Table Of Content2030: The Future of
Medicine
i
About Richard
Richard has spent most of his career in healthcare, as a leader of organizations,
as a board member and as a consultant. His leadership roles have spanned
therapeutics, diagnostics and informatics, both in the United States and in
Europe. He was recently voted as one of the top 50 most influential people
in UK healthcare and he sits on several healthcare and life sciences advisory
boards on both sides of the Atlantic.
His passions include securing a sustainable future for healthcare and
redesigning how new medical technology is brought into practice. He now
lives in London but is a frequent visitor to the US, where he spent 11 years
working in Boston, New Haven, New York, and San Francisco.
“A very engaging and enjoyable read, covering a colossal amount of ground
without feeling stretched…translating the more upstream science into
practical implications for the general public. A great primer on the health
future—for both the health-informed and those coming to such thoughts
for the first time.”
Sam Lister, Health Editor, the London Times
ii
“The next 20 years will see huge strides in how medical science could
transform our lives. This book not only describes what will be possible but
also whether and how we can afford it.”
Professor George Poste, Del E. Webb Chair in
Health Innovation, Arizona State University
“An accessible and comprehensive snapshot of the complex healthcare
environment with which policy makers wrestle…laying out the tremendous
tensions that exist in a manner which leaves a sense of optimism not defeat.
A must read for those who want to be part of solutions to get best treatments
to the most people and allow us all to benefit from one of the most
remarkably exciting fields of human activity…understanding and fixing
ourselves.”
Andrew Witty, Chief Executive, GlaxoSmithKline
“This book is a must for healthcare leaders on both sides of the Atlantic.
It grapples with the big question of how we can afford the future.”
Ken Jennings, Consultant to leading US health systems
and author of best-selling book The Servant Leader.
2030: The Future of
Medicine
Avoiding a Medical Meltdown
iii
Dr Richard Barker, MA, FRSM
Great Clarendon Street, Oxford OX2 6DP
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide in
Oxford New York
Auckland Cape Town Dar es Salaam Hong Kong Karachi
Kuala Lumpur Madrid Melbourne Mexico City Nairobi
New Delhi Shanghai Taipei Toronto
With offices in
Argentina Austria Brazil Chile Czech Republic France Greece
Guatemala Hungary Italy Japan Poland Portugal Singapore
South Korea Switzerland Thailand Turkey Ukraine Vietnam
Oxford is a registered trade mark of Oxford University Press
in the UK and in certain other countries
Published in the United States
by Oxford University Press Inc., New York
© Oxford University Press, 2011
The moral rights of the authors have been asserted
Database right Oxford University Press (maker)
iv First published 2011
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
without the prior permission in writing of Oxford University Press,
or as expressly permitted by law, or under terms agreed with the appropriate
reprographics rights organization. Enquiries concerning reproduction
outside the scope of the above should be sent to the Rights Department,
Oxford University Press, at the address above
You must not circulate this book in any other binding or cover
and you must impose the same condition on any acquirer
British Library Cataloguing in Publication Data
Data available
Library of Congress Cataloging in Publication Data
Data available
Typeset by Newgen Imaging Systems (P) Ltd., Chennai, India
Printed in Great Britain
on acid-free paper by
Ashford Colour Press Ltd., Gosport, Hampshire
ISBN 978–0–19–960066–3
10 9 8 7 6 5 4 3 2 1
Whilst every effort has been made to ensure that the contents of this book are as complete, accurate
and-up-to-date as possible at the date of writing. Oxford University Press is not able to give any
guarantee or assurance that such is the case. Readers are urged to take appropriately qualified
medical advice in all cases. The information in this book is intended to be useful to the general
reader, but should not be used as a means of self-diagnosis or for the prescription of medication.
Contents
Acknowledgements vii
Abbreviations ix
Introduction and summary v 1
1 The supply of new medicine—unlimited? 7
2 Healthcare demand—insatiable? 35
3 Medical meltdown—unavoidable? 51
4 Taking responsibility—a healthcare agenda
for the next 20 years 87
5 Conclusion—the US, the UK, and the Middle Way 103
Epilogue 111
Index 113
This page intentionally left blank
Acknowledgements
I owe a great debt to many close colleagues over the years, in the diverse
British and American organizations serving the world of healthcare for which it
has been my privilege to work. Colleagues from McKinsey, IBM, Chiron,
iKnowMed, Molecular Staging, the ABPI, and the NHS will all recognize insights
gained while working together in these very different settings.
However, those who kindly read, critiqued, and improved this book deserve
particular thanks: Professors Adrian Towse and Nancy Devlin of the Office of
Health Economics; Professor Sir Alasdair Breckenridge, Chairman of the UK
Medicines and Healthcare Products Regulatory Agency (MHRA); Professor
Sir Michael Rawlins, Chairman of the National Institute for Health and Clinical
Excellence (NICE); Professor Nick Bosanquet of Imperial College; Sam Lister,
Health Editor of the London Times. All commented very helpfully.
Thanks, too, to my editor at Oxford University Press, Nic Wilson, who has
been unfailingly encouraging and helpful from the outset.
Any errors and omissions are mine alone, of course. vii
My thanks go also to my wife Michaela, who has been both inspiring and
tolerant as this book took shape. I’m also grateful for three wonderful children,
Daniel, Joseph, and Hannah, for their encouragement and love over the years.
It is to their children that the book is dedicated: they will inherit the
healthcare innovations we see by 2030, and the changes we make to the
healthcare system in the intervening years. My hope is that these changes will
be for the better.
This page intentionally left blank
Abbreviations
ABPI Association of the British Pharmaceutical Industry
AIDS acquired immunodeficiency syndrome
ARP Alzheimer’s risk profile
AVM arteriovenous malformation
BMI body mass index
CME continuing medical education
COMT catechol O-methyl transferase
COPD chronic obstructive pulmonary disease
CT computerized tomography
DNA deoxyribonucleic acid
DRG diagnostic-related groups
EMR electronic medical record ix
ESC embryonic stem cell
FDA Food and Drug Administration
GCP good clinical practice
GDP gross domestic product
GINA Genetic Non-discrimination Act
GP General Practitioner
HDL high-density lipoprotein
HIV human immunodeficiency virus
HMO Health Maintenance Organization
HTA health technology assessment
IBS irritable bowel syndrome
IHS integrated health systems
IQWG Institute for Quality and Efficiency in Health Care
LDL low-density lipoprotein
MBP myelin basic protein
MHRA Medicines and Healthcare Products Regulatory Agency
MN motor neuron disease
