Translator: Claire Ghyselen Reviewer: eric vautier
Hello.
My name is Cécile and I am a medical doctor and a geek.
I was asked to talk about
the revolution of new technologies in the health sector.
So, let me take tell you a story of technology.
You always find human beings behind every technology.
So, in my story, there are many human beings too.
Is there anybody here
who has ever heard the story of a scandalized person
who has met a medical doctor telling him a serious diagnostic brutally,
without empathy, with too many scientific words,
in a hospital lounge and without taking any time.
It sounds familiar, right?
So, do you think that replacing this doctor by a computer
to do this diagnostic will make things improve?
Before we answer this question,
let’s go back a little bit in time.
When I was a young student,
it was the early days of the so-called connected health.
The first medical forums such as Doctissimo were launched at that time.
In these fora, you could learn that your pain in the right arm
was probably caused by a cancer at you left ankle.
It was the era of connected objects, like watches,
more or less reliable, if you see what I really mean.
Bid data and algorithms were very new concepts
that would eventually replace us, the medical doctors.
Generally speaking, Silicon Valley was invading France
for the better and for the worst.
For me, it was a revolution that would transform medical practice.
But many of my colleagues
were rather reluctant:
“These gadgets are absurd and useless.”
“The Internet? It’s evil.
Our patients really should not use it.
Anyway, I have not studied for 10 years
to be replaced by an algortithm, for God’s sake.”
So, how shall I put it,
I was kind of a UFO, unable to think like everyone else.
Because, I considered technology,
of course as an early stage and very immature technology,
but I thought it was a very fresh concept:
the idea to be able to share knowledge between everyone.
The concept to build new tools for health professionals
and their patients.
We simply needed to develop better tools together.
Yes, together.
And that is the problem.
We needed to overcome that thing
and connect the tech world with the medical one.
Not an easy feat.
Because, without the health professionals, and without patients,
you cannot develop good tools.
You know, tech entrepreneurs are often very young.
Chickepox and cold are all they know.
They do have many ideas, all right.
But these ideas are not always super useful for doctors and patients.
As an example, there was this start-up that developed a connected menstrual cup
with a battery and a bluetooth antenna inside the cup.
Thanks to an app, women could follow the heaviness of their bleeding,
in millimeters.
They could check their blood color on their smartphone -
no, no, this is not a joke -
and check their menstruation cycle,
just in case they had not realised
that, indeed, they had their menstruation.
And of course, when the cup is full, you get a notification.
And, they have raised 160 000 dollars.
I find this quite scary.
So, as if the health professionals were not reluctant enough,
the press added one more layer with spectacular headlines
declaring war between doctors and technology, between men and machines.
You can imagine that the doctor, that old dinosaur,
was not going to win this war.
But OK, technology has brought small miracles.
Even a big one.
With biotechnologies, we have developed new therapies
that let patients with cancer live months and even years longer.
What about genetics?
The genetic revolution took more time than we expected.
But with CRISPR-Cas9 genetic scissor’s democratization,
we can treat diseases that had been incurable until now.
Artificial intelligence
provides algorithm that have become able
to give a better analysis of X-rays and some scan images
than our radiologists.
Surgical robots have articulated arms
more precise than our surgeons can ever be.
Today, at public health centers, 95% of prostate surgeries
are performed by medical robots.
And an increasing number of anomalies
or very complex tumors difficult to treat with classic surgery
can be performed with robotic surgery.
But wait a minute.
Behind prescriptions, the robot’s arm, or even algorithm encoding,
who exactly has the final word?
There is a surgeon to command the robot’s arm.
There is a radiologist to finalize the scanner’s report.
Well, the a.i. might replace us tomorrow.
But if it does, it is a good thing.
We do not study medical science to get a nice-looking diploma
but to get people better.
If technology’s performance is better than me, so be it.
But for many specialized fields, this is not going to happen soon.
Technology cannot palpate a belly or examine a throat.
And we cannot get full body scan
each time something is wrong.
The radiation emitted by these scanners increase the risk of cancer.
Technology cannot talk with empathy either.
Yes, you must be thinking
that many doctors cannot do it either.
And you are right; it was the start of my talk.
But the solution to a problem is not always found in a machine.
The solution in this case is to train doctors to communication more efficiently.
Because, yes, no-one seems to expect this but you can learn to communicate.
Today, we do not teach it enough
but we are working on it.
And, no, no, no, no, no,
don’t talk to me about humanoid robots
able to analyse facial emotions of human beings
and then fake some empathy back.
Non authentic empathy can be fascinating but does not make the trick.
We often forgot that, when we are suffering,
when we bear the load of sickness,
well, we need information adapted to our personality,
to our state of mind, to our living context.
We need to feel someone is listening to us with care.
We even need affection and hope.
In these cases, technology can assist us, but not replace us.
It can assist us to make better diagnostics and treatments.
Sometimes, it can deal with technical tasks
so that we can spend more time in consultation with our patients.
Sometimes, it requires time that we cannot spend with the patient.
Too much time with the increasing complexity of the administration.
But sometimes, it is in our patient’s best interest too.
My point is
that technology is there to serve us
and that we, humans, are developing it.
So, we need to tell it what we want it to perform.
To ponder if tech will replace us is sterile.
The question to ponder is to determine what we want it to perform for us.
And today,
it offers us more and more opportunities.
So, what does it mean caring for patients tomorrow ?
Before we answer this, let’s go back a little bit in time.
Before, it was pretty easy
because you did not need any tool to treat a patient.
For instance, before the echography,
you could not detect anything in a fetus before the baby was born.
So the baby was born and then we managed the manageable.
Then obstetrical echograph was developed.
We could now detect all kind of anomalies during the pregnancy
and sometimes suggest solutions, in utero surgeries for instance.
By the way,
let me challenge those who think that technology will replace man:
Did you notice that the emergence of a tech, such as the echograph
did not deprive any gynecologist of their work.
It’s quite the opposite, it led to more work.
Or, today, genetics,
enables us to go further in controlling the good health of fetus.
You may be try to get some characteristics for your child to be born.
In medically assisted reproduction,
you may pick a sperm donor with blond hair.
Or, no, rather brown hair.
Or, a man with a good academic background,
and of course, very good looking.
In Ukraina, if you are rich enough, and this is the next step,
you may choose the sex and the color of the eyes of your future baby.
And you, what would you do?
If you could choose your child,
what kind of characteristics would you select?
Imagine that you choose a boy with blue eyes, for instance.
But when he is born, he has the big nose of the great-uncle,
or, when he grows up, he becomes a criminal.
Would you agree ?
Because, yes, we can choose some things,
but you can’t get everything, it’s impossible.
The unexpected always happens.
Or, would you prefer let nature do its job ?
Here, our babies are 100% bio.
This is stressful, isn’t it?
I find it stressful.
Because, when tech is used to repair the human,
we all agree.
But when technology is used to go further,
not only to repair the human, but to augment him,
then, it is a whole new world.
What I mean by repairing
is to get the human body back to a proper functioning state.
For instance, if I have myopia,
well, the doctor prescribes me glasses and there you go, I can see properly.
If I break my leg,
I wear a cast during the time necessary for my bone to heal
so that I can walk again properly.
To augment means to provide man with superior capacities
than human ones.
It can be, as I have just said,
parents who choose which embryo will be born.
But it can also be a retinal implant that we insert into our eyes
to see in the dark,
or a cochlear implant in the ear
to hear a larger sound range.
It could be an exoskeleton to run faster than Usain Bold.
It could be a chip in your brain
to increase your memory capacity.
But then, in these cases, do we become super-human?
Or on the contrary, do we get less human?
Maybe some kind of post-human?
These questions lead to an even more important question:
Thanks to medicine and technology,
what kind of humanity do we want for tomorrow.
We can find some good inspiration in a long time expert:
science-fiction.
SF has imagined, for instance, a world based on normopathy,
as in Minority Report, featuring Tom Cruise.
Everyone must fit the norm and be healthy.
Anomaly is tracked and punished.
Don’t even dream of that second croissant on Sunday morning
or spending the day on the coach.
Then, please, let’s smile at work.
It boosts the company’s productivity,
I mean your personal productivity, please excuse my slip of tongue.
In SF, you also find transhumanist scenario,
like in Terminator.
We have a never-ending race between super heroes, half-man, half-robot,
neither man, nor robot.
They are stronger and smarter.
But also more power thirsty, more irresponsible, more egoist.
Then, there are movies about eugenism,
such as Gattaca, featuring Uma Thurman.
You could only pick the sex and eye color,
and create a customized human being.
But if you shape human beings
until he has fully lost its capacity for self-determination,
is there any room for freedom?
Then of course, there are the immortality scenario.
But I wonder:
when you are immortal, can you have children endlessly?
Because, it’s going to get quite crowded.
Shall we, let’s say, limit parents to a child every 200 years?
No, no, no, every 2,000 years.
And, where shall they live?
On Mars?
But did you notice all these craters on Mars?
You see, on Earth, we don’t have them
because we have this special thing called magnetic field.
Thanks to it, the sky is not falling on us.
You know, I think I’ll stick to the Earth.
Another example: what if we imagine a world
where we replace every human competencies
by technology
and because of this, we would become complete idiots,
degenerated and dependent on technology,
unable to perform whatever it is,
until we loose our capacity to think by ourselves.
What is your worst case scenario?
What is your wish-to-come true scenario?
Now, this question may be a good reason
to watch all these films again that I have just mentioned.
It may also trigger good conversations during your next diner with your friends.
But, it sounds like a far-stretched question,
too far to worry about now, doesn’t it?
And anyway, I, alone, a very humble person on this large planet,
how could I have any influence at all?
Well, I do not quite agree.
Because, maybe we can’t prevent the future to happen,
but we can contribute to influence it in some kind of way.
It’s called the butterfly effect.
My personal philosophy is that in this live, we hold two treasures.
Our planet
and health.
One without the other is nothing.
So if the Earth is indeed our ship, as this TEDs Talk theme suggests it,
let’s use the three leverages that we do have:
nature, humanity and technology,
to focus on our destination and navigate, together and collectively.
Personally, I am not convinced
by a transformation into some kind of post-humanity.
Why?
Because, when you scrutinize technology,
yes, indeed, it has fostered huge progresses in many fields:
science, medicine, transport or housing.
But has it ever made any progress, and since the early days of humanity,
in our consciousness, our human consciousness?
Our thinking, our ethics, our internal happiness.
If tomorrow, we were to re-encode ourselves without flaws,
would the love of our partners be deeper?
Would the Earth be more restful,
should we have perfect bodies?
I believe we cause one major problem
by focusing too much on technology
as the ultimate source of all progress and all abuses.
But technology has never been the problem.
The problem lies in the ape behind the driving wheel, us.
The crucial point is how we choose to use it together.
And to go on choosing, choosing together,
we should talk about these topics,
we should teach them to us and the younger generations
so that we nurture our thinking and decision capabilities
without relinquishing it to any digital giant company
or to any politician.
So, before we talk technology and medicine,
the first question to ask might be to try to know
what will make us happier in our life on Earth,
and if technology is the right tool to make this happen or not.
And then, maybe, we can fancy to dream about augmented humans.
But that’s a story for another day because mine is over.
(Applause)