What does all this philosophical, paradigmatic waffle have to do with sick-care transforming into something that deserves the name healthcare? Well, whatever your perspective, we all agree that preventative and early-treatment measures would be good for us all and that it’s frustratingly perplexing that they seem to be so slow in becoming the new norm. And if you’re a reductionist, it’s very easy to find simple explanations for such a slow progression. Perhaps it’s the reluctance of payers to reimburse. Perhaps the technology isn’t right yet. Perhaps the market isn’t ready. All good, straightforward, reductionist answers. And all correct but all incomplete and overly simplistic. From an evolutionary point of view, the future hasn’t emerged yet because payers, technology, patients and many other factors haven’t yet combined to create the selection pressures that favour prevention and prediction.

But you don’t have to look too far to see the future emerging. I’ve enjoyed reading recently about Withing’s new patient-use device that combines ECG, blood pressure and digital stethoscope with surprising accuracy. Even more interesting was seeing recent surveys that physicians are starting to take these home results seriously. Complementing these patient-use devices, direct-to-consumer blood testing is gradually emerging too, along with self-administered tests for STIs, infertility and other conditions. Continuous glucose monitoring has transformed diabetes care in recent years and I’d guess it’s only a matter of time before we see patient versions of Abbott’s i-STAT device. Out of the home, innovations like Philip’s Ingenia are enabling early cancer detection by integrating MRI and CT scans, which of course is increasingly complemented with biomarker technologies, like Illumina’s Trusight. In structural heart disease, long an under-treated condition, AI is being used by Edward’s Egnite to interpret ECGs for better, earlier detection.

If, as I hope, we are finally moving closer to predictive and preventative healthcare, then how do we accelerate that trend? I’d argue that reductionist solutions, such as trying to convince payers to reimburse, are incomplete answers. We need to understand the combination of conditions – economic, sociological, technological and others – that have to come together to make it happen. Abbott’s work, encouraging diabetes patients to be proactive in managing their glucose levels, is a good example of this. And, as we know from Google search data, there is a large part of society that is ready and waiting to become obsessed with their own health data. Health technology assessors will need to be encouraged to evaluate whole systems and how they promote health and not, as they do now, assess how individual products manage illness. Pushing the trend revealed by the surveys, we will need to reassure professionals that home data is not synonymous with bad data. Most of all though, we in the industry will need to start shifting the way we think. No single factor will cause the future to happen but we can nudge, coax and persuade healthcare to emerge from sick care.