Health and Wellbeing Report
The Group Debate
The group then went on to consider “fundamental questions around illusions,” in terms of non-sentient beings’ such as robots and avatars and this potential role in the future of healthcare. Reflecting points raised in the Artificial Intelligence debate the group considered that whilst healthy people might be able to distinguish between a human and a robot, people who are ill or incapacitated in some way might struggle to do so. This raises important ethical questions around this sort of care. Professor Tallis suggested that for people who need care that they “require compassion and the presence of a human being”. As such, he suggested that robot and avatar ‘carers’ “could be quite a dangerous and destabilising illusion”.
Dick Davies responded with some examples of his work with Ambient Performance, who use virtual worlds and avatars to in clinical scenarios. He explained how through the use of clinically realistic avatars they have been able to create very effective training scenarios. By creating avatars which simulate the conditions of a real patient it is possible to help people learn what may happen in certain scenarios, for example, in emergency responder training.
Using Avatars to Predict Life Choices
The group then went on to consider how it might be possible to re-apply the use of avatars in training scenarios to young people. Benedict Arora asked if it was “possible to programme an avatar…to show what will happen to you based on life choices?” Dave Taylor then went on to outline a number of projects that he has been working on at Imperial College based around nutrition and which do exactly this[v]. For example, “if you make particular food choices then the size of the avatar is affected”. He also added that there is research emerging from the USA which suggested that “simply taking part in physical activity as an avatar,” alongside working collaboratively with others as a community, “can actually make you loose weight faster than if you are physically exercising”. Ghislaine Boddington added that community and belonging as well as the concept of “connected communities” have a big impact on well-being , whether in virtual or physical communities. Professor Tallis responded to Dave Taylor by saying that, “it is very interesting that in a virtual world one can get real effects” and echoed Boddington’s comments saying that “solitude is very bad for you and the more you connect with others the better your health”.
Cybernetics
Cybernetics is the field of science concerned with processes of communication and control, especially the comparison of these processes in biological and artificial systems[vi]. Professor Warwick gave the group an overview of how this cutting edge research is contributing to the future of health and wellbeing. He focused on neurological illnesses such as Parkinson’s and suggested how implants, which are far less visible than robots, might assist patients and how such devices could be of significant help to patients with other brain diseases. He explained that despite there being pharmaceutical drugs to help patients with Parkinson’s disease, these are “either are not too good or wear off after a while,” and so patients may be “very happy to have technology subbed directly into their brains, because it opens the possibility of overcoming their condition”. He also went on to explain how he agrees with Professor Tallis’s model of minimising the period of “woe” before death and how he believes that technology has a significant role to play in this to “counteract what your brain is deciding to do by itself”. He gave the example of a “slim plant” which could monitor your activity, improving your lifestyle by telling your brain that you shouldn’t eat certain foods at certain times.
Do doctors need bodies?
Joop Tanis asked the group why we accept technology in some places but not in others? Giving the example of the pacemaker, “which we accepted right from day one,” the group went on to consider how technology such as this has lead to a significant revolution in cardiology and beyond. Tanis also explained that he is “intrigued by the gap between what is possible and what is done,” and he asked the group whether the “anthropomorphic manifestation (when physical objects taken on human like characteristics)” of, say, robots “are a hindrance or a help?” He suggested that it might be easier if instead health care technologies were understood as “just another mechanical device rather than something that attempted to look like a person”.
Virtual and/or Real
Gavin Nettleton suggested that emotion and touch are vital in the conversation, “if you look at what old people really need…it’s not just the wiping of the bottom…it’s about human touch”. He added that it is not about replacement but instead about finding ways to enhance what we do already. Dick Davies then explained how we are “surrounded by these devices anyway…washing machines, vacuum cleaners…etc.” and suggested that we should focus on the “skill sets” rather than the machines themselves because these can, in theory, be active until cognitive impairment sets in. Later in the debate the group discussed what skills young people need to be developing from an early age to aid them in their latter years.
The virtual world appears to be a very good environment to “rehearse what you can’t get wrong in real life,” however, Professor Tallis felt that “the more time you spend in ‘second life’ the less you spend in the utterly unscheduled and uncontrolled mess of the real world”. Dave Taylor was keen to assert that the virtual world is every bit as chaotic as the real world. Professor Tallis challenged the group by asking if he thinks we will ever be able to supersede complexity of the brain and be able to “speak to it in the language it understands”? Professor Warwick went on to say how vital research into the brain is for the future of health and wellbeing[vii]. Suggesting that the “body is obsolete,” he explained how his research is trying to “extend and improve abilities – particularly mentally…improve the range of senses that you have as input, improve the ways of communication”. He sees that these developments are going to “significantly change what it means to be human [as the] brain becomes much more critical to your function as a human being in the world”.
The Dark Sides
The group then went onto consider the potential problems with these future visions. Paul Cheng asked, “what are the dark sides?” and whilst he recognised the positive elements to have come out of recent technology, he also wondered about the issue of isolation, with people spending “too much time in virtual worlds”. Professor Warwick immediately challenged this idea explaining that, “the point is that it’s not isolation” because “a child or an adult linked via a computer to the internet,” allows them to be deeply connected to the rest of the world. Professor Tallis explained again that whilst it might be useful for trainee doctors to enhance their learning through working with simulated patients, it is also a vital constituent of their study to “spend the vast majority of the time working with real patients”.
Is it a human that you need?
Telecare is a form of remote care that has been used to provide assistance to older and physically less able people by giving them the reassurance needed to allow them to remain living in their own homes. In its simplest form, it can refer to a mobile phone connected to a monitoring centre through which the user can raise an alarm. Technologically more advanced systems can use sensors, whereby a range of potential risks can be monitored. These may include falls, as well as environmental changes in the home such as floods, fire and gas leaks[viii]. Joop Tanis championed the use of telecare, which he traced back around 40 years when images of skin lesions were has been sent to doctors who were not physically with patients and who were remotely able to make initial diagnoses. However he went on to say that “he can count on one hand the clinics in the country that have adopted this technology”. For Tanis the question is about how to get both carers and patients to adopt these new methods?
Professor Warwick reminded the group that currently “robots are being built with biological brains”. Indeed, here the group returned to a fundamental question of the Robots and Avatars programme – is it going to be at all possible to artificially create something that will have the characteristics of a human? Professor Tallis asserted that “it is a person you want when you are ill…you want somebody, who even if they don’t feel profound sympathy are sympathetic enough to simulate sympathy”.Professor Tallis heralded the advances in medical technology in terms of MRI scanners and the CT scan as revolutionary tools for doctors but taking issue with telecare, expressed how he thinks technology has a future as “as support, as prosthesis, but not necessarily as a substitute”. In this context Dick Davies suggested how important the “fullness of human communication” was to the debate. He linked this idea to the work of anthropologist Gregory Bateson[ix], who makes a very clear distinction between analogue and digital communication, saying that “most of human communication is analogue” and the richness of human communication comes from our ability to “meta communicate”. Davies called for the group to embrace technological development but understand this development in the context of human (analogue) and not just digital communication.
Lastly, Joop Tanis was very keen to stress how important it is to not get trapped between “an either/or” when thinking about future technologies. Seeing technology’s role as augmentation rather than replacement, he explained that whilst you do, of course, want a person to look after you when you are ill, “it doesn’t mean that’s all you should have”.
