Transformative Technology, Patient Culture and Health Policy

Anders Sandberg

Eudoxa AB

Introduction

• Objective: To apply systems analysis to explore the effects of transformative technology on the health care system.

• Medicine and Technology• Medical institutions • Transformative technology• Systems analysis• What to do

• This talk is about the near future, the next 10-15 years

• I hope to show the importance of the near term for getting to a good long term future

Medicine and Technology

• Medicine increasingly technological

• Medical technology interacts with medical culture and organisation

• Medical eras– Overlaid on each other

– Combination of medical technologyand culture

Mechanical Medicine

• ”Cut and sew”• Up to WW II• Anatomy, surgery, transfusions• Bacteria and antiseptics• Nobel prizes for specific diseases:

1901 von Behring (Diphteria), 1902 Ross (Malaria), 1905 Koch (Tuberkulosis).

• The surgery as the key hospital part

Chemical Medicine

• ”Take a pill”• Solve problema chemically• Antibiotics, psychopharmacology• Transplants• Nobel prizes for treatment methods: 1945

Fleming, Chain & Florey, 1948 Müller (DDT), 1956 Cournand et al. heart catheter, 1979 Cormack & Hounsfield CAT scan, 1990 Murray & Thomas transplants

• Policlinical treatments

Electronic Medicine

• ”The machine that goes ’bing’”

• Track body signals

• 70’s and forward

• Intensive care

• CAT/PET/MRI/Ultrasound

• Endoscopy, keyhole surgery

• Centralized technical systems at centralized hospitals

Medical Institutions

• Main players: regulators, medical community, patients, medical companies, funding agencies

• Divided into various organisations

• Monopolies common– Health altruism

Current Known Trends

• Increasing globalisation of medicine

• Doctor-patient relation changing

• Demographics: older population, more chronic illnesses

• What exists in the lab today

Transformative Technology

• Today nobel prizes on cell- and gene level

• Control at the lowest level

• ”Human health is fundamentallybiological, and biology is fundamentally molecular”

• Next likely medical eras:– Infotech medcine

– Biotech medicine

– Nanotech medicine

Information medicine

• “Knowledge is power”• Medical process: information process• Delocalised, distributed and direct• Decision support, information

management, identity technology,imaging, visualisation, sensors,telemedicine

• The home as treatment location• The Internet Patient

Decision Support Systems

• Diagnosis, data analysis, reminders, memory empowerment, ”second opinion”

• Interactive broschures, simulations, smart objects, ”the digital doctor”

• Benefits patient participation, handle information overload

• Problems: conservative, silent knowledge,integration with patients and organisation

• Still rare. Not technology limited at present

Imaging

• Scanning + fast visualization+ information fusion

• Non-invasive exploration

• Direct information to doctors

• Shorten the treatment chain, reduce sidetracks

• Requires change in routines

Sensors and Telemedicine

• Trends– More conditions measurable, smaller, cheaper, plentiful, more functions per chip– More intimate and biological, both non-invasive and implanted– Active ”smart” sensors/actuators, wireless communication

• Pathogen sensors, automated medication• Moves the location of diagnosis and treatment to

the periphery• Information overload,

privacy, security, training

Cybersurgery

• Surgery supported by information technology– Remote surgery

– Direct visualisation

– Augmented reality

– Robotics

• Economy? Stumbles on organisation issues

Minimal Access Surgery

• More and more applications

• Faster recovery

• Faster surgery redistributes medical personell

• Need of a new kind of operating theatre?

• Strong link to VR and robotic surgery

Biotech medicine

• Regenerative medicine

• Rational drug design

• Bionics

• Genetic testing

• Vaccines

• Enhancing medicine

Regenerative Medicine

• Regenerative medicine– Direct biochemical control– Tissue culture– Stem cells– Artificial implants

• Fast development, very large potential ling run– Out-compete xenotransplants?

• Regulation- and financing problem for clinical use

The New Pharmacology

• Rational design– Based on genomics, simulation and knowledge of

basic processes

• Generics threatened, business models in pharma threatened

• Blurs the borders between palliative, curative, preventative and enhancing medicine

Prosthetics and Neurointerfaces

• Neurointerfaces rapid development (~300 electrodes, permanent)

• Prosthetic research underfinanced

• Large gains for small groups

Genetic Testing

• Cheap, fast genetic tests many conditions• How many wants to test? How does the health

system respond?• Benefits: More individually adapted, good for

preventative medicine and pharmacogenomics• Problems: Interpretation, too much faith in

genetics, diagnosis develops faster than treatment, breaks information monopolies

Reproductive Medicin

• Reproduktion as a right?

• We are willing to spend enormous sums on our children and their health

• Genetic testing, preventative medicine

• Perinatal medicin

The New Vaccines

• Vaccines for treatment instead of just prevention• Immune system control• Vaccines against

– Allergies– Diabetes– Autoimmune illnesses– Metabolic illnesses– Cancer– Narcotics

Neurotechnology

• The brain/mind increasingly visible

• New pharmacology + understanding of brain leads to treatment of many mental disorders

• Hybrid therapies

• Enhancing medicine and treatments likely

Nanotech medicine

• NBIC convergence

• Enhancement of previous technologies– Reduced price

– Increased effectiveness

– Increased portability

– Active and smart devices and drugs

• Development gradual and enabled byprevious technologies.

Effect on Medical Institutions

• Changing concepts of disease and health• Monopolies and gatekeeping challenged• Organisation changes needed for maximal benefit• Technologies that doesn’t fit in will not be used• Individualisation of medicine

– Well informed, demanding patients

– Monopolies of diagnosis andtreatment break up

– Individualized treatment methods

Effect on Medical Institutions

• Role of doctor

• Financing

• Attitudes towards enhancing medicine– Are we health altruist about enhancing medicine?

Not All Technologies Change the System

• A Cure for cancer

• Bionic limbs

• Distributed epidemic detection

Most Disruptive Technologies

• Information technology– Distributed sensors, identity technology

• New pharmacology

• Genetic testing

• Neurotechnology

Systems Analysis

• Study the interactions between different actors as a dynamical system

• Driving factors x’(t)=c y(t) + ...

• Enabling factors x’(t)= y(t) [...]

• Resisting factors x’(t)=-c y(t) + ...

DrivesResists

Enables

Feedback Loops

• Technology amplifies current trends

• Strong feedback loop in changed patient-doctor relationship and competition

• Drives problems both organisations and regulations

• Resistance doesn’t affect core loops

Doctor patient relationDoctor power

Patient power

Valence

Client

TeamCustomer

Adversary

Observations• Nanomedicine shares properties and organisatorial

effects with information and biotech medicine.

• NBIC convergence implies that rules for B, I and C will affect N

• Glitches in earlier steps may stifle development– Regulatory uncertainty– Centralised, monopoly or

gated access– Lack of application causes lack of

development

Summary

• Want to avoid– Lost opportunity (“regret”)

– Conflicts

• Want to achieve – Good health for all

– Transhumanists: Morphological freedom

• This kind of model helps us analyse where to work hardest to fix policies