Three fine books that I’ve recently had the pleasure to finish reading all underscore, in their own ways, the profound insight expressed in 1970 by management consultant Peter Drucker:
The major questions regarding technology are not technical but human questions.
That insights sits alongside the observation that technology has been an immensely important driver of change in human history. The technologies of agriculture, steam, electricity, medicine, and information, to name only a few, have led to dramatic changes in the key metrics in human civilisation – metrics such as population, travel, consumption, and knowledge.
But the best results of technology typically depend upon changes happening in parallel in human practice. Indeed, new general purpose technology sometimes initially results, not in an increase of productivity, but in an apparent decline.
The productivity paradox
Writing in Forbes earlier this year, in an article about the “current productivity paradox in healthcare”, Roy Smythe makes the following points:
There were two previous slowdowns in productivity that were not anticipated, and caused great consternation – the adoption of electricity and the computer. The issues at hand with both were the protracted time it took to diffuse the technology, the problem of trying to utilize the new technology alongside the pre-existing technology, and the misconception that the new technology should be used in the same context as the older one.
Although the technology needed to electrify manufacturing was available in the early 1890s, it was not fully adopted for about thirty years. Many tried to use the technology alongside or in conjunction with steam-driven engines – creating all manner of work-flow challenges, and it took some time to understand that it was more efficient to use electrical wires and peripheral, smaller electrical motors (dynamos) than to connect centrally-located large dynamos to the drive shafts and pulleys necessary to disperse steam-generated power. The sum of these activities resulted in a significant, and unanticipated lag in productivity in industry between 1890 and 1920…
However, in time, these new GPTs (general purpose technologies) did result in major productivity gains:
The good news, however, is substantial. In the two decades following the adoption of both electricity and the computer, significant acceleration of productivity was enjoyed. The secret was in the ability to change the context (in the case of the dynamo, taking pulleys down for example) assisting in a complete overhaul of the business process and environment, and the spawning of the new processes, tools and adjuncts that capitalized on the GPT.
In other words, the new general purpose technologies yielded the best results, not when humans were trying to follow the same processes as before, but when new processes, organisational models, and culture were adopted. These changes took time to conceive and adopt. Indeed, the changes took not only time but wisdom.
The Digital Doctor
Robert Wachter’s excellent book “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age” provides a dazzling analysis of the ways in which the computerisation of health records – creating so-called EHRs (Electronic Health Records) – is passing through a similar phase of disappointing accomplishment. EHRs are often associated with new kinds of errors, with additional workload burdens, and with interfering in the all-important human relationship between doctor and patient. They’re far from popular with healthcare professionals.
Wachter believes these problems to be temporary: EHRs will live up to their promise in due course. But only once people can set the hype aside. What’s needed is that designers of healthcare tech products and systems will:
- Put a much higher priority on ease of use, simplifying usage patterns, and on redesigning the overall flow of activity
- Recognise and deal with the multiple complexities of the world of medicine.
For a good flavour of Wachter’s viewpoint, consider this extract from a New York Times opinion article he wrote in March, “Why Health Care Tech Is Still So Bad”,
Last year, I saw an ad recruiting physicians to a Phoenix-area hospital. It promoted state-of-the-art operating rooms, dazzling radiology equipment and a lovely suburban location. But only one line was printed in bold: “No E.H.R.”
In today’s digital era, a modern hospital deemed the absence of an electronic medical record system to be a premier selling point.
That hospital is not alone…
I interviewed Boeing’s top cockpit designers, who wouldn’t dream of green-lighting a new plane until they had spent thousands of hours watching pilots in simulators and on test flights. This principle of user-centered design is part of aviation’s DNA, yet has been woefully lacking in health care software design.
Our iPhones and their digital brethren have made computerization look easy, which makes our experience with health care technology doubly disappointing. An important step is admitting that there is a problem, toning down the hype, and welcoming thoughtful criticism, rather than branding critics as Luddites.
In my research, I found humility in a surprising place: the headquarters of I.B.M.’s Watson team, the people who built the computer that trounced the “Jeopardy!” champions. I asked the lead engineer of Watson’s health team, Eric Brown, what the equivalent of the “Jeopardy!” victory would be in medicine. I expected him to describe some kind of holographic physician, like the doctor on “Star Trek Voyager,” with Watson serving as the cognitive engine. His answer, however, reflected his deep respect for the unique challenges of health care. “It’ll be when we have a technology that physicians suddenly can’t live without,” he said.
I’m reminded of a principle I included in a long-ago presentation, “Enabling simply great mobile phones” (PDF), from 2004:
It’s easy to make something hard;
It’s hard to make something easy…
Smartphones will sell very well provided they allow users to build on, and do more of, the things that caused users to buy phones in the first place (communication and messaging, fashion and fun, and safety and connection) – and provided they allow users to do these things simply, even though the phones themselves are increasingly complex.
As for smartphones, so also for healthcare technology: the interfaces need to protect users from the innumerable complications that lurk under the surface. The greater the underlying complexity, the greater the importance of smart interfaces.
Again as for smartphones, once good human interfaces have been put in place, the results of new healthcare technology can be enormous. The New York Times article by Wachter contains a reminder of vexed issues within healthcare – issues that technology has the power to solve:
Health care, our most information-intensive industry, is plagued by demonstrably spotty quality, millions of errors and backbreaking costs. We will never make fundamental improvements in our system without the thoughtful use of technology.
In a different way, Steven Kotler’s new book also brings human considerations to the forefront. The title of the book is “Tomorrowland: Our Journey from Science Fiction to Science Fact”. It’s full of remarkable human interest stories, that go far beyond simple cheer-leading for the potential of technological progress.
(photos by Kirsten Zverina)
Ahead of the event, I had hoped to be able to finish reading his book, but because of other commitments I had only managed to read the first 25%. That was already enough to convince me that the book departed from any simple formula of techno-optimism.
In the days after the event, I was drawn back to Kotler’s book time and again, as I kept discovering new depth in its stories. Kotler brings a journalist perspective to the hopes, fears, struggles, and (yes) remarkable accomplishments of many technology pioneers. For most of these stories, the eventual outcome is still far from clear. Topics covered included:
- The difficulties in trying to save the Florida Everglades from environmental collapse
- Highlights from the long saga of people trying to invent flying cars (you can read that excerpt online here)
- Difficulties and opportunities with different kinds of nuclear energy
- The potential for technology to provide quick access to the profound feelings of transcendence reported from so-called “out of the body” and “near death experiences”
- Some unexpected issues with the business of sperm donation
- Different ways to enable blind people to see
- Some missed turnings in the possibilities to use psychedelic drugs more widely
- Options to prevent bio-terrorists from developing pathogens that are targeted at particular individuals.
There’s a video preview for the book:
The preview is a bit breathless for my liking, but the book as a whole provides some wonderfully rounded explorations. The marvellous potential of new technology should, indeed, inspire awe. But that potential won’t be attained without some very clear thinking.
The third of the disparate trio of three books I want to mention is, itself, the third in a continuous trilogy of fast-paced futurist fiction by Ramez Naam.
In “Apex: Connect”, Naam brings to a climactic culmination the myriad chains of human and transhuman drama that started in “Nexus: Install” and ratcheted in “Crux: Upgrade”.
Having been enthralled by the first two books in this trilogy, I was nervous about starting to listen to the third, since I realised it would likely absorb me for most of the next few days. I was right – but the absorption was worth it.
There’s plenty of technology in this trilogy, which is set several decades in the future: enhanced bodies, enhanced minds, enhanced communications, enhanced artificial intelligence. Critically, there is plenty of human frailty too: people with cognitive biases, painful past experiences, unbalanced perspectives, undue loyalty to doubtful causes. Merely the fact of more powerful technology doesn’t automatically make people kinder as well as stronger, or wiser as well as smarter.
Another reason I like Apex so much is because it embraces radical uncertainty. Will superintelligence be a force that enhances humanity, or destroys it? Are regulations for new technology an instrument of oppression, or a means to guide people to more trustworthy outcomes? Should backdoors be built into security mechanisms? How should humanity treat artificial general intelligence, to avoid that AGI reaching unpleasant conclusions?
To my mind, too many commentators (in the real world) have pat answers to these questions. They’re too ready to assert that the facts of the matter are clear, and that the path to a better Tomorrowland is evident. But the drama that unfolds in Apex highlights rich ambiguities. These ambiguities require careful thought and wide appreciation. They also require human focus.
In between my other projects, I’m trying to assemble some of the best thinking on the pros and cons of key futurist questions. My idea is to use the new site H+Pedia for that purpose.
As a starter, see the page on Transhumanism, where I’ve tried to assemble the most important lines of argument for and against taking a transhumanist stance towards the future. The page includes some common lines of criticism of transhumanism, and points out:
- Where these criticisms miss the mark
- Where these criticisms have substance – so that transhumanists ought to pay attention.
In some cases, I offer clear-cut conclusions. But in other cases, the balance of the argument is ambiguous. The future is far from being set in stone.
I’ll welcome constructive contributions to H+Pedia from anyone interested in the future of humanity.
It’s now less than three weeks to the Anticipating 2040 event, where many speakers will be touching on the themes outlined above. Here’s a 90 second preview of what attendees can expect.