Nik Raupp studied Economics and Japanese at the University of Bonn, Germany. During his studies, he focused on the Japanese health system and the Japanese biotech market. Currently he is a postgraduate and re-search assistant at the DECHEMA Society for Chemical Engineering and Biotechnology, a non-profit scientific and technical society based in Frankfurt am Main, Germany. One aim of DECHEMA is to promote and support research and technological progress in chemical technology and biotechnology. One of his main tasks is to support an international network of German and Japanese biotech firms.

Can you envision major wild cards in the health
sector (positive or negative) that may occur in the next 20 years?

I consider the production of artificial organs as a major wild card. So this one might be of high importance to the European Union. Another important wild card might be the breakdown of European health systems, and, consequently, an abrupt and revolutionary change in these systems. This would be quite negative for the broad masses. Last but not least, I suggest the wild card "Personalized Medicine". In this scenario, patients will receive medicine and treatments exactly matching their individual genotype or other individual physical characteristics. Personal diagnostics might be standard procedure for all diseases. Several diagnostics might also be conducted automatically. People might go to a machine, insert a few drops of blood and the diagnosis machine analyses the blood and recommends an individually matching medication or treatment. Or the machine could, for example, generate a barcode, which
the patient hands in at a pharmacy, where he finally receives his medication mixture. This could also be conducted automatically by "pharmaceutical mixing machines".

What will be the dramatic impacts of the wild cards you mentioned?

Firstly, the wild card "Personalized Medicine" might have dramatic impacts on the pharmaceutical industry, classic pharmacies and the health system as a whole. Secondly, you might have fewer risks concerning well-known and undesirable side-effects, as medicines match a person's genotype and other individual physical characteristics. Besides, this individualization would lead to more efficient treatment of diseases. This would be a big step towards increasing health and wellbeing of societies.
On the other hand, you will have significantly rising expenditures on health and a higher risk, as you will no longer be able to conduct long-term studies with a massive number of test subjects, as in the case of conventional "one-fits-all" medicine. This might lead to some grave complications or unknown side-effects. This is risky, both for the producers of personalized medicine and for affected patients, who might even die because of unknown side-effects. To clarify, we are not talking about the development of personalized pharmaceuticals for harmless diseases such as coughs or colds. We are talking about effective personalized medicine against different types of cancer and autoimmune diseases.
So the current characteristics of European approval procedures might be high risk, as approval procedures for pharmaceutical tests differ from those for the actual pharmaceutical. Normally, approval for tests takes around three years, and approval for the pharmaceutical takes ten years. So there is a time gap of seven years between the test and the approval and, the test and its results are out of date.

What are the weak signals that could hint at a growing likelihood of the wild cards that you mentioned?

There have been quite a few breakthroughs recently regarding the wild card "Production of Artificial Organs". For example, scientists produced artificial lungs for mice for the first time. Normally, after having successfully achieved tests and experiments on mice it takes around 10 to 15 years before the same results or methods can be applied to humans.
I can suggest some weak signals regarding the second wild card, "Breakdown of European Health Systems" and "Revolutionary Changes in European Health Systems". Firstly, there is currently a lively discussion on how to restructure and optimize the ailing German health system. Secondly, demographic change and the ageing of populations leads to increased pressures on health systems. Last but not least, many new and expensive medicines will come onto the market in the next few years. Even today, specific treatments or medicines such as Herceptin cost so much that they can scarcely be financed. A regular treatment of breast cancer with Herceptin, for example, costs 100.000€.
Thinking about our third wild card, "Personalized Medicine", I can mention the growing use of pharmacogenetics in the field of vitamin and mineral supplements. Another important signal might be the recent developments in decoding the human genome. Within the next year it will be possible to decode it in about one day. A further signal might be the growing share of self-diagnostics by patients, with the help of rapid tests, e.g. for intestinal cancer. Altogether, these trends and signals might hint at the probable emergence of this wild card in the next 20 years.

Assuming that this wild card is considered as rather positive - how should it be addressed by future research?

In order to minimize the time gap between the approval of tests and the approval of the pharmaceutical, European approval procedures might have to change. Besides, interdisciplinary research might have to be strengthened, as well as research on efficient diagnostic methods. We do not have a lack of medicine, but of appropriate diagnostic tools.

Can you identify any causal relationships between the wild cards and weak signals you mentioned above?

Yes, there is a relationship between the three wild cards I mentioned in the beginning of our conversation. Both wild cards - "Personalized Medicine" and "Production of Artificial Organs" - would lead to a cost explosion in health systems, and might possibly lead to an accelerated emergence of the breakdown of European health systems. Another relationship exists between "Personalized Medicine" and the "Production of Artificial Organs", as they are based on the same fundamental research. Finally, it is obvious that ailing health systems, which suffer under high cost pressures, impede efficient research activities on the fields mentioned above. So these three wild cards form a kind of vicious circle.

Looking ahead to the future of European research - which of the wild cards/weak signals that you mentioned should be given top priority in the EU research?

In my opinion, "Breakdown of European Health Systems" is the most important wild card. Neither of the other two wild cards makes sense without a working health system. But the question is how European research or European policy could prevent the emergence of this wild card. European policy cannot influence financial concepts of national health systems, because this is not EU-responsibility. But it can foster transnational research on the generation and evaluation of different effective models of health systems by launching respective research programmes.

Do you prefer other definitions of wild card and weak signals? If these concepts are ambiguous in your opinion, how could they be more clarified and better defined?

I am fine with the standard definition used in the workshop. I might suggest the concept of the "black swan" that goes into the same direction, but I think it is not an appropriate alternative to the wild card concept.

Are there interesting lessons from previous foresight studies that employed the wild cards - weak signals approach?

No, the only applications of wild cards or similar concepts I can refer to are in the investment sector. There you have different funds based on the occurrence of unexpected and dramatic events.