#EAPM - Is Europe over-thinking the health-care conundrum?

Access for patients to the best treatment available sounds simple enough as a concept in the 21st century. Yet it’s not happening often enough nor fast enough, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan.    

Where did it all go wrong?

Access to optimal healthcare across EU member states has often been proven to be varied and inequitable, and of serious concern to an ageing population now suffering, in a growing number, from more than one disease. The problems caused to society as a whole by long waiting times, a lack of the best medicines available, inadequate implementation of cross-border healthcare, a shortage of hospital beds and other barriers is huge, leading to loss of quality of life for citizens and even of life itself.

And, lest we forget, we already have the ability to provide early diagnosis through tools such as screening programmes yet, to the consternation of many, this is not being used in a bid to thwart such a big killer as lung cancer, despite the overwhelming proof of efficacy shown by the NELSON programme’s results.

We know that our policymakers want to support improved access - and that topic is key to the current Romanian Presidency of the EU, for example, in its handling by necessity of the ongoing debate on health technology assessment (HTA), as well as patient mobility and cross-border health care.

Policymakers are experts at ‘mechanisms’, but it is making them fit-for-purpose and able to lock into each other that is an issue.

Different mechanisms are currently coming under the microscope. As well as EU-wide HTA, think the supplementary protection certificate, or SPC, waiver currently under discussion in Council, which ideally needs to be agreed before a new Commission moves into its Brussels HQ relatively soon. Also, consider the arguments over healthcare funding in the ongoing Horizon Europe budget discussions and how much cash down-the-line will feed translational research. And the shortages of medicines is another issue, which varies from member state to member state but is clearly a problem everywhere.

The UK is particularly worried about this as Brexit looms large. It is running out of storage space and now basically commandeering ferries to shift vital goods when necessary. Prevention is better than cure. So what’s preventing it?     Prevention is a key element in healthcare - so are we over-complicating matters with issues involved with bringing innovation in to realize earlier diagnosis?  Possibly. Much legislation is reactive, and it improving hard for laws to keep up with sciences that are moving at rocket-fast speed.

But it is not just the legislative processes, but also a matter of not moving quickly enough with the tools already - theoretically - at our disposal. For example, Big Data is still not being used optimally in the arena of healthcare, but when allowed to it is providing researchers with ever-growing and ever-more valuable information- often translated into better medicines and treatments for Europe’s patients.

EAPM and all stakeholders aim to focus, not just on the delivery of the right treatment for the right patient at the right time, but also on the right preventative measures to ensure reliable and sustainable healthcare. It is clear that investment is required in diagnostic approaches, such as the use of IVDs and more screening, certainly in lung cancer.

Also, 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. They need to understand what is now available (including next-generation sequencing), as do their patients.

Fortunately, treatment and medicine is moving from health professional-led decision making to evidence-based shared decision making. A number of European guidelines have been developed in specific disease areas, such as in the areas of urology, respiratory medicine, gastroenterology and cardiology.

But it is still important to address the major gap in engagement between the scientific community and key stakeholders as users and beneficiaries of guidelines. Well-informed healthcare professionals and unified guidelines can play an important role in harmonizing care, but this requires awareness building and training.

Guidelines, protocols and best-practice sharing are all key elements in prevention. Adequate methodologies, proper training, and much more collaboration and sharing of clinical data are all essential. Given the new understanding of disease at molecular level (especially in cancers), the promise of personalised medicine is real. But with patient screening, it can sometimes be difficult to find enough patients whose tumours harbour a particular molecular change for a clinical study.

Once Brexit takes place there will still be 27 member states and the welfare of more hundreds of millions of citizens to consider. Europe must learn not to over-complicate matters when it comes to access and innovation, by finding ways towards more efficiency. This can only be done together.

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