COMMENTARY

Self-driving Cars: A Perfect Prescription for Our Aging Patients?

Andrew N. Wilner, MD

Disclosures

January 23, 2018

Seeing the Future on Arizona's Backroads

My recent locum tenens work at the Mayo Clinic landed me in Scottsdale, Arizona, a scenic 2500-mile drive from my Rhode Island home. I soon discovered that Scottsdale is a national test site for autonomous vehicles. It wasn't unusual to see one, two, or three specially equipped Volvos driving around the neighborhood. These vehicles featured a bizarre bubble-shaped contraption on the roof and drivers who eerily rarely touched the steering wheel.

Apart from their novelty value, I couldn't see an advantage to self-driving vehicles. I enjoy driving and avoid the passenger seat, as I tend to get carsick. For me, self-driving cars were an invention looking for a purpose.

But then I started thinking about my patients and the inevitable dreaded discussions about driving. As an epileptologist, I must often advise patients who are usually young, otherwise healthy people that they should not drive because of the risk for an accident due to an unpredictable seizure. Because inability to drive severely limits job and social opportunities, my well-intentioned advice is often received reluctantly, if not rejected out of hand.

Of the estimated 3 million people in the United States with epilepsy, approximately one third have uncontrolled seizures. A rough calculation therefore indicates that uncontrolled seizures force approximately 1 million people out of the driver's seat.

Imperfect guidelines for determining when an epilepsy patient is "safe" to drive further bedevil sage recommendations.[1] The requirement in some states for physicians to report patients with uncontrolled seizures to the department of motor vehicles can also erode the physician-patient relationship, compromising care.[1]

Aging Patients, Abounding Driving Needs

In addition to people with uncontrolled seizures who should not drive, there are millions of aging patients with Alzheimer disease, Parkinson disease, and other neurodegenerative diseases who gradually lose the cognitive, motor, and visual skills requisite for safe driving.[2]

Many of these patients have lost the insight required to recognize the wisdom of "handing in their car keys," resulting in emotional scenes that are unpleasant for all concerned. Loss of driving privileges may be the watershed event that figuratively and literally deprives patients of an independent lifestyle, precipitating admission to a nursing home or other supervised living situations.

Imagine the metamorphosis in the driving discussion that an affordable, self-driving car could bring. Instead of bracing for an argument and stating, "You can't drive anymore," the physician could say, "It's time to trade in that old clunker and get one of those cool, self-driving cars." Problem solved. Maybe Medicare would even pay for it as a "durable medical device!"

I don't own Tesla stock, and I'm not sure whether autonomous driving technology is ready for prime time. But given the rapid pace of technological progress, reliable autonomous vehicles will become a reality long before cures for epilepsy, Alzheimer disease, Parkinson disease, and other neurodegenerative diseases that patients and their neurologists struggle with every day.

According to a recent article in Fortune magazine,[3] self-driving cars will join the roadway in a "noticeable way" in just 3 years. By 2040, self-driving cars will constitute 95% of all new vehicles.

For the sake of millions of people with epilepsy and neurodegenerative disease, I hope that those experimental self-driving cars I saw in Tucson pass muster and become a consumer reality as soon as possible. Neurologists will be relieved of countless disagreeable discussions, and our patients will enjoy improved quality of life.

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