Meeting Offers Vision of Future U.S. Personalized Healthcare System
What if within the next decade or so the U.S. healthcare system was completely transformed? Hospitals like Boston’s Beth Israel were all replaced by retail clinics and medical centers specializing in specific procedures, such as hernia repair or hip replacement. Diagnostics companies finally started reaping the big profits while pharmaceutical companies, biotechs, and device makers took their place as underdogs. And a newly hatched Center for the Determination of Comparative Efficacy was the most feared gauntlet anyone had to navigate to get a new test or treatment to market.
That’s the vision I heard from Clayton Christensen, Wayne Rosenkrans, and other notable speakers at last week’s personalized medicine meeting sponsored by the Harvard Medical School-Partners Healthcare Center for Genetics and Genomics.
In case you’ve already started to roll your eyes, let me assure you this is not the same “personalized medicine” we have been hearing about for the last decade or so. The term once meant matching patients to therapies based on fancy new gene tests. But now its meaning has become intertwined with “evidence-based medicine,” according to Rosenkrans, who is president and chairman of the Personalized Medicine Coalition (PMC) and director of Personalized Medicine at AstraZeneca.
Now, when people talk about personalized medicine, they likely mean “Segmenting patients so that care makes sense,” he said. “It’s not individualized, it’s just stratified.” And it’s no longer just about genomics, but more about assigning a treatment based on evidence from lab tests, imaging, and IT tools such as decision-support software.
Lawmakers like this idea, because it should mean we can stop paying so much for unnecessary care: The more quickly and accurately we can determine who needs what, the more efficiently we should be able to dole it out. As healthcare costs soar, lawmakers are becoming more and more drawn to this new vision.
But back to some of the possible radical transformations I heard about at the meeting.
Rosenkrans predicted that by 2010 there will be between six and 12 new tests approved that guide the prescription of specific drugs, in addition to the few that have been approved to date. VC funding for this new expanded version of personalized medicine will be up 25 percent, he predicted. What’s more, the government will have evolved into a key stakeholder and will be funding pilot personalized medicine projects. Meanwhile, he said, we’ll have some kind of new “non-governmental entity determining the value of products.”
According to Harvard Business School professor Christensen, the current healthcare system is a sitting duck staring down the barrel of the type of transformative disruption that reshaped the airline industry when Southwest introduced deep-discount flying. Cheaper, more efficient means of delivering healthcare will arise, he said, it’s just a matter of when and who will do it. The retail clinics and specialty medical centers popping up now are just the beginning of the trend. “It’s impossible to predict where the enabling technologies will come from,” he said. “But the new business models will almost certainly come from outside the current system.”
He also saw big changes for the pharmaceutical industry. “In the past, most of the money was in therapeutics, and diagnostics was a dog,” Christensen said. “I predict it will flip, and diagnostics is where the money will be.”
Probably the biggest take home message from this meeting, however, was the growing importance of “comparative effectiveness.” Dora L. Hughes, health policy advisor to senator Barack Obama, said this new jargon—which refers to figuring out which treatments for a condition work best—is catching on in Washington. Whatever else they might or might not do to change the healthcare system, lawmakers don’t want to keep paying for stuff that doesn’t work, that works only marginally better, or that actually hurts people.
It’s hard to dispute that kind of logic, but Rosenkrans warned that once you start making value decisions in healthcare, you risk becoming fixated on costs. “We need to stay focused on quality, and not just make decisions based on costs,” he said. “I think we can do better than NICE,” he added, referring to the U.K.’s National Institute for Health and Clinical Excellence, which decides which therapies will be covered in Britain’s National Health System. (NICE has made some controversial decisions over the years, and some experts think the group takes too much of a population-centric view, sometimes bypassing drugs that give huge benefits to few patients.)
Hughes, for one, heartily agreed with Rosenkrans. She recounted how she was “excited” to speak to some NICE representatives recently, until she asked them if their system covers interferon therapy for multiple sclerosis, and they said it didn’t. “As an MS sufferer who depends on those shots, I had to wonder what kind of ‘evidence’ they are using to make decisions over there,” she said.
Despite the potential potholes and hurdles ahead, many entrepreneurs and investors are eager to help drive these big changes in the U.S. healthcare system. “We have this fear that if the Beth Israel Hospital disappeared, it would be a terrible thing,” said Anthony Miller, managing director of Lemhi Ventures in Minnesota. “I’m not so sure of that.'”
Miller is putting his money where his mouth is, starting up a company that will offer an insurance policy that covers experimental therapies. Its product is a ‘rider’, or add-on policy, that people will be able to buy to enhance the insurance they already have. Many other entrepreneurs in this field have been waiting for traditional insurance companies to see the value of personalized medicine, and fund the research that will drive the field and push their products onto the market. Miller said that’s a mistake. “Stop looking to the payers to help you,” he said. “Start personalized medicine yourselves, now.”
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