Rapid Ascent: Unbridled Growth in Technology

Up until recently, perhaps in the past 100 years, humankind plodded along with innovation at a snail's pace. Sure the 18th and 19th centuries ushered in the industrial age, but it took decades to make changes in things such as lifestyle, public health, electrification, communications, and transportation. Many technologies used in the 15th century were still in use in 1900. As you will see in a few paragraphs, we went from wooden sailing vessels to Neil Armstrong stepping on to the moon in 1969. Acceleration, defined as the increase in the rate of velocity of some device, is often used in explaining the velocity of mechanical devices and of course humans as well as new ways of doing things. Sometimes it requires the acceptance of risk. If we all individually or collectively said well that is pretty risky, we may still be sailing large wooden ships.

Charles F. Kettering, a Dayton, Ohio native who developed the electric starter for the Cadillac car in the early 1910s, stated “The Wright brothers flew right through the smoke screen of impossibility.” Although he was interested in building Dayton, Ohio and the state of Ohio up as large manufacturer of automobiles in the early 20th century, the banks in Ohio were not really willing to take the risk. The banks in Detroit, Michigan, however, were very interested in investing. Obviously, the automobile capitol of the world is in Michigan not in Ohio. We use this as an example of how unbridled growth in technology fuels an entirely new industry. In our area of health, we are interested in how fast something takes effect.

Recently we had the pleasure of listening to several thought-provoking speakers who helped us understand where we are in the grand scheme of things: this age of acceleration. During the American Telemedicine Association annual meeting in Orlando, Thomas Friedman gave a plenary talk about innovation and the year that everything changed. His book, Thank You for Being Late: An Optimist's Guide to Thriving in the Age of Accelerations, ¹ provides us with many pearls of wisdom. The year was 2007. Think back to the 2004–2006 time period: no iPhone, no YouTube, no smart phones (the ones we are accustomed to—not the earlier versions of personal digital assistants, etc.)—well, you get the picture. This inflection point of 2007, everything changed: banking, commerce, healthcare, and ability to search and store data. You will have to read the book to understand how it all changed.

The second speaker, at a different scientific meeting, reflected on the previous 100 years and how technology has changed rapidly; the implication is it usually took several decades for it to become commonplace. A highlight worth noting was the speaker's comparison of sailing vessels. He referenced Ferdinand Magellan's circumnavigation of the globe in 1519, only a few years after Christopher Columbus' voyage of discovery. The circumnavigation of the globe started with five ships and several hundred men and ended with 1 ship and 18 survivors. Most men succumbed to scurvy.

Sir Frances Drake circumnavigated the globe from 1577 to 1580, also with five sailing vessels, and his return to England included most of his ships and crew. Both of these missions used similar sailing vessels. The difference was scurvy and the use of limes to minimize or eliminate its scourge on the crew. Fast forward to 1911, while Kettering was developing the electric starter that would transform the automobile industry, the Wrights were perfecting flight, Marconi was redefining how we communicate, and Roald Amundsen discovered the South Pole. He and his team sailed to the continent in a wooden sailing vessel, the Fram. From ancient times to the early part of the 20th century, sailing vessels were the norm. In a few short decades, rockets, computer, antibiotics, telephony, and a whole list of other inventions led the United States and all of mankind to the Sea of Tranquility.

From 1911 to 1957, < 50 years, we went from wooden sailing ships to rocketry. This brings us back to Friedman. The rate of acceleration is so rapid today that we literally cannot keep up with change. Since 2007, we have integrated more intelligence, more data, and more capability in systems we depend on than we can even imagine. In medicine, this acceleration has been transformative, although it is most likely only the tip of the iceberg. Today, each generation of a device that is released to the market has a short shelf life. Furthermore, as we have pointed out in previous editorials, the development of approval processes, such as patents, and policies cannot keep pace. In fact, there is much information available now that the human mind must adapt to new ways of thinking and processing data.

Moore's Law, named after Gordon Moore, states that the capability of integrated circuits doubles every 2 years or so. This was roughly the concept that indicated how fast computers would change and become more powerful. This acceleration is not going to slow down. It will continue to advance and in fact will probably change at a much faster rate. The implications of this to healthcare are enormous, both good and bad. In a recent issue of the Economist, an article entitled “Race Against the Machine” ² discusses technological unemployment. More on this later!

When you rapidly accelerate, there is always some trepidation, but once you achieve a steady state, there is some calm and relaxation. This used to be measured in centuries, decades, and years. Today, it can be measured in very short periods, perhaps 1–2 years or even in months. As we continue down this path of unbridled growth, do not lose track of the intent. Better patient care, better healthcare systems, and better quality of life.