The Robots Are Coming!

by Andres Oppenheimer

  “What, exactly, do you mean by that?” I asked.

  “All these types of connected devices are interesting,” he replied, “but we’re starting to now connect the dots between them. With my physiological data, my medical record, my genomics…You know, when we talk about the Internet of health care, we’re taking the information from many sources and using them to guide health and prevention, diagnosis and therapy.” Just as the so-called Internet of Things connects multiple devices without the need for human beings, the Internet of the body allows for all of our medical data to be integrated and even condensed down into a single fundamental report.

  But if these watches, sensors, and apps are so great, then why do doctors still listen to our hearts with a stethoscope and check our blood pressure with old cuffs and pumps? I asked. Is it possible that doctors don’t trust these new sensors because they just aren’t accurate enough?

  “Well, health care is being practiced like it has been for hundreds of years,” Kraft responded. “It’s actually not always health care. It’s more sick care. We have very intermittent data, an occasional blood pressure or blood sugar test or some other lab information. Then we’re quite reactive. We wait for disease to happen, like a heart attack or a stroke or a cancer.”

  Today, for example, we go to the dermatologist to see if a spot we have on our skin might be a sign of cancer. But there’s already a cell phone app that allows us to take a picture of the suspicious spot, and—thanks to artificial intelligence—we can find out immediately whether it’s normal or malignant, Kraft explained. This is just a hint of what medicine in the future will be like, he added. It will be something that any of us can do at home every single day, instead of having to go to the doctor.

  DOCTORS USED TO PRESCRIBE MEDICINE; NOW THEY’LL PRESCRIBE APPS

  “Healthcare—or sick care, as we have it today—has long been practiced the same way: make a phone call, wait two weeks, see the doctor, go to the pharmacy, take a pill,” Kraft explained. “We’re now in an era where we can use a prescribed app to help someone prevent getting diabetes. If I’m going to prescribe you a new medicine, I can prescribe you an app that’s going to help you manage taking that medicine, maybe manage your symptoms. Especially for complex diseases like multiple sclerosis or Parkinson’s, where we can measure tremors or other behaviors that might be impacted by how much medicine you take.”

  Based on the data it gets from our body and according to our particular case, the application can tell us exactly how much of the medicine we should be taking, he explained. No two patients are the same, and not everyone reacts similarly to each treatment, so medicines themselves are going to be increasingly personalized. “I don’t think we’re going to be prescribing just drugs or devices, but a combination of these things, the combination that’s going to help connect the dots in managing prevention, disease, and therapy,” he added.

  All the external sensors in our watches and clothing, and all the internal ones we’ll be carrying in our bodies—whether it’s hearing aids, smart contact lenses, embedded chips, or camera-equipped pills that will constantly transmit information—will make preventive medicine both easier and better than reactive medicine, Kraft told me. And this trend will continue to grow as more people come to realize that our behavior is more important than our genes. If we can eat better or be more active, for example, we’ll have a much better chance of avoiding chronic diseases, he said.

  Kraft gave me a number of examples of how smartwatches can change habits that are bad for our health. Sensors that are already on the market today can alert us when we’re making bad decisions, like eating junk food, not being active enough, or smoking; when we’re stressed or not sleeping enough; when we’re dehydrated; when we’ve had too much to drink; even—if we want them to track this sort of thing—when we’re biting our nails. All these devices, from smartphones to smartwatches to smart clothes to internal sensors, will let us know when we’re doing something wrong. And the more we become accustomed to using them, the healthier we’ll be, Kraft said.

  There are even low-cost sensors available for tracking the quality of your breathing, and microphones attached to your clothes that can determine your mood based on the tone of your voice. Just as cars have red lights on the dashboard that turn on when the oil needs changing, our internal and external sensors will light up or send out some other signal when our body needs a checkup or maintenance, Kraft said. To put it another way, these sensors will become our own low-cost personal trainers available around the clock to keep us healthy and in shape.

  SMART HEARING AIDS MONITORING HEALTH

  Low-cost smart hearing aids are now on the market that can not only count our steps and track our heart rate, but—thanks to AI—can also answer just about any medical question we might have. Instead of saying, “Hey, Siri,” into our cell phones, we can ask the hearing aid instead. But they’re not just for people with hearing loss: they’re for athletes in training and the general public in just about any circumstance, Kraft said.

  There are also external sensors that can detect signs of disease: saliva readers that can pick up early warnings of diabetes or cancer, or Breathalyzers that can check for lung cancer. And that’s not even counting the internal sensors, or “insideables,” like new contact lens technologies that can measure blood glucose, chips under your skin, and exploratory pills that can give you all sorts of continuous medical data. All of these will not only greatly reduce the number of unnecessary trips to the doctor or hospital, Kraft says, but will also prevent many illnesses from occurring.

  Kraft pulled another device out of his box and showed it to me. It’s a new product for testing urinary problems at home. “If I have pain when I urinate, I might use a diagnostic kit like this to test my urine and then use my smartphone to take a picture of the signal and use that to diagnose a urinary tract problem,” he said. “All that without ever having to call the doctor.”

  MUCH OF OUR HEALTH CARE WILL TAKE PLACE AT HOME, NOT AT THE HOSPITAL

  Pulling another gadget out of his box of surprises, Kraft told me it was a tricorder like the device Dr. McCoy used in the Star Trek TV series, a pocket-size device capable of measuring all vital signs and diagnosing many of the more common diseases. There are already a number of companies developing these mini home laboratories, and the X Prize Foundation has offered a $10 million award to whoever invents the best tricorder. It is expecting one of the participating teams to come up with a winning design sometime during the next five years.

  Tricorders will “detect our temperature, our heart rate, our blood pressure, our oxygen saturation,” Kraft said. “They’ll talk to our smartphones and they’ll give us an incredible amount of data that can help us diagnose a disease or manage a disease or triage it, and figure out whether we need to go to the doctor’s office or the emergency room….I think we’re going to see more and more things that we can measure that used to require an entire laboratory. Now they can be done in our pocket.”

  Just about every medical futurist agrees with Kraft in that the spread of home diagnostic devices will decrease the number of visits to hospitals and waiting periods at doctors’ offices. Much of the work of detecting and diagnosing diseases will be performed by patients in their own homes using tricorders or smartphones, which will become de facto portable health care centers.

  DOCTORS WILL BE INTERPRETERS AND PERSONAL COUNSELORS

  Skeptics argue that the new technologies for self-diagnosis won’t be a panacea because patients will be flooded with information they simply cannot understand. Patients will be so confused that they’ll need to see a doctor, the skeptics say. But, as was the case with computers and other technologies, new medical cell phone apps will be able to translate the complex medical jargon used by physicians into a much easier vocabulary that everyone can understand, and at the very least they’ll be able to tell us whether a particular symptom we have is serious or no
t.

  Vivek Wadhwa, a Silicon Valley futurologist with whom I consult frequently since first meeting him at Singularity University several years ago, believes that the doctors of the future will “serve as a filter, interpreting information and presenting it in a friendly and compassionate way.” At first glance, this might seem like a less vital role than what doctors are performing now, but it’s not: in the new reality—one in which we have at our disposal all the information from our sensors and tricorders, plus the data on our personal genetic code—we’ll need the advice of doctors to put everything in context and avoid overreactions, Wadhwa says.

  Soon enough, DNA tests to determine your chances of developing a certain illness will be as common as blood tests are today. Still, though, many people are worried. “When a genome test tells you that you are predisposed to a disease, you could take it very seriously and become demoralized, when in fact the factors that lead to disease are much more complex and often include aspects under our control,” Wadhwa writes. “The readouts that consumer devices produce could lead people who don’t have experience in medicine to make poor decisions.” Doctors will continue to be important, especially when it comes to helping us understand the prognoses provided by all these new technological innovations, Wadhwa says.

  ELECTROSHOCKS TO KEEP US FROM EATING MORE CHOCOLATE?

  During my talk with Kraft, I told him that I’m somewhat skeptical about smartwatches that track our steps and measure our sleep. My wife has given me a few of these devices as birthday presents in recent years. Most often, I’ll use them for a few days until I get bored with them, at which point they usually end up in a drawer. Many of us see them as a fad, as something fun, but when the novelty wears off, we decide not to keep using them. So what makes you think that they’ll become an essential part of our lives? I asked Kraft.

  “We know changing your behavior is hard,” he said. “If you’re my patient and I want you to lose weight, I can give you, in most cases, a little pamphlet and say, ‘Oh, read this. Go to the gym. Eat better.’ But we know behavioral change is hard. Now we can use connected tools on our wrists, sensors in our mattresses to track our sleep, apps that can track our diet, and use that to hopefully give us insights into our behaviors and answer questions like how many steps am I taking a day, how little sleep am I getting, and how much stress do I have in my life.” The more we know about our life habits, the easier it will be to modify them through small, gradual changes, especially when all the data are collected together and not spread across a number of platforms, he explained.

  Could you give me some concrete examples of that? I asked.

  “When we get insights into our behaviors, we can use that to adjust them. So, small changes in behavior, like walking an extra five hundred feet a day, eating one less cookie…over months and years, that can dramatically impact our weight, impact our overall health,” Kraft replied. “We’re going to see interactive images in our bathroom mirror that might show us our health score for the morning, and help remind us to take our vitamins or go to the gym.”

  In addition to the wearables that measure our vital signs, Kraft also expects us to be using more shockables, or sensors that give us little electric shocks. Really? I asked, chuckling as I pictured people getting electroshocked every time they smoked a cigarette, ate a piece of candy, or drank one too many glasses of wine. Yes, he said, adding that we’ll also be using trainables, showing me what looked like a strip of adhesive tape that’s already on the market and which is designed to help you with your posture. “You put this on your back for an hour a day, and it buzzes and gives you feedback when your posture isn’t good,” he explained. “After about a week of wearing this, people’s postures are dramatically improved. That’s an example of a trainable, and we’ll see other examples that might help you quit smoking, or give you feedback about your diet.”

  While Kraft was talking, the image that crossed my mind was that—with all these wearables, insideables, shockables, and trainables—we are going to become a society of wired individuals, like little Frankenstein monsters, who will experience little spasms every time we engage in some sort of inappropriate behavior. Science fiction? Probably most people won’t be eager to strap on sensors that produce electric shocks, but I wouldn’t be surprised if we end up wearing some benign version of these devices sooner or later. It could well be devices that produce a beep instead of an electric shock, or embedded chips that send some sort of silent—and mildly unpleasant—signals when we’re doing something unhealthy. If millions of people nowadays are willing to undergo cosmetic procedures and painful operations such as gastric bypass surgeries to look better, why wouldn’t they opt for a tiny invisible chip that would help them lose weight in a much less invasive way?

  DERMATOLOGISTS AND RADIOLOGISTS WILL BE THE MOST AFFECTED

  When I asked Kraft what kind of medical specialists will be most affected by the new technologies, he didn’t have to think much: dermatologists and radiologists, he replied. Whenever we have a skin irritation, instead of scheduling an appointment with a dermatologist, we will use applications in our smartphones that can already do a quick scan and instantly tell us whether it’s a melanoma or a harmless blemish, he explained. Asked whether dermatologists will lose their jobs, Kraft said no, but they will be doing a completely different job. Instead of seeing dozens of patients a day just to tell them whether they have a skin irritation that presents any danger, they will spend most of their time focusing on patients who really need medical care. Dermatologists will “spend more time on the therapy side, rather than looking at patients and going ‘Normal, not normal, normal, not normal,’ ” he said.

  The good thing about this is that many people with malignant skin lesions who wouldn’t otherwise find out in time will now be able to do so. “By using some of these sorts of artificial intelligence dermatology apps, patients will catch more lesions early, and then press a button and make an appointment with a dermatologist to do the biopsy or the therapy,” Kraft said.

  And Kraft believes the same thing will happen with radiologists. “Today radiologists see thousands of images,” he said. “They’re almost overwhelmed with chest X-rays and MRIs and ultrasounds. We’ll see more and more that machine learning and apps will read the basics and send the most concerning cases for a final reading by the radiologists, which could mean that we’ll have fewer radiologists.”

  In time, even pathologists, who study patients’ tissues and cells in search of cancer and other diseases, will let smart machines perform their more routine tasks. For years, Google has been working on its GoogleLeNet project—which was originally intended to interpret images for self-driving cars—to magnify, read, and recognize scans with better accuracy than pathologists with their microscopes can. According to some early studies, while an experienced pathologist is successful in diagnosing certain types of cancer in 73.2 percent of cases, GoogleLeNet has a 97 percent success rate. Google’s intelligent machine still has too many false positives among its cancer diagnoses, but according to its creators, it’s just a matter of time before it learns from its mistakes and eliminates them.

  ROBOTIC SURGEONS WILL SOON BE AUTONOMOUS

  Asked whether robotic surgeons and the microbots that will swim in our arteries and deliver medicines from inside our bodies will one day leave surgeons unemployed, Kraft told me that “we already are in the era of robotic surgery today.” He explained that there are thousands of robots around the world performing all sorts of operations every single day, and with greater precision and in less invasive ways than human surgeons can do. Robots controlled remotely by human surgeons make much smaller incisions, avoid unnecessary blood loss, reach parts of the body that were otherwise difficult to get to, and leave much less significant scarring.

  In most cases, the robot is perched above the patient in the operating room while the human surgeon is sequestered in a separate location directing the actio
n through a computer, much like the image that Shoham showed me on his laptop in Israel. But as the robotic surgeons hone their skills and develop their artificial intelligence, it will be less necessary to have a human doctor nearby to direct the robot’s movements, Kraft said. “Today the surgeon is literally controlling every move of the robot. But I think that, in the next few years, we’ll start to see parts of the surgery done autonomously,” he said.

  Surgical robots have been used since the 1980s. Their use expanded in the 1990s, when laparoscopies—in which small incisions allowed for cameras and surgical devices to be inserted into the body without the need to make major cuts—became more common. These operations were popular because they were less invasive and left less scarring, and patients were able to leave the hospital sooner. More recently, robotic surgeons became even more popular with the appearance of two creations by the U.S.-based Intuitive Surgical firm: da Vinci, which was first used to perform cardiovascular procedures and later also used for gynecological and urinary operations, and Renaissance, which performs spinal surgeries. According to a survey of American surgeons, operations performed by robots will increase from 15 percent today to 35 percent by 2021. The primary reason why there aren’t more robotic surgeons today is the high cost of the robots—over $1.5 million each, the study says.

  Critics argue that the growing use of robotic surgeons is mostly a marketing phenomenon. Many private hospitals in the United States are using robots as an advertising strategy to portray themselves as cutting-edge institutions in order to attract more patients, skeptics say. Many people naturally assume that robots are superior to human doctors, and are automatically attracted to hospitals claiming to use the latest medical technologies. When I asked Kraft about this, he acknowledged that there’s a grain of truth to it, but added that the growing use of robotic surgeons is a gradual, unstoppable trend. “We’re still many years away from fully autonomous robotic surgeons,” he said. In the meantime, there will be a “partnership” between human and robot surgeons. “It’s not a surgeon being replaced by a robot, but being helped and augmented, so the surgeon can do less invasive, safer, and smarter surgeries,” he explained.