Armed with Big Data on someone’s genome and health history, an algorithm could diagnose many ailments, and prescribe treatments, as well as humans if not better. Would doing so sound the death knell for doctors and surgeons? I suspect not. Medical professionals are likely to draw increasingly on data and algorithmic insights. But there will be an accompanying, increasingly important, role for human judgement, explanation and empathy. Indeed, it is already the case that these human skills are often among the most highly-valued by patients. In a world of robo-medical advice, the balance of doctors’ skills will shift further in this interpersonal direction. As with much of human history, this will be a case not so much of humans versus machines as humans with machines. The evolutionary arc of humankind will not switch, discretely, from one defined by neurology to one defined by technology. What we could see instead is a co-evolutionary arc with minds and machines, neurology and technology, co-mingled and complementary.34 In a number of tasks they already are. 31  https://www.bbc.co.uk/news/technology-34066941 Bughin et al (2018) Bakhshl et al (2015). 34 Tegmark (2017). 32 33  14  All speeches are available online at www.bankofengland.co.uk/speeches  14  Take chess. A generation on from Deep Blue beating Gary Kasparov, you might expect machines to have taken an unassailable lead. In fact, they have not. The world chess championship is not waged between mainframes.
Would it be remunerated or not and how appealing should any remuneration be versus commercial bank money held on deposit accounts? Would we apply limits or restrictions on its use to control demand in normal times or in stress? How and to what extent should data and privacy be protected? And crucially, running though all of these design questions of the question where the public/private boundary lie; which functions and services should be provided by the central bank and which by the private sector? These are profound questions and choices that would inform any decision to launch a CBDC. We certainly do not have the answers today. We should however recognise a couple of realities. First, that the form of money has always been evolving and that technology and consequent changes in the way we want to live and transact with each other are now driving rapid change in money and payments. We cannot hold that back. We need to think about and debate these issues now. And in thinking about CBDC, we should think about the role it could play in the future and how money and payments might evolve in its absence. Second, changes in the form of money have implications that go wider than finance and economics. We should recognise there are questions about privacy, competition, inclusion, the role of the public sector and other broader societal issues. These will require the engagement of the political authorities and will need broader debate.