Too Many Small Steps, Not Enough Leaps

I was driving home the other day, noticed all the above-ground telephone/power lines, and thought to myself: this is not the 21st century I thought I'd be living in. 

When I was growing up, the 21st century was the distant future, the stuff of science fiction.  We'd have flying cars, personal robots, interstellar travel, artificial food, and, of course, tricorders.  There'd be computers, although not PCs.  Still, we'd have been baffled by smartphones, GPS, or the Internet.  We'd have been even more flummoxed by women in the workforce or #BlackLivesMatter. 

We're living in the future, but we're also hanging on to the past, and that applies especially to healthcare.  We all poke fun at the persistence of the fax, but I'd also point out that currently our best advice for dealing with the COVID-19 pandemic is pretty much what it was for the 1918 Spanish Flu pandemic: masks and distancing (and we're facing similar resistance).  One would have hoped the 21st century would have found us better equipped.

So I was heartened to read an op-ed in The Washington Post by Regina Dugan, PhD.  Dr. Dugan calls for a "Health Age," akin to how Sputnik set off the Space Age.  The pandemic, she says, "is the kind of event that alters the course of history so much that we measure time by it: before the pandemic — and after."  

In a Health Age, she predicts:

We could choose to build a future where no one must wait on an organ donor list. Where the mechanistic underpinnings of mental health are understood and treatable. Where clinical trials happen in months, not years. Where our health span coincides with our life span and we are healthy to our last breath.

Dr. Dugan has no doubt we can build a Health Age; "The question, instead, is whether we will."

Dr. Dugan head up Wellcome Leap, a non-profit spin-off from Wellcome, a UK-based Trust that spends billions of dollars to help people "explore great ideas," particularly related to health.  Wellcome Leap was originally funded in 2018, but only this past May installed Dr. Dugan as CEO, with the charge to "undertake bold, unconventional programmes and fund them at scale."  Dr. Dugan is a former Director of Darpa, so she knows something about funding unconventional ideas.

Leap Board Chair Jay Flatley promised: "Leap will pursue the most challenging projects that would not otherwise be attempted or funded. The unique operating model provides the potential to make impactful, rapid advances on the future of health."  

Now, when I said earlier that our current approach to the pandemic is scarily similar to the response to the 1918 pandemic, that wasn't being quite fair.  We have better testing (although not nearly good enough), more therapeutic options (although none with great results yet), all kinds of personal protective equipment (although still in short supply), and better data (although shamefully inconsistent and delayed).  We're developing vaccines at a record pace, using truly 21st century approaches like mRNA or bioprinting.  

The problem is, we knew a pandemic could come, we knew the things that would need to be done to deal with it, and yet we -- and the "we" applies globally -- fumbled the actions at every step.  

We imposed lockdowns, but usually too late, and then reopened them too soon.  Our healthcare organizations keep getting overwhelmed with COVID-19 cases, yet, cut off from their non-pandemic revenue sources, are drowning in losses.  Due to layoffs, millions have lost their health insurance.  People are avoiding care, even for essential needs like heart attacks or premature births.  

Our power lines are showing.  The the hurricane that is the pandemic is knocking them down at will.  We might have some Health Age technologies available but not a Health Age mentality about how, when, and where to use them. 

Dr. Dugan thinks she knows what we should be doing:

To build a Health Age, however, we will need to do more. We will need an international coalition of like-minded leaders to shape a unified global effort; we will need to invest at Space Age levels, publicly and privately, to fund research and development. And critically, we’ll need to supplement those approaches with bold, risk-tolerant efforts — something akin to a DARPA, but for global health.

Unfortunately, none of that sounds like anything our current environment supports.  The U.S. is vowing to leave the World Health Organization and is buying up the worlds's supply of Remdesivir, one of the few even moderately effective treatment options.  An "international coalition of like-minded leaders" seems hard to come by.  Plus, only half of Americans say they'd take a vaccine even when it is here.

If COVID-19 is our Sputnik moment, we're reacting to it as we did Sputnik, setting off insular Space Races that competed rather than cooperated, focused narrowly on "winning" instead of discovering.  We will, indeed, spend trillions on our pandemic responses, but most will be short-term, short-sighted programs that apply band-aids instead of establishing sustainable platforms and approaches.  We're reacting to the present, not reimagining the future.

Credit: Darpa

Darpa's mission is "to make pivotal investments in breakthrough technologies for national security," and it "explicitly reaches for transformational change instead of incremental advances."  Her background at Darpa make Dr. Dugan uniquely qualified to bring this attitude to Leap, and to apply it to healthcare.  

The hard part is remembering that it is not about winning the current war, or even the next one, but about preparing for the wars we're not even thinking about yet.  

Most of our population are children of the 20th century.  Our healthcare system in 2020 may have some snazzier tools, techniques, and technologies than it did in the 20th century, but it is mostly still pretty familiar to us from then.  If we truly want a Health Age, we should aspire to develop things that would look familiar to someone from the 22nd century, not the 20th.

Every time I read about the latest finding about our microbiome I think about how little we still know about what drives our health, just as our growing attention to social determinants of health reminds me how we need to drastically rethink what the focus of our "healthcare system" should be. 

Not more effective vaccines but the things that make vaccines obsolete.  Not better surgical techniques but the things that make surgery unnecessary.  Not just better health care but better health that requires less health care.  If we're going to dream, let's dream big. 

That's the kind of Leap we need.