Brain Food for Pioneering Spirits: What are health technologies, and how are they reshaping our understanding of medicine and healthcare? In Room #867 of the Deep Talk Club, under our overarching theme “Pioneering Spirit with brAIn,” the group digs into wearables, telemedicine, electronic health records, and why we seem to wave through data-privacy trade-offs in healthcare that we’d fiercely question anywhere else. Listen in on the examples that came up and the perspectives that emerged in dialogue…
Note: This session was recorded live in German as part of the Deep Talk Club, so the video above is German-language audio only. What follows is an English translation of the conversation, lightly edited for readability — the back-and-forth between the moderator and participants is preserved, but the original timestamps and speaker names have been left out.
A wonderful good morning to you. Today we’re talking about health technologies under the umbrella Pioneering Spirit with Brain. What are health technologies, and how are they changing our understanding of medicine and our healthcare? That’s what we want to talk about today — so everything that falls under health, health technologies, and healthcare provision. I’m really curious — we already touched on the first areas in a medical context yesterday too, today it’s about another deep dive, so to speak, with a focus on health. So I’m really curious what examples come together today, what comes to mind for you, maybe from everyday life, your own everyday life, where we’re already using various things that fall exactly into this area. And so you’re warmly invited today, as every morning, to join and bring in various examples, thoughts, things you’ve picked up from the media, and again, like yesterday, to see together which direction the room develops. And yes, we saw very clearly yesterday, with this term biotechnology and the future of medicine, that was at first, I’d say, something some of you maybe looked at a bit humbly at first. But we’ve usually already read about, picked up on, consumed, or even use one thing or another, without being all that aware of it. So you don’t need to be an expert here, just bring in certain examples and aspects from your everyday experiences. And something emerges in the exchange, because that reminds someone else of something too, and these additions can wonderfully happen in exchange that way. So you’re warmly invited to join again today too. And another reminder, the room is recorded in full the entire time and then also published afterward — so anyone who joins automatically agrees to that too. And we have three small room rules — a profile photo where you’re clearly recognizable, first and last name, and at least one sentence in your bio. Anyone who doesn’t want that for whatever reason, or maybe can’t speak on stage right now because of background noise or similar, is warmly invited to just use the chat and put questions or thoughts in there, so we can pick that up over the course of the room too. And with that I’ll mute myself for now and see who’d like to open the round with me this morning.
Let me give you three terms as first impulses, just to see if that gets something going and one thing or another comes to mind for someone on the topic of health technologies. What are health technologies, and how are they changing our understanding of medicine and our healthcare? Health technologies include, for example, so-called wearables, telemedicine, and personalized medicine. With wearables — that’s any technology intended to be used while worn. Common types of wearable technology include, for example, smartwatches and smart glasses, according to Wikipedia, which I’ve quoted here. Then telemedicine, also quoted from Wikipedia, is a subfield of telematics in healthcare and refers to diagnostics and therapy while bridging a spatial or temporal distance between doctor, therapist, pharmacist, and patient, or between two consulting doctors, via telecommunication. And on personalized medicine, I found something from the BMBF, the Federal Ministry of Education and Research. It says, “New knowledge about the molecular processes of life expands our understanding of health and disease. Personalized medicine wants to make this knowledge usable for everyone, for tailored prevention, diagnosis, and therapy.” So, maybe that as first impulses. Some of you might use one thing or another for yourself in a health context too — especially with wearables, wearable technology, I could well imagine that some of you here in the room probably use that for yourself too. Maybe we can gather experiences there, talk about it, take a critical look at it — what does that actually mean, what happens there? And with that, let’s try a second attempt. Good morning.
Good morning. We came in just as you mentioned telemedicine — I have an example right there. My husband recently had a thrombosis with a pulmonary embolism, and he didn’t listen to me, as men sometimes are, and in the evening he really did call the tele-doctor his health insurance recommends, and I said, stop that, but he didn’t listen to me — and that doctor really told him, wait and see, wait and see, wait and see. The next morning he went to a doctor, and that doctor sent him straight to the hospital. So I wouldn’t propagate telemedicine for everything — for small things it’s certainly fine, but with his doctor, the alarm bells went off immediately, right away, and of course I would have expected that to happen with a tele-doctor too. One more thing, which I think everyone here uses, are smartwatches — we were just on vacation, and our kids all had their smartwatch too, and we compared how our heart rates went up and down on the mountain and so on. I think a lot of us aren’t quite familiar with that yet, myself especially — I had to have a lot explained to me. But of course it’s a good thing, because you get tracked permanently and can just check, hey, how are you doing, are you healthy or is something missing? That’s a great thing. That was my little contribution.
Yes, wonderful, thank you, thank you so much. And now, of course, I can shed light on both aspects from different perspectives too. Let me pick that up and raise different questions in that context, to open up different perspectives. You just said, the tele-doctor said wait and see, and the one who saw it live, so to speak, said, straight to the hospital. I definitely know that experience too, even in a live situation, where you go to the emergency doctor at the hospital because you’re not feeling well and get sent home again, and the next day your family doctor refers you straight to the hospital. So there are cases like that too, and it turns out it was a stroke. So these cases exist too. That means I wouldn’t attribute that so strongly to distance necessarily, but it could also have to do with the fact that different doctors have different levels of competence, in inverted commas, or a misjudgment — misjudgments happen too. What’s interesting to me here, and this would be worth discussing, or you could just ask yourself, whether an AI wouldn’t have acted better or differently, because it would simply make a diagnosis based on various pieces of information provided, regardless of whether it’s telemedicine or a personal encounter. That would be an interesting question in this context. And with the smartwatches, you said that’s of course something good, because everything gets tracked. Now I could flip that around and say, of course it’s also dangerous that everything gets tracked, in inverted commas, because here too countless data points are being collected about us, and very personalized data at that. And what does that actually mean, in reverse? So opening up this other side of consideration here too. Sabine, you wanted to follow up too.
Yes, Yasemin, you’re completely right about that. Let me bring in another short example — we recently used a mobile vet, because I didn’t feel like always dragging my cat to the vet, she scratches me half to death because she doesn’t want to go into that carrier. And I talked to him a bit about it, and it’s basically the kind of thing where any vet can just start doing this — you call a vet and you don’t even know who’s coming, so the quality is completely up in the air. This was about a vaccination, that’s fine. And I imagine it’s somewhat similar with tele-doctors too, that young doctors just say, I’ll do some shifts there, while with the other one, of course, we have a great family doctor. So I completely agree with you there, that there’s a difference. But maybe I can add one more thing on the topic of health insurance and how that all propagates. I’ve worked in health insurance, not as my main focus, but for over 15 years now. And back then I told clients, things are going to change in health insurance in the short term. We’re 15 years further along now, and hardly anything has actually changed. Of course we have a problem there too, that health insurers need to change something significant. And with my husband it was like this — they do pay for the tele-doctor. He then got prescribed examinations, which they then rejected, because they’re preventive examinations. “Hello, he was already one step further with a bear in his leg” — and then comes the preventive care, where he has to really put up a fight to get the bare minimum paid for. So the world doesn’t quite fit together there right now either — we’ll see, a lot certainly needs to happen, but I don’t know exactly how. But maybe that’s an idea too.
Yes, wonderful, thank you, thank you so much. And so we already have various examples from real life, so to speak, from everyday life. And next I’d like to bring in Layla and also Miriam, and then we can draw further cross-connections too. Layla, a wonderful good morning.
A wonderful good morning. Yes, interesting discussion, because I find health technologies, well, I find them positive in that, with my MS, there’s an app where I can enter my health status, just to get an overview, because that’s exactly what I have to do later, look back retrospectively at how things look — I have to analyze myself, so to speak, so the doctor can analyze me. That’s why I find that quite good, for example. There’s also a diagnostic tool I know, where you can figure out the form of MS you have — I’m referring to my own illness now because that’s what I know about. You can also look at what examinations still need to be done. That’s often really useful too, because, and I don’t want to attack anyone here, but it’s simply a fact that autoimmune diseases and some chronic illnesses that aren’t so common don’t have such a high throughput rate, not even with a regular doctor, and possibly not even with a neurologist. That’s why it’s quite good to inform yourself. Which doesn’t mean you should ask Dr. Google and then go in and say, I think I have a stomachache, I think I have cancer — that gets brought up very readily, even by doctors. No, it’s simply about creating a basis for yourself and saying, look, there’s this and that test, have you done that yet? Or, for example, well, I don’t know, if I think back, my family doctor once wanted to give me a live vaccine — that’s not meant maliciously, but a live vaccine is simply devastating with an autoimmune disease, you shouldn’t do that, and there’s a very clear diagnostic guideline for that, which I can look up myself. And that’s why I actually think technologies like this, websites like this, are always quite good. If you look at how, for example, getting a spot for psychotherapy can take a year in some cases, if not two — and not everyone in the world has the time to wait that out. And if you don’t have to, or don’t want to, declare yourself an emergency case, you might have the difficulty of, how do I even get to a doctor now? That’s why I think it’s a really good thing. What Sabine said about the diagnostic forms, that’s true, that in some cases you have to think about how the consultation was actually done — but then I have to think of Med1, for example, where you can get things done like hyaluronic filler injections and things like that. You also don’t know which doctor is treating you there in that moment — they have a high throughput rate too, and it’s often very young doctors just trying things out. And I have to say, some of these hyaluronic filler treatments, which love to get declared as cosmetic procedures, and I don’t want to make this sound normal, can be very, even if they don’t seem invasive, very invasive. That means, if you do it under the eye, you can go blind from it — there are a lot, a lot of blood vessels running through there. And that’s why it’d be quite good to choose a doctor with a lot of experience, ideally a facial surgeon, if you want to do that, to avoid these dangers — and you don’t necessarily get that at MedEins. And there are completely different companies too, only one company was named — you can use other companies too, before they sue me now, these are just experience values I’ve heard about. And I just have to say, I think it’s simply important to have a good doctor, but even with a regular doctor, when you look for a new doctor, you can never be sure what the throughput rate is when certain things are being done. That’s the point I wanted to make. Thanks for listening.
Yes, wonderful, thank you, thank you so much. And a really important aspect that’s shining through in this dialogue here is an aspect that’s also been discussed very intensively for quite some time already. This is about, and interestingly I covered this topic in a different context, namely with coaches, in my dissertation — namely this aspect of profession, professionalization, professionalism. And especially in this context, you look at the classic professions, among others the medical profession too, through this historical development — what actually is a profession, how does it arise, how does it get professionalized, especially in other fields of activity that classically aren’t yet a profession, or don’t have a chance to become one — there are various factors that play a role there, I don’t want to go too deep into that now. Just to look at, well, you can act professionally in an activity without belonging to a profession. So opening up this distinction here, and what’s really exciting about this exchange, I think, is that it was just mentioned, a good doctor, a new doctor, there are also quality differences and so on. That means, regardless of the technology we’re talking about, it’s also about quality characteristics or criteria, and professionalism characteristics and criteria, that we’re automatically talking about. And what’s interesting in this context is that these technologies, on the one hand, are a support both for the user and for the doctors, who can also draw on them in various contexts, for example to pick up data or similar. And on the other hand, at the same time, a development is taking place that doctors also love to complain about — Dr. Google was mentioned as a keyword, for example. That means, with almost every symptom, in inverted commas, I’m now able to ask Dr. Google what this could be, to get first hints about what illnesses it might be in connection with certain symptoms or similar — that can, on the one hand, lead to me working myself up before I’ve even been to a doctor, and none of it having any real substance. The same of course also applies to certain technologies you use. There are certainly big differences here too, whether we’re talking about a smartwatch or whether it’s really a medical product that might even be provided by a doctor, or with support from health insurance, or similar. So maybe here too we should distinguish, I’ll say, by the devices, the end devices. And at the same time, it could mean that I go to the doctor less often, because I rely on these technologies, which is also a danger in itself. And it also creates a fragility in the professions, because the “gods in white coats” suddenly aren’t the gods in white coats anymore, because other technologies can be used here too, and opening up this discussion in this context, I find, is also really, really exciting. Miriam, a wonderful good morning. What do you say about the topic?
A wonderful good morning. I don’t actually know when you all started, but Holger invited me, and this is exactly my area of focus too. I originally come from nursing myself, have since specialized in digital transformation, and I’m currently writing my two thesis papers. That’s about decision-making, for example with doctors, how digital decision-making can positively affect people. And I took the older generation as my group, over 60, and that’s a different focus too, because many of them, in the survey I conducted together with them, so supported them, since some of them don’t even have a smartphone. It’s fascinating to see where this journey can go — as you can currently observe, and you have to admit this, since the pandemic, more and more people, especially older people too, have a smartphone or a tablet, but they have problems using it. If I think about my own survey, how do I scan a QR code, how can I even press the right thing to get to the final result, and so on — all these small features, or things that are simple and self-evident for us, but represent a huge problem for older people. And I keep saying, as much as I advocate for digitalization, I also say at the same time, we need digital competence too. Because without real know-how, a certain know-how, how to operate something, and above all also knowing what consequences it can have, and especially data protection and so on is a big topic too, it’s always difficult.
So it’s a whole construct, which I can also mix up right away with Sabine, because you said, well, you don’t know which doctors are involved with new technologies. In principle I can now say, and I’m right in the middle of it, yes, I know a lot of doctors, I know a lot of nursing staff, I know researchers, I know startups, I’m really right in the middle of it, and I can say, the people who mostly advocate for digitalization are very engaged in it and mostly have more know-how by now, because they want to advance something, because it’s often not even taught during studies or training. That means they now have, I’d say, my interpretation, a lot of know-how in that regard, and a lot of motivation, and I definitely see it, and since you also mentioned professionalization, Yasemin — I believe, if I speak for nursing now, that nursing has the biggest opportunity if it were to get on board with digitalization. Basically every healthcare profession. And I don’t see it as competition but as support. I heard earlier, I’ve also engaged a bit with artificial intelligence and these topics, or it engages me all around, and I also know that there are now great research projects, especially in radiology too, sometimes with a 99 percent hit rate when it comes to tumor detection. Or with colonoscopies, where you detect these tiny particles you wouldn’t even see with the human eye — the algorithm simply plays along well there, if you look, in the end, at 10,000 people with a colorectal cancer issue, versus being in a very small clinic where you don’t have the competence, and maybe not even the time, that’s not the problem. But what I say absolutely needs to be trained is, on the one hand, the healthcare staff themselves, that they know what technologies exist — and that’s also my small research project, so to speak, for my thesis, how can you ultimately apply this technology in an understandable and sensible way with patients, and how can you also empower patients. On the one hand, so they can decide for themselves, does this actually bring me something, like Layla said too, with MS for example, does it add value, and do I even want that? I say the same, and that comes out clearly with me too, especially with the older generation, they don’t always want every tool, and not everything needs to be digitalized. But yes, Dr. Google plays a decisive role by now, but there are also, and I can say this, more and more apps like Ada Health, I don’t know if you know it, where you can enter various parameters, so, say, take a typical example, headache, and you’ve been to 10,000 doctors and so on — there are really good apps now that can help recognize symptoms. That still only means it presents a diagnosis, but with AI a lot is already possible in terms of being able to rule out certain things. And if you empower people to at least know about these tools and maybe use them, and then discuss that with the doctor accordingly, I find that absolutely sensible.
Yes, wonderful, thank you, thank you so much. And this brings in further aspects that we can pick up on too. We can also bring up the area of electronic patient records, for example, because we’ve already established, it’s also about tracking — meaning, on the one hand, data is being collected. Currently it’s mostly the case that we mainly still access and use our own data ourselves; of course the provider of various devices also has access to this data. Then there’s the discussion about an electronic patient record, which of course would also have certain advantages, because information wouldn’t first need to be requested from a family doctor or internist, but could be directly stored in a central file, for example, so that when you’re with a specialist, the doctor could access information much faster, information they need, in order to make appropriate diagnoses, to make decisions for treatments, and so on. And at the same time, though, there’s this other side, this downside too — the more digitalized things get here, that’s the topic of data, data protection, what can happen with this data, or what might happen with it, do we want that? Here too the question arises, do we want that, and what dangers might arise here too. And I also find it really exciting, and I’d like to put this into the room, before I give you the opportunity to draw cross-connections again in a moment — when we, and I find this a really exciting phenomenon right now, when we talked about AI or something like that, a lot, a lot of worries came up too, a lot of ethical discussions were held in the various rooms. And with health technologies, I’ve noticed, correct me if you perceive it differently, I did notice a few remarks put into the room, but per se it’s already the case that it’s viewed relatively positively. And I find that a really exciting phenomenon, because various technologies are working in the background here too, and so on, or even when we talk about an electronic patient record or something — that’s also about data protection, data collection, and so on. And suddenly it doesn’t seem to be viewed quite as critically. Does that have to do with the fact that we’re not as aware of what’s actually happening in the background, or how these technologies are being used, how data is being processed? Or does it have to do with the fact that we’re talking about health here, and because it’s about health, which is sacred and precious to us, so to speak, we have a different pain threshold here? Question mark. I’d just like to put that into the room, and I’m really curious — you don’t need to answer that immediately, but we’ve already brought in various different perspectives and examples from you, and we can gladly draw cross-connections again now. Sabine, Layla, Miriam, who’d like to follow up? Layla, gladly, and then Miriam, and then Sabine.
I thought that was a really exciting point, Yasemin, because I think it’s quite good to look at it from the outside. And I thought, yes, and why isn’t there, isn’t it, that people complain about that? And then I thought, well, we have the Hippocratic Oath, and with the Hippocratic Oath, we assume the doctor is supposed to help us. And I’ve looked into this a lot over the past few years, especially these digital records, and you can weigh this back and forth. And here we’re at the glass patient, like the glass citizen — what does my health insurance do with it? If I’m with a private health insurer, it’s a business enterprise, that’s actually the case, and you shouldn’t forget that. But what you said, I found that really exciting, because you have this hope, I think, well, but they’ll surely mean well by me. Well, as a patient I can say, if you ever get called by your long-term care insurance and get asked whether you’re already in assisted living, once you’ve applied for your care level and actually gotten it, and then had to deal with an assessor who looks at you and says, actually you don’t need any care at all, you can turn your neck and you can wash yourself — well, I have to add, I have very severe fatigue. I’m laughing about it now, Yasemin, but it’s actually not funny, because I have really severe states of exhaustion at times, and it cost me a lot to apply for that. And I think, well, not to get too personal, but I think I also thought about this business enterprise then. And then I also said, well, because of this assisted living thing, look, we need to make sure you still catch me as a patient, please. And I think, despite all the economic interests, we try to see the positive in it — you’re right about that. And to pick up the other point Miriam mentioned, I found that really exciting too, because my parents are old too — mom and dad, I’m sorry I’m saying this now, but you’re quite grown-up, let’s say it that way — and I always have to think about how to convey things to them. I’ve now gotten the pharmacy magazine, my father reads a lot, and he’s digital, but that has its limits too. And still I notice, no matter how much I know about it, it’s quite good to come to him with some expertise, whether that’s the pharmacy magazine or something else. And that’s quite good there, because you certainly have a bond to your family doctor from a certain age on, maybe even earlier — I’m talking about a personal example now, and I have to say, more opinions do you good there. And if I think about tracking, I also have a chronic illness, and with my parents too, if they have their watch on, my father recently said to me, Layla, wouldn’t it be so good if you had this watch, and, let’s say, in that case, it would be something — and yes, then we’d have an overview and we’d know. And I thought, well, it’s the same the other way around, I’d find that good too, if I had an overview, if that got shown to me. Because, I don’t know, in some states you’re maybe already alone. You don’t like going to the doctor, and that’s even somewhat independent of age, though I think the age factor plays into it too. And that’s why I think it’s good, showing my father something like that, or my mother, and also in apps like that, what’s possible with care, for example — I recently looked at the adult education center, they have courses on what you can do in care, what’s possible and what’s not, and often people have no overview of that at all. And I think it’s quite good then, if there are simply digital options where I can show that, and show it with a kind of expertise from a doctor, because my father loves me very much, and I’m his daughter, and still, this trust in the doctor is certainly very high due to his socialization, and then it’s quite good to know that, and to know it’s not as complicated as you think, you don’t need to do that much. And that’s why I find this kind of help really nice. That’s what I wanted to contribute. Thanks for listening.
Yes, thank you, thank you so much. And in this context, though, it’s important too, and I’d like to raise awareness of this, that we mustn’t only look at this individualized, at our own benefit — we’re looking at the whole thing under the umbrella Pioneering Spirit with Brain, meaning also looking at connections, effects, or possible effects, and building bridges into various areas here too. I’d also like to give a few keywords here, before I give Miriam and Sabine the opportunity to jump in — keywords like, we experienced this during the pandemic with the Covid app that suddenly appeared, and you can assess that differently, some find it good, others find it silly. But we also saw that it can lead to polarization and similar things, so how you handle it also plays a really important role. I’d also like to open up this aspect — it’s not just intended, or possibly won’t just be the case in application, that I can access this and doctors can access it, but the moment I have certain things centrally accessible somewhere — today it might be doctors who act in my interest, in the sense of a benefit, but you have to think further here. What are then the possible fields of application, and what might happen with the data? I’m thinking quite classically now that, for example, the state has information here in some way, especially, say, when something becomes mandatory, and if it’s not done, thinking in terms of sanctions, or maybe thinking again in terms of insurance. Especially in case of illness, and you probably know personal stories from your own circle or similar too, it’s quite common for insurers to keep trying to wriggle out of their obligation to pay, in inverted commas. And the moment certain things are simply documented and centrally accessible, there will also be possibilities to access that, for example, especially maybe in court or similar. So even if this isn’t per se permitted right now, that the insurer automatically accesses it, that could come in the future too. But even if it’s not accessible, you could imagine that a lot, a lot of these topics get brought to court, because there you have the possibility of having certain access to information you wouldn’t otherwise have per se, or it would be much more effortful to obtain somehow, or similar. So there are a lot, a lot of different aspects we can open up here too, to look critically at fields of application and in which direction — one of the questions is also, in which direction is the whole thing developing — to look a bit more critically here too, and not just see it initially from the benefit factor, but also recognize dangers. Miriam, you wanted to follow up too.
In the end there were so many points there, I think I could talk about this for hours. Layla, it’s funny and exciting that you just mentioned the pharmacy magazine, because that’s exactly what came out in my first research too — where do older people inform themselves, and point one is the pharmacy magazine, mind you, that’s a fact. Then the second is TV and radio. We’re always so focused on digitalization, but if you really take older people, when it comes to the topic of health, they inform themselves quite differently. And the family doctor, the doctor, has an enormous effect — the patriarchy has an effect too, definitely. I always say in my workshops, when I’m out there as a speaker, I often ask, how much is ultimately ethically justifiable when it comes to digitalization? Whether that’s in medicine, in nursing, whatever — how much is justifiable, on the one hand for the healthcare staff, but also for the patients? You always have to weigh that up, and I think, and I keep trying to bring in the ethical aspect especially, that happens far too little. And when you asked, Yasemin, whether it’s because, whether you’re positively or negatively disposed toward AI, is it because you know too little? Absolutely, a hundred percent, it’s the case that we know too little about it, and competencies are a central point, and it doesn’t matter whether you’re six years old or 99 — even at six you should at least know that something like this exists. I always say, we need to start early too, including the younger generation, which is often believed, we’re all so digitally savvy — no. When it comes to evaluating data, when it really comes to interpretations, Covid, best example, data flood, young people did very poorly compared to older people. Why? Because the others were more skeptical, can I trust this or not? That means, artificial intelligence, and that’s why I always say, it’s important that we, as people, are participants, have a stake, because we can talk about this together now. I was recently asked in a workshop, does it even still make sense for us to get involved, because in the end everything’s already being steered somehow behind the scenes anyway. I say, yes, now, now, exactly. And what I always find strange and odd is, since you also mentioned data sharing, the terrible thing is, and I’m now very much, also in Germany, engaged with this topic, and at Gematik it’s a topic too, which tries to ensure interoperability, meaning that all devices can communicate with each other, simply put. And when I hear, and I’ve discussed this, about the emergency data set, which can save lives — say you take a medication, don’t tolerate it, that’s in there, or you’re allergic to bees, that’s in there — but when I hear that this can’t be accessed by rescue workers, by emergency doctors, then I ask myself, we’re digitalizing and at the same time not making sure the people who really need it can have it. So I ask myself, what’s ethically justifiable there? Is it justified that people aren’t given the opportunity to save a human life? I’ll just put that into the room.
Yes, a wonderful question, and this question opens up a follow-up question too, which is quite legitimate and which we’re allowed to ask ourselves. Because data isn’t just data — and now you’d maybe have to think, on this level, what kind of information should this actually be, that, if linked together and available, is accessible to certain groups of people, professional groups for example, like emergency doctors — and which of the data is maybe too individual and personal, and could bring dangers or disadvantages with it too, so to speak, so that it’s not made accessible? That means you can control data, you can handle it differently. And these are also really, really important, relevant questions, on this ethical level, and this advantage-disadvantage, benefit-danger weighing, so to speak, decisions would need to be made here too. That means you can’t simply say it’s bad, but you also can’t simply say it’s good and should come, in inverted commas — instead it needs a correspondingly differentiated view, and that, ultimately, from my perspective, is how it needs to be handled to some extent. And here we see, as with many other topics we’ve opened up too, there aren’t just positive aspects, there are always negative aspects too, regardless of the topic. And accordingly it’s important to grasp this complexity, to look at it in a differentiated way, and to keep making new decisions, specific decisions, under weighted considerations. Sabine, you wanted to follow up too.
I’d like to give you the floor first, also because you’ve waited a bit — and then let’s gladly bring in Marc and Ria too.
Yes, what I wanted to say too, about the young doctors, I wouldn’t attribute that to young doctors necessarily. That often has to do with specialists too. I was recently at a gastroenterology exam, and I went to this group medical practice — a single doctor couldn’t afford what they invest there, and that’s great. I mean, from that angle it doesn’t really have anything to do with young or old or anything, but I think things are moving in that area — I mean that’s also what this “new healthcare reform” is aiming for, that a lot of hospitals, once they specialize, also dig deeper into their pockets to install the right equipment. I can also say, my brother-in-law is chief physician at the hospital where I was born, that was a general hospital, and he says we probably have two, three more years before we’ll have to close our hospital, because we just can’t manage it anymore, we can’t afford what the market demands of us, or what the healthcare reform will probably still allow us to do. I also wanted to say, on the topic of old and young — my brother-in-law is the best contact for my parents, who are both very old too. They don’t read the pharmacy magazine, they always call my brother-in-law. That’s of course great when you have a brother-in-law like that, or someone like that — well, whatever you call it, anyway, my mother will show up at the hospital directly if it’s an emergency, even if he’s in surgery. But my mother has since decided to opt out, she says, nothing more is going to be done to me, she doesn’t want any more surgery, she doesn’t want anything anymore, because she says, I don’t understand any of it anyway, and I want to stay the way I am. What I also wanted to say about the young people — my kids do a lot through the system, they always ask Dr. Google before they go to the doctor. I find that a bit of a shame, but I don’t want to say they’re not being careful either, they get relatively far with the information. But what I still wanted to say on the topic of costs and health insurance, with the health card — I’m an advocate for the health card, because if you look at what information a sick person has to bring from doctor A to doctor B to doctor C, how long all of that takes until you get a follow-up appointment — I think on that side you could save an enormous amount of costs if there were a health record like that. But, Yasemin, I completely agree with you, you can scale that down, you can allow permissions there, because the other thing you said scares me too, of course — as long as you’re healthy, that’s all not a problem, but if there are any problems, and then the health insurer says, now you’re being phased out — that happened to a friend of mine, they called every morning, first tried the health insurance and then tried to push her into occupational disability, and if someone keeps calling, what Layla said earlier, I could completely relate to that.
Good, thank you.
Yes, thank you, thank you so much. And here too, it could well be possible — there could be concepts where, say, the patient decides for themselves when to release what to whom, or similar, especially with these classic scenarios where you get sent from the family doctor or internist to a specialist — those usually aren’t emergency situations, for example, and you could look at how to leave that in personal responsibility, in inverted commas, to some extent, and not make it automatically freely accessible to everyone per se. So these are all options you could definitely think about, and that could also be realized in technical implementation, and there will certainly be pros and cons here too. But as I said, these are various things you can consider and then weigh up. Marc, I’d like to bring you in, and then we can see how we’re doing on time — I assume we’ll move into the closing round right after. That means, if you have further additions that come to mind, I saw Layla wanted to jump in again too, then I’ll combine that with the closing round afterward, so you have the opportunity, in the closing round, to jump in again, so to speak, and then speak your closing word for today. Marc?
I’d like to briefly bring in a completely different aspect, namely the entrepreneur’s perspective. Health insurance is a business model based on making money, and health insurers, and the whole of medicine, aren’t financed through donations. And if we look at Germany, we’re developing into, and on the way to becoming, a society of long life — meaning we’ll soon have more older people in Germany than young people, and that means we’ll have, at most, if at all, one contributor per pensioner in the future, maybe even fewer. And that’s why what you said, dear Yasemin, is really important to keep an eye on — what happens to our data? Because all of that has to be financed somehow at some point. And what I’d do as an entrepreneur, just like an insurer does, is say, if you don’t move enough, if you eat wrong, you get different terms. There’s nothing else I can do, you simply can’t finance us otherwise. And the second thing is health technologies, which I also find really exciting, because it’s a business model, and in medicine it’s also about making money. It’s also quite interesting that, in America, for example, it’s the biggest market for painkillers — 80 percent of all painkillers get sold in the US, and that’s a business model. Medicine doesn’t necessarily have to make sense. And at the same time it’s also the main gateway now for drug consumption, because people in the US have found, and you can research this, that heroin is cheaper than expensive painkillers, and these strong painkillers prescribed there have led to a really, really high drug problem in the US. That’s a different topic now, but I just want to bring that in as an aspect — medicine is great, I’m grateful we have it, I’m grateful to live in a country where we have hospitals and doctors we can go to. But medicine doesn’t always want just the best, it’s also a profit system.
Yes, absolutely. And against this backdrop too, it’s important to look at various pros and cons accordingly. On the one hand, it’s clear, in inverted commas, that it also has to pay off for the company somehow — of course they want to secure themselves too. On the other hand, here we’re specifically dealing with health, and we’re very quickly right in the middle of all these ethical discussions — what takes priority here, or how do we actually need to handle this, how do we want to handle it, in inverted commas? And especially with a lot of discussions and developments, yes, the pharma lobby in the background and so on, you have to look at some of this very, very, or always very skeptically, whether these are the desired developments at that point, and whether that wouldn’t potentiate things even further, in inverted commas. So I think it’s important to really look at this from various perspectives. On the one hand I’m totally with you, Marc, it’s ultimately a business too, and so on, and in a lot of places you can maybe say, it’s maybe not even reprehensible to say, there could be different contributions depending on how active someone is, in the sense that, we already have this today, if someone moves more, they get bonus points, for example, or something, that they can then redeem in another context, for example, that’s not fundamentally reprehensible either. But it mustn’t lead to a state where, for the sake of profit, the patient suffers. And here, especially if you look at the pharmaceutical industry in the background, which decisions get made on what basis at times, that’s purely about profit and not about what benefits the patient, in inverted commas. And that’s why a balance always needs to be established here again and again, it needs to be balanced out — really important aspects in this context. Ria, a wonderful good morning to you too.
Good morning. I somehow couldn’t find the button. Yasemin, you said something really important that I’d like to address. Some of you know I had cancer, and that I received a lot of medications, and I’m now getting follow-up treatment — this follow-up treatment is a medication I have to take daily, and I picked it up for the first time four weeks ago, and I had a similar discussion with the pharmacist there too — I have a ten-euro copay, and somehow we got onto the topic, and she said, what do you think you’re holding in your hand right now? I said, I don’t know. She said, that’s half the price of a small car — this medication costs 5,000 euros in this package. On the one hand I was shocked, then I was, well, I had to smile a bit too, because I said, I’ll just put a small car in my kitchen now, and my son said, mom, can we count that as a down payment? On the other hand I was incredibly grateful, but at the same time I know there definitely aren’t 6,000 euros’ worth of stuff in this little tablet — of course there’s a lot of research, a lot of scientific know-how in it, but with the production of, during coronavirus, a lot of trading on people’s fear happened too. And you know that especially cancer medications, or medications that were previously accessible, got taken off the market for half a year and then sold under a slightly different name with the same composition for 10 or 100 times the price, because it suddenly became a cancer medication. I agree with you there, the pharma lobby is a special, and sometimes very bizarre, topic. On the other hand, I completely agree with Marc — I’m very grateful that we have this healthcare system, and I’m also grateful now that we’re talking openly about all this data, because I know from personal experience that already 15 or 20 years ago, health insurers and insurance companies had an internal tool they accessed when it came to insuring people. I have a very personal example — my husband once worked with an insurance company and earned a bit of extra money, and someone contacted him about occupational disability insurance. He was a teacher and, as a young man, had once filled out insurance forms online and entered some information there, and when my husband then, he said he didn’t get insurance, they didn’t contact him, the young man was written to saying that, based on the information he’d once entered online, he couldn’t get this occupational disability insurance because he’s chronically ill. And then he realized, right, I did enter something there once, in an online inquiry — I don’t even know if he submitted it. And we were informed that health insurers and insurance companies have had an internal tool for a very, very long time, in which they collect all the information someone reveals about themselves online. And that was 15 years ago. And that people are only now having these considerations, saying, we need to be careful about what and in what form data about us gets collected — we’re actually a step behind there. And the third thing I wanted to say, Harari writes in his book Homo Deus that there are three challenges, one of them is lifelong life, and that too will only be available to those who have money. Thank you.
Yes, amazing, thank you, thank you so much. I’ll gladly follow up on that later as a closing word too. Given the time, since we usually wrap up our rooms around 9 o’clock daily, I’d like to move into the closing round now, in the order Sabine, Layla, Ria, Miriam. You’re welcome to take the opportunity, even if we run a few minutes over, but let’s try to keep it as short as possible. You’re welcome to draw cross-connections again and then speak the closing word for today. So, what were your highlights, or is there something you’d like to underline again from what was said in the room? Then you’ll have the opportunity, and then I’ll wrap up too by adding my own closing thoughts. Sabine.
Yes, what Ria just said, that’s basically the Schufa for the insurance industry — right, that’s existed for a long time, but in the past that was a health questionnaire that someone actually had to sign or agree to. And I think the fear is just a bit, we have this today in apps, how often do we just swipe away a data protection notice without even reading it. And I think it’s becoming a kind of matter-of-factness that data gets stored here where you’re no longer in control of your own data — I think that’s the problem. Otherwise I found the room really impressive again, and also these two sides of cost and benefit — cost-wise I think we all agree, something needs to be done there. But how is the benefit for an individual, yes, we need that, we all think that’s good because we all get something out of it, but how does that look on the negative side for the general public? Thank you.
Yes, great, thank you, thank you so much. Layla.
Yes, it became painfully clear to me again today that I’m an economic asset, and not just I benefit from myself or from certain information, but companies too, if these are insurers, and also the state, how much it costs with me, versus without. And I just wanted to briefly address one point — Yasemin, I want to thank you for bringing that up again, because of course there’s a benefit too. But the glass patient, and here we’re at things like insurance, and as a teacher, for example, that’s relevant — they’ve just introduced that you can have statutory insurance and still get a subsidy. And exactly what was mentioned by Ria, I can only confirm one to one, that it’s really the case that you always have to look at what do I disclose and what not, and what consequences that could have for me, because the point is, it might be a risk, and if I’m a risk factor, the insurer can’t make as much money with me. And if I’m a private patient and pick up a medication, I just wanted to say, then I have to pay these 5,000 euros one to one. And I had that with my MS medication — that was only 1,000 euros, but that’s over 1,000 euros I just have to pay right away, and if I’m lucky a payment deadline gets set, but some do direct billing too. And yes, that leaves me a bit at a loss, I have to say, because I don’t want to be an economic asset, and I don’t want things to be withheld and my health, in quotation marks, or yours, played with, because we bring advantages or disadvantages — instead, to close, I’d like to remind everyone of the Hippocratic Oath again. And that’s why I think it’s really, really important to inform yourself, to inform others, and this room has really served that purpose. So thank you for that, thank you for being here.
Yes, wonderful, thank you, thank you so much, Miriam.
Yes, thank you too, definitely. What can I say? We need more education, we need more competence, empowerment for everyone. We shouldn’t just say the problem, the problem, the problem, the problem — I say, we need more education, more competence, empowerment for everyone. We should pay more attention to really being participants, and it mustn’t happen, when someone is chronically ill, and I’m speaking from my own experience, that it can’t be that someone weighs whether that person gets the medication or not. That’s an ethical question too that you really need to think through, where AI might help, or might not — it always depends on who programs it, that has to be said upfront. The pharma lobby, yes, just briefly upfront, with DiGA, digital health applications, that’s becoming more and more of a central point — they’ve recognized exactly that the data is valuable, that’s why they’re buying in massively right now too. To close, I can only say, stay on top of it, keep informing yourself, and there absolutely must be no injustice happening — everyone should be able to participate as much as they want, and get the opportunity to do so too. I have to say goodbye now, I have a meeting coming up. All the best, definitely.
Yes, wonderful, thank you, thank you so much. And I found it really exciting — we covered various aspects today and looked more closely at things from these perspectives specifically. I think what can be brought together and held onto, to close, is, to some extent, becoming aware — and this applies to many other contexts too, not just this health context — that it’s always a danger when we give up too much responsibility. Self-responsibility, whose foundation is education — that term came up again today too. It becomes clear that, on the one hand, appropriate training is needed, support is needed, even with the application, but not just that — also education in the sense of, what actually happens with the data, and so on, and at the same time also personal responsibility, not transferring everything into external control, in inverted commas, I’ll say this a bit provocatively, into dumbing down, but really picking up this aspect of education again here — self-determination, self-organization, to establish self-efficacy — those are really important aspects that play a role here again. And under various weighing points, things must, or may, be discussed, and then corresponding decisions are needed too. “Hippocratic Oath” came up as a term — I can put a big question mark on that, because especially against the backdrop, we touched on this briefly yesterday too, of developments currently taking place in the background, that a WHO should in the future be able to determine pandemics itself, so to speak, from when something counts as a pandemic and what measures get derived from that, and so on — it’s nice, in inverted commas, that there’s a Hippocratic Oath, but if we hand responsibility over to another place where responsibility shouldn’t be handed over, then how can we, as a country, for example, still listen to our own experts, scientists, and so on, enter into discourse, and keep making new decisions against this backdrop, if we allow external control here, in inverted commas? And all of that are really, really important topics that we’re allowed to look at very, very critically here too, because it’s not just positive in the sense of centralization and everything going much faster, but can also bring a lot, a lot of disadvantages with it, and carries a lot of dangers too, because if wrong decisions, in inverted commas, get made, then you no longer have any leverage, because you no longer have any way to correct it. And that’s a really, really important aspect in this context. And on the aspect of companies buying data, and so on, because they’ve recognized the value — well, either they buy it, or if that’s not possible here in Germany, then we also observe that companies get relocated abroad, where they can get data much faster and easier. That’s also a topic we’re allowed to look at, and can look at more closely. And then, ultimately, the question arises, what does that actually mean? And that’s why I’m, for us individually, but also from a business perspective — so I hope a lot, a lot of question marks came up today, just to let that keep working on you, and to get into this juggling of thoughts, so to speak, to also recognize that this health area isn’t just to be viewed as a health area, but that, through all these entanglements, the data, the digitalization, and so on, bridges keep needing to be built into various areas, that chain reactions keep getting triggered with every decision, that it’s not just to be viewed positively or just negatively, but that it requires a differentiated view, analysis, reflection, and also decisions. And with that, tomorrow it continues with the deep dive “The Future of Nutrition” — we already touched on this yesterday too, with all our E-numbers. I’m really looking forward to it, I’m very, very curious — “The Future of Nutrition” is the topic we’ll be dealing with tomorrow, going deeper into things like genetically modified foods and so on. And I’m also very, very curious how we’ll look at this and what exchange there’ll be on it, to open up the corresponding different perspectives on this topic again, and see what insights we come away with from this room accordingly. So you’re all very, very warmly invited to join again tomorrow at 8 in the Deep Talk Club, to step in together, open up various perspectives with your examples, first impulses. And with that I wish you a wonderful day today, and I’m looking forward to tomorrow morning at 8 again here at Deep Talk. Until then. Thank you all for joining in.
