#EAPM: Access for patients to best treatments is an issue both sides of the Atlantic

Things are hotting up over in the United States as the November presidential elections draw ever-closer. The race to succeed current White House incumbent Barack Obama is gathering pace, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan.

And health is bound to be a big and divisive issue between the Democrat candidate Hillary Clinton and her rival, the Republican Donald Trump.  So-called Obamacare, otherwise known as the Affordable Care Act (ACA), had already split the nation and it is no secret that Trump (and the entire Grand Old Party) is in favour of scrapping it to be replaced by private plans.  Former Secretary of State Clinton, on the other hand, has said she wants to expand Obama’s ACA.

Among other things, the Democrat has put forward the idea of price-capping out-of-pocket drugs costs. Among her arguments is that it would be ridiculous to replace ACA now when marginally more than one-tenth of US citizens remain without coverage.

By the time the new president enters the Oval Office of the White House, ‘The Donald’s’ plans to see ACA consigned to the dustbin of history will prove difficult, regardless of whether or not the Republicans have a majority in both Congress houses post-polling day.

Surprisingly, perhaps, healthcare policy was largely ignored as a topic for discussion during the Democratic National Convention. The suspicion is that nobody seemed to want to raise the spectres of costs, regulations, and more that would be required in expanding insurance coverage under Obamacare, while making treatments more affordable for patients.

Clinton undoubtedly has ambitious healthcare proposals. But the big question, even if she wins with a majority in both Houses, is where will the cash come from? That’s the $64,000 question - and a lot more besides.  Meanwhile, across the Atlantic in Europe the problems of creating sustainable and equitable healthcare are never far away either. In this new and exciting era of personalised medicine (as attested to by another Obama initiative, the Precision Medicine Initiative) the key pairing of sustainability and equitable access affects all of the European Union’s 500 million potential patients.

Even taking into account an eventual Brexit, that’s still around 440 million, not including any candidate countries that will eventually join the EU family.  So, in Europe, what do those health inequalities consist of?  It is clear that individual and community health is influenced by several factors: work, wealth (or lack thereof), background, lifestyle, country of origin and more.

All of the above are central to the patient and, believes EAPM, the patient is central to his or her own treatment.  EAPM is a multi-stakeholder organization that brings together a range of stakeholders including patients, healthcare professionals, researchers, academics and policymakers among others and one of its key tenets is ensuring the right treatment for the right patient at the right time.

The Alliance notes that a particularly apposite publication, known as ‘The Marmot Review’ (named after its author Professor Sir Michael Marmot and published six years ago) has had considerable influence in the debate on health inequalities policy.   One chart in the review illustrated how life expectancy and more are, for example, related to differences in income. In truth, differences in income will never go away, of course.

Marmot’s work also showed that other factors are always important in explaining life expectancy differences between areas (and, by extension, one would conclude countries). These include employment versus unemployment, deprivation among older people and, perhaps surprisingly these days, gender.

Lifestyle clearly has a part to play - smoking, binge drinking, eating the wrong foods etc - but perhaps key among all of the reasons for a lower life expectancy is the issue of access to new drugs and treatments.  As mentioned, personalised medicine starts with the patient, and has enormous potential for improving the health of many patients and ensuring better outcomes.

But EAPM and other stakeholder groups are well aware that its integration into clinical practice and daily care is proving difficult given the many barriers and challenges to timely access to targeted healthcare that still exist today.  One of EAPM’s Working Groups is currently building on the Council Conclusions on Personalised Medicine produced by the Luxembourg Presidency of the EU at the end of 2015. These conclusions focused primarily on access issues.  Clearly, these are testing fiscal times on both sides of the Atlantic.

People are living longer and will, in most cases, be treated for not just one but several ailments – ‘co-morbidity’ – during their lifetime.  Meanwhile, there are many issues around pricing, reimbursement and incentives, while frameworks need to be put in place that can support research as well as the general needs of the research communities.  It is also necessary that patients’ grass-roots health literacy is stimulated at national levels and the pan-national level.

On top of this, an EAPM survey flagged up the clear fact that lack of training and knowledge in modern-day methods among health-care workers is one of the biggest barriers facing the full integration of personalised medicine today - and thereby access to it for all patients that need it.

There are many issues to be solved but what is key is that all stakeholders, on both sides of the Atlantic and including politicians, whether in the White House, Berlaymont, European Parliament and/or member state administrations, recognize and continue to recognize the benefits of good health when it comes to their populations and, as a result, the well-being of their economies.

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