Small is beautiful• Luxembourg has the potential to be a world leader in testing and implementing new advances in personalized medicine into its health care system• 5 hospitals, no medical school, 1 university• Small, but excellent scientific community – very collegial and embraces partnerships• Different Ministries work closely together on personalized medicine initiative• Ministry of Health believes that research will improve health• Introduction of new innovation involves only one level of government• One of three most expensive healthcare systems in world
Evolution of Personalized Medicine Consortium (PMC)• September 2010 – agree to support a major coordinated initiative in personalized medicine focused on four priority research areas: – Cancer (lung, colon, and breast) – Type 2 diabetes – Parkinson’s disease – Large population cohort• Creation of Consortium to bring together all of the key stakeholders under one umbrella• Goal: Establish Luxembourg as a leader in the adoption of new advances in personalized medicine
Transition from Traditional Medicine to Personalized Medicine Will Require Radical Change Worldwide Data Informatics Centre eHealth Results Record Tissue Hospital and Pathology labs Integrated Information Examine Symptoms DoctorPatient Clinical Tissue Molecular Data Diagnostic lab Summary Diagnosis Data Probable Treatment Diagnoses Examine + Disease Recommended Treatments Patient Doctor Best Treatment
Two Big Problems in Personalized Medicine1) How translate new knowledge into innovation? Translational research and clinical trials do this step reasonably well1) How transfer new innovation into a healthcare system? Need new research process here – topic of Luxembourg Health Summit
Problem: Introducing Innovation into Healthcare Often Fails Discovery Research Healthcare SystemResearch Translational Research Innovation Benefits for Very PMC citizens of small benefits Luxembourg Successful research does not automatically lead to successful innovation
Barriers to Change• Patients/public – many effective interventions require behaviour change (smoking, diet, screening)• Hard to change widely held beliefs – risk of vaccinations, genetically modified food, fluoridation of water, evolution• Physicians – too many new guidelines for treatment; changes often may impact income; require new knowledge• Hospitals – change requires radical redistribution of work• Government – concern that radical change will cost too much and be too disruptive (making re-election difficult)
Missing Step in Innovation Process BasicDiscoveryResearch Translational Research Clinical Trials and Studies Pilot Studies Use in inHealthcare Healthcare System
New Paradigm: Pilot studies followed by gradual introduction into the health care system Proposed new approach for innovation in healthcare in LuxembourgDiscovery Research Benefits for all Larger Pilot Healthcare System citizens of Luxembourg Small PilotTranslational Research Good PMC benefit Good for few benefit for more Research Innovation
Maimonides Project – Introducing Innovation in Healthcare• Ten countries are working together to test health innovations in pilot studies in a real healthcare systems• Develop process for introducing radical change into a healthcare system• Test new approaches in pilot studies on groups with 5,000 to 1 million participants• Jointly plan pilots to bring best practices to all countries• Share successes and failures• The PMC is working with the Ministry of Health to explore the possibility of joining this initiative
Maimonides Strategy Think Big Act Small• Luxembourg is leader in early • Small projects that can be adoption of new advances in easily replicated anywhere personalized healthcare • Partner with the most• Strive to: innovative companies and – Prevent the preventable research institutes – Cure the curable • Use best practices from – Manage chronic disease other countries and share when necessary our experiences (Big Dreams and Small Practical Projects)
Luxembourg Health SummitMay 2 • 40 Luxembourg opinion leaders will meet to discuss ways for Luxembourg to introduce innovation into its healthcare system. The goal will be to identify 3 or 4 projects that can be started this year.Potential themes for projects: • Healthcare Services • Personalized Health • Active Lifestyle for Health • Diet and Stress Management • Healthy and Aging Population
Organization of PMC Composition of PMC CRP-Santé Health• Leaders of each program in CIEC Economics personalized medicine• Leaders from each major partner PMC• CIEC Cancer Diabetes• Health economics IBBL• Laboratoire National de Santé Parkinson’s Normal Disease Cohort• IBBL accepts responsibility for the administrative budget of PMC and for coordination LCSB LNS• PMC meets monthly• Decisions made by consensus
Problems• Healthcare system not aligned with current health problems• Most patients have chronic disease and system was created to meet acute needs• Health system responds well to small innovations, e.g., new imaging technology, new laboratory tests• System not ready for radical changes to align system with needs
Opt-in:• To make Luxembourg the healthiest country on earth• To prevent diabetes• To prevent heart disease• To ensure the future health of your children and grandchildren• To make Luxembourg’s health system efficient, innovative and user friendly• To work closely with all groups striving to improve health
Solutions Difficult to Implement• Smoking – largest risk factor for preventabledisease - risks identified in 1938-1950; US SurgeonGeneral warning in 1964; still have 15-40% of adultpopulation smoking.• Lumpectomy – never good data supportingradical mastectomy. When data confirmingeffectiveness of lumpectomy, still took 15 years toobtain wide-spread use.• Overuse of antibiotics – described as problemover 30 years ago and still a problem• Electronic Health Records
Components of Personalized Medicine Initiative1. Excellent, multidisciplinary research teams a) focused on specific problems using systems biology b) conduct the innovative research c) coordinate the clinical testing of novel interventions.2. Sophisticated technology platforms a) collect high quality tissue and clinical data b) high through-put technologies generate the large datasets required by the teams.3. State-of-the-art informatics a) conduct informatics research b) support the disease teams for data mining, data analysis and model building.
IBBL – Integrated ConceptIBBL Vision: To be an international centre ofexcellence in biobanking and to accelerate theintroduction of personalized healthcare for the benefitof Luxembourg• Tissue and data bank• Technology hub• Research• Personalized Medicine Consortium (PMC)
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