Healthcare, medicine & pharmaceuticals

More Democratic Healthcare

The cost of going to the doctor, medication and hospital treatment is ballooning all over the western world. Part of the problem is population aging and the ongoing cost of treating chronic diseases. Governments may be unable to throw more money at this growing problem, but private companies are looking for ways to provide more healthcare, better and cheaper than before.

In the words of consultants, healthcare is being democratised and decentralised. This means so-called consumers of healthcare decide how and where they will be treated, rather than having limited centralised choices. A PwC survey in 2014 found many people were willing to try out more affordable and convenient options (who wouldn’t?). Nearly half said they would choose an at-home or retail option for certain medical procedures, such as diagnosing strep throat or administering chemotherapy.

The future of health is consumer-oriented and technology-enabled, which means existing pharma and health insurance companies have to compete with technology companies and even, surprisingly, General Motors and Ford. (Ford is developing services to help drivers with chronic conditions manage their health.)

While there is little interest in investing in life sciences, there are start-ups in digital health, workflow, electronic medical records and population health management. Other companies have used their existing products in a new way, such as AT&T’s mhealth platform or Samsung’s mobile phone heart rate monitor.

Everyone wants a chance at the $2.9 billion sick-care or $267 billion wellness markets. Some want to develop low-cost DIY methods (such as checking your own urine), while others just want to harvest valuable healthcare data. For example, people generate a wealth of data while using fitness trackers.

Convenience will be crucial. For too long, people have had to fit their visits to doctors or specialists within a narrow band of hours or days. In Canada, 52% of respondents to a PwC survey thought mobile health apps would make their healthcare more convenient and efficient by 2018.

One way to offer true convenience is if companies within healthcare stop competing and work together to provide a better service. For example, a start-up with new technology partners with an insurance company to create a better payment system. Or a life science company joins with a pharma company to focus on one particular disease or condition.

If people are able to access health care at lots of different locations and times, there is a danger of losing a whole person picture. So the need to address regulatory, privacy and security concerns about integration of data will be paramount in digital health.

With so much consumer-focused, technology-oriented healthcare, there is a danger of losing the human touch. A company that finds a way to include this will provide a very appealing alternative.

The Ethics of Editing the Genome

The work of an editor, as we well know, is to cut out the parts we don’t like and insert the parts we do. When a scientist edits the genome, they use “molecular scissors” to cut DNA to remove a gene and provide a template to introduce a new gene. This sounds clever, but the ethics of genome editing are still under fierce discussion.

Nuffield Council on Bioethics project and Progress Educational Trust in the UK, are both concerned this ground-breaking technique – CRISPR-Cas9 - will be shut down. They want to see this research well regulated with strong oversight, not a complete moratorium on genome editing research.

The same discussion is taking place in America. The National Academy of Sciences (NAS) and the National Academy of Medicine (NAM) have just issued a 2017 report, Human Genome Editing: Science, Ethics and Governance. They called for seven governance principles: promoting wellbeing, transparency, duty of care, responsible science, respect for people, fairness, transnational cooperation.

The report also addresses “off-target effects”: the unintended consequences of editing specific genes. It is these consequences that will create so much spirited debate.

Is it ethical to alter the DNA of an unborn child? For example, if we remove immune cells from a patient and rewrite their DNA, we can prevent inherited diseases. But making a change at the ‘germline’, as it is called, would be permanent and passed on to their offspring and their offspring.

Once again, it is seen as “playing god” and many are uncomfortable with such power in the hands of scientists (or any human for that matter). Still, fear of possible consequences is no reason to stop the research altogether.

Too Many Fat Kids

One of the world’s biggest and most alarming trends is obesity, but even more shocking is the rate of obesity among children. According to a WHO study in 2014, there are 41 million children under 5 who are either obese or overweight. In developing countries, figures are even worse.

Asia has nearly half of these obese children and Africa has a quarter of them. In the past 24 years, the number of overweight or obese kids in Africa has nearly doubled from 5.4 to 10.3 million.

Things are not much better in America where the obesity epidemic affects 10% of kids 2-5 years and more than 23 million children and teens altogether. Worse, 20 million Americans of all ages live in so-called “food deserts”, places where there is no access to healthy food.

In Britain, one leading doctor claimed the crisis in the NHS was caused, not by the aging population, but by the shocking increase over the last 30 years in fat children. He blamed “grotesque” changes to the great British diet. As a result, the NHS is spending about 10 billion pounds each year on treating type 2 diabetes alone.

A third of British children leaving primary school, age 10-11, are already overweight or obese, which is a record percentage. It used to be rarer to see fat children at school and other kids called them “fatso” to distinguish them from the rest. Now it would be so common as to be unremarkable. An Australian study found, even with our knowledge about obesity, there were few programs available that can specifically help these children lose weight.

Unfortunately, childhood obesity has long-term consequences, such as poor educational results, inability to get a job, psychological barriers, and chronic health problems such as diabetes or heart disease. It is worth addressing the problem early, before obesity in children starts to be viewed as normal. The trend contrasts ironically with the rise in young children and teens who only think they are fat and go on unnecessary diets.

Dishing the Dirt

The last few decades have seen a Western obsession with germs, not only in clinics and hospitals, but in our homes too. Some claim cleanliness and hygiene – as well as antibiotics - are the reasons why so many nasty diseases have been all but wiped out. But there is another opposing trend - dirt is OK and even necessary for health.

A Professor at the University of London, David Strachan, coined the “hygiene hypothesis” to explain the increase in hay fever and allergies because of lower instances of childhood infection. He also said smaller family sizes were preventing bugs from being shared. Not all experts agreed, but he had a point.

We each have 30 to 300 trillion bugs within us, known as the microbiome. Only a few hundred are harmful, and the rest help keep us alive and healthy. Some of the diseases that could be related to the microbiome are: autoimmune diseases like type 1 diabetes, inflammatory bowel conditions like coeliac disease, even mental illness and Alzheimer’s.

The problem with antibiotics is they kill many of the healthy bugs that we would be better off keeping. Dr Martin Blaser documents this in his book, Missing Microbes: How the Overuse of Antibiotics is Fueling our Modern Plagues. Blaser says we are increasingly defenceless, with as much as 15-40% of our microbiome diversity lost. Given we are more interconnected across the globe, with high levels of antibiotic resistance, he thinks we could be susceptible to new and stronger pathogens.

Some of the ways to support your microbiome are not what you might think. For example, yoghurt is not proven to make any difference to the microbiome. Unnecessary medication, such as antibacterial soap, just promotes resistance in bad bugs.

Another huge problem is unnecessary caesarean sections in childbirth, because the baby is supposed to be exposed to the mother’s vaginal and anal bacteria to build resistance. More than a quarter of births in the UK are caesarians and, in Australia, they are the most common type of birth in private hospitals. Yet the risks of autoimmune disease increase and type 1 diabetes double in a child born in this way.

One simple way to repopulate your microbiome is to out into the country, breathe some rural air and walk in the dirt. But when you get home, try to resist the urge to scrub away all that beautiful bacteria.

Alone Again, Not Naturally

We may be in the grip of a new epidemic and this one is not even a disease: chronic loneliness. This comes although there are a startling number of ways to stay connected with people – voice calls, text, instant messaging, WhatsApp, Skype, video, Facebook, Twitter, Instagram – even face to face conversation. But many people have described the experience of going into a train carriage or a bus, and seeing everyone peering down at their phones. Nobody looks up.

The experience of being on the street where nobody looks up is sadly isolating. For some people, it is much worse than this. A study by Age UK found half a million people over 60 can go for a whole week without any human interaction at all. It concluded 1.2 million older people suffered from chronic loneliness.

In Australia, by far the majority of callers to a popular helpline are people suffering from loneliness and just need somebody to talk to. Sometimes they are labelled with a mental illness, but the underlying problem is simply they have no real connections with anybody. Lack of connection even causes mental illness. We have long known babies who experience lack of physical touch do not develop properly.

Recent research has even found loneliness is exacerbated by social media platforms like Facebook, which give the impression everyone else is having a good time except you. Social media can be used, not for genuine contact, but to project a false and relentlessly positive persona to hide loneliness.

The most common household in Britain and Australia is increasingly the single person household, whether because of divorce, bereavement, or an active choice to remain single.