安永：新科技將如何解決人口老齡化帶來的醫(yī)療困境（英文版）

Howwillnew

technologiesmake

age-relateddiseases

athingofthepast?

Buildinganengagedagingstrategy

2|Engagedaging

InSeptember2016,MarkZuckerberg

stoodinfrontofapackedauditorium

toaskaprovocativequestion:“Canwecure,preventormanagealldiseaseby

theendofthiscentury?”

Soundaudacious?Itis.

ThroughtheChanZuckerbergInitiative,theFacebookfounderandhiswife,Dr.PriscillaChan,arededicating

US$3billionoverthenextdecadetoprevent,cure

andmanagesomeoftheworld’scostliestdiseases,

includingheartdisease,cancer,strokeandneurologicaldisorders.1Notbychance,theseglobalchronickillersalsohappentobeincreasinglycommonastheworld’s

populationagesandgrowsmoresedentary.

Ifevertherewasatimeforboldstatementsandeven

bolderambitions,nowisthemoment.

Itisestimatedthatsometimebefore2020—forthe

firsttimeever—theglobalpopulationofindividuals

aged65andolderwilloutnumberchildrenunderage

five.2Withtoday’slifeexpectancy,thehealthcare

expenditurescouldbeenormous:theWorldEconomicForumestimatestreatingchronic,non-communicabledisorderscouldcostanestimatedUS$47trillionfrom

2010to2030.3

Buildinganengagedagingstrategy|3

Driversofchange

Increasing

Wearables

Enablers

IoTdevices

Whenlifespanmeanshealthspan

Bysomeestimates,wespendabout50timesmoreasasocietymanagingdiseasesastheyoccurthanwedoonresearchthat

mightpreventthosediseasesfromhappeninginthefirstplace.Newgeneticanddigitaltechnologiescouldmakeagingmore

sustainable,acceleratingthediscoveryandcreationofsolutions(seeFigure1).

“Todaywearehealthyintheabsenceofdisease,”saysKenBloom,PresidentofHumanLongevity.“Butinreality,weareonly’healthy’becausewehaven’tidentifiedtheeventsthatwillageus,”Bloom

notes.Afteryears-longexposuretoinsultssuchasultravioletradiationandoxidativestress,ourcellsreachapointwhere

theycannolongermaintainoptimalfunctionandfalter,which

manifestsasage-relateddisease.Thegoalistousetransformativetechnologiestodelaythebreakdownoffunctionandextendthe

healthspan—theabilitytoagedisease-free.

IntheneartermthatmeansdeployingsensorsandInternetof

things(IoT)technologyinphonesandeversmallerwearables

tocost-effectivelymonitor,andthenmanage,knowndiseases

associatedwithaging.Longerterm,innovationsingeneticand

regenerativemedicine,coupledwithcheapcomputingpower,

improvedanalyticsandagrowingunderstandingofbothhumanbehaviorandthebiologyofagingwillmovetreatmentupstreamtothepre-diseasestate,whereconditionsshouldbecheaperandeasiertoremedy.

Yettherealshifttowellnesswillcomewhenpre-emptiveefforts

aresoentrenchedinday-to-daylifethattheynolongermeritthelabel“prevention.”Wellnesswillbejustanotherpartofthenormalroutine,likebrushingone’steethorwashingone’sface.

Figure1:Enablingtechnologiestomakeaging

moresustainable

Diseasemanagement

chronic

disease

Rising

Arti?cial

intelligence

health

Solutions

carecosts

Regenerativemedicine

Changing

demographics

Genetic

advances

Evolving

customer

expectations

Diseaseprevention

4|Engagedaging

Regenerativemedicine

Invisibles

Steppingalongthecontinuum:

fromdiseasemanagementtowellness

Arangeoftechnologiesareneededtomoveusdownthepathtolifelongwellness.Manycomponentsalreadyexist—orwillinthenearfuture(seeFigure2).

Considerthegeneticandscientificadvancesthatunderpinthe

emergingfieldofprecisionmedicine(i.e.,gettingtherightdrug

totherightpatientattherighttime).Withtheabilitytosequenceaperson’sentiregenomepoisedtocostlessthanUS$100,it

willsoonbereasonabletomapthegeneticblueprintsoflarge

numbersofindividuals.Asaresult,itwillbepossibletouncoverraresignalsthat,whenlinkedtoobservablecharacteristics—

calledphenotypes—identifynewmarkersfordiseaserisk.

Ongoingeffortstounderstandthehumangenomewillbefurtherenhancedbycombininggeneticdatawitharangeofotherdatatypes,including:

?Traditionalclinicallaboratoryresults

?So-called“multi-omics”analysesthatquantifycollectionsofbiologicalmolecules,includingthetotalityofproteinsor

genetictranscripts

?Real-timedatageneratedbywearablesandothermobiletechnologies

?Behavioraldatagleanedfromsocialmediasites(e.g.,FacebookandTwitter)andadvocacyorganizations(e.g.,PatientsLikeMe)

Theintegrationofthesedatawillultimatelytransformhealthcareandexpandprecisionmedicineapproachestohealthwrit-large.

Acceleratingthisshifttoprecisionhealth,whatresearchersalsocallscientificwellness,arearangeofenablingtoolsthatincludethird-partycloudsfordatasharingandartificialintelligence(AI).

Indeed,onebranchofAI,deeplearning,couldshortenthetimetoreachR&Dmilestones.Advancesincomputationalpowernowmakeitpossiblefordeeplearningsoftwaretoreplicatetheneuronal

activityinhumanbrains.Asaresult,thesoftwarecannowbeusedtoidentifypatternsinextremelylargedatasets,revealingpotentialnewlinkagesbetweenspecificgenesorproteinsanddiseasemorerapidlythanhumancounterpartscouldfindthem.

Deeplearningalgorithmscouldbeparticularlyimportantin

enablingprobabilisticdiseasepredictionbeforesymptomsmanifest,developingnewdrugtargetsforage-relateddiseasesaswellas

identifyingkeypointsforbehavioralinterventions.Alreadyarangeofstart-ups,includingCalicoandInsilicoMedicine,areusingthe

approachtoadvancethescienceoflongevity.

Figure2:Solutionstopromotehealthyagingcanbearrayed

onadiseasemanagement—preventioncontinuum

Disease

management

Diseaseprevention

Currentstate

Clinicaland

molecular

IoT-enabled

devicesand

wearables

Aritificial

intelligence

Futurestate

Gene

sequencing/-omics

diagnostics

Buildinganengagedagingstrategy|5

Theabilitytoshrink,andsync,sensorsandelectronicsisalso

important.Smallerdevicescanbeincorporatedseamlesslyinto

ourcurrentenvironmentviaclothing,jewelry,furnitureoreven

tattoos,passivelycollectingdataandmonitoringforbiologicalandenvironmentalchanges.The“alwayson”phenomenonreduces

thehasslefactor;consumersdon’thavetoengagewithaclunky

device,rememberingtochargeitorsyncitwithotherhealthtoolsordownloadthedatatoactuallymakeabehaviorchange.As

wewillcoverinaforthcomingpiece,embeddingtechnologyintoconsumers’livesinsuchafundamentalwayshouldreducethe

wearabletechfatiguethatcanlimitlastingbehaviorchange.

It’sstillearly,butthesedata-drivenapproachesarealreadybearingfruit(seeFigure3).Tobetterunderstandtheunderlyingcausesofdiseasesofaging,researchersatStanfordUniversityhavejoined

forceswithAppletostudythegeneticcharacteristicsofthesuperwell,extremeathletes.Verily,formerlyGoogleLifeSciences,haslauncheditsown10,000-personBaselinestudytobetterdefine

healthbasedongenomic,molecularandimagingbigdatasignals.Inaddition,RegeneronandGeisingerHealthSystemhavealreadyuncoveredanovelmarkerthatsignificantlyreducestheriskof

coronaryarterydiseasebasedonobservedassociationsbetweenpatientdataandgeneticsignaturesin100,000participants.4

Figure3:Pioneeringstart-upslookfortheupsidesofaging

Focus

Company(foundingdate)

Arivale(2014)

Personalizedhealthandweightlossservicesbasedonmultipledatainputscreateascientificpictureofwellness

Calico(2013)Hybridacademic-biotechfoundedbyAlphabettocombatagingandage-associateddiseases

Forward(2016)

PrimarycarepracticeusingsensorsandAItoprovideconsumerswithslick,seamless,personalizedhealthcare

HumanLongevity(2013)

Conciergeservicecouples-omictechnologiesandmachinelearningtomakemedicinemoredatadriven

iCarbonX(2015)AI-drivenplatformprovidescustomizedhealthandmedicaladvicetoconsumersviaapp

InsilicoMedicine(2014)

Biotechusingdeeplearningandanalyticsforinsilicodrugdiscoveryandtorepurposeexistingdrugstotreatage-relateddiseases

UnityBiotechnology(2016)

Biotechdevelopingtherapeuticsthatprevent,haltorreversediseasesofaging;mostadvancedproducttreatsosteoarthritis

Source:EYanalysis.

6|Engagedaging

General

population

Diagnostics

Interception

Atrisk

Treatment

Disease

progression

Identification

ofdiseaseorrisk

Personalizedintervention

P-medicine

Itisimportanttonotethatthepivotfromdiseasemanagement

toprecisionhealthintersectswithanotherlargertrendredefininghealthcare:P-medicine,whichismedicalcarethatispersonalized,

precise,preventative,predictive,pharmaco-therapeuticand

participatory.Atitsheart,P-medicinedoesn’tsimplyencompassnewtechnologiesandscience;itrepresentsanewmindset

thatemphasizespreventionandgreatercollaborationbetweenphysicians,consumersandotherstakeholdersinpre-emptingand/orsolvinghealthchallenges(seeFigure4).

Currently,healthcarerecommendationsarebasedonlarge

population-baseddatasetsthatdemonstrateabehaviorchange(e.g.,eatingmorefruitsandvegetables)oranintervention

(e.g.,takingstatinstoreducecholesterol)resultsinapositive

healthoutcome.Butwhat’sreallyneededisanunderstandingattheindividuallevelofthepotentialdiseaseburdenthatarisesasaresultofinteractionsbetweenaperson’sgeneticcodeandtheenvironment,includingbehaviorsthatpromote—orlimit—health.

TheultimategoalofP-medicineistouseknowledgegleanedfrom

thesedata-driveneffortstodevelopmoreintegratedtreatment

approachestocomplexdiseasessuchasmildcognitiveimpairment,aprecursortoAlzheimer’sdisease.Indeed,bycapturingbiological,clinicalandbehavioraloutputs,theapproachcouldrefinehow

providerseducateindividualsaboutbothdiseaseriskandillnesssothatbehavioralpromptsaredeliverednotjusttotherightpatientattherighttimebutintherightwaytoachievemaximalhealth.

Start-upssuchasHumanLongevityandArivaleareusing

P-medicinetorepositionhealthasascientificallydrivenprocess.HumanLongevity’sHealthNucleusprogram,forinstance,has

analyzedwholegenomesequencesofhundredsofindividualstoidentifyregionsoftheDNAthatareuniquetopeoplewhodiedbetween50and75.It’sstillearlydays,buttheexpectationis

thatbystudyingthesespecificgeneticregionsingreaterdetail,scientistsatthebiotechcanidentifyrootcausesofage-relateddiseasesthatcanbemonitoredviadiagnosticsortreatedvia

newtherapeuticinterventions.

Arivale,meanwhile,combinescutting-edgeresearch,personalizeddataandtailoredcoachingtohelpparticipantsoptimizetheir

wellness.Thestart-uptakesadvantageoftheconvergenceof

systemsbiology,bigdataandconsumerengagement,integratingwholegenomesequencingresultswithclinicalandotherdata.

Currently,morethan4000peoplearesignedupforArivale’s

scientificwellnessprogram,eitherasindividualsoratanenterpriselevel.Highlytrainedcoaches,withthesupportofaclinicalteam,

translatecomplexscientificinformationintoactionablehealthrecommendationsforparticipants.

Figure4:P-medicinecombinesthescienceofmedicine

andthescienceofbehavior

Behaviors

Real-time

monitoring

DxRxDx

Personalizedbehavioralinterventionspromoteadherenceandhelpavoidrelapseordiseaseprogression

Buildinganengagedagingstrategy|7

Nearterm,thegreatestbusiness

opportunityisthedevelopmentof

simple,conciergeservicesthateither

coordinatecareorsupportwellness

byintegratinginsightsfrombigdata

withhigh-touchbehavioraltools.

8|Engagedaging

Shiftingbusinessmodels

1Theinvisibletouch

Asourunderstandingofthedriversofage-relateddiseasesgrows,

thedemarcationbetweendiseasemanagementanddiseasepreventionwillblur,leadingtoearlierdiseaseinterception.In

essence,thatmeansbroadeningthedefinitionofdiseasetoincludesusceptibilitybasedontherelationshipbetweenbiologicalmarkersandthedevelopmentoffull-blownsymptoms.

Drivenbynewtechnologies,thisshifttopredictionandpre-emptionwillnecessitatechangesinhealthcaredeliveryandbiopharma

businessmodels(seeFigure5).

Inthecurrentstate,whenattentionisgiventoprevention,itis

largelyadhocandepisodic.Inaconsumerempoweredfuture,

however,providerswillbeabletopersonalizecarefurther,movingawayfromrelianceonpopulation-basedmetricstoindividualizedriskassessments.Nearterm,thegreatestbusinessopportunity

isthedevelopmentofsimple,conciergeservicesthateither

coordinatecareorsupportwellnessbyintegratinginsightsfrombigdatawithhigh-touchbehavioraltools.

Thebiopharmaequivalentof“Anappleaday…”

BiopharmaceuticalcompaniescurrentlyinvestbillionsinpreclinicalR&Dtodevelopexpensiveproductsdesignedtotreatthebodywhendiseasemanifests,or,inasmallnumberofcases,totreatasingle

orsmallnumberofriskfactors(e.g.,statinsandheartdisease).Butaswellnessanddiseaseinterceptionbecomethenorm,therewill

belessneedforsuchproducts,exacerbatingpricingandutilizationpressuresthatalreadylimitrevenuegrowth.

That’snottosaypharmaceuticalswon’tbeneeded—lifestyle

interventions,evenifdeliveredattherighttimeandviatherightformat,won’tbesufficienttomaintainoptimalhealth.Butthe

typesofproducts,andthedatademonstratingtheirvalue,will

shiftwhendiseaseinterceptionanddiseasepreventionbecome

moremainstream.Companieswillneedtodevelopmedicinesthatdeliversmallerinterventionssafelyandaffordably.Thecurrent

model,whichsupportscharginghundredsofthousandsofdollarsforananti-cancerdrug,won’tapply—orbepalatable—whentheinterventioncounteractsnotanactualdiseasebutadiseaserisk.

Buildinganengagedagingstrategy|9

Thegoodnewsiswealreadyhavemultipleexamplesofmarketed

biopharmaceuticalsthatinterceptdisease.Vaccinespreventboth

childhoodscourgessuchaspertussisanddiphtheria,aswellas

adultconditionssuchasshingles.Bisphosphonates,whichinhibit

boneresorption,andstatins,whichlowercholesterol,aretwootherexamplesworthnoting.Bothtreatearlysymptomsofmoreserious

andcostlyconditions—fracturesduetoosteoporosisandheartattacks,respectively.Biopharmacompanieswillneedtoassesshowtheycandevelop—andbuildtheevidencecasefor—similarinterventionsinothertherapeuticareas.

Figure5:Newtechnologiesdrivechangesinthebusiness

modelsofhealthcareandlifesciencescompanies

Relevancetostakeholder

Technology

(example)

Lifesciences

Providerorhospital

Payer

Policymaker

Consumer

Sensors/

wearables

(EKGmonitors)

Real-worlddata

cognitiveand

physicalfunction

Improvedcareinlowercostsetting

Morecost-effective,patient-centriccare

Balancingsafety

andefficacywith

innovation

Peaceofmind;greaterconvenience;privacyconcerns

App-enabled

servicesand

devices

(ElliQ,Uber,

Independa)

Closecriticalcare

gaps;enableremotemonitoring;link

healthoutcomestomedicines

Remotemonitoringtosupporthealth;greaterefficiencyofspecialists;

bettercarein

underservedareas

Avoidhigh-cost

events;proliferationoftechnologies

makesitdifficulttoknowwhichappstopayfor

Newpoliciesneededthatclearlydefine

apporserviceasmedicaldeviceorconsumerproduct

Convenience;promotesindependence;may

exacerbateloneliness/alienation

Regenerativemedicine

(stemcelltherapy)

Curativetherapiesrepresentstep

changeincare

Requirenew

protocolsfor

incorporatingintoclinicalpractice

Highcostmay

requirenewpaymentmodels

Existingtrial

methodologymaybeinsufficient

Accessandaffordabilityofcurativetreatment

Geneticadvances

(low-costsequencing)

Allowsearlier

interventionbeforevisiblesymptoms

Better

understanding

ofcurrent/futurediseaserisk;needstobeintegrated

intoclinicalpractice

Moreaccuraterisk

poolsasthelink

betweenspecific

behaviors/geneticpredispositionsandhealthoutcomesareuncovered

Needfordata

sharingandprivacypoliciesthatprotect

patients

Betterunderstandingofcurrenthealth/futurediseaserisk

Artificial

intelligence

Greater

understandingofdiseaseriskandbehaviorchange

Allowsdoctorstofocusonpersonalinteraction

Helpsestablish

returnoninvestmentforintervention

Evolvingdata-drivenrulesetsrequire

newregulatory

standards

Patientscanreceivecareorwellnessregimens

particulartotheir

background,environmentandhealthstatus

Source:EYanalysis.

10|Engagedaging

Layingthewellnessfoundation

Theshiftfromdiseasemanagementtodiseasepreventionandwellnessdependsonanumberoffactors.

?Regulatoryflexibility:Movingfromdiseasemanagementto

diseasepreventionrequiresutilizingdatainnewcombinations.

Whileregulatorybodiesinmanycountrieshavewell-developed

protocolsforsafetyandefficacy,theseframeworksarebetter

suitedtotraditionalpharmaceuticalsandmedicaldevicesthan

artificiallyintelligentsystemsandconsumer-generateddata.

Standardsareneededthatappropriatelymeasuresafetyand

efficacybutadaptrapidlyenoughtomeetthepaceofinnovation.

?Newreimbursementmodels:Eventhoughpay-for-valueis

gainingtraction,thecurrentfee-for-servicemodelincentivizes

diseasemanagementnotdiseaseprevention.Toprioritize

healthyaging,reimbursementmodelsthatemphasizepreventionandthecoordinationofcomplexcareareamust.So,too,are

affordableconciergewellnessservices.Currentofferingsare

notaffordableonapopulationlevel.Goingforward,payersandemployersshouldpartnerwiththecompaniesdevelopingthesebespokeservicestodeveloplowercostoptionsthatcanbe

deployedmorebroadly.

?Makingbehavioraleconomicsmainstream:Behavioral

economics,theuseofpsychologyandeconomicstounderstand

whatdrivesindividualbehavior,hasbeenslowlymovinginto

themainstream.Understandinghowcognitivebiasesaffectan

individual’sabilitytoinvestinlong-termhealthisessential.Onlybydevelopingtherightnudgesanddeliveringthemattheright

timewillitbepossibletohelpconsumersmakebetterhealth

choices,whetherthosearerelatedtoexercise,dietormedicationadherence.

?Platformcreation:Thepaceoftechnologicalinnovationin

thehealthyagingspaceistrulyexciting.However,totruly

transformagingandextendthehealthspan,it’snotenoughto

useemergingtechnologiestocreatepointsolutions.Partnershipsthatdevelopintegrated,platform-basedofferingsthatareeasytouseandflexibleenoughtoaccommodatefutureinnovationswillhaveacompetitiveadvantage.

Newgeneticanddigitaltechnologiesareanimportantcomponent

ofanyfuturewellnessinfrastructure.Attheircore,these

technologicaldevelopmentsareunlikelytoincreasehumanlifespanssignficantly.Farfrompursuingtheproverbialfountain

ofyouth,thesesolutionswillinsteadextendhealthspans,so

thatphysicalandcognitivefitnessismaximallyalignedwithlifeexpectancy.Thatwouldbeapowerfuladvance,indeed.

“Howwillnewtechnologiesmakeage-related

diseasesathingofthepast?”isthesecondina

seriesofarticlesexploringaging,amegatrendas

bigasdigitaldisruption.Additionalarticleswill

exploretheimportanceofconsumerengagementandcreativepartnershipsassocietalprioritiesshiftfromdiseasemanagementtowellness.

Buildinganengagedagingstrategy|11

Contacts

PamelaSpence

EYGlobalLifeSciencesIndustryLeader

pspence2@

+447