The biomedical scientist and entrepreneur Craig Venter recently described today’s approach to healthcare as “medieval”. This is not entirely fair; we no longer rely on astrologers for diagnosis or vendors of snake oil for drug discovery. Nevertheless, he makes an important point: we could do much better. More specifically, today’s medical systems are too reactive, when they could be more proactive.
As living standards improve across the world, ageing populations and the rising prevalence of non-communicable disease amplify the task of building health services fit for the future. I also spoke to the pioneering surgeon Ara Darzi while researching my book, Make, Think, Imagine, and he framed the challenge in stark terms: “The burden of disease is so big that we’re never going to be able to produce enough practitioners.”
Throughout my career I have been an active witness to the way engineering can reorient whole sectors, most notably energy and information technology. Now is the turn of healthcare, an area too often held back by traditional practices and conservative mindsets. Medical staff will need all the assistance they can get from robotics, artificial intelligence, efficient drug delivery pipelines and other maturing technologies.
This is a controversial view. Public opinion seems to be turning against technological solutions. Privacy concerns are hampering the sharing of medical data, Crispr gene-editing is reviving old fears of eugenics, and anti-vaccination sentiment is on the rise. Yet against this gloomy backdrop, I see three clear shifts in attitude and approach that must take place if engineering is to deliver on its great promise.
First, we must rekindle belief in progress. History shows it is engineers, rather than medics who have done most to save lives and extend them. Before they enter the clinic, every drug, vaccine, diagnostic tool and medical database must be engineered into a form that is safe, reliable and cost-effective.
Engineers today are developing extraordinary abilities to understand and intervene in human physiology. I recently visited Robert Langer’s lab at the Massachusetts Institute of Technology, where he described a device smaller than a grain of rice that he can inject into a tumour to test the efficacy of dozens of chemotherapy agents in parallel. This is just one tool in a growing arsenal of innovative ways to deliver drugs with unprecedented precision.
The judicious application of data analytics and machine learning, meanwhile, heralds a revolution in preventive medicine. For example, the UK’s National Health Service, which recently piqued the rather unhealthy interest of US president Donald Trump, holds seven decades of health records for an entire population. I am determined to ensure the effort to combine this information with growing genome sequence databases becomes a national priority. Initiatives of this kind are best managed by public-private partnerships to distribute control and manage risk. Crucially, they must prove that nobody’s privacy will be violated.
The second effort should be on the part of regulatory agencies to do more to ease the passage of discoveries and inventions from lab to clinic — and onward into the marketplace. The delivery of a new drug, procedure or device now takes on average more than a decade, at vast expense.
Safety testing is critical — its failure led to the thalidomide disaster of the 1950s and ’60s — but this process can be accelerated by the removal of unnecessary red tape and a more intelligent approach to clinical trials. I take heart from the rapid and near-universal condemnation of the dangerous and unlawful experiments in gene-editing conducted on human embryos in China. Governance is not broken and regulatory regimes can keep up with technological change.
Finally, we need to recognise that great advances usually emerge from the gaps between existing sectors. This is core to the ethos of the Francis Crick Institute, a world-class biomedical research hub whose board I chair. The institute is designed to accelerate scientific discovery by encouraging fluid interactions between disciplines, but also by fostering closer links with clinicians, engineers, businesses and the wider public.
The same appetite for pursuing innovation without boundaries should be nurtured in schools and universities to help create a world in which people and ideas move and intermingle more freely than ever.
Get all this right and engineering will propel healthcare provision out of the Middle Ages and into a future in which medical staff have the transformative tools they sorely need. That way they can get on with the crucial work that engineered products will never be able to do: caring for people with genuine compassion.
The writer is a former chief executive of BP and the author of ‘Make, Think, Imagine: Engineering the Future of Civilisation’