#EAPM: Information for the nation - health-care gaps need to be filled

Much has been said about potential over-diagnosis and over-treatment as a result of screening programmes and fast-improving diagnostic tools, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan. 

But not enough is written and said about the necessary information exchanges that need to occur to open up the fast-moving world of potentially life-changing (and life-saving) personalised medicine.

Regarding over-treatment, yes, there are arguments on both sides of the fence but it is clear that prevention is better than cure and also clear that investment is required in diagnostic approaches, such as the use of IVDs and more screening.  The discussion has taken place for some time and shows no sign of abating any time soon, with many arguing that over-testing can lead to over-treatment, including unnecessary invasive surgery.

The over-treatment argument has been used, for example, in respect of breast cancer screening, despite the fact that figures tend to show that it works very well in a preventative sense and even better in detecting early breast cancer in target age groups.  PSA testing for prostate cancer has also come in for similar criticism. Yet screening is one of the most potent preventative tools available to us today.

But, as stated above, often under-rated is the fact that information is also vital as a robust preventative measure and, fortunately, treatment and medicine is moving from health professional-led decision making to evidence-based shared decision making.  However, up-to-the minute education is desperately needed for health-care professionals who are facing a brave new world in which personalised medicine is a game changer.

EAPM has always advocated not only better trying for healthcare professionals (HCPs) but also more knowledge being made available to patients (to truly allow them to participate in decision making about their own healthcare) and policy- and law-makers, who need to understand the issues and opportunities much more solidly and in-depth than they currently do.

A recent UK government-funded study has revealed the fact that British general practitioners are helping to make antimicrobial resistance grow among their populations by unnecessarily prescribing antibiotics to 20% of patients with a sore throat or a cough.

This astonishing over-reaction by GPs is described in the published research as “substantial inappropriate antibiotic prescribing”.  A panel of medical experts undertaking the research revealed that HCPs in England (home to the UK’s largest population) are prescribing 32.5m each year with “at least” one-fifth being unnecessary. That’s a staggering 6.3 million.

Overall, the growing ineffectiveness of certain antibiotics leads to some 25,000 annual deaths across Europe.  Meanwhile, the UK GPs are giving out far too many antibiotics for conditions for which they are not justified. How can this be the case in the 21st century?  Well, the chair of the Royal College of GPs, Professor Helen Stokes-Lampard, blamed a heavy workload and a family doctor shortage in part, but added: “We are still coming under considerable pressure from some patients who need to understand that antibiotics are not a ‘catch all’ for every illness.”

Interesting that the patients take the blame here…  It is clear that not only patients, but doctors specifically, need to have better information available in order to avoid the temptation to prescribe a one-size-fits-all solution and therefore help thwart the creation of antibiotic-resistant superbugs as well as. Citing ‘patient pressure’ is just not going to wash and merely adds to the ‘over-treatment’ argument.

Meanwhile, a further study - again in the UK - has shown that the incidence of adults and older teenagers with diabetes has more than doubled during the last two decades with 3.7 million patients from 17-years upwards now suffering from the disease  The charity Diabetes UK argues that the number of diagnoses has risen drastically since the end of the 1980s, and that diagnoses of both of the two main forms of diabetes, type 1 and type 2, have increased, with the increase greater for type 2.

It is thought that the figures could actually be even higher than the data used.  An increase in obesity levels has contributed greatly while, some have argued, the rise in diagnoses is largely down to people living longer.

University of Glasgow Metabolic Medicine Professor Naveed Sattar said: “The good aspect is as life expectancy goes up, more people are able to develop diabetes in later life, when it is less of a concern, and equally we are keeping people alive with diabetes for longer due to better care.”

But he stressed that a particularly “bad aspect” of the data is that it shows that more people under the age of 40 are developing diabetes due to rising obesity levels. “It is here we need to be really concerned,” Sattar added.

Clearly lifestyle choices are key to certain aspects here and, once again, we are back to education through information.  But there’s another aspect: Crucially, when it comes to the incidences of diabetes, there are large variations in occurrence geographically. This dovetails with another revelation this month that strongly suggests that the spectre of the postcode lottery in healthcare has reared its ugly head yet again.  New figures, again from England, show that cancer patients are up to 20% more likely to survive based on where they live.

The shock figures show, for example, that just 58.1% of women diagnosed with cervical cancer in the north of the country survive five years. This stands in contrast to the fact that 75% of those in London will still be alive five years after diagnosis.  The figures show diagnoses made between 2011-2015 for 14 types of cancer, gathered by the Office for National Statistics.

Geographically, the data showed huge differences in the survival rates of cancers such as prostate, uterus and cervical, with an 8.4% gap between the best and worst performing areas in the deadliest cancer of all, lung.

Meanwhile, breast cancer five-year-survival ranged between a low of  82.7% and a high of 90.3%.  Various arguments have been put forward in medical, research, academic and stakeholder circles about whether the causes are an inequitable spread of resources, the unwillingness of certain potential patients to actually get checked, lack of information (in patients and their HCPs) and more, all of which can be scaled-up from a UK perspective to a broader EU one.

On top of this, elements used now in personalised medicine come into play in the form of genetic disposition in certain sectors of populations, as well as the richer/poorer divide in individual countries and even regions of countries.  All that is certain is that knowledge needs to be improved in modern-day healthcare and access for the patient needs to be equitable, and not dependent upon postcode and a lack of apposite information.

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