In the afternoon, slightly concerned about your sloth, you check the data from the metabolism meter, which is integrated into your watch. Its internal accelerometer has been tracking your every move since you woke up. Its camera has been snapping pictures of every morsel consumed, comparing each with a massive image database of foods of different portion sizes and their caloric values. Sophisticated algorithms chug all of these numbers and calculate your minute-to-minute energy flow. At your request, it spits out a recommendation: cardio exercise for 45 minutes. You head to the gym.

That’s the kind of future scenario that could be the answer to today’s obesity epidemic, says Kong Chen, director of the metabolic research core at the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases, who is working on developing such a device. For the last 30 years, our increasingly processed food supply and sedentary lifestyle have made two-thirds of the U.S. population overweight or obese. “I think technology helped us to be in this boat to begin with,” he remarks. “Hopefully, technology will help us get out of it.”

Pathways recently asked pioneers of health science: what’s in store for the next 15 years? Like Chen, many said that the answers to our largest health problems—from the slow death of drug development to the unknown costs of chemical exposures—will emerge from technological innovation. In addition, tomorrow’s healthcare will turn increasingly patient-specific.

As summed up in “Top 10 Health Industry Issues in 2010: Squeezing the Juice Out of Healthcare” from PricewaterhouseCoopers: “Faced with a revenue growth rate that has dropped from 9.9% in 1997 to 1.3% in 2008, pharmaceutical companies are shifting toward a more comprehensive patient-centered approach.”

A report by the New Development Paradigms (NEWDIGS) program of the Center for Biomedical Innovation at the Massachusetts Institute of Technology (MIT), outlines the basis of the problem: “Despite an enormous increase in R&D investment, and historical advances in technology through genomics, automation and computation, the number of new drugs produced each year remains at the same level that existed over 40 years ago (about 20 per year). Many of these new drugs do not match up to the most pressing medical needs we face today, and serious safety issues still crop up on medicines that have been approved, marketed, and administered to millions of patients.”

In short, the central business model of pharmaceutical companies is old, and ready for renovation. “Since World War II, big pharma has operated as a vertically integrated conglomerate,” explains Ron Wooten, executive vice president of corporate development at Quintiles in Durham, N.C. “They relied on their own research, development, sales, marketing—all within their own control.” That strategy worked while big pharma companies reaped the benefits of drugs for infectious diseases, cardiovascular diseases and other blockbusters. “Companies can no longer get that kind of return on capital,” says Wooten, “so they need a new model: more virtual, more partnering oriented and more collaborative with all of the stakeholders, including policymakers, payers and even financial resources.” In this way, the risk behind drug discovery and development gets spread among a team.

Such a business transition makes sense in theory, but presents numerous challenges in practice. While many large pharmaceutical firms face dwindling revenue as blockbusters go off patent, the companies also face higher expectations of drug safety and efficacy from regulators, payers and consumers. Moreover, drugmakers must leverage today’s technological tools to offer more personalized, patient-specific medicines for tomorrow and find ways to serve emerging markets, such as China and India, where economic boundaries and educational barriers are dissolving, paving the way for many more market opportunities. To make so many transitions at once, pharmaceutical companies will need new collaborations, fresh thinking, and all of the tools for furthering innovation.

The pile of useful parts increased dramatically with the sequencing of the human genome in 2003. This sequence provided fundamental elements for turning more data than ever into resources to better understand biological mechanisms in health and disease. Even genomes of other organisms, such as parasites and viruses, can advance healthcare. Unraveling plant genomes might lead to improved medicines and vaccines. With so many genomes that could prove beneficial to healthcare, the amount of sequencing information expands by the day. In 1982, for instance, GenBank—a sequence database managed by the U.S. National Institutes of Health—contained data on 680,338 nucleotides and 606 sequences. By 2008, those numbers grew to nearly 100 billion nucleotides and almost 100 million sequences. Then, there’s Europe’s primary sequence database, EMBL-Bank, and Japan’s DNA Data Bank of Japan, or DDBJ. On one hand, this broad expanse of information provides a healthcare bonanza; on the other, it creates a raging torrent of data, one difficult to control and use.

Even in the face of the genomics-data mountain, other classes of information promise to grow even larger, and far more complex. Today’s useful data range from sequences and single nucleotide polymorphisms to molecular biomarkers and biochemical pathways related to specific diseases. Moreover, recent developments mark a turning point—according to Stephen Friend, president and co-founder of Seattle-based nonprofit Sage Bionetworks—“from viewing diseases as defined by symptoms to considering diseases as changes in the [biomolecular] network state of the person.” The network, he says, is made up of interacting proteins, and most diseases arise as a consequence of often subtle but profound shifts in a network component rather than something going haywire with a handful of genes, as in Huntington’s disease. “If we can think of the disease in terms of network models, then when we go to design a drug [and] biomarkers, we can frame that biomarker in the terms of the network,” Friend says.

Further still, with so much information, from gene sequences to biomolecular pathways, researchers must take charge of even more data, especially data on individual patients, to smooth the pathway to personalized medicine.

To make tomorrow’s U.S. a healthier one, the healthcare industry as a whole—including drug and device makers, service providers, regulators and insurers—must find ways to improve overall value. As Fendrick and his colleagues note: “High-value healthcare has been defined as the right care to the right patient at the right time for the right price.” That multi-dimensional definition alone reveals the interactions necessary to bring more value to healthcare; indeed, all of health’s stakeholders must find ways to work together more effectively. The key question is: how can teamwork in this complex arena of health translate into value?

Improving healthcare demands innovation, but not just any innovation will do. It should be high-value innovation, which John Doyle, vice president and practice leader with the consulting group at Quintiles in Hawthorne, N.Y., defines as, “technology that makes a difference in real-world practice.” He adds, “The value is really a variable more than a fixed metric. It’s a function of who is using the technology and who derives value from it.”

In the past, many professionals in healthcare equated value with the amount that a payer would reimburse for a specific pharmaceutical product, medical treatment or device. But today’s healthcare value also depends on the perspective of patients, providers and healthcare policymakers. “Value will be measured differently by different stakeholders,” says Doyle. In fact, those different perspectives on value will grow even more important in the coming years, and every side will be looking for more powerful and accurate ways to measure healthcare value in the real world, rather than relying on some overly controlled aspects of past methods, such as placebo-based clinical trials.

The changing landscape of healthcare value, however, stretches far beyond the U.S. The demands for better health—improved outcomes, more economical treatments, advanced tools for diagnosis, techniques to improve adherence to medications and more—rumble in nearly every corner of the globe. Consequently, strategies to bolster value must investigate healthcare’s weak points at all stages—from birth to death, from drug discovery to treatment delivery—and build new and stronger approaches.

Today’s patients distrust many aspects of the healthcare system—the regulators, the medical gatekeepers, the drug producers—and grow continually more resolved to take charge of their own treatments. The well-publicized examples of unsafe drugs and the rising cost of healthcare are key drivers of today’s movement toward “patient- centricity.” As out-of-pocket expenses increase—due to the dwindling levels of insurance coverage, rising co-pays and large numbers of people completely uninsured—patients insist on knowing more about potential treatment options, and demand that this information be supported by real-world evidence. At the same time, expanding knowledge resources, such as the Internet, provide consumers with the opportunity to proactively learn more about their own or their loved ones’ medical conditions, treatment options and to even interact with other patients around the world. Consequently, patients play a crucial role in today’s healthcare, and that trend appears poised to escalate and drive further changes in the industry.

“Patients would rather not be passive consumers of healthcare services,” says market analyst Richard K. Miller, president of Richard K. Miller & Associates and author of the annual Healthcare Business Market Research Handbook, now in its 14th edition. “Given the choice, they want to know about their health and medical condition, what healthcare services would cost, the efficacy of prescribed treatments and the clinical competence of their physicians and hospitals. Fortunately, such information is increasingly available to them, and the effects on the healthcare system can be highly beneficial.”

Individuals are becoming more informed, choosy consumers. Moreover, their charge to take over their own healthcare goes even deeper than traditional approaches to health. In some cases—more than imagined by many industry experts—patients already opt for lifestyle changes over prescription medicines when possible. In addition, consumers insist on evidence, such as examples of real-world outcomes from patients like themselves, before they will pay for a treatment or endure one that might not produce the desired outcome.

With patient-centricity and consumer disgruntlement both increasing, the biopharma and healthcare industries must ask themselves: what will it take to regain consumer trust and how will these trends affect our business?

For today’s health challenges and tomorrow’s solutions, numbers tell many of the stories. The foundation needed to support a strong healthcare system, for example, depends on how many people it must accommodate. And perhaps even more important, the needed health infrastructure must be designed to adapt to a growing number of consumers. According to the U.S. Census Bureau, the world population doubled from 1959 to 1999— increasing from 3 to 6 billion in just 40 years. Although the growth rate is expected to slow, the bureau estimates that the world population will hit 9 billion by 2045. Even now, the sheer size of the world’s population creates a formidable healthcare challenge. With today’s population still under 7 billion and health systems already stretched beyond capacity in many parts of the world, what changes must be made to accommodate a world that will include roughly 30 percent more people?

Beyond building healthcare systems that can treat more people, there must also be accommodations for the changing collection of people, which will include a growing percentage of senior citizens. The United Nations’ “World Population Aging 2009” points out that people over 60 years old made up just 8 percent of the world’s population in 1950, but that percentage grew to 11 percent in 2009, and it is expected to reach 22 percent in 2050. So, in a century, the percentage of senior citizens will nearly triple.

Indeed, aging will change the needs of tomorrow’s healthcare, but other challenges are also emerging. For example, “HealthCast: The Customization of Diagnosis, Care and Cure”—a 2010 report from PricewaterhouseCoopers (PwC)—notes: “While aging is often cited as a key driver of health spending, there is a growing concern that spending is increasingly spurred by generations of children facing costly chronic disease.” To build this report, experts at PwC surveyed 3,500 consumers and conducted interviews with academics, government officials, pharmaceutical executives and others in more than 25 countries—from Argentina and Brazil to the UK and U.S. A key finding revealed that “[b]oth young and old consumers are developing chronic diseases in record numbers, leading to explosive growth in the consumption of resources that is driving up spending and creating liabilities for future generations.” For instance, the report points out that more than one fifth of Australians under the age of 16 have been diagnosed with asthma. In addition, the report indicates that Alzheimer’s disease in Australia is expected to increase by 50 percent from 2003 to 2023.

Changing demographics of disease also exist in other countries. For example, India Today reported on April 12, 2010, that “heart ailments have replaced communicable diseases as the biggest killer in rural and urban India.” Such changes will surely continue in India and other countries, especially for chronic diseases.

“More and more, we were seeing complex interactions among systems where things didn’t go as expected, because we didn’t know how the components interacted,” says Paul Maglio, lead scientist on the SPLASH project. “So we wondered if we could understand the interactions by putting together models, simulations and data from the components that make up the larger systems.” Although the IBM scientists could have tried out this approach on a number of areas, they selected health.

“Here the complex system comes in because people have behaviors and attributes, environments have behaviors and attributes,” explains Maglio. Rather than look at so many variables across all health, however, Maglio and his colleagues needed some focus, and so they selected obesity. At first thought, the factors related to obesity might seem obvious: eat less and exercise more. “But it really isn’t that simple,” Maglio says. “Obesity depends on a complex set of interactions: the food system, a person’s economic status, food choices and modes of transportation.” So the challenge of SPLASH is to understand how these variables—and many others—interact. “Then we can know how to advise, say, a community on things to change to have the best odds of reducing obesity.”

To get to where the IBM project can advise a community, the researchers first need to build one. “We’re not experts in playgrounds or how people spend their leisure time or make food choices,” Maglio points out. “This requires a community effort.” In order to incorporate a wide variety of sources, Maglio and his colleagues are collaborating with experts in a range of fields who have pertinent data, models and simulations to contribute to the effort. In a year, the project leaders hope to build a preliminary model of obesity. “Obesity is just a starting point,” says Maglio. “Later, we might focus on another chronic disease or look outside the U.S.”

Besides a community of experts, this work will require an array of computer resources. “We don’t know yet whether this will take a mainframe, supercomputers, clusters or the cloud,” says Maglio. “We could need to integrate all of those.”