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When Tomorrow Meets the American Health Care Professional
January 2006

Being a health care professional has always been challenging, but changes coming to this sector over the next 5-10 years will be unprecedented, offering both novel opportunities, and intimidating obstacles. These challenges will emerge from three principal areas: technology, demographics, and finances. Let’s start with technology.

Health historians will look back on this period as the time when humanity emerged from the dark ages of medicine into the first truly scientific period of medical research and treatment. This is not to denigrate the work and the researchers that have come before – we would not be where we are now without them. But today, for the first time, we have an understanding of genetics and molecular biology, coupled with breakthroughs in the application of information processing to health care, that is increasingly going to allow us to do things deliberately, and with foreknowledge of why we are doing them, that will result in seemingly magic breakthroughs in the management of health, and the treatment of disease. Let me give you an example.

Genetics*Squared is a ‘dry biotech’ company that uses a novel software technique called genetic programming. Genetic programming (‘GP’) mimics the process of Darwinian selection to evolve solutions to medical problems where other approaches don’t work, or can speed the process of finding answers, sometimes by several orders of magnitude compared with more traditional research techniques. (Personal disclosure here: I’ve worked with Genetics*Squared, which is how I know about them, and own shares in the company, but it’s privately held, and shares are not available for sale.)

One pharmaceutical company challenged them to look at stage three clinical trial results for a drug that was about to be discarded because it had been less effective than hoped. After analyzing the data, Genetics*Squared found that those people who responded positively to the drug had specific genetic markers, and the drug actually produced very positive results, while those who failed to respond, or had negative side effects, did not. Accordingly, Genetics*Squared recommended that the pharma screen potential patients for these genetic markers, and that if they did so, the drug would prove to be as valuable as had been originally hoped for. This reopened the potential for a new oncology drug, and may save the pharma involved the tens of millions of dollars in sunk research costs by rescuing a drug that would otherwise have been discarded.

Genetics*Squared also worked with the University of Southern California to analyze the stages of bladder cancer from tissue samples, rather than waiting for the gross presentation of physical symptoms. They found that they could produce a definitive diagnosis of which stage the cancer was at, and therefore how it could best be treated, by analyzing multiple gene expressions from the tissue sample. If you extrapolate this example, it implies that, down the road, we may be able to administer a simple, annual test for cancer, and find out if someone has cancer. If so, then the test will also identify what kind of cancer, where it is located, what stage it is, and therefore how to treat it. Such tests would dramatically increase the survival rates for sneaky killers like pancreatic and ovarian cancer.

Genetics*Squared is not the only company doing novel research in unexpected ways, and this trend illustrates three important changes coming to the practice of medicine. First, pharmaceutical companies will have to migrate away from the traditional ‘blockbuster’ model of success that Wall Street so loves to see, and move towards a model of targeted drugs that aim at specific, niche groups of people who fit a specific genetic profile. Second, this implies a multiplication of the information for health care professionals to absorb in order to be as effective as possible. And third, the introduction of IT into medical research – illustrated so dramatically with the conclusion of the Human Genome Project – is going to significantly accelerate the speed of change in new pharmaceuticals, diagnostics, and therapies. Instead of research moving at in vitro speeds, it is going to move at in silico speeds.

And this indicates one of the central challenges health care professionals face today: coping with more information. To be sure, this is a problem everyone faces, but with health care professionals it often has life-or-death consequences. Eventually, this will lead to new ways of supporting professionals in the treatment of patients, with everything from the handheld devices already emerging to give practitioners access to just-in-time data, to electronic patient records, which will allow for better use and integration of patient information between different practitioners, to evidence-based medicine. This last area is particularly controversial. On one hand, many practitioners worry that using statistical and computer analysis of specific cases may tempt administrators to shift emphasis for the management of patient care from the professional to a computer for cost reasons.

Yet, I believe that evidence-based medicine will eventually earn its way into the practices of health care professionals by supporting them, and making it easier for them to both keep up with new art, and to provide them with a greater depth of resources when they make a diagnostic or treatment decision. The proper way to use computers is to support and assist human judgment, not to replace it.

Moreover, the changes coming to health care because of demographics are going to make this a crucial change in future. Put baldly, there are going to be too many patients, and not enough doctors and nurses to treat them. Over the next 10 years, for every 10 professionals retiring from medicine in America, there will be only four graduates moving into the workforce. This applies to all jobs and professions across the economy because of the huge size of the baby boom, but the pinch will be felt most keenly in health care, especially when you combine this with the enormous surge in patients needing care. People’s need for health care remains reasonably consistent from about the age of four until the mid-50s, but then starts rising almost exponentially with age. With the leading edge of the baby boom turning 60 this year, we will see the biggest generation in history moving into the period of their lives when their need for health treatment skyrockets. And the number of such people is staggering: between now and 2016, the number of people aged 55 and up is going to explode by more than 30% – just when the number of doctors and nurses available to treat them goes into precipitous decline.

This has two implications: first, the health care system is going to do everything it can to persuade experienced practitioners to stay within the system, even if it means asking them to work part-time and paying premiums for their services. And second, it means that everyone involved in health care, from governments, to HMOs, to drug companies, to hospitals, to practitioners themselves, are going to look for ways of doing everything they can to increase the effectiveness and productivity of health care professionals.

All of which leads us to the third factor in the future of health care: money, the elephant in the middle of the living room that no one wants to talk about. There’s a very good reason why no one wants to talk about money; there isn’t going to be enough of it. There have been lots of headlines over the last few years about the double-digit increases in the cost to employers of supplemental health insurance, and the status of those 40 million Americans without health insurance, but that's just a part of the problem because the public sector is actually in worse shape.

For decades, governments have made promises to their employees, many of whom are unionized, about pensions and health insurance coverage for retirees. And until very recently, they financed such promises on a pay-as-you-go basis, which meant that they only stated the current cost of such promises. Now, however, the Government Accounting Standards Board has ruled that governments throughout America must account not only for the current cost of ‘other post-employee retirement benefits’, but also state the estimated future liability of such promised benefits. The figures that result are staggering. The Economist news magazine reports that California, for instance, which allocated $895 million for health insurance for retirees in fiscal 2005-06, could have an unfunded liability amounting to $36 billion or more – forty times its current costs. The Los Angeles Unified School District puts its unfunded liability at a minimum of $13-14 billion, which represents 80% of its general-purpose operating budget. All American employers and all American governments have conspired to allow us to deceive ourselves that we’re financially OK, when the truth may be disastrously worse.

For health care professionals, this means that money pressure is going to be a constant and growing theme for the rest of your career. Every decision you make is going to start with money, and end with money, and only in between might there be some consideration for the patient or the practitioner.

The future is a very mixed bag for health professionals of all stripes. The demand for your services is going to rise explosively. The tools you have to work with are going to get dramatically better as research gushes with results that would have seemed like magic even a decade ago. And everyone will worry about where the money will come from to pay for all this.

We are going to live, as the curse goes, in interesting times, and practitioners who want to thrive and survive will need to look at the whole picture, not just one part of it.

by futurist Richard Worzel, C.F.A.

© Copyright, IF Research, January 2006.

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