Eric Topol in his book, The Patient Will See You Now, painted this picture about the future of healthcare delivery; “It may just mean that the best way to cut the ever-increasing costs of health care around the world will be to provide cheap smartphones with Internet service to those who otherwise could not afford to buy them.”
Though I have been a believer in the power of technology and its impact on the health, I have often seen it from the viewpoint of innovations improving quality of care, the potency of medicines and minimising untoward effects. This week, whilst at a function, I had a light bulb moment that made me pause and think. As a panel member, I came into proximity of what I will term “designer healthcare” where the centre of health care provision is the patient and his convenience. At this function, discussions included how targeted medicines could be made specifically for individuals based on their genetic makeup, metabolic rate, gene composition, just to name a few. Other points of discussion included the individualisation of drug doses for patients using their unique biological information, and how the potential for developing a stroke or heart attack could be predicted from cardiac data collected by personal devices like smartwatches with other markers in saliva serving as confirmatory sources.
As the discussions continued, I made several submissions to the effect that the medical community should focus on the basics that affect the majority of humans and not the health aesthetics of a chosen few. In the end, I got into a post-function conversation with a leader in the pharmaceutical research and development area. He challenged me on my views that the drivers of global health were drawing a huge wedge between the haves and have nots. In his opinion, those of us with the greatest disease burden have done little to push the frontiers of technology to ensure that interest in our health needs is projected. I argued my case but left the function in a pensive mood.
Truth is, healthcare now is heavily reliant on data. Unfortunately, many countries in sub-Saharan Africa have had very little interest in this new raw material. Neither have we been interested in understanding the drivers of good health. We have portrayed ourselves as always being done to and have shunned away from most aspects of medical research. As the Ebola and Malaria vaccine trials demonstrated in Ghana, we also have a perception that large pharma has the intention of using Africans as guinea pigs. As a result, when it comes to many new medicines and health technologies, there is little knowledge of their effectiveness in African populations. I find it even more surprising that we still think research and development should be undertaken in other human populations but upon licensing, these products should then be made available to us.
Another sad reality I was confronted with, was in the area of healthcare access. Whilst we still struggle to get our people to see health professionals relying mainly on the argument that we lack the requisite numbers of health human resource, others are thinking innovatively to ensure that the new challenges designer healthcare brings are dealt with head-on. For example, whilst we argue on the need to train more doctors to bring our doctor to population ratio closer to one doctor to 1000 citizens, others realise their population is ageing and are using technology to upskill their auxiliary health professionals to perform many of the primary healthcare functions and newer geriatric health challenges. This frees up doctors time to deal with more complex healthcare issues confronting their societies.
Truth is, healthcare now is heavily reliant on data. Unfortunately, many countries in sub-Saharan Africa have had very little interest in this new raw material.
For me, this must be the starting point for technological intervention in our healthcare. Our focus must be to ensure that people, especially in middle age, are incentivised to seek routine health care. To do this, we need to start thinking about using technology to breakdown accessibility barriers, improve the efficiency of health provision and make convenience the centrepiece of our health system. We need to accept that in most cases, we die needlessly because many avoid these barriers until the bitter end. It is a misnomer that we console ourselves with phrases like “God knows best or God gives and he takes away.” We betray the strength and power inherent in our brains when we do so.
We need to think seriously about the health economy and the revenue, jobs and wealth that the 60% of Ghanaians who lack adequate access to primary healthcare could generate. We need to understand that unless we fix the challenges in primary health, our healthcare system will fail to deal with our changing disease burden. However, we must accept that no one will pause and wait for us to get serious. While the advancement of healthcare in the world is moving at such high velocity, we either act as though the race has not started or are expecting them to stop the race and help us. Talking to many at the function this week, it was apparent they could not fathom how with high mobile phone penetration, health education and access were still a challenge in Africa, and Ghana especially. Some even wondered if we were learning anything from the financial revolution the mobile phone has brought. We must begin to get more curious and challenge some of these inconsistencies too. If we do, we will begin to make linkages thanks to our better understanding of our environment and with that map a strategy that suits us best.
I accept that designer healthcare as it stands now is way out of our league. It is because even though the time it takes for genome sequencing to be undertaken has dropped from ten years to less than twenty-four hours with a substantial drop in the price tag from $5 billion to $1500; this is still out of the reach of most of us. For those who may have the means however, the relevance of such an activity to their overall quality of life is still lost on them. However, what we have is a better understanding of the anthropology of our people and a gradual realisation that brains and not celestial beings hold the keys to improving the quality of healthcare we receive. We better put our brains to work stop the overreliance on intercessors to celestial beings and get our strengths and planning in gear. We must aspire to let medicine play God too.
By Kwame Sarpong Asiedu