Digital future signals more active role for the patient

A Google smart contact lens which could help diabetics manage blood sugar levels AFP

Healthcare has been slower than other industries to feel the full force of digital technology.

Whereas everyday activities such as shopping and banking are being transformed online, most medical consultations and procedures still take place in hospitals and doctors’ surgeries.

Typically, patients turn up after the symptoms of ill-health are well advanced and they are treated with costly medicines of uncertain benefit.

Is all this about to change? Not immediately. Healthcare is a slow moving industry, from the 10-15-year development cycles in pharmaceuticals to the difficulty of pushing reform through politically sensitive health systems and the conservative medical profession.

In the long term, however, change seems inevitable as an ageing global population puts health budgets under pressure.

For the first time in history, the number of over-65s will soon exceed the number of under-5s on the planet and the ageing trend is accelerating as it spreads to newly industrialised economies such as China and Brazil. With more old people come more disease and higher health spending.

That would be good for the healthcare industry if the world could afford it. In reality it is likely to mean more rationing of care and pressure on the price of drugs, medical devices and services, as governments and insurers struggle to stretch finite resources.

What can be done to solve this conundrum? The answer, almost everyone agrees, is innovation. From drug development and disease diagnosis to the way care is provided, new ways of managing public health are needed.

“In the next 10 years, we’re going to see changes that will dwarf anything in the recent past,” says Joseph Jimenez, chief executive of Novartis, the Swiss drugmaker. “Health systems around the world are going to be under more and more pressure to find ways to improve health outcomes and lower the cost of care.”

Breakthroughs

The contours of a more efficient health landscape are slowly coming into view. Digital technology is at its heart.

Breakthroughs – from wearable sensors providing real-time data on an individual’s wellbeing to the ability to sequence a person’s genome for $1,000 (CHF965) within 24 hours – promise greater visibility over personal health and offer the possibility of earlier, more targeted treatment when people fall ill.

As with so much innovation, the US west coast is at the leading edge of this new world. The proliferation of wearable fitness gadgets and health apps, used to monitor everything from blood pressure to sleep patterns, might seem like a Silicon Valley fad. 

In fact, these devices herald the beginning of an important shift towards more informed patients taking greater control over their own health, according to Daniel Mahony, healthcare fund manager at Polar Capital. “We’re going through a Copernican revolution of healthcare, where the patient is going to be at the centre. The gateway to healthcare is not going to be the physician. It’s going to be the smartphone.”

No longer passive recipients of advice and treatment from doctors, people will have access to their own real-time “digital dashboard” of medical data.

To some, this raises fears of mass hypochondria, with people constantly consulting their smartphone for signs of looming disease. But believers in ehealth insist the benefits far outweigh any costs.

Christofer Toumazou, chief scientist at the Institute of Biomedical Engineering at Imperial College London, says there are “megabucks” to be saved by using technology and data to shift the focus of healthcare towards prevention.

But he warns of big obstacles from health infrastructure and business models that are geared towards reactive care.

There is still a big gap, says Prof Toumazou, between consumer-focused health technology of the kind developed by Google, Apple and Samsung and truly “medical grade” patient monitoring of the kind needed to make a serious impact.

He comments: “There is a divide between the consumer drivers and the healthcare practitioners. Convergence between those two industries is going to be absolutely paramount to the future of healthcare.”

One example of this starting to happen is the partnership announced by Novartis and Google in July to develop a contact lens equipped with a microchip to measure glucose in tear fluid. This information will be transmitted to the user’s mobile device, helping diabetics manage their disease.

Mr Jimenez says: “I really believe that the combination of technology and biology is going to solve some very hard-to-solve disease areas where we haven’t made a lot of progress.”

‘Real world data’

Novartis is working with Google on a varifocal “smart lens” that automatically adjusts between long and short-distance vision.

Mr Jimenez explains: “Think about a contact lens that autofocuses your eye like a camera when you look down and read and then when you look up you have distant vision. It will enable us to do things for the ageing population that have never been done before.”

Digital technology promises to aid drug development by allowing “real world data” from large patient populations to be pooled and analysed. This is opening new ways to assess the safety and efficacy of medicines – potentially accelerating the lengthy path to regulatory approval.

In the long-run, this should reduce the multibillion dollar cost of drug development. In return, big pharma’s customers will use real world data to establish a clearer picture of a new medicine’s value.

Mr Jimenez says: “We’re going to have to shift away from what has been a transactional approach in healthcare to an . . . approach where we are working with healthcare systems to deliver a positive patient outcome.”

Bill Hait, global head of research and development for Janssen, the pharmaceuticals arm of Johnson & Johnson, says the combination of big data and advances in genomic science is greatly increasing the potential to spot risk factors behind disease.

This, in turn, will call for big pharma to focus more on prevention than cures. “Once people know those risks, there will be a clamour for products that intervene before the disease occurs.

“In 100 years from now, people will look back and say: ‘People waited until they got a disease before they did anything about it? Can you believe it!’

Severin Schwan, chief executive of Roche, says that, for all the challenges, the combination of rising demand and advances in science and technology will be good for the healthcare industry.

“We see science at a turning point where our understanding of the molecular pathways of the human genome is finally reaching the stage where we can translate it into medicines.

“I really cannot imagine a more exciting time than today from a medical and scientific point of view.” 

Copyright The Financial Times Limited 2014