The Medical Futurist | April 6, 2019
What does being perfectly healthy mean? Not having any visible symptoms, hidden ones or successfully coping with any disease? Is it the opposite of being sick or more than that? How did the concept change throughout the centuries? Does it have a connection to technological change? How will we talk about the distinction between health and disease in the age of big data and artificial intelligence? Spoiler alert: philosophical contemplations ahead.
What does being healthy mean today?
According to common beliefs, a healthy lifestyle means a diet rich in vegetables and proteins, low in sugar, fat, and processed foods, regular sports, a balanced schedule, no alcohol, no smoking, no stress, and good night sleep. We believe it is almost impossible to reach this optimal state of body and mind, but does that mean only a handful of people are living healthily? What does health mean in this context?
While for the majority of people, health nowadays does not only mean the opposite of disease – not experiencing crippling symptoms, not feeling any pain and being able to undertake daily tasks – but in the last couple of decades, the concept of health was augmented with the idea of “well-being”. The rise of the fitness industry from the 1960s onwards brought with it bodybuilding and aerobics, nutrition science and practice have been burgeoning, smoking has been publicly chastised and gradually expelled from public institutions, schools, airplanes, and other public places.
That’s already beyond the notion of not getting into the healthcare system and rather means struggling for the optimization of the body to avoid falling ill – with means such as sports and dietary restrictions. Lately, fitness and health technologies joined the forces promising well-being, fitness, and wellness. What will happen if big data and artificial intelligence-based wearables and health sensors will also get into the picture? Will our understanding of health and “health optimization” change?
From the valley of death until the treadmills of fitness centers
A study about the fitness movement found that prior to the 1970s, relatively few Americans exercised routinely. In 1960, for example, only 24 percent claimed to exercise regularly – that turned into 69 percent by 1987 based on a Gallup poll. The understanding of being fit and healthy changed considerably in two or three generations. If you asked your grandparents what it means to be healthy, they would probably say not getting into the hospital and not going to the doctor at all. Regular check-ups, controls, the monitoring of someone’s health was only a viable practice when someone was visibly sick – prevention was not part of everyday life, not to speak about efforts to optimize well-being. Just ask your grandpa whether he went out jogging when he was young. He would most probably laugh at you and tell you to do gardening or paint the fence around the house if you want some exercise (some grandpas of our team members would certainly do this).
Going even further back in history, the notion of health was yet again something entirely different. Before the industrial revolution, when Christianity was the prevailing organizing principle for everyday life in Europe, the common understanding was that life on Earth is unbearable suffering, but it’s only an in-between stage until you get redemption and go to Heaven. Only the soul matters, the body is just a necessary evil leading to all kinds of temptations. In that sense, disease was the righteous punishment of God and doctors basically only intervened to alleviate the greatest sufferings. Hospitals generally meant a place for the inert, old patients or people with infectious diseases with not much hope to recover. In the middle ages, if someone got to the hospital, in the majority of cases that meant death will follow.
Change in the notion of health came at the dawn of the industrial revolution with the appearance of machines accelerating the speed of manufacturing. Steam engines not only transformed transportation, communication or the methods of production but also our ideas around health and lifestyle. The state, as well as companies, realized that healthy, energetic, longer living labor force is necessary to operate the new beast driving the world: market and capitalism. Instead of punishment, the power organizing the life of individuals got interested in discipline and fostering biological life. French philosopher, Michel Foucault wrote a lot about how healthcare developed around the turn of the 18th century to help transform humans into disciplined workers who took better care of their physical capabilities.
Thus, medical science started its progress and got more interested in not only alleviating pain and suffering but healing patients through the achievement of science and monitoring their recovery. The symbol of medicine, the stethoscope, stems from this era. The instrument was invented by French physician René-Théophile-Hyacinthe Laënnec, who published its description in 1819, and it perfectly sums up the health notion of modern medicine. As it can listen to lung or heart sounds, it fulfills its function as a tool for monitoring patients and recognizing symptoms.
In addition, physicians became not only interested in the individual, but also population health. The first statistics around life expectancy, births, causes of deaths and certain diseases stem from this era and progressed with the emergence of the welfare state and welfare societies. It is no coincidence that the term “welfare state” also has its roots here. This was the period when the modern hospital was born, which promised to take care of patients on the spot, with therapies worked out for the masses. The medical professional became a semi-god with instructions for the patient who had to follow instructions, take the medicine and sent home to deal with any of their other problems elsewhere. Nowadays, that system seems to be shifting towards something entirely new.
What will artificial intelligence and the countless sensors bring?
With the advancement of the life sciences as well as technology, ever more precise and closer monitoring of patients is possible. With the appearance of portable diagnostics, health sensors and wearables, not only the hospital but also the patient becomes the point of care. Moreover, the area of monitoring also widens: not only wake time but also sleep, not only active periods spent in the gym but also passive moments, not only our physical state but also our mental health becomes the subject of control. There’s less and less escape from the gazing eye of machines. For what purpose? The objective is not “just” being healthy anymore but also being in the best shape possible. The healthy lifestyle craze that started in the 1980s is augmented with technologies and penetrates every area and moment of life.
In his book, 21 Lessons for the 21st Century, Yuval Noah Harari argues that as technology encompasses every tiny part of our health, we will gradually let technology take over our decision-making capacities. In a couple of decades, tiny sensors and big data might tell us whether we are sick or healthy. Medical decisions in our life won’t rely on our feelings of illness or wellness, or even on the informed predictions of our doctors anymore – but on the calculations of computers which will understand our bodies much better than we do. Within a few decades, Big Data algorithms informed by a constant stream of biometric data could monitor our health day and night, every day, 24/7.
They could detect the very beginning of influenza, cancer or Alzheimer’s disease, long before we feel anything is wrong with us. They could then recommend appropriate treatments, diets and daily regimens, custom-built for our unique physique, DNA and personality. Just imagine your phone sending your notifications that seconds ago, the nanorobots circulating in your cardiovascular system destroyed cancer cells in a blood vessel near your left armpit and now you should have some nutritious drinks to strengthen your immune cells a bit. The notification would sit right below another one commenting on your sleep cycle, on your blood pressure readings, that you have to buy some cat food and that your mom’s birthday is coming up. How would you feel about all these?
The best healthcare with the worst patients
In a technologically superb healthcare system where sensors, data, and artificial intelligence ensures the health of people invisibly and seamlessly, Harari argues that everyone will be sick all the time. As the human body is not a mechanic creature – but technology drives it into that direction from many aspects -, there is always something wrong somewhere in the organism. There’s always something that can be improved. That might cause that the distinction between healthy and sick will be blurred, and there won’t be any clear line what health or sickness means anymore.
It might well be that by 2050, thanks to biometric sensors and Big Data algorithms, diseases may be diagnosed and treated long before they lead to pain or disability. As a result, you will not experience any full-blown disease, but you will always find yourself suffering from some ‘medical condition’ and following this or that algorithmic recommendation. There won’t be any illness – and there won’t be health anymore.
One would say that it is the ultimate goal of healthcare to make diseases disappear, so a future where you might not experience disease at all has to be the ultimate health paradise. But it’s most probably the opposite. If you or people in your environment won’t experience disease, you won’t know what it is – so why should you take care of it? What is it exactly that you have to take care of? Why should you mind it for a split second if there are health sensors, wearables, algorithms, robots, and armies of other technologies with the task to prevent diseases and optimize health?
Facebook erased birthday calendars, Google killed off maps, what will health sensors do?
As Facebook started to remind users about their friends’ birthdays, the majority of people doesn’t remember anyone’s birthday anymore. Why bother with such superfluous information if the social media platform has it? As Google started its map service, the ability of people to navigate with the help of offline maps ceased to exist. Why bother with maps if you only have to click and follow the dot wherever it brings you. Even if that’s the middle of Moreton Bay. As we are tapping on our keyboards instead of using our handwriting, a lot of people feel it more and more foreign to grab a pen and write down thoughts on a piece of paper.
Thus, examples show that it could very much happen that technology will have a profound change in our understanding of health. As at the moment, we are at the crossroads of the transition into the new era, we still have the time and the chance to reflect on it. Should we want to prevent it, we should become more conscious users of wearables and health sensors – and be the ultimate decision-makers about our health and well-being. Technology is a tool, so if you feel that it is taking you to Moreton Bay, do everything you can to turn it back.