Healthcare Revolution Part II: 5 Ways We Will be Living Better By 2030

In the Part I of this series (Healthcare Revolution — Part I: Living Longer), we explored the Healthcare Revolution as it unfolded during the 20th century and came away with three key lessons. First, innovations in other seemingly unrelated fields (e.g., chemistry, metallurgy, electronics, quantum physics etc.) are often major contributors to healthcare advances — many times more so than internal improvements. Therefore, for predicting future of healthcare, one will have to watch the relevant non-healthcare trends very carefully. Second, innovations in healthcare have much slower ramp up curves than in other industries like manufacturing and technology. New techniques and technologies need to be understood by the doctors, tried carefully and then adopted. Typically, it takes 15–20 years for a new innovation to become mainstream in modern medicine. Thirdly, while serendipity sometimes plays a role in innovation (e.g., Fleming noticing effect of penicillin), more often it is intense curiosity and determined effort made by hundreds of people over long periods of time which lead to significant advances in healthcare.

In this essay, we will explore some of the major 'non-healthcare' trends that have emerged over the last 20 years, and how they might help shape healthcare over the next decade. Instead of predicting what a technology will do, we will take the perspective of a healthcare user (i.e., a patient) or a professional (i.e., a doctor), and examine how healthcare might change using the technologies that have emerged or are emerging. Finally, we will try to paint one of the possible futures of healthcare in the year 2030 that might emerge.

Internal Trends

Let us start with reviewing three significant trends that are somewhat internal to the healthcare industry that are unfolding as we speak. First, genomics is finally beginning to deliver and have a real impact in the clinic. The human genome was decoded in 2001 and by 2018 nearly a million humans' genome has been fully sequenced. In addition, a new tool in the form of CRISPR-CAS system (clustered regularly interspaced short palindromic repeats — CRISPR associated protein 9) that can be used to edit genes within organisms. Companies like Amicus Therapeutics (NASDAQ: FOLD) are using such genomic information and tools to create novel treatments for genetic disorders like Fabry disease which is a lysosomal storage disorder caused by a rare genetic mutation. Second, implantable devices like NeuraLink (Developing ultra-high bandwidth brain-machine interfaces to connect humans and computers) or Second Sight's Orion system (which bypasses the eyes to bring artificial vision directly to the brain) make science fiction into reality. This trend towards fancier and more capable implants is likely to improve as we will discuss below. Finally, the biomarker revolution is upon us and it will define how information will be collected from our bodies and used to diagnose and monitor our health conditions. A biomarker is anything (generally a measurable quantity) that can be used as an indicator of a particular disease state or some other physiological state of the organism. Various types of biomarkers exist including classical blood tests (e.g., autoantibodies in blood for some autoimmune disorders), imaging biomarkers (e.g., objective findings on MRI), body parameters (e.g., BMI) and molecular biomarkers (e.g., for drug exposures, certain genomic or proteomic signatures etc.) and hundreds of new biomarkers are getting discovered every year. As discussed below, new information systems will help transform modern medicine using these biomarkers.

Living Better

Let us begin with a doctor speaking with a patient. Typically, the patient describes his symptoms from memory and in some situations, doctors have to reconstruct events from sketchy information (e.g., the exact nature of body movements during an epileptic seizure). This will change over the next 10 years. Patients will record events like seizures on video, and AI systems will analyze the images and doctors will get a list of possible diagnoses to choose from. Similarly, just the gait (a persons' manner of walking) of a patient can be diagnostic of many disorders (e.g., small shuffling steps of Parkinson's disease) and video systems operating in doctors' clinics will help diagnose these disorders easily. Voice and manner of speaking are other obvious data points that patients produce (e.g., patients with depression have characteristic speech patterns) and advances in voice recognition systems will empower doctors to decode the underlying problems without having to become linguistic experts. A phone-based app, into which a person speaks, and the app generates blood alcohol levels, is not difficult to build and will become a reality over the next 10 years.

Moving to examination of the patients' body, the tools that doctors use today are at least a century old, if not more. The stethoscope (invented 1816), sphygmomanometer (1881), knee hammer (1888), ophthalmoscope (1857) and thermometer (1714!) are all antiquated relics that should be sent to museums quickly as the world moves to more modern devices for examining patients. A sound monitoring system will record patients heart sounds, lung sounds, bowel sounds, joint sounds etc. and compare them with large datasets of millions of similar sounds using AI algorithms and give doctors a real-time interpretation of these sounds. Similarly, image recording and recognition systems (e.g., the phone camera — duh!) will get empowered with backend AI algorithms that will help doctor evaluate patient body structures, facial expressions, skin lesions like suspected melanomas and many more. Video recording and analyzing systems will enable insights into patients' movements like gait, tremors, hand-eye coordination etc. In fact, all of the above is an invitation for some start-ups to invade into the doctors' office and replace centuries old tools with newer ones that empower the doctors' decision making in a seamless manner.

All of patients' history and examination culminates into a medical diagnosis which identifies the underlying disease. As we learn more about medicine, we realize that the traditional disease categories need to be revised to consider the additional information that we gain from molecular, imaging, therapeutic and temporal patterns of many diseases. So, lung cancer is not one disease, but many different types. Same for Diabetes. Same for Stroke. As clinical data of millions of patients gets compiled into unified databases which can deploy novel AI algorithms to detect patterns that are undetectable by humans, our understanding of diseases will become more detailed and real-time. Patients will be able to get predicted trajectories of their diseases (e.g., when a diabetic might expect to get a retinopathy) and take necessary steps to change those trajectories.

Treatment of disease involves either a surgical procedure or medications. Most surgeries are done for one of four reasons: fix-it (e.g., bone fracture), remove-it (e.g., brain cancer), replace-it (e.g., failed kidneys) or augment-it (e.g., larger breasts). Over the next decade, the first two will continue to be important, but the real revolution will happen in the last two as replacement and augmentation becomes mainstream. Newer implantable devices will augment various human capabilities including vision, hearing, memory, walking, eating, drinking and many others. Expansion of human capabilities through surgical procedures will become common. Medical treatments will become more targeted and more expensive as molecular therapies become more effective and common.

A big change in medicine will happen through the gaming industry. Games have a proven ability to hold players' attention, change behavior and enable collaboration across millions of players around the world to reach a common goal — all in real time. These capabilities will start entering the healthcare system and transform how we deal with our ailments. Our battles with illness will become more collaborative and social as against the lonely struggles patients face today. Healthcare variants of Minecraft and Fortnite (which has 250 million players globally) will emerge with new type of medical 'enemies' and new weapons to kill them.

Robots will invade healthcare by taking care of the elderly by giving them physical and emotional support. Anyone who is less than 50 years of age while entering the third decade of this century can expect to have robots to assist him or her as they enter into their twilight years.

So, to sum up, there are five ways we will be living better by 2030. First, we will all get Digitalized and Dr Eric Topol's vision of Homo digitus will become real. All our personal health data will be digital on a cloud, controlled by us individually and represented by various types of Avatars. Our avatars will become our surrogates and participate in the themes mentioned below. Second, a new branch of medicine called Algorithmic Medicine will emerge. Doctors will collaborate with data scientists to design various types of algorithms (pattern matching, predictive, recommender systems etc.) which will consume digital health data of millions of individuals and give personalized medical recommendations to other doctors who are seeing patients. Because decision making is supported by these algorithms which will be quite accurate and transparent, doctors will have more time to spend with their patients to help them make the right choices given by the algorithms. Third, Health Games will emerge as a new form of social engagement and millions of people will play these games to help each other and get better. For example, cancer cells will become the new enemies, Immune system arsenal (e.g., T-cells, Antibodies) will become the new weapons and massive multi-player collaborations will happen to help every player. Creative and innovative games will make healthcare fun and social. Health Games will also discover newer algorithms so the second and third themes will feed off each other. Fourth, Augmentation Surgery will go mainstream and move beyond physical enhancements (e.g., breast implants, hair transplants, cosmetic dentistry) into enhancing capabilities like walking, memory, focused attention, vision and hearing. A wide range of new devices for such enhancements will be invented. If regulatory obstacles are found, individuals will fly or Hyperloop to unregulated jurisdictions to get the enhancements done. Surgeries to fix-it, remove-it and replace-it will become more minimally invasive and more multi-disciplinary and will form the core of the hospitals of 2030. Finally, empathic robots will compete with dogs for our love, and give a lot of love and attention in return. Unlike dogs, these friendly robots will be able to fetch our food and medicines, take us for a walk, play games with us and call 911 if there is an emergency and beam a live-stream of our situation if we are in trouble. These empathobots will become our second-best friends!!

Look forward to another dramatic decade of change in healthcare.