Dr Patrick Dixon Chairman Global Change Ltd

Future of Global Health and

Medical Technology 2020-2030

Every health trend will

impact all other health trends

Cloud

Nanotech

Mobile

BiotechGenes +

Cells

Digital Connect

Atoms

Converging - Combinations

Expect convergence and compe66on between pharma,

biotech and medtech in finding answers to major condi6ons

ONE WORD will drive the

future of health

The future is aboutEMOTION

Demographics will be greatest predictor of

future demand

1 billion children alive today

Growth in global health spend will be driven by growth of

middle class in emerging na6ons

IMF - adjusted for Purchasing Power Parity

>40% WDP by 2015

300 million move to cities in China and 475 million to cities in Africa by 2030

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Megacities mean greater risks of viral epidemics like Ebola with global impact

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1 billion over 60 year olds in 10 years

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Europe Dying !

4 couples to produce single great-grand child !

S Korea children per couple fell from 6 to 1.2 - 1950-2000

Title Text Body Level One

Body Level Two

Body Level Three

Body Level Four

Body Level Five

>65% of health spend will be on people

>65 years old

Chronic Conditions Multiple Needs

100 million Americans have chronic conditions

80% of health spending

88% of all prescriptions

70% of physician visits

66% Medicare cost = people with 5+ conditions

Almost all caused by people getting older

Expect major global demand for preven6on and treatment for cancer, heart,

brain, chronic wounds, infec6ons, infer6lity, arthri6s and diabetes

Pharma Companies

WILL find new blockbusters e.g. Alzheimers / Obesity

Alzheimers commonest cause of death in UK women

2010-2050 demen6a

1 in 3 babies in New York will develop adult-type diabetes - cost $100bn a year

Imaging and Diagnos6cs will be dominated by 3D and HD

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Cloud Processing

Positron emission tomography

Magnetic nuclear resonance

Imaging and Robotics

Food moth larva silk gland !

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Fat cells Cuticular

Mouse Retina

Micro-surgery will transform hospital care

$75bn endoscopy market by 2022 ($23bn 2010)

125,000 stents or carotid surgery a year in US

Length of hospital stay will fall rapidly

Virtual Medicine

Wearable Health Devices will be almost

universal

Home Tele-Monitoring

Most pa6ents will know more

than their physicians about their condi6on

Search: know more than your doctor

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Home Care will grow very fast especially for old people

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Diabetes, congestive heart failure, obstructive pulmonary

2.2 million at home

> $22bn by 2015

Mobile telephony

Biotech will drive most pharma

innova6on

coatings and robots

Build Nanotech Robots as Biotech Therapies

Adenovirus contains Math1 gene

Turns young ear cells into hair cells

Inject virus particles into inner ear

New hair cells grow near Organ of

Corti

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Research in Guinea Pigs

Cure for Deafness ?

Confidential

HSV1 causes cold sores. When engineered as Seprehvir (HSV-1716), it is harmless to healthy @ssue.

Oncolytic viruses Infect and kill cancer tumour cells No damage to healthy tissue Evidence of impact in clinical trials Able to deliver new genes into cancer cells Micro-dose chemo, micro-dose radiotherapy

Viruses to cure cancer

Electronic Medical Records will mean be\er decisions using Big Data

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Product scanning means safety !

Computer-aided decisions save lives and time

Ottawa Hospital, Ontario - 3000 ipads Mayo Clinic - 2000 ipads !

Zettabyte = 1024 Exabytes Exabyte = 1024 Petabytes Petabyte = 1024 Terabytes Terabytes = 1024 Gigabytes That's a data explosion of 44x in

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Big Data

Gene screening will dominate

disease preven6on

Genetic Prophecy

Genes for old age, speech, memory, criminality, depression, obesity and stable relationships

Fluidics

Biochemistry

Semiconductors

Genetics

Mathematics

Immunology

Robotics

Read genome in 2 hours for $5,000

Organ Repair will be rou6ne using own cells

Stem Cells

Pigs teeth grown inside rats

Mice grow new teeth from nerve cells / gum tissue

Grow New Teeth

Repair of heart, retina, brain or spinal cord

using adult stem cells

Repair Heart / Brain

Competition in spinal cord damage from chips implanted

into brain

New insulin cells in capsules to protect from immune system

Repair Pancreas to treat diabetes

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Competition from implanted devices containing insulin

Print Elastomere

We can print layers of living cells....

Print New Skin (Lexmar)

Life expectancy in most na6ons will increase by far

more than 1 week every month

Performance

Shift in retail health care from health treatment to life enhancement

Want to look better

may be

Want to think better......

20% students in US use memory-enhancing drugs to pass their exams

An6-Ageing will be a global

obsession - with rapid progress

Can we stop ageing ?

7 mechanisms of ageing in animal and human cells

Cell loss or atrophy without replacement

Oncogenic nuclear muta6ons and epimuta6ons

Mitochondrial muta6ons

Cell senescence (death resistant)

Intra-cellular junk

Extra-cellular junk (affects cells)

Random extra-cellular cross-linking

Worn out Mitochondria Energy Boost

R-alpha-lipoic acid

Acetyl-L-carnitine

Adenovirus

Infected mouse hair cells

Permanent colour change

Permanent Hair Colour

Treatment which restores and maintains the youthful elasticity of

hardened arteries and helps wrinkled skin. Global sales?

Low blood pressure and total body lift !

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Alteon

Monkeys on diet live longer After 20 years - 80% alive v 50% on normal calories

Less cancer, diabetes, heart disease, strokes, brain decay

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Slow or no ageing is a reality

Rockfish, Turtles, some Whales !

No signs of getting old

Rougheye rockfish (Sebastes aleutianus) 205 years Aldabra Giant Tortoise 255 years Lobsters are believed to live 100 or more years Ocean Quahog clam 405 years

Some animals do not seem to age in normal way

Many health costs will fall while total

spending will rise

Faster healing

Negative Pressure Healing

Adenoviral human

telomerase reverse

transcriptase

Funding of Health Care will be sensi6ve poli6cal issue

Patent Expiry

3000 Canadian Pharma Patents 2003-11

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Ra6oning of health care will

be seen in every na6on

Irrational Rationing

Rationing all government Health competes with .... Specialties compete Diseases / Patient groups Treatment methods Greatest impact for greatest number

Competition

Transurethral resection Laser destruction Microwave destruction Heat destruction Da Vinci robot

Competition

Patient campaigns / Google Legal / IT linked decisions Financial incentives Patient experience /quality life Local skills / experience Appropriate infrastructure

Impact on rationing

Expect rapid growth globally in private medical care, health

insurance and medical tourism

Expect many new ethical challenges e.g. beginning and end of life, data privacy, who owns genes, gene6c

discrimina6on

One of greatest ethical challenges will be improving access to health care in poorest na6ons

1 in 12 in Liberia UNICEF

1 in 10 women die in childbirth in some parts of Northern Mozambique

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1.8 million small children die every year because of dirty water supplies

In a global village, every local health problem can have a global impact - so expect more global health initiatives

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Crea6ng a Be\er World

Expect rapid innova6on in medical technology with many startups and health products launched by technology giants -

with major investment in S Korea

globalchange.com - slides and videos

Future of Health Care