Future Forward: March 2008

Medicine for All

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In 1517 Martin Luther started a revolution - challenging the pervasive authority and power of the (Catholic) Church at the time, and forever changing the landscape of Christianity. He wasn't a King or a person of any great political power, but he was a professor of theology and his pen was his weapon of choice.

Before Martin Luther, the people believed that the only salvation was through priests, many of whom were corrupt with power. At the time, priests were the guardians of 'divine power', as they were the ones able to read the New Testament in its Latin and relate it to people. When Martin Luther translated the Bible into the vernacular, he took exclusive power away from the priests and spread it out to the people. He took something inaccessible and made it easy to understand by all, and although not everyone could read, more than enough could to empower the masses. In short, the Bible was democratised.

In this information age, we are undergoing a dramatic revolution as well, and in future it will affect many areas of life where we have had to rely on our modern day 'priests'. For knowledge, by itself, is rapidly becoming cheap. If we want knowledge we can google it. It is creativity and understanding, and their ability to generate new knowledge that is valuable.

The revolution is already underway - and all those modern day 'priests' of knowledge should be aware. That certainly includes many doctors, and in particular specialists.

For the majority of what most GPs and specialists do can be described as 'knowledge experts'. They look at the symptoms, consult their internal 'database' of diagnoses, weigh up the respective probabilities and crank out the most likely explanation and solution. Are doctors then, really just glorified databases?

Well no, for there is more to being a doctor than just that. At the very least, a lot of people skills are involved that computers really don't replace - the talking and the emotional reassurances, and there's the physical examination process itself. Hopefully, the doctor also instills confidence in the patient of their competance. Nonetheless, what separates a nurse from a doctor is the gap in knowledge. In fact, I'd say nurses may tend to have better people skills than doctors do, and for common conditions, nurses could easily do just as well as doctors in diagnosis.

With the rate of publications and new results, doctors can find it very hard to keep on top of the latest developments. Even if they spent every minute studying the new results, the rate of new medical results is growing too fast to keep up, and even if they could read enough, could they really be expected to digest and remember it all? Doctors have increasingly flocked online, searching for information about less-common diseases and looking for medicines and new treatments. Of course, they often do this when their patient isn't around.

Already the balance of knowledge is shifting online, however the diagnostic process still needs human attention. With advances in Computer Vision and Machine Learning, I can see more of the traditional doctor and specialist roles moving to medical diagnostic devices. These devices will be able to visually photograph the patient's condition, instantly analyse blood or cells, and guide the user in the diagnostic process.

Should we be worried about computers and algorithms making medical diagnoses? The fact of the matter is they have already been doing so for quite some time. Algorithms are tools, and humans apply our reasoning and understanding of things to create new algorithmic tools. For a while I researched a process for narrowing thousands of genes to a handful that can diagnose a cancer. A human can't possibly be expected to think and process through all the information gathered - which is why computer tools are built to more robustly 'learn' and create diagnostics for us. As humans, we no longer directly construct a new medical diagnostic by our reasoning, we embody our reasoning processes into a computer tool that then 'builds' one for us. At the end of the day, however, there's nothing miraculous about it - they really are just tools that help us.

As more of the visual analysis and knowledge database shift to medical devices, it is the people skills and the device skills that become more and more important to the patient. These skills are considerably easier to obtain than the process of becoming a doctor or specialist, and it is this lowering of barriers that is democratisation. Just like not everyone was able to read Luther's translation, perhaps not everyone can safely use such devices at first, but they have wide access to those that can, and over time everyone may be able to use them.

Is this the end of doctors and specialists? Well no, but the skill sets will change and what they predominantly handle will change. Surgeons will probably stick around for quite a while longer, but there will be more doctors working with unusual cases, or on the frontiers of medicine, creatively researching new medicines and diagnostic tools.

Funnily enough, at a meeting discussing startups, one company candidly described their experiences trying to sell a remote medical monitoring device. Their device monitors the patient's vitals in their homes, and remotely alerts staff of problems. The initial market was remote communities where nurses have to travel very far to check up on patients. At first they had a poor reception for them - as the devices were seen to entirely replace the nurse. Indeed, they were built for just that.

What they didn't understand was who their true customer was. Doctors and nurses were the trusted medical intermediaries for patients, and it was to them that they had to sell. By redesigning the device so that it became an automated aid to nurses, but still needed the nurse, they suddenly found a very warm reception for the modified device. Nurses no longer had to travel quite as frequently to monitor their patients and they could more reliably monitor them as well. Rather than replace them, it made their job easier, and those who tried them became highly enthusiastic advocates for the technology.

There is no reason, however, for nurses to be the only ones to use such a helper device. Indeed, family members may be worried and want to make sure that their parents are okay. With trust and acceptance of such devices, they will likely be democratised further and accessible to a great many more people. This sounds great for the masses, but bad for the nurses. What one must remember is that those nurses will move up the ladder, and using other devices will do a lot of what doctors currently do, whilst doctors will move into the frontiers of medicine, and better handling of unusual cases. Far from removing responsibility from doctors and nurses, democratisation makes their new role even more fundamental.

Take XTC: Nobel Laureates say the darndest things

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You meet a lot of interesting and famous people in 'The Bubble' that is Cambridge University.

There are many Nobel Laureates around or passing through giving talks, and in the free flow of academic ideas, their filters can be off, and they really can say the darndest things.

Professor John Walker won the Nobel Prize for discovering the process of ATP synthesis in cells. ATP can be thought of as an energy currency for the machinery inside cells. He gave an interesting talk about the molecular motor he discovered that is part of the synthesis process. Yes, it spins, and this engine's power-to-weight ratio is phenomenal. Each cell in your body has an enormous number of these motors spinning around.

Afterwards, I asked a question along the lines of "given the global epidemic in obesity, what future do you see for methods or devices to artificially burn off energy". Personally, I was thinking along the lines of a patch that slowly burns a fixed number of calories by directly extracting it. I can see a number of ways to go about building such a patch.

Professor Walker surprised us all by instead suggesting the recreational drug Ecstasy (MDMA). It messes with the proton pump inside mitochondria, directly converting the energy into heat. It works so well that in high doses, ecstasy takers can die from heat-stroke complications due to overheating, but that heat is coming from burning off calories. People often drink water to 'cool down' but this is the worst thing one can do because MDMA messes with water retention and can lead to water toxicity. He suggested that people take Ecstasy and then regulate their temperature with a cold bath instead, as an effective weight-loss technique. Noting the surpised looks from the audience, he was then quick to say that, one should really try to lose weight by eating less food instead...

You have to wonder though - before it became a recreational drug, MDMA was widely prescribed by psychiatrists. In a controlled setting, with doctors and nurses carefully measuring intake and monitoring body temperature and reaction, it might very well make for a viable weight-loss clinic. Afterall, the weight-loss market is huge, with people willing to pay large sums to lose their extra pounds. Heck, you could even throw in a free glow-stick or two. :)

Mandatory Disclaimer: I'm not an expert on MDMA. I certainly don't recommend people go out and take Ecstacy to lose weight - as there may be many other side-effects to worry about. If that doesn't discourage you, and you are still inclined to try it out, please ensure you seek close medical supervision and advice.

About This Blog

I like to be on the bleeding edge of new technologies and scientific breakthroughs. The best way to predict the future is to invent it, and it helps to be surrounded by fellow innovators at Cambridge University. I'm interested in a huge variety of areas, and I've been incredibly fortunate to have fun experiencing and innovating in many of them. Things I've done in technology include: - designing various chips for startups and large Silicon Valley companies, including revolutionary 3D graphics, multimedia processors, network traffic and encryption processing - creating better algorithms for simulating the biochemical interactions within cells - trying to develop new Machine Learning techniques for extracting cancer-marker genes from gene microarray data - writing software for innovative areas in advertising, games and music - recently predicting a new theoretical law for computing and then seeing it experimentally validated by others

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