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  • Over the past two decades, neurosurgery has been transformed by technological advancements, interdisciplinary collaboration, and a deeper understanding of the brain
  • Breakthroughs like functional magnetic resonance imaging and minimally invasive surgery have enhanced diagnostics and treatments, steering the field away from its conventional practices 
  • By 2040, such changes will continue and accelerate as neurosurgery embraces augmented reality interfaces, robotics, and artificial intelligence, facilitating personalised interventions based on individual genetic profiles
  • The future of neurosurgery will not only showcase technological excellence but also a heightened commitment to ethical principles prioritising patient welfare and societal wellbeing
 
Neurosurgery 2040
 
Over the past two decades, neurosurgery has undergone a transformation, marked by increased precision, less invasive procedures, and swifter recovery, all driven by technological advances, interdisciplinary collaboration, and an enhanced comprehension of the brain. Progress ranges from neuroimaging technologies to refined surgical techniques. This Commentary briefly describes the milestones and ethical considerations of neurosurgery up to ~2040.
 
Since 2000, the convergence of technologies such as functional magnetic resonance imaging (fMRI) and minimally invasive surgery has improved diagnostic approaches and treatment methodologies. Departing from conventional norms, the advent of personalised medicine and the rise of neurostimulation hold the promise of advancing our comprehension and treatment of neurological disorders.
 
Looking forward to ~2040, we foresee these trends intensifying, with operating rooms (OR) equipped with state-of-the-art technologies like augmented reality interfaces, robotics, and artificial intelligence (AI), synergising with human expertise. Envisage progress in targeted medicine to also continue and further disrupt neurosurgical treatments by customising interventions according to individuals' distinctive genetic profiles and incorporating developments in gene therapies. As these technologies augment cognitive capabilities, addressing ethical concerns to increase in importance will become more relevant. Prioritising moral considerations will be essential to ensure responsible and compassionate utilisation of these tools.
 
Furthermore, the upcoming collaboration spanning various fields is positioned to speed up, playing a crucial role in driving neurosurgery to unprecedented levels. This cooperative endeavour is expected to break down traditional barriers and enhance our understanding of the complexities of the brain. Looking forward to 2040, an intensified sense of purpose among healthcare providers is predicted, highlighted by heightened global awareness and strategic initiatives aimed at reducing healthcare disparities by broadening access to neurosurgical expertise worldwide. Underscoring the increasing significance of robust ethical guidelines and ongoing dialogues, we highlight the importance of steering the path of neurosurgery beyond technical innovations. Contemplate a growing focus on ethical principles that prioritise patient welfare and societal wellbeing, indicating that the future of neurosurgery will be characterised by a blend of technological expertise and a more pronounced commitment to human values and purpose.
  
In this Commentary

This Commentary has two parts. Its overall aim is to nudge neurosurgeons and providers to reflect on their current modus operandi and strategically prepare for the future. Part 1, Neurosurgery since 2000, briefly describes technological developments and interdisciplinary collaboration, which have improved diagnostics, treatments, and our understanding of the complexities of the brain. Part 2, Neurosurgery 2040, anticipates integrated operating rooms where augmented reality, robotics, and AI merge with human expertise. This forward-looking approach stresses interdisciplinary collaboration and a purpose-driven mindset to enhance access to efficacious therapies.
 
Part 1
Neurosurgery since 2000
 
Over the past two decades, neurosurgery has evolved at a pace unparalleled in its history. From advancements that have improved diagnosis to the refinement of surgical techniques, the field, since the turn of the millennium, has been a testament to the determined pursuit of knowledge and the inventive spirit within the medical community. We briefly describe aspects of this transformative journey, shedding light on a few key milestones, ethical considerations, and the promising trajectory that lies ahead.
 
Technologies such as fMRI, diffusion tensor imaging (DTI), and positron emission tomography (PET) have become essential tools to improve diagnostics. Concurrently, minimally invasive surgical approaches, guided by real-time imaging, have not only reduced invasiveness but have also improved patient outcomes. The collaboration between advanced neuroimaging and refined surgical methods marks a shift in neurological care, by facilitating more precise and effective interventions. Indeed, a hallmark of neurosurgery's evolution since 2000 has been the increased use of precision medicine. Departing from the traditional one-size-fits-all approach, the field has shifted towards tailoring treatments based on individual genetic, molecular, and physiological characteristics. Genetic profiling, biomarker identification, and targeted therapies have emerged as effective tools to enhance diagnostic accuracy and pave the way for the expansion of personalised therapies. This departure from conventional approaches suggests a future where neurosurgical treatments are as unique as the individuals they seek to assist.
 
Empowered by technological progress, surgeons can now probe the brain with newfound precision and safety. Minimally invasive approaches, including endoscopic and stereotactic procedures, have minimised trauma, accelerated recovery times, and expanded the scope of what is surgically achievable. Neuron-navigation systems and robotic-assisted surgeries have further enhanced neurosurgical practice, redefined possibilities, and improved outcomes. The rise of minimally invasive procedures has not only reshaped neurosurgery but has also facilitated patient-friendly approaches over traditional open surgeries. Techniques such as endoscopic and laparoscopic procedures significantly reduce physical tolls on patients, improve recovery times, and minimise complications. Equipped with specialised tools and advanced imaging, neurosurgeons can navigate through the brain's structures with minimal disruption, and not only provide medical advantages but also cosmetic benefits and faster postoperative rehabilitation.
Since 2000, neurostimulation has introduced novel therapeutics for various neurological disorders. Technologies such as deep brain stimulation (DBS) and spinal cord stimulation (SCS) have brought relief to conditions such as Parkinson's disease and chronic pain. The integration of adaptive neurostimulation guided by real-time feedback, represents a shift towards personalised and adaptive treatments, offering hope for an improved quality of life.
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Brain disorders and the changing nature of neurosurgery
The burgeoning field of neurogenetics investigates the interplay between genes and complex neural networks. Personalised therapies, which have evolved from unravelling unique genetic signatures, hold promise for conditions such as Alzheimer's, Parkinson’s, and epilepsy. Neurogenetics not only carries the potential for targeted interventions but also provides insights into the individuality of our minds, suggesting a new era where the enigmas of cognition are elucidated.
 
Interdisciplinary approaches drive breakthroughs in neurosurgery that go beyond traditional boundaries. The fusion of neuroscience with engineering, computer science, and genetics enhances our understanding of the brain, leading to creative solutions. Whether neurosurgeons collaborate with engineers or data scientists, these partnerships redefine possibilities within the field, pointing towards a future where the complexities of the brain are unravelled through a range of capabilities. Translational research in neurological disorders provides additional hope by linking theoretical breakthroughs to tangible results. The combined efforts of researchers, clinicians, and pharmaceutical experts expedite the development of innovative therapies, bringing optimism to those affected by neurosurgical disorders.
 
Neurosurgical progress brings hope, yet finding a balance between technological development and ethical challenges is essential. While innovations hold promise, the ethical considerations associated with interventions related to the brain, including matters such as informed consent and privacy, become increasingly complex. Thus, it is crucial to reconcile the progress in neurosurgery with an awareness of ethical responsibilities, ensuring the utmost respect for the human mind.

 
Part 2
Neurosurgery 2040
 
Neurosurgery 2040 envisions a future shaped by ongoing developments since 2000, described in Part 1. Though predicting specifics is challenging, key trends are gaining momentum and set to rapidly redefine the field over the next two decades. The integration of AI and novel technologies, collaborative efforts across disciplines, a shift towards patient-focused precision care, improved accessibility to neurosurgical interventions, and a heightened focus on ethical considerations collectively signal the nature of forthcoming transformation. While these trends have been evolving since 2000, it is important to note the accelerated pace at which they are expected. This underscores the need for clinicians and providers to proactively prepare for imminent paradigm shifts. This section offers a partial glimpse into potential aspects of neurosurgery in 2040, emphasising the urgency for adaptation and innovation.
 
In January 2024, Neuralink, founded by Elon Musk in 2016, achieved a significant milestone by successfully implanting its inaugural device into a human patient. This marked progress towards realising Musk's visionary goal of helping individuals grappling with paralysis and diverse neurological conditions. Concurrently, Jaguar Gene Therapy secured FDA approval for its gene therapy designed to address genetic manifestations of autism spectrum disorder and Phelan-McDermid syndrome, instilling hope in thousands of individuals who have lacked effective treatment options.
 
While traumatic brain injury (TBI) continues to be a pervasive global health concern, affecting millions annually, (in the US ~2m cases each year), the resultant annual global burden on healthcare, patients, families, and society amounts to ~US$400bn. The current gold standard management of severe TBI involves an invasive procedure, which entails drilling a hole in the skull to insert a catheter for monitoring intracranial pressure (ICP). However, the evolution of neurosurgical techniques suggests that this invasive process will become obsolete by 2040. Emerging innovations are poised to replace it with a non-invasive method for monitoring ICP.
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Healthcare 2040

Such breakthroughs provide a glimpse into the future landscape of neuro-trauma and neuro-disorders expected by 2040, highlighting the rapid pace of progress in the field. It seems plausible to posit that, as neurosurgery undergoes these, and other, changes, clinicians and healthcare providers will witness a paradigm shift, fostering an evolution in patient outcomes and reshaping neurological care.
Expect the continued development and increasing adoption of minimally invasive techniques, neuroimaging, nanotechnology, and targeted therapies. These advancements are poised to replace standard surgical approaches in neurosurgery, leading to a significant improvement in the overall patient experience and making interventions more accessible. The future of neurosurgery envisions the use of microscopic robotics for intricate procedures, steering away from invasive surgeries and embracing non-invasive alternatives. AI techniques are set to play a crucial role, serving as co-pilots by analysing real-time data. Additionally, genetic insights will inform tailored interventions in this collaborative environment, blurring interdisciplinary boundaries and signalling a departure from conventional approaches. The focal point of this shift is personalised care.

Within this evolving ecosystem, genetic profiling empowers neurosurgeons to design custom neural implants and gene therapies. This has the potential to significantly reduce the need for invasive procedures. These changes highlight the urgency for adaptation and innovation in the field, underscoring the importance of staying at the forefront of these technological and medical advancements.
 
By 2040, a confluence of neurogenetics, personalised neurosurgical therapies, and genetic engineering is anticipated to surpass conventional medical norms. Novel technologies will unravel the intricate interplay between genetics and neurological disorders, delivering custom-made solutions, significantly reducing risks, and optimising therapeutic outcomes. In the approaching years leading up to 2040, Western providers are positioned to align themselves with a defined 'purpose' and actively participate in initiatives aimed at enhancing access to high-quality healthcare. While these pursuits complement the traditional focus on maximising returns for investors, they are increasingly becoming an intrinsic part of the worldview and demands of Generation Z. The imperative for traditional providers to adopt a purpose-driven ethos and acknowledge their global responsibilities is important, and encouraged by a growing call for greater inclusivity. Foresee a surge in global awareness regarding healthcare disparities, prompting a commitment to leveraging technology for the advancement of worldwide healthcare accessibility. A socially responsible approach, incorporating ethical business practices and community engagement, is not only a moral imperative but is also foreseen to contribute significantly to the enduring sustainability of the MedTech industry.
 
As we approach 2040, Western neurosurgical providers will be expected to adopt a sharper 'ethical' focus, particularly in response to the escalating utilisation of neural implants and genetic therapies. While many MedTechs currently profess ethical awareness, the impending changes in neurosurgery underscore the necessity for a significant revaluation and augmentation of ethical strategies.
 
As neurosurgery advances with the further introduction of disruptive technologies and heightened cognitive capabilities, ethical considerations are projected to take centre stage. Deliberations on fairness, consent, and the definition of "normal" cognitive function converge with the emergence of neuroenhancement techniques and the integration of brain-computer interfaces. Ethical frameworks will be indispensable to mitigate and prevent biases in AI algorithms, address privacy concerns, and ensure the judicious utilisation of genetic information.
 
Effectively navigating these moral complexities demands not only technical innovation but also a robust moral compass to align enhanced cognition with human values. The evolving interplay between ethical considerations and technical progress underscores the imperative for ongoing dialogues among neuroscientists, ethicists, and policymakers. The overall objective is to shape the future of neurosurgery not solely through technological advancements but by integrating ethical principles that prioritise patient welfare and contribute to societal wellbeing.
  
Takeaways
 
We have described the transformative journey that neurosurgery has undertaken over the past two decades and provided a glimpse into its future. From the integration of breakthrough neuroimaging technologies to the emergence of precision medicine, neurosurgery has evolved, promising enhanced diagnostics and personalised therapies.
 
As we cast our gaze forward to 2040, a future unfolds where operating rooms are integrated with augmented reality interfaces, robotics, and AI, working in tandem with human expertise. Precision medicine takes centre stage, tailoring neurosurgical interventions to individual genetic profiles. However, the progress is not without its ethical challenges. The heightened cognitive abilities brought about by innovative technologies demand an appreciation for morality to ensure responsible and compassionate use. We stress the increasing significance of interdisciplinary collaboration, transcending traditional boundaries to foster a deeper understanding of the brain, and suggest a future where medical technology providers embrace a heightened sense of purpose, addressing global healthcare disparities by expanding access to neurosurgical expertise worldwide. Emphasising the critical role of robust ethical frameworks and ongoing dialogues, the Commentary suggests the future of neurosurgery should not only be defined by technical prowess but must also prioritise ethical principles that safeguard patient welfare and societal wellbeing.
 
Overall, the Commentary is a nudge for neurosurgery clinicians and providers to reflect on their current positions and prepare for a different future as the field is developing fast. Our two-part exploration, spanning the past two decades and projecting into Neurosurgery 2040, encourages a forward-looking approach marked by interdisciplinary collaboration and a purpose-driven mindset. The vision presented suggests that the future of neurosurgery will be characterised by a blend of technological expertise and a commitment to human values, ensuring that the field continues to develop ethically and deliver impactful, accessible, and compassionate care to individuals worldwide.
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  • Effective MedTech leadership in the next decade requires adept navigation of companies through evolving markets, technological advancements, and simultaneous management of established legacy businesses
  • Historically, MedTech leaders have been drawn from a limited pool, potentially slowing effective adaptation to new technologies, and markets
  • This has allowed tech giants to disrupt the sector, emphasising a shift from the development of physical devices to integrated healthcare solutions
  • The 4th industrial revolution (Industry 4.0) is crucial in facilitating the transformation, breaking down traditional boundaries between medical devices, pharmaceuticals, software, and patient data
  • Executives with experience in service-based sectors adjacent to MedTech may be better equipped to lead, leveraging their tech-centric background to capitalise on digital technologies and big data strategies for successful adaptation and thriving in the evolving healthcare ecosystem
 
Is MedTech Entering a New Era of Leadership and Purpose-Driven Innovation?
 
MedTech leadership is at a crossroads, demanding a strategic overhaul to tackle unprecedented sector changes anticipated over the next decade. Navigating this evolving landscape requires reconciling traditional manufacturing expertise and cutting-edge digital capabilities. A forward-thinking CEO with digital acumen is pivotal for innovation, yet the complexities of manufacturing and stringent regulatory frameworks remain crucial. In response, it seems reasonable to suggest that a collaborative leadership approach would be optimal, pairing a visionary CEO with digital expertise alongside a seasoned COO well-versed in manufacturing and regulatory compliance. This, would not only alleviate the burden on a single leader but also combine the strengths of both domains, fostering a more resilient leadership model. By strategically aligning these skill sets, MedTech companies would be better positioned to adeptly bridge the gap between tradition and digital evolution amid the complexities of an increasingly competitive market.

Historically, MedTech leadership, drawn from a limited pool of individuals, may fall short in ensuring commercial success in the coming decade. The sector's reluctance to swiftly embrace emerging technologies has created an opening for tech giants to disrupt it, mirroring the upheavals witnessed in financial markets.
 To thrive, MedTech companies must shift from developing physical devices to strategically promoting integrated healthcare solutions and services. The 4th Industrial Revolution, (Industry 4.0) plays a pivotal role in this evolution, breaking down traditional boundaries between medical devices, pharmaceuticals, software, and patient data. It reshapes connections among the physical, biological, and digital realms within the healthcare sector, emphasising advanced data and digitalisation strategies.

In this paradigm shift, traditional MedTech executives may find themselves ill-equipped to lead effectively. Executives from adjacent service-based sectors, with a tech-centric background, seem better positioned to spearhead this transformation. Leveraging their expertise, these leaders can adeptly capitalise on digital technologies and utilise big data strategies to navigate and adapt business models. Strategic leadership from executives with a tech-centric background is essential for MedTech companies to survive and thrive in the future.
 
In this Commentary
 
This Commentary has two parts. Part 1: The MedTech Market describes opportunities and challenges within the evolving dynamic global market. Part 2: Navigating MedTech’s Evolutionary Challenges, examines the limitations of current MedTech leadership, suggesting a shift towards diverse skills, backgrounds, and perspectives. Future MedTech leaders need expertise in digital technologies, data analytics, and innovative business models, coupled with an understanding of global markets and a compelling sense of purpose to engage and inspire Generation Zs. Takeaways raise the likelihood that existing MedTech executives may be ill-equipped for upcoming industry transformations, highlighting the potential of leaders from service-based sectors with proven strategic agility and innovation.
 
Part 1
The MedTech Market

Currently, MedTech is undergoing a transformation, and shedding its traditional conservative image. The industry's growth is driven by various factors, such as the aging global population, an uptick in chronic diseases, and an increasing trust in medical devices among clinicians and consumers, which has fostered stronger collaborations between MedTech and pharmaceutical companies. Although the US and the EU continue to be significant contributors to MedTech markets, they face hurdles, including increasingly stringent regulations, shifts in reimbursement policies, and elevated costs linked to advanced medical technologies.
 
About two decades ago, foreseeing constraints, some large MedTechs like Johnson & Johnson (J&J), Abbott, and Medtronic, strategically established manufacturing and research and development (R&D) centres in emerging markets such as Brazil, China, and India. Back then, these markets were undergoing substantial growth, fuelled by burgeoning middle-class populations with an increasing demand for improved healthcare services. This situation not only presented strategic opportunities for continuous expansion but also served as a buffer against the escalating difficulties experienced by MedTechs in the more mature Western markets.
 
Despite facing challenges, the global MedTech market continues to be a promising arena for growth and innovation, extending its reach across diverse sectors and geographies. Projections indicate that its global revenues will reach ~US$610bn in 2024, with an anticipated compound annual growth rate (CAGR) of ~5.2%. This trajectory points towards a substantial market volume of ~US$748bn by 2028. The US stands as the primary revenue contributor, expected to reach ~US$216bn in 2024. Historically, MedTech business models have predominantly targeted affluent markets in the US, Western Europe, and Japan, comprising only ~13% of the world's population but holding a significant market share. This historical skew allowed MedTech leaders to focus their marketing efforts on healthcare providers in prosperous developed regions, benefitting from favourable fee for service reimbursement policies. Notwithstanding, recent years have witnessed a tightening of the wealthy Western markets.
In the coming decade, MedTech sectors in emerging regions are set to experience significant growth. For example, in 2024 China's MedTech revenues are anticipated to realise ~US$46bn, with a projected CAGR to 2028 of ~7.5%. This growth trajectory is expected to culminate in a market volume of ~US$61bn in the near term. In the face of dynamic shifts, MedTech leaders are confronted with the challenge of recalibrating their strategies to ensure sustained success amid challenging global politico-economic conditions and the use of more demanding outcome-based healthcare reimbursement models in traditional wealthy Western markets.


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Healthcare 2040


 
Following a peak in late 2021, MedTech stocks faced a setback around mid-2022, losing a significant portion of the gains accumulated during the Covid-19 pandemic. By July 2023, growth had slowed, with MedTech valuations showing only a modest increase of ~22% compared to January 2020. During this period, trading multiples experienced a decline, dropping from a peak of ~16x in September 2021 to ~7x by mid-2023, falling below the industry's 10-year average of ~8x.
 
Although there have been some recent improvements, the 2023 EY, Pulse of the MedTech Industry Report raised concerns about challenges ahead for the sector. In the post-Covid landscape, the industry is grappling with significant hurdles, including a notable decline in public valuations and ~30% decrease in financing. These challenges manifest in various aspects, such as a downturn in special-purpose acquisition company (SPAC) deals, a substantial decrease in the total value of initial public offerings (IPOs), and a slump of ~21% in venture capital (VC) funding. Compounding these issues is a decline of ~44% in merger and acquisition (M&A) activity.
 
Traditionally, M&A has played a crucial role for MedTechs, contributing to scale, operational leverage, financial performance, product portfolio diversification, improved therapeutic solutions, and international expansion - all while maintaining core manufacturing structures and strategies. Moreover, post-Covid, revenue growth has experienced a significant dip, dropping from ~16% in 2021 to ~3.5% in 2022, and remaining flat in 2023. The anticipated future growth of ~5% may encounter challenges due to a potential scarcity of new disruptive product offerings. These challenges have implications for equity investment, which hit a seven-year low in 2023, declining by ~27% to ~US$14bn. Notably this impacts smaller, innovation-driven firms.


A positive recent trend is the rapid growth of digital health with expected global revenues set to reach ~US$194bn by 2024, with a projected CAGR of ~9% from 2024 to 2028, which would deliver a market volume of ~US$275bn by 2028. China leads in global revenue generation for digital health, reaching ~US$53bn in 2024. However, many large diversified MedTechs with legacy products in slow-growing markets have yet to capitalise on this trend.
 
MedTech stands at a critical juncture, navigating challenges that necessitate a strategic overhaul for sustained success. The decline in key financial indicators and the sluggish pace of innovation pose significant threats, obliging leaders to embrace transformative strategies and capitalise on emerging trends, particularly in digital health, to secure a resilient future.

 
Part 2
Navigating MedTech’s Evolutionary Challenges

Changes in the MedTech landscape introduce difficulties for executives striving to stay abreast of technological advances and transformative shifts, particularly in emerging economies. Compounding these obstacles is the prevalence of middle-aged men in leadership roles, perpetuating traditional management styles that may impede the necessary adaptations required for growth.

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Redefining Leadership In The Evolving Landscape Of MedTech

Despite women constituting >50% of the MedTech workforce and significantly influencing healthcare decisions, they are underrepresented in executive positions. Addressing these disparities is not just a moral obligation but a strategic imperative to unlock the full potential by embracing diverse perspectives and talents. The historical contributions of women in healthcare underscores the urgency of closing the gender gap in MedTech leadership.
Further complicating matters is the median age of C-suite executives; ~56. This demographic nearing retirement, suggests that many company leaders embarked on their professional journeys before the pervasive influence of the Internet, email, and the rise of social media platforms, creating a technological generation gap. The sector's historical reliance on affluent markets in the US and Europe, coupled with fee-for-service healthcare policies, poses challenges in adapting to emerging markets and reimbursement policies centred on patient outcomes.
 
The integration of artificial intelligence (AI) and machine learning (ML) into medical devices adds another layer of complexity, necessitating a paradigm shift. However, this transformation proves challenging for traditional leaders, given that these impactful changes unfolded during the mature phases of their careers. Notably, out of ~691 FDA-approved algorithms functioning as medical devices, ~35% received clearance in 2022 and 2023. Despite the urgent need for adaptation, persistent leadership obstacles hinder progress, particularly in understanding and aligning with the fluidity of rapidly evolving technologies in new markets.
 
MedTech leaders face challenges in understanding the dynamics of emerging markets, especially in economically vibrant regions like Brazil, India, China, and sizable African nations. These areas experience economic development and a growing middle class, leading to increased demand for advanced healthcare. The global acumen gap is further intensified by a lack of first-hand experience among these professionals in these regions, presenting a hurdle to effective guidance. Consequently, many MedTech executives seem to struggle with delivering impactful direction, given the disconnect with transformative trends in emerging markets and advancing technologies. Addressing these perspective and knowledge gaps requires more than incremental adjustments; it calls for a shift in mindset and a recalibration.
 
Significant changes in MedTech call for a departure from traditional top-down directives towards an empowering leadership style. The sector now demands a new breed of leaders - tech savvy individuals with global experience capable of understanding and connecting with the needs and aspirations of Generation Z employees. This demographic shift in the workforce requires leaders who not only comprehend evolving technologies but also align with the values and expectations of today's highly skilled, young professionals. Beyond the pursuit of shareholder value, this demographic craves purpose-driven leadership and seeks companies with a clear sense of mission and societal impact. In this context, MedTech companies face a stark choice: adapt to lead with purpose or risk being left behind.
 
Takeaways

The future leadership of MedTech companies stands at a critical juncture as it is potentially faced with unprecedented changes over the next decade. While the necessity of a forward-looking CEO with digital acumen is essential for strategic innovation, the persisting challenges of manufacturing and regulatory frameworks highlight the need for a more collaborative leadership approach. To address this, we have proposed a strategic collaboration between a visionary CEO equipped with digital expertise and a seasoned COO skilled in manufacturing and compliance. It seems reasonable to assume that this would not only ease the burden on a single individual but also harness the strengths of both, fostering a more resilient leadership approach. Further, it recognises that navigating change demands a balance between embracing digital evolution and maintaining a strong foundation in traditional manufacturing and regulatory compliance. Future MedTech leaders must be able to bridge knowledge and perspective gaps, align with emerging technologies, and connect with the aspirations of the evolving workforce. The shift towards a more empowering leadership style, coupled with an understanding of Industry 4.0 principles and the dynamics of emerging markets, is essential for sustained success in a rapidly evolving market.

The urgency for MedTech leaders to adopt a forward-thinking, adaptable, and purpose-driven approach cannot be overstressed. The industry's capacity to allure and retain talent, foster innovation, and make substantial contributions to global healthcare pivots on a commitment to purposeful leadership and the incorporation of transformative strategies. In this demanding journey, the judicious collaboration between a forward-looking CEO and a traditional COO emerges as a strategic imperative, ensuring a comprehensive and resilient leadership model that can thrive in the next decade. 
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  • Up to ~5% of American and British citizens grapple with narcissism, which is characterised by self-centeredness and a lack of empathy
  • Narcissists disrupt organisations and relationships through hindering collaboration, discouraging teamwork, exploiting others, and displaying an exaggerated sense of self-worth, all while lacking empathy
  • Narcissists are drawn to healthcare for admiration, control and validation, which can pose a threat to the delivery of quality care
  • Narcissism's impact on efficiency and productivity often goes unnoticed by many healthcare leaders, despite the underlying harm it causes
  • Vigilance in identifying and effectively managing narcissistic traits within healthcare settings is necessary to preserve the integrity of patient-centred care and collaboration among healthcare professionals
 
Narcissism: Impeding Healthcare Quality and Organisational Effectiveness
 
 
Abstract

In the landscape of 2024, where the healthcare sector is strained by the aftermath of the Covid-19 pandemic, the challenges faced by healthcare executives are multifaceted. The surge in demand for care, driven by aging and chronically ill populations, collides with a diminishing supply of health professionals, creating a significant imbalance. Amidst this, many healthcare organisations grapple with declining workplace productivity and escalating gross margins. Such issues are further complicated by the struggle of human resource executives to foster collaboration, enhance teamwork, and improve employee satisfaction in the face of weak corporate cultures. A critical and often overlooked aspect contributing to the complexity of healthcare delivery is narcissism: a silent force that permeates the industry. The warning from Rob Behrens, the UK's Parliamentary and NHS ombudsman, sheds light on the impact of narcissistic tendencies among health professionals. The revelation of daily failings linked to narcissism raises concerns, supported by data indicating ~11,000 avoidable deaths in NHS England annually. An investigation conducted by the UK's Times Health Commission in 2023 emphasises the urgency of addressing narcissism within the healthcare system. As the Commission examined the future of health and social care, it uncovered a landscape fraught with challenges such as the aftermath of the Covid-19 pandemic, budget constraints, an A&E crisis, mounting waiting lists, health inequalities, obesity, and the challenges posed by an aging population. The extensive evidence sessions with diverse stakeholders, including senior doctors, nurses, midwives, hospital managers, scientists, business leaders, politicians, and health experts, provided a comprehensive understanding of the issues at play. Narcissists are attracted to healthcare, and narcissism, is identified as a rising concern with suggestions of a potential "narcissism epidemic" in Western economies. The prevalence of narcissistic personality disorder (NPD) in up to ~5% of the US and UK populations is alarming, with important implications for healthcare providers and the delivery of care. Early recognition and mitigation of narcissistic tendencies are critical to safeguard both care providers and patients. In the face of unprecedented challenges within the healthcare sector, recognising and actively addressing narcissism becomes necessary to strengthen the resilience of healthcare delivery. Unveiling the subtle yet impactful consequences of narcissistic tendencies and integrating targeted mitigation strategies into healthcare management are central to our suggestions. This proactive approach not only ensures a more robust operational framework but also paves the way for a patient-centric future, where the wellbeing of individuals takes centre stage in the evolving landscape of healthcare.
 
In this Commentary

This Commentary has three sections. Part 1: Decoding Narcissism, describes the condition, highlights some early warning signs, points to its incidence rates in the US and UK, and draws attention to the impact of narcissism on individuals and relationships. Part 2: Narcissism in Healthcare, discusses the prevalence and challenges of narcissism in healthcare settings, examining its impact on team dynamics, and patient-provider relationships. Part 3: Mitigating the Negative Effects of Narcissism, describes early warning signs and suggests key human resource strategies to alleviate the adverse effects of the disorder and considers some ethical implications of NPD for healthcare delivery. Takeaways emphasise: (i) early recognition of NPD and a proactive approach to its mitigation, (ii) professional help, and (iii) continuous learning and empathy development.  
 
Part 1
Decoding Narcissism
 
In recent years, the spotlight on narcissism has intensified, prompting discussions within the healthcare community. Narcissistic Personality Disorder (NPD) is a mental health condition characterised by a pervasive pattern of self-importance, a constant need for admiration, and a lack of empathy for others. More specifically, characteristics of the condition include: (i) a grandiose sense of self-importance and an exaggeration of one's talents and achievements, (ii) a preoccupation with fantasies of success, power, brilliance, beauty, or ideal love, (iii) an excessive need for admiration and a constant seeking of validation from others, (iv) a lack of empathy, (v) a sense of entitlement, (vi) a tendency to take advantage of others to achieve personal goals, often without regard for their wellbeing, (vii) a pervasive sense of envy toward others and a belief that others are envious of oneself, and (viii) arrogance.
 
People with the condition often engage in a behaviour referred to as gaslighting. This is a manipulative tactic that makes others doubt their own perceptions, memories, or sanity. Narcissists subtly or overtly distort facts, deny events, or present alternative narratives to undermine the confidence and reality of their victims. This can lead the person being gaslit to question their own judgment and feel confused, ultimately reinforcing the narcissist's control over them. Gaslighting is a harmful behaviour that undermines trust and can have enduring effects on the mental wellbeing of the individual experiencing it. The term gaslighting comes from a 1944 American movie, Gaslight, which is based on a 1938 play by Patrick Hamilton and stars Ingrid Bergman. The movie tells the story of a narcissist that drives his wife insane.
 
It is important to note that while everyone may exhibit some narcissistic traits at times, which are characterised by expressions of pride, egotism, and vanity, it does not mean that a person is a narcissist.  Individuals with the disorder display these traits consistently and to a degree that manifests as antisocial behaviour expressing callousness, remorselessness, and selfishness, with little empathy, and the condition impairs their functioning in various professional and personal aspects of life.

Narcissism casts a significant shadow over the psychological landscape. The condition affects up to ~5% of the American (~17m) and British (~3.4m) populations. The overwhelming majority of people with the disorder are males (~75%). Despite a prevalence among Afro-Americans (~12.5%) and Hispanics (~7.5%), ~87% of diagnosed Americans are Caucasian. However, such disparities could reflect access to therapy and treatment. A demographic breakdown reveals a higher incidence of the condition among young adults aged 20 to 34, with declining rates in those aged ≥50. Challenges in relationships are evidenced in the US statistics, with ~9.6% of narcissists being single, ~7.3% divorced or separated, and ~4.9% married. A higher percentage of narcissism is observed among mental health patients (~6%), forensic analysts (~6%), military personnel (~20%), and first-year medical students (~17%). These trends invite reflection on the socio-cultural factors contributing to the manifestation of narcissistic traits and emphasises the importance of tailored interventions across diverse demographics.

The causes of the disorder are rooted in a complex interplay of inherited traits, distinct personality characteristics, neurobiological influences, and environmental factors, all of which remain elusive. Notably, parent-child relationships marked by excessive adoration or criticism are believed to be contributory factors. The contemporary shift towards individualism, amplified by the omnipresence of social media, is also implicated in the increase of the disorder. A study published in the May 2021 edition of Personality Neuroscience suggests a connection between narcissism and heightened sensitivity to ego threats and emphasises social and emotional processing challenges and alterations in the brain's salience network as factors influencing the interpersonal dynamics of individuals with the condition. As society, organisations, families, and individuals grapple with these shifts, comprehending the ramifications of NPD's rise and impact becomes important. Here we discuss the negative influence of the condition on healthcare.

 
Part 2
Narcissism in Healthcare

In healthcare, the interplay between narcissism and health professionals is a complex and much debated subject. While quantifying the prevalence of narcissistic traits within healthcare institutions is challenging, studies suggest an affinity between narcissists and professions offering authority, recognition, and control: qualities inherent in certain healthcare roles. This proclivity can manifest in behaviours with potential repercussions on workplace dynamics and the delivery of care. John Banja's 2005 publication, Medical Errors and Medical Narcissism, illustrates how healthcare professionals, driven by a need to preserve their self-esteem, might hesitate to acknowledge and disclose medical errors.
 
The manifestation of narcissistic traits in healthcare professionals can divert their focus towards personal recognition, hindering collaboration with colleagues and impeding empathetic connections with patients. Identifying and addressing narcissistic traits in healthcare settings becomes imperative to cultivate a positive and collaborative environment. The inclination of narcissists to prioritise self-promotion over collaboration adds complexity to patient care, where emotional understanding and connection are necessary.
 
NPD casts a shadow on the dynamics between healthcare providers and their patients or collaborators, leaving an indelible mark on the relationships within the healthcare landscape, be it the collaboration and innovation-driven realm of MedTechs or the intricate doctor-patient connections. Healthcare professionals navigating narcissistic traits may find it challenging to comprehend and empathise with the emotions and experiences of colleagues and patients. This difficulty can create a perceived lack of compassion, posing a threat to trustworthy collaborative relationships within healthcare teams and compromising the balance in patient-provider connections.

 
The influence of narcissism on healthcare delivery is multifaceted, creating various disruptions. Providers swayed by narcissistic tendencies may prioritise personal validation over patient-centred care, challenging the importance of focusing on the patient's wellbeing in decision-making processes. Effective communication and empathy, critical elements in healthcare, may become casualties of narcissistic traits, impacting the informed consent process, and necessitating heightened ethical considerations to ensure respectful and informed patient consent. Maintaining appropriate boundaries becomes a struggle, giving rise to ethical concerns related to potential exploitation or invasion of patient privacy.
 
Beyond individual interactions, narcissism can also permeate collaborative efforts and teamwork, with ethical dilemmas emerging when personal interests overshadow collective goals. This compromises patient care and safety as collaboration and synergy take a back seat to self-centred motives. A culture of openness and accountability, vital for addressing concerns and errors in healthcare, faces hindrance, impacting care quality and the ability to rectify issues. Additionally, the prioritisation of personal recognition over equitable resource distribution raises ethical concerns regarding the fair and just use of healthcare resources. Thus, the ripple effect of narcissistic traits extends across a wide range of healthcare relationships and collaborations, demanding a nuanced approach to ensure the wellbeing of both providers and patients.

 
Part 3
Mitigating the Negative Effects of Narcissism

Early intervention plays an important role in addressing NPD and preventing its potentially harmful behaviours. Identifying early signs within oneself requires careful attention to behavioural patterns and interpersonal dynamics. Key indicators include feelings of grandeur, an inflated sense of achievements, and an incessant need for admiration. Additionally, individuals should assess their ability to understand and connect with the emotions and experiences of others, scrutinise their excessive need for praise and validation, and be cognisant of defensiveness or emotional reactions to feedback.
 
Similarly, recognising early signs in colleagues involves observing their interactions with others, noting potential signs such as a lack of genuine connection, self-promotion, and difficulties collaborating. Communication styles, domination in conversations, and reluctance to listen are red flags. Assessing their teamwork, prioritisation of personal goals over team goals, and conflicts with colleagues can provide further insights. Observing consistent patterns over time is important due to the enduring nature of the disorder's traits.
 
It is essential to emphasise that occasional narcissistic traits do not equate to NPD. However, if concerns persist, seeking professional help early enhances the likelihood of positive outcomes. Professional intervention fosters self-awareness and serves as a foundation for positive change. Therapy guides individuals through self-exploration, offering tools to navigate challenges, manage stress, and improve relationships. Early intervention is critical in mitigating the potential harm narcissistic traits can inflict on relationships.
 
Creating a positive work environment involves open communication, clear goals, and team-building activities. Acknowledging and appreciating team efforts, empowering members, embracing diversity, and establishing effective conflict resolution mechanisms contribute to a positive workplace. Leaders play a crucial role by exemplifying positive behaviour and encouraging constructive feedback, promoting collaboration, employee satisfaction, and increased productivity.
  
Addressing NPD in healthcare delivery raises ethical concerns, requiring a focus on patient-centred care, effective communication, professional boundaries, and a collaborative, ethical healthcare culture. Healthcare professionals and organisations must embrace these challenges, guided by ethical principles to ensure quality patient care. Human resources play a crucial role in fostering psychological safety: a culture where team members freely express ideas, admit mistakes, and contribute without fear. This openness supports innovation, risk reduction, and inclusivity, serving as a game-changer for team dynamics and performance. Properly managed, psychological safety leads to fewer mistakes, increased creativity, enhanced team performance, improved diversity, and greater organisational resilience. It is not a luxury but a necessity for thriving teams, encouraging open communication, building trust, and emphasising team dynamics over individual skills.
 
Takeaways

Successfully addressing the challenges posed by NPD requires a comprehensive and proactive strategy. Recognising the early signs and intervening promptly is essential to mitigate the negative impacts on personal relationships, work environments, and healthcare delivery. Seeking professional help, fostering self-awareness, and developing effective coping mechanisms serve as foundational pillars for cultivating healthier interpersonal dynamics. Building resilience against narcissistic challenges necessitates a commitment to continuous learning, empathy development, and the establishment of robust boundaries. Organisations, too, can benefit by promoting awareness, education, and proactive management of narcissism, thereby reducing associated stigma, and fostering open conversations about mental health. Education is a key component, targeting healthcare professionals to recognise early signs of the disorder and understand its impact on individuals, relationships, and healthcare delivery. Proactive management involves creating supportive environments, implementing interventions, and cultivating a culture of empathy and collaboration. Prioritising mental health, advocating for accessible resources, and adopting a compassionate and informed approach can collectively address the challenges associated with NPD, contributing to a more empathetic and understanding society.
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Peace, Health and Best Wishes for 2024
 
 
The HealthPad Team would like to wish you and your loved ones a joyful Festive Season and a prosperous and peaceful New Year.

Thanks for your continued support. As we celebrate another year together, we sincerely hope you've found our Commentaries interesting and helpful.

 
In the dynamic landscape of healthcare, 2023 has proven to be a year marked by 18 impactful publications. A trend has emerged, suggesting that many MedTech leaders, after enjoying success, are now managing legacy products in markets with subdued momentum. Confronted by challenges to enhance growth rates and add value, our focus has been to address issues that significantly impact MedTech companies, with an aim to both encourage and contribute to strategic discussions among industry leaders (MedTechs Battle with AI for Sustainable Growth and Enhanced Value, The Silent Obstacle to MedTech Growth and Value Creation, Forging a path for digital excellence in the MedTech Industry, Redefining Leadership in the Evolving Landscape of MedTech, Unleashing MedTech's Competitive Edge through Transformational Technologies, The Financialization Dilemma of MedTechs, Healthcare disrupters, Re-imagining healthcare, The impact of big data, artificial intelligence, and machine learning).

In our explorations, we've delved into women's health (Transforming Women's Health) and celebrated the endeavours of a remarkable woman who won the 2023 Nobel Prize for Physiology or Medicine (A Nobel Journey: Triumph over Adversity, Serendipity, BioNTech’s Rise, and mRNA Marvels).
 
Venturing into the realm of innovation, we've examined emerging technologies and strategies (PPG technology: Unlocking the Potential of Healthcare, The Future of Regenerative Medicine, 3D bioprinting and the advanced wound care market, Out of the hospital into the home). We've also charted new frontiers, questioning if Africa is the next hub for Western MedTechs (Is Africa the New Asia for Western MedTechs?) and speculated on the future landscape of healthcare in 2040 (Healthcare 2040).

We trust these Commentaries have been engaging, offering insights, and encouraging thought. As we bid farewell to 2023, we look forward sharing more thought-provoking content with you in 2024.
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The HealthPad Team would like to extend our thanks for your continued support. As we celebrate another year together, we sincerely hope you've found our Commentaries interesting and helpful and we look forward sharing more thought-provoking content with you in 2024.

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  • Since 2000 healthcare has been transformed by genomics, AI, the internet, robotics, and data-driven solutions
  • Traditional providers, anchored in outdated technologies, struggle to keep pace with the evolving healthcare landscape
  • Over the next two decades anticipate another seismic shift, bringing further disruptions to medical technology and healthcare delivery
  • In the face of this imminent transformation, risk-averse leaders may cling to outdated portfolios, showing little interest in adapting to a 2040 healthcare ecosystem
  • Providers must decide; embrace change now and thrive in a transformed healthcare landscape, or stick to the status quo and risk losing value and competitiveness
 
Healthcare 2040
 
Abstract

By 2040, the landscape of healthcare will have undergone a seismic shift, discarding antiquated models in favour of cutting-edge AI-genomic-data-driven approaches that will radically change both medical technology and healthcare delivery. This transformation signifies a departure from the conventional one-size-fits-all system, ushering in an era of targeted therapies grounded in molecular-level insights that challenge entrenched healthcare paradigms. The evolving healthcare narrative emphasises prevention, wellbeing, personalised care, and heightened accessibility. This departure from the norm is not a trend but a significant reconfiguration, where the fusion of biomedical science, technology, and expansive datasets merge to facilitate early detection and proactive interventions. This not only deepens our comprehension of diseases but also elevates the efficacy of therapies. At the core of this transformation is the empowerment of individuals within a framework that champions choice and fosters virtual communities. Genetic advancements, far from just addressing hereditary conditions, play an important role in enhancing diagnostic accuracy, optimising patient outcomes, and fundamentally shifting the focus from reactive diagnosis and treatment to a proactive commitment to prevention and holistic wellbeing. The indispensable roles played by genomics and AI-driven care in reshaping healthcare are not isolated occurrences; they will catalyse the emergence of new data-intensive R&D enterprises, which are poised to redefine the healthcare landscape against a backdrop of multifaceted influencing factors. Successfully navigating this transformative period necessitates a distinct set of capabilities and strategic alignment with an envisioned 2040 healthcare environment.

Providers find themselves at a crossroads, confronted with a choice: adapt and thrive or risk losing value and competitiveness in a rapidly evolving landscape. Recognising potential resistance to change and the scarcity of pertinent capabilities, leaders of traditional enterprises must acknowledge that immediate strategic action is not just beneficial but a prerequisite for success in the redefined healthcare ecosystem of 2040. The urgency of this call to action cannot be overstated, as the window of opportunity for adaptation narrows with each passing moment.

 
In this Commentary

This Commentary aims to help healthcare professionals to strategically reposition their organizations for success in the next two decades. Leaders must evaluate their strengths and weaknesses in the context of an envisioned future and implement strategies to align their organisations with the demands of a rapidly changing health ecosystem. Failure to do so will dent enterprises’ competitiveness and threaten their survival. Leaders should anticipate and address resistance to change among executives with a preference for the status quo. The Commentary has two sections: Part 1, Looking Back 20 Years, describes the scale and pace of change since 2000 and emphasises how genomics, the internet, AI, digitalization, data-driven solutions, robotics, telehealth, outpatient services, personalised care, ubiquitous communications, and strategic responses to demographic shifts have transformed medical technology and healthcare delivery. Part 2, Looking Forward 20 Years, seeks to stimulate discussions about the future of healthcare. While we highlight a range of factors positioned to impact medical technology and healthcare deliver in the future, we emphasise the significance of genomics, varied and vast datasets, and AI. We suggest the emergence of specialised agile, AI-driven research boutiques with capabilities to leverage untapped genomic, personal, and medical data. The proliferation of such entities will oblige traditional healthcare enterprises to reduce their R&D activities and concentrate on manufacturing. Over the next 20 years, anticipate an accelerated shift towards patient-centric, cell-based prevention and wellbeing care modalities, large hospitals replaced with smaller hubs of medical excellence, the rapid growth of outpatient centres, and the acceleration of home care and care-enabled virtual communities. The future dynamic healthcare ecosystem necessitates stakeholders to change immediately if they are to survive and prosper. Takeaways posit a choice for healthcare leaders: either stick to the status quo and risk losing value and competitiveness or embrace change and stay relevant.
 
Part 1
 
Looking Back 20 Years

Reflecting on the past two decades shows the rapid evolution and interplay of factors shaping medical technology and healthcare delivery. Appreciating the speed and scale of change helps to envision the future. Factors such as genomics, the Internet, AI, robotics, digitalisation, data-driven health solutions, telehealth, outpatient services, home care, personalised wellbeing, ubiquitous personal telephony, and strategic responses to demographic shifts have all influenced medical technology and healthcare delivery and will continue to do so in the future. Here we describe a few of these factors.

The completion of the Human Genome Project in 2003 was a pivotal moment in the direction of medical advancement, laying the foundations for the emergence of genomics. Genomics, encapsulating the mapping, sequencing, and analysis of DNA, is a pivotal tool for unravelling molecular information, variations, and their implications in both traits and diseases. This achievement not only transformed biomedical research but also changed healthcare, shifting it from a generic one-size-fits-all approach to finely tuned care tailored to the unique genetic makeup of individuals.

Over the past two decades, the decoding of the human genetic blueprint has provided unprecedented insights into diseases at the molecular level, triggering a paradigm shift in medicine. This ushered in an era of personalised and precision approaches to diagnoses, treatments, and prevention. From the advent of targeted therapies to the implementation of genetic screening, genomic research has had a transformative influence and is positioned to continue its impact on healthcare.

Indeed, genomic testing has become a standard practice, and US Food and Drug Administration (FDA)-approved genomic care modalities have advanced medicine. For example, pharmacogenonics tailors drug treatments to individual patients by utilising genetic information, with FDA-approved tests for specific biomarkers that predict medication responses. Hereditary assessments evaluate an individual's cancer risk based on genetic makeup, such as identifying BRCA gene mutations linked to elevated risks of breast and ovarian cancers. Gene expression profiling analyses a patient's tumour genetics to guide targeted cancer therapies, with FDA-approved companion diagnostic tests for specific cancer treatments. Carrier testing identifies genetic mutations that could be passed on to children, which contribute to family planning and prenatal care. Pharmacodiagnostic tests help pinpoint patients that would benefit from specific drug treatments, predicting responses, especially in cancer therapies.

In 2012, the UK government inaugurated Genomics England, an initiative designed to spearhead the 100,000 Genomes Project, which aimed to sequence the genomes of 100,000 patients with infectious diseases and specific cancers. The project’s goals included the enhancement of our understanding of various genetic factors in diseases, the facilitation of targeted treatments and establishing a framework for the integration of genomics into everyday clinical practice. The successful completion of the project in 2018, provided a basis for genomic medicine and a deeper understanding of the genetic framework influencing health and disease.

In addition to genomic data, since 2000, there has been a significant increase in health-related data, driven by the proliferation of electronic health records (EHRs), developments in information management technologies, initiatives to improve healthcare efficiency, and enhanced communications among stakeholders. The growth in data has, in turn, created opportunities for the utilisation of AI and machine learning (ML) algorithms. Over the last two decades, AI has changed medical technology and healthcare delivery by enhancing diagnostics, personalising treatment plans, streamlining administrative tasks, and facilitating research through efficient data analysis, which has improved patient outcomes, and advanced the field. As of January 2023, the FDA has approved >520 AI and ML algorithms for medical use, which are primarily related to the analysis of medical images and videos. Indeed, the rise of algorithms has transformed healthcare, with many of them focusing on predictions using EHRs that do not require FDA approval.

In addition to EHRs there has been the evolution of wearable technologies like the Apple Watch and Fitbit, which have transformed personal health. Initially focusing on fitness tracking, these devices have expanded to monitor an array of health metrics. Over the years, they have amassed vast amounts of personalised data, ranging from activity levels to heart rate patterns. These data reservoirs are a goldmine for healthcare and wellbeing strategies, enabling individuals, healthcare professionals and providers to gain unprecedented insights into health trends, customised care routines, and the early detection of health issues. This combination of technology and health data has created opportunities for proactive healthcare management and personalised wellbeing interventions.

Targeted medicine not only benefitted from AI but also from personalised telephony, which experienced a significant boost in the early 2000s by the widespread internet access in households across the globe. The period was marked by the introduction of the iPad in 2001, closely followed by the launch of the iPhone. These innovations triggered widespread smartphone use and accessible internet connectivity, laying the foundations for the emergence of telehealth and telemedicine. In the early 2000s, global cell phone subscriptions numbered ~740m. Today, the figure is >8bn, surpassing the world's population. This increase was driven by the proliferation of broadband, the evolution of mobile technologies and the rise of social media, all contributing to the ubiquitous presence of the internet. By the 2010s, the internet had integrated into the daily lives of a substantial portion of the global population. Initially, in 2000, ~7% of the world’s population had access online. Contrastingly, today, >50% enjoy internet connectivity. In a similar vein, broadband access in American homes has surged from ~50% in 2000 to >90% in the present day. Personal telephony has evolved into an omnipresent force, and has become an integral part of billions of lives, actively enhancing health and wellbeing on a global scale. After 2010, patient-centric wellbeing evolved and later was helped by Covid-19 pandemic lockdowns, with telehealth and telemedicine offering remote consultations and treatments, empowering patients, and emphasising shared decision-making between healthcare providers and patients.

On a more prosaic level, consider how robotics has changed surgery over the past two decades by offering enhanced precision, reduced invasiveness, and improved recovery times. The use of robotic systems, like the da Vinci Surgical System, which gained FDA-approval in 2000, has allowed surgeons to perform complex procedures with greater accuracy. Between 2012 and 2022, the percentage of surgical procedures using robotic systems rose from 1.8% to 17%. Robotic surgery is becoming increasingly popular, with an annual growth rate of ~15%. In 2020, its global volume was 1.24m, with the US accounting for >70% of all robotic surgeries.

The shifting demographics over the past few decades, marked by decreasing birth rates, prolonged life expectancy, and immigration, has transformed prosperous industrial economies, resulting in a substantial rise in the proportion of the elderly population. For instance, in the US in 2000, there were ~35m citizens ≥65; today, this figure has risen to ~56m, ~17% of the population. Concurrently, there has been an increase of chronic lifetime illnesses such as heart disease, diabetes, cancer, and respiratory disorders. In 2000, ~125m Americans suffered from at least one chronic condition. Today, this figure has increased to ~133m - ~50% of the population. Simultaneously, there is a shrinking pool of health professionals. Research suggests that by 2030, there will be ~5m fewer physicians than society will require. This, together with ageing populations, the growing burden of chronic diseases and rising costs of healthcare globally are challenging governments, payers, regulators, and providers to innovate and transform medical technology and healthcare delivery.

 
Part 2
 
Looking Forward 20 Years

This section aims to encourage healthcare professionals to envision the future. Over the next two decades, medical technology and healthcare delivery are likely to be affected by numerous interconnected factors, which include: (i) continued progress in AI and ML, internet of things (IoT), robotics, nanotechnology, and biotechnology, (ii) advances in genomics, (iii) increasing availability of multi-modal data (genomics, economic, demographic, clinical and phenotypic) coupled with technology innovations, (iv) accelerated adoption of telemedicine and virtual monitoring technologies, (v) changes in healthcare regulations, (vi) an increase of patient-cantered care and greater patient involvement in decision-making, (vii) emerging infectious diseases, antimicrobial resistance, and other global health issues, (viii) Investments in healthcare infrastructure, both physical and digital, (ix) an evolving and shrinking healthcare workforce, including the further integration of AI technologies and changes in roles, (x) economic conditions and healthcare funding, (xi) the ethical use of technology, privacy concerns, and societal attitudes towards healthcare innovations, and (xii) environmental changes and their impact on health and wellbeing. Such factors and their interconnectivity are expected to drive significant healthcare transformation over the next two decades. Healthcare systems throughout the world are tasked with: (i) improving population health, (ii) enhancing patients’ therapeutic journeys and outcomes, (iii) strengthening caregivers’ experience and (iv) reducing the rising cost of care. There appears to be unanimous agreement among healthcare leaders that these goals will not be achieved by business as usual.
 
In November 2023, BTIG, a leading global financial services firm, organised its Digital Health Forum, bringing together >30 healthcare companies that offer a diverse range of products and services. During the event, executives discussed business models, reimbursement, and commercial strategies, and unanimously agreed that: "The market is primed for the mainstream integration of digital diagnostics and therapeutics."  Here we focus on the anticipated accelerated convergence of genomics and AI technologies, and foresee the emergence of agile, AI-driven R&D boutiques as key players in reshaping medical technology and healthcare delivery.
 
These dynamic research entities thrive on the power of data. Currently, ~79% of the hospital data generated annually goes untapped, and medical information is doubling every 73 days. This emphasises the vast latent potential within these repositories. Traditional enterprises and healthcare professionals, constrained by a dearth of data management capabilities, have struggled to unlock the full potential inherent in these vast stores of information. By contrast, the adept data processing capabilities of these new innovative enterprises position them strategically to harness untapped data sources, extracting valuable insights into disease states and refining treatment modalities. Moreover, they boast advanced technology stacks, seamless connections between semiconductors, software, and systems, and are well-prepared to leverage specialised generative AI applications as they emerge in the market. Armed with cutting-edge technology and extensive datasets, they stand ready to enhance diagnostic precision, streamline treatment approaches, and reduce overall healthcare costs. Private equity firms will be eager to invest in these disruptive AI start-ups, anticipating M&A activities focused on specific therapeutic areas that will make them appealing to public markets.

These innovative entities are set to expedite the introduction of disruptive solutions, improve patients' therapeutic journeys, and optimise outcomes while driving operational efficiencies. Anticipate them to overshadow their traditional counterparts, many of which have outdated legacy offerings and historically have treated R&D as small adjustments to existing portfolios. Given that many conventional healthcare enterprises have: (i) failed to keep pace with technological developments, (ii) a dearth of in-house data-handling capabilities, and (iii) no experience in data-heavy disruptive R&D, it seems reasonable to suggest that they will most likely retreat into their core manufacturing activities, relinquish their R&D roles and lose value.

In the forefront of seismic change, the integration of digitalisation, AI, and cutting-edge decision support tools propels the emerging agile, data-driven R&D enterprises into a pivotal role within the landscape of well-informed, personalised healthcare. Meticulously safeguarding sensitive information, these enterprises not only adhere to the highest standards of privacy but also elevate security measures through state-of-the-art encryption techniques and decentralised storage solutions. As staunch guardians of privacy, they go beyond conventional approaches, crafting data repositories that not only shield confidential information but also facilitate the seamless flow of critical insights crucial for advancing medical technology and elevating care delivery. The seamless synergy between vast genomic, economic, demographic, clinical, and phenotypic data repositories and advanced AI techniques is poised to radically change healthcare R&D, redirecting it away from refining traditional products towards disruptive endeavours. Moreover, these agile research entities are anticipated to encourage widespread industry cooperation, harnessing the power of diverse data sources to innovate health solutions and services that transcend boundaries, thereby playing an important role in shaping a borderless health and wellbeing ecosystem.

In the regulatory arena, a transformation is anticipated by 2040. Regulators are likely to evolve from enforcers to stewards of progress, collaborating with industry stakeholders to promote a consumer-centric healthcare. Advocating transparency, patients' rights, and ethical innovation, regulators will become influential drivers of progress, contributing to a shared and equitable healthcare future. This collaborative effort is expected to contribute to a data-driven healthcare ecosystem that prioritises individual wellbeing, innovation, and accessibility in equal measure.

By 2040, expect healthcare payers to have undergone a transformative change, fuelled by a seismic shift in medical technology and healthcare delivery. New payment models will prioritise individualised therapies and patient outcomes, leveraging real-time health data for customised coverage. AI will streamline administration, reduce costs, and enhance overall healthcare efficiency. Increased patient engagement and collaboration among payers, providers, and patients will drive a holistic, patient-centred approach, ultimately improving the quality and accessibility of healthcare services.


This section has emphasised the transformative forces of genomics and AI shaping a personalised healthcare ecosystem. While traditional medical technology and healthcare delivery may be predicated upon physical devices and a one-size-fits-all approach, the future lies in the fusion of data and smart software to accelerate targeted care, which marks a significant departure from the conventional.
 
Takeaways

The shift towards genomic-driven healthcare marks a transformation in the medical landscape expected by 2040. Moving away from outdated models, the trend towards personalised care, rooted in molecular insights, necessitates a revaluation from health professionals. This shift, facilitated by the fusion of biomedical science, advanced technologies, and vast amounts of varied data, foresees a future where prevention, individualised wellbeing, and improved accessibility become the new norm. The convergence of genomics and AI not only improves diagnostics and treatments but also points to prevention and overall wellness. This Commentary has highlighted the transformative impact of genomics and AI-driven healthcare at the cellular level, making way for data-intensive R&D enterprises that will shape the future of medical technology and healthcare delivery. The path to 2040 demands a departure from conventional norms of the past, requiring strategic realignment and specific capabilities. Traditional providers find themselves at a juncture: those that adapt to an envisioned care environment of 2040 are more likely to succeed, while those that resist risk becoming obsolete. By acknowledging potential obstacles to change and the scarcity of relevant capabilities, leaders are encouraged to recognise the urgency of strategic action as a prerequisite for success in the redefined healthcare landscape of 2040. The future is imminent, and the time for transformative readiness is now.
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MedTechs Battle with AI for Sustainable Growth and Enhanced Value
 
Preface
 
The medical technology industry has experienced significant growth, consistently surpassing the S&P index by ~15 percentage points. This success is rooted in the early 1990s, a time when capital was costly, with interest rates ~10%. However, as we moved closer to 1998, interest rates began to recede, settling just below 7%. This early era of growth was not devoid of challenges. The US was still grappling with the aftermath of the oil embargo imposed in 1973 by the Organization of the Petroleum Exporting Countries (OPEC), which was a response to the American government's support for Israel during the Yom Kippur War and had lasting consequences. The oil crisis triggered hyperinflation, leading to a rapid escalation in the prices of goods and services. In response, the US Federal Reserve (Fed) raised interest rates to a historic high of 17% in 1981, which was aimed at curbing inflation but came at the price of increasing the cost of borrowing. As we entered the 1990s, the landscape shifted. The Fed’s monetary policies began to work, inflation started to decline, and interest rates fell to ~10%, eventually dipping below 7% in 1998. This created conditions for increased investments in research and development (R&D) and the American economy blossomed and benefitted from the internet becoming mainstream. It was during this period that many medical technology companies developed innovative medical devices, which were not only disruptive but also found a receptive global market characterized by significant unmet needs and substantial entry barriers. In the ensuing years, the industry thrived and matured. Fast-forward to the present (2023), and we find ourselves in a different scenario. Over the past five years, numerous large, diversified MedTechs have struggled to deliver value. One explanation for this is that growth of these enterprises over the past three decades, except for the early years, was primarily driven by mergers and acquisitions (M&A), often at the expense of prioritizing R&D. Consequently, many large MedTechs did not leverage evolving technologies to update and renew their offerings and are now heavily reliant on slow-growth markets and aging product portfolios. Navigating a successful path forward would be helped by a comprehensive embrace of artificial intelligence (AI) and machine learning (ML) strategies, since these technologies possess the potential to transform how MedTechs operate, innovate, and serve their stakeholders.
 
In this Commentary

This Commentary explores the role of artificial intelligence (AI) in reshaping the future landscape of the MedTech industry in pursuit of sustainable growth and added value. We focus on the impact AI can have on transforming operational methodologies, fostering innovation, and enhancing stakeholder services. Our aim is to address five key areas: (i) Defining Artificial Intelligence (AI): Describes how AI differs from any other technology in history and sheds light on its relevance within the MedTech sector. (ii) Highlighting AI-Driven MedTech Success: In this section, we preview three leading corporations that have utilized AI to gain access to new revenue streams. (iii) Showcasing a Disruptive AI-Powered Medical Device: Here, we provide an overview of the IDx-DR system, an innovation that has brought disruptive change to the field of ophthalmology. (iv) The Potential Benefits of Full AI Integration for MedTechs: This section briefly describes 10 potential benefits that can be expected from a comprehensive embrace of AI by MedTechs. (v) Potential Obstacles to the Adoption of AI by MedTechs: Finally, we describe some obstacles that help to explain some MedTechs reluctance to embrace AI strategies. Despite the substantial advantages that AI offers, not many large, diversified enterprises have fully integrated these transformative technologies into their operations. Takeaways outline the options facing enterprises.
 
Part 1

Defining Artificial Intelligence (AI)

Artificial Intelligence (AI) is a ground-breaking concept that transcends the simulation of human intelligence. Unlike human cognition, AI operates devoid of consciousness, emotions, and feelings. Thus, it is indifferent to victory or defeat, tirelessly working without rest, sustenance, or encouragement. AI empowers machines to perform tasks once exclusive to human intelligence, including deciphering natural language, recognizing intricate patterns, making complex decisions, and iterating towards self-improvement. AI is significantly different to any technology that precedes it. It is the first instance of a tool with the unique capabilities of autonomous decision making and the generation of novel ideas. While all predecessor technologies augment human capabilities, AI takes power away from individuals.
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Forging a path for digital excellence in the MedTech Industry


Unleashing MedTech's Competitive Edge through Transformational Technologies
AI employs various techniques, including machine learning (ML), neural networks, natural language processing, and robotics, enabling computers to autonomously tackle increasingly complex tasks. ML, a subset of AI, develops algorithms that learn, adapt, and improve through experience, rather than explicit programming. The technology’s versatile applications span image and speech recognition, recommendation systems, and predictive analytics. In the quest to comprehend the intersection of artificial and human intelligence, we encounter Large Language Models (LLMs), like ChatGPT, which recently have gained prominence in corporate contexts. These advanced AI models grasp and generate human-like text by discerning patterns and context from extensive textual datasets. LLMs excel in language translation, content generation, and engaging in human-like conversations, effectively harnessing our linguistic abilities.


Part 2

Highlighting AI-Driven MedTech Success

This section briefly describes three examples of MedTechs that have successfully leveraged AI technologies to illustrate how AI’s growing influence drives improvements in accuracy, efficiency, patient outcomes and in the reduction of costs, which together, and in time, are positioned to transform healthcare.
 
Merative, formally Watson Health, a division of IBM that specialised in applying AI and data analytics to healthcare. In 2022, the company was acquired by Francisco Partners, an American  private equity firm, and rebranded Merative. The company leverages AI, ML, and LLMs to analyse extensive medical datasets that encompass patient records, clinical trials, medical literature, and genomic information. These technologies empower healthcare professionals by facilitating more informed decisions, identifying potential treatment options, and predicting disease outcomes. For instance, Merative employs ML to offer personalised treatment recommendations for cancer patients based on their medical histories and the latest research. Integrating LLMs enables natural language processing to extract insights from medical literature, helping healthcare providers stay current with scientific and medical advancements.
 
Google Health, a subsidiary of Alphabet Inc., focuses on using AI and data analysis to improve healthcare services and patient outcomes. It employs AI and ML to develop predictive models that can identify patterns and trends in medical data, which improve early disease detection and prevention. One notable application is in medical imaging, where the company's algorithms can assist radiologists to identify anomalies in X-rays, MRIs, and other images. LLMs are used to interpret and summarize medical documents, making it easier for healthcare professionals to access relevant information quickly. Google Health also works on projects related to drug discovery and genomics, leveraging ML to analyze molecular structures and predict potential drug candidates.
Medtronic is a global leader in medical technology, specializing in devices and therapies to treat various medical conditions. The company incorporates AI, ML, and LLMs into their devices and systems to enhance patient care. For instance, in the field of cardiology, Medtronic's pacemakers and defibrillators collect data on a patient's heart rhythms, which are then analyzed using AI algorithms to detect irregularities and adjust device settings accordingly. This real-time analysis helps to optimize patient treatment. Medtronic also employs AI in insulin pumps for diabetes management that can learn from a patient's blood sugar patterns and adjust insulin delivery accordingly. Additionally, LLMs are used to extract insights from electronic health records (EHR) and clinical notes, which help healthcare providers to make more personalized treatment decisions.
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Part 3

Showcasing a Disruptive AI-Powered Medical Device

AI has been applied to various medical imaging tasks, including interpreting radiological images like X-rays, CT scans, and MRIs and there are numerous AI-driven medical devices and systems that have emerged and evolved in recent years. As of January 2023, the US Federal Drug Administration (FDA) has approved >520 AI medical algorithms, the majority of which are related to medical imaging. Here we describe just one, the IDx-DR system, which was developed by Digital Diagnostics. In 2018, it became the first FDA-approved AI-based diagnostic system for detecting diabetic retinopathy. If left untreated, the condition can lead to blindness. Globally, the prevalence of the disease among people living with diabetes is ~27% and every year, >0.4m people go blind from the disorder. In 2021, globally there were ~529m people with diabetes, which is expected to double to ~1.31bn by 2050.
 
The IDx-DR device utilizes AI algorithms to analyze retinal images taken with a specialized camera and accurately detects the presence of retinopathy that occurs in individuals with diabetes when high blood sugar levels cause damage to blood vessels in the retina. Significantly, the device produces decisions without the need for retinal images to be interpreted by either radiologists or ophthalmologists, which allows the system to be used outside specialist centres, such as in primary care clinics. Advantages of the system include: (i) Early detection, which can improve outcomes and quality of life for individuals with diabetes. (ii) Efficiency. The system analyzes images quickly and accurately, providing results within minutes, which allows healthcare providers to screen a larger number of patients in a shorter amount of time. (iii) Reduced healthcare costs. By detecting retinopathy at an early stage, the system helps prevent costly interventions, such as surgeries and treatments for advanced stages of the disease, which can lead to significant cost savings for healthcare systems. (iv) Patient convenience. Patients undergo retinal imaging as part of their regular diabetes check-ups, reducing the need for separate appointments with eye specialists, which encourages enhanced compliance.

 
Part 4

The Potential Benefits of Full AI Integration for MedTechs

Large, diversified MedTechs stand to gain significant benefits by fully embracing AI technologies that extend across all aspects of their operations, innovation, and overall value propositions. In this section we briefly describe 10 such advantages, which include enhanced innovation, improved patient outcomes, increased operational efficiency, cost savings, and access to new revenue streams. Companies that harness the full potential of AI will be better positioned to thrive in the highly competitive and rapidly evolving healthcare industry.
 
1. Enhanced innovation and product development
AI technologies have the potential to enhance R&D endeavours. They accomplish this through the ability to dig deep into vast repositories of complex medical data, identifying patterns, and forecasting outcomes. This translates into a shorter timeline for the conception and creation of novel medical technologies, devices, and therapies. In essence, AI quickens the pace of innovation in healthcare. The capabilities of AI-driven simulations and modeling further amplifies its impact. These virtual tools enable comprehensive testing in a digital environment, obviating the need for protracted physical prototyping and iterative cycles, which can shorten the development phase and conserve resources, making the innovation process more cost-effective, and environmentally sustainable.
 
2. Improved patient outcomes
Beyond improving the research landscape, AI improves the quality of patient care by enhancing diagnostic precision through the analysis of medical images, patient data, and clinical histories. Early detection of diseases becomes more precise and reliable, leading to timelier intervention and improved patient outcomes. Additionally, AI facilitates the personalization of treatment recommendations, tailoring them to individual patient profiles and current medical research. This optimizes therapies and increases the chances of successful outcomes and improved patient wellbeing.
 
3. Efficient clinical trials
Increasingly AI algorithms are being used in clinical studies to identify suitable patient cohorts for participation in trials, effectively addressing recruitment challenges and streamlining participant selection. Further, predictive analytics play a role in enhancing the efficiency of trial design. By providing insights into trial protocols and patient outcomes, AI reduces both the time and costs associated with bringing novel medical technologies to market, which speeds up the availability of treatments and facilitates the accessibility of healthcare innovations to a broader population.
 
4. Operational efficiency
Operational efficiency is improved with the integration of AI technologies by refining operations. AI-driven supply chains and inventory management systems play a significant role in optimizing procurement processes. They analyze demand patterns, reduce wastage, and ensure the timely availability of critical supplies. By doing so, companies can maintain uninterrupted operations, enhancing their overall efficiency and responsiveness. Another component of operational efficiency lies in predictive maintenance, which can be improved by AI. Through continuous monitoring and data analysis, AI can predict equipment failures before they occur. Such a proactive approach minimizes downtime and ensures manufacturing facilities remain compliant and in optimal working condition. Consequently, healthcare providers experience improved operational efficiency, strengthened compliance, and a reduction in costly disruptions. The automation of routine tasks and processes via AI relieves healthcare professionals from repetitive duties and frees up resources that can be redirected towards more strategic and patient-centric initiatives. This reallocation reduces operational costs while enhancing the quality of care provided.
 
5. Cost savings
Beyond automation, AI-driven insights further uncover cost efficiencies within healthcare organizations. AI identifies areas where resource allocation and utilization can be optimized, which can result in cost reduction strategies that are both data-informed and effective. AI's potential extends to the generation of innovative revenue streams. Corporations can develop data-driven solutions and services that transcend traditional medical devices. For instance, offering AI-driven diagnostic services or remote patient monitoring solutions provides access to new revenue streams. Such services improve patient care and contribute to the financial sustainability of enterprises. Further, AI-enabled healthcare services lend themselves to subscription-based models, ensuring consistent and reliable revenue over time. Companies can offer subscription services that provide access to AI-powered diagnostics, personalized treatment recommendations, or remote monitoring, which have the capacity to diversify revenue streams and enhance longer-term financial stability.
 
6. New revenue streams
AI's ability to analyze vast datasets positions MedTechs to unravel the interplay of genetic, environmental, and lifestyle factors that shape individual health profiles. With such knowledge, personalized treatment plans and interventions can be developed, ensuring that medical care is tailored to each patient's unique needs and characteristics. This level of customization optimizes outcomes and minimizes potential side effects and complications. AI's ability to process vast amounts of patient data and detect patterns, anomalies, and correlations, equips healthcare professionals with the knowledge needed to make more informed decisions. Such insights extend beyond individual care, serving as the basis for effective population health management and proactive disease prevention strategies. In short, AI transforms data into actionable intelligence, creating a basis for more proactive and efficient healthcare practices.
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7. Regulatory compliance and safety
In an era of stringent healthcare regulations, AI is a reliable ally to ensure compliance and enhance safety standards. Through automation, AI streamlines documentation, data tracking, and quality control processes, reducing the risk of errors and oversights. Also, AI-powered systems excel in the early detection of anomalies and potential safety issues, which increase patient safety and the overall quality of healthcare solutions and services. This safeguards patient wellbeing and protects the reputation and credibility of companies.
8. Competitive advantage
MedTechs that are early adopters of AI stand to gain a distinct competitive advantage. They can offer AI-powered solutions and services that deliver superior clinical outcomes and improve overall patient experience. By harnessing the potential of AI, companies can position themselves as leaders in innovation and technological capabilities, likely drawing a loyal customer base, valuable partnerships, collaborations, and investments.
 
9. Talent attraction and retention
Embracing AI technologies also has an impact on talent attraction and retention. The allure of working on novel AI projects that improve lives attracts scarce tech-savvy professionals who seek to be part of dynamic, purposeful, and forward-thinking teams. Such talent contributes to a skilled workforce capable of extending the boundaries of AI innovation within MedTech companies. Further, fostering a culture of innovation through AI adoption encourages employee engagement and job satisfaction, leading to improved talent retention.
 
10. Long-term sustainability
The integration of AI goes beyond immediate advantages; it positions MedTechs for longer-term strategic growth and resilience. As the healthcare landscape continues to evolve, adaptability and innovation become more important. AI enables companies to adapt to changing market dynamics, navigate regulatory challenges, and remain relevant amidst industry transformations. By staying at the forefront of technological advancements, companies ensure their relevance and contribute to shaping the future healthcare landscape.
 
Part 5

Potential Obstacles to the Adoption of AI by MedTechs

The integration of AI technologies into numerous industries has demonstrated its potential to significantly enhance operations, improve R&D, and create new revenue streams. However, despite AI’s potential to contribute significant benefits for business enterprises, its adoption by many large, diversified medical technology companies has been limited and slow. This section describes some factors that help to explain the reluctance of senior MedTech executives to fully embrace AI technologies, which include an interplay of organizational, technical, and industry-specific issues. Without overcoming these obstacles, MedTechs risk losing the growth and value creation they once experienced in an earlier era.

Demographics of senior leadership teams
According to Korn Ferry, an international consultancy and search firm, the average age for a C-suite member is 56 and their average tenure is 4.9 years, although the numbers vary depending on the industry. The average age of a CEO across all industries is 59. If we assume that the MedTech industry mirrors this demographic, it seems reasonable to suggest that many corporations have executives approaching retirement who may be more risk averse and oppose the comprehensive introduction of AI technologies due to a fear of losing benefits they stand to receive upon retirement.

Organizational inertia and risk aversion
Large medical technology companies often have well-established structures, processes, and cultures that resist rapid change. In such an environment, executives might be hesitant to introduce AI technologies due to concerns about disrupting existing workflows, employee resistance to learning new skills, and the fear of failure. The risk-averse nature of the medical technology industry, where patient safety is critical, further amplifies executives' cautious approach to implementing unproven AI solutions.
 

Technical challenges and skill gaps
AI implementation requires technical expertise and resources. Many MedTech executives might lack a deep understanding of AI's technical capabilities, making it difficult for them to evaluate potential applications. Further, attracting and retaining AI talent is highly competitive, and the scarcity of professionals skilled in both medical technology and AI can hinder successful implementation.
Regulatory and ethical concerns
The medical field is heavily regulated to ensure patient safety and data privacy. Incorporating AI technologies introduces additional layers of complexity in terms of regulatory compliance and ethical considerations. Executives might hesitate to navigate these legal frameworks, fearing potential liabilities and negative consequences if AI systems are not properly controlled or if they lead to adverse patient outcomes.
Long development cycles and uncertain ROI
The R&D cycle in the medical technology industry is prolonged due to rigorous testing, clinical trials, and regulatory approvals. Although AI technologies have the capabilities to enhance R&D efficiency, they can introduce additional uncertainty and complexity, potentially extending development timelines. Executives could be apprehensive about the time and resources required to integrate AI into their R&D processes, especially if the return on investment (ROI) remains uncertain or delayed.
 

Industry-specific challenges
The medical technology industry has unique challenges compared to other sectors. Patient data privacy concerns, interoperability issues, and the need for rigorous clinical validation can pose barriers to AI adoption. Executives might view these complexities as additional hurdles that could hinder the successful implementation and deployment of AI solutions.
  

Existing Revenue Streams and Incremental Innovation
Many large, diversified MedTechs generate substantial revenue from their existing products and services. Executives might be reluctant to divert resources towards AI-based ventures, fearing that these investments could jeopardize their core revenue streams. Additionally, a culture of incremental innovation prevalent in the industry might discourage radical technological shifts like those associated with AI.

 
Takeaways
 
Hesitation among MedTechs to integrate AI technologies poses the threat of missed opportunities, diminished competitiveness, and sluggish growth. This reluctance hinders innovation and limits the potential for enhanced patient care. Embracing AI is not an option but a strategic imperative. Failure to do so means missing opportunities to address unmet medical needs, explore new markets, and access new revenue streams. The potential for efficiency gains, streamlined operations, and cost reductions across R&D, manufacturing and supply chains is significant. Companies fully embracing AI gain a competitive advantage, delivering innovative solutions and services that improve patient outcomes and cut healthcare costs. Conversely, those resisting AI risk losing market share to more agile rivals. AI’s impact on analysing vast amounts of complex medical data, accelerating discovery, and enhancing diagnostics is well established. MedTechs slow to leverage AI may endure prolonged R&D cycles, fewer breakthroughs, and suboptimal resource allocation, jeopardising competitiveness and branding them as ‘outdated’. In today’s environment, attracting top talent relies on being perceived as innovative, a quality lacking in AI-resistant MedTechs. As AI disrupts industries, start-ups and smaller agile players can overtake established corporations failing to adapt. A delayed embrace of AI impedes progress in patient care, diagnosis, treatment, and outcomes, preventing companies from realising their full potential in shaping healthcare. The time to embrace AI is now to avoid irreversible setbacks in a rapidly evolving MedTech ecosystem.
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  • Katalin Karikó and Drew Weissman were awarded the 2023 Nobel Prize for Physiology or Medicine for pioneering the use of messenger RNA (mRNA) as a therapeutic tool for vaccines
  • mRNA translates genetic instructions from DNA to cellular machinery, driving essential protein synthesis in cell biology
  • Karikó and Weissman’s innovations led to the development of the first mRNA vaccine to combat the Covid-19 virus
  • Katalin Karikó overcame significant professional and personal setbacks before becoming a world-renowned scientist
  • Her life changed after a chance meeting with Weissman, which resulted in their ground-breaking contribution to biomedical science and the Nobel Prize
 
A Nobel Journey: Triumph over Adversity, Serendipity, BioNTech’s Rise, and mRNA Marvels
 
On Monday 2nd October 2023, Katalin Karikó and Drew Weissman were awarded the Nobel Prize in Physiology or Medicine for their contributions to messenger RNA (mRNA) biology that led to the unprecedented rate of vaccine development during the Covid-19 pandemic.
 
In this Commentary

This Commentary has four sections. In Part 1, Triumph over adversity, we highlight the journey of Katalin Karikó, which is a testament to her indomitable spirit. Despite facing entrenched prejudices and significant setbacks, Karikó's brilliance eventually triumphed, earning her the respect she deserved. As her work gained prominence, she emerged as a passionate advocate for women in science. Part 2, Serendipity, briefly describes a chance encounter between Karikó and Drew Weissman, which triggered a collaboration that defied the odds, and resulted in a major contribution to biomedical science that safeguarded the health and wellbeing of billions throughout the world and gained them the Nobel Prize. Part 3, “BioNTech doesn’t even have a website”, outlines the role played by a German start-up founded in 2008 by a husband-and-wife team, which leveraged Karikó's expertise and developed the first mRNA vaccine for the Covid-19 virus - a significant feat with global ramifications. The concluding Part 4, mRNA marvels, explains the science and describes the early contribution of Roger Kornberg, which enhanced our understanding of the molecular machinery that underpins mRNA’s functions. Also, we focus on how Karikó and Weissman championed the practical implications of mRNA for its use as a therapeutic. The combined endeavours advanced the field of molecular biology and opened unprecedented frontiers in both basic research and transformative therapeutic innovations. Takeaways follow.
 
Part 1

Triumph over adversity

Born in 1955 in a small town in central Hungary, Katalin Karikó grew up in a household devoid of running water, a refrigerator, or a television. From a young age she became fascinated with science, which led to her developing a passion for biology.
 
In 1982, she obtained a PhD from the University of Szeged, Hungary. Her research explored how mRNA could be used to target viruses: an innovative endeavour as gene therapy was in its infancy. Recognizing the therapeutic potential of mRNA, Karikó secured a postdoctoral position at the Biological Research Centre (BRC) of the Hungarian Academy of Sciences, where she embarked on a journey to advance her research.
 
At this time, Hungary was under Communist rule as part of the Eastern Bloc. The prevailing socio-political environment presented challenges for Karikó, which included glass ceilings that were obstacles for her scientific ambitions. After two years of research, her funding abruptly ceased: an illustration of the volatile and uncertain conditions she faced during those early years.
 
Buoyed by a boom in mRNA research taking place in the US, Karikó turned her gaze towards America and landed a research position at Temple University in Philadelphia. She sold her car, converted the proceeds into 900 British pounds on the Black Market, and sewed the currency into her two-year-old daughter's teddy bear to facilitate taking them out of Hungary. In the US in the late 1980s, she entered a male-dominated scientific community and encountered the prevalent gender biases and stereotypes: unequal opportunities, limited representation in leadership roles, and both subtle and overt discrimination.
 
In 1988, Karikó accepted a position at Johns Hopkins University in Baltimore without notifying Temple University. This prompted her sponsor to report her to the US immigration authorities, accusing her of being "illegally" in the country. After successfully challenging the resulting extradition order, Karikó faced another setback as Johns Hopkins withdrew her job offer. However, she secured a research position at the Uniformed Services University of the Health Services in Bethesda, Maryland.
 
A year later, in 1989, the University of Pennsylvania recognized her talent and hired her. Karikó dedicated her research to exploring the therapeutic potential of mRNA, envisioning its use to stimulate protein production within the human body. Her research faced scepticism during a time when synthetic mRNA applications for therapeutics were met with doubt. During clinical studies, the injection of mRNA-based therapies into animals triggered a severe inflammatory response, resulting in the death of the subjects, thereby eliminating any possibility of human trials.
 
Consequently, the excitement around mRNA as a therapy faded, and securing funding for such research became impossible. Karikó received multiple rejections from funding agencies. Her inability to raise research monies led the university in 1995 to suggest that she was "not of faculty quality" and presented her with an ultimatum: "leave or be demoted". This was a devastating and demeaning blow for Karikó who was on a tenured career path to become a full professor. She decided to accept an untenured position with a reduced salary and persevered in her research.

Even in the face of demotion and funding rejections, Karikó showed resilience. Overcoming doubts and questions from the scientific community is no small feat. It demands an unusual form of persistence and a deep belief in the value of one's research. She had to reconcile staying true to her visionary ideas and adapting to the feedback around her. What makes Karikó’s story even more remarkable is the personal adversity she faced. Amidst her professional challenges, her husband encountered visa problems, which obliged him to return to Hungary for six months. During this period, she was diagnosed with cancer, underwent two operations while simultaneously caring for her daughter and maintaining her research.

 
Part 2

Serendipity

Serendipity played a significant role in Karikó's scientific journey, as her fascination with mRNA had to endure a time when its potential was largely doubted by the scientific community. A critical turning point for her was a chance encounter with Drew Weissman, a senior professor of immunology at the University of Pennsylvania, who was well-endowed with research funds.
 
In the late 1990s, Karikó and Weissman bumped into each other at a photocopier. At that time, scientists copied the latest research from journals. Their meeting led to a recognition of a shared vision and complementary skills, and together, they pushed the boundaries of what was deemed possible. Their collaboration addressed challenges associated with using synthetic mRNA as a therapeutic tool. Weissman's expertise in immunology, combined with Karikó's focus on mRNA and protein synthesis, led to breakthroughs in modifying mRNA to reduce its inflammatory response and increase its stability.
 
In retrospect, Karikó's journey, coupled with her collaboration with Weissman, not only showcased scientific acumen but also emphasised the transformative potential of collaborative efforts in advancing the boundaries of knowledge. Their partnership became a catalyst for ground-breaking discoveries, particularly in the development of modified mRNA.

 
Part 3

“BioNTech doesn’t even have a website”

BioNTech, a German start-up founded in 2008 by a dynamic husband-and-wife team, UÄŸur Åžahin and Özlem Türeci, was launched without a website but had a mission to disrupt healthcare. In 2013, Karikó accepted an invitation to join the company as a senior vice-president. When she told her University colleagues they are reported to have laughed at her saying that the company does not even have a website. Later Karikó and Weissman licenced the mRNA technology they developed to BioNTech, which later partnered with Moderna and Pfizer. BioNTech’s partnership with Pfizer, a giant pharmaceutical company experienced in vaccine development and distribution, led to a global clinical trial of Karikó and Weissman’s mRNA tool as a therapy, which involved >43,000 individuals across six countries. The joint venture became a linchpin in the fight against the Covid-19 virus. Today, BioNTech is a Nasdaq traded company with a market cap of ~US$23bn, annual revenues of >US$18bn, >4,500 employees and research centres in San Diego and Cambridge, Massachusetts.
  
Unknown to Karikó and Weissman, in 2005, Derrick Rossi, while a postdoctoral researcher in molecular biology at Stanford University in California was impressed with a paper they published describing a modified form of mRNA that did not induce an immune response. In 2010, Rossi, together with colleagues from Harvard and MIT, founded Moderna, which, between 2011 and 2017, raised US$2bn in venture capital funding and later formed its partnership with BioNTech. In the throes of the global Covid-19 pandemic, BioNTech emerged as a pioneer, developing the first authorized mRNA vaccine by leveraging Karikó and Weissman's mRNA technology. This breakthrough had a competitive edge over traditional vaccines because it offered a faster and more efficacious solution. In April 2020, as the world clamoured for a solution to the Covid-19 virus, Moderna secured a significant boost, receiving US$483m from the US Biomedical Advanced Research and Development Authority to fast-track its Covid-19 programme. Today, Moderna, based in Cambridge, Massachusetts, is a Nasdaq traded company with a market cap >US$30bn, annual revenues of ~US$20bn, and a workforce of ~4,000.
 
From a humble start without a website to shaping the future of medicine, the stories of BioNTech and Moderna exemplify the transformative power of scientific innovation and unwavering determination.

 
Part 4

mRNA marvels
 
The molecular messenger: mRNA
mRNA functions act like a postal service of the genetic world, which takes instructions from the DNA in the cell’s nucleus and delivers them to the protein-producing machinery called ribosomes in the cell’s cytoplasm [a jelly-like substance that fills the cells and surrounds the nucleus]. Think of it as a template that guides the creation of proteins in a process known as translation. So, mRNA is the messenger that ensures the right genetic instructions reach the protein-making machinery, which helps cells produce specific proteins needed for different tasks.
 

Importance of mRNA in protein synthesis
mRNA plays a crucial role in protein synthesis, serving as the intermediary that carries genetic instructions from DNA to the ribosomes. This process is significant for several reasons: mRNA transfers the genetic code from DNA to the ribosomes in the cytoplasm, ensuring the accurate transmission of instructions for protein synthesis. Each mRNA molecule corresponds to a specific protein, providing the specificity needed for the synthesis of diverse proteins with distinct functions. The regulation of mRNA production allows cells to control when and how much of a particular protein is synthesized, contributing to the adaptation of cellular processes. Proteins are essential for the structure, function, and regulation of cells. The diversity and specificity of proteins determine the many functions that cells can perform. Thus, mRNA acts as a messenger, translating the genetic information stored in DNA into functional proteins, thereby influencing all cellular activities and maintaining the integrity and functionality of living organisms.
 

The transcription process and the role of RNA polymerase II
Transcription is the first step in the flow of genetic information, where a segment of DNA is used as a template to synthesize a complementary RNA molecule. RNA polymerase II plays an important role in this process, particularly in the transcription of protein-coding genes. Let us give a brief overview. Transcription begins with the binding of RNA polymerase II to a specific region of DNA called the promoter. This signals the start of the gene to be transcribed. Once bound to the promoter, RNA polymerase II unwinds the DNA double helix and starts synthesizing an RNA molecule complementary to one of the DNA strands. As it progresses along the DNA, RNA polymerase II adds nucleotides to the emerging RNA chain, always extending it in the 5’ to 3’ direction. Transcription continues until the RNA polymerase II encounters a termination signal in the DNA. This signals the end of transcription, and the RNA polymerase II detaches from the DNA template. The newly synthesized RNA molecule, called pre-mRNA, undergoes processing steps like capping, splicing, and polyadenylation to form mature mRNA. These modifications enhance stability, functionality, and transport of the mRNA. RNA polymerase II is responsible for transcribing protein-coding genes (mRNA). It recognizes the promoter sequences of these genes and catalyses the synthesis of the complementary mRNA strand. The precision and regulation of this process are vital for ensuring accurate gene expression and the production of functional proteins in cells.
Science made easy

Importance of mRNA in protein synthesis
Think of mRNA as a messenger in the protein-making factory of your cells. It is like the delivery person that carries important instructions from the cell's recipe book (DNA) to the protein-making machines (ribosomes). Here is why this messenger - mRNA - is important: (i) Accurate Delivery: mRNA ensures that the instructions from the recipe book (DNA) are accurately delivered to the protein-making machines (ribosomes) in the cell's kitchen (cytoplasm). (ii) Specific Recipes: Each mRNA molecule has a specific recipe for a particular protein. This specificity is important because it helps in making different proteins with different jobs in the cell. (iii) Controlled Production: Cells can control when and how much of a protein is made by managing the production of mRNA. It is like having control over how often and how many times a specific recipe is used in the kitchen. And (iv) Cellular Teamwork: Proteins are like the workers in the cell - they build structures, carry out functions, and regulate processes. mRNA, by delivering the right protein recipes, ensures that the cell's team is diverse and has the skills needed for various tasks. So, mRNA is the messenger that translates the genetic information stored in DNA into practical instructions for making proteins. This process is like the secret sauce that keeps the cell running smoothly and maintains the overall health and function of living organisms.

The transcription process and the role of RNA polymerase II
Imagine your DNA is like a cookbook, and you want to make a specific recipe from it. Transcription is the first step in this cooking process. RNA polymerase II is like the chef who reads the recipe and makes a copy of it.  The chef (RNA polymerase II) starts by finding the beginning of the recipe, which is called the promoter. Then, s/he reads the instructions in the recipe (DNA) and creates a matching copy in the form of RNA. This copy, known as pre-mRNA, undergoes some additional steps to become the final recipe (mature mRNA). The chef follows the recipe precisely from start to finish, and when s/he reaches the end of the instructions or sees a "stop" sign (termination signal), s/he finishes the job. The final recipe (mature mRNA) is then ready to be used in the kitchen (cell) to make a delicious dish (functional protein). This whole process is crucial to ensure that the right recipes are selected and copied accurately, leading to the creation of the correct proteins needed for the cell's functions.
Synthetic mRNA
Beyond its natural role, synthetic mRNA acts as a vaccine, directing cells to produce specific viral proteins, prompting an immune response without inducing illness. Initially, challenges arose with unwanted inflammation caused by early versions of these genetic instructions. Katalin Karikó and Drew Weissman addressed this issue by making adjustments, preventing inflammation, and enhancing target protein production. This breakthrough laid the groundwork for vaccine development.
 

mRNA, Roger Kornberg, Katalin Karikó and Drew Weissman
We have described how mRNA serves as a critical messenger, shuttling genetic instructions from the cell's nucleus to the protein-building ribosomes. Now, let us briefly describe the contribution to the field of Roger Kornberg, an American biochemist who, in 2006, was awarded the Nobel Prize in Chemistry for his research on RNA polymerase II, the enzyme central to transcribing DNA into mRNA. In the video below Kornberg explains his research interest in how biological information, encoded in the human genome, is accessed to inform all human activity.
 

Kornberg's research went beyond simply decoding genetic information; he illuminated the intricacies of transcription - the process translating DNA into RNA. Specifically, his work dissected the structure of RNA polymerase II uncovering the nuances of how RNA polymerase II interacts with DNA during transcription. This detailed molecular blueprint is central to understand how genetic instructions in DNA are accurately transcribed into mRNA, which, as we described above, is a crucial step in the cellular flow of genetic information.
 
Katalin Karikó and Drew Weissman built upon Kornberg’s insights and spearheaded the application of mRNA for therapeutic purposes. While they championed the practical implications of mRNA, Kornberg’s contributions enhanced our understanding of the molecular machinery that underpins mRNA’s functions. Their combined endeavours advanced the field of molecular biology and opened unprecedented frontiers in both basic research and transformative therapeutic innovations.
 
Takeaways
 
This Commentary tells a story of science, resilience, serendipity, and a ground-breaking achievement. We described the scientific intricacies of mRNA, flagging Roger Kornberg's pioneering contributions. A testament to the triumph of the human spirit, portrayed Katalin Karikó's journey: her brilliance, overcoming prejudice and blossoming into advocacy for women in science. The unexpected collaboration between Karikó and Weissman, which led to a biomedical breakthrough that transcended expectations, ultimately garnering the Nobel Prize. We introduced BioNTech, where a husband-and-wife team harnessed Karikó and Weissman’s innovative research to pioneer the development of the world's first mRNA vaccine to combat the Covid-19 virus. This not only marked a historic moment in biomedical science but also exemplified the power of collaboration, determination, and visionary leadership. As we reflect on this journey - from the molecular intricacies of mRNA to the global impact of a life-saving vaccine - it becomes clear that the convergence of scientific curiosity, individual tenacity, and collaboration can be a catalyst for transformative change. The 2023 Nobel Prize for Physiology or Medicine awarded to Katalin Karikó and Drew Weissman stands as recognition of their central role in reshaping the landscape of biomedical science and, more importantly, in safeguarding the health and wellbeing of billions throughout the world. In scientific discovery, their story serves as an inspiring chapter, encouraging us to embrace the boundless possibilities that arise when science and humanity join forces in the pursuit of a healthier, more resilient future.
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  • The MedTech industry has undergone a transformative journey marked by prolific mergers and acquisitions (M&A)
  • Between 2006 and 2016, the industry witnessed 2,680 acquisitions totaling US$607.8bn
  • In the pursuit of efficient integrations corporations often overlooked the significance of fostering a distinct organisational culture
  • In many cases this resulted in cultural dissonance, which is a silent but substantial obstacle to growth and value creation
  • Stories can overcome this obstacle and help to bridge gaps, align interests, and cultivate a shared sense of purpose among employees and stakeholders for long-term MedTech success
 
 The Silent Obstacle to MedTech Growth and Value Creation
 
The MedTech industry, marked by decades of prolific mergers and acquisitions (M&A), has undergone a transformative journey fuelled by factors like the pursuit of economies of scale, technological access, and navigating regulatory challenges. While strategic consolidations have yielded financial and organisational benefits, often they have inadvertently overlooked the softer facet of corporate identity - organisational culture.
 
Illustrating the magnitude of M&A within the industry, the decade from 2006 to 2016 witnessed 2,680 acquisitions with a value totaling US$607.8bn. Noteworthy is the consistency in the frequency of these acquisitions, juxtaposed against the variability in the consideration of individual deals.
                                                                                                                     
By 2023, a notable shift occurred within the MedTech M&A landscape. The deceleration of M&A activity led to a saturation in market segments with products and services, which intensified competition for market share and exerted pressure on pricing and profit margins. As the M&A market cooled, the accessibility to cutting-edge technologies became more elusive, putting companies at a disadvantage in terms of product development and maintaining competitiveness. Simultaneously, heightened geopolitical tensions and trade restrictions further complicated supply chains and distribution channels. The constrained M&A environment raised hurdles for expanding into emerging markets, which narrowed potential growth opportunities. Integrating talent from acquired companies, a common practice in M&A, also faced challenges amid the slowdown, which impacted the ability to sustain a competitive edge in expertise and innovation. Without the efficiency gains typically associated with M&A, numerous companies encountered escalating cost pressures, which encompassed R&D costs, manufacturing expenses, and other operational outlays that adversely affected overall profitability. The heighted expectations from shareholders for consistent growth, a hallmark for large diversified MedTechs, faced added difficulties due to the deceleration of M&A activity, potentially influencing stock prices and investor confidence.
 
Periods of integrating acquired enterprises tend to be dominated by the pursuit of efficiency, cost savings, and regulatory compliance, which often means relegating the significance of cultivating a distinct and cohesive organisational culture. In the current landscape, where M&A activity has decelerated and corporate values have plateaued, the ramifications of this neglect are becoming increasingly evident. Some enterprises are finding themselves with fragmented cultures, which have low levels of solidarity: employees disagree about organisational objectives, critical success factors, and performance standards. This can make organisations challenging to manage, and leaders unable to affect change. Organisational culture is not simply rhetoric; it is a critical element that molds how employees perceive their roles, comprehend their company's mission, and ultimately contribute to innovation and value creation. Further, a robust and distinctive culture plays a role in attracting and retaining top talent. In an industry driven by innovation, retaining the brightest minds is important for success. When employees sense a misalignment between their personal values and the organisational culture, it can result in disengagement, increased turnover rates, and a depletion of institutional knowledge - all of which undermine long-term growth.
 
Consider this scenario: A MedTech company with a clear and supportive culture is well equipped to navigate the intricacies of the industry. Such an environment fosters a shared sense of purpose and identity among employees, creating a collaborative space where diverse talents can thrive. This, in turn, augments a company's capacity to adapt to industry changes, respond to emerging healthcare needs, and drive sustainable value creation.
 
Culture embodies community; it is the essence of how individuals connect with each other. Flourishing communities arise from shared interests, mutual obligations, and a foundation of cooperation and camaraderie. A common oversight in certain management literature concerning corporate culture is the assumption that organisations are inherently homogeneous. However, just as one organisation differs from another, so do its internal units. Consider the contrasting nature of, for instance, the R&D function compared to manufacturing within a MedTech company. Moreover, hierarchical distinctions within an enterprise add layers of diversity; the cultural dynamics of senior leadership teams may differ markedly from those of middle managers and blue-collar workers.
 
In the MedTech industry, where financial and organisational factors maintain their importance, a strategy that develops a distinctive organisational culture is equally important. Overlooking cultural integration presents a nuanced yet potentially significant barrier to growth and value creation. This challenge manifests itself through indicators such as disengaged employees, talent attrition, and a lack of adaptability in meeting the evolving demands of the industry. Recognizing and addressing this cultural deficit extends beyond employee satisfaction; it emerges as a strategic imperative for long-term success in the dynamic landscape of MedTech.
 
Further, as corporations expand globally they encounter challenges to unite and motivate their constituencies. Internationalization means transcending geographical, linguistic, cultural, and religious boundaries. Multinational corporations operate in a world where employees are from various countries, speak different languages, and possess diverse cultural backgrounds, which emphasises the significance of establishing common ground and fostering a sense of belonging. Moreover, modern organisations are linked to an array of stakeholders, including governments, patients, insurance firms, advocacy groups, and a wide spectrum of customers. These often hold distinct interests and priorities, occasionally leading to conflicts with both each other, and the organisation's objectives.
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The power of stories

In this interconnected ecosystem, a cohesive and inspiring narrative emerges as a potential remedy for dissonance. A well-crafted story has the capacity to bridge divides, align interests, and instil a collective sense of purpose among both employees and stakeholders. This, in turn, contributes to a corporation's overall success.
The impact of a unifying narrative does not confine itself to an organisation's internal boundaries. It acts as a catalyst for collective action, motivating employees, and stakeholders alike toward shared objectives. This shared story becomes the driving force behind innovation, it bolsters problem-solving capabilities, and shapes the organisation into a responsive and adaptable entity. In a world where trust, differentiation, innovation, talent attraction, stakeholder engagement, and customer loyalty wield substantial influence, a captivating narrative emerges as a positive force for a diversified MedTech company. It adeptly communicates the company's mission, values, and impact, establishing trust, distinguishing the brand, fostering innovation, attracting top talent, engaging stakeholders, and cultivating customer loyalty. Ultimately, it solidifies a company's brand identity, nurtures relationships, and fuels long-term commercial success.
 
The potency of an inspiring company narrative lies in its ability to weave a common thread through the diverse interests of employees, creating unity and a shared company culture. A compelling story acts as a connective tissue, transcending departmental and hierarchical boundaries, resonating universally regardless of individual roles or backgrounds. Such narratives instill a collective sense of purpose and pride, fostering a shared identity embraced by every employee. When everyone is tethered to a common story, it encourages a cohesive culture where values and goals are not just communicated but lived and upheld by each member of the organisation. This shared narrative becomes a wellspring of motivation, aligning the workforce toward a singular vision and propelling the company forward as a unified and harmonious entity.
 
These claims may seem exaggerated when applied to a company narrative. However, to grasp the potential impact of storytelling, let us briefly examine the realms of religion, politics, finance, and the women’s movement. All these domains are predicated upon narratives that not only inspire and motivate diverse groups of individuals but also make them reshape their lives and dedicate their time and energy to the causes these narratives portray.
 
Religion

Religion plays an important part in the spiritual lives of billions of people around the world. Religious stories hold a significant influence over the beliefs and practices of faith communities, providing them with a sense of meaning and purpose. The potency of a narrative's impact is exemplified in the case of Jerusalem, a city that embodies the enduring power of stories.
 
For Jews, Jerusalem is a testament to the divine intervention of their narrative, where God commanded Abraham not to sacrifice his son Isaac. For Christians, Jerusalem holds multifaceted significance across various church factions, but it universally marks the hallowed ground where Jesus Christ delivered his teachings and shared the Last Supper with his disciples before his crucifixion. Similarly, for Muslims, Jerusalem bears importance as the place where the Prophet Mohammad started his mission and experienced a divine vision.
 
What is striking about these narratives is that they have endured through centuries, despite the absence of any scientific evidence, relying on the power of spiritual belief. This emphasises the influence of storytelling. People hold these stories dear to their hearts, embracing them with unwavering faith. Such narratives have the power to shape cultures, societies, and even geopolitical landscapes. The enduring power of religious narratives, like those surrounding Jerusalem, teaches us that stories are more than tales, but the scaffolding upon which belief systems are constructed, and they have the potential to move nations and shape destinies.
 
Politics

Consider politics. Political ideologies are founded upon stories that individuals hold so firmly that they are prepared to resolutely defend their convictions, even at the cost of armed conflict. These ideologies shape the governance, policies, and destinies of nations, and their power lies in the stories they tell.
 
Consider democracy, for instance. It is a powerful narrative that extols the virtues of power vested in the hands of the people or their elected representatives. Democracy's story emphasizes principles of equality, individual rights, and the regular exercise of those rights through elections. It speaks to the idea that citizens should actively participate in shaping their government and society through voting and civic engagement. This narrative has led people to fight for democratic values, even in the face of oppressive regimes, as they believe in the story of democracy's inherent worth.
 
Socialism is another political ideology grounded in a compelling narrative. It advocates for collective or state ownership and control of the means of production, distribution, and exchange. The story of socialism centres on reducing economic inequality and ensuring that resources and wealth are more equitably distributed among society's members. This narrative has inspired revolutions, social movements, and political changes across the world, as believers are motivated by the story of a fairer and more just society.
 
In contrast, authoritarian states are political systems characterised by centralised power and limited political freedoms. They too are predicated on stories. Such states often feature a single leader or a small group of individuals with substantial control over the government, little or no opposition, restricted civil liberties, and limited or no free elections. They prioritize order and control over individual rights and freedoms, often relying on censorship, propaganda, and coercion to maintain their authority. Despite its repressive nature, it has garnered fervent adherents who are willing to defend their vision of a disciplined and ordered society, sometimes at great human cost.
 
These political narratives are strong forces that shape the world we live in. They are stories that compel people to action, and at times, to support and engage in conflict. Understanding the power of these narratives is essential for comprehending the dynamics of political movements, governance, and global affairs. It emphasises that the stories we believe in are not just words; they are forces capable of reshaping societies and history itself.
 
Money

Money, in its essence, is a symbol devoid of inherent value. Take a $100 bill, for instance. It possesses no intrinsic worth; you cannot eat it, clothe yourself with it, or find shelter beneath its folds. In today's digital age, most monetary transactions occur virtually, further emphasizing that money is not a tangible commodity but a representation of value. What makes money intriguing is that its value is predicated upon a story, a narrative that commands the largest following worldwide, surpassing the collective adherents of all religions combined. Money, in essence, is a story with believers numbering billions.
 
This narrative begins with the idea that a particular piece of paper or digital entry holds value. It is a shared belief system, one upheld by individuals, corporations, and governments across the globe. This shared belief is what allows us to exchange money for goods, services, and even intangible assets like trust or promise. Consider the notion of a banknote. Its value exists because we believe in the authority and stability of the issuing government or institution. It is a mutual understanding that a piece of paper, despite its lack of intrinsic value, can be exchanged for something tangible or intangible in the real world.
 
This shared belief in money's value creates a complex web of economic interactions and relationships. It fuels trade, investment, and economic growth. It enables people to plan, save for retirement, and invest in education and healthcare. Money, as a story, is a unifying force in the modern world, transcending borders, cultures, and languages. Yet, like all narratives, money is not without its challenges and contradictions. Economic disparities, financial crises, and questions about the fairness of wealth distribution persist. But the fact remains that money, as a story, is a force of unparalleled influence, guiding the decisions and actions of individuals and nations alike. In a world where the value of money is woven into the fabric of society, it becomes clear that its true worth lies not in the physical notes or digital records but in the collective trust and beliefs that sustain this narrative. Money, in the end, is a story that shapes our lives, economies, and the world at large.
 
Women’s movement

The women's movement is a testament to the power and influence of a story about equality. Over decades, this movement has enhanced the status of women worldwide. What makes this narrative particularly interesting is that, unlike the stories underpinning religion, politics, and money, the pursuit of women's rights has largely been achieved through peaceful means, which is a testament to the millions of people around the world who embraced the story that activists told.
 
The narrative of the women's movement is simple: equality. It tells a story of a world where women and men stand on equal footings, where gender should not be a barrier to opportunities, rights, or dignity. This story resonated with countless individuals who recognized the inherent justice in this vision. The power of this story lies in its ability to inspire action. It mobilized women and men from all walks of life to come together and advocate for change. Grassroots activists, iconic leaders, and ordinary citizens joined forces, fuelled by the belief in the story's inherent truth. They organised rallies, signed petitions, and engaged in peaceful demonstrations, all with the goal of dismantling systemic inequalities and securing equal rights for women.
 
What sets the women's movement apart from many other stories that shape our world is its peaceful nature. While religious, political, and economic narratives have often been associated with conflict and violence, the women's movement has predominantly relied on peaceful activism and advocacy. This nonviolent approach has garnered widespread support and sympathy from people of diverse backgrounds, fostering a sense of unity and shared purpose.
 
The influence of this narrative has been significant. It has led to legal and societal changes, from suffrage and reproductive rights to workplace equality and gender representation in leadership roles. Women's rights have advanced on a global scale, improving the lives of millions. The women's movement is a powerful example of how a story can shape the world when embraced by a collective of individuals who believe in its message. It demonstrates that narratives grounded in principles of justice and equality can bring about transformative change, even without resorting to violence. The women's movement serves as a reminder that stories have the power to move societies and bend the arc of history toward progress and justice.
 
Takeaways

The MedTech industry's journey through decades of M&A activity has been a transformative one, marked by the pursuit of economies of scale, technological access, and regulatory mastery. The resulting financial and organisational benefits, however, have inadvertently overlooked a critical aspect: organisational culture. The magnitude of M&A activity, exemplified by 2,680 acquisitions totaling US$607.8bn between 2006 to 2016, showcases both consistency and variability in deal considerations. As we fast forward to 2023, global uncertainties prompted a recalibration of strategic initiatives, especially as MedTech companies aimed for operational scaling and global expansion. The challenges of uniting diverse constituencies in an internationalized context - spanning geographical, linguistic, cultural, and religious boundaries – emphasized the importance of establishing common ground and fostering a sense of belonging. The consequences of prioritizing efficiency and not cultivating a cohesive organisational culture during the integration of acquired enterprises has become increasingly apparent. Some companies find themselves with fragmented cultures, marked by low solidarity and disagreements about organisational objectives. This cultural deficit makes organisations challenging to manage, and leaders often feel powerless to effect change. In the MedTech sector, where collaboration and creativity are important for healthcare breakthroughs, cultural dissonance poses a significant risk. A robust and distinctive culture, however, is instrumental in attracting and retaining top talent, which is essential for success in an innovation-driven industry. A MedTech with a clear and supportive culture is better equipped to navigate industry intricacies, respond to emerging healthcare needs, and drive sustainable value creation.
 
This Commentary suggests that culture is community: a network of shared interests and obligations that thrive on cooperation and friendships. Acknowledging the heterogeneity within organisations is crucial, recognizing differences across departments and hierarchical levels. While financial and organisational considerations are critical, an approach encouraging a distinctive organisational culture is equally important. Neglecting cultural integration poses a silent yet substantial obstacle to growth and value creation - a challenge manifested through disengaged employees, talent attrition, and a lack of agility in meeting industry demands. Recognizing and redressing this cultural deficit transcends employee satisfaction; it emerges as a strategic imperative for long-term success in the dynamic landscape of MedTechs. As MedTech companies expand globally, the challenges to unite and motivate constituencies intensify. We have suggested that within this interconnected ecosystem, a unifying and motivating narrative emerges as a potential solution. A well-crafted story has the power to bridge gaps, align interests, and cultivate a shared sense of purpose among employees and stakeholders alike, contributing to a company’s success. The influence of a unifying narrative extends beyond an organisation's boundaries, serving as an inspiration for collective action. This shared story fuels innovation, enhances problem-solving, and transforms an organisation into a responsive and adaptable entity. In a world where trust, differentiation, innovation, talent attraction, stakeholder engagement, and customer loyalty are important, a captivating narrative becomes a positive contribution to the success of a diversified MedTech company. In the grand scheme of human endeavours, the power of stories seems undeniable. Whether in religion, politics, finance, or the women's movement, it is through stories that movements are built and legacies are shaped. Thus, for MedTechs to overcome the silent obstacle to growth and value creation, they might consider harnessing the power of narratives to fortify their brand identities, nurture relationships, and fuel long-term commercial success.
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  • GE HealthCare, Siemens Healthineers, and Philips Healthcare entered the Chinese market in the 1980s and prospered
  • The once-booming era for Western MedTechs in China has slowed and become challenging
  • Latecomers to the Chinese MedTech market face geopolitical uncertainty, changing market dynamics, domestic competition, stringent regulations, IP risks, and healthcare reforms
  • Due to these obstacles and the Chinese’s economy slowing MedTechs are seeking international growth opportunities beyond China and Asia
  • Africa is emerging as the new frontier driven by its burgeoning population, growing middleclass, economic growth, abundant natural resources, and Beijing’s investement
  • MedTech pioneers in China, such as GE HealthCare, Siemens Healthineers, and Philips Healthcare, are early entrants in the African market
  • Prudential plc, an insurance giant, has made a vast strategic bet on Africa’s growth potential
  • Given insurers are healthcare payers, should MedTechs view Africa as the new Asia?
 
Is Africa the New Asia for Western MedTechs?


Preface

In the realm of international expansion for Western MedTech companies, Asia, particularly China, has historically been a key focus due to its vast size and rapid economic growth. However, the shifting global economic and geopolitical landscape suggests a re-evaluation. Is Africa positioned to emerge as the next hub of opportunity and growth for MedTech enterprises? China's remarkable economic ascent, initiated by reforms in 1978, accelerated it to the status of the world's second-largest economy, following the US. Western MedTechs that ventured into China's market in the 1980s prospered. Yet, those who hesitated due to concerns, including intellectual property (IP) theft, now face mounting challenges, which include geopolitical uncertainties, evolving Chinese attitudes towards Western corporations, a limited understanding of the Chinese market, and China's ambition to lead global technology by 2030. The recent deceleration in China's economic growth adds to the apprehensions of Western businesses. Moreover, China's rapid economic expansion has led to an aging population, characterized by declining birth rates, and increased life expectancy. By 2040, those aged ≥60 are projected to reach ~402m, constituting ~28% of the nation’s population. This demographic shift, with a shrinking workforce and a rising number of elderly consumers, is expected to exert downward pressure on China’s GDP growth, while straining public budgets with escalating healthcare and retirement costs. Given this evolving landscape, it becomes prudent to explore whether the once-promising prospects for Western companies in China and Asia are diminishing, prompting an examination of alternative international markets. While established MedTech players in China continue to provide essential healthcare products and services, they may benefit from contemplating strategic adjustments and, in many cases, restructuring their commercial operations to adapt to the changing dynamics of the Chinese market. Notably, some companies view Africa as a promising new frontier. Early entrants into the Asian medical device market, such as GE HealthCare, Siemens Healthineers, and Philips Healthcare, have already established footholds in Africa. Could Africa be on the verge of becoming the new frontier, reminiscent of what Asia once represented?
 
In this Commentary

This Commentary is divided into two sections. In Section 1, we briefly mention the early successes of prominent MedTech companies in the Chinese market during the 1980s. The section also notes that because geopolitical tensions between Beijing and Washington have increased, and recently China's economic growth has slowed, some Western MedTechs are seeking alternative growth regions to expand their international presence and reinvigorate their stagnant market values. Section 2 challenges popular perceptions by proposing that Africa could emerge as the new frontier for the MedTech industry. Despite Africa's enduring challenges, including political instability, corruption, poverty, and limited literacy, it seems to have potential. Albeit from a low start, Africa is projected to be the world's fastest-growing region in 2023, characterized by a youthful population, abundant natural resources crucial for renewable technologies, and an emerging middleclass. Decades ago, Beijing recognized Africa's potential, and more recently, a group of MedTechs, including early entrants to China, have established a presence in the African market. The section concludes by noting the strategic entry of a giant insurance company into the continent. Given the role insurers play in healthcare expansion and the demand for medical technology this maybe a positive omen for the MedTech industry, with Africa as its new frontier.

Part 1
MedTech pioneers in China

In the 1980s, as China underwent transformative economic reforms under President Deng Xiaoping, several Western MedTechs, including GE HealthCare, Siemens Healthineers, and Philips Healthcare, entered China, and capitalized on the nation's economic growth and modernization over the ensuing decades. GE HealthCare, equipped with medical imaging devices and healthcare solutions, forged relationships with Chinese hospitals and research institutions. Siemens Healthineers, a leader in imaging and laboratory diagnostics, followed suit in the late 1980s, emphasizing local R&D and strategic partnerships with Chinese healthcare providers. Philips Healthcare, with its diverse range of patient monitoring systems and diagnostic imaging equipment, also made its mark.

These companies showed their ability to adapt and succeed by adjusting their products to fit the needs of local customers and by encouraging new ideas through partnerships. Initially, they embraced expansion-type business models with multiply marketing and sales tiers, which emphasized rapid growth over stringent financial discipline. The plan worked well because China's medical technology sector was thriving, and experienced annual growth rates of ~10 to ~15% during the first two decades of the 21st century. However, since then, things have changed. Now, the focus is on making operations smoother and more efficient, which has meant reducing the number of marketing and sales layers between enterprises and their principal customers.
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Recent Western MedTech entrants, attracted by the vast Chinese market, faced heightened scrutiny and regulatory obstacles. Their limited knowledge of local markets and different administrations hindered their growth, which was compounded by concerns about safeguarding their IP. Meanwhile, Chinese MedTech firms rapidly advanced, increasing competition for Western latecomers. As of December 2022, the number of Chinese medical device companies amounted to 32,632. The once-lucrative "gold rush" in China for Western MedTechs has faded due to shifting sentiments, regulatory hurdles, and local competition. As China pursues global technological leadership by 2030, Western firms are likely to encounter mounting challenges. To sustain international expansion, they should consider exploring alternative global markets where they can leverage their expertise and resources more effectively. This suggests a turning point, highlighting the need for strategic diversification and adaptation to evolving global dynamics in the MedTech industry.
Headwinds for MedTechs expanding in China

Here we describe some of the headwinds facing Western MedTechs attempting to increase their footprints in the Chinese market.
 

Geopolitical Uncertainty
Ongoing geopolitical tensions, such the political status of Taiwan, which Beijing claims is a province of the People's Republic of China, whereas Taiwan’s current Tsai Ing-wen administration maintains it is an independent country, and South China Sea disputes, which involve conflicting island and maritime claims by China, Taiwan, Brunei, Malaysia, the Philippines, and Vietnam. These and other geopolitical uncertainties pose risks, particularly for late entrants to the Chinese market. However, despite these tensions, US-China trade remains strong, but doing business in China has become increasingly challenging.
 

Changed Market Dynamics
China's healthcare landscape has evolved driven by the largest middleclass cohort in the world. Beijing has increased healthcare spending, which has intensified competition in the MedTech sector. Trade conflicts between the US and China add complexity to market dynamics. Relationships between the two countries deteriorated in January 2018, when American President Donald Trump began setting tariffs and other trade barriers on China. The objective was to force Beijing to make changes to what the US says are longstanding unfair trade practices and IP theft. A recent example of such tensions occurred in September 2023, during a visit to China by US Secretary of Commerce Gina Raimondo, who oversees regulating technology. The Chinese tech giant Huawei chose this time to release its new smartphone, powered by an advanced chip. This shocked American industry experts who could not understand how Huawei could have obtained such an advanced chip following efforts by the US to restrict China’s access to foreign chip technology.

Domestic Competition
Chinese MedTech companies (>32,000) have rapidly gained market share, technical sophistication, and innovation capacity. They understand local customer needs and regulations better, posing increasing competition for Western counterparts. In 2021, China’s 134 listed MedTech companies generated US$44bn in revenues, a compound annual growth rate (CAGR) of 36% since 2019, ~3X the market’s overall rate of growth. More than five Chinese MedTechs have obtained the US Food and Drug Administration’s (FDA) breakthrough designation, with innovations like the VenusP-Valve, which has already been approved in >30 countries, and in April 2022, secured EU’s CE marking under its Medical Devices Regulation (MDR). This suggests that Western corporations will not only encounter heightened domestic competition but are likely to face increasing competition from Chinese MedTechs in the global arena.
 

Regulatory challenges
Regulatory hurdles in China pose challenges for Western MedTechs. Adherence to regulations, standards, and compliance measures, often different from Western counterparts, necessitates an in-depth understanding and adaptation. Central to China's regulatory framework is the National Medical Products Administration (NMPA), which is akin to the FDA. It prioritizes safety, efficacy, and quality in evaluating medical device registrations for market entry. While global acceptance of real-world evidence (RWE) in healthcare is rising, China is in the early stages of embracing the concept. Notably, a 2020 NMPA draft guideline hinted at the potential utilization of RWE from Boao Lecheng. Situated in Hainan, an island province in the nation’s southernmost point, Boao Lecheng has become a medical innovation hub, focusing on technology, high-quality healthcare, and medical tourism. It actively promotes advanced clinical research, housing globally recognized medical institutions like the Raffles Medical Group and Brigham and Women’s Hospital (BWH). The collaboration between Western MedTechs and initiatives like Boao Lecheng holds promise in tackling China's regulatory complexities.
 

Intellectual property (IP) risks
Protecting IP is a concern for Western MedTechs in China. Enforcing IP rights can be challenging due to factors like judicial protectionism, evidence gathering obstacles, modest damage awards, and perceived foreign bias. China follows a "first-to-file" principle for IP registration, granting ownership to the first registrant. Foreign companies also face pressure from government and state-owned enterprises to transfer technology for market access, investment opportunities, or approvals. Some are compelled to license technology at below-market rates. Despite China's efforts to enhance IP protection, concerns persist. Corporations need to balance IP protection with local engagement and government cooperation to navigate China's complex IP landscape effectively.
 

Healthcare reforms
China's healthcare system has undergone a significant transformation driven by various factors, including increasing incomes, heightened health awareness among its citizens, and a rapidly aging demographic. The government has placed substantial emphasis on healthcare, as evidenced by its ambitious goals outlined in the Healthy China 2030 plan. This plan envisions the nation's healthcare market reaching a value of ~RMB16trn (~US$2.4trn) by 2030. China's dedication to enhancing healthcare is underscored by the establishment of a comprehensive health insurance system that now provides coverage to ~96% of the population, benefiting >1.36bn individuals. According to a 2023 McKinsey Report, China's MedTech sector, which was valued at ~US$70bn in 2021, is poised to potentially double in size by 2030. Such growth would elevate China's MedTech market share to ~20% of the global market. To thrive in this burgeoning market, enterprises must be agile in adapting to changes, forge strategic partnerships, and effectively navigate the evolving healthcare landscape.

Navigating China’s Diversity
Succeeding in the Chinese market hinges on effective communication and a deep understanding of Chinese culture. China's administrative divisions include 23 provinces, five autonomous regions (Inner Mongolia, Guangxi, Tibet, Ningxia, and Xinjiang), four municipalities (Beijing, Tianjin, Shanghai, and Chongqing), and two Special Administrative Regions (Hong Kong and Macao). Furthermore, China boasts 129 dialects, with Mandarin as the standard and Chaoshan as predominant in the Guangdong region. Given this diversity, Western MedTech companies often grapple with cultural and linguistic barriers. Establishing vital connections within China's intricate administrative and business landscape can prove challenging. Therefore, crafting effective market entry and expansion strategies is imperative. Chinese consumers have preferences and expectations when it comes to medical technology. Western companies must be ready to adapt their offerings to align with these preferences, a critical factor in gaining market acceptance. Failing to do so can hinder market penetration and long-term success.
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Data Privacy and Security Concerns
Data privacy and security are concerns in China. Entrants must navigate stringent data protection regulations, which may differ significantly from Western standards. Building trust with healthcare providers and patients is essential to address these concerns. Failure to do so can lead to regulatory issues, damage brand reputation, and erode customer trust.
 
Reassessing global strategies amid China's economic slowdown

China, as the world's second-largest economy, has been a pivotal market for major Western MedTech companies. However, the current economic climate calls for a strategic re-evaluation. China's economy has recently experienced a slowdown, with repercussions felt not only in neighbouring nations but also globally. South Korea, a historical driver of global growth, faces its longest factory activity decline in nearly two decades. Other major Asian exporters are also dealing with sluggish demand, and Japan's manufacturing activity has declined, with Taiwan reporting contracting output and weakened foreign demand. In September 2023, concerns grew as China experienced deflation, raising questions about currency stability, challenges in the property sector, and high local government debt. China's decision to not stimulate its economy further exacerbated the situation, impacting key financial hubs like Hong Kong and Singapore, as well as satellite economies. This economic slowdown in China is expected to persist and likely have far-reaching global consequences. Businesses worldwide, including those in the US and Europe, heavily reliant on China for growth, should explore alternative regions for sustainable value and expansion. Western MedTech companies need to carefully assess the challenges and costs associated with further expansion in China.

An alternative strategy emerges; companies should consider complementing their Asian focus and explore the growing economies of Africa. Just as early MedTech pioneers capitalized on Asia's rapid expansion, companies today should contemplate laying the groundwork for a fresh international strategy in Africa. The continent has potential, and a proactive approach could yield sustainable growth opportunities, helping to mitigate the impact of China's economic challenges and slowdown on global ambitions.


Part 2
Africa's Ascendance

 
With a few notable exceptions, Western MedTech executives tend to overlook Africa due to its challenging socio-economic conditions, which include political instability, corruption, extreme poverty affecting ~50% of the population, limited access to necessities, and a high illiteracy rate of ~40%. Notwithstanding, China has long recognized Africa's potential, which mainly revolves around Africa's abundant natural resources, which constitute ~30% of the world's mineral reserves, including critical resources for renewable and low-carbon technologies. For instance, Zambia leads in unrefined copper exports, Guinea boasts the world's largest bauxite reserves, and South Africa contributes ~90% of the world’s platinum group metal reserves. Furthermore, Africa has the world's youngest population, with substantial projected growth.
 
Asia plays a pivotal role in Africa's trade dynamics, accounting for >42% of its exports and >45% of its imports, surpassing Europe in both cases. According to a 2023, Business Insider Report, Africa is poised to become the world's fastest-growing region, with six of the ten fastest-growing economies located on the continent, albeit starting from a relatively low economic base. In addition to its mineral wealth, the continent's path to economic success is partly based on developing an export-led manufacturing economy, akin to China's transformation in the 1980s. This, already in progress, has the potential to lift >0.5bn people out of poverty, create >100m jobs, and establish a substantial and rapidly growing middleclass that will demand improved services, including healthcare.
 
Currently, Africa's manufacturing sector contributes only ~9% to the continent's gross domestic product (GDP) and ~2% to global manufacturing output. However, the African Union has placed manufacturing at the forefront of its Agenda 2063, a strategic framework supported by all 55 African countries, aimed at achieving socio-economic transformation over the next 50 years. This commitment gains significance amid escalating trade tensions between the US and China, which have global economic implications. Africa has weathered recent shocks, including weakened external demand, global inflation, higher borrowing costs, and adverse weather events, which have hindered its post-pandemic recovery. Nonetheless, in the coming decades, the "Made in Africa" label may come to symbolize quality products, solidifying the continent's position as a prominent player in global manufacturing, akin to how "Made in China" became synonymous with quality two decades ago.
 
China’s impact on African manufacturing

China has been instrumental in the economic transformation of African nations, which partly stems from the Chinese strategy to relocate its low-level manufacturing operations to Africa. As China's domestic manufacturers have advanced technically, they have systematically shifted their basic manufacturing capabilities to African countries. This provides Africa with an opportunity to mirror China's journey from standard manufacturing to advanced production processes over several decades.
 
Chinese companies have made substantial investments in labour-intensive manufacturing facilities notably in Ethiopia. This has created jobs and fueled the growth of local manufacturing sectors. For instance, the Huajian Group, a leading Chinese footwear manufacturer, established plants in Ethiopia in 2012, employing >7,000 people and producing ~5m shoes annually. The Group’s partner in this project is the China-Africa Development Fund (CADFund), a private equity facility promoting Chinese investment in the continent. Huajian also invested in Ethiopia's Jimma industrial park, contributing US$100m to build shoe and coffee processing plants and a technical education centre.
 
As Chinese enterprises expanded in Africa, they provided training to local workforces, and transferred their manufacturing expertise. This collaborative effort is helping to develop a skilled labour pool important for sustaining manufacturing growth. Notably, Ethiopia's Eastern Industrial Zone, supported by Chinese investment, evolved into a thriving manufacturing hub, attracting both domestic and foreign investors. Additionally, Beijing's Belt and Road Initiative has led to significant infrastructure developments across Africa, including roads and ports, which further stimulate the continent's manufacturing sector. China’s investment in Africa stands out due to its tangible presence, in contrast to other nations whose involvement in the continent is characterized by distant and arms-length financial engagements. With the influx of such investments, technology transfers, and ongoing skill development, some African nations are positioned to follow China's path towards a manufacturing transformation. 
 
MedTech’s early entrants to the African market

For years, support for Africa’s healthcare tended to concentrate on education and malaria nets. In recent years however, as developed-world disorders, like cancer and heart disease, grew in Africa so medical technology companies increasingly found a market in supplying devices to private healthcare operators and investing in healthcare initiatives through partnerships with governments. US President George W. Bush recognised Africa’s strategic importance, emphasising investments for development and health initiatives, including the President’s Emergency Plan for AIDS Relief (PEPFAR), which, announced in 2003, reflected a commitment to fostering stability and wellbeing on the continent. Since then, American governments have not shown much interest in Africa. However, the MedTechs that entered the Chinese market ~4 decades ago and prospered, have established footprints in the African market by adapting their products and services to local needs, building partnerships with local healthcare providers, and addressing challenges such as infrastructure limitations and affordability. Their presence caters to Africa’s large and growing middleclass and has contributed to the improvement of healthcare standards in the region.
 
Philips Healthcare has made inroads into the African market and operates in several African countries, including South Africa, Kenya, and Nigeria. One of the advantages they offer is a wide range of medical devices and equipment tailored to different healthcare settings, from high-end hospitals to remote clinics. Their focus on technology that can operate efficiently even in areas with unreliable power grids has been instrumental in their success. GE HealthCare has a presence in countries like South Africa, Nigeria, and Egypt. Their commercial advantage is in their commitment to providing innovative medical technologies across various healthcare domains, from diagnostic imaging to healthcare IT solutions. The company collaborates with local healthcare providers and governments to build sustainable healthcare infrastructures. Siemens Healthineers is active in South Africa, Kenya, and Ghana. The company’s advantage stems from their portfolio of medical equipment, laboratory diagnostics, and digital health solutions. They often tailor their offerings to meet the specific needs and budgets of healthcare providers in Africa, contributing to improved patient care and diagnostic accuracy.
 
Unveiling MedTech opportunities: the impact of insurers

Large insurance firms wield significant influence in shaping the trajectory of the medical technology industry. They play a pivotal role in extending health insurance coverage to middle-class populations worldwide, not only bolstering healthcare systems but also driving the demand for medical technology. In essence, these insurance giants act as catalysts for the MedTech industry's growth.
 
A case in point is Prudential plc., a global insurance powerhouse with >23,000 employees and 2021 annual revenues of >US$70bn. The company holds dual listings on the London and Hong Kong Stock Exchanges and is a constituent of the FTSE 100 Index. It also maintains secondary listings on the New York Stock Exchange and the Singapore Exchange. In February 2023, shortly after Anil Wadhwani assumed the role of Prudential's new CEO, he publicly declared his intent to chart a new course and focus on Africa for growth. Wadhwani highlighted that the growth drivers in Africa today closely resemble the trends previously witnessed by the company in Asia: rapidly expanding middle-class populations with a growing appetite for insurance and enhanced services, including healthcare. He emphasized that Africa would complement Prudential's expanding Asian presence. IMF's 2023 reports indicate that countries such as South Africa, Ghana, Kenya, Ethiopia, Côte d'Ivoire, and Rwanda are prime candidates for substantial future growth. It is increasingly plausible that Africa could emerge as the next frontier for MedTech companies, thanks to the leadership of individuals like Anil Wadhwani, who steer insurance giants toward new horizons.
 
Takeaways

In recent years, Western MedTechs have witnessed a significant transformation in China's healthcare landscape, driven by changing demographics and an increased emphasis on technological self-reliance. Notably, industry giants such as GE HealthCare, Siemens Healthineers, and Philips Healthcare, which established a presence in China during the 1980s, are now extending their reach into Africa with hopes of replicating their prior successes. While some may view this expansion as unconventional due to factors like political instability, corruption, and poverty, the continent has potential. Africa's attraction for MedTechs includes some of its countries with significant economic growth potential, a burgeoning youthful population, a growing middleclass, and abundant natural resources that align with the evolving demands of a rapidly expanding global green economy. Much like the historical pattern of MedTech companies venturing into Asia, a similar trend is emerging in Africa among a select group of firms. Another critical point to consider is the emerging role of insurance companies as potential guides in this new journey. These insurers are participating in the continent’s healthcare expansion and innovation, and where they lead, MedTech companies should consider following. The growing middleclass, equipped with medical insurance, will eventually exert pressure on healthcare systems in the region to enhance access to quality care. This, in turn, will expand the market for medical devices. Despite the complexities and contradictions that Africa presents, it represents an opportunity that warrants consideration. The question of whether Africa will become the new Asia suggests the need for MedTechs to embrace a new era where innovation and progress thrive on the courage to venture beyond the familiar. By doing so, corporations can discover a promising landscape for growth and innovation, tapping into Africa’s underserved opportunities and playing a role in enhancing global healthcare.
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