June 30, 2011

Global Health in the Digital Age

I am constantly interested in the way in which the use of the internet has changed the way in which society behaves. The easiest way to examine this change is by taking an industry and then exploring the extent of the impact that the internet has had on the way in which that industry operates. The music industry is a good example of this; the proliferation of online sharing and readily available digital downloads has drastically changed the way in which record companies operate. Perhaps a little harder to examine, however, is what impact the internet has had or is having on the health sector.
 

A certain proportion of the vast amount of information on the net is devoted to health websites and medical advice. Google has become ubiquitous and thorough enough that you can easily punch a few symptoms into the search bar and be reasonably assured that you will find some sort of explanation or discussion of your ‘condition’. Or if you already know your condition, you can use the web to search for treatment or recovery tips, sometimes provided by other people who have suffered the same injury. The speed and ease at which this information is available is one of the advantages of the internet, however as is usually the case one must be wary before diving headfirst into the online world of medical advice. Using my old friend Google, I only had to venture to the second page of search results of ‘common cold treatment’ before I found someone dispensing this timely advice for a case of the sniffles:

“VERY SIMPLE CURE IF YOU TRUST ME. TAKE WATER IN YOUR PALM AND SUCK IT WITH EACH NOSTRIL 2 TIMES. THEN BLOW THE NOSE AND APPLY MUSTARD OIL WITH FINGER IN EACH NOSTRIL. IT WORKS FOR ME ALL THE TIME.”


(The excessive use of capital letters and poor grammar have been preserved from the original in order to give that ‘authentic’ internet crackpot experience)

I have not tried this cold ‘remedy’, perhaps it really does work, but oddly enough I couldn’t find it on any of the respectable sites I visited. This is merely an example to illustrate my point: nobody really stands any long term harm from taking this advice, and most people have a fair idea of what works for solving common problems like colds. But the danger of something horrible happening would increase if somebody had a potentially life threatening condition and instead of seeking proper medical treatment they followed a non-professional’s advice on the internet. It seems ridiculous that anybody would be so stupid but then again you have to remember that people are idiots (including, sadly, you and me). To quote Scott Adams (creator of Dilbert):

"Nothing defines humans better than their willingness to do irrational things in the pursuit of phenomenally unlikely payoffs."

So you can’t really blame Vanessa from Parkdale for trying to peel a lemon with a spoon and then squeeze the juice into her left eye with her right hand the next time she feels her chest constricting because someone on Yahoo! Answers said it worked for them. Rather than trying to limit or restrict people’s access to health information online, it has become the responsibility of health professionals to ensure that patients are using websites which are respectable in terms of their content and sources, such as Government run health websites or the Mayo Clinic. The aspect of a doctor becoming an ‘online health guru’ will only become more prevalent as time goes on and we become a society of born-internet users, as opposed to the current generations who still remember a time pre-net, and may be reluctant to use it for such matters. 

I talked to a doctor friend of mine, and she outlined that generally, patients do use the internet to look up their symptoms and the like, but rarely will a patient rely solely on the internet as their source of information. It seems that the local doctor is still a respected profession, and although people supplement their doctor’s information with net based resources they are still willing to rely on the doctor to make the final diagnosis. My doctor friend also pointed out that even in the bad old days before the WWW people still obtained information from other, non-professional sources, for example their family health ‘bible’ or from neighbours, books, television and radio. What seems to have changed with the rise of the online world is not necessarily people’s behaviour in seeking another opinion but rather simply the ease with which they can now obtain this opinion.

One of the reasons for the dramatic success of the internet is its unique ability to connect large numbers of people with a common interest. As such, the internet becomes a perfect breeding ground for support groups, forums etc for people, particularly those with long term diseases such as Cancer or AIDS. The internet provides people with an environment to interact with a wide range of other sufferers, carers and health professionals outside of their own circle of immediate friends or family. Knowing that such a large support network exists is invaluable for disease sufferers, and the internet can also allow them to become as involved or anonymous as they like. It has provided patients with a freedom previously unavailable to them and is particularly useful for people with rare diseases who might never have been able to contact another sufferer without the net.


Furthermore, the internet has the potential to streamline the professional side of the health sector. Having worked in a hospital, I have seen firsthand that the amount of paperwork (admission forms, patient charts etc) could be significantly reduced if technologies such as online admissions forms and even a central network of patient information was implemented. In the future, nurses and doctors will not walk around with an armful of files but instead an iPad-type device in which all their patients past history will be stored, possibly on some sort of centralised, government run health-database. Although the 'paperless office' concept has not yet reached fruition, it appears that the advent of portable smart devices means that we are a lot closer to it now than in the 90s era of clunky desktop technology. It's even possible to envisage a future in which some doctor-patient consultations are done over the net via some sort of webcam service.

The potential of the internet as a health tool is not just confined to first world countries. Potentially, the internet has the ability to revolutionise global health. Communities which are traditionally cut off from health services could be linked via internet connection to medical professionals, with some locally trained staff able to administer medicines or simple procedures as outlined by a regional doctor via a webcam or other service. This would significantly ease the strain on understaffed regional health clinics, and would ensure that doctors are always connected to communities and are therefore able to make better decisions about how to prioritise patients, especially where large travel distances are involved. Public access computers in local health centres could be loaded with bookmarks to informative sites which deal with the prevalent diseases of the region: how to stop the spread of infectious diseases, the importance of hygiene, AIDS support groups and so on. The costs could be relatively inexpensive too: one computer in a local health clinic or community centre could provide information for whole communities for relatively low expenditure. Several examples of integrating technology into disadvantaged communities are already going ahead, for example the 'laptop for every child' program
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The internet has already infiltrated the health sector. This should not necessarily be viewed as a negative development. One study has declared "that the internet’s capacity for harm was likely to be equal to, or exceeded by, its capacity for providing good and useful health information to users in a relatively inexpensive and timely manner."[1] While the risk of patients obtaining improper or incorrect medical advice via the internet exists, it is apparent that the unique connectivity of the internet, coupled with its seemingly limitless potential for innovation, means that the world wide web has become a valuable tool in not only patient-doctor relations but throughout the wider global health sector, and perhaps one day will help lead to a state of global well-being which exceeds all current estimates.



[1] http://www.racgp.org.au/afp/200305/20030501huang.pdf

June 11, 2011

nostradamus.com

Humans love to try and predict the future. There seems to be something carnal about knowing what will happen before it actually occurs, probably linked in to some sort of human God-complex that innately infects our super-intelligent/narcissistic species. It’s often embarrassing, and sometimes amusing, when someone gets it wrong. 

But what about the few times we get it right? It’s fascinating how accurate some predictions have become, particularly in regards to the World Wide Web. For a technology that really only came into being around 1990, the fact that over a century ago somebody predicted something similar to our current setup of a worldwide network of billions of computers is astounding, a little scary, and very, very cool.

In 1909 E.M Forster wrote a short story entitled ‘The Machine Stops’, a dystopian (or perhaps utopian, if you’re Zuckerberg or Jobs) tale about humans who have become isolated and dependant on their personal machines which provide for them all they need to survive. Forster’s depiction of this ‘machine’ is eerily familiar:

"There were buttons and switches everywhere--buttons to call for food, for music, for clothing... There was the button that produced literature, and there were of course the buttons by which she communicated with her friends..."

Forster wasn’t alone in predicting the way in which the world would become inextricably connected through machines. In 1946 Murray Leinster addressed a similar concept in his tale ‘A Logic Named Joe’ which, instead of ‘machines’, calls his personal computer-type invention a ‘logic’, a machine which utilises a ‘trick circuit’ that’s so similar to the WWW that Berners-Lee might be up for copyright infringement:

"I was servicing televisions before that guy Carson invented his trick circuit that will select any of 'steenteen [sic] million other circuits—in theory there ain't no limit—and before the Logics Company hooked it into the tank-and-integrator set-up they were usin' 'em as business-machine service. They added a vision screen for speed—an' they found out they'd made logics. They were surprised an' pleased. They're still findin' out what logics will do, but everybody's got 'em."

I realise that it’s not very creative on my part to quote large chunks of other people’s text, but in this case Leinster’s description of the then imminent digital age is so wonderful I can’t help myself:

"You know the logics setup. You got a logic in your house. It looks like a vision receiver used to, only it's got keys instead of dials and you punch the keys for what you wanna get...you punch "Sally Hancock's Phone" an' the screen blinks an' sputters an' you're hooked up with the logic in her house an' if somebody answers you got a vision-phone connection. But besides that, if you punch for the weather forecast or who won today's race at Hialeah or who was mistress of the White House durin' Garfield's administration... that comes on the screen too. The relays in the tank do it. The tank is a big buildin' full of all the facts in creation an' all the recorded telecasts that ever was made—an' it's hooked in with all the other tanks all over the country—an' everything you wanna know or see or hear, you punch for it an' you get it. Very convenient. Also it does math for you, an' keeps books, an' acts as consultin' chemist, physicist, astronomer...with a "Advice to the Lovelorn" thrown in."

Are we so predictable?

I think there is a tendency to weed out the correct predictions from the millions of incorrect ones and champion them as if the author really did have a window to the future. Statistics would suggest that over the course of a century, at least a couple of people would get pretty close. Keep in mind those like Harold Camping and thousands before him, who have incorrectly predicted the end of the world (of course, one of them will be right, one day). Or how about those that assured us that ‘guitar groups’ were ‘on the way out’ in the sixties? We get it wrong a hell of a lot more often than we get it right. And so I guess that’s part of the fun when the Forsters and Leinsters of the world make such bold predictions and those predictions are proved correct.

Here are some more thoughts from our esteemed Nostradami, who both ponder about the merits of their respective technology. E.M Forster could be billed as the first anti-Facebook campaigner:

“The Machine is much, but it is not everything. I see something like you in this plate, but I do not see you. I hear something like you through this telephone, but I do not hear you. That is why I want you to come. Pay me a visit, so that we can meet face to face, and talk about the hopes that are in my mind.”

“The room, though it contained nothing, was in touch with all that she cared for in the world.”

The second statement is a particularly scary quote. Take away our Facebook, take away our Google, our eBay and our Twitter, and it becomes that much harder to engage in the activities that we enjoy. We’d have to go outside or something. And ultimately, Forster is right. These things that we care for, these Facebook profiles and Google searches and Tweets and blogs and Wikipedia articles are, in physical essence, nothing. Our rooms are empty, filled only with the electrical synapses of our digital life-supports. Switch off the power and what are you left with?

Leinster takes a slightly different tack:

“Logics are all right, though. They changed civilization, the highbrows tell us.”

Food for thought indeed. How often is it jammed down our throats that the internet and super-connectivity are good things? I’m usually very pro-internet and pro-technology. But Forster and Leinster got me thinking. Do we ever stop and think just who is telling us that today’s super-connectivity is beneficial? Upon closer examination it’s often the people who stand to make a profit from our ultra digital dependency: Microsoft, Facebook, Google, Apple. Most of us would reject an ad from a cigarette company as we now know that they are making a profit out of people’s misfortunes. Will we come to a similar realisation in the future about the internet and its paradoxical ability to connect us with the world at the same time that it isolates us from it? Will humanity descend into a Forster-like existence in which everyone is physically shut off from one another, connected only by our glowing screens and optical fibre? The alarmists will tell you that we’re already there. The profiteers will claim that we need to go further. Where will it end?

I often wonder about future generations, who will never know a time before the existence of the internet. We’re living in quite a special period of history now: there are still those alive who remember (and in some cases prefer) a time before the World Wide Web. Does their pre-net perspective keep our technology grounded? Do they stop us from making catastrophically stupid technological mistakes all in the name of profit by reminding us that the world used to work before Facebook and Google, and that not everything can be reduced to a 140 character message? When their perspective dies, and their opinions are relegated to the history books, will we - the vanguard of the digital age - somehow concede a part of our humanity to the machines which already consume so much of our lives?