5G’s positive impact on Telemedicine + “not in my backyard” (NIMBY) problem of small cells

The IEEE Techblog post below is an excerpt of a November 1, 2019 article titled 5G Is the Future, by Eric  Boehm- a reporter at Reason magazine. Reason magazine- Volume 51; Issue 6; ISSN:00486906.   Edits and additional comments by Alan J Weissberger.  You can read the entire article by subscribing to Reason here.

5G Impact on Telemedicine:

The ability to move more data more quickly between devices will open the door to new medical technologies, giving doctors volumes of information about patients even without being in the same room. That means telemedicine could finally be ready to go mainstream.

Market Research Future, a firm that predicts business trends, expects the American telemedicine market to grow by more than 16 percent annually from 2017 to 2023, in large part because faster connection speeds and lower latency will let doctors talk to and diagnose patients via high-definition video streamed from a phone. That could be a huge development for access to medical care-one that would be a boon for residents of rural areas, for the poor, and for the elderly. And everyone will benefit from spending less time sitting in a waiting room. If 4G gives you the ability to play Angry Birds until the doctor is ready to see you, 5G may let you skip the in-person visit altogether.

Some telemedicine will be fully automated, with wearable sensors providing real-time information about vital signs, falls, or physical activity, giving doctors a better understanding of a patient’s health with fewer invasive procedures. A Stanford University study estimates that, in 2020, Americans will produce 2,314 exabytes of medical data (an exabyte is equal to a billion gigabytes), up from a mere 153 exabytes in 2013.

“Those troves of information become the foundation for biomedical research,” the Stanford researchers conclude. “We are beginning to reconstruct the relationship between genes and life and health in ways that are likely to be transformative.”


5G’S NIMBY Problem:

Some of the U.S. government policies that will dictate 5G’s future are being made right now at the State Department, the Commerce Department, and the FCC. But equally important is what happens in places like Washington, D.C. office of Mayor Muriel Bowser and the city council.  During an October 2018 hearing there, Advisory Neighborhood Commissioner Ann Mladinov voiced concern about the “visual clutter” that could result from having “so many additional poles holding small cell boxes over sidewalks and in other public space.” At the same hearing, another attendee told the council it should protect D.C. neighborhoods’ aesthetic qualities from being “put at risk for more corporate gain.” Like tall buildings and other forms ofvisible urban development, 5G has a “not in my backyard” (NIMBY) problem.  For sure, it will be exacerbated with 5G mmWave spectrum which requires many more small cells due to limited range.

Those complaints, and many more like them lodged with city councils across the country, have to do with the physical hardware that will be necessary for widespread 5G adoption. Mobile providers are ditching the traditional cell tower, the backbone of cellular networks since they first emerged, in favor of so-called “small cell” antennas. These devices-some no bigger than a backpack, others as large as a refrigerator-will be affixed to telephone poles and buildings. Because each one has a considerably smaller range than a tower, covering a whole city requires a small cell to be placed every few blocks, a potential point of friction for residents who dislike change. But the benefits for users will be large.

Not only will the physical components be capable of making faster connections, but the physical proximity to users and greater bandwidth will allow more devices to be connected at once. A 4G network can handle about 4,000 devices per square kilometer. Verizon CEO Hans Vestberg has claimed that 5G networks will be able to handle up to 1 million devices within the same space.

“It’s going to introduce more competition, that’s for sure,” says Ian Adams, a 5G policy expert with TechFreedom, a nonprofit advocacy group. Because 5G mobile networks will offer speeds similar to wired connections, cable companies and traditional internet service providers will have more rivals. This may force them to innovate or lower prices, and the likely result will be better, cheaper online access for all.  But if the tradeoff is greater “visual clutter” on and above city streets, some people won’t be on the side of innovation.

In letters to the FCCtelecom companies have complained about a wide range of local regulations that have slowed the deployment of 5G infrastructure-often a result of trying to apply rules written for large cell towers to the small cell antennas. For example, one Pennsylvania town requires that an eight-foot fence be erected around any structure containing a small cell antenna. That’s common sense for older, larger towers, but it’s nonsensical for a device that can be attached to a telephone pole.

Similarly, AT&T complained that it has had to pause or decrease small cell deployments in parts of California, Maryland, and Massachusetts due to high fees, and that some municipalities in Washington and New York have used restrictive zoning to limit the placement of small cell antennas. Timing is also an issue. The Wireless Infrastructure Association (WIA), an industry group, claims that about a third of all wireless antenna approvals exceed the 90-day limit for review that the FCC established in 2009. In one extreme case, the town of Paramus, New Jersey, spent five years considering a Sprint application for a new cell site before denying the request. In Greenburgh, New York, a small cell contractor faced a review process for a single antenna that “took approximately two years and nearly twenty meetings, with constantly shifting demands,” the WIA says. When a telecom company wanted to attach 23 small cells to the sides of Houston’s NRG Stadium, it first had to spend $180,000 in mandatory historic review fees. The stadium was built in 2002.

In taking action to curb the worst abuses, the FCC is attempting to strike a balance between innovation and local control. The agency estimates that streamlining the approval process will save telecoms $2 billion that can be put toward further expansion of their 5G networks.

But federal pre-emption is always going to be an imperfect solution. Ideally, telecom companies would negotiate with individual property owners to obtain the right to place small cell antennas on the sides of buildings or atop privately owned poles. But local governments generally control where such devices can be installed and how much companies are required to pay for the privilege.

It’s fine for residents to voice their opinions, of course, but “a local government shouldn’t get to impede the development of a national infrastructure,” says Adams. “Putting guardrails on particularly egregious local actions,” as the FCC has tried to do, is “important if we want to have uniformity of infrastructure.”

The local interference can indeed be egregious. In 2015, San Jose, California, started charging telecom companies $3,500 for each small cell antenna installed-far more than what similarly sized cities like Phoenix ($100) and Indianapolis ($50) charge for the right to install the same equipment. By 2018, it was apparent that the costs were causing San Jose to fall behind in the early stages of 5G deployment. So the city reconfigured the per-antenna fee into a $1 million one-time payment coupled with ongoing tax obligations. San Jose Mayor Sam Liccardo promised to use the revenue for a “Digital Inclusion Fund” that would spend $24 million bringing high-speed internet to 50,000 low-income households within the next 10 years.

The FCC’s new rules put an end to that shakedown. By capping the fees that localities can charge for installing 5G small cell antennas, it ensured that companies like T-Mobile and Verizon don’t have to pay off cities like San Jose for the right to bring residents high-speed mobile internet.

Shireen Santosham, the chief innovation officer within the San Jose mayor’s office, has called the FCC’s rules “a $2 billion taxpayer-funded subsidy to corporate interests.” But that’s hardly accurate. The new policy doesn’t require that taxpayers underwrite the 5G rollout. It only prevents cities from extorting telecom companies for the right to deploy small antennas. Keeping those dollars out of city tax coffers means the companies will be able to invest in infrastructure where they know it’s needed rather than where bureaucrats decide it should go.

Governments should strive to make “an honest assessment of where the market is,” says Pai, “recognizing that government can’t predict and shouldn’t micromanage the future, and getting rid of the red tape that stifles innovation and progress.”

FCC vs Dept of Commerce on 5G mmWave at 24 GHz:

In May, NASA and the National Oceanic and Atmospheric Administration (NOAA), which are jointly responsible for America’s fleet of weather-tracking satellites, complained to Congress that 5G cellphone signals in the 24 GHz band could interfere with satellites that read water vapor signals coming off the ocean. Among other things, those satellites are critical for forecasting the paths of tropical storms. In 2012, for example, they correctly predicted that Hurricane Sandy would make an unusual westward turn toward the New York City metro area. Without that tip, the disaster could have been far worse.

NOAA relies on a signal band that runs between 23.6 GHz and 24 GHz, so there won’t be direct overlap with the 24 GHz space that the mobile companies bought, which is currently unused. The federal weathermen say things could get cloudy along the very edges, where the bands run up against one another. Pai’s agency predicts sunny skies ahead because there’s already a buffer zone between the two bandwidths-and because independent testing commissioned by the FCC has concluded that there’s no need to worry.

“The assumptions that undergird [NOAA’s 5G interference claims] are fundamentally flawed,” Pai told the Senate Commerce Committee in June. Among other things, the NOAA study did not take into account the fact that 5G signals will be more focused (“beam-forming signals,” in industry lingo) than the signals sent by traditional cellphone towers, which broadcast in all directions.

In the two years since NOAA initially objected, the agency has not completed a follow-up study to confirm its worries about interference. FCC Chairman Pai told lawmakers he was frustrated by the holdups. “The Department of Commerce [which oversees NOAA] has been blocking our efforts at every single turn,” he said.

If the possibility of interference with weather satellites “is truly a technical problem,” says Joel Thayer, policy counsel for The App Association, which represents more than 5,000 app makers and mobile device companies, “then these agencies can solve it with technical solutions instead of performing political theater.”


Realistically, 5G technology is going to make everyone better off, even if we can’t predict exactly how. When the first 4G smartphones went on the market in 2009, they were expected to usher in an explosion of new apps and other software. But few could have predicted the specifics, from Uber to Fortnite.

The same will be true for the 5G era. Brent Skorup, a senior research fellow at the Mercatus Center at George Mason University, predicts we’ll get “warehouse-floor robots that self-organize shipments, remotely operated electric air taxis that carry passengers high above rush-hour traffic, or smart glasses that connect blind people with professional guides who use audiovideo feeds to help wearers get around.”

Fast mobile connectivity is the foundation for whatever future innovations may develop. It promises more jobs, better communication, more enjoyable leisure time, and medical advances that let us live longer. “The speed of our connections is the speed of commerce,” says Adams, who favors the mostly hands-off approach the FCC has been taking with the 5G rollout. Whether for work or for play, he says, “the availability of virtually unlimited data is only going to improve the quality of life.”

The ability to move more data more quickly will open the door to new medical technologies, giving doctors volumes of information about patients even without being in the same room.

3 thoughts on “5G’s positive impact on Telemedicine + “not in my backyard” (NIMBY) problem of small cells

  1. 5G Will Mean Better Speeds and Telehealth, FCC Chair Says
    Federal Communications Commission Chairman Ajit Pai visited Abilene Memorial Hospital in Kansas last week to observe how broadband connects the local emergency department with specialists in South Dakota.
    “5G promises speeds that are 100 times as fast as 4G LTE,” Pai said. “The amount of data that you can send wirelessly will be much greater. Especially in some of these rural communities, 5G could be a significant benefit and not just for telemedicine but for precision agriculture, online education, e-commerce and civic engagement.”

    The Consumer Technology Association has pointed out that at 5G speed, one can download a 2-hour movie in just 3.6 seconds, versus 6 minutes on 4G or 26 hours on 3G.

    “We are focused on making sure that 5G extends to all parts of the country, particularly to rural Americans,” Pai said.
    Pai observed Avera Health, a telehealth system used by Abilene Memorial Hospital.

    Recently Pai had visited with Dr. Brian Skow, chief medical officer for Avera, in Sioux Falls, South Dakota.

    Speaking through an Avera internet connection last week, Skow said the certified emergency doctors and nurses in Sioux Falls can assist with the examination of and decision making for patients in Abilene.

    “Without connectability, it would not be possible,” Skow said of the program. “When we are promoting teleheath and how it can assist rural communities, that is probably the biggest piece: connectivity and the cost.”

    Avera has 200 participating hospitals in 30 states.

    “We help with critical cases like stroke, trauma, sepsis,” Skow said. “Broadband, the connectivity, is just critical to have either a T1 line or a fiber line that connects to the facility. If you don’t have a dedicated line when you are dealing with these critical patients and something would go down, it could potentially be a life loss.”

    Abilene memorial has AT&T and Eagle broadband connections.

    The doctors and nurses in Sioux Falls can zoom in during the incubation of a patient and can see inside the airway and the vocal cords.

    “We can assist with those type of things,” Skow said.

  2. 5 ways 5G will transform healthcare-Improving patient experience with personalized, preventative care

    For people in rural areas, with doctors located several miles away, traveling while ill can be challenging and time-consuming. With the advent of telehealth and remote home monitoring systems, though, we could receive care from the comfort of our homes. Doctors could make recommendations after a short video call, and even submit prescription requests. However, this remote monitoring, along with sophisticated imaging equipment, can lead to additional strain on the networks of businesses in the healthcare industry. This often increases congestion and slows network speeds, especially for healthcare providers that might be interfacing with dozens of patients a day. The lag is not only frustrating for those using it, but the poor quality can delay patient care, which could hurt outcomes in the long run. And because the use of Internet of Things (IoT) technologies continue to grow, the amount of data on networks is expected to only increase more. 5G technologies have the potential to help resolve these challenges. Here are five ways 5G can help healthcare organizations meet the growing demands of digital transformation.

    1. Quickly transmitting large imaging files
    2. Expanding telemedicine
    According to a study by Market Research Future, the telemedicine market is expected to grow at a compound annual growth rate of 16.5% from 2017 to 2023. The study determined that the reason for the predicted increase is demand in rural areas for healthcare, as well as a rise in government initiatives.
    3. Improving AR, VR and spatial computing
    While augmented reality (AR), virtual reality (VR) and spatial computing are already being used in healthcare on a limited basis, 5G may eventually further enhance a doctor’s ability to deliver innovative, less invasive treatments. Among 5G’s many ultimate potential applications, some of the most exciting involve its role in simulating complex medical scenarios and enabling alternative treatments for the critically ill. AT&T is working at the forefront of this exciting field, exploring opportunities to apply 5G to medical challenges. AT&T is collaborating with VITAS® Healthcare to study the effects of eventual 5G-enabled AR and VR on patient engagement. The goal is to reduce pain and anxiety for terminally ill patients in hospice by providing calming, distracting content via 5G-enabled AR and VR.
    4. Reliable, real-time remote monitoring
    By using IoT devices, healthcare providers can monitor patients and gather data that can be used to improve personalized and preventive care. According to Anthem, 86% of doctors say wearables, which are a common type of remote monitoring, increase patient engagement with their own health. Additionally, wearables are predicted to decrease hospital costs by 16% in the next five years.


  3. ‘I felt nauseous,’ Bucks County woman says of plan for 48-foot 5G cell tower in her front yard:

    Telecom infrastructure firm Crown Castle was putting a new 48-foot-tall small cell antenna in their public right-of-way, replacing a lamppost. Four times taller than the existing lamppost as permitted, the pole would be topped with an antenna to broaden wireless coverage in the Doylestown Township area and could be upgraded to superfast 5G.

    Already there are more than 1,800 small cell antennas in Philadelphia — with thousands more expected in the city — and discussions over them have occurred in the Main Line towns of Lower Merion and Radnor. Telecom firms and companies such as Crown Castle could install more than one million small cell antennas over the next decade nationwide, even as homeowners fear lower property values and local government officials say they will lose zoning control over rights-of-way in their municipalities.


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