Month: November 2017

 

As we build our world we build our minds: reboot

Six years ago, while I was writing my PhD on technology and human nature, I wrote a blog where I argued that:

1. Context builds us – Our social and technological environments can hinder, but they can also drive psychological development.
2. Technology drives human development – Physical and digital tools shape us and build our intelligence; small doses of technology cause transient changes and long-term exposure has lasting effects.
3. Our minds depend on technology – Much of what is unique and modern about human minds depends on technology for its development.
4. The technology we build, in turn builds us – Basically, as we invent stuff, we change the context of development for the next generation, and they grow up with different thinking and affordances.
5. Hence, technological innovation causes and sustains psychological evolution.

This reasoning was mostly based on the interplay of relatively static technological tools and human minds. However, we now see a range of dynamic and powerful technological tools emerging. This has important implications for human nature and the nature of society.

Building our minds

The symbols, media, tools, and methods that we invent shape and extend our minds. This is our brain’s ancient trick and amplifies what we are capable of achieving. We frequently make use of external supports to extend our brain’s capabilities (think words, lists, numbers, the abacus, abstract diagrams, calculators, number lines, and a range of other tools).

On the other hand, without technology we are mentally crippled. Without our abacuses and iPhones we are like Alzheimer’s patients without their post-it notes and pill schedules. As well as appearing rapidly, a lot of recent human evolutionary psychological advances could disappear overnight should the technological context sustaining them change.

These changes can be slow or fast. Geological processes are usually slow and ancient, but earthquakes show us that they can be sudden and dramatic. In analogous ways, small changes to technology can change the cognition of a population slowly over time, but significant innovations, such as mathematical symbols or the internet, can have sudden unexpected effects. With new technologies come new implications. Cue artificial intelligence…

The reason we see these effects is because the brain is a highly malleable organ. Stimulated at the right stage of development it can be made to do, or not do, almost anything.

But the more we offload responsibility and dynamic cognitive processes to intelligences other than our own, the more we risk becoming automated masters of our own creations. Instead of technology augmenting our intelligence, we risk merely obeying algorithms. If thought is offloaded to digital supports and never re-internalized, the cognitive loop is broken and instead we divest cognition, and therefore power and control.

A mother’s diet has a critical effect on the future health of the unborn. In similar fashion technological diet in childhood shapes thought processes. Given our ability to build a range of different technological environments for our children, then it is likely that our innovation wittingly or unwittingly causes an array of emotional and psychological traits. Ever since technology was invented, as we build our world we have been building our minds.

Building society’s future

That was my conclusion in 2011, but there is an important extension of the argument to society and democracy, as noted in a Scientific American article this year.

Society and social structures are just as malleable as human minds. The technological environment of a society produces a set of affordances, and with affordances come possible actions, institutions and norms. The technological environment, coupled with our tendency to now offload dynamic processes (once the domain of thought) to digital systems, means that technological uptake is wittingly, or unwittingly building the nature of our society.

The old dogma was that technology does not determine people, because it is how we use technology that is important. However, in the new world of dynamic and autonomous technologies that dogma must be called into question.

The moral of the story is that we must reflect carefully on the possible consequences of introducing even benign seeming technologies, and uphold a principle of precaution and willingness to respond with rules and norms should things not turn out as we expected.

At Adapt Research Ltd we are very interested in the social, philosophical, psychological and ethical aspects of technology and innovation. Contact us here to continue the discussion.

When deciding what medications to publicly fund PHARMAC uses multiple decision criteria, one of which is ‘health need’. So how can we establish who needs what in healthcare?

Distributive Justice

One approach is to take the perspective of justice. What factors do we need to consider to ensure a just distribution of resources? John Rawls provides an answer to this question by inviting us to consider what kind of society we would want, but we must consider it from an original position, behind a ‘veil of ignorance’ where we do not know who we will be in this society, or what our circumstances will be like.

Rawls thinks we would come to two conclusions.

Firstly, we would want there to be rights. In the case of healthcare everyone would have a right to healthcare because no one knows from the original position whether they will be sick or healthy.

Secondly, the only inequality in healthcare that ought to be pursued is inequality that also raises the health of those who are worst off. An example of this might be colorectal cancer screening programs, which are shown to widen health inequalities, while making the worst off better off. Overall, the aim of resource distribution should be to maximize the health of those worst off. This is deduced logically, because from the original position we ask ourselves, ‘what if we were the worst off?’

Impact of Justice on Population Health

This means that logically a minimum level of health will emerge, this occurs because all health resources will be distributed in the first instance to those least well off, to raise their quality of life to the degree currently possible with existing treatments.

Resources will also be justly given to those better off, if the process raises the level of health of those least well off. For example, the colorectal screening program identified above, or perhaps other health resources that improve the health of those already well off so that they can better care for those less well off.

Once those least well off have been allocated benefits to raise them to the level of the next least well off, or once they have been allocated all existing reasonable treatments, then we move allocation to the next least well off, and so on.

What might PHARMAC do?

So, how ought PHARMAC to interpret ‘health need’ from this viewpoint on distributive justice? I raise five issues:

1. PHARMAC currently considers ‘government health priorities’ – this is fair enough, provided these priorities are: (a) looming big expense items (e.g. due to demographics or epidemics), (b) aimed at addressing unjust health inequality, or (c) targeting those individuals who are living below some minimum standard of health (this is the maximizing the minimum approach favored by a Rawlsian concept of justice).
2. PHARMAC currently considers the ‘availability and suitability of existing treatments’ – this is also fair enough. The concept of a minimum standard of health ought to be important here. From the original position, we would all want to ensure that those who are very unhealthy are supported towards health if possible, whereas we would be less concerned about increasing health of those already in reasonable, though not perfect health (their health need is lower). There are usually diminishing returns by continuing to spend on those already nearer to full health but more importantly this does not help those worst off.
3. PHARMAC considers the ‘health need of the person’. This should be important but only in the context of the population. This is a critical qualifier. The person only has a health need if they are below the mean or minimum standard of health for the population. If they are not then they don’t have as much need, but others who are below the standard do have need.
4. A further point when considering need, is that quality adjusted life years (QALYs), which are the unit of accounting used by PHARMAC to designate utility, are not sufficient measures of worthwhile life. An example illustrates the point. It might be very meaningful for a grandparent to stay alive until her great grandchild is born. This could be true even if this means living a year at low quality of life rather than 6 months at higher quality of life. The person may prefer the first situation even if it amounts to fewer QALYs. So again context is critical.
5. In pursuing the logically derived minimum standard of health (deduced from an impartial original position and the health budget) then there are two important needs: (1) cure for people suffering ill health, up to the level of the next worst off, iteratively. And (2) prevention, to stop people from dropping below the minimum standard. The concept of prevention is important, and it allows for allocating resources to those who are more well off currently, because it maximizes health resources available downstream to help those least well off. Preventive need is determined by the probability and time course of dropping below the level of the least well off. Curative need is determined by the probability of success of the treatment (reasonable chances) and the magnitude of the gain (up to the point of the next least well off).

There’s a lot more to be said on distributive justice in health care as informed by a Rawlsian viewpoint. But these points are a good place to start discussion.