IEX# 167: Welcome to The Decade of Healthcare Innovation

Almost every aspect of healthcare is being re-imagined as we speak.

I have been blown away by the 60-30-10 challenge in healthcare. I first heard about it at the recently held UNGA Healthcare discussion, from Jeffrey Braithwaite, but then I also read his co-authored paper from 2020. In essence, the problem is this: “Healthcare represents a paradox. While change is everywhere, performance has flatlined: 60% of care on average is in line with evidence- or consensus-based guidelines, 30% is some form of waste or of low value, and 10% is harm. The 60-30-10 Challenge has persisted for three decades.”

So what’s changing? Why am I hopeful? And why do I think that the 2020s will be the ‘decade of healthcare’? Partly because I’m an eternal optimist. Partly because things have to change at some point. And partly because many forces are aligning as we speak to create not one but multiple points of inflexion. From a technology perspective, it’s not a surprising list - data gathering and usage capability, AI and Machine learning maturity, increased connectivity, reduction in the cost of sensors and monitoring, the growth of wearables, the ubiquity of networks and bandwidth, and of course Moore’s law, even as it wobbles. This combination of technologies has been extremely useful for managing chronic illnesses. Digital Therapeutics for instance involves clinically approved apps that can substitute or complement drugs for conditions like diabetes, insomnia, schizophrenia, and ADHD. There is certainly a scenario that at the end of this decade Apple is the worlds biggest healthcare company.

This week I also spoke with Dave Hurhangee, the founder of Waire Health. Waire’s device is the size of a smartphone, can be worn with an armband, tracks over 25 parameters and generates a NEWS Score every 120 seconds. As Dave pointed out - in today’s world we track and monitor our automobiles and our money far better than we track our health. Waire seeks to address that by making both a hospital grade as well as a domestic device, all clinically approved, secure, and capable of working across a number of networks. (or even when you’re not connected). Companies like Waire are changing the game for how we measure human health.

Everywhere you look, there are breakthroughs. Doctors have recently successfully transplanted a kidney from a pig to a human. Americans can now buy hearing aids without a prescription. And some of you may remember that DeepMind recently published what is effectively the human proteome - with 350,000 predicted protein structures.

Building on this, you have the entire world of genomics, mRNA, and increasingly, personalised medicine for cancer treatments. The success of mRNA vaccines for Covid19 have paved the way for other mRNA based treatments including for pancreatic cancer - which was in the works but was sidetracked for Covid vaccine research. The malaria vaccine too, is a huge step forward, although a lot more needs to be done. As the article says, “the SARS-CoV-2 virus has around 10 genes that code for 29 proteins, Plasmodium falciparum, one of five parasites that cause malaria, has a much larger genome that codes for over 5,000 proteins”

The overall thinking about healthcare has also shifted across the world, with most countries now recognising that investing in prevention is better than cure. This will become even more stark as the worlds population starts to age by the middle of the century. Consequently, more investment is being made available for innovations in keeping people healthy, or catching symptoms early. In Ireland, for example, they call this the shift left, stay left, strategy. In the UK, Boris Johnson’s government has also committed an additional £12bn a year to health and social care. In Scotland, organisations such as DHI are focused on re-inventing the data strategy and service delivery of healthcare.

The level of funding in healthcare and HealthTech is another barometer. According to CBI, global spending on healthcare rose for the 7th successive quarter, and specifically AI in healthcare has reached $2.7bn per quarter. Telehealth has more than doubled year on year and is attracting over $5b of quarterly investment. My discussions with Tunstall, whose research shows a saving of £4.5k per user per year with telecare, have only increased my belief that remote care and monitoring is a solution whose time has come. It’s almost the only way we can handle the growing demand-supply imbalance in care, especially in a post Covid world. But it will end up dramatically improving care quality once we stop thinking about it in terms of human-substitutes.

Another area that is finally receiving the entrepreneurial and financial attention it deserves is FemTech. This can definitely be correlated with the rise of female entrepreneurs. Jessica Ennis’s firm Jennis, lets women build “personalised daily workouts mapped to the four phases of the menstrual cycle”, or businesses like Maven are just a couple of the growing legion of FemTech startups.

And then of course there’s the stuff that will significantly shift how we see life. Altos labs and Calico Labs are both working to extend life expectancy. Neuralink and others want to connect systems directly to your thoughts with the brain-machine interface, which has been a bit of a final frontier for healthcare as well as technology. The acronym ISRIB might not mean much to you and me but it’s a wonder molecule that can potentially treat Alzheimer’s, ALS, and Parkinson’s. Each of these is a game changer.

We should remind ourselves that with every innovation there is the spectre of misuse, or questionable use. Bio Hacking, manipulating memories, and genetic engineering are just some of the areas already being discussed. Nor should we ignore the emergence of future problems - for one, the impact of climate change on global health (and mental health), and for another future new pandemics and virus mutations. And what would you do if you could find out what diseases your yet-to-be-born child could be prone to?

Jeffrey Braithwaite’s article, which I started with, points to the disjointed working of the healthcare system, and the lack of information sharing. This is discussed at length in Matthew Syed’s book ‘Black Box Thinking’. His analysis, which compares healthcare systems to airlines (who religiously share data about every incident across the industry including manufacturers), suggests that the avoidable deaths in healthcare is the equivalent of a plane falling out of sky every day. The greatest weapon we might have today is our ability to share data and knowledge more effectively. Braithwaite and his colleagues highlight the need to create a learning organisation within healthcare. Today we have all the tools to make this an easy task - at the smallest levels of proteins and genes, to the largest levels of population scale healthcare systems.

Reading This Week

EV Infrastructure Map: If you haven’t seen it already, the REV index put together by the Economist along with BP is a very handy guide to the readiness for electric vehicles across the world. (Economist)

Autonomous Vehicles: Cars that think - supercomputers on wheels. (IEEE Spectrum)

Flying Cars: How close are flying cars? Interview with the founder of Joby Aviation (Bloomberg)

Anti-Vax: Scott Galloway talks about his chart of the week. Proportion of people still resisting the vaccination. The US and Russia top the table. (YouTube)

Sustainability: Walls that can harness wind-energy. Who doesn’t want one of these at home! (Fast Company)

Wearable AR: Smart contact lens with Augmented Reality built in, from Mojo Vision. Could help you find the restaurant you’re looking for, but more importantly could provide additional information to the visually challenged. (via Charles Carter)

Product vs Marketing: Remember when Google didn’t advertise? Well, Tesla is the new Google - spending nothing on advertising and putting it all into product development. (See below: Visual Capitalist)

Weird News Corner: One in a hundred billion chance of a meteorite crashing through your ceiling and landing on your bed, they say. This lady should have bought a lottery ticket, I guess. (NYT)