Re-imaging the Doctor’s Black Bag

This article is written by Dr Jeremy Lim, who is a partner in the health and life sciences practice (Asia Pacific) at global consultancy Oliver Wyman.

Two hundred years ago, just about everything the world of medicine had to offer could be contained within a doctor’s black bag. Patients who could afford it, had doctors come to their homes to diagnose and treat ailments; where they would then convalesce in their own homes. As a result, hospitals were few and far between, and catered mostly to the poor.

The advent of medical technology such as X-ray machines, MRI scanners and laboratory diagnostics changed the way healthcare was delivered. People now had a reason to attend clinics and hospitals, where they could access services that could no longer be delivered to their doorstep.

Today, medicine is undergoing yet another paradigm shift, once again driven by technology. Three technological trends will be transformative collectively: miniaturisation, connectivity and machine learning. Miniaturisation has shrunk medical devices down to much more portable (or even wearable) sizes; improved connectivity means that data can be beamed to medical professionals anywhere in the world, making remote healthcare possible; and machine learning algorithms are helping doctors diagnose diseases and recommend treatments more accurately and efficiently. The upshot is that quality healthcare now has the potential to reach more people than ever before.

These advances are sorely needed. According to a World Bank and World Health Organisation report, half of the world’s population still lack access to essential health services, with 100 million people going into financial catastrophe due to healthcare expenses every year. Meanwhile, in developed countries like Singapore, chronic conditions such as heart disease and diabetes are on the rise. Rapid ageing populations further place healthcare systems under enormous stress.

Startups: flying lessons for light aircraft (that carry lots of fuel!)

Technology-driven transformation opens up unprecedented opportunities for addressing global health challenges, and entrepreneurs play an important role in bringing to market innovations that will help more people access better healthcare at lower prices.

With their nimbleness and speed, I think of startups as the light aircraft of the healthcare ecosystem. They have the potential to fundamentally change the world of medicine. Yet, many fledgling companies crash and burn before earning their wings.

I meet many young entrepreneurs who have developed swanky new devices or apps, but it is often unclear to me what problem their technology is intended to solve. To set themselves up for success, startups need to develop solutions to fit problems, rather than look for problems to fit their solutions. Doing the former requires closer collaboration between clinical practitioners, who have a laundry list of problems worth solving, and technology developers, who have the technical knowhow to address these problems in novel ways clinical practitioners cannot even begin to imagine.

Second, startups in the healthcare space (and their investors) should plan for a sufficiently long runway to not only develop their technology, but also to figure out issues related to regulatory approval and reimbursement. Barriers to enter the healthcare industry are very high; in my experience, many startups founded on good ideas often fail because of over-optimism as to how long it would take to obtain regulatory approval and commercial traction.

No risk, no reward

Startups in the healthcare industry face a unique paradox. While medicine is defined by innovation and constant change, it is also deeply conservative, and rightly so—you wouldn’t want to be a guinea pig for the latest experimental therapy each time you visit your doctor. That said, if medicine is to take advantage of new technology paradigms, healthcare regulators must also start to see themselves as industry enablers, encouraging innovation whilst striking a balance between safety and an acceptable level of risk.

If anyone can pull off this balance, it is Singapore. Unlike many countries where the regulatory regime often results in binary yes-or-no verdicts, Singapore—with its small size and ability to collect and analyse data in robust ways—can afford to consider many options in between.

One precedent for this is the regulation of the erectile dysfunction drug Viagra. When first approved for use in Singapore in the late 1990s, Viagra could only be prescribed by urologists, and (because of its effect on blood pressure) only to patients who had undergone a cardiac assessment.

After monitoring the situation for some time, health regulators found the drug to be relatively safe, and dropped the requirement for cardiac assessments. Eventually, the stipulation that Viagra could only be prescribed by urologists was also lifted; today, you can buy the little blue pills from general practice clinics. This example, while perhaps somewhat whimsical, illustrates the continuum of policy options that regulators can consider allowing for innovation.

The new barefoot doctors

The journey from the bench to the bedside is typically long and difficult. Given the potential game-changing impact of technology on global health problems, medical entrepreneurs, investors, healthcare professionals and regulators must work together to create sufficient room for technological innovation within the healthcare ecosystem.

During China’s Cultural Revolution in the 1960s, Mao Zedong started a programme in which village representatives were trained in the basics of healthcare, provided with rudimentary equipment and sent back to their villages to practice medicine. Despite the programme’s simplicity and low cost, these ‘barefoot doctors’ turned out to be remarkably effective at improving health in rural China.

Consider how much more effective these healthcare workers would be today if we armed them with smartphones, portable diagnostic devices and access to cloud-based, AI-driven guidance systems. Even in the remotest of areas, the barefoot doctor 2.0 has a superpower—the ability to tap into a wealth of medical expertise from all over the world. For the 3.5 billion people who still do not have access to basic healthcare, this doctor’s black bag is going to make a real difference.

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