cyberMedicine - Mainstream Medicine by 2020/Crossing Boundaries

By Kim Solez, M.D. and Sheila Moriber Katz, M.D., M.B.A.

The possibility of total immersion in the virtual experience is approaching(23). Through improvements in technology and bandwidth cues of videoconferencing and virtual reality will make people feel increasingly connected. For instance, better buffering and connection speed in Internet video will improve synchrony and naturalness of audio and lip movements increasing the effectiveness of Internet psychotherapy and speech therapy. Images will be in 3D enhancing the performance of telesurgery and other visually intensive cyberMedicine activities.

Exactly when the "fully immersive Internet" will be arrive is a balance between two forces: improving technology and human being's increasing ability to detect ever more subtle differences between the real and the virtual world. In the early days of cinema at the beginning of the last century, people ran out of the theater when a train was coming right at the camera. That no longer happens because human beings have learned the difference between movie images and real trains. We have reached the point where virtual sound is almost indistinguishable from real sound, and we will eventually reach the same point with virtual touch, virtual smell etc. all of which will impact on cyberMedicine.

If the imperfect "human" side of the Internet were a barrier to cyberMedicine one would expect that most human of the medical disciplines -psychiatry - to adapt poorly to new technology. Yet psychiatry was an early adopter of Internet technology and telepsychiatry is today quite successful.

Thirty-one percent of Americans now have broadband Internet access, most of them at work but increasingly at home, according to a new study from Arbitron Inc. and Coleman (24).

For the rest of the world, with only a phone modem connection or no connection at the moment, low bandwidth options for cyberMedicine need to be considered. Here Email discussion groups are the major vehicle. First described in the medical literature 12 years ago (25, 26), such groups have a pivotal role in cyber-medicine. In part because Email access is almost universal, Email discussion groups have been amazingly successful cyberMedicine tools as in the three specific examples given above.

The fear of cyberMedicine that exists among physicians, patients, medical publishers, regulatory agencies, and lawyers is largely a fear of the unknown. As outlined above cyberMedicine is rapidly entering the realm of the "known" and probably represents a danger only to those who ignore it as a trend. Careers in cyberLaw are very promising. Regional licensing limitations will be overcome in law just as in medicine.

There are many positive new technologies which are factors propelling medicine toward cyber-medicine: genomics, proteomics, nanotechnology, robotic medicine, telemedicine, machine translation breakthroughs, the medical publishing revolution, and new 3D imaging techniques. Ray Kurzweil's prediction that in twenty years there will be flawless machine translation from one language into another (27) has enormous significance for human interactions in medicine.

To a large extent the answer to the question of how to pay for cyberMedicine advances is "no problem!" when one considers the impact of the same technologies on human interactions outside of medicine. In the case of nanotechnology for instance, medical applications could be quite expensive but think of nanotechnology impacts on the fashion, home decorating, automobile, space exploration, and entertainment markets and the trillions of dollars those markets represent. Medicine will ultimately benefit very greatly from nanotechnologies developed for these other markets. Think for instance of the likely expenditures for digital paint that would allow a person at the push of a button to make the appearance of their walls and furniture whatever they wished, or digital clothing, and it quickly becomes apparent that the financial requirements of cyberMedicine are miniscule in comparison!

The inevitability of the cyberMedicine revolution and the fact that it is mainly a change for the best mirrors the beneficial effects of technology in the world at large. It may initially sadden the reader to know for instance that In Australia, ornithologists have discovered that the country's so-called "mimic birds" are starting to use cell phone noises in place of their traditional mating calls (28). While shattering certain nostalgic feelings about bird songs, this transformation is not in itself a bad thing. Birds with these singling abilities may have a selective advantage over others, and they represent the vanguard in the evolution of stronger productive ties between nature and machines.

And for those who sometimes see technology as leading a mad plunge into darkness it is interesting to consider the opposite possibility. It is technology that poet/singer Leonard Cohen is seeing as mankind's salvation in the song The Great Event when he has the synthesized Macintosh Text-to-Speech voice of Victoria say these words: "Next Tuesday, when the sun goes down, I will play the Moonlight Sonata backwards. This will reverse the effects of the world's mad plunge into suffering, for the last 200 million years." (29)

Art is not immune from the positive effects of technology. In May 2001 technology guru Ray Kurzweil unveiled the Aaron software program capable of creating museum-quality original art (30). Artist Harold Cohen taught the software program the nuances of his art little by little over thirty years and now it is ready to be sold to the public for $19.95 US.

Music, poetry, art – in all these areas technology appears to be poised to take man and womankind to new heights – so why not in medicine? All those things that we value in medicine can be even better in cyberMedicine, we just have to put up with some bumps in the road to get there!

References:

1. Lessig L: Code and Other Laws of Cyberspace, Basic Books, New York,

1999.

2. Banisar D: Stopping science: the case of cryptography. Health Matrix Clevel 9:253-87, 1999.

3. Vogel G: Stem cell policy. Can adult stem cells suffice? Science 292:1820-2 2001. http://www.nih.gov/news/stemcell/stemcellguidelines.htm

4. Kahn JP: The politics of stem cell research: Looking for middle ground in a minefield http://www.cnn.com/2001/HEALTH/06/25/ethics.matters/index.html

June 25, 2001

5. Snow, KL House GOP lawmakers push prohibition on stem cell research

http://www.cnn.com/2001/ALLPOLITICS/07/03/stem.cell/index.html July 3, 2001

6. Fox S, Rainie L et al. Pew Internet and American Life Project: The Online Health Care Revolution: How the Web helps Americans take better care of themselves http://www.pewinternet.org/ http://www.pewinternet.org/reports/toc.asp?Report=26 Nov. 26, 2000

7. Ellis D, McKie D: View from the Living Room: the Broadband Internet as a Mass Market http://www.omnia.ca/content/nmp_08.2000.shtml

http://cyberatlas.internet.com/big_picture/geographics/article/0,,5911_434711,00.html August 10, 2000

8. Chretien J Connecting Canadians: Message from the Prime Minister of Canada http://www.connect.gc.ca/en/ar/1016-e.htm April 2000.

9. Yankelovich Monitor http://www.yankelovich.com Referred to in Ref. 6, p. 8.

10. Christensen CM :The Innovator's Dilemma, Harvard Business School Press, Boston, 1997.

11. Anderson KR: From paper to electron: how an STM journal can survive the disruptive technology of the Internet. J Am Med Inform Assoc 7:234-45, 2000.

12. Kohane IS: The ever imminent electronic medical record. J Med Pract Manage 16:264-5, 2001.

13. de Wal AH, Smith R, van Der Werf G, Meyboom-De Jong B:

Towards improvement of the accuracy and completeness of medication registration with the use of an electronic medical record (EMR). Fam Pract 18:288-91, 2001.

14. Messmer E: HHS lets HIPAA health-privacy rules take effect, but promises change http://www.nwfusion.com/news/2001/0411hipaa.html April 12. 2001

.

15. Maheu MM, Whitten P, Allen A: E-Health. Telehealth, and Telemedicine: A Guide to Start-Up and Success, Jossey-Bass, San Francisco, 2001.

16. Willemain TR, Mark RG: Models of remote health systems, Biomedical Sciences Instrumentation 8: 9-17, 1971.

17. Brown SG: A telephone relay. Journal of institution of Electrical Engineers , May 5, 1910, pp590-619, 1910

18. Gershon-Cohen J, Cooley AG: Telediagnosis. Radiology 55:582-587, 1950.

19 Conley SB, Gregory M Nephkids cyber-support group for parents of children with kidney disease http://cnserver0.nkf.med.ualberta.ca/nephkids/ http://www.cybernephrology.org http://www.aapscot.org/

20. Johnson KB, Ravert RD, Everton A.Hopkins Teen Central: Assessment of an

internet-based support system for children with cystic fibrosis. Pediatrics 2001 107:E24, 2001 http://www.pediatrics.org/cgi/content/full/107/2/e24 (8 pages)

21. DeMaso DR, Gonzalez-Heydrich J, Erickson JD, Grimes VP, Strohecker C.J The experience journal: a computer-based intervention for families facing congenital heart disease.Am Acad Child Adolesc Psychiatry 2000 Jun;39(6):727-34.

22. Birdwhistell, Ray. Kinesics and context: essays on body motion

communication. Philadelphia: University of Penn. Press. 1970.

23. Kaplan K: A Virtual World of Sight, Sound and Even Smell

Los Angeles Times Service http://www.iht.com/articles/10344.htm February 12, 2001

24. Arbitron Inc. and Coleman: Nearly One-third of American Internet Users Have Access to Broadband According to Arbitron and Coleman Study, Press Release

http://cf.us.biz.yahoo.com/bw/010621/2188.html June 21, 2001.

25. Parsons DF: Telecommunication discussion groups for health services and medical research. Lancet 2(8671):1087-9, 1989.

26. Della Mea V: Internet electronic mail: a tool for low-cost telemedicine. J Telemed Telecare. 5:84-9. 1999.

27. Kurzweil R: The Age of Spiritual Machines - When Computers Exceed Human Intelligence, Viking Penguin Press, 1999 .

28. Reaves J: Cell Phones: Unsafe at Any Speed. Time Magazine Jun. 12, 2001 http://www.time.com/time/health/article/0,8599,130210,00.html

29. Cohen L: The Great Event, More Best of Leonard Cohen, 1997

http://www.leonardcohen.com/

30. Kurzweil R: AARON: A product of Kurzweil cyberArt Technologies , 2001 http://devweb.kurzweilcyberart.com/ http://www.scinetphotos.com/aaron.html