He helped eradicate smallpox, was the first director of Google.org and is now working on AI solutions to help prevent new pandemics. Dr Larry Brilliant has witnessed the emergence of modern medicine up close – from the power of science to the vulnerability of systems.
In conversation with ICT&health, he shares his vision for the future of healthcare: a future in which technology and ethics go hand in hand. ‘Healthcare innovation is not a technological race, but a moral imperative,’ says Brilliant. ‘The future of medicine depends on our willingness to maintain compassion in a world that is becoming increasingly smart.’
We are living in a remarkable moment in history, Brilliant argues. ‘For the first time, we are truly unravelling the choreography of life – how cells communicate with each other, how genes go awry, how ageing occurs at the molecular level. Scientists – such as Venki Ramakrishnan in his book Why We Die – describe biology with the eye of a poet. We are learning how life works and how we can influence it to heal.’
Systems are faltering
That is an extraordinary leap, Brilliant believes. "But here lies the paradox. While science has never been more powerful, the systems that are supposed to bring those benefits to people are faltering. In the US, the healthcare system is in deep crisis. Funding for Medicare and Medicaid is being cut, and reimbursement models for hospitals and medicines are changing in ways that threaten accessibility. Of the approximately 6,000 hospitals in the country, I wouldn't be surprised if a thousand, maybe two thousand, go bankrupt in the coming years."
The US is thus approaching a dangerous tipping point. The irony is that we have never known so much about how to heal people, yet we may soon have fewer opportunities to bring that healing to those who need it most. We have created islands of excellence surrounded by deserts of neglect.
The vagaries of politics
As a young doctor, Brilliant studied healthcare systems in Europe – in the United Kingdom, Sweden, Norway, the Netherlands and even the former Soviet Union. He wanted to understand how different societies deliver care. "What struck me was that most societies, despite their flaws, accepted healthcare as a public good. The US never really did that. We left public health to underfunded agencies and justice to the whims of politics."
Nevertheless, Brilliant also sees unstoppable forces that will shape healthcare in the coming decade. ‘First, the fusion of biology and digital technology: the bio-digital revolution. The convergence of AI, data, genomics and synthetic biology will redefine what medicine is.’
Secondly, Brilliant mentions personalisation. We are moving towards a future in which treatment is tailored to a person's genome and daily life, living environment, stress levels and even sleep patterns. "Imagine medicine that continuously adapts to you, just like your phone gets updated at night. Thirdly, decentralisation. Care is shifting from the hospital to the home, to community centres and even to smartphones. During the pandemic, telehealth exploded. Its use declined afterwards, but the possibility remains. Hybrid care models are expanding further, especially in regions with weak physical infrastructure."
But there is another trend that we cannot ignore: the rise of citizen science and self-management. Brilliant: "People are no longer passive patients. They collect data about themselves, form communities and demand transparency. This is a cultural revolution that is just as significant as a technological one. What concerns me, however, is that these trends could widen the health gap if we are not careful. Technology itself is neutral; it can democratise access or entrench inequality. But if AI diagnostics and data-driven treatments remain affordable only to the privileged, we will have missed the point."
This is part of the cover story featured in ICT&health edition 6, published on 12 December 2025.
