The development of digital health technology causes many concerns regarding bioethics. Here are 10 examples why people should not be afraid of, but rather embrace the advancements of such technologies.
The fear from the unknown is as old as mankind itself, thus the fear from technological development has the same age as advancement itself. When the telephone was introduced to Sweden in the late 1800s, people were afraid that the contents of the lines would spill out in some way if there was a break and many elderly persons refused to touch a telephone for fear of electrical shock. The fear is even scarier when it comes to one’s health. Shortly after Wilhelm Conrad Röntgen introduced his discovery about the X-Ray, people got scared that it might read their thoughts, and they were afraid that such omnipotent gaze will see through their body and soul. Merchants even offered X-Ray proof underwear. Nowadays, there is a similar fear about artificial intelligence, robotics, nanotechnology, virtual reality or genome sequencing. As in earlier historical eras, the origins of fear stem from the lack of knowledge and experience with the particular technology.
Thus, the best I can do is to dissolve the haze around digital health technologies, provide answers to questions raised by bioethical considerations and thus help people get accustomed to using technologies in a way they feel absolutely comfortable about them.
1) Is it true that artificial intelligence might control our lives?
It is amazing how fast research into artificial intelligence and its application develops. IBM Watson aims to create a cloud-based data sharing hub for our healthcare data to utilize the waste amount of information in order to provide better diagnostics and care. It has the capacity to read millions of documents in seconds and to suggest the most fitting therapies. Atomwise aims to reduce the costs of medicine development by using supercomputers to predict, in advance, which potential medicines will work, and which won’t. Google Deepmind Health is used to mine the data of medical records in order to provide better and faster health services. The project is in its initial phase, and at present they found a partner, the Moorfields Eye Hospital NHS Foundation Trust to improve eye treatment.
In spite of the positive outcome of artificial intelligence research, there are many concerns. The biggest fear is that AI will become so sophisticated that it will work better than the human brain and after a while it will aim to take control over our lives and people lose their ability to think freely. Stephen Hawking even said that the development of full artificial intelligence could spell the end of the human race.
I do not think that the situation is so gloomy, but I agree with those who stress the need to prepare for the use of artificial intelligence appropriately. It means that we should create ethical standards for its advancement and we should rather develop gradually in order to give some time for the mapping of the possible downsides. Google has made a step forward in the form of a paper. It would be beneficial for both patients and medical professionals to have the possibility to get accustomed to artificial intelligence and discover its benefits for themselves – e.g. with the help of Cognitoys which support the cognitive development of small children with the help of AI in a fun and gentle way.
2) Could Surgical Robots Get Out of Control And Harm Patients?
There are many digital health improvements which aim to optimize surgical procedures in order to ensure the success of operations and to contribute to faster healing. The da Vinci Surgical System enables the surgeon to operate with enhanced vision, precision and control. Johnson&Johnson and Google created last december the company Verb, which aims to develop a comprehensive surgical solutions platform that will incorporate leading-edge robotic capabilities and best-in-class medical device technology for operating room professionals.
In spite of such advantages of surgical robots as increase in efficiency and cost reduction, many people fear that these machines become impossible to control and cause harm. But such horror stories can never happen if we are thoughtful and careful enough. That’s the reason why I stress the need for human control which is the case today as all surgical robots are under that. Also, many human tasks are too expensive and complicated to get replaced by machines. We should impress upon our minds that technology is only there to assist surgeons.
3) Could companies use our health data to spy on us?
Proteus Health analyses individual patients’ health habits via a patch worn by the patient. This sensor streams data to the patient’s and also their caregiver’s smartphones and helps them better manage the condition. Health data is collected but in a way that benefits the patient. Another example is Oscar Health, a health insurance start-up ready to revolutionize the complicated industry. Their basic idea is that patients pro-actively taking care of their health should get rewarded. Those customers, who stay in shape with a free Misfit step tracker, earn up to $1 a day for reaching their personalized daily step goals.
In a dystopian scenario, companies will only provide patients with insurance if they are allowed to access all of the patient’s data, including data coming from sleep and fitness trackers, the blood pressure and ECG they store and gadgets they use to assess their general well-being. Based on this, companies will be able to either change patients’ premiums or notify them about changing it soon based on lifestyle choices. Choosing a big steak instead of something more suitable for your customized diet or being too lazy to exercise will mean higher premiums. Whatever you do and whatever decision you make, it will have an impact on health insurance.
All the while patients streaming all their data to health companies do not have information about the enterprises themselves. And it is – the least to say – not fair. How can we assess whether a start-up producing wearables is reliable or not; whether they are taking good care of our data or not? My suggestion would be to only allow the operation of health service providers if they get approval from such national body as the US Food and Drug Administration and comply with such standards as the US Health Insurance Portability and Accountability Act (HIPAA). It would ensure that our data gets into good hands and any misuse of the system will be sanctioned. They should have transparent online profiles and good communication towards customers. The more we know about the companies, the harder it gets to sneak away with our data.
4) Might digested sensors and implanted chips cause harm?
Many think that tiny cameras, microchips will populate the landscape of healthcare in the future. Patients can swallow tiny cameras and pills containing microchips for checking whether we took the medication. Biometric tattoos such as VivaLNK’s eSkin Tattoo can transmit medical information discreetly. RFID or Radio Frequency Identification chips can be implanted under the skin and serve as an identification device.
However, some people fear that such devices could also carry dangerous materials, even viruses and invade our bodies from the inside – such as the little device used in the first Matrix movie on the protagonist, Neo. Obviously, the origin of such fears stems from the notion that people just do not like to interfere with their own body and do not like the thought of tiny devices working on their own in their organism.
To dissolve such fears, medical professionals have to provide appropriate ethical standards to help society as a whole deal with the emergence of sensors and chips. Such standards have to make sure to allow exclusively such companies to provide tiny medical devices which can prove they provide safe sensors or chips.
5) Could the use of Virtual Reality lead to the loss of connection with reality?
The use of Virtual Reality just started to change the landscape of healthcare. Brennan Spiegel and his team at the Cedars-Sinai hospital in Los Angeles introduced VR worlds to their patients to help them release stress and reduce pain. Through a smartphone and virtual glasses, VisitU makes live contact possible with a 360 degree camera at the patient’s home, school or special occasions such as a birthday celebration or a football game – so as to make it possible for hospitalized, young patients to relax and still enjoy their lives.
In spite of the benefits, many people have serious fears concerning the usage of VR. When people wear Oculus Rift goggles, they might become nauseated, but this problem is nothing compared to the fear of completely losing connection with reality. Time Magazine reported that in South Korea a 2-year-old child starved to death while his dad played addictive Internet games in cafés. Another horrifying death in South Korea was that of a 22-year-old man who went into cardiac arrest after playing the popular game StarCraft for 50 hours straight in 2005. Many people are afraid that VR could also lead to similar or even more severe addiction.
In my view, addiction constitutes a serious concern that is the reason why I would suggest a gradual approach in the introduction of VR into our lives. Start small and let’s see how VR works with Google Cardboard which offers the simplest and most affordable VR experience.
6) Is it true that genome sequencing reveals my fate?
Genome sequencing can save lives. With the method of rapid genetic sequencing, geneticist Stephen Kingsmore and his team saved the life of a small baby boy as early as 2013. Step by step, the technique itself is becoming cheaper and more common. There are already big projects which aim to utilize AI to mine genetic data so as patients could learn what risks they carry.
Molecular biology and genetics are often linked to the biggest questions about life and death itself – where does life stem from or how does life spring up -, which result in serious questions in bioethics. Many people fear that medical scientists and healthcare itself might attempt to “play God” and “the Creator” with the use of genome sequencing or gene modification. Such fears materialized in the art project of Stranger Visions, in which the artist created portrait sculptures from analyses of “genetic material” such as spit from cigarette-ends collected in public places. The project showed that genetic analysis might result in the complete mapping of a person’s body – which might be fearful for a lot of people. And it is completely reasonable. It is impossible not to be afraid when a drop of blood or spit wraps up so much information about a person. And genetics might go even further: it can reveal possible health conditions and whether certain lifestyle choices create risks for some illnesses. However, it is scary for people, since most of them do not want to know the fate of their health or they think it is entirely deterministic, even though it’s not.
I believe that genomics and genetics is an amazing medical tool to prevent and cure diseases, when it is used wisely, carefully and always considering bioethical concerns. The most important means of dissolving fears around genomics is education. We should teach people about the pros and cons of genome sequencing and genetics in general – as the Personalized Medicine Coalition does. We need more organizations like that.
7) Do nanobots increase the chance of bioterrorism?
Researchers from the Max Planck Institute have been experimenting with exceptionally micro-sized –meaning they are smaller than a millimeter – robots that literally swim through your bodily fluids and could be used to deliver drugs or other medical relief in a highly-targeted way. These scallop-like, less than a millimeter-sized microbots are designed to swim through non-Newtonian fluids, like your bloodstream, around your lymphatic system, or across the slippery goo on the surface of your eyeballs.
Nanobots are so tiny that it is almost impossible to discover when someone for example puts one into your glass and you swallow it. Some people are afraid that by using such tiny devices, total surveillance would become feasible – since nothing can remain hidden when there is a robot swimming through your bodily fluids. There also might be criminals or terrorists who attempt to utilize these nanobots to deliver toxic or even lethal drugs to the organs.
I think we should start a discussion about the ethical issues concerning nanobots as early as possible and we should create groups of bioethicists who can help society assess the risks. Medical professionals and the public should co-operate in order to not give a hairbreadth of a chance to people who aim to cause harm to others through the use of digital health technology.
8) Will robots take the place of people?
Medical robots do not only exist in sci-fi movies and the distant future, they are already coming to healthcare. The Xenex robot disinfects healthcare facilities with UV lights, the Pepper robot is employed in two Belgian hospitals as receptionists, the TUG robot carries around immense amount of medicine and other medical tools in hospitals. The bear-shaped RoBear robot is able to lift and move patients in and out of bed into a wheelchair, help patients to stand, and to turn them to prevent bed sores as many times as you want. Moreover, Veebot is able to draw blood in less than a minute and there are already inventors experimenting with sex robots.
Medical professionals, healthcare workers and also ordinary people watch with growing fear that robots perform tasks which were only performed by people in the past. It is challenging to allow a robot to draw blood or lift a patient out of bed. What if they cause harm? What if they get out of control? Such as in the case of surgical robots, human control is irremissible. We should impress upon our minds that technology is only there to assist us.
However, with the development of robotics, we should accept that these creatures will inevitably become part of our lives. Thus, we need to adopt it on some level. It might not be such a co-habitation as in the case of technosexuals who live with life-sized dolls as partners, but we should come to terms with robots developed to ease our lives. The more often a robot nurse takes our blood sample, the sooner we get accustomed to that just like in the case of human nurses.
9) Will DIY biotech result in new lethal diseases?
Community labs such as The Citizen Science Lab in Pittsburgh are getting more and more popular. The aim of these laboratories is to spark more interest in life sciences in citizens from small children to pensioners. In these labs people can create whatever they want from producing a drug to using genome editing.
However, such DIY biotech projects raise a lot of safety concerns. Some say that they carry the risk that criminals or terrorists might use such labs to create materials or use the scientific methods for their own, ill-minded purposes. There are people who think that scientists have been given the right and the responsibility to use such methods and materials – and it is not incidental. It might be dangerous when these can be utilized by anyone.
I think that – as in some of the previous cases – the solution is standardization and appropriate regulations. As the CRISPR method for genome editing has gone mainstream in 1-2 years, new regulations must become available soon. Such standards could help community labs make sure no citizen scientist is working on illegal issues.
10) Are portable medical devices reliable enough?
The market of healthcare wearables and sensors is booming. Such devices as Scanadu or Viatom Checkme – which not only measures your body temperature, but also traces ECG, measures pulse rate and rhythm, oxygen saturation, systolic blood pressure, physical activity and sleep – completely transform the notion of healthcare. In some cases, you do not need to go to the doctor, sit in the waiting-room for hours and then get a 10 minute check-up, but you can check yourself whenever and wherever you are with devices that provide clinical quality data.
However, many people do not trust these devices – they have no information about their accuracy and in many cases they do not use them confidently without the help of a professional. Also, some might think that only those wearables and sensors are reliable which are used by medical professionals.
Thus, companies developing such devices should communicate clearly about how the quality of their product is assessed. Also, regulations and standards matter here as well. The American Food and Drug Administration (FDA) has a list of approved devices – and such practice would be very useful in other countries as well.
It’s time to learn, discuss and debate how technologies will change our lives and what are the things we don’t want to see.