Moore’s Law for More Health

In 1965, Gordon Moore, co-founder of Intel, predicted that the number of transistors per square inch of integrated circuits would double each year for the foreseeable future. It was a bold claim—the integrated circuit had only been around for seven years, so there was little history on which to base his forecast. But it proved accurate for so long and was so remarkable in representing a phenomenon that could transform a transistor that fit in the palm of the hand to something so small that 4,000 could fit across the width of a human hair, it became a law of sorts—Moore’s Law. More an aspiration than a law of nature, Moore’s Law is the definitive benchmark to measure the productivity gains achieved across a range of technical processes, from developing photo cells to brewing beer.

Moore’s Law has been applied to the life sciences, sometimes to great success. For several years in the early 2000s, the cost to sequence the human genome tracked Moore’s Law. The National Human Genome Research Institute calculated the cost of sequencing the genome at nearly $100 million in 2001. In just six years, that cost dropped to under $10 million, in line with Moore’s Law. Productivity got even better over the next seven years, when costs dropped to less than $5,000, a far better improvement than Moore’s Law would have predicted.

But the wider sphere of drug development has not always enjoyed this type of exponential improvement. For a time, Moore’s Law was applied to drug development in reverse. Calling the phenomenon Eroom’s Law—Moore’s Law spelled backwards—Jack Scannell wrote in a 2012 paper in Nature Reviews Drug Discovery that the number of new drugs approved by the FDA per billion of inflation-adjusted U.S. dollars has halved about every nine years, suggesting that drug development was worsening. At the 2012 Forbes Healthcare Summit, several pharma execs saw Eroom’s Law ending, due to improved technology, availability of biomarkers, and insights from genomics. Recent drug approval data give an encouraging sign of that improvement, with 41 new drugs approved in 2014, the highest level in the past decade.

The trouble is, progress in drug development is increasingly measured by more than drug approvals. Successful products today demonstrate safety and efficacy, meet an unmet need, achieve favorable reimbursement, and reduce the total cost of care—a complicated combination of goals that relate to a system of healthcare stakeholders. Achieving one goal while ignoring the others reduces the overall impact that promising new treatments can have on the healthcare system, whether that impact is measured in financial returns or lives improved. Connecting insights across the system helps ensure that the whole of the healthcare system improves as fast as the sum of its parts.

With homage to Dr. Moore and to the impressive gains that technology systems have achieved in 50 years, below are a few ideas to advance an interconnected system of healthcare.

Prepare For a New Healthcare Operating System
Containing the cost of healthcare requires new ways of operating, and most stakeholders believe it will come from working more closely together. In 2013, Quintiles published The Collaboration Mandate on the impact of healthcare’s changing landscape on the relationships of providers, payers, and biopharmaceutical companies. According to the surveys, less than 20% of these stakeholder groups thought they were aligned with others, but well over half expect to be in the next several years. Despite the challenges with aligning around incentives, about 75% of the stakeholders believed that working in a system presents an opportunity to improve healthcare. But the stakeholders need to figure out how to share data to make the system work. More than 70% said transparency around data and information sharing across stakeholders was vitally important to the success of an interconnected healthcare system, yet less than half thought they had the tools or expertise to optimize its use.

Backwards Compatibility Can Be The Way Forward
Oncology is the most prolific therapeutic area in the development pipeline and one of the most challenging with the lowest likelihood of approval. Challenge creates opportunity, even in discoveries that first seem like failures. In a recent opinion piece, Peter Huber and Paul Howard at the Manhattan Institute referred to a 2010 study where more than 90% of bladder cancer patients failed to respond to an experimental treatment, while one patient had “no evidence of disease” two years later. This positive result arose because of a biomarker found in 8% of bladder cancer patients that made her cancer sensitive to the experimental treatment. Reviewing other failed studies, the National Cancer Institute identified 100 responders where biomarkers may revive shelved products, the life sciences equivalent of backwards compatibility. As genomic capabilities mature, we can do more to prospectively identify unique patient populations and speed development of therapeutics suited for them. Work is already underway at places like Memorial Sloan Kettering Cancer Center with “basket trials,” which reverse the typical process of studying a specific organ first and instead examine cancers of different organs whose tumors share the same genetic mutation.

Engage Communities
I recently had the privilege to speak with a mother who enrolled her daughter in a trial to study a treatment for a rare and often fatal bone disease. Her experience was heart-wrenching, learning during pregnancy that her unborn daughter would not likely live beyond birth. As it was hopeful, with her baby girl beating the odds to survive and ultimately receiving an experimental treatment that helped her bones harden, making her capable of not only walking but also running. I asked this mom what more the drug development industry could do to help her and her inspiring daughter. I expected a request for more research of rare diseases and an impatience among those in the industry to find cures, both of which are certainly needed, but she did not ask for that. Instead, she asked that we help connect families going through the same harrowing experience so they can navigate the clinical research and healthcare systems together. We often first think of science as the means to take healthcare forward, but community helps make sure patients and families are not left behind.

Optimize the Experience
Chief Experience Officer sounds more like a role from a tech startup than healthcare. In 2007, Cleveland Clinic was among the first major academic institution to appoint a Chief Experience Officer (CXO), in response to having some of the lowest patient satisfaction scores in the country. In a few years, the clinic would be in the top 8%. Such an improvement is significant to a hospital’s economics since patient satisfaction scores are a factor in the amount Medicare reimburses. We would also do well to have CXOs that focus on patient satisfaction in clinical trial design. A recent study of oncology trials indicated that physicians under-reported as much as 75% the number of patients who had six common side effects to chemotherapy. As drugs reach the market, side effects drive down drug adherence, a problem thought to cost $100-300 billion each year. But patient experience goes beyond economics. One analysis of 55 studies across disease areas found patient experience in care settings to be positively associated with safety and clinical effectiveness. Another study of nearly 6,500 patients with acute myocardial infarction found that higher patient satisfaction was associated with better guideline adherence and lower inpatient mortality. We know that physician experience matters, but patient experience matters too.

The Gates Foundation, which focuses on global health among other priorities to promote equity for people around the world, described in its 2015 Annual Letter that it would place a big bet for the future of health. Whereas it previously took 25 years to cut the child death rate in half, the Foundation would cut that rate in half again in 15 years, an achievement of exponential improvement. It is fitting that the Foundation’s bet rests on applying to healthcare “close to the same amount of innovation that goes into making computers faster and smaller.”

Healthcare needs this type of systems thinking—and more than a few bold prognosticators with a vision for the future where there is a Moore’s Law for more health.