LANDRICH GROUP
Consumer Diagnostics and the Lifestyle Revolution in Public Health
This is Part 1 in a series on the growing opportunity for product development and clinical trials in consumer diagnostics.
In 2007, the British Medical Institute surveyed over 10,000 scientists with a question: What medical breakthrough had the greatest impact on extending human lifespans during the past 200 years?
The answer was surprising. It wasn’t anesthesia, the X-ray, the EKG or antibiotics. In fact, it wasn’t even a medicine or technology specific to doctors and medical institutions. Instead, it was the widespread development of public sanitation, first implemented in Victorian London during the cholera epidemic.
The cholera epidemic in Victorian London led to a wave of public health investment that increased human life expectancy.
Sanitation changed the way everyone in the city of London carried on in daily life. The key figures in this were John Snow, who showed that cholera was spread by water, and Edwin Chadwick, who came up with the idea of sewage disposal and piping water into homes. The process of introducing piped water and flushed sewer systems, spread from London to the rest of English. It was then adopted in other European countries and gradually expanded worldwide. It was a major catalyst for improved mortality rates in every country where it has been introduced during the past 150 years.
Scientific historians take two lessons from this success. The first is that changes that become ubiquitous, and therefore unavoidable, are more effective than attempts to convince people to make healthier choices. (A more recent example is the crackdown in smoking in public settings during the past 30 years.) The second lesson, which follows from the first, is that technologies aimed at a general population succeed better than those aimed at targeted groups.
Public sanitation in the 19th century created a lifestyle revolution. It targeted the entirety of the British urban population in their everyday environment. It pushed treatment outside of medical institutions and upstream into the broader society. This dramatically reduced downstream death and illness from infectious disease, alleviating the burden on the medical establishment.
Diagnostics go mainstream
Heart rate tracking on Apple watch device.
During the past decade, digital health has reached the mainstream through a series of new product lines such as smart watches, continuous glucose monitors and home testing kits. This proliferation of diagnostics in everyday life could have an impact on public health that is equally momentous as the one that started with water pumps of Victorian London. Public sanitation targeted infectious disease, the major killer of its time. Today the societies around the world struggle to cope with aging populations and chronic diseases that require effective tools for behavior modification.
The society of tomorrow will be what the Harvard’s biomedical informatics expert Zak Kohane calls “the flipped clinic”. This is when information technologies and medical diagnostics leap beyond the walls of labs and hospitals to become embedded in our home appliances and the gadgets we tuck in our pockets and strap to our wrists.
Three Megatrends
The growth in consumer diagnostics is driven by three trends. The first of these is the consumerization of health applications led by the major tech companies, who have provided a playbook for marketing and user experience to achieve mass adoption. Smart phones, carried by 5 billion people around the globe, increasingly provide basic health features. One in the American adults use wearables, such as smart watches and fitness trackers, to track activities such as heart rate, blood oxygen and sleep quality. The growth of these markets, coupled with the rapid advancements in biosensor technology, creates a vast array of opportunities for biometrics measurements and early diagnostics.
Diagnostics are now central to initiatives at the world’s most famous companies, such as Apple’s E5 project for non-invasive, blood glucose monitoring. The system, which still has no firm timeline for approval and release, utilizes silicon photonics and optical absorption spectroscopy to measure glucose levels by shining wavelengths under the skin and analyzing the reflected signals. With over 2 billion devices worldwide, Apple has also targeted heart rhythm monitoring, CGM integration and geriatric applications like SOS alerts and fall detection.
The 4 M framework for geriatric care
The Aging Global Population
This leads to the second megatrend driving consumer diagnostics. The population over 65 in the US is expected to grow to more than 80 million American by 2050. In East Asia and Western Europe, where longer lifespans are accompanied with fertility rates below replacement level, the shrinking population of medical workers finds it increasingly complex to care for the growing elderly community.
In developing economies that make up most of the world's population, societies are aging even more rapidly than they did in rich countries. For instance, it took more than 100 years for the portion of French people 65 or older to increase from 7% to 14% of the population. The same increase in elderly portion of the population only took 21 years in Brazil and 26 years in China.
The current system for geriatric care is fragmented and unreliable, with high rates of error, neglect and disconnection. New models are emerging for improved elderly care such as the 4 M framework (what matters, medication, mentation and mobility). These attempts to reimagine age-friendly care systems are suited to technological solutions for inpatient and at home environments, serving a patient base increasingly familiar with voice- and visual-software interfaces.
Key device sectors in population health
Strained Institutional Capacity
The aging population will make alternative solutions a necessity given the limitations of traditional medical infrastructure. The third megatrend driving consumer diagnostics is the worsening care gap driven by declining capacity in traditional medical infrastructure, including doctors, nurses and hospitals.
Annual hospitalizations are projected to increase by 10% in the next decade, reaching 40 million by 2030.During the same time, the US could face a shortage of 50,000 doctors and 200,000 nurses. Hospital beds have decreased in recent years driven by trends such as rural closures and private equity buyouts. With fewer beds, hospital occupancy has increased by 10 percent since pre-pandemic to 75% as of 2024. It is projected to reach 85% in the next decade. This would create a national hospital bed shortage and leave the country dangerously unprepared for a major health crisis such as the Covid pandemic.
Hospitals are already leveraging opportunities for at home care via digital health platforms, such as remote monitoring, telehealth and personalized care plans. Remote patient monitoring for chronic disease has grown 30x in the past decade, including devices such as blood pressure cuffs, pulse oximeters, CGMs, EKGs and other at home wearables.
History has shown that technologies can improve health through usage everyday life outside the traditional boundaries of medical institutions. When reaching a critical mass, these lifestyle products can reshape society and dramatically improve human living conditions. We are living through a period when consumer diagnostics hold this promise, driven by the three megatrends of digital adoption, global aging and the supply gap in traditional health care institutions. These three megatrends create an inexorable growth opportunity for in vitro diagnostics products with a forward-looking vision and patient-centered approach.
In the next article within these series, we’ll focus on specific recommendations for clinical trial management and regulatory strategies in this space.
Questions on consumer diagnostics? At Landrich Group, we'd love to discuss. Please contact us for a consultation!
