Dr Zoltan Lantos: Emotional Health & Care vs Algorithms to Rule Our Behaviour

Systemic changes that digital health technologies will bring to future health & care are the topic of this interview with Dr Zoltan Lantos, Head of Department of Virtual Health Guide Methodology at Semmelweis University in Budapest. Dr Lantos has recently authored a book “Health From Data: The Road to a Healthy Data Age Society”.

Q1: In an interview about a year ago you mentioned primarily two roles for digital health: earlier detection of diseases and better support after detection. You have now written a book that identifies quite a few other areas in future healthcare to be influenced by digital health technologies. Do you base your conclusions on technical opportunities or on technical aspirations, dreams? Or maybe both?

A1: Perhaps, both. Our technical availabilities and opportunities are much more advanced, as we are collaborating out in the society, so yes, we need to keep up the pace with the technological development that we are producing, and we need to find novel approaches to value generation, and we need to set a new social contract for data usage. We need a new economic model for the data triangle, that consists of three different points: data privacy, fair data economy, and the utility that is generated for the citizens. This triangle is very similar to a financial triangle or an investment triangle. Why always a triangle? To demonstrate that you can never bring these three points into a one single point. The proper generation of value will allow us to harmonise privacy and accessibility of data.

Q2: In your book you talk about the shift, in your opinion impending, from incident-based approach in healthcare to the life span approach. If you were to explain this shift to a patient, how would you do it? What shall this patient do different in the future than now?

A2: Recently I found out that the best analogy that suits to explain it is traffic navigation. We all use traffic navigation in our lives when we drive a car or even when we walk. We want to find our way to a specific destination. And in the future, not a very far future, we will have health navigation systems as well. It will make a major difference. Now any health management needs a lot of energy, every day and every minute. A proper health navigation system will support us and adjoining services. It will be much easier to maintain your health.

Q3: You also talk about the trend of moving away from large hospitals to smaller, specialized diagnostic centers augmented by digital tools. Please elaborate on this shift. What will future patients gain and what will they lose, if this approach is to win worldwide?  

A3: As we reach earlier detection of anomalies in cells or distorted processes in our organisms, the opportunities to reverse them will be much easier. When we bring everything closer to a healthy condition, a less complex intervention will be needed for a health maintenance. That is why a better distributed capacity close to local communities, settlements, workplaces, to everyday life, will bring more support to health management. While the highly complex, technically demanding interventions, will be managed only in specialized institutes. However, the amount of this type of intervention will decrease, and these large, sometimes huge, hospital complexes won’t be needed. Today we gain a lot in everyday development of healthcare, and with high-cost interventions there is a risk to lose equity and equal access. It may delay the development.

Q4: How will it affect the medical profession? Will it mean less generalists?

A4: The general medical profession will shift to personal contact, more emotions will be brought to curing meetings, because algorithms and robots will help physicians to concentrate on specific issues. However, healing depends on emotions involved. We know that a proper discussion with a patient provides a better cure for patients. Generalists will concentrate on care, on personal contacts, and human-specific interactions, more emotional and more supportive.

Q5: I am actually very interested in exactly this point of yours, let’s discuss it a bit further. In your book, you write about new occupation and functions to emerge in healthcare. Give some examples, what do you expect in the near future?

A5: Actually, in some countries, health coaching is already available. Health planning and health coaching supports patients to understand their conditions better, support the specific daily plans for health management, and discuss possible limitations that patients have or what individuals perceive as limitations, what may probably not be there but only represented in perception. This is one specific health coaching approach. The other one is health coaching, that is disease specific or even genetic predisposition-specific, based on genomic sequencing, which will probably be available to everybody in 5-6 years. Specialized health coaching will be available based on the genome sequencing, on a genetic profile of an individual.

Q6: This is something for the near future. What about a longer-term perspective?

A6: In the long perspective, I am sure we will have an opportunity to explore the emotional part of diseases and the emotional part of health management. Currently, we have very little knowledge on the psyche in diseases and the psyche in health. We know that personal behaviour, community network, family have a very significant influence on health. However, we do not have metrics to charterise, and we do not have proper solutions for curation of these aspects of diseases. We will learn much more on that, and let’s say, in twenty years we will have a much better solutions for mental issues and for emotional maintenance.

Q7: It is already starting, there app-based efforts to deliver emotional support to mental health patients. It is a journey, that have just started. Many European countries are looking into expanding their national medical coverage to digital health tools, both hardware, hardware + software, and software only. Germany, to name an example, has been doing it for a year now. Do you welcome this development? What lessons are there to be learnt by now?

A7: Yes, it is a very important progress. Personal support via an application or a smart device is a very strong format of support to all of us. The registration procedure and the European registration requirements are as important as credibility of these devices. Coverage by the bundled payments and joint services for these solutions are highly relevant.

Q8: In your book you write that more and more healthcare is moving to portable devices. In your view, which other developments in digital health will affect our health behaviour most, and how?

A8: A smart home is a very important area for development as well. A minilab in a toilet will help evaluate our conditions day by day. Air we breathe will be analysed in the near future, and even the air in our cars. Later some reflections on our mood will be mirrored by different devices. We will come to a deeper analysis of our everyday status, which can be characterized by novel metrics, related to state of health, rather than particular diseases.

Q9: In your book, you write, that algorithms are most useful, when human-machine interaction (HMI) is multi-faceted. Please explain what facets you envisage to be employed in future HMI?

A9: I mean algorithms based on multiple senses, hearing, seeing, touching etc. All types of sensory activity may be supported by algorithms. Robotic support is yet another format, exoskeletons, and other kinds of support to our neuro-muscular system. Also learning will be supported by various algorithms, for example databases will supplement our memory. There are a lot of different types of opportunities, and learning is very important here.

Q10: You are obviously a proponent of digital health technologies; hence my concluding question may seem a bit sudden. What are we going to lose with the advent of future healthcare in digital formats, if anything?     

A10: We are at the crossroads now, not only for health, but our global society as a whole. We have a lot to lose and a lot to gain. If we learn how to utilize algorithms, robotic technology, and artificial intelligence, we will be able to understand our humanity and dig deeper in our psyche. We will then be able to see the humanity progress. Unfortunately, we can see that algorithms can drive behaviour and control purchase, as we see on Facebook, Instagram and TikTok. We are too heavily influenced by the so-called Facebook bubbles. If we focus in this direction, we will not be able to understand our emotional life and humanity. We will then go rather towards rational, egoistic arrangements. And then we will lose a lot. Almost everything.