The market of medical technologies and services is one of the most popular and expensive, and its volume exceeds 7.5% of world GDP. It will be estimated at $8.7 trillion by 2020. Therefore, it is quite natural to use the blockchain in medicine as one of the most difficult areas of this technology implementation. However, the necessity of creating a single electronic clinic database on the supply is clear, and the countries are slowly but steadily evolving by that direction.
Blockchain and public healthcare system
The United States Congress has described the steps of creating a single electronic compatible system to identify and track specific recipes on 27 November 2013 in Title II of the Drug Quality and Security Act (DSCSA), according to which manufacturers and repatri have to use unique product IDs. And in September this year, the US Department of Health and Human Services, together with the Center for Drug Evaluation and Research and other services that are involved in the supply process, approved a draft guide for all suppliers and pharmaceutical companies. It is expected to adopt a law that will transfer all relevant operations to a single electronic system by 2023.
So the demand for this technology is obvious. And one of the first serious attempts to implement the fixation of supply chains through the blockchain was carried out by the MediLedger project, which has already attracted such major suppliers as Pfizer and Genentech. It is likely that this project will be the first test site in the United States to implement the plan approved by Congress. The President of the MediLedger company Eric GARVIN considers the project to be a kind of catalyst for cooperation, with due regard that the interaction of such giants is very rare. "These are companies that are competitors, sitting in a room, trying to advance technology for a business need" - said Mr. GARVIN.
The ambitious project aims to prepare a ready-made solution for the government by the end of the third quarter of 2018 and implement it within the next two years.
But despite the evidence of this need, in practice it is not a common phenomenon. Many startups claim their development on the basis of blockchain, but they have not offered any ready-made solutions yet. Even IBM Watson Health, which announced a joint initiative with the FDA at the end of 2017 to create a secure, efficient and scalable blockchain-based health database, is no longer in a hurry to make statements.
Mirko De MALDE, the president of the Italian Government Blockchain Association and TEDx speaker, in an exclusive interview for Bitnewstoday.com said that the use of blockchain technologies is considered in a variety of healthcare fields: "Experiments are ongoing (also at advanced stages) in drugs supply chain and drugs anti-counterfeiting, EHR management/record keeping, clinical trial management (patients’ recruitment, consent management), as well as for improving patients’ engagement through innovative forms of rewards and incentive”. However, according to Mr. De MALDE, despite the high expectations from the blockchain, the current maturity of the technology does not allow to fully implement it in everyday reality.
"Time will pass before we will see proper reliable products/services available for hospitals, citizens and industries. Especially in the clinical care, these products/services will have to meet the highest safety and security standards, at the same time guaranteeing stability, reliability and quality required in a highly-regulated environment as the medical one."
Amardeep SINGH, who works for an Indian startup at the United Arab Emirates, considers his project looking to actually connect the consumer to a personalized medical service through blockchain technology with the Ethereum consensus algorithm. According to him, the used Casper mechanism supposed to make Ethereum much more stable and energy efficient. As an outstanding example of the use of AI and DLT technologies in medicine, Mr. SINGH refers to the AI based project Google DeepMind, which is headed by a doctor Demis HASSABIS: "He is actually working with St Thomas' hospital to look at medical records and create algorithms which will singulate and read people's different healthcare conditions and then point them in the direction of which is the best treatment for them. What he does is he runs and specializes in deep reinforcement learning as a technique, so by using deep reinforcement learning he is effectively giving 80-90 thousand patients data to his algorithm, his algorithm then learns about what happens versus naturally healthy population, versus ill population and it makes an assessment of what will probably happen to that patient in the next 5-10-15-20 years. So it's kind of like predicting the future. I mean, he is a legend at the moment, he is really far ahead of everyone else.”
However, according to Mr. SINGH, DeepMind is still more focused on research than on the practical application of these technologies. In his opinion, the use of blockchain is reminiscent of the Wild West, as “at the moment in the medical healthcare bottle there is a battle between private healthcare providers and public healthcare providers".
The expert also adds that in general the public sector does not yet seek to experiment due to the lack of technology testing and the complexity of the health system itself: “One of the big promises of blockchain technology is prominence and supply chain traceability, so you know where drugs are coming from, you know what their sources are and you can track them through the supply chain process. And one of the biggest problems of public healthcare systems at the moment is that they have just far too many different supply chains. It's very inefficient - same problem in Canada, same problem in UK, it's worldwide, the Scandinavian countries as well, etc. They all have that same problem.”
According to Amardeep SINGH, the boom in the introduction of blockchain in medicine is observed only in the private sector, and here he sees another problem: outside the public sector, multi conglomerate corporations and different healthcare providers charge different prices for the same operation. “The patient, the consumer, have no sort of trust in what they are receiving and also about the price - there is no price stability and there is no transparency. This is really, really big problem” - says Mr. SINGH.
Medicine in the hands of AI, and AI in the hands of businessmen
According to blockchain evangelists, the creation of an open database is considered a priority, as it could solve many problems and conflicts and will give impetus to the development of all industries, especially with regard to "smart" medicine, where AI will be able to process personal medical data and make predictions about treatment.
Mirko De MALDE says: "What I consider the most interesting use case is the usage of blockchain for creating interplanetary open database driven directly by data owners, which would become the main resource for the development of specialised AI medical software, capable of providing predictions, risk assessment, and also early diagnosis and treatment options for particular conditions or specific for a patient. It is well known that AI tools need incredible amount of data to become efficient and capable of providing useful insight. So far, the siloed approach (i.e., data isolated in private siloes, usually property of big tech companies developing AI), risks to hinder AI capabilities to deal with specific populations or rare diseases, which might not be sufficiently reflected in the current databases.”
The issue of access to databases by AI developers in large IT-companies is really troublesome for the whole world, as far as we can not even imagine what supermachines are actually being created by secret research groups. The world's AI giants give out information in portions, clearly hinting that all of this is only the tip of the iceberg. And the world economy may one day stay in the hands of businessmen who invest their billions in innovative laboratories.
One of the key values of an open database based on the blockchain, as Mr. De MALDE believes, is the provision of distributed access to individuals data immediately and openly for all developers of AI. It could improve competition as well as the quality of AI tools, while at the same time allowing people to decide when and whom to share their data with: "Such a new individual control over data is surely encouraged in Europe by the General Data Protection Regulation and has been advocated by a variety of initiatives as (among the others) the #My31 movement launched by the US company Humanity. Individual compensation might be in the form of direct remuneration, personalised services or products, personalised care, and so forth”.
Amardeep SINGH also confirms that medicine is in the hands of private pharmaceutical companies, when in fact it should be under the state control. Among other things, Mr. SINGH believes that public healthcare should hurry with the introduction of blockchain, "as soon as big guys, pharmaceutical giants, control this technology they will charge extraordinary prices for it to be introduced into the market". Mr. SINGH added that DLT will be able to provide a simpler and more convenient way of choice for everyone. For example, in case we need to do a kidney transplant operation, we will be able to choose the best quality at same time as the best price of health services and products.
Personal AI medicine on the blockchain: predictions
The ability to develop an AI-machine personal medication in a matter of seconds based on a genetic database collected online — not the plot of a futuristic film. However, such a personalized medicine needs not only a huge database, but also a certain sequence of storage, so that the entire medical history of the patient was available in one click. Of course, equally important is the protection of such genetic data.
Mirko De MALDE says: “Truly personalised medicine needs huge amount of individual data. Data need to be longitudinal (meaning that it should cover a significant time span of the individual’s life) and should encompass various typologies: besides data usually generated into clinical centres (e.g., lab analysis, blood exams, imaging data, etc.) we need to add two new fundamental categories of data. First, genetic data, which are becoming increasingly available (and offered by private companies directly to individuals) thanks to the dramatic decline of genomic sequencing costs. Second, the whole new category of patient-generated data, i.e., data generated directly by the individual by means of mobile and wearable devices (from health-related data such as physical activity habits, sleeping patterns, weight, etc., to proper clinical data such as blood pressure, glucose levels, heart rates)”.
According to Mr. De MALDE, the blockchain is the prospect of creating a “virtual pocket” or “Personal Data Account”, where all the patient's clinical information will be collected from variety of hospitals, clinical centers, private companies, where the patient has ever been observed.
This new level of data availability will significantly improve AI's predictive ability to provide personalized findings, treatment options, and prevention tools based on patient data and genetic predisposition. "This would concretely enable the 4Ps medicine (personalised, predictive, preventive, and participatory), also allowing to focus on prevention, helping the individual to keep healthy, rather than on treatment," - says Mirko De MALDE.
A young scientist, doctor and AI developer Amardeep SINGH believes that in the next 50 years he will be replaced by the AI as a doctor. In his opinion, more than 50% of the doctor`s work is the analysis of the collected data and diagnosis. Mr. SINGH thinks that thanks to the merger of blockchain and AI, all of this can be fully automated. And for this purpose, in his opinion, Google DeepMind pays a lot of attention to scanning cancer, tumors of various sizes and other diseases to create the desired machine learning algorithm. And the remaining barriers will destroy the ubiquitous blockchain in the next 20 years or even faster:
"The most exciting thing in the medium future, in terms of big prediction, the walls of politics interfering with good healthcare will get completely eradicated, because you have this wild, unregulated space of blockchain. And if you think about what Ethereum does, Ethereum is going to be cloud computer, mining computer of the world. You basically get a thousand years of medical excellence being processed by an algorithm in less than an hour. It is the first example of how humans can be equal to AI in terms of reaching artificial general intelligence. If academics from all over the world can work together and with people like Demis Hassabis and Vitalik Buterin, I think that 20 years will turn into 10.”
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