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Innovation in Healthcare: big changes are coming…

I have been asked to  present at the next Chief Innovation Officer Summit in Sydney, about how biomedical and digital health innovation is going to impact on governments, industries and society,  as well as  the evolution of the role of the Chief Innovation Officers (CIOs) in the big life sciences corporations.

Great topic, I have plenty of interesting examples in mind, but I am afraid that my message  might not be well received by all the engineers, developers, pharmacologists, chemists in my audience of CIOs.

It is clear that the health sector is in desperate need of innovative solutions because from many perspectives the existing model is broken, non-sustainable. But the solutions require a different set of skills.

Take for example the effect of the combination of lifestyle and demography.

By lifestyle, I mean four commonly identified poor lifestyle habits: bad nutrition, lack of physical activity, stress and substance abuse (alcohol, drugs, tobacco). The effect of these habits is the incredible growth of a family of conditions, called Non-Communicable Diseases (NCD) because they are not caused by pathogens  such as viruses and bacteria.

By NCDs we mean cardiovascular issues (i.e. stroke, heart attack), metabolic diseases (i.e. diabetes), neurologic diseases (i.e. Alzheimer, Parkinson’s), and most of the oncologic conditions.

It means that all of the most threatening and most lethal diseases (at least in the most developed areas of the world) are related to our lifestyle.

These diseases have another typical characteristic in common: they are chronic, in most cases even multi-chronic, so they require ongoing care that must be typically delivered for many years, if not decades.

At the same time, the life expectancy in the developed world , as well as the percentage of the population whose care depends on the wealth generated by the younger generations has been increasing steadily

The combination of  NCD’s multi-chronicity and demography generates an enormous, constantly growing demand. Our existing healthcare systems are based on two layers, the consultation provided by general practitioners (GPs) and specialists from one side, and the high technology hospitals specialised in intensive and acute care from the other. The health systems are not engineered for this new, enormous demand.

There is a clear gap, a vacuum, between GPs and acute care.

If lifestyle is the cause, and multi-chronic diseases the effect, then  healthcare and prevention should be constantly and widely addressed on a daily basis, home by home. But instead, we deliver high cost, hi-tech emergency sick-care when it is already late.

Innovation has been helping, and we made plenty of technology available: big diagnostic machines and nano-sensors, novel drugs, tele-medicine solutions, wearable devices…

So the most desirable and necessary innovation is not  based on development of other products and new technologies. They are not scarce. What is missed is the innovation of the system, the governance, the model of delivery of the right type of care. I mean the way to prevent, to induce a change of behaviours, to monitor, to deliver a less intensive, capillary, more pervasive and continuous care.

Next, another important example, leading to the same conclusion.

Think now to the Moore’s law, the constant acceleration of computing power, applied to genetic sequencing. The constant reduction of the cost of sequencing of human genomes and the faster computation speed is making available a great amount of genetic data, that are constantly growing with an impressive logarithmic progression.

The genetic data will soon offer us a great advantage: the possibility to predict the effect of a drug on each patient and to deliver a pharmacologic therapy only when we are sure that it matches with the specific genetic profile of that patient (personalised medicine).

But this big change is not accompanied by an evolution of the drug development process, based on long and extremely expensive clinical trials.

Each approved novel drug is the result of a process of at least 10 years of research, that generates an average cost of a billion dollars; per each approved drug there are another 9 that have gone through expensive clinical trials without success.

Nevertheless,  the model has been sustainable until now. Big pharmaceutical companies are profitable because each of their pills can be potentially sold to all the 7 billion patient/clients in the world, so the return on investment is easily granted even in the short period granted by the intellectual property rights. We know that in many cases the pill may not be effective, but we don’t have an alternative.

When the access to genetic data  eventually segments the market into smaller patient cohorts, the model will be broken. The price of each treatment will see an increase of several orders of magnitude in order to provide the return of the investment for a target that may be extremely small. The rich elites will afford it, but what about public health systems and insurance companies? Is it ethical?

We already have the first examples of recently introduced novel drugs targeting specific genetic profiles with a personalised medicine approach: their price is several tens of thousands of dollars per each month of treatment!

As before, the solution to the problem requires an innovative approach. And, as before, the solution is not about new technology, new pharmacologic entities, faster scientific equipment or more elaborate data analytics. We already have them… We need innovation in the delivery model, in the partnership patterns, in the regulatory framework.

On another note, access to genetic data will allow us to select a diet matching our specific genetic  profile. Big food companies would like to serve us innovative and genetically targeted diets, mass-produced in their industrial food processing facilities, but they miss the required scientific, research and regulatory expertise.

Bigpharma corporations possess this expertise, but miss all the rest: access to raw material, manufacturing, logistics, access to the food consumer market, consumer goods culture.

Product innovation is not technically challenging, the real innovative breakthrough will be in the complicated development of specific partnerships between big food and big pharma corporations to target the new need.

Again, another case where the most desirable skills of the successful CIOare not those generally described as technical, required for the development of a new product and a new technology…

This is why I look forward to the conference, and to the comments from the audience of CIOs of global corporations…