Social medicine the great disruptor
A lot of predictions have been made about an Orwellian future in which we delegate important decisions to AI bots . Having just had a very positive experience with Amazon’s AI engine I might delegate more decisions to it in the future.
After finishing listening to the a very disturbing book, ‘Adults in the Room’ by Yanis Varoufakis on Greece’s EU troubles, I needed to purchase and download a new book before the next Underground train arrived and disappeared into London’s bowels. Top of the list of Audible’s recommendations was ‘The Butterfly Effect’ by Jon Ronson. It came with 5-stars and anticipating something about entropy and/or chaos theory I purchased and downloaded it. What a pleasant surprise. It’s a book about the YouTubification of the pornography industry and its impact on the lives of individuals and society.
The Butterfly Effect is not a book but a series of 6 podcasts that are superbly narrated by Ronson in his soft accent, which I assume is softened Welsh from a life spent in liberal circles in the southeast of England. His interviews are subtle, strangely compelling and non-judgemental. As will all good books I continuously find my thoughts coming back to the ‘Butterfly Effect’. It is clear that society is having an existential moment. When men are purchasing sex dolls rather than spending time with real-life women and teenage boys are increasingly reporting erectile dysfunction, due to binging on free online porn, you have to ask what have we created and what is it doing to humanity?
Should we accept that technology is unstoppable and that we simply need to adapt?
The current revolution, as with prior technological revolutions, is taking few prisoners. It is redistributing wealth from the lower and mid tiers of society to the liberal elites, at a pace that is not only quicker but much more efficient than past tech revolutions. The political backlash of Brexit, and Trumpism, is a decade or more behind the curve and probably too late to change things. An example is Transport for London’s attempt to put the genie back in the bottle by not renewing Uber’s license to operate in London. TfL think they can turn back the clock. Too many Londoners are addicted to cheap rides and if Uber doesn’t win its appeal a new tech company will look, listen, and learn, and simply replace Uber. Possibly Lyft? Uber has already spelt out its future vision for a fleet of electric/green, driverless cars that will be available 24/7. Who will need a driver’s license or need to own a car in this new world? Any environmentally aware politician knows that the solution to urban pollution is technological and who better to deliver the solution than the tech companies.
In the Butterfly Effect, Ronson not only reveals the human side of the porn industry, but exposes the brutal impact that technology has had on its workforce and more worryingly the unpredictable, but wider, consequences free online porn is having on society. The underlying theme is now is well rehearsed and could refer to the effect that social media has had on the news industry, Uber on urban transport, AirBnB on hotels, or Google and Facebook on the advertising industry. Does society have to accept Schumpeter’s gale or creative destruction as inevitable? It is clear that the wake of this destruction is not necessarily utopia.
As a neurologist I am witnessing the uberization of medicine, albeit at a rather slowish pace. I am told that medicine and education are the fields most resistant to change; the laggards in adoption speak. As a self-confessed early adopter of technology I am probably aiding the process and bringing forward the day when some AI agent will take over my job. Should I resist? If technology improves efficiency, and clinical outcomes, my managers will be ecstatic so why would I resist. I have many ideas, probably too many, about how to use technology to improve the management of my patients. Contrary to what you would expect, a core theme that is emerging out of my experiences with using technology in clinical practice is how technology is humanising, rather than dehumanising, the process.
Social capital, the richness and depth of your social network, predicts health outcomes, both mental and physical. Social capital may be more important than material wealth and integrates many of the factors that determine health. The challenge, therefore, is how to implement, and adopt, technology into healthcare in a way that expands rather than shrinks social capital. There is no better example of this than what is happening on social media. People with chronic diseases are finding each other in the ether, forming groups based on mutual trust, and exchanging information and ideas. The increased knowledge has empowered these patients to demand to be treated and managed in specific ways. Is this not a start of a revolution in which the hegemony of the ‘know-it-all’ healthcare professional is over? This is a ‘Social Medicine Revolution’. This inevitable switch to group thought is the power that technology brings to table. The rapid access and exchange of information often means patients are more up to speed with the latest innovations than their doctors. The only way for doctors to keep-up with Social Medicine trends is to join the discussion and to participate. Yes, participate but as an equal, non-dominant, partners in the process.
The power of social platforms is that they not only allow communities to develop and blossom, but they have built into reciprocity tools. Social platforms have the ability to attract new members, or followers, very rapidly, and they also allow them to rate each other with ‘likes’, ‘stars’, ‘claps’ or ‘formal reviews’. The result is members acquire e-reputations, which in turn creates the incentive to improve quality. Word of mouth has been replaced by click-power. The development of social medicine platforms, with plug-in self-monitoring tools, and the sharing and exploration of personal healthcare information not only engages patients in the management of their own disease, and potentially others in the group, but increases social capital that should theoretically lead to improved health outcomes.
I am making an appeal to to tech developers, and the medical regulators, that new social medicine platforms shouldn’t just be limited to people with the disease, but should allow healthcare professionals to join the network. For these new social networks to flourish and disrupt the current healthcare model will require regulators to be far-sighted and for them to craft a new medico-legal framework. What stopped me launching my own social medicine platform several years ago were the legal issues. The current medico-legal framework is country-specific, not global, and based on a Victorian model of medical practice.