Our predecessors have made some lengthy strides in healthcare over the past century. We have managed to stave off terrible widespread plagues. We are living longer, with developments so rapid that for every month you live, medical science adds a week to your life expectancy, partly thanks to the drastic drop of infant mortalities. Furthermore, according to The Atlantic, in 1900 poor health swallowed up a staggering 32 percent of global GDP, whereas now it chews into just 11 percent. This number is expected to be halved by 2050, according to economists.
Today, in some corners of the medical world, scientists are wielding microscopic scissors, ready to cut and paste genetic material to manipulate the DNA of humankind with Crispr. The possibilities are compelling, with companies having already made, cancer-curing medicines, climate-change-fighting crops, biofuel-oozing algae, and self-terminating mosquitoes.
Big dollars are also being spent on healthcare in the quest to live longer lives. A growing list of billionaires, including Jeff Bezos and Peter Thiel, aswell as big companies like Google, have pumped millions into research and development towards ‘life extension’, with the view that death is merely a problem that can be fixed. The tides of medical investment will continue to surge, according to The Bank of America, which expects the immortality market to be worth $600 billion by 2025.
However, while billion-dollar booms in DNA hacking and immortality tend to grab the headlines, possibly the earlier shifts will be in the way healthcare is managed. Although access to medication and specialist treatment has enabled humans to live longer lives, we are still plagued with the pains of disease along with an industry yet to come to grips with an aging population.
The Ministry of Health found that disease, commonly caused by aging, remained the leading cause of death in this country in 2015, which included cancer, heart disease, strokes, bronchitis and asthma.
These old pains sit inside a reactive healthcare model: we get sick, we visit the doctor, then we take medicine. It’s seen acutely in the care of elderly people, who fall into depressing cycles of health emergencies, as their prescription list grows and the quality of life diminishes – especially for those who cannot afford quality healthcare. Physicians are busily keeping people alive with medication, but patients aren’t necessarily leading healthier lives.
But deeper access into patient data and new technologies presents another proposition: a move from a traditional bricks-and-mortar style of healthcare into a preventative system based on a holistic, nuanced and customised approach to medical care. Patients may be able to anticipate health issues before they become a problem. Thus, doctors will focus on keeping the public healthy, rather than only reacting to patient illness.
So, perhaps the most radical reform in healthcare won’t lie in the realms of immortality or gene-editing, but incrementally, in the way healthcare itself is being treated.
Prevention, not intervention
One local company at the forefront of preventative healthcare is Edison, which is based in Auckland and launched in September last year. Its founder, Jay Harrison, exclaims that Edison’s vision is to sell time.
“We want to become globally trusted traders of time: preserving medical heritage with leading edge technology advancements,” he says.
Its name is an embodiment of the ideology formed by inventor Thomas A. Edison, who stated in 1903: “The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease.”
The company’s binary mission is the extension of human health-span and life-span using precision health and technology. To do so, it uses detailed analysis of somebody’s health profile, right down to their DNA molecules.
Harrison says a convergence of factors has enabled Edison and other companies in the medical community to make these strides in healthcare.
“We have access to genetics like we have never had before, the advancement of artificial intelligence allows us to partner with IBM or Google who have built infrastructure we can tap into, and also wearable technology – it has exploded in the last ten years.”
Edison’s alternative full body holistic treatment is separated into three parts. Firstly, patients experience a robust ‘baseline medical’: a series of personalised genetic profiling, bloodwork, 3D body imaging, mental and physical evaluations, wrapped into a 90-minute consultation.
After it has collated the data on patients, instead of simply prescribing medicine, patients are given what’s called an Edison protocol: a comprehensive health programme based on a patient’s genetic profile and goals. This could see an unconventional prescription from a doctor of a change in diet, sleep pattern, medication, or mindfulness practice.
Lastly, patients are consistently monitored through its various tools. One example is the Oura Ring – a piece of wearable tech that tracks the bio-markers of the person 24/7. Plus, patients are given various touch points throughout the year, where they visit a doctor or clinician to re-assess progress, analyse biomarkers, health developments, or to “recalibrate the biogenic age”, which provides patients their chronological age – how old somebody is – then factors in the age of their body, based on good or bad health habits throughout their life.
“From a management perspective, we can nudge a client back into action, because we are seeing them regularly, we are helping a patient lay down long-term behavioural change,” Harrison says. “It’s not a flash in the pan relationship, it’s a life-long relationship, where their bio-medic team are working with them using proactive treatment.
“We don’t look at anything in a silo, we have a whole-body plan, or a holistic plan, with the idea that we have tried to attune an entire system to the human body.”
As a result, patients have seen a range of positive health benefits. Harrison speaks of clients who have battled with elevated cholesterol levels for upwards of twenty years, having previously tried everything using the traditional route, from medication to lifestyle changes, yet weren’t able to make significant progress.
He says after three months with Edison, clients were able to completely normalise cholesterol and cardiovascular risk markers.
“It’s not unusual for a client to lose 15kg in three months because they harmonise their physiology,” he says.
But the benefits of a whole-body, customised approach to medical care means patients receive unexpected benefits as well, Harrison says, including improved energy, better complexion, as well as improved gut health.
“If we take a much more proactive approach, the load on GPs and the current reactive model would reduce. In essence, we could put GPs in a much more positive context. We are currently in the transition, because right now is when it is happening. It’s super encouraging for GPs to work in this domain, and ultimately we would like to be a part of this transition.”
Democratising digital health
It’s easy to get excited about the benefits of transitioning into a digital health system, but there are equally large challenges. Firstly, the barrier to entry into a personalised healthcare system is still largely reserved for the rich.
In terms of costs, Edison's baseline product starts at $2499 for a targeted report and solution based on genetic profiles. It draws parallels with the inequality that lies within many existing preventative health care programmes that are costly, such as yoga retreats, naturopathy, mindfulness courses, health apps, wearable technologies, or new treatments and drugs based on your genetic profile.
Future insights manager at Callaghan Innovation James Araci believes to lower the cost for preventive healthcare, there needs to be more support into healthcare research, specifically towards supporting new technological solutions coming to the market.
“The treatment for sickness tends to be at the cutting edge of science, so it’s very expensive to develop,” Araci says.
So, what can the government do about the wide gaps of inequality within healthcare, and the prospect that new technologies will only make the gap wider?
“I can’t see a government being able to afford the latest technologies at a national level, but a government that is doing everything it can to keep us healthy through network help support and providing a strong and trusted system of sharing medical data – that is vital,” Araci says.
He adds the importance of primary health care by encouraging early intervention and promoting wellness as “one of the most feasible and practical things that our government can do right now”.
“If we can keep people healthier, we can provide small interventions that means someone doesn’t have to go to hospital, or if we could reduce the rates of obesity, it could then reduce the rate of diabetes. So, investment in those areas and better tools in the health system to understand communities, if we can reduce illness less people will be sick, so it will limit the need for expensive drugs.”
Another way to bridge resources to marginalised communities is teleheath, or remote healthcare, where people in regional areas can access specialist treatment online. It’s already happening across New Zealand, a new virtual medical centre has begun operations in Patea, which assists physicians with ‘digital health deputies’ to deliver extra resources to rural communities.
“It doesn’t sound like a big change, but if you live in rural New Zealand, it’s significant. Currently in Kaikoura, patients are being seen by specialists in Christchurch via skype and broadcasting. It’s not just saving time, but it’s equalising access to specialist treatment,” Araci says.
Furthermore, there are an increasing number of patients developing tools to treat and manage their own healthcare. Araci points to a few examples, such as Nori health, a chatbot that enables patients to treat and manage Crohn’s disease, or another local example, Uri-Go, a lightweight variable device that helps disabled people go to the toilet.
“It is already here, it’s popping up in pockets, it’s just unevenly distributed at the moment.”
Who owns your data?
The ability to harness far greater information about the health of individuals means issues like reliability, security and data privacy are paramount to the future of healthcare. As reports of data breaching and hacking continues to run rife, how can we trust our online health records won’t be manipulated, or accessed by sharky insurance companies?
“If we get the management of big data correct and secure, that would be powerful, I’m more concerned with that than any particular physical treatment,” Araci says. “There is a lot of work in this space in New Zealand. Over the next 20 years, you will see a secure platform emerge where gradually our economy is digitising. We are getting better at understanding controls around data, and when we start talking about health, we always need to balance technology with regulation, so there is a strong role for government in setting down standards of how critical data is looked after.
Araci believes New Zealand sits in a strong position to be leaders in the security of health data. Aotearoa already ranks fourth in the world for quality of care, compared to the US, which ranks 41st. Plus, New Zealand tends to score highly in transparency and trustworthiness.
“Of all the countries in the world, I would want our health data to be stored, it would be New Zealand,” He says. “Interestingly enough, I've had conversations with global biotech companies who believe we could make more of our story.”
Araci further alludes to ‘health equity’, ensuring that different populations are being included in decisions about what happens to their data, then given input about what is appropriate for how far this data is used.
“New Zealand is doing some great stuff in this space, like Genomics Aotearoa, who brings a Maori dimension and perspective to the use of genetic sequencing and the use of DNA information in New Zealand. We need to keep going down the track to make sure there is informed consent and trust about what is being used with our data.”
Currently in the US, a research programme named All of Us, which uses the health data and DNA of Americans to build a precision medicine database for individualised disease treatment and prevention has come under scrutiny for its plan to capture and use data from native American tribes without properly consulting them.
Araci explains another controversial example of data manipulation: “America has quite a checkered history of practicing genetic testing and genetic information on indigenous people. For example, 20 years ago a researcher approached a group of native Americans, who said, ‘Could I have a look at your genetic sequencing because there might be a genetic trigger as to why you are more susceptible to diabetes.’ Then, 10 years after the trial, they found out that their data had been used for all sorts of other trials of which they didn’t give their permission for, including schizophrenia screening.”
Though these concerns persist, most in the industry are hopeful these new technologies emerging will pave the way to making personalised care more readily accessible to the general public, rather than a privileged few.
Instead of living forever, perhaps it’s just a case of living more healthily as the way people prevent, diagnose and cure diseases is overhauled, with patient empowerment at the forefront of this movement.
Robyn Whittaker, the clinical director of innovation at the Institute for Innovation and Improvement at Waitemata District Health Board and honorary Associate Professor at the National Institute for Health Innovation shares her stance on the future of healthcare.
“The idea with moving in to a more digital health system supported by technologies like AI is that we will be able to potentially collate far greater information about individuals that may be able to be used to help support more personally tailored health care.
This is not just the increased electronic health information that we are now starting to get with the digitisation of our health system (for example, Waitemata District Health Board now has electronic prescribing and administration of medicines, and electronic collection of vital signs and nursing observations) and new data that we are only just beginning to understand such as genomic data.
However, it is also a broad range of other information that may be collected via wearables (such as wristbands and smartwatches), environmental and other sensors (in the home and in the community), and also via the smartphone itself. There is already a multitude of data that can be collected during the routine use of mobile phones that can provide information on the person’s movements, mood, stressors, connections, conversations, activity levels, location, and more.
The broader the information on the individual, particularly those with chronic conditions, the more personalised and tailored health care and wellbeing support that could be provided.
However, there is still much work to be done to develop such a system. At this point, we don’t really know how to collate all this information in way that would make it truly usable and useful, and at the same time secure and accessible appropriately.
We don’t necessarily know what to do with 24/7 data on parameters that have previously only been measured episodically. We may not yet know how to take all that data and turn it into information that can easily be used and acted upon to help individuals to live healthier lives.
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