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View From The Future

By Simon Eastel & Pythia Demosthenes

May 12, 2005 | Nearly 100 years ago, in 1953, the structure of DNA was revealed, heralding a new age of biomedical discovery. Fifty years on, the new millennium dawned and the human genome was sequenced, signaling the beginning of the fantastic genome voyage. People of industrialized nations dreamed of improved health and longer lives. U.S. President Bill Clinton predicted that children born back then (in their 50s now) would know cancer only as a sign of the zodiac.

But the astrologers did a better job of predicting and, as we know now, health benefits were few and far between. Ailing biotechnology and pharmaceutical companies merged and merged again as patents expired, regulations became more onerous, and new blockbuster drugs failed to appear. By 2020, only two large corporations — the drug duopoly — survived. The biomedical model of the 20th century (the pharmaceutical age) was itself terminally ill. At the same time, our parents and grandparents expected better health services as they lived longer. The ‘new old,’ as they became known, would not age gracefully and quietly, as people had in previous generations. They had grown up expecting to get what they wanted, and they now expected long, healthy lives.

Medicine in the early 21st century seems crude and barbaric to us now: foggy MRI scans, broad-spectrum drugs with nasty side effects, and patients who knew more than their doctors. Today’s vibrant, dynamic, global ‘healthscape’ was unimaginable. The blooming of our health system was like the growth of the World Wide Web at the end of the 20th century. Now ubiquitous, powerful, and pervasive, its arrival was silent and largely unnoticed. What surprises historians today is that, as recently as 2020, people expected better health to be delivered by doctors (the medical professionals as they were then known) and by the economic juggernauts of the time, ‘the pharmas.’ To everyone’s surprise, it was delivered instead by technologists riding the wave of the new media (formerly ‘the press’).

In 2014, the Museum of Media History published its classic account of the decline of the fourth estate and the rise of EPIC — the Evolving, Personalized Information Construct. EPIC was described as “the system by which our sprawling, chaotic mediascape is filtered, ordered, and delivered. Everyone contributes [most as both producers and consumers of content] — from blog entries, to phone-cam images, to video reports, to full investigations.” Developed in 2014 by Googlezon (formed when Google and Amazon merged), it used fact-stripping robots that dynamically created personalized news stories, and was built on the Google Grid. Its success marked the demise of Googlezon’s main competitor, Microsoft.

EPIC’s impact on healthcare was slow in coming, but by 2030, the outline of today’s health system had emerged. Following the Standards Wars of the early 2020s, the MEDical Information Construct (MEDIC) was established as the universal standard. An older standard known as the Personal Health And Life Long Information Construct (PHALLIC) lingered for a few years in parts of the United States, where it first arose, before becoming limp and ineffective. MEDIC was more than just a standard: it was the information infrastructure that empowered people to manage their own health, and not be controlled by the power brokers that dominated healthcare in the late 20th century.

A defining and surprising feature of the Media Wars of 2010 was that none of the players (or winners) were media organizations themselves. Similarly, the established players in the health industry — hospitals, pharmaceutical companies, government health departments — were absent from the battlegrounds of the Health Standards Wars of the early 2020s. When the World Health Organization called a global summit in 2025 to discuss ethical, intellectual property (IP), and privacy issues, its agenda was already irrelevant, pre-empted by MEDIC’s widespread adoption, acceptance, and success.

The Science
It’s hard to believe the health we enjoy today was rare even a generation ago. The past 100 years have seen ‘health’ displace ‘medicine’ as a concept. Health is about prevention of sickness and physical decay, and about the treatment of causes, not just symptoms. The story of how our current health system was born — the road to MEDIC — begins in the 1940s, when the first computer (‘Colossus’) was built.

The task faced by that computer is not unlike that faced by today’s HealthGrid, which underpins MEDIC. HealthGrid is a fabric of billions of computers holding trillions of bits of health information, all linked in real time to information about millions of people, the world’s expanding repository of scientific and medical knowledge, and thousands upon thousands of research projects and trials.

In 1980, James Fickett and colleagues at the Los Alamos National Laboratory established GenBank as a repository of gene sequences emerging for the first time from research laboratories. GenBank would eventually move to the National Center for Biotechnology Information (NCBI), which quickly became a driving force in the emergence of digital life science.

The sequencing of the human genome by Celera Genomics and a public international consortium cemented the fusion of IT and life science. IBM’s establishment of its Life Sciences business in 2000 and a global Healthcare and Life Sciences Division in 2004 signaled the maturation of information-based medicine. These events also established private and corporate capital as driving forces in biomedical research. Government funds continued to be important well into the 2020s, but had become insignificant by the late 2030s.

Molecular bioscience was by now well established in medicine. Individual genomes were sequenced as early as 2004. By 2020, personalized “genoming” was a routine procedure.

By 2010, government agencies required robust information management systems as a condition of funding. Similar requirements were made for clinical trials, and within a decade, standards and systems were established to allow direct access to research results within companies and institutes around the world. The Global Research Grid was born. The system was originally intended only to improve productivity and use of resources within the research community, but once set up, it became much more widely available. All that was required was the impetus to access it.

In 2020, the world’s first modern biomedical research institute opened its doors in San Francisco. The only permanent staff were executives and IP lawyers. All research was carried out under contract, mostly at facilities in India and China. Warner Brothers was a substantial investor in the new venture, bringing its expertise in aggregating talent on a project basis for the entertainment industry, which it applied to the new growth area of biomedical science R&D outsourcing. Scientists, technicians, and engineers, mostly free agents, were recruited to work on individual projects. What we now know as the Bollywood model of scientific research was born. The new institute was able to immediately tap into the Global Research Grid.

The Patients
While scientific information was rapidly digitized, health information was slower to take hold in the digital world. In 1996, Netscape founder Jim Clark launched Healtheon (later absorbed into WebMD) as part of his dream of removing waste from the healthcare system. As Clark put it: “We want to empower the doctors and the patients and get all the other [idiots] out of the way, except for us.” But his dream was never realized. It did not go far enough.

Initial attempts to digitize medical information focused on institutions rather than individuals. It was not until attention shifted to people that the real impact of IT on health was felt. Leading the way was the U.K. National Health Service, which in 2003 launched HealthSpace, providing people with their own personal health planner. Although ultimately unsuccessful, HealthSpace led to wide acceptance of people accessing, controlling, and eventually owning their own health information.

The Australian government’s foresight in piloting one of the earliest patient-centered record systems in 2007 paid off and led to the partnership that gave rise to GoogleHealth. Launched in 2010 and powered by GoogleGrid, GoogleHealth allowed individuals to store privately or publish their own health information. All components of the healthcare system participated and, for the first time, diverse information provided by patients and their own monitoring devices was combined with records supplied by hospitals, pathology and imaging services, and general practitioners.

Initially intended for young adults, the system was most enthusiastically embraced by the baby boomers. They eagerly populated it with information about themselves and insisted their doctors do the same. In time, people published their own health information in anonymous form and were able to compare aspects of their health and lifestyles with millions of others. GoogleHealth’s powerful search engines allowed participants in the fast-growing Health Grid to see ‘virtual populations’ of individuals who were genetically and behaviorally like themselves. They could see health trends in these populations that had real and direct meaning to their lives, and they started to adopt the practices of their ‘virtual peers’ to derive the same health benefits.

The Knowledge
In 2000, NCBI began open-access science publishing when it launched PubMed Central, its freely available, digital archive of life science journal literature. The Public Library of Science and other open-access publishers quickly followed suit. In 2005, the National Institutes of Health began requiring the free availability of results from publicly funded research. By 2010, all major funding agencies around the world had followed and, with back issues scanned and digitized, virtually all the world’s published scientific knowledge was freely available to everyone.

Despite direct access, much of the published scientific literature was written in arcane language, fragmented, and of unclear significance. Editors and aggregators emerged, interpreting and repackaging material for specific purposes, combining their own expertise with computer editing technology. These new professional ‘bioinfomediaries’ were the precursors of today’s Health Guides.

Science Commons, launched in 2005 as part of the Creative Commons initiative, provided the legal framework that ensured ongoing control over the use of content by authors in an open-access environment. It fuelled the growth of self-publication, leading to the demise of commercial and independent scientific publishers and ultimately the peer review system. By the 2020s, peer review had been replaced by online expert review, and impact was measured by citation, access and download data, and peer commentary. Fully open, dynamic assessment and evaluation of research was here to stay.

Science Commons’ contribution to the nascent Open IP movement extended beyond copyright to include patents, but two breakthroughs ensured the survival of the patent system. First, patent offices made their filings and other content freely available to developers of natural language processing and related technologies. IP transaction costs plummeted as searches and analysis of dependencies and overlaps were automated using open standards. Second, the patent offices open-sourced their examination process, hence they were no longer dependent on their in-house capabilities.

A system that had once threatened to stifle progress was now restored as the engine for new technologies and business processes. When it was finally integrated with Science Commons and the System for Automated Royalty Payments, innovation flourished.

The Convergence
In 2022, Googlezon launched MEDIC, plugging EPIC’s powerful engine directly into the Global Research Grid, the community of bioinfomediaries with their knowledge-mining capabilities, and GoogleHealth’s individual health management platform. MEDIC generated anonymous aggregated lifetime information about all its participants and combined these with dynamically edited digests of published knowledge and research to produce relevant information constructs tailored to meet individual needs.
MEDIC directly linked individuals with healthcare providers, researchers and engineers, and the scientific and medical literature. ‘Health guide’ arose as a new profession. Part doctor, part patient advocate, part journalist, and part investment advisor, health guides provided assistance and a range of ancillary services to MEDIC users.

MEDIC’s real success was based not on its powerful technologies, but on the business processes that these enabled. MEDIC became a platform by which individuals engaged directly with research production companies in studies and clinical trials. This direct access greatly enhanced the value and scope of these studies and trials. It also substantially reduced transaction and insurance costs and the need for regulatory oversight. Many more people participated, and the scope of data collection became virtually limitless.

More important, people became active participants rather than the passive subjects they had been in the past. Participants were given tradable shares in exchange for their participation. This single measure was transforming. Wealth and health converged, and health literacy soared. Participants became acutely interested in the progress of trials and the outcome of research projects. They could also actively invest in the companies managing projects or withdraw their participation at will.

MEDIC users also had access to extensive de-identified information about the health of others who had similar genetic make-up, life history, and dietary and exercise regimes, or who used the same medications or suffered similar ailments. They were able to compare their well-being and progress in real time and determine for themselves the efficacy of their health management programs.

The Legacy
‘Health maintenance’ has become a global pastime. Most people are now active participants in research and contribute data from all aspects of their lives. They also spend more time understanding their own health than they do watching sports or managing their finances.

Some research institutes embraced the Bollywood model and survived: reinvigorated and transformed from their former selves, they are now key elements of the healthscape. Most did not. Clinging to their old ways, they limped on, doing what they had always done well - producing arcane work of little relevance beyond the confines of their own world. They contributed little and their activity was no longer sustainable. Government support waned, their reserves dwindled, and they were sidelined and finally closed.

Remnants of the former biotechnology and pharmaceutical industries survive to this day. Those that did survive adapted and set up their own successful research production companies. Many of today’s leading biotechnology production facilities in India and China were once part of large transnational companies, and many freelance researchers and engineers were once their employees.

In the 2050s, we enjoy healthcare that is largely free from government control. Home-based care and mobile clinic companies work with health guides to provide most services. Some hospitals survive, but thankfully almost all of the crumbling monoliths of the past have disappeared.

If MEDIC’s parent company were ever to consider abusing its monopoly position, the demise of Microsoft is there as a reminder of what would happen; the open-source spirit is alive and well and ready to leap into action whenever the need arises. MEDIC works because it is what we want our health system to be. It’s what we got when people, not genes or cells or hospitals, became the focus of our attention - when we harnessed powerful technologies and put them to work in an open market. And in the end it works because it gave us control of our own destinies.

Those of us approaching our second century of life demanded something better and were allowed to have it.  l

Professor Simon Easteal is at the John Curtin School of Medical Research, Canberra, Australia. Pythia Demosthenes is a pseudonym. This essay is adapted from, and was first published in, Australian Life Scientist magazine.

Photo by Stephen Webster

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