25 septembre 2018Comment rendre la ville plus harmonieuse ? Quels sont les défis à relever ? Quels obstacles à contourner ? Quelles évolutions/révolutions prendre en compte ? Jean-Paul VIGUIER, Architecte et urbansime ; Olivier CARRE, Maire d’Orléans
Comment rendre la ville plus harmonieuse ? Quels sont les défis à relever ? Quels obstacles à contourner ? Quelles évolutions/révolutions prendre en compte ?
IMPROVING CANCER SURVIVAL VIA DIGITAL TECHNOLOGY AND HUMAN FACTOR
Extract of CEPS's E-health session in April
CEPS's E-Health Club has invited Dr Fabrice Denis, MD, PhD, to present the first e-health solution that has demonstrated a significant improvement of survival in cancer. The following article is an excerpt of these essential facts.
"Cancer is a chaotic, and unpredictable system," he explains. "But this chaotic system includes subsystems of which observability provides relevant insights into the overall dynamics of the system." Through complex equations, Dr Denis thus demonstrates that it may be more pertinent to follow the reaction of healthy cells than that of cancer cells.
"Consider a patient who has a tumor of 2 grams, and who has lost nearly 15 kg. The proposed model is equivalent to tracking the patient's rather than the tumor’s weight." In other words, rather than "measuring cancer", he proposes to measure the more easily observable response of the rest of the body to the disease.
“Patient centricity” is more efficient than “technology centricity”.
He decided through this original approach to confront the traditional follow-up of cancer patients with medical imagery, generally a scan every 3 months, with the follow-up of symptoms declared by the patient via a web solution based on a document connected to an algorithm.
"Rather than losing time waiting for the next scan and seeing the disease progress unnecessarily, the patient assesses every week 12 symptoms (weight, fatigue, bleeding ...) in a web formulary. Data is then processed by an algorithm that will alert his physician and induce a consultation if a relapse or a complication is suggested."
The study, which was presented at the world's largest oncology conference, ASCO, and which has just been published in JNCI, a prestigious scientific journal, has demonstrated an incredible improvement in survival and quality of life in these very seriously ill patients with advanced lung cancer. Their average survival has thus increased from 12 months to 19 months, a performance that no such innovative treatment can now equal.
On a more philosophical level, the Moovcare project demonstrates that medical progress has been much greater by investing in the patient himself, who is the one who knows best his own body and by automating the medical interrogation with digital tools, rather than on another technological evolution of imagery.
To be adopted, e-health needs to be evaluated by traditional methodologies
At a time when hundreds of thousands of "health applications" coexist, the approach of Fabrice Denis has everything to convince the healthcare professionals to adopt it. Indeed, the medical profession is very conservative by nature and needs to be convinced of the value of an innovation by robust evidence. Fashion effects have no place in medicine. It is for this reason that Fabrice Denis has chosen to evaluate this e-health solution with a very traditional approach: randomized clinical studies versus the conventional approach, that were presented at an international medical congress, challenged by his peers, and finally published in a peer-reviewed medical journal.
The problem is that there are many pathologies that can’t afford the luxury of a long clinical development (6 years). Fabrice Denis is currently working on the implementation of innovative evaluation protocols that would accelerate these evaluations (in 1 year) while guaranteeing a good level of clinical proof.
"Without proper evaluation, no application can claim the slightest medical interest."
France has not lost the battle of e-health; At a time when major medical companies are signing huge cooperation agreements with Silicon Valley giants to invent perhaps the drug of tomorrow, Moovcare has shown that it is possible to invent and develop innovations that can legitimately be described as "disruptive" with the frugality of the means available to public structures in France.
A motivated physician with a small team has achieved more results than the GAFA that has promised great innovations for years, thanks to Big Data, Blockchains and Artificial Intelligence. In this context, the concept of personalized medicine does not mean analyzing atom-by-atom DNA strings with NASA-like devices, but simply changing the medical paradigm from treating a disease to that of a patient.
The ethics committees that Fabrice Denis approached to validate his protocol had the foresight to let him innovate. The French system, which has been deemed so cumbersome and ineffective, has just demonstrated that it can generate great projects by trusting its doctors.
At a time of presidential election, let’s hope that France will choose to facilitate the industrialization and the deployment of the solutions invented by its researchers.
Notes taken by Olivier GRYSON, board member of the club e-health of the CEPS