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21st century Technologies

A possible solution to 21st century challenges in healthcare

Dr Dimitri Stamatiadis, CEO MAIA ConsultingDr Vangelis Karkaletsis, Research Director at NCSR Demokritos

Every day, medicine performs new miracles

A visit to Vienna

The Hapsburg crypt contains 145 members of the family including 12 emperors and 18 empresses from 1633 until today

Moulded sculls decorate many sarcophages

Health and healthcare in the 20th century. Steady progress but…

Courtesy: Wikimedia Commons

Source: Eurostat

Gain in life expectancy

28%

Best results have highest cost

21st century is not as we thought it would be

Economy is under high stress

And spending is expected to increase further

Health cost breakdown

Conway, P., Goodrich, K., Machlin, S., Sasse, B. and Cohen, J. , Patient-Centered Care Categorization of U.S. Health Care Expenditures. Health Services Research, no. doi: 10.1111/j.1475-6773.2010.01212.x

Hospitals34,6%

Doctors10,3%

Drugs19,3%

Clinics10,9%

Source : EcoSanté, d’après les comptes nationaux de la santé, Drees 2010

Can we still preserve what was achieved ?

The social state, which has seen steady progress for nearly 100 years is on the verge of collapse and can not be sustained in absence of economic growth

Therefore equal treatment of patients is threatened

In parallel, conditions that were not considered as diseases in the past (e.g. allergies, mild depression, ADS, stress, heartburn) are now viewed as unbearable and consume healthcare resources

Finally, within the boundaries of the EU there is a growing need for mobility and for optimization of the infrastructure use which is made difficult by language, cultural and technical barriers (e.g. different medical practices, prescription habits, currency, drug nomenclature etc.)

The philosophy professor

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Part 2

« Technology solves known problems and creates unknown ones »Unknown author

Can technology help?

MIT Technology Review

Which technologies are useful in such context?

Those that lower the cost of development for new drugs

Those allowing better use of information

Those allowing more efficient use of existing infrastructure (hospitals, specialized centers etc) and lower the cost of health care

Those allowing elderly people and people with special needs to be more autonomous

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DrugsWhy are they expensive?

The highest cost is in research and development

All cost of R&D inclusive, each new drug costs between 4 and 11 billion dollars

(Matthew Herper, Forbes Staff, Pharma & Healthcare 2/10/2012)

Of which, 54% is spent in the final stages of development

Drug development cost breakdownR&D cost breakdown

Computing power: The nuclear bomb lesson

Clinical trials simulation

FDA scientists use, and are collaborating with others in the refinement of, quantitative clinical trial modeling using simulation software to improve trial design and to predict outcomes…..basis for systematizing information linked to outcome

Internet: Virtual clinical trials

Pfizer launches virtual clinical trial

BMJ 2011;342:d3722

The giant drug company Pfizer is conducting a “virtual” clinical trial that relies solely on electronic rather than face to face encounters between researchers and participants.

Freda Lewis-Hall, Pfizer’s chief medical officer, said that the company is trying to reduce barriers to participation in clinical trials; to offer a consistently strong experience that does not vary by location; and potentially to save money in conducting trials in the future, if the concept proves viable.

Social media in clinical research

Dr. Katz, director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research, said that using social media for real time adverse event reporting, patients supporting each other and helping with trial adherence were all positives.

Dr. Katz didn’t feel that designing a clinical trial via crowd sourcing would be a regulatory issue and mentioned the example of “Transparency Life Sciences” multiple sclerosis trial. He explained that using social media for recruitment was fine, but that the real issue relates to large numbers of patients interacting during a trial.

Patient Recruitment via Social Media: Lessons Learnedhttp://blog.pharmexec.com/2012/02/13/patient-recruitment-via-social-media-lessons-learned/

Published: February 13, 2012 By Marylyn Donahue.

All-told the Mayo Clinic’s recent pilot study on clinical trial patient recruitment using social media and online networks not only helped researchers assemble large and demographically diverse patient groups more quickly, but also less expensively than they could through other means.

“This study is a prime example of patient-initiated research that could be used by other health care professionals and institutions,” conclude the authors of the Mayo report.

Internet, social media and chronic diseases

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Big Data« The number of possible combinations in

each human birth is by far greater than the total number of atoms in the universe »

Jean-Louis Serre, professor of genetics at the university of Versailles-Saint Quentin

Moore’s law and how biology surpassed

electronics

"Computers in the future may weigh no more than 1.5 tons.”Popular Mechanics, forecasting the relentless march of science, 1949

Big Data: from personal data to personalized medicine

The creation of personalized data banks can help better diagnosis and better use of drugs

It can also allow faster and cheaper development of new medication

However, confidential patient data must be stored according to strict rules and with the patient’s explicit consent

Welcome to GATTACA

Personal medical and genetic data: For or against?

Preventive diagnosis and adapted healthcare: an information delema

Enormous possibilities to maximize resources but also a threat to individual freedom

Source: Kettunen J, Wurtz P, Fischer K, et al. Biomarker Profiling by Nuclear Magnetic Resonance Spectroscopy for the Prediction of All-Cause Mortality: An Observational Study of 17,345 Persons. PLoS One. 2014.

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Standards

Optimizing the use of infrastructure

Information exchange: The difficult « easy solution »

“The nice thing about standards is that you have so many to choose from.”

Andrew S. Tanenbaum, Computer Networks, 2nd ed., p. 254

Crisis, Europe and opportunity更改是机会 *

«People only accept change in necessity and see necessity only in crisis, this is why Europe will be forged in crises, and will be the sum of the solutions adopted for those crises»

Jean Monnet, one of the founders of the European Union

*change is chance (chinese quote)

EU member states make a significant step in eHealth cooperation by publishing guidance

for information exchange

Speaking at the eHealth Network meeting, Paola Testori Coggi, Director General for DG Health & Consumers, European Commission, said:

"The adoption of these guidelines is a landmark agreement on EU cooperation on eHealth. This is where we really begin to see a concrete outcome on collaboration in eHealth for the benefit of patients, after years of discussion."

eHealth: healthcare in the European Union

...Hope was still in Pandora’s box...

Research report: Old age mortality and macroeconomic cyclesHerbert J A Rolden, David van Bodegom, Wilbert B van den Hout and Rudi G J Westendorp,J Epidemiol Community Health doi:10.1136/jech-2013-202544

Conclusions: In developed countries, mortality rates increase during upward cycles in the economy, and decrease during downward cycles. This effect is similar for the older and middle-aged population. Traditional explanations as work-stress and traffic accidents cannot explain our findings. Lower levels of social support and informal care by the working population during good economic times can play an important role, but this remains to be formally investigated.

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Questions?

21st century TechnologiesA possible solution to 21st century challenges in healthcare

Dr Dimitri Stamatiadis, CEO MAIA ConsultingDr Vangelis Karkaletsis, Research Director at NCSR Demokritos