The SARS-CoV-2 global pandemic has delivered to the forefront of public consciousness many of the inadequacies and shortcomings of 21st century healthcare writ large – faults which had previously slipped below the radar of the fortunate many, whose own personal or families’ good health had perhaps allowed these deficiencies to otherwise go unnoticed—that is, until now. However, with the attention of the entire world suddenly laser-focused on medical healthcare industries and public health organizations like never before, the opportunities for improving human health have also grabbed our collective attention like never before in our lifetimes.
Today – and in the few short years that will follow the eventual resolution of this coronavirus pandemic – is a real moment in history for meaningful action: to launch a new wave of needed health innovation. Opportunities abound to create health solutions and systems that will deliver better care, greater preparedness, and more equitable delivery of best-in-class life-saving services. As a community of innovators, the world’s entrepreneurs can arise to this occasion, and harness both new technologies, as well as older unheeded knowledge, and lay the foundations for improved health systems that can grow and flourish throughout this century and the millennium to follow.
Some pre-covid trends continue, newly accelerated:
Telemedicine is (finally) here!
Perhaps more apparent than any other single change (*at least, for those personally unaffected by Covid-19, and that have had no other need to visit a hospital in recent months) it is the sudden emergence of long-heralded telemedicine tools that have already changed healthcare experiences most drastically.
For many, especially for small medical issues, a trip to the primary care provider is simply not needed in many or most circumstances, even ones where there were previously no other options available except a visit to the doctor’s office. But for something routine, or that can be readily self-diagnosed, and particularly from individuals who are frequent suffers of a given acute condition – such as a clear case of strep throat, or a backyard brush with poison ivy – sometimes a phone call or video chat really is all that a patient truly needs: to get confirmation of their own self-diagnosis suspicions from their doctor and to receive a script for a common drug or treatment option, often for something that they have taken before to resolve the exact same issue.
Telemedicine can free up a doctors’ most valuable asset: time. The result can be greater access to medicine, and lowering barriers to entry by putting providers directly in front of more patients. Another benefit of telemedicine is likely to be realized via greater collaboration among providers – by lowering barriers for getting specialists into rooms that they can’t be in physically, like a specialist MD phoning into an ER to advise on a particular organ system damaged in a critical patient.
While telemedicine has been widely talked about for for over a decade, it was only the recent forcing function of a global pandemic that is finally bringing about the technology’s long-promised wider adoption among healthcare providers. So how else have the medical and health sectors been disrupted by the coronavirus?
Major Covid-19 Disruptions:
Health facilities and medical provider systems have a scaling problem. Healthcare systems are often designed, for financial reasons, to actually minimize excess capacity, because beds that sit vacant represent a sunk cost. The result amidst Covid-19 has been some providers becoming quickly overwhelmed, because facilities cannot adequately scale up their services (or their physical space) to meet a sharp increase in needed demand.
Paradoxically, the pandemic has hurt medical providers’ revenues. Because many people are afraid to visit healthcare facilities for routine services like checkups and elective surgeries (for fear of becoming infected by the coronavirus), not only are there negative consequences on patient health from this delayed care, but hospital and healthcare providers revenues have plummeted correspondingly. Ironically, even though hospitals may be jammed to capacity, they simply are not making money by providing emergency services for the worst-case COVID patients who have no where else to go.
Medical service provider revenues come from billing individuals and insurance companies for routine services and elective surgeries, which have largely ground to a halt in the US amid the pandemic. And provider costs have not reduced - if anything, they have increased. This balance sheet equation has lead to a tragic cost-cutting outcome in many places, where healthcare workers are actually being laid off, leading to the absurdly sick result of trained medical professionals sent home jobless, amidst the backdrop of a raging pandemic.
A refocus on preparedness and prevention is needed. The SARS-CoV-2 pandemic has illustrated that healthcare and public health sectors have generally underinvested in preparedness measures for emergencies globally - this includes things like equipment stockpiles of respirators and PPE.
But societies have also underinvested in the scientific intellectual pursuits inherent in preparing to combat emerging diseases. Going forward, one likely silver lining is that public health measures will take a more proactive approach in preparing for existential risks like the emergence of new zoonotic diseases. That is an important step, but there is much more that medicine and health communities can do to improve human prospects in the future.
Health Industry Opportunities & Market Predictions
How can humanity combat a new disease, never before seen in humans? Or predict when a new zoonotic disease will make the jump from an animal host species into a human population? Now cast in a newly urgent light, this conundrum presents an enormous opportunity for technology to make all the difference: to prevent the next pandemic before it can emerge into a human population. The ‘how’ for accomplishing this predictive feat will likely come from the combination of big data analyses and wide genetics sampling from the environment, a crossover of tech and biological sciences that falls under the umbrella often referred to as ‘genomics.’ The potential is to create “platforms” for rapid detection of new diseases, as well as for the development of vaccines and treatments to combat them.
Personalized Medicine will deliver on its promises.
As the price of sequencing DNA continues to fall, the opportunities to apply the learnings of genetics science to the health of individual people continues to grow. The rate of decrease in cost is truly astounding, exceeding even the rate of the much-touted Moore’s Law, known widely amongst startup technophiles.
Source: Genome.gov
Today, personal DNA sequencing is already commonplace for ‘partial genome’ reads – this is the sequencing of short, known snippets of genetic material – tiny parts of the human genome known to correlate with specific outcomes or traits. The way consumers interact with this ‘partial genome’ data today lies largely outside the context of typical healthcare services – these are kits that usually contain tubes which users fill with their saliva, and mail off to have their DNA sequenced by the provider. The results sent back to the users elucidate something about their personal genome - most commonly today, about their ancestry. You likely know the big brand-names in this space: 23andMe, Ancestry.com, among others.
Partial genome kits are for more than just discovering gaps in family ancestry though. More recently, companies have begun to offer services that sequence individuals’ microbiomes - that is, not their ‘own’ DNA exactly, but the DNA of the personal bacterial makeup on their skin, the flora/fauna of their own gastrointestinal tract, or of the birth canal. These microbiome bacterial colony makeups have very real impacts on the health of individual human 'hosts'. And soon, partial genome kits will be able to glean information about more complex personalized traits, like the nuances of one’s own metabolic pathways. As the genetic sciences verge into the broader lifestyle spaces like diet and wellness, the industry standards for which are today less rigorous than consumers would hope, the results will improve human health.
Generally speaking, DNA kits performed at home today still leave much to be desired, and privacy is still a big concern. Consumers often misconstrue the results of such tests as very definitive (when really they are only probabilistic), or falsely believe they are receiving a complete genome sequencing instead of a partial snippet reading of their DNA. But still, the future here is bright, and full of possibilities as the science of genetics continues to advance.
In fact, having a complete genome sequence - knowing one’s own entire genetic code - is quickly also becoming an affordable reality, and will truly unlock the promises of personalized medicine. So assume you have your own personal genome entirely sequenced, a data set that contains all 3 billion of your own base pairs - but now what? How can that data help you to live healthier than before?
The answer is that access to your own fully-sequenced genome gives you and your medical providers much deeper insights than any partial sequence could ever provide from just a small sampling of DNA snippets. As patients begin to sequence their full genomes, analytics companies will compete to help them to understand and interpret that genetic information on an ongoing basis, and tailor recommendations for their own specific needs and lifestyles. Genomics services will apply machine learning methodologies to monitor vast academic publication outputs, to follow the latest emerging research and continually update their services’ recommendations, all in order to provide latest and best information to their users.
While the advancement in the interpretation of genetics will continue at ever-accelerating breakneck pace, your own personal genome will remain the constant for your lifetime. In other words, once you have your DNA entirely sequenced, it won’t ever change - but you will be able to continually learn new things about your DNA, as genomics industries continue to publish the newest findings unlocked by cutting edge scientific research. Certain medications or treatments will be recommended to specific patients over other alternatives, in light of the knowledge of the patient’s underlying genetic dispositions and likelihood react predictively to certain treatment options. For patients, the results of personalized medicine through genome sequencing will be medical recommendations that are far more specific to their own needs and use cases, and the outcomes for individuals will be overall improvement in care and better patient results.
New Vaccine ‘Platforms’
In light of the global toll in the destruction of human life, as well as the pandemic's enormous global economic reverberations, new precedent will push for technology that can stop this damage from occurring in the future. Platforms will be built with the purpose of developing rapid responses to future biological threats, whether natural or man-made, and will be valued as a considerably higher priority than in the pre-Covid era.
Examples include the new RNA and DNA vaccine types, which are among those being tested in clinical trials now to combat Covid-19. Moderna is a prominent US company pushing forward with an RNA-based vaccine, a vaccination technology that has been applied successfully in animals before but never previously in humans. But the fact is that these gene-based approaches to vaccination offer far more specificity, as well as ability to develop vaccines rapidly, versus the traditional, slow vaccination development methods of the 20th century.
The promise of these technologies is truly great for the future of humanity - make no mistake, vaccines will be more important than ever in a globalized world that can transmit disease amongst disparate human populations more rapidly than ever, and a human society constantly encroaching upon the natural world, where zoonotic diseases are likelier than ever to make the initial jump into human populations. Anti-vaccination sentiment has no place in a society guided and informed by science and evidence. While the current situation is atypical, with tens of promising vaccine candidates around the world in development via countess laboratory groups focusing their efforts on the coronavirus, even when things readjust to a new post-Covid normal, the promises of these new vaccine technologies will remain important. Consider the fact that the fastest vaccine ever developed prior to COVID, the mumps vaccine, took four years - in the 21st century’s globalized world, we cannot (and will not) wait that long to prevent humankind of falling victim to future emerging diseases.
Gene Therapeutics
CRISPR-Cas9 and its derivative gene-editing technologies have exploded in recent years into very exciting and rapidly developing new arenas of science in our understanding of genetics and the development of new medicines and treatments. While germline gene editing should rightfully remain taboo for ethical reasons, somatic cell gene therapies are now becoming reality, and have none of the same thorny ethical implications.
Transplanting edited cells, created from one’s own cells that are removed and grown outside body, and then put back into the patient, will change the treatment of many human diseases that have a genetic component. Eventually, even tissues and entire organs will be edited through somatic gene therapies, growth and then transplanted directly back into perfectly matching recipient patients, from whose own cells the edited tissues were derived.
"Dr. Robot will see you now."
Whether you realize it or not, robotically-assisted surgery is already here. DaVinci Surgical Robots are a market leader, but are still new enough that no unified (or particularly rigorous) standards yet exist for surgeons in the training or use of robotics surgical tools.
Your mind may jump to scenes from Elysium - but it’s not just Matt Damon being stitched back together in futuristic robot medical pods. Robotic surgical devices will also become micro in their scale, functioning more internally and invisibly than depicted on the Hollywood big-screen.
Endiatx is a Silicon Valley portfolio company creating this reality today, having recently completed its first in-human trial. Endiatx’s medical ‘PillBot’ robotic device is one that patients will swallow, instead of opting for a more intrusive endoscopic procedure, like a colonoscopy (the startup’s initial target market).
Wearables data will provide real medical value.
Consumer wearables touting health or wellness benefits have been around for a while already - brands like Fitbit and Apple Watch are now commonplace. But also fertility tracking, sleep tracking, and biomarker monitoring devices are becoming increasingly commonplace. With a caveat of privacy concerns that pervade many of these advancing heath technologies, these wearable devices will collect value data that will benefit consumer-patients.
The data gathered from consumer wearables can provide insights not only for users, but maybe even more valuable information for the companies that collect it in aggregate, or provide it to researchers - hopefully in the form of anonymizing meta data that protects consumer privacy.
And on the provider side, wearables in augmented reality are already changing the medical industry too. Mircosoft’s HoloLens, a personal heads-up AR device, has moved away from consumer markets, in favor of B2B plays that include pushes into medicine, where doctors can use the mouseless/keyboardless display and UI to bring up relevant information directly while interacting with their patients.
All in all, these examples offer only a small and high-level sampling of how HeathTech stands to revolutionize patient care and epidemic preparedness in the years to come. The entrepreneurial opportunities abound seemingly endlessly for knowledgeable scientists and medical technologists to advance these and many other prominent ideas, by bringing them into the market, for the benefit of all humankind.
While Covid-19 has been devastating and tragic, the hope that such a ‘before and after’ moment in human history can spur forward the promises of HealthTech is not an unlikelyoutcome - and as a global community of entrepreneurs, the time to seize the moment of HealthTech is now.
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