Transformative Technology, Patient Culture and Health Policy Anders Sandberg Eudoxa AB.
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Transcript of 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) + ...
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
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