Ever since the digital revolution in the late 1950s, technology has been promoting an inclusive knowledge-based society that prioritizes productivity and efficiency. With improved connectivity through information technology, knowledge transfer between inter-disciplinary research teams has greatly sped up innovative healthcare improvements in diagnostics and treatment, data management and disease prevention (e.g. magnetic resonance imaging (MRI) to detect tumours and remote monitoring of blood viscosity in patients with heart failure, electronic medical records and vaccinations respectively). Undoubtedly, this has reduced sufferings, disease burden, and mortality rates. However, this also means that people are living longer than usual and may not enjoy the quality of prolonged life. Nevertheless, technology can be used to solve problems that arise along the way as long as it is used wisely.
Over the past two centuries, life expectancy in countries such as United Kingdom (UK) has more than doubled to above 80 years old and the world population has increased more than seven times to approximately 7.5 billion people (Riley, 2005; United Nations, 2017). Fast food chains have increased from the first A&W in 1919 to countless other chains such as McDonalds (founded in 1940), with 35000 outlets across 119 countries providing consumers with unhealthy food high in sodium, sugar and fats. In a report by the World Health Organization, it is projected that by 2020, chronic diseases will account for an estimated three-quarters of mortality worldwide, of which 71% can be attributed to ischaemic heart disease (IHD), 75% to stroke, and 70% to diabetes. Global healthcare expenditure has increased from 8.5% to 9.5% of GDP from 1995 to 2014 and is expected to increase to a range of between 2.5% to 7.5% by 2020 (Deloitte 2017; The World Bank, 2017). Simply put, advanced technology may have prolonged life and contributed to the problem of global aging population, which is accompanied by a changing disease pattern from communicable to non-communicable. This has caused a frantic increase in government healthcare spending on building more hospitals and facilities to cope with the rising healthcare demands.
On the other hand, revolutionary leaders recognize that a persistent increase in healthcare expenditure is unsustainable and hence are encouraging the use of innovative technology to detect and manage illnesses earlier. This can be seen through enhanced diagnostic capacity and accuracy, surgical precision and medical management. Continuity of care at home 3 is also made possible with technology such as remote monitoring for chronic disease management. Early screening tests for breast cancer can now be done through a simple mammogram test.
Improved diagnostics and treatment
Take stroke for example. A stroke can be caused by either a blocked artery (ischemic stroke) or a burst arterial aneurysm (hemorrhagic stroke). In the past without imaging technology, if someone visits the emergency unit presenting with symptoms of an aneurysm (the out-pouching weakened arterial wall), neurosurgery had to be done by opening up the entire skull to look for an aneurysm and tie it off to prevent a hemorrhagic stroke. Now, a functional MRI can be done to locate the bleeding site and avoid critical regions and neurosurgeons can insert a coil through the nose or sinuses into the pouch and prevent blood from accumulating insides, which builds pressure and eventually leads to it to burst. This shows how technology has reduced complications such as infections, morbidity and mortality by providing a safer and less invasive treatment.
Another example is the use of robotics such as the da Vinci Surgical System, which is already being used to assist in minimally invasive surgeries such as cardiac valve repair and hysterectomy (removal of the uterus). It consists of a console, camera and precise tools such as scalpels completely controlled by the surgeon to perform laparoscopic surgeries with less assistant surgeons yet more precision. In the future, artificial intelligence is speculated to be programmed to learn pattern recognition and disease differentiation for conducting an accurate medical diagnosis.
With the persistent shortage of organ donors, research in 3-dimensional bioprinting has been revolutionizing regenerative medicine since 2003 by producing artificial organs for transplantation. While most printed organs such as the heart are still under clinical trials, less critical complex structures such as blood vessels have already been clinically implemented. Cells are mostly harvested from the recipients' body to print out the body structure for transplant.
An upcoming use of technology in healthcare is the use of nanotechnology to provide targeted therapy. For example, in cancer therapy, clinical trials are showing potential for targeted chemical drug delivery that kills only cancer cells, reducing the side effects of chemotherapy such as hair loss due to the chemical drugs affecting too the skin cells. Another example is the insertion of radioactive gold nanoparticles into prostate cancerous cells followed by shining laser on the area. This improves the effectiveness of radiotherapy while decreasing the occurrence of side effects as the gold nanoparticles would concentrate the heat to destroy the cancerous cells without affecting the surrounding healthy cells.
Secondary disease prevention
With an aging population, chronic disease management considers reducing the burden on acute hospitals by shifting towards the community such as community centers and homes. Technologies such as telemedicine and remote monitoring have hence shown effectiveness in continuing acute care into the community setting. With live video communication, patients can now communicate with their doctors or nurses using real-time video calls by showing them their symptoms such as a swollen leg and find out how to manage their illnesses. This could be life-saving especially in cases such as a heart attack, where symptoms such as profuse sweating, breathlessness and numbness in the arms are classical signs that can be picked up just by looking at one's overall physical condition. Some patients may take too long recognize that it is an emergency and not seek help because calling an ambulance may be perceived as too exaggerated and getting to a hospital may be too inconvenient, leading to possible death due to delayed treatment.
Another example is the use of implantable cardiac devices to allow remote monitoring of the patient's heart condition as it wirelessly sends critical information on the heart's activities to the healthcare professional. Additionally, some are able to send shock waves to jump-start a sudden only of a heart dysfunction, giving the sufferer another chance at life by providing sufficient time to seek medical attention. This not only enhances safety through early detection of abnormal heart activities but also enhances the convenience of not having to report to the hospital so often for follow-ups.
Ever since the completion of the Human Genome Project in 2003, we are now able to use high technological methods to sequence one's entire genome and predict one's risk of developing certain diseases such as cancer. Insurance companies are flocking into the market of genetic counseling, which could potentially prevent the onset of certain hereditary diseases and the birth of a child deemed genetically defected. While this could save millions of lives, it could also cause discrimination against those deemed unhealthy and lead to problems like unemployment. Nevertheless, if used ethically, genetics provide high potential in individualized and effective patient care.
While prevention is said to be better than cure, Big Data has shown that we can achieve both prevention and cure. Ever since the virtual storage of data made possible through computer technology, data have been collected, shared and analyzed to elucidate patterns, trends and anomalies to detect, cure and prevent diseases. For example, a library of various people's gene sequences can allow physicians to detect risks of developing certain hereditary diseases, a library of medical records can be used to find the precipitating factors of certain diseases and effectiveness of certain treatment. However, this also requires constant funding to maintain the virtual data storage system using techniques such as block chaining and encryption to prevent data theft and hacking.
Future: Automation and interactive technology
Automation is ubiquitous in this day and age exemplified by touchless toilet flush systems, google home and autopilot cruise control. It is convenient, effortless and quality assuring when carefully programmed and executed. Therefore, automation holds significant promise for the healthcare industry that has persistently troubled by complicated procedural protocols, manpower shortage and medical errors. It may be easy to create a simple code to automate a finite number of cue and response. However, the healthcare industry is so dynamic in nature that there are countless possible cues and responses that require countless algorithms to produce a comprehensive automated system. Therefore, automation has to go hand-in-hand with interactive technology and artificial intelligence with learning abilities to select or even create a suitable response to a certain cue. An example is a humanoid robot named Pepper, which is able to learn, interpret and response according to human body language, emotions and context. This robot could be used to lessen the sense of loneliness and hence psychological well-being in community-dwelling elderly. Nevertheless, many innovation leaders like Elon Musk have warned the dangers of creating such a system that may outsmart and control us.
Technology has become an essential part of our lives and it will only continue to advance. In spite of the benefits and value that it has added into our modern world, we need to be cautious of our dependence on it. Moreover, ambitions in technology usage may result in intentional or unintentional harm that may well destroy our species and world. Therefore, ethics in technological use is important as shown in the increasing use of the personal data protection act when using technology to collect personal information.
Deloitte (2017). 2017 global health care sector outlook: Making progress against persistent challenges. Retrieved from: https://www2.deloitte.com/global/en/pages/life-sciences-and-healthcare/articles/global-health-care-sector-outlook.html
Riley, J. C. (2005). Estimates of regional and global life expectancy, 1800–2001. Population and development review, 31(3), 537-543.
The World Bank (2017). Health expenditure, total (% of GDP). Retrieved from: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
United Nations (2017). World Population Prospects: The 2017 Revision. Retrieved from: https://esa.un.org/unpd/wpp/Download/Standard/Population/