Digital Is Political: Why We Need a Feminist Conceptual Lens on Determinants of Digital Health

Colonialism in the new digital health agenda

The advancement of digital technologies has stimulated immense excitement about the possibilities of transforming healthcare, especially in resource-constrained contexts. For many, this rapid growth presents a 'digital health revolution'. While this is true, there are also dangers that the proliferation of digital health in the global south reinforces existing colonialities. Underpinned by the rhetoric of modernity, rationality and progress, many countries in the global south are pushing for digital health transformation in ways that ignore robust regulation, increase commercialisation and disregard local contexts, which risks heightened inequalities. We propose a decolonial agenda for digital health which shifts the liner and simplistic understanding of digital innovation as the magic wand for health justice. In our proposed approach, we argue for both conceptual and empirical reimagination of digital health agendas in ways that centre indigenous and intersectional theories. This enables the prioritisation of local contexts and foregrounds digital health regulatory infrastructures as a possible site of both struggle and resistance. Our decolonial digital health agenda critically reflects on who is benefitting from digital health systems, centres communities and those with lived experiences and finally introduces robust regulation to counter the social harms of digitisation.

Medical Student Experiences and Perceptions of ChatGPT and Artificial Intelligence: Cross-Sectional Study

BACKGROUND

Artificial intelligence (AI) has the potential to revolutionize the way medicine is learned, taught, and practiced, and medical education must prepare learners for these inevitable changes. Academic medicine has, however, been slow to embrace recent AI advances. Since its launch in November 2022, ChatGPT has emerged as a fast and user-friendly large language model that can assist health care professionals, medical educators, students, trainees, and patients. While many studies focus on the technology's capabilities, potential, and risks, there is a gap in studying the perspective of end users.

OBJECTIVE

The aim of this study was to gauge the experiences and perspectives of graduating medical students on ChatGPT and AI in their training and future careers.

METHODS

A cross-sectional web-based survey of recently graduated medical students was conducted in an international academic medical center between May 5, 2023, and June 13, 2023. Descriptive statistics were used to tabulate variable frequencies.

RESULTS

Of 325 applicants to the residency programs, 265 completed the survey (an 81.5% response rate). The vast majority of respondents denied using ChatGPT in medical school, with 20.4% (n=54) using it to help complete written assessments and only 9.4% using the technology in their clinical work (n=25). More students planned to use it during residency, primarily for exploring new medical topics and research (n=168, 63.4%) and exam preparation (n=151, 57%). Male students were significantly more likely to believe that AI will improve diagnostic accuracy (n=47, 51.7% vs n=69, 39.7%; P=.001), reduce medical error (n=53, 58.2% vs n=71, 40.8%; P=.002), and improve patient care (n=60, 65.9% vs n=95, 54.6%; P=.007). Previous experience with AI was significantly associated with positive AI perception in terms of improving patient care, decreasing medical errors and misdiagnoses, and increasing the accuracy of diagnoses (P=.001, P<.001, P=.008, respectively).

CONCLUSIONS

The surveyed medical students had minimal formal and informal experience with AI tools and limited perceptions of the potential uses of AI in health care but had overall positive views of ChatGPT and AI and were optimistic about the future of AI in medical education and health care. Structured curricula and formal policies and guidelines are needed to adequately prepare medical learners for the forthcoming integration of AI in medicine.

Digital Transformation in Healthcare: Technology Acceptance and Its Applications

Technological innovation has become an integral aspect of our daily life, such as wearable and information technology, virtual reality and the Internet of Things which have contributed to transforming healthcare business and operations. Patients will now have a broader range and more mindful healthcare choices and experience a new era of healthcare with a patient-centric culture. Digital transformation determines personal and institutional health care. This paper aims to analyse the changes taking place in the field of healthcare due to digital transformation. For this purpose, a systematic bibliographic review is performed, utilising Scopus, Science Direct and PubMed databases from 2008 to 2021. Our methodology is based on the approach by Wester and Watson, which classify the related articles based on a concept-centric method and an ad hoc classification system which identify the categories used to describe areas of literature. The search was made during August 2022 and identified 5847 papers, of which 321 fulfilled the inclusion criteria for further process. Finally, by removing and adding additional studies, we ended with 287 articles grouped into five themes: information technology in health, the educational impact of e-health, the acceptance of e-health, telemedicine and security issues.

Women in Systems Science and Gender Parity: Why and How to Democratize the "Technology, Innovation, and Society Nexus"

A career in systems science offers exciting prospects as well as challenges around the world, which are often underexplored or unknown. Gender parity, diversity, inclusion, and equity are essential for knowledge production, systems science research, and innovation to be representative, democratic, and critically informed. By virtue of its focus on systems, omics science is ideally poised to understand and respond to systemic and structural issues that hinder gender parity, equity, and democracy in science and society. In this context, voices from women in systems science in resource-limited countries are often inaudible, a gap that this article aims to bridge. We present here some of the pressing issues and possible ways forward for equitable representation of women in science. We highlight emerging frontiers of systems science such as digital transformation, Industry 4.0, and cyber-physical systems where gender parity and equity are crucial. This article also examines some of the challenges faced by women scientists in Africa. All in all, much work is needed across communities and countries worldwide for diversity and gender equity in Science, Technology, Engineering, Mathematics (STEM)-based programs. Adapting a critical lens that examines power asymmetries in STEM in Africa and around the world, and new ways of thinking for bringing women scientists in Africa to leadership positions in traditional STEM fields such as computer science and engineering where large gender equity gaps exist, is a timely and principled necessity in 21st century science and society.

Decolonizing Knowledge Upstream: New Ways to Deconstruct and Fight Disinformation in an Era of COVID-19, Extreme Digital Transformation, and Climate Emergency

Lies and disinformation have always existed throughout human history. However, disinformation has become a "pandemic within a pandemic" with convergence of COVID-19 and digital transformation of health care, climate emergency, and pervasive human-computer interaction in all facets of life. We are living through an era of post-truth. New approaches to fight disinformation are urgently needed and of paramount importance for systems science and planetary health. In this study, we discuss the ways in which extractive and entrenched epistemologies such as technocracy and neoliberalism co-produce disinformation. We draw from the works of David Collingridge in technology entrenchment and the literature on digital health, international affairs, climate emergency, degrowth, and decolonializing methodologies. We expand the vocabulary on and interventions against disinformation, and propose the following: (1) rapid epistemic disobedience as a critical governance tool to resist the cultural hegemony of neoliberalism and its master narrative infinite growth that is damaging the planetary ecosystems, while creating echo chambers overflowing with disinformation, and (2) a two-tiered taxonomy of reflexivity, a state of self-cognizance by knowledge actors, for example, scientists, engineers, and physicians (type 1 reflexivity), as well as by chroniclers of former actors, for example, civil society organizations, journalists, social sciences, and humanities scholars (type 2 reflexivity). This article takes seriously the role of master narratives in quotidian life in production of disinformation and ecological breakdown. The infinite growth narrative does not ask critical questions such as "growth in what, at what costs to society and environment?," and is a dangerous game of brinkmanship that has been testing the planetary ecological boundaries and putting at risk the veracity of knowledge. There is a need for scholars and systems scientists who break ranks with entrenched narratives that pose existential threats to planetary sustainability and are harmful to knowledge veracity. Scholars who resist the obvious recklessness and juggernaut of the pursuit of neoliberal infinite growth would be rooting for living responsibly and in solidarity on a planet with finite resources. The interventions proposed in this study, rapid epistemic disobedience and the expanded reflexivity taxonomy, can advance progressive policies for a good life for all within planetary boundaries, and decolonize knowledge from disinformation in ways that are necessarily upstream, radical, rapid, and emancipatory.

Disinformation as COVID-19's Twin Pandemic: False Equivalences, Entrenched Epistemologies, and Causes-of-Causes

We are currently facing and traversing in the thick of a twin pandemic: coronavirus disease 2019 (COVID-19) and disinformation. Disinformation is false information created and spread deliberately with the intention to mislead public opinion, obscure truths, and undermine trust in knowledge. The digital age we live in is quite different than the printing revolution and invention of the oil-based ink printing press centuries ago. Digital technologies can spread and repeat disinformation at extremely high speeds, while anyone, a qualified expert or not, and with internet access, can become an author. To fight disinformation, we ought to dismantle the entrenched and extractive epistemologies that act as upstream drivers and sites of disinformation production. Epistemology refers to the value-laden knowledge frames, overarching master narratives, and storylines, in which knowledge is produced. If the epistemologies in which we generate knowledge are false, then the knowledge products will be laden with disinformation. Moreover, the harms caused by disinformation can extend well beyond the immediate knowledge domain where disinformation has originated. This occurs when "false equivalence" is used as a form of rhetoric. False equivalence is a type of flawed sense making where equal weight is given to arguments with concrete material evidence, and those that are conjecture, untrue, or unjust. This article presents an analysis of the disinformation pandemic attendant to COVID-19, with an eye to its causes-of-causes: unchecked extractive epistemologies (e.g., technocracy), and the practice of false equivalence in pandemic discourses. We argue that holding the political agency of master narratives to account is essential (1) to fight the disinformation pandemic and (2) for prefigurative politics to build egalitarian and democratic societies in place of the instrumental/transactional relationships that typify the contemporary nation states and the neoliberal university whose ossified rituals lack the normative capacities for critical governance in a time of converging social, digital, and ecological crises. For liberation from disinformation, we should start with liberation from entrenched extractive epistemologies in science and society.

Horizon Scanning: Rise of Planetary Health Genomics and Digital Twins for Pandemic Preparedness

The Covid-19 pandemic accelerated research and development not only in infectious diseases but also in digital technologies to improve monitoring, forecasting, and intervening on planetary and ecological risks. In the European Commission, the Destination Earth (DestinE) is a current major initiative to develop a digital model of the Earth (a "digital twin") with high precision. Moreover, omics systems science is undergoing digital transformation impacting nearly all dimensions of the field, including real-time phenotype capture to data analytics using machine learning and artificial intelligence, to name but a few emerging frontiers. We discuss the ways in which the current ongoing digital transformation in omics offers synergies with digital twins/DestinE. Importantly, we note here the rise of a new field of scholarship, planetary health genomics. We conclude that digital transformation in public and private sectors, digital twins/DestinE, and their convergence with omics systems science are poised to build robust capacities for pandemic preparedness and resilient societies in the 21st century.

Thanatechnology and the Living Dead: New Concepts in Digital Transformation and Human-Computer Interaction

In a digital society, shall we be the authors of our own experience, not only during our lifetime but also after we die? We ask this question because dying and bereavement have become even harder, and much less private, in the digital age. New big data-driven digital industries and technologies are on the rise, with promises of interactive 3D avatars and storage of digital memories of the deceased, so they can continue to exist online as the "living dead" in a digital afterlife. Famous rock and roll icons like Roy Orbison, Frank Zappa, Ronnie James Dio, and Amy Winehouse have famously been turned into holograms that can once again give "live" performances on the touring circuit, often pulling in large audiences. Death studies, dying, and grief have become virtual in the 21st century. We live in truly unprecedented times for human-computer interactions. Thanatology is the scientific study of death, dying, loss, and grief. In contrast to the biological study of biological aging (cellular senescence) and programmed cell death (apoptosis), thanatology employs multiple professional lenses, medical, psychological, physical, spiritual, ethical, descriptive, and normative. In 1997, Carla Sofka introduced the term thanatechnology as "technological mechanisms such as interactive videodiscs and computer programs that are used to access information or aid in learning about thanatology topics." Onward to 2021, the advent of social media, the Internet of Things, and sensors that digitize and archive nearly every human movement and experience are taking thanatechnology, and by extension, digital transformation, to new heights. For example, what happens to digital remains of persons once they cease to exist physically? This article offers a critical study and snapshot of this nascent field, and the "un-disciplinary" sociotechnical issues digital thanatechnologies raise in relation to big data. We also discuss how best to critically govern this new frontier in systems science and the digital society. We suggest that new policy narratives such as (1) the right to nonparticipation in relation to information and communication technologies and (2) the planetary public goods deserve further attention to democratize thanatechnology and big data. To the extent that systems science often depends on data from online platforms, for example, in times of pandemics and ecological crises, "critical thanatechnology studies," introduced in this article, is a timely and essential field of scholarship with broad importance for systems science and planetary health.

Digital Death and Thanatechnology: New Ways of Thinking About Data (Im)Mortality and Digital Transformation

Digital technologies such as the Internet of Things and artificial intelligence are changing how we live and do research, for example, the ways in which patient-reported outcomes and phenomics big data are curated and analyzed. Digital transformation is everywhere and is reshaping data (im)mortality in a wide range of sectors in medicine, engineering, journalism, and beyond. In this context, thanatechnology is a term introduced by Carla Sofka over two decades ago, referring to "any kind of technology that can be used to deal with death, dying, grief, loss, and illness." The field of thanatechnology has become relevant in the digital age as social media is full of accounts from dead individuals, whereas digital media is often harnessed as a source of data and metadata, and in times of pandemics and normalcy. Emerging macroscale analyses forecast billions of social media user accounts from deceased persons in the current century. What happens to digital remains of persons once they cease to exist physically? Digital death, or its absence in the case of deceased individuals, becomes a challenge for both data availability and veracity, and confound research and public health services. Data (im)mortality and digital death are also relevant for research on past events of significance for public health, for example, to discern the history of pandemics and ecological threats. This article examines and calls for new ways of thinking about digital death and thanatechnology as integral dimensions of digital transformation in medicine, new media studies, and society in the 21st century.