19 March 2018
Science and technology promise a host of new ways to help individuals optimise their lifelong health. Could this begin even before birth?
The PHG Foundation project My Healthy Future seeks to understand not only how emerging and future technologies may improve health, but also what the implications of their availability will be for individuals, health systems and society. The first stakeholder workshop for the project examined technologies that could affect different stages of the reproductive cycle, from fertility treatments and pregnancy to managing the early health of newborns. It also considered their use within health services and in the home - and the potential interface between the two.
Many of the new scientific knowledge and technologies focus on improving information about health risks – whether of a prospective parent or their offspring – and what can be done to reduce a risk. In the context of pregnancy, this could relate to the chance of achieving a healthy pregnancy, or to the health of the parents and child. For example, the science of epigenetics is revealing insights into how environmental influences such as a poor diet can affect the future health of children via changes to parental DNA. Similarly, the importance of healthy sperm to fertility is increasingly recognised. A good knowledge of potential reproductive health could become as important to men as it has been to women. Our case study highlights some of the more promising emerging therapies.
A good knowledge of potential reproductive health could become as important to men as it has been to women.
Once a pregnancy is established, maternity services currently use a very broad brush approach to deciding which are ‘high risk’ – but it is anticipated that new clinical tests will soon be able to give us more precise individual information. By combining these tests with intensive monitoring, interventions might be targeted more effectively towards those at greatest risk of complications, whilst reassuring those at lower risk. However, increased monitoring might in itself increase parental anxiety, and ultimately create greater demands on health services..
“Wouldn’t it be great to use new tests to keep women who are at low risk in that category?” commented one technology optimist at our recent workshop, arguing that maternity care is currently over-medicalised, with prospective mothers who fall outside the norms for age or weight automatically labelled as high risk, without regard to other individual medical or physiological factors. Data gathered by wearable health trackers - from heart rate to bloodstream sugar or alcohol levels - could arm individual women with evidence for their doctors that they are fit and healthy, despite having medical risk factors for pregnancy such as older age.
Once the baby arrives, parents could make use of wearables based on the same principles as personal health trackers to monitor their baby’s heartbeat, hydration, sleep patterns or even levels of proteins, metabolites and transcripts in the baby’s blood. Where a baby has been identified as at risk of a health problem, some devices can provide crucial real time data on vital signs that parents might find harder to detect and interpret. Some hope that devices will offer invaluable reassurance to anxious parents whilst protecting against rare but serious risks of harm to babies; others feel that too much scrutiny of normal, healthy babies could be counter-productive.
But just because we can do something, does that mean we always should?
In the next 20 years it may well be viable to routinely sequence the genome of new babies, information which, it is supposed, could help to keep the child healthy. As more parents take up this option, will those who choose not to, such as our fictional couple Hannah and Ray, feel the weight of social approbation?
As more direct to consumer devices enter the market, they will become cheaper and more user-friendly. Could their potential ubiquity help address systemic inequalities in reproductive health? Or conversely, might they increase health inequalities as women who may be older, with better education or more material resources are able to exploit the wealth of new technologies available to have successful pregnancies and healthy babies, while their younger, less educated or advantaged counterparts continue to be over-represented in the infant mortality statistics?
Where there are real medical concerns over an unborn or newborn baby, having to hand reliable, continuous data about known vital signs can be life-saving. But for the majority of pregnant woman and new mothers, could such devices create a tyranny of technology?
Where there are real medical concerns over an unborn or newborn baby, having to hand reliable, continuous data about known vital signs can be life-saving. But for the majority of pregnant woman and new mothers, could such devices create a tyranny of technology? Take a look at Chloe. At time when a woman may be feeling unsure of her new role and the responsibility of getting it right, could technology designed to reassure, actually increase anxiety? Could the benchmark for being a ‘good enough’ parent be raised even higher? After all, if the technology is there, wouldn’t any responsible parent be using it?
Understanding of the clinical usefulness of new technologies such as proteomics and metabolomics is very much in its infancy. Yet there is a proliferation of tests being developed for health services and citizen use. Taken together with increasing upake of wearable devices, it is claimed this science and technology will empower the user by enabling self-knowledge. However, many questions remain. Will devices become indispensable and indivisible from our social environments, and if so will their impact transform health outcomes or violate privacy, or both? Who will have access to the data being generated by citizen-held devices? If they make transparent the relationship between parents and their children, will their ubiquity force new obligations upon the state to monitor and sanction repressive or harmful parenting practices?
On a behavioural level, would data and devices empower people to be more effective and responsive parents, or will we become slaves to their directions? What regulatory frameworks and processes will be needed to ensure that commercially produced devices, the biological samples they use and data they produce are regulated in ways that are proportionate and robust? Are new EU regulations on data and medical devices sufficiently future proofed to address these challenges?
These questions have been highlighted by our work and the recent workshop. Looking forward, there needs to be a wide-ranging discussion to ensure that the right agendas are served and that all voices are heard. It is a broad and thought provoking topic and we welcome your comments and participation in the project via the LinkedIn group and the usual social media (#myhealthyfuture for twitter users).