technological change

Technological change and public action - 1

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Whether they are already part of our daily lives or are still in the realm of science fiction, technological change is shaping our relationship with the world. Yet public action is struggling to take account of their potential consequences, not only on individual freedoms, but also on equality, sovereignty and even the future of mankind. At the frontiers of health and the digital age, certain subjects are particularly sensitive.
Part 1: Technological change in health and risks to society
 
« Ne claim to live in a "knowledge society", but it would certainly be more accurate to say that we live in a society of the use of technology". This statement by Étienne Klein[1] highlights our daily use of products of great technical complexity, while ignoring everything that makes them possible.
In addition to this familiarity with uses and this "strangeness" of the scientific foundations of technologies, there is (with a few exceptions, such as GMOs) a political impotence and a moral blindness to their consequences, even though technological change has a decisive role in our lifestyles and our relations with the world and with others.
 
The use of technologies is guided by the "interplay" of supply and demand. Although it is based on the expression of individual preferences, the resulting order is undemocratic because it does not involve the collective definition of objectives. Moreover, it is not political, precisely because it merely aggregates preferences. individual...ignoring the common space between men who make politics. This order is finally, under the effect of the digital revolution, of international scope, almost beyond the reach of national rules, and represents for States a loss of sovereignty not collectively consented to.
 
S. Escher, Staircase

Familiarity with customs, strangeness to science, political impotence and moral blindness

It is therefore understandable that the issue of the use of technology is not a central concern of the political debate, except as a supposed lever for job and value creation. This form of political powerlessness is certainly not specific to technological issues, and exists on many long-term issues or those affected by globalization. It is nevertheless necessary to anticipate, guide, if necessary prevent and in any case take into account collectively, in a thoughtful and deliberate manner, the new uses of technologies that can transform society.
 
Finally, some uses of technology pose not only political but also moral problems. The critical distance needed to build informed societal choices is all the more difficult to conquer since innovation is often seen as an end in itself. Yet, while being increasingly complex, technologies make intermediaries disappear or become invisible, serve the homogenization of behaviour, the automation of tasks, in short, make life easierwhich implicitly conveys certain values. Changes in society seem to happen of their own accord, without waiting for democratic choices or ethical considerations.
 
The focus here is primarily on the health sector. In this sector as in others, from transport to telecommunications, from security to education, technological change has of course many beneficial aspects. However, they have the particularity of mixing life sciences with technologies, particularly digital technologies, which give rise to complexity and particular risks for the human body, the environment and society. Health, which affects each and every one of us intimately, is undoubtedly the field in which the aspiration to progress is the most obvious, the most unassailable, and therefore the one with the most politically demanding demands and the most morally blinding promises.

New Fronts of Technological Change in Healthcare

Let's start by giving some examples of the changes taking place in the health sector:
- trend towards widespread data recording and sharing (current "quantified self"The new "wearable computing" technology (e.g., mobile health or "m-health"), thanks to "wearable computing", the already familiar connected bracelets and applications that measure sports activity, sleep cycles, heart rate, food consumption or blood alcohol level.[2] ;
- the birth of implanted medicine (e.g., partnerships between Google and Novartis and Sanofi to develop contact lenses that measure blood sugar levels and combat diabetes)[3], company chips Biotech Microchips a cardiac tissue combining organic and electronic elements developed at Tel Aviv University, which delivers drugs directly into the body.[4]…) ;
- access to low-cost DNA sequencing and decryption (e.g. by the company 23andMe) and then to share it (for example on the social network "..."). OpenSNP ») ;
- prospects for improving physical performance through technological prostheses[5] ;
- attempts to improve sensory or intellectual performance (augmented reality glasses, more or less elaborate memory prostheses, etc.).[6]s, stimulation programs or interfacing the brain of the " Brain Initiative " of DARPA, the U.S. Army research agency...) ;
- gene therapy (in 2015, Chinese scientists announced that they had succeeded in removing from an embryo a gene responsible for beta-thalassaemia; the United Kingdom has authorised fertilisation techniques). in vitro using DNA from three parents for the treatment of severe mitochondrial disease)[7] and its possible excesses, from genetic doping to eugenic practices.
 
 
Admittedly, some of these examples may be science fiction: the improvement of the body by prostheses, while the repair itself does not have equivalent qualities (some functions are not covered).[8]); the "NBIC" convergence (nano-, bio-, computer- and cognitive technologies) and certain transhumanist aims, which lend themselves to fantasies and sensationalist titles; the promises of computer reconstitution of the brain or certain prospects of "genetic editing", regularly denounced as deceptions.[9]. Among the examples mentioned, only the connected objects already belong to the everyday life. No one knows which brain-machine interfacing technologies, which embryo selection tests, which "improvement" projects from Singularity University, Google X Lab or DARPA will emerge and spread widely. There are undoubtedly barriers that cannot be overcome by technology. Concerns are then as unfounded as promises are exaggerated.[10].
 
Nevertheless, many services are already available, in particular to quantified self". In the realm of augmented reality, isn't the popularity of "Pokémon Go" preparing the way for the release of augmented reality goggles, helmets and screens? Early case law also gives some tangible signs, from the ruling of the Court of Arbitration for Sport allowing Oscar Pistorius to compete as a valid athlete at the 2008 Beijing Olympic Games to the decision of the British authorities to allow color-blind artist Neil Harbisson to wear his "eyeborg" on his identity papers.[11] through the Conseil d'Etat's decision to prohibit the use of a "remote monitoring" system as a condition for the treatment of sleep apnea, which was provided for by the French health insurance system.[12].

Explanatory notes

Beyond the scientific advances that make these changes possible, it is changes in behaviour and relationships to technology and health that provide fertile ground for their deployment:
- Turning to technology seems to offer an easy solution to societal problems (from climate change to security and education, there is a widespread belief that technological means could provide answers to real political questions.[13] ; health is no exception);
- the use of technologies in the fields of health and the environment leads to an entanglement of natural, health and technological risks, the latter reaching an unprecedented scale, making a "curative" technological intervention all the more legitimate, and so on;
- society is becoming accustomed to data sharing as a currency for the exchange of services, under strong social and economic pressure to put in place more effective tools ;
- the aspiration to health widens to an aspiration to the well-being[14] (or even limited to it, for the healthy, thanks to the reduction of suffering allowed by medical progress), favouring a conception that not only repairs but also improves health, and legitimizing the modification of daily behaviour under external control that is not necessarily medical (connected bracelets, but also social networks). Pascal Bruckner diagnoses that "the right to health for all" has turned into collective anguish, social conquest has turned into the right to consume to avoid getting sick."[15] ;
- addiction to measure performances, physical but also psychic, and the confrontation between men and machines (from media games of chess and go to the automatic cash registers of our supermarkets through the "bots", these robots which already occupy a majority place on the Internet).[16]...) could lead, as Pierre Cassou-Noguès suggests, to an evolution of our perception of thought, from a notion analogous to pain (intuitive and personal) to a notion analogous to fever (measurable, detectable by a third party with the help of tools).[17] ;
- In line with this aspiration to performance, the collective imagination seems to be marked by a certain cult of 'form' and even a certain idealization of 'augmented' man and nature (whether you think of Thierry Mugler's 'Amen' perfume ads or HSBC posters featuring bar-coded fish or bionic bees under enthusiastic slogans).
 

Consequences

Let's face it: the fact that technological developments may change the nature of certain activities or call into question their social organisation is not a problem in itself. Technological change has always met with opposition on these grounds alone, which history has rarely found to be justified. The problem lies in the fact that certain developments lead to a shift in the aims of these activities or in the values that led to their organisation, and in the fact that the actors who implement these changes now have considerable resources and act outside the political arena and democratic control, with mercantile and sometimes ideological objectives.
 
We distinguish consequences for individual freedoms, for sovereignty, for equality and for the future of the human species.
 
On individual liberties
 
A common feature of several of the services described above is the central role of mass data collection and processing. The "GAFAs" (Google, Amazon, Facebook, Apple) provide access to even more services as more data is transferred to them: many are only accessible to people who agree to identify themselves, to synchronize or share their data, to be geolocalized, etc. The "GAFAs" (Google, Amazon, Facebook, Apple) provide access to even more services as more data is transferred to them: many are only accessible to people who agree to identify themselves, to synchronize or share their data, to be geolocalized, etc. The "GAFAs" (Google, Amazon, Facebook, Apple) provide access to even more services as more data is transferred to them. Their business model, which is becoming more widespread, is based on free access in exchange for consent to provide data for commercial exploitation. As the critic Geert Lovink puts it, "Anonymity is nothing more than a nostalgic notion."[18].
 
 
This massive processing of data coupled with the use of certain technologies carries risks for individual freedoms: risks of illegitimate commercial exploitation, uncontrolled misappropriation or theft, recovery for the purposes of blackmail, harassment or discrimination, or even authoritarian abuses. This aspect is regularly mentioned[19]so let's not dwell on it. Addressing these risks solely from the perspective of protecting liberties individual elude the truly political issues, i.e. those that are not of concern to individuals, but to the collective.
 
On sovereignty
 
Access to countless data and powerful algorithms opens up the possibility of services being offered by companies, or even individuals, in areas hitherto monopolised by the public authorities. In some respects, this is to be welcomed, and in any case no one can be blamed for offering new services. Other aspects are more worrying.
 
In the field of health, the emergence of personalized and connected medicine is accompanied by a transfer of power from the State, responsible for the health and social security system, to data managers, and from doctors to private operators. The NHS, the UK's national public health agency, recently entrusted a Google subsidiary specialising in artificial intelligence with the processing of data on 1.6 million patients.[20]. The Court of Auditors noted in a recent report that in the United Kingdom "the issue of opening up [medical data] to the private sector is essentially approached from the point of view of innovation, the competitiveness of countries and the profitability of investments".. The same report notes that in the United States, "the ambition of the major IT companies is now to manage the personal medical records of billions of users worldwide, financed by the commercial exploitation of their content".[21]. It is in this respect that the order of supply and demand to which these technological developments belong leads to a loss of sovereignty, including for the States where these companies have their headquarters. Moreover, it can be noted that there are close links, at least in the United States, between the transhumanist and libertarian movements.[22]. Both are in favour of the liberalisation of data uses, because for them the State is an obstacle to the development of a free society.
 
 
Moreover, in areas such as labour law or international trade, the law is being replaced by the contract, which weakens the weight of democratically defined rules and the judiciary. The use of private arbitration in disputes between multinationals and states is being considered in the negotiations on the TAFTA and Privacy Shield treaties between the United States and the European Union. The functioning of these bodies is opaque and undermined by conflicts of interest (as illustrated by the announcement, in the context of these negotiations, that US Under Secretary of State Catherine Novelli, former Apple's Director of Public Relations, would act as mediator in charge of examining complaints, etc.).[23]).
 
The recent dispute between Apple and the FBI over access to mobile phone data in the context of an investigation has finally revealed that states are no longer perceived by everyone as having greater legitimacy than companies to guarantee individual freedoms.
 
On equality
 
Perhaps the most dangerous for society is not so much the irregular use of data or their capture by authoritarian regimes or ill-intentioned "hackers", but the voluntary servitude of the population to companies putting products on the market with a high level of "piracy". marketing. A certain ideological climate coupled with economic incentives given by private operators, or even taken over by public services lacking the means, can lead to increased inequalities.
 
For example, insurance companies or companies offer benefits to people who agree to wear a connected bracelet to monitor their physical activity.[24]. In Germany, health insurance companies will soon be collecting and using data from connected bracelets.[25]. The French Assurance Maladie's plan to use a "tele-observance" system to condition the assumption of responsibility for treatment was mentioned above. Several lending agencies use available data on social networks to assess the creditworthiness of their clients.[26]. The CNIL points out that "The scenario in which health insurance or a mutual insurance company would make obtaining a favourable tariff conditional on the performance of a certain number of physical activities, with figures to back this up, is taking shape. In the coming years, individuals could be asked to provide evidence of healthy behaviour, along the lines of the"usage-based insurance" "[27]. Refusing to enter such a system will only be possible for those who have sufficient means.[28]This is not guaranteed in a competitive world.
 
The fact that many people spontaneously adhere to certain developments, as well as the setting up of ethics or reflection committees among innovation promoters (e.g. the "..."), is a sign of the fact that many people spontaneously adhere to certain developments, as well as to the setting up of ethics or reflection committees among innovation promoters (e.g. the "..."). Brandeis Program "DARPA or the Google Ethics Committee...[29]), does not dispense with collective ownership by political representation. The protection of data and private life alone would moreover not be sufficient to stem the risks that these uses pose to equal access to the health system and more generally to public services.
 
On the future of the human species
 
Imagine a society in which monitoring of physical activity would become mandatory, in which access to routine services would be through implants, in which embryos would be selected for their resistance to a disease.[30]s, is already asking all kinds of legal and political questions. To imagine such a society, accustomed to the measure of everything, guided by an ideology of performance, struggling or renouncing to define limits to the hybridization of the living and the technical, is to imagine a society that is accustomed to the measure of everything, guided by an ideology of performance, struggling or renouncing to define limits to the hybridization of the living and the technical.[31] and subjecting themselves to a form of voluntary servitude, also raises more fundamental questions about the future of the human species.[32].
 
Companies are unashamedly displaying their ambition to change the world. Google embodies the project of improving the human species and society through technology. The company launched its subsidiary Calico with the goal of "defeating death".[33]. With a less pronounced sense of advertising, the French leader in connected healthcare, Withings, has just been acquired by the technology division of Nokia (based in California).[34]s commitment to enabling people to change their relationship to health, to live healthier, longer lives.
 
Advances in prenatal and pre-implantation diagnosis (PGD) have made the risk of eugenics real: while they have had undoubted benefits, they have also opened up the possibility of "from the selection of embryos and the destruction of those that are affected."as noted by the National Ethics Advisory Committee in a 2009 advisory opinion[35]. The NEAC also noted that some"uses of PGD are forms of misdirection of medicine, its reduction to biological engineering." and that "If such tests [carried out on embryonic DNA from the blood of the pregnant woman] were available from private pharmacies marketing their technology electronically, it would be possible to envisage a choice of couples being developed in the absence of medically appropriate information and external moderators. We would then be witnessing the implementation of true predictive tourism, with a clientele composed of couples who are alone and helpless in the face of non-validated tests. » The use of the conditional tense, still de rigueur in 2009, is much less so today with the emergence of cheap private services for sequencing, deciphering and sharing DNA such as those mentioned above.
 
In the absence of sufficient thought, effective regulation and control, "improvements" or extensions to the human body that provide the possibility of limiting the ageing of certain organs, "enhancing" them (e.g. to see in the infrared) or simply, in a more down-to-earth way, reducing health and community spending, will end up being of such economic or social benefit that they will become widespread.
 
If we want to simplify our lives, we might end up with se simplify everything[36]. The overtaking of man by machine may be illusory unless men are halfway there. By subscribing to the promises of simplification or progress brought to us by certain technological changes, we are also subscribing, even tacitly, to a social project. But as Pierre Manent remarks "by constantly pushing the limits, you get to a point where you stop improving life"[37].
 
Ambroise Pascal, Bridges, Water and Forestry Engineer. 
Ambroise Pascal is a polytechnicien, engineer of bridges, water and forests. After specialising in the management of food, health and environmental risks and working at the Institute for Radiological Protection and Nuclear Safety (IRSN) in the laboratory for the economic analysis of nuclear risks, he held two positions at the French Nuclear Safety Authority (ASN), first in charge of the office for radiation protection, the environment and labour inspection at the Nuclear Power Plant Directorate, then as Director of the Office of the Director General's Cabinet. 
The contents of this article are the sole responsibility of the author.
 
 
[1]Étienne Klein, Le small bang des nanotechnologies, Odile Jacob, 2011 (p. 107).

[2]The following article gives an example out of the sanitary field: this bracelet delivers electric shocks when your bank account goes overdrawn: These connected bracelets that want to keep us on a leash, Up' magazine, May 25, 2016 (link).

[3]The fight against diabetes: Sanofi and Google join forces, Voices, August 31, 2015 (link).

[4]A cyborg heart patch to repair hearts, Up' magazine, 21 March 2016 (link).

[5]Even more interesting than Oscar Pistorius' high-profile case, that of Danielle Bradshaw who, deprived of one leg, wanted to have the second one amputated in order to benefit from prostheses on both sides: 'Cut off my foot so I can run faster': Sporty teenager who had one limb amputated for medical reasons now wants the OTHER one removed, Daily Mail Online, 18 September 2014 (link).

[6]Memory Implants: A maverick neuroscientist believes he has deciphered the code by which the brain forms long-term memories, MIT Technology Review, April 2013 (link). See also the presentation by Élisabeth Métais of the Conservatoire national des Arts et Métiers (link) and Sixth Sense: Perceiving Infrared with Neuroprosthesis, Futura-Sciences, February 15, 2013 (link).

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[7]See Laurent Alexandre's articles: Why the authorization of the genetic modification of a human embryo by Great Britain is neither the first nor the worst of what could be done (and will be done very soon), Atlantico, February 2, 2016 (link) and Why won't the Chinese listen to Westerners about genetic modification of embryos they have decided to experiment with, Atlantico, July 3, 2015 (link).

[8]Watching the opening of the 2014 football World Cup by a paraplegic with an exoskeleton, remarkable as it is, is enough to convince oneself that functions remain unrepaired. This does not exclude the possibility of improving other functions.

[9]God's Red Pencil? CRISPR and The Three Myths of Precise Genome Editing, Independent Science News, April 25, 2016 (link).

[10]See Nik Brown: Hope Against Hype - Accountability in Biopasts, Presents and Futures, Science Studies 16(2): 3-21 (link).

[11]Neil Harbisson, the first cyborg with a passport, Europe1.fr, 17 March 2014 (link).

[12]National Council of the Medical Association, Connected Health. From e-health to connected health, white paper, January 2015 (link).

[13]On climate change, the following article diagnoses a "schism between the reality of the world and the evolution of governance" and a triple illusion "of the possibility of apolitical management", "of the possibility of isolated management of the problem" and "of being able to carry out the inevitable industrial and social transformation indirectly": Stefan C. Aykut and Amy Dahan, Les négociations climatiques : vingt ans d'aveuglement ?, CERISCOPE Environnement, 2014 (link).

[14]WHO defined health as a "state of complete physical, mental and social well-being" as early as 1946.

[15]Pascal Bruckner, Didier Tabuteau, Jean-Pol Durand, C'est la vie entière qui est devenue comme une maladie..., Les Tribunes de la santé, 1/2003, no 1 (pp. 105-111) (link).

[16]AI: The robot invasion has already begun. And it's massive, Up' magazine, March 29, 2016 (link).

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[17]Pierre Cassou-Noguès, Lire le cerveau, Seuil, 2012.

[18]Anonymity is now only a nostalgic notion, Libération, January 12, 2008 (link).

[19]In the press but also in the public space where this seems to be the only reservation commonly expressed (see for example the contributions to the consultation carried out on the site http://www.faire-simple.gouv.fr/bigdatasante).

[20]Document reveals how Google has access to millions of patient data, Up' magazine, 8 May 2016 (link).

[21]Personal health data managed by the Assurance Maladie: a use to be developed, a security to be strengthened, Court of Auditors, March 2016 (link).

[22]One example is Peter Thiel, the first to invest in Facebook in 2004 and a supporter of Singularity University and the Seasteading Institute, founded by Milton Friedman's grandson.

[23]MEPs call for vote in principle on data transfer, Euractiv.fr, 29 April 2016 (link). The biography of Catherine Novelli is available on the United States Government website (link).

[24]See Assurances : sommes-nous prêts à être espionnés pour payer moins cher, L'Obs avec Rue89, 12 août 2014 (link) and Data Sharing for Preventive Health Care, Biotech Finances, No. 1, p. 2.o 728, 20 June 2016.

[25]Die Zeit and Der Spiegel of 9 February 2016 quoted by Courrier international no 1327, from 7 to 13 April 2016.

[26]No Friends, No Credit, International Mail, October 7, 2013 (link).

[27]CNIL, The body, new connected object. Du Quantified Self à la m-santé : les nouveaux territoires de la mise en données du monde, Cahiers Innovation & Prospective, no 2, mail 2014 (link).

[28]The Biotech Finances article quoted just now reveals that while only 22% of the French would agree to transmit data from connected bracelets to their insurer, this figure rises to 43% if a health insurance premium reduction is granted in return.

[29]Inside Google's Mysterious Ethics Board, Forbes, February 3, 2014 (link).

[30]Let us recall as another element of context in France the suppression of the condition of "distress" of the pregnant woman before an abortion: the law n° 2014-873 of August 4, 2014 for the real equality between women and men modified article L. 2212-1 of the code of public health by replacing the subject of the sentence "The pregnant woman that her condition places in a situation of distress can ask a doctor for the interruption of her pregnancy" by "The pregnant woman who does not want to continue a pregnancy...".

[31]Several examples of the incorporation of technological objects into living organisms have been given, but there are also "other direction" hybridization possibilities, such as the use of DNA as a data storage medium: seeLe stockage sur ADN, disque dur du futur ?, Les Échos, January 13, 2014 (link).

[32]Such a world is romantically depicted in Dave Eggers' Le Cercle, recently translated into French (Gallimard, "Du monde entier" collection, 2016).

[33]Google vs. Death? The Huffington Post Blog, March 10, 2013 (link).

[34]Withings resells himself to Nokia, Libération, 26 April 2016 (link).

[35]Opinion on Ethical Issues in Antenatal Diagnosis, Opinion No.o 107, October 15, 2009 (link).

[36]It may be noted here that in the field of health and biology, this simplification may run counter to the maintenance of a significant diversity which may constitute, if only for purely utilitarian reasons, an asset (e.g. to limit the transmissibility of external diseases).

[37]Peter Thiel, Pierre Manent. What if the truth was scandaleuse ?, published in Philosophie magazine, noo 83, October 2014.

 
 

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