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.