Greg Beatty
Bellingham, Washington, United States

In the original Star Trek, the real Star Trek, there were several major recurring characters. There was of course James Tiberius Kirk, Captain of the Enterprise, the ever conflicted Vulcan first officer Mr. Spock, the charmingly clichéd Scottish engineer “Scotty,” and of course the chief medical officer Dr. Leonard “Bones” McCoy.

Since Star Trek was set in the far future, when all technology was impossibly advanced, medicine equally and impressively advanced. Yet in more than one episode, Bones railed against having to practice under exceptionally primitive conditions, complaining about being a medical doctor such as those the twentieth century audiences knew. This made for a fine blend of drama and humor, depending on how that week’s show went. Sometimes he was forced to improvise, like a cranky, futuristic MacGyver. Sometimes he simply complained about what he could have done if he had the proper instruments.

Chief among these instruments was the tricorder. This was an all-purpose sensor, one the medical officer simply held near the body and voilá! Bones listened to some odd sounds, observed the occasional flashing lights, then issued clear and specific diagnoses. While there were times when the tricorder fell short — most often when Bones was asked to examine new alien lifeforms — there was never an occasion when the tricorder went fundamentally wrong. It never made mistakes. More strikingly, there was never an occasion when some anti-vaxxer or member of the Enterprise crew rebelled against the impossible, impersonal authority of the tricorder. Everyone simply accepted that the technology was perfect, the medicine was perfect, and Bones could do miracles.

Everyone in the world would of course love to have a tricorder, and the medical technologies that accompanied it, like painless shots. However, like the impossibly easy transportation that the Star Trek transporter provided — simply beaming people from one place to another — what viewers saw in the tricorder was the finished product. It was a perfect and stable example of medical technology, and Bones saw it as an essential part of being a medical doctor.

The tricorder provides both utopian fantasy and a warning for those of us living in the world beyond Star Trek creator Gene Roddenberry’s imagination. The fantasy of course is that we could have medical technology that could do so many things and so well. The warning is twofold. First, what you see here is essentially offloading a great deal of the doctor’s authority and responsibility into a handheld device. This is a harbinger of what was to come, a change we are living through. People have offloaded much of their decision-making, and much of their memory, to their cell phones. We are in the process of seeing doctors do this as well, as they accept the very real help that digital technology can provide. Big data analysis can find patterns more quickly than a living human could, and can crunch more numbers than any person could. Options can be reviewed, and obscure diseases searched for.

This is beyond doubt a breakthrough. Great possibilities arise for improving medical care. However, Dr. McCoy’s relative helplessness when he was robbed of his advanced tools also sketches the risk involved in all of this. The more medical expertise gets offloaded to machines, the less doctors will be doctors.

There is a standing joke among Star Trek fans about the crewmen in the red shirts. The joke is that whenever the crew from the Enterprise beams down to a new planet to explore it, the planet shows how dangerous it is by killing off a member of their expedition. It cannot be Kirk or Spock — they are the stars — so the person who dies is always the nameless crewman in the red shirt. This is so well-known a cliché that it shows up in the movie Galaxy Quest, a spoof of the Star Trek universe and its fandom. Well, the more machines take over the responsibility for medicine, the more closely doctors will become nameless crewmen in redshirts, commodified and disposable, rather than the intensely personal ideal medicine has long held of the caring empath who applies his or her expert knowledge in service of the heart.

This transfer of medical authority to the machine has other, more subtle, implications as well. In 1947, long before Star Trek appeared on its five-year mission, science fiction great Jack Williamson wrote “With Folded Hands.” This story describes a situation in which robots programmed to care for humanity take that responsibility too far. Because they cannot let humanity come to harm, they do everything for them. This keeps humanity safe, but also infantilizes and castrates humanity, leaving people sitting on the side “with folded hands.”

Williamson’s robots were humanoids, the classic man-shaped mechanical servants who went about their work visibly. People could see they were being displaced, and react to it. What Williamson and the rest of Golden Age science fiction did not anticipate is what is now being called the “Internet of Things.” The Internet of Things is made up of electronic devices that share digital connections. These connections allow them to communicate directly, without any need for human intervention, and often without human knowledge. This happens all the time, and is the reason why when you search for shoes on Google, the next time you login to Facebook shoe ads show up in your feed. Information is being traded about you, me, and all of us. Many people have sounded the alarm about the loss of privacy. I will not go into that here. What I will do is note that the Internet of things is ripe for abuse, even benign abuse, in the medical realm.

Imagine a world where robots of incredible capacity have the ability and responsibility to take care of human beings. This is, obviously, a scenario borrowed from Williamson. Now imagine something already underway: a world where all electronic devices communicate with one another continually. As a result, when you add that chocolate-covered indulgence to your electronic grocery list, your smart house might delete it from the list. If you add it to your cart anyway, the supermarket might not let you buy it. If it does, your refrigerator might not let it in. At best you might have to negotiate for a daily exception to your dietary rules, which are preprogrammed into all your electronics, to better care for your health. At worst you simply will not be allowed to eat that delicious chocolate-covered treat. Nor the deep-fried blank you so enjoy, the breaded blank, or the artificially seasoned bag of blanks. On one hand, this is a doctor’s dream: many of the situations and illnesses people suffer from today arise directly from their inability or unwillingness to do what is best for them. Everyone knows that super sizing things is bad for them. Everyone knows that a big gulp of soda is horrific for their health. But they do it anyway. For now. Eventually, medical robots will interface with phones, cars, refrigerators, grocery lists, and maybe treadmills. People will lead healthy lives, and medicine will be easier and better informed. But just as Bones is no longer a real doctor, people will no longer be fully people. Science fiction has warned us: we will have better medicine, almost miraculously better. We will have better health, and be guided to better quality of life. But the price may be reduced autonomy, and minimalized doctors.