I am so pleased to be participating in the Fred Alger Management “Think Further” program that, this year, is focusing on disruptive technologies that will impact healthcare in the next 5 to 10 years. What I particularly like about the projection into the near future is that it means that many of these technologies are already on the drawing board and innovators around the world are working diligently to build, test, and introduce them to the market in that relatively short time frame.
Technology is poised to shake up just about every aspect of healthcare from diagnosis to care delivery, from payment to purchase, from care providers to caregivers and, most importantly, care consumers. Within the next 5 to 10 years, we can expect significant improvements in consumer experience, cost of care, and health of populations (the Triple Aim) as a result.
Disruptive healthcare technologies
By category, here are the technologies that I think are most likely to revolutionize care:
Traditional blood tests will be replaced with bloodless technologies, a particularly welcome advance for needle-phobes and folks who have to have frequent blood tests, such as diabetics.
Focusing first on diabetes, it is heartening that a variety of approaches are being explored for non-invasive glucose measurement, including (but not limited to) laser light reflection, near-infrared spectroscopy, microfluidics, and non-invasive sensors that can measure glucose in non-blood fluids, such as tears and sweat.
Nanotechnology is being explored for early diagnosis of cancer. For example, magnetic nanoparticles are being used in combination with magnetic resonance imaging (MRI) for early detection of brain cancer. As these technologies become more refined and hopefully follow the “better, faster, cheaper” paradigm, we may see them replace our traditional screening tests such as colonoscopy and mammography.
And, speaking of advances in imaging, artificial intelligence based on big data analytics, is being developed to read routine images, and indeed, other types of visual diagnostics that rely on pattern recognition, such as skin lesions. This doesn’t mean that we will do away with radiologists or dermatologists, both specialists in pattern recognition. Rather, these technologies will allow them to practice as the proverbial “top of their license” focusing on atypical or complex diagnostic challenges instead of routine screening tests.
The next 5 to 10 years, of course, will see remarkable advances in the contribution of genomics to diagnosis (and treatment). As sequencing of the genome becomes faster and cheaper, many, if not all, people will eventually be tested. And, the technologic advances in the field will move from sequencing to analytics as we continue to hone our understanding of exactly what the various patterns of genes (and environmental influencers of gene expression (i.e., epigenetics)) mean when it comes to the health of individuals and populations.
We are just beginning to explore the microbiome, the bacteria that live on and in us, and influence many different aspects of our health including obesity and autoimmune disorders. We can expect advances in this arena to blossom over the coming decade.
“Big data” will continue to inform diagnostic approaches as our ability to collect and merge huge data sets continues to progress. I suspect this may lead to us finally understanding the etiology of diseases that heretofore have been mystifying because they don’t fit nicely into the categories of disease that we currently understand.
2. Care delivery
We are just at the beginning of the telemedicine revolution with a flurry of new options appearing regularly (synchronous, asynchronous, telephone, video, kiosk, mobile, text). Diagnostic tools such as sensors, haptics, and digital imaging will be combined with sophisticated algorithms that will allow diagnosis of much more complex conditions to be diagnosed and treated that is currently the case.
The reason I think these technologies will rapidly become standard practice is that they offer consumers the three big C’s they really want: Choice, Convenience, and (lower) Cost. Although I don’t think one-on-one doctor patient visits will disappear entirely, at least not anytime soon, I do think that remotely delivered care will become the norm, not just in rural areas or developing countries, but, all across the globe regardless of where one lives.
One of the challenges for telemedicine going forward will be to better understand which type of care delivery modality is most appropriate for what type of patient and what type of problem.
No question, the next 5 to 10 years will see personalized approaches to everything in healthcare. We will no longer accept a one (or two)-size fits all approach to treatment, whether it is medication dosing, cancer treatments, or diet and exercise prescriptions. We will want, no insist, on knowing what will work for ME.
Genomics is helping us already in approaches to treatment, particularly in cancer and infectious disease. New, much more targeted immune therapeutics and other types of drug treatments are being introduced with regularity and I expect this to accelerate as our understanding of the impact of certain gene patterns on outcomes as research continues in this area.
In fact, basic science has made great strides in immunology furthering our understanding of the inner workings of this complex system. Although there is still a lot to learn, practical applications are already being developed. One exciting area to keep an eye on is the ability to manipulate T cells that is now being applied to cancer immunotherapy. The advantage of this approach is that once the cancer is destroyed, immune memory cells will be constantly on the lookout for evidence of recurrence. Once detected, the immune cells will destroy the new tumor cells before they are able to get a foothold. This could mean cures for certain cancers instead of just temporary containment.
These advances in immunology are not just limited to cancer. The same approaches are being applied to autoimmune diseases, such as rheumatoid arthritis, lupus, Crohn’s disease and the like, offering a whole new range of therapeutic options for these difficult to control diseases.
We are also gaining detailed molecular understanding of Alzheimer’s disease and psychiatric diseases such as autism and schizophrenia. The most notable breakthrough in brain research is optogenetics. This involves insertion of a bacterial gene, opsin, which “lights up” when exposed to laser light. This allows the manipulation of single neurons or whole regions in the brain. Currently, the technique is limited to animal use. But within 10-15 years, it will probably be in clinical use to treat a variety of neurological conditions.
And finally, with the rapid increase in the aging population, great efforts are being made to make aging healthier and longevity longer. Genetic manipulation that is already increasing life span in experimental animals will be translated into clinical applications.