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Megatrends for this decade XXX

A representation of the three main pillars for future innovation in healthcare: Digital Health, Precision Health and Big Data. The graphics shows pretty well the correlation among these three pillars. Image credit: ACC – American College of Cardiology

22. Healthcare in the Cyberspace

This Megatrend is likely to land in slightly different ways and at different pace in different Countries (and regions within a Country) but I consider this as unavoidable under the pressure of:

  • steady increase of pro-capita healthcare cost
  • availability of better cure / preventative cure that are considered as part of the basic human rights
  • change in paradigm:  from exams for diagnoses to exams for curing

as well as sustained by:

  • ambient, wearable and implantable sensors
  • EHR – Electronic Health Record
  • personal digital twin
  • body on a chip
  • artificial intelligence
  • Chatbots

All of the above is being accelerated by the 2020 pandemic. In fact, the shift towards a digitalisation of Healthcare goes back at least a decade and potentially it could have found broad application in the last 5 years but bureaucracy and siloed systems have retarded its implementation. The pandemic has put healthcare institutions under severe stress and, sometimes like in Italy, the cyberspace has been used as a digital crutch. As an example, all of a sudden, all Italians have shifted to the electronic prescription that originates from the family doctor upon a remote consultancy and goes directly to the pharmacy where we can pick up the medicine. The whole machinery was already in place but not used. The pandemic did in a week what has been attempted for at least 3 years. At the same time special support centres have been set up to evaluate Covid-19 symptoms and risks and in many areas at home testing has been implemented. Furthermore, the data harvested from individuals and from institutions are being used to drive Government policy almost in real time (the changes to the containment measures have been so frequent to generate sarcasm and opposition: why did they change their mind? The culture of people is still rooted in the past). I believe that these changes are here to stay and will become the new norm by the end of this decade.

a) steady increase of healthcare cost

Public health cost has increased everywhere, as shown in this graphic, both in absolute value and as % of a Country GDP. Image credit: Our World in data

Healthcare cost has increased dramatically in developed Countries in the last 50 years as shown in the graphic both in absolute value and as percentage of the GDP and this trend is continuing today. As reported by Our World in Data healthcare spending was a meagre 0.5% in the 1900 in the US (and the % was quite similar in many other countries) reaching 8.5% in 2014 and an astounding 17.7% in 2019 (3.3 trillion $, 11,582$ per person). And that was before the pandemic! The total cost (including GDP decrease, jobs loss, countermeasures) is estimated in 16 trillion $ for the US. The average cost for in-patient care for Covid-19 ranges between 51,000 and 78,000$ depending on patient’s age. Vaccination for a Country like US goes into the tens of billions $.

Even without consideration to Covid-19, and the graphic is quite clear on this, healthcare cost have been on an accelerated rise in the last five decades and have reached a critical level where both Countries and single citizens can no longer afford further increase.

b) availability of better cure / preventative cure

Various measures of preventative healthcare services for women. A similar graphic can be made for men. Image credit: Aeroflow Healthcare

Medicine has progressed enormously in these last twenty year, thanks to both science and technology (with technology in the driver seat, since science has progressed thanks to technology).

The portfolio of available drugs has increased, resulting in more efficient drugs and in drugs able to fight a broader slate of ailments. In parallel surgery and other medical procedures are able to address situations that just 10 years ago would have been impossible.

Prosthetics are becoming more and more effective in addressing disabilities but they are not cheap. An Argus II retinal implant (bionic eye) may cost well over 500,000$, a liver transplant also cost over 500,000$…

We have the possibility of mass screening, and focussed personal screening (the “check-up”) and it is often said that the cost of preventative measures is way lower than the cost of cure. Hence, the interest of healthcare institutions to move towards preventative measures. To maximise the effectiveness, and minimise cost, preventative measures (like colon cancer test, prostatic cancer test, …) target the higher risk population leveraging on statistical data.

c) change in paradigm

In the coming years of this decade we are going to see an increase in personalised cure. We already see this approach in preventing recurrence of breast cancer, in the cure of lung cancer. Exams are run to identify specific genes that can make the patient at a higher risk of recurrence, or other genes that can make a specific therapy more effective. Doctors are now prescribing exams to decide the cure, rather than exams to make a diagnoses. This is a change in paradigm and we are going to see this becoming the norm by the end of this decade. Precision Healthcare is the name of this new approach. Rather than using the approach “one fits all” doctors are looking for the therapy for that specific person. By the end of the decade we will have medicines that are so person specific that they will not be effective on a different person and because of that these medicines have not been used for any other person. This changes completely the approach to the approval of medicine since we can no longer trust statistical data, that medicine has been designed for that person, there are no data on its effectiveness (nor on its side effects!). This will call for a completely new way of monitoring the patient.

more to follow

About Roberto Saracco

Roberto Saracco fell in love with technology and its implications long time ago. His background is in math and computer science. Until April 2017 he led the EIT Digital Italian Node and then was head of the Industrial Doctoral School of EIT Digital up to September 2018. Previously, up to December 2011 he was the Director of the Telecom Italia Future Centre in Venice, looking at the interplay of technology evolution, economics and society. At the turn of the century he led a World Bank-Infodev project to stimulate entrepreneurship in Latin America. He is a senior member of IEEE where he leads the New Initiative Committee and co-chairs the Digital Reality Initiative. He is a member of the IEEE in 2050 Ad Hoc Committee. He teaches a Master course on Technology Forecasting and Market impact at the University of Trento. He has published over 100 papers in journals and magazines and 14 books.

2 comments

  1. Derrick de Kerckhove

    Super comme toujours. I guess “more to follow” will address the use of “Personal Digital Twins” that is presently spearheaded by the health professions and opens the way to an even more complete duplication of human persons…