Future of MedTech - how medical technology will transform human life and health care. MedTech keynote speaker for APAX Partners - MedTech investment fund

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12 ways that medical technology will transform health care

(Watch video of keynote for CEOs of a wide variety of leading Medtech corporations, for APAX in New York)

* Feature on Future of Medtech by Dr Patrick Dixon, Futurist, Physician and author of 16 books on global trends including Futurewise and The Genetic Revolution.  Clients include Phillips Medical, Siemens Medical, Smith and Nephew, GSK, Novartis, Wyeth, Sanofi, Johnson and Johnson, Ottobock, 3M, NHS, and a wide range of techno companies such as Google, IBM, Microsoft, Nokia, AT&T and Vodafone.

Medtech is driving rapid change in health care.  Expect the greatest advances in Medtech to come from combinations of technologies such as biotech (genetics and stem cells), nanotech (atom-level surfacing and microbots), mobile connectivity and digital / cloud-based innovation.

Major innovations will come from multidisciplinary teams – world class mathematicians working with Nobel Prize – winning physiologists, nanotech engineers working with surgeons, radiologists working with pharmacists – all collaborating in a focused effort to transform lives of particular groups of patients.

12 MEDTECH AREAS THAT WILL HELP CHANGE HUMAN EXISTENCE

Here are 12 key areas where we can expect astonishing innovation within the lifetimes of most people in developed nations who are 60 years old today.  

Remember that 65% of all health care spending is on those who are over 60, and most health care is related to a simple fact which is the person’s date of birth. So one could say that most Medtech is to help people overcome the effects of ageing.
(Can we stop or reverse ageing in humans? See elsewhere on this site.)

All Medtech innovations will be used in combination with other Medtech, drug therapy, physical techniques – complemented by the best healing method of all, which is supportive, caring teams, with time to look after the whole person. 

1. BIG DATA

Expect huge growth in data matching:  genetic profiles linked to disease or to response to drugs (pharmacogenomics), or clinical decisions to outcomes. 

Expect decisions by physicians to be guided increasingly by computer programmes, which are becoming more accurate than the best clinical experts in the world.  This is already happening in intensive care units, and in emergency rooms.

Physicians will find themselves challenged in law courts if they fail to follow computer advice.  This will all have profound impact on how we train physicians in future.

2. GENE TYPING TAKES OFF

Expect explosive growth in gene mapping, linking disease profiles and risks to gene sequences.  Genetic Prophecy will transform the way we diagnose and treat.

We can already identify genes linked to old age, speech, memory, criminality (yes some genes are more common in people on death row), depression, obesity and stable relationships.

The cost of reading the entire genome of a human being has fallen from $100 million in 2001 to $10 million in 2008, to $12,000 in 2012.  Expect this to fall to less than $1000 by 2017, in a process taking less than two hours.

Watch out for the Ion Proton system, first launched in late 2012: using chips to read gene sequences directly.  Each chip has over 130,000 different wells in which sequences are read. 

Each tiny slice of human genetic code is later built back up into the entire picture, using breathtaking mathematics and pattern recognition software.

Imagine a world where we have a million people’s genomes on file, together with their entire medical histories to date, plus some lifestyle information, family histories and other data.  

We already have crude genome data on hundreds of thousands of people, but we are talking about the difference between a photo of a distant landscape taken two miles away, and a close up photo of the eye of a butterfly.

Genetic Prophecy will present us with huge moral choices: personal, corporate and legal.  Do you want to know that you carry genes that mean you will develop severe memory loss before you reach 60? 

Do you want your insurance company to know that you are likely to develop 4 life-threatening conditions in the next decade?  Should airlines be able to demand comprehensive gene testing of all pilots? 

Why stop there?  Why not extend gene testing for risk of sudden death to all people that operate dangerous equipment or drive trains or trucks?

On the other hand, Genetic Prophecy will mean we know precisely who will benefit or be damaged by a particular drug.  It means we can totally customize how we treat people with the same condition, to get the fastest possible recovery at the lowest possible cost.

3. DIGITAL CARE

Expect explosive growth of mobile Medtech devices by physicians, nurses and other care workers. Ottawa Hospital in Ontario, Canada, recently bought 3,000 iPads for staff, while Mayo Clinic has invested in 10,000 iPhones and 2,000 iPads. 

These are not just to allow medical information to flow at the speed of light, but also to control what care workers do.

4. DO-IT-YOURSELF HEALTH CARE

In the Google Age, many patients know far more about their condition and the latest research, treatment results and so on, than their physician or surgeon.  People talk to people. Social networks may have greater impact on choices a patient makes than any amount of direct medical advice.

In a way this is nothing new:  for decades it has been a fact that most prescribed medication has stayed in bottles in medicine cabinets, because of commonly held fears about side effects.

Expect explosive growth in sales of Do-It-Yourself diagnostic kits, used in the privacy of your own home.  This is a million worlds apart from pregnancy tests or blood pressure monitoring. 

With a few clicks, anyone can get access to a very wide range of laboratory tests, conducted privately from a small blood sample than can be delivered by courier with results in hours.

5. CREATING SPARE PARTS AND REPAIRING ORGANS

Watch out for organ production using bio-printers:  using technology similar to bubblejets.  Polymer scaffolds, seeded with bone marrow stem cells in bioreactors. 

The scaffolds get reabsorbed after implantation, leaving a replacement structure – a trachea for example.  Harvard Bioscience is a leader in this area.

Another example is breast reconstruction, following cancer surgery, using LifeCell’s tissue matrix, which allows a far simpler one-step process.

6. BREAKTHROUGHS IN IMAGING

Expect huge fall in price of Medtech machines that produce elegant, precise, multi-coloured 3D images of what is going on inside organs or individual blood vessels. 

Today’s machines are so expensive that there are few of them even in wealthy nations.  It means that people often have to travel large distances to get to specially equipped medical centres.  In future such machines will be a fraction of the size and cost, mass-produced for smaller medical centres.

Watch out for Positron Emission Topography, and new uses of Magnetic Nuclear Resonance.  In future, much of the mega-processing power needed will be in the Cloud, harnessing spare capacity of hundreds of thousands of PCs around the world.

Expect many innovations in imaging of diseased tissue – for example Dune’s light wand used by surgeons to detect breast cancer cells that may have escaped removal in the first part of an operation. 

7. GROWTH IN ENDOSCOPY – KEYHOLE ACCESS SURGERY

Expect rapid growth in day-surgery as surgeons continue to extend the range of major operations they are able to carry out safely using keyhole surgery.

Endoscopy device sales were $23bn world-wide in 2010.  Expect this to exceed $23bn by 2022.   Insertion of Stents or other carotid artery proceedures were carried out 125,000 times in America alone last year, using endoscopic equipment.

8. ROBOTS TO CUT AND SHAPE IN OPERATIONS

Expect rapid growth in robotics:  sophisticated machines for operating theatres with up to 10 arms, each controlled individually, each inserted through a tiny hole in skin, each able to cut, cauterize, suture, see, feel. Arms on such machines are already armed with micro-lasers, microwave emitters or diagnostic probes.

Operating robots such as Da Vinci are popular with patients.  Most people like the idea that a robot helps a surgeon to do very delicate things more safely.  They need no persuading when they hear that the length of operations is reduced, bleeding is less, recovery time is faster and there are less mistakes.

9. HOME TELE-MONITORING

Over 2 million people are already being supported at home with tele-monitoring systems.  Expect this to be a $22bn a year market by 2015.  The most basic home monitoring systems are panic buttons worn around wrist or neck, allowing a vulnerable person to call for help if they fall.

The latest systems can watch patterns of daily activity around the home – movement, light switches being turned on or off, appliances being used, to build up a picture of what is normal for the individual.  Alerts are triggered by unusual activity or lack of it.

Mobile monitoring allows us to transmit blood pressure data, pulse, blood oxygen levels and a variety of other clinically important readings, to remote centres where alerts trigger an almost instant response from clinicians.

One of the commonest risks at home is people forgetting to take medication, or forgetting they have already taken it, and taking a double dose.  Tiny sensors can be added to each tablet, so that there is an electronic record.

10. VIRTUAL MEDICINE

Expect rapidly growing use of video links and remote diagnostic services, to allow people at home or in rural communities to access world-class medical expertise.

11. ACCELERATED WOUND HEALING

Chronic wounds are often very hard to manage, and can take months or years to heal.  They cause long term disability, loss of confidence, and are expensive to treat.  Expect many innovations to help wound healing, ranging from wider use of ultrasound, hyperbaric oxygen chambers (14 times higher oxygen levels in wound tissue), to negative pressure wound dressings, to nanotech coated antimicrobial wound dressings.

Expect further research into use of telomerase to activate sleepy fibroblasts, by lengthening their telomeres (ends of chromosomes that shorten with each cell division, until the cell can divide no more, as part of the body’s anti-cancer systems).

12. NANOTECH ROBOTS

While many stories about microscopic robots operating inside the body are rather fanciful, the fact is that biotech robots are already widely used in medicine. 

Robots exist that have legs which probe the surface of human cells. The legs have sensors which are able to detect the difference between skin cells and brain cells, liver cells and gut cells. 

When the robot finds the cells it is looking for, it attaches its legs and injects a package into the cell cytoplasm, which is activated within minutes and takes control of the cell.

We are of course talking about viruses, because that is how viruses work.  Virus particles are the ultimate biotech machines.  They do not live, consume no energy or food, and can be damaged but not killed.  They contain genes which hijack normal cell function, turning infected cells into virus factories.

Scientists have been building mutant viruses for medical treatments for many years. 

One such defective virus had been designed to infect only cancer cells and to destroy them, without any damage to healthy tissue.  Oncolytic viruses could turn out to be the greatest advance in cancer therapy for the last 30 years.

MEDTECH OVERTAKEN BY OTHER TREATMENTS

Medtech miracle today, irrelevant tomorrow. 

Look what happened to polio treatment.  30 years ago, hundreds of thousands of people needed calipers and other devices to help them walk after polio had permanently destroyed their nerves and weakened their muscle power.  Polio is no longer an issue today.

NEW HIPS

Joint replacements are in competition with remarkeable advances in joint repair, using a range of techniques to grow new cartilage.  The process takes a long time, and results can be disappointing. 

However, we have the technology now to resurface knee and hip joints, using polymers impregnated with stem cells, inserted into arthritic joints which have been ground smooth by orthopedic surgeons.  Similar results follow transplantation of small islands of cartilage.

NEW SIGHT

Many attempts have been made to restore sight in people with damaged retinas, using light-sensitive chips inserted into the back of the eye, or special glasses which transmit electrical impulses direct to the visual cortex of the brain.

But as an alternative, scientists are now restoring sight in people with macular degeneration, by seeding their retinas with stem cells, which automatically divide to become specialist retinal cells, and connect to the optic nerve in the normal way.

NEW HEARING

The same is true for deafness.  There are a huge number of different devices to help people hear better, mainly providing louder high frequency sound in the external ear.  A radical alternative has been development of cochlear implants, for use in cases where the middle ear structures are missing or damaged.

But once again, expect new approaches to hearing loss.  For example, scientists have found ways to stimulate growth of new hair cells in rats, using viruses which infect only cells in the inner ear.

ADAPTING MEDTECH FOR EMERGING MARKETS

Some of the greatest new markets for Medtech will be in countries like China, India, Nigeria or Indonesia.  These nations have rapidly growing health care systems, which operate in different ways to those in developed nations.  At the top end, private health care can be similar wherever you are in the world. 

But the greatest growth opportunities are for Medtech which is adapted to high volume, lower cost.  Less features, and perhaps a higher failure rate, which can be tolerated by patients, physicians and governments if the result is that 20 times as many can gain access to life-changing technology.

IRRATIONAL RATIONING

Health care rationing will continue to be a controversial issue:  every Medtech innovation has to compete with every other type of spending on people with the same condition. 

Clinical conditions compete with other clinical conditions for priority spending.  High-tech hospital spending competes with low-tech community care.  Health care competes with education, and every other demand on government budgets.

Rationing decisions will be made not only on economic grounds but also on emotional grounds:  how vocal are the pressure groups?  What will be the reputational risk to the government in marginalising a particular group of patients?

Rationing will be influenced by a wide range of other factors such as financial incentives for hospital or clinician, patient experience and clinical outcome, availability of local people with the right skills to use the Medtech, appropriate health care infrastructure to justify the investment, and so on.

MEDTECH INNOVATION OVERLOAD

One of the greatest Medtech challenges is information overload: inventors are often completely unaware of spectacular progress by scientists in other fields that will have an impact on the problems they are trying to solve.

Take stem cell research.  Over 2,500 peer-reviewed research papers are published each year, each describing significant advances in the use of human stem cells to treat disease or enhance health. 

That’s more than any Professor of stem cell research can possibly hope to read.  But stem cells don’t work in isolation:  you cannot possible understand the wider picture without a reasonable knowledge of the rapid advances in maybe 10-20 related areas of health.  Read on for the answer to information overload…

MEDTECH BLINDNESS

Medtech companies often suffer from institutional blindness, or from tunnel vision:  small teams of geniuses, that are totally focused on very narrow areas to produce stunning innovation. 

That is why many Medtech companies never manage to develop beyond their first big invention, and why so many fail to thrive and survive beyond their initial rounds of funding.

OVERTAKEN BY EVENTS

Many Medtech companies are run by people with huge passion, commitment, energy and experience – but often limited to particular areas.  Things happen,  Disease patterns change.  A new drug can make a Medtech solution completely irrelevant. 

OPEN INNOVATION IS THE KEY TO FUTURE MEDTECH

Welcome to the world of Open Innovation, of CrowdSourcing:  where complex challenges are thrown out to wider scientific communities to help solve. 

Open Innovation is also the answer to information overload.  I recently had a complex problem to solve, which I broadcast to my own 43,000 Twitter followers.  I had a complete solution at zero cost in less than ten minutes.

Life is too short to waste re-inventing wheels, redoing the same experiments, ignoring spectacular achievements by teams in other disciplines or nations.

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