Debate: A revolution in medicine

By Allan Flyvbjerg, Dean of the Faculty of Health, Aarhus University | Henrik Ullum, Chairman, Organisation of Danish Medical Societies | Erik Jylling, Director of Health Policy, Danish Regions.

There is really good news for Danish patients. The government has recently allocated the initial millions towards developing a project that will utilise gene technology and health data as tools for making medicines more effective in the treatment of individual patients.

We can guarantee that we have the potential to start a medical revolution, where we can design treatments that can help the individual patient in a completely new manner – and save us from a large overconsumption of ineffective drugs, as well as their side effects. This should be seen in light of the fact that we in the healthcare sector calculate that between 50-75 per cent of the medicine that is prescribed within the major disease groups such as cancer, diabetes and arthritis, does not have the expected effect.

If we become better at targeting medicine, so that the patients who receive it also actually benefit from it, we can help give the right patients the correct treatment. Secondly, we can save a great deal of the medicine which is given unnecessarily, so that thirdly: we will better be able to afford the new expensive medicines that can help to improve the health and quality of life of selected groups.

What we are talking about is tailor-made medicine, personal medicine, precision medicine and individualised treatment. Different names for the same thing.

The common understanding of tailor-made medicine is that by performing a genetic test, we will be able to develop a new medicine that matches the individual patient. This technology is already being used for selected diseases. If the technology also proves to be applicable for a wider range of disease groupings then what we are facing is, as we said, a minor revolution in our approach to prevention and treatment.

When we claim that there is a special Danish perspective for the development of personal medicine, we do so due to our particularly strong position in the area of health data and registers.

In Denmark we have up to 70 quality databases and a range of health registers such as the Danish Civil Registration System, the Danish National Patient Registry and the Danish National Prescription Registry. Some of these contain health information all the way back to 1968, which is when the Danish civil registration number was introduced.

In this health data we can find the answer to how a selected drug works on the individual patient. The positive effects and any side effects it has, and the correlation between the drug and other diseases that the patient suffers from.

Unfortunately, the registers cannot communicate with one another. Neither are they available to medical doctors in their daily work and in their consultations with patients.

When 64-year-old Niels Hansen goes to his general practitioner because rheumatism is causing him pain, the approach is therefore often one size fits all. Simplifying things a little, you could say that patients with the same diagnosis are often given the same type of medicine, regardless of whether they will definitely benefit from it or not. But people are different and medicine works differently on patients with different family backgrounds and medical histories. Other diseases and diseases that the patient may also suffer from also have a bearing on how well a drug works, and whether it causes side effects.

Medicine expenditure in Denmark is high and the total cost of medicines is only going in one direction: upwards. Both the patient and society can therefore benefit from the medicine being tailored to the individual patient, so it has a greater effect and fewer side effects. This may be by means of advanced gene technology being used on collected samples, the utilisation of health data, or a combination of both.

The registers are currently used for clinical research. Danish registry researchers have achieved groundbreaking results by linking register information and examining correlations between selected diseases and medicinal drugs. For example, studies have shown that heart patients should be careful with certain types of arthritis medicines, and they have documented that neither the standard child vaccines nor antidepressant medicines could be the cause of autism in children.

With the large amounts of high quality date that we in Denmark are so lucky to have available, we can be even more ambitious on behalf of the patients. This will be possible if we make the path from the research carried out at the universities to the clinical practice at hospitals and medical practices even shorter.

The good news is that the first steps towards a more uniform correlation of health registers and quality databases have already been taken. In January of this year the Danish Ministry of Health and Danish Regions launched an ambitious national project called PROCRIN (Program for Clinical Research Infrastructure). This is a two-year pilot project established with donations from the Lundbeck Foundation and the Novo Nordisk Foundation totalling DKK 50 million. The purpose of the project is to create the world's most complete and useful national population-based clinical data infrastructure.

PROCRIN will ensure that researchers and medical doctors can negotiate smoothly between data from national health registers, clinical quality databases and data from general practitioners, while at the same time safeguarding patient confidentiality. The ambition is that the project will lead to better diagnosis and treatment, greater patient safety, and last but not least, improved health economics.

But we must be even more visionary and forward-looking. The wealth of information contained in the Danish health registers must be available to practitioners and clinicians in their meeting with the patient – in anonymised form, of course.

A realistic future scenario will therefore be one where Niels Hansen's general practitioner can prescribe medicine that is tailor-made for him, because the computer provides information showing that drug A will be the most effective for Niels Hansen's arthritis, because he has also previously had cancer, suffers from raised blood pressure, has poor kidney function, diabetes and a poor heart.

The computer will also be able to work out that Niels Hansen should not be prescribed drug B, because the experience of other patients shows that it does not work when patients have the special disease profile that he has.

With an increasing number of older medical patients suffering from more diseases at the same time, it is high time for us to gather together the treasure trove of knowledge lying at our feet.

Of course, it is just as important that this is done with the support of the population in general. It is crucial that a system which brings health information closer together is continuously developed and is at all times one hundred per cent secure and anonymous. The importance of handling the population’s health information confidentially and responsibly cannot be emphasised enough.

But there are huge perspectives. With the help of modern technology and the intelligent use of health data, we can streamline medical treatment such that many more Danish patients will receive targeted, tailor-made and effective treatment. We can deliver groundbreaking research and thus, at the same time, strengthen the Danish pharmaceutical industry. For this reason, the Danish government deserves praise for focusing on personal medicine. We should just bear in mind that the initiative is based on two pillars, i.e. genetic analyses and the utilisation of health data. An investment in both pillars will really be a benefit for Denmark’s citizens and the national economy.

The article was originally published in the Danish newspaper Jyllands-Posten on 25 November 2015