Transformative Technology, Patient Culture and Health Policy

1. Transformative Technology, Patient Culture and Health Policy Anders Sandberg Eudoxa AB

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. Medical Institutions • Main players: regulators, medical community, patients, medical companies, funding agencies • Divided into various organisations • Monopolies common • Health altruism

9. Current Known Trends • Increasing globalisation of medicine • Doctor-patient relation changing • Demographics: older population, more chronic illnesses • What exists in the lab today

10. 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

11. 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

12. 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

13. Imaging • Scanning + fast visualization+ information fusion • Non-invasive exploration • Direct information to doctors • Shorten the treatment chain, reduce sidetracks • Requires change in routines

14. 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

15. Cybersurgery • Surgery supported by information technology • Remote surgery • Direct visualisation • Augmented reality • Robotics • Economy? Stumbles on organisation issues

16. 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

17. Biotech medicine • Regenerative medicine • Rational drug design • Bionics • Genetic testing • Vaccines • Enhancing medicine

18. 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

19. 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

20. Prosthetics and Neurointerfaces • Neurointerfaces rapid development (~300 electrodes, permanent) • Prosthetic research underfinanced • Large gains for small groups

21. 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

22. 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

23. The New Vaccines • Vaccines for treatment instead of just prevention • Immune system control • Vaccines against • Allergies • Diabetes • Autoimmune illnesses • Metabolic illnesses • Cancer • Narcotics

24. 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

25. 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.

26. 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

27. Effect on Medical Institutions • Role of doctor • Financing • Attitudes towards enhancing medicine • Are we health altruist about enhancing medicine?

28. Not All Technologies Change the System • A Cure for cancer • Bionic limbs • Distributed epidemic detection

29. Most Disruptive Technologies • Information technology • Distributed sensors, identity technology • New pharmacology • Genetic testing • Neurotechnology

30. 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) + ...

31. Enables Drives Resists

32. 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

33. Doctor power Client Valence Adversary Team Customer Patient power Doctor patient relation

34. 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 orgated access • Lack of application causes lack ofdevelopment

35. 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