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THE FUTURE OF HEALTHCARE:

PREVENTATIVE, PERSONALISED

AND PRECISE

THE FUTURE OF HEALTHCAREPREVENTATIVE, PERSONALISED AND PRECISE

© The Economist Intelligence Unit Limited 20181

Executive summary 2

Key takeways 2

What can be measured 2

Getting personal and precise 3

Customising health 3

About the research 4

Introduction 6

Necessity and access induce progress 6

Going from disruptive to mainstream 6

Chapter 1. Measuring your health 8

Converting health into data 8

Starting with genes 8

Tracking activity 9

Mobile monitoring 10

Measuring health status 11

Translating data into better health 12

Chapter 2. Delivering more personalised medicine 15

Precision medicine and genetics 15

3D printing 16

Immunotherapy 16

Chapter 3. Mainstreaming new technologies 18

Standing in the way of progress 18

Combining the old and the new 19

Seeing into the horizon 21

Contents



Habits of the wealthy and globally mobile can often provide examples of how cutting-edge healthcare technologies integrate into people’s lives, and may serve as the preliminary stage of

widespread future adoption. To explore this phenomenon, The Economist Intelligence Unit recently surveyed 480 high-net-worth individuals (HNWIs) across the fast-growing regions of Asia, the Middle East and Africa to study how their current healthcare habits might lead to breakthroughs for society as a whole.

The data tell of a healthcare future that is increasingly preventative, personalised and precise. It is also one that may be far less focussed on treatment and more on tailoring lifestyle interventions to manage one’s personal health risk and avoid diseases.

Many of today’s innovations are moving in lock-step to enable this change. Mobile apps, genetic testing and advanced screenings are just some of the new technologies producing biometric data on an unprecedented scale. Big data analytics and artificial intelligence (AI) are leveraging large collections of information to provide more powerful insights that help physicians and patients better target health goals and measure progress. Advancements in precision medicine, immunology and 3D printing are also allowing for more personalised intervention when diseases do arise.

However, when new healthcare technologies go from niche use to broader application, they can find their efficacy and potential challenged by legacy systems, ethical debates and practicality barriers.

What will impede future technologies and propel others, and why? Which of today’s technologies have the greatest potential for impact in the near and far term, how are they being adopted, and how will they ultimately work their way into everyday healthcare?

These are the questions explored in The future of healthcare: preventative, personalised and precise, the third part of a research series on Better Life Breakthroughs, sponsored by Standard Chartered Private Bank.

Key takeawaysWhat can be measuredl HNWIs report using technology to self-manage their health through the inputting, tracking

and monitoring of their personal data. Other main uses include monitoring and managing food intake and diet and encouraging users to exercise.

l Based on the habits of today’s wealthy, wearable technology is shifting from an affluent niche to mainstream adoption. Nearly all respondents said they use wearables to help care for their health, with 62% doing so to track their exercise and movement and 47% to track their daily sleep habits.

Executive summary



l As wearables become a lifestyle necessity and self-monitoring the norm, big data will be more ubiquitous, with the aim of driving more disease prevention through better management of one’s personal health risks. However, this future appears far off for most. When asked if the greater collection of personal data improves their ability to care for their health, only 39% strongly agree, while 43% somewhat agree and the remainder are either neutral (13%) or disagree (5%).

l The key to unlocking the potential in big data lies in building ecosystems that layer a number of technologies together, including AI capabilities and data analytics. Eighty-three per cent of respondents see better data analytics as impactful on the personalisation of preventative healthcare and medical treatments.

l However, there are significant ecosystem gaps to be filled. Despite communities being an important influence on health and lifestyle decisions, using technology to connect with them ranks in the bottom three uses of technology to self-manage one’s health. This is below using technology to stay engaged with health research and news and just above using it to connect with the Internet of Things (IoT).

Getting personal and precisel New treatments are leveraging today’s technologies to drive solutions that are more personal

and precise. Ninety per cent expect that precision medicine will improve the personalisation of preventative healthcare and medical treatments. Seventy-eight per cent expect the same from gene therapies, 85% from immunotherapies, and 72% from 3D printing for medical use.

l There are many barriers to mainstreaming these technologies, ranging from ethical objections, to costs, access, talent and resources. Respondents see a lack of training for medical staff (30%) and gaps in healthcare infrastructure (29%) as the most immediate challenges to tackle for new technologies to be mainstreamed. Public awareness (26%) and technology costs (25%) are also seen as significant barriers.

Customising healthl HNWIs combine a variety of traditional, alternative and conventional healthcare practices in

caring for themselves. Almost half report using homeopathic medicine for the treatment of minor illnesses. Thirty-five per cent use Ayurvedic medicine and 28% use Chinese traditional medicine for the same purpose. In comparison, use of conventional medicine is significantly higher than other forms when it comes to the treatment of chronic diseases and acute illnesses; over 40% use it in these instances, compared with only 25% using homeopathic remedies.

l HNWIs travel to seek treatment, with many being quite mobile in caring for their health. Almost three in ten (28%) frequently or always travel outside their country of residence for treatment, while 19% do a few times and 11% plan to do so. The remainder (41%) stay in their home country.

l HNWIs individually tailor their healthcare investment interests. Respondents, on average, invest in at least three different technologies at one time. When asked to indicate their investments across 14 technologies, the top three include wearable technology for patients (29%), mobile apps (29%) and AI technologies for healthcare (26%).



To see into the future of healthcare, The EIU surveyed 480 HNWIs with investable assets (excluding personal assets and property such as primary residence, collectibles and consumer durables)

of US$5m to over US$30m in Asia, the Middle East and Africa. All respondents indicate they use conventional medicine (pharmaceuticals, diagnosis and treatment from medical doctors, radiation, surgery, etc).

A series of global experts have also contributed to the report. Thanks are due to the following people for their contributions to the research programme.

l Abed Al Llah Husseini, director, 3D Middle East, Dubai

l Anuradha Acharya, CEO, Mapmygenome, India

l Bruce Liang, CEO, Integrated Health Information Systems and chief information officer, Ministry of Health, Singapore

l Dr Benjamin Seet, executive director, Biomedical Research Council, A*STAR, Singapore

l Dr Daniel Carlin, founder and CEO, WorldClinic, US

l Josef Woodman, CEO, Patients Beyond Borders, US

l Dr Khalid Fakhro, director, human genetics, Sidra Medicine, Qatar

About the research

US$5m to <US$10mUS$10m to <US$20mUS$20m to <US$30m

>=US$30m

Note: Due to rounding, totals may not equal 100%.Source: The Economist Intelligence Unit

Survey demographics(% respondents)

52

30

12

6

18-30 years old31-40 years old41-50 years old51-60 years old

16

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9Men

Women

79

21

Full-time employeesCompany owners

InvestorsFreelancers

77

12

92



l Nicola Mulder, head, computational biology division, department of integrative biomedical sciences, University of Cape Town, South Africa

l Pratik Saraogi, founder and CEO, ActoFit Wearables, India

This report was written and edited by Rashmi Dalai, managing editor for The Economist Intelligence Unit, with editorial support from HuiQi Yow.



Necessity and access induce progress

In November 1998 Russian solo-sailor Victor Yazykov was more than a month into an around-the-world race and around 1,000 miles outside of Cape Town when he found himself with a dangerous

abscess in his right elbow.

He was too far from land to seek medical attention, and had just a small kit of emergency supplies. His only hope was a new technology—untested in situations like these—email.

“My right elbow does not look good,” he wrote. “Some yellow spot in the middle of red and it feels dead. Waiting for your help.” He hit send. The next morning, he updated his message. “All skin is glossy and shiny white. It is like a pillow with some liquid inside.”

On the other side of the world, Daniel Carlin, an infectious disease specialist at the time and physician-on-call for the race, used the same cutting-edge tool—an email—to help. He sent back a message outlining steps for the sailor to operate on himself.

On his boat, Mr Yazykov made a one-inch incision and inserted a drain to remove the pus. “I was covered in blood,” he told reporters later. “I thought I was going to die.”

But he didn’t—far from it. Mr Yazkyov came fifth out of nine racers to Cape Town,1,2 and Dr Carlin used the experience to found WorldClinic, one of the world’s first telemedicine companies.

Going from disruptive to mainstreamIn many ways, WorldClinic’s origin story is archetypal of how medical technologies go from experimental to mainstream. Someone connects a new technology to a traditional healthcare problem and pioneers its use among those who need, and can afford, a new solution. Thus, innovations are often led by the wealthy.

Because well-resourced and globally mobile populations are often first-adopters of innovations, their habits can point towards the future of today’s cutting-edge technologies and exemplify how new solutions can be integrated into people’s lives.

To see into the future of healthcare through this group’s eyes, The EIU recently surveyed 480 HNWIs across the fast-growing regions of Asia, the Middle East and Africa.

The data tell of a future of healthcare that is increasingly preventative, personalised and precise. It focussed less on treating diseases and more on tailoring lifestyle interventions to avoid them.

Introduction

1 “Lone sailor uses e-mail instructions to operate on himself”, CNN, November 19th 1998, http://edition.cnn.com/WORLD/africa/9811/19/email.operation/index.html

2 “DIY surgery on the seven seas”, BBC News, November 18th 1998, http://news.bbc.co.uk/2/hi/health/216769.stm



This makes sense, Dr Carlin says, because “the affluent are generally experts at managing risk. They do it everyday in their portfolios. They identify and focus on a handful of key metrics, track them closely over time, and respond quickly to trends.”

He sees this approach expanding to other population segments in the future. As lifespans and incomes grow around the world, mass public health issues will worsen and require new approaches. A change in mindset—one already adopted by the wealthy—will need to become mainstream for everyone.



Converting health into dataIn 2013 American novelist Dave Eggers published his dystopian book, The Circle, in which a company gives its employees wearables for their wrists and trackers to swallow. The two devices work together to precisely monitor every biorhythm. The data generated serves two purposes: giving the company a body of information to study health and disease patterns, and nudging individuals to change behaviour.

“In this universe all human ills are banished, a reassuring thought until it becomes clear that this is possible only through constant and self-inflicted surveillance,” wrote The Economist in its review at the time of publication.

Fast forward to today, a time in which wearables are becoming the norm and 76% of today’s healthcare organisations are planning to invest heavily in big data and analytics.3 The future that Mr Eggers paints seems imminently possible.

“Over the next decade, we’re going to have much more deterministic information,” says Khalid Fakhro, director of human genetics at Sidra Medicine in Qatar. He describes a world in which doctors will have access to much greater amounts of information about the factors that might affect one’s body in the near or long-term future. For example, a computer will be able to predict what infections a person is at risk of getting based on his or her travels.

This surge in data is being facilitated by the many new ways available to capture one’s health information. Although not an exhaustive list, this includes four key areas: genetic testing, wearables, mobile apps and advanced screenings.

Starting with genesAt conception, every human being contains physical predispositions towards physical strengths, patterns and weaknesses. These instructions, encoded in DNA, direct the body’s growth, performance and, in some cases, death.

For centuries, genetic data has long remained elusive due to the high cost of mapping one’s genome. However, all of that has changed with the recent decline in genetic chip prices; the cost of sequencing a genome has fallen dramatically, from nearly $9m in July 2007 to just over $1,000 in July 2017.4

As a result, bioinformatics researchers like Nicola Mulder, head of the computational biology division in the department of integrative biomedical sciences at the University of Cape Town in South Africa, can solve pieces of the genetic puzzle that couldn’t have been seen otherwise.

Ms Mulder’s current bioinformatics research network has 28 nodes in 16 African countries. “What we’re trying to do is increase the information on background reference population from which you can compare disease in populations, and increase the number of disease cohorts that can be studied,”

Chapter 1. Measuring your health

3 “Healthcare Organizations Expect Significant Impact from Digital Transformation in Next Two Years”, SAP News, October 16th 2017, https://news.sap.com/2017/10/sap-study-healthcare-organizations-expect-significant-impact-from-digital-transformation-in-next-two-years/

4 “DNA Sequencing Costs: Data”, National Human Genome Research Institute, updated April 25th 2018, https://www.genome.gov/27541954/dna-sequencing-costs-data/



she says. “You might find different causal variance or background information for a specific set of the population that might not yet be recognised because many of the current genetic associations are based on Eurasian populations.”

The consumer market for genetic data, expected to grow to 4.6bn by 2025, according to a February 2017 report by Grand View Research,5 is also fuelling genetic data growth. Companies like 23andMe and Mapmygenome are providing consumers with their genetic information for recreational use, ancestry mapping and guiding lifestyle changes. Mapmygenome also does genetic counselling and genetic diagnosis for guiding treatment or confirming a diagnosis. This allows users to both learn more about their genome and feed the underlying analytical tools, creating a self-improving cycle, says Anuradha Acharya, CEO of Mapmygenome.

Tracking activityAnother important source of health data comes from wearables. These are devices worn on the outside of the body to track body parameters that can be measured from the skin, such as heart rate, blood pressure, activity levels and sleep.

Judging by the habits of the survey respondents, wearables are so widely accepted that they appear poised to eventually become a lifestyle norm. The vast majority of survey respondents—93%—already report using them, with 68% doing so for multiple purposes. Adoption is also healthy across all age groups, with both old and young consumers incorporating them into their daily lives.

The wearables market is growing more sophisticated each year as measurement tools improve and

5 Sapna Agarwal, “The growth of genetic testing and personalized medicine”, Livemint, April 17th 2018, https://www.livemint.com/Opinion/ 7MoeRjUEQrx1M51MQKLgzJ/ The-growth-of-genetic-testing-and-personalized-medicine.html Source: The Economist Intelligence Unit

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Figure I. What gets measuredWhich of the following wearables do you adopt for your health? Choose all that apply (excludes 7% of those who don’t wear wearables). (% respondents)

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Wearables to track mydaily exercise and

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Wearables associatedwith recovery from or

management of a diseasesuch as a stroke, diabetes,

or cancer

Wearables associatedwith management of

pain or recoveryfrom an injury

Between 18-30 years oldBetween 31-40 years old

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evolve. For example, ActoFit Wearables is adding precision to the activity tracker market by analysing both the quantity and the quality of one’s exercise. When lifting weights, it seeks to understand not just the fact that you’re active but also the velocity and strenuousness of your exercises. The corresponding software can be used to set personalised circuit sessions and drive better outcomes.

“Many fitness trackers are just counting the number of steps that users take and identifying how active an individual is or not. This is not for people who are already active or already working out because you can’t really measure your fitness based on the number of steps you take,” says Pratik Saraogi, founder and CEO of ActoFit Wearables.

Similar levels of data precision are working their way into patient wearables for health and disease management. As more and more data can be read from one’s skin—such as from sweat—these devices can go beyond monitoring for heart attacks or physical injury to checking dehydration and glucose levels.

As wearables become more precise, they are also becoming more mainstream. This is being helped by insurers, governments and other healthcare system stakeholders that are promoting wearables usage among consumers in hopes of leveraging this data to encourage healthier lifestyles and manage chronic diseases. Falling prices are also helping; in Singapore, participants of the National Health Promotion Board’s National Steps Challenge have received a free wearable from the government.6

Taken together, these trends have helped drive total wearable device shipments around the globe in 2017 to 115.4m units, up by 10% from 2016.7 While this growth rate is actually a slowdown from 27% growth the year before, this is because many smaller players have either closed or been acquired over the years by larger wearables companies like Fitbit. In addition, smartwatches like Apple Watch are now bundling a series of wearable functions together, including those provided by Actofit.

“Increasingly, technologies are expected to be more modular,” says Mr Saraogi, “and connect over a single hardware. They have to come together into a singular form factor to become a holistic solution to consumers who want everything.”

Mobile monitoringIn the mobile app space, there is a wider range for creativity in the types of data one can collect and that could impact one’s health. For example, a mindfulness app can be used to help track mental health habits while a travel app can be used to track environmental exposures.

However, many mobile apps require manual input, which introduces risks of inaccuracies into the data. For example, apps that track people’s diets rely on the precision of each person’s records, but calorie counting can include a lot of guess work. Daily data entry can also become onerous, leading many users to eventually abandon the effort.

Moreover, most apps do not talk to one another, meaning the potential for interesting data cross-correlations is not being realised. According to research firm IQVIA, out of the more than 300,000 mobile health applications available to download, the vast majority (85%) have been downloaded by

6 https://www.healthhub.sg/programmes/37/nsc

7 “Global Wearables Market Grows 7.7% in 4Q17 and 10.3% in 2017 as Apple Seizes the Leader Position, Says IDC”, IDC, March 1st 2018, https://www.idc.com/ getdoc.jsp?containerId=pr US43598218

8 https://www.iqvia.com/institute/reports/the-growing-value-of-digital-health



fewer than 5,000 people. Those that have become popular, with 10m downloads, are concentrated on helping patients with diabetes and tracking behavioural health (fitness and wellness).8 Apps that build links, such as those on health-tracking device Fitbit, which links exercise activity with diet data entered on MyFitnessPal, have an advantage over their competitors.

Measuring health statusAdvanced medical screenings can offer deeper and more precise measurements of one’s current health status. These complement regular check-ups by expanding the scope of imaging and tests done for the purposes of early detection and prevention. Screenings can also include health and lifestyle counselling that is meant to interpret data collected from genetics, medical history and daily habits.

That the survey respondents rank advanced screenings as the most impactful for improving the personalisation of preventative healthcare and treatments—above big data, data analytics and AI—speaks to the larger need for more tools that cross-reference and analyse health data.

“The whole future is how you correlate or collect that data onto a single platform so your doctors and professionals can analyse it,” says Mr Saraogi. Without this connected ecosystem, it is hard for data to be used for goal-setting, accountability and change.

Source: The Economist Intelligence Unit

Figure II. Bringing data to lifeHow impactful do you feel the following technologies will be in terms of improving personalisation of preventative healthcare and medical treatments?(% respondents)

Very impactful Somewhat impactful Don’t knowNot impactful

Advanced screenings

Big data and data analytics

Artificial intelligence

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Bruce Liang, CEO of Singapore’s national HealthTech agency, the Integrated Health Information Systems (IHiS), adds that beyond data that is presently available through clinical systems, genotypic, lifestyle and socio-economic data will collectively enable greater personalisation for preventive healthcare and treatments.



The role of consumer technologies cannot be underestimated, especially as countries embark on population health initiatives, he says. “When you shift gears to do population health at scale, the only hope you have is technology that can allow you to nudge at the personalised level of one,” says Mr. Liang. Consumer technologies range from mobile apps to wearables and social media platforms such as WeChat, WhatsApp and Facebook, which individuals interact more often with than clinical systems.

The IoT ecosystem is also becoming more important to healthcare. In Singapore, the government is building smart houses that use IoT to connect patients to sensors throughout their living space. These sensors report data back to caretakers to watch for needs and notable changes.

Many of the survey respondents are self-creating similar ecosystems but not universally, suggesting there is a long way to go before a healthcare ecosystem of reliable and robust connections exists. Only 22% indicate they connect to communities and 20% to sensors in their homes.

Translating data into better healthAccording to the survey respondents, a future in which data give us more control is not yet in the grasp of the wealthy. When asked if monitoring their health gives them a feeling of more control, 44% strongly agree, but the remainder somewhat agree to disagree suggesting a level of uncertainty.

Furthermore, the survey results show that confidence in data is directly correlated to levels of wealth. Of the majority of those with the lowest-value investable assets in the survey—US$5m to US$10m—only 30% strongly agree that greater collection of personal data will improve their ability to care for their health, compared with 76% of the wealthiest.

Strongly agreeSomewhat agree

Neither agree nor disagreeSomewhat disagree

Strongly disagree


Figure IV. The power of knowledgeDoes monitoring your health give you a greater feeling of control over it?(% respondents)

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Figure III. Connecting the dotsHow do you leverage technology to self-manage your healthcare? Select two (excludes 2% answering “I don’t know” and “I don’t use technology to self-manage my healthcare”).(% respondents)

To input, track and monitor my personal health data

To encourage me to exercise

To monitor and manage my food intake and diet

To remind me to have regular health check-ups

To stay engaged with health research and news

To participate in communities, online or o�ine, thatsupport my health

To use connected home sensors to monitor my health

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This may be because the wealthiest group can afford to set aside ample resources for their health, including consultations and technology tools that help analyse and leverage their data. Of those with US$30m and above in investable assets, 41% strongly agree that they consciously set aside money for future medical emergencies and 52% strongly agree they have access to the resources (technology and financial) to maintain their health as they would like. These responses are well above those on the other side of the wealth spectrum—those with US$5m to US$10m in investable assets—of whom 26% strongly agree they consciously set aside money, and 39% strongly agree they have access to the resources.

For needed integrations to advance into the mainstream, many practical issues must be adequately addressed. “The technologies to generate data about an individual’s DNA and biomarkers of health and disease are already available today. What remains to be done is to make sense of this data and to use it reliably to predict diseases or treatment outcomes,” says Benjamin Seet, executive director of the Biomedical Research Council at Singapore’s A*STAR.

To make sense of genetic data, says Dr Fakhro, physicians need to rethink the way they care for patients’ health. “How do you integrate people’s genetic information with their clinical information? A patient may have a variant that predisposes him to a disease in 20 years. How do I alert the patient to this and take care of it today?”

Answering these questions is made all the more difficult by the fact that genetic data cannot yet reliably be altered. Although a cutting-edge form of technology known as CRISPR holds the promise of allowing scientists to edit genes after they’ve been inherited, it is not yet at a point where it can be relied on to change DNA inheritances. It’s difficult to ensure one delivers the right dose to the right place, says Dr Fakhro. “There’s definitely a big wall that’s standing between genetic editing and some diseases.”

As a result, if someone is identified as having a rare genetic disease, such as Creuztfeldt-Jakob Disease, which is guaranteed to present itself in the course of one’s life and cannot be cured or avoided, this knowledge can be difficult to personally process. In some places, there can also be a stigma associated with having known genetic disorders, something people may fear unearthing through genetic testing.

Source: The Economist Intelligence Unit Note: Due to rounding, totals may not equal 100.

Figure V. Confidence with wealthDoes greater collection of your personal data improve your ability to care for your health?(% respondents, by wealth)

Strongly agree Somewhat agree Neither agree nor disagree Somewhat disagree Strongly disagree

$30M or more

$20M to less than $30M

$10M to less than $20M

3243

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1076

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$5M to less than $10M 30 53 13 4



There are also many large knowledge gaps in tracking and understanding of data and their utility. For example, many fitness trackers use a plain vanilla approach for every user, in most cases a standard man’s data to drive assumptions. This may create blind spots in analysing the data for other groups, like women. “A lot of people are different than each other and something that works for you doesn’t necessarily work for someone else,” says Mr Saraogi. “We need to have different programmes for each individual. To do this, we need to track people better. There are a lot more classifications than what exists and there needs to be proper analysis done to before converting that data into an actionable insight.”



Precision medicine and genetics“The next changes [ in healthcare] will come with the introduction of genomic sequencing into routine clinical practice. This forms the current basis for precision medicine, where a patient’s biological information at the molecular level informs clinical decision-making, for example, the choice of treatment,” says Dr Seet.

Ultimately, the aim behind building future data ecosystems is to achieve two key purposes: help people better prevent and identify diseases early, and drive more precise and effective medical treatment. The latter goal can be translated into precision medicine—creating treatment pathways for patients that take into account a wide variety of individual factors.

The survey respondents reflect similar expectations on the future of personalised healthcare. They expect, in equal measure, advances to increase the speed and accuracy of disease diagnosis and improve treatment outcomes, ahead of all other benefits, including prevention.

Chapter 2. Delivering more personalised medicine


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One already established way of using genetic information is through preimplantation diagnosis (PGD), a way to increase the speed and accuracy of disease diagnosis by identifying it at conception. In this reproductive method, a known genetic defect is identified, a couple uses in vitro fertilisation to produce embryos, and those embryos are screened using PGD to identify which have inherited the disease. Only the non-affected embryos will be implanted in the mother. In this way, diseases can slowly be eliminated from a population.

Gene therapies, or treatments that insert new genetic information into a patient’s cells to fight a disease, are also growing. Experts are currently experimenting with gene therapies as a means to treat a wide range of diseases, including adrenoleukodystrophy (ALD), sickle-cell disease and others. The science is still new on the commercial market, but healthcare companies in this space are slowly gaining ground. In late 2017 the US Food and Drug Administration gave its first approval to a directly administered gene therapy that targets a specific genetic mutation; it was for a drug called Luxturna, designed to treat patients with an inherited form of vision loss that may cause blindness.

3D printingAdvances in 3D printing are driving personalisation in medicine from a different angle, by helping customise dental models, medical implants, hearing aids and other devices.

Until recently, says Abed Al Llah Husseini, director at 3D Middle East in Dubai, 3D printers were used largely to facilitate healthcare processes. This includes helping personalise the shell of a hearing aid and, in dentistry, to fit a mould to the shape of the jaw in order to produce the aligners.

That is now changing. “Recently, something happened in dentistry, just announced this year in Chicago; the approval of medical material to be printed in a 3D printer,” he says. “Now, with materials in a 3D printer, you can print a temporary crown and use it for a patient for 72 hours, or you can print an aligner.”

He sees this opening up an array of new possibilities, particularly as the cost of 3D scanners and printers are dropping. In another example focussing on patients with implants, “usually the doctor will go inside the theatre with different lengths, diameters and shapes of the implants. Now with an MRI, he can use a scan to produce the exact implant. This is better for the patient because it’s made for him. There are no trials. The doctor knows this will fit exactly.”

ImmunotherapyImmunotherapy is another therapy that aims to leverage each person’s individual defences to fight disease. One type of treatment involves drugs called checkpoint inhibitors. These are used to counter a mechanism used by diseases like cancer, which turns off the immune system, and spur T-cells back into action. The other uses gene therapies in combination with immunotherapy to also spark the immune system back into action.

This is the future, says Dr Seet. “There will be an increasing ability to harness and enhance the body’s immune system to combat chronic disease and cancer. The current focus of immunology research is



immunotherapy for cancer, as well as the identification and clinical validation of immune biomarkers to aid diagnosis, prognosis and treatment.”

When asked for their predictions, our survey respondents rank immunotherapy as the second most impactful therapy on the personalisation of preventative healthcare and medical treatments, just after precision medicine.

Source: The Economist Intelligence Unit Note: Due to rounding, totals may not equal 100.

Figure VII. Measuring impactHow impactful do you feel the following technologies will be in terms of improving the personalisation of preventative healthcare and medical treatments?(% respondents)

Very impactful Somewhat impactful Not impactful Don’t know

Precision medicine

Immunotherapy

Gene therapies

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Standing in the way of progressHistory is littered with legends of scientific advances that took root at inexplicable speeds. For example, the importance of handwashing has been recognised as an important hygiene practice since the mid-1850s and yet, according to the World Health Organisation, up to 37% of people admitted in intensive care units become infected due to a lack of washing hands.

Compared with this simple practice, today’s technologies face even greater barriers to mass adoption. Notwithstanding the early state of readiness for some—such as gene therapies and immunotherapies—implementing today’s new technologies involve high costs, new and more robust training, and a reimagining of how medicine could be practiced.

“The challenges will be for doctors to catch up with the exponential growth in technology and information, for healthcare systems to evolve to benefit from this, and for healthcare reimbursement systems to be able to support cost-effective and sustainable implementation,” says Dr Seet.

Ethical questions around new technologies can also prove to be significant barriers, “One of the issues around doing precision medicine,” says Dr Fakhro, “is the ethical side. You have such a high burden of diseases. Should you focus on a few people who you could treat really well or spend that money to treat more people not quite as well.”

For example, in the past five years European regulators approved two gene therapies but only three patients have been commercially treated with them, in part because of extremely high costs. One treatment, Glybera, which is used for a rare blood disorder, costs about US$1m per patient and has been taken off the market due to a lack of demand.

Ethics also extend to data sharing and patient privacy. Questions around how much data and how widely it should be shared for the sake of patient health, and how to prevent abuse, are hotly debated across medical systems. One company, Nebula Genomics, is trying to creatively break down that barrier by allowing patients to monetise their data—something novel for an industry that still largely assumes that sharing personal data for the greater good should be incentive enough. The company also uses blockchain solutions to protect data, a viable model for future data ecosystems.9

Finally, training and resourcing issues cannot be ignored. New technologies require healthcare practitioners to change and incorporate new tools into their daily habits. As seen in the case of handwashing, behaviour can often be the factor that is the last to change.

Chapter 3. Mainstreaming new technologies

9 Emily Mullin, “This new company wants to sequence your genome and let you share it on a blockchain”, MIT Technology Review, February 7th 2018, https://www.technologyreview.com/s/610221/this-new-company-wants-to-sequence-your-genome-and-let-you-share-it-on-a-blockchain/




Figure VIII. Standing in the wayWhat are the most significant barriers to the greater adoption of a personal data-driven approach to healthcare? Select two. (% respondents)

Lack of physicians and other trained professionals tosupport personalised healthcare strategies

Gaps in my country’s healthcare infrastructure

Faulty analytics/diagnosis

Public awareness

Cost (eg lack of a�ordability)

Data privacy

Fear of creating undue worry (eg with genetic or otherpersonal information)

Unequal access to new technologies(eg availability of access)

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Figure IX. Something old, something newAt what stages in healthcare do you use the following forms of treatments?(% respondents)

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6 68 9

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5

Preventativecare

Treatment ofminor illnesses

(colds, flu, minorinfections)

Treatment of morechronic diseases(diabetes, heart,

disease, dementia)

Treatment ofacute illnesses

Surgery I don’t use thistype of medicine

Homeopathic/natural remediesAyurvedic medicineChinese traditional medicine Other forms of alternative healing (eg crystals, salt baths)

Conventional medicine (eg antibiotics, outpatient andinpatient care)

Combining the old and the newNew healthcare technologies circulate in tandem with other more traditional solutions and opinions about healthcare. When asked about their own mix of personal healthcare practices, the majority of survey respondents indicated they seek a range of therapies from both conventional and non-conventional sources.



In addition, notable variation exists across age groups, particularly with regard to the use of conventional medicine. Older people (41 years and above) tend to use conventional medicine more for treatment of chronic diseases, acute illnesses and surgery than younger people. Much of this can be attributable to differences in health challenges faced at different ages. However, it also suggests a high level of receptivity to conventional medicine in older HNWIs. This is a group that can also lead experimentation in new treatments.

Survey respondents also seek a mix of in-country and out-of-country specialists to care for their health; 28% either always travel or frequently travel outside their home country for medical care and about a third do so infrequently or plan to.

Those who travel the most are the most optimistic about connective technologies such as telemedicine. Of those who said they always travel outside their country, 51% expect telemedicine to be “very impactful” in terms of improving preventative healthcare’s personalisation and medical treatments, compared with only 25% for those who never travel out of their home base.

According to Josef Woodman, CEO of Patients Beyond Borders, this could be because those who do not travel may be limited by cultural or language barriers. “After all, it’s not convenient to travel for care. You must be able to

understand what your doctor is saying to you or your companion.”

AlwaysFrequently

A few timesI plan to do so

Never

Note: Due to rounding, totals may not equal 100.Source: The Economist Intelligence Unit

Figure XI. Leaving home

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Do you ever travel to a country other than your main residence for medical treatment because the quality of care in your home country is inadequate? Select one.


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Figure X. Being conventionalPlease indicate in what stages of healthcare you use conventional medicine (eg antibiotics, outpatient and inpatient care). Select all that apply.(% respondents, by age group)

34

28

19 18

39

48

3431 31 33

5356

39 39

55

41

18

32

46

31

Preventative care Treatment of minorillnesses (colds, flu,minor infections)

Treatment of morechronic diseases(diabetes, heart,

disease, dementia)

Treatment ofacute illnesses

Surgery

18-30 years 31-40 years 41-50 years 51-60 years



Seeing into the horizonGiven the challenges ahead, where does the future healthcare horizon lie?

On a personal level, the survey respondents are quite confident about the future of their health, with a significant proportion expecting to live well past the average life expectancies in their respective regions.

Survey respondents also seem to expect that this good health will come from a variety of digital technologies—wearables, mobile apps, AI and big data and analytics—and new diagnostics and treatments—precision medicine, advanced screenings, gene therapies, immunotherapies, 3D printing and others.


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Figure XII. Great expectationsHow long do you expect to live in good health?(% respondents, by region)

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23

63

35

15

Asia Africa Middle East

% who expect to live past 60 % who expect to live past 70 % who expect to live past 80



This is also reflected in investment patterns. When asked whether they invested in any company, stock or stock market tracker in a range of healthcare technologies, the top responses are wearables for patients (medically approved devices for disease management) and mobile apps for top investments, followed closely by AI technology for healthcare, and data storage and analytics.

On the whole, the survey data suggests that a collection of better life breakthroughs will transform healthcare together. Dr Fakhro adds that greater patient awareness, driven by social media, will also help new technologies become more effective and integrated over time.

“You’re going to see more user-driven research projects. There will be people saying ‘I have disease X’ and social media forums will rally around these diseases. Information is going to spread a lot faster and it’s all going to be user-driven. This will grow the data interpretation space,” he says. “Those are going to be the platforms of the future.”


Figure XIII. Placing betsHave you invested in any company, stock or stock market tracker focussed on any of the following sectors? Select all that apply.(% respondents)

Wearable technology for patients (medically approveddevices for disease management)

Mobile apps

AI technology for healthcare

Data storage and analytics for healthcare

Patient care clinic ( inpatient and/or outpatient)

Wearable technology for consumers(general consumer devices, eg FitBit)

Medical implants and devices

Advanced screenings/diagnostics or imagingtechnology

Disease studies/health research

Personalised drugs

Gene therapies

Telemedicine

3D printed organs

Other pharmaceuticals

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