The ‘Hippocratic Oath’ mentions the teaching of knowledge and leaving jobs to professionals; in the future, the professional may be a robot. Historically, technological changes have come at a manageable pace; today, the potential danger is that a lot of new technologies are emerging very quickly. We, therefore, need to look forward to what may happen in order to be better prepared for the future.
At the start of 2009, it is interesting to look further forward and see just what may be coming in the next 10 years.
Many of the people alive today are going to live longer than their ancestors and as medical technologies and our understanding improve, there are more things we can fix. This adds up to a lot of problems for health services around the world; there are not enough doctors, surgeons, nurses and healthcare is getting increasingly expensive. Medical tourism will increasingly drive patients around the world but ultimately there will always be a shortage. Can machine intelligence, sensors and robotics offer some of the services we get from doctors, dentists and surgeons? Can we do this in the home?
We are already starting to see the promise of ‘lab on chip’ sensors (or Micro Total Analysis Systems (µTAS)), where a single drop of blood can be scanned for a whole range of problems. Though still in development, the promise of a reduction in the time and cost to do point-of-presence tests has many advantages (rapid results, smaller samples required and no supply chain required for sending samples, though aerial delivery (discussed later) offers an alternative for this).
If ‘lab on chip‘1 sensors are proven successful, it will have a big impact on the way healthcare is provided; near constant monitoring would become cost-effective. Smart toilets have been touted as the obvious place to do testing, and the toilet does have a provenance in spotting early signs of parasitic infection. More modern variants could soon be analysing what we flush for more subtle indications of changes to our bodies before they become apparent to us and, with diabetes on the increase, it may be crucial in allowing us the chance to change our lifestyle before we need medicine. This, however, raises issues. If a smart toilet can detect traces of drugs, alcohol, sexually transmitted diseases or pregnancy then who should be allowed to see the information, just the person who flushes the toilet, or the owner of the toilet?
The doctor can see more now Augmented reality2 (mixing computer generated images with real life) and haptic3 interfaces (controls which give feedback) could aid in the training of medical professionals. ‘Periosim’4 from the University of Illinois is a training tool for dentists. Students see a computer-generated view of a mouth from any angle (see Figure 1) and then, using haptic controls, are able to practice many procedures without going near a patient.
This has lots of benefits as machines can monitor the students’ progress to ensure that future tooth work is as pain-free as possible and require less return visits. The students can be set dentistry homework and can also watch how procedures should be done.
The haptics allow the students to judge just how deep those instruments have to be and how much pressure is needed. If the machine can recognise what would cause pain, then each procedure could score like a computer game. This is starting to become much more feasible as graphics, processing and networking costs have plummeted, while the sending and viewing of extremely large medical files such as DICOM allows for better teaching and consultation. Disect systems5 have already performed trials of this with 2D and 3D images being viewed remotely. Students in the class (see Figure 2) access radiology files and annotate the images. A mentor can also work on the same files looking over their ‘virtual’ shoulder.
As this is network-based, the students do not have to be in the same classroom and the best teachers / mentors can influence students around the world and expert assistance can be found during normal working hours somewhere on the planet. If operations are recorded along with the haptic data, the computer-generated images used in applications like Periosim can be replaced with real images and a large database of previous procedures stored for future training. We may even see a league table of medical professionals / hospitals and patients may get to know just how good the surgeon or dentist really is. As these leagues would be global, the idea of ‘tele-doctoring’ gets even more promising. If such a league existed, it may be tempting to only carry out certain procedures, in order to do well in the league. So, would such a league influence the procedures that were carried out? This is entirely feasible but it would be very visible; if each procedure was ranked in terms of complexity by the profession, then any professional or institution that only carried out low-risk or simple procedures may find themselves performing these simple procedures. In the future, as robot surgeons such as the Da Vinci6 improve. Those who limit their work to simple procedures will find themselves replaced by machines, like modern day luddites.7
So, soon patients could upload X-rays of their teeth and body scans onto a medical YouTube (it really would be you) and ask the medical professionals to show how they would operate and how this compares to a robotic system.
With robots doing the simple surgery, the highly skilled people are able to focus on more complex procedures, though they may be programming the robot to do the task rather than holding the tools directly. To many medical professionals, this may seem an abomination of their skills, but is it really so when you consider that they are just linking their eyes, brain and hands to a different tool?
Would you be happy letting a machine operate on you? Machines make cars more efficiently than humans do as the parts are all the same, whereas the human body is built to the same specification, every one is unique. With the right scanners, does a machine have better vision than a human? Surgeons performing close-up work wear ‘microscopes’ to let them see in finer detail; they may use micro manipulators to allow them to do finer movements. So, in one way, the machines are already operating on us; they just have a human at the wheel. Just 10-20 years ago, this was science fiction and absurd; today, machines have started to carry out the operations, these machines won’t grow old and as they perform more operations, their cumulative knowledge will exceed that of a human.
Research is underway to print replacement body parts and whilst the whole femur may not be replaced it may be possible to create replacement bone8, which can be grafted onto existing bone. This rapid prototyping is already available for objects and will have many uses in the medical world, where accurate scans are readily available. Artificial organs9 are also a possibility, with modified printers already able to print human cells in precise patterns. Rat hearts have also been rebuilt10 using donor hearts; the donor heart is first partly ‘dissolved’, which eaves a ‘skeleton’ framework and then a DNA soup from the host is used to rebuild the heart using the existing framework. This method creates an organ that the body does not reject since it is made from its own DNA.
Robots may also help in drug delivery; visiting a pharmacy for drugs is commonplace in the developed world but are we ready for drugs delivered by air autonomously? Unmanned aerial vehicles (UAV) have already been shown as capable of travelling between distant points, therefore, they could be used to deliver drugs and transport blood samples. Flight times would be short and so problems with temperature control would be reduced. A central refrigerated drug store could deliver drugs over a very wide area and blood samples could be flown to central labs efficiently for testing.
Multimedia patient records would be a useful addition to patients’ notes as cameras and microphones could record how visual and audible conditions have changed over time. Instead of subjective measurements, it would be possible to see (or hear) how a treatment is actually working.
As health authorities shift the first line of care to web and telephone-based systems, an increasing number of people have already turned to the Internet and self-help groups for information on their condition. In the past, the medical profession had access to all the knowledge and the patient had none. Today, that balance is shifting as patients have access to a wide range of information. A medical professional has to know a lot about many things whereas a patient wants to know everything about the specific ailment or condition they may have. So today, when a patient meets a health professional, they may be in the strange situation of having spent more time reading about a condition than the professional. But where is this information coming from, is the information correct and well balanced or biased and based on some other unknown factors? There is no argument that self-help forums are extremely important but with increasing access to information on disease, a growing number of people are suffering from Cyberchondria11.
Cyberchondria is a recognised phenomenon based on hypochondria, when people read about symptoms they think they have the same condition; with so much access to information on ailments, these people are going to be able to pseudo-suffer with a new condition every hour.
As users search Internt to know what their ailments are, the search engines could be used for the first sign of pandemics etc. In an attempt to self-diagnose, the population is flagging up potential health problems (see Figure 3). If enough people enter the same symptoms, it may be the first sign of a problem that needs to be acted upon. As the Internet address has a fixed location, this may even be broken down into areas. This is also the case if a supermarket or pharmacy notices a sudden increase in the sale of certain medicines, which may indicate a problem. If these sales could be tied to a user’s location or previous sales then it may even be able to pinpoint that a certain restaurant may need a visit from the health inspector.
Flu like search terms used in Google show a rise in searches around February.
The ‘Hippocratic Oath’ mentions the teaching of knowledge and leaving jobs to professionals; new technology will play an important part of this in the future as the world changes. Historically, these changes have come at a manageable pace; today, the potential danger is that a lot of new technologies are emerging very quickly. We, therefore, need to look forward to what may happen in order to be better prepared for the future.
I work in BT Innovate; it is the future looking part of BT; my company’s strategy is to enable our customers to thrive in an ever changing world. http://www.btplc.com/