A 100-Year-Old Martian In An Exoskeleton

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• The story of The Medical Futurist
• The mission of a futurist
• The most transformative technology: A.I.
• The mission of The Medical Futurist
• The business model
• Communication of science to wide audiences
• Science fiction and science
• Data measurement
• Data privacy
• Advice to health policy-makers
• The gap between the haves and have-nots
• Nightmare scenarios
• The future of the doctor-patient relationship
• Genetics and gene editing
• Mars and healthcare

What do archaeologists and futurists have in common? Why was the Internet underestimated as a technology to transform society while A.I. is over-hyped? What’s the most transformative concept in healthcare? What are the medical nightmare scenarios that humanity should be afraid of? The editorial team sat down with Dr. Bertalan Meskó, Director of The Medical Futurist Institute and The Medical Futurist himself to talk about the future of medicine, genetics, and many more on the occasion of the launch of the Great Thinkers article series. Read on, live long and prosper.

First thing first. How did Dr. Bertalan Mesko become The Medical Futurist?

I had a dream at the age of six. I received a scientific encyclopedia from my mother from which I learned about the notion that if we don’t understand something, we do research and then we will get a clue about it. I fell in love with the scientific process forever. So, I knew I wanted to become a scientist. Later, it became a bit clearer that it was more about medical science than physics or chemistry. So, I earned my medical degree and then a Ph.D. in genomics, but I felt like my love for technologies was missing from my life.

And when you go in-depth in genetic research, you don’t have a chance to take a look at other areas: artificial intelligence, robotics, sensors, etc. That’s out of your scope. We even had a patent about one of the results we had in a study that would later become a personalized test for patients with cancer where they could just choose the right treatment for them based on their genetic profile. So, the practical recommendations and considerations were clearly there but a decade from then. You make a discovery, if you are lucky maybe in 5-10-15 years, this becomes a reality and gets into practice. But I was quite involved with how A.I., sensors and other technologies have been evolving and I felt like the world will change faster than that. So instead of diving into one, really fantastic cave, but just one cave, I decided to have supervision over 200 caves not at depth, but still, somewhere in the middle.

So, that’s how I made the hard decision to switch from life sciences to social sciences, more specifically to futuristic studies. It was absolutely new to me, and I didn’t know how to do what I had in mind: talking about technologies to the general public, and doing research about their impact on society and on medicine. So I went to Singularity University, I did a course at Harvard Extension School, but still, there was no profession like what I had in mind. So I had two ways: 1) putting myself in a box I’m not comfortable with or 2) creating a new box.

As I’m not a conformist, I went for the second one. I created a new profession, the medical futurist combining futuristic studies with a focus on the medical/healthcare aspects. That’s how in 2012, I became The Medical Futurist.

How do you see the mission of a futurist? If you would want to give a piece of advice to a future futurist, what would you say?

Most people think that futurists have a purpose of predicting the future. They need to have a crystal ball at home that they keep clear, and any time they want to look into the future, they look into it and see what’s going to happen. That’s why people keep asking futurists in how many years things would take place. But that’s nonsense – I don’t think that’s the role of futurists.

Instead, it’s to make people who don’t care about the future care about the future, actively think about what might happen next. Show them how many visions are possible, and make them embrace those that they want to live through in the future. Also, the futurist’s job is to find out what’s missing between the two time points.

I believe futurists do exactly what archeologists do but about the past. You don’t actively think about how Romans lived 2000 years ago, but when you talk to an archeologist, you start asking questions, you start becoming interested about a part of life that you never think about. And with their help, you get a glimpse of the past. With the help of a futurist, you can get a glimpse – about the desired future.

Speaking about the desired future – which technology do you think will prove to be the most transformative?

The Internet changed everything 25 years ago. The next one is clearly the mid-level of A.I.: artificial general intelligence. As we won’t get to superintelligence, because humanity will get vanished by then, while artificial narrow intelligence is already here, it must be A.G.I. When the first time, you as an individual will have the chance to talk to an algorithm, a chatbot, whatever you call it with A.G.I, you will feel that something new has just begun. Something new that you never experienced in your life. From that point on, you can talk to that being or algorithm with consciousness, curiosity, creativity like with a human being. It will give you the impression that it has the same values and jokes. It will be transformative because we will have to reevaluate ourselves and our role in society. Humanity will feel inferior in many perspectives to A.G.I.

When they are able to reply to all my questions in my daily work, I become dependent on them, I become inferior, and I will have to look for a new place. I think that’s what happened when the Internet became widely available. We had to redefine how we sell products, how we find information, how we talk to each other. But it was more about how society works. A.I. will redefine how we think of ourselves.

That’s quite interesting how you compare the Internet and A.I. because when I think about the 1980s or the 1990s, I’m not sure that the Internet had such a cloud of expectations around it, that A.I. has. At the same time, the first experiences with smart algorithms don’t really live up to the expectations. What do you think of that?

When I read about how the Internet was formed at CERN as an intranet, it was just a network of computers connected to each other with one single computer with a sign on it saying “don’t turn it off because then you turn off the whole internet.” They underestimated what that network can bring to our lives. They underestimated it but we gradually learned about the advantages, dangers, privacy issues and we still keep on learning.

Let’s not make the same mistake in the case of A.I. Let’s not underestimate its potential impact. And I think that’s the role of futurists in the 21st century. Not to try to over-claim, over-hype technology but to make sure we don’t underestimate a danger or a possibility. Not to come up with blind predictions about what might happen in 15 years, but to make sure that policy-makers, decision-makers, the general population actively think about what might come next and what they want to see of it in action.

And what do you personally do not to underestimate or overhype technologies?

I think I still make mistakes. What I do is I learn every day. I think I read more than during my Ph.D. I read hundreds of books every year. I do online courses, I watch a lot of presentations, I go to places and talk to people. I reach out to those experts whom I think in one area or expertise, they are the right persons to go to. For me, the best example is Nick Bostrom. I’m sure there are hundreds of great A.I. experts, but his life and blood are A.I., so when I read his book, Superintelligence, I felt like that’s the best ground understanding I could get about A.I. The vision, the levels, the algorithms, machine learning versus deep learning – that gives you a good overview and from there, I can just reach out to more books and experts to keep on learning.

On the other hand, there’s no other way to make the right assumption when it comes to answering a tough question, then to have the ability to connect the dots. You can become a fantastic A.I. expert, really, learning and reading 24 hours a day about A.I. But something might come from the energy sector that will change how A.I. is structured. Something might come from logistics or security, like blockchain, that will transform medical records forever. If you don’t have at least a superficial knowledge about all these dots, then you won’t be able to connect them. And that’s what matters when you have to answer hard questions: the ones about the future of jobs, work, and healthcare. For those, you have to be able to step up, get a high-level vision. The ability to be able to make these distinctions between high-level and in-depth knowledge, that’s the right skill-set that a futurist needs to have today.

Could you also say that’s the mission of The Medical Futurist?

I think that’s the role of The Medical Futurist team now. To help people point out what dangers and possibilities should not be underestimated, and at the same time to buzz those who over-claim something. The Medical Futurist took up that role several years ago. And, as the third task, to make people who are never motivated or pressured to think about the future, contemplate about it. We don’t want to make them futurists, but we want them to anticipate something. Like in chess. You can play chess re-actively, but you won’t win many games. But from the point when you start thinking about what might come next, you become a winner player.

And what do you think has been the greatest achievement of The Medical Futurist so far? And what might come next?

The fact that it’s a team. The fact that it’s not one individual’s vision or dream but that many people took on this dream. So, now we can describe it in better details, in a more emotional sense that people can understand and acknowledge better. We don’t have to share the same dream, but we want people to fantasize about the future because that could make more manageable for people who are working on changes to choose desired scenarios of the majority.

How does the business model of The Medical Futurist work?

The model is quite different from what we see today in big companies. What we do is we don’t have clients, we don’t advertise on the site, so we have no financial gain from popularity. That goes against every rule in the online world today. We build a pyramid.

At the bottom, we have about half a million people every day for whom we produce content for free. We create videos, articles, reports, studies, social media posts, context about digital health and the cultural transformation behind that because we want to help them understand all this. And bring this knowledge, expertise, vision into their own lives. That’s for free.

On the top of the pyramid, we have me as a keynote speaker. I travel around the world, I fly for more than 60 times a year to different places when I meet people in person and describe digital health to them. And in the middle, we are forming a community of proactive individuals. From empowered patients to empowered physicians, to innovative policy-makers and technologists, researchers, we are building a community that can really bring this notion of digital health to their own countries, respective fields of science or just general lives and jobs.

So you said at the bottom, there are half a million people, who are following the channels of The Medical Futurist, and you said earlier that you are a researcher. Usually, researchers and scientists only talk to a small scientific community and not such a wide audience. How do you see this?

Science is not only for scientists. When you do research, most researchers received grants and funding from institutions, high-level organizations like the EU, or countries and governments. We are obliged to give back to society. I think as a scientist, I took up the responsibility to communicate my findings to people. Of course, I have to be able to demonstrate my knowledge in a professional way to my peers, but I love the fact that I have been trying to deliver all the findings either in genetics or in digital health to the general public as well.

Because without them, how can we expect them to keep on funding, financing and supporting us? We only see a few influencer-scientists from Bill Nye the Science Guy to science channels on Instagram or YouTube. But I think it should be a part in every Ph.D. education, that you learn how to communicate your findings. Even between peers, I think we should be able to come up with short abstracts or short videos because we have to be able to explain our findings in one or two minutes. I know it’s a weird idea that we have to be as popular as the Kardashians but in digital health.

We have to be able to reach out to hundreds of millions of people with the right message. We have to make that message attractive enough so we can compete with non-essential strains of information coming from celebrities and cat videos. If our words don’t reach you, I think it’s not your fault, it’s ours. So we, as scientists, have to keep on improving the skills that let us communicate our findings better to the general public.

So, I know that you are a huge science fiction fan and in my mind, I already connected the dots. I can see how science fiction can help scientists communicate science better to a broader audience, but how do you see the role of science fiction?

Science fiction – and data for that matter – is for me the fuel I have to have every day to keep on working. The way sci-fi movies and books make me think about the ethical considerations, the nightmare scenarios, the advantages and the technological sublime, that’s where I get my inspiration for my work.

Many science fiction writers were the best futurists in life. Arthur C. Clarke was a prolific science fiction writer, he predicted GPS satellites, the Internet, artificial intelligence back in the 1960s – when computers were as big as one huge room. No one could anticipate that – and he still did because, from the age of 5 or 6, he kept on stargazing every day or so. Clarke grew up on a farm, he collected cigarette cards because they had dinosaurs on them. That’s actually the range of toys he had. He couldn’t go to college or university, he had no formal background in education. Still, I think he was the best futurist who ever lived on this planet – because every day he kept on reading science fiction. Every day, he kept on thinking about anticipating the future.

So your fuel is science fiction and data. So, let’s go back to data. You measure tons of markers about yourself, you just had your whole genome sequenced. Do you know how much data is out there about yourself?

I’m sure it’s gigabytes. I’m sure the vast majority of it is still uncovered and undiscovered. And I look forward to using algorithms, better ones that we have today, that can give me even more suggestions about my life, health, and lifestyle. But I don’t want to sound like someone obsessive. I turn to these solutions because otherwise, I would never go out for a run, for example. If I could choose between binge-watching Stranger Things on Netflix, or going out for a run, that’s a no-brainer. Of course, I sit down and watch Stranger Things for hours. But I know that if I exercise every day, my cognitive health becomes better, and my emotional health gets better in the long term. That’s my algorithm.

I have to live like someone from ten years from now to show people an example, what they could learn or what they could lose in their privacy by using these services. I offer my data in a public way, but I’m happy to take that blow in exchange for a longer and healthier life. I learn about what I could do differently, what risks I can go against, what I can prevent, how I can avoid diseases. That’s my real purpose here by quantifying my lifestyle.

Do you see any peril in having so much data about yourself?

Absolutely. When I studied pathology as a medical student, and learned about diseases every single day, sixteen hours a day, I started to feel like having them. That’s what happened when I learned about my genomic fate, what kind of data I can measure about myself and I started thinking about them. I became a bit of a hypochondriac. Or better, a cyberchondriac.

But gradually, I grew out of it. Because I found a meaningful way to use the data. Sometimes, I just want to go to sleep without any sleep trackers or health trackers on me. I know that with a sleep tracker I can make myself wake up at the absolute best time – feeling energized and ready for the day without even coffee, but sometimes, I just want to go to sleep and sleep until I wake up myself. So, I need that freedom of choice in my life to remain technology-free, but when technology offers me such advantages, I want to live with them.

So, one peril is the privacy issue, where I know that my data is pouring out of the system but I know about that, I take that responsibility, I’m okay with that. The second is about the freedom of choice, and a third is, which might be the hardest point here. By using technologies in your lifestyle, you gradually learn about your relationship with technologies. It’s essential because if you don’t know your own relationship with technologies, when you have to work with something as an A.I. algorithm, if you start thinking about that then, that might be too late, and you might reject them more easily. But if you learn how you relate to new technologies with a few gadgets, I think you become prepared when more significant changes come into our lives. I think that’s the point where using technologies and quantifying my lifestyle turned out to be the most useful.

Let’s go back to data privacy for a moment. Are you not afraid that your data might end up in the wrong hands?

I think that has happened already. I had six genomic tests done, I’m pretty sure that some of those companies have already sold my data even though I clicked on “no”. I’m pretty sure that people can access parts of my genomic data results, too. But that’s the danger I have to live with because I live my life in a public way. The role of The Medical Futurist is to take that challenge, live up to the expectations, and deal with these dangers. But by showing my example, and raising issues about privacy, we might end up with better policies and regulations.

So what advice would you give to regulators who want to do it better?

They should have a better knowledge of digital health technologies than we do. We, whose blood is digital health, with which we wake up and go to sleep. Those politicians should have a better knowledge about it. Or, get people like us, ask leaders of tech companies the right questions. When Mark Zuckerberg had his Congressional hearing, the issues raised were so stupid sometimes you couldn’t believe it.

It’s the job of politicians to step up and get into the forefront of innovation. We have crowdfunding, crowdsourcing, Amazon and social media, so if they aren’t fast enough, patients will find a way to innovation. They will be creating their own bionic pancreas at home, as we’ve seen in the US with the „We are not waiting” movement. 5,000 patients created a DIY artificial pancreas at home. While it’s impressive, we don’t want that to become a general rule of thumb. That people turn to unregulated technological solutions, just because policy-makers are slow.

It seems to me that technology is too fast, while both regulations and medicine take up new innovations very slowly. How should we bridge these gaps? Because as we can see in technology, there are advancements which are just a passing fling, there are innovations about which we don’t know yet whether they will prove to be appropriate for people. How should we go about these issues?

I think if we don’t bridge that gap, about three things might happen next. One, patients will turn to unsafe technological solutions. Second, garage start-ups will create technologies that might be harmful to the whole society. And third, technologies become available at a large scale from tech companies that think they have solutions for healthcare, but they have no knowledge or experience how healthcare works.

We don’t want any of these, and we can’t bridge these gaps without governments acting up. We’ve seen good examples in Denmark, Australia, New Zealand, Canada, Rwanda, maybe Israel. A few countries have been shaping their own digital health policies, and when bridging this gap comes from the highest level of the government, that could be a solution. Politicians don’t have to reinvent the wheel – they should just turn to digital health best practices, policies, regulations out there and use those examples to make it happen in their own government.

Talking about nightmare scenarios. What is yours?

I have two. One is the obvious one. Politicians do nothing, garage start-ups 3D-print organs, patients just download algorithms, print out any hard drugs or medications at home, we have no healthcare system to turn to because the system doesn’t take care of the patient. I have no privacy – I have to give up everything to be able to live – not longer and healthier but to be able to live a whatever-level healthy life. I have to give up everything I have: my DNA sequences, my sensor’s data because I have no health insurance if I don’t do that. So you are being minimalized to a tiny dot in the healthcare system. No freedom of choice, no proactivity, you are just a passive element that needs to do what it’s told to. That’s my biggest fear. And I think we are running towards that direction right now.

The second might be weird, but it’s that healthcare becomes an amazingly perfect system. Healthcare is mind-blowing, we have technological sublime: robot companions, robot dispensers, 3D printing, transplantations and bioprinters, genomic data, algorithms, A.I., – healthcare is state-of-the-art and amazing. So, you stop taking care of yourself. You stop being afraid of injuries or diseases and everyone starts smoking because it looks great on the screen, everyone starts drinking alcohol in excessive amounts, and don’t care about their lifestyles, so we lose touch with reality. Because whatever happens next, you get cured.

For me, the two scenarios are on the same level. I don’t want healthcare to be that good, because then we lose touch with ourselves – or the nightmare scenario, because then we lose everything that makes us individual human beings, the freedom of choice and decision-making capacity.

For me, when you talked about these two scenarios, in the first landscape the patient was missing, he was just a tiny dot, and in the other vision, healthcare was an utterly perfect machine, it didn’t need physicians. But in fact, how do you see the desired role of the patient as well as the doctor in the future?

The reason why I feel like these are nightmare scenarios is that the personal touch with someone with medical expertise is missing. When you go through a disease, or when your loved one goes through a condition, you are vulnerable, and you know that one tap on the shoulder saying that „ we know that’s hard, but we do our best to make it right,” is very engaging, compelling and compassionate. And that’s what humans will always need. When you get that tap on the shoulder from a chatbot, it’s not going to feel like it’s real compassion. It’s going to feel like you are a part of a robotic system. That’s why I feel like these are nightmare scenarios.

So, you might envision that the future is all about human connections. The future is all about patients who are proactive, knowledgeable, who look for information, who want to get better or want to prevent diseases from taking shape for decades from now on. So they are right there.

And physicians or medical professionals are proactive, too. They are not these semi-Gods we have today, because they cannot possibly know everything when there are 30 million studies on PubMed.com. They can have a great experience, personality, vast knowledge, and expertise, but they don’t have superpowers. When the patient and the doctor start a discussion about a vulnerable issue, they work hard to find a solution – for which they need disruptive technologies.

I want them to have eye contact as the patient is telling the symptoms, I want the physician to think about what might be the solution, and I want the chatbot, the algorithm, the A.I. behind that to start looking for everything. So when me as a physician, asks for help, I just get the right amount of information, the right way from the correct studies, so I don’t look through 50 when we have 30 million. But the A.I. will point my attention to two studies that might be the most relevant in the patient’s case. It will also give me the results of lab marker analysis, the genomic data, so I make the decision with the patient together, but I have everything I need. I don’t have to use rudimentary tools, I don’t have to diagnose at the point of care, it’s already been taken care of by the time you get to me. But what you get from me, is the human touch. We will always need empathy and compassion, no matter how mind-blowing technologies we will have in our lives.

What if we just go back a little bit to technologies and medicine, the accessibility and the costs. Do you think the availability of technologies and medical services to particular groups will result in biological differences?

The top 1 percent wealthiest Americans and UK citizens live now 10 years longer than the bottom 1 percent in each country. So the biological gap is already there, and it’s based on wealth, thus access to care. When digital health technologies come to the picture, it will be extended, I’m pretty sure about that. If some have brain microchips, they might get a better chance on the job market. If some have exoskeletons, with which they can work for 15 hours without being tired, they will get promoted. That can create a wider gap, although we call disruptive technologies truly disruptive for a reason.

That means they should be more effective, faster, more accessible, and cheaper than any technology before them. If it’s not cheap, it’s not disruptive enough. Plus, I think it’s a better chance that someone in the rural part of Rwanda or Indonesia will get access to a portable pregnancy ultrasound than you do in a great capital city like Budapest right now. Patients in Rwanda might have a better chance to talk to a physician via telemedicine even living in the most rural part of the country than us living in Budapest – because they have digital health, and we don’t.

There are two interesting perspectives here. One is that these technologies seem to be very expensive, some of them are, but then, they are not disruptive enough. And the second perspective is that those cheap technologies become deployed sooner in low resource regions than in the most developed countries in the world. So, let me ask back, is it fair that low-resource areas might have a better care system because patients will become the point of care in a few years than what we have in a relatively developed healthcare system in a capital city? Is this fair? Of course, not. Is it fair that some technologies are not accessible financially to certain populations? Of course, not. That’s why we push those companies to understand that if your solution is not cheap, it’s not disruptive enough. Not just because of ethical reasons, but also because if it’s not cheap enough, someone in a garage might be able to create the same for a much lower price.

These concerns also exist about genetics. A couple of days ago, we could read that a Chinese scientist claims he has genetically edited two baby girls. And we can say that we can have the nightmare scenario of having a society with genetic haves and genetic have-nots, who would not be able to afford gene therapies to live a better and healthier life. What do you think of that?

I think it’s already taking shape. I had the chance to have my genome sequenced. Maybe you can’t afford that. I have a vast amount of information about my genome, the risks I can avoid, diseases I can prevent from happening, and maybe you don’t have that chance. So, it’s not just about designer babies and CRISPR, it’s already about the access to such technologies. But when CRISPR becomes a much more accessible technology, and a safer one as well, the chance is there.

I mean I have to be honest, I can’t possibly think that ethically we would be able to prevent the birth of designer babies in the future. I’m more than fine with correcting genetic defects that you know about because that’s like giving someone a diabetes medication for the management of diabetes. For me, that’s the same as curing a genetic defect with CRISPR while being in the womb, but when people, especially parents, start to look for certain features or traits, I’m not supporting that because we have no idea about the long-term impacts using the technology for such purposes. Those baby girls might have no HIV in their lives, but we have zero idea how that genetic change might impact their epigenetics, or other genetic factors – millions of them. We have zero knowledge, so purely for scientific reasons, I would not recommend anyone shooting for designer babies. But regarding birth defects and known genetic diseases that we can prevent from happening, I’m all for using CRISPR for that purpose.

So, we arrived at my last question. You said earlier that you want to live beyond 100, and that you want to go to Mars. And I’m just curious how can we keep someone on Mars alive? How will healthcare make that possible in the future?

Mars might be the best example because if astronauts on Mars don’t become the point-of-care, they have a low chance of survival. In an emergency, with the 40-minute communication delay, limited storage, you have to act immediately and at the point-of-care. Portable ultrasounds, lab tests, sensors, obtaining data, big data algorithms, artificial intelligence, everything will have to be at their disposal to keep them healthy and safe in a hostile environment. If we can make digital health happen for astronauts, they will be the best practice examples for Earth.

And my plan is to board a spaceship to Mars at the age of one hundred. I have an agreement with my wife that by then, I can board a spaceship if I can walk in there even in an exoskeleton. This is the vision I look at every single day that makes me shoot for a healthy life: me as a centenarian boarding a spaceship to a new planet.

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