Smarth Health: when technology and ethics collide

There is no question that the healthcare budget is under pressure, even when the group at the peak of the population pyramid has yet to reach the age with the greatest need for care. Both the financial and organisational burden of the system will therefore increase in the future. Ageing not only increases expenditure on health care and pensions - the changing ratio of active to passive population also puts extra pressure on the financing of our social security system.

All of this combined makes prevention the number one priority. That makes perfect sense one would think, but there is an important consequence in the already intensely debated issue of health becoming an individual responsibility. Leading to ‘health fascism’, according to some: those who do not do their utmost to stay as healthy as possible, will drop out of the system. But first things first. What can technology contribute in preventing disease?

The rapid developments in gene and biomedical technology are just as useful in treatments, as in setting up an effective prevention policy. The human body has become a quantifiable object that you can measure, read, manipulate, monitor, steer, etc. To such a level, that there is even a whole new industry for it: biohacking. Referring to managing one's own biology using a combination of medical, nutritional, and electronic techniques. More biohacker groups appear that want to make bio-technology accessible to everyone.

Of course, they give rise to a whole series of ethical questions that demand an answer. Where is the boundary in what is 'human' or 'natural'? Where is the line between 'healing' and 'upgrading'? How malleable can or should the human be, undermining or at least challenging the concept of medical solidarity? As far as genetic screenings are concerned, the question of whether and when the acquired knowledge should lead to intervention is a legitimate one. Moreover, who should or may be informed of the risks involved? And how do people deal with this information?

Today there are already countless wearables, apps and other technologies available that can provide us with data about ourselves. We monitor or measure our heart rate, sleep pattern, weight and fat percentage, calorie intake, number of steps,.... And some have actually been prescribed an app by their doctor that can monitor their heart rhythm or measure their blood pressure. Of course there is much more. How healthy is the air I breathe, the nutrients I take in, how is my digestive system doing, my brain activity, my serotonin, my blood level, my hormone balance...?

Gathering data of a number of health indicators over a longer period of time is key, thus giving people a more reliable picture of their health. Those data are collected in a digital twin of the body. In this way, doctors and specialists can experiment with new treatments and medications, risk-free. For example, AI can analyse data from wearables and select meals that meet the necessary nutrients of the individual. Add to this the preferences in terms of flavours, shapes and texture of the food, and the result is served in the form of 3D printed meals with artificial meat and fish. And check which nutrients were actually absorbed and which were left on the plate…

Obviously, if everyone in the world were to collect these data about themselves in one large database, we would end up with a gigantic mass of data that could then also be linked to how people feel, what illnesses they develop, what complaints they have,.... It is beyond doubt that artificial intelligence - certainly in combination with genetic predetermination - will enable us to establish many more links between these parameters than we do today. The chance of developing certain disorders will be predicted even more accurately.

But at the end of the day, the million dollar question remains: is having this information desirable? What about the individual freedom to choose not to know and/or not to intervene? There is no doubt that technology could help us prevent illness and that we will be able to enjoy more healthy years. But a broad social debate will be necessary to answer the many ethical questions. Just by looking at the increasingly hostile divide between Covid vaccinated and non-vaccinated people, the debate has only just started and can turn ugly very quickly.