The Future of Medicine: The World Around Us

Photography by the author

Speakers at the FutureMed 2013 Conference this November 2013 in San Diego, Calif. had their respective messages for the audience.

Most speakers were not physicians; indeed those standing at the podium were not familiar with the minutiae of medicine. They didn’t know how to deliver a baby, nor set a Colles fracture nor counsel a depressed teenager; they were not my peers.

But, significant authorities in their own field, they were well known to their colleagues and they did see the big picture. And, boy, did they have the slides to show that picture. I had never seen so many slides. It reminded me of a rural medical meeting in Texas in the early 1960s: “I’m here to speak about a rare disease,” the speaker said. “I’m a specialist! Know what a specialist is? A bastard from Boston with slides!”

Excuse my language but I was quoting.

Sometimes memories leave just sound bites and the conference followed up with emailed “takeaways,” some of which I comment on here.

Neil Jacobstein (co-chair of Artificial Intelligence and Robotics Track at Singularity University): “The brain hasn’t had a major upgrade in over 50,000 years. If your laptop hadn’t had an update in five years, you’d be upset about that.”

Raymond McCauley (chief science officer at Genomera): “How do you react to a future in which tools previously restricted to dozens of labs are now in the hands of thousands and eventually millions of people?” (Comment: This will be the challenge for the “empowered and engaged patient.”)

John Mattison, MD (chief medical information officer, Kaiser Permanente): The five key drivers of health care costs are: “Failure to implement evidence-based preventive care; fee-for-volume payment incentives; end-of-life care; the pervasive influence of ‘pharma;’ and disorders of lifestyle, such as obesity and diabetes. ‘Information therapy’ has failed us — consumers don’t change their behavior despite knowing about calorie counts and smoking dangers.”

Lisa Kennedy, PhD (In 2005, Dr. Kennedy joined GE Healthcare as Chief Economist): “Patient engagement affects future expenditure.”

I’ve picked on these themes because the slides and presentations were particularly impressive and touched on some of my own concerns.

Medicine faces a geopolitical challenge and most American physicians seem oblivious to this

I lived in the U.K. for 28 years before relocating to the United States in 1960. I may be more open-minded than some Americans. So I may be over-reacting to the data presented to the FutureMed audience.

Nevertheless, I was startled to see Eric Rasmussen, MD, a disaster response leader, show his first slide; with a circle around southeast Asia on a world map that he said has “more people inside it than outside.” And another slide that I thought worrying showed that 95% of the increase in world population by 2050 will be in the cities of the developing world. And that, as recently as 2007, 1 billion people were living in slums and “for the first time in human history we are more urban than rural.”

Rasmussen wears many hats: amongst them is one of CDC’s congressional Task Force on Global Biosurveillance. Currently the managing director at Infinitum Humanitarian Systems he has led disaster responses in more than 15 world crises.

Another Rasmussen slide made this clear. Greater New York City with 22 million has slowed its annual growth to 0.30%; even Los Angeles with 17.9 million is gaining only 1.1%.

However, cities in Pakistan with 16.9 million, in India with 23.9 million, in Bangladesh with 14 million and in China with 24.9 million are set to have annual growth of 4.9%, 4.6%, 4.1% and 4%, respectively.

Those are not cities famous for their public health facilities or prominent for their tropical health knowledge or even for generous governments that care for the “common man.” It is almost laughable that some persons in our American public are prostrated with fear over global warming yet seemingly unconcerned about the dangers of over-population.

Americans need more insight into the realization they are no longer leading the way

The United States has been the world’s policeman for more than half a century. We have squandered our political goodwill and, perhaps more important, emptied our treasuries. The banks are bare.

Even as we and the Western world preen ourselves on our contributions to countries suffering national disasters we are falling behind other nations in addressing the global problems of national ill health.

Lisa Kennedy presented her insights into the future of affordability in global health care. Her wide background extends from a PhD in health economics from St. Andrews University in Scotland to winning awards for improving WHO’s treatment of tuberculosis in Ethiopia. Physicians would surely agree with her comment, “Third-party payment disengages the patient.”

Her slides were detailed: China, for example, expects to increase its life expectancy by three years and reduce infant mortality 10% by 2020 at a cost of 1 trillion per year. I was too scared to ask if that was yuan or U.S. dollars in case it was dollars.

India, too, is going to give its population (if you can believe it) universal health coverage by 2017 at a cost of 1.5% to 2.1% of GDP. Africa claims it will have 80% of the population insured at a cost of 8% to 10% of GDP (another hard statistic to believe as the continent surely doesn’t have a composite or federal authority to make such assertions).

And how does Eurocentric health compare with other nations’ bold global hopes for the future? Badly. Europe would appear to be in decline cutting its health spending by 5% per year.

And America? We have the faltering promise of Obamacare,

What do they say about the value of one picture? One thousand words? This slide made its point; a comparison between the costs of health care versus life expectancy. It was illuminating.

I’m familiar with the suggestion U.S. statistics suffer because we are spread over so large an area that some people, by location or choice, do not receive proper health care till it’s too late but I fear that’s a weak argument. The graph shows that at a cost of $2,750, life expectancy in Japan is 81.4 years whereas in America at a cost of $7,437 life expectancy is 78.1 years. An anomaly? U.K. costs $3,051 for a life expectancy of 78.1 years. Sweden $3,432 translates to a life expectancy of 79.8 years, in Canada $3,844 per person brings 80 years.

European health economists say American patients (by their European standards) may be medically over-sophisticated, overeducated, over-investigated and over-treated. And they say, without sounding convinced, maybe it’s a cultural thing.

It’s not just outsiders who are startled by our health costs. The slide entitled “The Curse of U.S. Healthcare System” was created by Stanford University! Forget the life expectancy obtained at the price — just look at the total costs to see what an outlier the United States is.

It may not be enough for those speakers at FutureMed that the United States has won all those Nobel Prizes in Medicine and Physiology. Some speakers felt there were things our patients are missing. I’ll talk about that next week.

The Andersons live in San Diego. Eric is a retired MD. The one-time president of the NH Academy of Family Practice, he was a senior contributing editor at Physician’s Management for ten years and a contributing editor to Geriatrics and to Medical Tribune at the same time. He has written five books, the last called The Man Who Cried Orange: Stories from a Doctor's Life.