Why technology and the Internet may not be good for patients

Paro the robot baby harp seal was the final straw.

I had vowed to myself not to think about or write about “the internet makes you smarter, the internet makes you dumber” argument.  Even when some of my favorite authors (Steven B. Johnson, Clay Shirky, Nicholas Carr, and Jonah Lehrer) weighed in, I thought it best not to participate.

And then I read about Paro, either “a disturbing turn in our treatment of the elderly or the best care-giving gadget since the Clapper.”  This $6,000 Japanese robot is approved by U.S. regulators as a Class 2 medical device, and some believe it soothes dementia patients and helps them communicate.  The non-profit Danish Technological Institute has encouraged every Danish nursing home to get a Paro, and Danish filmmaker Phie Ambo featured the robot in her Mechanical Love documentary. Isn’t Denmark supposed to be a model for the U.S. of what wired medicine will look like in the future?  Maybe the Danes are on to something.

Not so fast say others who worry about the Paro on ethical grounds. “If we wind up with nursing homes full of baby-seal robots, the robots will be trying to fulfill the relationship piece of care giving, while the humans are running around changing the beds,” states Dr. Bill Thomas of the Green House Project.  MIT’s Sherry Turkle asks, “Why are we so willing to provide our parents, then ourselves, with faux relationships?”

Are all these disruptive technologies and changes a good thing or a bad thing?

A recent New York Times/CBS News poll found that some Americans think computers and smart phones are intrusive, increase their level of stress, and make it difficult to concentrate.  Almost 30% of those under 45 said the use of these devices made it harder to concentrate and focus.

The wife of a California software entrepreneur whose professional and personal life revolves around the Internet says, “It seems like he can no longer be fully in the moment.”  Scientists note that responding instantly to emails, tweets, and phone calls provokes excitement by stimulating dopamine squirts in the brain that can become addictive.

“The technology is rewiring our brain,” said Nora Volkow of the National Institute of Drug Abuse, and she compares the lure of digital stimulation to our need for food and sex, which are essential but counterproductive in excess.

Eyal Ophir of Stanford has done some important studies on the human ability to multitask.  Multitaskers have trouble filtering out irrelevant information, take longer to switch among tasks, are more sensitive to incoming new information, and cannot shut off multitasking tendencies even when they are not multitasking.  We all think we are great at multitasking, but studies show our performance suffers in several ways.

I would bet that Clifford Nass of Stanford is not going to buy a Paro seal for his elderly parents.  Nass is worried about heavy technology use diminishing our capacity for empathy by limiting how much people engage with each other, even in the same room. “The way we become more human is by paying attention to each other.  It shows how much you care. We are at an inflection point. A significant fraction of people’s experiences are now fragmented.”

The latest champion of this pessimistic view is Nicholas Carr, the author of The Shallows:  What the Internet Is Doing to Our Brains.  I ordered a hard copy of it on Amazon and read it.  (Full disclosure:  I do not own a Kindle or an iPad yet.)  I learned about the book by reading a Wall Street Journal article by Carr titled “Does the Internet Make You Dumber?”

Carr is worried that easy access to unprecedented amounts of information is harming our ability to focus the mind and sustain concentration.  He references the UCSF neuroscientist Michael Merzenich who believes our brains are being “massively remodeled” by our use of the Web and related media.  He also compares the cognitive effects of the Internet (scattering our attention) with the printed book (focusing our attention).  For Carr, to read a book is to practice an unnatural, but useful, process of thought that is essential for us to develop rich thoughts, memories, and personalities.

Steven Johnson’s Everything Bad Is Good For You covers similar ground, but comes up with a far different conclusion.  Johnson wonders how we would judge reading if it had come after video games.

Reading books chronically under stimulates the senses. Unlike the longstanding traditions of game playing – which engages the child in a vivid, three-dimensional world filled with moving images and musical sound scapes, navigated and controlled with complex muscular movements – books are simply a barren string of words on the page.  Only a small portion of the brain devoted to processing written language is activated during reading, while games engage the full range of the sensory and motor cortices.  Books are tragically isolating.

Johnson, the writer of several books, goes on and on with tongue firmly planted in his cheek showing how today’s popular culture is actually better than reading.

Nothing in the last five years has seemed to change Johnson’s mind because he recently wrote approvingly about Amazon’s “popular highlights” where Kindle readers can see what passages other readers thought important.  Reading is becoming social, according to Johnson.

Jonah Lehrer, the author of the excellent How We Decide, gets in on the discussion by reviewing Carr’s book for the New York Times Book Review.  For Lehrer the preponderance of scientific evidence shows that the Internet and related technologies are good for the mind.  However, he salutes Carr for documenting the losses that accompany new technologies:  “The rise of the written text led to the decline of oral poetry; the invention of movable type wiped out the market for illuminated manuscripts; the television show obliterated the radio play.”

In a blog, Lehrer writes, “Carr and I might disagree about the science, but I think we both agree that the act of engaging with literature is an essential element of culture. (It might not be ‘good’ for my brain, but it’s certainly good for the mind). We need Twitter and The Waste Land.”

Did you really think Clay Shirky would stay out of this fight?  I am only half way through his new book Cognitive Surplus:  Creativity and Generosity in a Connected Age, but I already know which dog he is betting on.  Luckily for me, he summarized his latest thinking for the Wall Street Journal in an article titled “Does the Internet Make You Smarter?”   For Shirky the essential insight is that a billion people are now connected into the same network, and these amateurs are now creating content and not just consuming it.

Shirky says the case for digitally driven stupidity assumes that the recent past was an irreplaceable high-water mark of intelligence, that the present is only represented by the silly stuff, and that young people will fail to invent cultural norms that do for the Internet’s abundance what the intellectuals of the 17th century did for print culture.

He notes that the recent past was dominated by TV not intellectual achievement, and the present has created useful innovations like patient-driven social media sites.  “It is tempting to want PatientsLikeMe without the dumb videos, just as we might want scientific journals without erotic novels, but that’s not how media works.”

Harvard’s Steven Pinker also comes down on the side of “these technologies are the only things that will keep us smart.”  He observes that new forms of media always cause moral panic, but he also notes that when comic books in the 1950s were accused of creating juvenile delinquents, crime rates were going down, not up.

“These days scientists are never far from their e-mail, rarely touch paper and cannot lecture without PowerPoint.  If electronic media were hazardous to intelligence, the quality of science would be plummeting. Yet discoveries are multiplying like fruit flies, and progress is dizzying.”

If I had found Nick Bilton’s excellent bits blog “The Defense of Computers, the Internet, and Our Brains” sooner, I would probably not have concentrated so much of my energy and focus trying to make sense of this argument.  You should probably check out his take on this discussion.

So where does that leave me with Paro, the cute little seal robot that seems to comfort some old people in nursing homes with dementia?  I don’t like Paro because it is not alive and is not a genuine harp seal puppy.  I would prefer that all old people with dementia have a caring human being to be there for them.  If a human is not available for whatever reason, I would prefer that a live puppy be there to cuddle. (Full disclosure, I love bichons, two in particular).  If people and puppies are not available, I see no reason not to use Paro.

Holding her seal robot, Lois Simmeth, 73, who lives in a Pittsburgh nursing home says, “I love animals.  I know you’re not real but somehow, I don’t know, I love you.”  Love is good, plain and simple.

Kent Bottles is President of the Institute for Clinical Systems Improvement and blogs at the ICSI Health Care Blog.

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  • http://www.occampm.com/blog Michelle W

    Thanks for such a practical, rounded approach to this issue. I don’t fight those who say that the Internet is changing us: I agree wholeheartedly, and then ask how that is new. The wheel completely changed human society, as did the written word. We do not live the same way the Egyptians did. I’m personally glad for public water works and libraries, which did not exist in certain times. In the same sense, the Internet and new media are making former ways of life less tenable to some and opening up new avenues to follow. We will lose something in the process, that’s always been true.

    But as you said, love is love. As is friendship. I think back on my school days and how the online world allowed me to positively interact with those I might never have met otherwise, and how email allows me to better communicate for work and pleasure. I don’t want to go back to letter correspondence, or landline phones. For generations, people have longed for a day when all would have equal access to information. Now we’re reaching that point; everyone just isn’t interested in the same info. And that’s OK.

  • http://cocoonhealth.co.uk/ Jays S

    I completely agree with Michelle: we’re not all interested in the same info. I would be very interested to find out whether there are certain genetic types who revel in technological advances and others that flounder. It’s like the saying goes: ‘First we form our environment and then it forms us.’ Some of us are going to adapt better than others. This has always been the case.

    I use my iPhone an awful lot. But I think it’s actually made my life a lot simpler and less stressful. I run a small startup so it’s essential that I have 24 hour access to email and the internet as well as the social media apps that I rely on. The key is to know when enough is enough. Personally I use meditation to keep me on the straight and narrow. It just gives me the awareness and peace of mind to be able to switch off – something it seems a lot of people aren’t capable of doing these days.

    Truly, people need to engage with their health on the same level as they do with their iPhones. That’s something we’re trying to achieve in the UK with http://www.cocoonhealth.co.uk As a society we still have a long way to go, but we can use technology to help people to help themselves.

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