Preventive medicine - Interview
Collaboration is key

There is a new view of preventive medicine emerging. Callan Emery speaks to Dr Claus Biermann of Philips Medical Systems’ eHealth.

An ounce of prevention is a pound of cure, so the saying goes.

The practise of preventive medicine has been around for quite some time, particularly in the form of vaccinations. However, with the more recent development of sophisticated medical imaging and screening devices a new view of preventive medicine is starting to emerge in the consciousness of consumers – the view that you can maintain your good health by having regular screening to detect disease early and treat it quickly and successfully. This, rather than waiting for symptoms of disease before visiting the doctor.

But it is early days, and at this stage it is only largely the relatively affluent younger and middle-aged generation in the Developed World who can afford these preventive measures. In large part, health insurance companies won’t pay for preventive screening. They say if there is no illness there is no need to pay. Nonetheless, increasingly young adults, especially in Europe, are no longer waiting for symptoms of illness before visiting their doctor. They are instead having regular health checks – for high blood sugar levels, high cholesterol, hypertension, cardiovascular disease and early signs of cancer. In most cases they will leave the clinic fit and healthy. In a few cases disease will be detected early, and the chances of successful treatment will be greatly improved.

Speaking at the Health Expansion Congress in Dubai in September, Dr Claus Biermann, vice president, New Business Development eHealth, Philips Medical Systems, said preventive medicine is an increasingly important part of the ‘Cycle of Care’ – that is prevention, diagnosis, treatment, rehabilitation, and management of disease.

Looking to the future of healthcare in the Middle East, he noted that there were three areas of concern:

1. The population growth, which is expected to nearly double in the GCC by 2025 at current growth rates;

2. The ageing population – in Saudi Arabia, for example, the number of people over 65 will increase more than sevenfold during the next 25 years;

3. The increasing prevalence of preventable chronic diseases such as diabetes, hypertension and heart disease.

“Due to changing lifestyles and diets, chronic diseases are rising rapidly. Worldwide, many more people now die of chronic diseases – cardiovascular disease, cancer, diabetes – than infectious diseases such as malaria, tuberculosis and HIV/AIDS, with the exception of Africa.

“This is a human and financial tragedy as chronic diseases are preventable, and the management of chronic diseases is very expensive,” he emphasised. Speaking to Middle East Health, Dr Biermann said preventive medicine will need to play an increasingly important role in the cycle of care in order to manage and ward off this impending financial burden in the region.

He said that in Europe there was a growing number of so-called ‘prevention centres’, which focussed exclusively on health screening and early diagnosis.

“They are quite expensive, but more companies are getting involved by paying for their staff rather than the cost being borne by the general insurance companies,” he said.

These visionary companies foresee the long-term benefits of preventive medicine. By keeping their staff healthy and detecting disease early they can keep the cost of treatment relatively low, the time of treatment relatively short and in turn have their staff take less sick time off work and be more productive.

Insurance companies

Dr Biermann said that in order to advance the practice of preventive medicine, the collaboration of key players in the healthcare industry will be required, that is government, the private sector and, importantly, health insurance companies.

“I strongly believe that all players in the healthcare sector have to work together and co-operate across traditional boundaries – business, governments, insurers and healthcare providers. No single group can meet all the challenges and answer all the questions on its own.

“This also means that we have to align all incentives in our healthcare systems. For the good of patients, healthcare providers and tax payers, we have to ensure that the financial and professional interests of all players are in line with our overall, common goal – to provide quality healthcare to people in a financially sustainable way.”

Through these alliances access to healthcare can be expanded and the scope of preventive medicine extended.

Currently many health insurance companies do not cover health screening. They fail to do so, even though the long-term economic benefits of early diagnosis and treatment clearly outweigh the economic burden of late diagnosis and long-term management of these chronic conditions.

Asked how best the insurance companies could be brought on board in an alliance that was supportive of regular health screening and preventive medicine, Dr Biermann pointed out that the “health insurance companies require data to prove the economic benefits of preventive medical screening, and this data is not yet available”.

Innovative devices

Apart from the need for these alliances, some companies are already playing an active part in promoting preventive medical care by researching and developing devices to enable individuals to better monitor their own health and to be alerted early to any signs of illness. ‘My Heart’ is one such R&D programme. This initiative was set up by a consortium, comprising 33 industrial, research, academic and medical organisations from 10 European countries. With a budget of some Euro 35 million they are working on both the preventive and management aspects of chronic cardiovascular disease. The initiative is expected to run until 2008.

Philips Research is one of the key contributors to the My Heart project and is looking specifically at the application of technology that monitors vital body signs, analysing the measured data in relation to heart function and providing direct feedback to users or clinicians.

The technology common to all of these applications are on-body sensors and electronics for monitoring vital body signs and the physical movement. These sensors have been integrated into functional clothing and combined with wireless-based telemetry and user interaction systems to produce prototype product concepts which are currently undergoing clinical trials.

Referring to the cycle of care, Dr Biermann noted that “we know prevention is better than cure, but where a disease cannot cured then disease management is better than hospitalisation”. And it is here that Philips has focussed their research in the My Heart project, specifically with two prototype systems – a disease management system for heart failure patients and a sleep monitoring system that can be used by patients suffering from sleep disorders or anyone who wishes to improve the quality of their sleep.

The heart failure management system can provide several days advance warning of life-threatening events, giving doctors time to stabilise the condition by modifying the patient’s drug regime rather than having to admit them to hospital.

The system comprises an electronic weight scale and blood pressure monitor, a zip-up body vest with integrated electrodes and control electronics to measure the patient’s ECG and sensors that are placed in the patient’s normal bed to measure heart rate, breathing rate and body movement while sleeping. All of these devices communicate measurement data via wireless links to a PDA on which the heart failure management software runs. This software guides the user through a daily ritual of taking their weight, blood pressure and ECG measurements, and then combines this data with information from bed sensors to assess changes in overall heart function. It also identifies specific conditions such as atrial fibrillation and cardiac arrhythmias that require medical attention. Measurement data can then be delivered to healthcare providers either via the phone network or a system such as Philips’ Motiva Interactive Healthcare Platform.

The same bed sensors and electronics that are used in Philips Research’s heart failure management system can also be used to analyse sleep quality and give users valuable feedback on how to improve it.

And like the alliances Dr Biermann recommends, Philips emphasises that the innovations in preventive medicine resulting from the My Heart project could not be achieved without the collaborative, multi-disciplinary approach which is so fundamental to this research and development, an approach which brings together hardware engineers, software engineers, textile manufacturers, industrial designers, clinical experts and healthcare providers.