The truth about future health: why many health costs will fall dramatically eg drugs off patent, AI impact, yet care budgets will soar. Impact on society, budgets, pharma, biotech, medtech, hospitals and home care - keynote speaker on future health trends

Futurist Keynote Speaker: Posts, Slides, Videos - Future Health Care and Pharma Keynote Speaker

Expect more health care innovation from 2045 - 2050 than in all human history

As a physician and a Futurist, I work with many of of the world's largest Pharma and MedTech companies, helping them develop next-generation treatments to improve human health and wellbeing.

Health care knowledge is doubling every 24 months, so we will know 32,000 times in 2048 than today more about how the human body works, why disease happens, how to detect early disease, how to treat illness effectively, and how to promote health. The growth of medical knowledge shows no signs of slowing down, indeed it is accelerating.

Impact of AI / Artificial Intelligence on health and pharma innovation

AI / Artificial Intelligence is driving much of this massive boost in speed of innovation and discovery.

We will know 32,000 times in 2048 than today more about how the human body works, why disease happens, how to detect early disease, how to treat illness effectively, and how to promote health.

The growth of medical knowledge shows no signs of slowing down, indeed it is accelerating.

I have been predicting health care trends since 1988. I have given future health keynotes to many of the world's largest health companies over the last 20 years - and as I forecast, there have been dramatic changes.  Take for example the Human Genome Project, which I first wrote about in The Genetic Revolution - book published in 1993.

Back in 2001 it cost around $800m to decode or sequence most of the genetic code of just one human being. 

By 2006, the cost per genome sequence had already fallen to around $300,000.

Today, the same can be achieved for around $1000, using Illumina’s highest-end products, including reagents and an appropriate contribution to the capital cost of its machines -the NovaSeq 6000 machine costs around $1m to buy.

What will it cost to sequence a human genome in 2035? 

The answer is that full gene screening for all disease risks will probably be free for members of the public in many developed nations, provided by pharmacists as a service to regular customers, or by governments or by health insurance companies, by pension funds or life insurance providers.

The genome revolution has already begun, and will have huge consequences, some of which will be very controversial. 

While there are no reliable figures available for the number of people whose genes have been sequenced, the CEO of Illumina has stated that the company expected 1.7m to have been profiled by the end of 2017.

We can debate the statistic, and speed of uptake, but one thing is clear.

Every week, the number of people whose genes have been read, is growing rapidly. 

And when we match information from all their medical records, and lifestyle information, with their different gene profiles, we have powerful new tools to begin predicting future health care events, with extraordinary precision and accuracy.

- Who is most likely to have a heart attack in the next five years.

- Which people are most likely to develop particular cancers.

- Which cancer types in which people will respond best to which chemo, with least side effects.

And so on.

Huge ethical questions from gene screening - gene tests for insurance

But with these new gene screening tools there are huge ethical questions.  

For example, is it right for life insurance or health insurance companies to insist on screening your genes?  

Should they be allowed to discriminate against people with "bad" genes who are likely to be sicker or die earlier than average people?  

Is it right to allow airlines to screen pilots for genes that increase risks of sudden death at a young age?

Insurance underwriting has become riskier because of over-the-counter gene testing kits.  

You can send a small sample from your mouth to be tested for a few dollars for a range of very important conditions.  There are enough cells in saliva for gene testing companies to give you a useful set of predictions about your health car future.

So someone can discover for a few dollars that they are going to have major medical problems in future.  The following day they could take out a massive health insurance policy, covering them for all the illnesses they expect they are going to get.  

If the insurance company is banned from conducting gene screening tests themselves, then they could rapidly go out of business, effectively defrauded by people pretending that they have ordinary health risks, when they know the opposite is true.

The same applies to life insurance companies.

The fact is that whatever we may feel about this, insurance can only work if the insurance company can be sure it has access to the same set of information that the person has access to, who is filling in the application form.

Insurers were in the same tough situation a few years ago with HIV testing.  

Such a test is very sensitive and results need to be strictly confidential.  

But governments in many nations began to realise that people could take out huge life cover or health insurance shortly after receiving a highly confidential HIV positive test result - one which even their own personal doctor might not know about.  

So regulations were changed, to allow insurers to test all insurance applications for more than a certain level of life or health cover.

Do you really want to know results of your own gene tests?

A further ethical challenge is this:  even if a gene test is carried out with your full consent, do you want to know the results?  

Suppose the test predicts that you are likely to start losing memory at the age of 55 and will be likely unable to even recognise members of your own family by the age of 65.  

Do you really want to be burdened with such knowledge at the age of 35, when no treatment is available for you at that age that will make any difference?

Half my audiences at large corporate events tell me that they would not want to know - we need to be very careful about these things.

New ways to travel inside the human body

And then there is the future impact of digital, new diagnostics and all of MedTech innovation.

My first company was a MedTech startup back in 1980, using the worlds' first desktops to run medical records and make diagnoses.  

New 3D imaging is now revolutionizing both diagnosis and treatment.  Companies like Siemens and Phillips have led the way.

We can visualize tiny structures inside the human body, in real time, in an operating theatre.  Surgeons are already able to operate using 3D augmented reality headsets, showing for example coloured imaging over cancer cells.

Endoscopic instruments mean that complicated operations can be carried out with minimal trauma or blood lost, in a short time, with patients often able to go home the same day.   

The global endoscopy market was worth around $33bn a year in 2017.

These rod-like tools are inserted through small holes in the skin, with cameras, cutters, stitching equipment, and remote control instruments on the end of flexible tubes.

Every week, more ways are found to carry out major surgical treatments, in ingenious way with very minor trauma.

Open heart surgery replaced by thin wires and tubes

Take heart disease - a major killer but death rates are now falling rapidly.  

One reason is that doctors have better tools to predict who is likely to have a coronary, better imaging to watch blood flow through the heart, and better ways to mend damaged blood vessels.

127,000 people with blocked coronoary arteries have stents inserted every year in America alone. 

In each case, we are preventing a huge heart operation, opening the chest, connecting the patient to an artificial heart machine – a long and dangerous procedure.

The stents are inserted using a thin wire, which slides into an artery in the upper leg, under x-ray control. 

The wire is fed right up into the heart, and then guided into the tiny coronary arteries one at a time, then used to place the stent tube as a permanent structure, keeping blood flowing to heart muscle. 

Once the guide wire is removed, the person is effectively cured of their heart problem and can live a normal life, so long as they have regular checks and continue to take the right medication to control blood cholesterol levels.

New ways to listen to the human body

We are seeing a huge number of digital innovations in health care – MedTech devices which are worn on the outside of the body or inside, sensing data and transmitting for analysis.

This is far beyond the present capabilities of iWatch or FitBit sensors. 

The global market for wearable MedTech devices is likely to exceed $30bn a year by 2020. By 2017, a third of most of my audiences at global executive events were already using some kind of mobile health monitoring device.

An example of what's coming is a contact lens prototype produced by Google, which senses sugar levels in the tears produced by the eye.  Levels of sugar in tears go up and down in a similar way to what is happening in the blood.  Data can be transmitted hundreds of times a day to a nearby device.  

Now the technology is not perfect, and some experts in diabetes point out that the correlation between sugar in tears and sugar in the blood is not always as good as doctors would like.  But the fact is that these kinds of sensors are already multiplying in a wide range of health care settings.

Other devices can be swallowed, which then transmit important information about the functioning of the gut.

Or they sit under the skin, powered by mini-batteries, sampling tissue fluids, transmitting data.

And some of these devices are robots - not only making a diagnosis, but also deciding on treatment and delivering therapy.  

A good example is a heart implant, where an electrode is embedded deep into heart muscle.  The sensor detects every heart beat, and if the heart rises suddenly to a dangerous level, or there is some other near-lethal event, the heart implant automatically fires an electric shock to reset the heart's own pacemaker back to normal.

Health care will always be rationed - so long as treatments are free

It is often claimed that health care costs in each country will continue to rise rapidly until they reach unsustainable levels. 

And there is some truth in this, because there is an almost unlimited demand in every nation for better health care, better eye care, enhanced performance, cosmetic surgery and so on.

There is an economic law of the universe, which is true in every situation, in every society, which is that whatever has value and is available free of charge, will always have to be rationed because of overwhelming demand.

Exactly the same is true of health care: if all health care is free, you can guarantee that in that nation, there will always be waiting lists.  People will go on demanding more health care appointments and treatments until the benefit to them becomes less than the cost of treatment.  And if the only cost is waiting, then you will have a long wait.

And when that happens, rationing has to take over.  There has to be a rational way to allocated limited time and health care resources to the most sick, the most vulnerable, the most urgent and so on.

Costs per episode of treatment will fall dramatically

But it is also true that we are seeing a massive collapse in health costs for many individual treatments – whether operations, for reasons above, or pharma drugs.

For a typical pharma company, it takes 15 years to bring a new drug from laboratory studies, to animal studies, to human safety trials, to full clinical trials, to drug approval, to widespread use in health care.  The entire process can cost over $1.2 billion. 

Almost all the cost of a new drug is usually the research and development – marketing, making and distributing it costs almost nothing in comparison.

But the patents granted to protect such discoveries are usually only for 25 years.

So a pharma company only has a decade or so before any other company in the world can start manufacturing their own versions without any licence or pharma royalties being paid.

And once the generic manufacturers scale up their own production, we typically see the price fall by 90-95%. It can happen in just a few weeks.

I work with every industry, in every region, and I have never seen any other type of business where world-class products have sales prices which collapse as dramatically as this.

Take the most expensive drug in the world – far beyond the affordability of most of the poorest nations.  We have an absolute guarantee that at some point in the relatively near future, that same drug will be widely available for 5% of the previous cost.

Many patients already know more than their physicians

Most owners of smartphones turn to Google search as soon as they feel unwell, or just after seeing a physician about a health problem. 

In minutes they are reviewing the latest research as well as maybe many different social media groups of people with a similar health condition. 

Such search results can be confusing, alarming and yield inaccurate information, but the fact is that Google has forever changed the relationship between physican and patient. 

More than that, the phsicians themselves are being ranked on many different websites for their own bedside manner, health care expertise and so on.

And then there are specialist advisory sites like Babylon Health Diagnostics. 

Babylon is a revolutionary new diagnostic App for mobile phones, which asks loads of questions when you are feeling unwell, and recommends action to take.

Millions of consultations have been handled by the system and compared with decisions made by real doctors and nurses. 

In most cases the system is already better than most professional health care workers, and is improving every day in accuracy.

Babylon can switch a worried person direct to a video or voice call with a doctor or nurse, can call an ambulance, or can direct the person to a local pharmacist, give basic health advice and so on.

MedTech Apps mean better and safer health care at home

But we also need to combine all this stream of online knowledge with information fro MedTech devices on the person’s on body, inside them, or in their own home.

Someone with their own blood pressure machine, or their own oxygen blood level detector, or an iWatch detecting heart beats etc, will probably know in a second or two if a problem has been detected. 

And by the time they get anywhere near talking with a doctor or nurse, it may be the machine itself has diagnosed the problem, activated a response, contacted the right hospital department and so on.

Boom in community care and shorter hospital stays

All these changes point to one gigantic health trend which is a boom in home care for sick patients, and a rapid fall in the numbers of days of hospital care per medical event.

I have visited people at home who are 100% dependent on ventilators for every breath they take, and have been cared for superbly by home care teams, keeping them out of impersonal intensive care units.

It is truly astonishing how many complicated treatments we can already deliver at home, or in outpatient clinics.

At the same time, in many nations we are seeing a crisis in hospitals, over-full with patients who want to be in their own homes, and should be in their own homes, or in a suitable alternative, but who are trapped in hospital beds because of lack of community resources.

Therefore we can expect a huge growth in home care teams:  doctors, care workers, social workers, nurses, occupational therapists, physiotherapists and many other types of professionals, all working together as an integrated community care team.

Who is going to pay for future health care?  Budget conflicts

A key challenge for the future is not just whether society can afford appropriate levels of health care, but which government department or company or institution is going to actually pay the day to day costs of a particular person’s treatment or support.

Take the NHS in the UK for example.

Here are some conflicts of interests which serve sick people really badly:

- Hospitals are paid per case on a fixed average price e.g. hip operation or gall bladder removal. One way to save money is to shorten days per person in hospital.

- When health care is not at the right level, people can get sent home too early, automatically becoming the responsibility of social services after a short period.

- Social services funded by local authorities are responsible for simple care with things like getting dressed, shopping, cleaning, reminding people to take their medicines.  (Remember that most people over the age of 85 are becoming forgetful and can be confused by changes in their environment or routine.)

- When social care is not at the right level, there is a far higher risk that the person will fall over, or have some other kind of accident, or will become ill without being treated early enough.

- And when that happens, the person ends up in hospital – paid for by the hospital, not by social services.  They may never come home.

Here is an all too common pattern:  when an older person ends up in hospital, they can easily become anxious, confused.  In the middle of the night they get out of bed on their own, fall onto a concrete floor and break a hip.  When they fall at home, they are cushioned by carpets, soft furniture and wooden floor boards.  A confused person tends to recover very badly from a broken hip, leading to further problems.

The answer of course is to combine health and social care budgets: one person, one life, one set of needs, one government support budget.

So then - we have seen just a few ways in which health care in future will change significantly, impacting all our lives. 

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