“People are the sum of their data.”
An interview with Markus Müller, rector of the Medical University of Vienna
Professor Müller, as Austria’s largest health insurance provider we would like to know: what are the biggest trends that will shape medicine in the years to come?
Today, we are at the point where we can portray a human genome – the thing that makes this one person different from everybody else – at an economically viable price. In the beginning, this cost 3 billion US dollars; today, it is feasible for around €500. Behind this lies the incredible progress of digitalisation. And meanwhile, we are already approaching the next phase – the new model emerging in medicine, which states: people are the sum of their data. So now you can not only characterise a person in detail at the genetic level, but also at many other levels, such as that of their proteins and metabolism and save a digital “avatar” of a person. This means you are in a position to predict how a person’s health will develop in future.
So, do these developments mean that humans will live longer?
Yes, because it means that any disease will be seen as a unique situation. You don’t just have cancer, but rather a specific and individual tumour that will also be treated individually. This concept could be used for any illness, not just for oncology.
Won’t medication become extremely expensive if it has to be made specially for each patient?
Not necessarily. In Austria, we currently have about 10,000 medicines at our disposal. What we often don’t know is exactly which of them will be useful against a disease. So we don’t really have a good basis for making decisions; medication is administered on an empirical basis. With the new methods you can basically look for the needle in the haystack, so to speak, to find the pivotal switch. You thus can analyse exactly which of the already existing medications will work best in a particular case.
“Today, we are at the point where we can portray a human genome at an economically viable price. In the beginning, this cost several billion dollars; today, it is feasible for around €500.”
What does this development mean for a sick person?
In about ten years we will probably analyse every person’s genome right when they are born. That will make the so-called precision-medicine model viable, meaning that you will no longer get off-the-shelf medicine, but rather customised medicine.
Then society would become healthier as a whole?
Yes, that is the hope. Today, we mainly practise curative medicine – so we wait until a disease appears and then we treat it. This isn’t really ideal. Conversely, the idea behind the new technologies that I mentioned is to target prevention. In other words: moving away from hospitals and towards near-patient care. Ideally, you discover a disposition towards a certain illness very early, and can already start treatment in this early stage. And so the trend is moving away from curative medicine to preventative medicine.
“The objective is not to maximise the years you have, but to have as many healthy years as you can. Because this is our biggest problem nowadays, especially in Austria. We are living very long, but we are also unhealthy for many of those years.”
How would a person’s lifetime develop in light of these new changes in medicine?
There are futurists who say that a person can live to be 130 years old. And then there are realists who say that the goal is not to maximise the amount of years you have, but rather to have as many healthy years as you can. Because this is our biggest problem nowadays, especially in Austria. We are living long, but we are unhealthy for many of those years. From the age of 60, most of us have plenty of pains and often end up spending the next 20 years in suffering. I think the challenge is to reduce this period of suffering from the bottom up. And the best way to add healthy years to your life is through a healthy lifestyle: nutrition, lifestyle, hygiene, exercise. The fact that we live to be 80 nowadays instead of 40 is a civilisational achievement.
Why is Austria doing so poorly?
Because many Austrians smoke and drink alcohol on a regular basis.
So that means that Austrians would have to eat differently, more vegetarian, in order to live longer and, above all, healthier?
Well, you don’t necessarily have to eat a vegetarian diet, but a healthy one. This would allow us to make progress and reduce costs in the healthcare system.
“The genome is like a book that contains everything your parents passed on to you.”
Can I picture the genome like a personal code?
Yes, exactly. You are made up of 25,000 genes and the genome is like a book that contains everything your parents passed on to you. In addition, there are also other influencing factors, such as the environment, and risks to which you expose body.
But what does that mean now for insurance? Will insurance companies in future only provide health insurance to people who can show that they have a good genome in terms of health?
There are certainly many discussions about that. But this “cherry picking” would go against the concept of insurance, after we had just evened the odds against fate.
"Austria continues to be among the front-runners when it comes to the number of hospital admissions and the length of stays compared to other countries.”
What effect will these trends have on hospitals?
Austria continues to be among the front-runners when it comes to the number of hospital admissions and the length of stays compared to other countries. This isn’t very wise because a hospital is not a safe environment – there are dangerous germs there. In the US, the first “hospital without patients” was founded. This is a telemedicinal concept that uses sensors and wearables via Skype to try to prevent patients from going to the hospital, and instead to support them at home so that they can take care of themselves. It works quite well for some diseases, such as diabetes. This form of self-management will become a trend. And that means that huge hospitals like the ones we know today may cease to exist.
“Today, around 80 per cent of patients receive their chemotherapy on an out-patient basis. The step from in-patient to out-patient care will become more common.”
We also see this very prominently in oncology: today, around 80 per cent of patients receive their chemotherapy on an out-patient basis. The step from in-patient to out-patient care will become more common. We also won’t need to have doctors for every specialisation any more. One example might be radiology, or, image recognition. You have already seen this on your mobile phone, where photo recognition can pick out all the pictures of your mother automatically. In future, you will send in an x-ray and a machine will generate a report. This means that patients will no longer be dependent on the subjective impression of a radiologist. The principle is also similar in pathology. It’s about pattern recognition, and that’s what machines will do in future. Because it’s so easy to process by machine, pure knowledge no longer has any economic value, which means that even as a well-informed human you no longer have any competitive advantage.
“In 2045 there will be an interface between humans and machines. That means you can plug the brain into a computer.”
Will it ever come to the point where humans have built-in sensors and in future are simply notified when they should go to the doctor?
I think so, in 20 to 30 years maybe. It’s already being worked on. Many things that happen today were unthinkable 30 years ago. It was thought that it would be impossible to identify a genome in less than 100 years. At that time, they simply underestimated the rapid development of technology. In 2045 there will likely be an interface between humans and machines. That means you will be able to process information that is formed in the brain directly on a computer. So you could save the information stored in your brain on a hard drive, where your feelings, your memories, would be recorded. But I am not worried that doctors will disappear, quite the contrary. There are many things that machines cannot do nearly as well as we do: show feelings, integrate and cooperate, be creative. In future in this high-tech environment doctors will stand by their patients as empathetic companions. And in my opinion that is good, because it helps to make the medical field less technical and cold. Doctors will accompany people along life’s path.
“In the future, you will send in an x-ray and a machine will generate a report. This means that patients will no longer be dependent on the subjective impression of a radiologist.”
Markus Müller has been rector of the Medical University of Vienna since 2015. Previous to that he was head of the Univer sity Clinic for Clinical Pharma cology at the Vienna General Hospital (AKH). He completed his training as a specialist in internal medicine and clinical pharmacology in Austria, the US and Sweden.