Getting Real: It’s Her Turn

23rd June 2021 about a 7 minute read

It is hard to believe that we started this project a year ago. The 12 stories from the team of writers we have worked with have been entertaining and thought-provoking. In reading the final installment, It’s her Turn by Anne Charnock, I spent as much time reflecting on the project itself as I did the story and its implications. We are running an event on the 30th of June to consider the purpose of Sci-Fi explorations in a policy environment, and it will certainly be a useful discussion.

It has been interesting to see which current technologies the authors perceive to have longevity and which emergent concerns need to be considered as a result. The past year has been largely unique for the health and social care sector. The COVID-19 pandemic has dominated news feeds and dictated our daily lives. Pandemics are not new, records dating back to AD 165 show that many civilizations have dealt with major epidemics and pandemics. The more globalized nature of trade and holidays certainly is a feature that has played a major role in the COVID-19 pandemic. But it is also the first time that data and digital technology have played such a significant role in the public health response. Through this series, it has been useful and interesting to consider the fictional narratives and relate them to our policy work and wider programme of research. I will be writing a post next month to reflect on the full series and consider some of the next steps, as there is Anne’s excellent final installment to the “All I Asked For” trilogy.

This month’s story is an unusual one from the perspective of the Getting Real series. Where I normally focus on the health and social care technology underpinning the story, this time I will mostly be centering on the technology which is built into the recreational activity of the main characters.

We return to the story of Alice’s life, from baby bag to leaving home, viewed largely through the eyes of her parents. In the previous installment, Alice’s mother was experiencing anxiety about Alice’s safety and a range of psychological features related to being put in the position of having a preemptive caesarean and artificial womb. In this installment, it is Alice’s Father who is experiencing anxiety now that Alice has left home and is no longer such a central part of their daily lives. On multiple occasions, the trilogy highlights the emergence of psychiatric symptoms related to the pre-emptive procedure. As technology is developed to improve lives or solve a particular clinical concern, it can also lead to other unintended consequences. The story also suggests that new categories of symptoms may need to be developed as new technologies are brought into clinical practice. From the clinical and care perspective, this story largely focuses on mental health and the narrative is not so technology-focused.

For this installment of “Getting Real” we will move away from purely medical and healthcare technology and explore some of the recreational technology described. Anyone who follows Anne on Twitter will know how fond she is of spotting seabirds while out on the shoreline of various parts of Scotland. This story features birdwatching and technology in combination. In the story, we see an augmented reality (AR) set of binoculars, which are being used for bird watching. AR is a relatively new consumer technology, reaching the mass consumer market through Pokémon Go. AR can be implemented in a variety of devices and mobile phone technology is currently the most accessible form of the technology. AR overlays virtual objects or features on the real world either to enrich an experience, or to virtually interact with. While often used for gaming purposes, the potential uses of AR are extensive. There are a range of retail apps on the market for home improvement, fashion retail, and makeup, amongst others. As an example, users could see what a new sofa would look like in different parts of their home, in real-time. Similarly, they can see which clothes look best on them or try new hair and makeup options before committing to a change.

These examples all place a virtual object or feature into a real-life setting and, in the story, we see the augmentation is overlaying information on a live view. This is still quite early-stage technology, Google Lens allows users to identify objects in a picture and search for them in the browser. This is not quite the real-time overlay that we see in the story, but it is not far off. There is a range of these sorts of tools that can be used on images to identify species using the iNaturalist App. The app uses image recognition artificial intelligence (AI), trained on large datasets which have been meticulously labelled by volunteers and nature enthusiasts. This is very close to the binocular technology in the story, but currently only works on static images, rather than a real-time overlay. Conservation technology has come on rapidly in recent years, with citizen science and forms of AI being used to identify species and poachers to help maintain populations of endangered animals. WILDLABS and Zooniverse are key initiatives that readers may be interested in reading more about. Such initiatives could, in time, be the driver of consumer technology like the birdwatching binoculars.

The examples so far have all been from the mobile application market. There are several products on the AR market, which are being explored for consumer and industrial application. Several years ago, Google Glass promised to revolutionize seeing, by providing real-time overlays of information and data on a users’ reality. Unfortunately, the product failed for several reasons. But in part because the technology needed to enable the glasses was not reliable enough, cost-effective or small enough to be built into the lenses and frames of a pair of glasses. More recently, Microsoft launched HoloLens and HoloLens II, the former being AR and the latter promising to be Mixed Reality (MR). Where AR overlays virtual objects, MR creates a hybrid environment and overlay, where altering something in the virtual overlay would result in changing something in the real world and vice-versa. This could be used for monitoring equipment or processes in a factory or working environment and has also been implemented for anatomy demonstrations for medical students. There are many other scenarios in health and care where this technology could be of use.

Through the “Alice Trilogy” it was interesting to see how different technologies and medical considerations arose in the lives of the characters as a lifelong progression. The final story is interesting to consider in terms of distinguishing health and wellbeing. This is a subject which is regularly a concern in health and social care. It is very difficult to define exactly what counts as a medical technology or social care technology over a lifestyle technology. It is arduous to navigate the regulatory environment in healthcare and if you view your product to be a lifestyle or wellbeing application, you may not deem CQC (care quality commission) or MHRA (Medicines and Healthcare products Regulatory Authority) registration and approval to be necessary. Ultimately developers need to consider the potential for harm. As more technology reaches the direct-to-consumer market, these issues become increasingly important. At times things we do for our wellbeing, as in the story with the birdwatching, ultimately significantly improve our health. Concerns arise when harms go unchecked or products are developed without consideration of the potential for harm.

The findings from a recent UK Government inquiry into direct-to-consumer genomic testing suggest there is very little regulation or legislation currently in place for this rapidly developing consumer market. The main recommendations are about the development of regulations and standards to which genetic testing companies should adhere to. There was also a focus on responsibilities about communication of information and transparency over data protections and third-party analysis.

These are all themes we have explored through the Getting Real series and will be core issues in most new technologies deployed to health and social care. It has been a fantastic series to see progress and it has been a pleasure to write this series alongside the stories, especially where I’ve been able to ask the authors about specific details.