In State of Wonder, the American writer Ann Patchett imagined the discovery made by a charismatic but despotic professor, Dr Annick Swenson, who travelled deep into the Amazon basin and found a tribe in which the women went on bearing children until the end of their lives. While their bodies aged as normal, their reproductive systems stayed daisy-fresh.
“This is the end of IVF. No more expense, no more shots that don’t work, no more donor eggs and surrogates. This is ovum in perpetuity, menstruation everlasting …”
A miracle fertility drug, taken in this case from the bark of an endemic jungle tree, is one of science’s most enduring dreams. Miniature robots designed to prowl the bloodstream when injected through a vein seeking out and destroying undesirable micro-organisms is another. And there are many darker visions of monsters, plagues and organ trading.
Dreaming is what we should be doing, in science, in medicine and in life. If we do not imagine the future, how can we invent (or prevent) it? That is why I welcome what is described as the world’s largest health science-fiction prize, which seeks to unlock an array of hypothetical futures.
“Writing the Future” is open to writers of any nationality who are asked to submit a story of up to 3,000 words about the state of health and healthcare in the UK in the year 2100. The winner, to be announced in October, will take home £10,000.
As director of the Institute of Global Health Innovation at Imperial College London, I spend a lot of time debating the future of medicine. But change is hard to predict, and it doesn’t help if you spend much of your time with healthcare insiders, as I do, trying to solve the problems created in the past.
So why not ask people more familiar with conjuring dreams to help us out? The aim with this prize, for which we have provided a small sum in sponsorship, is to attract outsiders who can bring a fresh perspective with a story that displays ingenuity and insight, as well as being a cracking good read.
Thinking about the state of our health 83 years from now is vital if we are to continue delivering the best possible care. Looking back 83 years to the 1930s, the NHS was yet to be founded and penicillin existed only on Alexander Fleming’s petri dish. Of every 1,000 babies born, 63 died in infancy. Yet just 40 years later, babies were being conceived in test tubes.
The health industry has actually been remarkably good at innovation. Some advances have been the result of technical wizardry, such as in-vitro fertilisation, organ transplants and CT scanning for cancer. Others have transformed the outlook for whole populations, such as antibiotics, vaccination, and the contraceptive pill.
Asked to think about future innovations in health, most people might mention a new HIV vaccine, a cure for Alzheimer’s disease – or a drug to confer long-lasting fertility. These would certainly be blockbuster gains for humanity but with the rising cost and diminishing returns from drug development, there are likely to be few such silver bullets in the next decade.
The big gains are likely to come from innovations in general-purpose technologies – smartphones, computing, bio-engineering – that have already transformed our world. Until 1998 there were no online bookstores. Yet today, Amazon has 40% of the books market. Until a dozen years ago few people banked online. Today 60% do. Mobile phones may play as significant a role in healthcare in this century as the stethoscope did in the last.
So what is next? We have made astonishing progress in the last eight decades. More of us survive childbirth and infancy, our lives are longer and there is more that medicine can do to help when we are sick.
We have made enormous strides against the major killers of the past such as smallpox, tuberculosis and diphtheria. The new challenge comes from the chronic conditions that blight so many lives in the modern world – diabetes, cancer and heart disease. Here, advances in genomic medicine could help us to identify individuals at risk and allow us to intervene earlier.
Entrants for Writing the Future may have very different visions of what is to come. Social enterprise Kaleidoscope Health and Care, which conceived the prize, has its own ideas about how to encourage innovative thinking in health.
Established in 2016 by Richard Taunt, a former civil servant and director of policy at the Health Foundation thinktank, its 10 staff include clinicians and managers who have seen the problems from the inside and want to “change the conversation” by attracting talent that can see beyond the limits of budgets and hospital walls.
One way they do this is by offering envelopes containing £100 in cash to selected individuals to spend in any way they like – on coffees, a lunch, or a train ticket – as long as it is in the cause of having an unexpected conversation about health and care that they can blog about afterwards.
We need innovative thinking in healthcare now more than ever. There is substantial interest in Writing the Future from leading science fiction writers around the world. We should all expect to be excited, enlightened and entertained.
