Healthcare, medicine & pharmaceuticals

Google medicine

You’ve heard of social networks but what about gene networks? In the future people will post their genetic profiles as openly as they currently post photographs and descriptions of their lives on sites like MySpace and FaceBook. Indeed, if the history of Web 1.0 teaches us anything it’s that the killer application of the Internet is to link people together and that people will share their innermost secrets with strangers.The idea of people publicly posting genetic and hereditary profiles on the Internet is politically delicate to put it mildly, but ethics alone won’t stop it from happening. As this information becomes more available the more some people will flaunt it or flog it. Why? Because genetic make up determines everything from health and beauty to intelligence and character. So if you’re looking for a mate – or even just a date – checking someone’s genetic profile could reap dividends. In the next decade or so we can expect to see everything from home-use genetic testing kits to software that enables people to upload their entire personal DNA onto their hard drive or sites like ‘Google DNA Search’. And if you think this won’t happen, consider this. People are already uploading naked pictures of themselves so what’s a little extra DNA? We are also routinely conducting DNA testing on unborn children to detect defects and engaging in genetic discrimination of other kinds by selecting potential mates on the basis of skin colour, eye colour and body shape on sites like Match.com. So forget wife-swapping. The future is DNA file swapping. We will be logging onto genealogy sites to find out where we’ve come from and using predictive software to work out where our offspring will be going if harry63@hotmail ends up with sally33@gmail. These genetic networks will obviously open up a whole host of privacy issues, not only for ourselves but also for our parents and grandparents. And you can be sure that everyone from governments and police forces to hospitals and insurance companies will be pretty keen to see what’s hidden inside our family trees once they go public. Such information will undoubtedly spawn a flood of quackery and self-prescribed medicine but networked patients and treatment networks also offer the possibility of open innovation. Currently drug companies and regulatory agencies shy away from certain ideas, but if the freedom to experiment passes to the wisdom of crowds we may see a blossoming of new possibilities.

Open wide

If you are of a nervous disposition please stop reading this immediately. Transgastric surgery or Natural Orifice Translumenal endosurgery (NOTES) is a new surgical technique that allows surgeons to operate without making external incisions. The idea involves passing flexible surgical tools, including cameras, into a patient via the patient’s mouth or another external orifice. For example, two patients recently had their gall bladders removed via an incision in their vaginas. The benefits of this new type of surgery are legion. First it is scar free (externally at least) and is generally pain free too because most of the discomfort of conventional surgery is caused by exterior skin incisions. Hence recovery times are considerably reduced. Second, it is usually considered safer because general anaesthetics are not required. This in turn means that patients can often return home the same day. Last, but not least, the technique (which is a natural extension of keyhole surgery) avoids many post-operative infection risks. MRSA, for instance, generally lives on the skin so entering a patient via their mouth and stomach bypasses this threat.

The Future of Hospitals

If you’re an investor or property developer here’s a possible opportunity in healthcare construction. In the US (and elsewhere for that matter) many hospitals that were built in the 1950s, 60s and 70s are reaching the end of their useful life. Moreover, baby boomers are reaching retirement age in some pretty serious numbers. The number of people aged 65+ is predicted to double to 72 million by the year 2030 in the US and, as you’d expect, these boomers will all need healthcare services like hospitals. Interestingly, the design of most modern hospitals largely dates from the Nightingale Ward established by Florence Nightingale to attend to the needs of wounded and dying soldiers during the Crimean War. However, what worked then (an open floor plan designed to aid the convenience of nurses) doesn’t necessarily work now. What’s increasingly needed these days is a design based on the convenience of the patient and also one that helps people to get well. So guess what? The model for the hospital of the future isn’t hospitals at all – it’s luxury hotels. For example, the Cooper University Hospital in Camden, New Jersey (US) has staff trained in customer service by Ritz Carlton Hotels. Why? Simply because improvements like these translate into productivity improvements and cost savings. Other ideas that work include en suite bedrooms, family waiting rooms and standardized room layouts that reduce staff errors. Even ideas as seemingly crazy as rooms with views, indoor gardens and pet visiting times have been proven to speed up recovery rates and reduce the level of drug delivery.

McMedicine

Could McDonald’s be the future of medicine? The idea isn’t quite as silly as it sounds. One potential route is to embed clinics and kiosks inside retailers like McDonald’s. In other words, take the medicine to the people. The other, less literal, idea is to use the McDonald’s model. In other words develop a huge network of ultra-convenient walk-in or drive-thru establishments that offer consistent standards, convenient access and low pricing. Why is it, for example, that healthcare is almost the only industry left where the customer is not in charge and has to put up with inconvenient opening hours, unpredictable quality and poor customer service?So what’s the solution? One idea is the one-stop health shop – ultra-convenient clinics that are staffed by ‘nurse-practitioners’. These clinics, like those operated by Health Stop and RediClinic in the US, are usually located within or alongside other retail establishments and have prices that reflect their low overheads.In the case of Minute Clinic (Motto: ‘You’re sick, we’re quick’) this means locating clinics inside or alongside Wal-Mart supermarkets and giving waiting customers pagers that go off when the nurse is ready to see them. Being next to a supermarket that has a drugstore inside also means that picking up any subsequent prescription is also fast. So what other ideas are on the horizon? When it comes to more complex diagnosis and procedures, the answer seems to be ‘medical tourism’. I’ve written about this before but essentially if you’re sick and can’t afford to wait (or perhaps you can wait but want to save a bit of money) the answer is to travel abroad for high-quality low-cost treatment. This idea has not been lost on many of the large stock market-listed hospital groups in countries like Thailand and Singapore that are building new hospitals targeted at dissatisfied western baby boomers and Asians. This could, of course, create a backlash from healthcare workers in western countries who are effectively being outsourced to cheaper countries, but that’s globalisation for you. Expect countries like Singapore, China and India (and perhaps the Gulf States) to compete for complex treatments while countries like Thailand, Vietnam and the Philippines move into areas like low-cost cosmetic surgery.

The computer says no

Every day throughout the world doctors are faced with a serious dilemma – whether or not to operate on terminally ill patients and, ultimately, whether or not to turn off life-support systems. Currently the decision is taken in consultation with peers and next of kin but in the future it could be a computer that makes the decision. Scientists at the US National Institute of Health claim that they have developed a computer that can predict outcomes and patient wishes better than humans can.The software behind the computer is based on survey data collected from thousands of patients and is said to be accurate 64% of the time. Bad luck for the other 36% then.Seriously though this idea does raise one very important question: What’s more important, the quality of the final decision or who makes it?