Sandberg

Transformative Technology, Patient Culture and Health Policy: 

Transformative Technology, Patient Culture and Health Policy Anders Sandberg Eudoxa AB

Introduction: 

Introduction Objective: To apply systems analysis to explore the effects of transformative technology on the health care system. Medicine and Technology Medical institutions Transformative technology Systems analysis What to do

Slide3: 

This talk is about the near future, the next 10-15 years I hope to show the importance of the near term for getting to a good long term future

Medicine and Technology: 

Medicine and Technology Medicine increasingly technological Medical technology interacts with medical culture and organisation Medical eras Overlaid on each other Combination of medical technology and culture

Mechanical Medicine: 

Mechanical Medicine ”Cut and sew” Up to WW II Anatomy, surgery, transfusions Bacteria and antiseptics Nobel prizes for specific diseases: 1901 von Behring (Diphteria), 1902 Ross (Malaria), 1905 Koch (Tuberkulosis). The surgery as the key hospital part

Chemical Medicine: 

Chemical Medicine ”Take a pill” Solve problema chemically Antibiotics, psychopharmacology Transplants Nobel prizes for treatment methods: 1945 Fleming, Chain & Florey, 1948 Müller (DDT), 1956 Cournand et al. heart catheter, 1979 Cormack & Hounsfield CAT scan, 1990 Murray & Thomas transplants Policlinical treatments

Electronic Medicine: 

Electronic Medicine ”The machine that goes ’bing’” Track body signals 70’s and forward Intensive care CAT/PET/MRI/Ultrasound Endoscopy, keyhole surgery Centralized technical systems at centralized hospitals

Medical Institutions: 

Medical Institutions Main players: regulators, medical community, patients, medical companies, funding agencies Divided into various organisations Monopolies common Health altruism

Current Known Trends: 

Current Known Trends Increasing globalisation of medicine Doctor-patient relation changing Demographics: older population, more chronic illnesses What exists in the lab today

Transformative Technology: 

Transformative Technology Today nobel prizes on cell- and gene level Control at the lowest level ”Human health is fundamentally biological, and biology is fundamentally molecular” Next likely medical eras: Infotech medcine Biotech medicine Nanotech medicine

Information medicine: 

Information medicine “Knowledge is power” Medical process: information process Delocalised, distributed and direct Decision support, information management, identity technology, imaging, visualisation, sensors, telemedicine The home as treatment location The Internet Patient

Decision Support Systems: 

Decision Support Systems Diagnosis, data analysis, reminders, memory empowerment, ”second opinion” Interactive broschures, simulations, smart objects, ”the digital doctor” Benefits patient participation, handle information overload Problems: conservative, silent knowledge, integration with patients and organisation Still rare. Not technology limited at present

Imaging: 

Imaging Scanning + fast visualization + information fusion Non-invasive exploration Direct information to doctors Shorten the treatment chain, reduce sidetracks Requires change in routines

Sensors and Telemedicine: 

Sensors and Telemedicine Trends More conditions measurable, smaller, cheaper, plentiful, more functions per chip More intimate and biological, both non-invasive and implanted Active ”smart” sensors/actuators, wireless communication Pathogen sensors, automated medication Moves the location of diagnosis and treatment to the periphery Information overload, privacy, security, training

Cybersurgery: 

Cybersurgery Surgery supported by information technology Remote surgery Direct visualisation Augmented reality Robotics Economy? Stumbles on organisation issues

Minimal Access Surgery: 

Minimal Access Surgery More and more applications Faster recovery Faster surgery redistributes medical personell Need of a new kind of operating theatre? Strong link to VR and robotic surgery

Biotech medicine: 

Biotech medicine Regenerative medicine Rational drug design Bionics Genetic testing Vaccines Enhancing medicine

Regenerative Medicine: 

Regenerative Medicine Regenerative medicine Direct biochemical control Tissue culture Stem cells Artificial implants Fast development, very large potential ling run Out-compete xenotransplants? Regulation- and financing problem for clinical use

The New Pharmacology: 

The New Pharmacology Rational design Based on genomics, simulation and knowledge of basic processes Generics threatened, business models in pharma threatened Blurs the borders between palliative, curative, preventative and enhancing medicine

Prosthetics and Neurointerfaces: 

Prosthetics and Neurointerfaces Neurointerfaces rapid development (~300 electrodes, permanent) Prosthetic research underfinanced Large gains for small groups

Genetic Testing: 

Genetic Testing Cheap, fast genetic tests many conditions How many wants to test? How does the health system respond? Benefits: More individually adapted, good for preventative medicine and pharmacogenomics Problems: Interpretation, too much faith in genetics, diagnosis develops faster than treatment, breaks information monopolies

Reproductive Medicin: 

Reproductive Medicin Reproduktion as a right? We are willing to spend enormous sums on our children and their health Genetic testing, preventative medicine Perinatal medicin

The New Vaccines: 

The New Vaccines Vaccines for treatment instead of just prevention Immune system control Vaccines against Allergies Diabetes Autoimmune illnesses Metabolic illnesses Cancer Narcotics

Neurotechnology: 

Neurotechnology The brain/mind increasingly visible New pharmacology + understanding of brain leads to treatment of many mental disorders Hybrid therapies Enhancing medicine and treatments likely

Nanotech medicine: 

Nanotech medicine NBIC convergence Enhancement of previous technologies Reduced price Increased effectiveness Increased portability Active and smart devices and drugs Development gradual and enabled by previous technologies.

Effect on Medical Institutions: 

Effect on Medical Institutions Changing concepts of disease and health Monopolies and gatekeeping challenged Organisation changes needed for maximal benefit Technologies that doesn’t fit in will not be used Individualisation of medicine Well informed, demanding patients Monopolies of diagnosis and treatment break up Individualized treatment methods

Effect on Medical Institutions: 

Effect on Medical Institutions Role of doctor Financing Attitudes towards enhancing medicine Are we health altruist about enhancing medicine?

Not All Technologies Change the System: 

Not All Technologies Change the System A Cure for cancer Bionic limbs Distributed epidemic detection

Most Disruptive Technologies: 

Most Disruptive Technologies Information technology Distributed sensors, identity technology New pharmacology Genetic testing Neurotechnology

Systems Analysis: 

Systems Analysis Study the interactions between different actors as a dynamical system Driving factors x’(t)=c y(t) + ... Enabling factors x’(t)= y(t) [...] Resisting factors x’(t)=-c y(t) + ...

Feedback Loops: 

Feedback Loops Technology amplifies current trends Strong feedback loop in changed patient-doctor relationship and competition Drives problems both organisations and regulations Resistance doesn’t affect core loops

Doctor patient relation: 

Doctor patient relation

Observations: 

Observations Nanomedicine shares properties and organisatorial effects with information and biotech medicine. NBIC convergence implies that rules for B, I and C will affect N Glitches in earlier steps may stifle development Regulatory uncertainty Centralised, monopoly or gated access Lack of application causes lack of development

Summary: 

Summary Want to avoid Lost opportunity (“regret”) Conflicts Want to achieve Good health for all Transhumanists: Morphological freedom This kind of model helps us analyse where to work hardest to fix policies