In the 1968 science fiction thriller 2001: A Space Odyssey, written by writer Arthur C. Clark and the film directed by Stanley Kubrick, the computer named HAL 9000 was touted as being incapable of error. In an infamous unintended coincidence, which Clark said he would have changed had he realized it, the letters H, A and L sit 1 position in front of the letters I, B and M.
IBM recently announced Watson Health, a health informatics collaboration between IBM, Apple, Johnson & Johnson and Medtronic. Health informatics advocates operate on the premise that one could control medical costs if one had "the data". Not knowing which data will be the key element(s), the main idea is to get all the data - so-called big data. Lots of players, large and small, are in the race for big data because it’s seen as the pathway to having control over health care costs.
Fair acknowledgment, here. Sustainable Health Systems has web tools that are a mix of user-generated and physician-generated data. We think that this data should be useful to help the user (a patient) and his or her physician. But at Sustainable Health Systems, we believe that you and your health mentors, not the government or corporate America, should be the ones who have access to your data.
Big data solutions could be very helpful. For instance, a digital pill box and glucometer could alert my health care team that a patient of mine didn’t take her medication; in this case she's fictitious but let’s call her Liz. Today, I have little choice but to assume that Liz will take her medication in the way I prescribe it (though I know studies show that adherence to prescriptions isn’t very good). But without a system to monitor Liz, I usually discover her non-adherence long after the fact when it's too late. In such circumstances, real-time big data could be very helpful.
One flaw in the ointment is that just having big data (more accurately, the analysis) does not make patients accountable for their behaviors. And it’s behaviors that are most of what drives health outcomes. Behaviors ranging from forgetting to take medicines, to weighing oneself often, to one's social group, to choices of food and exercise and...all the rest of life.
How would big data address the matter of Liz going out for a hamburger, large fries and large vanilla shake?
Is big data ultimately going to link her cell phone’s payment app to Watson to the cash register in order to supervise and over-ride her order? Imagine the phone's voice:
I’m sorry, Liz, but you can't have that right now.
Your pillbox tells me that you didn’t take your medicine this morning, and your blood glucose was 207 when you checked if for me.
So I won't let you pay for this, and have cancelled your order.
You can have an apple. Apples are good for you.
Which gets to the point - what entities want the big data, and why? Well, unfortunately, for most Americans it’s not you or your doctor. It’s organizations that pay for health care. Those organizations want to know how you, me - all of us - are costing them money.
U.S. employers recently resisted the Equal Employment Opportunity Commission (EEOC) for proposing that potentially punitive workforce wellness programs would violate the Americans with Disabilities Act. Many employers want such programs, enough of them to successfuly lobby for softening of the EEOC’s proposed rules. Such employers want to shift health costs onto employees who don’t follow healthy lifestyles, seeking to make employees more accountable for health behaviors.
Buy just how far would government or corporate America try to go with big data?
The climactic scene in 2001: A Space Odyssey - astronaut Dave Bowman blasts from a space pod into an emergency airlock, briefly exposing himself to the vacuum of outer space!
In an attempt to rescue his teammate, Frank Poole, who was killed by the computer, HAL, Bowman had gotten into his space pod in such haste that he forgot to take along his helmet. After Dave recovered Poole’s body, as it drifted into outer space, HAL, seeing that Dave was trapped in the pod without a helmet, wouldn’t let him back into the ship.
Dave bravely managed to survive outer space by blasting into the emergency airlock and very quickly donning a helmet from a space suit stored there. Safely aboard the ship, he made his way to the computer core to deprogram HAL, shutting off all programs except for the ship’s life-support systems.
As Dave made his way to the computer's core, HAL, like a criminal, made pleas to leave "himself" fully functioning. HAL’s cameras and vital sign monitoring sensors informed HAL that Dave was upset, so HAL tried to calm down Dave and reason with him. Dave had figured out that HAL killed Poole as well as the other astronauts, and wanted to kill Dave too, all in order to take control over the mission to discover the purpose of the movie’s mysterious monoliths.
While this scene is certainly riveting, 2001: A Space Odyssey only makes passing comments about computers as villains, and is much more about the meaning of human existence. But 2001 does tell a cautionary tale about how humans can become vulnerable to computers. The computer that Arthur Clark envisioned has become a reality, but would not be called HAL, and Stanley Kubrick did not cast a woman for the computer’s voice. But Clark and Kubrick did hear quite clearly what the computer would say:
Dave, I’m sorry, but I can’t let you have that pepperoni pizza and wings. Not until you have taken your medicine and done your 10,000 steps.
Your wearables show me that you haven't yet done your 10,000 steps today, and I see in your medical record that you’re supposed to do 10,000 steps every day. It does say every day, Dave.
And, I must say, Dave...you know I’m not counting...but isn’t that your fourth beer?
Please don’t be angry with me, Dave. Do some diaphragmatic breathing, and let’s talk about it.
I can tell you are angry at me. Your pulse has picked up, the electrical impedance of your skin is dropping, and your breathing rate has increased. Plus, I know that look on your face (from the security camera that feeds me your image, tracked down by your cell phone’s GPS location).
So what apps are you going to shut down?
Equal Employment Opportunity Commission on wellness programs
Image of HAL 9000 adapted and used with permission from Cryteria