FREEDOM AND SAFETY
The World Health Organization (WHO) has identified non-communicable diseases (NCDs) as one of the major challenges in health for the 21st century. Now declared a global concern, their increasing prevalence is no longer limited to first world countries, as they overarch low- and middle- income states, causing 85% of premature deaths. The evolving nature of NCDs, as well as variations in human responses to treatment, call for an urgent revolution in healthcare where collaborations with multidisciplinary teams will yield greater improvement in health outcomes.
The usual healthcare paradigm relies heavily on patient-clinician interaction, with the latter solely responsible for diagnosis and treatment. Though this has been a longstanding practice, I do believe that a more efficient approach will entail the involvement of scientists in the system. The identification of disease affecting an individual and which treatment, whether pharmacologic or palliative, can be achieved through medicine; yet managing diseases goes far beyond the walls of the clinic. Science supplements medicine by answering why certain treatments work on others, but not for rest of the patient population. Furthermore, science has paved the way for the discovery of disease-specific genes, resulting in more precise markers for risk assessment and diagnosis. By keeping these two fields separate, we lose the opportunity to provide patients with the utmost in medical care. This is especially true for NCDs where host genetics play a crucial role in their development and progression.
Cancer is the second most aggressive NCD resulting in 9.6 million deaths worldwide in 2018, with a predictive mortality of 13 million by 2030. This makes it more challenging to achieve sustainable goal 3.4, which aims to reduce premature deaths from NCDs by one-third in the latter year. This insurgence in mortality rate will inevitably lead to a global rise in first-course chemotherapy demands by 53%, as well as cancer physician workforce by 2040. Fortunately, there is a way to circumvent this. The fact that malignancies take time to develop can work to our advantage. First, this will give us ample time to detect precancerous cells, even before they fully transform and proliferate. Catching cancer in its early stages will give patients a higher chance of survival.
On the other hand, a full-blown disease will merit the need for a more accurate and efficient way of selecting targeted and appropriate treatment through cell marker identification and intervention – this is where scientists come in. The advent of precision medicine has made it possible for scientists to actively participate in patient care. We are now able to conduct research that can map out the genetic make-up of individuals and develop tailored diagnostic and treatment methods without harming non-cancerous cells.
In the case of breast cancer, a mutation found in the protein Human Epidermal Growth Factor (HER-2) was proven to be associated with cancer progression, and this is only expressed in selected patient groups. Detection of HER-2 aberration by tumor profiling of breast biopsies is used as the basis for Trastuzumab treatment. More recently, a potential vaccine for HER-2 positive patients is being studied and shows a synergistic effect with the drug. This combined treatment may not only stop cancer progression, but also prevent recurrence.
Although scientists continue to discover targeted screening and treatment methods, such a measure usually takes 17 years until its actual utilization in clinics. This slow pace in the translation of research emphasizes the need for the current healthcare system to lean towards a more scientifically oriented route; one that is more open to collaboration with researchers. As a young scientist in the Philippines, I’ve witnessed firsthand the fragmented relationship between the bench and the bedside, where each works separately in a linear continuum. While scientists work in the lab to establish theories and develop new technology, clinicians attend to their patients. This type of isolated system does not guarantee that scientists and clinicians will be able to deliver exactly what the patients need. What can we do to bridge the gap?
Physicians and scientists have different expertise, but neither is more important than the other. Clinicians are well-oriented in pathological process of diseases and the type of care the patients need. On the other hand, scientists are able to test clinical hypotheses using biological methods and create new approaches for patient care based on their discovery. Without collaboration between the two, it is impossible for medicine to advance and for science to serve the people.
Data-gathering and laboratory results during initial patient consultation are crucial for determining a patient’s condition. Scientists must already work with physicians at this point by supplementing patient data with molecular-based techniques. This is also the perfect time to acquire information on how diseases progress and why manifestations vary across patients. Having an idea about these things will help them generate more clinically significant research questions.
Convergence of the aforementioned fields means that a more open health system be established. The Fourth Industrial Revolution emphasizes the need for diverse fields to help one another improve our communities. Medicine and science can empower each other and extend collaboration with other stakeholders, such as data scientists, biomedical engineers and other healthcare practitioners to make sure the healthcare remains for the people, not against it.
This has been a challenge in both fields due to data privacy and preserving the novelty of research findings. There has to be a way to transmit information that will protect privacy and allow scientists to use the information while maintaining patient’s anonymity. Blockchain may be a potential solution for more secured data transmission, though this has not been fully integrated in healthcare institutions. In terms of novelty, we should learn to draw the line between prestige and purpose.
Science is perceived as intimidating, technical and difficult to understand, but that shouldn’t be the case. Scientists must learn how to communicate their work in a more understandable manner and make it accessible to all people.
There is so much work to do in order to bridge the gap between science and medicine. Before we address other areas, such as industry partnerships, commercialization, accessibility of genomic testing and policy-making, let us begin by cultivating a strong collaboration between clinicians and scientists during patient care.