Sunday, April 17, 2011

Healthcare in 20 Years (In 500 Words)

I was asked yesterday to predict the practice of medicine in 20 years. After stating that any such prediction is massively speculative, I indulged because it is massively fun.

I am persuaded by Clayton Christensen’s arguments in “The Innovator’s Prescription” that healthcare will go the way of other massively disrupted industries, wherein healthcare will follow the arc of decentralization.

Using the music industry as an example, Christensen's arc begins with consumers going to centralized experts like those at Carnegie Hall, then to buying players and music in local stores, and eventually to using a mobile device to purchase and listen to music in the back of a taxi. Similarly, much of the publishing and retail industry have traced this arc. It is only a matter of time until healthcare does the same.

Here’s how I think it’ll be done within the next 20 years:

Most of what goes on in a doctor’s office will be carried out by Eric Topol's legions of wireless devices measuring our blood chemistries, heart function, vital signs, and many more parameters that modern medicine isn’t yet even currently aware.

All these devices will be networked with a central database and processing unit, a machine that goes bing. This machine will correlate real-time data with the information riches of your own genetic profile. But, more than just you, this data will also be meshed with several other informative contexts: your family’s genetic information; the behavior and habits of your friends and neighbors; the demographics that enjoy your lifestyle. Last but not least, this machine that goes bing will be continually updated with the latest findings of the medical science world. (It might have a lot to do with Archimedes Outcomes Analyzer.)

With some beeps and whirls, it will churn through data streams that would overwhelm the most cognitively capable of today’s doctors.

In twenty years, the patient with diabetes, the victim of congestive heart disease, the smoker with emphysema, all will have their medicines optimized and managed (your new meds arrive in your mailbox... will we even have mailboxes?) before their diseases advance to a point that today’s medical system would even notice that something's up.

And yes, just as we get our music from our pocket devices where once it necessitated a trip to the music hall, we will get today’s medical care from our personal devices without having to go to the doctor's office.

Before you jump down my throat for predicting the demise of the medical profession, hear this: I do not predict the demise of the medical profession. While I do think that the practice of medicine as we know it today will be largely irrelevant, doctors in the future will be doing fantastic things that we can’t conceive.

I’ll leave it to someone else to speculate what that’ll be. Instead, I’ll cheerfully admonish against the assumption that technological growth will leave us all milling about with nothing to do.

*Addendum: Some of the machines that go bing: Check out Daniel Kraft's TEDXtalk: "Medicine's Future? There's an App for That."


Anonymous said...

Doctors today are seduced by bits of paper with 'scientific' measurements on them. They would rather treat these than the human in front of them.
So the response to any worry is not dicussion but yet another damn bood test.
All very vetinary. and pricey.
Healthcare in the future will be mostly cheap slot machine stuff.

Drew Weiss said...

All predictions like this are a little silly. A much more likely prediction is that that Health Care will be recognized as a commodity like soy beans or electricity, and distributed through quasi-public organizations like regulated utilities. The killing off of HMO's was brutal but they will rise again. There really isn't any viable alternative.

astupple said...

Do you think patients are less healthy with less discussion and more tests?

Mr. Weiss,
Silly, indeed. The commodity aspect intrigues me, specifically the question of whether patients are customers or not, which was addressed in depth by Paul Krugman on the NYTimes recently.

Why are you so convinced of this particular "HMO as utility" model?

Thanks you two for reading!


Anonymous said...

Given that healthcare is mostly a personal interaction between two people one of who is recognized as an expert and one an individual seeking knowledge there probably will be little discernible change in the day to day practice of medicine. However, the average age of the clients will be 10 years greater than today's patients. The provider will likely have easy access to large databases only imagined by current practitioners.

astupple said...


Funny how strong that argument continues to be- the more things change, the more they stay the same.

People will always be seeking health, and some people will always be experts to aid and guide that search. End of story. The basic relationship will be maintained.

Wow, I love it!


evanclayton said...

Health care will be more sophisticated in twenty years. I think the new health care law will have its intended effect of helping the poor get health insurance.

Lucien Engelen said...

The future of health is more interesing then the future of healthcare, since this is going to set theheadng for healthcare.
In that the impact of exponential technology and the rise of the empowered patient will disrupt healthcare as we now it. It should by the way, given the challenges we face like doubled healthcare demand, shortage of skiled personel and unsufficient budget.
Never before healtcarefaces bigger changes then at present.

Lucien Engelen
Radboud University Nijmegen Medical Centre, the Nerherlands
@zorg20 on twitter

astupple said...

Mr. Engelen,

Exponential technology, right? I just don't think this concept gets enough press. What could have a bigger impact than exponential growth. When we look at what mobile phones have become in the last 5 years, how can we not focus on the fact that they will do EXPONENTIALLY more in the next five years.

Thanks for your input, and hail Holland!


astupple said...

A point that was made in another forum regarding this post:

People will always seek improved health. There will always be experts to guide and aid that pursuit.

Therefore, the heart and soul of the doctor/patient relationship will endure.


Anonymous said...

Hi Aaron,
I've been discussing this with you over at Marginal Revolution, and just thought of something that I'll post here. The basic premise you outline is that more data (both across time and in depth) will lead to better medical outcomes and better access to care. I hope I haven't misrepresented you too much. Anyway, as I said over at MR, one axiom of good medicine is never order a test that you won't know how to decisively interpret if the result comes back abnormal. Treating test results, instead of patients, leads to increased cost and increased complications, but generally not increased health. That's my premise, and I think having vastly more laboratory data on seemingly healthy people will more likely lead to unnecessary treatment and confusion than it will to more focused and earlier treatment of actual illness.

The problem is the sensitivity and specificity of testing data. Very few lab tests or internal measures are significantly sensitive and specific. Correlating vast amounts of nonspecific data over time may turn out to ultimately lead to real sensitivity and specificity, but I don't think it naturally follows for most illnesses.

Fetal monitoring is a great example. When this was developed decades ago, it seemed like a no brainer that having ongoing direct measures of fetal oxygen levels during childbirth would dramatically improve the morbidity and mortality. We know that hypoxia in the fetus is correlated with brain damage. No more guessing if the fetus was suffering from hypoxia had to lead to better outcomes.

In fact, though fetal monitoring has been the standard of care for years, it has not made childbirth cheaper or safer, and may have in many cases done the opposite. Here's a link that details some of the issues. Unfortunately, we're now in a place where if a doctor declines to use fetal monitoring, or decides that a C-section or inducing labor isn't necessary despite 'abnormal' fetal monitoring data, they'll be an easy target in a lawsuit. So like lemmings most obstetricians play along. Despite decades of fetal monitoring and many, many studies, we really don't know how much hypoxia is dangerous, or where the tipping point is for any given patient. Obstetricians have this staggering wealth of new data, data that is obviously relevant and seems crucial, and it only serves to cloud the picture.

I suppose you could argue that, in time, fetal monitoring could involve measurements of even more maternal and fetal processes, and that over time this data could drive mathematical models that would be correlated with long-term outcomes, and fetal monitoring would fulfill it's promise of being superior to an obstetrician's judgment about when to induce, when to use forceps, and when to use the scalpel. But in this one very specific area of medicine, we don't seem to be moving in that direction. Moreover, we have no mechanism for course correction, so my bet is that we could have this same debate about fetal monitoring in 20 years.


astupple said...


I'm so happy you continued your comments here.

I think you misunderstand me thus: I am in no way saying that more data is better simply because there's more. What's better is having BETTER data, and more of it.

I enjoyed your EFM piece, and I'm in 100% agreement- bad data is worse than no data, and we're in a sticky place because of it (I'd love to expound on signal/noise stuff and quote from James Gleick's "The Information" here, but I'll just cheap out and close these parentheses).

What I'm proposing is that disruptive tech in the form of data sensors will be the force that eventually topples EFM and other excessive tests and bad data sources, not the other way around.

A big problem with EFM is that the mother's heart rate gets mistaken for the baby's heart rate (I witnessed this). The caretakers think the baby is doing fine when in fact they're looking at the maternal rhythm.

What if the mother instead wore several sensors that continuously uploaded her vital signs, blood chemistry, and even fetal blood chemistry and vital signs, to a central display? And what if these sensors could be taken anywhere? And what if a central processor were installed to separate signal from noise with this torrent of real-time data?

Would we need EFM's? Certainly not. Would we use them anymore? Certainly not.

Is such a body area network feasible within 20 years? Absolutely.

I hear and sympathize deeply with your general point, and EFM's are a great example. I like to consider myself a skeptic. But, I'm an optimist about the future. I think things are happening in the tech world that render many old arguments and perspectives precisely that- old.

I'll leave you with this, trite as it sounds, and poorly appropriated from Taleb's "The Black Swan": before anesthesia, no one could conceive of painless surgery; before flight, no one could conceive of, well, flying. Before AC, no one could conceive of living in Florida. Now, we take these all for granted, as we should. That's why humans have all this cool stuff that beavers and dolphins don't have- we get used to what we've got and seek more.

I believe we are standing on the threshold of medical and information breakthroughs that will be more transformative than anesthesia, flight, and AC combined, and many lives today will be profoundly improved if we can usher these changes in sooner, smoother, and more effectively. That's not to say we blindly leap, but that we do do a good bit of stretching and reaching. And guard our knee-jerk attempts to write off these changes.

Of course, I humbly submit that I could be entirely wrong.


Mat Phillips said...

This, albeit speculative view of future healthcare is too narrow in perspective. Surely the biggest gains will be in those parts of the world where access to clean water, sanitation and preventing transmittable diseases is far more profound than things 'that go bing'?


astupple said...


I certainly agree- the debate I've been engaging in revolves around US healthcare, which seems to be broad enough in perspective to warrant consideration that excludes global issues. I mean, climate change should have an impact on healthcare too, no?

Thanks for reading!


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