We are in the midst an unprecedented revolution in healthcare – The Great Disruption – that is transforming medicine.
Each week seems to bring news of astonishing breakthroughs in the battle against obesity, cancer, Alzheimer’s and other diseases. Artificial intelligence is empowering the ability of doctors to diagnose conditions while ChatGPT and other technologies enable patients to access more detailed information about their bodies. At the same time that telemedicine is redefining the doctor visit, a wide-array of companies, from Google and Apple to Hims and Ro, are offering medical services and prescription drugs to millions of people.
Disruption has been a defining characteristic of medicine whose history is defined by advances in treatment and care. What is happening today is different, as broad forces reconfigure every aspect of care, everywhere, all at once. These developments are significantly improving patient outcomes. They also pose hazards, including health risks and increased financial costs. To maximize the promise and minimize the perils in the years ahead, we must start seeing the healthcare industry holistically, appreciating that its many moving parts – from basic research to how we deliver and pay for care – all form a single engine whose performance impact one another.
Advances in artificial intelligence and machine learning (AI/ML) suggest we are on the cusp of a golden age in treatment. The explosion of “omics” – genomics, proteomics, metabolomics, metagenomics, phenomics, and transcriptomics – is unlocking the mysteries of biological mechanisms at the most basic level. Advanced computers are allowing us to harness this knowledge to design effective new drugs and vaccines with lightning speed. In the near future, we will likely tame scourges many that have long plagued humanity, such as malaria, tuberculosis, and multiple sclerosis. However, the advances will be expensive, complicating our ability to deliver the treatments to those who need them.
Consider the effective obesity drugs that have recently come to market. This is very welcome progress in a nation in which more than 40% of adults and almost 20% of adolescents are overweight. But several of these drugs currently cost hundreds of dollars a month. Delivering this treatment to all who would benefit is not just a question of medicine but economics in a nation already spending about 18% of GDP on health care. As ever more “miracle cures” come online, we will have to have hard discussions – like those already taking place in many European countries - about how to balance efficacy and cost.
At the same time, the way we deliver care is undergoing profound change. Even within the traditional system of doctor’s offices and hospitals, the rise of online telemedicine galvanized by the pandemic is fundamentally altering the doctor-patient relationship. Growing numbers of physicians are using remote devices, such as blood pressure, glucose and heart rate monitors, to monitor health in real time. These and other developments are driving a shift in which increasing numbers of patients, even those recovering from acute diseases[JZ1] , might receive much of their care at home, instead of a hospital bed. While providing benefits to patients, this presents stiff challenges to the economic assumptions of hospital systems.
As we learned during the pandemic, turning our bathrooms into a test lab can have real benefits. But the onus will increasingly fall on patients to determine the quality of care they are receiving as more and more non-traditional caregivers enter health care.
For instance, the rapidly growing, multi-billion dollar market for self-testing kits—which assess, among other conditions, menopause, food sensitivity, and sexually transmitted diseases—is expected to grow significantly in the years ahead. Alas, many of the product providers are relatively if not completely unknown, and their products have not infrequently been plagued by inaccurate results, toxic chemicals, and confusion.
A host of well-financed companies, including Amazon, Google, and Apple have also made forays into health care in recent years.
Fundamentally, the growth in home test kits suggests and non-traditional providers signal a new era in which patients increasingly use the power of the internet to diagnose and treat their own symptoms. Such an approach is fraught with danger. Indeed, this is the irony of the moment. Many patients are seeking care elsewhere while trained caregivers are increasingly able to improve patient outcomes.
The Great Disruption is just beginning. Over the next decade, every aspect of medicine will be transformed by powerful forces of science, economics and business. To manage this change, every stakeholder – government, hospital systems, physicians, patients and retailers – must work together to ensure that we are able to meet the timeless challenge of medicine: delivering the right treatment to the right patients at the right time.
Marschall S. Runge, MD, PhD, is Executive Vice President for Medical Affairs and Dean of the Medical School for the University of Michigan. His new book is “The Great Healthcare Disruption: Big Tech, Bold Policy, and the Future of American Medicine.”
