By Doug Beaudoin, vice chairman, US Life Sciences & Health Care leader, Deloitte LLP
The 1920s is widely known for being a decade of invention. Henry Ford’s Model Ts were rolling off assembly lines, homes became wired for electricity, and families began hearing their first radio broadcasts and going out to see silent movies.1 It was also a decade of significant medical innovations. Immunizations reduced the prevalence of diphtheria, insulin was used for the first time,2 and penicillin was discovered.3 Even the BAND-AID was invented in the 1920s.4
At the beginning of the decade, the average life expectancy was 58.8 years for men and 60.6 years for women. Inventions and innovations developed in the 1920s had a significant impact on our life expectancy today. A baby born in 2017 is expected to live to 78.6 years old.5 As we begin a new year and a new decade, I thought it would be interesting to look back 100 years and consider how far we’ve come…and imagine how far we might go.
Innovations of the 1920s vs. anticipated innovations of the roaring 2020s
Then: Radio – Guglielmo Marconi invented the radio in 1895, but the first radio news broadcast didn’t take place until 1920.6 For the first time, information could be distributed to a mass audience in real-time.
Now: 5G – Some communications companies are already touting fifth-generation cellular wireless, which could dramatically improve internet speed and the amount of data that devices can send. 5G connections could make it possible for surgeons to oversee robotic surgeries regardless of their locations, improve remote patient monitoring, and increase the reliability of virtual visits. 5G combined with AI and cloud computing could also help spot disease outbreaks in real-time.
Then: Radio dispatch – In 1928, the Detroit Police Department launched the first one-way communication system between the police station and its patrol cars.7
Now: Interoperability – The US health care system is a collection of disconnected components (health plans, hospital systems, pharmaceutical companies, medical device manufacturers, etc.). During the 2020s, we expect these disconnected components will become interoperable and share data—internally and externally—through and open, secure platforms. In his 2020 Outlook blog, my colleague Mike DeLone called data “the currency of the future of health,” and noted that it was not far-fetched to think that the world could contain 100 billion connected devices 10 years from now or sooner. I expect all of these islands of health data will become integrated to create a complete picture of each individual, which will help them make more informed decisions about their health, prevent illness and stay healthier longer.
Then: Health insurance – The first employer-sponsored hospitalization plan was created by Dallas teachers in 1929. The policy, which covered services at only one hospital, was the forerunner to modern HMOs.8
Now: Value-based care – Health plan and health system CEOs say the transition to value-based care arrangements will be among the top drivers of change in the future and will have a major impact on their profit margins and traditional financial models. (Note: Our annual CEO survey results will publish this month). We also expect to see more outcomes-based contracts between biopharmaceutical companies, health plans, and health systems. In a recent blog post, my colleague Jeff Morgan noted there have been more publicly announced value-based contracts over the past two years than we have seen in the past decade.
Then: Insulin – Insulin was first used to treat diabetes in 1922 after being discovered a year earlier. Prior to this, people who had Type 1 diabetes typically lived no more than a year or two after developing the disease.9
Now: Cell and gene and therapy – The idea that we can manipulate an individual’s cells and genes to actually cure disease in some cases has been a tremendous technological advancement. Along with treating illnesses, we expect more rare and genetic diseases will be cured during the 2020s. There are thousands of therapies in the FDA approval process, and over the next 10 years, more than one-third of therapies will be cell and gene-based, according to CRISPR Therapeutics’ CEO, Samarth Kulkarni.10 The US Food and Drug Administration has approved two cell-based gene therapies for cancers of the blood and one directly administered gene therapy for an inherited eye disorder.11
Then: BAND-AIDs –The first adhesive bandage was invented in 1920 by Earle Dickson, a Johnson & Johnson employee. The invention meant Dickson’s wife was able to treat their family when they were cut or burned.12
Now: Home medical devices – Consumers are growing more comfortable with using at-home tests to diagnose infections and treat themselves before going to the doctor for treatment, according to our 2018 consumer survey. Nearly half of our respondents (45 percent) said they would consider an at-home genetic test to identify existing or future health risks, and 44 percent are comfortable using an at-home blood test that connects to an app to track overall health trends, such as cholesterol, blood glucose, inflammation, and triglycerides.
Then: Vaccines – A vaccine to treat diphtheria was invented in the late 1800s, and by the 1920s, 21 US companies were licensed to manufacture biologics (primarily a smallpox vaccine and diphtheria antitoxin).13
Now: Prevention and wellness – In the years ahead, we expect that other diseases will go the way of smallpox and diphtheria and be essentially eliminated. About 80 percent of health outcomes are caused by factors unrelated to the medical systems (e.g., diet, exercise, socioeconomic status, transportation, housing, air quality). Industry stakeholders are beginning to focus more attention on these drivers of health, according to our recent paper on smart health communities.
Then: Consumerism – The age of the consumer took root in the 1920s. Everything from phonographs to vacuum cleaners to mass-produced and affordable automobiles became available to help improve the lives of consumers. Even automatic bread slicers (the greatest thing since sliced bread) were developed in the ‘20s.14
Now: Consumerism – Consumers are also increasingly demanding a health care experience that mirrors their interactions with other consumer-facing industries like travel and entertainment. Health consumers are no longer passive participants. They will determine the type of care they receive, where they receive it and from whom, and they will demand transparency, convenience, and access. According to our recent paper on measuring disruption in health care, the sector will need to respond to this increasingly influential consumer with patient-centric approaches to care.
Then: Vitamins – In the early years of the 20th century, researchers began to recognize a correlation between our foods and certain diseases. In 1920, Vitamin D—prevalent in cod liver—was shown to prevent rickets. Vitamins A, B, C, and K—and their role in maintaining health—were discovered the same year.15
Now: Wellness – We are seeing people becoming more interested in tracking their health through wearable fitness trackers. But we could see those trackers become even more effective this decade. Our recent STEP UP study with the Perelman School of Medicine at the University of Pennsylvania demonstrated the effectiveness of behavioral nudging in encouraging healthy behavior. People will also have better access to their own health records and data about their environments. In the 2020s, I expect all of these islands of health data will become integrated to create a complete picture of each individual, which will help them make more informed decisions about their health, prevent illness and stay in a state of wellness longer. In the future, sensors in a smart toilet, for example, might be able to detect vitamin deficiencies and suggest customized prevention therapies to optimize health.
When I think about the roaring 1920s, images from the Great Gatsby immediately spring to mind. While F. Scott Fitzgerald’s 1925 novel captured the corruption, excess, and dark side of the golden era, it also revealed the growing influence of consumers and a societal transformation. As we re-enter the roaring twenties, I expect consumers will help set the course for the next decade as we move toward the future of health.
1. The soaring twenties, Forbes, July 2019
2. Vaccines: Past, Present, and Future, National Research Council (US) Division of Health Promotion and Disease Prevention, 1985
3. Discovery and Development of Penicillin, American Chemical Society, November 19, 1999
4. Get stuck on BAND-AID history, Smithsonian.com, October 10, 2017
5. Centers for Disease Control and Prevention's National Center for Health Statistics
6. 1920: News radio makes news, Wired, August 31, 2010
7. 90th anniversary of Detroit police radio celebrated, APCO International, April 26, 2018
8. A brief history of private insurance in the United States, Academic Health Plans, March 18, 2019
9. Two tons of pig parts: Making insulin in the 1920s, American Museum of Natural History, November 1, 2013
10. FDA’s Efforts to advance the development of gene therapy, FDA Center for Biologics Evaluation and Research, May 1, 2019
11. Forging a new path to commercialization for cell and gene therapies, Deloitte LLP, July 11, 2019
12. Get stuck on BAND-AID history, Smithsonian.com, October 10, 2017
13. History of Diptheria—timeline, History of Vaccines, The College of Physicians in Philadelphia
14. Inventions of the 1920s, American-Historama.org
15. The discovery of the vitamins, US National Library of Medicine, National Institutes of Health