Predictions

The World Future Society’s list of ten predictions for “2009 and beyond,” summarized and paraphrased a bit, was as follows:

1. Everything you say and do will be recorded by 2030. Everyone will have a nanoimplant with a unique IP address connecting them to the Internet.
2. “Bioviolence” will become a greater threat with our greater ability to engineer bacteria and viruses.
3. Wireless communication will reduce demand for travel, flying delivery drones will replace trucks, and policies will restrict the number of vehicles owned in each household.
4. New kinds of job and career, and new college degrees to support them, will flourish.
5. The Global Legal Information Network (GLIN), a database of local and national laws for more than 50 participating countries, will grow to include more than 100 counties by 2010. It will have a unifying effect.
6. The race for biomedical and genetic enhancement will be what the space race was in the previous century.
7. Professional knowledge will become obsolete almost as quickly as it’s acquired, requiring lifelong education and constant re-training for almost every worker.
8. Sixty percent of the world’s population will live in cities by 2030, making environmental, health, and socioeconomic problems worse.
9. TheMiddle Eastwill become more secular whileChinawill become more religious.
10. Electricity will reach 83 percent of the world by 2030.

A month following the WFS list, IBM published its third annual list of innovations that could change the way we work, live, and play. The “Next Five in Five” list has just five predictions and looks only five years into the future. It is based on market and societal trends and on technologies emerging from the labs. The list:

• Energy saving solar technology built into asphalt, paint, and windows,
• A personal health “crystal ball” based on a less-than-US$200 personal genome sequence and the ability to tailor personalized pharmaceuticals,
• A Web that understands and speaks human languages,
• Personal digital shopping assistants that replace human shop assistants, and
• Total recall, as all details of our individual everyday lives will be recorded, stored, analyzed, and provided at the appropriate time and place by all the technologies around us.

The Cleveland Clinic, meanwhile, focuses on strictly medical innovations for its annual list of ten “very important things” that “could have big, measurable effects on patients and are affordable.” The list, paraphrased:

1. Circulating tumor cell technology that measures tumor cells in the blood and helps doctors understand how a cancer is progressing and how to adjust treatments in patients who have repeat cancer.
2. A warm organ perfusion device that pumps warm blood through a donor heart, keeping it viable for up to 12 hours. Refrigerated hearts must be transplanted within four hours.
3. A diaphragm pacing system that lets paralyzed patients breathe without bulky mechanical ventilators, resulting in better quality of life for patients and a reduction in ventilator-induced pneumonia.
4. Multi-spectral imaging systems attached to standard microscopes, enabling pathologists to see up to five stained proteins at a time. This will “take personalized medicine to an entirely new level, a doctor said.
5. Percutaneous mitral valve regurgitation repair, an alternative to open-heart surgery for extremely ill patients.
6. New strategies for creating vaccines for avian flu, such as creating a mock version of the virus to trigger an immune response that protects against the real virus.
7. Laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) to reduce infection rates and pain, and speed healing among patients.
8. Integration of diffusion tensor imaging, which produces images that help brain surgeons preserve fiber pathways during surgery.
9. Doppler-guided uterine artery occlusion.
10. A national health information exchange.

We have used boldface to draw to your attention what may be an important thread in these three lists, suggesting a level of complexity in health-related data that will make the EMR seem like a walk in the park, but bring correspondingly great benefit in terms of our ability to predict and prognose.

Writing in Science (July 24), Alessandro Vespignani says that advances in complex networks theory and modeling, along with access to new data (as will be available through, for instance, the NHIN and personal data collection points mentioned in the lists), will enable humans to achieve true predictive power in areas never before imagined. Key enablers are not just progress in data gathering but also new informatics tools and increases in computational power.

Vespignani is more concerned with a crystal ball for populations rather than for individuals, in order to understand then predict aggregated human behavior. “This new ‘reality mining’ should … enhance the ability … to accurately forecast the effects of phenomena like catastrophic events, mass population movements or invasions of new organisms into ecosystems,” he said.

Complex systems modeling would be of huge benefit in healthcare, and hospitals could be employing advanced data mining tools today that take them a step in that direction, but except for a handful of the usual suspects—Mayo, Cleveland, etc.—they are not.

Industries in Peril

In a period of accelerating, tumultuous change, accurate prediction becomes important at many levels—individuals, groups, society, and industries. The results of failing to make predictions (or the right predictions) is evident from the predicaments in which the telephone and recording industries now find themselves.

Phone companies are losing both voice and broadband customers to cable companies at an alarming rate. In 2Q 2009, cable got 80 percent of new broadband subscribers. “The telcos’ wired businesses suddenly look not only like they are weakening … they look like they are positively collapsing,” one analyst has written. The phone companies also continued to lose voice lines, both to cable companies and to cellphone users deciding they no longer need a voice landline. AT&T lost 1.56 million phone lines in the quarter, while Comcast added 555,000 VoIP (voice over IP, or Internet telephony) customers. Why AT&T did not see that coming is a mystery.

The Recording Industry Association of America, which has aggressively prosecuted copyrighted music file-sharers for years, finally accepted the writing on the wall and announced in January that it would no longer prosecute new individual cases. With music sales falling in large part because of illegal file sharing, the industry is desperately searching for a way to stay alive. One proposal is to grant permission to share music files, but collect royalties. Another is to get money from advertising, sponsorship, and subsidies from internet service providers and portable player manufacturers. A third is to sell an all-you-can-eat music service as part of a broadband, TV, phone, and music package.

“The industry is still in the turmoil, and no-one knows how the future will look,” wrote BBC reporter Ian Youngs. He’s right about the turmoil, but wrong about knowing the future. We believe there is no excuse for any industry (including healthcare) to be in turmoil, because the factors leading up the turmoil are discoverable and indeed are often predicted (see, for one example among many, my article “Don’t Be Surprised” in Hospital & Health Networks,August 10, 2004.)

Retail Rehab?

A harbinger of change in the healthcare industry may be the gym club, a.k.a. health club or athletic club. Some gyms have begun to offer exercise programs to people coping with a variety of ailments. The American Cancer Society and theAmericanCollegeof Sports Medicine are creating a special certification for gym workers who work with cancer patients on exercise programs.

A suburbanBostongym offers patients diagnosed with anything from heart disease to arthritis to diabetes 60-day strength and cardiovascular training programs costing $60. Women at aDallasgym pay $580 for an evaluation, eight training sessions, two lectures, and a workout booklet.

We predict that gyms will eventually offer complex rehabilitation programs currently reserved for formal rehab centers. Ever-smarter and cheaper computerized and robotic exercise devices will fuel that trend.

Fitness Pill

But who’ll need gyms when we have a “fitness pill”? One experimental pill, called AICAR, has produced “marathon mice” possessing increased stamina and muscle that burns fat. The mice were able to run 44 percent further. And all without any additional exercise.

Don’t say nobody told you it was coming!