Pundits prognosticate, but how do we measure a future for healthcare when every trend morphs asymptotically?
The Singularity is near, yet meanwhile industry must try to predict consumer and technological trends–and so must their legal counsel.
Everyone knows that healthcare technology is pushing the envelope, but which technology, or in what domains?
Wearable health tech, to be sure – expect everything to be trackable and tracked. You will be photographed, videotaped, measured, and compared – privacy is dead, except perhaps some company might develop a shield to protect you from the infrared rays of your neighbor’s prying drone.
As a healthcare lawyer, I never took much interest in Obamacare – touted as “health care” “reform,” but in reality, a redistributive mechanism, ultimately upheld as a legal matter, as a tax. Obamacare was old news – expensive old news for most healthcare consumers, except those subsidized – the moment it passed.
Technological developments quickly swept past political ones. We entered the mobile medical app era, with FDA indecision about how heavily to intrude into the marketplace, and eventually, a long guidance document that left many apps outside the medical device domain and asserted FDA’s power to regulate while declaring that FDA would exercise “enforcement discretion” in most cases.
Telemedicine exploded. Robotics and nanotechnology are coming soon as the “Internet of Things” will bring health and wellness out of the era of siloed services and products, into interpenetration with every facet of our lives.
I much like a recent article by Christopher Surdak, Shields, Spears, Digital Tattoos and Bionics: 6 Healthcare Disruptions for 2020.
Surdak notes the enormous market for healthcare in the U.S. (about $3 trillion), and forecasts the future of healthcare as comprised of six major disruptions:
- Medical diagnostics.
- Smart Medical Devices.
- Predictive analysis.
Surdak says that government red tape will constrain pharmaceutical advances, while “professional associations and regulatory bureaucracies” will stifle innovation in the professional sphere.
Hear-hear. I wrote about the classic clash between medical paternalism and patient autonomy in my books on legal issues pertaining to integrative medicine. It’s no secret that medical societies worked to eradicate chiropractic and other competitors from the healthcare sphere, and that historically, “doctor knows best” predominated medicine.
The Internet has changed all that. While the holistic healthcare movement engendered greater attention to informed consumer choice as a countervailing value, it’s truly the power of Google that helps equalize the healthcare playing field and reduce the distance between doctor and patient.
Knowledge is power.
With the Web, mobile medical apps, smartphones, telemedicine, fitness apps, robotics (bionics too), medical devices that are smarter and smarter (and in many ways, already smarter than us), medicine is morphing into general wellness (as even FDA now calls it), and Herr Doctor is now becoming Dr. Google.
Self-help, self-care, fitness, wellness, health monitoring, health goal-setting, these are today’s buzzwords; medicine is moving into your local retail store, and people are trading their doctors for health coaches.
Even “mind-body” is past pluperfect – we so recognize how one interpenetrates the other, that the dichotomy-unified-by-a-hyphen now seems gimmicky.
And legal distinctions between these different kinds of professionals (medical doctor: takes care of the body; mental healthcare provider: takes care of the “mind”) no longer reflect the more unified dimensions of care that our vaster knowledge can accommodate.
Our laws need upgrading. Medical licensing laws, for instance, are relics from the late 19th century – anachronistic as they are, these laws still create legal peril for many practitioners; just as FDA’s reliance on diagnostic and therapeutic concepts to distinguish FDA-regulated products from other healthcare consumer products, are also relics that exert power in a vastly transformed modern world.
As Surdak beautifully describes these trends: “change and disruption in the healthcare marketplace… will come … from other societal mega-trends such as appification, thingification and socialfication as they leech into the nooks and crannies of the institutional controls maintained by the healthcare industry,”
By 2020, he predicts, “going to “visit” a doctor likely will seem abnormal, while “seeing” our doctors will occur with much greater frequency and brevity” via telemedicine, online encounters or through our smartphone apps or other technologies.”
Enjoy your toothbrush while you can. Some day soon it will be “smart” talk back – a ruder awakening than Charlton Heston faced in Planet of the Apes when they could speak and the humans of their world couldn’t.
The bottom line is that technology itself drives change – not regulations. And as Ray Kurzweil pointed out, the rate of technological innovation is itself accelerating.
We’re living Future Shock on steroids, and we don’t even know what’s coming.
Sure, if you’re in the healthcare market today you must pay attention to Stark, anti-kickback and fee-splitting laws; definitions of unlicensed practice; archaic rules such as corporate practice of medicine; HIPAA and CLIA and lots of other statutes with acronyms. To remain ignorant is to risk enforcement action. FDA, despite lifting the scales from its regulatory eyes with the new guidance on low-risk, general wellness products, can still act swiftly and heavily if it sees claims on your website that trigger enforcement scrutiny for your medical device, cosmetic, OTC drug, or dietary supplement; and if FTC finds false and misleading advertising, prepare the treasury for the penalty. These legal and regulatory boundaries will adapt more slowly, as technological developments outpace regulators’ ability to keep up. You still need good legal counsel, and this may never change (if it does, I’m counting on 3D printers to supply all our material needs).
Ultimately, the marketplace–the innovators, the disruptors-and the patients who hunger for their products, will claim the healthcare landscape. Surdak is right that most healthcare pundits miss the mark when they aim their predictions by assuming that what is will continue moving along in the same linear fashion; and that the trends he’s identified–a consumer-driven healthcare marketplace; medical care via remote telemedicine encounters; advanced medical diagnostics like the Star Trek tricorder; medical apps and smart medical devices in the Internet of Things; bionics and the human-machine merger; and advanced predictive analysis–will drive healthcare toward prevention and wellness.
This is the trend that integrative medicine has prophesized (or at least articulated as necessary) all along, except that the driver here is not only consumer awareness and demand, but also the shape of things to come – including how they communicate with one another and with us about our health.
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