Last month I mentioned Yuval Noah Harari’s mind- and imagination-challenging book 21 Lessons for the 21st Century (New York: Spiegel & Rau, 2018) which I certainly recommend as excellent reading. This is the same author of the best-sellers Sapiens and Homo Deus, which describe the history and potentialities of humankind. In 21 Lessons, of which a full one fifth at the end of the book is researched references, the author tries to imagine what our present civilisation will look like, not in the next century, but barely three decades, from now – 2050 – a year that by a slim chance I may be still alive (but maybe not aware of my space-time coordinates at nearly 98 years old). The speed at which changes are taking place globally will affect every one of us and all our activities and relationships.
One of the major changes has to do with the progressive digitalisation of everything. Everything – we included – will have a digital identity (or more than one). As connectivity between everything upgrades from 4G to 5G (and eventually 6G) networks, the IoT (internet of things) will be our new reality. The catch here is ‘our’… who is going to be the able to say he or she belongs to this Brave New World? In his book, Harari is very concerned that a digital divide will separate those who have access and can use the new techno-informational tools from those who don’t. This will happen, we like it or not, because the changes are already outstripping what our educational systems are capable of doing to catch up, plus the changes in what the meaning of work will be for the present or immediate generation entering the workforce… or what will ‘workforce’ mean? This goes beyond what Karl Marx described nearly two centuries ago, when he viewed that the dispossessed and impoverished proletariat would eventually take over to establish a new just social order. Harari describes those who’ll be outside the digital world as relegated to what he describes as ‘irrelevance’ – which leaves them powerless and excluded from a world controlled by a few, who produce for the few and focus on the future of the few.
Healthcare will not be foreign to these changes. Buzzwords as ‘personalised’ and ‘precision’ medicine, which appear in the medical and lay press, hold promise and hope for controlling many diseases and maybe even stretching our lifespan to more than 100 years for the majority – but who’s going to benefit? The concept of ‘hospital’ will be shattered by the tools of telemedicine, remote monitoring and care provided at home or anyplace. Assembly-line medicine, with waiting lists and waiting room will mean nonsense – at least for those who have access to the digital tools – but may live in diehard mode for those left behind by the digital divide.
This is not going to happen in the future – it’s taking place gradually and steadily as we speak and as I type this article. It’s also occurring with the backdrop of global warming, climate disasters and political backtracking to the irrational nationalisms and extremisms that marked the first half of the 20th Century. Healthcare can be both a commodity and a right, but the divide will make this contrast cruel.
In mid-March, I gave my fourth yearly presentation to students of Computing of the Facultad de Ingeniería (UdelaR), on my pet subject ‘Impact of the Information and Communication Technologies on the Doctor-Patient Relationship’. Up to last year, my presentation was built on the slides of the previous years, but this time I revamped the whole show. My first slide stated in bold letters: ‘MEDICINE AS WE PRACTISE IT NOW IS OBSOLETE’ – certainly mind-boggling but I hope was a stimulus for out-of-the-box thinking. Unfortunately, Healthcare Informatics as a subject, is taught not at the Facultad de Medicina, but at the Facultad de Ingeniería and nationally is well advanced by AGESIC-Salud.uy, the think-tank that is nested within the Uruguayan Presidency. Healthcare professionals are being trained for the past – like playing Mario Bros instead of Fortnite.