Health care's biggest wild card

• Alternatively, most of these developments may never live up to their hype. Or they could, for one reason or another, never make it to market.
• Or they could exacerbate existing inequities, or make the system even more expensive. And of course, reality often lies somewhere between complete failure and complete success.
• That's the nature of a wild card — we just don't know! But decisions being made today could make a big impact on the ultimate success or failure of some of the most exciting prospects.

Where it stands: The development pipeline is stacked.

• AI-based products designed to aid clinicians, including through reducing administrative tasks like note-taking, are already on the market, as are hundreds of AI-enabled medical devices. AI also holds enormous promise for drug discovery, diagnostics and precision medicine.
• The first gene-editing CRISPR product was approved last year. Cell and gene therapies are rapidly coming to market, and thousands more are under development.
• Elon Musk's Neuralink is only one of several companies testing brain implants that would allow users to control tech devices simply by thought.
• And AI could even allow for forecasting someone's risk for disease similar to how we can forecast the weather, Scripps Research's Eric Topol recently wrote in Science.

Friction point: The U.S. regulatory system is very good at testing products before they make it to market for safety and effectiveness.

• But it could struggle to handle everything that's coming down the pipeline at once — in addition to new post-marketing monitoring that AI products and gene therapies likely require.
• "All of these are coming at us at the same time, each with a potential 'eureka,' and our pipeline — our capacity to study them all, separate the wheat from the chaff," is going to be a challenge, said Amy Abernethy, a former senior FDA official.

What we're watching: Health care access and outcomes are already characterized by glaring inequities. But this new wave of innovation could exacerbate them and create a class of products primarily accessible to the select few who can afford them.

• "These innovations are where our current regulatory frameworks, our current ways of thinking about equitable access are going to break down if we're not careful," Abernethy said.
• To some extent, this is already happening with access to GLP-1s for obesity treatment. Demand is so large and the cumulative costs so high that only a small, though growing portion of those who could benefit from the drugs have been able to use them.

When it comes to AI, Topol told me, a common assumption is that it's not going to help people having the hardest time accessing health care.

• But "there's already evidence that if you work at it, you can actually go the opposite direction" and reduce health inequities.

The bottom line: The upside could be enormous for patients, providers and health care companies that stand to profit.

• "There's going to be all these new inventions … I feel like we're going to have one of these step changes in performance in health care in the world, which is exciting," said Bob Kocher, a partner at Venrock.