Medicine of the near future
In advance, on the Internet, just for you
Galina Kostina, "Expert" No. 16-2013
Balzac's heroine was only thirty. In the XX century, ladies of Balzac's age were called almost pensioners. And partly for good reason: in the middle of the XIX century, a lady slightly over thirty, burdened with almost adult children, was considered an elderly woman. At the end of the XVIII century, the average life expectancy in Europe was a little more than 30 years. By the middle of the XX century, it had grown to 46, by the beginning of the XXI century – to 66. Today, the average European lives 80 years, an American – 78, the main centenarians are Japanese (82 years old).
This is gratifying for people, but alarming for governments: due to such an increase in life expectancy, dragging a huge pile of age-related and chronic diseases, health budgets are bursting at the seams. According to the World Bank, EU healthcare spending in 2030 may amount to 14% of GDP (in 2000 it was 8%). In the USA, where expenditures still make up a huge share of GDP – 17%, while maintaining the current status quo, they will grow to 23% at all, which is recognized as almost unbearable for the US budget.
Europe and other countries are starting to reform their healthcare systems in order to respond to the challenges of the new century: the aging of the population, its awareness and demand for medicine, as well as the rise in the cost of treatment. The priorities are preventive medicine, focus on effective medicines for chronic diseases and new regenerative technologies, informatization of medicine.
Age-related diseases and personal medicineAs WHO experts poetically expressed in one of their reports, our volatile and urbanized world is aging rapidly and will continue to age.
The World Health Organization predicts that by 2050 there will be 2 billion people over the age of 60 in the world. 85% of them will live in today's developing countries and mostly in urban areas. All this brings various chronic diseases to the fore.
WHO has identified 13 priority areas where there is a shortage of necessary medicines: cancer, diabetes, Alzheimer's disease, HIV, heart disease, depression, malaria, osteoarthritis, stroke, tuberculosis, liver disease, chronic obstructive pulmonary disease, advanced diseases – for example, Dengue fever, leishmaniasis, etc. Billions of investments of pharmaceutical companies in the world are also looking at these diseases. IMS, a leading analytical institute in the field of healthcare, predicts that in the next few years 42% of expenses will fall on the 20 leading areas of treatment. And here there will be funds with innovative mechanisms of influence and an increased level of efficiency.
AstraZeneca, a top big pharma company, signed an agreement with a little-known company Moderna Therapeutics earlier this year, which was established just two years ago. And this is due to the fact that its development is not even at the cutting edge of science, but, according to the head of information support for AstraZeneca R&D in Russia and Eastern Europe, Vitaly Prutsky, "at the tip of this tip": "The fact that AstraZeneca immediately invested $ 240 million in the development of this company speaks volumes. The agreement is about 40 new molecules that can be used in various fields of medicine, including oncology, neurology, the treatment of immunological and cardiovascular diseases." Moderna Therapeutics has developed unique synthetic informational RNAs that can be placed in a cell, where they will produce the necessary proteins – insulin, interferons, enzymes to reduce pressure, the necessary proteins for Alzheimer's disease, and so on. The revolutionary thing, according to Vitaly Prutsky, is that, unlike natural RNAs, these molecules will be stable, and unlike drugs of similar function obtained by recombinant means, they are not immunogenic and are designed so that they will be directed only to the right cells.
Well-known companies such as Phfizer, Novartis, GlaxoSmithKline, Merck & Co., Sanofi, Roche, AstraZeneca are developing a lot of really innovative drugs that can close gaps in the treatment of certain diseases. In particular, Roche is in the late stages of development of the first in its class drug for the treatment of schizophrenia – "Bitopertin". Only in the last decade, science has found out the mechanism of the so–called negative symptoms in schizophrenics - withdrawal into oneself, unwillingness to be in society. And it is this target that the new drug is aimed at. The community of doctors is looking forward to the appearance of "Bitopertin" with impatience. Schizophrenia is an important social problem. Young people under the age of 25 get sick with it, they become disabled, many of them turn into homeless people. Mental illness in general is one of the problematic areas in medicine. In the world, according to WHO, about 450 million people suffer from mental disorders. According to statistics alone, there are 600 thousand schizophrenics in Russia, and according to expert data – about 2 million.
Chronic diseases in connection with new scientific discoveries began to be divided into sub-diseases. It is known that traditional therapy for some diseases can be effective only in 20-50% of cases. It became clear that many diseases are very variable, so they cannot be treated with one drug. Personalized medicine has become an important trend in the development of funds. All the same giants have joined the development of highly specialized funds – Pfizer, GlaxoSmithKline, Astra Zeneca, Johnson & Johnson, Abbot, Eli Lilly & Co., Bristol-Myers Squibb and others. The leading positions in this area are occupied by Roche and Novartis.
In particular, Novartis last year acquired production facilities together with technological equipment from Dendreon, known for its personalized Provenge anti-cancer vaccine. As stated in Novartis, they will support and develop new personalized therapy products. One of these candidates is currently being investigated jointly with the University of Pennsylvania.
At the beginning of the year, Roche registered its new unique drug Kadsila in the USA against HER-2-positive breast cancer. If before that the most successful in this area was Herceptin (Roche's first personal swallow), which was used in combination with chemotherapeutic agents, then the new drug combined the functions of both. According to clinicians, it showed very good effectiveness.
According to PricewaterhouseCoopers, the volume of the market of medicines for personalized medicine in the United States from 2010 to 2015 should almost double and reach $ 425 billion. In the coming years, these drugs will make up almost a third of all drugs sold. Innovative medicines are still not cheap. Investments in their development will start from a billion dollars. In addition, personalized medicine products are designed for relatively small groups of patients. This cannot but worry both the sick and the government. However, experts estimate that as a result of the use of new technologies, indirect benefits will be significant – primarily due to the ability of patients to work. Economists from the University of Zurich calculated that the treatment of breast cancer with Herceptin led to an increase in the life span of women, each able-bodied year of which was estimated at about 12 thousand euros.
Everything will be in electronic formNow a nurse and a doctor visiting an old woman in the northern part of Lancashire county will be equipped with tablet computers, according to the website of the Blackpool Medical Network, part of the UK National Health Service.
Employees of the network working with electronic media in the workplace complained that when visiting patients at home, they have to make notes by hand, and then stuff them into a computer. The smartphones issued for testing did not suit the doctors with their small size. Then the management of the network decided to provide its employees with tablets. The British have calculated that by doing this they will save a whole hour of working time every day and the purchase of tablets will pay off within a year.
Before that, a system of electronic cards was introduced in Blackpool, which are already used in many European and American clinics and medical offices. This is really very convenient – all the information about the patient converges in one place, even if he turned to specialists in other clinics and diagnostic centers. The attending physician always knows when his ward has passed certain tests, measured blood pressure, and X-rayed. He does not have to sort out the clumsy handwriting of a colleague to understand what is written. The map collects all the electronic information obtained during the examination using various tomographs and other equipment, and it can be viewed if the patient, for example, got to a clinic in another city. The patient can even enter information about his well-being into the card himself.
According to the US Department of Health, almost 80% of doctors from about 4 thousand clinics in the country use electronic medical records. I must say that this is greatly facilitated by the monetary compensation that medical institutions receive from the government.
AT&T has identified the main trends of information technology in medicine in the near future. According to analysts, individual medical applications will increasingly merge into integrated solutions, the scope of remote monitoring of the health status of patients with chronic diseases will expand, the telemedicine sector will grow. With the help of telemedicine, the patient can communicate with the attending physician or with other specialists remotely. On his mobile phone, he can receive both recommendations from doctors and reminders about taking medications or visiting a clinic.
German economists have calculated that the transition to information medicine saves 35 billion euros a year
At a recent international conference, Eric Topol, a professor at the Scripps Research Institute, said that in the current century everything has appeared for the digital revolution in medicine. As examples, he demonstrated a pulse oximeter on his finger that connects to an iPhone, as well as a smartphone case that takes a cardiogram when it is attached to the body. In addition, Mr. Topol spoke about Apple's intention to equip some iPhones with glucose meters to measure blood sugar. And all this information should flow into one place – an electronic card.
Manufacturers of medical equipment, in particular Philips, Siemens, General Electric, Fujifilm and others, have already created many devices – monitors, scanners, various sensors – that can be used both in clinics and at home. A lot of small innovative companies are now involved in this area, which offer such solutions so that information about the health status of patients is read and transmitted seamlessly into a single database. A lot of partnerships are being created between developers of devices, medicines and communicators. In particular, Sanofi, one of the leaders in the production of a wide range of anti–diabetes products, together with AgaMatrix, launched the first blood glucose meter that integrates with iPhone and iPad. By order of Sanofi, an iPhone application called Go Meals was also made, which allows the patient to get advice on food intake, daily menu, calorie counting, etc.
In the USA, after 2009, when the law on IT in healthcare for economic and clinical recovery was adopted, up to $ 40 billion is spent for these purposes. By next year, it is planned to create a unified medical information network that will collect all information about patients from different sources and make it accessible to both doctors and patients themselves, for which a lot of money is spent on the security of this network.
The European Commission last year published the "Action Plan for Health Informatization for 2012-2020". One of the main ideas of the plan is the transition to patient–oriented healthcare, which consists in greater accessibility of information for the patient, his involvement in the processes of treatment and prevention, in the ability to learn and use modern technologies in the treatment, including chronic diseases.
Despite the fact that the informatization of medicine is fraught with additional costs, experts believe that in the future it will help to significantly save money. For example, a pilot project was implemented in Australia, which showed that the savings from the introduction of a unified information system for registering clinical data of patients amounted to 300 million Australian dollars per year, mainly due to reducing the number of errors and duplication of actions of medical personnel. Experts believe that due to the integration of information technologies into medicine, it will also be possible to significantly reduce the "beds" by establishing a closer and permanent connection with the patient at home. And German analysts estimate that the transition to an information patient-oriented healthcare system will save about 35 billion euros per year. Only the replacement of paper recipes with electronic ones can save more than 180 million euros per year.
However, no matter how much they save on treatment, prevention, which governments are also betting on now, can become the main factor in restraining costs.
It is easier to prevent than to cureMonotonously humming and clicking, the state-of-the-art magnetic resonance tomograph seems to cut the body lengthwise and across into thin slides, which will then be recorded on two discs.
Another portion of the "slicing" will be done on a CT scanner, it is especially good to look at the heart. The movie is unforgettable – everything inside is visible: brain curls, some holes in the spine, vascular bushes. It's not very clear, but an experienced doctor comments on what this huge mass of images shows. The most encouraging conclusion for a concerned woman who is undergoing a diagnostic examination at the LifeCheck Center is that there are no tumors from the crown to the heels. Further along the systems: the heart, other internal organs, blood vessels, brains, etc. The photo album "about everything inside" will be supported by an extensive blood test. Such diagnostic centers, which have become widespread in recent years in the USA, Europe and other countries, are called check-ups. Such a checkup was opened in Moscow in the luxurious Ritz-Carlton by Dr. Michael McNamara, after his similar center in Monaco, in addition to the Prince of Monaco and Hollywood stars, began to receive up to 80% of Russian visitors.
An active promoter of a healthy lifestyle and preventive medicine, Michael is able to convince. A young man of about thirty-five, with no obvious signs of ill health, is interested in why he should pay five thousand dollars for diagnostics, is it not better to relax for a couple of weeks in Monaco. "So, when you're sitting in a casino or a bar, sipping whiskey," says Michael, "estimate how long you have to live, based on the average life expectancy of a Russian. A little over twenty years. If, as a result of preventive diagnostics, you are aware of possible risks and make some efforts, you can add another thirty or fifty years."
The possibilities of modern diagnostics are not only imaging methods, they can significantly expand new directions – genetic testing and protein testing. The US National Institutes of Health has set a task in the coming years to reduce the cost of genome sequencing to $ 1,000, which will allow issuing a genetic passport to every newborn. Already, genetic tests allow you to see mutations that indicate either the presence of a genetic disease, or the risks of developing many diseases, for example, heart attack, stroke, coronary heart disease. This knowledge allows a person to build his life in such a way that he can delay the development of the disease for a long time, or even avoid it. And although so far the interpretation of the complete genome sequence does not give much, the rapid development of science constantly throws up new information to practitioners. Modern diagnostic complexes in some countries can no longer imagine themselves without an appropriate laboratory.
"The discoveries of recent years have made it possible to anticipate diseases by the state of autoantibodies," says Noel Rose, a well–known scientist in this field, professor at Johns Hopkins University in Baltimore. – Now many laboratories, including in Russia, are engaged in these studies so that fundamental knowledge can take its rightful place in the clinic. Known for his research on autoantibodies, Professor Alexander Poletaev from the Institute of Normal Physiology of the Russian Academy of Medical Sciences and the Immunculus Research Center has developed more than 50 tests that are already used in many clinics and diagnostic centers. He is convinced that such tests can warn of an impending illness long before, when preliminary measures can be taken. Poletaev is the author of the idea of creating a professional community of "Preventive Medicine" practitioners in Russia, he is convinced that Russia does not necessarily have to trail in the tail of the global trend of healthcare reform from repair medicine to prevention medicine.
Experts do not cease to convince that preventive measures can significantly save health care costs. Nevertheless, until now, the lion's share of state funds has been spent on the creation of drugs and on treatment. In particular, one of the WHO reports cited the following ratio: the US government spent 97% of the budget allocated for oncological diseases on the development of anti–cancer drugs, and only 3% on preventive measures.
Preventive medicine is becoming one of the health trends of the current century. In Europe, they plan to adopt a law on health reform next year. It is assumed that healthy lifestyle programs, construction of sports facilities, diagnostics of risk groups, prevention of the most common diseases – cardiovascular, diabetes, respiratory tract - will be funded. Experts estimate that as a result of preventive measures, the damage to the European economy from cardiovascular diseases by 2030 may be halved compared to the current one (in 2008 it was estimated at 192 billion euros).
Many countries plan to pay more attention to promoting a healthy lifestyle. Informing the population, for example, about the harm of certain habits in some countries is accompanied by an increase in taxes on alcohol and tobacco products; some of these funds replenish the health budget. The unprecedented anti-smoking campaign in the United States has shown how effective such measures can be. If in the 1990s more than 25% of the population smoked in the USA, now it is about 18%. The same massive propaganda attack is being conducted in the United States against obesity. Until recently, almost $150 billion was spent every year in the country on the treatment of diseases associated with overweight. Europe is going to fight this problem, including with the help of a tax on foods that contribute to obesity and diabetes, in particular those containing large amounts of sugar.
Portal "Eternal youth" http://vechnayamolodost.ru22.04.2013