Personalised Healthcare

Nuala Moran, Senior Editor, Science|Business

Indeed, the move to personalised healthcare is not only about technology, it is also an outflow of a longer-term value shift in which people no longer accept being treated (patronised) as weak patients, but have the means and the desire to be more in control.

“Or as we say, they want to be treated as health consumers,” said Johan Hjertqvist, President, Health Consumer Powerhouse, speaking at the Science|Business conference, ‘Health for all, Care for you’ on Personalised Healthcare, held at the Royal College of Physicians in London last month.

In a panel session on how the wealth of personalised healthcare products that are starting to pour out of industry gets to patients, Hjertqvist said viewing patients as consumers sets the whole agenda for delivering personalised healthcare in a different way.

For a start, there is a value shift in which patients say it is acceptable not to comply with prescribed treatment, without consulting their doctor. “We are no longer in the position where the doctor is god,” said Hjertqvist.

Surfing this value shift is one of the key requirements to make personalised medicine fly.

Second, it follows that patients must be given access to their medical records, and to information comparing what outcomes can be expected from different treatments.

Third, Hjertqvist said, changes to accommodate personalised medicine have to be incorporated into the wider system of healthcare. This means, for example, that reimbursement rules must change to allow higher pricing for personalised medicine services.

In addition, medics need to be trained in a different way. Without this, personalised medicine will not have a chance to penetrate Europe’s healthcare systems.

Some of the complexities in moving to personalised medicine as summed up in contemplating abandoning the current blockbuster paradigm of one size fits all, in favour of recognising that diabetes represents about 70 different diseases. “You have to move from a model that reduces the cost of care and the level of skill people need to deliver it, to a system that is more complicated and needs more expertise,” said Sudhesh Kumar, Professor of Medicine and Associate Dean, University of Warwick.

To justify such a shift, it will be necessary to produce the right evidence. “It’s not enough to produce the technology, the diagnostic, or the drug. You’ve got to show it has value. This means showing a benefit to the healthcare economy, for example, by cutting the number of adverse reactions,” Kumar said.

For patients, there are compelling arguments in favour of personalised healthcare, which should be deployed in moves to advances its adoption, believes Anup Patel, Consultant Urological Surgeon, at St Mary’s Hospital at Imperial College National Health Service Trust. At present, patients are victims. “You lose control over yourself; you conform to the healthcare system,” Patel said, adding this is the issue he would like to see addressed in a move towards personalised healthcare.

One obvious way to do this is through better information. The barrier here is that medics fear the loss of control they believe will come with empowered patients. This leads the empowered patient to be characterised as having the information, but not having the expertise or objectivity to digest it.

However, as Hjertqvist noted, information is freely available in other regulated sectors, such as financial services and the mobile phone industry. “You should trust both sides: patients aren’t stupid; they can evaluate information,” he said.

Indeed, such information and education should be a cornerstone of how health services go about deploying personalised healthcare, suggested Kumar. “In the complex common diseases there are not enough experts to go round, so people have got to be educated to look after themselves. If consumers can be educated about [topics such as] the digital switchover, why not about health?”

Patel agreed, noting that such information should also be at the heart of prevention, which needs to go beyond generalised messages about diet, exercise, alcohol consumption, smoking and so on, to actually give people practical tools with which they can monitor their own health.

That’s healthcare at its most personal.