3 Questions – 3 Answers: Bioviva

A new format starts here on the blog: The 2b AHEAD expert network in dialogue. Health experts regularly raise relevant questions on the future of health. Other experts from our network comment on this – and in turn ask new questions that will go to new experts. In this way, an inspiring dialogue grows and we will continue to expand it. Would you like to become a part of it? Just send me a short mail or comment here.

In the focus today: Liz Parish and Avi Roy from Bioviva

The expert questions today go to Liz Parrish, founder and CEO of Bioviva, and Avi Roy, CTO of Bioviva. Bioviva is one of the pioneers of telomerase – or to describe the result: Bioviva is working to prolong human life by intervening in the genetic code. Significantly prolonging it. Bioviva’s research focuses on the ageing processes of individual cells. Parrish, Roy & Team are among the most important drivers of the longevity movement.

Success-based medicine

Peter Ohnemus, DacadooPeter Ohnemus, Founder and CEO of dacadoo: With digital health, the proof of positive outcomes of drugs can be fully documented. When do we want to start designing a 100% outcome-based healthcare system?

 

Liz Parrish, BiovivaLiz Parrish, Founder and CEO of Bioviva: We do not have any evidence to support the claim the ‘digital health’ can absolutely prove positive (or negative) outcomes for drug trials. Most molecular and physiological biomarkers are hard to measure digitally without having an advanced molecular pathology lab. But regardless, your question regarding the outcome-based healthcare system is a valid one. Currently, in the UK the National Institute for Health and Care Excellence (NICE) balances the choices of medicines available to patients based on a multifactorial assessment of cost-effectiveness, opportunity costs associated with decisions, and the impact of treatment option on quality-adjusted life years (QALY). QALY’s and disability-adjusted life years (DALY) are the main outcome-based method to test the efficacy of a treatment in a healthcare system. Although flawed this is currently considered the gold standard by health economists and politicians. In conclusion, all countries that can afford to have a functioning health care system try to assess the efficacy of treatments based on outcomes, but the biomedical science community need to provide them with better biomarkers than QALY and DALY’s.

Who do we trust?

Arkadiusz Miernik, Universität Freiburg Professor Arkadiusz Miernik, Freiburg University:  Should we trust the big pharmaceutical companies or rather biohackers in the future?

 

 

Liz Parrish 2, BiovivaLiz Parrish: We think that it is foolish to blindly trust any organisation or system. At BioViva we really like the Russian proverb, which was used by President Ronald Reagan on many occasions, “Trust but verify.” To elaborate, we are building a standardized bioinformatics testing platform which will test the efficacy of anti-ageing treatments regardless of them being produced by big pharmaceutical companies, or small biotech startups, or indeed biohackers.

Consequences for the immune system

Florina Speth, 2b AHEADFlorina Speth, Senior Researcher, 2b AHEAD ThinkTank: How does our immune system react when we continuously and permanently prevent diseases?


Avi Roy, BiovivaAvi Roy, CTO, Bioviva: Dr Speth, I am not quite sure that I understand your question, but I’ll try to answer it. In biogerontological research, and at bioviva we are trying to rejuvenate the human body and its organs and tissues at a cellular level. Our research and therapeutics target the hallmarks of cellular ageing which includes genomic instability, telomere attrition, epigenetic alteration, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication.  these processes happen in every cell type in the human body. when we think about treating a disease we are not necessarily thinking about cardiovascular disease or dementia instead we are targeting these fundamental cellular processes that go awry overtime. Therefore immune system cells will be beneficially affected by these anti-ageing treatments and would produce favourable outcomes. We imagine a future where we can rejuvenate long live cells, kill cells that are senescent or cancerous, and create new functional cells from stem cells.

The immature patient has had his day

The roles of doctor and patient in the future: What was the immature patient yesterday has long since changed. The one who just had to wait patiently and yield to the judgement of the only competent expert in white is no longer satisfied with this role. Or at least should not do it anymore. See below for counter-examples.

Steven Joffe from the University of Pennsylvania has just described in a pleasingly differentiated and clear article how the three factors of patient rights, available knowledge and direct-to-consumer tests have lastingly changed the doctor-patient relationship. He outlines how the immature patient comes to eye level. Joffe’s article deserves an urgent reading recommendation. It is hereby pronounced.

Three factors
  • Factor 1: Patient rights. For the first time ever, their formulation has led to the claim of patients to have their own opinion, their own decision and the corresponding information provided by the physician.
  • Factor 2: The Internet as a constantly growing source of medical knowledge.
  • Factor 3: The increasing availability of medical tests with scientific requirements directly for patients. We have already discussed this new role for laboratories with the associated business models on various occasions here and here. Joffe clearly emphasizes the impact of this development on the entire healthcare system.

For the sake of precision, we are talking here exclusively about the doctor-patient relationship between practicing physicians. The immature patient of the hospital is a similar but more complex subject. I will take up this point at a later date.

A contemporary role of the doctor

Joffe shows how, on the one hand, our traditional image of roles in health care is still very much alive. Here is the expert whose judgement is to be followed. There the receiving patient. On the other hand, Joffe demonstrates how these roles already lose their justification.

The contemporary and forward-looking role of doctors is therefore threefold:

  • The doctor as the patient’s advisor and health coach,
  • the gatekeeper for advanced medical knowledge and special testing, and
  • Finally, access to optimal follow-up services. That is, the medically necessary, although perhaps not directly required of the patient. Here, the doctor is the one who has an overview of the consequences of an illness and treatment. Who, on his own initiative, is committed to what is medically necessary – and in this way creates added value.

So much for the present.

Second opinion at Yahoo?

However, this present also includes this picture from a doctor’s office, which has been circulating on Twitter these days and has received thousands of approvals within a very short time:

 

The immature patient - Dr. Google must stay outside
The sign reads: “Patients who have already received their diagnosis via google are asked to obtain a second opinion not from us, but from yahoo.”

 

The reaction: several thousand likes, hundreds of comments along a line “Patients can be so annoying if they don’t trust the doctor’s diagnosis”. Yes, they are, at least for perceived half- and three-quarter gods in white. Is a doctor afraid of patients who want to take responsibility for themselves? In any case, he has difficulties with setting commas in the4 German language. But there is always something.

Those who hang up such signs in their practice deny their patients much more than just the ability to search the Internet for specific health information. With the reference to Yahoo, the poster looks like it did in the year 2000. The mentality behind it is much older; it goes back deep to the last century.

Counter-question: Who seriously wanted to recommend to a patient to rely exclusively on the knowledge that a single expert reproduces from his memory within a few minutes? With an effort of research, limited by the time that the health care system is currently paying.

A future-oriented role for the physician

Even more important from the point of view of futurology is the question of how to continue the series of trends and drivers:

Patient rights, available high-quality knowledge and B2C test procedures are followed at least by

  • Artificial intelligence in everyday use by doctor and patient,
  • an exponentially growing database in type and quantity,
  • large international players who are entering the healthcare market and claim a competent role here,
  • more and more: an interpretation of biology and medicine as information technology.

On this basis we then negotiate the roles between health seeker (ex-patient) and competent companion, supporter and initiator (ex-physician). The immature patient has had his day.

 

Healthcare of the Future (2/2)

In the summer of 2018, I gave the keynote speech at the Roche Days “Diagnostics in Dialogue”. I then noted a few very basic thoughts on the healthcare of the future. They have just been published by Roche. The first part is here; this is the second part of the slightly shortened text.

From patients to healthcare customers

Data-based knowledge of people’s sensitivities will also blur the boundaries between illness and health. The fact that people are not either 100 percent healthy or ill is not a new idea for the healthcare of the future. However, the broad data basis makes it possible not only to discover existing diseases. In the future, healthy people will also know a lot about the risks of potential diseases. This in turn raises the question of where the line between healthy and sick lies. The WHO defines health as a state of physical, emotional, mental and social well-being that goes far beyond the absence of illness or complaints. A forward-looking understanding.

Today’s patients depend on the data collection, evaluation and interpretation of their attending physician. In their perception, they are dependent on him. Patients of the future have the largest amount of data on their own health status and have access to their evaluation and interpretation. While classical patients look towards illness, symptoms and deficits, future customers focus on health. Patients become health customers.

Customers look for suitable service providers

Health customers are changing the health market with their attitude. They choose the right health service provider to optimize their state of health. Its attractiveness will depend on the added value it can deliver. It will be crucial for the successful service providers of the healthcare of the future to know exactly what the needs of potential customers are. They will analyse how each of their healthcare customers “ticks”, what their needs and expectations are and how best to communicate.

In the sense of “optimized” health, technologies could also be used in the world of tomorrow to expand or fully maintain bodily functions: The contact lens displays necessary information when needed. New organs are created in the 3D printer from the patient’s stem cells. Perhaps it will also be completely normal to order organ replacement from the doctor long before the first organ resigns.

Healthcare of the Future Michael Carl

Human – Machine Organisms

In the future, personal interaction will lose its central role today. People will increasingly experience that a machine simply understands them better. Communication with machines can be superior precisely because it follows clear structures and takes into account a multitude of data and parameters. If we continue to consistently think ahead, computers could become personal assistance systems that make calls on behalf of their owners, obtain information and offers at a frequency and perseverance that people would not be able to. Service providers in the healthcare of the future will have to adapt to this.

As a result, the way work is done will change completely. Where today we are talking about interfaces between man and machine, in the future we will look at man-machine organisms. In learning systems, algorithms will emancipate themselves as human tools. They will become de facto fully-fledged team members and will even take on management tasks.

New way of thinking

All these changes require a fundamentally new way of thinking and thus a change in corporate culture. In order to do justice to the possibilities and progress of digitalisation in the healthcare of the future, we must fundamentally rethink our ideas of values, quality and dealing with mistakes. Our way of thinking so far does not allow us to keep pace with the exponential pace of change. We must not just wait and see. We must act, even if we exceed our competencies and avoid good intentions. In the world of tomorrow, the maxim applies: Better to apologize afterwards than to ask for permission beforehand.

The Future of Healthcare (1/2)

In the summer, I gave a keynote speech at the Roche Days “Diagnostics in Dialogue”. Afterwards, I wrote down some very basic considerations about the future of healthcare. They just appeared in a Roche publication. This is the first part of the slightly shortened text.

The feeling that the world is turning faster and faster is not deceptive. The familiar linear and controlled pace of development is increasingly becoming a thing of the past. Our environment is changing exponentially – one could actually say that our world will never again develop as slowly as it does today. This development will be driven by the large amount of data available – also in the future of healthcare.

Internet of Everything

Today’s idea of data composition and data quality is generally too narrow. Technology experts confirm: By 2020 at the latest, thoughts and sensations will also be part of everyday data. Even today, electrodes can read brain waves used by paraplegic people to steer their wheelchairs. In a few years’ time, electrodes will no longer be attached directly to the patient’s head, but sensors will read our thoughts from a meter away.

Every object of everyday use will potentially be connected to the Internet and networked – the chair on which we sit, our refrigerator or our car. In the so-called Internet of Everything, not only computers, laptops, tablets and smartphones are connected to each other, but also intelligent machines that generate additional data. For tomorrow’s children, the phrase “I’m going online” is incomprehensible, since it would mean that they were offline before.

Networking large amounts of data leads to highly adaptive products that can adapt to the individual, changing needs of people. This especially applies to the future of healthcare: Recorded data from smartphone apps, sensors from smart homes and wearables open up new possibilities for individually adapting health services to each patient.

Personal health networks

This form of personalized medicine is therefore data-centered medicine. Data about a patient is already numerous today, and continues to increase exponentially. Where yesterday perhaps a laboratory value and an X-ray image were the basis of a medical decision, in the future a multiparametric overall picture will be created for the medical recommendation of action. This will also change structures and processes in the context of patient management. Patient data assume the leading role in the entire treatment chain. The data-based knowledge of a patient’s condition and the potential diagnoses, therapies or preventive measures derived from it are also driving the increasing specialization of professions in the future of healthcare.

New health providers

Dynamic healthcare networks will emerge around the individual, whose nodes will be both the traditional players in the healthcare industry and new providers: companies in the food industry, sports and fitness, medical technology or the IT sector. The pace of decision-making for preventive measures or therapies is increasing, as is that of new developments for products and health services. In addition, this form of personalized medicine offers the opportunity to find new places for health and to place health topics flexibly, for example at home, in the car, in a restaurant or at work.

Future of Healthcare Michael Carl

Data Interpretation and Data Sovereignty in the Future of Healthcare

When patients have more and more information, this does not mean more knowledge or understanding at the same time. This is why the explanation and interpretation of data and the communication of risks, for example, are becoming increasingly important. Patients need experts to advise them. However, this role will no longer automatically fall to the family doctor in the future. On the contrary, different players in the healthcare industry are competing for this function, which is usually limited in time. These can be contact persons for certain clinical pictures – for the cancer patient the oncologist, for the woman who wishes to have children the gynaecologist – or contact persons who are important in a certain phase of life, e.g. a caregiver for an elderly person. There will be competition for the control function. Because whoever plays this role will have a decisive influence on the other players in the network and their care tasks.

Blockchain as key

Of course, all these predictions only occur when people release their personal data for medical analysis. Data protection of the future must therefore mean that the patient has sovereignty over his or her data. He determines how they are dealt with. They must be able to rely on the fact that their data is available at all times. At the same time, he must be protected against access by unauthorized third parties.

Blockchain technology plays a decisive role in this context. The best-known and oldest blockchain application is the digital currency Bitcoin. In the blockchain, information is not stored on a single server, but rather decentrally on different computers in a network. In order to falsify information, it is no longer sufficient to hack a single server, but every single computer in the blockchain. This makes the technology particularly secure. It is thus also suitable for the exchange of sensitive health or disease data in the future of healthcare.

Read in part two of the text how data-centric medicine leads to a new picture of disease and health. Digital communication is fundamentally changing the future of healthcare.

Beyond Verbal: The Voice Leads to Diagnosis

When the voice becomes an early warning system for serious diseases: A pointer to a technology that may not be entirely unique, but which is exceptional in any case. Yuval Mor developed it with his team at Beyond Verbal. This is where voice control takes on a whole new meaning in the healthcare of the future.

This is the approach: Beyond Verbal can show that specific severe diseases lead to characteristic patterns in the human voice. These include severe heart diseases, but also neurological diseases such as Alzheimer’s and Parkinson’s disease. These patterns cannot be identified by human ears. Beyond Verbal has developed an algorithm that can detect these subtle changes with amazing precision. The special thing: The algorithm is able to hear these changes before the heart fails, before Alzheimer’s can be diagnosed in the conventional way. Voice analysis therefore allows a much earlier intervention, permitting action instead of reaction. Which language someone speaks is, by the way, completely irrelevant for the analysis. The characteristic patterns occur in Mongolian as well as in Swiss German.

Yuval Mor was a speaker at the 2b AHEAD Future Congress 2018 with his topic and presented his project for discussion. The colleagues at 2b AHEAD have already put the video of his impulse online. It is available here.

Beyond Verbal - Yuval Mor

A matter of course, but always worth remembering: Beyond Verbal introduces one of the technologies into the healthcare of the future, which very concretely lead to a fundamental shift of knowledge. This is an effect that we are seeing again and again. It is particularly easy to show here: The algorithm generates knowledge that can lead to a considerable increase in well-being and well-being. The traditional players in the healthcare industry can only distinguish themselves by how well integrated and self-evidently they deal with this knowledge.

Please test it for yourself!

And to make it even more concrete: Beyond Verbal has made the app “Moodies” freely available in the app stores as a kind of by-product. It accesses the same algorithm and analyses the emotional state of the speaker within a few seconds. I now use this app regularly on keynotes, both to demonstrate the power of Artificial Intelligence, and as feedback of my own effect, simply to improve myself. I can only encourage you to try “Moodies” for yourself.

Digital diagnostics: Disruption does not start in harmlessness

Today, two tweets have rushing through my timeline. Both touch on the subject of digital diagnostics and they show an idiosyncratic, seemingly contradictory picture. Does digital diagnosis lead to better results – or a diagnosis by a human doctor? And from whom do we want to receive such a diagnosis?

Digital diagnosis as a life saver?

The Intelligent Health AI from Basel is bringing positive news, enthusiastic about the feasibility.

Digital diagnosis: AI can do

One could object: Where is the news? The fact that the diagnostic capability of halfway modern systems of artificial intelligence is superior to human expert knowledge should come as no surprise. This imbalance is well documented. Every oncologist, radiologist and probably almost every laboratory doctor will confirm this. Even if the ideas of the consequences probably differ considerably: The fact is indisputable.

Analog students at MIT?

Futurist Andrew McAfee paints a different but remarkable picture of his practice at the university:

Digital Diagnostics

Contrary to all reason, it seems that the next digital elite – nothing else is being trained here at MIT – is actually putting up with disadvantages. They opt for human diagnostics and not for digital diagnostics. He does not comment on the motives. Even if he did, this would hardly lead to a statistically reliable picture.

Three models of interpretation

Let us place the two impressions next to each other and interpret them together. Three patterns of interpretation seem plausible:

Interpretation 1: In case of doubt, technological fascination is always the solution for the others. Autonomous driving is as inspiring as it perfectly makes sense, if only one’s own steering wheel does remain. I call this the deficit model of technological disruption. The guiding principle is the fear of losing familiar solutions, services and features, despite all the technological fascination.

Interpretation 2: The time lag shows an apparent contradiction. This is the model of harmonization over time. Today, students reject what they will get used to over the coming years. At first glance, this is an obvious idea. At second glance deceptive: Those who allow themselves to be guided by this interpretation are in danger of covering up the disruptive character of innovation with harmony sauce.

Interpretation 3: In this juxtaposition we clearly see how one of the most important innovations in health care will take place. The model of the creation of meaning through innovation. A conventional diagnosis that does not involve life and death will – with good reason – be made and communicated by a human doctor in the foreseeable future. Even if an AI would actually be better, there is no real risk. However, when it comes to the threat of fatal diseases, AI offers a leap in quality; those who want to overcome this threat are less choosy when it comes to choosing the means. The main thing is: something works, even if it´s digital diagnostics.

Disruption does not begin with harmlessness

If this third approach prevails, we will see AI in use very soon. The triumph of digital diagnostics, however, will not begin in the harmless and risk-free, but – on the contrary – where it really counts: In the fight against life-threatening diseases. Ebola, malaria, rapid cancer will bring AI into the everyday life of healthcare before it also devotes itself to the fight against colds and lice infestation. Sometime later.

I tend, you will suspect, to the third interpretation. The most important innovation of healthcare of the future will begin with questions of life and death. But please, judge for yourself.

3D Printing of Organs: State of the Art and Prognosis (2)

The future technology 3D printing of organs. The first part focused on Dr. Anthony Atala and his work at the Wake Forest Institute for Regenerative Medicine in Winston-Salem, North Carolina. He will probably be the first to receive formal approval for 3D printed implants. Dr. Gabor Forgacs has a different focus. While Dr. Atala strives to replace organs 1:1 with printed implants, Dr. Forgacs sees greater potential in the field of pharmacology. He is interested in printing individual biomaterials on which doctors can test the effectiveness and mode of action of pharmaceuticals. A test on the individual body, but before prescribing the drugs to the individual patient. The advantages are obvious: risks are reduced, intolerances become apparent in advance, and dosages can be tested. As a result, patients can be treated more efficiently: cheaper, gentler, more effective.

With Organovo, Dr. Forgacs can claim to have founded the first commercial company in the field of 3D printing of organs. He was already a guest at the 2b AHEAD ThinkTank in 2012. With his focus on samples for toxicological tests, he also avoids most hurdles to approval. In addition, he expects an application of 3D printing, especially in the area of prostheses, which has long since become reality in many areas. Hearing aids have long been in use in the double-digit millions. However, the actual potential of Forgacs’ approach seems to lie in the area of pharmaceutical development anyway. Every day that technology can shorten the enormous development cycles of new drugs is enormously valuable in monetary terms alone.

3D printing of organs Gabor Forgacs

Use cases as drivers for 3D printing of organs

It’s worth taking a look at TeVido BioDevices, a company based in Austin, Texas. In contrast to Atala and Forgacs, founder Laura Bosworth does not start on the technology side, but from a relevant problem. In this case: the reconstruction of the breast after cancer. More precisely: The medically correct, but often visually unsatisfactory reconstruction. TeVido manufactures artificial nipples using 3D printing technology with natural optics thanks to natural substances.

3D printing of organs is therefore a safe candidate for a promising future: technology with experience and potential for scaling, decentralized know-how, relevant use cases.

3D Printing of Organs: State of the Art and Prognosis (1)

3D printing of organs is a regular guest on almost every list of technologies  influencing the healthcare of the future. At the same time, this technology seems almost old again, we have been talking about it for so long. Would we still call it a future technology? Without compromise, yes. 3D printing of organs has the potential to fundamentally change healthcare. The image of our body is changing. yesterday, medicine was working on restoring an original state given by God or nature, tomorrow the improvement and expansion of physical functionalities will become the central task. Here is a brief overview of the main players and their roadmap.

Probably the most important actor is Anthony Atala, surgeon, urologist and director of the Wake Forest Institute for Regenerative Medicine in Winston-Salem, North Carolina. During my most recent visit in spring 2018 I could not only hold a printed kidney in my hand, I could observe machines printing blood vessels, bones, livers, heart cells. His initiative to industrialize the processes for the production of any organs is even more promising. Only half of his total of 500 employees in the laboratory are physicians. At the same time, mechanical engineers, among other things, are working on reliably standardizing the processes in order to be able to offer them at many locations in this way.

The principle “3D printing of organs” is always the same and simple in logic: Whoever is able to grow organs from human stem cells can a) produce organs whenever he needs them and b) will prevent the organ from being rejected by the body. Risks are reduced and lifelong therapies are eliminated. The acute shortage of donor kidneys in particular is eliminated; the transport of transplants is no longer necessary. So far the consensus.

100% or more?

Among the researchers developing this technology, opinions differ at c): Will we also be able to improve the organs? Will my printed heart, my kidney, my liver be more efficient than the original one? And will my organs receive additional functions that were not yet provided for in the original configuration of my body? We see how the image of our body changes in the face of this possibility alone: The functional scope of the institutions, the coordination among each other – all this becomes a configuration. The body becomes a configurable machine. The only difference is whether the ideal is to restore the initial 100% as accurately as possible – or an individual and targeted deviation.

Dr Atala is the most important representative of those who rely on the 100% model. At the same time, he is the one whose laboratory is closest to formal approval by the FDA. His perspective: At the beginning of the 2020s, the first procedures for 3D printing of organs will be approved. First for rather simple structures, later step by step also more complex ones. Until the mid-2040s, it will be normal in many parts of the world to talk to your physician of trust about an exchange of almost any organ as a matter of course. In this way, he expects to be able to increase normal life expectancy to around 120 years.

3D Printing of Organs
Dr. Atala showing a printed kidney

Read about the work of 3D printing pioneer Gabor Forgacs in part 2.

Demographic change and healthcare: Good News

Demographic change and healthcare: The core business of health insurance in the future will no longer just be healing the sick. Health insurers will support healthy people – from the prevention of diseases to increasing well-being and life expectancy. This is the result of a current trend study by 2b AHEAD ThinkTank. Demographic change has a direct impact here.

Trend study health insurance

The healthcare sector will undergo unprecedented change by 2030. With digitalization, the possibilities of medical research, diagnostics, therapy, rehabilitation and prevention are growing at exponential speed. These effects are nowhere more evident than among the fastest-growing groups in our society:

  • The old who don’t feel old even when they retire,
  • the still older, who in many cases can still lead an active and active life, and
  • the very old, still rare today, soon an everyday occurrence.
The good news

The majority of today’s forecasts and future studies address demographic change as a problem and a threat. Of course, it will present us with social and economic challenges of an unprecedented scale. But for both individuals and our communities, demographic change represents the greatest conceivable progress: the considerable extension of one’s own life in activity and self-determination. Demographic change may be expensive news, but above all it is good news.

People born in this decade realistically reach an age of over 100 years. It is the interaction of four influential drivers that brings the dream of longer life within reach. The first condition is the freely available gene analysis. The second development concerns the breeding of individual copies of internal organs, which may be optimised compared to the previous version. The third prerequisite is a comprehensive understanding of the aging processes of humans. The fourth element is the synchronization of the human psyche with the virtual world. A breakthrough in research in all four fields is likely in the coming years.

For the sake of completeness: There is a well-founded opposite position to this, especially taken up here in the blog. It is represented among others by the medical ethicist Ezekiel J. Emanuel. He fears extension as a phase of helplessness and diminishing dignity.

The increase of well-being

A decisive change in dealing with human health is the disappearance of the binary assumption that a patient is either healthy or ill. This categorical distinction has always been a fiction anyway. Nobody’s just sick or just healthy. Instead – assuming the corresponding amount of data and its continuous collection – the individual well-being can be measured and located on a scale. This is changing the goal of medical action. While yesterday the focus was on repair and damage prevention, tomorrow it will be on gradually improving one’s own well-being. What can I do to feel a little better tomorrow – and who will support me? The enlightened healthcare customers of the future are very consciously and with the support of digital assistance systems selecting the most competent physician for their situation, the appropriate insurance and the trustworthy data manager from their individual healthcare network. At the same time, they will no longer accept that the interaction of several service providers is associated with increased effort for them.

In the near future, evidence-based, personalised recommendations for targeted prevention will replace the always identical bonus booklets of health insurance companies and lump-sum and overall undirected health-promoting measures.

Test Case Robotics in Nursing

This can be clearly seen in the emergence of robotics in care. Robotics became a widely accepted matter of course in the course of the 1920s. This has long been the case in the field of dementia care. The fact that a robot has the patience to listen to the same question, the same story, the same excitement over and over again as it did the first time makes this development even easier.

However, the development will not be limited to animated stuffed animals. This is shown in the example of medication. Where nursing staff still have to work by hand today, the procedure is time-consuming and prone to errors. The next step is automated dispensing of medication to the patient at home: individual implementation of the medication plan by a pill robot. In the next step, robots learn to analyse the state of health of humans. By blood sample, air analysis, nutrition tracking, later by observing the skin temperature, the movement patterns and by voice analysis. The dosage of the active ingredient is calculated in real time.

In the next expansion stage, the medication robot is able to print the individually appropriate active ingredients onto a carrier directly before ingestion. Is this a relief for the nursing service? With great certainty. Does this development, and thus indirectly the demographic change, have the potential to improve the well-being of the individual patient? With a very high probability. These are the simple questions. But whose knowledge is the robot`s work based on? As soon as he has access to networked medical knowledge, his professional competence will always be higher than that of the individual doctor. For the time being, the family doctor is still needed to issue prescriptions, which also makes up for a reason to exist professionally. His profession will change permanently, a thesis that Markus Bönig of Vitabook has just confirmed here. The medicines or active ingredients do not have to be purchased in the pharmacy around the corner anyway. This opens up completely new business areas for new players.

Smart Home

An additional driver of this development is the currently exponentially growing networking of buildings, starting with Ambient Assistant Living. The smart home of the person in need of care is the first and most competent care robot. This means that completely new players are suddenly active in the health industry: Network operators, property managers, building contractors, manufacturers of electronics and sensor technology. This, too, is an indirect consequence of demographic change.

Health insurers as the health promoters of the future must start much earlier in the process, which means that they will occupy a much more active and positive position in the perception of health customers. The one-size-fits-it-all-principle has had its day. In future, health promoters will not react only when health customers are ill, but will continuously monitor their current state of health and act before the onset of a foreseeable illness. This too: That’s good news.

 

Healthcare in old age: Why this man limits his medical care himself

We live longer and longer. So far so familiar. In any case, from a Western perspective, this is basically synonymous with: This is an enormous step forward in civilization. We are getting older – and we will be able to enjoy the gain in lifetime healthy and fit. Healthcare in old age ensures that we extend the phase of active life. It promises to limit and limit the time of helpless, suffering existence.

The counter thesis represents Ezekiel J. Emanuel, oncologist and medical ethicist at the University of Pennsylvania. He’s pointing: We’ll postpone the date of our death. The time, however, when we can no longer live fit and active, is moving forward. And drastically. His consequence: He plans to limit his life. 75 is a good age to be remembered positively by family and friends. To be precise, Emanuel is not planning suicide or euthanasia. But after his 75th birthday he will only accept palliative medicine, not curative medicine. No tests for prevention, no nutritional optimization, no exercises for mental fitness. Healthcare in old age exclusively for the well-being, not for the prolongation of life.

Ezekiel Emanuel Healthcare im AlterHe published his position and the underlying statistics in a detailed article in The Atlantic: Why I hope to die at 75. The editor Mareike Kürschner took up a conversation again and now, four years after the statement, asked again (Paywall). Meanwhile Emanuel is 61 years old – the self-chosen end is in sight. We’re in position.

The path to self-determination

Two thoughts stand out: Emanuel describes quite touchingly how the fact of the self-chosen end completely changes his perspective on the years before. How he feels activated to take care of the big questions of life. To attract important people from his environment, to learn, experience, experience… Obviously, the limitation of life expectancy leads to exactly the degree of self-determination and self-efficacy that healthcare providers often promise in vain in old age.

The second idea lies on a higher level: We afford to spend a considerable portion of the health care costs for the last 14 days of life alone. Against this background, the conscious renunciation of the attempt of healthcare in old age to find out a few more months of life is almost revolutionary. As understandable as this attempt may be in individual cases – from an overarching perspective it sometimes seems somewhat desperate.

I put this up for discussion: the better we understand how to prolong human life, the greater our responsibility grows to determine the point in time at which the bow closes with dignity. tbc.