#EAPM: Deafening silence on health care in presidential debates

In the wake of 2010’s Affordable Care Act (dubbed Obamacare) and the current US president’s launch - during the 2015 State of the Union address - of the Precision Medicine Initiative, it is a more than a little surprising that health care for the nation’s 320 million citizens has barely been touched upon in the three feisty debates leading up to next month’s election, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan.

OK, it is true that the Republican candidate, Donald Trump, has previously spoken of “much-needed free market reforms to the health-care industry”.

He has added: “But none of these positive reforms can be accomplished without Obamacare repeal. On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.”

Meanwhile, for her part, Democrat candidate Hillary Clinton has said: “I've fought for quality, affordable healthcare my entire career. As president, I'll defend the Affordable Care Act, build on its successes, and go even further to reduce costs.

“My plan will crack down on drug companies charging excessive prices, slow the growth of out-of-pocket costs, and provide a new credit to those facing high health expenses.”

All very well - we have some idea of where they both stand. Yet given the planet’s ageing populations and the sky-rocketing costs of healthcare, in the US, Europe and beyond, the fact that the health of 300-million-plus potential patients has been banished to the sidelines in the run-up to one of the most news-grabbing elections in history is bordering on the jaw-dropping.

Let’s back-track just a little: as stated above, early last year the US made the news with its One Million Genome project, which was launched with $215-million at its disposal.   At the heart of Obama’s precision medicine initiative, or PMI, is the creation of a pool of people, both healthy and sick, both men and women, both old and young, who are being studied to expand knowledge of how genetic variants affect health and disease.

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Of course, this is a testament to the great leaps in genomics-based science that underpin personalised (or precision) medicine but, while the two heavyweight presidential candidates have been wading into each other regarding policy (or lack thereof) over the conflict in Syria, numerous sex-related allegations, ‘nasty women’ and ‘bad hombres’, fitness for the White House top job and much more besides, neither has even scratched the surface when it comes to the nation’s health.

In Europe, we have come to the conclusion, in the wake of much historical evidence, that a nation’s good health has a positive economic impact. Healthy people can work for more years (which is vital with the huge gaps between future pension needs and actual resources).

Healthy people spend less time requiring sick notes, filling up doctors’ surgeries and taking up hospital beds. In essence, they are undoubtedly more productive and help to underline that health means wealth.

On Europe’s side of the Atlantic, at the end of Luxembourg’s Presidency of the EU (December 2015), the European Council issued its conclusions on personalised medicine for patients, stressing that its adoption on an EU-wide basis would allow health care professionals to offer better-targeted treatment, avoid medical errors and reduce adverse reactions to medicinal products.

However, there are a number of highly relevant challenges that may limit its positive impact on 21st century medicine. These include increasing costs, inequitable access across European countries and regions and the need for a relevant ethical, regulatory and reimbursement environment.

The problems of creating sustainable and equitable healthcare are never far away. In this new and exciting era of personalised medicine 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.

The Brussels-based EAPM believes that 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, health-care professionals, researchers, academics and policymakers among others and aims to ensure the right treatment for the right patient at the right time.   The Alliance notes that one of the key tenets of the European Union is equitable access for all citizens to the best healthcare available.

Personalised medicine approaches have already been particularly effective in certain cancers, and have brought practice-changing clinical benefits to patients. But, as suggested above, there are notable barriers to its full integration into health-care systems.

For example the spiralling costs associated with personalised or precision cancer medicine highlight the need to address the cost-value dilemma. Too many medicines are simply too expensive - and what constitutes ‘value’, anyway? Who should decide?

Resources on both sides of the Atlantic are relatively scarce when weighed against health needs and costs, so much ‘smarter’ uses of these limited resources need to be developed and worked into health care systems.

Other issues include the fact that much legislation is behind-the-times. The rules shackling the sharing of the masses of health data theoretically available today for research and development have often been labelled as too tight, although there is no doubt that robust ethical and privacy safeguards need to be in place. It’s all about balance, or should be.

On top of this, based on the age-old adage of ‘prevention is better than cure’, investment is required in diagnostic approaches such as the use of IVDs and more screening, certainly in lung cancer.

Finally, up-to-the minute education is required for healthcare professionals who are facing a brave new world in which personalised medicine is a game changer. They need to understand what is now available (new treatments, clinical trials, cross-border opportunities), as do their patients.

With all these scientific leaps occurring in both the US and the EU, it is clear that an opportunity for debate during the race for the White House has, sadly, been missed by both candidates, to the potential detriment of citizens everywhere.