In a weekly column, alternately written by Lucien Engelen, Maarten Steinbuch, Carlo van de Weijer, Daan Kersten and Tessie Hartjes, E52 tries to find out what the future will look like. All five contributors are all working on technologies that can provide solutions to the problems of our time. This Sunday, Holst Centre’s Ton van Mol is our guest writer.

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    By Ton van Mol

    “The answer lies in keeping people out of hospital as much as possible.”Ton van Mol, Holst Centre

    The world is aging. There were 600 million people aged over 60 in 2000, and predictions suggest there will be more than 2 billion by 2050. As we get older, we typically get more health problems. Long-term illnesses like Parkinson’s and Alzheimer’s are rising and are set to accelerate. These conditions can be treated but at a cost. Already, many countries spend as much as 20% of the GDP on healthcare.

    So how can we give more people a higher quality of life for longer while keeping health care costs under control? The answer lies in keeping them out of the hospital as much as possible. By giving people access to high-quality, responsive care in their own homes, they can live as normal a life as possible.

    Where with wearables?
    This ambition is driving a trend towards wearable monitoring devices, a trend that Holst Centre has led for many years. Through developments such as our Health patch (picture), we have shown it is possible to track primary vital signs – including body temperature, heart rate, breathing rate, blood pressure and blood oxygen levels – with clinical quality in a real-life setting using comfortable, unobtrusive wearables.

    Now, with the technical feasibility well established, we are working with clinical and industrial partners to explore the business and use cases that will allow wearable devices to become a frontline tool in keeping people healthy. We know it is possible to track all five vital signs simultaneously but is that the most cost-effective way to help people and their care providers? And if we concentrate on just a few vital signs, which ones? At the same time, does the market need or want a single wearable health care monitoring platform? Or should we focus on tailored solutions for specific diseases?

    These are all still open questions. And we would love to hear from any interested parties on how wearables could bring the most benefit to healthcare monitoring.

    Continuous prevention
    Holst Centre has always wanted to help shift the focus of healthcare from managing a disease to managing health. And when it comes to health, I think everyone agrees that prevention is better than cure.

    One way we could prevent disease is to allow people to routinely monitor so-called biomarkers in their bodies. These are molecules that can give early warning of potential issues before you feel any symptoms. For example, blood glucose levels can highlight the risk of diabetes, cortisol indicates stress and bilirubin suggests a danger of jaundice in newborn babies.

    Combining biomarker early warnings with personalized information and advice could help people or their doctors take action earlier. And the earlier you act, generally the smaller the change required and the better the result.

    However, there are thousands of molecules that are potentially interesting biomarkers for managing our health. Which diseases and which biomarkers should the industry focus on? And how do we monitor them in a non-invasive way? We can’t expect billions of people to undergo blood tests every day.

    Picking the right path together
    To answer the second question first, Holst Centre is already exploring what is feasible. In particular, we are looking at what you can measure using sweat, breath or a combination of both. Sub-dermal monitoring through micro-needles so small that you don’t even feel them is another possibility. As is using microfluidics to analyze blood. Using transdermal light – as in pulse oximeter – has also been suggested in some places. But my feeling is that the concentrations of biomarkers would be too low for this to be effective.

    The first question – which molecules are most interesting – is not one any single organization can answer on its own. So we are talking with our colleagues at TNO and imec, and also with clinical partners and hospitals to identify target diseases and their biomarkers. There is a lot of interest on all sides to find the right answers to that question.

    Alongside what is technologically and medically possible, there are also big questions about whether industry and the market are ready for continuous biomarker monitoring. Are companies looking for this kind of solution now or in a few years’ time? Are insurers and healthcare providers willing to pay for them given the potential savings down the line?

    We are already in discussions with various players across the healthcare chain to define common roadmaps and timelines. But we are eager to broaden these discussions and hear the opinions and needs of more people and organizations.

    So if you have a view on healthcare monitoring for today or tomorrow, please get in touch via [email protected]

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