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Future of Health Care - extract from The Future of Almost Everything book, by Futurist keynote speaker and physician, Dr Patrick Dixon, strategy and trends advisor to over 400 of the world's largest corporations, including many multinational pharma and health care companies.

We have seen how the future of every nation is linked to demographics, migrations and cities. But these things are also linked to the future of health care: not only how many people are born, but how fit they are, how long they live and other future health trends - all of which, as will see, are hugely impacted by inequalities of income and wealth.

Most of humankind will see an astonishing health care revolution over the next 30-50 years.

The fact is that 65% of all health spending in developed nations is on those over the age of 65, most of whom have several chronic medical conditions, almost all related to the ageing process.  Things like high blood pressure, blocked coronary arteries, arthritis, alzheimers or reduced ability to metabolise sugar (Type II diabetes).

Therefore it could be said that every pharma company and every hospital will exist in future primarily to serve the needs of older people, in those parts of the world.

And the greatest future health challenges in the next two decades will almost all relate to ageing, as many emerging nations also become older, with rapid rise in age-related chronic  health conditions. 

Shift from sickness prevention to enhancing performance

The whole emphasis of health care is already shifting from treatment of disease to prevention, wellness and improving performance.

Many pharma drugs used today to treat illness will be used in future to enhance performance in normal, healthy people.

For the last decade we have seen this trend unfold in sexual health and treatments for memory loss.

Drugs like Viagra and Cialis were first prescribed for men with varying degrees of sexual dysfunction or impotence, conditions which are more frequent as men become older.

But both are now more widely used to enhance ‘normal’ sexual performance, with growing sales on the online black market.

Drugs to help students pass exams and researchers write papers

The same has happened with Ritalin and other pharma drugs which are often used by doctors to enhance brain function in older people with memory loss, from a range of conditions like Alzheimers.

When it comes to enhancing normal brain performance, 20% of all US and UK students are now using such drugs to help pass exams.  

But such patterns are spreading beyond students. At a recent conference of neurophysiology professors and researchers, a survey showed that most of them were regularly self-medicating with a range of prescription only drugs, to help them concentrate, write better or give better lectures.  

What is more, these global experts on brain function were convinced that such drugs were significantly improving their own mental performance, with few risks or side effects.

Energy boost for older people - improve memory, immune system and healing

In the past, the question might be, ‘What do you expect at your age?’. In the future the question will be, ‘What can you do to help me stop feeling my age?’

The commonest complaint of older people is lack of energy, tiredness and slowing down.  So is chronic tiredness just an acceptable and normal part of slowing down as we get older, or is it a medical condition to be reversed?  The history of medicine is full of examples of things we used to regard as normal parts of every day life, but we now recognise are treatable conditions.

The greatest blockbuster pharma drugs of all time will rejuvenate old bodies and brains by targeting common systems in every cell, increasing the efficiency of mitochondria, for example, which generate electrical power.

Mitochondria have their own genes, they divide and can be swapped between animals and humans. 1% of all the genetic code in every one of our cells, is in the mitochondria. Their function is to turn our food into electricity - to power up every process in every cell.  The more efficient they are, the more active those cells will be.

Old mitochondria have been revived in mice and rats, with treatments such as alphalipoic acid in combination with other drugs. The old mice run around faster, and solve mazes more rapidly.  Now we need to be careful before jumping to conclusions about whether we can revive old mitochondria in humans, but it is clear that the impact on human health and performance could be huge.

Future of cosmetics, cosmetic surgery trends, skin care and face lifts

We are seeing a similar trend in cosmetics – performance enhancement in skin. The greatest drivers of sales in cosmetics will be ageing populations and emerging middle class consumers, buying over the counter skin creams, lotions and other therapies. The global cosmetics market will be worth around $300bn by 2020, growing by 3-4% a year.

Hundreds of million women over the age of 30 already want to look far younger.  We live an age which is ever-more obsessed with youth and personal appearance, amplified a billion times a day by smartphone cameras recording every moment of our lives, social media selfies, and a global culture of celebrity.

Some wealthier women will end up paying more than $1000 every year for the latest ‘miracle’ skin treatments.

The damaged ozone layer still covers 10 million square miles and will continue to fuel tourist concerns about skin cancers. Sunlight will be blamed for an increasing number of health disorders, including cataracts and non-Hodgkin’s lymphoma (a type of cancer).

Skin cosmetics will increasingly emphasise ultraviolet ray protection. Sun screens are now so strong that with their use it is almost impossible to develop a ‘normal tan’.

Expect dark brown, tanned skin to become even less fashionable in northern parts of Europe as has been the case in India, with a return to paleness as a sign of sophistication and true inner health, echoing the fashions of the nineteenth century, when a tan was a sign that you were an outdoor labourer. Increasing numbers of people will view beach holidays in hot countries with suspicion.  

At the same time, we will see increasing incidence of rickets (bendy bones due to low Vitamin D), in children which have been over-protected from natural sunlight by very anxious parents.

We will see reliable research over the next decade that demonstrates clearly that certain formulations really do stop wrinkles, restore the skin colloid that gives the skin its natural thickness, help restore healthy skin elasticity and make people look up to a decade younger.

Future health care challenges for the next 40 years

Brain degeneration – Alzheimer’s Disease is now the commonest cause of death for women in the UK.

Over 130 million people globally will be affected by dementia by 2050, up from 44 million in 2015.

Expect huge research efforts to find an early marker to detect whether drugs are working, before having to wait 20 years for clinical trials to complete.

This research will also teach us more about the physiology of the brain – how we think or remember; where events are stored; how decisions are made; what is conscious thought.

Cancers – in many nations 70% of all cancers are already curable with early diagnosis and the best treatment. The definition of cure is usually that someone with cancer is free of disease for more than five years.

Expect more therapies that teach the immune system to attack cancers more effectively, and gene screening to select anti-cancer drugs based on the precise character of each tumour (pharmacogenomics).

Obesity-related conditions including diabetes - 30% of humanity is overweight, which costs around 2.8% of global GDP (in health care and lost work days), and causes 5% of all deaths. One in 10 of all men in the UK have diabetes, and the problem is becoming worse each year.

Half of the world will be obese by 2030, as more people become wealthier.

One in three babies born in New York in 2015 will develop adult-style diabetes as children because they are so fat. Obesity is costing the US economy over $100bn a year in ill health and lost productivity – with over 300,000 deaths a year, while 20% of all health costs in all developed nations are linked to obesity.

Expect new therapies, such as ones based on the hormone thyroxine, which are designed to speed up metabolism without affecting the heart. Expect huge growth in regulations, ranging from chocolate advertising to children to sugar content in convenience foods, or drinks, and major initiatives to encourage fitness.

Heart disease and strokes – we will see astonishing reductions in deaths worldwide from medical conditions like heart disease and strokes, due to screening of all adults for high blood pressure and cholesterol levels, and because fewer people smoke tobacco.

Anti-high blood pressure tablets and statins to lower blood cholesterol will used by over 350 million older people in 2025.

We will see more widespread insertion of small tubes (stents) to unblock cardiac arteries – 127,000 people in America are treated with these each year, whereby a flexible tube is inserted through a tiny hole in the groin, and then guided using a thin wire, through blood vessels right up the heart.  The procedure can be complete in a couple of hours, and the person may be home the same day.  Compare this to the massive costs and risks of open heart surgery ten years ago.

Strokes will also be less common, with better recovery, as clot-busting drugs are used more widely.

Chronic wounds - around 100 million older people around the world will be affected by chronic wounds by 2025, particularly in their lower legs, caused by poor circulation.  Part of this is linked to diabetes, because higher blood sugar not only slows down wound healing, but also feeds bacteria in wounds, and damages blood capillaries.

Expect huge investment in new dressings and drug therapies to accelerate healing including telomerase, to reactivate old and tired fibroblasts in wound margins.

(When cells have divided too many times, the ends of strands of genetic code inside them become shortened so the cells cannot divide any more. Telomerase is an enzyme that lengthens those ends or ‘telomeres’ back to a more ‘youthful’ state so they can divide again.)

Bacterial infection and sepsis, including TB - multiple drug-resistant bacteria are a nightmare for surgeons and patients, and make 2 million people ill each year in America, costing $20bn in health care and killing 23,000.

If irresponsible prescription practices continue, we could see more than 8 million deaths globally each year by 2045, 150 million deaths over 30 years, wiping out $50 trillion of economic activity.

The last major breakthrough in new antibiotics was in the 1960s. Pharma companies do not make big money from antibiotics, because they are taken only for days.

Expect new government and industry partnerships. Expect much stricter controls on over-prescribing and bans on use in animal feeds by farmers. The TB pandemic has also been made worse by drug resistance, often linked to HIV infection.

Parasitic infections including malaria – malaria will continue to be one of the world’s worst medical problems for the next 20 years, with 100 million cases a year, killing 660,000, especially young children.

Expect major breakthroughs in vaccines and treatment for malaria by 2020, with growing numbers of vaccination programmes in every hard-hit nation by 2030.

Infertility – we will see an ‘epidemic’ of infertile, older aspiring parents.

This is because more women wait until age 35 or more to try to conceive, but fertility falls rapidly with age.

Sexual diseases are also rising globally and sperm counts have halved in the last 50 years - probably because of pollution / chemical exposure e.g. in plastics / food.

Care of older people – over 100 million older people in the EU will need care, at home or in an institution, in the next 20 years.

Despite popular perception, length of final illness is not much longer than it was 20 years ago, and remains less than two months, even though people are living longer.

Most older people die peacefully after a short final illness. Others will need heavy-duty care for a number of years.

Expect huge growth in home carers, and growth of e-monitoring of health. Robots will not form any significant part of this solution, even by 2050. Low-cost migrant labour will fill many new, relatively low-skilled, care jobs in the EU over the next 25 years. 

Future viral pandemics – major health risk

Every year we see new mutant viruses, and as populations grow, mutations develop and spread faster.

Mutation is particularly likely when viruses from animals infect humans, or when people are treated with antivirals.

Humankind is very vulnerable to viral attack because we have very few, and relatively feeble, antiviral therapies.

There is not a single antiviral today that is as effective as penicillin when first discovered.

Antiviral research is 50 years behind antibiotics. Our only really effective weapon is vaccination.

Hepatitis C virus is just one threat, carried by 3% of the entire world, including 4 million in America and 215,000 in the UK. Hepatitis B and C kill over a million a year.

AIDS will be a global menace for future decades

AIDS has killed over 40 million people with a further 35 million infected, mainly in Africa, and will continue to be a global health threat in 2040.

HIV mutated as it jumped from animals to humans decades ago, and is a warning of other mutants to come, against which we will have no immunity, vaccines or treatments.

I have been deeply involved with AIDS work since 1988, when the international AIDS agency ACET started in our family home, as a result of my NHS work with people dying of cancer in London, during which I discovered people with AIDS who were dying in great physical and emotional distress.

Today ACET has prevention and care projects in 18 nations, mainly in the poorest parts of the world.

Back in 1987, I said that developing a vaccine against HIV would be very difficult, because the virus keeps changing its outer surface, and escapes every vaccine trick we know. I predicted back then that it would be at least 15 years before a vaccine would be developed, and today there is still no likelihood of an effective, widely available vaccine by 2035.

Treatments have improved, as well as availability, and AIDS is becoming a chronic illness. But there is still no cure, treatments are toxic and are taken for life. We are discovering rare genes that provide partial or complete HIV protection, and which will lead us to gene-linked therapies.

Even if a cure is discovered tomorrow, it will take over 12 years for clinical trials to prove safety, and at least 25 years more to bring HIV under control. TB, for example, became curable in 1944, yet we still have the world’s largest pandemic today.

The good news is that prevention works, with falling or stable infection rates in many nations like Uganda where up to 30% of all sexually active men and women were infected at one time. However, complacency will be a constant challenge, in many nations among different parts of the community.

Spanish flu, SARS, bird flu, swine flu

Another mutant virus on the scale of HIV was the Spanish flu epidemic of 1918?19, which spread across the world in months, on foot, horses, donkeys, trains and ships, eventually killing over 30 million people, of  world population of 2 billion.

If a similar highly infectious and lethal pandemic begins tomorrow, it is likely to spread on international flights in days and weeks, not months, with no time for vaccine development or global distribution, and could kill 100 million people within a year.

That is why the World Health Organisation keeps warning governments about these threats.

From swine flu to ebola

The genetic code of the Spanish flu virus is almost identical to that of swine flu.

Therefore it was worrying when swine flu reappeared in Mexico in 2009. It spread globally in weeks and caused 14,000 deaths, despite mass-mobilisation of health resources, bans on travel, and almost instant lock-down of parts of Mexico.

SARS also appeared without warning in 2003. Over 8,600 people were infected with the virus within a few weeks, despite huge containment efforts, and 860 died.

And 1% of carriers were so infectious that even touching a light switch 24 hours after they had done so could have been enough to kill you.

SARS was only stopped by aggressive contact tracing and quarantine, in China, Canada and other nations. The outcome would have been very different if a single ‘super-spreader’ had travelled across Africa in a crowded plane, seeding clusters of infection in remote rural areas.

The 2014-15 ebola outbreak killed and orphaned many thousands, paralysed West African economies, stopped farming, closed markets, and caused widespread hunger and deaths from other treatable diseases, with constant threats of more outbreaks from infected animals in the bush.

How much more evidence do we need? Mutant viruses will be a major future threat, and we will see far greater investment into antiviral therapies, rapid vaccine development and epidemic monitoring as a result.

The ultimate nanotech robot - future of nanotech / virus vectors

Around 28 years ago I predicted in The Truth about AIDS that doctors would one day use viruses as a therapy. Such an idea sounded very strange back then, but as I write this, I am chairman of a company that is doing just that, to destroy cancer cells.

Viruses are naturally occurring nanotech robots. They are not living, need no food, use no energy – just biological machines.

Viruses have legs with sensors to detect what kind of cell they are touching. Once the legs latch onto the cells they are programmed to infect, the body of the virus fuses with the cell membrane, injecting a payload of genetic code.

Within minutes, the genes are read by the cell, and new proteins are being built.

Every virus contains instructions to hijack each infected cell and turn it into a virus factory. The cell soon starts to fill with new virus particles until it explodes and dies, and the cycle of infection continues.

Scientists have redesigned different types of human viruses to target, infect and destroy cancer cells without damaging healthy tissue.

At the same time, many of these viruses provoke an immune response against the cancer. Viruses can also be used to deliver extra genes, instructing cells to behave in certain ways as part of therapy.

Viruses will be used as weapons of war

These same techniques can be easily used to design viruses as weapons of war, perhaps with receptors that have an affinity to a particular race for example.

But while bio-weapons undoubtedly exist in different nations, most will be very poorly targeted, with extremely high risks for those that deploy them.

Some fear that HIV and other dangerous viruses were created in bio-weapons labs, but HIV has been around for many decades and there is no evidence that any new dangerous virus has ever been created and released (yet).

However, we do need to take great care to regulate the use of viruses, especially where properties have been altered.

And we also need to recognise that old viruses will inevitably be used as ‘low-tech’ weapons at some point – for example, to deliberately cause a huge outbreak of foot and mouth disease across farms of an enemy nation.

Very easy to do – just one person driving a van for day, dropping bits of infected meat near pigs on a few farms. And how could anyone prove which country was responsible? The cost of a single outbreak in the UK was more than $13bn. 

Medical technology will change the future of all our lives

Almost all the greatest medical advances will be from medical technology, (MedTech) pharma or biotech, or a combination. Medical technology alone will transform health care over the next 20 years. Here are just a few examples:

* Endoscopy – rapid growth of tiny telescopes, keyhole surgery, shorter hospital stays. $75bn a year market by 2022.

* 3D imaging – ability to watch living tissue in astonishing resolutions, ‘travel’ inside blood vessels, see inside the heart, detect cancer cells during operations.

* Ultra-resolution microscopy – able to observe things going on inside an individual cell in real time, watch a photon of light excite a retinal cell, a drug molecule attach to a receptor.

* Digitised patient records – instant availability in the Cloud of all tests, scan images and other medical records. The US Veterans Health Administration has Big Data on 20 million patients, 2 billion text entries, 16 million X-ray images and 1.5 billion prescriptions.

* Computer-aided diagnosis and Artificial Intelligence – let robots treat the sick, using AI and Big Data to predict what will happen. Such tools will transform what doctors need to remember, and how they are trained. Computer-assisted diagnosis will be universal in some countries for some types of conditions by 2025, with doctors forced to use it not by law but by insurance companies. If a patient dies, the first question to be asked by lawyers will be whether the doctor sought and followed digital advice.

* Telemonitoring, telemedicine and home diagnostics – huge growth in virtual medicine, where doctors and specialist nurses make decisions in a faraway location. However, we will not see many surgeons controlling robots many thousands of miles away, because speed of light is too slow, with delays from surgeon, to robot, to image, to surgeon, as well as risks when things go badly wrong that no one locally can sort out.

Greatest ethical issue in health care is inequality of access and wealth

More than half our world is living on less than $3 a day, and 22,000 children die each day from poverty. 

Nearly 1 billion people cannot read or write. 

Every day around 840 million are hungry. Almost one in three of those in the least developed countries die before the age of 40.

Vast wealth inequalities will drive huge revolutionary forces

The wealthiest 1% in our world own 50% of the world’s wealth and 20% own 75% - their income per head is 60 times that of the poorest 20%, and the gap is increasing rapidly. This is reflected in every aspect of heath care spending around the world.

Expect contrasts to keep growing over the next 30 years until 1% in the world own 60-65%.  This issue is the greatest moral challenge to the future of humanity and the greatest threat to peaceful existence.

The richest 80 people on earth own as much wealth as the poorest 3.4 billion people. 

Around 1,600 billionaires own $6.4 trillion, more than the combined income of the poorest 120 countries in the world. 

In America, the wealth owned by the top 3% in the country rose from 51.8 to 54.4% between 2007 and 2013 while the share held by the bottom 90% fell from 33.2% to 24.7%. 

And the same kind of shift has taken place in most other developed nations.

The contrasts are greatest in rapidly growing cities. In Mumbai, for example, in the shadow of the most expensive real estate in the world, you will find slum dwellers in shacks of plastic and plywood, and street pavements crowded with sleeping workers at night.

The greatest moral challenge of our age is how to deal with these problems, including access to basic health care for billions of people who are excluded of it because of where they live.

* Growth of Do-It-Yourself health care – web-based diagnostics and knowledge areas, so that many patients know more than their doctors about their own condition.

* Social media and sharing health experience – scoring carers, rating doctors and hospitals.

* Replacement of reading glasses by a tiny implant into the cornea, made of hydrogel, to change the curvature of the eye.

* Low cost gene readers 

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