Intended for healthcare professionals

Medical Milestones

Computers: transcending our limits?

BMJ 2007; 334 doi: (Published 04 January 2007) Cite this as: BMJ 2007;334:s8
  1. Alejandro R Jadad, chair, professor, and founder,
  2. Murray W Enkin, emeritus professor
  1. 1Centre for Global eHealth Innovation, University Health Network, and University of Toronto, Toronto ON M5G 2C4, Canada

    By transcending physical, geographical, and cultural barriers, computer technology could help achieve optimal health for all

    The capacity to compute is at least as old as life itself. It has been driven for billions of years by organic software encoded in elaborate sequences of base pairings embedded in DNA. Thanks to this biological computing system, nature was able to explode into a diverse community of living things as simple as prions and as complex as humans—creatures armed with deliberative computers, their brains. The hominid brain continued to evolve over hundreds of thousands of years, gaining increasing layers of interconnecting neurones. This complex interconnectivity gave us the ability to recognise our limitations and our mortality and set us on an inexorable quest to overcome them.

    A perpetual overcoming

    Since the Stone Age we have evaluated, interpreted, calculated, and computed. As we observed the effects of our primitive interventions we tried, tried again, and modified our technology. Our legs could take us only so far, until we extended their reach through increasingly sophisticated means of transportation—technology that took us across land and sea and through the air. We overcame the limits of our visual acuity with lenses, opening new vistas of the heavens and the microcosm. Our clinical gaze was augmented by new understandings of anatomy, physiology, and pathology. New tools, such as the stethoscope, radiography, and anaesthesia, let us listen to and see into the human body and tinker with it.

    Inevitably, we moved beyond augmenting our limbs and our sense organs. Our powerful brain began to realise its own limitations. With its insatiable urge for self improvement and its unparalleled parallel processing capacity it began building tools to enhance itself. We created external devices that exponentially increased our ability to calculate, analyse, and learn. It took us two millennia to jump from the Babylonian abacus to the mechanical eight digit calculator that Pascal built in the Enlightenment. After only two centuries Charles Babbage envisaged a massive, steam powered mechanical calculator designed to print astronomical tables. Less than a century later Alan Turing created Colossus, an electronic computer that helped end a war plagued by our self destructive drive and power. Over only decades in the second half of the 20th century we developed powerful resources to communicate and exchange unlimited amounts of knowledge, almost anywhere and at any time. We created a global network of computers able to decode the genome; machines capable of seeing our body and its functions in three dimensions; tools to track and control diseases remotely. Computers started to change the way we learn, live, communicate, and heal.

    Nevertheless, the effect of computers on the delivery of health services, even in rich countries, was not obvious. By the end of the century most people still lacked electronic health records, and few health professionals used email or even the phone as part of their clinical communication. Most budgets targeted the control or treatment of diseases, rather than prevention or health promotion. Collaboration across institutional or geographical boundaries was almost non-existent. In deprived areas of the world computers had little effect on perinatal mortality, major infectious diseases, or access to clean water.

    Twenty first century visions

    Extrapolations of 20th century trends into 21st century visions are not optimistic. Trans-humanists believe that our role will be over when our brains create intelligent machines that will continue the exponential pace of evolution for ever.1 Their views have been reinforced by the defeat of the best human at chess by a computer, the advent of pilotless aircraft and spaceships, the emergence of robots able to perform surgery without human intervention, and the creation of prosthetic limbs that can be operated mentally. Apocalyptics believe that what we call civilisation is nothing more than a dead end trap, leading to human extinction.2 3 4 Current trends in climate change and environmental degradation, the raised threat of nuclear conflict, the prospect of devastating pandemics, and the unmanageable burden of poverty, chronic diseases, and ageing are strong signals that the arrival of the four horsemen of the Apocalypse may not be far off.

    Humanodes in the global superorganism

    But extrapolation does not acknowledge the complexity of evolution. A more exciting scenario may be unfolding, in which the future is not predetermined by immutable forces but shaped by our values, our interactions, and our will to survive as autonomously as possible against all odds.5 The 21st century computer age gives us the opportunity to create a “noosphere,”6 a true planetary thinking network with individual but interdependent humans as its nodes. The exponential development of wireless networks, mobile computing tools, and the internet may already be giving us a glimpse of a future in which we could work as “humanodes” in a true global superorganism.7 8

    Computer technology can help us achieve optimal levels of health and wellbeing regardless of who or where we are. It can help us transcend our cognitive, physical, institutional, geographical, cultural, linguistic, and historical boundaries. Or it can contribute to our extinction. We believe that the choice is ours. We hope that we choose, not just with information, not just with knowledge, but with wisdom.


    • Publication of this online supplement is made possible by an educational grant from AstraZeneca

    • Competing interests: None declared.

    • For a biography of Alejandro Jadad and Murray Enkin see


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