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The greatest threat to long term US economic stability is runaway health care costs. Nanotechnology is at the center of most new medical diagnostic processes. Increasingly, the information gained from new diagnostics will encourage preventive medicine (or precision medicine as defined by Clayton Christensen in his book, Disruptive Prescriptions) that will save billions of dollars in future healthcare costs. Precision diagnostics, based in part on nanotechnology, is on the critical path to national health cost containment and control , and by extension, furture economic sanity.
June 21st, 2010
Nanotech and Preventive Medicine Need for Major Government Sponsored Biomarker ID Program Part 2
Nanotech and Preventive Medicine
Need for Major Government Sponsored
Biomarker ID Program
Alan B. Shalleck
The greatest threat to long term US economic stability is runaway health care costs. Last month I discussed the development of new medical diagnostics as a key element in controlling future healthcare costs. Nanotechnology is at the center of most new medical diagnostic processes. Increasingly, the information gained from new diagnostics will encourage preventive medicine (or precision medicine as defined by Clayton Christensen in his book, Disruptive Prescriptions) that will save billions of dollars in future healthcare costs. (Precison equates to reduction in waste and to lower total costs.) Precision diagnostics, based in part on nanotechnology, is on the critical path to national health cost containment and control , and by extension, furture economic sanity.
New families of diagnostics (detecting biomarkers like DNA fragments, unique protein metabolites, circulating cancer cell fragments, rare antiboides to disease related antigens, newly identified biomarket ratios, combinations of critical genes, etc) will precisely and quickly tell the medical Point of Care (POC) practitioner exactly what specific therapy to recommend, and more importantly what expensive therapies not to recommend, saving expensive wasted procedure costs that are now prescribed for defensive medical reasons. (Note the level of physician - the subject of another article) Expensive ineffective therapies will not be prescribed and lower cost rifle shot therapies will be ordered to heal directly a precisely identified malady. With expanded precision, billions of dollars of projected healthcare expenses can be saved.
In addition, precision diagnostics will provide information for the POC physician to work with each patient individually to help him with wellness and preventive health care to forstall or avoid later in life expensive macromaladies that require other expensive and shotgun type therapies. Nanotechnology is part and parcel of the solution to this fundamental national need.
A successful example of the effect of precision diagnostics on health care costs is Geneomic Health, Inc. Genomic Health identified 21 genes that could yield a ‘recurrence score' that would tell whether a cancer patient who had undergone a breast mastectomy or lumpectomy had a probability of the tumor recurring based on the patients gene make up. A high genomic health test score indicated recurrence, while a low score, regardless of chemotherapy, indicated a low probability of tumor recurrence. With a low score, the cost and side effects of expensive chemotherapy ($40,000 - 50,000) could be avoided for the low test cost of $3,500. Those with a high recurrence score needed chemotherapy to improve their life outcome. The test has caught on. Millions of dollars in unnecessary chemotherapy costs and pain have now been avoided by this simple test. Sales of GHs' tests are now well over 13,000/quarter and GH will have total sales at year end of $200 million and will be profitable. If half of those tested avoided chemotherapy, the health system will have saved 6,500 X ($50,000- $3,500) x 4 quarters =$1,209,000,000 from this one specific benefit test alone … the core information of which was derived from the nanotechnology sensitive genome decoding program. Projecting over the next decade, nanotechnology augmented precision diagnostics can reverse many of the expensive trends in healthcare cost growth.
Therefore, Increasingly, biomarker specificity will rein in healthcare costs? Lovely picture? Not So!
Today such revolutionary diagnostic tests, in all branches of medical therapies (including mental health) present a national problem. Sufficient numbers of biomarkers and specific biomarkers in sufficient distinction generating heirarchical depth to make a difference aren't yet available. We don't have the tools yet to accomplish effective cost containing precision diagnosis with the currently available families of biomarkers and new diagnostic systems.
It is obvious that we need to identify many many more precise biomarkers to provide that precise diagnosis. It is one of the best investments we as a nation can make. With today's restrictive budgets, we don't have a clear path to the resources to fund the identification those additional biomarkers. However, without information from additional biomarkers, healthcare costs will continue on their unhealthy expensive path threatening our very economic well being.
Therefore, I am herein calling for a multi-billion dollar ten year government funded national "inner space" biomarker discovery program to quickly expand the inventory of useful biomarkers so that we will have a shot at controlling future healthcare costs that threaten to bankrupt the country. That effort requires the conceptual separation of the need for therapeutics emerging from the diagnostic biomarker program to a pure diagnostic biomarker discovery program not linked to any therepeutic possibility. Let's first find out our conditions, then let's find the rifle shot solutions. Knowledge before therapeutic action. It is clearly the best national investment we can make for our children and grandchildren.
Interestingly, nanotechnology is at the heart of every projected technique for expanding the biomarker inventory of our medical community. It can be a new source of major funding for the bio side of the nanotechnology industry.
Follow on from last month's article. In my first discussion, I outlined some of the new tools, like nanoarrays and naotech derived tests for proteins, genetic materials, immunocomponents, and other biomarkers that are in various stages of development and test that will simplify and amplify the powers of the POC physician. From the last month's press releases, it looks like I was precient. We are at the beginning of the wave of big Pharma and Bio real concentrations on diagnostics, restructuring of major pharma companies to include diagnostics as primary new projects, with some review by the government of the manner in which very specific diagnostic procedures that serve to save payments over the life cycle of the presenting patient can be fairly compensated.
I will write next month on the last aspect of the diagnostic and precision healthcare revolution - how to modify the healthcare payment system to incent physicians to perform precision diagnosis and wellness practices and how to allow companies to profit from the development of these new diagnostic tests.
Alan B. Shalleck
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