How do you prevent the problem of prevention?

An ounce of prevention may be worth a pound of cure. But try telling that to a cash-strapped state health administrator.

Boris Dimitrov, CEO of Checkpoint Cardio, a small health services company based in Sofia, has developed a new device to detect heart problems early. It uses an electronic monitor, worn like a necklace for five to six days, that automatically monitors a patient’s vital signs and transmits the data back to a medical centre for review. The reasoning: a patient may be suspected of having heart problems, but they won’t necessarily show up in a brief exam at the doctor’s office. “Adverse pathologies do not pick the time and place to show themselves,” Dimitrov says.

The result in one clinic in Sofia was that of 4,286 patients who wore the device, 78 per cent were found to have previously undetected heart problems. Of these, 34 per cent subsequently received treatment in hospital. The technology itself may not be wildly new, but the branding is: “The Internet of Care,” Dimitrov calls it. “It’s a way to save a lot of lives,” he says.

Yet the cash-strapped Bulgarian health system won’t pay for it. So it’s a private service, paid for by patients, at €10 a day. Doctors like it, Dimitrov says, but the Bulgarian health system “is very conservative.”

Undaunted, he is working on a fancier system using artificial intelligence to analyse vital signs data and is expanding his contacts and market opportunities beyond Bulgaria, with support from the European Institute of Innovation and Technology.

His story, related in Toulouse on 11 July at the Euroscience Open Forum conference, is typical of the difficulties in getting over-stretched, under-funded health systems to pay attention to early detection and prevention of disease. The tools to do so are already available, with technical standards developed for data gathering on half of all common diseases, software to analyse it, and the medical skills to act on it. But the obstacles are high. “Healthcare systems are very conservative,” agrees Pierre Meulien, head of the EU’s large health research programme, the Innovative Medicines Initiative. “They don’t want to change anything.”

The obstacles to change

Finance is one obvious problem. It costs money upfront to deploy monitors like Dimitrov’s, at a time when more acute, previously diagnosed problems are of necessity first in line for funding. And with healthcare already costing the EU an average 10 per cent of gross domestic product, the financial problems are only going to get worse as the population ages, and chronic disease and complex multiple ailments become more common.  “If we don’t do things better or differently, there is going to be a (budgetary) tsunami,” said Herb Riband, vice president of International Policy and Government Affairs at Amgen, told delegates.

Resistance to change in the medical profession is another problem, and so too, is resistance from patients themselves. For new prevention methods to work, researchers need data from lots of patients to identify warning signs of disease, said Philippe Ravaud, professor of epidemiology at Paris Descartes University. But people are increasingly wary of authorising use of their data, even though the benefit to society could be great. It’s a classic case of where, “the risk is mainly individual and the benefit is collective,” Ravaud said, arguing that for all us, as citizens, “data sharing is a moral obligation”.

Fixing the problem requires action from many parties, the panellists said. To encourage data sharing, the medical profession has to get better at explaining who sees patient data, and with what restrictions. Advocates for change have to show good examples of prevention programmes that have worked in one country and could be easily applied in another. And healthcare insurers must shift from paying for individual medical processes, to paying for whatever treatments provide the best outcomes.

That, said Riband, would help make healthcare systems financially sustainable. “If we don’t have healthcare prevention, we won’t have any money left [for anything else],” he said.

Discussion of the prevention problem was organised by the ScienceǀBusiness Healthy Measures project, a public-private initiative to improve health services through better use of patient data and the outcomes of their treatments.