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“It’s not just the medical experts who have challenges to face, but the entire healthcare system”

An interview with Professor Dr. Hans-Peter Deigner, director of the Steinbeis Transfer Center for Personalized Medicine

Personalized Medicine: What exactly is it, what benefits does it offer and what challenges does it present? What does the future have in store for it? Professor Dr. Hans-Peter Deigner spoke to TRANSFER magazine about these topics.

Hello Professor Deigner. Could I ask how you would describe personalized medicine, and what benefits does it offer to patients?

Personalized medicine basically refers to all measures that can be used to make a more exact diagnosis and offer more precise treatment. It also entails making better prognoses. In the future, it will make it possible to avoid certain diseases. So this means we’ll be able to make earlier interventions and introduce measures that are targeted at and adapted to specific individuals. Cancer treatment will likely be one area where the concept of personalized medicine will be introduced the quickest – for several reasons. It’s been known for a while that no two tumors are the same, so the likelihood of a successful treatment outcome is higher if treatment is matched to patients and their circumstances.

What are the challenges faced by medical experts when using these techniques, and what can or should they do about these challenges?

It’s not just the medical experts who have challenges to face, but the entire healthcare system. An important part of this is reimbursement – “Who’s paying for what and under what circumstances?” This is an issue that people are currently offering some absurd answers for. The insurance companies and paymasters expect service costs to be met for each diagnosis or each diagnostics parameter, and average costs are supposed to come to a certain amount. Blanket fees per case are not exactly helpful when it comes to making progress in medicine. It would make more sense to invest a lot more in certain areas, because some investments will pay for themselves in the long term. But ultimately the problem is that approaching the entire field of medicine from a business perspective is simply not in the interests of the patient. For me – and the same applies to doctors – it’s absurd to look at this mainly from a commercial perspective and it’s certainly not in the interests of patients, but unfortunately this is increasingly what happens with privatization.

Does personalized medicine solve skyrocketing costs in the healthcare industry or does it at least help cut costs in the long term? Opinion is divided on this one. What do you think?

Naturally I think it’ll be more expensive in the short term, because development costs money. The more parameters you have, the more exact the picture of the condition of a patient, but that means investing more time and energy – and that costs money. But if you can extend the healthy stages of life of an individual, or avoid damage to someone’s health later in life, or even make it possible for a patient to stay alive, the costs will be worth it in the long term. Timelines are different depending on the role you play in the healthcare system. Often, prognoses and prevention don’t look beyond the next 20 years. Instead people try to work out what’s worth doing for the next one or two years. So overall I’d say things don’t necessarily have to be more expensive, but of course it does depend on people’s interests, which can be highly diverse.

What developments do you think will shape the future of personalized medicine?

I think personalized medicine is already in a position to be introduced successfully today, at least in areas where it doesn’t have to cost much. For example it’s already possible to use existing data to run evaluations at fairly reasonable cost. I have a colleague who evaluated the data of patients in intensive care with a hospital. They looked at data that’s generated anyway, but nobody had actually looked at it in so much detail before, or not in the way they did. What this means is that relatively large volumes of data are already being gathered, so if you can use data mining and approaches based on bioinformatics and statistics, data can be used for the benefit of patients. A number of companies that understand the ins and outs of data processing have worked this out already. They actually originate from a completely different field, but they’re now moving into personalized medicine.

One thing that should be noted is that it’s the overall condition of data that’s decisive when it comes to moving personalized medicine forward, in view of the accelerating developments. In other words, we’ve finally got to have some population studies that cover off a good section of the population and run over an extremely long period, ideally for an entire lifespan. A lot of time will still have to pass for the foundation of data to improve significantly, especially if it is to be combined with existing data and used much better than it is now. On top of that, for the majority of people in the industrialized world, the most important diseases are extremely multifactorial and are dictated by hundreds or even thousands of gene activities. Of course this can’t be evaluated properly if you only base studies on a couple of thousand patients, because you don’t have enough data. But if you had access to the data of millions of patients and this even spanned a longer period or told you something about relatives or families, that would completely change things. On that basis, we could make significantly more accurate predictions and we could even make treatments available, but that will still take us decades. But on the other hand, as I already mentioned, very soon there will be ways to use the data that already exists. Technological progress in areas like sequencing is accelerating things and doing even more to cut costs. More information can be obtained from genes, gene activities, RNA, proteins, or metabolites, and it’s becoming increasingly possible to analyze and evaluate this data in the right context. So the technical prerequisites are being fulfilled and the developments are happening that will dictate this process – and there are also social developments. Consensus is needed on this, plus the right guidelines regarding data use, for us to collect and evaluate such large volumes of data from individuals. And of course we also have to think about ethical issues. So as you can see, there certainly are a lot of problems that still need to be worked out, but we have to tackle them and we have to do this quickly if we want to make progress for the good of patients.