TTM 2014 - Future of Health Care

Reducing the cost of drug development is one of the big challenges for the next decades. Credit: Foundation of Mitochondrial Medicine

The progress made by medicine has been staggering in the last three decades: organ implants, bio-implants, robotic surgery and micro-invasive surgery, novel diagnostic tools to peer inside the body, better drugs, to name but a few areas.

All of these progresses have been fuelled and sustained by technology evolution. At the IEEE Technology Time Machine 2014 coming up this October 21st-22nd in San Jose, there will be a talk on the Future of Health care, a talk that will look at today's technology, players and regulation to stimulate thinking about tomorrow.

Health care is, in a way,  "applied medicine" and more than ever it is tied to technology advances. At the same time it remains strongly tied to economic aspects (would investing in the search for a cure, if successful, bring sufficient revenues in return? And if not should the Government step in to do what private companies are unlikely to do?) and to regulatory aspects. Very possibly along with technology evolution over a time span of twenty years we will also be seeing economic and regulatory evolution.

I'm no expert in health care, although I have been following the evolution of medicine and health care for over fifteen years from the point of view of technology. And if I look at it from this point of view I can see impressive evolution ahead. There are of course many aspects of medicine and health care that will experience a profound evolution in the next twenty years, but I will mention just 4 of them:

1. Novel approaches to customised health care

2. More accurate diagnostic methods

3. Regenerative medicine

4. Growing personal awareness of keeping healthy

The first area is stemming from the growing knowledge derived from the human genome. Today we have just started and I don't think that in the next 20 years we will have a full grasp on the genome and of its consequences. However, technology is making genome sequentialisation faster and cheaper. Expect a whole human genome sequentialised in a day at a cost below 100$ by the end of this decade, even faster and cheaper by the end of the next decade. This will allow the accrual of an amazing mass of data that can be analysed in a comparative way, leading to unprecedented customisation and a shift in paradigm. Whereas till the end of the XIX century what mattered were the symptoms and in the last century (and still today) diagnostic tools took the upper hand, in the coming decades knowing who you are at the metabolic and genomic level will be important to understand your problems and to customise the cure. We are still far from that point, but we are seeing the first sign of genomic data comparison and the resulting clues on what a genomic variation leads to. 
This is likely to remain the turf for big companies plus a few medium ones and an area that will remain strongly regulated.

The technology advance in diagnostic tools is the second area that I see having a strong impact in the coming decade. It will provide monitoring, often in real time, and will contribute to customised health care. We are starting to see unprecedented details of the brain as it works (and thinks) and this is opening the door to better understanding and detection of anomalies that might eventually be cured. Embedded electronics, bio-implants will sense a variety of parameters and will make possible to release drugs at the time and in the µdoses required. Advances in material science will make these implants possible, without disrupting the normal life of cells in the body. Accurate continuous monitoring with devices on the surface of our body or embedded will go hand in hand with the customisation of cure and will potentially restructure part of the cost involved in designing a new drug, as shown in the graphic. This is an area where I can see quite a bit of innovation being created by start ups (usually stemming out from university research labs) and a strong presence of big players.

Regenerative medicine has just started with the help of technology making bio-printing of tissues feasible. Skin printing is common and bone printing has been experimented on a few patients; in the labs researchers have started to print more complex 3D structures with the goal of printing organs. A first prototype of a kidney has been shown and within twenty years printing of liver, kidney, muscle and heart may become feasible. The advance in understanding on "how" tissues and organs are created from stem cells will also make bio-engineered organ growth a reality although looking at how technology is evolving I would bet more on organ printing as the first step. This area is the turf for innovation by small and medium companies although the sort of regulatory control involved will likely see the presence of the big guns that will absorb the most promising start ups. This does not mean that it is impossibile to see a small start up (like Organovo?) becoming the next big thing.

The last area I like to address brings to the fore a variety of players, most of them non existing today, that will play the health care game in an unregulated space. It is the area of Apps and wearables, an area where everybody can easily exploit technology advances to provide clues and hints on your well being and tracking on your progress. Wearable devices (including smartphones) are growing and because they are worn they can easily track (although often with low accuracy) several life parameters. Applications may process these parameters along with ambient data (external temperature, humidity, presence of pollen, altitude, acceleration...) and provide each of us with a general picture on how we are and how we improve.

They will not take any responsibility on our health, hence they will not be subject to regulation, but overall they will change our perspective on health care and our responsibility in being healthy.  I would expect new issues coming out of this, since it is a fuzzy boundary the separation between well-being and health care, and this is also likely to generate intrusion from insurance companies that may start to charge more for their medical insurance if you are not monitored and if you are not living a healthy life style.  We have seen in some cases car insurance companies offering a better deal if you accept a black box in your car (or a more pricey insurance if you are not!) and I wouldn't be surprised to see a black box embedded in our body in the future. Not for me, but it might be something my grandchildren will have to be concerned about.


Author - Roberto Saracco

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