Over the course of numerous economic cycles and different eras in medical technology development, I have witnessed many trends, some with obviously more staying power, or greater impact, than others.
Having a bit of experience in judging the success of prior forecasts (through de novo forecasts that have confirmed prior forecasts), I wanted to look at 2009, in light of the current state of the medtech universe (in all respects), to point up what I see as some of the most important trends in medical technology development:
- Outcomes drive more, but not all, development than do episodic success. Manufacturers are focusing on longer term solutions, competing against the full spectrum of therapeutic alternatives rather than incremental improvements in their widgets.
- The recessionary economy demands, rightly or not, that homage be paid to cost. Cost is poorly understood in healthcare (hence the problem!), but it is recognized as important simply by the rate at which premiums increase or the percentage of GDP attributed to healthcare spending. Cost is difficult to assess in medical technologies, because there are long term, unforeseen implications of nearly every medtech development. Nonetheless, the manufacturer who does not bow down in homage to Cost will be quickly put out of business.
- The life spans of "gold standards" of treatment are getting shorter and shorter. Technology solutions are being developed, from different scientific disciplines, at such a pace as to quickly establish themselves, in a broad enough consensus, as new gold standards. Physicians are increasingly compelled to accept these new new standards or find their caseload shifting to those who do.
- Many manufacturers strive for being able to claim their products are "disruptive" — overturning existing paradigms. However, few medtech manufacturers really ever achieve anything more than marginal improvements. Note the relative amount of 510Ks versus PMAs in regulatory approvals (not that a PMA denotes a "disruptive" development).
- Without a broad understanding of materials technologies that encompass traditional device, pharma, biopharma, biotech, cell biology and others, manufacturers will limit their ultimate success.
- VCs are less interested in medtech than are large-cap medtech companies. The recessionary economy is causing a shift in financing from those with a short(er) term focus on innovation — venture capitalists and angels — to those with a vested stake in medical technology’s success in the long haul — the mid-cap and large-cap medical technology companies. Established medtech companies intend to stay in the medtech business, regardless of current economic variables, and therefore need strong innovation pipelines. VCs are in the business of "returns" rather than "healthcare", which may be an entirely different set of incentives.
- The credit crunch is a good thing for medtech development. Those companies who could not complete development of clinically proven, regulatory approved products during the days of free-flowing capital simply don’t belong in the business. (I recall the money-pit days of biotech in the 1980s, when capital flowed endlessly into biotechs that never realized development must have realizable value in the marketplace, not just in basic science.)
- Healthcare reform will have little negative impact on medical technology development. I am convinced of the convergence of different scientific disciplines — materials technology, cell biology, biotech, pharma and others — being capable of producing therapeutics matching the cost du jour demands of the healthcare marketplace.
- Information technology is having, and will have, profound effects on medical technology development and the manufacturers who "get" this, will always gain an advantage. This happens in ways too numerous to mention in full, but worth noting are: drug and device modeling/testing systems, meta-analysis of clinical research, information technology embedded in implants, and microprocessor-controlled biofeedback systems (e.g., glucose monitoring and insulin delivery).
- The virtually untapped frontier of medical technology applications in neurology. The collective scientific understanding of the functional roles of the brain and nervous system has reached a near critical mass at which point the equally advanced capabilities of medical technology are rapidly accelerating in their ability to modulate those functional roles for intervention in neural disease and trauma.
These are in no particular order, nor is this a complete list of important trends. Given a suggestion or further thought, too, I might well add, omit or revise these significantly.