The U.S. is a powerhouse in technology, so it’s no surprise that the biggest success in the medical field has been technology based. Medicine in the U.S. is a powerful engine of creation, with more clinical trials and more medical start-ups than any other country. If you need a treatment for a rare disease, or heart transplant surgery, or cancer immunotherapy, the U.S. is the best place to be—it is the center of cutting-edge technologies and procedures.
But the trend towards faster, better and cheaper that characterizes the evolution of technology has not translated to health care, which each year seems to get more cumbersome, expensive and, especially considering the recent fall in life expectancy during the pandemic, worse in terms of outcomes.
Technology is not the culprit here, of course. What’s needed is a shift in the way technology is used and directed. Rather than training most of the nation’s technology on treating the sick, what’s needed is a shift in focus to keeping people as healthy and disease free as possible. That means developing technology and fostering start-up companies that can put in place a wellness infrastructure to implement the scientific wellness ideas being developed by Phenome Health.
The U.S. spends close to one-fifth of its GDP trying to help the sick, but this is not paying off in increased lifespan or increased health-span—the number of healthy, productive years a person can be expected to live. When you look at health-care spending worldwide, the U.S. is paying way more than other developed nations—in some cases, three times more per capita—and getting less in return. Although lifespan has increased dramatically for all developed countries in recent decades, the U.S. is lagging its peer group of developed nations. The average Japanese person now lives 85 years compared with 76 years for the average American. Citizens of the U.K., France, Italy, Chile, among other countries, all live longer than Americans on average. These nations spend half as much per capita on health care as the U.S.
A major difference between the U.S. and these other nations is how they prioritize and incentivize health-care decisions. The U.S. uses a fee-for-service model, in which patients pay for the procedures that doctors perform, not for the outcomes they achieve. This financing structure has led to a health-care system that has advanced, technological interventions for the very sick, but poor public-health infrastructure. Fee-for-service has distorted health-care priorities in favor of expensive treatments for people who are sick, rather than measures to keep them from getting sick in the first place. It has encouraged health-care spending on rare diseases; special-interest groups lobby Congress and the National Institutes of Health on behalf of small groups of people, sometimes at the expense of focusing on preventive measures that could improve the lives of more people.
The U.S. system may work well for people who are rich, but it is not geared to keeping 330 million people healthy over the long term for a reasonable price; the Medicare system, for instance, largely neglects people until they reach age 65 and their bodies are beginning to fall apart, at which point they can receive lavishly expensive interventions. From the standpoint of the nation’s overall health, this system almost guarantees overspending and underachieving. Keeping people healthy costs far less per capita than treating them when they have already developed preventable illnesses.
Things work differently in many other developed nations. In Britain, the taxpayer-funded National Health Service, which is imperfect in many ways, measures the effectiveness of everything it does in terms of disability adjusted life-years (which looks at years of life lost due to disability, poor health, and premature death). When the NHS budgets a medical intervention, whether it’s a pill or a transplant or nutritional advice, the operative question is: Will this increase the years of healthy life, unencumbered by disease and disability, for most individuals?
The focus on outcomes in the U.K., Canada, and elsewhere, is powerful. It creates an incentive to value nutrition, vaccination, exercise and other relatively inexpensive choices. It drives clinicians and educators to pay particular attention to the health of children, educating them on the importance of eating well, exercising regularly and getting a good night’s sleep. In France, for instance, kids learn how to eat nutritiously in primary or secondary school classes.
The rise of well care will face much resistance from powerful forces—some health-care companies and hospitals profit greatly from the status quo. Recently, however, some parts of the U.S. health-care industry, driven by businesses and insurers, have slowly and tentatively shifted towards prevention. Investment from venture funds, like the one I am a part of, are focusing on health-care start-ups that aim for prevention. Some health-care providers are paying for “value-based” care, in which financial incentives are structured to keep a population healthy. In September 2022, the White House sponsored its second nutrition-health summit, 50 years after the first. The summit, which focused on hunger, nutrition and health, was part of the Biden administration’s plan to end food insecurity in the U.S. within eight years. That should happen every year, because food and exercise are fundamental and underfunded aspects of affordable health care.
If the U.S. could reorient its health-care industry towards wellness, it would foster the rise of technologies in service of that goal. There is a large pool of capital waiting to be invested in wellness, courtesy of the almost unprecedented creation and concentration of wealth in the U.S. in the past decades. Billionaires tend to worry about living long, healthy lives. They want to avoid diseases that will kill them and are pouring money into start-ups that research longevity, healthy eating and lifestyle-preventive medicine.
One can successfully invest in and support these trends. For instance, a company called ShapeUp, acquired first by Virgin Pulse and then by a growth equity firm, was founded by two medical students who dropped out of Brown University after realizing just how much patient suffering is driven by obesity and diabetes. They started a nonprofit that got a significant part of the population of Rhode Island to walk and lose weight. Then they scaled internationally as a for-profit company. Even a five percent average reduction in body weight has a significant impact on the costs and outcomes of a health-care system. Another company we backed, Foodsmart, offers nutrition advice as a telehealth service, again providing significant results in chronic disease. These outcomes have been verified by large insurers who are now driving similar programs.
To live a long, healthy life in this world, you need to keep your brain healthy. But we are just at the early stages of mapping the brain, much less understanding how to cure diseases and improve brain health. More than 90 percent of drugs that target the central nervous system fail in trials.
But this is shifting. Ed Boyden, a neuroscientist at MIT who co-directs the K. Lisa Yang Center for Bionics at MIT, has been hyperproductive at generating the basic instruments and technologies to begin to analyze and control the brain. He and colleagues are developing technologies that communicate directly with the nervous system for the purpose of helping people with disabilities.
Electrical signals, tailored to the individual, could eventually coax tissues and organs back to health.
Michael Levin’s group at Tufts, which is experimenting with radically different ways to regrow brains, has demonstrated the potential of this new technology. They started with a slightly unusual model: the flatworm. If you cut a flatworm in two, a few days later the head grows a new tail, and then the tail grows a new head. (You can cut a flatworm in this way hundreds of times.) So far, so good for brain regeneration. But then Levin and his team found that a little electricity after the cut radically alters the morphology of the worms, creating an animal with two heads. Apply electricity in a different way and you grow five heads, or the head and brain of a different species, without ever altering the genome. This finding raises some intriguing thoughts. Someday, could we radically alter the morphology of human cells, and even organs, not with chemicals or genome engineering, but with electricity? Perhaps emerging technologies like electroceuticals—using electricity to do the work of drugs or even surgeons—could someday bend the cost curves of health care.
Other wellness technologies could make their way into routine medical care. At the health startup Openwater, Mary Lou Jepsen, a former executive at Facebook, Google and other tech companies, is building inexpensive, portable wearable MRI machines that could be placed in ambulances or be used in doctors’ offices, where they could detect strokes or other issues. Eventually, these devices could be used to measure blood flow to the brain, perhaps providing the personalized brain maps that could spot brain abnormalities and prevent damage. With incentives that direct the U.S. technological enterprise towards wellness, we could scale new technologies like this to a level that would improve the health of entire populations.
Juan Enriquez is a venture capitalist who invested in Openwater, Foodsmart, ShapeUp, and a series of other health start-ups. He is the author of several life science bestsellers, has given a dozen TED talks, is an affiliate at MIT’s synthetic neurobiology lab, and loves to teach.
Find out more about Phenome Health’s efforts to transform the future of health care here. Learn more about phenomics, the new science of wellness, in other stories in this special report.