International cooperation is key to fulfilling our vision of making cancer treatments more precise, and giving the patients new treatments more quickly.
This opinion piece is written by Ketil Widerberg, General Manager at Oslo Cancer Cluster. It was first published in the Norwegian newspaper Today’s Medicine, Dagens Medisin, 30 October 2018.
The countries in Northern Europe have contributed to developing medical treatments that we today could not imagine living without. From the British discovery of antibiotics to the Danish development of a treatment for diabetes. Once again it is time for Northern European health innovation, this time in the field of health technology. What might the prime ministers from Northern Europe focus on when they meet in Oslo on 30 October to discuss health technology?
They might want to point out concrete and state-of-the-art initiatives from their respective countries. It could be Swedish biobanks, Finnish artificial intelligence, Danish health data, English genomics and Estonian health blockchain. These are exciting initiatives that make medicine more precise. This is particularly important when it comes to cancer because more precise treatments could save lives and limit the late effects resulting from imprecise treatment.
At the same time, we see the contours of serious challenges arising with more precise medicine, such as each unit becoming more expensive. Smaller patient groups also mean that it is harder to find enough patients to understand the biological processes and the consequences of new medical treatments. As the prime ministers gather in Oslo to discuss health technology and plan the road ahead, it would not be amiss for them to look back in time and find inspiration from another technological development.
Precise through cooperation
In the 1990s, the search engine Yahoo helped us to quality-assure by categorising and being precise when we needed information on the internet. Yahoo thus contributed to the internet changing the world. However, the amount of data soon became enormous and complex, and a never-ending need for resources and experts arose. The traditional categorisation to ensure quality and structure the data became an impossible task.
This is very similar to what is happening in the health field today. We are constantly collecting more data and educating an increasing number of experts. With a few exceptions, every country is now collecting their data in their own registers and using a great deal of resources on assuring the quality of the data. The countries are rightfully proud of their initiatives. In Norway, we are proud of our biobanks and our health registers, such as the Cancer Registry of Norway. At the same time, we need to ask ourselves whether this national strategy really is the smartest way forward.
Let us go back to Yahoo. Towards the end of the 1990s, some engineers in California thought differently about the internet. How about using cooperation as a quality indicator? Instead of categorising, the links between the websites could ensure data quality. This is how Google was born, and we got precision, quality and insight into data that changed the world.
There are different challenges in the health field than on the internet. Data are more sensitive and the consequences for individuals can often be more dire. At the same time, health technology, in many ways, has reached the same point as the internet faced in the 1990s. We do not have the quantity, the methods for analysis, or the quality to fully exploit the data to gather insight, or for treatment or innovation – yet.
From Yahoo to Google level
One way in which we could tackle the health technology challenges the data present us with is through international cooperation. It is about two things: to gather enough data, and to analyse the data to provide better and more precise treatment. The initiatives so far are promising, but they lack the potential to make the leap from Yahoo to Google.
The Northern European prime ministers can probably acknowledge this. The question is: what can they do? Should they encourage smart young engineers to analyse health data instead of developing the next app? Or should they change the way the hospitals buy technology?
A step in the right direction could be to look at what works best in the other countries. At the same time, we need to avoid new initiatives merely becoming a better horse-drawn carriage. Are there initiatives in existence that are scalable internationally so that we can bring health data up to the next level together? The answer is yes, but it requires visionary initiatives that have not been done anywhere else.
Common clinical studies
An area that the prime ministers will be able to highlight is a Northern European initiative for clinical studies. Together, the countries have a large number of patients, which gives researchers and doctors a better basis in their studies to understand more and provide better treatment. Such an initiative could also use health data from the national health services collected on a daily basis in several countries, known as real world data, instead of eventual clinical studies with patients over several years. This would be both quicker and much cheaper.
The prime ministers might also agree on cooperating on Northern European genetics. For 13 years, we collaborated on mapping our genes in the international Human Genome Project. Now we need to get together to understand genes and treat the patients. With prioritised funding, genetics will soon be a part of the everyday clinical life in England. We can learn a lot from their experience.
Lastly, the Northern European prime ministers may wish to collaborate on artificial intelligence in the health field. Today, cancer treatment, for instance, often only works on three out of ten patients. Artificial intelligence will change how we understand diseases such as cancer and how we treat the patients. The experiences from Finland of introducing artificial intelligence will help other countries to understand where the barriers are and where help might be needed first.
Oslo Cancer Cluster’s vision is to make cancer treatment more precise and provide new treatments more quickly to the patients. We see that international cooperation is key to obtaining this goal. As a result, we could also discover diseases more quickly and reduce the costs of the national health services. We hope the Northern European prime ministers will delve into these issues when they meet to discuss the health technologies of the future here with us.
By Ketil Widerberg, General Manager at Oslo Cancer Cluster.