Among the many disruptive forces that the Fourth Industrial Revolution promises to unleash is a revolution in healthcare. We’re entering the century of biology – in which up-to-now crude interventions in our genetic makeup will become far more sophisticated, allowing us to fine-tune our essential biological structure.


These changes will scare some, excite others, and generally raise questions that cannot be answered. As well as the philosophical implications, there are practical ones, too, as healthcare worldwide undergoes a total transformation.


Here are our predictions:


1. Death will be optional. The Hayflick limit describes the theoretical restrictions on human life, partially based upon the length of one’s telomeres (roughly 125 years of age). To put it another way, cell death is simply a defect in our genes. This defect may be remedied by techniques that are now beginning to make effective medicines for once intractable diseases.



2. Biotech, like pharma, will be displaced. Forty years ago, the founding of Genentech heralded a new era, one overlooked by pharma. Biotech grew to become a more efficient, highly powerful way to develop drugs, while pharma continued down the same path, now operating with a productivity lower than the cost of capital. Two driving forces will again reshape drug development: computational biology and distributed development.


At the intersection of life sciences and supercomputers is computational biology, the use of biological data to frame biomedical problems as computational problems. This has already begun to reshape therapeutic development and is poised to induce a seismic shift in data integration and a new era of disease insight.


In parallel, the next wave will be led by a distributed labs around the world, including China and other regions; medicine will be no longer dominated by the US and Europe. The regulatory environment in the US and Europe makes clinical trials somewhat difficult, and for good reason. However, China has a more open view of regulation in many new areas of medicine, coupled with the world’s largest market for most diseases and medical procedures.


3. Our relationship to disease will fundamentally change. Today, our ability to manipulate genes is in its infancy. Nonetheless, dozens of diseases that once were a death sentence are becoming treatable. As our understanding of genes deepens rapidly, less invasive techniques will emerge, starting with native gene control using the body’s own biology to cure disease, rather than inserting genes and hoping. Further, the emergence of in utero and pre-conception gene sequencing enables the elimination of many congenital birth disorders by sorting rather than editing – sex may even evolve to be solely for recreation, not procreation. Expect a massive in-vitro fertilization (IVF) company to emerge in China that will challenge Western ethics.


'Native gene control' could use the body's own biology to fight disease.


4. The future of medicine belongs to smaller, nimbler organizations. According to a recent paper that analysed 121 blockbuster drugs (which made more than $1 billion sales per year) between 1980 and 2010, 87.6% were marketed by a major pharmaceutical firm. However, 24.7% were originated by a non-major firm and licensed to big pharma, 37.1% were originated by a non-major firm and acquired or merged into big pharma, and 4.1% were licensed from an academic institution. Thus, 65.9% or two-thirds of all blockbusters originated outside of big pharma. The pharmaceutical industry will continue to exist, as it sheds research jobs and consolidates. However, as capital becomes more available and talent more fluid, smaller organizations will be able to launch new products without big pharma.


5. Previously unimaginable wealth will be created. Let's say that you are the entrepreneur who owns the rights to telomere extension, mentioned above. If you sell this process at an average of $1 per day to 3 billion people, that amounts to $1.1 trillion a year in revenue. It could also be a completely different innovation, such as the development of human augmentation, instant sleep, instant learning, or something just now having its "eureka" moment in the cramped quarters of a Tokyo graduate student's lab. We predict that the world’s first trillionaire will be a biotech or healthcare entrepreneur. Healthcare accounts for over 20% of the economy in the US, and due to its entrenched bureaucracy, it is a market ripe for disruption. Expect future tycoons to emerge from this chaos.


6. Drugs will get smarter. The joke in venture capital circles is that you can triple your company’s valuation by adding cell or gene therapy, immune-oncology or artificial intelligence to your elevator pitch. However, many breakthroughs will emerge from less dramatic advances, including drug delivery technologies such as Sensulin’s “stimulus-responsive drug delivery” platform. This technology enables a once-a-day insulin, versus the four to eight injections typically required by patients with type 1 diabetes.


In the year 2000, during the Human Genome Project, the cost of sequencing a human genome was $100 million. Today, the cost is $1,000, or a mere $99 if you only want a partial sequence. Expect similar exponential leaps forward in the coming decades, where all drugs are personalized.



7. Life sciences will permeate most industries. The tools of biology enable previously unimaginable impact in even some of the most distant industries including, for example, a fascinating company that uses microbes to replace toxic chemicals in the extraction of metals, increasing yields and reducing environmental impact. The company is well-capitalized, and their technology is a “no-brainer” for mining and metals companies. We believe these techniques will ripple across supply chains worldwide, in surprising ways.


The end result?


For the coming biotech wave, the change to our lives will be dramatic. What is certain is that new winners and losers will result. We foresee great leaps in human health, the mitigation of today’s chronic diseases, a great number of new jobs created and massive leaps forward in quality of life.


But change will come at a price. Societal conventions will be challenged, increasing inequalities that tear the very fabric of our societies. Perhaps most poignant, this change will make us question what it means to be human. What happens in a world where disease is avoidable? Where death is optional?


Preparing for the future


We do not pretend to have all of the answers, but let us ask this crucial question: what must we do in the next decade, to prepare for the coming biotechnology wave?


For starters, scientific literacy is key for our broader population and especially for our leaders. Higher levels of scientific literacy tend to correlate with better governance; thus we urge those in democratic countries to elect leaders who are data-driven in their decision-making.


Secondly, we urge an inclusive dialogue between scientists, regulators, elected officials and the general public. Without informed guidance, there will be chaos.


Advances in biotech may not be readily noticeable for some time; though once the proverbial cat is out of the bag, the changes will be too late to influence in a meaningful way. Let us address these challenges while we still can.


Mike MoradiCo-Founder & CEO, Sensulin

David BerryGeneral partner, Flagship Pioneering