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Over the last few decades, technology and medicine have worked side by side. Technology is being used to fight illnesses, develop new vaccines and medicines to help people live healthy lives. This week on Download This Show, we are looking into the impact of technology on the healthcare industry and what it looks like in the future. From advancements in medicine to the growing danger of cyber attacks and what does the future of healthcare look like when AI is involved.
All of that and much more coming up, I'm Mark Finell and welcome to Download This Show. Yes indeed, it is a very special episode of Download This Show. We have very special guests. First joining us from Brisbane, Jennifer Dudley-Nichelson, future economies reporter with the AAP. Welcome. Thank you. Happy to be special.
We have joining us from London, Dr. Jack Kriandler, CEO of Well Founded Health Medical Tech Innovator Extraordinaire. That's what I've made you an extraordinary. Welcome to the show. I'm hugely grateful to be here. There's a lot to get through in the intersection between technology and medicine. I do want to talk about some of the things we should be mindful of, some of the things we should be concerned about.
I'm actually just going to start with something that you're feeling optimistic about. Jack, this is a space you've worked in for a long time. When it comes to the intersection between technology and medicine, are there things going on right now that excite you, that kind of fill you with optimism, that can change the way we live in the future?
Well, as a tech optimist, yeah, I mean, there's an enormous amount of tech, which is really changing the way that we practice medicine and make us able to do more of the good old hands-on stuff that we all really want to do more of.
I think everyone has heard of AI, artificial intelligence. One of the things that came out quite recently that I was incredibly impressed by was work by a company called NABLA and NABLA and turn them into voice with consultations and turn them into notes and then extract the information from those notes and just do the summaries, which you can then edit, but it saves an hour per physician per day in a big health system called Kaiser, which is kind of like an NHS out there in America.
So an hour a day in the UK, that would be like 200 million hours of spare time, suddenly freed up for nurses and doctors. That's cool. And for you, Janna, when you're looking at the intersection between medicine and technologies, there's something that particularly excites you. There's lots of things that excite me and there's lots of things that make me very afraid all the one time. And so it's kind of hard to separate the two.
It kind of reminds me of when we all got promised that we'd have a health record that would follow us around everywhere. And it was like, oh, it's going to be great because all of your medical problems that you've had diagnosed with one doctor will follow you across to the next doctor. And then you realize that there's problems with that and then there's problems with the government being trusted with a kind of technology as well. So I have difficult feelings.
Well, let's talk about that. This is a consistent theme that we're seeing playing out all over the world. Increasingly, our medical records, in some cases, our interactions with medical professionals are completely digital. And of course, the more information you put online, that creates privacy risks. I mean, I know that there was a particularly notable cyber attack on the health system in Ireland in 2021. Jack, is this something that you're seeing from your vantage point as well?
Certainly wherever there's information, it's subject to attack and issues. I think we're referring to this really terrible incident where statistically, sorry, more people died of cancer problems because of lack of follow up when the Irish health care system was attacked by ransomware. I think we're talking about that. We were unable to actually pull out records for cancer patients and like radiotherapy and stuff was stopped.
So clearly, there are some incredible vulnerabilities when you don't think about the malice that can happen and the mistakes that can happen when you've got such incredibly powerful information and critical information, which goes wrong, goes missing. That is a massive concern. Everybody is thinking about it. Whether we're doing something about it quickly in our visit is another question.
So that is a worthwhile question. I mean, there have a normal level of skepticism when we upload our personal details to most services, but it is significantly more sensitive when it comes to medical information. Are people more or less trustful when it comes to uploading their medical information? I think that we've gotten to a place now where a lot of people just assume that their privacy is bust, but this is an area in which it's really important that it's not.
We're forced to share a lot of information with doctors because otherwise you don't get the right diagnosis. And doctors in order to keep records of that have to keep a digital record of that, especially in places like hospitals, which are being targeted by ransomware groups. So I think it doesn't matter if you're trustful or not, it's going to happen anyway. And so I think a lot of these organisations probably require a lot more assistance to make sure that their systems are safe.
When you're talking about this situation in Ireland, for example, as I understand, they got in through an errant email and someone clicking on the wrong link, which is horrible.
But in a lot of cases, we've seen ransomware attacks based on exploits that should have been patched and old systems that are in use. And according to a lot of security professionals I've talked to, they have said that hospitals and health care services get targeted because they have a wealth of really important information that could leave people very vulnerable, that they probably be willing to pay money not to have published.
And at the same time, there's stored in systems which are potentially archaic that are not well supported that they don't have emergency systems in place and plans in place for if data is taken and encrypted or made inaccessible. It's a bit of a meeting of two terrible eventualities that we need to really address.
Jack, I'm curious about the effect on patients here. If there's an increasing number of cyber attacks or if people's medical data does start to be released, if these things happen, and that's a big if, because there's obviously been some reports, but it hasn't necessarily exploded in ways it could have.
But if a few more of those events happen, do you think that there will be an effect on patients perhaps not wanting to get certain things diagnosed to have not wanting to have certain things sitting in a record potentially waiting to explode in their face? Is that a concern? Yeah, well, certainly we already know there are threats of data leaks. You're not going to give up as much information perhaps about the sexual health, your mental health.
But I do think that there is almost an impossibility that if something's really going wrong with you and you end up out of your own control, ambulanced into an emergency room, you're not going to have much of a choice as to whether you give information about yourself. So it's inevitable. We'll have to engage with health systems. The point is not really whether we have choice. We just got to do something about the issue of security.
It's critical national infrastructure if you think about it. We would protect information about our defense systems, our energy systems, about our supply chain systems, and we put incredible amounts of effort into that. But I think it's now time that we start thinking about our health systems as well in exactly the same way.
One thing to show is what you're listening to. We are talking about the future of medicine. I guess this week is Dr. Jack Cronler from Well Founded Health and Jen Dudley Nicholson from the AAP. Jack, you mentioned earlier a really wonderful example of how AI can be useful in the medical profession.
It is inevitable that AI will produce a suite of tools that are being used as we start to fold AI inevitably into medical practice. What are the things that we should be mindful of? Are there sort of broad top line guidance that you think should be observed?
I think the biggest danger with breakthroughs is that they do break things. Let's first of all say AI is not new. It's like a really cool rebranding. What is new are these extraordinary things that we've all heard about like chat GPT assuming that they will speak to us with the same nuance and subtlety and understand real deep understanding of how that human front of you is working.
The assumption that AI in that respect is going to replace supersedes superscale all of the healthcare stuff in your health system is night. That I think is the biggest thing that we need to really be mindful of is that co-pilot is great. They can help us scribe. They can help us take notes. They can help us summarize things. They can help us do all the horrible coding to put into these ghastly electronic record systems.
That's really fantastic. The ability to help spot the node in the lung when you're as a radiologist might look at it that you might have missed or characterize it better. Great. But it's the reliance or the expectation that it might suddenly replace the human nuance thinking and just the compassion frankly that I think is one of the biggest things that we need to be mindful of.
I know you're a tech optimist at all. Is there an example of a piece of technology in medicine that makes your blood run cold where you're like, you know what? We should not be doing that. Does anything stand out? Well, no. Every single thing that we do has two sides to the coin. Let's take the example of a system that maybe helps with describing notes like we just described.
The plus side of it, as I said, it can save an enormous amount of time. But the other side of it really is that we will sort of lose our ability to spend as much time with patients potentially if we're not careful. Instead, we might actually reduce the number of people that we train to do my job for the sake of cost savings. Now that really is scary.
So it's not really the technology itself, but it's kind of the budget. If we got budget X and we're trying to reduce it and hear some technology to do it, then like in the UK, we're not seeing as many specialist trainees being put through the system. We are not giving so much budget for more GPs paid to look after patients for family health in the community.
We're getting folks who maybe haven't had as many years of training, but are quick to get through the system, who are great in certain areas, but maybe don't have that in the same level of experience. That's a dark side of technology.
So I think that's really interesting, because we often fixate on the individual, the new apps, the new technology that comes out, and its direct implications. But actually when you introduce these tools into a system, there's a ripple effect across an entire interconnected medical system in any country. And that's where things start to shift. That's really interesting.
Jen, for you, when you look at new announcements coming out about medical technology, where's the course for hope and where's the course for alarm for you? It is everywhere. So I've seen some announcements around sort of AI being used to pinpoint scans, for example. The good doctor mentioned around, you know, even guiding radiologists to look in certain areas and abnormalities after an AI model has been trained on previous scans.
And I think that's a great use of the technology. I've also seen instances where it'll say, you know, this app will scan your skin for skin cancer, which is a great use in Australia, for example, where we've got heaps of the stuff. Personally, I tried out one of those and it did not find the area where I now have like a scar that I'm pretending was made by a giant shark bite. So it fails. It needs human oversight the whole way along. I don't want to be diagnosed by a doctor.
I think it's interesting where we've seen like chat bots put in place so that you can ask, you know, a chat bot a question and it will sort of rely on all of the start of it. It's been fed in to spit you out an answer, but that's not the same as talking to a human doctor who knows much more than a chat bot who has many more years of training and reservoirs of information.
And I think all of these things are fantastic tools potentially that could have other consequences. However, they are just tools. They're not replacements for medical professionals. And I think that's a really important thing to note. Here's a thing, Jennifer, just bouncing back off that, which is, let's say that technology is misses 10% more of the diagnoses that a human would.
What if we have a capacity shortage of 50% waiting lists of six months or a year to be able to see a doctor in the first place? I think one of the challenges that we've got, which we really have to face technology or not, is that we've got more and more and more sick people who are getting sicker and sicker because of poor investment in health and dietary matters and food quality policy and processing and so forth. And I think that's something that we really need to talk about too.
That's particularly interesting. One thing that stood out to me listening to Jen's story that is intriguing to me is datasets. I mean, the reason it didn't pick up without being an absolute expert on this, the easy assumption would be that the reason it didn't pick up on your skin cancer is because the dataset hadn't acquired enough knowledge to do it accurately. One would assume over time it does become more effective over time. Does that not give you a little bit of hope, Jen?
Yeah, it makes me hopeful, but at the same time, I still want to see a real doctor. I still want to see a human-shaped doctor who can recognize that stuff immediately. As you say, like, as data sets improve, these things can get better over time and certainly that was an early version that I used.
I think it's interesting though, because it kind of indicates that if you don't have a complete data set on a patient, then potentially you could have a misdiagnosis, which is no better than having no diagnosis at all. I think there's reasons for excitement and reasons for complete fear as well. I definitely take your point, Jack, about filling up the shortfall and making sure that we can service the breathtaking numbers of people that need medical attention.
But is there ever a concern for you about people falling through the cracks where the technology isn't at the level that it needs to be yet, but people are potentially being misdiagnosed? What things being missed and completely is that something that we need to be paying more attention to? It's always a worry. The worst feeling you can get as a doctor is that you've missed something or you've misdiagnosed something.
If there are tools that help us to minimize that or to screen people, even if they're not 100% right, if we can get to, in the end, see more people, that's great. I think the dangers, as I explained before, we start to rely on the technology more and more without thinking about the overall number of humans compared to the overall number of patients that there are. We are going to end up for quite a long time with an over-aligned situation within complete data sets.
A suite of technologies that still will not perform better than a very well-trained human being. What we need to really focus on is making sure that more people are trained, put through medical school, put through specialist training, and put through the use of technology or made to be trained with technology.
A huge believer though that if there is enough data in the system, it is protected enough, and dealt with all the correct privacy things that we need to do, that eventually it will give real superpowers and scale to the number of people that we can diagnose with things. Download this show is what you're listening to, it is your guide to the week in media technology and culture. This is a special episode dedicated to the future of medicine.
Our guest this week, Dr. Jack Crandler, joining us from London and Jennifer Dudley-Nicholson, future economies reporter with the AAP. Mark Fennel is my name, and of course during the COVID years, that's right, they happened. I know you've blocked them out. One of the things we discovered is that we could remote just about anything, we could remote teach classes, and it also led to a huge boom in people taking up telehealth.
So what is the future of that? We know we can do it, but is that the direction people want to go? Jen, when you look at remote access for medical help, what's happening?
It's interesting, because I do think we have a lot more access now to telehealth appointments, and that can be very useful when people are certainly very far away as well, or if you can't get to see a GP within a reasonable time, sometimes they're a telehealth appointments available that are much quicker than that, after our doctor services by telehealth too.
So I think it's strange that it took a pandemic for this to happen, but I think overall it had a net positive effect, but it wasn't always positive as with all of these things. And so, you know, a doctor will not be taking your blood pressure in one of these appointments, and they won't be giving you sort of a physical once over. They might not order the same tests, or be able to order the same tests as a result of seeing you over the telephone, or even in a video chat.
It has pluses and minuses. It's interesting to see now which doctors have chosen, which GP practices have chosen to continue telehealth appointments, and for what purpose, and which ones now say, no, you've got to be here in person just like coming back into the office. It's one of those things. It's a nice to have, but it's potentially not going to suit all situations.
This must be something that you're seeing all the time, a take up of telehealth. What are the, I guess the advantages and disadvantages of increased telehealth take up, Jack? Yeah, I mean, capacities improved amazingly. There is massive concern about not being able to physically lay your hands on someone, or even, you know, there are subtle things.
I don't know. I call it ESP extraordinarily subtle pattern recognition, but there is something about being in front of somebody, you know, the laying on of hands, which is something we ain't going to replace with zoom or what to have calls. But that said, we used to meet up as an alumni group, former medical students at UCL once a year using what's happened to organize which pub we were going to over COVID that that that what's that group became pretty well.
A critical piece of how we dealt with the pandemic in the UK because so many of my year ended up being by coincidence, really, you know, key players in intensive care and in respiratory medicine and with, you know, health policy and in government and vaccine work. And it literally, it was a miracle, you know, it was a miracle to see how the sort of telecommunications helped us not in front of the patient, but, you know, behind the scenes.
That's a different aspect that people don't realize is actually, you know, we consult each other as doctors all the time. And that has absolutely, you know, it's been a stratospheric, different altitude of work really. It's a level of productivity and a level of interaction that you can never previously hopeful with patients. I think the fact that they don't need to travel is simply the biggest thing.
If 90% of what you can do doesn't need the laying on the hands, you should do that 90% but with all the time savings, you really, really need to invest in more time physically seeing a patient because, you know, with six minutes average GP time for a patient in the UK. There ain't time to lay on hands. It's a big rush. I think that what we need to be working on really is, you know, so buying our time with telehealth in order to spend more physical time in front of patients are really needed.
That's really interesting. I had, by the way, I had a three to half minute GP encounter the other day. I almost timed it to see how long it went, but you make a really interesting point. Do you reckon there will come a time where the technology accelerates to a point that you will be able to pick up on the ESP as you put it? Is that something you can foresee in our lifetime?
I don't know. I think the sort of the hope of a future where we put on goggles and we can even smell what's going on in the room in front of us is promised. I still genuinely feel and also enjoy true physical presence. And I think that, you know, health is important to us and we shouldn't be trying to eliminate that aspect of real human to human interaction.
But where I do see, for instance, it being absolutely incredible is in the area of robotic surgery, you know, today you can have a number of surgeons telepresent in the operating theatre of somebody in a completely different country where those skills don't exist. Guiding surgeons who are training or colleagues in different parts of the world to be able to do operations they've never done before.
And that saves lives. That is a real, real example of how telemedicine technology is improving. It sounds a bit like Star Trek, but it's happening right now. As you describe an idea of a remote controlled robot doing surgery, there's a part of my brain that just instinctively wants to reject it, right? It's like the idea of being an operator on a robot sounds horrifying, but then you do have to sort of take in the nuances, right?
Where, you know, in some cases, these people wouldn't necessarily be getting any of that surgical intervention, right? So do you think there's a bit of work to be done, Jack, with kind of messaging to the public about technology and having a public conversation about where the boundaries of in people in the future of people's health?
Absolutely. Massive amount of work needs to be done. And it's not being done. You get kind of maybe less balanced tech optimists promising very far distant futures and with all the positivity none of the negative aspects. And you know, it's being heard by vast majority of people that are just saying, well, that doesn't work for me. I need to see someone human and I need computers to not make mistakes or be broken into so that my care stops.
So I think an incredible amount of work needs to be done. Not only messaging to the public, but also the profession about where it's going, not for tech to just be sold to us by big companies, but serious efforts by government organizations, national health systems as well.
To talk about strategy of how we answer those questions, how we integrate the technologies, and that will give people a whole hell of a lot more comfort than they are right now. I think a fraction of people have a positivity and optimism and really see the advantages and the rest of us need a lot more help to be convinced.
In a sense, Jen, this is about sort of taking the concept of informed consent and kind of exploding it into a public forum where we need to have these conversations about where technology should interact with our health, but we need to be doing it before we end up needing them.
Because I think what happens now is technology, like all kinds of technology, kind of sneaks up on you, becomes part of your interaction with a government or becomes part of your interaction with a corporation and we usually don't consent to it, but it feels like particularly with medicine, it needs to be something we talk about before this technology part of our lives. I feel like we don't do that enough across the board, do we, Jen?
No, I don't think so, and I think that it's one of those things around AI that we talk about a lot is transparency. If you see an image and it's got six fingers, then eventually you will probably work out that it's either from the Princess Bride or it's actually been digitally manipulated and created.
However, I think we really need to have that conversation before you show up to hospital and find out that a robot is about to operate on you, because again, just for a movie reference, I saw a Scissorian section happening in Prometheus by a robot and it looked very uncomfortable.
I think it's important to have those conversations and I think that a lot of people would feel more comfortable about going to a doctor and having their conversations potentially transcribed and notes created if they knew that that was happening. Just the same as they'd feel more comfortable if it was explained to them that with a certain type of skin, that would be given the once over by a program to kind of help out whatever radiographer or what have you was having a look at it afterwards.
People are willing to accept that sort of digital assistance when it's explained to them, but if it's kind of jumped on them at the last minute, then it's a bit of a shock and we need to have a bit more of a conversation around that, which I don't think really exists.
If somebody's listening to this now and thinking, I don't want to, I don't want a future where there's more AI involved in my medical health, or I don't want a future where robots can have the capacity to operate on people, how would you begin to start that conversation with them to talk about where the safe boundaries are, Jack? Well, first of all, I just want to point out that right now there are no robots that are operating on humans without the humans being behind the robot.
We're a bit far away from a totally autonomous robot, actually, all operating. Give it time, Jack. Give it time. Yeah, yeah. You never know. You never know. I've watched Terminator 2. We need evidence. We need to present the evidence well in a way that people understand, because that's what informed choices about. When you go in for a cesarean section, if it's elective, you'll get told what the probability is of things going wrong.
And if you've got great experience clinicians around, they'll tell you, you know, what they're a bit on nuance, what you're likely outcomes going to be. And you've got to trust that they're telling you the right thing. There's always going to be harm in medicine, even though do no harm is our primary objective. It's never 100% safe. But we need to have the comparative data, and we don't have that really yet. We try and we're ever striving towards more and more evidence.
But until we really get the evidence of, you know, Dr. Jack versus AI Jack, we are just sort of shooting in the dark really. I would like to know for my patients, for myself, if ever I need to be a patient, I want to know that whatever system is in front of me, human augmented, entirely future, dystopian robotic, or kind of a nice, kind of mix of tech and human beings, I want to know what's the outcome going to be.
I want to know what the likely complications are. And you know what? I want to know who I need to deal with when things go wrong. Things do go wrong. But no one ever really talks about that. Even today in pure human based medicine. Who do I approach? What are my rights? How do I go about making a complaint? Who's held accountable? Is it the same level of accountability if a doctor who's perfectly capable of hiding things? You know, computers are very often on.
As good at hiding stuff, but who do I approach and maybe technology will be easier to hold to account because the writing will be on the wall. There won't be any kind of well. I tried this, but that didn't happen quite so well. You know, human defense is very often can be quite tricky to litigate against. That's the other thing that I think we need to think about. It's like, you know, okay, how do we get the evidence?
How do we give really informed consent in this hybrid and automated world? And then, you know, who's held to account when things don't go right? Very good question indeed. We are out of time. Dr. Jack Crindler, thank you so much. Really appreciate you both your time, but also your thoughts as well. Thank you very much for having me. Really appreciate it. And Jennifer Dudley-Nickelson, a future economies reporter with the AAP as always, a massive pleasure. Thank you so much.
And if you enjoyed this episode, do leave a review on whichever podcasting app you happen to prefer. Of course, you can listen to Download this show and any other ABC show on ABC. Listen, my name is Mark Fnell and I'll catch you next week for another episode of Download this show. Until then, have a great week. You've been listening to an ABC podcast. Discover more great ABC podcasts, live radio and exclusives on the ABC Listen app.