Contents
Western medicine and Tech are joined at the hip. It is already impossible to imagine healthcare without tech and future visions of healthcare take this union ever further.
The Medical Futurist declares that “no matter how scary the future might seem at the moment, we cannot stop technological development”. But there are fundamental aspects of both Tech and Western medicine that are making this future even scarier.
One way these aspects manifest themselves is in blinkered pursuits of perfection. In Tech’s case it is the pursuit of the perfect data. In medicine’s case it is the pursuit of the perfect human. At first glance these seem completely reasonable – what you might expect. But from an environmental perspective, their effects are lethal.
This article examines how these quests have come about, why they are so risky, and how each can be replaced by a broader, less perfectionist vision, so medicine and tech can progress together with less risk of trashing the planet.
Tech and the Environment
Tech, like Western medicine and STEM based sectors generally, is founded on the scientific method for building knowledge.
The purpose of the scientific method is to remain sceptical, objective, rational. Accurate measurement is crucial – we must not jump to conclusions. As William Thomson, the future Lord Kelvin, put it in 1889:
“when you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind”.
Measuring the environmental impacts of digital technologies is extremely complex and the data we have is not accurate. This makes digital technologists very uncomfortable, and consequently digital carbon calculators are proliferating, (Green Software Foundation tools, Impact Framework, Green Algorithms, Cloud Carbon Footprint), each trying to outdo its predecessors in the ingeniousness of its pursuit of accurate, or “perfect”, data.
What’s the problem with this?
While the tech industry goes down this perfect data rabbit hole it is vulnerable to greenwashing, in the form of discourses that conflate sustainability with efficiency.
There are seductively articulated and well marketed “net zero” and “carbon aware” strategies, which can be particularly disarming as they are often delivered by well intentioned people genuinely trying to make a difference.
These strategies focus on improving the efficiency of digital technologies, so they consume less energy, and ensuring that the energy they do consume is, as far as possible, renewable. The wider complexities of digital technologies’ impact on the environment, and how electricity grids actually work, are often not addressed.
As a simple example, the rebound effect is often ignored. This effect occurs when a piece of tech is picked up by more and more people as it becomes more efficient, frictionless and cheaper. Any reduction in the energy required, and hence carbon footprint, of one instance of its use is more than made up for by the surge in people using it. Examples of this are legion – most apps you have on your phone for starters.
For many in Tech it is tempting to hunker down in the perfect data rabbit hole and get greenwashed. But this can’t be an option. Since 2021, the advent of AI has turbo charged the problem. Even if we can’t measure them exactly, we know that digital technology, and particularly AI and the big data it feeds off, have stratospheric environmental costs.
Many are now calling out Tech’s pursuit of perfect data on environmental harms, pointing out that it not only generates its own carbon footprint (particularly as AI is bought in to help with the measurement), but it is distracting us from acting with the sense of urgency the situation demands and making space for the green washers.
Western Medicine and the Environment
In much of western medicine, precision or personalised medicine is the holy grail. This requires accurate and complete data. This data can come from multiple sources. It can come from us, using apps to monitor our sleeping or exercise or blood glucose levels. It can also come from the NHS, who, along with our health records, might have our whole genome sequenced or our brain scanned. A mountain of personal health data is being built up for many of us, and the tech industry is generating ever more powerful tools to analyse it. As the AI wave breaks over us, healthcare is being transformed and ‘achieving’ precision medicine appears tantalizingly close.
The environmental impacts of digital and AI enabled healthcare are less talked about than those of Tech more generally. The sustainability focus in healthcare has been more on things like buildings and transport, single use plastics and greenhouse gases used for anesthesia. Doctors are supposed, first and foremost, to ‘do no harm’. But in this context, harm is usually understood as harm to the patients in their care. If they are bringing benefits to these patients, harm to the environment tends to be overlooked.
Is the personalised approach bringing benefits to patients?
Personalised healthcare is seductive – what could be more interesting than understanding everything about your own body? But it can have significant negative effects.
It can lead us into uncharted territory. The NHS is ramping up whole genome sequencing, and, as the distinction between its use for screening and diagnosis blurs, more people will be faced with disturbing uncertainties. You may have a higher risk of some alarming condition developing, but it may not be clear what, if anything, can be done about it. You may be put in a difficult position with regard to whether, and how, you communicate this knowledge to relatives who may also be at risk. You may be a relative that this is communicated to.
Digital products and services to facilitate the pursuit of our own individual peak health are ubiquitous, even though the science behind them can be questionable. Blood sugar monitors, for example, can lead to an “obsessive focus on numbers which, in the most extreme cases, “can translate into eating disorders”. Mental health apps can increase the very symptoms they are supposed to address. It is worth noting that the business models behind these offerings, and their “individualistic focus on health promotion” also creates obstacles to achieving wider public health goals, including greater health equity.
Personalised medicine can certainly deliver benefits to patients, but it also has downsides.
Back to the Environment
Despite these downsides, it appears that medicine, turbo charged by tech, is deep in its own rabbit hole pursuing the perfect human. This has made it oblivious to the fact that health data is now the fastest growing component of the datasphere, and this has knock on effects on the carbon and water footprints of its storage and analysis, as well as the extractive mining, and its associated pollution, that come with the technical infrastructure necessary to support this.
Digital healthcare is doing significant and rapidly increasing harm, and the irony is that this harm contributes to man-made climate change which represents the biggest threat to human health globally.
Where do we go from here?
Tech and Western medicine need to broaden their views. They need to come out of their rabbit holes and engage with a wider landscape of complexity. It is futile to isolate one element and pursue a once and for all answer – in the form of a perfect carbon calculator or a perfectly maintained human. Such goals are illusory.
Even if the perfect carbon calculator could be achieved or a human could be perfectly maintained, rapidly evolving technology and the complexity of environmental systems mean these “answers” would be transitory. Something in the complex system would change and these answers would be washed away.
Tech has to broaden its view to accommodate uncertainty – it needs to acknowledge that carbon calculation will always be a work in progress, and start acting on “good enough” data.
Medicine has to broaden its view to acknowledge the interconnectedness of the planet, people and all other life on earth. We know our anthropocentric viewpoint must shift. We just need to do it.
Neither of these shifts are easy. Both are overdue.
Mary Pitt worked in the tech industry for three decades before leaving to do a Masters in social policy and social welfare. She now works as the coordinator of the SHADE research hub. SHADE considers a fundamental question: How should the balance between AI/digital enabled health and planetary health be struck in different areas of the world, and what should be the guiding principles? To find out more about SHADE, sign up to the newsletter.