Exploring Pharma’s Far Future
Will healthcare and pharma in the year 2100 feel like utopia or dystopia? And why should we care, when we won’t be around to see it? In short, the foundations for a sustainable future need to be laid now.
Incredible advances are already shaping the medicine-making business. Cell and gene therapies are commercial realities; advanced research is revealing new avenues for drug discovery on a daily basis; and, in manufacturing, systems are becoming more flexible, automated and cost-effective. And yet, the challenges have never been so high – unsustainable drug costs, the threat of an antibiotic apocalypse, and calls for pharma to get drugs to patients faster, while retaining safety profiles. What kind of future awaits healthcare and the pharma industry?
Kaleidoscope Health & Care, a not-for-profit company focused on finding new ways of overcoming old barriers to improve health and healthcare, launched a thought-provoking writing competition earlier this year called “Writing the Future.” The remit: imagine health and healthcare in the year 2100. Worryingly, nearly all entries had a dystopian vibe, highlighting tremendous concern that the remarkable advances being seen in science might not translate to happier, healthier lives for the many. In the winning story, OPSNIZING Dad, written by Elisabeth Ingram Wallace, long-term data storage makes it possible to preserve memories from family members. The narrator’s father is preserved as a robot, but keeping that memory alive costs money – and the narrator is certainly resentful. Meanwhile, Andrew Dana Hudson’s Mend and Make Do describes a future shaped by climate change and antibiotic resistance. The Oracle, written by Matthew Warren, tells the tale of an artificial intelligence that tells people what to do to ensure they live healthier, longer lives and how to mitigate the risk of developing illnesses, but the end result is a daughter devoid of human rights and unable to enjoy life. You can read the six shortlisted entries at www.kaleidoscope.healthcare/health2100.html.
The year 2100 may seem too distant for most to consider, but pharma has its role to play in aiming for utopia rather than dystopia. We speak with Richard Taunt, Founder of Kaleidoscope Health & Care, to find out why we need to start thinking and talking about our future.
Tell us about Kaleidoscope’s competition...
We asked entrants to write a short science-fiction story of 3000 words or less about health and healthcare in 2100. The aim was to bring new ideas and creative thinking into conversations around health. We had 150 entries – so around 500,000 words in total (about five sci-fi novels worth). Fortunately, the general levels of creativity and quality were fantastic – the judging panel had a tough job narrowing down the entries to a shortlist of six (see The Shortlisted Six).
Why is it so important to think about the long-term future?
Our competition was very creative, but what we are really interested in is the ripple effect and getting conversations started about the future of healthcare – and those conversations could potentially affect what we do today. There are many challenges facing healthcare and medicine and we need to think about the future to ensure that it is sustainable. As part of the project, I spoke with Enrique Ruelas, who, in his work with the Mexican government, was often asked, “Can you modernize our heath service?” His reply was, “Yes, but modernize towards what?” In other words, where are we going? What does a modern healthcare system look like? What does a modern drug development industry look like? What will success look like in the future, and how do we ensure we can lay the right foundations today? We wanted the competition to get people thinking about what they do, and how it actually impacts upon the here and now, rather than some esoteric thing that will be left to future generations to sort out.
83 years may seem too-far a time point to consider, but it is closer than most people realize. Think of this – there is good evidence linking an adverse childhood on lifelong healthcare outcomes. If you undergo particular experiences when young, you will be affected for life. Most babies born today will live over the age of 83, so events today will still be having an impact in 2100. Moreover, the doctors and scientists trained today will train the doctors and scientists working in 83 years’ time.
In other words, timescales in healthcare are very long. Often, companies in this sector think about health as a business run year on year, with perhaps a five-year plan or a 10-year plan. If you look at other industries, such as nuclear power, they use a 50 or 60-year timescale. In the UK, the government is building its HS2 high-speed railway line to reap benefits over 40 years. In both cases, it’s clear that significant infrastructure needs significant forethought. Why don’t we think about health and medicine in a similar way? We want to spark this type of conversation. If people actually start thinking about what healthcare will look like in 2100, then perhaps we can make some changes now that will positively shape the future. Right now, it feels as if we are flying blind – we’re too busy firefighting in the present to focus on the future.
Why sci-fi?
In a previous role, I worked closely with Don Goldmann (Chief Medical and Scientific Officer for the Institute for Healthcare Improvement based in Boston, Massachusetts) and we often talked about what we didn’t know – and how certain things that seem perfectly natural today were unknown to previous generations. When looking back, there’s always an air of, “How could they not have known that? It was so obvious!” As one example, consider surgery before anesthesia. Even at the time, it was known that there were substances that reduced pain, so how come it took so long to make the connection? Goldmann and I enjoyed discussing how future generations would look back and laugh at our follies and the obvious connections we had not made. It led to the question of how to crack open a debate about ideas we are not talking about. We concluded that those already working in health and healthcare were probably the worst people to ask, given how immersed we already are in one way of thinking.
At Kaleidoscope, we decided it would be interesting to welcome sci-fi writers into our conversations about the future; to get a handle on different realities. Science fiction is fiction, but it is important to get many ideas on the table to start discussions. Although science fiction is rarely an accurate portrayal of the future, it can certainly offer hints. Think of Alduos Huxley’s Brave New World, published in 1931, where the citizens of London are kept sane with mood-altering medicine, and compare it with the use of antidepressants today. The point is not to provide and accurate picture of the future, but to start interesting conversations.
It’s Good to Talk
With Richard Taunt
I set up Kaleidoscope Health & Care in 2016. My background lies in working with governments and think tanks, and one concept that has always fascinated me is the great disconnect. Different sects are formed that do not really talk to one another. And when we do say we should talk to one other we often don’t apply the same rigor and effort as we do in other activities. Kaleidoscope is about supporting collaborations and releasing knowledge. Even within a single organization, various departments often do not speak, resulting in trapped knowledge.
We have worked with a range of organizations, including Public Health England, NHS trusts, charities and others. We also run Melting Pot Lunches where we bring diverse groups of people together across health and care in energizing locations to talk about key topics. It’s not so much about the topics but about getting people to form connections and start talking. If you get people with different perspectives together from management, pharma or healthcare, we hope they may start to see or do things differently.
We’re always looking for creative ways to start new conversations and I think it’s important to avoid death by PowerPoint. If you want people to have meaningful conversations, they need to feel energized, which is difficult to achieve if people are staring at a screen all day. In think-tank land, it’s also common to put out massive masterpiece reports, yet we know few people read these. Our approach is all about face-to-face conversations. We’re a not-for-profit and we seek to put as much of our learning as possible into the public domain.
The link between the sci-fi prize and our collaboration work is another energizing approach to start new conversations. We’re really interested in working with people on finding new ways to crack open an old problem, and then debate and discuss what’s required. If your standard method of discussing a topic is to have a conference, then you might need to find a new way of doing it.
The Shortlisted Six
Six entries in Writing the Future were shortlisted for the grand prize of £10,000. You can read the full stories at www.kaleidoscope.healthcare/health2100.html
Winner: Opsnizing Dad, by Elisabeth Ingram Wallace
The winning story imagines a father held together by robotic limbs and LED eye-bulbs who is slowly losing his memory. The narrative deals with the emotional strain associated with having a dependent relative who can’t express gratitude, nor remorse for past misgivings. Wallace explores the relationship between human emotional fragility – bitterness and resentment – with technology that may be able to preserve our existence, both in terms of our physical bodies and memories, indefinitely.
Runners up: Mend And Make Do, by Andrew Dana Hudson
Hudson imagines the Isle of Ely in Cambridgeshire, UK, as an actual island – surrounded by seawater as a result of climate change. This dystopian world also faces an antibiotic apocalypse, with the story centering around a physician carrying out an environmental antibody survey. All hope is not lost, however, as a greater understanding of the relationship between health and ecology arises out of the desperate situation.
The Oracle, by Matthew Warren
In the words of “Genelytics” CEO, Blake Fox, The Oracle can “tell you exactly what you could do throughout your lifetime to ensure that is the longest, healthiest existence possible.” Warren’s story is a letter from a mother to her daughter, explaining why she put her faith in the Oracle: to reduce her daughter’s chance of developing the lethal Fünder’s disease. The reader is left wondering, was it all worth it? And when does living the “healthiest existence possible” entail tyrannizing loved ones – or even yourself?
Shortlisted: Sticking Plaster for the Tin Man’s Broken Heart, by Ida Keogh
Keogh’s story evokes Phillip K. Dick, and deals with inequality and access to healthcare. The protagonist is the prosthetic surgeon, Suki. Suki’s young daughter – despite 3D printed limbs becoming widely available 36 years from now – is unable to get a replacement prosthetic leg because, as her dying friend Charlie puts it, “The biotech companies, the insurers, they’re all in this together. If you don’t have good insurance, you don’t get good maintenance.”
Project Seahorse, by Hannah Harper
After successive financial crises, an aging population, and a dwindling birth rate, the idea of “Male Motherhood” (MM) gained traction. The story follows the researcher, co-writer and art-director of the MM campaign, “Project Seahorse,” and her efforts to build a promotional campaign around footballer Craig Brogan. Harper explores the relationship between pregnancy and parenthood, and paints a picture of a future in which the state and media exert control over pregnant male bodies.
Burnout, by Matthew Castle
Burnout explores the conflicting priorities faced by physicians: the need to diagnose and treat according to stringent targets, while being empathetic and caring, with good bedside manner. Castle’s protagonist is an artificially intelligent physician, struggling to maintain meaningful emotional engagements with its patients, while pining for a six-month sabbatical.
What were the common themes across the entries?
There was a common theme of 2100 being more plentiful in terms of information on your future health state at birth, more technology, a better understanding of medicines, and increased longevity. However, questions were posed about how “plenty” gets divided and what effect it has. If we are going to have a far greater range of ways to improve health, who actually gains access and what factors determine the equity of the future healthcare system? We’re already seeing aspects of this today with increasing attention being paid to the cost of healthcare and drugs. Another interesting theme was how medical advances affect the family dynamic, with intriguing questions on parent-child relationships when you have more time at the end of life and greater information at the beginning of life.
The pharma industry was portrayed quite negatively in some of the entries…
Many of the stories have large corporations playing a very significant role in healthcare of the future – for good or bad. Many views of the future have the state playing a very small role and big corporations having far more power. The upside painted in the stories is that you will have more innovation and technology coming through that will advance health and medicine well beyond where we are today. But there are questions about how some of those organizations use their power; some of it won’t make happy reading for those working within the pharma industry! It highlights an interesting tension between the focus on innovation and advancing science, and real fears of social impact with very different standards of healthcare with different groups.
The vast majority of the stories we received were dystopian rather than proposing a rosy vision of where we want to go. The challenge for the industry is that these stories are born out of people and their perception of pharma today. Even looking outside of our competition, there aren’t many stories where there’s a benevolent role for large organizations. How do you shrug off that typecast and demonstrate that organizations who drive innovation also have a very clear social side? That’s something for the pharma industry to address…
I am interested in the sociology of medicine and healthcare. The culture of medicine has not changed fundamentally in a very long time. What I’m really interested to see is how roles for participants in healthcare – from doctors, to nurses, to drug developers – may change. In my optimistic view, we are moving towards a health system that will be far more connected (there is a significant connection between education and health for example), with the overall focus being on how people can live good lives rather than how we fix them when they fall over. Compared with 80 years ago, as a society we are much more aware of the wider determinants of health, which is fantastic. The challenge for the next 80 years is what can we do about it? How can we have a more joined up conversation about health and healthcare? And what else do we need to concentrate on beyond scientific and medical advances? I’m an optimist; I think we can get there, but changes will be needed in how people and organizations perceive their role, and how they relate to the wider economy – and this will take a long time.
The dystopian elements of the stories in Writing the Future stem from a system that does not support the outcomes we want. Rather than trying to think about who are the bad guys, we need to think about how we steer systems so that organizations and individuals are operating in a way that maximizes health and happiness for all, rather than mass inequality.
What happens next?
We are running events on the back of this competition, including a live reading of the stories at Europe’s oldest operating theatre on December 5. We are also working with the Global Health Institute at Imperial College London. We want people to take the stories from our competition and to diffuse the information wherever they might be, using them as way to frame some of the challenges today. At Kaleidoscope, we also talk to organizations about the future – and we now have a rich treasure trove of visions of the future that we are able to analyze and delve further into. The six shortlisted stories are really just the tip of the iceberg in terms of the wonderful array of different ideas and visions that came through. We want people to take what we’ve done, reflect on what it means for them, and think about how they could use it to start discussions for their journey to 2100.
You can find more views on the long-term future of health and medicine at www.themedicinemaker.com. We’d also love to hear your ideas on how healthcare and the pharma industry could look in 2100 to kick start the discussion. Get in touch at [email protected].
Making great scientific magazines isn’t just about delivering knowledge and high quality content; it’s also about packaging these in the right words to ensure that someone is truly inspired by a topic. My passion is ensuring that our authors’ expertise is presented as a seamless and enjoyable reading experience, whether in print, in digital or on social media. I’ve spent fourteen years writing and editing features for scientific and manufacturing publications, and in making this content engaging and accessible without sacrificing its scientific integrity. There is nothing better than a magazine with great content that feels great to read.
