Health trends and predictions for 2018
Looking to the new year, Dr Sneh Khemka, MBChB, MRCOphth, (Hon) MFPH, President of Population Health for Aetna International discusses how these key trends and new technologies will reshape the healthcare sector in 2018.
Global healthcare trends
Trend 1 – Burgeoning global middle class.
The world’s middle class is growing (in particular across the Middle East and Asia), providing the backbone of a revolution in healthcare demands. This class has new expectations from their healthcare system, demanding of digital, more convenient and more sophisticated access, meaning challenges in how to deliver.
Trend 2 – The change in global disease patterns.
Partly as a result of this emerging middle class, there is an increase in lifestyle related diseases, such as cardiovascular disease and cancer, as opposed to infection-related diseases such as TB. This is putting a huge strain on local healthcare systems, with people living longer and needing more expensive and longer-term treatment.
Trend 3 – Impending and current antibiotic and opioid crises.
While world news is finally attuned to the global antibiotic crisis, the opioid crisis is also sweeping developed countries as we increasingly see addiction to prescription medications. Both are equally critical global crises in their own right, and need to be urgently addressed.
Trend 4 – The ticking time bomb of undiagnosed diabetes.
Obesity rates have fuelled a time bomb of undiagnosed diabetes around the world. To meet this crisis, healthcare systems will need to acknowledge this simmering epidemic, currently manifesting as pre-diabetes and as metabolic syndrome, both of which most people are unaware they have.
- Ascension and Providence St Joseph could be the US’ next biggest health merger
- Fullerton Health acquires 60% stake in the Intellicare Group
- The FDA launches new guidance surrounding the development of new health-tech
Trend 5 – Mental healthcare as a growing issue in developing markets.
In developed economies, there is acceptance and awareness of mental health issues and systems to cope with them. However in developing economies, healthcare providers will need to work with governments to overcome social taboos and understand what effect mental health has on other conditions, as well as productivity in the economy.
Trend 6 – Global disparity of healthcare leads to unwarranted variation.
There is polarity in the quality of healthcare provision and access around the world. 70% of people in the world have too little access to healthcare, yet 5% of people have too much access. America spends 19% of its GDP on healthcare, indicating far too many and unnecessary services provided to people; while developing nations are often less than 3% of GDP – so how to address the inequalities?
Trend 1 - Technology is on the frontline of patient care.
Technology is fundamental to most healthcare systems around the world. However while technology has advanced in healthcare, affordability has not. We are seeing increasingly expensive demands for enhanced solutions. This raises ethical questions of how, and at what cost, we should extend life using technology - it is not easy to determine where technological intervention should end and where the human life cycle should kick in.
Trend 2 – The data revolution is changing healthcare into a data-driven industry.
Healthcare has access to a wealth of data from wearable devices like Fitbit, to online analytics available on Google. Using this data, doctors can see what factors keep people healthy, rather than what makes them unhealthy. For example, aggregated data from online search engines are now the best predictor of a viral epidemic. Data and technology also makes it easier for healthcare professionals to diagnose, treat and cure - programmes such as IBM Watson can search through 15 million journals to inform doctors about rare diseases and treatments.
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.