13 November 2018
For most people, adulthood is a time of relatively good health and infrequent contact with health services. However, throughout our lives, genes and environmental factors are continuously interacting to shape physiological and pathological changes that could eventually lead to disease, which mostly manifests in later life.
In many cases, the effects of genetic, lifestyle and environmental factors on health go unrecognised during adulthood.These years contain an important and largely missed window of opportunity in which individuals could better understand their own health, optimise their current health and reduce their chances of serious disease in later life.
As part of My Healthy Future, PHG Foundation are hosting stakeholder workshops and roundtables to explore the role of evolving biomedical and digital technologies in improving the health of individuals in 20 years’ time. Participants have been considering the challenges, opportunities and potential impacts on health systems and wider society that these technologies present. The last of four life-stage workshops focussed on the future of adult health, with particular areas of interest in the potential of new personalised health technologies to optimise health and prevent disease.
Developments in biomedical and digital technologies are bringing us closer to an era of personalised medicine, in which our individual characteristics and behaviours may be analysed to enable prediction and earlier diagnosis of disease. This could lead to earlier interventions, for example in the form of personalised prevention strategies or targeted therapies.
To visualise how these technologies might work together to deliver personalised medicine within mainstream healthcare, we described the medical journey of a fictional individual who becomes aware of her risk factors and has access to a multitude of tools to help her to live more healthily. We reflected on some of the themes and ideas that have emerged from the life-stage workshops, to propose a vision of what health systems may be able to offer her in 20 years’ time.
Chloe is a 25 year old woman, who is attending an appointment with her GP because she wants to start taking the combined oral contraceptive pill (COCP). She is an overtly healthy adult and has never had any significant health problems, other than mild childhood asthma and minor ailments. To determine whether the Pill would be suitable and safe for Chloe, her GP reviews her risk factors for breast cancer and cardiovascular disease.
Chloe has a family history of cardiovascular disease and prostate cancer. At birth, she received whole genome sequencing as part of the newborn screening programme. She was informed of the results at age 18, but this hasn’t impacted on her lifestyle choices. Chloe’s GP reminds her that she has genetic risk factors that increase her likelihood of:
Chloe also has a number of lifestyle risk factors, particularly relating to diet and physical activity. Her body mass index (BMI) indicates that she is overweight and health-related data from Chloe’s wearable fitness tracker and online grocery records reveals that she is only physically active at weekends and that her diet is likely to be too high in sugar and saturated fat. Chloe has never smoked and drinks the equivalent of two bottles of wine each week.
Chloe’s GP advises her that the Pill slightly increases the risk of breast cancer and that it would be beneficial for her to reduce her overall risk by changing some of her lifestyle choices. Chloe’s GP is able to prescribe an evidence-based weight loss programme delivered by an approved app, which collects and analyses data from paired wearable devices and allows her to communicate with an AI dietician. In addition to an activity tracker, a tooth-mounted biosensor can monitor her consumption of refined carbohydrates, fat and alcohol. Machine learning enabled data analytics generate insights into Chloe’s routine, preferred types of food and exercise, and when she is most likely to be receptive to motivational messages, so that activity and dietary reminders can be delivered without prompting ‘alert fatigue’.
Chloe’s GP is able to prescribe an evidence-based weight loss programme delivered by an approved app, which collects and analyses data from paired wearable devices and allows her to communicate with an AI dietician. In addition to an activity tracker, a tooth-mounted biosensor can monitor her consumption of refined carbohydrates, fat and alcohol.
Chloe is prescribed the Pill, on the understanding that this will need to be reviewed at age 35 and that she should perform regular breast self-examinations. In view of her genetic risk factors, implantable biosensors providing continuous monitoring of blood cholesterol levels and circulating cancer biomarkers are offered to Chloe, which provide extra reassurance and will signpost her to seek medical advice should any significant changes be detected. Chloe is also reminded that, when she is ready to start a family, a pre-pregnancy screening programme is available to assess her risk of fertility problems and pregnancy complications.
Whilst by no means a prediction of healthcare in 20 years’ time, ideas generated through our life-stage workshops are used here to demonstrate how emerging biomedical and digital technologies could impact common scenarios in routine healthcare. Anticipating the issues that these technologies could provoke can help us develop pre-emptive strategies to manage their successful implementation.
For example, at first glance, technology driven healthcare systems may seem to conflict with healthcare approaches that intend to put personal circumstances, values and desires at the centre of decision making (as in person centred care). How can we make them work in harmony? How can we ensure increasing availability of technologies equates to accessibility to all and does not exacerbate health inequalities? What are the implications for overdiagnosis? And how can we ensure all technologies are rigorously regulated and evaluated? In addition, it will be essential to engage patients and citizens with their own health before they become ill and to empower them to benefit from these technologies with support from the health system.
We are continuing to explore each of these issues at PHG Foundation, in advance of publishing a full report of the findings and recommendations from My Healthy Future in 2019.