Issue link: https://maltatoday.uberflip.com/i/634260
14 AT a glance, it seems as though Malta – and, for that matter, the rest of the world – may be on the cusp of a brave new digital health revolution. Not only is the ability to treat certain diseases and con- ditions improving thanks to the application of information tech- nology… but with the sequencing of the human genome, the same technology can also be applied to prevent disease: thus radically im- proving the quality of life, while also alleviating the strain on the national health service. Well, maybe not quite yet. The technology and data exist to make this a reality, but processing the information and using it as an ef- fective preventive health tool is not, at present, a standard medical practice anywhere in the world. Health Minister Chris Fearne, however, predicts it will be the absolute norm in as little as 15 years from now. "It's an exciting time to be involved in the health sector," he tells me in his office at Palazzo Castelletti, Valletta. "We are about to witness a sea-change: not just in Malta, but everywhere in the world." In Malta, however, this change may be more deeply felt. It is not just in bio-technology that things are changing… there have been a number of radical structural reforms announced of late: the construction of a new Gozo hos- pital and the refurbishment of St Luke's, both to serve (inter alia) as learning hospitals for Barts Medical School… which in turn introduces competition in the medical education sector, where previously there was none. The health ministry has also en- tered into agreements with private clinics and hospitals to cut back on waiting lists at Mater Dei. The latest news concerns dis- cussions with a Chinese biotech company – iCarbonX: a bio- techT-IT venture co-founded by Dr Jun Wang, ex-CEO of Beijing Genomic Institute (BGI) – with the possibility of a private opera- tion that as yet remains unclear. The latter development is ad- mittedly very interesting from a medical science point of view: we will shortly discuss the implica- tions. But in the meantime, all these developments seem to point in a certain direction. Are we looking at the thin end of the wedge here? Is the gov- ernment slowly ceding more and more of its responsibilities for public health to private entities… and could this in any way impact the government's stated objective to keep the service 'free for all'? "Let me start by saying this: my job, as health minister, is to give the best possible level of health service, along three basic princi- ples. Excellence, whereby we op- erate, to the best of our abilities, to achieve the highest standard level possible; accessibility, which means the service remains free for all Maltese and Gozitans, regard- less of individual means; and also sustainability. All that we do is guided by those three principles. Excellence implies that the serv- ice is provided within good time; so we're addressing the issue of waiting lists. We're also ensuring that medicines are kept in stock, and that people are no longer ac- commodated in corridors...." As for accessibility, Fearne as- serts that his government is com- mitted to keeping the service free for all. So the fly in the ointment, as it were, remains sustainability. "Of course, all this comes at a cost. The service has to be sus- tainable. We believe that this can be guaranteed by the concept of medical tourism…" In fact, 'medical tourism' was the topic discussed in our last inter- view, back in March. Fearne once again defines his government's understanding of the term: that Malta develops a medical capac- ity beyond its immediate needs, so that – while Maltese patients continue to receive free service – the extra capacity can be used to attract paying patients from third country nationals (note: EU citizens are covered under vari- ous agreements between member states). "Today it is becoming a reality. In the space of a year and a half things are moving forward. This should place us, for the first time ever, in a situation where the health sector no longer eats into the national exchequer, but will instead contribute to the econo- my…" The current national expendi- ture on health, he adds, reaches around half a billion euros a year. "Most of that will continue to come from people's taxes, natu- rally. Up to now, however, all of it has traditionally been financed by taxes. We are convinced – and it's already happening – that a significant percentage of that cost will be covered by medical tour- ism. To give an example: the capi- tal outlay for the construction of a new, 450-bed hospital in Gozo; for the extensive refurbishment of Karen Grech hospital, to turn it into a gerontology ward; and to refurbish and reopen St Luke's… that capital amounts to around 210 million euros. It will all be put forward by our private partner, who will recoup the investment through paying patients from other countries…" At the same, however, the Min- ister is giving the impression that medical tourism is already reap- ing dividends, even though the new hospitals are not in opera- tion yet… He shakes his head. "No, what I said was that we are confident that it will reap dividends. And so are the investors, who were satis- fied enough with the prospects to invest over 200 million euros. The real benefit for us, however, is not just that it helps to make the na- tional health service sustainable. The additional facilities will also be used by Maltese patients… for free. They will improve the exist- ing service, in line with our excel- lence goals." The real challenge, he contin- ues, is more long-term. "We also have to look forward, and see how the medicines industry is going to develop over the next 15, 20 years. We want to position ourselves as leaders in this sphere, not fol- lowers. And this entails a radical overhaul of how we view the en- tire health sector…" Fearne points out that, rather than a 'health sector', Malta's service is geared mostly towards curing disease. "Up to now, al- though we claim to have made progress, the reality is that we don't take 'prevention' as seri- ously as we take 'cure'. This has to change. The medical profession is moving in this direction, and we need to start aligning ourselves to what is happening in the wider world." Ever since 2003, when the first complete human genome was sequenced, medical science has been evolving towards a situa- tion where the risk of disease be- comes easier to identify, and thus prevent. "The Americans call it 'preci- sion medicine', we call it 'person- alised medicine'. But the future of medicine is to have treatment tailored for the specific medical needs of the individual." The Human Genome Project es- tablished that each individual has about 20,000 genes. "But there are 3 billion 'base pairs' – i.e., bits of genetic information – in every human being's DNA. We already know that our health depends on three basic factors: genetics, the environment in which we live, and our lifestyle… and how these react with one another. We know the environment we live in; everybody is free to choose his or her own lifestyle… but before 2003, 'genetics' was the one thing we didn't know enough about. Thanks to the genome project, it is now possible to determine exactly what the genetic health factors might be for every indi- vidual…" While the original project was purely academic, since 2003 a number of private companies have harnessed the knowledge and put it to medical uses. "It is now possible to give these com- panies a DNA sample – blood, a hair, etc. – and within a day or less it would be possible to know your precise genetic makeup. We want to reach a situation where the genetic information can be matched with environment and lifestyle, to give the citizen com- prehensive advice on how to avoid health problems. It's like a prescription on how to prevent disease. Real, preventive medicine for each individual patient. That is where medicine is heading in the next 15 years. We want to be at the forefront…" This may be exciting news for medical science, but it also sounds a little ominous. Helpful though genetic knowledge may be for doctors, it is also highly sensitive information. Among the concerns raised by the genome project, for instance, is what would happen if private genetic information were to be made available to insurers or employers. People with high- risk congenital issues might face higher premiums, etc… and there may be discrimination in other spheres. "Yes, and that is true also for all medical information, with or without genome sequencing: if an insurance company gets hold of your medical records, for in- stance. It is of course a concern for us, and we will be taking data protection very seriously. Natu- rally, the patient would have to give his full consent for the test to be done, and for the data to be used. There will be firewalls in place; we are already discussing what sort of data protection in- frastructure we will need." One thing that will certainly be needed is considerably more in- formation technology infrastruc- ture and computing power than is actually present on the island. "To analyse those 3 billion base- pairs, you need more than just an ordinary computer. You need ar- tificial intelligence. In the last few days we have had talks with one of these cutting edge companies, with a view to carrying out the research here in Malta…We want to become a world centre for per- sonalised medicine. This is our vision, naturally; I'm not saying it will happen tomorrow. But we plan to be among the first coun- tries in the world where a citizen can get this kind of fully person- alised health service. The reper- cussions would be enormous… not only in terms of benefit to the patient, but also society as a whole. And the health sector in particular…" Interview By Raphael Vassallo maltatoday, SUNDAY, 31 JANUARY 2016 Prevention is better than We're not pushing people towards private healthcare, as we're still paying for it ourselves. But we are using all the resources the country has to offer PRIVATE PARTNERSHIPS It's like a prescription on how to prevent disease. Real, preventive medicine for each individual patient. That is where medicine is heading in the next 15 years. We want to be at the forefront PERSONALISED MEDICINE