Would you like to live to 100, if it meant changing your entire lifestyle? Or is there a darker side to longevity? This month’s Intelligence Squared panel focuses on the future of healthcare in our super-ageing society, where 70 is the new 50, diseases can be predicted and prevented with greater accuracy than ever before, and an abundance of self-tracking data means more patients are becoming their own practitioners.
From quantified self to quantified health
“Modern cars have between 300 and 400 sensors, but you only pay attention when your check engine light comes on,” says Dr Daniel Kraft. “What if you had a check engine light for your body?” Kraft is Faculty Chair for Exponential Medicine at Singularity University, where he works with global enterprises to leverage the latest technologies into solutions to critical healthcare problems. That can mean prescribing apps for everything from pregnancy to pre-op and post-op care, fine-tuning the way med students learn anatomy with VR and AR, 3D printing bespoke prosthetics and implants.
As more and more self-tracking data begins to flow into and out of our smartphones via tools such as Fitbits and Apple Healthkit, Kraft believes it will be possible for consumers to become “CEO of their own care,” whether that be livestreaming EKG data to their physician, or digitizing their genome to identify early indicators for hereditary conditions.
“The future will be kind of like we drive today,” he says. “When you drive with Google Maps, you share some information, and in exchange you can crowdsource a map, look at traffic, and get information that changes your trajectory… What if we can do the same with healthcare?” Kraft believes that, just as we have blood and organ donors, becoming a “data donor” will soon be the norm.
“We can all be participants in the future of healthcare, speeding up clinical trials,” he says. “Today you can download multiple trials, from Parkinson’s to autism to asthma… We can democratize healthcare.”
70 is the new 50
“Ageing is neither inevitable nor universal,” says João Pedro de Magalhães, Senior Lecturer at the University of Liverpool, whose work centres on the study of ageing at a cellular level, and the possibilities of delaying ageing by replicating what already exists in the natural world. “Of course it’s not just ageing but also age-related illnesses,” he says. “We want a 70 year old with the health of a 50 year old.”
Over the last forty years, the average Briton’s life expectancy has lengthened by a decade. When the NHS was set up in the 1970s, it largely dealt with acute illnesses. Now that people are living longer and surviving conditions like cancer, heart attacks and strokes, 70 per cent of the UK’s healthcare budget is spent on chronic disease management.
“We need to get serious about prevention,” says Professor Tony Young, NHS National Clinical Director for Innovation and “disruptor-in-chief.” He outlines three key areas that the NHS needs to work on in the next five years if it is going to serve these vastly different needs. Firstly, there is a health and wellbeing gap that necessitates a radical upgrade in preventative measures. Then there is a quality gap that requires new care models, and finally a funding gap in need of greater efficiency and investment.
Historically, doctors have been the “gatekeepers” of healthcare, but Young believes that putting this power in the hands of patients will be the key to positive, sustainable change. He points out that everything you find in a GP’s bag can now be made available to general consumers through digital technology, and that self-tracking will lead to huge steps in innovation when it comes to patient-led care.
“There are some fantastic examples of patient entrepreneurs out there,” says Young, citing the example of a bowel transplant patient who originated a method of notifying users when a stoma is halfway full; something which he admits would never occur to the doctor carrying out the surgery. “If we don’t have citizens and patients at the heart of what we’re doing, as we redesign healthcare and bring in all this new technology, we won’t get it right,” he adds.
Can you afford the rest of your life?
The standard retirement age in the US is 65, but a baby born today can expect to live to at least 82; Kraft comments that society will need to be restructured around this increased longevity. Additionally, in insurance-driven countries like the US, healthcare is often linked directly to personal wealth; not everybody will be able to afford to care for their elderly relatives as they develop a greater proportion of age-related illnesses.
This may not be the case in the future. Pretty soon, even the poorest people in the world will own smartphones, by extension gaining access to the quantified self. Rather than being at the mercy of insurers, citizens will be able to take ownership of their own health through self-tracking, inexpensive cloud-based medicine, and that all-important prevention.
Then there’s a potential scenario where insurers will be able to willfully discriminate against customers with a genetic profile that includes a high risk of heart disease or dementia. Legislation will be needed, Young says, to prevent abuse of these technologies for profit.
“This is where the NHS will come into its own; we have a pooled risk model,” he says. “I think it’s widely acknowledged that the most efficient, cost-effective way to run a national healthcare system, is through a centrally funded taxation route, time after time.” And the jewel in the NHS’s crown is its data-set, shared across a unified system which can make a difference to healthcare populations all around the world.
But don’t fear; technology isn’t going to rip the heart out of medicine. Young recalls an experiment where elderly patients were given hi-tech remote treatment, but soon reverted back to visiting their GP in person. As our life expectancies grow, social connections are going to be more vital than ever before.
He believes that the question “what’s the matter with you?” will shift to “what matters to you?” For some, that will mean preventing illness, while for others it will mean planning a “good” death.
“It’s not just about prolonged existence,” says Young, “but all those other things that make life worth living.”