A special report on health care and technology

Medicine goes digital

Apr 16th 2009
From The Economist print edition

The convergence of biology and engineering is turning health care into an information industry. That will be disruptive, says Vijay Vaitheeswaran (interviewed here), but also hugely beneficial to patients

Illustration by Otto Steininger

INNOVATION and medicine go together. The ancient Egyptians are thought to have performed surgery back in 2750BC, and the Romans developed medical tools such as forceps and surgical needles. In modern times medicine has been transformed by waves of discovery that have brought marvels like antibiotics, vaccines and heart stents.

Given its history of innovation, the health-care sector has been surprisingly reluctant to embrace information technology (IT). Whereas every other big industry has computerised with gusto since the 1980s, doctors in most parts of the world still work mainly with pen and paper.

But now, in fits and starts, medicine is at long last catching up. As this special report will explain, it is likely to be transformed by the introduction of electronic health records that can be turned into searchable medical databases, providing a “smart grid” for medicine that will not only improve clinical practice but also help to revive drugs research. Developing countries are already using mobile phones to put a doctor into patients’ pockets. Devices and diagnostics are also going digital, advancing such long-heralded ideas as telemedicine, personal medical devices for the home and smart pills.

The first technological revolution in modern biology started when James Watson and Francis Crick described the structure of DNA half a century ago. That established the fields of molecular and cell biology, the basis of the biotechnology industry. The sequencing of the human genome nearly a decade ago set off a second revolution which has started to illuminate the origins of diseases.

The great convergence

Now the industry is convinced that a third revolution is under way: the convergence of biology and engineering. A recent report from the Massachusetts Institute of Technology (MIT) says that physical sciences have already been transformed by their adoption of information technology, advanced materials, imaging, nanotechnology and sophisticated modelling and simulation. Phillip Sharp, a Nobel prize-winner at that university, believes that those tools are about to be brought to bear on biology too.

Robert Langer, a biochemist at MIT who holds over 500 patents in biotechnology and medical technologies and has started or advised more than 100 new companies, thinks innovation in medical technologies is about to take off. Menno Prins of Philips, a Dutch multinational with a big medical-technology division, explains that, “like chemistry before it, biology is moving from a world of alchemy and ignorance to becoming a predictable, repeatable science.” Ajay Royyuru of IBM, an IT giant, argues that “it’s the transformation of biology into an information science from a discovery science.”

This special report will ask how much of this grand vision is likely to become reality. Some of the industry’s optimism appears to be well-founded. As the rich world gets older and sicker and the poor world gets wealthier and fatter, the market for medical innovations of all kinds is bound to grow. Clever technology can help solve two big problems in health care: overspending in the rich world and under-provisioning in the poor world.

But the chances are that this will take time, and turn out to be more of a reformation than a revolution. The hidebound health-care systems of the rich world may resist new technologies even as poor countries leapfrog ahead. There is already a backlash against genomics, which has been oversold to consumers as a deterministic science. And given soaring health-care costs, insurers and health systems may not want to adopt new technologies unless inventors can show conclusively that they will produce better outcomes and offer value for money.

If these obstacles can be overcome, then the biggest winner will be the patient. In the past medicine has taken a paternalistic stance, with the all-knowing physician dispensing wisdom from on high, but that is becoming increasingly untenable. Digitisation promises to connect doctors not only to everything they need to know about their patients but also to other doctors who have treated similar disorders.

The coming convergence of biology and engineering will be led by information technologies, which in medicine means the digitisation of medical records and the establishment of an intelligent network for sharing those records. That essential reform will enable many other big technological changes to be introduced.

Just as important, it can make that information available to the patients too, empowering them to play a bigger part in managing their own health affairs. This is controversial, and with good reason. Many doctors, and some patients, reckon they lack the knowledge to make informed decisions. But patients actually know a great deal about many diseases, especially chronic ones like diabetes and heart problems with which they often live for many years. The best way to deal with those is for individuals to take more responsibility for their own health and prevent problems before they require costly hospital visits. That means putting electronic health records directly into patients’ hands.