In today’s world, just a touch of a keyboard is enough to access a wealth of general health information. Before long, however, specific information about what diseases we are predisposed to, what drugs we would most benefit from, even what time of day we should take our pills will also be available – and probably sent straight to our smartphone.

Indeed, a recent Ogilvy CommonHealth Worldwide report listed 20 ideas they say are likely to come to fruition in the next decade – and all are based on technology that is already at our fingertips. From evolving current services such as healthcare at home to the more futuristic, the report says these advances will revolutionise the way people live and think about health.

In an era where disease burden, growing populations, and financial pressures are choking healthcare systems, there is a natural shift in thinking to how prevention and self-care can cut costs and save money. And the potential technology can play is huge, says Jennifer Covich Bordenick, chief executive at US-based eHealth Initiative.
Using technology to monitor and manage patients from the home is just one example of how healthcare will change in the future, and headway is being made in these areas with numerous pilot schemes underway to demonstrate the financial advantages of keeping people out of hospital while simultaneously improving patient experience. In one small telemedicine pilot conducted in Northern Ireland, for example, 22 patients with chronic obstructive pulmonary disease were provided with a home monitoring device to measure various vital signs over a 12-week period. The information was transmitted to a secure server for nurses to review and take action if needed and the results showed an almost 12% reduction in hospital admissions, a 25% reduction in face-to-face visits with patients, 36 prevented hospital admissions – which in itself saved an estimated £83,000 – and a 25% improvement in patient quality of life scores. The trick for the future is to get these pilots rolled out on a nationwide basis.

Genetic profiling coupled with specific disease screening via diagnostics and imaging should also push the prevention agenda, the Ogilvy report reveals. And implants using radio frequency identification technology, currently employed in the medicines supply chain and counterfeit prevention, will be developed to monitor vital signs and transmit information to health services for diagnosis and speedy intervention; indeed, lab-on-chip systems are already being developed and could be small enough to fit under a temporary tattoo to measure nerve and muscle activity. These advances, coupled with developments in nanotechnology, personalised medicine, personalised polypharmacy (combination drugs) and next generation targeted therapies like stem cell technologies, gene therapy, cloning and regenerative medicine, offer up a powerful set of tools to monitor and directly treat future health and disease.
From a digital point of view, available technology is already making inroads in improving patient health and helping systems become more efficient. Text message reminders for medicines adherence are becoming commonplace, for example, while the number of medical smartphone apps for patients and healthcare professionals has jumped 78% in the past year, according to Ernst & Young.

Moving forward, geolocation and GPS tracking could detect patterns of infectious disease outbreaks, the Ogilvy report notes. And augmented reality – a computer-generated 3D graphic – could become the norm. Already Genzyme (agency Langland) has used the technology to show doctors the cardiovascular risks in chronic kidney disease patients that take calcium-based medications by producing a 3D image of a beating heart with calcium deposits.

Add into the mix the expectations for near-field communication – a way for mobile devices to wirelessly interact with other devices or objects that are in close proximity – and healthcare looks set to be transformed. This technology could be used in a plethora of ways – to track patients in hospitals, to improve medication compliance, and make drug prescribing more efficient. Meanwhile, digital display devices such as talking medicine cabinets or fridges that could remind us to take our medication or eat more healthily based on feedback loops from monitoring implants are on the horizon. And even more ‘sci-fi’ are brain-computer interfaces – using the power of thought to interact and communicate – which has huge potential for immobile and terminally ill patients.

The data cloud
Meanwhile, electronic health records are also expected to be important in the future. But it won’t just be a matter of past health information being stored in an easily accessible ether, future health scenarios will also be generated from large databases of information including lifestyle and genomic data, as well as medical intervention choices. Known scientifically as predictive analytics, this medical forecasting and patient profiling will become increasingly popular, believes Ian Gallifant, managing director at Zaptag, a UK-based personal health record company. “This means patients will have a personal future health profile, bespoke and individual to them, compiled from previous illnesses, family history and medications, which predicts their future health risks and creates a health forecast outlining steps for a healthier and longer life.”
Indeed, Sarah Gordon, associate director at OgilvyHealthPR, says widespread use of cloud-based electronic health records that can be accessed anywhere at any time will be the “tipping point of future progress”, and with smartphones playing a major role in realising this potential, she says they will be “the digital glue that will allow technological advances to interact with our bodies”. For example, adds Rohit Talwar, chief executive of futures research and consulting firm Fast Future, “I could scan the product bar code in the supermarket to tell me whether or not I should buy it – for example, rejecting foods with high sugar content if I’m a diabetic”. The future will see “individuals using their own genetic data to make healthy lifestyle choices, have deeper conversations with their healthcare provider and more actively participate in research”, notes Ashley Dombkowski, chief business officer at genetic profiling company 23andMe.

Patients are the drivers
So our destiny is gadget-led, but while technological advances increase capabilities and save financially, these are not the main forces behind this dramatic healthcare shift. Much comes back to the patient, their increased interest in health and in interacting with technology. “People are realising they have a choice and are gaining control and knowledge, thereby becoming more proactive rather than reactive to health issues,” says Gallifant. “The realisation of support and education from online technology and apps and their increasing availability is fuelling the opportunity, and drive, for improved health and care.”

Indeed, according to recent market research carried out by Novartis, 92% of patients and 84% of seniors said they were comfortable using technology overall and almost two-thirds of patients think technology is helping them to better manage their health. “Patients are showing an increased interest in managing their own care and research shows they understand how technology can help them improve their health and are embracing solutions to do so,” a Novartis spokesman says. As such, the firm’s portfolio already includes a variety of smartphone apps and an electronic medication bottle cap, called GlowCap, which notifies healthcare professionals if a transplant patient misses a medication dose. Novartis is also experimenting with ingestible microchips, a sensor-based technology that monitors whether patients are taking their medication, with success shown in early trials.
While some might think it seems like technology overload, the irony is for future preventative healthcare to materialise you need technology to enable it, says Michael Reilly, managing director at Triantan Solutions. Patients and consumers need to be empowered through access to information, which will allow greater independence and reduce the cost burden on healthcare, he says. It is, he adds, “irrefutable” that we need greater adoption of technologies to connect patients and consumers to the health system, while allowing independent living and, importantly, reduced cost of care through out-of-hospital treatment. “Patients and consumers are increasingly more demanding, they desire choice and are technically literate,” he says.

However, “the challenge”, warns Pamela Spence, UK and Ireland head of life sciences at Ernst & Young, “is how you encourage consumers to take charge of their own health rather than demand the right to get better when sick?” For example, she says, genomic data is “helpful” but it may be at the mercy of insurance companies, which means the genomic test acts as a disincentive. “There is no denying technology can help healthcare delivery and management but unless there is a benefit to the consumer why would they change their behaviour?”

Technology is not a panacea
So “technology in itself is not a panacea; it needs to be adopted and incorporated into our everyday behaviour” and information overload will have to be managed, Gordon notes. It is the “interface between technology and the person that is more important than the technology itself and that will be key to changing behaviour”. As such, public and individual patient communication will be important in unlocking the benefits of new technologies.

For example, computer-generated video documentaries of future health scenarios could help people understand the impact of their disease, potential future consequences and drive patients to make better decisions about their health.  “The challenge will be to use technology to bring to life future scenarios that are perceived to be real, not make-believe, that empower rather than frighten, so that people will actually apply the message and adopt recommended health behaviours,” Gordon notes.

However, as former Labour Health Secretary Alan Milburn noted at the recent Future Health and Care Expo: the potential for technology is “enormous” but there is a “mismatch between the services that are provided and what is needed”. Furthermore, some people adopt new technologies more quickly than others – and, says Dombkowski, many won’t always fit neatly into existing procedures and systems; it takes time to develop new or broader approaches that enable the effective application of new technologies.

What is pharma’s role?

Companies have to decide, says E&Y’s Spence, between enabling health outcomes or being famous for scientific innovation and medicines. However, Talwar believes the demarcation won’t be quite so distinct. “Industry boundaries will blur. Pharma will focus more on wellness and also get into lifestyle drugs, such as treatments to enhance mood, reduce stress, improve concentration,” he predicts. He also suggests companies may move to acquire providers of self-care and prevention tools, including greater tie-ups between the pharma and food industries.

Likewise, Gallifant doesn’t believe it’s an either/or situation for pharma. “Industry will continue to produce pharmaceuticals to treat illness and disease; however companies need a more patient-focused and supportive method to communicate with, and support, local communities and patients in prevention and self-care.” He also agrees with Talwar that pharma will increasingly make acquisitions in the prevention healthcare and technology space, but cautions:

“In this new era of prevention, pharmaceutical companies are in danger of alienating themselves further and gaining a worse reputation for being purely profit, rather than patient, focused.”

Novartis is all too aware of this, he says, adding that marketing should continue to be responsive to patients’ needs. “Our marketing efforts should also ensure proper integration of new technologies to reach these patients in new and effective ways.”

Drugs and cures won’t lose their place, says Gordon, but what companies invest in will need to be chosen wisely. The bling might capture our imagination but “we need to remind ourselves that the focus of future healthcare remains the individual”.

Pharmatimes : Senior Reporter: Katrina Megget. Edited by: Jenny Hone/Claire Bowie 

NTAC has worked on a number of projects which have enabled medically proven technologies be adopted by the NHS, thus ensuring patients are able to benefit from these innovations.

NTAC believes that examples of innovation are not an issue in the UK but the lack of a ‘pull’ culture within the NHS which often prevents these benefits from being realised.

For example, in March 2011 NICE extended its recommendation on the CardioQ estimating that it could save the NHS in England more than £400m a year. The blood flow monitor, which was originally developed in the UK, reduces the rates of post operative complications as well as reducing the length of critical care and overall hospital stay. However, in order for these patient and financial benefits to be realised it is vital that this innovative technology is widely implemented throughout the NHS.

NICE is recognised as the organisation with the expertise to review the evidence linked to individual technologies but experience shows that NHS organisations also benefit from receiving practical support at the front line of care delivery to enable rapid uptake of this technology.  This is where NTAC comes in. In order to actively support the uptake of CardioQ NTAC published a detailed How to Why to Guide™.  These Guides provide comprehensive and relevant information for clinicians, managers, key decision makers and other stakeholders on how to implement specific technologies.

Deltex Medical Group Chief Executive, Ewan Phillips said:

“It takes a long time for ideas from the clinicians to feed through to the senior management – the sort of people who can make decisions to do things on a wide scale. That’s always been a problem in the NHS.

“NTAC is vital to widespread adoption of this, and many other, technologies with proven patient benefit and the opportunity to save the NHS millions. Essentially NTAC provides the roadmap which can help the NHS achieve better patient outcomes and also achieve the significant cost savings it is striving for,”

NTAC Chief Executive Sally Chisholm said: “Our work is focused on achieving reproducible benefits in the clinical setting, or more crudely, the real-world. By working with the NHS we can take under-utilised technologies which have shown that they can improve clinical outcomes whilst saving the NHS money and quite literally ‘show’ the NHS how to implement them effectively. Headlines such as ‘savings of £400m per year’ are incredibly exciting, particularly in the current economic climate and with the financial pressures being faced by the NHS. However, the stark reality is that if technologies such as the CardioQ are not implemented throughout the NHS these benefits will never be anything but a headline.”

Analysis of more than 50 previous studies showed non-steroidal, anti-inflammatory drug (NSAID) diclofenac, even in doses available without prescription, elevated someone’s risk of heart attack or stroke. The findings also indicated that indomethacin and new NSAID etoricoxib were associated with an increased risk.

Drugs naproxen and low dose ibuprofen were least likely to increase risk of heart and circulatory, according to the research.

Doireann Maddock, Senior Cardiac Nurse at the British Heart Foundation, said: “The potential risks for heart patients taking certain painkillers have been known for some time and these new findings shouldn’t be ignored. But scientists and drug regulators will need to delve deeper before we draw any firm conclusions about these drugs and their side effects.

“As with any medicine there are benefits and potential risks to taking painkillers. If you’re already taking these types of drugs and are worried, don’t simply give up on your medication. You should always speak to your doctor first because the benefits may well outweigh the risks for you.”

The research was published in the Public Library of Science Medicine journal.

The World Alzheimer Report 2011, ‘The benefits of early diagnosis and intervention’, commissioned by Alzheimer’s Disease International estimates that early diagnosis could create savings of up to US$10,000 (£6,254) per person. It suggests this could be achieved in various ways, including providing Alzheimer’s drugs and support for carers earlier, delaying the need for people to go into hospitals or care homes. The report makes recommendations including every country having a national dementia strategy promoting early diagnosis, and to increase investment in research. This is the first comprehensive review of all worldwide evidence on early diagnosis and intervention for dementia.

Thousands of people will take to the streets this weekend to mark World Alzheimer’s Day on Wednesday, 21 September. Alzheimer’s Society Memory Walks will bring together celebrities and families around the country to walk in memory of loved ones.

Alzheimer’s Society comment:

‘In the UK right now 60 per cent of people with dementia are struggling in the dark with no formal diagnosis. These people must be helped. Empowered with an early diagnosis, they can benefit from potential treatments and support which could vastly improve their quality of life.

‘Today’s report must rouse us to take decisive action now and transform diagnosis rates everywhere. Alzheimer’s Society urges people to visit their GP if they are worried about their memory, and is also working with GPs to increase awareness and understanding of dementia.’

Jeremy Hughes, Chief Executive, Alzheimer’s Society

Retinal screening is one of a checklist of 15 measures³ to help people with diabetes understand what services they should get to help them manage their condition. Recent figures⁴ show that people with diabetes are also not receiving other essential annual checks. Nearly a third (32 per cent) of people with Type 1 diabetes and one in seven (15 per cent) with Type 2 diabetes have not had a foot check. Diabetes causes 100 amputations a week, of which around 80 per cent are potentially preventable. Diabetes UK is calling on people with diabetes to let them know about the gaps in care where they live by filling in an online survey at www.diabetes.org.uk/care-survey

Barbara Young, Chief Executive at Diabetes UK, said: “Diabetes is a serious condition which can lead to devastating long term complications including blindness, kidney failure and amputations. The tragedy is that, for example, 90 per cent of cases of sight loss could have been avoided if they had been identified early enough and treated appropriately.

“The 15 measures will help ensure people with diabetes are getting the care they need, and if they’re not, Diabetes UK wants people to use the checklist and ask for the standards of care that have been recommended by expert bodies and patients across the UK. With the right care and education, there is no reason why people with diabetes shouldn’t live long and healthy lives.”

The 15 measures are part of Diabetes UK’s  campaign ‘Diabetes Watch’ a programme to monitor and highlight standards of diabetes care across the UK, and to support people with diabetes to get access to the right standards of care. The charity wants people to use the checklist and if there are any gaps in care, raise the issue with their healthcare team.

Scientists at the University of British Columbia found that mice modelled to show symptoms of Alzheimer’s had nearly double the density of capillaries compared to normal mice. They also found a similarly higher density in brain samples of people who had died of the disease compared to those who hadn’t had the disease.

Alzheimer’s Society comment:

‘Identifying early changes that can be easily measured in people with Alzheimer’s is one of the big challenges for scientists trying to develop treatments and ultimately a cure. This new research builds on existing knowledge and points towards an exciting new avenue of investigation. This could one day pave the way towards a better future for hundreds of thousands of people.

More research is now needed to confirm this link and also to answer the proverbial chicken and egg question of whether these changes are a cause or a symptom of the disease. One in three people over 65 will die with dementia yet dementia research is still drastically underfunded. We must invest now.’

Dr Susanne Sorensen, Head of Research, Alzheimer’s Society

Consensus Action on Salt and Health surveyed the salt content of 294 fresh and packaged loaves, with the worst offender containing more than 2g of salt per 100g.

The findings also show that high street chain bakeries generally sell the saltiest bread and some loaves don’t have crucial nutritional labelling.

Eating too much salt is linked to high blood pressure, which in turn increases your risk of developing heart disease. Adults should eat less than 6g of salt a day – that’s about one teaspoon of salt or around 2.5g of sodium.

Victoria Taylor, Senior Dietitian at the British Heart Foundation, said: “Contrary to popular belief, salty food doesn’t necessarily have to be junk food. A lot of bread is clearly packed with sodium and because it’s such a staple part of our diet, bread can end up significantly bumping up the amount of salt we eat each day.

“Worryingly, some loaves are missing important labels showing nutritional information, making it incredibly difficult for shoppers to make healthy choices.

“We know too many people are eating too much salt each day which can have an effect on their blood pressure, a major risk factor for heart disease. Some manufacturers are working towards targets for salt reduction, but we need more action to cut the salt content in bread and make sure they provide colour-coded food labels to help their customers.”

The National Institute for Health and Clinical Excellence (NICE), which provides guidance to medical practitioners, has for the first time recommended using home monitoring to take regular readings over specific time period.

This would help identify people with ‘white coat hypertension’ where the stress of being tested in a GP surgery can cause their blood pressure to rise for a short period, but does not mean they have hypertension.

Cathy Ross, senior cardiac nurse at the British Heart Foundation, said: “The number of people with high blood pressure in the UK is staggering. Some 12 million people are diagnosed with the condition and it is estimated another 5.7million people have it but are unaware. It’s a major risk factor for heart disease and strokes so it’s crucial we do all we can to get people diagnosed and properly treated as soon as possible.

“This new guidance will refine the way we test and treat people for hypertension, particularly by helping to identify people suffering from ‘white coat hypertension’.

“It doesn’t mean that current methods aren’t working, only that they can be improved further. Anyone currently concerned about their blood pressure or treatment, should speak to their GP or practice nurse.”

Researchers studying girls and young women who lived through the Dutch famine at the end of the Second World War have found those who were severely affected by the famine had a 27 per cent greater risk of developing heart disease compared to those unaffected.

Victoria Taylor, senior heart health dietitian for the British Heart Foundation, said: “This study showed a link between children and young adults experiencing famine and the likelihood of them developing heart disease later on in life. Although it wasn’t clear exactly what changes occurred in the body to increase the risk, this highlights how our environment can have a long term impact upon our heart health.

“Fortunately, the problems of famine seen in other countries have not been an issue in the UK in recent times. But that doesn’t make this study irrelevant for us. It adds to the importance of providing a healthy diet for children and young people because of the way it can shape their future heart health.”

The study is published online in the European Heart Journal.

The scientists are developing a programme for testing plant extracts for the ability to stop cells from ovarian tumours growing. In initial tests, several plant extracts killed the tumour samples, taken from cancer patients.

The extracts are complex mixtures of many different chemicals but ingredients in the plants could be used as starting points for new medicines to tackle the disease. The scientists are now planning further investigation of the most promising compounds.

Ovarian cancer is the fifth most common cancer in women, affecting more than 6,500 in the UK alone each year. It is also one of the most deadly, killing more than 4,000 women in the UK annually, despite survival rates nearly doubling in the past 30 years.

The research is an example of the pioneering work of the Strathclyde Institute of Pharmacy and Biomedical Sciences in developing new medicines for illnesses and conditions including infectious diseases, cancer, heart disease, and schizophrenia. An £8 million fundraising campaign is underway for the Institute’s new £36 million building, to expand and enhance its innovative research and education in medicine discovery, development and use.

Alan Harvey, Professor of Pharmacology at Strathclyde Institute of Pharmacy and Biomedical Sciences, said: “Ovarian cancer’s inherent danger to women’s health is compounded by the fact that it is notoriously difficult to detect. The disease’s high death rates urgently need to be dealt with through safe and potent new treatments.

“Our collection of natural plant samples gives us a broad range of possibilities for treatment and we have had good results from many plants. A great many samples have been studied in our collaboration with Portsmouth and a lot of activity has been detected that wouldn’t have been picked up in conventional tests.

“The high throughput screening in the method we have used has produced a high return and we are hoping that more tests will bring new treatments a step closer.”

Ian Cree, Professor of Histopathology, Pharmacy and Biomedical Sciences at Portsmouth’s Institute of Biomedical and Biomolecular Science and Director of the Cancer Laboratory at Queen Alexandra Hospital, said: “This is a first – no one has managed to use cells obtained directly from cancers to screen an entire library of plant extracts and we are very excited by the results obtained.

“The key now will be to obtain further funding to produce drugs from those samples showing that they can kill cancer cells.

“It should be remembered that drug development is a very lengthy process and that these results, though exciting, are a long way from being used in patients.”

The research was funded by The Portsmouth Hospitals Trust Rocky Appeal, which bought the equipment used, and by CanTech Ltd.

Health technologies are among the themes of the Technology and Innovation Centre at Strathclyde (TIC), announced earlier this year- a world-leading research hub for academics and industry at the heart of Scotland’s International Technology and Renewable Energy Zone (ITREZ) in Glasgow.