Where Are We Going?

How did I become a healthcare futurist? I was a failed poet, desperate to make some money, somehow, from my highest skill, which was writing. My wife said, “Why don’t you try this?” I said, “I don’t know anything about healthcare.” She said, “All you have to do is learn the acronyms.”

There was definitely a lot more to do than learn acronyms… but the work that bloomed from that dinner table conversation now spans 37 years, half a dozen books, and thousands of articles. Once I got into it, I found it fascinating, from the bloom of new technologies, to the passionate personalities, to the enormous problems. I learned about healthcare by writing and reporting about it, by interviewing thousands of experts, practitioners, executives, and pharmaceutical scientists across the globe.

It was 20 years before I could truly say that I understand how healthcare actually works, and why it works so poorly. Right now, the system is a mess that leads to hundreds of thousands of unnecessary deaths in the US alone, while bankrupting individuals and society at the same time. I began to see that I could, just maybe, make a difference if I could help people inside and outside the industry learn about how healthcare has become so different from what we all hoped for.

How we run healthcare is a life and death issue for every human who owns and operates a human body. Yet we have managed to design our healthcare systems as a strip mine for our individual and private interests – more so in the US than elsewhere, but far from exclusive to us. It is easy to see countless policy, funding and innovation decisions up and down the line that serve the narrow interests of the people making the decisions and outsourcing the cost to society. Look up “corruption” in the dictionary and you will see no daylight between that and much of what goes on in healthcare – all under legitimate legal cover because we built the system that way.

Knowing the future

To paraphrase JBS Haldane, the future will not only be queerer than we suppose, it will be queerer than we can suppose. If you look back at the futures forecast in science fiction and by expert futurists over the last century, you find only one important innovation that really came true: Isaac Asimov’s description of communications satellites. Consider the technological innovations that have become mainstays of our lives – like the smartphone I am dictating this into, and Google, which just told me how to spell JBS Haldane – not only did they not exist 20 years ago, they were not even imagined.

Every prediction of the future will likely turn out to be wrong, but what we need is deep, systemic, complexity-based futurism that explores the emerging possibilities in a rigorously flexible framework. If we learn to do this as a normal part of running healthcare, imagining and responding to the systemic consequences of any policy change, invention, or funding shift, then we can imagine a future that is as different from our own as we are today from medieval alchemy. If we don’t, then any dystopian future you can imagine is far more likely. I believe that the following points are essential:

• We must know the future. The changes that are coming are larger and of wider scope than we can possibly imagine or prepare for.
• We can’t know the future.
• We must anyway. We must gain insight into the future, by building the deep and constant discipline of studying its emerging elements and their interactions, using the insights and methods of complexity science, behavioral economics and other fields. 
• Futurism is a craft that can be learned, and should be learned and practiced by anyone who hopes to lead organizations into the future.

The will to change

Certainly, there are a number of key technologies that are almost certain to play a part in shaping the future. I believe that AI will become as ubiquitous, as easy to access, and as taken for granted as electricity is today, and will super-power all medical information gathering and decision-making. Blockchain will also likely drive transaction inefficiency toward zero. However, there are thousands of emerging innovations right now that could produce astonishing outcomes (and it’s easy for any futurist to pull some of these shiny things out of their magic bags and wave them around). The real study needs to be how these new technologies work within the system of healthcare. Vaccines are probably the single most effective medical advance ever. Yet we did not eradicate smallpox because a new vaccine had been invented; we eradicated smallpox when we realized that we could do it, set ourselves to doing it, and gathered the global political will, social drive, funding, and army of volunteers to carry it out.

If healthcare and drug development are to be sustainable in the future, then one important change is to economically disconnect the development and patenting of new compounds from the marketing and distribution of drugs. In our current model, compounds are developed, translated, and tested so that they can become big sellers and support a company for years. This means that promising research is often abandoned if it does not seem to immediately produce a compound with a large market. At the same time, life-saving drugs with profound implications for millions (such as the recent cure for Hep C) come with high price tags. This model does not produce pharmaceuticals that are well-matched to the real needs of the society at a price that the society can afford.

Pharmaceuticals are not optional luxury items. They are fundamental to keeping people alive. They are a part of the infrastructure of any modern society, and we should fund them that way. In the US, we did not build the Interstate Highway System by letting private companies decide which would be the most profitable routes and leaving them to get the land rights to build them. The government decided the routes and put together the funding, then hired private firms to build them.

We need an industrial policy for pharmaceuticals. Drug development should be driven by government groups (such as the US NIH or the UK NHS) deciding priorities and picking promising areas of research, then letting large grants for research into promising compounds and approaches. The results of all research should be made public, with the government retaining patents to any discoveries. The government license all comers to market and distribute the resulting drug. The pharmaceutical companies make their money by doing what they do best: the research and development, then marketing and sales. The government does what it does best, allocating resources for the good of society.

Joe Flower is a Healthcare Futurist (www.imaginewhatif.com).