The world is leaving behind the 20th century one-size-fits-all approach to healthcare and moving towards personalised predictive medicine, health futurist and medical economist Jeffrey Bauer believes.
He points out that the genetic breakthrough in the last few years has heralded a new era for healthcare - the ability to predict a patient's risk to fall ill with certain diseases and how he would respond to different medications, bringing to an end the previous one-size-fits-all model.
"In the 20th century we thought that everyone was the same and would respond in the same way to the same treatment. Equipped with genetic information, we are now discovering that diseases, and patients' response to medication, are different according to the patient's gene-pool," Dr Bauer says.
He continued that the ability to metabolise drugs differs between different populations, outlining that Koreans, especially males, are unable to metabolise popular drugs used to treat depression.
Dr Bauer believes that rather than being daunting for minorities, this is actually very good news.
"I find it very hopeful because we can finally focus our pharmacology on genetic differences," he says.
Dr Bauer - who was in Malta last week for a conference organised by Affiliated Computer Services - continues that after the initial investment, personalised predictive healthcare will not be more expensive than the current regime.
"Personalised predictive medicine will cut the costs associated with repeat tests, like regular mammograms for women who do not carry the gene which predisposes them to breast cancer."
This also poses ethical questions, and Dr Bauer points out that genetic counselling and psychological support also need to be developed.
"In my ideal future scenario everyone will have the right to decide whether to be genetically profiled and know what diseases one is prone to suffer from."
An important dilemma for patients would be whether this genetic information could be used against them, for example by insurance companies. Dr Bauer points out that the US recently passed a law - Genetic Information Non-discrimination Act (GINA) - which does not allow insurance companies to discriminate against a person on the basis of genetic information.
As we go along people are living longer, suffering from more diseases and as medical advances continue, have higher expectations for treatment. Does he believe that a fully-funded government health system like the local one has a future? Dr Bauer thinks that it is as viable as any other type of healthcare.
"Any healthcare system is equally faced with a cost challenge. I don't think that anybody has the luxury of assuming that they can continue to spend on healthcare without making the tough decisions and looking at the trade-offs between different treatments and diagnostic regimes."
He agrees that patients who have to pocket part of the healthcare costs are less likely to see a doctor on the first onset of symptoms or fill all their prescriptions. "But we do not yet have clear information that this makes them less healthy."
Moreover, Dr Bauer argues, the ageing population is not a threat to the healthcare system, at least in his country. "Ironically the baby boom generation is healthier than previous generations, while we have serious healthcare problems on the other hand of the spectrum, with high levels of obesity, mental health problems and even substance abuse among the young." This is making employers in the US think twice before offering early retirement packages - which were the order of the day a decade ago - to employ younger workers.
He lauds Malta for not "succumbing to the technology virus" but rather taking a measured approach before investing in new equipment. "This is positive because many of the newest technologies have not yet been proven. Malta has a much greater desire to evaluate new technology rather than buy something just because it's available."
Although he agrees that new technology also offers hope, which is very important in healthcare, Dr Bauer says there have been investments which went wrong. He points out that the US invested heavily in new cardiac technologies and there was a move to replace open heart surgery with stents to open clogged arteries, a less invasive procedure which gives patients a much better quality of life immediately after the intervention.
"But we are now clearly seeing that five years later patients who underwent bypass surgery are doing much better than those who had stents put in. We rushed into stents assuming that those would open up the artery forever. But in many instances the arteries close up again, which does not happen in bypass surgery."
Dr Bauer thinks Malta's investment in IT puts it in a good position to shift from the face-to-face medicine that was a norm in the past to virtual medicine, which he sees as the future.
"We have now developed the capabilities that allow people to be monitored remotely. Patients no longer need to go and see a doctor for everything," he says.
He believes that the local health authorities should look very closely at telemedicine because it is robust and also helps economise on medical resources.
He points out that the genetic breakthrough in the last few years has heralded a new era for healthcare - the ability to predict a patient's risk to fall ill with certain diseases and how he would respond to different medications, bringing to an end the previous one-size-fits-all model.
"In the 20th century we thought that everyone was the same and would respond in the same way to the same treatment. Equipped with genetic information, we are now discovering that diseases, and patients' response to medication, are different according to the patient's gene-pool," Dr Bauer says.
He continued that the ability to metabolise drugs differs between different populations, outlining that Koreans, especially males, are unable to metabolise popular drugs used to treat depression.
Dr Bauer believes that rather than being daunting for minorities, this is actually very good news.
"I find it very hopeful because we can finally focus our pharmacology on genetic differences," he says.
Dr Bauer - who was in Malta last week for a conference organised by Affiliated Computer Services - continues that after the initial investment, personalised predictive healthcare will not be more expensive than the current regime.
"Personalised predictive medicine will cut the costs associated with repeat tests, like regular mammograms for women who do not carry the gene which predisposes them to breast cancer."
This also poses ethical questions, and Dr Bauer points out that genetic counselling and psychological support also need to be developed.
"In my ideal future scenario everyone will have the right to decide whether to be genetically profiled and know what diseases one is prone to suffer from."
An important dilemma for patients would be whether this genetic information could be used against them, for example by insurance companies. Dr Bauer points out that the US recently passed a law - Genetic Information Non-discrimination Act (GINA) - which does not allow insurance companies to discriminate against a person on the basis of genetic information.
As we go along people are living longer, suffering from more diseases and as medical advances continue, have higher expectations for treatment. Does he believe that a fully-funded government health system like the local one has a future? Dr Bauer thinks that it is as viable as any other type of healthcare.
"Any healthcare system is equally faced with a cost challenge. I don't think that anybody has the luxury of assuming that they can continue to spend on healthcare without making the tough decisions and looking at the trade-offs between different treatments and diagnostic regimes."
He agrees that patients who have to pocket part of the healthcare costs are less likely to see a doctor on the first onset of symptoms or fill all their prescriptions. "But we do not yet have clear information that this makes them less healthy."
Moreover, Dr Bauer argues, the ageing population is not a threat to the healthcare system, at least in his country. "Ironically the baby boom generation is healthier than previous generations, while we have serious healthcare problems on the other hand of the spectrum, with high levels of obesity, mental health problems and even substance abuse among the young." This is making employers in the US think twice before offering early retirement packages - which were the order of the day a decade ago - to employ younger workers.
He lauds Malta for not "succumbing to the technology virus" but rather taking a measured approach before investing in new equipment. "This is positive because many of the newest technologies have not yet been proven. Malta has a much greater desire to evaluate new technology rather than buy something just because it's available."
Although he agrees that new technology also offers hope, which is very important in healthcare, Dr Bauer says there have been investments which went wrong. He points out that the US invested heavily in new cardiac technologies and there was a move to replace open heart surgery with stents to open clogged arteries, a less invasive procedure which gives patients a much better quality of life immediately after the intervention.
"But we are now clearly seeing that five years later patients who underwent bypass surgery are doing much better than those who had stents put in. We rushed into stents assuming that those would open up the artery forever. But in many instances the arteries close up again, which does not happen in bypass surgery."
Dr Bauer thinks Malta's investment in IT puts it in a good position to shift from the face-to-face medicine that was a norm in the past to virtual medicine, which he sees as the future.
"We have now developed the capabilities that allow people to be monitored remotely. Patients no longer need to go and see a doctor for everything," he says.
He believes that the local health authorities should look very closely at telemedicine because it is robust and also helps economise on medical resources.