Medicine, Health Care and Philosophy

, Volume 21, Issue 1, pp 31–41 | Cite as

E-health beyond technology: analyzing the paradigm shift that lies beneath

  • Tania MoerenhoutEmail author
  • Ignaas Devisch
  • Gustaaf C. Cornelis
Scientific Contribution


Information and computer technology has come to play an increasingly important role in medicine, to the extent that e-health has been described as a disruptive innovation or revolution in healthcare. The attention is very much focused on the technology itself, and advances that have been made in genetics and biology. This leads to the question: What is changing in medicine today concerning e-health? To what degree could these changes be characterized as a ‘revolution’? We will apply the work of Thomas Kuhn, Larry Laudan, Michel Foucault and other philosophers—which offers an alternative understanding of progress and revolution in medicine to the classic discovery-oriented approach—to our analysis. Nowadays, the long-standing curative or reactive paradigm in medicine is facing a crisis due to an aging population, a significant increase in chronic diseases and the development of more expensive diagnostic tools and therapies. This promotes the evolution towards a new paradigm with an emphasis on preventive medicine. E-health constitutes an essential part of this new paradigm that seeks to solve the challenges presented by an aging population, skyrocketing costs and so forth. Our approach changes the focus from the technology itself toward the underlying paradigm shift in medicine. We will discuss the relevance of this approach by applying it to the surge in digital self-tracking through health apps and wearables: the recognition of the underlying paradigm shift leads to a more comprehensive understanding of self-tracking than a solely discovery-oriented or technology-focused view can provide.


e-Health Paradigm shift Preventive medicine P4 medicine Self-tracking 



We would like to thank Lisa Parker, Brenda Diergaarde, Jonathon Erlen, Katleen Gabriels and three anonymous reviewers for the useful insights they have provided.


Funding was provided by University of Gent, Department of Philosophy and Moral Sciences (Mobility Grant of the Faculty Research Fund).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Abettan, Camille. 2016. Between hype and hope: what is really at stake with personalized medicine? Medicine, Health Care and Philosophy 19 (3): 423–430.CrossRefGoogle Scholar
  2. Ackerknecht, Erwin H. 2016. A short history of medicine, 4th edn. Baltimore: Johns Hopkins University Press.Google Scholar
  3. Appelboom, Geoff, Melissa LoPresti, Jean-Yves Reginster, E. Sander Connolly, and Emmanuel P.L. Dumont. 2014. The quantified patient: a patient participatory culture. Current Medical Research and Opinion 30 (12): 2585–2587.CrossRefGoogle Scholar
  4. Árnason, Vilhjálmur. 2012. The personal is political: ethics and personalized medicine. Ethical Perspectives 19 (1): 103–122.Google Scholar
  5. Bynum, William. 2008. The history of medicine: a very short introduction. New York: Oxford University Press.CrossRefGoogle Scholar
  6. Centers for Disease Control and Prevention (CDC). 2009. The power of prevention. National Center for Chronic Disease Prevention and Health Promotion. Accessed 15 Aug 2016.
  7. Chen, Rui, and Michael Snyder. 2012. Systems biology: personalized medicine for the future? Current Opinion in Pharmacology 12: 623–628.CrossRefGoogle Scholar
  8. Comstock, Jonah. 2012. Scanadu unveils smartphone-enabled home diagnostics. Mobi health news. Accessed 15 Aug 2016.
  9. Devisch, Ignaas, and Myriam Deveugele. 2010. Lifestyle: bioethics at a critical juncture. Cambridge Quarterly of Healthcare Ethics 19: 550–558.CrossRefGoogle Scholar
  10. European Commission. 2014. Population ageing in Europe: facts, implications and policies. Directorate-General for Research and Innovation. European Commission. Accessed 30 Aug 2016.
  11. Eurostat. 2016. Population structure and ageing. Eurostat. Accessed 30 Aug 2016.
  12. Flores, Mauricio, Gustavo Glusman, Kristin Brogaard, Nathan D. Price, and Leroy Hood. 2013. P4 medicine: how systems medicine will transform the healthcare sector and society. Personalized Medicine 10 (6): 565–576.CrossRefGoogle Scholar
  13. Foucault, Michel. 1994a. The birth of the clinic. New York: Vintage Books.Google Scholar
  14. Foucault, Michel. 1994b. La politique de la santé au XVIIIe siècle. In Dits et écrits, eds. Daniel Defert, and François Ewald. Paris: Gallimard.Google Scholar
  15. Gadamer, Hans-Georg. 1996. The enigma of health. Stanford: Stanford University Press.Google Scholar
  16. Golubnitschaja, Olga, Ian D. Watson, Elizabeta Topic, Sverre Sandberg, Maurizio Ferrari, and Vincenzo Costigliola. 2013. Position paper of the EPMA and EFLM: a global vision of the consolidated promotion of an integrative medical approach to advance health care. The EPMA Journal 4: 12.CrossRefGoogle Scholar
  17. Goodwin, William. 2015. Revolution and progress in medicine. Theoretical Medicine and Bioethics 36: 25–39.CrossRefGoogle Scholar
  18. Grady, Janet. 2014. Telehealth: a case study in disruptive innovation. The American Journal of Nursing 114 (4): 38–45.CrossRefGoogle Scholar
  19. Hood, Leroy, Rudi Balling, and Charles Auffray. 2012. Revolutionizing medicine in the 21st century through systems approaches. Biotechnology Journal. doi: 10.1002/biot.201100306.Google Scholar
  20. Kuhn, Thomas. 1974. The structure of scientific revolutions. 2nd and enlarged edition (1970), fifth impression (1974). Chicago: The University of Chicago Press.Google Scholar
  21. Laudan, Larry. 1977. Progress and its problems. Berkeley: University of California Press.Google Scholar
  22. Mather, Mark, Linda A. Jacobsen and Kelvin M. Pollard. 2015. Aging in the United States. Population Bulletin 70: 2. Accessed 15 Aug 2016.
  23. Organisation for Economic Co-operation and Development (OECD). 2015. Health expenditure by function. In Health at a Glance 2015: OECD Indicators. Paris: OECD. doi: 10.1787/health_glance-2015-61-en.Google Scholar
  24. Piwek, Lukasz, David A. Ellis, Sally Andrews, and Adam Joinson. 2016. The rise of consumer health wearables: promises and barriers. PLoS Medicine 13 (2): 1–9.CrossRefGoogle Scholar
  25. Scanadu. 2015. Scanadu vitals. Accessed 15 Aug 2016.
  26. Schwamm, Lee H. 2014. Telehealth: seven strategies to successfully implement disruptive technology and transform health care. Health Affairs 33 (2): 200–206.CrossRefGoogle Scholar
  27. Straus, Eugene, and Alex Straus. 2006. Medical marvels. The 100 greatest advances in medicine. New York: Prometheus Books.Google Scholar
  28. Swan, Melanie. 2013. The quantified self: fundamental disruption in big data science and biological discovery. Big Data, 1 (2): 85–99. Available at:
  29. Topol, Eric. 2015. The patient will see you now. New York: Basic Books.Google Scholar
  30. Trivedi, Amal. 2016. Causes of high health care costs. Merck Manual. Accessed 15 Aug 2016.
  31. United Nations (UN). 2012. Changing levels and trends in mortality: the role of patterns of death by cause. Department of Economic and Social Affairs, Population Division (United Nations publication, ST/ESA/SER.A/318). Accessed 30 Aug 2016.
  32. Wang Rui-Sheng, Bradley A. Maron and Joseph Loscalzo. 2015. Systems medicine: evolution of systems biology from bench to bedside. Wiley Interdisciplinary Reviews: systems Biology and Medicine. doi: 10.1002/wsbm.1297.Google Scholar
  33. Westbrook, Johanna, and Jeffrey Braithwaite. 2010. Will information and communication technology disrupt the health system and deliver on its promise? Medical Journal of Australia 193: 399–400.Google Scholar
  34. Weston, Andrea D., and Leroy Hood. 2004. Systems biology, proteomics, and the future of health care: toward predictive, preventative, and personalized medicine. Journal of Proteome Research 3: 179–196.CrossRefGoogle Scholar
  35. White House. 2015. FACT SHEET: President Obama’s precision medicine initiative. Accessed 11 Sept 2016.
  36. World Health Organization (WHO). 2010. Tackling chronic disease in Europe: strategies, interventions and challenges. European Observatory on Health Systems and Policies. Accessed 30 Aug 2016.
  37. World Health Organization (WHO). 2016. Trade, foreign policy, diplomacy and health: E-health. Accessed 15 Aug 2016.

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Department of Family Medicine and Primary Health Care, Research Unit Ethics, Autonomy and Responsibility in Health CareUniversity of GentGhentBelgium
  2. 2.Department of Philosophy and Moral SciencesUniversity of GentGhentBelgium
  3. 3.Visiting Researcher at the Center for Bioethics and Health LawUniversity of PittsburghPittsburghUSA
  4. 4.Department of Philosophy and Moral SciencesVrije Universiteit BrusselIxellesBelgium

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