(Editor’s note: The following is an excerpt from my forthcoming book, 20/20 Foresight: A Futurist Looks Ahead to the Ten Trends That Will Shape the World of 2020, which I am writing with the able assistance of fellow futurist Simon Anderson, host of www.futur1st.com. This chapter takes a look at the future of healthcare.)
Jonathan Rothberg, a life sciences technology pioneer and the CEO of gene sequencing technology company Ion Torrent, has claimed that sometime in 2013 society will have the ability to sequence a human genome in under two hours for the relatively bargain price of $1,000. To put this in some perspective, it helps to consider the first human genome project was completed in 2001 for the sum of $3 billion dollars. The project has already had major implications for the healthcare industry and the way we prevent and treat disease. Alas, fast and inexpensive gene sequencing is just a small part of the incredible changes that have already started occurring in the field of healthcare.
By the beginning of the next decade, in addition to the developments in genomics, continued advances in information technology, biotechnology, nanotechnology, robotics, data mining, artificial intelligence, sensors and social networking will have transformed the face of modern medicine. What follows is a scenario involving one individual with a single ailment.
On October 21, 2020, Roger Martin, a 67 year-old unemployed attorney, suffered a massive heart attack while tending to a small plot of land on an urban farm in a once thriving suburb of Atlanta. Had the event occurred 10 years earlier, Roger would not have made it to the hospital alive.
The first sign of impending danger came when sensors in Roger’s shirt detected an unusually high pulse. Unbeknownst to Roger his shirt sent a wireless alert to his “PMD” (Personal Mobile Device) so it could begin more closely monitoring his other vital signs. After noting his symptoms, it compared them—along with his medical history and genetic file—to its vast database of all known diseases and injuries. Among the possible causes were a number of serious conditions so it also contacted his primary physician, who immediately contacted Roger via mobile video connection.
“How are you feeling, Roger?”
“Fine,” he replied, “maybe a little tired but nothing out of the ordinary.”
Seeing that Roger looked a sedative-meds.com, the doctor asked him if he had his permission to activate a mesh network of nanoscale diagnostic chips that had been placed inside Roger’s body following his first heart attack in 2017.
“What if it’s another false alarm,” asked Roger, who had been contacted by doctor in response to a similar situation last year.
“I can’t be 100 percent it isn’t,” replied his doctor. “The technology’s still far perfect but I don’t want to take a chance. Do you?”
“No, but are you sure the signals from those little nanobots won’t do more harm than good,” asked Roger, who was still nervous about the chips efficacy after hearing various reports from bio-health some news organizations hinting at the possibility that activated chips could be contributing to the recent rise in reported cancer cases.
“The rise in rates has nothing to do with the chips themselves,” said the doctor, “and everything to do with our ability to detect cancer at an ever earlier stage. If you need further evidence,” continued the doctor; “I suggest you query your personal assistant (which was actually just a sophisticated algorithm) on your PMD. It’ll confirm your worries are nothing more than an insidious urban myth. I can’t believe it still persists in this day in age.”
Moments later, after gaining Roger’s approval, the network of nanometer-sized circuits patrolling Roger’s arteries was activated and began sampling his blood. Within seconds, the doctor was aware that the level of C-reactive proteins in Roger’s blood was abnormally high.
The doctor’s voice took on a more serious and ominous tone. “Roger, I want you to sit down, stop whatever you’re doing and take a deep breath.” Roger did as the doctor instructed.
“Now, I want you to remain calm—and please know that I’m going to be with you the entire time—but there’s an 80 percent probability you’re on the verge of having a serious heart attack. The nearest hospital has been alerted and an ambulance is already on its way.”
“You’re kidding, right? I’m just feeling a little tired. All I’ve been doing is working outside—getting some fresh air and exercise like you suggested.”
“Just relax, Roger. Over the last few years, I’ve come to appreciate the computer’s ability to more quickly and accurately diagnose healthcare-related issues than either I—or my patients—can. Plus, better to be safe than sorry, right?”
“Yeah, I guess,” replied Roger pensively as his breath became more labored. In an attempt to lighten the mood, he added, “I hate to think what this will do to my insurance rates.”
By the time the ambulance had arrived, Roger was happy it had because he had begun to feel constricted in his chest. Then, only moments after being placed in the ambulance, Roger went into full cardiac arrest. The paramedics were prepared and followed the new protocol established by the American Medical Association only two years earlier.
Normally, Roger would have been taken to Emory University hospital but due to traffic congestion and the severity of his condition, the ambulance was rerouted to an outpatient clinic located just off the freeway. Once there, Roger was whisked away on a gurney to a “clean” room where he was anesthetized and prepped for surgery. Then, in a procedure that would have been all but unthinkable even five years earlier and which was only approved the previous year by the Food and Drug Administration for emergency situations, a robotic surgical device was wheeled into the room and positioned over Roger. With only a nurse and a young attending doctor in the room, a heart specialist located in Havana—connected via a secure, redundant fiber-optic internet connection—began guiding the thin, flexible arms of the device through the intricate surgical procedure using nothing but hand-gesture technology.
When the surgery was completed just 23-minutes later, all that was visible on Roger’s chest was a band aid-sized incision where the robotic arm had entered his chest cavity to insert a temporary stent.
Roger awoke a little later and was greeted by a split screen display showing both the heart surgeon and his primary physician. “You’re lucky to be alive,” said his doctor. “I’d now like to introduce you to the person responsible for extending your life, Dr. Daniela Famosa. Under the recently passed International Health Services Act, she was able to perform your surgery from Cuba.” Roger smiled and nodded in her direction.
“During the operation,” said Dr. Famosa, “I harvested some of your stem cells and, with your permission, I’d like to have them transferred to the Institute for Regenerative Medicine at Wake Forest University where they will grow you a new, fully compatible artery. If all goes according to plan it should be ready in a few weeks and can be inserted sometime the week before Thanksgiving. Based on your personal health record and history of patients with similar health background to you, you should be able to travel over the holidays if you so desire.”
“You’ll have to stay away from the eggnog this year,” added Roger’s doctor with a wink.
Later that afternoon, Roger was discussing his outpatient treatment with, “Cindy”—a computer animated avatar that resides on his PMD and acted as his personal nurse. The avatar was responsible for continuously monitoring his health status in addition to scanning the latest healthcare information in order to recommend and deliver Roger the best possible care.
“Based on your genetic profile and the presence of the following genes—SMAD3 and CXCL 12,” said Cindy in a smoothing and reassuring voice, “we know that the blood thinner Warfarin—Type C3 will be best for you during this interim period. It’s also recommended that you not take it with any of the other following drugs.” The avatar went to list those drugs that Roger was to avoid, including the new anti-depressant he had been prescribed. (In early 2020, the FDA was forced to pull the leading electronic brain stimulant treatment for depression.)
“I realize this is a lot of information for you to process. Don’t worry,” continued Cindy, “I’ll remind you not only when to take your medication, but I’ll advise also you what other foods and medications you should avoid.” In a tone that then offered just the slightest hint of admonition, the avatar then added, “When your heart is ready, we’ll also do a better job of keeping you on track with your exercise regimen.” Roger voiced his approval.
“Are there other questions can I answer for you,” queried Cindy.
“Well,” said Roger; who, in spite of avatar’s growing popularity the past few years, was still a little surprised with how natural it felt to be conversing with a virtual nurse, “Could you tell me a little more about the how the doctors are going to grow my new artery and install it?”
“Sure.” Cindy promptly called forth the 3-D digital scans of Roger’s heart and showed him the blocked artery that had been colored-highlighted for his convenience. The avatar went on to explain how plaque, fatty substances, cholesterol, cellular waste and calcium had been slowly building up over time and was the main culprit of his heart attack.
Once Cindy was confident that Roger understood the cause of his heart attack—which she figured out by using facial recognition technology to scan his physical reaction to the information that was being presented—she went on to show him how his new artery would be grown. Cindy called up a short video tutorial produced by the Institute of Regenerative Medicine that demonstrated how a small scaffold would first be constructed using bio-friendly material and a 3D printer and how that scaffold was then seeded with Roger’s own stem cells and cultured until an artery replacement of the precise proportion was grown. “There’s virtually no chance your body will reject the new part,” said Cindy. The avatar then explained other treatment options to Roger along with the costs and benefits of each procedure. “I’m happy to arrange a conversation with a doctor if you have any additional questions, but I recommend the replacement surgery.”
Roger asked Cindy a few questions regarding his insurance coverage and what costs he would be responsible for but once he was satisfied with those answers, he indicated he didn’t have any additional questions. The avatar then began preparing Roger for outpatient services.
“The first thing we’ll need to do is outfit you for a new line of external sensors. Your current clothes are pretty good but as an extra precaution we’ll want to keep extra close tabs on you during your recovery period.” Continuing Cindy said, “I have also taken the liberty of putting together a list of friends and colleagues who have either had heart attacks or have lived with someone who has had one.” Knowing that Roger was the type of person who responded better to scientific information, Cindy added, “Past heart attack patients who have joined health networks are 37 percent less likely to suffer a repeat heart attack within the next five years. They also experience an increase in life expectancy of 2.8 years over those who don’t.” To make the point more vivid, Cindy also displayed the information in a visually compelling format. She then added, “A good way to use your network is to enroll in “Healthy Hearts”—your insurance provider’s new game to encourage an active and healthy lifestyle. It’s even possible your rates could go down in the future if you score above the 85th percentile.”
Two months after his successful artery replacement surgery, Roger received a small 3-D model of a human heart when he refilled his personally tailored heart medication prescription. It was a discount offer from a new biotech company that had only recently begun growing and marketing human hearts. Roger activated the chip inside the model that then displayed an advertisement on this PMD. The ad read: “It’s not soon to begin thinking about your next heart. You can never know when you’ll need it but it sure ‘beats’ the alternative.”
Roger then called up Cindy and asked her what the odds were that he would need a new heart by the year 2030.
“If you continue to follow the recommended therapy and exercise, 42 percent,” replied Cindy. “Just as an FYI, due to your projected increase in life expectancy, the odds of you contracting prostate cancer have also increased. But don’t worry, I’ll keep a close eye on all the indicators and notify you if anything is spotted.”
“Thanks.” Roger turned back to his PMD and directed his personal assistant to revise his finances so that he could be assured he could cover that portion of the cost of a new heart that the federal government didn’t cover.
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