Rethinking healthcare in the age of AI & the rise of upstream medicine.
Challenges and opportunities during the transition.
Protecting health has always been of paramount importance to human beings, essential for our survival over millennia. Optimal health serves as the cornerstone for achieving personal goals, building relationships, and attaining self-fulfilment, making it a foundational component of the much-celebrated Maslow’s Hierarchy of Needs.
A brief evolutionary perspective on the changing face of medicine
Science is ever-evolving, as is healthcare. Now, we are embarking on a new era known as Medicine 3.0, also called Upstream Medicine.
The transformation will be driven by a profound systemic change, aimed at enabling a life lived to its fullest potential rather than mere survival. It will reshape how healthcare services are redesigned and consumed in the coming decade.
Before we delve deeper, let’s first explore the predecessors of Medicine 3.0, setting the stage for what lies ahead.
Medicine 1.0 refers to ancient medicine, where specialists primarily relied on observation to prescribe cures. This era predates the systematic use of the scientific method in medical practice. During this period, the life expectancy of humans was, on average, between 30 and 35 years, and people did not survive infections and injuries.
Medicine 2.0 represents modern medicine, characterised by the systematic use of the scientific method. However, it usually becomes relevant only after a disease has progressed, often in its later stages.
The dual nature of Medicine 2.0: progress and its price to modern living
This approach has enabled significant advancements in medical interventions such as surgeries and vaccines, particularly in addressing infections, and injuries, and in controlling the conditions that lead to sudden deterioration of one’s health and even leading to deaths in a short period. The success of Medicine 2.0 led to a significant increase in life expectancies, nearly doubling them.
The extended lifespan has brought about a new health challenge: the slower decline of health via non-communicable diseases (NCD) and claiming 75% of annual death tolls in 2019. Many are progressive and manifested over decades, affecting multiple organ systems of the human body often leading to chronic illnesses, various disabilities, and even premature death(30% of deaths globally). It must be this search that got humans to look upstream for solutions and also delve deeply into the very basic building blocks of our existence: into the study of genes.
Various environmental and lifestyle habits, along with other external factors, have triggered the rise of many non-communicable diseases (NCDs) over the past two decades. Cardiovascular diseases and cancer are among the top two causes of death globally, claiming around 28 million lives out of a total of 54 million deaths in 2019.
The search for solutions to these non-communicable diseases (NCDs) has found its roots upstream, where many diseases progress slowly over decades. Recent research has established the genetic origins of many of these diseases, shedding more light on their evolution across generations.
Genetic sequencing uses various data, to accurately identify cancer risks, leading to more targeted and cost-effective screenings, diagnoses and precision medicine for treatments. Genetic’s greatest advantage is early detection, which can result in less invasive and cheaper treatments.
If it is about the treatment, genetics helps in individual cases to enable precision treatment in its true sense that can reduce unnecessary trial and error procedures and medications, particularly in complex cancer cases, making treatments more effective and efficient.
Transitioning to Medicine 3.0: overcoming hurdles, seizing opportunities in India
With the weight of years of cultural beliefs, stigma and myths surrounding life-limiting diseases like cancers, and consumers’ insistence on bargaining for lower prices on everything except when facing imminent death, the transition from Medicine 2.0’s reactive approach to Medicine 3.0’s proactive health management will be a significant and drastic yet much-needed shift.
In the current landscape, Medicine 2.0 remains the dominant paradigm. While Medicine 2.0 is focused on extending ‘lifespan’ through disease treatment, the upcoming phase, Medicine 3.0 aims at enhancing the overall ‘healthspan’ as its primary goal.
This paradigm shift empowers individuals to take proactive measures in managing their health at an optimal level, emphasising lifestyle modifications and clinical interventions wherever needed. However, the goal remains the same: to address potential health issues upstream, tackling them long before they manifest, and ushering in a new era of preventive healthcare.
According to the Annual Health of Nation report by Apollo Hospitals, India, the country is quickly becoming known as the “cancer capital of the world.” The report highlights the increasing prevalence of non-communicable diseases (NCDs) in India, such as cancer, diabetes, hypertension, cardiovascular diseases, and mental health issues. These diseases have a significant impact on the nation’s overall health.
Preventive care has not yet reached its full potential in India for several reasons. By 2030, it is estimated that these diseases will result in India losing $3.55 trillion in economic output.
Firstly, this change involves more than just the adoption of new tools or technology; it requires a shift in mindset among the consumers as well. In nations like India, healthcare is often approached reactively, with an emphasis on optimizing expenses by paying only for services that one is certain to use.
Secondly, in markets like India, there is a tendency to offer a wide range of services with significant price disparities to appeal to the majority of the population. Under pressure, many service providers may cut corners in quality. Unlike tangible products and services, it is challenging for the average consumer to evaluate the quality of these tests. The pressure to provide affordability often compromises the accuracy of the services, raising questions about the efficiency of the tests. This, in turn, impacts the trust of doctors, who are seen as the proxies of quality, as it eventually impacts a doctor’s reputation.
Thirdly, many people are not yet prepared to acknowledge potential positive results, fearing that doing so would diminish their present piece of mind. The thought itself is stressful for many, as the concept of grief is often unappealing, leading individuals to try to avoid it.
It is not the disease itself that concerns people, but rather the suffering and the grief it inflicts upon individuals and their loved ones, including premature death, permanent disabilities, diminished quality of life, missed opportunities, and the overwhelming burden that extends far beyond mere financial costs.
However, with the convergence of AI and ML advancements, coupled with the growing influence of the creator economy, India will see a swift and seamless transition to Medicine 3.0 than other nations around the world. We have already witnessed significant adoption of fintech and ed-tech in India over the past few years.
Many non-communicable diseases progress over years, if not decades and deteriorate one’s health slowly. Predictive algorithms can analyse various data sources, including electronic health records, medical images, tissue samples, and genetic information, to provide doctors with valuable information for precise disease detection much better than a human can do. By leveraging these algorithms, individuals can proactively make lifestyle changes or initiate medication to effectively mitigate the risk or manage it better.
Just ignoring proactive steps in fear will not make them disappear is one strong message we need to communicate. Even better would be the economic upside of preventive care which goes unnoticed by many.
Transforming our family healthcare budget from a cost to an investment is truly a game-changer. Once we recognise the power of preventive care as a strategic investment, this shift in mindset can bring revolutionary results. It has the potential to save millions from misery and financial crises, and, more importantly, to help them be the best versions of themselves.
On the brighter side, as many of these diseases have a late onset, by the time one reaches that age of situation the world might already have a solution to it, if not already existing, especially with the emergence of gene editing, diseases once deemed incurable may become curable in a matter of years.
The challenge lies in preparing for defensive strategies against thousands of possible diseases when you don’t know which one will strike or when. Preventive care can at least prepare you for hundreds, if not thousands, of these possibilities, which is a significant advantage to start with, considering we only have one life to live.
Cheers,
Dhaneesh Jameson
Co-founder SugarStrings.ai
References
Global Burden of Disease Collaborative Network, Global Burden of Disease Study 2019 (GBD 2019) Results (2020, Institute for Health Metrics and Evaluation — IHME)
The annual Health of Nation report by Apollo Hospitals
A brief history of human disease genetics| www.ncbi.nlm.nih.gov (PMCID: PMC7405896)
Outlive — book by Peter Attia
