Kia ora Dr Lance: On surviving the Age of Ignorance

In the first of a new monthly column by Dr Lance O’Sullivan, the former New Zealander of the Year addresses the anti-establishment mood, and the potential of technology in the internet age to both challenge and enhance science and medicine.

There is nothing new about rebelling against elites, but there is a deepening mood of suspicion worldwide about the motivations of the establishment. Donald Trump came to power precisely by preying on idea that the establishment is bent upon duping people. It’s discernible elsewhere, too, including around scepticism about security and intelligence operations. And it at times translates into a wider suspicion of expertise, including in areas like medicine.

That presents a challenge to those of us who work in health and science. The illuminations of a globally connected world has a downside, too: a wealth of information means people may find themselves reading material that is inaccurate or poorly researched, lacking any real science behind it.

I’ve always celebrated the fact that people might come to my clinic as patients and say, “Hey, I’ve looked this up on Google, and this is what I think.” I’ve never tried to dissuade patients from doing that. To doctors and medical students, my advice is to welcome patients looking into things and coming to you with ideas. If their ideas are wrong, it’s our job to use our curated knowledge to say, “Look, this is why you don’t have a brain tumour. Yes you have a headache, but it’s not a brain tumor.” I see the internet and Google as a way for people to confirm what I’m telling them. And if they feel it doesn’t match their symptoms, and they’re not getting better, then come back and see me.

PHOTO BY REAGEN BUTLER FOR 1972 JOURNAL

So there’s a delicate balance between a world of instant knowledge being available, and some of that knowledge being inaccurate. We need to teach people how to figure out what’s useful and what’s harmful. If there were a little more scepticism and critical thinking, if patients were to come to me with a more informed idea with what’s going on, it would make my job easier and more importantly it would make our health system more efficient.

There is immense value in people asking critical questions, particularly when you’ve got groups like the anti-Vaxxers I recently stood up against actively going around, peddling misinformation. If I could have one of those people in my room for a whole year they wouldn’t change their mind, but the dangerous thing is not so much one blinkered individual as it is the harm they do by discouraging others with their fanaticism – because in the face of the evidence, fanaticism is what it is.

Technology is a large part of the reason these groups can propagate false information and influence, eventually creating echo chambers. But at the same time the intersection of technology and medicine provides incredible opportunities. It just requires putting a lot of responsibility back in the hands of communities. That’s about us as clinicians and as the health profession actually realising we have to give up a little bit of power.

At its heart this is about democratising healthcare and health services. I don’t believe that doctors and nurses are the only oracle of truth, and certainly in the information age a lot of different people can be non-traditional messengers of health. But I’ve found that we do have to have trust in the fact that people in our community are wholly capable of disseminating accurate health messages.

Large parts of our health system hinge on a model that’s centuries old and due for a change. Technology and information gives us that opportunity to do that. Giving people the opportunity to be in control of their own health may be a roll of the dice, but I think we’ll get it right more times than not.

At the intersection of medicine and technology is the biggest opportunity to improve and to change many, many people’s lives that we have. It is hugely exciting – more exciting to me than the next wonder cure for cancer. I have a son who has significant health issues and I would desperately, desperately love to find a cure for his severe health problems. I know realistically that the likelihood of a cure is not on the horizon. It is not around the corner. Of course I wish it were. I would love the cure for cancer to be discovered tomorrow, or the next day, or next week, but that shouldn’t mean pouring all resource into that priority. Technology, I’m convinced, so much potential to lift the health of people really quickly. Technology gives people access to care and may even change who provides the care. Even the technology we have in our possession right now could achieve massive health gains around the entire world.

Take one example. I’ve just returned from Hawaii, where I met with members of a very significant school system called kamehameha, as well as some native Hawaiian physicians and other cultural leaders. There are 4,500 people on Molokaʻi, 60% of whom are indigenous and with limited access to health services. The health problems they face there are exactly the same as the ones in our more vulnerable communities like Pukekohe. I walked away from that incredibly inspired, and what we are planning now is to have pilot iMoko, software I’ve been involved in developing that is designed to provide high quality basic health services to communities with high needs, on one of the islands, from the middle of next year. Can you imagine a child on one of the Hawaiian islands being managed by a digital health program in Kaitaia? I’m going back in September with a team to make that happen.

As told to Don Rowe.

Portrait of Dr Lance O’Sullivan by Reagen Butler for Barkers’ 1972 journal.


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