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I have never been comfortable about making inferences
about people’s subconscious motives, but my life experience makes
me believe that the reason people give for opposing something is
often not the real reason at all. I first noticed this when I got
caught up in a situation precipitated by my research.
I had always been of the opinion that being honest with
patients was important to maintaining trust. After all if we started
lying whenever it was convenient (even if it was to the benefit of
the patient) confidence in medical practitioners would decline and
patients would think we told lies to make money. But I was working
with patients who wouldn’t remember if I had lied to them. I
reasoned to myself that in this situation being honest with the
patient's family was really what was important, and this could end
up helping not only the patients directly affected, but everyone.
Still what I was about to do was nothing more than an elaborate ruse;
at least as far as the patient was concerned.
However, the results of that experiment and those that
followed steeled my resolve that this was something that needed to be
implemented at every hospital and assisted living home. My enthusiasm
spread quickly among my colleagues and the insurance companies agreed
to pay for it, but there was a public backlash. My university was
shutdown for a day when what was suppose to be a protest turned into
a riot. Amid cries of “MY MOTHER DESERVES BETTER!” and “PEOPLE
BEFORE PROFIT!” ten people had to be hospitalized and one was
killed. After that I was not surprised when the death threats
started coming.
The
uproar that ensued even led to congressional hearings and proposed
legislation banning the therapy. I ended up subpoenaed before
congress and reluctantly subjected myself to the talking heads on
television where I was called a cold-hearted scientist that couldn’t
understand what it meant to be human, or that only someone with a
financial interest could advocate such a thing. After media
investigations found no evidence that I had any business ties to the
robotics industry, and that I was not being paid to lobby for the
insurance industry the matter was dropped, but not rectified.
Those
who wanted my medical license revoked remained resilient. I could
empathize with the people that were uncomfortable with the use of
robots to trick patients into thinking that they were interacting
with a human, but their outrage was only outmatched by their
irrationality. Instead of looking at the matter at hand, the patients
and their families, my personal life was scoured for anything that
could discredit me. They somehow figured out that someone I had a
physics class with in college (we hadn’t been in contact since)
owned a robotics company. I was even called a racist because the
robot used in my research was named Roberta (the inventor named it
after his mother). The more reasonable opponents stated that all we
really needed was to get people to come and spend time with people
with dementia. But of course nobody wanted to pay for it and not many
were willing to volunteer their time to do it. Not that I can blame
anyone for not wanting to.
As an
undergrad volunteering with dementia patients I saw the worst things
I’d ever seen; mothers drowning in anxiety and depression because
they cannot recall their children's names, people begging their long
since deceased parents to come free them (the patients had to be
restrained to the bed). Despite how widespread dementia was most
people still had no direct experience with it. The only reason this
therapy was not banned was because of the support of patients'
families and even patients in the early stages of dementia. They
understood that even with video chat their loved ones could not
always have somebody with them.
The critics were correct about some things. The
sitter-bots did not have souls and they had no empathy, but they were
very good imitators. Before the bodies themselves were built the
sitter-bot was nothing more than software that could talk to patients
via an intercom. The results were incredible; all measures of anxiety
plummeted, the rate of memory loss decreased. It appeared that
having someone to interact with protected the brain from the still
murky forces ravaging it. The rate of convalescence accelerated,
enabling patients to be discharged from the hospital quicker. In a
later study where games were introduced via a tablet computer the
results were even more dramatic. Sitter-bot could continue conversing
with the patient while playing the games and could even converse
about the game itself; engaging in friendly trash talk and displaying
mock anger when defeated. Through the games Sitter-bot could even
identify cognitive weak spots and trends in cognitive decline. This
data proved useful clinically and for further research. Soon
Sitter-bots where developed that change game strategy to aid the
patient therapeutically.
It was a shock to people that had never interacted with
individuals with dementia that many patients came to believe that
Sitter-bot was an old friend that they had known for years (often
after just a few minutes of interaction). For instance, a patient of
mine named his sitter-bot Evelyn and when he introduced Evelyn to
his wife she became enraged and assaulted the tablet computer the
sitter-bot avatar was on. I latter learned through the hospital's
lawyer that Evelyn had been the name of the gentleman’s first wife.
It became necessary to prep family and friends for the possible “side
effects” of sitter-bot.
The improved moods of the patients were also reflected
in their family members. All objective measures of stress decreased
and from my own subjective experience with the families they seemed
much more at ease. I wouldn’t go as far as to say they were happy,
after all their loved one was slowly slipping away from them, but the
situation was now less painful.
The
loudest critics were those who worked in health-care. It is an open
secret that much of the concern was about their jobs being replaced
by robots and this was the litmus test. If a robot could be used to
treat mental health, why couldn’t one wipe a butt, give a shot, or
take a blood sample. Indeed all of these things eventually happened.
I too felt anxiety about my own future caused by the exponential
march of artificial intelligence and robotics, but when I look at the
positive contributions these have made toward patients whatever
befalls me is worth it. If we oppose a technology that can aid a
patient because it will do us financial harm we are no longer
healers. I am a firm believer that one should not waste their energy
fighting the inevitable. I know from personal experience, when robots
started being used to diagnose and treat common mild diseases, but
one must prepare for the future. This needs to be recognized not just
within health-care, but in society in general.
The transition to the use of robots in health-care may
not have been seamless, but today you would be hard-pressed to find
someone who would want to go back to the old ways. I am old enough to
remember a time before autonomous cars. Young people today can not
fathom how allowing individuals complete control over the movement
of their cars was once considered an acceptable risk. Indeed, it does
now seem absurd that we once preferred having a person operating an
object that weighed a ton moving at 80 mph. Or how doctors once
thought washing their hands before seeing a patient was a waste of
time, because they had never done it before. That appears to be the
nature of change, everyone bemoans it when it’s happening, but
cannot imagine going back to the old ways once it’s done. I am of
the opinion that health-care is at another one of these junctures.
The pharmaceutical industry entered its most profitable
era after a consortium of the industry's biggest players developed an
artificial intelligence software capable of scanning an isolated
pathogen or molecular defect and then design a therapeutic. They
split up the areas of manufacture based upon their respective
strengths. This breakthrough should have heralded in a new age of
personalized medicine; in a sense it did by taking into account a
limited set of genomic information. The industry quickly developed a
series of blockbuster drugs that they could control the manufacture
of.
When
the technology reached it’s limits instead of trying to improve it,
resources were diverted to the legal, lobbying and marketing
departments. Those who improved upon the technology were held up in
court or sued into non-existence. Lobbyist insured that the patent
office saw things from big pharma’s point of view. The marketers
were needed for the few instances where a rival therapy made it
through the gauntlet of lawyers and lobbyists. With their patents now
about to expire the industry is feverishly attempting to have the
laws re-written to protect their monopoly.
Now
that their software is about to become opened sourced they fear
improvements beyond their control will be made to it; allowing others
to make a profit. They fear that improvements in technology have made
it possible for drugs to be manufactured locally, on demand. Despite,
the fact that this technology is by any measurable standard safe and
dependable, big pharama is lobbying to have it outlawed; all in the
interest of “patient safety”. As a society we should not succumb
to the fear campaign of the pharmaceuticals industry. They may have
convinced themselves that ‘thousands upon thousands’ will die if
others are allowed to design and manufacture therapeutics, but the
only evidence they have for this claim is their own motivated
reasoning.
We live in a world where information is the
infrastructure, and information changes rapidly. Never before has
humanity lived in a world where the underlying structure that
dictates how we survive can change so fluidly. It is hard to know
which direction is forward, and as a society we must learn to be more
accepting of the fact that many people will find themselves on a path
that is no longer viable. If change is no longer seen as something
menacing than the transitory periods will be less painful. Someone
else's gain will not be another’s ruin and we can have an honest
conversation, as a society, about the possible costs and benefits of
the change in question. Those of us who work in health-care can
become the paragon of this new paradigm. We can start by not letting
our colleagues in the pharmaceutical industry fool themselves into
thinking that they are now representing the best interests of
patients. Not only are they not helping patients but they are also
doing themselves a disservice. There was a time when we were
reluctant to wash our hands to protect patients from infection, now
we must get used to washing our hands of the past if we are to
protect patients from ourselves.
