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Do what we need not just what we can

May 30, 2016


So it won’t be long before we have driverless cars and lorries and fast food outlets are already looking to use robots to serve their food. I am sure there are benefits in both but the story of the relentless drive to replace people with machines cannot but stir some level of anxiety about the future.

The use of technology is one of mankind’s defining achievements.  Whether it was the discovery of fire, the first use of stone tools, the development of agriculture, the invention of the steam engine or the internal combustion engine or the arrival of the internet and the i-phone, humans have had a brilliant capacity to harness technology to triumph over their environment and promote their species.  However have we now got to the point where the process of technological development has got out of control?

There is nothing new in such fears. We are familiar with the term “luddite” with its origins in the early 19th century agitators who tried to stop the adoption of new technology in the cotton industry.  The French word “saboteur” has similar origins referring to the fact that the French agitators threw their clogs “sabots” in the machinery to put it out of action.

Much of the time those who have been anxious about the advent of new technology have been proven wrong. New technology has been disruptive but in the end has increased prosperity.  Old jobs have been replaced by new jobs and the world has moved on.

We have even survived 71 years in the shadow of nuclear weapons, the technology which gave humankind the potential to self-destruct. However, as the details of history become clearer, we have discovered that we came closer on occasions than we may have thought to doing so. As Barrack Obama’s speech in Hiroshima on Friday, highlights, despite a quarter of century since the end of the Cold War, the nuclear threat is far from finished.

I am not a natural Luddite although at times the passing of the “old ways” can be upsetting. I do have concerns, however, that we have lost some of the ability to harness technological innovation to address the most pressing problems faced by humankind. There are two issues.  First we have allowed scientific problems, in some senses, to be prioritised over moral ones.  Second, and in part as a result of the first phenomenon, we have abrogated too much of the control of technological development to private interests.

This has left us with a mixed legacy from the golden years of technological development. For instance we harnessed technology to massively drive up living standards but have been unable, or unwilling, to address the issue of inequality or even to eliminate levels of absolute poverty in certain parts of the world.  Technology has not succeeded in making the world a safer or more secure place, indeed at times, has done the opposite.

There is a dimension to this healthcare. Medical research has achieved phenomenal things in the century or more in combatting disease and in extending the span of human life.  For a person born in 1900 the modal age of death would have been 1, for someone born in 2010 it is estimated to be 90.

However its progress has left significant issues in its wake which we have failed to resolve and to address with the same focus as we have brought to biological medical research.

The development of medicine has n’t succeeded in reducing health inequalities and there is an increasing concern that priorities for research, in particular in pharmaceuticals, will be driven by the needs of the global elites able to pay for new treatments.

A model of medicine focused on extending life has also left a moral question about the balance between additional years and wider issues of wellbeing. I have just finished reading Atul Gawande’s excellent book “Being Mortal” which makes a very powerful case for rethinking paradigms about what matters as we grow older and frailer and what the role of medicine is in facilitating this.

So my plea is not to stop the development of technology in healthcare but rather to reframe the debate in which helps drive its priorities. Happiness, quality of life and wellbeing for the greatest number should be more central in our thinking.  That would inevitably shift more focus to research in mental health, at present hopelessly underrepresented in research priorities in proportion to the size of the burden of misery and costs to individuals and society it is linked to.

In an age where there are increasing concerns about the costs of universal healthcare systems more effort should be invested into interventions which reduce rather than increase the cost of healthcare delivery, either because they can offer the genuine prospect of cure or because they can significantly reduce the costs of delivery of existing treatments. More research should go into self-care and self-management where technological enablers have some genuine potential to improve outcomes.  Public health and research which focus more on the determinants of health and illness should also feature higher

All of this will require some significant changes in the setting of research priorities, systems of funding and the processes set by NICE for the adoption of technological advances and new treatments.

Technological advancement has been mankind’s defining achievement. Let it not become our master rather than servant and let’s harness it to solve those problems which are most pressing for our society.


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One Comment
  1. Jonathan Souray permalink

    “… self-care and self-management” ….. AND early detection and intervention – bio-psychosocial directed prevention – high techno capacity to assist.

    Thanks for challenge, Paul.

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