to is now in charge of your health digital health care our topic here on this edition of made i've been physical one we put our lives in their hands but doctors and no longer just medical professionals they're being forced to become dataran lists as well they're trading in their stethoscopes for virtual reality goggles it may not sound all that reassuring but it does give doctors a whole new skill set to do their jobs all that much better standing there buck naked in front of my g.p. recently it was the p.c. doing all the checks for skin cancer computers the faster and robots can be so much more precise so where does that leave my doc let's take a look. to determine whether a mole is malignant doctors are now consulting computers artificial intelligence being used to detect skin cancer drawing on a database with over $100000.00 image samples because train ai like you would a small child if we show b a i. and then perhaps a black malignant melanoma eventually after viewing thousands of images be ai recognizes the patterns behind the diagnoses and is able to generate answers. one for. aga handler is himself a dermatologist so does this mean he's handing his job over to a computer. doesn't it's more a change of role the doctor takes a step back and becomes a management controller. dermatology is at a relatively advanced stage of digitalisation. on the ground however hospitals can have a slow internet connection and still usually have hard copies of patient files but not for much longer digitalisation is changing the working world for doctors while also opening up a range of questions. when do patients need a human face to interact with and where can the stakes by artificial intelligence being voided. when will we see x. rays being evaluated by ai instead of humans. and are doctors themselves ready for the revolution. is not. currently in a transformation period we know what direction the vision is headed. but it's still some way off so right now the next generation of doctors and especially the current one are not prepared for that. introductory seminar on digital health care it's the only course of its kind in germany which is part of the problem the aim is to familiarize budding doctors with the new options available to them and to look at which ones are useful in this instance would be we have to consider whether using this technology will help the patient and how i can make it an integral part of routine procedure and we might find that no it isn't helpful so i won't make use of it or i will use it in this case. technology is increasingly being used for other forms of training here young doctors hone their surgical skills with the help of the chill reality. which gives them the floor in this room and you're surrounded by the liver is that were you can look into whatever detail you like zoom in mark something is a really new experience of. system crucially different people can view the same thing together even if they're separated by continents so you can consult someone else where who has more experience of this procedure. that's set up already in use by you run a just for example with some operations now being conducted by a robot called davinci young doctors get to grips with the davinci simulator part and parcel of training for the next generation by expect to see a lot of reports a similar development. the 1st step in training is a kind of driving lesson with a robotic assistant. digitalisation means major investments in new technology and training programs even seasoned doctors need lots of practice where their expertise is also essential is knowing what procedure makes sense. when come which digital tools be of genuine assistance. and who's to define what beneficial even means. on the as a doctor i need to know which apps have which capabilities so that i can decide whether a tool has benefits for my patient. does it do what it's supposed to do other it's an app that appears to have medical background knowledge it might do something different with that data and often adopt most of. the mole on dr holger handlers patient turns out to be harmless say both a dermatologist and the ai of course computers can make mistakes too just like us ai after all was created untrained by human beings. sometimes we've seen grievous mistakes a lesion is classified as benign but is clearly anything but and sometimes very advanced forms of skin cancer fail to be identified on them i mean it would be good to be able to explain why this or that wasn't detected and right now we can't explain everything. and so it's very difficult to iron out mistakes. there's religion is there are still plenty of pitfalls. out some. fresh like. there is indeed still plenty of work to be done from improving top to training programs to laying down quality standards but meanwhile the very occupation of doctor is changing as it always has done with the evolution of technology for the benefit of patients. is another benefit for us personalized medicine the latest buzz word in the industry it's not just about customizing medications your needs to make sure they work against things like cancer a riveting but also checking the effects of the meds 247 this whole new way of doing health care is sparking a major rethink for the pharma giants. personalized medicine instead of blockbuster drugs. is sick she's been taking blood pressure medication for years to little effect. the jugs were developed by big pharmaceutical companies and tested mainly on men that mass produced medicines are marketed to achieve maximum sales despite often only helping home for the patients in question. it typically costs $800000000.00 to develop a new drug. fat lot of us the drug needs to earn over 1000000000 to make it worthwhile that the days of standardized medication are numbered personalized medicine is starting to take off. lisa's personal genetic profile can now be decoded in 25 hours for a few $1000.00 in the u.s. companies using the data to forecast future ailments with 1000000 signing up i medical tech firms use x. rays tissue samples blood cells and pathogens to develop an individual health profile including if the micro biome the hope is that will allow them to identify the drugs and therapies that are more likely to work. those firms are also looking into the benefits of artificial intelligence a digital plaster on lisa's arm could in future trigger an alarm if her drugs are no longer having an effect around the clock monitoring costing just a few $100.00. lisa schmidt is hoping that personalized medicine could finally provide her with a cure but who has access to all the data that she's giving away. the doctor obviously but now a growing number of companies are also offering these services. established pharmaceutical firms are also having to rethink instead of just producing tablets for the masses they now need to think in smaller numbers bringing together diagnoses research and treatment options to become service providers for patients like lisa. here's something else you can say modern health care for because of prenatal diagnoses fewer people being born with disabilities sounds like great but this next guy has mixed feelings. with spinal bifida he wants to see inclusion rather than selection let's hear what he has to say. when i'm with a model i once asked my mother what would have happened had she known about my disability and whether she might have had an abortion she started crying. soon after i was born it was clear that i had a neural tube defect what's called spinal bifida. all that meant i had various difficulties especially when it came to walking on by the point another common symptom with spinal bifida is hydrocephalus which is a condition where cerebral spinal fluid can drain properly from the brain and shortly after i was born i had a shunt implanted it drains that fluid through a catheter into my abdomen and. soon after that doctors told my mother that i probably wouldn't survive to adulthood today we know that those kinds of predictions were completely off base of course the doctors were wrong and it caused us a great deal of fear and stress. but i felt. that this finished us on the whole i don't want to demonize prenatal diagnostics it can be helpful for example it can help couples who are having a baby know what to expect. but i don't believe it should result in what i would consider hasty or unnecessary abortions when as you have to see a time when. was had to feed a cause that fewer people with disabilities would have all sorts of consequences for our health care system as. insurance providers would say they could save lots of money or fewer people had special needs. but medical care is always getting better which would also lessen the impact of a disability. the idea of a society full of designer babies is something that does concern me that i do find disturbing. i don't believe it would be good for society if only the differences among us were raised. for me that also means that people with disabilities are an important part of our society they're part of the diversity of our society depends on it. well these ethical questions become even more important as the digitalisation of medicine gains traction as we mentioned the big internet companies also want to play ball like amazon but whether or not they're in for healthy profits what digitisation is doing is helping put patients in charge of their own health care here's how it's democratizing medicine. so raja corage are from india is one of 7000000 users of ada an app he consults whenever he feels. first he types of symptoms on his phone then the program ask them a series of questions similar to a doctor when did the symptoms 1st emerge for example a couple of minutes later he's presented with what the system considers to be the most likely diagnosis. it is a day uses a lot of technical terms when describing the symptoms of medical language it's often difficult to understand language of. every 3 seconds the app generates a possible diagnosis for a patient somewhere in the world it's especially popular in countries where seeing a doctor is expensive or where health care services are poor. or not is the c.e.o. of the company behind a startup based in berlin. firstly we never claim that ada provides the right diagnosis there's always the doctors for objective we make that very clear in the op. we never tell the patient that we're providing a 100 percent diagnosis based on 20 questions asked of us. 150 people work for a to health including 40 doctors. the company also works with health insurance companies they can make considerable savings if the app diagnose is one of 7000 rare diseases for example. is that. this is an area where the advantage of technology over doctors who work alone is particularly apparent. depending on the study you look at it takes on average between 5 and 8 and a half years to get the right diagnosis for someone unlucky enough to contract a rare disease. but is worried that the app may cause some people to not see a doctor at all to try to save money. remitted 3 point one problem is that poor illiterate people might take the diagnosis provided by the software as definitive and they might start using medication it recommends sometimes this could be harmful. medicine so you've got. doesn't want to take any chances and as recommended by the app he goes to see a doctor that is permanently blocked nose. as you know most of the indians in our country they are quite ignored they are going to. just parties in wanting to . buy i think with this. rules of the software. immediately. immediately come up with this that you must concern. space is not. both a doctor and the app diagnosed inflammation of the mucous membranes nothing urgent and easy enough to treat cirrhotic or jar says the app does come up with reliable results use of the app looks set to increase on the. google is for general information we want to be for people seeking medical information. will eventually be helping 1000000000 people to have a better understanding of the state of the health of our city and. siraj gorge i says he's happy to consult the out for himself. but when it comes to his young daughter good to he would definitely go straight to see a doctor in person. out official intelligence as another diagnostic tool in fact today google can identify a flu outbreak faster than the health of ari's just by analyzing the search terms that you use but a form of don protection official has told made that data protection has not been a priority in digital medicine that's a huge worry in a business that relies 100 percent on doctor patient confidentiality the risks of a new industry that's moving ahead at light speed. patient confidentiality means nothing to them they just want to make as much money as possible with the data. that advises the european parliament and other organisations about data privacy in digital health care. didn't tell you zation has a lot of potential so why not just ignore data protection so that we can make that big step forward what about. when. you can do a lot of useful things with data of course data can also be used in harmful ways. for example you can bring people into disrepute leaving them stripped and exposed. health data is especially sensitive data privacy activists insist it should only be sent to 3rd parties would be expressed agreement of the patient is that realistic. we're now seeing internet companies entering the health care sector especially in the us. that does concern me they have no concept of doctor patient confidentiality so they have one goal to use the data to make as much money as possible. the inevitable result is that we've been reduced to what you might call data objects. in germany regulators can't always money toward doctors or lawyers for data protection compliance that increases the risk that data might be passed on illegally for financial gain. doctor or a lawyer my claim patient confidentiality or client confidentiality then regulators can't ensure that data privacy protections are upheld this is completely illegal under both e.u. law and the german constitution but thanks to lobbyists this is now been incorporated into law this has an impact on digitalisation in health care. the digital health care. making increase use of genetic data this could lead to breakthroughs in the treatment of cancer and dementia but it also poses risks. the worst scenario i can imagine is if it became mandatory to assemble a comprehensive record of everyone's genetic data. our genetic disposition has a massive impact on our health we might see our society making decisions about people on the basis of their genetic disposition then you'd see things like we don't want them they get no money they get no insurance certain people will be seen as a threat and people with good genes would get preferential treatment before so. despite these the risks. that we have the capacity to protect the data privacy of citizens but what's missing is the political will. germans are wary about anything involving data privacy but israel has been collecting patient data for decades tech startups use the medical records to develop algorithms and they businesses so far there's been little pushback on the contrary israel wants to become a world leader in digital medicine it's already reputed to be one of the most innovative countries in this sector let's take a look. israeli companies are usually. bringing in fresh angle tool for having an existing problem in health care that's where we expect to really start to shine. with a population of around $9000000.00 israel is a small country but it's looking for a large piece of what's said to be a large part by the digital health market. for 20 years the israeli health system has been gathering the medical data of more or less the whole population a database like this exists only in israel and serves as an ideal basis for the development of deep learning algorithms that could potentially save lives. was among the pioneers of this development he co-founded zebra medical vision in 2014 the company was granted access to the data of israel's main health organization to optimize patient care. of its introverted care providers the meaning we know the outcome and what happened with all those patients and they can create many many different tools and help. there are they today quickly and more efficiently. zebra's analytics tools are already in use. and his head of ai are overseeing their introduction in hospitals the technology reduces the time it takes radiologists to recognize acute symptoms by 80 percent with a brain hemorrhage for example that could make a crucial difference because ybor is also collaborating with google scans can be uploaded to the google cloud and analyzed many hospitals still hesitate to upload sensitive data to the cloud. gura says it's safer there than on a hospital server and that the data zebra works with is all completely anonymous. he worries that privity concerns about dealing progress. millions of patients will be saved in china. before they are being saved in europe and the us there is quiet of a balance nations and citizens need to consider. impact on patients live versus perceived privacy with. israel's government is now having a range of data collected on what will be one digital platform it will be the world's largest database of medical data will eventually be made accessible to start ups in terms of digital health the country is dreaming big. invests mainly in health tech startups part of what we need to do as investors is to connect and build bridges between the israeli entrepreneurs and the world out there the market here is tiny this bridge building between israel and the world is what really grounds these really entrepreneurs as fears of a health care data breach this investor says such concerns are typically european. the population here is a little bit less risk averse we're used to living in vironment when risk is part of the equation and we constantly balance between risk and reward lisa goal is co-founder of the start of day 2 and this identified personalized nutrition as a major trend the company provides customers with personalized health solutions based on their gut microbiome its methodology could revolutionize diabetes treatment. so how come israel has become such a hope of visionary ideas. because. we're in survival mode all the time we need to be able to find the creative solutions to move forward we're not about organization and getting multi you know $1000000000.00 companies up and running smoothly and scale that we do know how to end a very. another factor is that in israeli business culture failure is seen as healthy if an idea doesn't work out it's always worth trying again. to see you again here are made and make sure you keep up on the leaps and bounds being made in the business of digital medicine it's all about your health of the end of the day i'd see you again sir. marjorie god the international talk show for journalists discuss the topic of the week sailors are traveling once again in the middle east as the standoff between the u.s. and iran intensifies could u.s. pressure produce a new and better nuclear deal as washington claims more result in the war that's our child the country join us. 30 minutes w. . the kind that is tightening its grip across the globe and hunger for energy it's expected to double in the next 20 years. can be satisfied with. what technology is more of a company. where resource needs from. life comes. in 75 minutes on d. w. . you're going to unofficial estimates more than $1200000.00 venezuelans or even colombia legally and illegally. already. returned to australia. i visit friends i don't think i'd ever go back there to live you know what i live there again i don't know so i'm not sure. bearing witness global news that matters to make phone lines. plus 19 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