Prevention, the Guardian Angel of Health
Early diagnosis is one of the great challenges for Mexico in its battle with cancer. Education, and as a result prevention, are two other key pillars in the fight against a disease that shows no sign of slowing down, Juana Ramírez, CEO and Founder of SOHIN, told the audience at the opening of the fourth edition of the Mexico Health Summit held Thursday at the Sheraton María Isabel Hotel in Mexico City
“Mortality is drastically reduced when cancer is diagnosed early. For example, 75 percent of pediatric cancer diagnosed early has a cure. The challenge, then, is in prevention and early diagnosis,” Ramírez said in her opening presentation. “Between 30 and 50 percent of cancers can be prevented.”
During her presentation, entitled “Prevention and Early Diagnostics: Barriers to Cancer,” Ramírez emphasized the impact that cancer will have on the Mexican economy in the short to medium term, saying that in 2030 one in three Mexicans will be diagnosed with cancer due to lifestyle habits such as smoking, sedentary lifestyle, overweight, alcohol consumption or environmental pollution. “It is a real public health problem. It is a problem that will put the economy in check,” she said. “Forty percent of the national health budget in Mexico is dedicated to chronic noncommunicable diseases.”
Ramírez was optimistic about the health policies that may be implemented by the incoming presidential administration of Andrés Manuel López Obrador. Equal access, the creation of a national plan for the prevention and control of cancer, the reduction of risk factors and the training of professionals are some of the points on which, according to Ramírez, the new government must put its focus, especially in a country where “we depend on our socio-economic status and our labor relations to receive treatment.”
Another of Ramírez’s proposals to fight cancer through public policies is “to remove cancer from the clinical and pharmaceutical space to illustrate that it is a social problem that affects us all and that has enormous dimensions. Cancer is not a problem of oncologists but of all health professionals,” she said. “We need better trained general practitioners to improve early diagnosis.” Ramírez also advocated using traditional advertising techniques to spread the message about cancer. “We must compete with Apple or Maluma in the positioning of the message. Health must leave the medical environment and start competing with the advertising messages we see every day. The communication must influence the life habits of the population,” she said.
Finally, Ramírez highlighted the role of women in the global health industry. “Eighty-three percent of the health decisions in the world are made by women and 97 percent of cancer patients in the world are cared for by women. There is a lot to be done in education.”
Is Patient Centricity a Passing Fad or a Long-term Trend?
When people become patients, they should also become the center of attention, panelists at Mexico Health Summit 2018 said on Thursday at the Hotel Sheraton María Isabel in Mexico City. The patient-centric model sees the patient as the center of care where all healthcare elements, including providers such as hospitals, doctors, nurses and all the people around the patient, provide care with greater humanity and efficiency.
During their discussion, the panelists talked about patient centricity from its construction as a concept, the change in philosophy and the impact it could have on patients and other players in the health industry. “Patient centricity is a concept that has evolved over time and depends on the service or product with which the health agents participate. For pharmaceutical companies, the impact of patient centricity must be considered from the clinical research stage until the moment people have access to the medicine,” said Monique Clúa, Regional Director of the Transformation Area at Novartis Mexico.
The patient as the center of medical attention also should become a matter of philosophy and conviction for the industry. “Companies must leave aside the idea of being pharmaceuticals that only sell drugs and hospitals that only sell health services, to evolve into a more comprehensive model of medical attention. The purpose of new business models must be to combine all the necessary elements to provide effective, accessible, customized and humane attention to each individual,” said Jaime Cervantes, CEO of Vitalmex.
This change in philosophy should also consider how the patient is perceived and supported. “The pillar of change should start by shifting the patient from being a victim to being empowered. This transformation will spread to the health system and later impact positively the epidemiological profile of the country,” said Lizete de la Torre, Director of Corporate Affairs and Health and Value at Pfizer Mexico. “The future of health in the country will rely on how the industry and the government provide better and more resources to empower the patient through this model. Healthcare is an issue for everyone: the patient, the government and the industry.”
Although the panelists agreed on the relevance of the new model in health, they also stressed there are conceptual differences among industry players and obstacles in the health system to overcome before this model can be successfully implemented in Mexico. Alejandro Paolini, Director General of Siemens Healthineers for Mexico, Central America and the Caribbean, told the audience that “patient centricity is a very present topic in the industry, but there is still doubt whether all the players in the sector share the same idea.” He explained that the model “should not be about having the patient on your mind all day but about generating a connection between the patient, the services, resources and the system that surround healthcare.”
Alejandro Luna, Partner and Life Sciences Co-chair of Olivares and moderator of the panel, asked the participants to share how the patient and the various players in the health industry could become part of this model. For some, the answer was technology and for others, multisectoral collaboration. Paolini said that “approximately 60 percent of the population has access to digital health apps and wearables, but this is only the first step. The health sector must accompany the patient along the process with technology and by creating more customized spaces and experiences that have a greater impact on the well-being of the individual.” However, for others the key to this change is collaboration. “There is still a long way to go before we have a functional model in Mexico, but as more players in the industry align to the patient-centric model and work together, healthcare attention will continue to evolve positively,” said Cervantes.
The panelists agreed that patient centricity is not a fashion but a trend and a necessity. “Mainly, because the patient-centric model has become one of the key solutions to achieving greater sustainability in healthcare and the patient has become an informed consumer of health services,” said Paolini. As a result, “the way in which companies treat the patient, provide services and products will become not only an obligation but a key differentiating factor for the patient when choosing where to receive treatment,” he said.
Health Regulation for the 4th Industrial Revolution
The fourth industrial revolution is transforming many sectors and healthcare is no exception. Clinical decision-support systems, artificial intelligence and other information technologies are critical to improving the health system but just as in other industries, data security is a key element to consider, according to Antonio Carrasco, Director General of PLM Latina.
“Having a digital identity is key to boosting patient centricity,” said Carrasco during his presentation at the fourth edition of Mexico Health Summit 2018 at the Hotel Sheraton María Isabel in Mexico City on Thursday. “However, patients must have the right to share their data with each of the subsystems in the Mexican health sector and they must be sure their information will be secure.”
According to Carrasco, a person’s banking data is worth US$3 on the black market while their clinical history is worth approximately US$150, which shows how valuable this data is. The government is a key player in fostering a technologically advanced environment and it is also the best safeguard of patients’ information, said Carrasco. Nevertheless, there is a gap between the different entities in this sector that prevent effective communication. “When patients go from IMSS to ISSSTE or Seguro Popular, there is no follow-up on their previous treatments and they have to provide their personal information again,” he said. “This makes the process highly inefficient and prevents the industry from reaching true interoperability.”
Carrasco said interoperability is what the country should strive for to achieve true patient centricity. Furthermore, any digitalization strategy to be implemented must consider not only hospitals and medicine producers but laboratories, pharmacies, research centers and all other enities participating in the sector. “Institutions must have access to files from a third party that show a patient’s clinical history to make decisions in favor of the patient and thus boosting prevention. Meanwhile, general doctors must have access to new tools that allow for better follow-up of treatments while sharing the generated information with other players involved in the treatment,” he said.
Carrasco gave the audience the example of people insured by IMSS who choose to fill their prescription at the local drugstore due to convenience. “In Mexico, 45 percent of healthcare expenditure is out of pocket and much is related to convenience,” he said. Through interoperability, different industry entities could communicate and reimburse the patient from purchases related to their treatment. “Digitalization could help build a unified structure that works in favor of the patient and reduces redundancies between different public institutions. But the government must be open to invest in these systems,” Carrasco said.
The Ministry of Health must be the central axis to implement interoperability advances, according to Carrasco. However, “having an official norm (NOM) on interoperability is not enough,” he said. “The Ministry must determine the costs and procedures to treat patients and unify them in a single health ecosystem. We also need a public policy that pushes for centralization and interoperability.”
How to Increase the Productivity of a Country Through Health
The health of its citizens has a direct impact on the productivity and economic development of a country, panelists agreed on Thursday at the Sheraton María Isabel Hotel in Mexico City during the fourth edition of the Mexico Health Summit. “Health is a very important element for increasing the productivity of a country. Poor medical care directly affects productivity,” said Sandra Sanchez-Oldenhage, Owner and CEO of Pharmadvice and Country Manager of Biogen. She was also the moderator of the panel entitled “Health as a Catalyst for Mexico’s Long-Term Economic Competitiveness.
The continuous economic growth experienced by Mexico since the beginning of the 21st century has improved the quality of life of Mexicans, although, according to Marco Antonio Navarrete, Deputy Director of Health Services of PEMEX, that success has been accompanied by negative developments such as the aging of the population and the increase in chronic non-communicable diseases. “When life expectancy increases, so does the pressure on pensions. We need to keep citizens healthy for as long as possible, because a sick and retired population can bankrupt any country, in addition to generating greater poverty and lower productivity,” said Navarrete, who highlighted France as an example. “France was forced to extend the retirement age. In Mexico, we are in a worse scenario because we have a very high life expectancy but less productivity and more chances that a citizen will fall ill.”
One solution proposed by the PEMEX executive to try to correct this trend is education, with the objective that citizens have greater control over their health. Navarrete said that although the issue must first be addressed through education it should then move on to labor environments. “A work physician is as important as a top-notch surgeon. Health is not only the responsibility of hospitals but of any social or occupational area.”
Joel Cano, Director of Incubation and Innovation at Grupo Altavista, proposed risk investment as a potential solution. “There are hardly any risk investments in this field,” he said. “We must create new companies that help to solve the impact that the aging of the population has on productivity. Trying to solve new problems with old solutions is difficult, that is why I believe that both the private and the public sectors should bet on innovation.” Héctor Valle, Founder and Partner of INNOVASALUD, pointed out that the application of a “predictive, preventive, professionalized and participatory system” is the key to attacking a problem that Mexico is already facing.
One institution working hard to decipher the impact that health has on the macroeconomic variables of a country is the WHO/PAHO. Juan Manuel Sotelo, Country Representative of PAHO/WHO, suggested the creation of “a macroeconomics commission to collect data that would offer evidence on the impact of health on the economy, since a healthy person will contribute to the development and productivity of a country.” He acknowledged, however, that “Mexico’s health budget is not very flexible.” Sánchez-Oldenhage agreed, saying, “health has not been a priority in the country’s federal agenda.”
Navarrete added that the keeping people healthy should be the incoming government’s priority. “The next government’s focus should be on paying for services and products that help people stay healthy. It should not spend on treating diseases,” he said. “In so doing, we could better direct services, especially in very isolated places in Mexico.”
Universal Healthcare: Are We There Yet?
Although the public sector has made huge advances, the country is still far from implementing universal healthcare. According to Javier Potes, Director General of Consorcio Mexicano de Hospitales, there is still a huge part of the population unattended and it is unclear how sustainable the public healthcare sector is regarding offering service in the future.
Working toward the ideal of universal healthcare was a critical topic discussed during one of the panels at Mexico Health Summit 2018, which took place on Thursday at the Hotel Sheraton María Isabel in Mexico City. Potes acted as moderator of the discussion that covered different sides of universality, including access, financing, service and prevention. According to Antonio Chemor, National Commissioner of Seguro Popular, to reach universality it is not necessary to integrate all participants in the healthcare sector. “IMSS, ISSSTE and Seguro Popular have grown at their own rates to cater to different areas of the population,” he said. “The goal should be for communication between all systems.”
This opinion was shared by Miguel Alberto Salazar, President and Director General of Boehringer Ingelheim México, who said that even though there is already a huge offering of services, healthcare education, doctors, medicine and equipment, the challenge now is to attract the patient and work as a unified front. “We already have the technology to make healthcare available to everyone but we must work together,” he said.
Not everyone in the panel agreed on the alleged advances on universality in healthcare. Efrén Ocampo, President of Grupo Neolpharma, pointed out that Seguro Popular and universal healthcare are not synonyms and even highlighted that life expectancy has been stuck for the past 10 years. “Universal healthcare without budget is not possible,” he said. “The government has continuously reduced healthcare budget and many hospitals are not working properly.”
The vision of the government has been flawed, according to Guillaume Corpart, Managing Director of Global Health Intelligence, who said the country has looked at healthcare as an expenditure when it should be seen as an investment in productivity of the able workforce. “Our GDP is growing because of an increase in our workforce instead of growing because of an increase in productivity,” he said.
Salazar countered by saying that although healthcare was not a priority for the current administration in the beginning, the Peña Nieto government has done much for the sector. “However, there is still not enough expenditure to address the main issues in the country,” he said. Efficiency is key, both in resources and infrastructure, according to Chemor. “There is already collaboration between the public and private sectors and thanks to this, out-of-pocket expenditure has been reduced,” he said. Chemor also highlighted that the Peña Nieto administration has invested over MX$29 billion (US$1.5 billion) in renovation of equipment and infrastructure. “Investment is still needed but we have learned to manage our resources to make the system more efficient.”
Ocampo disagreed, saying that public expenditure in healthcare is still low. “Mental health issues are not addressed while child mortality is on the rise.” Even though he agreed that there had been investment, Salazar argued that the general population perceives public as bad in terms of service, although he pointed out that the perception of the public service depends on where the patient is being treated. “There are deficiencies in the system but we must also consider how much the country has advanced and how it compares to other regions in the world,” said Chemor. “In Mexico, over 40 percent of the population does not have to spend anything on healthcare no matter what the cost of the treatment.”
Regardless of how much the healthcare system advances, Roberto Esses, Country Manager of Gympass, said attacking health issues at their root was key for the country’s healthcare system to advance. Almost 70 percent of all hospital entries are related to obesity and sedentarism, he said, while an active lifestyle could help diminish this. “The active population can reduce health-related costs for companies by 60 percent,” Esses said. “For each dollar we invest in prevention, we can earn over US$3 dollars.”
DNA & Genomics: Building the Future of Healthcare
Genomic medicine is advancing at an accelerated pace and it is generating complex and changing scenarios that the industry and the government must face, sooner or later, Victor Saadia, Founder and CEO of BioCenter, told Mexico Health Summit 2018 during a panel discussion he moderated on Thursday at the Hotel Sheraton María Isabel in Mexico City.
Since its inception in the 20thcentury, genomics has evolved alongside the health industry and will only grow in importance, said panelist Xavier Soberón, Director General of INMEGEN. “Genomic medicine from its origin has evolved hand-in-hand with the health industry and in the future, it will continue to be key for transitioning into medicine with greater precision.”
Francisco Kuri Breña, Director of New Developments of Landsteiner, agreed: “Over a decade ago, the concept of genomic medicine did not exist as it does today. Genomic medicine relied on discovering new therapies for diseases that had no cure, but now the industry knows it can also serve to improve existing treatments with greater precision.”
With the evolution of genomics, the availability of applications has also increased. Now, “genomic medicine can improve healthcare in different areas such as early detection of diseases, greater personalized treatments, the possibility of improving efficacy and reducing the side effects of drugs and, finally, in identifying new drugs with greater speed,” said Soberón.
Despite the knowledge about the applications of the genomic medicine, there are still barriers hindering access and further development. José Campillo, former CEO of Funsalud, told the audience that there are two barriers related to the development of genomic medicine: the lack of a budget to support this medicine and the lack of access to information about it. He added that another barrier is that “the research and development of genomic medicine is so accelerated that it also represents a challenge for those who regulate it, as well as those who practice this science.”
Other panelists suggested that privacy of genetic information and the inherent challenges are also hindering the development of this science. “The next step for genomic medicine and other areas of medicine will be the regulation of sensitive data and the generated information,” said Kuri-Breña. Added Soberón: “The immediate concern is going to be what information becomes private and what becomes public, as well as the criteria for who has and who does not have the right to this type of information.”
The importance of genomic information raises a serious question for the industry and the authorities, said Campillo. “How will the authorities draw the limits of science based on bioethics but also move toward improving treatments for diseases?” he asked. Kuri-Breña answered that “the possibilities and opportunities offered by genomic medicine are countless, and it is the task of the different players in the health industry, such as insurers and others, to rely on this knowledge to improve access to health and improve healthcare.” He continued: ”Genomic medicine is the medical science that has mot embodied the patient-centric model in its core. The closer the industry is to genomic medicine, the closer it will be to providing better and more precise medical care.”
Unsustainable Practices Enable Silent Killer
For pharmaceutical companies, people needing more medicine might not be a problem at first. But when resistance to medicines outpaces the development of new solutions, the industry must take a moment to understand what is hindering the efficacy of antibiotics, Alba Tiley, Head of the Sustainable Antibiotics Division of DSM Sinochem Pharmaceuticals said on Thursday at the Mexico Health Summit in Mexico City.
During her presentation at the Hotel Sheraton María Isabel, Alba Tiley, Head of the Sustainable Antibiotics Division of DSM Sinochem Pharmaceuticals, explained to the audience that even though antibiotics are the cornerstone of modern healthcare, they are not valued as they should be. “Antimicrobial resistance (AMR) is one of the biggest problems in the industry, comparable even to climate change due to its scope in the global population,” she said. “By 2050, up to 10 million deaths could be attributable to AMR, costing trillions of dollars to the global economy.”
Tiley explained AMR is a recurring phenomenon in nature due to the overuse of antibiotics in humans and animals. “Many doctors prescribe antibiotics for viral diseases and in the US, two out of every three antibiotics prescriptions are useless,” she said. The problem is not new, however, which Tiley explained by citing Alexander Fleming who said that the man who uses penicillin carelessly is responsible for the death of a person resistant to penicillin.
However, Tiley highlighted another cause for AMR that might be overseen by many companies. “Pollution and misuse are among the main drivers for antimicrobial resistance,” she said. Companies tend to neglect proper wastewater treatment in medicine manufacturing, which leads to pollution in rivers and other water bodies that can lead to AMR in animals and humans. “This industry is very competitive and has low margins,” Tiley said. “Clients are looking for the cheapest drugs, which leads to companies cutting corners to reduce costs. However, someone, somewhere is paying the price of those bad practices.”
Tiley provided three potential solutions that involve not only companies but clients and even the government. First, the industry must work to higher standards and improved transparency, thus helping users understand why pollution is important and why medicines might have higher production costs. Second, companies must follow stricter production guidelines. “We work in a highly regulated industry, so why do we not include AMR and sustainable manufacturing practices?” Tiley asked. Finally, governments should consider sustainability criteria in procurement of pharmaceuticals.
Tiley highlighted Sweden as the only country currently working under sustainable procurement standards with the Netherlands following suit. “Mexico is the second-largest market for antibiotics in Latin America, which means it could play a leading role in fighting AMR,” she said. “We need to make sure we get the sustainable angle under control and we need international cooperation on a problem that is borderless.”
Obesity, a Complex Disease in a Complex Medical Ecosystem
Obesity, its implications beyond medical treatment, its origins and possible solutions were some of the axes on which the presentation ‘Obesity and Diabetes: Education The Key to Prevention?’ that was directed by Yiannis Mallis, General Manager and Vice President of Novo Nordisk Mexico. “The obesity is an illness. We have to be very clear, because in the past obesity was not treated as an illness,” said Mallis in the fourth edition of the Mexico Health Summit held on Thursday at the Sheraton María Isabel Hotel in Mexico City. “Prevention, education and awareness are critical in fighting obesity. Physicians and the general population need more information on this issue”.
Mallis, representative of one of the leading insulin manufacturers in the world, proposed several steps to start facing a disease that is expanding at high speeds, especially in regions with emerging economies. “To improve obesity treatments we must do four things: understand the disease, understand its impact, understand the patient and work in the search for a solution.”
“Obesity affects not only our quality of life, but also our life expectancy,” he said and marked its origins in several routines common in modern societies such as physical inactivity, lack of sleep, psychology and genetics. In addition, it can cause depression and anxiety.
The disease, he recalled, has had a great impact in Latin America. Mexico, for example, is the second country in the world with the highest rates of obesity, although the problem is global. “More than a third of the Mexican population is obese and another third is on the frontier of obesity,” said Mallis, who launched a question to the audience: “Should we focus on patients or on the people who can develop a condition in the future? The answer should be to focus on both.”
In terms of global data, Mallis said that there are 650 million obese people in the world, although there are no data on diagnoses. “Of those 650 million, only 11 million are receiving treatment,” Mallis said. Worrying data for a silent disease that however have their origin in a purely personal issue of each patient. “Eighty-two percent of patients recognize that obesity is completely their responsibility, which is why they do not seek medical help. Four out of every five Mexicans with obesity think they are just overweight,” he explained.
As one of the possible solutions, Mallis pointed out that losing between 5 and 10 percent of the weight can generate immediate benefits, since, for example, with that small percentage can limit cardiovascular risks. With this small decrease, Mallis said, “13,000 cases of cancer would be avoided by 2030.”
However, in his opinión to achieve this it is necessary to act from different fronts.””One action alone, like raising the tax on sugary drinks, is not going to be the solution that changes wellness culture in Mexico.”
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