George Poste, DVM, Ph.D., FRS, Professor of Health Innovation and Chief Scientist, Complex Adaptive Systems Initiative, Arizona State University
Healthcare is entering an era of conflicting opportunities and constraints. The pace of discovery in biomedical research is accelerating with the promise of unprecedented opportunities to improve health. The demographics of an aging society will dramatically increase the prevalence of high cost diseases such as cancer and neurodegeneration and reveal the growing imbalance between infinite demand for care versus finite resources and the economic unsustainability of the current $3 trillion healthcare ecosystem. The best opportunity to balance these conflicting forces lies in the evolution of precision medicine which seeks to understand how genetics, environment, lifestyle and behavior affect individual disease risk. These insights will shift care from the current wasteful, inefficient ‘one-size-fits-all’ approach to disease treatment and prevention to more proactive approaches in which care is increasingly customized to the risk profile of an individual. Making precision medicine a reality will depend on convergence of technologies for profiling disease at the molecular level with the use of sensors, mobile devices and social media to monitor health status in real-time both in and outside of healthcare facilities. Integration of these diverse technologies will redraw the boundaries of traditional medicine and engage new participants from the telecommunications, electronics, logistics, consumer services and social media sectors. These trends will generate data of unprecedented scale and complexity. Precision medicine and data-intensive medicine are inextricably linked. The healthcare ecosystem culturally is ill-prepared for this data deluge. Implementation will impose disruptive changes in clinical practice, the design of new organizational models for health services and an increased emphasis on data analytics, machine learning and computerized decision support tools in clinical decisions. Despite the appeal of these technology-centric trajectories, demonstration of their economic value in reducing the cost of care will be the critical determinant in the speed at which precision medicine becomes routine practice.