On Thursday, the Supreme Court delivered its ruling as to whether the Affordable Care Act (ACA), which was shepherded — some would argue force-fed — through Congress was constitutional. In a complex ruling that arrived amid a flurry of confusion, the High Court upheld the individual mandate, which rested at the heart of the law. Now, it is time to look forward to how we can indeed do what is right and provide health-care coverage for everyone. Many people are pessimistic that health care will consume a disproportionate share of our national resources, but I see a reason for optimism.
There is a path to correcting the fundamental problem of health-care costs, and it is carved by technologies that are advancing so rapidly it may now be possible to make health-care abundant and available to all. But we need to focus our energies on harnessing these rapidly emerging technologies and removing bureaucratic and overly burdensome regulatory hurdles.
Let’s start with medical records. One of the least controversial parts of the ACA was the incentives to bring health records online. Electronic medical records (EMRs) not only improve record keeping, reduce medical errors, and provide quick access in emergency situations, they also provide the data necessary to analyze health information across populations and improve medical care. Imagine being able to do Google-esque searches to determine which medications people with certain diseases took, and the results those medications achieved over time. Daniel Kraft, a Harvard and Stanford trained physician and my colleague at Singularity University, says that we need more programs like the Health and Human Services Health Data Initiative, and public-private collaborations like the recent Health DataPalooza’s (held June 5-6 in Washington, D.C.), to bring new innovators, energy and ideas into leveraging the massive amount of new data that will be available from EMRs and the data sets that the government is making available.
And then there are smartphones, which are rapidly increasing in capability and are becoming health-care platforms. An example is the iPhone case that I have been testing as part of a clinical trial, which turns my phone into an EKG monitor and automatically transmits data to a cardiologist. This case is being developed by a startup called Alivecor. If approved by the FDA, this product will allow heart patients to check their symptoms whenever they want, wherever they are, and get quick feedback from their doctor. The product is expected to cost $100 or less—which is comparable to the cost of a single EKG test today.
With health data captured and transmitted from outside of the traditional health-care setting, vast improvements in feedback loops and outcomes can be achieved. Take hypertension as another example: according to the Centers for Disease Control and Prevention, 32 percent of American adults have high blood pressure, yet less than half are adequately controlled (with their measured numbers reduced to a safe range), resulting in significant morbidity and mortality rates (i.e. from strokes, vascular disease). Now, for less than $100, one can purchase a mobile phone-enabled blood pressure cuff, and a patient can easily measure, track, visualize and share their blood pressure readings. They can also enable optimization of interventions be they diet, exercise or drugs. Significant downstream savings can be achieved through such smart innovations, but they need to be integrated and reimbursed with the health-care system to fulfill their capability.
Artificial Intelligence based systems also provide great promise. The technology that IBM Watson used to defeat human champions on “Jeopardy” is now being applied to health care. Despite my respect for my cardiologist, I would rather have a computer, with access to comparable data from millions of people, diagnose my EKG. Like IBM Watson, the computer has access to the latest knowledge from all over the world. It has the ability to analyze and integrate more information than the most accomplished clinician every could.
The cost of DNA sequencing has been dropping at a breathtaking pace over the past decade. By the end of this year, a complete genetic sequence will likely cost about $1,000 and be available within 8 hours. At this rate, within five years, the gene sequencer may be an iPhone accessory—like my EKG monitor. Genome data of hundreds of millions of people will be available. We will be able to discover the correlations between disease and DNA and to prescribe personalized medications more tailored to an individual’s genetics and other attributes.
We can also now “write” DNA. In an emerging field called “synthetic biology,” researchers, and even high-school students are creating new organisms and synthetic life forms. Entrepreneurs have developed software tools to “design” DNA. These technologies provide the ability to generate designer drugs, therapeutic vaccines, and microorganisms. Leveraged appropriately, this field can dramatically impact the development of novel, and more effective therapeutics.
The good news is that we aren’t dependent any more on “Big Pharma” or government to create these advances; entrepreneurs are leading the charge. The EKG devices, DNA sequencers, and DNA printers are all being developed by entrepreneurs. That’s because the costs associated with developing these technologies have dropped dramatically. So, we could see major medical breakthroughs coming from the unlikeliest of places.
Kraft says that he fears that government and over regulation will, however, hold entrepreneurs back.
“While technologies ranging from medical apps, point of care diagnostics, synthetic biology and wearable health devices race ahead, regulatory bodies such as the Food and Drug Administration urgently need to keep up, both in their ability to foster and encourage the safe adoption and approval of many emerging breakthroughs, but also to re-imagine better ways to run faster, safer and more relevant clinical trials to bring these innovations to market” says Kraft.
“Unfortunately in today’s political environment, often with perverse dis-incentives in place which hinder new approaches moving forward, drugs as common as aspirin and even table salt might not make it to market, let alone more bold modalities such as bone marrow transplantation.”
Kraft is right. When was the last time you heard of a congressional hearing grilling a regulator on why it delayed approval of a drug that could have helped thousands? The Supreme Court decision may have been historic, but we are still fighting the wrong battles.
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