Stratified medicine in Europe

Stratified medicine in European Medicines Agency licensing: a systematic review of predictive biomarkers

The potential of predictive biomarkers for the development of stratified medicine has been highlighted for more than a decade. The current situation is very concrete. In Europe, EMA has accepted 49 biomarker-indication-drug combinations over 16 years, mostly used in cancer and as a predictive of drug efficacy, and in a minor scale of drug toxicity (4 cases).
These data confirm that currently the new wave of "personalised" or stratified medicine is really minor, although the investments and return expectations are huge.

Given the large body of literature documenting research into potential predictive biomarkers and extensive investment into stratified medicine, we identified relatively few predictive biomarkers included in licensing. These were also limited to a small number of clinical areas.

 Just released

Healthy behavior strategies

Healthy Behavior Change in Practical Settings

This is the article to read today. If you don't have enough time, have a look at this figure and ask yourself if you can apply it.

PS. Afterwards you may fill the questionnaire (Article 4) to check your understanding.

Psychological wellbeing and health

Subjective wellbeing, health, and ageing

What is the relationship between wellbeing and age?. This is precisely what this article tries to disentangle considering three types of subjective wellbeing:

• Evaluative wellbeing: evaluations of how satisfied people are with their lives
• Hedonic wellbeing: feelings or moods such as happiness,sadness and anger
• Eudemonic wellbeing: judgments about the meaning and purpose of life

Is it possible that positive subjective wellbeing is a protective factor for health?
Their conclusion:

Research into subjective wellbeing and health at older ages is at an early stage. Nevertheless, the wellbeing of elderly people is important, and evidence suggests that positive hedonic states, life evaluation, and eudemonic wellbeing are relevant to health and quality of life as people age. Health-care systems should be concerned not only with illness and disability, but also with supporting methods to improve positive psychological states.

Do you have any clue of how to do it?

Deciding by default

Choosing Not to Choose. Understanding the Value of Choice

The core of the application of behavioural economics to decision making on health lies in my opinion in choice architecture. I explained that 2 years ago in this post. Now Cass Sunstein is providing us with a new book that shows the details and rules for "choosing no to choose", a must read.

The choice among impersonal default rules, active choosing, and personalized default rules cannot be made in the abstract.To know which is best, both choosers and choice architects need to investigate two factors: the costs of decisions and the costs of errors (understood as the number and magnitude of mistakes). An understanding of those kinds of costs does not tell us everything that we need to know, but it does help to orient the proper analysis of a wide range of problems.
It should be obvious that a default rule can much reduce the costs of decisions. When such a rule is in place, people do not need to focus on what to do; they can simply follow the default. But a default rule can also increase the costs of errors, at least if it does not fit people’s situations; it can lead them in directions that make their lives go worse.

In approaching the underlying issues, he shows five propositions. I'm right now in the middle of the book. I can't have a final opinion, however I'm sure that this will be a key reference for the future.

Knowing what works

A systematic review of barriers to and facilitators of the use of evidence by policymakers

Evidence-based health policy should be grounded on knowledge on what works. Too often we see that policy-maker decisions' are far from that. Understanding why, is the first step to fixing it. In this article you'll find a systematic review on this topic:

The most frequently reported barriers were the lack of availability to research, lack of relevant research, having no time or opportunity to use research evidence, policymakers' and other users not being skilled in research methods, and costs . The most frequently reported facilitators also included access to and improved dissemination of research, and existence of and access to relevant research. Collaboration and relationships between policymakers and research staff were all reported as important factors.

Incentives, a modern frame (2)

Ética de los incentivos a profesionales sanitarios

Revisitng this report released 5 years ago, and comparing some statements with a former post, I can find relevant differences. Though this one is applied and the former is more general, the perspective is focused on having clear answers to specific problems. The definition, appropriateness and foundations of the argument requires deeper elaboration, in my opinion. That's why I suggest you should read the book.

Incentives, a modern frame

Strings Attached: Untangling the Ethics of Incentives

I've found extremely appealing the chapter 2 of the book "Strings Attached", it helps to understand the etimology of incentives as a word in the english language and its meaning:

For more than 250 years, starting in about 1600, the word “incentive” meant “inciting or arousing to feeling or action, provocative, exciting.” Uses cited by the authoritative Oxford English Dictionary include: “The Lord Shaftesbury . . . made an incentive speech in the House of Lords (1734),” or “This Paper is principally designed as an incentive to the Love of our Country (1713).” The last example cited of the term in this sense is dated 1866 and, like the others, it comes from an English source. Then there is a striking change. “Mr. Charles E. Wilson . . . is urging war industries to adopt ‘incentive pay’—that is, to pay workers more if they produce more.” This is the first example from the same dictionary of the use of the term in its contemporary sense, and it is an American example dated three quarters of a century later in 1943.

There is a huge gap in time, place, and meaning between the two sorts of citations, a gap that introduces several puzzles. What was happening in America when the new meaning of incentives was introduced? Why is this conception missing from the vocabulary in the seventeenth and eighteenth centuries, the very years in which the idea of a market economy was being discovered and articulated? We are accustomed to believe that our thinking about political economy rests on the work of the likes of John Locke, Bernard Mandeville, Adam Smith, David Hume, Jeremy Bentham, James Mill, John Stuart Mill, and the authors of The Federalist Papers. But with very few exceptions, “incentive” does not appear in any of their writings.

Beyond chapter 2, the whole book deserves to be read.