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We have the power to mitigate the adverse impact of rapid advancement in information technology.
If you find yourself on a mountain or at a lake this summer with those rarest of modern gifts-peace, solitude, and the chance for a few days of uninterrupted reading-I recommend Tom Friedman’s Thank You for Being Late.1 It is vintage Friedman with the meticulously researched reportage expected from a three-time Pulitzer Prize winner. The book addresses three of the weightiest subjects of our time: the simultaneous acceleration of information technology, economic globalization, and climate change. While these three challenges ought to matter to every human on the planet, they have special resonance for ob/gyns because globally their impacts fall disproportionately on women and because women hold a key to the planet’s ability to overcome their collective threat.
When did the world change?
While these three forces seem suddenly upon us, climate change reflects centuries of industrialization. On the other hand, the explosion in computing power and economic globalization have emerged over decades. In fact, most of the critical components of the latter two forces date back to one year – 2007.1 That year the iPhone and Android operating system were introduced, AT&T invested in a massive expansion in software-enabled networks setting the stage for logarithmic increases in wireless traffic, and IBM’s Watson was created giving birth to the dawn of artificial intelligence (AI). Also, in 2007, Kindle was rolled out by Amazon, and Airbnb was conceived. Twitter, LinkedIn and Facebook all started around that year using software developed by a company called Hadoop that generated software algorithms allowing hundreds of thousands of computers to function as one. In biotech, 2007 saw leveraging of this raw computational power to begin to dramatically reduce the cost and unimaginably increase the speed of DNA sequencing. Interestingly, that was also the year that experimental proof of CRISPR was reported.2 Thus, “infotech” and “biotech” are inextricably linked. All these changes accelerated economic globalization disrupting traditional markets in goods and services (including healthcare), labor and capital.
How is the world changing?
Acceleration of information technologies
Moore’s law states that the speed and capacity of computing doubles every 2 years in parallel to the number of transistors that can be placed on a microchip. To illustrate this geometric expansion, Friedman notes that compared to its first-generation microchip, Intel’s sixth-generation chip has 3,000 times the performance and 90,000 times the energy efficiency at 60,000 times lower cost. The acceleration in information technology has also been made possible by startling advances in collectively developed open-source software (e.g., GitHub) and development of seamlessly interactive application programming interfaces (APIs). These APIs are the programming commands that allow you to save and send files, connect various web applications, buy stuff on-line, make apps, and permit individual computers to be networked – basically they make the Web the Web. Moreover, investments in ultra-fast transmission fiberoptic cabling coupled with introduction of Code Division Multiple Access (CDMA) software to exponentially increase wireless capacity have allowed unprecedented and previously unimaginable levels of connectivity.
The “cloud,” a vast network of computers spread across the globe, now stores, accesses, and shares data and permits software and services to run directly off the Internet, further amplifying acceleration of information technologies. Simultaneously, there have been dramatic improvements in computer sensors from cameras to detectors of motion, water pressure, energy consumption, engine performance, traffic congestion, temperature, global positioning, etc., all of which can broadcast their data, leading to the “Internet of things” and permitting both preventive and prescriptive maintenance (i.e., letting you know when a device will fail). In health care the Internet of things will generate 1 million GB of personal health information for each patient in her lifetime, which is equivalent to about 300 million books.3
All these advances have vastly amplified the flow of data while reducing the complexity and cost of accessing it and accelerating the potential power of AI. One consequence for physicians is that a primary care doctor would need 630 hours per month just to keep up with the explosion of new literature.1 However, this accelerated flow of information affects all professions, contributing to the pervasive burnout being experienced across society.
Acceleration of economic globalization
Friedman’s second great acceleration is globalization of the economy. Access to abundant and nearly free flows of information has led to many disruptive business innovations from Amazon, Lyft and Uber to Airbnb, all of which have displaced workers and whole industries across the planet. I recently received a harangue from a taxi driver in Nashville about the evils of Uber and what it had done to his income. While I sympathized with his plight, I realized he might as well be howling at the moon. Self-service whether it’s to create legal contracts, complete tax returns, book hotel and airline flights, or conduct real estate transactions has disrupted all those industries. Your iPhone is quickly replacing credit cards, and blockchain-derived currencies like Bitcoin may soon replace cash. Physicians will not be immune from this revolution. Wait till telehealth and facilitated self-service Internet-based medicine drive the provision of health care to the lowest bidder and soon we may be howling at the moon as well.4
Access to abundant and free information also allows innovative start-ups to blossom from anywhere in the world where someone has sufficient training, a computer, and access to the Internet.1 Friedman notes that Massive Open Online Courses (MOOCs) are allowing poor students in rural India take some of the most advanced IT courses offered by top US colleges. Even manufacturers now crowdsource across the globe to optimize designs for new products. All this is fueling acceleration of the globalized economy. And restricting immigration will not limit the spread of innovative business disruption delivered via a new app developed by a creator in Turkey or Turkmenistan. Friedman points out that in 2014, $30 trillion in goods, services, and capital-equal to nearly 40% of the planet’s gross domestic product-crossed national borders, a 6-fold increase from 1990. And that does not begin to measure the impact of the free flow of information around the world. Tariffs may raise costs but are unlikely to stop that flow!
Acceleration of climate change
Freidman’s third great acceleration is climate change. The atmosphere now has 400 parts per million (ppm) of carbon dioxide, which is 50 ppm above the limit needed to prevent catastrophic global warming. Biodiversity is diminishing as deforestation has reduced the earth’s original forests to 62% while most climate scientists believe we cannot afford to dip below 75%. Pesticides and fertilizers are creating toxic algae blooms while ocean acidification is destroying our coral reefs and native fish populations. Desertification is a major threat to sub-Saharan Africa and drought is leading to crop failure in Central America. Climate change is also harming global health by driving alterations in vector ecology including expansion of pathogens such as malaria and Lyme disease, and arboviruses such as chikungunya, dengue, Zika, and West Nile. Additional adverse health effects accrue related reductions in drinking water quality, air pollution, and heat-related illnesses.
Friedman also notes, ironically, that improved global health measures have reduced infant mortality, fueling population increases in impoverished lands already unable to fully feed, educate or employ their current populations. Overpopulation leads to over-farming, deforestation, and a growing scarcity of fresh water, which in turn worsen climate change. For example, Niger’s population in 1950 was 2.5 million, in 2016 it was 19 million, and by 2050 it is predicted to be 72 million, while the planet will have 9.7 billion inhabitants.
Why adapting to change is so difficult for humans
Since 2007, the pace of change in information technologies, economic globalization and climate change have all accelerated beyond Homo Sapiens’ ability to adjust their educational structures, economies, energy consumption, government regulations, and social safety nets to accommodate to them. Friedman argues that while technology platforms turn over every 5 to 7 years, it takes 10 to 15 years for humans to adapt to these new technologies. And this maladaptation is far greater in under-resourced countries that are also the most adversely impacted by climate change, leading to further impoverishment, famines, and mass migrations of primarily young men northward into Europe and North America.5,6 Thus, in these under-resourced areas it is women who are left behind on failing farms, often with no education and with elderly relatives and many young mouths to feed. Increasingly, though, women and children are contributing to the refugee crisis, exacerbating the adverse public health consequences of associated violence, accidents, inadequate nutrition, and lack of medical care.
So how do Americans and the citizens of industrialized nations cope with the disruptive impact of information technologies and a globalized economy? For example, how do ob/gyns and other physicians adjust to an era when medical knowledge doubles every 73 days such that between the start of medical school and the end of residency training, students will experienced three doublings of medical knowledge?7 The strategy is the same for physicians and plumbers. To remain viable in this new workplace, everyone must embrace lifelong learning by transforming AI into IA – which includes intelligent assistance and intelligent assistants.
Friedman suggests that intelligent assistance is a way for government, employers, and, I would add, universities and academic health centers to provide powerful online learning tools to facilitate lifelong learning. New companies are already filling this niche (e.g., Udacity, edX, Coursera, Khan Academy) and LinkedIn has assembled a large repertoire of mini-courses to assist lifelong learning. Universities are offering MOOCs while medical schools and hospitals are expanding their professional development programs and simulation centers. For our part, Contemporary OB/GYN monitors current women’s health reports and pushes out summaries in our weekly e-newsletter while assembling various resource centers containing curated reviews.
Intelligent assistants consist of the AI interface between humans and the tools they need to complete a job. (Think of a Da Vinci robot blocking you from ligating a ureter). In medicine, intelligent assistants could also consist of an electronic health record with AI-stoked decision support providing just-in-time and point-of-care access to relevant data needed to precisely choose the correct diagnostic test or prescribe the optimal personalized medication. It could also include AI-empowered search engines that not only search what you query but know what you don’t know and should be searching.8 Of course, when search engines decide what you should know, should do and should think, we will have even bigger problems!
But what about the vast majority of the globe’s population who do not live in industrialized nations or worse, reside in failed states like Syria where chaos holds sway? It has been estimated that 4.5 billion people are either urban or rural poor. As noted, these parts of the globe are most affected by climate change and overpopulation, which is promoting collapse of their agriculture. They also have substandard educational systems, limited web access, and inchoate manufacturing sectors. This leaves millions of disaffected young men (and some young women) prone to join drug gangs, guerrilla groups or jihadists. While addressing climate change should be the planet’s top priority, Friedman suggests that in the short run we should focus on three simple remedies. The first is planting trees across sub-Saharan Africa to slow desertification (“the Great Green Wall”). The second is providing chickens to desperately poor families because chickens require minimal resources to maintain and can serve as both a source of protein-rich nutrition and modest income. But perhaps the best hope for these countries to escape the effects of the three “accelerations” is increased access to high-quality education for women. This will enhance economic development and help break the cycle of violence generated by disaffected young men who fall prey to irrational ideologies. Education should also help increase access to and use of contraception so desperately needed to break the cycle of poverty in under-resourced nations.
We live in the age of acceleration. Advances in information technology occur at a pace exceeding the human mind’s ability to adapt. This, in turn, is fueling acceleration of economic globalization and both trends are disrupting traditional employment models. Economic privation and climate change are also accelerating mass refugee migrations from under-resourced countries and failed states to Europe and North America fueling a toxic cycle of extremism, violence, and nativism. But humans created all three of these accelerations and if we embrace empiricism, rationality, and evidenced-based policies while eschewing baseless ideologies, mysticism, and fear, we have the power to mitigate their adverse impacts. In addition to addressing climate change by thoughtfully but expeditiously transitioning to renewable energy sources and promoting “reforestation”, we need to address accelerating technological complexity and economic globalization by embracing lifelong learning achieved through converting AI to IA. We must also pursue a global commitment to educating all the world’s women and providing universal access to contraception.