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 (eg, immuno and gene therapies) would gain traction. Read on... and pick up again in 2029 to see if we get it right.
A New Environment
The next decade will be all about reimagining patients in new ways and deeply understanding the segmentation of the future. Health care is about the only industry that everyone uses, no matter their age. We start and often end our lives in a health care setting. Our health is with us every day of our lives. We take it round with us and yet our access to it and how to optimize it is limited by a lack of accurate data, is obfuscated by wellness trends, and is often taken for granted or hidden away through misunderstanding or shame.
This confusion in the patient landscape is mirrored in the still-siloed organization and shareholder-centric mindset of big pharma. There may not be a scientific revolution in the next 10 years, but there will certainly be an evolution. Inspired by three main reasons, 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 seen in the last several decades has led to one of its biggest challenges. The ageing population means a greater incidence of cancers, cardiovascular conditions, and neurodegenerative diseases, placing a strain on health care budgets, and 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 over, the job becomes more difficult. But for that, even more rewarding.
And what of the fruit a little higher up the tree? As the human genome project (and the genetic health landscape generally) matures, diagnosis of known and new conditions will increase, offering up opportunities in rare diseases too. But, as artificial intelligence, pragmatic trial design, and technological innovation combine with globalized resources, rare diseases, when considered altogether, will not be rare.
Medical data is the final frontier of health care, a huge as yet untapped goldmine. So goes the rhetoric of at least the last five years. But health care has struggled to capitalize on the data and the digital environment. One reason is the entrenched view of R&D 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 will 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 and the lag is also partly down 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 towards 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 distributed and delocalized health care arena.
Precision gene-based medicine will be in renaissance. Due to screening at or even before birth, each newborn will have a full DNA profile and most genetic defects will be correctable. Peri-natal health and support services will need to be intensified, placing additional strain on resources until there is a rebalancing of priorities. Personalized health maps will track disease predispositions through life and help to combat non-genetic conditions. But this will come at a cost. Individual health insurance contributions will have to 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 that can afford it. Biochemical monitoring will be miniaturized.
Other potential abuses are non-medical genetic enhancements to hormone production for physical and mental gains. 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 OTC regulations open up on the trend of psychoactive micro-dosing for personalized mood and behavior optimization.
THE NEW INDUSTRY
In order to play successfully in this new environment, health care players need to think about both integration and expansion, according to three focus areas (Figure 2).
Pharmaceutical and biotech companies will need to be more outward looking. They will move increasingly towards a customer-facing model rather than its current industry-centric one. That means more household name CEOs like Elon Musk or Jeff Bezos and, of course, none like Martin Shkreli. Added exposure means added accountability, 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 trends will continue as big pharma invest 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 US, and China is critical. Some regulations will be tightened, some loosened in order to create a workable international model.
Running in parallel to these industry and market changes will be the continued evolution of the engaged patient. And this means offering product as a service. Over the last few years patient-centricity has come and gone, mHealth has stuttered, and the concept of value sits on shifting sands. The solution is simplification. Standalone drugs will be available easily 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 GP pop-ups sit next to office gyms.
Taking our cue from the opening 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.
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.
The working age population will be served by a more integrated and personalized approach that leverages digital infrastructure as much as new media does today.
Treating the elderly 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 also throw a few surprises our way. But without a crystal ball, these are impossible to predict. Perhaps we will see diabetes eradicated through gene therapies, or the neurodegenerative conditions that have so far eluded science’s best efforts will be preempted by vaccines.
Maybe we will all take a morning vitamin pill, especially designed with our own biochemistry in mind. And, of course, it includes a digital monitor that measures our gut flora and sends 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 treating, curing, and preventing ill health. And that will never change.
About David Carr, PhD
Dr Carr is a Senior Engagement Manager in the Global Pricing, Market Access & Analytics practice in Precision Xtract. He is a passionate advocate for strategic innovation in the market place and leads European Market Access in the Cell and Gene Therapy Centre of Excellence at Precision Xtract.