It's a long shot, but it just might work! Perspectives on the future of medicine

Abstract

What does the future of medicine hold? We asked six researchers to share their most ambitious and optimistic views of the future, grounded in the present but looking out a decade or more from now to consider what's possible. They paint a picture of a connected and data-driven world in which patient value, patient feedback, and patient empowerment shape a continually learning system that ensures each patient's experience contributes to the improved outcome of every patient like them, whether it be through clinical trials, data from consumer devices, hacking their medical devices, or defining value in thoughtful new ways.

Keywords: Machine learning; Medical informatics; Patient engagement; Patient reported outcomes; Smartphones.

Fig. 1

Paul Wicks is Vice President of Innovation at PatientsLikeMe, an online community for people living with medical conditions. Specializing in the conduct of clinical research using the Internet, Paul is responsible for shaping the scientific validity of the PatientsLikeMe platform and generating insights from personal health data shared by members. This sharing of online medical data has led to over 70 novel studies including a patient-led observational trial of lithium in ALS, digital tools to develop patient-reported outcome measures, a “dose-response” curve for the benefits of friendship between patients, and new methods for gaining patient input into clinical trial design. Prior to joining PatientsLikeMe, Paul worked at the Institute of Psychiatry (King’s College London) studying cognition and neuroimaging in rare forms of ALS, and the psychological consequences of Parkinson’s disease. In 2011, he was awarded MIT Technology Review’s TR35 “Humanitarian of the Year” award and was recognized as a TED Fellow in 2012

Fig. 2

Matthew Hotopf is Director of the South London and Maudsley NHS Foundation Trust National Institute of Health Research Biomedical Research Centre (BRC) and Professor of General Hospital Psychiatry at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London.He is also an NIHR Senior Investigator.. Matthew was trained in epidemiology at the London School of Hygiene and Tropical Medicine and in Psychiatry at the Maudsely. His main area of research is in the grey area between medicine and psychiatry, exploring the interaction between mental and physical health, and uses “big data” approaches to understand this interface better. He has worked extensively in areas where mental health relates to other walks of life, including occupational and military health, mental health law, and the wider community. Matthew also co-leads the Innovative Medicines Initiative RADAR-CNS (Remote Assessment of Disease And Relapse in CNS disorders) program, which seeks to use data streams from smartphones and wearables to assess and predict health states in people with epilepsy, multiple sclerosis and depression

Fig. 3

Vaibhav Narayan is Senior Director of the Neuroscience Therapeutic Area, at Janssen R&D, and Head of Neuroscience Integrated Solutions and Informatics at Janssen Neuroscience. The Neuroscience Therapeutic Area at Janssen is pioneering a more personalized and holistic approach to therapeutic intervention that goes “beyond the pill”, to offer data-driven and science-based “integrated solutions” for preventing, diagnosing, treating, and monitoring CNS diseases. Vaibhav’s work is currently focused on utilizing state-of-the-art informatics methods and digital technologies for developing markers for early diagnosis, disease progression, drug response and treatment monitoring in Alzheimer’s and mood, and to develop novel “point-of-need” tools and technologies for management of adherence and prediction of relapse in patients with Schizophrenia

Fig. 4

Ethan Basch, is a Professor of Medicine and Professor of Public Health at the University of North Carolina, where he directs the Cancer Outcomes Research Program. He is an oncologist and outcomes researcher whose work focuses on bringing the patient voice into clinical research and practice. Ethan’s research group has developed and evaluated multiple questionnaire and software systems for patients to report their own symptoms and side effects, including the PRO-CTCAE system for the National Cancer Institute, which is coming into use in cancer drug development trials. He currently leads two US national studies – developing patient-reported outcome quality metrics for use in oncology, and integrating PROs into routine cancer care

Fig. 5

Jim Weatherall is Head of the Advanced Analytics Centre (AAC) at AstraZeneca, a department of approximately 30 clinical and health data scientists across three countries covering the disciplines of advanced statistics, scientific computing, and biomedical and health informatics. A particle physicist by training, Jim spent time as an academic researcher, before becoming a scientific software engineer consulting across a range of different industries, including the life sciences. He has had affiliate staff status at the University of Manchester since 2012, most recently being appointed as honorary reader at the University’s Health eResearch Centre. Jim and his team have introduced a number of innovations into the clinical research field, in areas such as data and text mining, data visualization, health technology evaluation, and clinical trial design

Fig. 6

Sir Muir Gray is Consultant in Public Health at Oxford University Hospitals NHS Trust, and a Visiting Professor in Knowledge Management in the Nuffield Department of Surgery. He has been awarded both a CBE and a Knighthood for services to the NHS. Sir Gray entered the Public Health Service by joining the City of Oxford Health Department in 1972. The first phase of his professional career focused on disease prevention, and he also developed a local, then national programme of work to promote health in old age, at a time before the implications of population ageing had been recognised. Based on work in Oxford he developed a number of national initiatives, particularly designed to prevent hypothermia, publishing a Fabian Society report on the relationship between housing and poverty and the excess winter deaths, many from hypothermia, that took place in the UK. He was appointed to the board of the Anchor Housing Association and helped develop their Staying Put campaign. He has alsodeveloped all the screening programmes in the NHS, for pregnant women, children, adults and older people for example offering men aged 65 screening for abdominal aortic aneurysm and, for both men and women, screening for colorectal cancer. Working on the principle that the delivery of clean clear knowledge was analogous to the provision of clean clear water he saw the organisation and delivery of knowledge as a public health service, for example developing NHS Choices (www.nhs.uk), and setting up the Centre for Evidence Based Medicine in Oxford. During this period he was appointed as the Chief Knowledge Officer of the NHS. Sir Gray is now working with both NHS England and Public Health England to bring about a transformation of care with the aim of increasing value for both populations and individuals

Fig. 7

Personalization of medicine relating to a patient’s needs and values. Re-used with permission from Offox Press [51]

Fig. 8

Key activities that clinicians need to develop to increase value. Re-used with permission from Offox Press [51]

Fig. 9

Point of optimality is reached beyond which additional resources do not cause any additional increase in value, and the reverse takes place. Re-used with permission from Offox Press [51]

Fig. 10

As more resources are invested in the population, the types of patients offered treatment will change, with less severely affected patients being offered treatment. The less severely affected the patient is, the smaller the benefit they will perceive, but both the probability and magnitude of harm remain constant. Re-used with permission from Offox Press [51]