What will medicine look like by 2050?

Adapted from an address to the Royal College of Physicians, London, on the Occasion of their 500th Anniversary by Andrew Thompson, President and Chief Executive Officer Proteus Digital Health

Let me start by making a specific prediction about medicine.

Digital Medicines — drugs that communicate with your mobile phone when ingested — are here now and will quickly become a required part of therapy. They are already in commercial use and thousands of patients have used them. Within ten years every drug in the supply chain will be a digital object, every patient will know what they take and how it affects their body. Your grandchildren will be incredulous that you put things into your body and did not know if they were real or fake, in date or out of date, the right drug or the wrong drug, the right dose or the wrong dose. One hundred and twenty years of innovation based on chemistry, (Bayer 1899, Aspirin) and 36 years of biology (Genentech 1982, Humulin) will be turbocharged by a new era of physics, innovation based on silicon and software (Proteus, 2017 Abilify MyCite). Silicon and software is what is turbocharging innovation in every other industry. It will do the same for pharmaceuticals, and that is already underway.

What can happen over the next 30 years is hard to imagine, but with certainty it will be astonishing. More scientists are working today than in the rest of history combined. If you want to know what is going to happen in the next thirty years, it's a good idea to look back at the last 100 years.

My grandmother, Kathleen Mabel Bayles was born in Norwich in 1899. She had two sisters, Alice and Gladys. Their father was a legal clerk. He died in 1904 from spinal tuberculosis and their mother could not support the family alone.

Kathleen and her two sisters ended up in the Norwich Poor House, a very difficult place to grow up. Kathleen got her first pair of shoes at the age of 11 in 1910 when she was sent to work as a downstairs maid (which means she was not to be seen above the basement).

At the age of 17 a minor miracle occurred. Kathleen married my grandfather, Hammond. He worked at something invented by GE: a power station. This invention — the electric power grid — dramatically changed the lives of everyone in Norwich, in England and indeed all of Europe and America.

It transformed the arc of Kathleen’s life. She witnessed for the first time in history a plug for an electric appliance; light bulbs; a car (a horseless carriage); flight; refrigerators; consumer credit (another GE invention that enabled poor people like Hammond and Kathleen to own a fridge); jet engines; X-Ray machines; a man on the moon; death from infectious diseases dropping by over 90%; life expectancy almost doubling.

Kathleen died in 1994. All of her grandchildren were wearing shoes. At the time of her passing, GE was the largest industrial company in the world and had revenue equivalent to about one percent of US GDP.

In 1999, Kathleen’s great grandson Robert (my son) was born. By Robert’s 17th birthday (the same age Kathleen married Hammond who worked at the Norwich power station) there was another company, with another new grid or network, reshaping his life and this time the lives of just about everyone in the world. Not even 20 years old, that company was already more than twice as valuable as GE... As all the smart readers here have guessed, it’s called G….OOGLE.

The mobile internet is a transformative technological step change. It is remaking all aspects of our lives and that will increasingly include medicine. So the number one mega trend that will transform medicine is digital technology. The 20th century paradigm of Building, People, Product (go to a bookstore, to see a clerk, to buy a book) is becoming Mobile, Software, Service (go to an iPad, to use software, to download content).

The second global mega trend is demographic: aging, urbanization and affluence. These three together are leading to global pandemics of dementia, depression and diabetes.,

The third global mega trend is globalization of free markets and capitalism. In 1990 about one billion people lived in markets that were more-or-less economically free. Today maybe five billion people live in markets that are more-or-less economically free. That means much more innovation and a faster pace of change. Today in healthcare we have a seven trillion dollar global industry, half of that revenue and nearly all the profits in the US. By 2040 it will be a twenty trillion dollar industry and most of the revenue and profit will not be in the US.

Let’s dig into healthcare some more. The first thing to note is that we don’t have a healthcare system. We have a sick care system. It was designed in the last century to deal with the major problems of the time: acute disease and trauma. It does the job for which it was designed quite well, and it uses the best technology of the 20thcentury. Buildings where you plug into electricity (the new utility of the time); people with knowledge in their heads (education an important 20th century development); and products designed and tested to be safe in everybody and work in somebody (mass standardization was another great achievement of the industrial era).

The healthcare challenges we face today are mainly chronic non-communicable diseases. We spend over 80% of our resources on managing these conditions. They are mainly treated in community settings with oral pharmaceuticals and are not well suited to being managed in our sick care system. To succeed with this challenge we are going to build a healthcare system, using the best technologies we have today, not to replace sick care, but to enhance it and make it better.

The potential of a building where you plug in to electricity is magnified by the awesome power of a mobile device where you log on. The capacity and expertise of people with knowledge in their heads is massively extended by software and servers with intelligence in the cloud. Products designed and tested to be safe in everybody and work in somebody will become services, tailored to you, your genes and your lifestyle. They will be delivered where you live, work, play and pray; in ways that you see, measure and understand; at a price you can afford to pay. That is the enormous potential of a digitally enabled healthcare system.

Patient centered, digitally enabled healthcare solutions can be built following a strategic roadmap laid out by the technology industry. That industry is already well on the way to delivering powerful computing for everyone, everywhere. The mobile internet is spreading much faster than electricity ever did.

There are three keys to making this happen that we can adopt in medicine.

First, consumerize: a computer has become a cell phone, not a work station. More computing power is now owned by consumers than by governments and corporations combined. Second, systematize: tech companies operate in ecosystems that enable a seamless experience with all the complexity dealt with by producers, not by consumers. Third, globalize: sell to everyone, not just rich people in rich countries.

Most people who own a mobile device make less than $10 a day. That’s not an accident, not an act of Congress and it’s not gravity. It's a business strategy. There are at least five tech companies that will be trillion dollar companies soon - 3 or 4 times the size of any healthcare company.

In healthcare we have a long way to go if we want to follow the roadmap laid out by the technology industry. Consumerize? No, we sell to governments and professionals. Systematize? No, we sell expensive components and make the user figure out how to make them work as part of a solution. Globalize? No, the innovation focus of the entire pharmaceutical industry is very expensive therapies for the rich.

What we do in healthcare today is also not an accident, not an act of Congress and it’s not gravity. It's also a business strategy. It is not sustainable. In healthcare, too, we are going to consumerize, systematize and globalize and we will do it with a four-dimensional care paradigm: drugs, devices, digital and data. These will drive both diagnosis and therapy.

By 2030 patients will be diagnosed at home for free using the consumer’s own mobile device and crowd-sourced medical expertise.

There will be many high-fidelity tests that can be built into the mobile device and they will be extremely inexpensive. This will happen first in China, and will be ubiquitous there by 2025.

The most important innovation in therapy will be Digital Medicines.
Genes account for maybe 15% of health outcomes, luck for maybe another 15%. Where and how you live is about 70% of what determines health.
So your zip code beats your gene code when it comes to medicine.

Digital companies have been able to use phenotyping to create exquisitely tailored products and services. Amazon phenotypes how you shop and delivers precision commerce. The same will happen with medicines. Your care team will know how you take them, how your body responds and will deliver precision Digital Medicines.

On the device side we will move from fun toys to FDA-certified consumer friendly, medical grade wearables that deliver accurate, actionable health data.

Digital apps will be much more sophisticated and make use of sensors and analytics integrated into the consumer’s own mobile devices. These apps will store data and forward actionable insights to care teams based on AI, and provide engagement tools that support patients and their families.

Data will increasingly be specific, accurate and actionable as opposed to general, variable and entertaining.
The focus on data fidelity in healthcare will give way to a focus on data fusion and the power that comes from many different signals that capture the life flow of the consumer, which is much more important for healthcare insights than money flow of the payer or work flow of the doctor.

To finish let me restate what I began with and what you all now know to be true:

Digital Medicines - drugs that communicate with your mobile phone when ingested - are here now and are quickly becoming a required part of therapy. They are in commercial use and thousands of patients have used them. Within ten years every drug in the supply chain will be a digital object, every patient will know what they take and how it affects their body. Your grandchildren will be incredulous that you put things into your body and did not know if they were real or fake, in date or out of date, the right drug or the wrong drug, the right dose or the wrong dose. One hundred and twenty years of innovation based on chemistry, (Bayer 1899, Aspirin) and 36 years of biology (Genentech 1982, Humulin) will be turbocharged by a new era of physics, innovation based on silicon and software (Proteus, 2017 Abilify MyCite). Silicon and software is what is turbocharging innovation in every other industry. You could not use a car or a television today without these technologies. The same will be true for pharmaceuticals very soon. The age of Digital Medicines has already begun.