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Transformative Technology, Patient Culture and Health Policy. Anders Sandberg Eudoxa AB. Introduction. Objective: To apply systems analysis to explore the effects of transformative technology on the health care system. Medicine and Technology Medical institutions

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  • 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
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 technologyand 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 fundamentallybiological, 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
  • 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
  • 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
  • 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 byprevious 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 andtreatment break up
    • Individualized treatment methods
effect on medical institutions27
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 power






Patient power

Doctor patient relation
  • 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 orgated access
    • Lack of application causes lack ofdevelopment
  • 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