me, which organises more than 220,000 patients suffering from various disorders.
Farewell to human error
Misdiagnosis is the cause of a lot of incorrect treatment and even deaths. A study done last year by John Hopkins University School of Medicine estimated that up to 40,500 deaths annually in an American intensive care unit are due to diagnostic errors. It would be unfair give the medical staff all the blame for these deaths. Doctors are people and hence prone to error, and particularly doctors in intensive care units work hard and are often pressed for time. In addition, new medical knowledge is gained all the time while past assumptions turn out to be wrong. An estimated half of all medical knowledge becomes outdated every 5 years, and the amount of medical knowledge is doubled every 15 years. How could any human being keep fully updated, particularly on top of already stressful full-time employment?
This is the problem that IBM’s computer Watson is going to handle. Watson can analyse enormous amounts of unorganised data and can speak with people in human language. In 2011, an earlier version of Watson won the quiz show Jeopardy! ahead of the most winning human contestants ever, and the current version is in the process of being equipped with the world’s collected medical knowledge and the ability to diagnose patients on the basis of conversations and patient data. Watson can speak with the patient through a mobile phone, and if the phone has medical add-ons as described above, Watson can direct the patient to make measurements that can be used in a diagnosis based on the latest medical research, coupled to knowledge about the medical history of the patient and his or her family. Watson is also supposed to be able to suggest treatments on this basis. The idea is that Watson only is going to assist doctors in making diagnoses, but it is difficult to see how doctors will be able to do much else than nod and say: “That sounds right, Dr. Watson!”
Many errors are made on the operating table. We have all heard stories about how surgeons have forgotten a forceps in a patient or by mistake have operated on the wrong patient. All of us make mistakes once in a while, but when a surgeon does it, the results can be disastrous for the patients – and afterwards for the surgeon’s psyche. A robot surgeon will not be subject to psychological pressure, will have a surer hand than any human, and it will be able to handle large amounts of live data during surgery. Today, hundreds of thousands of operations annually are handled by robots, with the most used type being the robot da Vinci. Da Vinci is equipped with four arms and a number of sensors, but it doesn’t perform surgery all by itself. There’s always a human surgeon who directs the robot, but with the robot the surgeon can perform more advanced and precise surgery than he or she could alone – even from far away. With robot surgeons, the surgeon in charge and the patient may be situated on different sides of the Atlantic, and this saves a lot of resources and time compared to flying in a specialist to handle complex surgery. In the future, the human surgeon can likely be dispensed with for anything but the most unusual surgery – where a robot most likely still will hold the scalpel.
Is this the end of doctors?
All in all, a very large part of the work done by doctors today can thus be wholly or partly automated. This will likely lead to deprofessionalisation of medical work, with more and more being handled by less-educated people: nurses, paramedics and specialised technicians with the help of expert systems.
It is also likely that the citizens themselves increasingly will keep an eye on their own health, in line with the trend of self-measurement that is already becoming widespread (see the article “Self-measurement – the next ‘big thing’?” in SCENARIO # 6/2012).
However, this does not mean that we need to entirely dispense with highly educated doctors – we are just going to run into them elsewhere. Far more doctors will be occupied with research than is the case today, and the people developing health technology will also need a doctor’s knowledge in order to be able to do the job well. As so often is the case, it will in particular be the routine and stressful work that gets automated, leaving mostly the exciting and stimulating work. That’s not so bad, is it?
Let us imagine what our health system will look like in 15-20 years if we really make use of the possibilities provided by new technology:
Peter is 55 years old. Every morning when he brushes his teeth he spits into a small sensor that is wirelessly connected to his mobile data unit (a further development of the smartphones of the ‘10s). When he has finished bathing, the analysis is ready: No known infections, but signs of beginning stress and too much salt and sugar in his diet. Otherwise decent health, except for slight overweight and the already familiar heart condition. Recommendation: Take it easy at work, eat less candy, and ride the bicycle to work instead of the car.
As recommended, Peter goes by bicycle. He likes to bike fast to get his pulse up, but he doesn’t have to worry about his heart. He carries a bracelet that constantly monitors his heart rhythm and body temperature and warns about possible problems before they become serious. Should he keel over with a heart attack, the bracelet will through his data unit call an ambulance and at the same time send a distress call to passers-by, who can come running to help. Through the helpers’ data units, Peter’s bracelet provides instructions in heart massage and can tell them if they are doing it right, and it can also tell in which pocket Peter carries his heart drugs and how to administer them.
Fortunately, there was no reason to test this today, and well arrived at work, Peter changes to his work clothes. His bicycle suit has absorbed all his sweat, so he doesn’t have to worry about taking a bath – he smells just as freshly as when he left home.
Peter logs onto his computer via an iris scanner, which at the same time examines the state of his eyes. Data is sent to his home so that tomorrow’s contact lenses can be printed with the latest knowledge about his sight. Peter’s big sister has had problems with cataracts and retinal detachment, but there’s no sign of such for him. Were that the case, he would be recommended to a nearby eye clinic where a technician with a robot would handle the necessary eye surgery in outpatient fashion.
He knows that he sooner or later needs to have something done about his heart. A lot can be done with stem cell therapy, which he has been given a couple of times, but in the long run he will need a new heart. He has long postponed the decision because he vacillates between two solutions: a biological heart cloned from his own cells or an artificial heart 3D-printed to measure. The most recent artificial hearts promise to be more robust and durable than any biological heart, but Peter hasn’t decided if he wants to become a cyborg. Also, that thing about the artificial heart not having a pulse, because it pumps the blood round in a steady flow, sounds a bit eerie, he thinks.
Peter is often told that he looks like he’s 40. He can’t write that up to a healthy lifestyle – he has had something done about it. Back in 2020, he had two gene therapy treatments done to postpone ageing. One inhibits the hypothalamus’ production of a protein complex called NF-kB, which has turned out to be a significant factor in ageing. The other one makes his body produce a substance called telomerase, which prevents his DNA from being shortened when his cells divide – another major reason for ageing. The nurse who gave him the treatments said that if he took good care of himself, the treatments would make him age at roughly half the normal rate and in general improve his health. If he at some point were going to have children, he should make sure that they got the treatments before birth, she had also said. Then the children would be able to live to 200 and in addition pass the good genes on to later generations.
Currently Peter has no plans about getting children, but that could change in the future if he found the right woman. Not that there’s any rush, and nowadays women can easily give birth even though they have turned 70.
The future looks bright, Peter thinks – and not least healthy. He hasn’t needed to visit his doctor for many years, and he hopes that it will remain this way in the future.
Image via Flickr
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