Blockchain: Future-proofing healthcare
When Bitcoin, the first cryptocurrency, launched in 2009, the world was in the middle of a great recession. More than a decade later, with the world engulfed in a pandemic, the technology underpinning Bitcoin has the potential to solve many of the challenges our healthcare systems face, both now and in the future.
Blockchain is a type of digital database that stores transactions in such a way that the information cannot be altered. When a 'block' becomes filled with data it joins the back of a chain and receives a timestamp, forming a blockchain in chronological order. Each transaction is signed with a private key, and distributed among a peer-to-peer set of participants. Without a valid signature, any new blocks created by data changes are ignored and not added to the chain. While the chain is visible, it doesn't reveal any data, only the timestamp.
This visibility is important because it makes it possible to trace the history of a transaction, or a supply chain. Take De Beers, the world's biggest diamond producer, a sector that has frequently come under fire due to where the diamonds are sourced. In 2018 the firm began using blockchain to trace the entire journey of their diamonds across the supply chain, to ensure they were all sourced ethically and sustainably. It is these advantages that give blockchain such potential for the healthcare sector.
Patient health records
"Data portability across multiple systems and services is still a real issue within the healthcare sector," says Rupert Spiegelberg, CEO of Doctorlink. "For example, in the UK, your hospital records are not attached to your GP records, but if they were, the advantages are clear in terms of treatment and preventative care.
"Blockchains could be used to store our medical records, enabling patients to resume ownership of their personal data, while also allowing professional healthcare practitioners to interact with it, revolutionising the delivery of treatments and preventative care."
Estonia, a Baltic country that borders Russia, . People’s health records are stored on a blockchain, which among other things allows medication to be tracked from its manufacture all the way down to the patient's adherence.
IBM Watson recently released their using blockchain technology. The Health Pass has been designed to help organisations verify the health of an employee – particularly their Covid status – while keeping their data private. Users are in control of their health information, managed in their own encrypted digital wallet which they can access on a mobile device.
Sharing medical research
Leaders in the medical and life sciences sectors have made frequent calls for a data sharing platform where researchers can share the findings of clinical trials and other medical research. Experts have also called for more data sharing between pharma companies and those in chemicals, technology, manufacturing, and supply chain, amongst others.
According to the WHO, , generally because the results are negative. This leaves gaps in knowledge for stakeholders and patients. A secure, yet visible database with the results from trials of new medicines for instance, could improve patient care, and reduce the possibility of fraud.
has cited Enigma and OPAL developed by the Massachusetts Institute of Technology as two examples of blockchain that are "a revolutionary way of preserving privacy for epidemiological research as it's developing."
While we've witnessed a rise in the availability of home DNA tests for individuals to find out about potential health conditions, whole genome sequencing, where the entire genetic code of a person is analysed, is still prohibitively expensive for consumers. Additionally, some people are concerned over the confidentiality of handing their DNA over to other people.
This means that the small amount of genetic code available to scientists makes it difficult to carry out meaningful research, which could be beneficial to learn more about cancer and other diseases.
, a San Francisco-based startup, offers whole genome sequencing for free to people willing to let their data be used by scientists. The analysis is stored in a blockchain so that only the DNA's owner and researchers have access, with the owner’s authorisation. The aim is to encourage more people to submit their genetic code, persuaded by blockchain's secure system, which will give scientists more to work with to understand the causes of disease and develop personalised treatments.
Addressing global health inequalities
There are millions of people around the world who do not have a legal identity, and therefore don't have access to healthcare services. Dr Jane Thomason, an author and associate at the Centre for Blockchain Technology at University College London (UCL), says that that they owned themselves would be "game-changing".
Additionally, in countries where access to good quality medication is limited, a blockchain supply chain would allow each member to see the supplies as they move. Up to 10 per cent of drugs in low and middle income countries are either counterfeit or of poor quality, and it's estimated that around .
Lastly, various studies have found that foreign aid disproportionately flows to the richest regions of the destination country, rather than the poorest. Blockchain could ensure that foreign aid donations intended for healthcare programmes in low income countries would reach those who need it the most.
Blockchain - the future of healthcare?
There are of course, challenges. "These applications still require strict authentication and record sharing requirements," Spiegelberg says.
"As with all new technologies, there are still concerns that blockchain will have its own vulnerabilities which are yet to be discovered. For example, could mining attacks become an issue and if a user misplaced their private key, would the data be permanently inaccessible?
"Whilst the healthcare sector is undergoing a digital overhaul, we are still only at the beginning of this process and without a centralised model to follow or adopt, it is a huge undertaking for healthcare systems to embark on. In order for blockchain technologies to become widely adopted in healthcare systems, industry leaders and policy makers, along with private and government bodies, will need to work together and adopt a joint approach."
The time seems ripe for this type of collaboration, as COVID-19 has accelerated a digital explosion in healthcare. The focus has shifted from being able to handle more patients to being able to handle them more effectively and treating their conditions more easily. Blockchain’s unique ability to both protect and flexibly hold data could play a vital role in underpinning healthcare’s digital progress and overhaul how it is delivered.
"Research already suggests that ," Spielberger says. "Given its unique ability to ensure appropriate encryption and security, I believe that blockchain technologies are set to become a major factor in future healthcare programs."
Long haul Covid, the brain and digital therapies
It is estimated that around 10% of people who get Covid-19 develop long haul Covid, a debilitating condition that can last many months and cause breathlessness, exhaustion and pain.
Research is underway to find out who is more likely to get it and how to treat it. Here neuroplasticity expert and owner of Harley Street Solutions in London Ashok Gupta tells us how the condition affects the brain.
What is long Covid exactly?
Long Covid is when patients who have experienced Covid-19 go on to have continuing symptoms for weeks and months afterwards. These symptoms can include breathlessness, exhaustion, brain fog, gastric issues, pain, and post-exertional malaise. It is estimated that around 10% of Covid-19 infections may result in developing long haul symptoms, and in the USA, this may be affecting over 3 million people.
How does it affect the brain?
Here at our clinic, we hypothesise that it is due to a malfunction in the unconscious brain, creating a conditioned response that keeps the body in a hyper-aroused state of defensiveness. At the core of this hypothesis is the idea that we are here because our nervous system and immune system have evolved to survive. We are survival machines!
When we encounter something such as Covid-19, the brain perceives it as life threatening, and rightly so. And in the era of the pandemic, with more stress, anxiety and social isolation, our immunity may be compromised, and therefore it may take longer for the immune system to fight off the virus and recover.
If the brain makes the decision that this is potentially life threatening and we get to the stage where we’re overcoming the virus, a legacy is left in the brain; it keeps over-responding to anything that reminds us of the virus. Even if we’ve fought off the virus, the brain will react in a precautionary way to stimuli reminiscent of the virus.
The brain may get stuck in that overprotective response, and keeps stimulating our nervous system and our immune system, just in case the virus may still be present.
What symptoms does this cause?
These signals cause a cascade of symptoms including breathlessness, extreme fatigue, brain fog, loss of taste or smell, headaches, and many others. And these are caused by our own immunes system.
In the case of long-haul Covid, symptoms in the body get detected by a hypersensitive brain which thinks we’re still in danger. The brain then chronically stimulates the immune and nervous systems, and then we have a continuation of a chronic set of symptoms.
This isn’t unique to long-haul Covid. Many patients develop chronic fatigue syndrome, sometimes known as “ME”, for example, after the flu, a stomach bug, or respiratory illness. Covid-19 may be a severe trigger of a form of chronic fatigue syndrome or ME.
How does long-haul Covid affect mental health?
Anxiety is a very common symptom in long haulers. It can be frightening to wonder about what may be happening in your body, and what the prognosis is going to be for one’s long term health. Reaching out for support for mental health is crucial for long-haulers.
How does neuroplasticity treatment work for long-haul COVID patients?
We have been working with patients for two decades with a brain retraining programme using neuroplasticity or “limbic retraining.”
We believe that through neural rewiring, the brain can be “persuaded” that we are no longer in danger and to come back to homeostasis. But to be very clear, we are not saying it is psychological in any way, but we believe there are novel ways of accessing the unconscious brain.
We recently worked successfully with a 56-year-old male with long-haul Covid, who prior to contracting Covid-19 in March of 2020 was running half-marathons and cycling, but afterwards he struggled to get off the sofa for months. Within 3 months he’s now back to 100% and running half marathons again.
At our clinic, we train the patient to be able to recognise those subtle unconscious danger signals on the periphery of consciousness. This, coupled with supportive techniques and the natural hallmarks of good health such as sleep and diet help prepare the patient to respond to perceived threats that might trigger the response.
The natural state of our brain is to default to protection. The brain prioritises survival and passing on our genes to the next generation, over any other impulse. It cares more about that than you feeling healthy and well. Protective responses are evolutionary, and are the right thing for the brain to do – it’s survival.
What digital therapies or apps are proving effective at treating long-haul Covid?
It seems that long haul patients are availing themselves of many online therapies and services, including meditation apps and wellness websites. We have an online neuroplasticity “brain retraining” video course called the “Gupta Program” which hosts 15 interactive videos and many audio exercises. This is proving very popular with long haul patients, and we are currently conducting a trial to test the effectiveness of this therapy.
What is the danger of leaving long-haul Covid untreated?
The longer it goes untreated, we hypothesise that it may become more entrenched in the brain, and become chronic in the longer term. Therefore we advise all patients to get help and advice as soon as possible.