This article examines a future driven by Moore’s Law and the trend of circuits and components getting smaller, faster and cheaper exponentially over time and the eventual blending of science and technology (INFO + BIO + NANO + NEURO). I approach this topic from the unique perspective of an IBM technologist, market strategist, futurist, and consumer advocate. See About the Author and About Modern Health, below, to better understand what shaped this view of the future. You can also see my slide presentation and related articles & infographics at the bottom.
Futurists regularly consider alternative scenarios and examine factors that can steer the future in one direction or another. That way, clients can select a preferred version of the future and know what they might do to make that future happen.
It’s relatively easy to extrapolate past trends, assuming that nothing prevents those trends from continuing at the same rate, but will they? One can also look at what’s possible by tracking research lab activity and then estimating how long it will take to bring those new technologies to market.
But a potentially better approach is to start with a solid understanding of market NEEDS and what drives the development of solutions for them, or factors that inhibit solutions. Changes in politics and public policy, for example, can be a huge driver, with Obamacare as an example, or a huge inhibitor. That’s why I’m so interested in various healthcare reforms that accompany tech innovation.
Let’s start with NEED as a driver of our healthcare future.
World population more than doubled in the 65 years I’ve been on the planet, from about 2.5 billion to now over 7 billion, and even though we live some 30 years longer, we’re generally less healthy. That’s largely because of technology, including electricity that allows us to work on computers in office buildings and under artificial lights. Those lights cause us to stay up later at night and interfere with our natural circadian rhythms. And the increased stress and lack of restorative sleep (1/3 get less than 6 hours/night when they should be getting 7-9) causes all sorts of health problems that seem to get worse as we age or gain weight.
Medical professionals tell us that 75% of healthcare costs go to treating chronic diseases that are largely preventable, but many of our lifestyle choices are influenced by technology. Modern architecture and transportation systems, for example, have given us easy access to food whenever we want it.
In ancient hunter-gatherer days, we might not know when we’d make another kill and eat again, so we’re genetically predisposed to eating all that’s on our plate. Our DNA has not evolved as fast as technology, so our bodies still drive us to over eat in order to store energy in case of famine. This, the lack of restorative sleep, and other factors have contributed to a population with two-thirds of adults who are overweight or obese and one third who are obese. That obesity also affects our health and contributes to rising healthcare costs.
Most other industrialized nations provide universal healthcare, but Americans rely instead on private health insurance and a for-profit system that views patients as paying customers. That system works hard to keep us coming back, treating symptoms without much regard for wellness and prevention, since that would avoid the need for medical care in the first place.
Americans spend over $2.7 trillion/year on medical care, an amount projected to reach $4.2 trillion by 2020 (or about 20% of GDP). We already spend more than twice as much as other nations in the OECD, but even with all that, we still don’t have better care. As a nation we live sicker and die younger, according to the World Health Organization.
That’s the starting point.
Next look at the 10,000 baby boomers reaching age 65 every day and the impact this aging population will have on future healthcare costs and our delivery system. We’ll soon have a major shortfall in the number of doctors and nurses to offer care, as well as a shortage of young workers to drive the economy and help pay for care.
Then there are advancements in genetic research that may soon conquer most inherited diseases, as well as therapies that repair cell damage before it accumulates. These developments will dramatically extend longevity and may one day allow people to live for a thousand years, futurists say. But at what cost?
Governments at federal, state and local levels are not ready for the coming demands on the healthcare system. Neither are the unpaid family caretakers who already spend more time caring for elderly or disable loved ones than their own children, taking time off from work, sacrificing promotions, and impacting their own health. The AARP puts the annual cost burden of these unpaid caretakers at over $480 billion per year, which is more than the $361B in Medicaid spending, and nearly as much as the $509B in Medicare spending. It will just get worse without effective tools to help.
Technology as an Enabler
Applied appropriately, technology can provide just the right tools to help us cope with the aging population and increasing healthcare costs. It must. But public policies must change too, and embrace tech-enabled change. Fortunately, the pace of tech innovation accelerates exponentially with Moore’s Law.
I often compare today’s smartphones with one of the mainframe computers I worked on in the mid-1970s. The IBM System/370 Model 158-3 became a common performance benchmark, because it could execute 1 million instructions per second (MIPS). This $3.5 million computer was so expensive it was shared by hundreds or thousands of people. Just ten years later they all had personal computers, and each one cost 1,000 times less.
Now back to the smartphone comparison. Where that IBM mainframe was fast (1 MIPS), even the older generation Apple iPhone 4 was rated at 5,000 MIPS – i.e. 5,000 times faster than the million dollar mainframe that required a large computer room, liquid cooling, and special air conditioning. And rather than share, you carry the smartphone in your pocket everywhere you go, with the ability to sync with medical sensor devices and do Anywhere/Anytime video calls with your doctor. But with real-time monitoring of sensor data, you’ll soon have medical care Everywhere/AllTheTime.
Technology keeps getting faster, cheaper and smaller, and it’s now being embedded into everyday devices, including light bulbs, doorknobs, your clothing, and your toothbrush. For at least 5 years I’ve used a Philips Sonicare toothbrush that has an embedded microprocessor chip that’s so small and inexpensive that Philips couldn’t find a cheaper one. What I find interesting is that the processor in my toothbrush is 10 times faster than the $3.5 million IBM mainframe I worked on – my Toothbrush!
What’s next for processors and sensors?
We’ll find them in everything with a digital heartbeat, powered by electricity or not. The Philips Hue, for example, is an energy saving LED light bulb that can talk to your smartphone. Because it needs some simple electronics to convert AC current to DC, Philips added a computer chip and support for a Wi-Fi home network. As a result, you can use your smartphone to turn the light on or off, make it bright or dim, and even change its color temperature from cool blue to warm orange, which is better for nighttime and interferes less with sleep patterns.
Sensors have been used in automated homes for years, but mostly in high-end homes with professional installation, or in DIY systems cobbled together by hobbyists. With wireless networks and smarter technologies like the NEST thermostat, these sensors will gradually become mainstream – very gradually in my opinion.
As “smart” as the NEST is, it doesn’t know if I’m feeling hot because I just finished exercising or cold because I just ate ice cream. But if NEST could connect to wearable devices that sense skin temperature, it might.
I think sensors for medical applications will become mainstream faster than for smart homes, because there’s more of a need. And they’ll monitor more things. Beyond motion, light, temperature, moisture and gas; medical sensors will also monitor pressure, chemicals and biomarkers. Doctors will then be able to determine how well a drug is being metabolized and adjust the dosage and frequency accordingly.
Consider extrapolations of Moore’s Law – where technology exponentially gets smaller, faster and cheaper – and information science (processors & networks) converges with cognitive & neuroscience (neuron signaling) and biology (chemistry, genes & proteins).
As small computer processors shrink to the size of a cell or smaller, futurists believe they’ll communicate with neurons directly. Nano-scale robots could be injected into the blood stream to seek out and destroy cancer cells. And “smart” drug delivery could deposit medications exactly where they are needed and nowhere else. But this raises new security concerns and the need for body firewalls to prevent our medical sensors from being hacked.
Moore’s Law also affects the performance of powerful supercomputers like IBM’s Watson, which is now being applied to medical diagnostics and other healthcare tasks. Watson is significant because it understands nuances of the English language and includes the artificial intelligence ability to Learn. Watson is also fast – real fast. IBM demonstrated its ability to read and analyze the equivalent of 300 million books in less than 3 seconds during a widely publicized game of Jeopardy, where Watson competed against the all time top money-winner and the guy who won the most games. Watson won.
For perspective, if those 300 million books were stacked along a very long bookshelf, it would cover the equivalent of 7 football fields. Keep in mind that technologies that first appear in million dollar supercomputers will eventually move down-market to consumer products. The iPhone’s SIRI speech recognition software is an example since it already understands much of the English language and can carry on simple conversations. It’s not as fast as Watson yet, but watch this space.
Smartphones and tablets already serve as health gateways between sensor data and powerful cloud-based services that monitor, store and analyze that data as needed. But over time more of the storage and analysis of this sensor data will occur in the mobile device itself.
Healthcare Gets Personalized & Personal
Powerful supercomputers like Watson will lead the way toward personalized medicine, doing the analytics of “big data” and helping physicians diagnose problems and personalize the medications and care plans based on a huge global knowledge base of medical information, a repository that’s doubling in size every 5 years. Such personalization will also consider the patient’s own medical record info, DNA, and monitored sensor data.
Remote access to Watson can be extended beyond doctors and will then trickle down the chain from specialists to general practitioners, physician assistants, nurse practitioners, RNs, LVNs, medical aids & techs, and eventually to consumers themselves. This will accelerate the current trend of e-patients taking more responsibility for their own health and scouring online websites (e.g. WebMD and PatientsLikeMe) for medical information about their own conditions. After all, they have more skin in the game than their physician, just not as much formal medical training.
Telehealth & Telemedicine
Some patients are already connecting with practitioners through high-def video calls from retail clinics or kiosks, from their home PCs (using software like Skype), or through their smartphone or tablet computer. It’s called telehealth, and new services are springing up to support it.
Your specialist and general practitioner may be miles away, but you can see and talk with them remotely; and with a few medical sensors (blood pressure cuff, digital stethoscope, medical imaging attachment), they can do remote exams too. If you don’t have the skills or tools, a nurse or aid can come to your home or workplace connect you all in a video conference with the remote expert(s).
As this trend continues, regulators must adapt and figure out how to handle licensing and oversight across state lines or international borders. Traditional States Rights will be challenged as our world becomes increasingly mobile and connected and where we change jobs and careers every few years and move about to exploit new opportunities. If we want to keep our health provider, how will that happen if she lives, and is licensed to practice, in another state?
What if the person providing personal care at home is not a person at all but a robot instead? Japan, with its One Child per Family policy, faces a much more significant aging problem than we do, and they’re turning to healthcare robots for help. Japan is pioneering the early development of healthcare robots and hopes to have a robot in every senior’s home by 2015. That’s just 2 years from now. South Korea also faces an aging issue, as does most of the globe, and they’ve mandated a robot in every home by 2020.
They do this because robots can easily do repetitive tasks, or ones that are too dangerous or difficult for humans. They can easily lift and transfer heavy patients, but their strong arms lack sensitivity today. That will be fixed with improved sensors.
What’s especially attractive about robots is that they can work 24×7 without complaining about low wages or the lack of benefits; and while they’re expensive to buy now, those costs will fall as technology allows. Robots can be directed by humans or made to learn and operate on their own. And they can serve as personal assistants (e.g. Roomba vacuum or Paro companion robot seal), can be something we wear or ride in (e.g. exoskeleton or Google’s self-driving car), or even something inside our bodies (nano-scale bots in our blood stream).
The Brain-Computer Interface
The ability to sense electrical activity of nerve endings is already leading to advanced prosthetics for amputees and so quadriplegics can control robot arms just by thinking about it. A brain-computer interface could also be used to control an exoskeleton or robot, and the military is already envisioning soldiers with telepathic helmets by 2020.
So what might be the result of converging Information and Cognitive Computing? Futurist Ray Kurzweil has studied this field and foresees a supercomputer exceeding the computational and analytically power of the human brain this year, in 2013. In many ways, IBM’s Watson already has. But by simply extrapolating Moore’s Law into the future, Kurzweil predicts that by 2023, a $1,000 computer will have the power of the human brain and by 2037 a $0.01 computer will too. By 2049 (still possible in my lifetime), a $1,000 computer will exceed the power of the human RACE, and ten years later a $0.01 computer will. Way before then we’ll see improvements in the brain-computer interface, so changes in healthcare beyond 10-20 years get much harder to imagine.
The Most Likely Inhibitors
As I mentioned at the beginning, politics and public policy can be either a huge driver of change or an inhibitor. So what I worry about most is the corrupting power of big money in politics and special interest lobbying. I’m appalled that most new bills today are drafted by corporate attorneys and not by elected politicians. Then highly-paid lobbyists help push the bills through Congress to become law.
Steven Brill, in his 38-page special report for TIME Magazine, described an immensely profitable healthcare industry that doesn’t want to change and spends twice as much on lobbying than the military industrial complex. If proposals such as universal healthcare were to actually eliminate the need for private health insurance and replace the profit motive with incentives to instead focus attention on wellness and prevention and thus avoid the need for medical care in the first place, the nation could easily save over $1 trillion per year. That’s each and every year, not spread over 10-20 years, and that would be a lot of money NOT pouring into the healthcare industrial complex.
No wonder the hospitals, insurers, drug companies, testing companies, and equipment providers have been fighting so hard to prevent real health reforms. Doctors themselves are less to blame, but even from their first day in medical school, they too have learned that preventative medicine kills – it kills repeat business, and profits.
GREED – and the widening gaps in income, wealth and opportunity – is a global problem, but it’s most pronounced in the United States. And unless we address this problem, we won’t be able to contain the rising healthcare costs and will continue paying more than all other industrialized nations for inferior care overall. Sure, the wealthy will get great care, but the others won’t.
About the Author
I want readers to know about the lens that makes up my perspective of healthcare and its future, so here’s some quick background. I’m a retired IBM technologist, market strategist, futurist, consumer advocate, and social entrepreneur. I started my professional career as a punch card operator with IBM while still in college. I progressed through computer operator, application & systems programmer, systems engineer, marketing support rep, and market strategist before retiring in 1999.
While I have no formal medical training, I have a fairly good basic understanding of the industry (not so much medicine itself) from my work as an IBM Systems Engineer with large hospital accounts, where I installed systems for patient accounting, patient care, pharmacy, and medical records. And I married a registered nurse (RN, BSN).
I’ve always been interested in tech innovations and tend to think in IBM Scale, i.e. about big, multi-billion dollar problems.
About Modern Health Talk
After retiring from IBM, running a digital home consulting firm, and co-founding a 501(c)(4) nonprofit consumer advocacy firm representing homeowners in the Texas legislature, I started Modern Health Talk. I was looking for a compelling intersection of industry trends and market needs with my skills and interests, and that’s exactly where Modern Health Talk is positioned – at the intersection of several industry and market trends and positioned between online support groups on one side and technology websites on the other.
It’s a content website and blog with tools providing a personal assessment and product comparisons. There are lots and lots of healthcare statistics, many of which are packaged in nearly 300 infographics, and there are well over 400 articles on topics ranging from health reform to low- and high-tech solutions for home healthcare and aging-in-place.