Leaders in Healthcare 2016
Ladies and Gentlemen,
Good morning, and a very warm welcome to you all. I am pleased to see that, you, distinguished members of the medical community, have once again chosen the Emirate of Dubai for this annual event.
This year, healthcare is all about personalised medicine.
Personalized Medicine, often referred to as precision medicine, individualised medicine, customised medicine, and even on occasions bespoke medicine, are buzzwords used interchangeably to create excitement, confusion and apprehension in equal measure among healthcare professionals, researchers, and the public. What does it all mean? Why is it relevant, and why should we, a nation in the infancy of healthcare development, care?
In the UAE, improving our nation’s healthcare is one of our top priorities. We embrace His Highness Sheikh Mohammed Bin Rashid Al Maktoum’s belief that the wealth of our nation is closely tied to the health of our nation. Our partnership with you, our talented healthcare professionals and healthcare providers, aims to keep our nation healthy. Together, we have made significant progress in delivering patient centred care, care that continues to ensure that our resources and personnel are organised around the patient.
However, our rapidly growing population, with unique genetic makeup, changing demographics, and lifestyle habits, continue to present us with significant challenges. We are still bombarded with new cases of diabetes, heart disease, and cancer that make us wonder that perhaps we need to do more than just have universal healthcare provision, with one size fits all? Perhaps it is time to get personal?
Personalized medicine, broadly speaking, is tailoring treatment to individual patients based on their genetic code. It is a move away from a ‘one size fits all’ approach to treatment and care to one which uses emergent approaches in diagnostic tests, functional genomics, molecular pathway, and real-time data analysis to tailor make the treatment to fit the individual patient needs – more of special size for one person. This allows target therapies to achieve the best outcomes, as well as ensure cost-efficient use of the scarce financial resources.
I hope that by the end of my speech, you are willing to consider the implications of this shift in thinking on genetic testing and the ethical dilemmas associated with it, on the pharmaceutical industry and the future of drug development, and on targeted patient-specific therapy and the benefits it brings. Only when we have considered all of those factors can we identify reality from the hype associated with personalised medicine.
Let me start with this. Do your children buy the same clothes as you, go on holiday to the same places as your neighbour, or even order the same food as their friends?
I am guessing that the answer is probably no. However, you are all likely to receive the same medical treatment for a particular illness despite many of your genetic differences.
Why is that? Is it because even the world’s best doctors do not fully understand, yet, how different people develop disease and respond to treatments? Is the safest option to devise treatments based on broad population averages, the so-called "one-size-fits-all" approach to medicine?
Emerging evidence over the past two decades tells us that this traditional practice often misses its mark, because each person’s genetic makeup is slightly different from everyone else’s, often in very important ways that affect health, in our potential to have a particular disease, and in the way we respond differently to injury or an illness.
Every day, millions of people around the world are taking medications that are not useful to them. At best, the top ten highest grossing drugs in the USA help less than 50% of those taking them. Approximately one third, of the millions of patients, prescribed Clopidogrel, an anticoagulant that thins the blood and prevents clots from causing strokes and heart attacks, have a genetic variant of an enzyme needed to convert the drug to the active form, which makes them unable to activate the drug. The drug is simply ineffective to that group of patients, yet millions are taking it. This puts them at increased risk from clots which cause strokes and heart attacks.
How about some of the current cholesterol-lowering drugs where the benefit is only seen in less than 5% of those taking it? Is it right to subject patients to side effects from drugs that are of no benefit to them? Is this ethical or justifiable? In a time of scarce healthcare resources, is it sensible to be spending money on medications that simply don’t work for the majority of those who take them?
Personalized medicine will move us closer to more precise and effective healthcare that is customised for the individual patient. Our greater understanding of our genetic makeup and how this drives our health predisposes us to certain illnesses and governs our response to treatments and drugs will enable our healthcare professionals to provide better prevention, more accurate diagnosis, and more effective and safer drugs at a price that is more affordable.
So, personalised medicine may be good for patients but bad for drug companies, or is it? Improvement in efficiency and having fewer side effects of drug therapy will benefit the patient, doctors, and those who fund healthcare such as insurance companies and governments. The benefit for the pharmaceutical industry may be more difficult to see in the short term, and therefore their willingness to embrace personalised medicine is less certain. Maybe we can encourage them to do the right thing for everyone which is to provide effective drug therapy with fewer side effects that are cost-efficient.
When we talk about genetics, it is easy to assume that genetic testing is complicated and expensive. Haven’t we got millions of genes that can have slight variations making them difficult to tell apart? How exactly does identifying these genes help us devise better and more effective treatments? Have we, in the UAE, got the right ingredient for “personalised medicine”?
In the ten years since the completion of the Human Genome Project (HGP), advances in genome technology have led to an exponential decrease in sequencing costs. Each one of us has millions of genes. Each gene provides the blueprint for the production of a certain protein in the body. These proteins affect the way we react to certain drugs and treatment in the way we absorb or metabolise a drug, act as a receptor for it, or modify its action. This information, which has become more readily available, has advanced pharmacogenomics with more than 100 drugs available that have been designed based on this information.
When researchers compare the genomes of people taking the same drug, they may discover that a set of people who share a certain genetic variation also share a common treatment response, such as the risk of side effects, different dose requirement for effect, and even optimal duration for treatment. It is truly an individualised treatment for each patient.
Having heard that our genetic makeup is responsible for what diseases we are susceptible to does not mean that we should just accept it and live with it.
Genetic predisposition to obesity or heart disease does not make us helpless, but on the contrary, evidence suggests that it gives us an early warning sign that we need to modify our lifestyle to reduce the risk of getting the illness in its worst form.
The International Diabetes Federation estimates that the disease costs 7000 dirhams per person in the UAE. At approximately 800,000 cases tabulated for 2014, the seemingly negligible per person figure becomes dangerously alarming at a total of 5.6 billion dirhams. Imagine what we could do with this money if we did not have to spend it catering to a disease that could be curbed through the synergies of modern medicine, diagnostics and pharmacology.
We know that from Darwin in the 19th century to Watson and Crick in the 20th century that our blueprint for development is passed down from our parents. But evidence now shows that we are not hardwired by our genes and that many of the genes we are born with can be modified by our experiences, and those “modified genes” are then passed down to our children.
What a mother eats during pregnancy affects how the baby develops inside the womb; young children who suffer abuse have epigenetic changes that reduce their ability to deal with stress later in life; twins whom both inherit a gene predisposing them to cancer, only one may develop cancer if exposed to bad habit such as smoking but the other twin remains cancer free if not exposed to those factors.
Our food, exercise, mental stress levels and even the pollution we are exposed to, influence our genetic makeup, and it is this modified genetic makeup that what we pass onto future generations. It is our responsibility to future generations to hand down genetic material in as good a condition as possible.
In order to maximise on the research that has revealed the power of our genes, we must make sure to offer the right support and exposure to this field. It starts with establishing a reliable database of disease prevalence findings, factors at play, and vulnerable populations. This basic step would move us leaps and bounds enabling more precise research. This is when we can expect to make a larger dent in personalised medicine through the use of latest technological advances.
We are proud to have the Harvard Medical School Centre for Global Health Delivery as a partner, and leading advocate for connecting data with health delivery. HMS has brought its renowned experts as well as global leaders in this field to keep the momentum strong and build a sustainable system necessary for individualized medicine to thrive.
Traditionally, big pharmaceutical companies with their blockbusting high earning drugs were often preferred to their poorer relation, device manufacturers and diagnostic companies. This is now changing with strong alliances being forged as diagnostic companies are becoming indispensable to the pharmaceuticals industry in the push for more personalised medicine. The convergence of healthcare and digital technology is helping to match the right drug to the right patient.
Medical device companies are pioneering ways to monitor and manage patients’ wellbeing. Many consumers are already using mobile sensors to measure basic functions such as heart rate and physical activity through lifestyle apps. Technology has the potential to collect more sophisticated clinical information “healthcare apps” that can help patients and doctors better understand and manage long-term conditions such as diabetes and depression. These innovations are generating large volumes of medical data, which could hold the key not only to more effective care of individual patients but also to the analysis of population-wide patterns in search of the causes and cures of disease.
Major equipment vendors, including some of the most prominent international companies who have become our partners in the Mohammed Bin Rashid Academic Medical Centre at Dubai Healthcare City, recognise that technology and data promise to make health systems more efficient at a time of rising demand from ageing populations.
These possibilities are attracting new companies into healthcare with new alliances. For example, Medtronic, one of the biggest medical device makers, announced a “broad-based strategic alliance” with Samsung Electronics to deliver “real-time health data to physicians and patients so they can more effectively manage treatment, therapy, track symptoms and wirelessly monitor data received from Medtronic devices”.
Even Google has struck a similar partnership with Novartis, the pharmaceuticals group, to develop a contact lens capable of monitoring glucose levels in eye fluid. This is an exciting time as we see a convergence between different disciplines, with companies like Google, with a lot of bright minds, coming to the table and bringing forward new ideas to improve health.
Innovation Week held this past November, was an event crafted from the vision of His Highness Sheikh Mohammed that brought local and federal government, as well as the private sector, to showcase ideas reflecting the UAE's drive to innovate.
IBM presented its Watson technology, one aspect of which is a partnership with Memorial Sloan Kettering Cancer Centre, to understand a patient's clinical diagnosis and determine a treatment plan specially tailored for the patient. It represents a decision support system that links the latest research, evidence and expertise to help doctors determine the best course of treatment. Through individualised medicine, the hope is to zone in on the best clinical pathway and achieve highest success rates with more rapid response time. This is pushing technology to capture data and analyse beyond what one physician, or a care team, can offer, and putting us ahead of the game.
Throughout history, the practice of medicine has largely been reactive – we normally wait until the onset of disease before we start treatment. Because we do not fully understand the genetic and environmental factors that cause major diseases such as cancer, Alzheimer’s and diabetes, our treatments are imprecise, fairly unpredictable and often ineffective. In addition, common drugs and treatments are tested on broad populations and are prescribed using statistical averages, and consequently only work for some patients but not for many others.
Personalized medicine, is based on each patient’s unique genetic makeup, and is beginning to overcome the limitations of traditional medicine. It is allowing health care providers to shift the emphasis in medicine from reaction to prevention, predict susceptibility to disease, improve disease detection, pre-empt disease progression, and customise disease-prevention strategies and treatments. It also allows the use of more effective drugs with predictable side effects, therefore, reducing the time, cost, and failure rate of treatment.
By the time medical students have graduated from the Mohammed Bin Rashid University, we should have ready for them the tools and offer them the best chance to make advancements in genomics, for personalised medicine, further. We need to have the policies, infrastructure, systems, funding and research revved up for a fresh generation of clinicians to take the lead.
A wise man once said “you do not have a right to the cards you believe you should have been dealt with. You have an obligation to play the best game with the cards you are holding”. So although our genetic makeup is responsible for what diseases we are susceptible to, we do not have to accept that our fate is sealed. Our genes should act as a springboard from which we launch a better lifestyle that reduces our risk to those illnesses we are predisposed to.
We should keep the genes that hardwire us to enthusiasms, honesty and endeavour, and use those as drivers for change of those genes that predispose us to illnesses and long-term conditions. It is our responsibility to future generations to hand down genetic material that is better than the one we have inherited.
With this in mind, I wish you all the very best of luck for 2016 and beyond, and encourage every one of you to take steps to improve your health by modifying your genes for the benefit of future generations.