Four ‘tensions’ for personalised medicine to ease

| September 4, 2015 | 0 Comments

long-termBy European Alliance for Personalised Medicine Executive Director Denis Horgan

In the world of health care, personalised medicine is gaining ground at a grass-roots level among health-care providers and, indeed, among patients too. But there are still plenty of barriers, or ‘tensions’. Many common, chronic diseases are progressive in nature, some of whose progression can be slowed or stopped by appropriate care before they go too far to be effectively treated. Obviously, a progressive disease does the patient no good whatsoever, and such a state of affairs is also   expensive down the line, as more intensive treatment will be necessary.  

It’s true that effective preventive care also costs money, but this sum often adds up to much less than allowing the disease to progress.  Healthcare professionals (HCPs) are normally paid to undertake specific services. This gives them an incentive to perform more services for which they will be reimbursed by health services or the patient’s private health plans. There is less of an incentive to perform the right service, however.  The Brussels-based European Alliance for Personalised Medicine (EAPM) works on the ethos of giving the right treatment to the right patient at the right time. It believes that there should be incentives for HCPs to do the job appropriately as Europe should be paying to keep patients healthy instead of paying for treatments that do not necessarily achieve this.  In Europe today, there are often circumstances in which some patients receive better care than others.

This could be down to which member state they live in or even in which region of a member state they have their home. Here are some of the ‘tensions’:

Guideline fatigue 

Of course there are Europe-wide guidelines which, individually, may be excellent. But the huge amount of such guidelines can create its own problems and in an ideal world it should be the case that HCPs compare the benefit of the guideline against the potential harm adopting it may be doing. This because implementing the guideline could move HCPs away from potentially more important jobs. It turns out that the best HCPs are not necessarily those who doggedly follow each one, but are more likely to be those who prioritise their time, with a view to working on a patient-by-patient individualized basis. Training in up-to-date methods is vital.

Patient power 

Modern-day patients want empowerment, and to have their illnesses and the treatment options explained   in a transparent, understandable yet non-patronizing manner to allow them to become involved in shared decision-making.  They want to own – and have unreserved access to – their own medical data as well as greater access to clinical trials and cross-border treatments that could improve their lives and, in some cases, save them.

Current thinking suggests that as more patients demand data, it will start to flow more and more, and one would expect that any individual clinic offering better access for the patient’ to his or her own data will attract more ‘business’ with patients preferring to be treated there. EAPM believes that this information   flow should also involve access to any raw DNA sequencing. Unfortunately, that is not yet the case in the EU.

End-of-life care 

There is a growing perception today in Europe that patients often receive more care than they actually want. A step-up in doctor-patient dialogue should lead to end-of-life care that is much more matched to what the patient actually wants.  But this doesn’t mean giving less care than is needed, especially for financial reasons. Although it is true that more money is spent at the end of a person’s life, patients shouldn’t be bundled into a hospice instead of being given what may often be intensive and aggressive treatments. Less care for the ill in the end-of-life scenario would have a pretty positive effect cash-wise, but it should be the patient’s choice and not that of a provider trying to save money. An over-arching requirement is that patients must be able to trust their doctor to be focused totally on agreeing the best treatment through joint decision-making.

Policy engagement 

Overall, what is required to further the goals of personalised medicine is a great deal more policy engagement, which ultimately means getting politicians and civil servants to understand the value and  societal benefits of personalised medicine in an EU of 28 Member States and an ageing population of 500 million. On top of this, there should be a multi-stakeholder mentality and increased collaboration, not only between those in the same discipline but also between disciplines. With all of the above in place, the goal of a healthier and, thus, wealthier Europe will be easier to reach. And that will only be good news for the EU’s patients and potential patients now and well into the future.

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Category: A Frontpage, EU, European Alliance for Personalised Medicine, Health, Personalised medicine

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