Imagination: Where Would We Be Without It?

Happy New Year? This issue begins our 30th year. I have mentioned the journal and its growth quite a lot recently. In fact, we closed out 2023 (our 29th year) with a record number of submissions, nearly 700, and with that a record number of rejections. A journal simply cannot publish everything that is submitted; so you will only see the best of the best here.

Recently, I returned from the NASA Johnson Space Center, where I was recognized for my 33 years of work in human spaceflight and aerospace medicine. Telemedicine has been a key component of both fields for more than 60 years. For me, it has been the imagination of what can be done if we put our minds and skills to work. This concept of imagination, creating or forming new ideas, allows us to think outside the box. Although the construct of space exploration has many attributes, exploration and understanding the Earth are paramount to the human race.

We are now in what is called the Anthropocene Epoch, which often refers to the current time period, where humans are directly impacting the Earth. Although the official term is Holocene, the term Anthropocene is often used; Haines reviews the challenges to human health in this epoch.¹

A key task of NASA and the National Oceanic and Atmospheric Administration (NOAA) as well as many nations is to improve the quality of life on Earth. I am not sure we are doing a good job at the moment with conflicts worldwide and changing climate. Haines mentions imagination in the form of better metrics to assess human progress. Furthermore, the recent work of Tong et al. on the need for human solidarity in addressing human health issues is of greater importance now than ever before.² Although there is only a small amount of scholarly work on this issue of imagination and the Anthropocene Epoch, we must lean into our imagination to affect change.

In the early 2000s, several of us visited the media laboratory at the Massachusetts Institute of Technology (MIT).³ For me, it was like being a kid in a candy store. Imagine graduate students playing with Legos!™ This is where imagination leads to rapid prototyping of creative designs for all sorts of things. Although I took a course in artificial intelligence (AI) in graduate school, it was the visit to MIT where I observed firsthand the human computer interface and the possibilities. Although the field of AI is rapidly growing and impacting our lives, we must (1) imagine life without it and (2) imagine life with it. This might be a paradox.

A recent study by Rao et al. on ChatGPT and clinical decision-making in 36 clinical vignettes at Mass General Brigham indicated a diagnostic accuracy that ranged from 76.9% to 60.3%.⁴ However, it did not score well on differential diagnosis. Now, this may seem both awesome and even a bit premature to say it is successful, but it is the imagination that has driven this—in the sense of using technology to improve health outcome. The work continues.

Imagination in medicine is not new. Altschuler’s Lancet article from 2016 discusses this at length.⁵ He wrote of Benjamin Rush, an American physician in the late 18th century. Rush’s basic tenant was that physician’s observations and experience helped distill new truths. A quote from a Columbia professor “the history of medical discovery is a long chain of imaginative experiences whose links have been welded and fixed by passing through the fiery ordeal of appeal to experimental tests. And could we but set forth, in fitting language, the true story of these mental experiences, with all their vicissitudes of hope and despair, success and failure, we should certainly dispel for all time the wide-spread notion that medical research is a dry painful task, to which only an unimaginative mind can turn with satisfaction,”⁶ reinforces this for us today.

Paul Farmer once said “As you seek to imagine or reimagine solutions to the greatest problems of our time, harness the power of partnership… the power of those partnerships to bridge what seem like different worlds.”⁷ For these past three decades, perhaps even longer, this is exactly what we have imagined. Our researchers, our scholars, our industry partners, and yes, even the government bureaucrats!

Our imaginations can and have created amazing technologies that have transformed our ability to survive and flourish in this world and sometime out of it. It will take all of our imaginations and perseverance to keep us all healthy! Just imagine where we would be without imaginations!

What Is in This Issue

I include a note of thanks at the end of this issue to all those who have served tirelessly in helping me with peer review. You will also notice significantly larger issues for a few months as I am working with the publisher to decrease a backlog, which is not unique to this journal.

This issue contains 31 articles from Australia, Brazil, China, Czech Republic, Malaysia, Poland, Qatar, Saudi Arabia, Turkey, the United Kingdom, and the United States. There are also nine articles on COVID-19.

I wish you all a productive new year. Be imaginative!