personalised medicine

The argument has raged for some time and shows no sign of abating any time soon: screening for diseases, yes or no? Take the case of prostate cancer screening: Richard Ablin - the author of “The Great Prostate Hoax”, and the man who claims to be the first to have identified PSA (a protein created by the walnut-sized prostate gland that can easily be measured) - maintains that PSA testing can do, and often does, more harm than good. Ablin, of the University of Arizona, has noted that a man’s PSA levels may be high but that doesn’t mean that he has cancer. On the reverse side of the coin, a low PSA level doesn’t necessary mean that a potential patient’s worries are over in this regard.Yet the fact remains that around one-in-three men aged from 40-60 has traces of prostate cancer, and the risk rises with ageing. So all men should be regularly tested, right? Well, not necessarily… Ablin and others argue that over-testing can very easily lead to over-treatment, including unnecessary invasive surgery to remove the prostate gland. The over-treatment argument has also been used in respect of breast cancer screening, although the figures tend to show that it works very well in a preventative sense and even better in detecting early breast cancer in target age groups. Yet over-treatment is clearly an issue, with many women (plus those aforementioned men with early ‘signs’ of prostate cancer) simply wanting all traces of the disease, or potential disease, removed right away, regardless of the potential cost to them personally or, indeed, fiscally to society in general. So over-treatment is clearly something that cannot be side-stepped. The counter-arguments - and they are very strong ones - is that our ‘social contract’ has obligations to ensure the highest standards possible regarding...
Shouldn’t we be rewarded for healthy behaviour rather than repeatedly punished for being ‘bad’? Fat tax and sugar tax, duty on cigarettes and vodka – everyone can think of a ‘sin tax’ they pay from time to time. These are the penalties we pay for making unhealthy choices. The idea of sin taxes has been gaining ground in recent years. The success of price rises on cigarettes and alcohol in curbing consumption is leading governments to consider what other disease-causing products could be taxed out of existence . In Europe, Denmark were the early movers: they introduced a tax on fatty foods in 2011. It applied to meat, dairy products, oils and certain other foods which contained more than 2.3% of saturated fat. The tax ‘worked’ in that it raised revenue and cut consumption of fatty foods by 4% . However, the policy didn’t last long. It was scrapped within 18 months because the government said the tax was too difficult and expensive to collect. Japan is taking a different route . Instead of hitting shoppers in the pocket to reduce the size of their gut, authorities impose fines on employers and local governments who fail to keep waistlines in check. Other countries, including the UK and Ireland have targeted sugary drinks by proposing a ‘soda tax’ to nudge consumers into making healthier choices. Celebrity chef Jamie Oliver – a campaigner for healthy eating – hailed the move as a victory for children’s health. He was so happy about the new tax that he did a little dance at the end of a TV interview which was captured by BBC! There’s no doubt that taxes can be used to push people into making ‘better’ choices. But what ever happened to incentives for positive change? GPs in the UK get bonuses...
Authors: this article was written by Hans Martens, Martha Emneus , Anders Green and Camilla Sortso . This is the first blog of the series presenting the economic value of being in good health and the broader consideration of cost of disease. Europe’s health systems are struggling to maintain sustainability. One of the major challenges is the exponential increase in the prevalence of chronic diseases and the number of patients in advanced and costly disease stages. A challenge, which is predicted to only increase in the years to come. Chronic diseases make high demands on health systems for continuous, quality care. For patients, chronic diseases are associated with shorter lifetime, reduced quality of life and economic as well as socio-economic burdens on the patients, their caregivers - formal or informal. For society, the burden is excess healthcare, pharmaceuticals, nursing, reduced labour market participation and ability to be socially and economically active and premature mortality. Altogether these costs underpin the major challenge of chronic diseases for our societies – not least in Europe where health is a collective rather than an individualised responsibility. This challenge must be dealt with by the health systems and perhaps by reconsidering where investments should be made in the future as with many of the chronical diseases onset and progression can be prevented if diagnosed early and precisely and if the process is well managed. Among chronic diseases, diabetes mellitus is one of the most burdensome with app. 371 million people diagnosed globally and evidence of rapidly increasing prevalence. In a recent study from Denmark it was estimated that costs of diabetes amounted to 14,349 Euro per person year. Of these, health care costs accounted 17% and pharmaceuticals 4%, while for example loss of productivity amounted to 42%. And this is not the whole story, because...
In the second of a two-part series, Dr. Johnny Walker talks about Jinga Life and the power of managing healthcare at home. Read the first part here . We have an ever growing clinical demand and an ever rising consumer expectation to deliver "best of breed" services across every step of the patient journey. We are living in a world where consumer-led market disruption is the norm in business, where technology that at one point was contained purely in the realm of Sci-Fi is now ubiquitous and commoditized. The current resources are strained and incapable of delivering services in this way and we are buckling under the daily fight for survival at the clinical coal face. The traditional healthcare system is simply unsustainable despite the phenomenal efforts of everyone within the ecosystem in putting their shoulder to the wheel. We need to rethink the healthcare structures. An important observation from my experience is that, in 92% of cases, the ever present custodian of well-being in a family is female. Whether this is accompanying the patient, or being the first person members of the family call when they are sick, the centre of well-being in many family units is the female, the protector, the shepherd, the warrior. The Jinga [1] . Jinga Life aims to engage, embrace, enable, empower, and educate the Jinga. By populating an Electronic Health Record, designed and maintained by the Jinga for the family, extending primary care models to include the home, and using simple technologies to increase the connectivity between the Jinga and the family’s care professionals, Jinga Life desires to place the Jinga at the centre of her healthcare team. Our vision is to change focus from the traditional hospital based doctor focused solution, and put the Jinga at the core of her and her...
eHealth technologies are pulling together personal information from diverse sources to ensure a more personalised, informed healthcare service – it’s what patients expect Precision medicine is the use of all available information about a patient to produce the most informed care plan possible. This is often associated with using genetic or other “-omics” information to help doctors select which medicine to prescribe for their patient. For example, testing a cancer patient for specific biomarkers can tell doctors which chemotherapy will work best. But it’s much bigger than that. If you look at what contributes to premature death, around 30% is thought to be genetic. The rest is a combination of our environment, diet, exercise, work, mental health, social interactions and other exogenous factors. So why limit ourselves to genetic data alone? As healthcare is now in the information era, the challenge is to pull together the vast quantity of data that exists and aggregate it in a way that allows health services to be tailored to each patient. There is already a wealth of data and this is expected to increase 50-fold in the next eight years. There is no way any physician can cope with this volume of information. That’s why software companies are playing an increasing role in healthcare. Information overload is essentially an IT challenge: how do we access and surface these data in a way that makes them accessible and actionable? How do we acquire and aggregate data, then reason against it to help manage populations and drive insights? Healthcare is unique but software experts have already overcome huge challenges in areas such as e-commerce and financial services to deliver a more tailored and user-friendly experience while safeguarding data privacy. In fact, the public is so used to this kind of customised intelligence that some patients...
Revolutionising and reinventing Medicine We are currently experiencing a great period of particularly stimulating technological breakthroughs. A great deal of progress is expected in practically all areas of our daily life: health, home, work, consumption, the environment… In the health sector alone, there are plenty of new inventions: you can manage your diabetes with a mobile application, make a prosthesis with a 3D printer, continuously monitor your own statistics and there are new techniques for predictive analysis . These inventions are gradually transforming our approach to health and the relationship between hospitals and patients. As these innovative technologies become more and more widespread, the patient becomes more active in monitoring his own state of health and the hospital’s role is changing: we spend less time in hospital, there’s greater comfort for the patient, and the costs for our social security system are reduced. So, in the long run, medical innovation may improve both the quality of healthcare for the patient and the performance of our health system. At this time of medical innovation, surgical robotics is a particularly promising area. A sign of its potential: surgical robotics alone represents a world market which should reach over 20 billion dollars by 2020! This is mainly due to the boom in minimally invasive surgery, which is a way of operating patients via very small incisions. I created Medtech because I was convinced that this trend was inevitable and positive both for patients and the medical world. By democratising the access to minimally invasive surgery, this technology facilitates and considerably improves the surgical act - serving patients and practitioners - and contributes to the performance of hospital facilities. Let’s transmit and connect these innovations! As innovations are only meaningful when they are shared, surgical robotics also aims to make modern surgery accessible to...