Queen’s House Consulting was among the delegates at the Royal Society of Medicine 16th Medical Innovations Summit. Covering four general themes, presenters from around the world presented their novel approaches to problems of mental health, issues around the delivery of healthcare, new treatments for disease, and the potential of digital medicine.
Approaches to Mental Health:
While news reports are highlighting the dangers of social media, the Summit heard about two schemes aimed at young people. “MeeTwo” is a peer-oriented, moderated app which allows the posting of problems, concerns and anxieties. It allows users to share solutions and reassurance that they are not alone in their experiences, while also offering links to relevant information, other support groups and expert help.
Moving to the physical world, new procedures have been developed in primary and secondary schools which could reduce exclusions and referrals to mental health services. Adopting a holistic approach to the problems, the system embeds fully-funded and trained pastoral support staff within the school, to work with teaching staff, students and parents/carers. Although the approach is adaptable to different circumstances of age, affluence, education and environment, the benefits of full-time staff appears to offer benefits to everyone and reduce the burden on outside social/health services.
A novel therapeutic approach for some mental health problems was presented, which uses virtual reality to reproduce anxiety-inducing situations in a safe environment. It appears that repeated exposure to the cause of anxiety may induce tolerance and coping strategies which improved the patient’s quality of life.
These presentations prompted discussion about the sustainability of provision; if positive outcomes reflect long term efficacy then these approaches will be sustainable (subject to maintained funding); however, if continued intervention is needed to maintain the outcome then demand will rapidly exceed the capacity to deliver and the programmes will become unsustainable.
Healthcare Delivery
A chance family event prompted the design of an interactive cup to promote hydration of people in hospital or nursing care. The Droplet® device combines a machine-washable mug or beaker with a digital base which can alert user and carer about the frequency, quantity and need to drink. An anti-spill lid without a humiliating “baby” spout completes the design. It is more expensive than an ordinary mug, but probably not if the secondary cost of dehydration (confusion, organ failure, hospitalisation and recovery time) is included in the calculation.
Parental experience of paediatric oncology services prompted a digital innovator to create an app which accompanies children through the bewildering and frightening experience of cancer treatment. The interactive app, which is still in development, uses virtual reality inform and prepare the child, who remains in control by “pulling” information at the level and rate they can cope with, rather than having information “pushed” upon them regardless of their emotional and cognitive state. It also allows physically-restricted and sometimes lonely patients to play virtual-reality games with other children. Presumably there is a significant cost in developing and maintaining such a platform, which would be ripe for charitable investment so that no child with a mobile device need want for such 24/7 virtual support.
On a different business level, the potential benefits of social finance to fund preventative medicine and healthcare compliance was described. The money comes from investors, rather than insurers or national bodies, who fund treatments or prevention programmes while receiving a dividend calculated from the resulting lifetime healthcare savings. The first medical model for such a system is the treatment and prevention of diabetes, where investing in the promotion of healthy lifestyle can reduce the incidence of type 2 disease and the long-term treatment costs for primary and secondary healthcare needs.
Finally, there was discussion about the Access to Medical Treatment (Medical Innovation) Act which could change the basis for new drug availability and clinical trial enrolment. There was a healthy debate about the possible benefits for some patients and the potential to undermine scientifically-based demonstration of efficacy.
A common strand through these presentations was the assumption that funds would flow to the product on the promise of larger healthcare savings in the future. It is not clear whether any cash-strapped provider can afford to make that leap of imagination. The schemes have an implicit expectation that future savings will then be available for re-investment in other healthcare needs; however, the temptation merely to pocket the savings will be strong in any cost-conscious healthcare organisations. Furthermore, the business model should not combine savings based on costs in developed healthcare systems with maximum growth in countries with limited healthcare provision.
New Treatments
The Summit showcased three new pharmaceutical developments which address the challenges of immunisation, genetic disease and treatment compliance/efficacy.
Pathogen mutation which confounds vaccine efficacy may be overcome by the development of vaccine-vector combinations. These can recognise and disrupt the less-mutable internal molecules, rather than raising antibodies against surface antigens which evolve to evade recognition. By overcoming the natural mutation of the pathogen, this technology offers long-term protection against, e.g., influenza, avoiding the need for regular re-immunisation. As well as most stable long-term pathogen recognition, the new approach delivers pathogen-destroying agents, in contrast to conventional vaccines which rely upon the host’s natural defence and elimination pathways. This ability to recognise and destroy internal structures within cells and pathogens also promises improved targeting of cancer cells.
The progress in gene therapy was also discussed, with a growing number of gene therapy clinical trials. The challenges of validating safety and efficacy in a new branch of medicine are great, even though the limited patient numbers seem to indicate long-term correction of the defective gene expression and disease phenotype. The challenge is to determine the need (if any) for repeat dosing with the viral vector and the long-term monitoring for delayed adverse effects. In a commercial world, the high development cost and potentially one-time treatment of a life-long morbidity are not easy to monetarise. Outside the sphere of experimental medicine, such therapies will probably require deep pockets, lease-for-life contracts, or both.
The final area for consideration was the use of intelligent drugs containing a sensor which reports information such as patient compliance, drug function and other physiological response. If used in the formulation of an antipsychotic drug, where patient non-compliance can lead to a spiral of decline, it was suggested that the additional information could inform and justify future clinical treatment decisions. Delegates at the Summit were exercised by ethical, financial and technical concerns around this development. Again, the business model seemed reliant on revenues from grateful healthcare funders whose future costs of poor compliance/efficacy would be avoided.
Potential for Digital Medicine
Finally, the use of technology to improve access and delivery of healthcare was described by three different approaches.
For developing nations, where disperse populations cannot always verify their identity, peripatetic healthcare professionals can use digital fingerprint recognition to confirm the correct medical history of an individual on their mobile device. This device is climatically and physically robust in the poorest parts of the world, even without reliable electric power or internet.
In a different digital field, computer networks are being used to gather, collate, analyse and feedback data on healthcare staff well-being, motivation and delivery, as well as being a scaffold to progress and promote ground-up improvement programmes. It will be interesting to see if the reported benefits over the early months of the scheme within an NHS Foundation Trust can be sustained by both staff and management. In the non-digital world the initial enthusiasm of such scheme’s early-adopters is defeated by: creeping cynicism; realisation that second-wave improvements are more complex than the high-profile initial “quick wins”; and distraction as newer, glossier or urgent distractions emerge. If the digital systems can buck this trend, they would be transformative.
At the very sharp end of healthcare provision is the monitoring and diagnostic power of artificial intelligence (AI) such as the Google DeepMind programme. Such systems can gather and analyse immense amounts of information and retrieve it very quickly. The challenge, which was discussed by the audience, is the weight and credibility given to the AI output, compared to the judgement of the human physician. This becomes particularly relevant when the AI reports unique events which are not detected by the human physician. If the subsequent AI-generated treatment plan is different to the physician’s diagnosis, will the human being be confident (and legally protected) in following their own judgement rather than that of the AI? Conversely, is the human being liable for implementing an unsuccessful AI-generated treatment?
Queen’s House Consulting
Queen’s House Consulting does not claim answers to all the issues raised by this Summit, but can offer strategies which navigate the process/product development cycle from concept to patient. Please contact Queen’s House Consulting to discuss your particular needs.
