We Live in Exciting Times

by Teofilo Lee-Chiong, MD

The future of Sleep Medicine is fast approaching, and every new discovery, technology, and policy takes us one step closer to it. Each new breakthrough in the sleep sciences and new innovations in sleep therapies has the potential to drastically alter clinical care, disrupt business practices, and change patient lives.

There are many trends in Sleep Medicine that are already self-evident – growing healthcare inequity, personalized medicine, environmental stewardship, and commoditization and politization of healthcare, to name just a few – and, therefore, are not included in this exploration of our future. Their exclusion does not diminish their impact on regional, national, or global healthcare, but simply reflects the present-day acknowledgement by other, better thinkers.

“Technology, by itself, cannot foster human wellbeing because technology is silenced, disconnected, and excluded from human values. Technology is not immoral; it is simply amoral.”

As we start thinking about and choosing our future in Sleep Medicine, in general, and in sleep apnea therapy, in particular, it is vital that we consider today’s important drivers of change.

• Interconnectedness – We must understand the impact of therapy on everyone, including patients, societies, as well as on fiscal sustainability. We need to move beyond measures of an individual’s medical outcomes, mortality, and quality of life, and focus as well on the well-being of families, communities, and the environment.
• Accommodation of multiple solutions – We should strive for closer collaboration among medical clinicians, dentists, surgeons, technologists, weight counselors, and researchers, and recognize that patients have preferences for healthcare that should be respected.
• Fair resource distribution – Everywhere, resources are limited, and everywhere, allocation is unavoidable; we must, therefore, compare the outcomes of our solutions with other health interventions, such as better access to care, housing, food security, clean water, mosquito control, among Lastly, we have to acknowledge that not every person who needs therapy can afford it – where policy ends, philanthropy must begin.
• Uncertainty and continuous reassessment – Let’s be mindful that the greatest danger of policy and “science” is when it becomes dogma or ideology.

Focusing on technology alone is not the solution to improving human welfare. It is tempting to dream that the technologies of the future (e.g., artificial intelligence, nanotechnology, additive manufacturing, wearables and virtual care, or genetic modification) will address many, if not all, of today’s health concerns, including (a) advancing access and timeliness of care, (b) increasing efficiency, effectiveness, safety, affordability, and quality of care, (c) improving health outcomes, (d) elevating patient experience, (e) enhancing professional satisfaction, (f) fulfilling public health needs, and (g) supporting research and innovation.

However, technology, by itself, cannot foster human well-being because technology is silenced, disconnected, and excluded from human values. Technology is not immoral; it is simply amoral. We see its actions but not its plan; we feel its impact but not its meaning; and we trust its decisions but not its purpose. Technology and data may improve medical knowledge, but not understanding. So how do we ensure that technology and data are harnessed to enhance personhood? We link them to actual lives. In designing our devices, we also design our future. The creation of technology and artificial intelligence by humans may be flawed by biased, sexist, and racist data and algorithms. Whereas it may be straightforward to detect biases, sexism, racism, and poverty-ism in human behavior, these may go unnoticed and unchallenged in devices and algorithms. Without lived experiences, technology, and data, left on their own, may eventually rob Sleep Medicine of its humanity.

The future of Sleep Medicine lies not in advances in technology or regulations – not in a better device, a better mask, a better program, or even a better policy. The greatest advance in Sleep Medicine will be in the way we think. We will rebuild our undifferentiated technologies to ones that are targeted to each individual’s needs and values. We will reshape our fossilized policies to ones that matches today’s realities and tomorrow’s aspirations. We will reorganize our protocolized healthcare strategies to ones that humanize lives. We will recognize that change is not only necessary, but possible.

Predicting the future of sleep medicine is not a prophecy of how the future will exactly unfold, but rather approximates probabilities to reduce uncertainties so that we can better prepare for them. This requires addressing equity, sustainability, public safety, and quality through a commitment to advocacy, knowledge creation, and philanthropy. Predicting the future is also not a surrender to the whims and fickleness of fate but is a conviction that our future is our responsibility.