FROM smart clothes, to genome editing, cell therapy, patient-centred medical homes, virtual house calls and "benevolent bribes" — 2014 is set to usher in a new era of precise, effective, and best of all, preventative treatments for a range of health problems and diseases.
Technology is at the forefront of the push. It is the main driver analysts have identified as about to make healthcare into a proactive, rather than a reactive industry, as it has been in the past.
This year, Forbes magazine profiled venture capital-backed entrepreneurs in the US, who are leading the way internationally to "bring healthcare into the 21st century, all of whom are seizing on opportunities not even feasible until very recently".
The magazine quotes Zoe Barry, CEO and founder of ZappRx, a US healthcare startup company that combines e-prescribing with mobile payment technology into one simple smartphone app for managing prescriptions, among trends that are "opening up what could be a land grab for ambitious startups who want to disrupt the healthcare space".
One trend is new legislation in the US known as the Hitech Act, which is encouraging electronic medical record adoption, and has forced major players such as Amazon’s Web Services to make technology available to those working in healthcare.
Another is the rise of "accountable care organisations". Forbes quotes Barry as saying that these will shift doctors’ compensation models away from fee-for-service to pay-for-performance. That is a controversial issue in South Africa, one that has long been of concern to those seeking ways to halt runaway healthcare costs.
Accountable care, according to analysts, will mean that to be reimbursed by medical schemes, doctors will need more information about patients, and to get the data, they must be more open to adopting more technology into their practice.
Other trends identified by researchers in and out of academia are:
Data-Rich Wearable Devices
The next big thing in personal medical technology will be a next generation of truly useful devices and sensors that can send data to care providers, says Dr Michael Blum, chief medical information officer of the University of California (UCSF) Medical Centre on the university’s website.
"The only way this technology is going to revolutionise health is if it actually tells doctors what they really need to know about their patients, when they need to know it.
"The marketplace is awash in wearable medical technology, but these devices won’t really help doctors treat their patients until we figure out how to manage all that data," he says.
At design level, that means wearable heart rate monitors that do not merely mimic the look of an ECG — electrocardiogram — but also collect clinically usable data on heart signals, he says.
"At the level of organisation, it means collecting the kind of data that a physician finds meaningful, and not just what seems cool to consumers."
Researchers are also developing wearable "smart garments" that are expected to be on sale next year. According to a recent Mashable post, a Canadian-based company, OMsignal, has devised the world’s first bio-sensing apparel to track daily health and wellness.
On its website, the company says embedded sensors in the apparel will monitor heart rate, breathing and activity while an app displays your data in real-time on cellphones.
OMsignal co-founder and CEO Stephane Marceau is quoted in a press release saying: "When you think about it, clothing is the original wearable. We’re going to see technology integrated directly into our clothing — first through sensors, but eventually it will be weaved into the fibres."
Rather than directly targeting the cancer cells, immunotherapies are focused on driving a cancer patient’s immune system to eliminate tumours, says Dr Lawrence Fong, UCSF associate professor of medicine, in the university press release.
"In contrast to conventional cancer treatments, immunotherapies can lead to long-lasting clinical responses."
Dr Fong is one of growing numbers of specialists and oncologists worldwide who say that conventional chemotherapy for cancer is seriously lacking.
"Currently available compounds kill normal cells as well as cancer cells, leading to serious side effects," Dr Fong says.
The immune system, meanwhile, is "remarkably effective at combating foreign bacterial or foreign invaders while sparing normal cells, but the goal of coaxing immune cells to target cancer has eluded researchers for decades", he says.
In recent years, researchers have identified receptors expressed on immune system cells that put the brakes on the immune response. In recent clinical trials of antibodies that block these receptors, doctors have seen "unprecedented responses in metastatic melanoma and lung cancer, both of which are almost always fatal with conventional treatments".
Because the immune system has a "memory," these responses have proven far more durable than those to targeted cancer drugs, the university says; some patients treated at UCSF for late-stage metastatic prostate cancer with immunotherapy are still living more than six years later.
More companies are looking at the benefits of paying their staff to be healthier. A leader in the field internationally continues to be Discovery’s Vitality programme. Originating as part of what turned out to be a revolutionary insurance product under the Discovery brand in South Africa in 1997, Vitality has since been widely credited with pioneering a global wellness movement based on incentivising change to healthier lifestyles. One Vitality executive described the rewards programme as "benevolent bribes".
The programme has since spread to the UK, the US — where it was rapidly adopted as a stand-alone wellness and preventive disease model in the workplace — and Asia (China and Singapore).
Other companies have piggy-backed on extensive, independent scientific research on the benefits of Vitality by offering financial incentives to encourage participation in workplace wellness activities. Analysts say there will be increasing use of technology to track and reward people for healthy habits.
In the US, a system known as Crisprs (short for clustered regularly interspaced short palindromic repeats) gives doctors "unprecedented ability to reach in and surgically alter and manipulate the genome", says Dr Wendell Lim, UCSF professor of cellular and molecular pharmacology, on the university’s website.
Their effect on basic discovery and on biotechnology and medicine will be "revolutionary", he says.
The 1998 discovery of RNA interference (RNAi) provided scientists with a "powerful tool to target and switch off the expression of particular genes to unravel their function", Dr Lim says.
However, RNAi can be imprecise, causing unintended "off-target" silencing of genes, and the technique can be time-consuming and cumbersome to employ in experiments. Other methods, such as zinc-finger proteins, have "similar limitations", he says.
Crisprs are a gene-editing system that could revolutionise everything from disease treatment to plant biology, Dr Lim says. The technique involves programming an RNA guide molecule to target a section of defective DNA and replace it with "good" DNA, the university says.
The human microbiome
"Microbiome research is rapidly identifying relationships between the bacterial ecosystem in the human gut and an ever-expanding range of diseases," says Susan Lynch, associate professor of medicine at UCSF, on the university’s website.
"This field of research will prove transformative in the development of novel microbiome-based therapies to treat or prevent respiratory, gastrointestinal and even neurological disorders," says Dr Lynch
Though scientists have long known that bacteria reside in and on our bodies, it is only over the past few years that research has unveiled the staggering scale of these populations and their crucial importance to health, she says.
There are as many as 1,000 bacterial species known to live in the human gut alone, and all told, these organisms — collectively known as the microbiome — outnumber our own cells by a factor of 10 and account for 1% to 3% of our total body mass, Dr Lynch says.
Disturbances in these microbial communities have now been associated with a range of serious chronic diseases, such as inflammatory bowel disease, allergies, obesity, cancer, and even psychiatric and neurological disorders, she says.
The emergence of new therapies targeting the microbiome is one of the most exciting frontiers in medicine.
The university says Dr Lynch has recently shown how having a dog in the home alters the gut microbiome, which in turn modulates the immune system to lower the risk of asthma and respiratory infection.
Patient-centred medical homes
Primary care is not a new idea, says Kevin Grumbach, chairman of the UCSF department of family and community medicine, on the university’s website.
What has changed in the US, he says, is that everyone — from the president to hospital CEOs to individual patients — has now recognised that high quality, affordable health systems all share a common characteristic — a robust foundation of family physicians and other primary care clinicians who serve as patients’ entry point and the medical "home" for personalised care.
We are experiencing an unprecedented era of innovation in primary care, he says.
The term "patient-centred medical home" describes new models of care that can include same-day appointments and "virtual visits" using digital forms of communication; emphasising wellness and prevention; addressing patients’ comprehensive care needs by integrating nurses, pharmacists, counselors and other health professionals into the primary care team; and co-ordinating care provided by specialists, hospitals, home-care services and other sectors to keep a focus on the whole person.
Ron Gutman, founder and CEO of HealthTap, an online service that arranges free medical advice on any topic, is quoted on a recent Mashable post, saying it is ironic that patients are called patients.
"When someone is feeling emotional or is in physical pain, they are anything but patient," Mr Gutman says.
His company’s new app, Talk To Docs, allows for medical questions to be answered on mobile devices.
Other developments, such as Google Helpouts, allow for personalised help over live video chat.
Technology is already available to generate stem cells from a sample of a patient’s skin, correct the genetic mutation in those cells and return the "gene-corrected" cells back to the patient for therapy, says David Rowitch, professor of paediatrics and neurological surgery at the university.
"These cells have the advantage of containing the patient’s own genetic code, so they escape rejection by the body’s immune system," Dr Rowitch says.
"For years, investigators have worked to enable gene therapy to correct mutations resulting in human disease — but successfully delivering repaired genes into cells has been a formidable challenge," he says.
The discovery of induced pluripotent stem cells, or iPS cells, by Nobel laureate Dr Shinya Yamanaka, and colleagues in 2006 has brought new hope to the field by making a cell-based approach to gene therapy possible, Dr Rowitch says.
Researchers can now use a patient’s skin cells to create iPS cells that then can be induced to differentiate into the specialised cell types that make up the various organs of the body, he says. Faulty genes can be corrected in these differentiated cells, which can then be placed directly into affected organs.