"The observation that patients with the same clinical diagnosis or symptoms respond differently to the same treatment has led to the development of Precision Medicine (PM), a novel therapeutic approach that relies on biological information and health data from patient tiers to develop tier-specific treatments that lead to better health outcomes." PM is the evolution of healthcare from a “one-cure-fits-all” strategy to the tailored development of precise medications targeted at specific individuals. It is a holistic approach to diagnosis and treatment in which traditional healthcare plays only a minor role in a patient's health, treating each patient as an individual and using his or her unique clinical data, genomic profile, family history, environmental factors, and lifestyle to more efficiently guide diagnosis, treatment, and prognosis Advancements in PM have been driven by the growing understanding of the biological pathways of diseases at the molecular level and the identification of novel biomarkers (a signature component detected in the blood, body fluids, or tissues, such as genes, proteins, etc.) that signal a normal or abnormal cascade of biological processes within the body. These biomarkers act as specific targets for more accurate diagnosis or more efficient treatment. The concept of PM is not new; oncology has been the main early adopter of this approach in treatment, such as with Xalkori from Pfizer. Wider adoption of PM in other therapeutic areas was limited, owing to the high associated costs and technological limitations in data access and utilization. However, the picture is changing due to rising demands to reduce escalating healthcare costs by reducing reliance on: Unnecessary, non-effective medications, especially for diseases (e.g., psychiatry, oncology, and rheumatology) that are commonly associated with high costs of prescription drugs and low response rates. Traditional diagnostic tools, which are characterized by low accuracy and limited detection of biomarkers, increasing the likelihood of subsequent medical interventions to treat complications. On the other hand, advanced diagnostics can screen millions of circulating biomarkers and detect early signs of diseases. A paradigm shift in the way drugs are developed and manufactured Pharmaceutical companies are under increasing pressure to justify the return on their R&D investments. A few years ago, they were reluctant to invest in R&D for PM due to the compromised commercial values associated with targeting limited populations. Nowadays, pharmaceutical companies are shifting their profit focus to price, not volume, as new drugs targeting niche populations can achieve higher selling prices with much lower marketing expenditures and more guaranteed sales. Big pharma companies can technically rely on their in-house manufacturing capabilities to produce precision therapies, but this is not economically viable because small batches of precision therapies will result in underutilized time, machinery, and resources. The traditional pharmaceutical manufacturing process relies on the production of several batches of high volumes of products to control costs and benefit from economies of scale. This cannot meet the complex needs of PM to produce a wider variety of batches of temperature-sensitive, complex products at lower volumes to serve a wider variety of patient populations. Flexible manufacturing and single-use technologies are emerging to provide companies and CDMOs (Contract Development and Manufacturing Organizations) with greater flexibility to manage the production of a variety of products in smaller batches by allowing companies to replace disposable single-use reactors for each medication. This not only reduces cross-contamination but also improves operational efficiency by significantly reducing the time needed to clean the reactors between different product lines. Advances in digital technology are key enablers for realizing the potential of PM For healthcare organizations to realize the full potential of PM, they must be able to collect enormous amounts of genomic, social, and physical data. They must also leverage modern technologies to transform this complex data into structured datasets that generate accurate insights regarding the best treatments while reducing time and errors. The following are key examples of high-potential technologies. Data analytics and AI Advances in computational power enable the processing of huge amounts of data from various sources and provide valuable insights about the human body’s interactions with drugs. NLP technology NLP created new opportunities for hospitals to leverage their data, an opportunity that was unattainable with humans alone. NLP can learn and understand the human language within the healthcare context more effectively and rapidly than humans. NLP then extracts valuable information from this vast unstructured data and translates it into more structured data sets ready for analysis. Digital biomarkers They are physiological and behavioral data collected via digital devices such as wearables and portables. The widespread use of smartphones, along with the rapid development of sensor technologies, has enabled the accurate collection of health and wellness data in real-time. Digital biomarkers can disrupt traditional clinical assessments because objective and specific data is collected in real-life settings without any external bias. This increases the statistical power and increases the accuracy and sensitivity of the clinical results. A huge promise with challenges ahead Despite the unique potential PM can bring to public health, and how technology is making it more feasible than before, PM is not yet broadly integrated within healthcare systems due to some challenges such as: Quality of data An average hospital produces around 50 petabytes of data annually (1 petabyte is equivalent to 11,000 4K movies). Most of this data is non-standardized and comes from multiple EHRs (Electronic Health Records) and disparate data repositories, making it very challenging and time-consuming to process and use. Economic value Building an economic case for PM is not an easy task because advanced diagnostics and screening tests have much higher costs than traditional tests. Still, PM has strong potential to increase the efficiency of treatments, produce better outcomes, and thus reduce the overall costs of care. This is because PM eliminates the need for repeated diagnostic tests and the traditional trial-and-error approaches, which are more costly and less accurate. Capacity building Physicians lack technological expertise and need to be trained and qualified to be able to interpret the data models built from genetic and biological markers via modern data analytics tools and technologies. Data privacy PM involves the flow of enormous amounts of data among different stakeholders, and it is very critical to ensure the protection of such sensitive data and maintain patients’ privacy. Over the past decade, at least 14 countries have launched genomics-based medicine initiatives According to GlobeNewswire, the global PM market size was estimated at USD 65.89 billion in 2021 and is forecast to increase by a CAGR of 12.1% during 2022-2028, reaching USD 146.57 billion in 2028. Governments and insurance companies are strong advocates of PM to bring healthcare costs down and improve the quality of care, which are the essences of value-based healthcare models. In that sense, they have an important role in developing policies, regulatory reforms, and novel reimbursement plans to accelerate the transition of PM from research to clinical application. Over the past decade, at least 14 countries (Australia, Japan, the USA, the UK, Qatar, KSA, etc.) have collectively invested billions of dollars in large-scale projects to collect genomic and demographic data from thousands or even millions of citizens. These initiatives have great potential to accelerate the integration of genomics within healthcare systems and support the development of PM. Also, big pharma and technology companies are fostering strategic collaborations with strong investments to support the development of precision therapies, for example, in 2022: Google participated in a USD 65 million series A investment round for Vicinitas Therapeutics, which is a precision medicine startup for cancer and genetic disorders. Sanofi has entered into a research collaboration with Exscientia to leverage its AI-based capabilities and personalized medicine platform to develop a pipeline of precision-engineered therapies. Like any new disruptive technology, PM still has many hurdles to overcome, and the key to its success is to get all the ecosystem stakeholders (governments, insurers, pharma and biotech companies, technology providers, etc.) working in silos to collaborate, share resources, and establish standardization frameworks for the diverse data out there. Collaboration is also crucial to reducing costs and driving the development of a sustainable PM-based ecosystem. Sources: https://persmed.elpub.ru/jour/article/download/3/4 https://www.startus-insights.com/innovators-guide/top-10-pharma-industry-trends-innovations-in-2021/#precision-medicine https://www.thermofisher.com/eg/en/home/clinical/precision-medicine/precision-medicine-learning-center/precision-medicine-resource-library/precision-medicine-articles/overview-precision-medicine.html https://www.efpia.eu/about-medicines/development-of-medicines/precision-medicine/#/ https://www.cancer.gov/publications/dictionaries/cancer-terms/def/biomarker https://www.mckinsey.com/industries/life-sciences/our-insights/what-are-the-biotech-investment-themes-that-will-shape-the-industry https://www.technologynetworks.com/biopharma/blog/downstream-processing-in-the-age-of-precision-medicine-trends-and-challenges-365452 https://www.linguamatics.com/solutions/precision-medicine https://www.infosys.com/about/knowledge-institute/insights/documents/precision-medicine.pdf https://www.mckinsey.com/~/media/mckinsey/dotcom/client_service/pharma%20and%20medical%20products/pmp%20new/pdfs/mckinsey%20on%20personalized%20medicine%20march%202013.pdf https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-02910-6 https://www.globenewswire.com/news-release/2022/08/23/2503224/0/en/Global-Precision-Medicine-Market-Generate-Revenue-of-146-57-billion-2-68-Billion-Invested-in-R-D-Activities-in-2021-and-is-Projected-to-Expand-to-5-Billion-by-2028-SkyQuest.html https://techfundingnews.com/google-backs-65m-investment-in-precision-medicine-startup-for-cancer-and-genetic-disorders/ https://www.beckershospitalreview.com/healthcare-information-technology/google-backs-65m-funding-for-precision-medicine-startup.html https://www.sanofi.com/en/media-room/press-releases/2022/2022-01-07-06-00-00-2362917
A massive amount of data is generated every second by billions of active users across many devices, such as computers, tablets, and mobile phones. Over the past decade, from 2010-2020, the amount of data created increased by an astounding 5,000%. Data is everywhere, but it is worthless unless it is properly processed and analyzed. In today's landscape, data analytics, especially in healthcare data analytics, serves not only to formulate business strategies and optimize performance but also to improve the lives of individuals. The efficiency of healthcare organizations depends on converting clinical raw data into valuable and actionable insights to improve patient and clinical outcomes. For instance, electronic health records (EHRs) and other health-related smartphone apps are now essential to determine the patient’s status, optimize the utilization of resources, and provide efficient solutions. What is “Data analytics”? In general, data analytics is the process of collecting, transforming, and analyzing data to identify trends and patterns in order to draw conclusions, make predictions, and drive informed decision-making. Data can be analyzed manually or using tools such as software and algorithms. Data analytics can help optimize operational efficiency, increase revenues, enhance customer service, and boost performance. There are four main types of data analytics: Descriptive data analytics uses past and current data to identify trends and relationships and to understand what’s already happened in an organization. One of the common uses of descriptive analytics is the tracking of KPIs to assess the health and value of a business. Diagnostic data analytics uses the insights identified by the descriptive analytics and dives deeper to understand the causes of the outcomes. Diagnostic data analytics answers the question “Why did it happen?”. Predictive data analytics explores historical data and past trends to predict future outcomes. Predictive data analytics answers the question, “What is likely to happen?” Prescriptive data analytics combines the insights of all the previous data analytics types to identify what actions to take to achieve certain goals or outcomes. It suggests the best possible next steps based on simulations aiming to optimize the performance of an organization. Prescriptive analytics answers questions such as “What is the best course of action?” and “What if we try this?”. What are healthcare data inputs and tools? The healthcare industry is generating a colossal amount of data linked to the health of a patient and the population as a whole. Healthcare data is being collected from a variety of health information systems (HIS) and tools, allowing data to be stored, shared, and analyzed. These tools and systems include: Electronic Health Records (EHR) Personal Health Records (PHR) Electronic Prescription Services (E-prescribing) Patient Portals Master Patient Indexes (MPI) Health-Related Smart Phone Apps Healthcare data is valuable knowledge about the global healthcare system, including patients, staff, and hospitals’ performance. Initially, data inputs are unstructured, uneven, and can be difficult to understand. Data analysts, with the help of several analytical programs and software, clean and validate the gathered data to draw valuable and actionable insights that can help stakeholders formulate decisions. How could data analytics serve the healthcare system? The main function of healthcare data analytics is to gain better insights and enable healthcare organizations to make well-informed clinical and business decisions. Examples of healthcare applications of the four types of data analytics mentioned above include: Descriptive analytics: analyzing the number of positive tests in a specific area in order to determine how contagious a virus is. Diagnostic analytics: detecting an illness or an injury based on the symptoms experienced by a patient. Predictive analytics: exploring the case data of an infectious disease in order to forecast its spread in the future. Prescriptive analytics: examining the pre-existing conditions of a patient in order to determine the risk of future conditions and implement specific preventive treatments. Healthcare data analytics applications can lead to several benefits. According to ArborMetrix, healthcare data analytics is helping organizations enhance their competitive position, improve clinical quality and patient care, promote research advancement, and optimize internal processes (see image below). [caption id="attachment_8268" align="alignnone" width="579"] Source: ArborMetrix[/caption] These key applications cannot be realized without extensive use of advanced software and tools that transform unorganized data into actionable insights. These include artificial intelligence tools, cloud computing platforms, blockchain networks, health information exchanges, and machine learning models. Market overview of HDA The fast rate of technological advancements, the increase in healthcare expenditures, and the massive digitalization of the healthcare industry are driving monumental growth in the healthcare analytics industry. According to Grand View Research, the global healthcare analytics market was valued at USD 29.1 billion in 2021 and is forecasted to grow at an annual growth rate of 21.5% between 2022 and 2030 to reach USD 167.0 billion by 2030. Now let’s look at some of the leading market players that are constantly innovating and using cutting-edge technology to interpret healthcare data and deliver solutions to healthcare providers and institutions. These leading companies include: UnitedHealth Group McKesson Corporation Health Catalyst Microsoft IBM Corporation Cerner Corporation Allscripts Healthcare Solutions MedeAnalytics, Inc. Apixio Inc. Lumiata Inc. Healthcare data analytics in the time of COVID-19 The pandemic has had a significant economic and social impact around the world. Disrupted supply chains, medical supply shortages, and the healthcare system's burden are some of the drastic examples of the detrimental effects of the COVID-19 crisis. Big Data Analytics in Pandemic Decision-Making Big data analytics tools have played a significant role in decision-making to counteract the effects of the pandemic. The enormous amount of data generated by the pandemic incentivized researchers and providers to turn to data analytics and predictive modeling as a means to optimize resource allocation, predict surges and outbreaks, improve patient care, and implement preventive measures. Leveraging Predictive Models During the Pandemic During the pandemic, health organizations started to leverage predictive models to better identify the patients at risk by understanding the factors influencing disease severity and forecasting the number of cases, hospitalization rates, and death rates. In June 2020, Cleveland Clinic researchers developed a predictive analytics model that aims to determine an individual's likelihood of testing positive for COVID-19 and the potential consequences. Predictive models were also useful at a time when patients overwhelmed hospitals and health systems. Many organizations have implemented predictive tools to optimize resource allocation. It has helped hospitals predict staff needs, bed capacity, ventilator usage, and many other metrics. The use of data analytics in the healthcare industry has become crucial. By collecting, processing, and analyzing data, healthcare organizations are able to make more informed decisions. Data analytics in healthcare allows organizations to improve patient care, enhance their competitive position, advance their research efforts, and manage their financial and clinical risk. The global healthcare analytics market is rapidly expanding. This is driven by the monumental rate of technological advancement and the digitalization of the healthcare industry. New technologies continue to emerge at a high pace, driving the healthcare industry toward a major change. From artificial intelligence (AI) to natural language processing (NLP) to machine learning, data analytics is changing every facet of the healthcare industry. Conclusion While healthcare data analytics has a bright future ahead, there are also major security concerns. Patient data is particularly sensitive, and it is difficult to determine the acceptable uses of data while prioritizing security and patients' right to privacy. Healthcare data, no matter how crucial it is for medical scientific development and the success of healthcare providers, should only be utilized if security and privacy concerns are addressed. Sources https://www.arbormetrix.com/blog/intro-big-data-analytics-healthcare https://online.hbs.edu/blog/post/data-analytics-in-healthcare https://www.sisense.com/glossary/healthcare-analytics-basics/ https://www.grandviewresearch.com/industry-analysis/healthcare-analytics-market https://online.maryville.edu/blog/data-analytics-in-healthcare/ https://online.shrs.pitt.edu/blog/data-analytics-in-health-care/ https://healthitanalytics.com/news/how-big-data-analytics-models-can-impact-healthcare-decision-making https://www.ibm.com/topics/healthcare-analytics https://www.emergenresearch.com/blog/top-10-leading-companies-in-the-healthcare-analytics-market https://www.testingxperts.com/blog/Big-Data-Analytics-Healthcare https://www.oracle.com/business-analytics/data-analytics/ https://www.naukri.com/learning/articles/types-of-data-analytics-and-their-applications-in-real-world/ https://healthitanalytics.com/news/3-ways-healthcare-is-using-predictive-analytics-to-combat-covid-19 https://www.marketsandmarkets.com/Market-Reports/healthcare-data-analytics-market-905.html https://www.mordorintelligence.com/industry-reports/global-healthcare-analytics-market-industry https://www.alliedmarketresearch.com/big-data-analytics-in-healthcare-market
Amidst the growing global coronavirus caseload, and the saturation of healthcare systems across the world, the concept of telemedicine has seen a rapid and pronounced rise to prominence. But just what is telemedicine? The World Health Organization defines it as “The delivery of health care services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries […]”. Telemedicine is not a new phenomenon, however, having registered one of its first applications in the early 20th century when electrocardiograms were transmitted at a distance using the telephone line. The technology would go on to find one of its most famous applications in the 1960s, when it was used by NASA to monitor astronauts’ biometric data away from Earth, with the aim of providing remote support in the event of a medical emergency. Telemedicine and the COVID-19 Pandemic With the advancement of ICT, and its ever-increasing penetration rates, telemedicine has seen its possible applications multiply over the last few decades. Before the outbreak of the COVID-19 pandemic, however, there was very limited investment in telemedicine and remote patient monitoring solutions by most countries. Instead, there were only experimental projects that met with limited physician adoption. In Italy, for instance, 2019 research by the Polytechnic University of Milan’s Digital Innovation in Health Observatory showed that only 5% of specialist doctors and 3% of family doctors used these solutions, although more than half were interested in doing so (osservatori.net). In response to the pandemic, governments and healthcare providers were forced to resort to telemedicine in an effort to counteract the shortage of available hospital rooms, beds, and medical staff. Private practices were forced to act similarly as they sought to avoid in-person visits where possible, in a bid to limit further spread of the virus. Telemedicine saw a further surge in adoption as countries pushed their healthcare systems to fill the technology gaps impeding its wider adoption. Looking again at Italy as an example, new data published by the Observatory clearly shows the extent to which the pandemic has brought telemedicine into the spotlight. Three out of four specialist physicians reported believing that telemedicine was critical during the peak of the crisis, with 36% reporting that they were convinced of its benefits and intended to use it in the future. On average, according to general practitioners (GPs), 30% of chronic patient visits and 29% of visits by non-chronic patients could be carried out using digital tools, while for specialist providers these proportions dropped to 24% and 18% respectively. According to McKinsey, by April 2020, overall telehealth utilization at the global level for office visits and outpatient care was 78 times higher than the level registered in February of the same year. By July 2021, that figure had stabilized “at levels 38X higher than before the pandemic” (McKinsey, 2021). Telemedicine in a Post COVID-19 World Given the above figures, it is clear that telemedicine is undergoing something of a renaissance in various parts of the world. Less technologically advanced countries have rushed to pave the way for its development just as eagerly as their more advanced counterparts. But what will the future of telemedicine look like once healthcare resources are no longer so thinly stretched? Will it continue along the trajectory it has followed thus far? Or, will it find itself instead relegated to the theoretical realm, as is so frequently the case with such innovative ideas? The issue needs to be examined from two different perspectives: that of the consumer, on one hand (patients, clinics, hospitals), and that of the providing structures, companies, and governments on the other. Regarding the former, recent surveys carried out by various institutions indicate that both patients and physicians see great value in telemedicine, with many intending to continue using it once the pandemic subsides.(These results vary greatly depending on the type of care provided – psychiatric care witnessed the highest rate of telemedicine uptake, while specialties such as surgery and ophthalmology, quite logically, saw much less significant uptake rates). (McKinsey, 2021). Regarding the latter, we need to consider the profitability of telemedicine to the companies supplying the technologies. Viewed from this perspective, telemedicine is unlikely to spur significant market interest if it remains simply a method to conduct remote patient visits. Analysts seem to agree that videoconferencing visits seem unlikely to disappear any time soon, but that they will have to become more than just a tool to facilitate calls between doctors and patients. Instead, companies active in the sector will have to combine their services with both digital therapy technologies, as well as more traditional treatments. Only vertically integrated players who provide end-to-end solutions will be able to survive. A Good Strategy: Adding Digital Therapeutics to the Package For telemedicine to be profitable and hence attractive to the market, companies providing this service will need to integrate it with other functions. Digital therapy technologies serve as a prime example of the type of additional services that could make a company more competitive in the ever-growing digital healthcare sector. Also known as "digital therapies" (or "DTx"), digital therapy technologies are those that offer therapeutic interventions guided by high-quality software programs. These programs are based on scientific evidence obtained through rigorous clinical trials with the aim of preventing, managing, or treating a broad spectrum of physical, mental, and behavioral conditions. Digital therapy, then, does not refer simply to telemonitoring interventions, nor does it refer to the types of systems offered by pharmaceutical companies to help patients in the management of their diseases (such as Patient Support Programs to monitor adherence to drug treatment). Rather, it represents a host of validated curative interventions, capable of improving clinical results. Whereas pharmacological treatments interact with the patient's biology, digital therapies interact with the thoughts and behaviors of those who use them. They can take the form of apps, video games, websites, or wearable devices, and work by spurring behavioral or lifestyle changes, as well as the application of cognitive-behavioral interventions through the digital creation of guidelines and programs. There are already various examples of digital therapeutics in the market. In 2017, The FDA approved ReSET, an app that offers cognitive-behavioral therapy to those suffering from addiction and opiate abuse issues. That was followed by the June 2020 approval of Endeavor, the first video game for therapeutic purposes, designed for children with attention deficit hyperactivity disorder (ADHD). From Telemedicine to Digital Care to Value-Based Healthcare The deployment of telemedicine, coupled with the addition of other digital health services such as digital therapeutics, goes hand in hand with an approach that has been gaining traction in recent years; that of Value-Based Healthcare (VBHC). This approach recognizes the importance of putting the patient at the center of the healthcare discourse, urging policy-makers and healthcare providers to build a system in which the human side of the patient is not only acknowledged but pushed to the forefront of all considerations. In this context, telemedicine, digital therapeutics, and digital care, in general, can help to create a more holistic and personalized approach to healthcare. Considered alongside the more obvious benefits of telemedicine, such as the decentralization of health interventions and the increased reach of, and accessibility to medical care, it would seem that telemedicine is destined to thrive, becoming a fundamental element of care in the years to come – but only so long as it is accompanied by a general evolution towards more patient-centered, cost-saving and socially sustainable healthcare policies. Sources https://www.marionegri.it/magazine/terapie-digitali https://www.eng.it/resources/whitepaper/doc/telemedicina/ENG21_IP_Telemedicina_ita.pdf https://www.who.int/goe/publications/goe_telemedicine_2010.pdf https://www.osservatori.net/it/ricerche/osservatori-attivi/sanita-digitale https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality https://www.endeavorrx.com/
COVID-19 Vaccines and the Nocebo Effect Ever since Covid-19 vaccines were approved in December 2020 (if not before) public opinion has been strongly polarised between supporters of the life-saving drug (which include the vast majority of the medical and scientific communities) and skeptics. While most of the skeptical positions regarding the need or efficacy of the vaccine can be traced back to a misunderstanding of epidemiology and public health, misinformation, or even political bias, the conversation surrounding the vaccine’s side effects is more complex. For one, vaccines actually have officially recognised and common side effects. These are the now-ubiquitous headaches, fever, body aches, nausea, and general tiredness that we’ve come to know. However, as vaccination rates grow beyond high levels (>70%) more cases of rare severe side effects (such as an allergic reaction) will emerge. This is not because vaccines are more dangerous than initially estimated, or because of some nefarious governmental conspiracy, but because of a “paradox effect” where the absolute number of severe side effects increases because of the growth of the vaccinated population. In this case, correlation really is not a causation. This issue, especially when it encounters a hypercharged media environment, can cause quite a headache for governments who are trying to anticipate public anxiety and encourage people to take the vaccine. This was the case last March when viral-vector-based vaccines, like the Oxford-AstraZeneca and Johnson & Johnson vaccine, became temporarily associated with rare, but dangerous and even fatal blood clots. Countries were too fast to react, with some completely banning these vaccines, or restricting them to the 60+ population. Further investigation showed that the cases of blood clots were in fact consistent with rates in the general population, and the vaccination campaign has resumed. However, the structural growth of side effects (whether they be real or only correlated) is a major factor contributing to vaccine hesitancy worldwide. What’s worse is that social apprehension surrounding vaccination may even be inducing adverse effects unrelated to the chemical properties of the drug. For example, the following phenomenon occurred in vaccination centers in the US: cases of “fainting, excessive sweating, nausea, and vomiting” were reported in vaccination centers across the country, after individuals received their dose of the Johnson & Johnson vaccine. The CDC noted that for most individuals, fainting, nausea, etc. were indeed anxiety-induced events. Why do individuals experience such effects after receiving the new COVID-19 vaccine? The answer lies in the phenomena known as the placebo and nocebo effects. What is a Placebo or Nocebo Effect? The previously mentioned (indirect) effects of the COVID-19 vaccine on individuals, causing dizziness, fainting, nausea, etc. is a clear example of an altered nocebo effect. Literature defines the classic nocebo as “a substance without medical effects but which worsens the health status of the person taking it by the negative beliefs and expectations of the patient”. For example, as proven in many experiments, patients are given a sugar pill as a treatment for a certain condition and are told to expect side effects such as nausea, drowsiness, or pain. Although they are merely given a sugar pill, patients still reported experiencing such side effects. It’s easy to understand how powerful this effect can be for a treatment like the COVID-19 vaccine, which has been the source of daily discussions and media coverage for the better part of a year. On the other hand, a placebo is the exact opposite of a nocebo. Defined as “a substance without medical effects, which benefits the health status because of the patient's belief that the substance is effective”. Like a nocebo, a placebo sees patients experiencing a clear improvement of symptoms and general advancement of wellbeing. In conclusion, whether interlinked with positive or negative health outcomes or experiences for individuals, both effects are the result of psychological and physical reactions to non-active ingredients and most often occur due to expectations, conditioning, idea framing, and individual psychological state. Clinical Management and Reversing (or Fortifying) of Both Effects The question remains as to how both effects can be clinically managed, or if they even should. Recent research and experiments, especially regarding the nocebo effect, highlight the importance of managing patient expectations, providing a comprehensive overview of the treatment plan, clearly discussing possible side effects as well as double-checking with each patient on an individual level if all parameters associated with the treatment are understood and accepted. Additionally, the method of “counterconditioning” has also been proven to be highly effective in the case of nocebo effects. By “turning previously negative learned associations into positive ones”, nocebo effects can be drastically reduced and even converted into a (sometimes) useful placebo effect. By definition, a nocebo effect is always undesirable as it produces negative effects in a patient. It is not always possible to completely reduce or prevent nocebo effects, however, they can be countered by combating false rumors of unfounded side effects, and improving effective communication between doctor and patient, etc. On the other hand, placebos pose a slightly different type of problem as they produce effects that to a certain extent can be beneficial to patients. In fact, a placebo effect may even be desirable if it occurs within the context of an appropriate treatment since it reinforces the positive outcome. On the other hand, a placebo is dangerous when it occurs within the context of inappropriate treatment and it only provides the illusion of an improvement convincing the patient to insist on an ineffective or even dangerous therapy and to ignore better ones. Placebos therefore should be carefully examined and managed, following a “Minimize, Maximize, and Personalize” approach. Research indicates that during clinical trials, the placebo effect should be minimized as far as possible to correctly evaluate the efficacy and success rates of a drug still in the clinical research phase. However, once a drug is approved, physicians should aim to maximize placebo effects by managing patient expectations. This can be optimally achieved by personalizing care to a patient's genetic predispositions, personal preferences, personality, and medical history. In sum, both effects are very common globally, and the COVID-19 pandemic has exacerbated them tremendously. In this period of public health crisis, policymakers face the double task of suppressing nocebo effects which undermine national vaccination campaigns while at the same time also contrasting placebo effects associated with alternative and unproven Covid treatments (such as hydroxychloroquine, ivermectin, or homeopathic remedies) which may even be dangerous to individuals or prevent them from seeking proven medical help. In both cases, the only instrument is transparent and coherent communication especially from physicians which aims at educating the public on these phenomena. Now more than ever public relations play a fundamental role that directly affects our wellbeing, determining even whether we may get a headache or not. Sources Information and Data: https://www.frontiersin.org/articles/10.3389/fphar.2020.581840/full https://clinicaltrials.gov/ct2/show/NCT04325893 https://jamanetwork.com/journals/jama/fullarticle/2774382 https://pubmed.ncbi.nlm.nih.gov/23449306/ https://pubmed.ncbi.nlm.nih.gov/29119079/ https://journals.lww.com/painrpts/Fulltext/2019/06000/How_to_prevent,_minimize,_or_extinguish_nocebo.23.aspx https://www.healthline.com/health/placebo-effect#the-psychology https://www.healthline.com/health/placebo-effect#real-examples https://www.healthline.com/health/placebo-effect#what-we-dont-know https://www.healthline.com/health/placebo-effect#takeaway https://www.webmd.com/pain-management/what-is-the-placebo-effect https://www.healthline.com/health/placebo-effect https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00801/full https://www.karger.com/Article/FullText/490354 https://www.webmd.com/balance/features/is-the-nocebo-effect-hurting-your-health https://www.nejm.org/doi/pdf/10.1056/NEJMra1907805 https://www.nejm.org/doi/full/10.1056/NEJMra1907805 https://pubmed.ncbi.nlm.nih.gov/24909245/ https://www.foxnews.com/health/anxiety-fainting-johnson-johnson-covid-19-vaccination-cdc-warns https://www.nature.com/articles/d41586-020-03441-8 https://www.who.int/news/item/31-12-2020-who-issues-its-first-emergency-use-validation-for-a-covid-19-vaccine-and-emphasizes-need-for-equitable-global-access https://www.fda.gov/news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-authorization-first-covid-19 https://jamanetwork.com/journals/jama-health-forum/fullarticle/2779081 https://www.kent.ac.uk/news/science/28135/explainer-why-do-covid-19-vaccines-cause-side-effects https://www.linkedin.com/pulse/35-vaccinations-second-nocebo-effect-rich-parker https://pubmed.ncbi.nlm.nih.gov/33682603/ https://www.euronews.com/next/2021/05/27/why-are-aztrazeneca-and-j-j-vaccines-causing-blood-clots-scientists-claim-they-have-the-an
In recent years, Big Tech companies’ interest in the healthcare industry has strengthened. The global pandemic accelerated Big Tech’s march into a sector experiencing a digital revolution and generating an ocean of data. Today, after making vast fortunes from processing data, these companies are orienting their expertise to healthcare and are very keen to offer their services to overwhelmed healthcare systems. The current state of healthcare The rise in the number of wearable sensors, the digitization of patient records and expansion of virtual healthcare services formed digital biomarkers, this type of biomarkers is expected to have the biggest impact on medicine because of the vast amount of data it’s creating. Benefiting from computing power and expertise in data analytics, Big Tech is entering a $3.6 trillion market in the U.S. just by utilizing the same tools that have allowed them to disrupt other industries. GAMA’s interest in healthcare Accelerated by the Covid-19 pandemic, the digitization of healthcare fueled investors interest in digital health companies raising a record $14.8 billion in VC funding in 2020 and amplified big 4 tech firms’ collaboration with healthcare industry and support of startups and new innovations. The chart below showcases the considerable interest in Telemedicine which increased by 140% compared to 2019. At the same time, Big Tech companies are accelerating their presence in the healthcare market with different strategies. Below, we break down the tools and efforts of these players to disrupt healthcare. Amazon Amazon launched a health care service called ‘Amazon Care’ for its own employees allowing them and their families to get in touch with health care providers within a minute of their requests. Amazon is also leveraging its delivery capabilities to make headway into the medical supplies’ distribution space. Microsoft In 2021, Microsoft announced that it had struck a $19.7 billion agreement to purchase Nuance Communications. This company’s technology is used by almost 80% of hospitals in the US and helps automate the process of taking notes during patient consultations, reducing the time doctors spend on administrative work. Apple Apple enables the collection of healthcare data via apps and wearable tech through the Apple Watch. The company has teamed up with various institutions to establish the clinical accuracy of Apple Watch features. One of the most recent ones showed that the cardiac metrics it monitors is as good as clinical tests. The results suggest that the Apple Watch could be adequate for remote monitoring of elderly patients with cardiovascular disease. Google (Alphabet) Google uses artificial intelligence to read electronic health records and then try to predict or identify medical conditions. The company uses machine learning to analyze a vast array of health records collected by hospitals and other medical institutions. The matrix below showcases Big tech companies’ strengths, weaknesses, opportunities, and threats in the healthcare industry. Challenges in Digital Healthcare Infrastructure As the virus spread and safety concerns grew, virtual interactions became a necessity exposing weaknesses in healthcare infrastructure. Healthcare systems around the world have been quite slow in using modern technology to revolutionize their sector as revealed by a study conducted by OECD on 23 countries. The study indicates that many members of OECD have a high proportion of digitized health data but only a small percentage of them are regularly linked with other sources of information making vast quantity of data redundant. In other words, Big Tech companies need to assemble and link datasets to give insights and identify patterns and trends. However, digitization of healthcare systems around the world is slowed by the technological readiness of some countries and lagging of regulatory legislation. Privacy Evidently, governments play a crucial role in facilitating Big Tech’s entry in healthcare especially allowing access to patients digitized health records, a very sensitive subject considering tech companies’ spotty track record regarding privacy and use of personal data. A survey conducted by Rock Health shows that patient’s willingness to share health data, with technology companies is predictably low with only 11% of respondents willing to do so. By contrast, patients were more willing to trust their doctor as the study indicates that 72% of patients are willing to share health data with their physician. This is not happenstance, Apple’s and Google’s previous mishandling of user data is slowing their progress in healthcare markets as they need to rebuild their public image before gaining patient’s trust back. Outlook of Digital Health market Big Tech giants are targeting a growing market armed with $500 billion in cash giving them a substantial force for disruption. A Roland Berger forecast predicts an estimated 24.7% CAGR in the global digital health market reaching $657 billion in 2025. As tech companies move into healthcare, it is necessary for legacy players such as hospitals and pharmacies to adapt their strategies and embrace new technology like telehealth and remote patient monitoring tools. Products and solutions from tech companies will increasingly become more distributed and sophisticated as the quality and volume of data improves. It goes without saying that the future of healthcare will be told outside the hospital. In a future where healthcare is embedded into all aspects of everyday life, it will be crucial for Big Tech to win over consumer trust with their solutions and digital advances to make primary health care more convenient, accessible, and helpful to the general population. Sources Google to Store and Analyze Millions of Health Records https://www.spglobal.com/marketintelligence/en/news-insights/latest-news-headlines/big-tech-to-continue-healthcare-push-in-2021-with-500b-in-capital-to-deploy-61583319 https://www.investorschronicle.co.uk/ideas/2021/04/15/ideas-farm-is-a-big-tech-healthcare-revolution-on-its-way/ https://resultshealthcare.com/wp-content/uploads/2021/01/Big-Tech-in-Healthcare-Results-Healthcare.pdf https://medicalfuturist.com/tech-giants-in-healthcare-2021/ https://www.pharmiweb.com/article/the-influence-of-big-tech-on-healthcare https://newrepublic.com/article/162553/amazon-care-pharmacy-big-tech-universal-healthcare https://www.globalxetfs.com/introducing-the-global-x-telemedicine-digital-health-etf-edoc/ https://www.businessinsider.com/2-14-2021-big-tech-in-healthcare-report https://www.oecd-ilibrary.org/docserver/55d24b5d-en.pdf?expires=1623542895&id=id&accname=guest&checksum=D3993356186104EECFED54092A2764D9
