Healthcare futures

Leila Luheshi

20 March 2016

Biomedical science and digital technologies are going to transform our health in the 21st century. Surely this is beyond debate? The questions now, as I see it, are how can we make the most of our burgeoning biomedical knowledge and how will we determine which tools in our technological armoury are going to be the most effective for improving health.

I am particularly excited by the potential of biomedical science and digital technology to enhance the personalisation of healthcare. Why? Because empowering individuals to take control of managing their health, providing them with healthcare services that meet their individual needs and is cognisant of the aspects of their physiology and environment that make them unique, has to be a more effective way to improve health than treating them as indistinct parts of a homogeneous population group. 

There is a tendency to conflate personalisation of healthcare and genomic medicine. By understanding our genome and therefore the fundamental origins of what makes us unique, the reasoning goes, we can deduce the best means of managing our health as individuals, by tailoring treatments and personalising our approac h to disease prevention. But this is an overly simplistic approach to ‘personalisation’. There is an abundance of evidence, both from the scientific literature and our own experiences, which shows us that what makes us unique is about much more than our genome. Yes, our genomics sets some boundaries on what we can and cannot be, but the way in which our genome is ‘expressed’ in the person we become is heavily influenced by our environment and behaviour and also by intrinsic variation in the way our cells ‘interpret’ the instructions laid down in our genome, all of which change markedly over our lifetime. 

So if our genome sequence is not sufficient to provide the insights into our individual health that will empower us (and our clinicians) to improve our health, what will? This is the question we are seeking to answer through our healthcare futures project. We are scanning the horizon to catalogue the wide range of biomedical and digital technologies and novel therapeutics that are being presented as belonging to the future personalisation of healthcare. We are applying our multidisciplinary expertise to critically analyse the science underpinning these technologies, and to evaluate their implications for the future of healthcare from the perspective of individuals and society. 

Because empowering individuals to take control of managing their health, providing them with healthcare services that meet their individual needs and is cognisant of the aspects of their physiology and environment that make them unique, has to be a more effective way to improve health than treating them as indistinct parts of a homogeneous population group

Over the coming months we will be publishing on our website a series of blogs and accompanying infographics that summarise our analysis of many of the key biomedical and digital technologies that have the potential to deliver our vision of personalised healthcare in the 21st century. The first of these, one looking at the microbiome and the other on epigenomics, are now available. Importantly, although we are initially analysing each technology individually, we are clear that their implementation and utilisation (through centralised health policy or through consumer-led adoption) must occur synergistically and with some degree of coordination, as there is unlikely to be ‘one technology to rule them all’. 

Exciting as many of these technologies are, there is an important caveat – they are unlikely to have the desired impact on our health if we continue to consider them as individual products to be implemented into current systems of healthcare delivery. Our existing monolithic and centralised health systems are notoriously resistant to the disruptive power of new technology. They are simply not set up to deliver biomedical and technological innovation in an integrated and impactful way. 

A radical re-imagining of how we do health, as individuals and as a society, is essential to maximising the benefits, and the return on investment, of biomedical science and digital technology for the future personalisation of healthcare.

What this radically transformed, personalised approach to health will look like is very much up for debate. Our aim at the PHG Foundation is to lead and inspire this debate by offering insights into how to tackle the challenges and opportunities ahead, coupled with thought provoking visions of how we really can make science work for health.