In this report, we don’t shy away from making specific predictions on just how the dominoes fall. To make those forecasts, we picked the 26 most powerful forces in the world that will shape medicine. Eleven of these forces are new medical technologies. Seven of the forces are computing technologies, and eight are global sociodemographic forces. Our panel of futurists and consulted experts each ranked the 26 forces on a scale of 1 to 10. The average across all futurists resulted in a force strength score.
Using the same methodology, we ranked all the stakeholders in healthcare on a motility scale. A higher motility score meant that stakeholder was more likely to break away, or switch. Stakeholders who have demonstrated previous switching behavior, for instance, would likely switch again. For example, in the last decade we’ve seen physicians take buyouts en masse to be employed by hospital networks, and we’ve seen a major migration to self-funding among large employers.
Factoring force by motility led to a model that identified where change would happen first. As those first movers began to break away, or adapt, the inertia of the whole system was destabilized, step by step. Over time, yet other pieces broke away. By this method, we arrived at market predictions over time, and we forecast adoption curves for the new technologies over 25 years. That calculus roots our stories, sector by sector.
Healthcare will not just be altered by the proliferation of new medical technologies coming up from research labs. Change will also be driven by exponential growth in computing technologies, as well as long-term sociodemographic trends.
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MOORE’S LAW
Reports of a slowing in Moore’s Law are inaccurate. Graphical processing units, used for artificial intelligence, have kept it on track.
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SENSORS
Not only is the cost of sensors going down 15% per year, but their quality and sensitivity is simultaneously going up at the same rate. Ultra-low-field sensors that ping the network less frequently reduce the cost 10x.
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DIGITAL MANUFACTURING
Already, we can print 3-D devices and stents that are a precise fit for any patient. Bioprinting tissues, even organs, will be necessary for every hospital.
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MIXED REALITY
Imagine hospice pods where the dying are virtually transported to sunny beaches. Imagine replacing medical charts with visualizations of a patient’s different systems.
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SMARTPHONE CANOPY
By 2020, 7 billion people will be connected to the internet. 5G wireless will increase data transfer speed by 100x over 4G. Phone plug-ins turn a phone into a medical device that can read scans, connect to sensors, process lab tests and offer telemedicine.
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BLOCKCHAIN
The future of security is splintering data into infinite fragments stored all over the world. Each fragment is meaningless on its own. The index is kept in unhackable blockchains.
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QUANTUM COMPUTING
Massively more powerful than classical computers, quantum computers will let us create tomorrow’s drugs in a fraction of the current R&D cycle—and easily break the military-grade cryptography protecting today’s medical records.
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INTERNATIONAL MIDDLE-CLASS EXPLOSION
Just in the last seven years, half a billion people in China have become able to afford first-world diets. The first world’s medical conditions will follow—an avalanche of diabetes and vascular diseases.
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OPEN FORCE MOVEMENT
Consumer activism that demands full transparency of every product’s origins, in banking and healthcare, will lead to consumer control of their own data. In drug development, connected consumers will put pressure on pharma like never before.
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BIRTH RATE & AGING OF POPULATION
Worldwide infant mortality has been cut in half since the new century began. Subsequently, birth rates fell—and continue to fall.
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URBANIZATION & GLOBALIZATION
The density and mobility of people mean much greater risk for epidemics and the spread of disease. Global health brands will emerge; health deliveries that are confined to national borders will be long-term losers to organizations that can operate as global corporations.
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ONLINE EDUCATION
Today, people Google their symptoms. Soon, patients will be able to take an entire class on their condition, taught by a doctor. Patients will be as informed as medical professionals. We will retrain doctors and train nurses online, too.
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JOB DISPLACEMENT FROM AUTOMATION
Over the next few decades, large segments of the population are likely to become unemployed due to automation, significantly changing our economic structure and presenting new lifestyle diseases.
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WEALTH GAP
Historically, health was the great equalizer. Even the wealthy got diseases, in some cases at higher rates. In 1977, if you were lucky enough to live to 65 in the US, you were (on average) going to live to 80 years old, rich or poor. No longer is that true—wealth extends life by 6 years.
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RELIGIOUS BELIEFS
The US is the most religious of all industrialized countries; it’s also the epicenter of medical research. Religious beliefs slow the adoption of assisted reproductive technology (ART), and will repel the adoption of epigenetic editing, though it was in stem cell research that religious beliefs hit the brakes the hardest. The outlier here is end-of-life care; surprisingly, the more religious patients are, the more likely their families are to choose very expensive end-of-life procedures. Hospice care is the preferred option for less religious and nonreligious people.
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IMMUNOTHERAPY
Cancer cells avoid detection by our immune systems by camouflaging themselves. Immunotherapy unmasks the cancer cells so that our body can naturally attack them.
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OPTOGENETICS
Literally shining a light into the brain, to alter the neural oscillation of brainwaves or take control of neuronal firing. This will be used on Alzheimer’s, where it upregulates microglia cells that clean up plaques. It also will be used to take control of pain, and in mental health applications.
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BIOELECTRONIC MEDICINE
Implanting microchips that stimulate the nervous system with current, whether to bypass failed motor neurons or to trigger the natural drugs the body needs to heal itself.
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NANOMEDICINE
Bottom-up assembly of machines that can perform actions at the cellular level. For instance, delivering chemotherapy payloads directly into cancer cells (and only to cancer cells).
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ARTIFICIAL INTELLIGENCE
Computational learning of hidden patterns over vast datasets of genetic libraries, patient records and medical images. AI is already being used to find biomarkers, diagnose diseases and monitor patients’ vital signs to send them alerts before symptoms appear.
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ROBOTICS
Miniaturization of robotic instruments will aid in highly complicated or repetitive surgeries, while replacing humans in data-driven procedures like radiology and anesthesiology. Robots will not lead to massive layoffs, but we will need fewer people in healthcare over time, as is the case in almost every industry. At hospitals, robots can clean rooms, transport patients, pick up laundry and deliver medicine.
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CRISPR
A gene editing tool that’s cheap ($75), precise and fast becoming universal, CRISPR adopts the mechanism that bacteria use to recognize and attack viruses. It can be used on any organism, any species, plant or animal.
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EPIGENETIC ENHANCEMENT
Gene-expression editing doesn’t change the underlying genetic code, and doesn’t introduce code from other organisms. Rather, it just tweaks how a gene gets expressed. Because of this difference, epigenetics is likely to be the vector by which gene editing for enhancement reasons (not medical necessity) becomes socially acceptable.
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STEM CELL REACTIVATION
Rather than injecting new stem cells, these methods hack the signaling that causes our existing stem cells to slow down with age. The effect is to wake up our aged stem cells to function like young stem cells, repairing and regenerating the body.
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TRIAL-IN-A-DISH
You can grow your own brain in a dish. You can grow 100 of them, in fact, and test out medicines to see which works best. Individual drugs can be tried against a patient’s own neurons or heart muscle cells to look for efficacy before prescribing. This could drastically reduce side effects and the guessing game that doctors must play when prescribing chemotherapy and antipsychotics.
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PAIN BLOCKERS
One in five adults lives with chronic pain. Pain signals travel along nerves’ Nav 1.7 sodium channel. No less than nine channel blockers are in development, with three already in clinical trials. The potential to decrease pain more radically, without the side effects of opioids, could rescue a huge portion of the population from debilitation.