On the Way to the Prevention Age
- It is a general error of the modern world to repair rather than anticipate and avert worse i.e. to prevent.
- Economically-driven societal designs are relying on the costliest problem-solving imaginable.
- Precision prevention addresses everyone and does so in an educational way, at least if ethically responsible strategies and - in the case of for-profit offerings - corresponding clean business models are in place.
- Any sustainable society must be prevention-centred and health-oriented.
On the Threshold
Digital Medicine As Ethically Grounded, New Medicine and Prevention Utopia
Precision prevention addresses everyone and does so in an educational way, at least if ethically responsible strategies and - in the case of for-profit offerings - corresponding clean business models are in place. The threshold of participation, education and strengthening of the health data sovereignty of patients must decrease overall in order to avoid a digital health literacy divide and vice versa. Only an inclusive digital transformation of prevention can be convincing. “In the future, ‘health’ and ‘disease’ will become new or at least adapted terms to be grasped, which also make a new health literacy classification in the digital necessary. Not only more and more digital competencies will become important in medicine and the health industry (and indeed also for the ‘professionals’) (Heinemann 2020), but digital medicine itself offers, in addition to ethical risks, very many opportunities, especially for all those who are able to develop a certain literacy in this context. For those who fail to do so, many doors to new precision prevention options, therapy options, financing channels, etc. will not open in the first place. This triple divide appears to be an essential challenge: the general public in the sense of general digital health literacy, moreover the participation in new opportunities in medicine in particular, as well as the professionals, who could either develop game changing competencies themselves or be left behind” (Heinemann 2021).
Ultimately, precision prevention, data-preventive medicine, will work. At least if it prioritises evidence and methodological credentials, which is also necessary for this form of complex intervention (Fischer 2020). Cyberchondria is not a desirable consequence of persistent self-tracking, and “guessing with data” is not a smart approach for less-smart “health” apps (whether as unregulated apps or as regulated medical devices). It would make sense for ultimately all digital prevention products and services to have evidence of efficacy and safety, even if they are - as is almost always the case currently and “only” - about behavioural prevention. From obesity, diabetes and addiction to exercise, with vital, gene-analytical and/or other phenotypical and core medical data, prevention can be optimised tailored to each individual. Also in the context of old and new work, a “BPGM” (company precision health management) is certainly welcome in companies and among employees by principle. From health promotion to primary, secondary and tertiary prevention, the diverse approaches range, more networking (also with ePA) makes sense. If you look at the “First Prevention Report in accordance with § 20d para. 4 SGB V” of the “National Prevention Conference” (which received the mandate for strategy development in 2015 with the Prevention Act) from mid-2019, it outlines actors of prevention, health, safety and participation promotion”, and you immediately get an idea of how the system complexity often makes good ideas difficult to implement, and on the other hand that the private sector and wider society play no role here. Which is certainly a problem, since the social funds can neither restrict nor should restrict private consumption, social disadvantage etc. in a strong sense (loc. cit., p. 257). Thus, prevention is not that simple as it may sound either. “Eat healthy and exercise! Be nice and friendly to people and behave!” - basically, grandma was already a prevention coach.
How Dare We!
Understood in this sense, digital precision is a utopia. If it wants to be more (which it can and thus should, the reverse does not apply) than a renewed - and medico-historically not new - further stage of harnessing technology in the orthodox mindset of “medicine”. In contrast, it would be better and ethically imperative (since it is objectively possible) to abandon chronic treatment in neo-feudally structured institutions, guided by an ethically based but economically reshaped (and therefore also not sustainably economically successful) and overly bureaucratised framework system, in favour of a better, digital, fairer medicine in a sustainable, sufficiency-successful and moderating overall context, which is organised and lived in a data-sovereign and partnership-based manner by professionals as well as the patients standing at the centre. Current discourses on systemic medicine (Schmidt 2021) make it clear within medicine, but also far beyond it, that there may well be a broad sense that “digitisation” in “medicine” is not sufficiently in-depth, is too technocratically conceived, and that the comprehensive change potentials of an overall systemic nature, such as those envisaged by the flagship initiative “Smart Hospital” in a certain reading (Werner et al. 2020), offer much more potential for impact.
Any sustainable society must be prevention-centred and health-oriented. “How dare you!” (Greta Thunberg’s angry announcement in 2019 before the UN Climate Summit ) (youtube.com/watch?v=qHqKaDUlVhM ) - how can we dare to talk about “future” with any conviction at all and at the same time not let the massive empirical evidence, ethical arguments and the daily growing suffering of more and more people become the principle of our decisions and actions?
Prevention for one’s own health is at the same time always prevention for the health of all and vice versa and in this sense, it is perhaps the highest solidarity that can be had at the same time at the lowest price. However, since human beings do not live on the basis of ethical (as well as economic) insight alone, but rather cling to the often unethical or even supposed benefit, ideas, initiatives, measures etc. that bring a high benefit to all, but at the same time do not bring at least a lower benefit to the individual - and vice versa - are quite regularly not a social success model.
We know that sustainability will only succeed as “sustainable sustainability” (Heinemann 2011), we know that it will not work without changes in consumerist lifestyles marked by renunciation (since efficiency is not enough, what matters is effective sufficiency), we know that health communism is neither just nor realistic, and we also know that without at least a sufficiently large proportion of prevention-centred people shaping their lives, it is five past twelve. Without health there is no sustainability, without sustainability there is no health.
And now? To develop prevention into a leitmotif of an open and successful society in the 21st century is perhaps a utopia without alternatives. There will be “illness”, but to expect a loss of freedom for the eHealth-self where this appears to be avoidable without major efforts is not completely unjustified and can still be shaped. For this is the concrete “how” that matters. Enlightened prevention is the means of choice - not the uncritical, data-forgetting banal use of all kinds of digital measuring devices on people, but the strengthening of digital health literacy for the sustainable development of a digital prevention lifestyle appropriate to the democratically secured form of government. Without encroachment, but also without recklessness at the expense of all.
At least the cost bearers have been dreaming this dream for decades, even in analogue form. So far, however, it has not really succeeded. This is also because the possibilities of marketing campaigns for preventive care, more sport, etc., which could not be interpreted as a disruptive, patronising intervention, were rather limited, the benefits were already individually hardly directly tangible for too many - and the argument of solidarity with everyone simply does not hold water. In the digital world, different rules apply. Some of them are to be evaluated critically, others can be used wisely. For prevention that is perceived as a benefit, as an opportunity, as positive, that is data-based and therefore precise, and at the same time benefits public health in an equally data-based way, integrated models are still lacking. A sheer immense number of products, institutional activities of hospitals, health insurances, industry etc., governmental formats, research and much more do not shed light on the opaque health care system so far.
This requires a completely new approach to thinking about prevention. Digitally, ethically and critically. In other words, consistently aligning all strategies, measures and success measurements with the idea of precision prevention. Not so that we all become machines that live forever. Not so that we can carry out every overexploitation of ourselves in a controlled manner, but because digital prevention will be a decisive addition to the enlightened citizen in the 21st century, indeed it will co-constitute him. Because without this guiding principle, sustainability worthy of the name will hardly be possible. Where is the motivation to take seriously the ethically firstranking right of future generations supposed to come from, if even the value of one’s own health is underestimated, and even more so the value of the health of others?
Only by rethinking the healthcare system from the principle of digital prevention. Value creation should no longer be geared to diseases, but to prevention. Medicine should no longer be oriented towards subjects, but towards the human system and ethics as a whole. Care should no longer be interpreted as a tension between the economic and the social, but as economically successful action that is only made possible by values. Thinking of prevention in terms of biographical dynamics, at every age. And much more. Only in this way can we all become and remain chronically healthy, digitally sovereign and sufficiently successful.
Conflict of Interest