“An apple a day keeps the doctor away.” Most of us are familiar with this quaint expression from 1913. Although research studies have confirmed that an apple a day does not, in fact, result in fewer doctor’s visits, almost everyone can agree that eating nutrient-dense foods such as apples and other fruits, vegetables, whole grains, and various types of proteins can lead to a healthier life. 

Major contributing factors to growth in this market are the growing prevalence of malnutrition and diabetes worldwide. According to the World Health Organization, 462 million adults are underweight. Medical foods are considered the first choice to provide nutrients to malnourished patients. The number of people with diabetes has been increasing, reaching 463 million adults in 2019. By 2045, the number of adults with diabetes is projected to be 700 million. About 60-70% of diabetics suffer from neuropathy, damage to the nerves outside of the brain and spinal cord. The risk for neuropathy increases with age, unhealthy lifestyles, and poor nutrition. Medical foods for the prevention and treatment of diabetic neuropathy held the highest share of the market in 2020. 

Other conditions that may require medical foods include neurological conditions such as cystic fibrosis, stroke, and dementia which causes difficulty in swallowing; Crohn’s disease and ulcerative colitis which inhibit nutrient absorption from conventional foods; chemotherapy-induced diarrhea; and chronic kidney disease among others. Revenues for medical foods geared toward patients with chronic kidney disease are expected to have the highest compound annual growth rate (CAGR) through 2028 due to the rising incidence of chronic kidney disease, especially in those 65 years old and over, and patients’ changing nutritional needs. 

Due to their commercial availability and their ease of consumption, more than half of medical foods sold are in liquid, semi-liquid, or semi-solid form. The market share for liquid formulations is expected to increase due to this form being preferred by both the geriatric and pediatric populations. Some of the examples of liquid formulations are Nutrison Energy by Danone, Glucerna Therapeutic Nutrition Shake by Abbott Nutrition, and Novasource by Nestlé Nutrition. Revenues for powder formulation are expected to grow at the highest CAGR through 2028. Powder formulations are easy to administer and are convenient, having a longer shelf-life than other non-pill formulations, do not require refrigeration, and may be less expensive. Medical foods in pill form constitute the smallest market share.

By region, North America had the highest market share in 2020, 29.9%. The presence of leading companies in the industry along with an increasing prevalence of chronic conditions and a willingness by health care professionals and patients to utilize medical foods will lead to growth in this region. The Asia-Pacific region also has a strong presence from companies in this industry. As well, incidences of diabetes, malnutrition, obesity, cancer, and cardiovascular diseases are on the rise. Combined, the regions of North America, the Asia-Pacific, and Europe held more than three-quarters of the global market share in the medical foods industry.

A nurse at a hospital drawing blood to check a patient’s white cell count after treatment. A phlebotomist at a diagnostic laboratory drawing blood to check a patient’s cholesterol levels as part of a routine physical exam. People donating blood at a Red Cross blood drive. Most adults, and some children, are familiar with blood collection products: needles and syringes, blood collection tubes, blood bags, and others. Today’s market size shows total global revenues of blood collection supplies in 2018 and projected for 2026. The increasing incidence of infectious and non-communicable diseases, as well as the rising number of people injured as a result of trauma and accidents, will contribute to growth in this industry.

Floatation centers are alternative health and wellness businesses that have one or more float tanks for their clients’ use. Float tanks are tanks filled with skin-temperature warm water mixed with enough Epsom salt to allow a person’s body to float. The temperature of the water makes it imperceptible to the person floating in the tank. The tank is sound-proof and pitch-black blocking out any outside stimuli. These tanks are sometimes called sensory deprivation tanks or isolation tanks.

In the 1950s, interest in the brain’s reaction to sensory deprivation began among neuroscientists. Some scientists believed that the brain would shut down into a coma-like state. Others believed that the brain would still remain active, just looking inward for stimulation. Neuroscientist John C. Lilly built the first float tank in 1954 at the National Institute of Mental Health Laboratory in the Virgin Islands; however, unlike modern floatation tank clients, the subjects of Lilly’s experiments were submerged underwater and needed to wear divers helmets with tubes to breathe. The results of the experiments proved that the brain does not go into a comatose state when deprived of stimuli. Subjects reported feeling energized and motivated to fulfill their highest life potential afterward. This led Lilly to build more float tanks in research centers in the United States.

In the early 1970s, Lilly partnered with Glenn and Lee Perry to develop a commercially available float tank that people could have in their homes. In 1979, the first floatation center opened in Beverly Hills, California with 5 of these tanks. The business was a success and floatation centers opened across the United States. Business boomed in the early 1980s. Now called Restricted Environmental Stimulation Therapy (REST), research continued although some scientists found it difficult to get funding. Lilly’s reputation for being eccentric and the 1980 cult-classic movie Altered States, inspired by Lilly’s life, led some to believe that floatation tank research was “a hippie fad.” By the mid-1980s, AIDS was taking a toll on the population and on floatation center businesses. Most went out of business. Then in the 2000s and especially the 2010s, floatation centers saw a resurgence in popularity as alternative health and wellness practices became more available and acceptable.

According to some studies, after float sessions, patients experience lower levels of stress-related hormones.¹ Lower blood pressure and improvements in mood, pain, and muscle tension have also been reported. In some cases, effects last for several months. Floating has been shown to lessen stress-related pain, anxiety, and depression. Patients suffering from various conditions such as addiction, arthritis, fibromyalgia, and post-traumatic stress disorder may also be helped by floating.

Today’s market size shows the number of floatation centers in the United States in 2011 and 2019. California had the highest number of floatation centers in 2019, 70, followed by New York and Florida (tied with 29 each), Texas (20), Pennsylvania (18), and Illinois (17). In a majority of cases, floatation centers offer other services such as massage, infrared saunas, reiki, yoga, meditation, sound and light therapy, counseling services, and acupuncture. Despite this, according to a survey conducted by Float Tank Solutions, more than three-quarters of these businesses earn most of their income from floating. In 2019, the average annual revenue from a float tank totaled $41,939.

According to the World Health Organization, 235 million people suffer from asthma worldwide.¹ Chronic obstructive pulmonary disease (COPD) sufferers number 251 million, with 65 million having a moderate to severe form of this respiratory condition. Globally, deaths caused by these diseases numbered 383,000 and 3.17 million, respectively.

Inhaled medication, administered via an inhaler, is one common treatment. Inhalers have been used since the late 1700s, but the pressurized metered-dose inhalers that patients use today weren’t invented until 1955, by American doctor George Maison. Maison’s invention allowed the prescribed dose of asthma medication to be expelled into the lungs by pushing a button. These inhalers were meant to be an improvement over nebulizers which some patients found difficult to use and as a result failed to get the proper dose of medicine.

Despite metered-dose inhalers being an improvement from earlier methods of medication delivery, studies have shown that patients who use them make at least one mistake while taking their medication in this manner 70-90% of the time, resulting in only 7-40% of the medication reaching their lungs. The two most common mistakes include a delay between inhalation and administering the dose of medication and not breathing deeply enough.

An improvement over these traditional inhalers may be smart inhalers. Smart inhalers have either built-in sensors or clip-on sensors that turn a traditional inhaler into a smart inhaler. The sensors are used to track the medication, dosage and time taken for each dose. Some have monitors for inspiratory flow rate. These sensors link with an app on a smartphone or tablet, with the data saved to the cloud so that doctors and caregivers can access the data. Doctors can monitor whether patients are taking their medication as prescribed and if they are using their inhaler correctly. The app can also provide reminders to patients when they need to take another dose. All of these innovations are meant to help patients get the proper dose of medication on a more consistent basis so that the use of a rescue inhaler is minimized and their quality of life improves. There are also clip-on sensors for rescue inhalers that monitor usage and send notifications when the users leave their inhalers behind. The data gathered can also be used to determine what triggers their asthma attacks.

Today’s market size shows the global revenue for smart inhalers in 2018 and projected for 2026. The North American market generated the highest revenue in 2018 while the Asia-Pacific region is expected to experience the highest growth over this period. Some leading companies in this industry include Propeller Health; Adherium Ltd.; Teva Pharmaceutical Industries Ltd.; AstraZeneca, PLC and GlaxoSmithKline, PLC.

Osteoarthritis is the degeneration of the cartilage that cushions the ends of bones. This causes stiffness, pain, swelling, and loss of mobility in the affected joint. It is the fifth leading cause of disability in the world, affecting 10% of the world’s population 60 years of age and older. In high-income countries, up to 80% of people aged 65 and older will suffer from osteoarthritis. In the United States, it is the most common cause of disability in adults. More than 30 million Americans suffer from this condition and 14 million have symptomatic knee osteoarthritis.

Viscosupplementation is one type of treatment for this condition. It was developed in Europe in the 1980s specifically to treat knee osteoarthritis. In 1997, the U.S. Food and Drug Administration approved it “for the treatment of pain in osteoarthritis … of the knee in patients who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics, e.g. acetaminophen.”¹

Viscosupplementation is a medical procedure in which a gel-like fluid containing synthetic hyaluronic acid is injected into a joint to treat symptoms of osteoarthritis. The fluid provides cushioning for the bones. Hyaluronic acid is naturally secreted by mesothelial cells present in the joints. Treatments are performed once a week for three to five weeks. Some newer forms only require one injection. Once the pain and swelling from the procedure itself dissipate, some patients experience reduced arthritis pain and better mobility for up to 6 months. Others may not experience any pain relief at all. Viscosupplementation is generally prescribed for people who have early, mild to moderate knee osteoarthritis, patients who previously have taken NSAID pain relievers but whose pain was not alleviated. Some brand names include Synvisc, Euflexxa, Orthovisc, Hyalgan, and Monovisc, to name a few.

Today’s market size shows the amount spent on viscosupplementation worldwide in 2016 and projected for 2026. Demand for viscosupplementation treatments is expected to increase due to the preference for minimally-invasive procedures, the growing geriatric population worldwide and the increase in the number of people who have conditions that make them prone to osteoarthritis such as obesity, diabetes, hypertension, cardiovascular disease, and trauma to the joints due to repetitive movements. Several leading companies in this industry include Sanofi, Allergan, Hoffmann-La Roche, Zimmer Biomet, Smith & Nephew Plc, Anika Therapeutics Inc., Fidia Farmaceutici S.P.A., Ferring B.V., Bioventus, Regen Lab SA, among others.

Medicare for All. That’s the new buzz phrase among Democratic Presidential candidates for the 2020 election. But, proposals for a national health insurance program are nothing new. By the 1930s many Western democratic countries were adopting national health insurance programs, but the United States continued to rely on private health insurers. In 1934, in the midst of the Great Depression, President Franklin D. Roosevelt created the Committee on Economic Security. This committee was to draft a bill that would do just that, namely give economic security to Americans. The Social Security Act that was drafted included an old-age pension program, unemployment insurance financed by employers, health insurance for people in poverty, and financial assistance for widows with children and the disabled. However, the bill that Roosevelt signed into law on August 14, 1935, was more limited in scope and did not contain a health insurance component. President Roosevelt wanted to keep provisions for health insurance in the Social Security Act but feared the backlash would jeopardize passage of this legislation. Opponents argued that government-financed health care would allow the government to come between the doctor and the patient, mandating how doctors treat patients and how much they charge.

In 1937, the U.S. Surgeon General proposed that National Health Insurance, which was still being debated in Congress, first include Social Security beneficiaries. Two decades later in 1957, after years of national health insurance proposals going nowhere,¹ Congressmen Aime Forand and Cecil King proposed limiting this type of insurance to only cover some of the medical expenses of those 65 years of age and older, paid for by Social Security payroll taxes. The media dubbed this proposal Medicare. Those in this age cohort required twice as much hospital care as those younger than 65, and despite getting Social Security benefits, could not afford the rising cost of hospitalization. Only half had health insurance. Nearly one in three lived in poverty.

Despite Democratic support in the House and Senate, support from labor unions, and support from the candidate, then President John F. Kennedy, the strong opposition from fiscal conservatives in Congress, the insurance companies and the American Medical Association stalled legislation. It would take more debate, compromise, a landslide victory for Democrats in the 1964 election, reforms and reorganizations of committees and their rules and the newly elected President, Lyndon B. Johnson, to make this program his top priority to get Medicare passed and signed into law on July 30, 1965. When the law took effect in 1966, more than 19 million people enrolled in the program.

Original Medicare, as it is now called, contains Part A, inpatient hospital coverage,² and Part B, outpatient medical coverage,³ for Americans aged 65 and older receiving Social Security or Railroad Retirement benefits. Part B premiums are deducted from beneficiaries’ monthly Social Security or Railroad Retirement payments. In 1972, Medicare eligibility was extended to Social Security Disability Insurance beneficiaries younger than 65 and those with end-stage renal disease.

In June 1980, President Jimmy Carter signed the Social Security Disability Act of 1980 which created Medigap insurance policies. These policies, issued by private insurance companies and paid for by monthly premiums, pay for some or all of what Medicare does not, such as deductibles, coinsurances, and copayments, depending on the policy. Federal standards for these policies were not established until 1990.

The Balanced Budget Act of 1997 established the Medicare+Choice program, now called Medicare Part C or Medicare Advantage.⁴ These plans, alternatives to Original Medicare, are run by private insurance companies and are regulated by the Federal government. They must cover all of the services Original Medicare Part A and Part B covers. Medicare pays Medicare Advantage providers a per-enrollee fee to provide this coverage.⁵ In addition, many plans cover services Original Medicare does not such as vision and dental care. Most also offer prescription drug coverage, although Original Medicare beneficiaries can also opt-in for prescription coverage through Medicare Part D. Medicare Part D is administered by private insurance companies. Regardless of whether Medicare beneficiaries opt for Original Medicare or choose to pay for a Medicare Advantage plan, they must pay the Original Medicare Part B premium, which is $135.50 per month in 2019.⁶

While these plans offered new choices in health coverage for many seniors, they also complicated the process of choosing health coverage. To provide information for seniors about their choices, the Federal government launched the Medicare.gov website in 1998. Starting January 1, 1999, the 1-800-MEDICARE toll-free phone number was available nationwide and the first annual Medicare & You Handbook was mailed to all Medicare beneficiaries. Whether these informational resources help or not is debatable, but more than two decades later, the process is still confusing for many seniors and their loved ones who are trying to help them.⁷

Today’s market size shows the number of enrollees in Medicare Advantage plans in 1999, 2009, and 2018 in the United States. In 1999, 18% of Medicare beneficiaries were enrolled in Medicare Advantage plans; in 2009, 23% and in 2018, 34%. From 1999 to 2004, Medicare Advantage plan enrollment fell from 6.9 million to 5.3 million enrollees. Since then, however, enrollment has grown year after year. In 2018, 67% of Medicare Advantage enrollees had individual plans. Twenty percent were covered by employer- and union-sponsored group plans and the remaining 13% had special needs plans. Special needs plans are tailored to beneficiaries who have certain chronic conditions, are institutionalized, or qualify for both Medicare and Medicaid. While only 20% of enrollees nationwide are covered by Medicare Advantage group plans, nine states have a disproportionately high percentage of enrollees covered by such plans. In Alaska, 100% of Medicare Advantage enrollees were covered by group plans in 2018. The other eight states include West Virginia (53%), Michigan (51%), Illinois (42%), Kentucky (39%), Delaware (37%), Maryland (35%), New Jersey (34%), and Wyoming (30%). As more unions and large employers, including state governments, seek to lower their retiree healthcare costs, more are turning to Medicare Advantage plans to provide healthcare coverage. The Congressional Budget Office predicts that enrollment in all types of Medicare Advantage plans nationwide will include 42% of all Medicare beneficiaries by 2028.

Cancer is the second leading cause of death in the world.¹ In 2018, an estimated 17 million people worldwide were newly diagnosed with cancer, an increase from 12.3 million in 2007. When a doctor suspects cancer, the first step in the diagnosis process is usually a biopsy, a microscopic examination of a patient’s tissue sample performed by a pathologist. After the sample is prepped, the tissue undergoes hematoxylin and eosin staining. This process stains different cells and structures so that they’re visible under a microscope. The pathologist can then detect any abnormalities. In most cases, this is the only step needed for diagnosis.

In other cases, specialized staining is needed to determine amounts of specific proteins or the presence of certain genes, which then determines how a patient might respond to treatment. In an immunohistochemistry (IHS) test a diagnostic antibody is used to detect proteins in cells or cell membranes. If the specific protein looked for is present, the antibody binds to it. This can be detected as a color change under a microscope. In this way, an IHS test can determine what type of drug therapy will be most effective. An IHS test can also detect if a tumor is benign or malignant.

Beyond cancer diagnosis, IHS tests are used to diagnose autoimmune, cardiovascular, infectious, and nephrological diseases. They are also used to diagnose diabetes. In medical research laboratories, they’re used to test the effectiveness of new therapeutic drugs. This type of test is considered the most profitable tissue diagnostic test. In 2017, IHS test revenue was valued at $1.6 billion.

Other types of tissue diagnostic tests include fluorescent in situ hybridization and silver in situ hybridization. They are used to detect the presence of human epidural growth factor receptor 2 proteins, also known as HER2 proteins, on breast cancer tumors. Tumors that tend to grow and spread faster have higher than normal levels of the HER2 protein. These tumors respond better to newer cancer drugs that specifically target HER2-positive tumors.

Today’s market size shows the total revenue from tissue diagnostic tests globally in 2018 and projected for 2025. Demand for tissue diagnostics is expected to grow due to an aging population and rising incidence of chronic diseases worldwide. Not surprisingly, hospitals claimed half of the market share due to the high volume of tests done for disease diagnosis, monitoring, and treatment. Research laboratories claimed about 25% of the market. Pharmaceutical organizations and clinical research organizations combined claimed the rest. Leading companies in this industry include F. Hoffmann-La Roche Ltd., Abbott, Siemens Healthineers, and QIAGEN.