Les médecins sont dans la place… pour la dernière édition du podcast CORDIScovery!
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CORDIScovery podcast- Episode #4 - Transforming EU health systems
This is an AI transcription.
00:00:00:00 - 00:00:41:01
Abigail Acton
This is CORDIScovery. Hello and welcome to this episode of the CORDIScovery podcast with me, Abigail Acton. Today we'll be talking about innovations in European healthcare in the wake of Covid 19 health healthcare professionals working flat out for a year. Living through experiences nothing could really prepare them for health system stress to breaking point a population facing fear, insecurity and grief without the human contact to make these bearable.
00:00:41:03 - 00:01:03:00
Abigail Acton
The pandemic will cast a long shadow. Doctor Hans Klug, the World Health Organization's Europe director. Once we are facing a growing mental health crisis, the impact of which is likely to be long term and far reaching. Contact nology. Help ease the burden on health care providers when it comes to treating mental health challenges post-Covid. Prevention being better than cure.
00:01:03:03 - 00:01:27:07
Abigail Acton
Now more than ever. Can next generation sensors help people recognize and anticipate their mental conditions, making them easier to cope with? Having been deprived of much human contact over the last year? Will people want to turn to devices for insights, or will they be more dependent now on health care professionals? And how can Europe's financially stretched health systems identify what new devices to provide, which will benefit patients, and which have limited use?
00:01:27:09 - 00:01:53:11
Abigail Acton
The looming post-Covid mental health crisis makes insights from today's guests more valuable than ever. Welcome to Lars Montelius the director general of the International Iberian Nanotechnology Laboratory. He is the professor of nanotechnology at Lund University, Sweden. Lars is also the founder of several Swedish companies working in the field. The interface between nanotechnology and life sciences is one of his many interests.
00:01:53:15 - 00:01:55:03
Lars Montelius
Hello everyone!
00:01:55:05 - 00:02:20:19
Abigail Acton
Corina Sas Professor of Human Computer Interaction and Digital Health in the School of Computing and Communications at Lancaster University, is interested in human to computer interactions in which emotional information is communicated by the user. Mental health technologies are one of her interests. She coordinates the EU supported AffecTech Innovation training network. Hello. Eleana Philips is based at the Hamburg Center for Health Economics.
00:02:20:20 - 00:02:35:10
Abigail Acton
Elena is a managing director of the ICQE project, which received funding under the EU's horizon 2020 program. Her areas of interest include digital health and mobile health research, with particular focus on digital interventions for mental health.
00:02:35:12 - 00:02:39:13
Elena Phillips
Hello. Also from my side. And thank you for inviting me.
00:02:39:15 - 00:03:07:04
Abigail Acton
Aleksandra Torbica associate professor at the Department of Social and Political Sciences, is the director of center for research for Health and Social Care Management. CERGAS at Bocconi University in Milan. She is the president of Italian Health Economics Association. I Alexandra is particularly interested in the impact of economic analysis on decision making in healthcare, and has been recently focusing on exploring different methods of analyzing this interplay.
00:03:07:06 - 00:03:10:16
Abigail Acton
Alexandra was involved in the EU's COMED project.
00:03:10:18 - 00:03:12:23
Aleksandra Torbica
Hello everyone. Nice to be here with you.
00:03:13:00 - 00:03:37:23
Abigail Acton
Hello and welcome everybody. Lars, if I could start with you. Nanotechnology and nanoscience are fascinating areas and and, frontiers in ongoing research and science. There seems to be so much potential, and capacity for these technologies that were really just touching the tip of the iceberg. Can I ask you how they are being harnessed to create the next generation of sensors?
00:03:38:03 - 00:03:46:16
Abigail Acton
Could you tell us a little more about the potential of of these technologies and the benefit that they can bring to sensors and medical devices?
00:03:46:18 - 00:04:10:07
Lars Montelius
Yes. So first of all, I would like to say that sensors, they are really a part of the digitalization. So digitalization is about data and processing data. But in order to have some data to process you need to measure something. So that's where the sensors come in. And now as a consequence of the microelectronics and donated tonics, these sensors can be very small.
00:04:10:09 - 00:04:21:16
Lars Montelius
And they can also be very affordable. And that can be very precise and tailored to a certain specific function. And they could be invasive or they could be noninvasive.
00:04:21:18 - 00:04:25:20
Abigail Acton
May I stop for a second and ask you what you mean by invasive and noninvasive.
00:04:25:22 - 00:04:37:03
Lars Montelius
Yeah, a typical noninvasive is something you have on your body. For instance, if you talk about an health sensor, an invasive, it could be something that you have inside your body, could be like pacemaker.
00:04:37:05 - 00:04:38:23
Abigail Acton
Implanted or not implemented.
00:04:39:03 - 00:05:22:12
Lars Montelius
But if you spoke about the body, it could also be in other bodies, not human bodies, right? It could be implanted in machines, etc., etc.. So but these sensors are of course very important. And now with the the increased speed of communication from the sensors to some kind of decision platform or some kind of orchestrating layer in your mobile phone use experience or whatever the speed of the communication, enable these sensors to take real time decisions, and that's what's make autonomous driving possible in the future, because we will have now with the 5G, the possibility to have a car being taken, decisions by itself on the edge.
00:05:22:12 - 00:05:37:09
Abigail Acton
But also real time prompt to the user or the person who's who's gaining the data. Okay. That's interesting. And how does nanotechnology and nanoscience fit in to making these more? I can only think of the French word performance more powerful.
00:05:37:11 - 00:05:57:16
Lars Montelius
What? I mean, this is the whole basis for sensors because they are based on materials, and you, you kind of tune the materials properties to get a certain function. For instance, if you would like to measure the pH or glucose level in blood or whatever, so you're tuned in for something specific and you use as little material as possible to make them small.
00:05:57:20 - 00:06:34:06
Lars Montelius
So they be, I mean, easy to integrate, but also with a function you need. And that's where is known as technology is all about is to understand the material properties at the nano scale and tailor them to a certain function. And then of course, I mean, when you have these sensors and they are connected, I mean in a connected layer with each other, talking with each other like IoT products or what we nowadays call nano IoT products, they will exchange the information, and that network in turn, will be able to give information to a user and not you to do certain things.
00:06:34:06 - 00:06:53:07
Lars Montelius
So you can think about these connected sensors as a as a kind of, a network that is, let's called a guardian angel for you. It will it will not ask you to avoid dangers. And these dangers could be in traffic, but it could also be there in your health.
00:06:53:10 - 00:06:56:01
Abigail Acton
So almost like a safety net, one could think.
00:06:56:07 - 00:07:03:18
Lars Montelius
Yeah. I mean, you could think it like a safety net or a these kind of safety pillars that blows up in the car. Oh yeah.
00:07:03:18 - 00:07:04:17
Abigail Acton
Yeah yeah yeah. Right.
00:07:04:17 - 00:07:08:16
Lars Montelius
So it's kind of you don't see it, but when you need it you will notice it.
00:07:08:17 - 00:07:19:10
Abigail Acton
And so the nanotechnology element of course is the ability to reduce in size. And also I imagine enhancing performance. So the reduction in size plus the enhanced performance.
00:07:19:10 - 00:07:20:20
Lars Montelius
And the reduction of cost.
00:07:20:22 - 00:07:22:08
Abigail Acton
Right. Yes. Because less material.
00:07:22:08 - 00:07:25:17
Lars Montelius
Which enable the possibility to deploy them in large scale.
00:07:25:19 - 00:07:33:00
Abigail Acton
Right. And how could this be used in health surveillance since today we are interested in health in a post-Covid world, how could this be used in that application?
00:07:33:03 - 00:07:53:06
Lars Montelius
Yeah, I mean, you can you can think about them of, collecting all these kind of different data. Right. So the data could be collected through to your skin, for instance, glucose level. Or it could also be through somebody's liquids. So you can imagine a contact lens which has a glucose sensor measuring the glucose level in the liquid, for instance.
00:07:53:08 - 00:08:15:00
Lars Montelius
And all these datas or could be integrated in your body for something. In some instances, if you have having some kind of surgical treatment, you could place a sensor there if you like. But I think the most important thing is the pattern that is generated by this data. And that is specific. One be Pacific person and then compared with all the other population of course.
00:08:15:05 - 00:08:34:11
Lars Montelius
And it's a variation of the data that gives you the early warning. Right. And that could be done to tell you your student getting sick, okay. So you can actually be prevented and stay healthy rather than getting sick. And you need to go to the care. So it's a kind of a turning the the health system upside down, right?
00:08:34:11 - 00:08:36:07
Abigail Acton
Yes. Basically prevention being better than.
00:08:36:07 - 00:08:41:13
Lars Montelius
Cure starting with the sensors. And then have the healthy living, you know, and avoid going to hospitals.
00:08:41:13 - 00:08:46:15
Abigail Acton
In the first place, which of course, after the coronavirus crisis is more important than ever with health systems.
00:08:46:15 - 00:08:48:00
Lars Montelius
It is for sure facing.
00:08:48:00 - 00:08:52:01
Abigail Acton
Such enormous backlogs of non related Covid conditions.
00:08:52:03 - 00:09:15:23
Lars Montelius
Yeah. So I think in this perspective, I think the the interesting thing with a virus or so is that with these sensors being for instance, in the sewage system, in an elderly care or hospital or even in your homes, in, in the air, in your home, etcetera, that can provide information about the spread of the, of the, of the infection.
00:09:15:23 - 00:09:47:17
Lars Montelius
Right? 3D and that would give information, of course, to the collective or to society, but also to you as a person. So it's all about the connectivity. So by having them connected, the society can take advantage and you yourself can take advantage of the specific things. And so I think here there is a high very interesting possibility for the future to have these kind of systems to help you to monitor air quality, for instance, in your home or in your office or in the hotel room or whatever.
00:09:47:22 - 00:09:52:02
Lars Montelius
So I think this is the this is the possibility for the future.
00:09:52:08 - 00:10:17:23
Abigail Acton
No great potential. Great potential. And, thank you, Lars. And, this kind of takes us to Corinna, your area of interest, which is, you were involved in the, in the EU supported AffecTech project, which should try to develop prototypes to demonstrate how sensors can help people manage mental health challenges. Obviously, with the pressure that we've all been under, mental health is an issue that concerns many more people than perhaps before the crisis.
00:10:17:23 - 00:10:34:02
Abigail Acton
So this is more relevant than ever. Talking as long as was about the use of sensors to to allow people to behave proactively. What parameters were the sensors tracking in your AffecTech project, and how could people benefit from the insight provided?
00:10:34:04 - 00:11:04:11
Corina Sas
That's a very good question, Abigail. We used particularly biosensors, measuring respiration and heart rate. And these are bodily functions that operate without conscious control. Perspiration is sensitive indicator of changes in the intensity of our emotional responses. And another one is heart rate. And measuring the number of times our heart beats per minute. And for example, under stress, we experience higher emotional intensity, which leads to increasing the sweat and heart rate.
00:11:04:11 - 00:11:35:20
Corina Sas
A little bit of what's happening with me right now. In our work, we did capture these changes of emotional arousal through biosensors, and their main benefits is bringing these unconscious bodily processes to our awareness and ultimately under our control. Conscious, controlled, biofeedback provides people access to bio data that signals, for instance, is a sharp increase in emotional intensity during stress.
00:11:35:22 - 00:11:42:15
Corina Sas
And by accessing such data, people may learn to consciously control these specific bodily functions.
00:11:42:15 - 00:11:59:05
Abigail Acton
So you're giving people the information they need in order to be able to recognize that they might have some sort of crisis coming. What did the project actually develop? Did you develop the sensors themselves, and if so, did you find that there was any market interest in these?
00:11:59:07 - 00:12:00:02
Corina Sas
So.
00:12:00:02 - 00:12:00:22
Corina Sas
We.
00:12:00:22 - 00:12:26:09
Corina Sas
We often use, commercial sensors, but we worked at a level of what we call the way they are represented, actuation. And, I can give you a couple of examples of the stuff that we are developing with a range of research prototypes. A few of those are wearable devices to be worn on the wrist. For this we have used biosensors again, the ones measuring perspiration or heart rate.
00:12:26:11 - 00:12:53:13
Corina Sas
And we integrated them with novel interfaces for representing bio data. And we use color, vibration or temperature based bio biofeedback. So when people experience, for example, an increase in their emotional arousal, they can immediately see feel on their skin. This feedback, which can be either static or animated shapes changing colors could be subtle vibrations or gentle warmth.
00:12:53:15 - 00:12:54:00
Abigail Acton
Right?
00:12:54:00 - 00:12:57:13
Corina Sas
And this biofeedback has them to become more emotionally aware.
00:12:57:15 - 00:13:17:11
Abigail Acton
Right. And and with that awareness is in the data. And the access to data is fascinating. And of course, we're exposed. If I can use the word exposed to more and more data, there's data everywhere. What makes these devices very interesting is that there is a dimension where people can harness that data to actually change their behavior slightly, otherwise it's just data.
00:13:17:13 - 00:13:32:04
Abigail Acton
So, did your devices also come with some kind of mechanism that would inform the user what perhaps would be a useful thing to do at a certain point, like take a step back and and breathe deeply for five minutes or something like that. How did that work?
00:13:32:04 - 00:14:00:20
Corina Sas
And for a very good point, because of course, of emotional awareness is just the first step, to address exactly what you are suggesting. We developed other interfaces, other types of interfaces, providing visual and haptic representation of slow breathing and slow heart rate to help people actually lower them and calm down. And we built some smartwatch applications guiding people to slow down their breathing rate.
00:14:00:22 - 00:14:17:20
Corina Sas
We use visualizations, through which people can inhale and exhale, following, for example, a slowly expanding and contracting circle. And another smartwatch application delivers vibrations that are 40% lower than user's current heart rate in order to guide them to lower theirs.
00:14:17:24 - 00:14:35:08
Abigail Acton
Yeah, and that's very interesting. Is it? That's almost like a target to reach. But yes, in a way that's perhaps more calming than thinking of the word target, which automatically is competitive and therefore not very tranquilizing. But yes, it's almost like you're following the lead of of something that is showing you what, what, what direction you should be going in.
00:14:35:08 - 00:14:39:19
Abigail Acton
Yeah. Like something's holding your hand or minutes. It's on your wrist, but it's almost holding your hand. Yeah.
00:14:39:21 - 00:14:42:05
Corina Sas
It's a lot of comfort in that. In that gesture.
00:14:42:08 - 00:14:48:13
Abigail Acton
Indeed. Thank you. And are you finding that there's much interest in in market take up? How is that.
00:14:48:13 - 00:15:15:13
Corina Sas
Going? Yes. We are pleased to say that these devices have been recognized as innovative by the ACS Innovation Rider Prize, and we are now focusing on taking them to the next place and needed for the market. We receive some interest. We have. We are in conversations with potential investors. But I like to take this opportunity as a call for folks to reach out to us, if possible, because I think it's exciting work which deserves to, to to to move forward.
00:15:15:13 - 00:15:39:00
Abigail Acton
Absolutely, absolutely. No. Please do anybody interested then then contact Corinna. Very good idea. Lars and Corinna you've been talking about since is the technology behind the sensors and the application of of that information and that data to benefit the user? Could I ask you all if you would have any questions to Lars or Corinne, or you might have questions for each other, about this aspect of today's, conversation.
00:15:39:06 - 00:16:04:00
Lars Montelius
I mean, there is one aspect that I think is interesting to to think about, and I think, I mean, now in, in this, in, in the sense that we've discussed, it's something that nudge the person, the individual, of course, to take better decisions, let's call it like that. Right. Or, or behave better or whatever. The other aspect is, of course, who owns the digital data and who can take advantage of that, who can valorize it, who can sell it, etc..
00:16:04:02 - 00:16:19:05
Lars Montelius
So my take that I should own it, right? Not the guy who make the device or give the software to me that I have, some kind of relation with. Right. So I think and this is questions that is not yet really discussed right.
00:16:19:05 - 00:16:19:17
Abigail Acton
Now.
00:16:19:20 - 00:16:22:10
Lars Montelius
In my mind at least what I. No.
00:16:22:12 - 00:16:30:20
Abigail Acton
No, I think you're right. It's because it's also cutting edge and new. We're almost to the stage where the technology is of taking society's reactions to the technology. Yeah.
00:16:30:21 - 00:16:47:21
Lars Montelius
And I think it's individual is fine. I mean, because I get the information so I can I can behave better. So the way I have a better life, whatever. Right. So it's fine. But there is, there is another dimension to this. And that is how if someone is is taken advantage of that, then I would also like to have a piece of that pie.
00:16:47:23 - 00:17:02:14
Abigail Acton
So yeah, of course. How is it going to be marketed? Yes. Is it going to be useful for someone to contact you and tell you that it looks like you're going to need more? What? I has to know something because you seem to be stressed. That's exactly okay. Very interesting. Any other questions for Lars and Corinna?
00:17:02:17 - 00:17:03:21
Elena Phillips
I have a question.
00:17:03:21 - 00:17:04:21
Abigail Acton
Yes, please. Eleanor.
00:17:04:22 - 00:17:33:20
Elena Phillips
Yes, but actually, it could go for both for Corinna and Lars. I am interested in acceptability from from patients or from participant sites. How does it feel to to wear sensors? How do people respond to this? I would be interested. And you do make an studies on this. And another question to Corinna, I wonder. This is very awareness of the motion.
00:17:34:00 - 00:17:40:17
Elena Phillips
How does it change the motion I was thinking of? Did you make any surveys on that or any investigations?
00:17:40:19 - 00:18:13:24
Corina Sas
Yes. So to answer the last question, the awareness of emotions. Yes. When people become aware, they start to understand a little bit of the process of understanding where emotions came from, what has caused it, to try to see patterns between similar contexts that have led to the same kind of negative feelings and realize, in a very visceral way, the importance of stepping back, breathing in, breathing out, relaxing even without the regulatory aspects implemented directly on the on the, on the on this back.
00:18:13:24 - 00:18:21:12
Corina Sas
So even those supporting just emotion awareness offline support people regulation as well prompt people to regulate.
00:18:21:14 - 00:18:37:02
Abigail Acton
Yeah. So basically it's providing a context for people to recognize perhaps there's a pattern. So you could think, well I feel fine in a certain situation then. In fact perhaps you are not as fine as you think you are. So the next time you're in that situation, perhaps you realize that you need to to take a step back.
00:18:37:04 - 00:18:52:14
Abigail Acton
Now, I was going back to you. I mean, we were talking about nanoscience and nanotechnology and the benefit of that being that things are shrinking in size. I mean, I'm an Apple Watch wearer, and I'm quite comfortable in my Apple Watch, but it does feel a little like I've got a computer on my wrist. I mean, you know, do you feel a little self-conscious?
00:18:52:14 - 00:19:01:17
Abigail Acton
Especially if I take a call on my wrist? I feel like an idiot. What's the future for for these type of wearables? Are they going to get ever smaller?
00:19:01:19 - 00:19:21:24
Lars Montelius
I think they will be built smaller, maybe, and also integrated in different ways. I mean, one of the most, I think one of the most interesting sensors that do very much I mean, the Apple Watch is a sensor in a way, because they measure a lot of things. Right? Besides being a watch and in the information provider, a person get that assistant or whatever.
00:19:22:05 - 00:19:46:16
Lars Montelius
But there are other kind of form factors now with rings, for instance, that give the same kind of thing that you can wear as a ring. And I think the the acceptance is really to find what is socially acceptable, so to say. Right. Because I mean, nowadays more and more people are having what I have. I mean, if phones and you are going in the street and talking with yourself, etc., and it's becoming acceptable, right?
00:19:46:18 - 00:20:02:21
Lars Montelius
Which was not the case when I was a kid, it was totally unacceptable. If you would do that. So I think the the it will change, but I think it will be integrated more and more in different things. And you can have sensors in your in your fabrics, in your clothes. You can have it, under the skin.
00:20:02:22 - 00:20:24:20
Lars Montelius
I mean, you can have tattoos being printed on your skin, for instance, that are sensors, and you can integrate it in your glasses in the, and so there are a lot of things, and I think the social acceptance about these kind of if you call it in a way, it maybe it's not individually performance enhancers, but in a way it is.
00:20:24:24 - 00:20:44:24
Lars Montelius
It's a glass. This is also an individual performance enhancer which is totally socially accepted hearing aids the same. So I think it with time it will not become complicated. And I think the if it is not nice to wear, no one will wear it. Right. So I think the wear ability to use experience will be the dominating factor for this, right?
00:20:44:24 - 00:21:10:19
Abigail Acton
Absolutely. The design. Yeah. Eleanor, I'm just going to turn to you now, if I may. We were talking earlier and one of the things that we we were sort of almost laughing about was the notion that just because the technology exists should we actually necessarily use it? So there's sometimes a feeling that that we're able to do things and so we do them, but we're not necessarily paying attention to to whether the people who will be using these things want them in the first place.
00:21:10:21 - 00:21:34:23
Abigail Acton
So, one strand of the IQCE project analyzed how people feel about the use of technology to overcome mental health challenges. So rather than what we were talking about with Corinna, about, noticing what's going on in your body or in your reaction to stress and perhaps taking taking action to try and mitigate that. Here we're actually talking about therapies and treatment for people with mid to low level, mental health challenges.
00:21:35:02 - 00:21:43:12
Abigail Acton
So can you tell me what the Iki project was, seeking to establish in this particular strand of it and a little bit about your methodology. Yeah.
00:21:43:12 - 00:22:15:17
Elena Phillips
So, just to maybe to give you a bit, background information, our research focus where so-called mental health interventions and this, intervention tions, that are based on CBT, cognitive cognitive behavioral therapy, and they're designed for people who have mild to moderate symptoms. And they're, they enable, people to work by themselves, at their mental health problems.
00:22:15:19 - 00:22:50:02
Elena Phillips
So, and the recent certificate evidence suggests that, such interventions can be effective, but, also there is evidence that, people, patients are still quite hesitant regarding, uptake of those interventions. So they're curious, why is why is this like this? And, how could we maybe increase the acceptability of, of these interventions? So, so we wanted to, to shed a bit more light of this, of this hesitation.
00:22:50:02 - 00:23:32:22
Elena Phillips
So we conducted the discrete choice experiments among almost 2000 participants in Germany. And, in this in this experiment, we wanted to see the preferences of participants for, singular features of those interventions. So to give you a concrete example, what we have done. So we defined the interventions. By specific features like a content delivery, like peer support, like, proof of effectiveness or, or human contact or let's say form of human contact and, human contact.
00:23:32:22 - 00:24:01:20
Elena Phillips
I will I will go here a bit deeper. We offered several levels, levels of human contact, such as no human contact, human contact by email, human contact via phone call, video call or it was the last option, human contact with their psychotherapist in a traditional psychotherapy session. And their mental health. Hi. Mental health interventions would be, a part of this therapy journey process.
00:24:01:22 - 00:24:33:10
Elena Phillips
So and then then we they asked people, so what would you prefer? And, well, the result was surprising because the most preferred, feature of the mental health interventions was human contact. And then in contrast, in context of traditional psychotherapy. So basically it was a questionnaire survey about digital technology in mental health. But we came up with the strongest preference for human contact, in this area.
00:24:33:10 - 00:24:54:09
Abigail Acton
Could I ask you I mean that was the patient's perspective. Yeah. So yes, we're we're interested perhaps perhaps they said we're interested in various options and, and concepts and, and technological advances. But what we really want to do is sit down and talk to somebody face to face. What was the therapist's reaction to the notion of blended care, as you would call it?
00:24:54:11 - 00:24:59:11
Abigail Acton
A mixture of e interventions and, human intervention. What did the therapist think?
00:24:59:13 - 00:25:30:04
Elena Phillips
Yeah, that was it was our next project. So if I wanted to see the perspective of German therapists on that, because there is a difference when we talk about therapist view on a mental health or blended care, when you mix psychotherapy and technology, there's a big difference among countries healthcare systems and among therapeutic schools. So CBT therapists are naturally more open to mental health interventions, whether psychodynamic therapists or humanistic therapists are more hesitant sounds.
00:25:30:04 - 00:26:10:02
Elena Phillips
We got a similar picture in our, last study. CBT therapists were very welcoming where the psychodynamic therapist there valued, more time. More personal time is a patient. They opted for larger shares of of personal sessions regarding to digital interventions. But, both therapists were well, yeah, both of us schools in our survey were quite positive regarding this mixed, blended care, treatment form.
00:26:10:05 - 00:26:38:16
Elena Phillips
So they were both optimistic to integrate technology into their therapeutic process. But the preference was, as you can blend it in different in different forms. You can you can integrate the technology in their in their therapy process or you can do it before or after therapy. So the preference in our survey was to integrate digital, digital interventions into the therapy process.
00:26:38:16 - 00:26:41:07
Elena Phillips
So the parallel they follow running.
00:26:41:10 - 00:27:04:01
Abigail Acton
But it's an interesting idea that, that, that perhaps the digital therapy could be used also as a backup, you know, that people could reinforce what they had, come to understand or realized with the psychotherapist through a follow up using digital, digital to therapy and perhaps, games and and so on. That's very interesting. Thank you. Elena, does anyone have any questions for Elena about this?
00:27:04:03 - 00:27:04:09
Abigail Acton
Yes.
00:27:05:10 - 00:27:19:10
Corina Sas
very interesting project. I know that the cost of providing, this human contact is very high. And I just wondering what's the appetite for people to explore peer support in, in talk therapy.
00:27:19:12 - 00:27:45:06
Elena Phillips
Peer support for basically the levels for peer support. We had a voice, possibility of an online community, unmoderated online community, all, face to face meetings with a moderator. But peer support didn't play such a big role. And here again was a preference for more human contact. But but when we look at all features, peer support didn't plays often play a big role?
00:27:45:08 - 00:28:03:05
Elena Phillips
It can be a cause. So while our our hypothesis was that, mental health is quiet for some people stigmatized topic. So there is not this big openness to to connect this a lot of people, but there is an openness to connect maybe to 1 to 1 person, like a psychotherapist.
00:28:03:07 - 00:28:05:04
Abigail Acton
And it's, it feels like it's private, doesn't it?
00:28:05:04 - 00:28:07:03
Elena Phillips
Yes. Like a more intimate connection.
00:28:07:03 - 00:28:31:05
Abigail Acton
Yeah. No, that does make sense. I think that that would resonate. That makes sense. That interesting point, Karina, you made about the comments. This is actually Alexandra. Thank you very patiently. Hello. This actually chimes a little bit with what you were looking at. So you were involved in the COMED project supported by the EU, which aimed to make sense of all these new devices and, sensors and other new technologies in advance.
00:28:31:05 - 00:29:04:17
Abigail Acton
That's coming on to, the health care, if I can say, market by establishing ways to measure how effective they are and suggesting parameters health care providers can use in order to decide whether or not to offer them. Since the long term cost effectiveness of clinical devices and sensors and everything really depends heavily on how they are adopted into routine clinical practice, if they're brand new and haven't actually been adopted that much into routine clinical practice, how can health care systems determine which innovative projects and devices to provide?
00:29:04:19 - 00:29:25:12
Aleksandra Torbica
Thank you Abigail thank you very much indeed at the end. But, this is a you not usually that is the case because in the in the journey of the new technologies, innovation is really as we have somehow, followed in this case, like from the very, very basic research and innovative solutions to patients preferences.
00:29:25:12 - 00:29:54:15
Aleksandra Torbica
And then at the end, somebody has to pay for it, right? So, what are the criteria that the policymakers, put in place in order to decide which technologies to cover with limited public funds? So basically tuition, guarantee coverage and reimbursement and so to, to face and and to overcome so-called fourth heart, all that the innovations have to be made before, before, before they come actually to the final user, which is the patient.
00:29:54:15 - 00:30:20:24
Aleksandra Torbica
So if you think about all the innovations that we have heard about, through, through the interventions of my colleagues here at the end of this journey, the technologies need to be evaluated across some dimensions and policy makers more recently, in Europe and not only Europe, have, been using this framework of health technology assessment that looks into clinical effectiveness, but also cost effectiveness.
00:30:20:24 - 00:30:55:18
Aleksandra Torbica
So economic impact of these technologies when they are used in real life, in real world, under real patients. So for the medical technologies, especially for the very innovative one like we have heard about today, it is really, you know, the uncertainty around the effects in real life is huge. Once they have, you know, come to the market and they have obtained all they had to obtain in order to, to get, you know, the market license, because this gap between the evidence that is needed for this, especially to, for medical devices, not so much for pharmaceuticals.
00:30:55:20 - 00:31:17:21
Aleksandra Torbica
So the evidence that is needed to get the key market, for example, in Europe to get to the market and the evidence needed to pass the health technology assessment, evaluation, there is a huge gap. So what the policymakers do in front of this gap traditionally, you know, with a yes or no decision. So, yes, we pay for it.
00:31:17:22 - 00:31:38:08
Aleksandra Torbica
No, we don't pay for it. The whole the risk was on the burden of the policymakers. They take the risk of saying yes to something that means that maybe cost effective or effective at all in the real populations. And they say no, they take the risk of not granting access to patients, for something that potentially could really improve their lives.
00:31:38:10 - 00:32:15:21
Aleksandra Torbica
So the, this idea with this new innovative, arrangement, that was one part of comment, the project was that to spread the risk between the manufacturer of the innovation and the policy makers with this innovative, policy tools, I would call them how to allow quick or quicker access to innovation, but by sharing the risk that, you know, reserving some, let's say, potential to even, reverse a decision in case the evidence proves that the technology is not that good enough for, to be used on a wider scale.
00:32:15:23 - 00:32:41:17
Aleksandra Torbica
And these policies are labeled, different ways, different names in different countries. The coverage with evidence development was, one way that we use it, especially in Europe, to label a set of policy tools that are basically what the word itself says. I grant for coverage and reimbursement the provided that you generate evidence that they need to make a more robust decision.
00:32:41:19 - 00:32:54:21
Aleksandra Torbica
In this way, the manufacturers and producers share the risk of, generating the data, but also, obtaining, safe and effective and cost effective devices on the market.
00:32:54:23 - 00:33:22:07
Abigail Acton
That's fascinating. And and it makes absolute perfect sense. So basically, as things develop and, and the context changes because new technology emerges soap so quickly. Now, basically what you're doing is permitting people to accept that there's a gray area that is not black and white. Exactly. And that we don't stall everything, in favor of trying to get something that is a simplistic overview, but that we acknowledge that there's some ambiguity and that we proceed in progress.
00:33:22:09 - 00:33:26:11
Abigail Acton
But the decisions can be changed if needed. That's, I think, what you're saying.
00:33:26:13 - 00:33:50:20
Aleksandra Torbica
Exactly, because the main purpose of this coverage with development schemes is really to reduce the uncertainty about the effects, whether the clinical and economic effects of a specific technology by obtaining data on real patients, which may not be in a position to obtain for millions of reasons before the, technology comes to the market, the wider use is not possible before.
00:33:50:20 - 00:34:16:04
Aleksandra Torbica
Of course, the technology is available to patients, to physicians, to hospitals. So, rather than saying no because evidence is limited, we say something in between, as you said. So yes. But provided that you generate evidence, sometimes those decisions can be only in research. So we allow it to access a limited number of patients to conduct the more research or only with the research.
00:34:16:04 - 00:34:47:15
Aleksandra Torbica
So wider scale, but with the research generating the data, this is especially challenging, for the technologies that we have discussed today. So variables for example, there is still no agreement on what do we actually have to measure as effectiveness of variables. Because the health technology assessment framework was somehow based on pharmaceuticals, where we look at the mortality rates, we look at, some surrogate outcomes of, you know, blood pressure or, other indicators, of course, that we are interested in.
00:34:47:17 - 00:35:13:06
Aleksandra Torbica
How do you measure whether variable is effective? You know, there is a whole range of dimensions that are not captured in traditional framework. So, you know, of this gray area really, you know, opens the door to evaluation of different types of technologies. And, you know, the medical devices we have, you know, I think half a million of different types of technology that we label as medical devices and not the same rules can be applied to all of them.
00:35:13:08 - 00:35:34:14
Abigail Acton
So I think also it must be the case that people become more courageous. Health care providers become more courageous because they're not locked in to financing something that that they then decide they don't want to finance anymore. They can change their minds. One thing I was going to say also is that it must be very difficult. And this is perhaps for Lars and Corinna and and Elena too.
00:35:34:16 - 00:35:49:04
Abigail Acton
It must be very difficult to prove a negative. No, because what you're saying is that if these people hadn't been wearing these devices, their condition would have would have worsened. So with pharmaceuticals, you say I take this tablet, I get better, things improve.
00:35:49:04 - 00:36:11:15
Aleksandra Torbica
But there are study designs that can that can allow you to do this analysis. Okay. So I mean and so-called counterfactual or control group, you know, there are ways you can write. You can do it with the study design. But of course, you know, there are limitations to that. That's why, you know, sometimes, like conducting a trial in a pre-market phase would not be feasible or even ethical for some of these, situations.
00:36:11:15 - 00:36:56:17
Aleksandra Torbica
So once it's on the market, you, you, you would need to think through with the manufacturer. And this is also the possibility for the manufacturer and the payer to come together, decide on the design of the study, share the risk, but also share the knowledge, on a specific issue and also providers to be part of the evidence generation process, not just the recipients, but really an active actor protagonist in generating evidence, which then it's not only about being, I think, courageous, but really being more involved and having more governance tools to, to allow, again, quicker access to something that can really improve people's life but also cost.
00:36:56:19 - 00:37:09:02
Aleksandra Torbica
Have you got, let's say a, a bigger, influence on how the money is being allocated because we know that, of course, that, you know, innovation, the speed of innovation is so high, but the resources are by definition, limited.
00:37:09:07 - 00:37:11:24
Abigail Acton
You know, they remain the same even though the amount of.
00:37:12:01 - 00:37:14:18
Aleksandra Torbica
You know, they will never grow as fast as.
00:37:14:20 - 00:37:31:06
Abigail Acton
Yeah, as fast as the choice is provided. Can I thank you, Alexander. It's fascinating. And it makes perfect sense. It's one of these wonderful things where, you know, until someone's pointed it out, you haven't thought of it. And then when someone points out that the system needs a slight shift in the way that it approaches these noble technologies, it just makes perfect sense.
00:37:31:06 - 00:37:47:11
Abigail Acton
Very logical. Alexandra, I would have one more question to you. That would be, did you find that, the I mean, it's a little bit like a disruptive technology or an approach, really. Did you find that the health care authorities are interested in embarking in a new direction in this way?
00:37:47:13 - 00:38:24:01
Aleksandra Torbica
We it in common project evaluate really like what are the perceptions of policymakers vis-a-vis these new policy tools because so far, most of the again experience has been generated in the world of pharmaceuticals, where things are a little bit more structured and controlled and established. Then, then in the world of medical devices, so the policymakers do recognize a great potential, to these new, tools, especially in the field of medical devices, given these uncertainties that we talked about and, and lack of evidence and so on.
00:38:24:03 - 00:38:48:21
Aleksandra Torbica
There are, however, a series of, challenges of criticality, as always, in order to fully implement these scheme. So, one, you know, maybe the most important one is really resources available because this doing this properly cost also you know to build up a coverage with evidence development scheme really requires some investment also from from policymakers.
00:38:48:21 - 00:39:11:15
Aleksandra Torbica
So it has to be worthwhile. And when is it worthwhile? When the purpose of the scheme is really to generate evidence that will be used if a policymaker, it's a, you know, a more rational decision to just to to do some price negotiation with the manufacturers, say whatever evidence you have, let's just talk about the price and to see what would be the best deal.
00:39:11:19 - 00:39:32:05
Aleksandra Torbica
To put it very simply, then it may not be worth to invest all this money in building the structure of, coverage with evidence development. But if, there is really a need to gap. So to close the gap on the uncertainties of evidence, then the policymakers are very open to, to, you know, to these new avenues.
00:39:32:05 - 00:39:56:10
Aleksandra Torbica
Yeah. I'm sure the issue of funding and availability is fundamental because different countries adopt different models. Who pays for, you know, is it, you know, is it the Ministry of Health who wants this evidence? Or again, the funding should come from the manufacturer. But what is then it for the manufacturer? What about if the results are negative, if there even being, you know, they paid for something that will then make them reverse the decision reimbursement.
00:39:56:10 - 00:39:58:15
Aleksandra Torbica
So I mean it's not as simple.
00:39:58:21 - 00:40:18:18
Abigail Acton
No, no no no it's balance. Absolutely. Yeah. No I can imagine that in some situations perhaps. Yeah, perhaps people would rather just negotiate the price and then walk away and have the certainty of the fact that their, that their device has been adopted and, and, and that they're contractually obligated. Yeah. It's interesting, but it seems to me to be the way forward, given what we've been talking about.
00:40:18:18 - 00:40:40:11
Abigail Acton
Now regards to cutting edge technology, I have one question now that I would like to ask each of you. It's perhaps a little predictable, but I think it's really worth asking, especially given the subject today, because we're talking about, about almost slightly futuristic tendencies in healthcare and provision. So I will go around the table, and I will start with you Lars what do you imagine the next decade will bring?
00:40:40:13 - 00:41:12:03
Lars Montelius
I think strongly that we will have this kind of interconnectivity with different kinds of sensors that will help us to stay more healthy, but those who help the care to give better care and better kind of treatment. And I think one of the one or maybe one of the challenges is the, let's say, how can we how can the new knowledge being generated by all these kind of sensors, how can that be incorporated and linked to certain kind of diseases or certain kind of treatments that we should do?
00:41:12:03 - 00:41:39:03
Lars Montelius
I mean, how can we link that into the let's call education sector, right? Because it's so quick. It's an exponential growth of data. And how can that kind of exponential growth be incorporated into the educational programs? Because otherwise it would be difficult for, for doctors to I mean, you can with all your data and say, here is my data and this is what I see you sleep not so much and you have this blood pressure.
00:41:39:03 - 00:41:43:20
Lars Montelius
What the what shall I do with that? Yeah, I think this is the kind of challenge for the future.
00:41:43:23 - 00:41:50:11
Abigail Acton
Actionable data. Yeah, yeah, yeah. Thank you. Lars. Corinna. Next ten years, what's going to happen? Crystal ball.
00:41:50:13 - 00:42:14:14
Corina Sas
I go with, with Lars. Prediction about interconnectivity. I will add to that. I can see multiple layers of things. Things will be weaved in the fabric of our lives without really seeing those actuators or sensors. I think through through speech inputs, we'll have access to, to a range of therapies and, and biofeedback devices. There would be multiple layers.
00:42:14:16 - 00:42:42:16
Corina Sas
But to me is really about how this personal data becomes big data and how I can can revolutionize this space. I mean, there is a lot of work already ongoing. And to me, before we get there is a issue of of ethics. And again, who is owning the data, which business models are underpinning them? I think there are big philosophical questions we have to to, to ponder over, in order to really push this field forward from very solid foundations.
00:42:42:18 - 00:42:56:07
Abigail Acton
In an ethical way. Yeah, yeah. Interesting. Yeah. Elena next ten years, what do you think is going to be the case when it comes to how people approach treatments and, and perhaps use e e therapies and so on?
00:42:56:09 - 00:43:31:15
Elena Phillips
I guess, I would touch the big, philosophical questions because I'm more in the mental health area than in the technology area. So I see the the bright future in the area of, self empowerment, of patient empowerment. On prevention. So I think this are great potentials of all this, developments we discussed today. I also see that, these devices and technologies, give us a sense of control that we can have over our lives and this sense of control.
00:43:31:17 - 00:43:55:20
Elena Phillips
It's interesting how real it is, actually. And, so what I also my, my, my biggest takeaway from this discussion came actually from the Corina's question or remark that the a therapist contract is a it's it's an expensive factor. So I was thinking that actually yes, the human contact, the human connection is the most expensive factor. But it's also the most visible one.
00:43:56:13 - 00:44:09:13
Abigail Acton
And if we're thinking about the overall cost to society of somebody who is perhaps suffering from mental conditions, then perhaps most effective therapy is the one that ultimately is the cheapest. Alexandra, next ten years, what's it going to bring.
00:44:09:15 - 00:44:13:19
Aleksandra Torbica
Yeah. So I'm not sure whether, you know, I have a crystal ball. I can tell you what I hope for.
00:44:13:24 - 00:44:15:12
Abigail Acton
Yeah, would be good. Tell you what you hope.
00:44:15:16 - 00:44:44:13
Aleksandra Torbica
Actually, I do hope that these are maybe two out of the many lessons that we can learn from the current pandemic as well, because I think this is something that we should learn from what is going on in the world. The first one, you know, the the centrality of in all policy decisions. You know, it's not only about the domain of, of health policy or minister of Health, but the health is central to our economy for finance, for social systems, for health is, you know, across is a cross-cutting theme.
00:44:44:15 - 00:45:06:20
Aleksandra Torbica
And you know, I do believe and I do hope the policymakers of all the countries really, you know, realize that you are paying the high price to realize it so that this is something to pivot, to discuss, to change the narrative about the health care in terms of spending and costs, to investment for the future. In terms of also economic development and not only.
00:45:06:22 - 00:45:36:07
Aleksandra Torbica
And the second hope is about really opening our eyes on the importance of data and evidence to inform those decisions, because, also with these new technologies, we are really overwhelmed. The overabundance of data make it actionable is less and, useful for policymakers who are now more open and more receptive with some criticism to science and evidence to inform, you know, whether to, invest or not, to invest to close, about to close, about to open.
00:45:36:09 - 00:45:47:24
Aleksandra Torbica
But, at least you know, this, this bridge between the science and policymakers, has become so evident in the current crisis. So I do hope it will stay there solid for the years to come.
00:45:47:24 - 00:46:07:12
Abigail Acton
Yeah, absolutely. Absolutely. We have to come out of this with improvements to the way that we operate and the way that we think. Absolutely. Listen, I want to thank you all very much. That was truly fascinating, very, very interesting. And I'm grateful all to all of you for having joined me, and I wish you all the best in your future research.
00:46:07:13 - 00:46:16:00
Abigail Acton
And, I look forward to hearing more about what what's going on in your various domains in the future. Thank you for joining us today. CORDIScovery says, thank you very much.
00:46:16:01 - 00:46:17:02
Aleksandra Torbica
Thank you.
00:46:17:04 - 00:46:18:01
Lars Montelius
Thank you, thank you.
00:46:18:03 - 00:46:19:02
Aleksandra Torbica
Bye bye bye.
00:46:19:03 - 00:46:21:00
Elena Phillips
Thank you. Bye bye.
00:46:21:02 - 00:46:22:10
Aleksandra Torbica
Bye.
00:46:22:12 - 00:46:53:07
Abigail Acton
interested in what other EU funded projects are doing to transform European health systems in the wake of Covid 19? Take a look at issue 101 of the research EU magazine available on the Cordis website. Cordis.europa.eu. Here you can also find daily news articles, interviews with researchers working on domains ranging from paleo archeology to space results, PACs which drill down deeper, gathering groups of projects by subject area, and the magazine, which offers insights into a different subject every month.
00:46:53:07 - 00:47:13:17
Abigail Acton
In its special section. Interested in applying for an EU research grant? Visit the Cordis website to see how your work relates to that currently being done in your field. So come and check out the research that's revealing what makes our world tick. Our next episode will consider how EU researchers are tackling pollution for a cleaner, greener Europe land, sea and air.
00:47:13:22 - 00:47:31:24
Abigail Acton
What are the latest findings coming out of cutting edge EU research? Join me to find out. We're always happy to hear from you. So drop us a line editorial at Cordis Dot Europa. EU. Until next time.
This is an AI transcription.
00:00:00:00 - 00:00:41:01
Abigail Acton
This is CORDIScovery. Hello and welcome to this episode of the CORDIScovery podcast with me, Abigail Acton. Today we'll be talking about innovations in European healthcare in the wake of Covid 19 health healthcare professionals working flat out for a year. Living through experiences nothing could really prepare them for health system stress to breaking point a population facing fear, insecurity and grief without the human contact to make these bearable.
00:00:41:03 - 00:01:03:00
Abigail Acton
The pandemic will cast a long shadow. Doctor Hans Klug, the World Health Organization's Europe director. Once we are facing a growing mental health crisis, the impact of which is likely to be long term and far reaching. Contact nology. Help ease the burden on health care providers when it comes to treating mental health challenges post-Covid. Prevention being better than cure.
00:01:03:03 - 00:01:27:07
Abigail Acton
Now more than ever. Can next generation sensors help people recognize and anticipate their mental conditions, making them easier to cope with? Having been deprived of much human contact over the last year? Will people want to turn to devices for insights, or will they be more dependent now on health care professionals? And how can Europe's financially stretched health systems identify what new devices to provide, which will benefit patients, and which have limited use?
00:01:27:09 - 00:01:53:11
Abigail Acton
The looming post-Covid mental health crisis makes insights from today's guests more valuable than ever. Welcome to Lars Montelius the director general of the International Iberian Nanotechnology Laboratory. He is the professor of nanotechnology at Lund University, Sweden. Lars is also the founder of several Swedish companies working in the field. The interface between nanotechnology and life sciences is one of his many interests.
00:01:53:15 - 00:01:55:03
Lars Montelius
Hello everyone!
00:01:55:05 - 00:02:20:19
Abigail Acton
Corina Sas Professor of Human Computer Interaction and Digital Health in the School of Computing and Communications at Lancaster University, is interested in human to computer interactions in which emotional information is communicated by the user. Mental health technologies are one of her interests. She coordinates the EU supported AffecTech Innovation training network. Hello. Eleana Philips is based at the Hamburg Center for Health Economics.
00:02:20:20 - 00:02:35:10
Abigail Acton
Elena is a managing director of the ICQE project, which received funding under the EU's horizon 2020 program. Her areas of interest include digital health and mobile health research, with particular focus on digital interventions for mental health.
00:02:35:12 - 00:02:39:13
Elena Phillips
Hello. Also from my side. And thank you for inviting me.
00:02:39:15 - 00:03:07:04
Abigail Acton
Aleksandra Torbica associate professor at the Department of Social and Political Sciences, is the director of center for research for Health and Social Care Management. CERGAS at Bocconi University in Milan. She is the president of Italian Health Economics Association. I Alexandra is particularly interested in the impact of economic analysis on decision making in healthcare, and has been recently focusing on exploring different methods of analyzing this interplay.
00:03:07:06 - 00:03:10:16
Abigail Acton
Alexandra was involved in the EU's COMED project.
00:03:10:18 - 00:03:12:23
Aleksandra Torbica
Hello everyone. Nice to be here with you.
00:03:13:00 - 00:03:37:23
Abigail Acton
Hello and welcome everybody. Lars, if I could start with you. Nanotechnology and nanoscience are fascinating areas and and, frontiers in ongoing research and science. There seems to be so much potential, and capacity for these technologies that were really just touching the tip of the iceberg. Can I ask you how they are being harnessed to create the next generation of sensors?
00:03:38:03 - 00:03:46:16
Abigail Acton
Could you tell us a little more about the potential of of these technologies and the benefit that they can bring to sensors and medical devices?
00:03:46:18 - 00:04:10:07
Lars Montelius
Yes. So first of all, I would like to say that sensors, they are really a part of the digitalization. So digitalization is about data and processing data. But in order to have some data to process you need to measure something. So that's where the sensors come in. And now as a consequence of the microelectronics and donated tonics, these sensors can be very small.
00:04:10:09 - 00:04:21:16
Lars Montelius
And they can also be very affordable. And that can be very precise and tailored to a certain specific function. And they could be invasive or they could be noninvasive.
00:04:21:18 - 00:04:25:20
Abigail Acton
May I stop for a second and ask you what you mean by invasive and noninvasive.
00:04:25:22 - 00:04:37:03
Lars Montelius
Yeah, a typical noninvasive is something you have on your body. For instance, if you talk about an health sensor, an invasive, it could be something that you have inside your body, could be like pacemaker.
00:04:37:05 - 00:04:38:23
Abigail Acton
Implanted or not implemented.
00:04:39:03 - 00:05:22:12
Lars Montelius
But if you spoke about the body, it could also be in other bodies, not human bodies, right? It could be implanted in machines, etc., etc.. So but these sensors are of course very important. And now with the the increased speed of communication from the sensors to some kind of decision platform or some kind of orchestrating layer in your mobile phone use experience or whatever the speed of the communication, enable these sensors to take real time decisions, and that's what's make autonomous driving possible in the future, because we will have now with the 5G, the possibility to have a car being taken, decisions by itself on the edge.
00:05:22:12 - 00:05:37:09
Abigail Acton
But also real time prompt to the user or the person who's who's gaining the data. Okay. That's interesting. And how does nanotechnology and nanoscience fit in to making these more? I can only think of the French word performance more powerful.
00:05:37:11 - 00:05:57:16
Lars Montelius
What? I mean, this is the whole basis for sensors because they are based on materials, and you, you kind of tune the materials properties to get a certain function. For instance, if you would like to measure the pH or glucose level in blood or whatever, so you're tuned in for something specific and you use as little material as possible to make them small.
00:05:57:20 - 00:06:34:06
Lars Montelius
So they be, I mean, easy to integrate, but also with a function you need. And that's where is known as technology is all about is to understand the material properties at the nano scale and tailor them to a certain function. And then of course, I mean, when you have these sensors and they are connected, I mean in a connected layer with each other, talking with each other like IoT products or what we nowadays call nano IoT products, they will exchange the information, and that network in turn, will be able to give information to a user and not you to do certain things.
00:06:34:06 - 00:06:53:07
Lars Montelius
So you can think about these connected sensors as a as a kind of, a network that is, let's called a guardian angel for you. It will it will not ask you to avoid dangers. And these dangers could be in traffic, but it could also be there in your health.
00:06:53:10 - 00:06:56:01
Abigail Acton
So almost like a safety net, one could think.
00:06:56:07 - 00:07:03:18
Lars Montelius
Yeah. I mean, you could think it like a safety net or a these kind of safety pillars that blows up in the car. Oh yeah.
00:07:03:18 - 00:07:04:17
Abigail Acton
Yeah yeah yeah. Right.
00:07:04:17 - 00:07:08:16
Lars Montelius
So it's kind of you don't see it, but when you need it you will notice it.
00:07:08:17 - 00:07:19:10
Abigail Acton
And so the nanotechnology element of course is the ability to reduce in size. And also I imagine enhancing performance. So the reduction in size plus the enhanced performance.
00:07:19:10 - 00:07:20:20
Lars Montelius
And the reduction of cost.
00:07:20:22 - 00:07:22:08
Abigail Acton
Right. Yes. Because less material.
00:07:22:08 - 00:07:25:17
Lars Montelius
Which enable the possibility to deploy them in large scale.
00:07:25:19 - 00:07:33:00
Abigail Acton
Right. And how could this be used in health surveillance since today we are interested in health in a post-Covid world, how could this be used in that application?
00:07:33:03 - 00:07:53:06
Lars Montelius
Yeah, I mean, you can you can think about them of, collecting all these kind of different data. Right. So the data could be collected through to your skin, for instance, glucose level. Or it could also be through somebody's liquids. So you can imagine a contact lens which has a glucose sensor measuring the glucose level in the liquid, for instance.
00:07:53:08 - 00:08:15:00
Lars Montelius
And all these datas or could be integrated in your body for something. In some instances, if you have having some kind of surgical treatment, you could place a sensor there if you like. But I think the most important thing is the pattern that is generated by this data. And that is specific. One be Pacific person and then compared with all the other population of course.
00:08:15:05 - 00:08:34:11
Lars Montelius
And it's a variation of the data that gives you the early warning. Right. And that could be done to tell you your student getting sick, okay. So you can actually be prevented and stay healthy rather than getting sick. And you need to go to the care. So it's a kind of a turning the the health system upside down, right?
00:08:34:11 - 00:08:36:07
Abigail Acton
Yes. Basically prevention being better than.
00:08:36:07 - 00:08:41:13
Lars Montelius
Cure starting with the sensors. And then have the healthy living, you know, and avoid going to hospitals.
00:08:41:13 - 00:08:46:15
Abigail Acton
In the first place, which of course, after the coronavirus crisis is more important than ever with health systems.
00:08:46:15 - 00:08:48:00
Lars Montelius
It is for sure facing.
00:08:48:00 - 00:08:52:01
Abigail Acton
Such enormous backlogs of non related Covid conditions.
00:08:52:03 - 00:09:15:23
Lars Montelius
Yeah. So I think in this perspective, I think the the interesting thing with a virus or so is that with these sensors being for instance, in the sewage system, in an elderly care or hospital or even in your homes, in, in the air, in your home, etcetera, that can provide information about the spread of the, of the, of the infection.
00:09:15:23 - 00:09:47:17
Lars Montelius
Right? 3D and that would give information, of course, to the collective or to society, but also to you as a person. So it's all about the connectivity. So by having them connected, the society can take advantage and you yourself can take advantage of the specific things. And so I think here there is a high very interesting possibility for the future to have these kind of systems to help you to monitor air quality, for instance, in your home or in your office or in the hotel room or whatever.
00:09:47:22 - 00:09:52:02
Lars Montelius
So I think this is the this is the possibility for the future.
00:09:52:08 - 00:10:17:23
Abigail Acton
No great potential. Great potential. And, thank you, Lars. And, this kind of takes us to Corinna, your area of interest, which is, you were involved in the, in the EU supported AffecTech project, which should try to develop prototypes to demonstrate how sensors can help people manage mental health challenges. Obviously, with the pressure that we've all been under, mental health is an issue that concerns many more people than perhaps before the crisis.
00:10:17:23 - 00:10:34:02
Abigail Acton
So this is more relevant than ever. Talking as long as was about the use of sensors to to allow people to behave proactively. What parameters were the sensors tracking in your AffecTech project, and how could people benefit from the insight provided?
00:10:34:04 - 00:11:04:11
Corina Sas
That's a very good question, Abigail. We used particularly biosensors, measuring respiration and heart rate. And these are bodily functions that operate without conscious control. Perspiration is sensitive indicator of changes in the intensity of our emotional responses. And another one is heart rate. And measuring the number of times our heart beats per minute. And for example, under stress, we experience higher emotional intensity, which leads to increasing the sweat and heart rate.
00:11:04:11 - 00:11:35:20
Corina Sas
A little bit of what's happening with me right now. In our work, we did capture these changes of emotional arousal through biosensors, and their main benefits is bringing these unconscious bodily processes to our awareness and ultimately under our control. Conscious, controlled, biofeedback provides people access to bio data that signals, for instance, is a sharp increase in emotional intensity during stress.
00:11:35:22 - 00:11:42:15
Corina Sas
And by accessing such data, people may learn to consciously control these specific bodily functions.
00:11:42:15 - 00:11:59:05
Abigail Acton
So you're giving people the information they need in order to be able to recognize that they might have some sort of crisis coming. What did the project actually develop? Did you develop the sensors themselves, and if so, did you find that there was any market interest in these?
00:11:59:07 - 00:12:00:02
Corina Sas
So.
00:12:00:02 - 00:12:00:22
Corina Sas
We.
00:12:00:22 - 00:12:26:09
Corina Sas
We often use, commercial sensors, but we worked at a level of what we call the way they are represented, actuation. And, I can give you a couple of examples of the stuff that we are developing with a range of research prototypes. A few of those are wearable devices to be worn on the wrist. For this we have used biosensors again, the ones measuring perspiration or heart rate.
00:12:26:11 - 00:12:53:13
Corina Sas
And we integrated them with novel interfaces for representing bio data. And we use color, vibration or temperature based bio biofeedback. So when people experience, for example, an increase in their emotional arousal, they can immediately see feel on their skin. This feedback, which can be either static or animated shapes changing colors could be subtle vibrations or gentle warmth.
00:12:53:15 - 00:12:54:00
Abigail Acton
Right?
00:12:54:00 - 00:12:57:13
Corina Sas
And this biofeedback has them to become more emotionally aware.
00:12:57:15 - 00:13:17:11
Abigail Acton
Right. And and with that awareness is in the data. And the access to data is fascinating. And of course, we're exposed. If I can use the word exposed to more and more data, there's data everywhere. What makes these devices very interesting is that there is a dimension where people can harness that data to actually change their behavior slightly, otherwise it's just data.
00:13:17:13 - 00:13:32:04
Abigail Acton
So, did your devices also come with some kind of mechanism that would inform the user what perhaps would be a useful thing to do at a certain point, like take a step back and and breathe deeply for five minutes or something like that. How did that work?
00:13:32:04 - 00:14:00:20
Corina Sas
And for a very good point, because of course, of emotional awareness is just the first step, to address exactly what you are suggesting. We developed other interfaces, other types of interfaces, providing visual and haptic representation of slow breathing and slow heart rate to help people actually lower them and calm down. And we built some smartwatch applications guiding people to slow down their breathing rate.
00:14:00:22 - 00:14:17:20
Corina Sas
We use visualizations, through which people can inhale and exhale, following, for example, a slowly expanding and contracting circle. And another smartwatch application delivers vibrations that are 40% lower than user's current heart rate in order to guide them to lower theirs.
00:14:17:24 - 00:14:35:08
Abigail Acton
Yeah, and that's very interesting. Is it? That's almost like a target to reach. But yes, in a way that's perhaps more calming than thinking of the word target, which automatically is competitive and therefore not very tranquilizing. But yes, it's almost like you're following the lead of of something that is showing you what, what, what direction you should be going in.
00:14:35:08 - 00:14:39:19
Abigail Acton
Yeah. Like something's holding your hand or minutes. It's on your wrist, but it's almost holding your hand. Yeah.
00:14:39:21 - 00:14:42:05
Corina Sas
It's a lot of comfort in that. In that gesture.
00:14:42:08 - 00:14:48:13
Abigail Acton
Indeed. Thank you. And are you finding that there's much interest in in market take up? How is that.
00:14:48:13 - 00:15:15:13
Corina Sas
Going? Yes. We are pleased to say that these devices have been recognized as innovative by the ACS Innovation Rider Prize, and we are now focusing on taking them to the next place and needed for the market. We receive some interest. We have. We are in conversations with potential investors. But I like to take this opportunity as a call for folks to reach out to us, if possible, because I think it's exciting work which deserves to, to to to move forward.
00:15:15:13 - 00:15:39:00
Abigail Acton
Absolutely, absolutely. No. Please do anybody interested then then contact Corinna. Very good idea. Lars and Corinna you've been talking about since is the technology behind the sensors and the application of of that information and that data to benefit the user? Could I ask you all if you would have any questions to Lars or Corinne, or you might have questions for each other, about this aspect of today's, conversation.
00:15:39:06 - 00:16:04:00
Lars Montelius
I mean, there is one aspect that I think is interesting to to think about, and I think, I mean, now in, in this, in, in the sense that we've discussed, it's something that nudge the person, the individual, of course, to take better decisions, let's call it like that. Right. Or, or behave better or whatever. The other aspect is, of course, who owns the digital data and who can take advantage of that, who can valorize it, who can sell it, etc..
00:16:04:02 - 00:16:19:05
Lars Montelius
So my take that I should own it, right? Not the guy who make the device or give the software to me that I have, some kind of relation with. Right. So I think and this is questions that is not yet really discussed right.
00:16:19:05 - 00:16:19:17
Abigail Acton
Now.
00:16:19:20 - 00:16:22:10
Lars Montelius
In my mind at least what I. No.
00:16:22:12 - 00:16:30:20
Abigail Acton
No, I think you're right. It's because it's also cutting edge and new. We're almost to the stage where the technology is of taking society's reactions to the technology. Yeah.
00:16:30:21 - 00:16:47:21
Lars Montelius
And I think it's individual is fine. I mean, because I get the information so I can I can behave better. So the way I have a better life, whatever. Right. So it's fine. But there is, there is another dimension to this. And that is how if someone is is taken advantage of that, then I would also like to have a piece of that pie.
00:16:47:23 - 00:17:02:14
Abigail Acton
So yeah, of course. How is it going to be marketed? Yes. Is it going to be useful for someone to contact you and tell you that it looks like you're going to need more? What? I has to know something because you seem to be stressed. That's exactly okay. Very interesting. Any other questions for Lars and Corinna?
00:17:02:17 - 00:17:03:21
Elena Phillips
I have a question.
00:17:03:21 - 00:17:04:21
Abigail Acton
Yes, please. Eleanor.
00:17:04:22 - 00:17:33:20
Elena Phillips
Yes, but actually, it could go for both for Corinna and Lars. I am interested in acceptability from from patients or from participant sites. How does it feel to to wear sensors? How do people respond to this? I would be interested. And you do make an studies on this. And another question to Corinna, I wonder. This is very awareness of the motion.
00:17:34:00 - 00:17:40:17
Elena Phillips
How does it change the motion I was thinking of? Did you make any surveys on that or any investigations?
00:17:40:19 - 00:18:13:24
Corina Sas
Yes. So to answer the last question, the awareness of emotions. Yes. When people become aware, they start to understand a little bit of the process of understanding where emotions came from, what has caused it, to try to see patterns between similar contexts that have led to the same kind of negative feelings and realize, in a very visceral way, the importance of stepping back, breathing in, breathing out, relaxing even without the regulatory aspects implemented directly on the on the, on the on this back.
00:18:13:24 - 00:18:21:12
Corina Sas
So even those supporting just emotion awareness offline support people regulation as well prompt people to regulate.
00:18:21:14 - 00:18:37:02
Abigail Acton
Yeah. So basically it's providing a context for people to recognize perhaps there's a pattern. So you could think, well I feel fine in a certain situation then. In fact perhaps you are not as fine as you think you are. So the next time you're in that situation, perhaps you realize that you need to to take a step back.
00:18:37:04 - 00:18:52:14
Abigail Acton
Now, I was going back to you. I mean, we were talking about nanoscience and nanotechnology and the benefit of that being that things are shrinking in size. I mean, I'm an Apple Watch wearer, and I'm quite comfortable in my Apple Watch, but it does feel a little like I've got a computer on my wrist. I mean, you know, do you feel a little self-conscious?
00:18:52:14 - 00:19:01:17
Abigail Acton
Especially if I take a call on my wrist? I feel like an idiot. What's the future for for these type of wearables? Are they going to get ever smaller?
00:19:01:19 - 00:19:21:24
Lars Montelius
I think they will be built smaller, maybe, and also integrated in different ways. I mean, one of the most, I think one of the most interesting sensors that do very much I mean, the Apple Watch is a sensor in a way, because they measure a lot of things. Right? Besides being a watch and in the information provider, a person get that assistant or whatever.
00:19:22:05 - 00:19:46:16
Lars Montelius
But there are other kind of form factors now with rings, for instance, that give the same kind of thing that you can wear as a ring. And I think the the acceptance is really to find what is socially acceptable, so to say. Right. Because I mean, nowadays more and more people are having what I have. I mean, if phones and you are going in the street and talking with yourself, etc., and it's becoming acceptable, right?
00:19:46:18 - 00:20:02:21
Lars Montelius
Which was not the case when I was a kid, it was totally unacceptable. If you would do that. So I think the the it will change, but I think it will be integrated more and more in different things. And you can have sensors in your in your fabrics, in your clothes. You can have it, under the skin.
00:20:02:22 - 00:20:24:20
Lars Montelius
I mean, you can have tattoos being printed on your skin, for instance, that are sensors, and you can integrate it in your glasses in the, and so there are a lot of things, and I think the social acceptance about these kind of if you call it in a way, it maybe it's not individually performance enhancers, but in a way it is.
00:20:24:24 - 00:20:44:24
Lars Montelius
It's a glass. This is also an individual performance enhancer which is totally socially accepted hearing aids the same. So I think it with time it will not become complicated. And I think the if it is not nice to wear, no one will wear it. Right. So I think the wear ability to use experience will be the dominating factor for this, right?
00:20:44:24 - 00:21:10:19
Abigail Acton
Absolutely. The design. Yeah. Eleanor, I'm just going to turn to you now, if I may. We were talking earlier and one of the things that we we were sort of almost laughing about was the notion that just because the technology exists should we actually necessarily use it? So there's sometimes a feeling that that we're able to do things and so we do them, but we're not necessarily paying attention to to whether the people who will be using these things want them in the first place.
00:21:10:21 - 00:21:34:23
Abigail Acton
So, one strand of the IQCE project analyzed how people feel about the use of technology to overcome mental health challenges. So rather than what we were talking about with Corinna, about, noticing what's going on in your body or in your reaction to stress and perhaps taking taking action to try and mitigate that. Here we're actually talking about therapies and treatment for people with mid to low level, mental health challenges.
00:21:35:02 - 00:21:43:12
Abigail Acton
So can you tell me what the Iki project was, seeking to establish in this particular strand of it and a little bit about your methodology. Yeah.
00:21:43:12 - 00:22:15:17
Elena Phillips
So, just to maybe to give you a bit, background information, our research focus where so-called mental health interventions and this, intervention tions, that are based on CBT, cognitive cognitive behavioral therapy, and they're designed for people who have mild to moderate symptoms. And they're, they enable, people to work by themselves, at their mental health problems.
00:22:15:19 - 00:22:50:02
Elena Phillips
So, and the recent certificate evidence suggests that, such interventions can be effective, but, also there is evidence that, people, patients are still quite hesitant regarding, uptake of those interventions. So they're curious, why is why is this like this? And, how could we maybe increase the acceptability of, of these interventions? So, so we wanted to, to shed a bit more light of this, of this hesitation.
00:22:50:02 - 00:23:32:22
Elena Phillips
So we conducted the discrete choice experiments among almost 2000 participants in Germany. And, in this in this experiment, we wanted to see the preferences of participants for, singular features of those interventions. So to give you a concrete example, what we have done. So we defined the interventions. By specific features like a content delivery, like peer support, like, proof of effectiveness or, or human contact or let's say form of human contact and, human contact.
00:23:32:22 - 00:24:01:20
Elena Phillips
I will I will go here a bit deeper. We offered several levels, levels of human contact, such as no human contact, human contact by email, human contact via phone call, video call or it was the last option, human contact with their psychotherapist in a traditional psychotherapy session. And their mental health. Hi. Mental health interventions would be, a part of this therapy journey process.
00:24:01:22 - 00:24:33:10
Elena Phillips
So and then then we they asked people, so what would you prefer? And, well, the result was surprising because the most preferred, feature of the mental health interventions was human contact. And then in contrast, in context of traditional psychotherapy. So basically it was a questionnaire survey about digital technology in mental health. But we came up with the strongest preference for human contact, in this area.
00:24:33:10 - 00:24:54:09
Abigail Acton
Could I ask you I mean that was the patient's perspective. Yeah. So yes, we're we're interested perhaps perhaps they said we're interested in various options and, and concepts and, and technological advances. But what we really want to do is sit down and talk to somebody face to face. What was the therapist's reaction to the notion of blended care, as you would call it?
00:24:54:11 - 00:24:59:11
Abigail Acton
A mixture of e interventions and, human intervention. What did the therapist think?
00:24:59:13 - 00:25:30:04
Elena Phillips
Yeah, that was it was our next project. So if I wanted to see the perspective of German therapists on that, because there is a difference when we talk about therapist view on a mental health or blended care, when you mix psychotherapy and technology, there's a big difference among countries healthcare systems and among therapeutic schools. So CBT therapists are naturally more open to mental health interventions, whether psychodynamic therapists or humanistic therapists are more hesitant sounds.
00:25:30:04 - 00:26:10:02
Elena Phillips
We got a similar picture in our, last study. CBT therapists were very welcoming where the psychodynamic therapist there valued, more time. More personal time is a patient. They opted for larger shares of of personal sessions regarding to digital interventions. But, both therapists were well, yeah, both of us schools in our survey were quite positive regarding this mixed, blended care, treatment form.
00:26:10:05 - 00:26:38:16
Elena Phillips
So they were both optimistic to integrate technology into their therapeutic process. But the preference was, as you can blend it in different in different forms. You can you can integrate the technology in their in their therapy process or you can do it before or after therapy. So the preference in our survey was to integrate digital, digital interventions into the therapy process.
00:26:38:16 - 00:26:41:07
Elena Phillips
So the parallel they follow running.
00:26:41:10 - 00:27:04:01
Abigail Acton
But it's an interesting idea that, that, that perhaps the digital therapy could be used also as a backup, you know, that people could reinforce what they had, come to understand or realized with the psychotherapist through a follow up using digital, digital to therapy and perhaps, games and and so on. That's very interesting. Thank you. Elena, does anyone have any questions for Elena about this?
00:27:04:03 - 00:27:04:09
Abigail Acton
Yes.
00:27:05:10 - 00:27:19:10
Corina Sas
very interesting project. I know that the cost of providing, this human contact is very high. And I just wondering what's the appetite for people to explore peer support in, in talk therapy.
00:27:19:12 - 00:27:45:06
Elena Phillips
Peer support for basically the levels for peer support. We had a voice, possibility of an online community, unmoderated online community, all, face to face meetings with a moderator. But peer support didn't play such a big role. And here again was a preference for more human contact. But but when we look at all features, peer support didn't plays often play a big role?
00:27:45:08 - 00:28:03:05
Elena Phillips
It can be a cause. So while our our hypothesis was that, mental health is quiet for some people stigmatized topic. So there is not this big openness to to connect this a lot of people, but there is an openness to connect maybe to 1 to 1 person, like a psychotherapist.
00:28:03:07 - 00:28:05:04
Abigail Acton
And it's, it feels like it's private, doesn't it?
00:28:05:04 - 00:28:07:03
Elena Phillips
Yes. Like a more intimate connection.
00:28:07:03 - 00:28:31:05
Abigail Acton
Yeah. No, that does make sense. I think that that would resonate. That makes sense. That interesting point, Karina, you made about the comments. This is actually Alexandra. Thank you very patiently. Hello. This actually chimes a little bit with what you were looking at. So you were involved in the COMED project supported by the EU, which aimed to make sense of all these new devices and, sensors and other new technologies in advance.
00:28:31:05 - 00:29:04:17
Abigail Acton
That's coming on to, the health care, if I can say, market by establishing ways to measure how effective they are and suggesting parameters health care providers can use in order to decide whether or not to offer them. Since the long term cost effectiveness of clinical devices and sensors and everything really depends heavily on how they are adopted into routine clinical practice, if they're brand new and haven't actually been adopted that much into routine clinical practice, how can health care systems determine which innovative projects and devices to provide?
00:29:04:19 - 00:29:25:12
Aleksandra Torbica
Thank you Abigail thank you very much indeed at the end. But, this is a you not usually that is the case because in the in the journey of the new technologies, innovation is really as we have somehow, followed in this case, like from the very, very basic research and innovative solutions to patients preferences.
00:29:25:12 - 00:29:54:15
Aleksandra Torbica
And then at the end, somebody has to pay for it, right? So, what are the criteria that the policymakers, put in place in order to decide which technologies to cover with limited public funds? So basically tuition, guarantee coverage and reimbursement and so to, to face and and to overcome so-called fourth heart, all that the innovations have to be made before, before, before they come actually to the final user, which is the patient.
00:29:54:15 - 00:30:20:24
Aleksandra Torbica
So if you think about all the innovations that we have heard about, through, through the interventions of my colleagues here at the end of this journey, the technologies need to be evaluated across some dimensions and policy makers more recently, in Europe and not only Europe, have, been using this framework of health technology assessment that looks into clinical effectiveness, but also cost effectiveness.
00:30:20:24 - 00:30:55:18
Aleksandra Torbica
So economic impact of these technologies when they are used in real life, in real world, under real patients. So for the medical technologies, especially for the very innovative one like we have heard about today, it is really, you know, the uncertainty around the effects in real life is huge. Once they have, you know, come to the market and they have obtained all they had to obtain in order to, to get, you know, the market license, because this gap between the evidence that is needed for this, especially to, for medical devices, not so much for pharmaceuticals.
00:30:55:20 - 00:31:17:21
Aleksandra Torbica
So the evidence that is needed to get the key market, for example, in Europe to get to the market and the evidence needed to pass the health technology assessment, evaluation, there is a huge gap. So what the policymakers do in front of this gap traditionally, you know, with a yes or no decision. So, yes, we pay for it.
00:31:17:22 - 00:31:38:08
Aleksandra Torbica
No, we don't pay for it. The whole the risk was on the burden of the policymakers. They take the risk of saying yes to something that means that maybe cost effective or effective at all in the real populations. And they say no, they take the risk of not granting access to patients, for something that potentially could really improve their lives.
00:31:38:10 - 00:32:15:21
Aleksandra Torbica
So the, this idea with this new innovative, arrangement, that was one part of comment, the project was that to spread the risk between the manufacturer of the innovation and the policy makers with this innovative, policy tools, I would call them how to allow quick or quicker access to innovation, but by sharing the risk that, you know, reserving some, let's say, potential to even, reverse a decision in case the evidence proves that the technology is not that good enough for, to be used on a wider scale.
00:32:15:23 - 00:32:41:17
Aleksandra Torbica
And these policies are labeled, different ways, different names in different countries. The coverage with evidence development was, one way that we use it, especially in Europe, to label a set of policy tools that are basically what the word itself says. I grant for coverage and reimbursement the provided that you generate evidence that they need to make a more robust decision.
00:32:41:19 - 00:32:54:21
Aleksandra Torbica
In this way, the manufacturers and producers share the risk of, generating the data, but also, obtaining, safe and effective and cost effective devices on the market.
00:32:54:23 - 00:33:22:07
Abigail Acton
That's fascinating. And and it makes absolute perfect sense. So basically, as things develop and, and the context changes because new technology emerges soap so quickly. Now, basically what you're doing is permitting people to accept that there's a gray area that is not black and white. Exactly. And that we don't stall everything, in favor of trying to get something that is a simplistic overview, but that we acknowledge that there's some ambiguity and that we proceed in progress.
00:33:22:09 - 00:33:26:11
Abigail Acton
But the decisions can be changed if needed. That's, I think, what you're saying.
00:33:26:13 - 00:33:50:20
Aleksandra Torbica
Exactly, because the main purpose of this coverage with development schemes is really to reduce the uncertainty about the effects, whether the clinical and economic effects of a specific technology by obtaining data on real patients, which may not be in a position to obtain for millions of reasons before the, technology comes to the market, the wider use is not possible before.
00:33:50:20 - 00:34:16:04
Aleksandra Torbica
Of course, the technology is available to patients, to physicians, to hospitals. So, rather than saying no because evidence is limited, we say something in between, as you said. So yes. But provided that you generate evidence, sometimes those decisions can be only in research. So we allow it to access a limited number of patients to conduct the more research or only with the research.
00:34:16:04 - 00:34:47:15
Aleksandra Torbica
So wider scale, but with the research generating the data, this is especially challenging, for the technologies that we have discussed today. So variables for example, there is still no agreement on what do we actually have to measure as effectiveness of variables. Because the health technology assessment framework was somehow based on pharmaceuticals, where we look at the mortality rates, we look at, some surrogate outcomes of, you know, blood pressure or, other indicators, of course, that we are interested in.
00:34:47:17 - 00:35:13:06
Aleksandra Torbica
How do you measure whether variable is effective? You know, there is a whole range of dimensions that are not captured in traditional framework. So, you know, of this gray area really, you know, opens the door to evaluation of different types of technologies. And, you know, the medical devices we have, you know, I think half a million of different types of technology that we label as medical devices and not the same rules can be applied to all of them.
00:35:13:08 - 00:35:34:14
Abigail Acton
So I think also it must be the case that people become more courageous. Health care providers become more courageous because they're not locked in to financing something that that they then decide they don't want to finance anymore. They can change their minds. One thing I was going to say also is that it must be very difficult. And this is perhaps for Lars and Corinna and and Elena too.
00:35:34:16 - 00:35:49:04
Abigail Acton
It must be very difficult to prove a negative. No, because what you're saying is that if these people hadn't been wearing these devices, their condition would have would have worsened. So with pharmaceuticals, you say I take this tablet, I get better, things improve.
00:35:49:04 - 00:36:11:15
Aleksandra Torbica
But there are study designs that can that can allow you to do this analysis. Okay. So I mean and so-called counterfactual or control group, you know, there are ways you can write. You can do it with the study design. But of course, you know, there are limitations to that. That's why, you know, sometimes, like conducting a trial in a pre-market phase would not be feasible or even ethical for some of these, situations.
00:36:11:15 - 00:36:56:17
Aleksandra Torbica
So once it's on the market, you, you, you would need to think through with the manufacturer. And this is also the possibility for the manufacturer and the payer to come together, decide on the design of the study, share the risk, but also share the knowledge, on a specific issue and also providers to be part of the evidence generation process, not just the recipients, but really an active actor protagonist in generating evidence, which then it's not only about being, I think, courageous, but really being more involved and having more governance tools to, to allow, again, quicker access to something that can really improve people's life but also cost.
00:36:56:19 - 00:37:09:02
Aleksandra Torbica
Have you got, let's say a, a bigger, influence on how the money is being allocated because we know that, of course, that, you know, innovation, the speed of innovation is so high, but the resources are by definition, limited.
00:37:09:07 - 00:37:11:24
Abigail Acton
You know, they remain the same even though the amount of.
00:37:12:01 - 00:37:14:18
Aleksandra Torbica
You know, they will never grow as fast as.
00:37:14:20 - 00:37:31:06
Abigail Acton
Yeah, as fast as the choice is provided. Can I thank you, Alexander. It's fascinating. And it makes perfect sense. It's one of these wonderful things where, you know, until someone's pointed it out, you haven't thought of it. And then when someone points out that the system needs a slight shift in the way that it approaches these noble technologies, it just makes perfect sense.
00:37:31:06 - 00:37:47:11
Abigail Acton
Very logical. Alexandra, I would have one more question to you. That would be, did you find that, the I mean, it's a little bit like a disruptive technology or an approach, really. Did you find that the health care authorities are interested in embarking in a new direction in this way?
00:37:47:13 - 00:38:24:01
Aleksandra Torbica
We it in common project evaluate really like what are the perceptions of policymakers vis-a-vis these new policy tools because so far, most of the again experience has been generated in the world of pharmaceuticals, where things are a little bit more structured and controlled and established. Then, then in the world of medical devices, so the policymakers do recognize a great potential, to these new, tools, especially in the field of medical devices, given these uncertainties that we talked about and, and lack of evidence and so on.
00:38:24:03 - 00:38:48:21
Aleksandra Torbica
There are, however, a series of, challenges of criticality, as always, in order to fully implement these scheme. So, one, you know, maybe the most important one is really resources available because this doing this properly cost also you know to build up a coverage with evidence development scheme really requires some investment also from from policymakers.
00:38:48:21 - 00:39:11:15
Aleksandra Torbica
So it has to be worthwhile. And when is it worthwhile? When the purpose of the scheme is really to generate evidence that will be used if a policymaker, it's a, you know, a more rational decision to just to to do some price negotiation with the manufacturers, say whatever evidence you have, let's just talk about the price and to see what would be the best deal.
00:39:11:19 - 00:39:32:05
Aleksandra Torbica
To put it very simply, then it may not be worth to invest all this money in building the structure of, coverage with evidence development. But if, there is really a need to gap. So to close the gap on the uncertainties of evidence, then the policymakers are very open to, to, you know, to these new avenues.
00:39:32:05 - 00:39:56:10
Aleksandra Torbica
Yeah. I'm sure the issue of funding and availability is fundamental because different countries adopt different models. Who pays for, you know, is it, you know, is it the Ministry of Health who wants this evidence? Or again, the funding should come from the manufacturer. But what is then it for the manufacturer? What about if the results are negative, if there even being, you know, they paid for something that will then make them reverse the decision reimbursement.
00:39:56:10 - 00:39:58:15
Aleksandra Torbica
So I mean it's not as simple.
00:39:58:21 - 00:40:18:18
Abigail Acton
No, no no no it's balance. Absolutely. Yeah. No I can imagine that in some situations perhaps. Yeah, perhaps people would rather just negotiate the price and then walk away and have the certainty of the fact that their, that their device has been adopted and, and, and that they're contractually obligated. Yeah. It's interesting, but it seems to me to be the way forward, given what we've been talking about.
00:40:18:18 - 00:40:40:11
Abigail Acton
Now regards to cutting edge technology, I have one question now that I would like to ask each of you. It's perhaps a little predictable, but I think it's really worth asking, especially given the subject today, because we're talking about, about almost slightly futuristic tendencies in healthcare and provision. So I will go around the table, and I will start with you Lars what do you imagine the next decade will bring?
00:40:40:13 - 00:41:12:03
Lars Montelius
I think strongly that we will have this kind of interconnectivity with different kinds of sensors that will help us to stay more healthy, but those who help the care to give better care and better kind of treatment. And I think one of the one or maybe one of the challenges is the, let's say, how can we how can the new knowledge being generated by all these kind of sensors, how can that be incorporated and linked to certain kind of diseases or certain kind of treatments that we should do?
00:41:12:03 - 00:41:39:03
Lars Montelius
I mean, how can we link that into the let's call education sector, right? Because it's so quick. It's an exponential growth of data. And how can that kind of exponential growth be incorporated into the educational programs? Because otherwise it would be difficult for, for doctors to I mean, you can with all your data and say, here is my data and this is what I see you sleep not so much and you have this blood pressure.
00:41:39:03 - 00:41:43:20
Lars Montelius
What the what shall I do with that? Yeah, I think this is the kind of challenge for the future.
00:41:43:23 - 00:41:50:11
Abigail Acton
Actionable data. Yeah, yeah, yeah. Thank you. Lars. Corinna. Next ten years, what's going to happen? Crystal ball.
00:41:50:13 - 00:42:14:14
Corina Sas
I go with, with Lars. Prediction about interconnectivity. I will add to that. I can see multiple layers of things. Things will be weaved in the fabric of our lives without really seeing those actuators or sensors. I think through through speech inputs, we'll have access to, to a range of therapies and, and biofeedback devices. There would be multiple layers.
00:42:14:16 - 00:42:42:16
Corina Sas
But to me is really about how this personal data becomes big data and how I can can revolutionize this space. I mean, there is a lot of work already ongoing. And to me, before we get there is a issue of of ethics. And again, who is owning the data, which business models are underpinning them? I think there are big philosophical questions we have to to, to ponder over, in order to really push this field forward from very solid foundations.
00:42:42:18 - 00:42:56:07
Abigail Acton
In an ethical way. Yeah, yeah. Interesting. Yeah. Elena next ten years, what do you think is going to be the case when it comes to how people approach treatments and, and perhaps use e e therapies and so on?
00:42:56:09 - 00:43:31:15
Elena Phillips
I guess, I would touch the big, philosophical questions because I'm more in the mental health area than in the technology area. So I see the the bright future in the area of, self empowerment, of patient empowerment. On prevention. So I think this are great potentials of all this, developments we discussed today. I also see that, these devices and technologies, give us a sense of control that we can have over our lives and this sense of control.
00:43:31:17 - 00:43:55:20
Elena Phillips
It's interesting how real it is, actually. And, so what I also my, my, my biggest takeaway from this discussion came actually from the Corina's question or remark that the a therapist contract is a it's it's an expensive factor. So I was thinking that actually yes, the human contact, the human connection is the most expensive factor. But it's also the most visible one.
00:43:56:13 - 00:44:09:13
Abigail Acton
And if we're thinking about the overall cost to society of somebody who is perhaps suffering from mental conditions, then perhaps most effective therapy is the one that ultimately is the cheapest. Alexandra, next ten years, what's it going to bring.
00:44:09:15 - 00:44:13:19
Aleksandra Torbica
Yeah. So I'm not sure whether, you know, I have a crystal ball. I can tell you what I hope for.
00:44:13:24 - 00:44:15:12
Abigail Acton
Yeah, would be good. Tell you what you hope.
00:44:15:16 - 00:44:44:13
Aleksandra Torbica
Actually, I do hope that these are maybe two out of the many lessons that we can learn from the current pandemic as well, because I think this is something that we should learn from what is going on in the world. The first one, you know, the the centrality of in all policy decisions. You know, it's not only about the domain of, of health policy or minister of Health, but the health is central to our economy for finance, for social systems, for health is, you know, across is a cross-cutting theme.
00:44:44:15 - 00:45:06:20
Aleksandra Torbica
And you know, I do believe and I do hope the policymakers of all the countries really, you know, realize that you are paying the high price to realize it so that this is something to pivot, to discuss, to change the narrative about the health care in terms of spending and costs, to investment for the future. In terms of also economic development and not only.
00:45:06:22 - 00:45:36:07
Aleksandra Torbica
And the second hope is about really opening our eyes on the importance of data and evidence to inform those decisions, because, also with these new technologies, we are really overwhelmed. The overabundance of data make it actionable is less and, useful for policymakers who are now more open and more receptive with some criticism to science and evidence to inform, you know, whether to, invest or not, to invest to close, about to close, about to open.
00:45:36:09 - 00:45:47:24
Aleksandra Torbica
But, at least you know, this, this bridge between the science and policymakers, has become so evident in the current crisis. So I do hope it will stay there solid for the years to come.
00:45:47:24 - 00:46:07:12
Abigail Acton
Yeah, absolutely. Absolutely. We have to come out of this with improvements to the way that we operate and the way that we think. Absolutely. Listen, I want to thank you all very much. That was truly fascinating, very, very interesting. And I'm grateful all to all of you for having joined me, and I wish you all the best in your future research.
00:46:07:13 - 00:46:16:00
Abigail Acton
And, I look forward to hearing more about what what's going on in your various domains in the future. Thank you for joining us today. CORDIScovery says, thank you very much.
00:46:16:01 - 00:46:17:02
Aleksandra Torbica
Thank you.
00:46:17:04 - 00:46:18:01
Lars Montelius
Thank you, thank you.
00:46:18:03 - 00:46:19:02
Aleksandra Torbica
Bye bye bye.
00:46:19:03 - 00:46:21:00
Elena Phillips
Thank you. Bye bye.
00:46:21:02 - 00:46:22:10
Aleksandra Torbica
Bye.
00:46:22:12 - 00:46:53:07
Abigail Acton
interested in what other EU funded projects are doing to transform European health systems in the wake of Covid 19? Take a look at issue 101 of the research EU magazine available on the Cordis website. Cordis.europa.eu. Here you can also find daily news articles, interviews with researchers working on domains ranging from paleo archeology to space results, PACs which drill down deeper, gathering groups of projects by subject area, and the magazine, which offers insights into a different subject every month.
00:46:53:07 - 00:47:13:17
Abigail Acton
In its special section. Interested in applying for an EU research grant? Visit the Cordis website to see how your work relates to that currently being done in your field. So come and check out the research that's revealing what makes our world tick. Our next episode will consider how EU researchers are tackling pollution for a cleaner, greener Europe land, sea and air.
00:47:13:22 - 00:47:31:24
Abigail Acton
What are the latest findings coming out of cutting edge EU research? Join me to find out. We're always happy to hear from you. So drop us a line editorial at Cordis Dot Europa. EU. Until next time.
Des professionnels de la santé travaillant sans relâche pendant un an, vivant des expériences auxquelles rien ne pouvait les préparer; des systèmes de santé soumis à des pressions jusqu’au point de rupture; une population confrontée à la peur, à l’insécurité et au chagrin, sans contact humain pour les rendre supportables — la pandémie de COVID-19 va en effet laisser une lourde empreinte, même si les campagnes de vaccination en Europe s’accélèrent enfin et que la lumière semble désormais poindre au bout du tunnel. Dans cet épisode de CORDIScovery, notre animatrice, Abigail Acton, mène une discussion avec quatre invités de marque pour découvrir plusieurs innovations passionnantes qui contribueront à transformer les soins de santé européens au cours des années à venir dans le monde post-pandémique. Lars Montelius, directeur général du Laboratoire ibérique international de nanotechnologie et professeur de nanotechnologie à l’université de Lund, en Suède, nous fait part de son point de vue sur la façon dont les nanotechnologies vont dynamiser les soins de santé. Corina Sas, professeure d’interaction homme-machine et de santé numérique à l’université de Lancaster, s’intéresse aux dispositifs susceptibles de nous aider à gérer les problèmes de santé mentale. Mais aussi sophistiquées que soient les solutions numériques, les gens ne préféreront-ils pas toujours le contact direct avec un psychiatre? Dr Elena Phillips, basée au Centre d’économie de la santé de Hambourg, apporte quelques réponses. Et enfin, compatissons avec les autorités de santé publique chargées de déterminer les technologies de pointe à financer. Cette décision peut-elle être simplifiée? La présidente de l’Association italienne d’économie de la santé, Aleksandra Torbica, nous en dit plus.
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CORDIScovery, CORDIS, podcast, soins de santé, COVID-19, systèmes de santé, santé mentale