As we say goodbye to the 2010s, we look at the prevailing trends and project forward to what we think are the key topics to consider in the coming decade—not an easy task. Looking back at commentary and predictions from 10 years ago, the main issues were the patent cliff and the move to specialty biologics. Some foresaw the rise of information technology impacting patient-consumer dynamics, but few envisaged the degree to which whole new areas of therapeutic development, such as immuno and gene therapies, would gain traction. Pick this article up again in 2029 to see if we got the projections right.
The next decade will be all about reimagining patients and deeply understanding the segmentation of the future. Health care is an industry that everyone uses, no matter their age. After all, we start and often end our lives in a health care setting. Our health is with us every day of our lives. Yet, our access to health care and how we optimize it is limited by a lack of accurate data, obfuscated by wellness trends, and often taken for granted with health issues hidden away through misunderstanding or shame.
This confusion in the patient landscape is sometimes mirrored in the still-siloed organizational structure of big pharma. There may not be a scientific revolution in the next 10 years, but there will certainly be an evolution. Propelled by three main drivers, the health care industry will need to adapt to succeed (Figure 1).
Like a snake eating its own tail, the improved health care we have experienced in the last several decades has led to one of its biggest challenges: the growing population of older adults. An aging population that is living longer means a greater incidence of cancers, cardiovascular conditions, and neurodegenerative diseases, placing a strain on health care budgets while reining in spending on other equally valuable disease areas.
Proportionally less people working means less taxes and insurance contributions and less money in the system. Health technology developers now play in a constrained environment and yet are expected to deliver on the fiercest of feats: curing the world’s ills. With the so-called low-hanging fruit picked and the blockbuster era evolving, the job becomes more difficult. But with that, it becomes even more rewarding.
What of the fruit that is a little higher up the tree? As the human genome project, along with the genetic health landscape in general, matures, diagnosis of known and new conditions will increase, offering up opportunities in rare diseases. Yet, as artificial intelligence, pragmatic trial design, and technological innovation combine with globalized resources, rare diseases—considered in total—will not be so rare.
Medical data is the final frontier of health care, a huge as-yet-untapped gold mine. So goes the rhetoric of at least the last 5 years. But health care has struggled to capitalize on the data and the digital environment. One reason is the entrenched view of R&D (research and development) as a clinical and medical endeavor, shunning technology outside its traditional domains. This is a legacy of previous successes, but, if it continues, health care players may find less and less of them.
On the biopharma side, it would be disingenuous to cite the call to arms as merely lip service. There is genuine motivation, with the lag at least partly attributable to the lack of digital infrastructure, to allow a total embrace of the vision. Some of the blame, therefore, rests on the playing field itself, which has not made any active change to bridge toward a more digital space. Parallel advances in the worlds of next-generation mobile data networks (5G and beyond), the internet of things, and big data analytics are required to create a truly new site of care—a truly distributed and delocalized health care arena.
Precision gene-based medicine will experience a blossoming. Due to screening at or even before birth, each newborn will have a full DNA profile; most genetic defects will be correctable. Perinatal health and support services will be intensified, placing additional strain on resources until there is a rebalancing of priorities. Personalized health maps will track disease predispositions throughout life and help to combat nongenetic conditions. All of this will come at a cost. Individual health insurance contributions will likely increase. Serious thought will therefore need to go into how to manage potential inequalities in access to the system.
This will be an even greater concern for medical technologies that enhance normal health. Lab-grown tissues and 3D printing will allow regular organ transplants, extending lifespans for those who can afford it. Biochemical monitoring will be miniaturized. Brain-machine interfaces will help the paralyzed move and the blind see, but we will not yet be uploading memories and downloading knowledge from the cloud. Neural enhancement will move to the lifestyle industry as over-the-counter regulations open up on the trend of psychoactive microdosing for personalized mood and behavior optimization. Potential abuses include nonmedical genetic enhancements to hormone production for physical and mental gains.
The New Industry
To play successfully in this new environment, health care players need to think about both integration and expansion in three focus areas (Figure 2).
Pharmaceutical and biotech companies will need to be more outward looking. As a result, they will move increasingly toward a customer-facing model and away from the current industry-centric model. That means, for better or worse, more household-name CEOs like Elon Musk or Jeff Bezos. Added exposure means added accountability and fewer of the misteps of the past, which can only be a good thing for the rest of us.
Collaboration will be critical to bring about a more integrated service-led business model. Existing functions within pharma will be supported by specialist account teams dedicated to stakeholder engagement. M&A (merger and acquisition) trends will continue as big pharma invests in more agile biotechnology companies.
Health care policies will need to evolve at a global level. Africa will be the next big player leveraging an increasingly educated and motivated labor force as well as favorable cost structures. We are already seeing the African continent as the test bed for drug delivery by drone, just for example. But to meet its potential, collaboration with and between Europe, the United States, and China is critical. Some regulations will be tightened, some loosened, in order to create a workable international model.
Whether drug pricing policy is reformed in the United States will dictate how manufacturers sequence their product launches. Combined with global migration trends that alter population genetics, patient-finding and simultaneous access will be a joint effort. This will be especially true in oncology, where prices may take the biggest hit and where increasing personalization means treatment by genotype, not by tumor site.
Running in parallel to these industry and market changes will be the continued evolution of the engaged patient. This means offering products as a service. Over the past few years, patient centricity has come and gone, mobile health technology has sputtered, and the concept of value sits on shifting sands. The solution is simplification. Stand alone drugs will be readily available over the virtual counter, and checking health-tracking wearables will be as automatic as waking up in the morning. Health care will merge with lifestyle as, untethered from brick-and-mortar clinics, private general practice pop-ups sit next to office gyms.
Scientific advances will continue apace. Supported by early access opportunities and the collection of real-world evidence in parallel with health technology assessment, these advances will hit the market sooner. Many innovations will move delivery away from the chronic primary care setting to acute interventions, often being curative. In the past decade, we have seen a cure for hepatitis C and more will follow.
The New Purpose
As mentioned at the beginning of this article, companies will need to double down on patient segmentation to fulfill the unmet needs across the population and provide the care and support throughout a patient’s lifetime. For example, in infants and children, the aforementioned genetic evolution will create a completely new care pathway that biopharma can and should support in a meaningful way. Also, the working age population will be better served by a more integrated and personalized approach that leverages digital infrastructure as much as new media does today. Finally, treating older adults will perhaps be the biggest challenge, and one that requires more collaboration with governments to change health and social care policies.
The new decade will likely also throw a few surprises our way. Perhaps we will see diabetes eradicated through gene therapies or neurodegenerative conditions that have so far eluded science’s best efforts preempted by vaccines. Maybe we will all take a morning vitamin pill, specially designed with our own biochemistry in mind. Of course, such a pill would include a digital monitor that measures our gut flora and then send a message at the first sign of a stomach ulcer or bowel cancer. Whatever happens, our common purpose is to make a difference to people’s lives by preventing, treating, and curing ill health, and that will never change.