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Tuesday 18 April 2023

Are sports watches and AI the future of medicine ?

 With doctors and nurses on strike (despite the service from the NHS being appalling) I am sure people in power are asking whether there's a more cost effective way to provide health care.

The UK is a small country with a population of supposedly 68 million people yet the NHS is the 5th largest employer in the world with 1.7 Million employees.  NHS England alone is the 12th largest organisation in the world with 1.3 Million employees.

The NHS costs tax payers half a billion pounds per day yes £500M per day.  Yet its virtually impossible to get a doctor's appointment, waiting lists are colossal.  Adding more staff to the colossal 1.7Million employees  is clearly not the answer.

Clearly there is something fundamentally wrong with the healthcare system. 

For a start it is reactive - you wait until someone is ill. There is little to no proactive prevention of illness.

Now before I start getting attacked for daring to criticise St NHS, we need to be pragmatic.

We have an ageing population - ie more people that will need more healthcare and place burden on taxpayers.

We have a falling birthrate - it has steadily fallen from around 3 in the 1960s to around 1.56 in 2020

That crudely means there are fewer people entering the workforce to pay the tax to fund the healthcare for the elderly which outnumber the youngsters.  

Proportionally it means yet more people will be needed in the NHS in the next 20-30 years to care for the elderly which means fewer people are productive in the economy and hence pay tax to fund the healthcare (and old age pensions). 

The UK has a demographic timebomb.

The UK is not alone in this.  Japan is slightly ahead of the curve.  They have cities where there are simply no young people. No schools.  Shops there sell nappies.  Not nappies for children.  Nappies for incontinent adults !  

Japanese authorities are therefore focused on how to solve this.  They are opting for robots - robots that can perform healthcare duties.

However I am wondering whether Sports Watches could be part of the solution. I recently bought one and although it is not particularly accurate (ie not medical grade so the data needs to be treated with caution) however I am impressed at conceptually what it can do.  It can measure blood oxygen levels,  blood pressure, blood glucose,  perform ECGs ad detect upto 30 heart anomolies.  It can process the data to detect sleep Apnea. There is quite a lot of leading edge science doing digital signal processing on ECG signals to detect blocked arteries and similar conditions. 

I have never worked in healthcare but I would happily place a bet that it follows the Pareto principle.  80% of problems are the same.  20% of problems consume 80% of the effort - in fact I would guess 20% of the 20%  (ie 4% of problems) consume 64% of the effort.

That would point to establishing "factories" for the 80% of problems.  Eg Cataracts factories where there's a production line fixing people's eyes.

Now I speculate that 80% of the 20% are preventable.  Strokes, heart attacks, diabetes etc I suspect fall into this 80%.  

Now if the NHS issued everyone with an accurate Sports Watch (which doesnt yet exist) and measured and collected all this data, it would firstly be able to proactively identify people who are at risk of expensive healthcare and proactively treat them.  It would also have vast amounts of data for machine learning (AI) and could improve detection and gain new medical insights.

At the moment it looks like, Apple, Samsung and Google want to be healthcare providers in the future.  Huawei, the Chinese tech giant, want to be in this game too but are blocked for political reasons.  It does have to be questioned, considering that many of the budget Sports watches are Chinese, whether the Chinese have insights into the health of the nation and so could exploit this for war or similar purposes eg where are all the unhealthy people? 

AI seems to be a natural fit for many diagnostic parts of healthcare.  For example examining cancerous cell phones.  Humans seem to be weak at medical decision tree problems - I think this is Pareto at work where experienced doctors get selection bias since they are used to seeing the same problems and tend to jump to conclusions.  AI can be trained to make sure it considers all inputs.  Even as a diagnosis tool for doctors it may force them to ask questions in order to eliminate certain diseases. 

One thing is clear - the world of healthcare has to change - it is not sustainable economically and technology looks like a key way to be more proactive and use big data to make care advances with lower costs.