domingo, 23 de abril de 2017

PHG Foundation | A vision of the future for personalised healthcare

PHG Foundation | A vision of the future for personalised healthcare

A vision of the future for personalised healthcare

Earlier this month, a major report was released recommending fundamental changes to the UK National Health Service (NHS).
The House of Lords Select Committee’s report The Long-term Sustainability of the NHS and Adult Social Care examined critical sustainability issues in the context of a ‘dramatic’ pace of change in health driven by technological developments enabling increasing personalisation of both treatment and care. The report devoted a whole chapter to this issue, recommending that the UK Government offer financial incentives and penalties to drive NHS adoption of innovation and technology.
Another chapter was devoted to public health, prevention and patient responsibility, with preventable ill-health said to be ‘a major threat’. Besides calling for an urgent restoration of ring-fenced public health budgets (hard hit amid austerity measures in recent years), the report also noted the particular importance of personal responsibility in disease prevention, and the need for increased health literacy and self-care.

Imagining the future

A new report on the future of personalised healthcare driven by technological, scientific and social trends from a group of international experts echoes many of the Lords Select Committee’s conclusions. Personalised healthcare: bringing the future into focus is the product of a UK-based summit that brought together experts in public health, medicine, policy, law and ethics to discuss healthcare 15-20 years from now. The PHG Foundation hosted the summit, held at Ickworth House in Suffolk, which examined the increasing personalisation of healthcare including the policy steps needed to enable the transition from current models to a future based on personalised disease prevention and treatment.

Potential benefits of personalised healthcare

One of the key benefits of personalised healthcare was anticipated to be a more effective and efficient (and hence sustainable) health system, typified by improved disease prevention, better medical interventions against disease, and more responsive patients and sub-populations. For clinicians, the future was thought to offer a realignment of the ‘intuitive personalisation of medical practice’ with evidence-based medicine, improved decision-making and a rational reclassification of disease. Patients were expected to benefit from improved health outcomes, more accurate diagnosis and treatment with fewer unnecessary or harmful interventions, and greater personal autonomy. 
There were also thought to be wider social benefits to look forward to, not least a fall in current levels of health illiteracy and inequalities, and a democratisation of genomics. This will be good news for personal genomics companies like 23andMe, which has recently received FDA approval to resume marketing of selected direct-to-consumer ‘Genetic Health Risk’ medical services. These allow purchasers to receive information on their genetic risk of developing certain health conditions including late-onset Alzheimer’s disease and Parkinson’s disease.

Challenges ahead

Unsurprisingly, the meeting participants also anticipated a range of challenges to be surmounted before the future of truly personalised healthcare could be realised. Despite rapid scientific progress, they noted current gaps in the evidence base for genuinely personalised risk evaluation and treatment – that is, on a genuinely individual basis as opposed to merely stratified into different sub-populations.
There were also major gaps in knowledge and understanding among health and public health professionals and policy makers, thought to pose a significant barrier to implementation of personalised healthcare. There was a suggestion that policy-making would need to integrate expertise from a much broader range of disciplines in order to cope with the challenges. These included issues relating not only to complex science and risk prediction, but also to personal and social attitudes to and responsibility for health. Leadership from multiple sectors (politics, medicine, science and industry) was also considered important.
Ethical concerns raised included issues of genetic risk, social responsibility, individual reproductive choice and discrimination, as well as the problems posed by more vulnerable individuals less able to take personal responsibility for their own health. Questions were raised about how far the increasing availability of genomic information would actually empower or enable citizens to manage their own health, and how sustainable and equitable a more person-centred approach to healthcare might actually be.

Delivering change

In looking to the steps needed to deliver the fundamental changes in healthcare demanded by personalisation, the summit participants found that public health values would be vital, notably an increased role for health systems and individuals in disease prevention and health management – views strongly echoed in the Lords’ report. Whether traditional public health and policy approaches to population health could adapt sufficiently to achieve this in an era of increasing personalisation was less clear.
Another point of clear agreement between the two reports is on the need for strongly radical and visionary leadership to achieve transformational change in health systems; the Ickworth summit emphasised the need for these leaders to work effectively with citizens and patients as well as health professionals to deliver such disruptive innovation.

Take-home messages for policy makers

Participants agreed on four urgent action points for policy-makers to pave the way towards more personalised healthcare. The joint statement Paths to Precison Health: Act Now (released immediately after the summit in late 2016) called for policy action to:
  • Free the data - enable creation of clinical and research health datasets with shared access
  • Engage the citizen – support active collation and contribution of all forms of health data
  • Break down silos – between research, clinical care and population health
  • Actively develop leaders – to influence, inspire and motivate disruptive innovation and citizen engagement in health systems
The UK is very proud of its health system and associated strengths in academic, clinical and commercial research and development, as well as law and regulation. The current NHS sustainability crisis, itself an echo of similar issues with which all health systems in developed countries must currently grapple, could be the crucial tipping point for a choice between essential failure and radical transformation. This is surely a call to deliver the disruptive change needed for an effective, efficient and more personalised approach to disease prevention and care. If the UK doesn’t lead on this, other countries surely will.

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