Genomics and other innovative ways to bring down soaring healthcare costs

 
Tracey Boles
Genomic Workshop
Genome sequencing could become more commonplace (Source: Getty)

Genomics, the branch of molecular biology that maps human genomes, is changing how drugs are discovered as the pharmaceutical industry integrates genetic information into the process.

The science has already yielded tailored treatments for cancer and hepatitis C and, it is hoped, will soon produce a cure for HIV.

With the major pharmaceutical companies such as Glaxosmithkline, Merck and Novartis taking an interest in genomics, it even holds out the prospect of turning off faulty genes, thereby preventing some illnesses entirely.

The science has some other heavyweight supporters: England’s chief medical officer Sally Davies wants genome sequencing to become as standard as blood tests and biopsies.

In her annual report last week, she said that the NHS must deliver her “genomic dream” within five years.

As well as medical benefits, genomics potentially has welcome budgetary side effects for health services and insurers grappling with spiralling costs.

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“In a couple more steps, we will be not just controlling a condition, but getting to a stage where we are curing it.” says Peter Mills, associate medical director for Cigna Global Health Benefits, a branch of the insurer.

“That is where genomics holds out the biggest bang for the buck: freeing up healthcare resources.”

In addition to genomics, telehealth (remote working by medical professionals) and wearable devices could also help bring down burdensome healthcare costs in his view.

In the UK, such costs have risen from just over three per cent of GDP in 1960 to 10 per cent today.

In part this is due to ageing populations and poor lifestyles: at 65 you might have a life expectancy of 21 years, of which only nine or 10 are in good health.

With the number of over 65s projected to account for a quarter of the EU population by 2030, costs are expected to rise further.

This so-called “medical inflation” is not just down to the chronic conditions associated with age: it can also be attributed to the many ways we now have of investigating and treating disease which are better than in the past, but more expensive.

All of this has left the government scratching its head over how to pay for the NHS and social care.

Mills says: “We need and will continue to need healthcare resources. Who is going to pay for it? Either we pay more tax or take money from something else.

“Healthcare is the last unmodernised industry in the world, plagued by inertia. Cost can help focus thinking, with technology one way to mitigate it.”

Genomics arose out of the pioneering work by scientists Francis Crick and James Watson, who worked out the structure of DNA, paving the way for everyone’s genome to be mapped.

The science is generating targeted drugs against specific gene defects.

The therapies tend to be expensive due to the high cost of discovery and clinical trials. However, they will get cheaper as understanding increases.

Telehealth in areas as diverse as radiology, pathology and surgery, will also be a “gamechanger” in Mills’ view, in part by reducing the need for pricey physical infrastructure.

He explains: “Populations are struggling to afford quality healthcare. The question is: how can we modify the model? Doctors do not have to see everyone face-to-face on every single occasion. Once they have made a diagnosis, you do not necessarily need to see them.

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“The opportunity to use technology exists now as devices have good enough screens.

“It makes remote consultation a reality. For example, consumers in expat communities can have psychological consultations over Skype. These types of services can be expanded out,” he adds.

Some GPs already consult remotely and surgeons carrying out some operations use robots to assist, notably in prostate procedures and neurosurgery.

Wearable devices with medical applications include heart rate and blood glucose monitors, and peak flow meters. However, they have met with some scepticism by medical professionals.

Mills says: “There has been reticence for healthcare providers to embrace patient reported data; they don’t know what to do with it. Another hold up has been back-end functions that get data to a provider.

“But more data points allow for better prescriptions.”

This extra data can be self-reported, he says, by patients and then used to aid the management of chronic conditions such as high blood pressure and diabetes.

He believes that personal responsibility towards health is to be encouraged, with wearables as part of that.

He says: “It is a discussion we have to have; people are way too passive and have been since the war. The NHS is expected to step in.

“As a nation have to think about how we prepare for retirement, and life after work.”

The alternative could be the bitter pill of ever higher healthcare bills.

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