Medical technology (medtech) in its many forms, is applied to the diagnosis, monitoring, or the treatment of diseases or medical conditions and it is undergoing technological disruption at an unprecedented depth and speed. This revolution presents both stunning new opportunities for humanity and unparalleled risks as reported by the World Economic Forum.
Customer empowerment, hyper-connectivity, digital technologies including ubiquitous devices and sensors, supercomputing and advanced computing, artificial intelligence and robots, and a mashup of social, mobile, data, analytic, cloud and automation are driving exponential change in medtech. And the convergence of digital technologies is propelling the rise of biometrics, 3D bioprinting, neurotechnologies, nanotechnologies, biotechnologies; new competitors and disease eradication.
Statistica estimates the global medtech market will grow from USD$392b in 2016 to almost USD$530b in 2022. However Accenture reports growth in medtech is slowing; earnings amongst incumbents industry players have declined, and there is widening the gap between innovation and financial performance. Also, changing customer behaviour and patient demographics, ongoing cost pressures, and increasing regulatory scrutiny require medtech companies to revise their strategies and create opportunities for new entrants.
EY reports the impact of these macro trends are driving scale and business model transformation, and forcing an understanding that the currency determining value now — and in the future — is not first-in-class medicines or technologies it’s the data those products generate.
PwC confirms the USD$5 trillion healthcare ecosystem in the USA is ripe for disruption at the hands of digital technologies and that companies must respond by rapidly adapting, innovating and building value.
Customer Empowerment and Hyper-connectivity
Customers are increasingly adopting online applications to compare prices, schedule services e.g. ZocDoc, and take responsibility for their health care, e.g., using Apple’s HealthKit through Epic‘s MyChart application — the most-used patient portal in the US; empowering them and disrupting the healthcare system.
The United Nations reports almost 7.1 billion people, over 95 percent of the global population, now has mobile coverage and Statista reports the number of Internet users worldwide is now 3.5b – irrevocably changing customer behaviour and removing traditional information asymmetries in medical care.
Roland Berger reports the consequences are reshaping traditional business models for healthcare providers, medical practitioners, pharmacists and governments with significant challenges from both startups and global technology giants.
McKinsey reports the healthcare industry is already shifting toward higher levels of consumer control, and new technologies will likely hasten the trend.
Confirming these change the National Health Service in the UK has launched plans to allow patients to consult with their doctors via their smartphone via e.g. Babylon, given technology companies special access to the health service and its data, and announced NHS national payment rules would for the first time cover devices and apps.
Ubiquitous devices and sensors
IHS forecasts that the Internet of Things (IoT) will grow from 15.4 billion devices and sensors in 2015 to 30.7 billion devices in 2020. Gartner reports increasing levels of connection through wearables and medical devices (e.g. blood glucose monitors). And predicts by 2019, wearable devices will be used to monitor at least 30% of hip and knee replacement patients, those most at risk e.g. those with diabetes and those recently released from the hospital as e.g. with ImpediMed’s L-Dex device for managing complications in cancer patients and those with heart conditions. Also, Cochlear implants have revolutionised hearing loss treatments.
Gartner also predicts by 2017, 70% of multinational corporations will sponsor the use of wearable fitness-tracking devices to encourage healthy living, and by 2020, 40 percent of employees can cut their healthcare costs by wearing a fitness tracker.
Despite this bullish outlook, a recent study at the University of Pittsburg revealed trackers are ineffective in maintaining weight loss suggesting the need for a more cautious assessment of their use, and HP has warned that an estimated 70% of IoT devices are hackable.
Separately, the UK National Health Service has launched a trial of sensors in the home to help those with dementia stay in their home longer, and in Australia, Find-Me Technologies the creators of a watch that helps care for people living with dementia has raised $3m from OneVentures.
Elsewhere Professor Hassam Haick of the Technion-Israel Institute of Technology has invented a device that can detect 17 diseases from your breath, including cancers and is next developing Sniffphone for disease detection via smartphones.
This trend explains, in part, why Telstra has launched the world’s first Gigabit LTE network with data downloading up to 10 times faster than the maximum for a home user on nbn) and also its recent wave of acquisitions in medtech.
Supercomputing and Advanced Computing
China holds the position as the global leader in supercomputing applying this capacity to various applications including the simulation of protein folding to help scientists better understand diseases such as Alzheimer’s and Parkinson’s supercomputing is available to us all via global platforms.
Gartner predicts by 2021 20% of all the activities an individual engages in will involve at least one of the top-seven digital giants Google, Apple, Facebook, Amazon, Baidu, Alibaba, and Tencent. These global platforms will increasingly dominate our digital world “web search, mobile, social networking, messaging and music streaming…Mobile apps and payments, smart agents (such as Amazon Alexa), and digital ecosystems (such as Apple HomeKit, WeChat Utility and City Services) will make the digital giants part of many more of our activities”. Their depth of capability and resources is driving disruption across all industries and is particularly relevant to information intensive industries including healthcare.
Concurrently, researchers at the University of New South Wales are racing to create and commercialise technology that could lead to the world’s first quantum computer in silicon. And Microsoft has announced that they are developing computers built from DNA which can be programmed to identify cancer, and the associated Bio Model Analyzer software is already helping researchers understand and treat leukaemia more effectively.
Artificial Intelligence (AI) and Robots
When AlhpaGo played a near perfect game on 12 March 2016 in Korea and beat the world champion Lee Se-dol, it demonstrated the power of AI and machine learning – a process that teaches computers to analyse huge volumes of data and identify patterns. While DeepMind, a Google-owned company, developed AlhpaGo to play Go it demonstrated underlying algorithms which are potentially more general-purpose, and applicable to Google Assistant and a variety of tasks e.g. proactively recommending personalised and preventative healthcare solutions.
Specifically, within the healthcare domain, IBM’s Watson has demonstrated more accurate cancer diagnosis rates than humans and also the ability to deliver personalised treatment options. Similarly, Entilic has applied machine learning to identify cancers in radiology scans, faster and more accurately than experienced radiologists – helping to address the shortage of doctors trained to interpret scans.
Robots have already been deployed to deliver medication and manage inventory e.g. at Fiona Stanley Hospital in Perth. And in Japan and Europe, they are assisting the elderly to stay in their home for longer. Leading to the European Commission to consider the law about robots.
Robotic limbs controlled by brain waves have been demonstrated successfully e.g. by the University of Melbourne, and robots are already being used to perform surgery. The outlook is for a further wave of innovation characterised by the convergence of AI and data gathered from robotic systems.
In this context, an Oxford study predicts that up to 47% of all US jobs in 2010 are highly susceptible to computerization from AI and robotics in the next 10-20 years (as below) and healthcare practitioners are not immune.
Data and Biometrics
Big data, small data, clean and dirty data is being applied to solve age-old problems in new ways. The malaria death rate in sub-Saharan Africa has declined by a stunning 57% since 2000, yet there are still 500,000 children dying of malaria every year. Now Maps with Precision give the ability to see malaria outbreaks in sub-Saharan Africa and marshal interventions accordingly.
Elsewhere, the focus of the University of Sydney Centre for Translational Data Science is the analysis of small data sets to understand better and develop pathways for mental health, breast cancer care, pre-term baby survival and metabolic diseases. Concurrently, researchers at Sydney Medical School are focused on interdisciplinary studies in obesity, diabetes and cardiovascular disease.
Meanwhile, Aadhaar, the Indian government’s cloud-based identity system now holds detailed information on over 1.09b Indians, and during 2017 all Indian adults will provide their fingerprints, iris scans, name, birth date, address and gender in return for their 12 digit unique identifier.
‘India Stack’ digital infrastructure which leverages Aadhaar allows people to store and share their data including e.g. medical records and businesses to design and deliver new services.
Aadhaar compatible scanners for both iris’ and fingerprints on mobile phones open the way for India to leapfrog developed world models and bypass established bureaucracy to deliver personalised and low-cost health care delivery across the country.
Clinical researchers already use 3D printed organic tissues for drug testing, and there is hope they may one day alleviate the global shortage of organs. The World Economic Forum has predicted within a decade, the first transplant of a 3D printed liver will have taken place.
And in Australia Anatomics has delivered patient-specific 3D cranial, spinal, heel, rib cage, hip and shoulder implants changing people’s lives, lowering the cost of delivery, and removing the need for warehousing.
3D printers are also driving demand for new education and collaboration as between the Queensland University of Technology (QUT) and the University of Wollongong and their European counterparts to offer a world-first first international masters degree in 3D body part printing.
Neuroethologies with its focus on the human brain and role of the nervous system in behaviour offer a new way forward, with smart drugs, neuroimaging, and machine-brain interfaces to read the brain activity.
Neuroethologies with its focus on the human brain and role of the nervous system in behaviour offer a new way forward, with smart drugs, neuroimaging, and machine-brain interfaces to read the brain activity. In support of research into the reversal of spinal cord injury, Alzheimer’s, Parkinson’s and other neurodegenerative conditions the University of Technology Sydney has launched the Centre for Neuroscience and Regenerative Medicine.
The application of nanoscale materials offers a bright future for the powering of devices and sensors to monitor health and well-being. The Australian Institute for Nanoscale Science and Technology, the most advanced facility for nanoscience in the region, has been launched at the University of Sydney – where design, fabrication and testing of nanoscale medical devices can occur under one roof.
The completion of the human genome project in 2001, was expected to provide the foundation for a new generation of cures and diagnostics. EY reports nearly two decades later there has been robust growth in the creation of precision therapeutics but not yet in precision diagnostics. Perhaps this focus will change with the launch of the Beijing Genomics Institute China National Genebank and its positioning as the prime destination for scientists and pharmaceutical companies worldwide who seek to sequence whole genomes for disease and infection control.
Elsewhere at Sichuan University, a team of scientists has become the first to treat a human patient with an aggressive form of lung cancer with the groundbreaking CRISPR-Cas9 gene-editing technique.
Prompting Siddhartha Mukherjee in the recently released The Gene: An Intimate History to say “in the last four years – between 2012 and 2016 – we have invented technologies which allow us to change human genomes intentionally and permanently [which] alters our conception of what it is to be human”.
The discovery of a blood biomarker for MS by Macquarie University researchers and the work of Professor Alan Mackay-Sim, who has transplanted nasal nerve cells into the spinal cord to make spinal cord repairs has highlighted the power of biotechnologies. And concurrently, Orthocell has commenced the commercialization of a non-invasive stem cell therapy for damaged and degenerated tendon tissue.
Separately the University of Cambridge has declared an artificial pancreas which monitors blood glucose in patients with type 1 diabetes and then automatically adjusts levels of insulin entering the body – will likely be available by 2018.
Eradication of Disease
While ageing populations, superbugs and the rise of chronic diseases dominate headlines, extraordinarily in 2016, the World Health Organization (WHO) announced that after 50 years, they and their collaboration partners have been successful in eradicating measles (in the USA). They also announced they are on track to announce the global eradication of polio in early 2017. And the new Ebola Vaccine proved to be 100% effective.
Exceeding all expectations the Bill & Melinda Gates Foundation has pledged $3.6b to date to combat malaria, tuberculosis and Aids and increased funding to Sydney’s Atomo Diagnostics to develop and deliver 20m affordable HIV self-test kits for resource-poor countries.
Similarly, the Chan Zuckerberg Initiative has pledged to spend $3b on biomedical research over the next ten years to “cure, prevent or manage all disease by the end of the century”. The first part of the program saw the launch of Biohub, which will map every cell in the human body and where researchers and scientists can collaborate.
Meanwhile, the Novartis Foundation is applying technology to the eradication of Leprosy.
Cyber Security and Data Sovereignty
Our increasing cyber dependency renders us increasingly vulnerable to data fraud or theft, security breaches, cybercrime and cyber-attacks. As powerfully demonstrated in late 2016 when the private lives of approximately 550,000 blood donors were made public by the Australia Red Cross Blood Service in Australia’s largest security breach.
On the launch of Cyber Maturity in the Asia-Pacific Region, 2016 Tobias Feakin, Ambassador for Cyber Affairs warned of the two most concerning trends over the past year – the targeting of critical infrastructure including e.g. hospitals and the use of information as a weapon (i.e. the weaponisation of data).
What the Ambassador failed to address was data sovereignty and the dangers which lie in our increasing reliance on the aggregation of personal data and its manipulation by underlying algorithms. Vast volumes of data are collected (e.g. Facebook collects 98 data points for its 2b users), traded (e.g. by data brokerage companies including Acxion with 1500 data points), and stored in private databases including unregulated DNA databases.
However, as highlighted by Trusted Impact in their recent report medtech cyber security is not merely about protecting data, it is also about saving patient lives, and government and health care leaders needed to act with this knowledge.
The global healthcare industry is facing a period of profound change. Medical practitioners and those in the healthcare ecosystem and customers are by their nature rightly cautious.
However, barriers to entry are low. Customer empowerment, hyper-connectivity, digital technologies and their convergence is propelling the rise of biometrics, 3D bioprinting, neurotechnologies, nanotechnologies, biotechnologies presenting unprecedented and unimagined change.
Unpredicted successes in disease eradication offer profound hope for the future. This future is however not without significant risk.
The National Innovation and Science Agenda recognises Australia’s position as world leader in health and medical research and the challenges associated with commercialisation the Federal Government has announced the National Innovation and Science Agenda Biomedical Translation Fund with more than $500 million. Australia’s leadership role could usefully be expanded to include consideration of the associated ethical and moral dilemmas, governance models and risk management frameworks.