The unintended consequences on healthcare systems of a Brave New World?

The Royal Society of Medicine’s Medical Innovation Summit 2011 was held on the 25th June and presented an eclectic mix of topics (videos are available here) ranging from the use of genetically engineered sterile mosquitos to control dengue fever to the use of “Plumpy’Nut” as a food to treat acute malnutrition in the community; via pluripotent stem cells to treat cancer and skin cell sprays as a better option than grafts for treating skin burns. It was a stimulating way to spend a Saturday and a powerful illustration, as one of the speakers said, of the innovation that can come from combining knowledge and specialists from different fields of science.

But as I was marvelling at the amazing potential of combining the fields of genetics, cell biology, immunology, materials science and engineering I began to wonder what the effect of all this would be on the delivery of healthcare. What would be the impact on today’s healthcare system of introducing these technologies? There would be obvious benefits for patients from regenerative and reconstructive technologies but would there be unintended consequences on the delivery system?

The common characteristics of the new technologies are:

    • personalised treatment: use of the patient’s own cells, which are transformed outside the body (pluripotent stem cells), to regenerate damaged tissues or to trigger the patient’s own immunological system to reject or accept specific types of cells. Replacement of the patient’s damaged tissue by non-biological substitutes which combine with the patient’s surviving tissues.
    • complex technology: these technologies, at least initially, will be expensive because they require a series of complex manipulations to generate a large enough mass of suitably differentiated cells which can then be structured to perform the required function using approaches that require precision engineering. It is a complex manufacturing process combining biological and non-biological materials.
    • manufacturing process: unlike most treatments or procedures today where the patient is integral to all elements of the treatment, these technologies involve a three step process where the patient has specific tissues collected or anatomic features measured; there is then an external manufacturing process involving artificial material or multiplication and maturation of the patient’s own cells; finally there is a procedure to combine the manufactured component with the patient and a period of monitoring.

To effectively deliver these treatments will, at least initially, need a specialised “manufacturing facility” that can maintain the required level of quality. There is no need to locate this near the patient and there should only need to be one facility for each specific technology in a country with good transport links. The patient will need outpatient and brief inpatient care and this would have to be local.

The healthcare system would be a development of today’s cancer networks and would sensibly be organised around multi-disciplinary teams, representing the different skills required to deliver the treatment, and strict protocols managed by the network to ensure consistently excellent outcomes.

The patient’s requirement is for the delivery of a specific technology-based treatment, rather than a knowledge-based disease management service using pharmaceutical treatments based upon a facility local to the patient, and this will present major challenges to existing healthcare systems.

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