Safer Big Data for safer medicines?

14-15 November, 2016: The European Medicines Agency invited experts from the European Union and the USA to discuss 5 key perspectives to speak on Big Data at a workshop in London aimed at identifying opportunities from 'Real World and other "Big Data" to improve development of new medicines and surveillance of licensed medicines for safety, risk and effectiveness.

The 5 key 'stakeholder' perspectives? Patients and the public, health professionals, academia, regulators and policy makers, industry (both health sector and software/hardware) and payers (considering a change in strategy to payment for health impact rather than sales, as exemplified by the Health Impact Fund).

A pragmatic definition from Lu and his colleagues states that "Big data analytics (BDA) applications are a new category of software applications that process large amounts of data using scalable parallel processing infrastructure to obtain hidden value." There are many potential applications from planning for public transport flows to using large health record datasets to improve patient safety such as in the US FDA-Harvard Sentinel partnership.

The FAIR principles for Big Data, Finding, Accessing, Interoperability and Reuse of Big Data, have both general and special challenges and potential benefits when applied to healthcare.

For example, in a recent issue of Nature Reviews Cardiology, Rumsfeld and colleagues from Colorado and Boston outline 8 potential applications of big data analytics to improve cardiovascular care, including "predictive modelling for risk and resource use, population management, drug and medical device safety surveillance, disease and treatment heterogeneity, precision medicine and clinical decision support, quality of care and performance measurement, and public health and research applications".

The EMA note: "Rapid developments in technology have led to the generation of vast volumes of data, which have the capability to transform the way the benefit-risk of medicinal products is assessed over their entire life cycle. However, it is recognised there are multiple challenges in the exploitation of these data.

"These range from the fundamental need to establish methods to enable the access to, integration and analysis of heterogeneous datasets to understanding the limitations in its use. Importantly, robust and transparent mechanisms to protect patient confidentiality are key to secure patient trust. It is important for the European Medicines Agency and the European Union medicines regulatory network to gather information on the latest developments in big data from the perspective of all stakeholders in order to identity how and when the multitude of data sources may contribute to medicinal product development, authorisation and post-marketing surveillance."

Some key themes:
- Patrick Ryan on which patients chose which treatments
- Sophie Louveaux discussing new EU regulation of data, meaningful consent and processing sensitive health data
- David Martin addressing challenges in Big Data analytics from FDA and PPP perspectives
- Julian Isla from the Dravet patient charity on making the patient the centre in digital health
- Baroness Helene Hayman on ethics, governance and public confidence
- Ronald Brand from the University of Leiden on informed consent v. opt out
- Nicolas Tatonetti from Columbia University, NY on data mining for medical discovery
- Nico Gaviola from Google on cloud data for safer medicines

See more on key threads and discussion points including on the European Open Science Cloud, new EU General Data Protection Regulations - from May 2018, replacing Directive 95/46, machine-learning for chemogenomics, challenges to implementing applications to precision medicines, access to the OHDSI community, social media to find new adverse drug event signals, FDA case studies using then Sentinel-HMO-Harvard collaboration,  opening access to the 28 EU independent national health care systems and more in due course when talks are made available on the EMA website for public access.

Entries open for the 2014 Hippocrates Prize for poetry and medicine

Entries are open for the 2014 Hippocrates Prize Open, NHS and Young Poets categories - deadline 12MN GMT 31st January, 2014.

Submit entries online

With a 1st prize for the winning poem in each category of £5,000, the Hippocrates Prize is one of the highest value poetry awards in the world for a single poem. In its first 4 years, the Hippocrates Prize has attracted over 5000 entries from 55 countries, from the Americas to Fiji and Finland to Australasia. 

Awards for the 2014 Prize will be announced by the judges in May, 2014 at the Wellcome Collection in London at the end of the 5th International Symposium on Poetry and Medicine. 

Rules for the Hippocrates Prize
Awards are in an Open category, which anyone in the world may enter, and an NHS category, which is open to UK National Health Service employees, health students and those working in professional organisations involved in education and training of NHS students and staff. 

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The judging panel for the 2014 Hippocrates Prize includes poet Philip Gross, a winner of
the TS Eliot Prize.

Co-organizers are medical professor Donald Singer and poet and translator Michael Hulse.  

The Hippocrates poetry and medicine initiative received the Award for Excellence and Innovation in the Arts in the 2011 Times Higher Education awards. This award aims to recognise the collaborative and interdisciplinary work that is taking place in universities to promote the arts. Entries were open to teams and all higher education institutions in the UK. 

Major support for the Hippocrates initiative has come from the Fellowship of Postgraduate Medicine, with additional support from the Wellcome Trust, the Cardiovascular Research Trust, the National Association of Writers in Education, and the University Warwick's Institute of Advanced Study

Hippocrates in Venice: workshop on poetry and medicine

Hippocrates in Venice

Weekend of Saturday 21^st – Sunday 22^nd September

Venue: 15^th Century Palazzo Ca' Pesaro Papafava
For more information: email the organizers.

15^th Century Palazzo Ca' Pesaro Papafava

Aims of the workshop

This workshop is designed as a scoping and networking event to take forward the work of the Hippocrates Initiative for Poetry and Medicine.

The four annual International Symposia on Poetry and Medicine held since 2010 by the Hippocrates Initiative have shown that there is a substantial wish for an international umbrella association that would serve as a switchboard for the gathering, coordination and dissemination of information in the field, and to institute activities that further an understanding of relations between poetry and medicine.

The Venice workshop will principally be a two-day exchange of views aimed at establishing the priorities an umbrella association ought to have, identifying focal interests for potential research groups and working parties, and identifying interests for exploration in subsequent workshops.

There will be a small number of talks but the emphasis will be on discussion and consultation. Themes to be considered by speakers and during break-out sessions and round table discussions will include historical perspectives, epidemics of infection from the plague of Athens to syphilis, tuberculosis and HIV-AIDS, and modern non-infectious epidemics, from obesity to heart disease, psychiatric disorders and cancer.

Other themes may be added arising from suggestions from workshops participants.

The Venice workshop offers a key opportunity to be part of the planning process and to help shape a significant new aid to workers and researchers in a growing field.

Palazzo Pesaro Papafava is a few minute’s walk from the Rialto Bridge and Ca’ d’Oro.

It is located on the Canale della Misericordia, opposite the Scuola Grande della Misericordia, with views towards the Grand Canal and the Lagoon.

Entries from 29 countries for the 2013 Hippocrates Prize

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Entries are now closed for the 2013 Hippocrates Prize Open and NHS categories.
There were over 1000 entries from 29 countries: from throughout the United Kingdon and USA (39 states), and from Canada to China, Switzerland to South Africa, Netherlands to Australia and New Zealand.
In order of number of entries received, poems were from: United Kingdom, USA, New Zealand, Ireland, India, Canada, Australia, France, Switzerland, Nigeria, Germany, South Africa, Greece, Belgium, China, Mexico, Netherlands, South Korea, Sri Lanka, Brazil, British Virgin Islands, Hungary, Israel, Italy, Montenegro, Zimbabwe, Poland, Macedonia and Spain.

Entries remain open for the 2013 Hippocrates category for Young Poets aged 14-18 years: deadline 12 midnight GMT 1st March.  

This new category in the Hippocrates Prize is for Young Poets from anywhere in the world and is for an unpublished poem of up to 50 lines in English on a medical theme. The entry fee is £2 per individual poem or £15 per group of 10 poems entered e.g. from a poetry society or school.
The Hippocrates Prize for Young Poets will be judged by poet Clare Pollard, who published her first collection of poetry at the age of 19. The Young Poets Prize offers an award of £500 for the best poem. There will also be ten commendations.
Short-listed poets in all categories of the Hippocrates Prize will be informed by mid-April.
Awards will be announced by the judges on 18th May, 2013 at the Wellcome Collection in London at the end of the 4th International Symposium on Poetry and Medicine.

Judges agree short-list for 2012 Hippocrates Awards for Poetry and Medicine

2012 judges Martha Kearney, Marilyn Hacker & Rod Flower FRS

@HealthMed In London on 4th April, after a lively discussion at the FPM, judges broadcaster Martha Kearney, Paris-based US poet Marilyn Hacker and medical researcher Professor Rod Flower FRS  agreed the short-list for the 2012 Hippocrates Awards for Poetry and Medicine. 

Judging was anonymous. In addition, to avoid runs of poems by the same poet, where there was more than one entry by the same poet, judges were not given poems in alphabetical order by surname of poet.
The 46 awarded and commended entries will be published in the 2012 Hippocrates Awards Anthology, to be released at the 2012 Hippocrates Awards in London, on Saturday 12th May.

The NHS-related short list includes one poet from Scotland and two from England. The Open international short-list includes one poet from the USA and two from the UK. Themes ranged from identity and immunity to psychiatry and alienation, and from global health to medicine in archaeology, and the role of women in health (see full details of short-listed names, biographies and judges comments below).

The judges also agreed commendations for 20 entries in the NHS category and 20 in the Open International category - 2 from Australia, 1 from New Zealand, 7 from the USA and 10 from the UK. Commended entries considered themes from birth to imaging, cancer, health and disease in art, history of medicine and illness in the family.

Awards will be announced by the judges on Saturday 12th May in London at an International Symposium on Poetry and Medicine at the Henry Wellcome rooms, with speakers and readers from the USA, France, Denmark, Russia, Cyprus, Greece and the UK.

Useful links

Key dates for the Hippocrates Initiative for Poetry and Medicine

Register for the 12th May Awards Symposium

Download programme for the 12th May Symposium

Open International and NHS-related short-listed and commended entries 

NHS-related short-list by entry title

Allogeneic   Andy Jackson
Claybury    Nick MacKinnon
Mr Blatný perseveres   Jane Kirwan

Top 20 commended NHS-related entries

I must speak for this man - Edward John Anderson
At the clinic - Neil Ferguson
Into the tunnel - Alex Josephy
A nurse's châtelaine - Alex Josephy
Sara's wig - Frances-Anne King
Anatomy - Jane Kirwan
Delivery - Jane Kirwan
Heal thyself - Jane Kirwan
Not raging - Jane Kirwan
Eighteen - Denise Kitchiner
These are the stories doctors tell - Jonathan Knight
A question for neuroscientists - Valerie Laws
Rorschach - Andrew Thomas Martin
Intensive care, Friday afternoon - Kev O'Donnell
Still birth - Janet Smith
The bones - Sarah Stringer
Shrink - Tricia Torrington
Whitby - Carol Whitfield
Syphilis II: Treponema pallidum - Alison Wood
The little mercury I have taken - Chris Woods

Open International short-list by entry title

Los Subiros - Shelley McAlister
The Edwin Smith papyrus - Kelly Grovier
Women’s Work - Mary Bush

Top 20 Commended Open International entries

A lobsterman looks at the sea - Richard Berlin
The lonely walk - Timothy Edward Brewis
Recent past events - Rafael Campo
Artifact - Amanda Carver
R-O-M-J-X - Martyn Crucefix
Heartburn - Claudia Daventry
Bone says  - Julie Dunlop
Post-traumatic stress disorder - Elizabeth Anne Gleeson
Ana and I - Natalie Ann Holborow
To an anatomical Venus - Matthew Howard
In the ward with my son - Leah Kaminsky
Careful - Kathleen M Kelley
Ablation - Connie Levesque
Birth - Renee Liang
Forensic pathology - Kona Macphee
District nurse - Alice Malin
Next of kin - Vicky Paine
Rembrandt - Lynn Roberts
Tomorrow will be a day beloved of your father & of you - Rosie Shepperd
Day off - Caroline Wilkinson

Further details on short-listed and commended entries for the 2012 Hippocrates Prize

A former nurse, a dentist, and an emerging US poet, are among six finalists for this year’s Hippocrates Prize for Poetry and Medicine - one of the highest value poetry awards in the world for a single poem. Themes ranged from medicine in archaeology to the role of women in new life science, and from health in the developing world to frailty and memory.

Now in its third year, the short-listed entries for the 2012 Hippocrates Prize for Poetry and Medicine have been selected by judges broadcaster Martha Kearney, distinguished US poet Marilyn Hacker and medical scientist Professor Rod Flower FRS, from over 1000 entries from 32 countries.

Rising US poet Mary Bush, academic and writer Kelly Grovier, who has published two poetry collections, and published poet and writer-in-healthcare Shelley McAlister have made the shortlist for the Open Category.

The prize, which has a £15,000 award fund, is split into two strands – an open category and an NHS category with both carrying a first prize of £5,000.

In the NHS section, medical librarian Andy Jackson is competing with retired dentist Jane Kirwan and former nurse Nick MacKinnon, for the major £5000 award.

The winners will be announced at an International Symposium on Poetry and Medicine at the University of Warwick on May 7th, which is being supported by the Fellowship of Postgraduate Medicine.

The judges also agreed commendations for 20 entries in the NHS category and 20 in the Open International category - 2 from Australia, 1 from New Zealand, 7 from the USA and 10 from the UK. Commended entries considered themes from birth to imaging, cancer, health and disease in art, history of medicine and illness.

Martha Kearney said: ‘Who would have thought that such beautiful poetry could be inspired by lab instruments, tissue engineering or MRI scans? It has been fascinating to sift through such an interesting range of work right at the very nexus of science and art.’

Rod Flower added: 'Like literary X-rays, these poems penetrate into the emotional structure of humankind’s age-old struggle against disease, whether it be at the hospital, the patient's bedside or in the science laboratory'.

Marilyn Hacker said: 'The best of these poems reminded the reader of poetry's capacity to delight and instruct. They find their strength in merging knowledge, craft and feeling: they affirm poetry's ability to arise from and to address crucial issues of human life, both individual and collective'.

The awards symposium will consider the relationship between poetry and medicine, with topics including poetry as therapy, using poetry in health professional training, the impact of health and disease on the professional poet and the history of poetry and medicine.

Speakers on the day will come from the around the UK, the USA, Cyprus, Denmark, France, Greece, and Russia. MEP Eleni Theocharous will speak and attendees will also be treated to a reading by Jo Shapcott, the recent winner of the Queen’s Gold Medal for Poetry.

The Hippocrates Initiative – winner of the 2011 Times Higher Education Award for Innovation and Excellence in the Arts – is an interdisciplinary venture that investigates the synergy between the medicine, the arts, and health.

To attend the Symposium see http://go.warwick.ac.uk/cpt/poetry/symp/

Notes to editors
Photos of all of the finalists, along with extracts of their poems are available on request, and all finalists have agreed to be contacted by press. For more information, please contact hippocrates.poetry@gmail.com

Awards: In each category there will be: 1st prize £5,000, 2^nd prize £1,000, 3^rd prize of £500, and 20 commendations each of £50.  

Entries are judged anonymously. To avoid the judges seeing clustered runs of entries by the same poet, judges are given the anonymous entries ordered alphabetically by title.

Short lists for the 2012 Hippocrates Prize for Poetry and Medicine

Short list for Open Awards 

Mary Bush: Women’s Work

Mary Bush recently (2011) earned a Ph.D. in Creative Writing/Poetry from the University of North Texas while continuing to work in my long-term career as a project manager in the Information Technology industry. I write poetry for pleasure, and I have always been interested in the overlap of art and science—whether writing “scientific” poetry or “elegant” software. My husband and I have three adult children, one of whom is autistic, and his unique use of language fascinates and inspires me. We live in a ramshackle old house in a small town in North Texas, where my husband plays loud guitar and I write poems.

She said: ‘I was inspired to write this poem by reading about the tissue engineering work of Dr. Doris Taylor (http://www.nytimes.com/2008/01/14/health/14heart.html). I was taken first by the fact that a woman was a leader and spokesperson for this cutting-edge scientific work and secondly by the notion of using a detergent or shampoo as part of the engineering process, as in a commercial context, detergent and shampoo are stereotypically considered "women's products." Everything about tissue engineering seemed beautiful to me, from the ethereal nature of the scaffolds to the idea of re-use and rebirth implicit in the process.’

Kelly Grovier: The Edwin Smith Papyrus

Kelly Grovier is the author of two collections of poetry with Carcanet Press: A lens in the palm (2008) and The Sleepwalker at Sea (2011). He is a regular contributor on arts to The Times Literary Supplement and co-founder of the scholarly journal European Romantic Review. In 2008, his popular history of London’s infamous Newgate Prison, entitled The Gaol (John Murray publishers), was a BBC Radio 4 Book of the Week. He is a lecturer in the Department of English and Creative Writing at Aberystwyth University and co-founder and co-director of the interdisciplinary David Jones Centre.

About the poem he said: ‘I’ve always been drawn to poems about fragments and ruin. So I found especially exciting the subject of ancient surgical papyri: those endlessly deteriorating tissues ironically intended to reverse the deterioration of tissues. “All composition is decomposition”, so the eighteenth-century traveller Walking Stewart once wrote. In the case of the so-called Edwin Smith papyrus (the oldest treatise on trauma we have, written around 1500 BCE), the allure was only amplified by hints of the interweaving of science and superstition, medicine and myth, and enticing allegations of possible forgery on the part of Smith himself, who acquired it in Egypt in 1862. In the poem I try to imagine the word and the world, the writer and the written, pixels and stars, in a ceaseless cycle of visions and division.’

Shelley McAlister: Los Subiros

Shelley McAlister grew up on the west coast of America and came to the UK in 1977. She writes short fiction and poetry and has previously been a writer in residence in healthcare on the Isle of Wight where she lives. She was commended in the 2010 Hippocrates Prize and has poems in a variety of publications including Magma, Iota and The Rialto. Her first poetry collection, Sailing Under False Colours, was published by Arrowhead Press in 2004.

Inspiration for the poem

As a lecturer in health and social care, I often read about inequalities in health. On this occasion I had a dream about a hospital on top of a mountain where the poorest people had no access to healthcare. I am fascinated by carriers of all kinds so once I had this setting clear in my mind, I knew that this was a poem about the bringers. 

Short list for Open Awards 

Jane Kirwan: Mr Blatný Perseveres

Jane Kirwan qualified as a dentist in 1970, retiring in 2005, now divides her time between London and the Czech Republic where Ivan Blatný is still admired as a poet. Her mother and sister have worked as psychiatrists. She has had two poetry collections published by Rockingham Press and more recently a prose-poem memoir with her partner, a Czech dissident and former political prisoner. In 2002 she won an Arts Council Writers Award. She is currently working with Wendy French on a project about the NHS. 

Andy Jackson: Allogeneic

Andy Jackson is from Manchester but lives in Fife, Scotland, where he is Medical Librarian at Ninewells Teaching Hospital in Dundee. His poems have appeared in Magma, Blackbox Manifold, Trespass and Gutter. He won the National Galleries of Scotland competition in 2008 and the inaugural Baker Prize in 2012. Debut collection The Assassination Museum was published by Red Squirrel Press in 2010 and he is editor of Split Screen : Poetry Inspired by Film & Television, also published by Red Squirrel in 2012. Currently working with WN Herbert on an historical anthology of poems about the city of Dundee.

The poem Allogeneic is partly informed by experience as a patient having bloods taken as part of a research programme into cholesterol levels conducted by the Tayside Medical Science Centre and partly by the eternally wonderful Hancock’s Half Hour episode The Blood Donor.

Nick MacKinnon: Claybury

Nick MacKinnon was an auxiliary nurse on Duncuan psychogeriatric ward of the Argyll and Bute Hospital in the early 1980s. The subject of his poem is Claybury Asylum where his mother Rosan worked as an SRN in the 1970s. Claybury's water tower is still the chief landmark in Roding Valley, but the buildings are now the gated housing estate Repton Park. The poem aspires to be a history of psychiatry from Victorian place of safety to our Care in the Community, from the point of view of the tower.

The Hippocrates Prize judges

Rod Flower is Professor of Biochemical Pharmacology at the WIlliam Harvey Research Institute[21] in London. His main scientific research interests concern inflammation and anti-inflammatory drug mechanisms. He was formerly President of the British Pharmacological Society and is a Fellow of the Academy of Medical Sciences.

Marilyn Hacker's book of poetry Presentation Piece (1974) won the National Book Award. In 2009, she won the PEN Award for Poetry in Translation for King of a Hundred Horsemen by Marie Étienne. In 2010, she received the PEN/Voelcker Award for Poetry.

Martha Kearney is the main presenter for BBC Radio 4’s lunchtime news programme ‘The World at One’. She previously worked for Channel 4, presented the BBC’s Woman’s Hour, Today and PM and was political editor for Newsnight. She has been commended for her national and international reporting, including for work on child poverty. She has been a judge for the Webb Essay Prize and the Guardian First Book Award, and has chaired the judging panel for the Orange Prize for Fiction.

Hippocrates Prize Organisers
Donald Singer is Professor of Clinical Pharmacology and Therapeutics, University of Warwick, and President of the Fellowship of Postgraduate Medicine. His interests include research on discovery of new therapies, and public understanding of drugs, health and disease.

Michael Hulse is a poet and translator of German literature, and teaches creative writing and comparative literature at the University of Warwick. He is also editor of The Warwick Review. His latest publications are: The Secret History (poems, Arc) and The Notebooks of Malte Laurids Brigge (translation of Rilke's novel, Penguin Classics). With Donald Singer he co-founded in 2009 the International Hippocrates Prize for Poetry and Medicine.

Sorcha Gunne is a Post-doctoral Teaching Fellow in the Department of English and Comparative Literary Studies. Prior to this appointment,she was an Early Career Fellow at the Institute of Advanced Study. Her research specialism is World Literatures in English, particularly twentieth-century and contemporary writing.

The 2012 Hippocrates prize is supported by

The Fellowship of Postgraduate Medicine, a national medical society founded in 1918 and publisher of the Postgraduate Medical Journal and Health Policy and Technology.

The Cardiovascular Research Trust, a charity founded in 1996, which promotes research and education for the prevention and treatment of disorders of the heart and circulation. 

Commended 2011 Hippocrates entry published in Br J Psychiatry

@HealthMed 'Street-wise' by Wendy French, one of 20 NHS entries commended in the 2011 Hippocrates Prize for Poetry and Medicine, has been published in the December issue of the British Journal of Psychiatry.

 

Entries are closed for the 2012 Hippocrates Awards. With a 1st prize of £5000 for the Open International category and a separate 1st prize of £5000 for the UK National Health Service-related category, this is one of the best funded awards anywhere in the world for a single poem.

Judges for the 2012 Hippocrates Awards are New York poet and critic Marilyn Hacker, medical scientist Professor Rod Flower FRS and BBC broadcaster and journalist Martha Kearney.  

Awards will be presented in London on Saturday May 12th 2012, at the 3rd International Symposium on Poetry and Medicine, to be held at the Wellcome Collection rooms in London. 

During the 2012 Symposium, there will be readings by Jo Shapcott, Past-President of the Poetry Society, and US poet and 2012 Hippocrates awards judge, Marilyn Hacker.  

Favourite poems on a medical theme from entries in the 2012 Hippocrates initiative poll

@HealthMed To mark the launch of the 2012 International Hippocrates Prize for Poetry and Medicine, the organisers invited nominations of favourite poems with a medical theme. The top 5 favourites were:

Dylan Thomas – Do not go gentle into that good night
William Butler Yeats - When you are old
Dannie Abse - The Pathology of Colours
Jo Shapcott - Of mutability
Stevie Smith - Not waving but drowning

You can see examples of comments received and find links to many of the submitted favourite poems on the earlier blog on favourite poems on a medical theme.

'Medical' was to be interpreted in the broadest sense, with only one nomination to be made by any one person. Nominations were to be for poems written by a poet from anywhere in the world and in any language. The poem were to be contemporary or from any historical period.

The Hippocrates Prize of £5000 for the winning poem is one of the highest value awards in the world for an unpublished poem in English on a medical theme.

Entries for the 2012 Awards are now closed. 2012 Hippocrates Prize judges include New York poet and critic Marilyn Hacker and medical researcher Professor Rod Flower, Fellow of the Royal Society. Awards will be presented on Saturday 12th May 2012 at the 3rd International Symposium on Poetry and Medicine, to be held at the Wellcome Collection in London.

Information on health and disease from the patient's perspective

@HealthMed Where can patients and their family, friends and carers go for advice from the patient's perspective about  health-related conditions? And how can health professionals gain insight into patients' perspectives on their health or illnesses. Individual disease-focused charities and patient associations are ever better at providing patient friendly advice.
A further excellent web resource is Health Talk Online, with over 60 serious and common diseases represented, based on the experience of over 2000 patients. Conditions and issues covered range from heart risk and disease to cancer and women's health. This resource was established by the Charity DIPEx, in collaboration with health scientists from the University of Oxford (the Health Experiences Research Group), and is coupled to the website Youth Health Talk, which is about 'young people's real life experiences of health and lifestyle'. Health Talk Online aims to use the real life experience of people to discuss health, health-related conditions and illnesses, including insight into tests and therapies (and their possible adverse effects), what outcomes to expect from treatment with drugs and/or devices, news, and updates on progress in medical research, patients' viewpoints about the impact on their life of the health conditions of interest,  and discussion forums.
It is vital that information sources such as this are reliable. With that in mind it is noteworthy that the charity DIPEx has been selected by the UK's Department of Health to help to pilot an accreditation scheme  using 'kite marking' to indicate reliability of organisations that provide information about health and social care.

Networks and personalized medicine for better drugs?

For more on this theme see 
- article with Andrew Marsh in the inaugural March 2012 issue of Health Policy and Technology
- article in the October 2011 issue of Public Service Review: Science and Technology Review.  

For many individual patients treatments may not exist, may not be very effective, or may result in unpleasant adverse effects. How can prescribers improve drug selection andreduce the harmful effects of medicines? Are there better ways to develop drugs for patients who are difficult to treat?  And what can we do to improve poor adherence to medicines? These elements underpin ‘personalized medicine’, in current use the concept that by considering differences among patients in genetics, disease burden and other factors, more effective and safer drugs can be developed. Personalizing medicine is a path to better disease prevention and control where limited treatment options exist, such as for many cancers, resistant infections and dementia syndromes, and better drug development for new medical challenges. These concepts have in recent years attracted interest from the Royal Society, the Nuffield Council on Bioethics and cognate international institutions.

It is clear that there needs to be consistent investment and support from policy makers and regulators to develop and sustain the academic and industry pharmacology expertise and activity needed for the long-term success of a personalized medicine strategy, so that we can continue to be able to improve the health of the public and individual patients.

NICE is an international leader in developing evidence-based treatment guidelines. Its reports increasingly recognize the need to refine drug choice based on patient characteristics. For example, updated national hypertension guidelines released in August 2011 advise drug selection guided by age, gender, ethnicity, and monitoring, with treatment modified depending on clinical response. NICE also recognizes the need for research on ways, tailored to patient preference, to improve long-term adherence to drug treatment.

Pharmacologists are developing two complementary approaches aimed at achieving “precision medicine” in as many patients as possible: better drug discovery combined with high definition biomarkers for drug selection and monitoring. Network pharmacology brings together sophisticated databases of genetic mechanisms for disease, pharmacological pathways, candidate drugs, and population data describing important variants among individuals in drug handling and responsiveness.  These methods also allow ways to find previously unexpected “off-target” actions of existing or new drugs, which may accelerate discovery of new treatments for serious diseases.

Diagnostic methods are increasingly being used to improve drug selection for individual patients. For example growth tyrosine kinase receptors can be blocked using the biological agent imatinib to treat particular patterns of Philadelphia chromosome-positive chronic myeloid leukaemia, and rare gastro-intestinal tumours. Understanding genes and drugs that influence enzymes that modify drugs in the body, improves accuracy in defining patients who will not respond to a given medicine, or may develop adverse effects.  For example, to minimize risk of serious harm, pharmacogenetic testing is recommended for variability in a specific liver enzyme before deciding whether or not to prescribe the anti-HIV drug abacavir. This knowledge also allows better prediction of a patient’s risk of harm from interactions between treatments, based on recognition of medicines and other remedies that interfere with how drugs are cleared by the body. 

See my previous blogs on 
- preventing adverse drug reactions
- new UK guidelines on managing high blood pressure