This book is about the existential threats facing healthcare, and the factors that will shape the future of medicine. It predicts that healthcare ‘over the next 10-20 years…is headed for its own meltdown‘ (page 1). Rising healthcare spending is the major indicator of this looming catastrophe, the author saying costs are ‘…rising faster than our ability to raise taxes or insurance premiums’ (page 3). The author supports his arguments with worrying statistics of health spending progressively outstripping the gross domestic products of most countries. He however reviews the technological advances, and practical measures, that could avert this impending disaster.
He book examined the various causes of the rising cost of health care. At the core is the impact of an ageing population, and the rise in the costly diseases that accompany old age, such as cancer and Alzheimer’s disease (pages 36-39). He pointed out the growing impact of infectious diseases, making reference to the three horsemen of the pandemic apocalypse– HIV, tuberculosis and malaria (page 47). He discussed the cost-implications of the rising prevalence of obesity, and the diseases of lifestyle choices such as smoking. He also touched on the contribution of wasteful healthcare practices such as cancer screening, inappropriate testing, over-treatment, and the exorbitant cost of drug development (page 43, 65-66).
The author explored how technology will change future medical practice, listing the ‘eight frontiers‘ of scientific progress that will provide ‘a new deeper understanding of how our biology is wired together’ (page 7). He says this improved knowledge of systems biology will lead to ‘more precise medicines that interact with the body’s biological networks in more sophisticated and predictable ways’ (page 10). He focused particularly on developments in genetics, with illustrative examples such as gene expression chips, gene silencing using small interfering RNA molecules (siRNAs), and DNA vaccines for diseases such as multiple sclerosis. He discussed many other promising advances including the impact of pluripotent stem cells on regenerative medicine, and medical imaging progress that will use magnetic nanoparticles to track the spread of cancer (page 17-19).
How will these advances directly affect patient care? As technology facilitates the establishment of personalised medicine, the author expects a huge shift in how patients are managed in future. The changes he predicts include the use of smart devices to manage patients remotely (pages 30-31); electronic medical records to improve the quality and safety of care (page 26); and decision support systems to enhance the skills of physicians (page 27). The author explores the potential impact of genomics on precision medicine, showing how this is already facilitating better targeting of treatment. He gave the examples of how HLA-B5701 profiles are now predicting the risk of side effects from flucloxacillin and abacavir (page 23), and how the Her-2-neu marker predicts response to breast cancer treatment with herceptin (page 24). The author skilfully illustrated how all this might play out in future with the running saga of a fictional Carter family living in 2030.
At the practical level, the author makes several recommendations to reduce future healthcare costs, and to improve patient experience. He lists 10 healthcare levers which will make ‘the vital difference between balance and bankruptcy’ (page 3). These levers include integrated patient care, the rigorous analysis of outcomes, and cost-effective end-of-life care (pages 4 and 82). He says his agenda for practical action will ‘proactively tackle demand growth, make new technology more affordable, and turn the patient into a consumer’ (page 52). Most importantly, it will bring care closer to patients (page 4).
Many of the author’s recommendations are radical and far-reaching. He suggests, for example, that we jettison the randomised controlled trial (RCT) as the basis of assessing drug efficacy, giving excellent reasons for this. He advocates, in place of this, seven approaches to simplify the drug development process (pages 61-62). He also suggests a reform of the litigious atmosphere that drives healthcare costs, calling for an exemption from liability for doctors who avoid unnecessary tests and procedures when following best practice pathways (page 93). His wide ranging recommendations also cover the responsibility of governments and employers, reform of medical education, and remodelling of health insurance structures (pages 96-100).
The author has masterfully extrapolated the future of medicine, showing how technological advances will impact healthcare. He paints a clear picture of the financial pressures on healthcare, and offers practical measures to avert the crisis these will inevitable trigger. He recommends a gradual process of improving healthcare, in contrast to the disruptive approach advocated by Clayton Christensen in The Innovators Prescription. The book is well-written and the arguments well-made. There were minor mistakes such as spelling Huntington’s as Huntingdon’s (page 22), and shortening motor neurone disease to MN instead of MND (page 63). The content is otherwise well-researched, and it reflects the author’s long involvement in different aspects of health care.
This deceptively small book makes a significant contribution to health care planning, and the author’s recommendations are well-thought out. The book addresses a subject that is key to doctors who are involved in all stages of healthcare planning and practice, and I highly recommend it.
- Publisher, Place, Year: Oxford University Press, Oxford, 2011
- Number of Chapters: 5
- Number of Pages: 127
- ISBN: 978-0-19-960066-3
- Price: £18.99
- Star rating: 4 stars