Healthcare: How Far are We from Predict-and-Prevent?

Gopi Katragadda
Updated: Aug 23, 2012 06:33:58 AM UTC

Rajesh Khanna has passed on… It is interesting, how much of a fan-following he generated in a period of three years 1969-1972 when he had most of his hit movies… One of my favorite movie scenes is the climax from the movie Anand. The lead character (Rajesh Khanna) finally succumbs to cancer, and as his doctor and friend (Amitabh) gets hysterical, a pre-recorded tape plays from the background in Rajesh Khanna’s voice… Zindagi aur maut uparwale ke hath hai jahapana, jise na aap badal sakte hai na mein (life and death are orders from above, we do not control these matters)…

Have we made progress in healthcare over the past decades to feel that we have a little more control on health, life, and death?

In 2003, my son developed fever that had lasted a week. I was to leave for the US in a couple of days, and the doctor requested several tests. Meanwhile, the fever seemed to come under control, and I left for the US. I called home on reaching the US and I had difficulty getting hold of anyone. The next day, I called my dad and got evasive responses and knew all was not well. Finally after many calls to my wife and dad, I got to know that my son was diagnosed with Dengue. Not long before, a colleague on travel had contracted Dengue and unfortunately did not recover, and this made it a bit scary for me. The hospital kept my son under watch for several days (apparently there isn’t any real treatment) and kept track of his blood platelet count. Several times a day blood would be drawn. A few days later my son was out of the hospital and declared out of danger.

More recently, my dad was holidaying in Munnar, Kerala and suffered a stroke. He was the latest member in his family with a history of stroke after the age of 65 to suffer a stroke. It started with my grandparents, followed by my dad’s older sister and then his older brother, and then my dad. My dad was diagnosed with hypertension at the age of 28, same as much of his family. He was very fastidious with his medication for controlling his blood pressure and blood thinning. However, at the time of the stroke he was off the blood thinner for a few weeks due a cataract operation and post-operation instructions. After initial treatment in Munnar, he was admitted to a hospital in Bangalore, where first a CT scan was run which did not show the affected brain area, and then an MR scan was run which showed the region of the brain affected by the stoke. Again, there was not much by way of treatment, and a year and half after the stroke my dad is slowly recovering the use of his right hand and leg (the stroke was in the left hemisphere of the brain).

So, progress?  Certainly!  The ability to diagnose has considerably improved.  Some big challenges remain; however, there are some big breakthroughs round the corner.

The biggest gains of the past two centuries in medicine were the discovery of vaccination and antibiotics.  Vaccination is our defense primarily against viruses and antibiotics a counter measure primarily on bacteria. These discoveries helped significantly with infant mortality and hence contributed to the overall increase of measured life expectancy. In the past few decades, while medicine has made several strides in terms of understanding various diseases and their causes, we still have a long way to go on prediction, prevention, diagnosis, and treatment. The obvious desire of the customer (in this case any of us), is that a disease not occur, and if it does occur that it be diagnosed immediately and treated effectively.

The trend in healthcare is rightfully moving from ‘diagnose and treat’ to ‘predict and prevent’. Interestingly, based on an 18 month worth study of journal literature (2006-2007) in healthcare (conducted by the Whitney Knowledge Center, GE JFWTC), obesity and hypertension are the most published areas of research each with more than 3600 publications in the period; also there are more than 2000 publications related to smoking. Compare this with less than 1700 publications each for stroke and heart failure, and the ‘predict and prevent’ focus is obvious. There are also more than 3500 publications related to quality of life versus less than 2800 on breast cancer and less than 1900 for prostate cancer. Quality of life is the ability to measure the impact of illness on the perceived physical and mental health. There are several measures that then enable appropriate intervention at the individual level or a population level to increase the quality of life. The most researched modality is still MR with over 4500 publications (with a good amount of work in diffusion MR) compared to CT with less than 1200 publications in the period. The most researched demographic is ‘children’ with over 7000 publications compared to less than 3000 publications on the elderly and aging. Publications in the areas of genetics and gene expression are coming up with over 2000 publications in the area.

In addition to the areas mentioned above, significant amount of work is ongoing in in-vitro diagnostics. The promise is point-of-care diagnostics. Molecular diagnostics with advances from the human genome projects is the fastest growing research and market in this area. In particular the Polymerase Chain Reaction technique enables one to look for particular pathogen (infection causing agent) DNA sequences and then multiply the DNA to get enhanced signals making it possible to better diagnose infectious diseases. New research is focused on multiplex PCR with the promise of a single test being able to detect any pathogen you may have in your body (eliminating the battery of tests that are currently utilized)!

Another advance that was in the news recently was that of a UK couple that screened embryos for avoiding a gene present in the father that could mean a propensity to cancer of greater than 50%:..Doctors screened out from the woman’s embryos an inherited gene that would have left the baby with a greater than 50% chance of developing the cancer. The woman decided to have her embryos screened because her husband had tested positive for the gene and his sister, mother, grandmother and cousin have all had the cancer. The couple produced 11 embryos, of which five were found to be free from the gene. Two of these were implanted in the woman’s womb and she is now 14 weeks pregnant.

While we talk about all these advances in technology, it is important to remember that there are vast populations without access to decent healthcare. In India, there are more than 165,000 primary and sub-care centers. These centers typically have no equipment, and run on paramedical assistance with periodic access to doctors. At the other end of the spectrum is the increased incidence of allergies particularly in the developed world. There are children, especially in the west, for whom eating peanuts can be near fatal! From all indications, the incidence rates of allergies and also other bronchial disorders including asthma is increasing. Many a child now carries a pencil box and an inhaler as part of their school kit! Allergens include nuts, pollen, dust mites, shell fish, and the list goes on…

As the demographics change, and the population ages in counties such as China, a whole new set of challenges will be uncovered.  The good news is that, at this point, technology advances to improve quality of life and life expectancy certainly outpaces new challenges which are emerging!  All said, a good mix of a holistic life-style, good diet, ample sunlight and exercise, are still the best way to good health.

The thoughts and opinions shared here are of the author.

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