2019 Forecast: Amara's Law: Health Data, Gene Editing, and Artificial Intelligence

Kim BellardI have two predictions for 2019.

One is that at the end of 2019 our healthcare system will still look a lot like it looks now. Oh, sure, we'll see some cool new technologies, some innovative start-ups, some surprising corporate pairings, some moves by Big Tech, and some promising clinical findings. But our healthcare system moves slowly, and many in it have strongly vested interests in the status quo.

The second prediction is that, more than ever, Amara's Law still prevails. In case you don't know this "law," it is attributed to Roy Amara, who was President of the Institute for the Future, among other things, and goes like this:

We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.

There are several technologies which impact but are not exclusive to, healthcare, that I believe we're in that short run of. I'm going to talk about three in particular: data, and gene editing, and artificial intelligence.

Data:

We're finally coming to realize how our personal data is not just at risk from hacking, but from the very institutions, we've been entrusting to it, such as Facebook or Google. Our data is being analyzed, bought and sold, manipulated, and used to target us in ways that we still don't fully understand, Legislators and regulators are waking up to this, such as in Europe (GDPR) or California (Consumer Privacy Act).

At the same time, there are signs that the long-awaited healthcare interoperability may be closer on the horizon than ever. Apple's Health Records initiative and ONC's Trusted Exchange Framework and Common Agreement are encouraging examples.

Here's the thing we're not still getting: we're never going to go back to any Golden Age of privacy if there ever was one. Data about you is going to be collected, and shared, by an ever-increasing number of devices in an ever-increasing number of ways from an ever increasing number of entities.

E.g., it's not just your phone, it's every device your phone interacts with. It's not just your phone, it's your wearable, your implants, your car, the street cameras, and so on. Your EHR will talk not just to other EHRs but to, well, just about everything. Future versions of us will laugh at the notion that interoperability was ever an issue, or that we'd have control over our data.

We are not ready for a world in which there will be so much data about us, so widely available, and used in ways that haven't even been invented yet.

Amara's Law

Gene Editing

Much furor resulted from the recent claim that a Chinese researcher had genetically edited babies. It's not ethical! We haven't set rules yet! But no one can really claim to have been surprised: it was only a matter of time before someone, somewhere, did something like this.

We've gone from needing huge research efforts to sequence the human genome to be able to sequence our own for a few hundred dollars. CRISPR is making gene editing dangerously easy. Current gene therapies remain very pricey -- and will remain so if pharma has its way -- but they will become much more widespread.

One of two things will happen, both with profound implications. One is that gene editing remains very expensive -- perhaps out of the reach of most insurance. Wealthy people would then disproportionately benefit from them, widening the current health inequities between rich and everyone else. Only these advantages would become genetically baked in.

Or we'll have these therapies widely available, as happened with sequencing. Anybody and everyone could tailor their genes and the genes of their children, not just "fixing" defects but altering them to suit personal preferences.

Genes wouldn't even have to remain entirely "human." Current genetic differences may seem trivial.

We are not ready for a world where some, or even most, can tailor their genetic make-up, in ways we haven't thought of.

Artificial Intelligence

A.I. has been promised literally for decades and has consistently proved harder to achieve than expected. As 2019 starts, though, there would be few who do not think that A.I. is going to play increasingly important roles in our lives.

In healthcare, A.I. leaders like IBM Watson or Babylon Health may have suffered some recent embarrassing setbacks. but there seems to be growing, if sometimes grudging, a consensus that A.I. is going to be used, especially to augment human doctors. A.I. will, in this scenario, be able to analyze the data, sort through all the research, interpret the diagnostics, and assist doctors in diagnosing and pinpointing treatments. Not using it would be like not using MRIs or prescription drugs.

We don't get it. A.I. isn't just going to augment physicians and other clinicians. It isn't going to exactly replace them either, doing what humans do but faster and more accurately. They're going to do new things.

For example, Sandip Panesar recently wrote of the approaching surgical singularity. He reports on how AI-controlled surgical robots are already operating on animals and foresees when this moves to human patients. They will have skills no human could hope for, and be able to do surgeries no human would dare.

Google's DeepMind AlphaZero has taught itself complex games like chess and Go, and plays in ways that aren't like a human but are new and surprising. As Cornell professor Steven Strogatz wrote, "It was humankind's first glimpse of an awesome new kind of intelligence."

Moreover, it is a kind of intelligence that we may not be able to understand. In healthcare, it will find health problems and design treatments that we never could have and that it may not be able to "explain."

A.I. won't be physically constrained, won't have a limited number of patients, and will be omnipresent. More significantly, traditional healthcare approaches like medical licensing or maintenance of certification aren't going to be applicable.

We are not ready for a healthcare system where our "doctors" are, for the most part, not humans -- nor think like them. We tend to think about the future as being very much like the present but with better tools, when, in fact, those tools change us and our institutions in ways we hadn't expected. So it will be with these technologies.

As exciting as 2019 may be for healthcare, it will be the calm before the storm.