Six healthcare problems I care about

“Start with the problem, not the solution” is common advice - whether it’s about building a company, doing research or solving a personal problem.

With all our new technological advancements, it can be very easy to take a cool new technology (ie. a solution) and start looking at a problem that it can solve.

But the issue is that when you’re holding a hammer, everything can look like a nail.

I’ve definitely fallen into this in the past. While working as a doctor, I became fascinated by machine learning and spent several years deep-diving. As I was learning, I kept thinking “this is really cool.. I wonder how this could be applied to medicine”. The problem is there are many problems for which machine learning is not the best solution.

While coming up with potential business ideas, I found I’d need to keep pushing myself away from the solution-focussed approach to a more problem-based one.

And today, as a continuation of this effort, I’m going to try and sketch out what I see as some of the big problems in healthcare today - things I plan to try and solve, regardless of what the solution looks like. This will be far from comprehensive, but are just some of the problems I’m thinking about most at the moment.

These are just my thoughts, and I’m not an expert in this. I’d love to hear from you - do you agree with the points? Which are you most passionate about? Any big points I’ve missed? Please hit reply!

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1. You don’t own your health data

Your health data is owned by hospitals and by commercial companies. You have limited control over who accesses your data or how it’s used. Your health data is valuable, including monetarily, but you never benefit from this.

Medicine has traditionally been paternalistic. Doctors know best, tell you what to do and you dutifully follow orders. However, when you are given control over your health information, you have greater autonomy - and this has been shown to improve health outcomes (ref).

To participate in research that would benefit you and your community, you have to give up rights to your own data - and you don’t get much back in return. You typically don’t find out the results or receive any of the commercial benefits.

2. Your health information is in many places

Traditionally, health management was only done in medical facilities by healthcare professionals. That’s now changing. More information is available and more management of health is shifting outside of the hospital setting.

New technologies generate individual-owned health data. The cost of sequencing a genome has reduced from $2.7 billion to $300, making it far more affordable. An estimated 100 million people now have their genetic sequence and over 100 million people have a smart watch, capable of monitoring their vital signs, activity levels and sleep. This offers them detailed insight into their health.

Unfortunately, this information isn’t well-linked to the ‘traditional’ healthcare information that hospitals look after. Yet 85% determinants of health are from outside the healthcare setting (ref).

If you want to go away and research your condition, or to get a second opinion, you don’t have all the information your doctors do. This makes it much harder to be proactive with managing your health.

Data is poorly shared between neighbouring hospitals - let alone those in different countries. Doctors often have to make decisions with incomplete information. 10% of all medical scans are unnecessary duplicates (ref) - and things still get missed.

3. Health research datasets are too small and lack diversity

The majority of the world’s population is not represented in existing datasets - which predominantly contain people of caucasian, Western descent. This makes personalised health insights far less accessible outside of those populations. It is research performed in these groups which have formed the basis of our understanding of diseases and their corresponding treatments.

4. Health advice is not globally accessible or equitable

Your access to healthcare is based on where you are. Health expertise is not evenly distributed across the globe and health infrastructure and cost varies significantly. There is high variability in the level of care that is accessible, dependent both on geographical location and socio-economic status. This leads to a lot of disease and death for individuals who would have otherwise been healthy.

5. Health provision is reactive - not preventative

Our current healthcare systems were set up when people were mostly young and healthy. As a result, care is reactive rather than proactive - the systems are set up to treat your heart attack, but not to prevent it.

This is a problem because an estimated 50% of global disease is chronic (ref). With more disease, there is more suffering. And healthcare costs approximately double for each additional chronic disease in the population, with more medication usage and more hospital presentations and admissions (ref). Yet much of this disease is preventable.

6. Your health data is not safe

A healthcare data record can sell for more than $1000 on the black market (ref). The next most-valued record is a credit card, which is $5.40. Your health data is worth for several reasons.

You can’t change it, so the value to criminals lasts longer. With a stolen credit card, you can cancel it and fraudulent charges can be disputed. With healthcare data, it’s not so simple.

There’s more ways it can be used against you. If you have a diagnosis that you don’t want made public, criminals can use it as blackmail. Medical records often contain addresses, birthdates and family members - which can be cross-referenced with stolen financial information. Your medical information may be used to seek medical treatment including access to prescriptions for drugs of abuse.

Healthcare systems spend only a small part of their budget on security (ref) and don’t invest in the latest technology. In 2017, a large part of the UK’s NHS was brought to a standstill by WannaCry ransomware because they were still operating Microsoft Windows 7 - an operating system replaced by Windows 8 in 2012.

Since 2009, over 2,100 data breaches have been reported in healthcare (ref). In 2021 in the US alone, over 40 million people had personal health data exposed in data breaches (ref). These breaches aren’t always publicised (one health insurance company took almost a year to notify 1.1 million members who’s data was hacked (ref), but they are happening.