Live long and prosper

As we develop more Innovation Platforms and delve into the specifics of the challenges that they contain, we get really caught up in the detail and the focus.  Every now and again, it is necessary to take a step back and look at our portfolio of activities and reframe what we are doing. Our recent work with the Biotechnology and Biosciences Research Council, the Medical Research Council and the Office of Life Sciences has taken us on just such a journey through our growing “medical” portfolio. 

We started with Assisted Living in 2007 – actually, as is the way with Innovation Platforms, we had been working with the National Institute for Health Research for about a year before the actual launch, understanding the challenge, listening to the needs of the various communities involved and generally preparing the ground.  

The underlying cause of this area of work is the changing demographics of the UK – and most other developed countries. We are lasting well past our design life (?) and so suffering from illness caused by wearing out our bodies, muscular-skeletal disorders, pulmonary disorders, cardio and circulatory disorders and various forms of dementia.  These can increasingly be treated to delay or ameliorate symptoms, but the increased number of old people means that the current care models will be strained within a decade or so. 

Infectious diseases still ravage many people of all ages and are increasingly dispersed by our penchant for travel. The current news has made us all aware that old diseases can develop resistance to the medicines we currently rely on to avoid them and new diseases can arise by mutation or by crossing the normal inter-species boundary. The development of drug-based therapies, which for years has enabled us to fight off many diseases, is getting more difficult and more expensive. The lower efficacy of the new, more complex or specialised drugs means that we will have to move to a more targeted use of such drugs, where the genetic character of the patient, the disease and the therapy all need to be optimised. 

Lastly, there is a growing trend away from treating illness to maintaining wellness. This requires earlier diagnosis, and therapies that treat early stage development of the disease or the immune response. This, in turn, will require different diagnostic techniques, or long term monitoring to detect differences in longitudinal signals. 

Answering each of these challenges requires the amassing and analysis of huge datasets. Most models for assisted living have non-invasive sensors monitoring the “wellness” of the person in their home, a local analytical tool that determines whether they need any help and at what level. This will have a regular reporting regime to some kind of service hub, but must also have continuous and guaranteed connection in case an emergency arises. The service hub will need to interface with the various forms of service provider, from simple social care, through health visitors, doctors to ambulances.  It is not obvious what the business model for all this will be. Currently, healthcare is provided by the National Health Service when we are ill and is free at point of care.  By contrast, the more social aspects of care are covered by local government and often isn’t free. Will private provision of this type of service become more normal – and who will pay for it, and how?

In order to detect and identify the agents that spread infectious diseases, we will need a new generation of diagnostic tools, and to intercept these infections earlier, they will need to be faster and more accurate. This is the challenge being addressed by the Detection and Identification of Infectious Agents Innovation Platform that we launched last November. Although diagnosis does not constitute a large amount of the NHS budget (about 5%) it determines how most of the rest of it is applied.  And it is not just people that can benefit from advances in this area of technology – animals, both livestock and domesticated, can be tested for the onset of disease and treated earlier and more effectively.  There are a range of scientific techniques that can be used to identify and characterise disease agents, each with their particular advantage and limitation.  We are working with the clinicians and the technology providers to develop what will probably be a set of complementary diagnostic tools, that will give the required information very must faster than is currently possible.

We are now working with MRC, BBRSC, NIHR, OSCHR and the ABPI to evaluate the potential of an Innovation Platform in what is called “Stratified Medicine”. This addresses the growing problem that many new drugs only have limited efficacy.  This specificity of effectiveness is a consequence of the complex biological systems that make up us, the patient, and the disease.  It can be addressed by classifying the genetic make-up of the patient, understanding the genetic make-up of the disease and fitting the therapy to this particular combination.  It would be almost impossible to do this at the “person” level (there are already over 6 billion of us) so the approach is to break people into “strata”. This will require that we understand and record our genetic make-up to a certain level, use the sort of diagnostic being developed under the “Detection and Identification of Infectious Agents” Innovation Platform, and then look up that combination in a library for the most effective treatment.

As is apparent from the descriptions, all of this advances require fairly large amounts of data gathering, analysis and communication and since it is concerned with human health the accuracy and availability of all this will need to guaranteed. All these advances will also challenge our current models, both for service provision and financial return. There is much to do to develop the healthcare that I will enjoy in my own old age, a fact that makes me slightly partial!!

This wider view does not limit itself to the specific class of challenge we address in our Innovation Platforms. The home and local communications requirements of Assisted Living are more or less the same as those under the Low Impact Buildings Platform, where the house must be monitored for optimum energy performance. The systems understanding and wider communications challenge is not too dissimilar from that in Intelligent Systems and Services and since it is an absolute necessity that large quantities of information about the person that all this is focused on must be gathered, analysed and communicated, it is essential that we understand the trust and privacy issues that we are tackling in Network Security.  What strikes me most about this area is the requirement for wholesale change. Whether it is evolutionary or revolutionary, most of our current ways of doing things will not be appropriate within a few decades. That gives those who can understand the challenges, identify answers and then implement them an opportunity to develop new businesses that will offer better health to future generations.

 

Last updated on Thursday 06 August 2009 at 09:30

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  • ExpatAsia|31/07/09 at 12:46 PM

    Excellent article, you have some good insights

    Bratt|31/07/09 at 12:45 PM

    Good to know, never realized it worked like that

    David Bott|31/07/09 at 12:44 PM

    Christoph,Stratified Medicine is the term we have picked up to describe personalised medicine at a higher level of granularity. Instead of truly "personal" medicine, the population is divided into "strata". David

    Christoph Schultes|31/07/09 at 12:42 PM

    Very interesting article, especially the part about "Stratified Medicine." Coming from the oncology field, how much overlap do you see with this program and what is currently being called "Personalised Medicine," which essentially also involves grouping people by genetic makeup with the aim of enriching populations that will respond favourably to particular mdeicines?

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