Can technology make healthcare more human?

In this series of Moonshot interviews, imec Netherlands talks to experts about the impact of nanotechnology on our future society. In this second episode, Dianda Veldman, director of the Netherlands Patients Federation, together with Patrick van Deursen, Program Director Health at imec within Holst Center, explores the role technology can play in making patients feel more human again.

The Netherlands ranks among the most prosperous countries in the world, with the highest life expectancy. The downside to this, is that stress and typical lifestyle diseases such as diabetes and obesity are relatively common. No less than 57% of the Dutch have one or more chronic conditions, among the over-75s this percentage even rises to 95. More and more Dutch people are therefore categorized as patients with one or more conditions, who depend on healthcare. Can technology help us to reduce the daily impact of that care need and allow people to fully participate in society again without a patient stigma?

More human, less patient

Patrick van Deursen is convinced that it's possible. From imec, he and his team work within Holst Center on promising care applications based on microelectronics, to restore patients' quality of life. He gives an example: "When you have diabetes your daily life completely revolves around insulin injections. Furthermore, in case of kidney failure, it's very common that you need to go to the hospital for kidney dialysis three times a week. At imec, we work together with, among others, the Kidney Foundation on the development of an artificial kidney. We proceed with small steps, and our first goal is to make the dialysis process more intelligent, and then portable. Ultimately, the artificial kidney could become an implantable device, that can actually technically replace your kidney."

Dianda Veldman is also a great proponent of technology in healthcare: "I think this is an excellent example of the vision that we have formulated for 2030 at the Patients Federation: 'more human and less patient'." Patrick: "Our one-liner from imec has a similar meaning: 'taking the patient out of the person'."

Make yourself redundant as a specialist

In daily practice, Dianda comes across many prejudices about technology in healthcare. "It would be at the expense of the warm personal attention. But I don't see it as a contradiction. In the book "Deep Medicine" Eric Topol describes how technology, and especially AI, can actually help us to spend more time with the patient. You need both. Real care can therefore also mean that you can avoid needing care."

Patrick agrees. "I think chronic care is one of the biggest challenges. For me the question is not: how can you improve chronic care, but how can you ensure that someone is no longer a chronic patient? In fact, your ultimate goal as a specialist should be to make yourself redundant. With primary prevention, such as lifestyle changes, you can partially achieve that goal, but you also have to take external factors and DNA into account. Then the next step is secondary prevention, to ensure that people stay out of that chronic care system." Dianda: "Exactly, support people who are at risk so the risk will not erupt."

The hospital should be able to repair you

How does Dianda see the vision 'more human, less patient' become a reality in the future? "In the first place, it means that we have to work towards a situation in which it is easier for everyone to stay healthy. Technology can certainly play a role in this, but it also requires human behaviour, plus a living environment that stimulates healthy choices. And when you do get ill, you should have more control over your situation. That is why we argue, partly as a result of the corona crisis, for hybrid care. During this lockdown, we already see digital solutions for remote care next to phone services. We want to continue to work with this after this crisis. With remote guidance the urgency to go to the hospital is a lot less." And if it turns out to be necessary to go to the hospital after all, treatments can improve considerably thanks to technology, she says. "By using surgical robots your hospital stay can be shortened significantly. And thanks to less invasive treatments, you recover faster. At the same time the role of doctors is changing. On the one hand, you will have generalists with a very broad spectrum of care who will coach you and point out the right care. On the other hand, you get highly specialized doctors who have all the accumulated global knowledge in this specific field and know how to use specialist instruments." Patrick also sees the changing role of hospitals: "In future you should only need to go there when things really go wrong. You get your treatment and you leave the hospital in a better state than when you went in. The current situation is like this: I suffer from kidney failure, I go to the hospital and I end up spending the rest of my life on dialysis. What you really want is to be 'repaired', no longer in need of care."

Tailor-made medication

Nanotechnology has the potential, according to imec, to not only restore functions, but also to enlarge or transform human capabilities. Patrick: "With so-called wearables, ingestables and implantables, you will soon benefit from invisible, imperceptible technology on and inside your body that improves your health in a very precise and personal way. You are no longer aware of your condition." Dianda: "Like a pacemaker." Patrick: "I think that's a nice comparison. Despite the fact that you have a significant health issue, you are no longer constantly aware of it and you fully participate in society."

Dianda: "I truly feel sorry for all those women who suffered from breast cancer and depend on hormone therapy for years, which completely destroys their lives. This kind of treatment should be much more tailor-made." Patrick: "That's right, a lot of people struggle with an enormous amount of pills every day. What if we could store medication in our bodies, which is then carefully distributed in exactly the right amount, at the right time?" Dianda: "That ties in nicely with the 'more human, less patient' pursuit: medication is no longer a hassle. And you are not worried about it either."

Diagnosis colon cancer

Unfortunately Dianda is an expert by experience. She was diagnosed with colon cancer in December last year. "I am clean after two operations, but for the next few years I will have to go to hospital every three months. I would really like it if there was some sort of device in my body that signals when something is wrong, that gives peace of mind. During that period I also spent a lot of time looking for data from patients like me with colon cancer. What is my survival rate? That's why I absolutely believe in sharing global knowledge of medical doctors and patient data and make it accessible to everyone, so that you can diagnose more accurately and receive tailor-made treatments."

Dianda touches on a sensitive issue: the sharing of data and privacy in healthcare. Patrick: "For me that is a technical-operational challenge, for which there are good technical solutions. AI-based technology makes it possible to securely exchange anonymized data. Dianda: "I am not an ICT specialist, but I am in favour of a data train that only collects relevant data. Patrick: "That's what we do with 'privacy preserving': only exchange data at the level of algorithms or warnings. Then you no longer have to send all raw data to the cloud. Moreover: when in future a device is placed on or inside your body, you can keep data completely to yourself. Only when an intervention is necessary does a signal go out." Dianda: "I think we both feel that big data has a lot of advantages, but that at the same time you have to arrange privacy properly. For me that is also about political choices. When tech giants enter the healthcare market, there might be different interests at play. A doctor must take the Hippocratic Oath, but what about the Facebooks and Googles of this world? That ethical, governance side of healthtech is a very important one."

Whats' next?

Finally, if we look a little closer into our crystal ball: where will technology take us when we have overcome chronic diseases and added more and more healthy years to our lives? Patrick: "If we take it one step further we're looking at augmentation of human. Then we'll not only be able to repair what's broken, but to actually improve a person." Dianda: "As in human 2.0. Just like Yuval Noah Harari describes in his book 'Homo Deus', about makeable humans, who may one day become immortal. I think we should be careful with these kind of developments, which can also further widen the wealth gap." Patrick: "We are already seeing it on a limited scale; humans are already better than 10,000 years ago. Are we going further in that direction? I don't know. We will see."

* Figures as of January 1, 2019 from the Ministry of Health, Welfare and Sport published on Volksgezondheidenzorg.info