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The state of cancer: Are we close to a cure?

Cancer is the leading cause of death across the globe. For years now, researchers have led meticulous studies focused on how to stop this deadly disease in its tracks. How close are we to finding more effective treatments?
researchers in the labHow far has cancer research come?

The World Health Organization (WHO) note that, worldwide, nearly 1 in 6 deaths are down to cancer.

In the United States alone, the National Cancer Institute (NCI) estimated 1,688,780 new cancer cases and 600,920 cancer-related deaths in 2017.

Currently, the most common types of cancer treatment are chemotherapy, radiotherapy, tumor surgery, and — in the case prostate cancer and breast cancer — hormonal therapy.

However, other types of treatment are beginning to pick up steam: therapies that — on their own or in combination with other treatments — are meant to help defeat cancer more efficiently and, ideally, have fewer side effects.

Innovations in cancer treatment aim to address a set of issues that will typically face healthcare providers and patients, including aggressive treatment accompanied by unwanted side effects, tumor recurrence after treatment, surgery, or both, and aggressive cancers that are resilient to widely utilized treatments.

Below, we review some of the most recent cancer research breakthroughs that give us renewed hope that better therapies and prevention strategies will soon follow suit.

Boosting the immune system’s ‘arsenal’

One type of therapy that has attracted a lot of attention recently is immunotherapy, which aims to reinforce our own bodies’ existing arsenal against foreign bodies and harmful cells: our immune system’s response to the spread of cancer tumors.

But many types of cancer cell are so dangerous because they have ways of “duping” the immune system — either into ignoring them altogether or else into giving them a “helping hand.”

Therefore, some types of aggressive cancer are able to spread more easily and become resistant to chemotherapy or radiotherapy.

However, thanks to in vitro and in vivo experiments, researchers are now learning how they might be able to “deactivate” the cancer cells’ protective systems. A study published last year in Nature Immunology found that macrophages, or white blood cells, that are normally tasked with “eating up” cellular debris and other harmful foreign “objects” failed to obliterate the super-aggressive cancer cells.

That was because, in their interaction with the cancer cells, the macrophages read not one but two signals meant to repel their “cleansing” action.

This knowledge, however, also showed the scientists the way forward: by blocking the two relevant signaling pathways, they re-enabled the white blood cells to do their work.

Therapeutic viruses and innovative ‘vaccines’

A surprising weapon in the fight against cancer could be therapeutic viruses, as revealed by a team from the United Kingdom earlier this year. In their experiments, they managed to use a reovirus to attack brain cancer cells while leaving healthy cells alone.

“This is the first time it has been shown that a therapeutic virus is able to pass through the brain-blood barrier,” explained the study authors, which “opens up the possibility [that] this type of immunotherapy could be used to treat more people with aggressive brain cancers.”

Another area for improvement in immunotherapy is “dendritic vaccines,” a strategy wherein dendritic cells (which play a key role in the body’s immune response) are collected from a person’s body, “armed” with tumor-specific antigens — which will teach them to “hunt” and destroy relevant cancer cells — and injected back into the body to boost the immune system.

In a new study, researchers in Switzerland identified a way to improve the action of these dendritic vaccines by creating artificial receptors able to recognize and “abduct” tiny vesicles that have been linked to cancer tumors’ spread in the body.

By attaching these artificial receptors to the dendritic cells in the “vaccines,” the therapeutic cells are enabled to recognize harmful cancer cells with more accuracy.

Importantly, recent studies have shown that immunotherapy may work best if delivered in tandem with chemotherapy — specifically, if the chemotherapy drugs are delivered first, and they are followed up with immunotherapy.

But this approach does have some pitfalls; it is difficult to control the effects of this combined method, so sometimes, healthy tissue may be attacked alongside cancer tumors.

However, scientists from two institutions in North Carolina have developed a substance that, once injected into the body, becomes gel-like: a “bioresponsive scaffold system.” The scaffold can hold both chemotherapy and immunotherapy drugs at once, releasing them systematically into primary tumors.

This method allows for a better control of both therapies, ensuring that the drugs act on the targeted tumor alone.

The nanoparticle revolution

Speaking of specially developed tools for delivering drugs straight to the tumor and hunting down micro tumors with accuracy and efficiency, the past couple of years have seen a “boom” in nanotechnology and nanoparticle developments for cancer treatments.

nanoparticlesNanoparticles could be ‘a game-changer’ in cancer treatment.

Nanoparticles are microscopic particles that have garnered so much attention in clinical research, among other fields, because they bring us the chance to develop precise, less invasive methods of tackling disease.

Vitally, they can target cancer cells or cancer tumors without harming healthy cells in the surrounding environment.

Some nanoparticles have now been created to provide very focused hyperthermic treatment, which is a type of therapy that uses hot temperatures to make cancer tumors shrink.

Last year, scientists from China and the U.K. managed to come up with a type of “self-regulating” nanoparticle that was able to expose tumors to heat while avoiding contact with healthy tissue.

“This could potentially be a game-changer in the way we treat people who have cancer,” said one of the researchers in charge of this project.

These tiny vehicles can also be used to target cancer stem-like cells, which are undifferentiated cells that have been linked to the resilience of certain types of cancer in the face of traditional treatments such as chemotherapy.

Thus, nanoparticles can be “loaded” with drugs and set to “hunt down” cancer stem cells to prevent the growth or recurrence of tumors. Scientists have experimented with drug-filled nanoparticles in the treatment of various types of cancer, including breast cancer and endometrial cancer.

No less importantly, minuscule vehicles called “nanoprobes” can be used to detect the presence of micrometastases, which are secondary tumors so tiny that they cannot be seen using traditional methods.

Dr. Steven K. Libutti, director of the Rutgers Cancer Institute of New Jersey in New Brunswick, calls micrometastases “the Achilles’ heel of surgical management for cancer” and argues that nanoprobes “go a long way to solving [such] problems.”

Tumor ‘starvation’ strategies

Another type of strategy that researchers have been investigating of late is that of “starving” tumors of the nutrients they need to grow and spread. This, scientists point out, could be a saving grace in the case of aggressive, resilient cancers that cannot effectively be eradicated otherwise.

illustration of microscope and syringes

One novel method of ‘attacking’ cancer is by ‘starving’ cancer cells to death.

Three different studies — whose results were all published in January this year — looked at ways of cutting off cancers’ nutritional supplies.

One of these studies looked at ways of stopping glutamine, a naturally occurring amino acid, from feeding cancer cells.

Certain cancers, such as breast, lung, and colon, are known to use this amino acid to support their growth.

By blocking cancer cells’ access to glutamine, the researchers managed to maximize the impact of oxidative stress, a process that eventually induces cell death, on these cells.

Some aggressive types of breast cancer may be halted by stopping the cells from “feeding” on a particular enzyme that helps them to produce the energy they need to thrive.

Another way of depleting cancer cells of energy is by blocking their access to vitamin B-2, as researchers from the University of Salford in the U.K. have observed.

As one study author says, “This is hopefully the beginning of an alternative approach to halting cancer stem cells.” This strategy could help individuals receiving cancer treatment to avoid the toxic side effects of chemotherapy.

Cancer treatments and epigenetics

Epigenetics refers to the changes caused in our bodies by alterations in gene expression, which dictate whether certain characteristics appear or if certain “actions” are affected at a biological level.

According to research that addressed the impact of such changes, many cancers, as well as the behaviors of cancer cells, are determined by epigenetic factors.

“Recent advances in the field of epigenetics have shown that human cancer cells harbor global epigenetic abnormalities, in addition to numerous genetic alterations.”

These genetic and epigenetic alterations interact at all stages of cancer development, working together to promote cancer progression.”

Thus, it is crucial for specialists to understand when and where to intervene and the expression of which genes they may need to switch on or off, depending on their role in the development of cancer.

One study, for instance, found that the gene responsible for the advent of Huntington’s disease produces a set of molecules whose action may actually prevent cancer from occurring.

Now, the researchers’ challenge is to channel the therapeutic potential of this process without triggering Huntington’s disease. However, the scientists are hopeful.

“We believe a short-term treatment cancer therapy for a few weeks might be possible,” says the study’s senior author.

Another recent study was able to establish that estrogen-receptor positive breast cancers that become resistant to chemotherapy gain their resilience through genetic mutations that “confer a metastatic advantage to the tumor.”

But this knowledge also gave researchers the “break” that they needed to come up with an improved treatment for such stubborn tumors: a combination therapy that delivers the chemotherapeutic drug fulvestrant alongside an experimental enzyme inhibitor.

What does this all mean?

Cancer research is running at full speed, taking advantage of all the technological advances that science has achieved over recent years. But what does that mean in terms of coming up with a cure for cancer?

Whether or not there will ever be a cure for all cancer types is currently a matter of strong debate; although promising studies are published and covered by the media almost every day, cancer types vary immensely.

This makes it very difficult to say that an approach that works for one type will be adaptable to all.

Also, while there is much emerging research promising more effective treatments, most of these projects are still in their early stages, having conducted in vitro and in vivo experiments. Some potential treatments still have a long way to go before clinical trials in human patients.

Still, that doesn’t mean we should lose all hope. Some researchers explain that these efforts should make us optimistic; while we may not be at the stage where we can claim that cancer can easily be eradicated, our furthered knowledge and ever more precise tools keep us ahead of the game and improve our odds in the fight against this disease.

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Work-life balance for physicians: The what, the why, and the how

Burnout rates and physician dissatisfaction are at an all-time high. Work-life balance is the buzzword answer often cited to solve these problems, but incorporating “life” into a physician’s career is easier said than done.
Doctor stress

Is striving for work-life balance causing physicians additional anxiety?

The Cambridge dictionary defines work-life balance as “the amount of time you spend doing your job compared with the amount of time you spend with your family and doing things you enjoy.”

For physicians, the concept of work-life balance is not so straightforward, as highlighted by Siva Raja, M.D., from Cleveland Clinic Foundation in Ohio, and Sharon Stein, M.D., from University Hospital Case Medical Center also in Cleveland, OH.

“In the three ‘A’s of physician excellence – able, affable, and available – available is often the easiest to perfect,” Dr. Raja wrote.

Defining what work time means is complex in modern medicine. Typical physician duties include patient contact, administrative duties, charting, teaching, meetings, and community outreach activities. And with the addition of mobile technology, work time can easily creep into life time.

Even so, the life aspect of work-life balance is more straightforward. Time outside of work can include wellness needs such as sleep, nutrition, exercise, spiritual pursuits, and interactions with family and friends.

But, as Dr. Raja pointed out, it also includes daily living activities such as household needs, including groceries, laundry, cleaning, and paying bills.

With most physicians working 40 to 60 hours per week and nearly 20 percent reporting 61 to 80 hours each week, after sleep, how easy is it to fit in this elusive “time outside of medicine”? And should all physicians strive for work-life balance, or is a career in medicine incompatible with this concept?

Is work-life balance just hype?

Arun Saini, M.D. – an assistant professor in the Division of Critical Care Medicine at the University of Tennessee Health Science Center in Memphis – described the reasons for physicians seeking work-life balance as varied and personal, in an opinion article published in Frontiers in Pediatrics.

“Dissatisfaction, depression, and burnout are common in physicians,” Dr. Saini wrote. In fact, a recent article on physician burnout published by Medical News Today points to research showing an increase in job dissatisfaction despite a decrease in working hours.

“Most millennial physicians are paying more importance to work-life balance after seeing the first-hand effect of burnout in their colleagues and among their family members. There is also a shift in the family dynamics of [the] millennial as most families have both parents working and limited support from immediate family members. This has put additional pressure on their abilities to manage work-life balance,” Dr. Saini told MNT.

An American Medical Association survey noted that 92 percent of physicians aged 35 or younger felt that work-life balance was important.

One respondent noted, “We are focused on maintaining our identities and relationships outside of work, and many older physicians sacrificed having a life to be good doctors.”

Female physicians in particular report work-life balance as a significant concern, with the goal of achieving work-life balance often impacting their career choices.

Although statistics show the increase in the numbers of female physicians in the United States – where 47 percent of medical students and 46 percent of residents are female – research suggests that there has been little change for women in terms of domestic tasks and responsibilities.

Yet some take exception to the concept of work-life balance.

Andreas Schwingshackl, M.D. – an assistant professor in pediatrics at the University of California, Los Angeles, and Mattel Children’s Hospital in Los Angeles, CA – suggested in an opinion article published in Frontiers in Pediatrics that the pursuit of work-life balance that can actually worsen a physician’s quality of life by “adding additional, often unrealistic, expectations to [their] already stressful lives.”

Dr. Schwingshackl suggested that seeking work-life balance implies that “life only occurs whenever we are not at work” and assumes that “life is good and work is bad.”

To him, this separation means that there is always a conflict. He suggests a different approach instead.

“Once I was able to integrate rather than separate all my daily activities, [and] harmonize rather than divide my time not only between work and life but also between clinical care and research, the pursuit of balance shifted from work-life to life-nature-universe. The result was an overwhelming daily feeling of balance,” Dr. Schwingshackl explained.

Whatever the definition, what practical advice can physicians follow to avoid dissatisfaction and burnout by achieving the balance that is important to them personally?

Four tips for finding your work-life balance

“In the hustle and bustle of busy work schedules and chores of daily life, young physicians often let themselves operate in autopilot,” Dr. Saini pointed out in his paper.

Below are the four elements that he sees as being central to finding work-life balance.

1. Purpose

Young physicians may lose passion or satisfaction with their work because they no longer find meaning in their work or have lost sight of its purpose.

Finding meaning in one’s work should also take into account family needs and aligning your own needs with those of your organization.

Lori Bryant, M.D. – a pediatrician at Hyde Park Pediatrics Cincinnati, OH – told MNT, “I intentionally do more of the things that remind me why I went into medicine, call patients/parents at home a few days after visit to check up on them, send cards to kids at home to encourage them or praise them on their school accomplishments, treat my staff like friends so we have fun at work.”

2. Time management

Balancing work and life roles requires good time-management skills. Effective time-management involves setting both long- and short-term goals, planning and organizing, and not engaging in time-wasting activities.

Dr. Bryant’s time-management skills include having a “huddle” about patients before clinic, preparing electronic health record templates, making clinic checklists, outsourcing housework, batch-cooking meals, staying on top of laundry every day, and treating herself and her family to takeout on long days.

3. Prioritization

Among your various responsibilities, it is important to identify what is important to you. Dr. Bryant, who has a dual physician family, said that she puts family first. As a result, she works 3 days per week to stay on top of her family life.

4. Reassessing and resetting

During life transitions such as completion of training, marriage, childbirth, and the death of family members, taking time to reassess and reset both work and life goals can be helpful in creating balance.

“Don’t feel like you always have to say yes. It’s better to say no and succeed at what’s already on your plate, than to say yes and perform poorly or worse,” Dr. Bryant suggested.

In his article, Dr. Saini explains that for him, “it is about finding your purpose in life both at work and at home – and striving to fulfill it. The balance is in the motion, so keep the cycle moving.”

In researching and writing this article, it has become evident that there is no single standard for work-life balance. Therefore, success is only possible when one seeks his/her own personal work-life balance.”

Nurse Solomon.

 

Future challenges for digital healthcare

The digital health “revolution” appears to be well under way. According to a recent survey by the American Medical Association, the vast majority of physicians believe that adopting digital health tools will improve their ability to care for their patients.
Digital health tech

Will digital health revolutionize medical care?

The American Medical Association (AMA) reported that physicians want new technology to fit into existing systems. Importantly, physicians wanted to be part of the decision-making process when it comes to new technology.

The main requirement of new digital tools – including telemedicine/telehealth, remote monitoring, mobile health (mHealth) apps, and wearables such as activity trackers – was to help physicians with their current practices, rather than radically change what they do and how they do it.

Why are some healthcare professionals becoming disenchanted about the development of digital healthcare and its use in daily clinical practice? Do they view it as being based on little or no evidence?

Enthusiasm curbed as expectations not met

In a recent article in NEJM Catalyst, the authors note that “fewer [digital health] products than expected are being deployed in real-world clinical settings.” This may be related to complaints that in practice, these products have failed to deliver on the promise that they will lead to improved quality and outcomes and reduced costs in the management of chronic diseases.

For instance, the uptake of wearable sensors into routine practice for monitoring patients with chronic diseases has been less than anticipated. These devices transmit real-time data to the healthcare provider (HCP) using a patient’s smartphone or tablet, and in studies their use has been linked to improvements in a variety of outcomes, from quality of life to improved survival.

Until recently, however, it has been difficult to duplicate these findings in clinical practice, cardiologist and IT researcher Lee R. Goldberg, M.D., of the University of Pennsylvania, told a recent meeting of the American College of Cardiology (ACC). Some studies even reported increased costs (of utilization), no impact at all, or even harm, he added.

Physicians also say they have found that managing the data and incorporating them into clinical practice presents a significant challenge. They are also faced with patients who use their own apps and sensors – many of which are untested or unproven.

From ineffective electronic health records, to an explosion of direct-to-consumer digital health products, to apps of mixed quality, [these products are] the digital snake oil of the early 21st century.”

Nurse Ritah Namwanje

“More and more we’re seeing digital tools in medicine that, unlike digital tools in other industries, make the provision of care less, not more, efficient,” Madara added.

Tech industry and healthcare profession disconnected

Increasingly, disappointment with digital health is linked to a cultural barrier that exists between the technology entrepreneurs, investors, developers, and practicing physicians. Development of the technology shows “a shocking lack of focus on the place where healthcare takes place,” John S. Rumsfeld M.D., chief innovation officer of the ACC, told the society’s 2017 annual meeting.

The main reason for this may be the lack of involvement of medical professionals in the development of some digital tools. In 2016, 85 percent of companies that publish medical apps said they consulted with HCPs in-house or externally, which represented a drop of 11 percent from the previous year. Furthermore, 11 percent of companies said that they did not work with HCPs at all.

“Unfortunately it often takes the critical eye of a physician to judge whether there is a credible level of evidence for an app or whether it is just a bunch of hocus pocus,” noted David M. Levine, M.D., primary care physician and researcher at Brigham and Women’s Hospital and Harvard Medical School, both in Boston, MA, while speaking with Medical News Today.

A plethora of apps for that

Critics say that as a result of the failure to consider what may be of most value to physicians, many existing digital tools “address health issues in piecemeal and haphazard ways.”

Many apps focus on a single disease, whereas patients with the greatest need have multiple chronic conditions. A senior with multiple chronic conditions could end up with 20 different apps on their phone, thinking that that is helpful, Dr. Levine pointed out. “This is very antithetical to the way PCPs [primary care providers] think,” he said. “I believe that people are going to start moving toward holistic approaches,” he predicted.

Apps for the management of chronic diseases are mainly focused on diabetes, obesity, hypertension, depression, bipolar disorder, and chronic heart disease, but high-quality apps for use in other chronic conditions, such as rheumatoid arthritis and pain, are lacking.

Evidence base needed for many digital health tools

Much of the new digital health technology, especially mHealth apps, lacks an evidence base. Commercially successful apps do not necessarily have medical value for physicians to apply to decision-making for patient evaluation, diagnosis, treatment, or other options. For this reason, many PCPs are cautious about using them.

It is very difficult for a PCP to know what is a good app and what is not, which ones are evidence-based and which one has been validated. I don’t want to introduce a new intervention to one of my patients unless I know there is evidence that it works […] it’s the same as of medication.”

Nurse Solomon

Digital health products that do show impressive results in clinical trials often fail to be adopted into clinical practice. This is because clinical trials are conducted in highly controlled environments, which make use of tools such as training, close monitoring, and payments to ensure that patients use the technologies appropriately. This rarely exists “in the real world,” according to Joseph C. Kvedar M.D., vice president of Harvard-associated health technology company, Partners HealthCare Connected Health.

Digital health products designed for the prevention or treatment of chronic diseases mostly do so through changing patient behavior. In order to be successful, patients need to be highly motivated. Digital companies should focus on patient engagement, Dr. Kvedar advised.

More connectivity in the future

A big problem for current practice is that many digital health tools do not connect with each other. Interoperability – that is, systems and devices exchanging data and interpreting the shared data – “therefore remains largely unattainable.” Integration of new technologies is very important, Dr. Levine stressed – particularly development of technologies that are more easily incorporated into the electronic health records (called “Plug and Play”).

“We want it to all be visible to our entire health team so that anyone can log into it and it is all in one place,” Dr. Levine said. Currently, most of these apps create their own platform with their own set of log-ins and their own security issues and alerting issues. Connectivity is a big issue for the future because “oftentimes that is what keeps us from using some of these digital health solutions now,” he said.

More clinical guidelines needed

Digital strategies have been compared to complementary medicine in that neither of them appear in clinical guidelines. Few professional medical organizations have tackled digital healthcare in their guidelines, but in 2016, the AMA issued guidance on the safe and effective use of mHealth apps and other digital health devices, such as trackers and sensors.

Recently, the American Heart Association (AHA) published recommendations for the implementation of telehealth in cardiovascular and stroke care and telemedicine in pediatric cardiology.

The AMA and AHA, together with the Healthcare Information and Management Systems Society and digital health nonprofit DHX Group, have set up an organization called Xcertia, dedicated to improving the quality, safety, and effectiveness of mHealth apps. Xcertia will offer guidance for developing, evaluating, or recommending mHealth apps, but it will not certify them.

How will physicians be able to choose the most appropriate technologies for their practice in the future? Perhaps independent organizations will test apps in collaboration with practicing physicians, producing online recommendations. One suggestion is that professional medical associations produce app “labels,” listing the characteristics of, and warnings about, each app for both patients and physicians.

mHealth: What is it, and how can it help us? – Digital Healthcare

A great number of healthcare practioners and patients alike remain wary of electronic health. Doctors claim that they don’t have enough time, and patients are concerned about their data going awry. As such, the uptake of mobile health has been slow. In this Spotlight, we investigate its pros and cons.
doctor with mhealth app on tablet

mHealth offers improved patient monitoring, among many other things.

Given the scale and speed of our technological advancement during the past few decades, it is no surprise that around 4.68 billion people will use a cell phone by 2019.

In the United States, just “40 percent [of general physicians] have evening and weekend working hours,” which may isolate a great number of patients in the U.S. who work 9–5.

However, in developing African countries such as Zimbabwe, the situation is much worse.

There is just one doctor per 10,000 people. Similar scenarios present themselves in many other developing countries.

According to the 2014 Information and Communication Technology Household Survey — by the Zimbabwe National Statistics Agency — “at national level, the proportion of households with at least one household member with a [cell phone] at home was about 89 percent compared [with] about 11 percent without.”

It may therefore appear intuitive to exploit the growing worldwide popularity of cell phones — and other such personal electronic devices — to create more convenient healthcare for all.

Indeed, “The proliferation of cell phones across the globe, even in locales without basic healthcare infrastructure, is spurring the growth of mHealth in developing countries,” according to West Wireless Health.

However, despite the global advent of electronic health (eHealth) — and, more specifically, mobile health (mHealth) — during the past couple of decades, many individuals remain unsure of its uses and benefits.

What is mHealth?

The World Health Organization (WHO) have stated that “no standardized definition of [mHealth] has been established.” However, for the purposes of a survey that the Global Observatory for eHealth conducted in 2009, mHealth was defined “as medical and public health practice supported by mobile devices, such as [cell] phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.”

With nearly 4.7 billion cell phone users around the world, using such devices as a way to aid health is surely a step toward achieving global wellness. As mHealth Alliance explain:

[T]he ubiquity of mobile devices in the developed or developing world presents the opportunity to improve health outcomes through the delivery of innovative medical and health services with information and communication technologies to the farthest reaches of the globe.”

Since their introduction to the global market during the 20th century, mobile devices have aimed to improve connectedness — and perhaps the most recognized benefit of mHealth is its ability to keep us connected with our healthcare provider at all times and from all distances.

How else can mHealth improve our wellness?

How can mHealth help us?

The connectedness and convenience that mHealth — and most other facets of eHealth — provides have the potential to greatly improve quality of life and ease of care when used appropriately.

From improved medication adherence to aggregated patient data, the benefits are plenty.

Treatment compliance

One of the main challenges that healthcare practioners now face is ensuring that their patients take the correct medication as and when they are supposed to.

senior hand picking her pills

Some mHealth apps can prompt users to take their medication.

A study that was published in the journal Risk Management and Healthcare Policy in 2014 included some worrying statistics.

“Medication nonadherence is widespread and varied by disease, patient characteristics, and insurance coverage,” the authors write, “with [drug] nonadherence rates ranging from 25 percent to 50 percent.”

Failure to take prescribed medication correctly, among other things, “is associated with poor therapeutic outcomes, progression of disease, and an estimated burden of billions per year in avoidable direct healthcare costs,” report the study’s authors.

Noncompliance with a medication regime has a whole host of issues, including hospitalization, relapse, disease flare-ups, poorer quality of life, and possibly even death.

However, there are certain mHealth apps — easily downloadable to a phone or other personal device — that can help people stick to their medication regimen by tracking pills they have and have not taken, prompting them to take a certain drug, and allowing them to log any symptoms.

Improved monitoring

A lot of mHealth apps can connect a patient with their healthcare provider to improve ease and speed of contact. Being able to chat with a doctor or get advice on a condition, symptoms, or drug at any time has a host of benefits — the most important being the possibility of earlier intervention.

If a patient expresses concerns about their health but can’t physically get to a doctor, they can use an mHealth app to communicate. The doctor might see fit to intervene, thereby potentially saving the patient’s life.

Improved monitoring has benefits at the wider population level, too; some mHealth apps are able to collect patient and general healthcare data and store it in a single place.

This allows healthcare providers to peruse the most recent advances in the field, ensuring that the best possible patient outcome can be achieved.

By having such convenient access to health trends — often in real time — healthcare professionals can stay on top of up-and-coming practices, giving them a better idea of how to proceed with patient care.

Paperless information

The growing popularity of electronic communication devices, such as laptops, cell phones, tablets, and PDAs, is also beneficial for the environment; it has set in motion the decline of paper-based communication and documentation filing.

Many companies — including Expensify, a tool for expense report management, and TicketText, a ticketing company — have “gone paperless,” instead favoring internet-based storage solutions such as the Cloud.

Going paperless not only cuts office and hospital supply costs and reduces wastage, it also lowers doctors’ office clutter and helps keep all patient data secure and in the right place.

However, while some people have suggested that using paper documentation actually reduces the risk of losing patient information, studies have so far been inconclusive.

How might mHealth harm us?

Human mistrust of technology is hardly new; for decades, we’ve been resisting any form of change or advancement that may take power away from us.

In many ways, this is what mHealth apps do: take a great deal of responsibility out of the hands of healthcare professionals and assistants and deliver it straight to cyberspace. However, could this cause more harm than good?

Lack of regulation

Before a drug is allowed to go to market, the Food and Drug Administration (FDA) have to approve its safety. Without their approval, the drug cannot legally be sold.

The FDA explain that they are “responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices.”

According to research2guidance, as of 2017, there were approximately 325,000 mHealth apps available. Though users have hailed many of these beneficial, the FDA have so far only approved a fraction of them.

mHealth apps are perhaps not at the top of the FDA’s priority list; they are considered by experts to be “low-risk,” meaning that the use of them is noninvasive and unlikely to cause considerable physical harm.

For this reason, the FDA do not believe that they require regulation in the same way that drugs and other therapies do.

Although this means that app development companies can roll them out to the paying public faster, it does also mean that there is little testing in patient communities to catch any issues the app may have, which could cause harm to the user further down the line.

Interestingly, there have been hints that instead of the FDA working to approve apps themselves, entire app development companies could gain their approval.

Too reliant

Despite the fact that, as discussed above, the majority of mHealth apps have neither been tested in the patient community nor approved by regulatory bodies such as the FDA, many patients do rely on them in their everyday lives.

sad woman looking at phone

Doctors fear patients becoming too reliant on their mHealth apps.

Somewhat concerningly, many users of mHealth apps are choosing to use them instead of seeking professional help.

This is problematic for several reasons — the most important being the fact that the vast majority of these apps are not regulated.

In fact, in 2015, researchers at Harvard Medical School in Boston, MA, conducted a study into symptom-checking websites and apps.

The researchers discovered that, of the top 23 symptom checkers, “correct diagnoses were listed first in only 34 percent of standardized patient evaluations.”

The analysis also revealed that the correct diagnoses were listed by the symptom-checking tools within the “top 20 possible diagnoses” in less than 60 percent of the evaluations.

This has dangerous implications — especially the fact that receiving an incorrect diagnosis or not getting one at all could hinder proper treatment and possibly endanger life.

The future of mHealth

Many people believe that mHealth is the future of healthcare — but what is the future of mHealth? Where will this technology take the healthcare industry and all those who rely on it?

In an ideal world

In several ways, the future is already here; “wearables” are now a part of millions of people’s lives, and seeing a doctor via an app has never been easier. What else can we expect from mHealth?

We can assume that mHealth will offer greater access to healthcare in developing countries while also decreasing the cost of healthcare in developed nations by transforming expensive systems into “prevention-based and patient-focused” ones.

Using mHealth apps to track symptoms and keep in touch with a healthcare provider can reduce the need for invasive treatments by staying one step ahead of disease.

Openness is a key goal of mHealth developers. James Michiel — senior mHealth and informatics analyst at Emory University’s Rollins School of Public Health in Atlanta, GA — says, “the future of mHealth is open — open access, open source, open data, and open innovation.”

However, mHealth faces many obstacles in achieving that goal.

Challenges to face

For mHealth to continue along its successful growth trajectory, there is need for proper regulation.

According to the researchers M. Mars and R.E. Scott, “eHealth’s ability to transcend sociopolitical boundaries holds the potential to create a borderless world for health systems and healthcare delivery.”

“But,” they continue, writing in the journal Health Affairs, “the policy needed to guide eHealth’s development is limited and just now emerging in developed countries.”

What’s needed to foster eHealth growth in the developing world is thoughtful policy to facilitate patient mobility and data exchange, across both international border and regional boundaries within countries.”

What’s next?

Researcher Harold Thimbleby — writing in the Journal of Public Health Research in 2013 — explains that the “future of healthcare is about the patient (or stopping people becoming patients), but patients are not the main stakeholders in healthcare.”

“Insurance companies, big pharma, doctors, managers, suppliers, builders, governments, and many other forces will influence the future,” he adds. “Will innovation help patients or will it be partly to help monitor clinicians delivering healthcare?”

Perhaps answering this question is key for the development of mHealth; after all, appropriately developed means of delivering treatment can mitigate risk to patients and put in place best practices for doctors.

Regardless of what comes next, Michiel recognizes that “[n]ever in the history of development have there been so many powerful tools and platforms available to those who have traditionally been marginalized and excluded from the vanguard of technology and innovation.”

“It is imperative, though,” he goes on, “that these tools and technologies are used deliberately and efficiently, with an eye toward the end user in a way that ensures long-term sustainability and development.”

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