Featuring new and leading obstetrics and gynaecology devices, equipment and solutions, the Obs-Gyne Exhibition and Congress 2018, saw more than 50 speakers from the Middle East, UK and US bring in international perspectives and insight into medical and health issues prevalent worldwide, as well as tackle current issues and challenges within women’s health specific to the MENA region. Co-located with MEDLAB for the first time this year, the event was held at the Dubai International Convention and Exhibition Centre, UAE, from 5 - 8 February 2018.
Keeping abreast of the advances in medicine
A specialist in minimally invasive procedures for advanced laparoscopic and hysterectomy surgery, Dr Sadoon Sadoon, Medical Director, Consultant, Obstetrics & Gynecology, Danat Al Emarat Hospital, Abu Dhabi, believes that the opportunities for interaction between regional and international experts with participants at the 2018 edition of the Obs-Gyne Exhibition & Congress holds the key to the ongoing success of this event.

“Obs-Gyne is undoubtedly the region’s leading expo and congress for obstetricians and gynaecologists,” says Dr Sadoon, who also served as a member of the Scientific Committee of the 2018 Obs- Gyne Congress. “This year we had a line-up of eminent experts from the region and beyond who addressed current issues and challenges within the industry, as well as presenting best practice case studies that practitioners could implement into their day-to-day work. My colleagues and I worked together to produce a comprehensive scientific programme involving all areas in the field of general obstetrics and gynaecology, oncology, maternal and foetal medicine and infertility which were the focus areas of the conference this year. Interactive sessions with participants was one of the most positive outcomes of the Conference as it enabled practitioners to keep abreast of the latest advances in medicine, particularly for women’s health in the Middle East.”

Dr Sadoon, who was also a speaker at the event, says the event offered an opportunity to address “how we at Danat Al Emarat manage or develop the services for advanced laparoscopic surgery and how we perform complex procedures including the advanced hysterectomy laparoscopically. Apart from gaining an insight into research from within the UAE, the event also shed light on advances made by our colleagues in the MENA region and beyond.”

Rising infertility rates
Infertility was one of the key topics at the Obs-Gyne Exhibition and Congress, as it is a prominent health issue women across the globe face today. According to Dr Elsamawal Elhakim, IVF & Reproductive Medicine Consultant, HealthPlus Fertility Centres, UAE, “Obs-Gyne brings in internationally renowned speakers and clinicians which makes it a fantastic event for practitioners to discuss complex cases, exchange ideas on new approaches and learn about recent advances in this field.”

It is a great opportunity to meet with experts in the field and share knowledge, he adds as infertility is a worldwide issue. “Women are delaying child bearing because of a host of reasons,” he explains. “Compounding the problem is that obesity – considered an epidemic worldwide – is affecting fertility rates of both men and women. Junk food, irrational use of drinks and tobacco, lifestyle factors – all affect sperm and egg quality.”

One of the most interesting topic for IVF clinicians is the challenge of implantation failure, he adds. “Why does pregnancy sometimes not occur despite transferring a good quality embryo inside the uterus? This raises an important question for us all. As a speaker at the event, I spoke about the role of blood thinning injections in reducing implantation failure and preventing miscarriage. In some patients, natural killer cells in the body or clotting factors could prevent the flow of blood to the womb. This was based on data I have collected from all over the world including meta-analysis, randomised, controlled studies, etc that look into the role of blood thinning injections in implantation.”

The infertility plenary track at the Obs-Gyne Congress also reviewed recent research evidence and discussed different treatment options, including IVF, and the pros and cons of every treatment plan.

New technologies
Obs-Gyne 2018 featured a host of device and equipment manufacturers including imaging companies who showcased the latest technologies in ultrasound and mammography. Other product areas at the event ranged from endoscopic, laparoscopic and hysteroscopy equipment to more conventional surgical equipment, cervical cancer screening products to gynae chairs and stretchers.

According to Machel Norman, Managing Director, m.e.r limited, UK, “We have been exhibiting at Obs-Gyne for five years now. We are very happy with the outcome and that is why we continue to exhibit at this event as we see year on year growth.”
 
m.e.r limited is a resource business, specialising in niche, superior quality devices, with unique attributes for the gynaecological and obstetrics disciplines, adds Norman. One of the popular devices on exhibit was the babyLance safety heelsticks that are reputed for their smooth and accurate incisions, ease of use and safety.  

The Medica Group, the leading distributor of beauty solutions, aesthetic products and medical equipments, attracted the attention of visitors at the event as it offered a fantastic choice for women to improve symptoms of laxity or loss of sensation, urge incontinence, stress incontinence and overactive bladder. Corrine Dowling, Training Supervisor, Medical Equipment Department, MEDICA Group, UAE, explained that Viveve Geneveve is a breakthrough one-time 25-minute procedure using radio frequency for vaginal tightening and stress incontinence symptom relief. “The treatment uses clinically proven cryogen-cooled monopolar radiofrequency (CMRF) to uniformly deliver gentle volumetric heating while cooling delicate surface tissue,” she said. “This unique technology stimulates the body’s natural collagen formation process.”

Founded by a midwife and said to induce the positive effects of upright positioning and moving during birth, the aptly titled ‘Moving Mattress’ displayed at the Obs-Gyne event naturally garnered plenty of attention. According to Anna Peters, Midwife & Co-Founder, Vibwife GmbH, “Continuous active mobilisation and positioning of the woman giving birth is essential for the natural progression of labour. What we have developed is an automated system that moves the woman’s pelvis during childbirth so that she does not have to rely on the time and strength reserves of her midwife. The aim is to reduce the duration of labour through optimal movements, thereby avoiding unplanned cesareans.”

Quoting scientific studies undertaken recently, Anna explained that upright positioning and moving techniques have led to 29 percent fewer unplanned Caesareans and 19 percent fewer requested epidurals. It has also reduced duration of labour, shortening the process by 1 hour 22 minutes.

Screening tests
A superior first-line screening test for all women was showcased by Scientific Clinical Laboratories with Panorama, a non-invasive prenatal screening test (NIPT) that analyses cell-free DNA in a pregnant woman’s blood to estimate the risk of foetal chromosomal abnormalities. Performed through a simple blood draw from the arm, Panorama works by distinguishing between foetal and maternal cell-free DNA thanks to SNP-based sequencing and Natera’s proprietary Natus™ (Next-Generation Aneuploidy Test Using SNPs) algorithm.

Panorama is a highly accurate and comprehensive screening that screens for common genetic conditions caused by extra or missing chromosomes in the baby’s DNA including Down Syndrome. Compared to first trimester screening, it has higher sensitivity and lower false positive rate for the conditions screened.

India’s leading diagnostics chain, SRL Diagnostics, continued its ongoing support for the Obs-Gyne event by showcasing its superior quality diagnostic services to its customers that works through a very efficient network of labs and collection points. According to Nikita Panchal, Senior Executive -Sales & Insurance at SRL, “Our mission is to become the first-choice diagnostics provider for customers in all the markets that we operate in, and participation at Obs-Gyne is important to showcase our accurate and precise diagnostic, prognostic and predictive testing services to a large audience. We use this platform to cultivate new business contacts and we will certainly be back again next year.”

The building blocks of life
Another area of focus at the Obs-Gyne exhibition were the cord blood bank and stem cell technology based organisations that are involved in the collection and storage of potentially life-saving stem cells that secure immense health benefits and are often seen as the future of human medicine. Exhibiting their latest stem cell service at the event, Darryn Keast, Managing Director at Med Cells International FZ LLC, explained that Cells Plus powered by TotiCyte was a ground-breaking new cord blood separation technology that had the potential to deliver 2 to 5 times more stem cells at the point of treatment than any other method.

“It has been developed and patented by Cells4Life and is the highest performing cord blood processing system in the world,” he said. “The key to TotiCyte’s incredible cell recovery is that it causes the red blood cells to sediment, leaving the stem cells and other cell types suspended in plasma. This enables almost all of the red cells to be removed without losing any stem cells. As only the number of viable cells at the point of therapy actually matter, CellsPlus offers the best chance of successful treatment for regenerative therapies than ever before.”
Also exhibiting at the event was Future Health Biobank, the only stem cell bank to successfully release a sample for treatment in the Middle East. Ahmad Al Ahmad, Territory Manager GCC for Futurecells FZ-LLC, Dubai, explained: “This was in 2012 when a cord blood sample processed and stored by us was released and transplanted into a sick teenager in Jordan who had Fanconi’s Anemia, a condition that affects the bone marrow’s ability to make healthy blood cells. In the absence of a suitable bone marrow sample, fresh hopes arrived with the birth of his baby sister whose cord blood sample proved to be a perfect match for her sick brother.”
Storing stem cells could prove to be a lifeline not only for the child but also for his/her sibling and parents, he says. “Here at Obs-Gyne, we have had several guests approach us to know more about the system and the conditions it treats. Backed by scientific research and clinical trials, this field of study is constantly evolving, thereby increasing the potential for the use of stem cells for an ever-expanding range of health issues.”
Clinical excellence
American Hospital Dubai showcased its range of care offered to women by the Obstetrics and Gynaecology department that included care during pregnancy, infertility, menopause, as well as a multitude of other women’s health related afflictions.

One of the largest stands at Obs-Gyne belonged to Danat Al Emarat Hospital, part of United Eastern Medical Services Group, and the Gold Sponsor of the event. “We are a world-class specialty women and children’s hospital, and Obs-Gyne was a very good platform for us to inform and update people about our services and what we do,” said Dr Sadoon. “The UEMedical also manages HealthPlus, a network of highly specialised outpatient centres in Abu Dhabi including HealthPlus Fertility Centers. The IVF Laboratory of HealthPlus Fertility is the first of its kind in the UAE to receive international accreditation by the College of American Pathologists (CAP), a testament to its high quality and its compliance with internationally recognised standards and procedures. So, Obs-Gyne was the apt venue for us to meet with visitors, interact with them and get some good ideas that we can bring back to our Group because we believe that quality is a responsibility, and that a flow of ideas is critical to keep raising the bar of excellence.”

With an impressive portfolio of 18 hospitals with more than 5,000 beds, over 4,000 doctors, 2,500 medical students and more than 250,000 patients per year in emergency room services, Italy’s Gruppo Ospedaliero San Donato (GSD) has firmly cemented its position as the largest private healthcare group in the country. With three of their institutes classified as IRCCS (Scientific Institute of Recovery and Care) - a recognition distinguishing those institutions within which the research activity has a direct and immediate impact on the quality of the cure delivered to patients – the result is 4 million patients treated each year.

The history of GSD is tied to the history of Luigi Rotelli, a physician and founder of the first hospital in 1957 - the Istituto di Cura Città di Pavia, followed by the Policlinico San Donato - from which he went on to lay the grounds for the Group as it is known today.

With its foundations rooted in science and research, and the central belief that the patient is primarily a human being and should be cared for on a personal level, research, cooperation, and transformation of results into cure are the three activities that have accompanied GSD throughout their more than half a century history.

“Our way of curing and caring, with paths that we personalise in all respects, is inspired by this fundamental belief,” says Paolo Rotelli, who took over as President of GSD in 2015 from his father. “As a family-owned Group, this belief has remained at our core and was a particular point of pride as we celebrated our 60th anniversary in 2017. My grandfather was the founding father of the Group and, after him, my father used his lawyer’s acumen to build a further 16 hospitals and make the Group the success that it is today.”

Focus on the UAE

Last year, GSD Healthcare (the UAE arm of GSD International) opened its first office in the United Arab Emirates, based in Dubai Healthcare City. In 2018, the focus for GSD Healthcare is to offer medical training courses to regional medical professionals looking to develop their medical skills and to earn Continuing Medical Education (CME) accredited by the Dubai Health Authority (DHA).

Hosted in partnership with international medical device companies, GSD brings out their top chief surgeons and medical officers from their various institutes and hospitals in Italy to teach the latest techniques on the most cutting-edge medical devices. To date, they have successfully carried out two training courses that were fully booked and well received by the attendees.

“What sets us aside in the training world is that all of our teaching and training is done by those at the very top of their medical professions,” says Rotelli. “Secondly, people don’t pay to listen to a lot of theory presented through a slideshow; we focus solely on hands-on, practical training that attendees take back to their practices and apply them immediately. During the training course, we teach particular skills, we allow them to practice these skills using the latest medical devices and we assess each of our participants individually at the end of the course.”

All GSD Healthcare training courses in the UAE are certified by the Vita-Salute University in Milan, which has been ranked by TIMES Higher Education list as the No.1 University in Italy.

“For us, these training courses are a means to understand the needs of the market – what the physicians really want to learn. Our two-day courses are just the beginning of what we have to offer in the UAE and we are extremely flexible with how and what training opportunities we are able to customise for those that have the passion to keep learning,” Rotelli explains. “If any of the participants want to apply for further training in a specific field, they can apply to attend more in-depth, certified training courses at our university in Milan.”

According to Rotelli, these UAE-based training courses are a first step in creating a network of cooperation and knowledge sharing between the healthcare facilities, healthcare professionals and local patients in the UAE and with those in the GSD network in Italy.

“Our country is traditionally known around the world for our food, fashion and, of course, the Ferrari brand. We want to change this perception of our country. For example, the fashion industry is worth 70 billion euros of our GDP while healthcare is worth 180 billion euros. The healthcare industry in our country is a much stronger product and we want the world to become more aware of our brand of healthcare.”

Once their network in the UAE is sufficiently strong, and they have achieved strong brand awareness within the local medical community, Rotelli explains that their ultimate goal is to open a healthcare facility in the UAE. “This is our long term goal, but right now, our focus is on building connections and introducing ourselves to the region and making our name synonymous with over half a century of medical excellence.”

 “While we are now concentrating our main efforts on creating partnerships within the UAE, we are keen to utilise these connections to eventually begin to explore opportunities in the wider regional healthcare market such as in the Kingdom of Saudi Arabia.”

Trust in science and research

In Italy, GSD has a stellar reputation for scientific research, especially molecular medicine and gene therapy. Ranking second only to CNR (National Research Council) among the Italian institutions, GSD produces more than 1,600 publications, many of which have a wide resonance inside the international scientific community.

Through the three IRCCS institutes (Scientific Institutes of Recovery and Care), GSD has achieved an important position in the international arena of scientific research. The high number of publications, the training of young physicians and scientists, and the new treatment options offered to patients testify to the results achieved in highly interesting disease areas.

It is within the Ospedale San Raffaele shelter for science, which is the educational centre of the Vita-Salute University in Milan, in which researchers focus their efforts on understanding the molecular processes underlying the diseases, and has reached excellence in the field of molecular medicine. Meanwhile, the focus of the Policlinico San Donato institute is on the study and treatment of heart and large vessels diseases. Founded in 1969 and with an extension of 50,000 square metres in the south-east of Milan, the Policlinico is a multi-specialised healthcare institute renowned for cardiovascular excellence and carrying out the largest number of cardiac surgeries in Italy (over 1,500 per year).

While the IRCCS institutes have been credited with discovering workable cures for some of the world’s rarest genetic conditions, today, they have turned their attention towards discovering a cure for a genetic diseases that is much more prevalent in the Middle East – Thalassemia.

“Within the same modalities, our researchers are now working in collaboration with pharma giant GlaxoSmithKline to find a cure for Thalassemia,” explains Rotelli. “Although this is a rare disease, there are tens of thousands of patients, especially in this region, who could benefit from a more effective treatment for this genetic disease.”

The Ospedale San Raffaele institute has also made considerable advancements in the treatment of leukemia. They have the latest Phase 1 drugs and treatment options, much like in the US. The institute also has an experimental treatment for Diabetes Mellitus Type 1 in the form of a stem cell transplant.

“All of this was made possible because, for the last 30 years, the Italian government continued to allocate huge amounts of funding into medical and scientific research,” says Rotelli. “Today, due to fiscal deficit in the country, this funding has been significantly reduced.”

“This is why we are increasingly focusing our efforts on showcasing our medical technologies and specialist research capabilities to the global medical community in order to find funding that will enable us to continue to develop these techniques that are changing the face of medicine.”

GSD is willing to enter into partnership with medical laboratories in the UAE in order to co-develop some of these revolutionary techniques that are bringing hope to so many patients around the world. “We know that the UAE government is one of the largest donors worldwide and that they are committed to making the world a better place through medical research. We are fully aligned with this vision and we would like to share our know-how and expertise on how to make it possible to go from the research stage, all the way to being used on real patients in a clinic setting.”

International expansion

GSD is a family-owned private hospital group operating for profit; however, the funding for over 80% of their patients comes directly from the national health system in Italy. This is a form of Public-Private Partnership (PPP) which works under a “checks and balances” system to ensure that the government does not overspend and exceed their budgets. Each private hospital in the country can only generate a maximum of 80% of their revenue from patients that are referred by the government and each type of treatment is charged at the same fixed rate, regardless of if you are treated in a public or private hospital. GSD generates 1.25 billion euros per annum from the national health system and this figure is capped at its maximum capacity.

“The remaining 20% of our business comes from out-of-pocket (OOP) payments or from health insurance companies. While Italian patients are traditionally reluctant to pay OOP, or to invest in private health insurance for themselves, we are still seeing that this figure is growing year-on-year. This is one of the reasons why we are setting our sights on the international market,” Rotelli explains.

Last year, GSD welcomed more than 1,600 international patients from countries such as Canada, Australia, Romania and The Maghreb. Due to ongoing humanitarian efforts where surgeons from GSD travel abroad to train local surgeons in specialist paediatric cardiac procedures, particularly in countries such as Tunisia, Morocco and Egypt, GSD continues to receive hundreds of paediatric patients whose treatment is paid for by the respective governments.

Similarly, GSD receives a large number of paediatric cardiac patients from Romania due to a bilateral agreement signed by the Government of Italy and the Romanian government to treat Romanian nationals in Italian hospitals. “As a result of this, if we receive a patient from Romania, we will get reimbursed for this by the Italian national health system,” Rotelli adds.

In 2017, GSD opened their doors to a brand new market of international patients from ex-Soviet countries such as Ukraine, Moldavia and Russia. This was as a direct result of the establishment of two GSD offices in the region and the in-bound flow of patients initially began because surgeons and physicians from GSD hospitals were willing to accept the impossible cases.

“These were the cases that no one else would take on,” says Rotelli. “For example, last year we successfully carried out the first ever organ transplantation on a foreign patient, with a foreign (living) donor, in Italy. It took nine months to get all the appropriate approvals from the government but once the ethics part of the process was taken care of, our patient from Russia was able to go ahead a receive a kidney transplant in our hospital.”

From over half a century of cutting-edge medical research, to training an army of Italy’s future surgeons and physicians, the Gruppo Ospedaliero San Donato certainly has the pedigree to make a statement in the global healthcare arena. With their international expansion plans well under way, and their ambitions to begin to collaborate with the UAE government on finding a cure for some of the region’s troubling diseases, the future certainly look interesting for this successful family Group.

With the healthcare environment changing for healthcare providers around the world, Siemens Healthineers aims to enable healthcare providers worldwide to achieve better outcomes at lower costs by empowering them on their journey towards expanding precision medicine, transforming care delivery, improving patient experience and digitalising healthcare, says Dr Bernd Ohnesorge, President Central Europe, Middle East & Africa at Siemens Healthineers.

A leader in medical technology, at Arab Health 2018 earlier this year, Siemens Healthineers presented its latest innovative portfolio of products and services in the company’s core areas of diagnostic and therapeutic imaging and in laboratory diagnostics.

“Arab Health is a key tradeshow for Siemens Healthineers not only in the Middle East and Africa region but also globally,” says Dr Ohnesorge. “It serves as a great platform for us to exhibit our innovations and meet key decision makers, thought-leaders and industry experts.”

In an interview with Arab Health Magazine, Dr Bernd Ohnesorge discusses the main ideas and strategies that are transforming the healthcare industry, and the innovations that Siemens Healthineers brings to the healthcare arena to meet these new challenges.

1. As President Central Europe, Middle East and Africa at Siemens Healthineers, what do you think is currently driving the healthcare industry forward, both in the Middle East and Africa region and globally?
   
   The healthcare environment is changing for healthcare providers around the world. The main trends of the business – consolidation, industrialization and managing health – affect the way decisions are made. Cost pressures and outcome orientation are dominant drivers. It is our ambition to enable healthcare providers worldwide to achieve better outcomes at lower costs by empowering them on their journey towards expanding precision medicine, transforming care delivery, improving patient experience and digitalizing healthcare.
   
   As a leader in medical technology, we are constantly innovating our portfolio of products and services in our core areas of diagnostic and therapeutic imaging and in laboratory diagnostics and molecular medicine. In addition, we are actively developing our digital health services and enterprise services.
    
2. What current trends do you see specifically in the UAE healthcare industry and what do you see as the growth areas going forward?
   
   The UAE healthcare industry is continuing to develop further as healthcare has always been a prime focus for the country. Presently, one of the main pillars outlined in the country’s National Agenda – Vision 2021 – is to develop a world-class healthcare infrastructure. Reducing out-bound medical tourism, further emphasis on preventive medicine and curbing life-style diseases are some of the targeted objectives. Considering the increasing in-flux in population levels, key areas that will continue to grow are precision medicine, preventive care and improving patient experience.
    
3. What, according to you, are the main ideas/strategies that will transform the healthcare industry of the future?
   
   The healthcare industry is going through a transformation that’s being driven by the rapid growth of healthcare data. The number of connected devices is growing exponentially with projections that by 2020 there will be more than 50 billion smart connected devices. Despite these statistics, only 20 percent of these data are structured for use and analyzed. There’s a tremendous opportunity to tap into this data pool and create new insights and value.
   
   New technologies have emerged to tackle these data: The Internet of Things connects devices and sensors to collect and exchange data. Big data computing analyzes large, complex stores of data to extract value. And artificial intelligence (AI) allows digital machines to sort through all the data and think, reason, and solve problems like humans do. This transformation will change the way our customers deliver care to their patients. At Siemens Healthineers we want to support our customers in tackling these changes by helping them generate, aggregate, analyze, and operationalize data.
    
4. How important is innovation in healthcare? What are the technological, medical and strategic innovations that your company brings to the healthcare arena?
   
   Some of the biggest challenges for healthcare delivery are to confirm the right diagnosis, make the right treatment decision for every patient, and appropriately utilize therapy resources. It is all about increasing the specificity and sensitivity of medical tests, and artificial intelligence can support this big time. What could help are integrated decision solutions that are currently being developed in the Diagnostic Imaging Business Area. They could support personalized diagnostics and treatment decisions using real-time, global, and connected datasets and enable quality and efficiency analytics. Therefore, it is important to have historical patient data as well as genomic and lab data.
   
   The actual status of the patient – whether it is lab information, imaging information, or information from physical tests – is also important. This might even be correlated to reference data and population cohorts in order to make the right decisions along the whole pathway of care, from early diagnosis to therapy and follow-up care. But it is not just about data access. It is also about data quality assurance and data curation. There are hundreds of different algorithms we need to develop. We need to industrialize the process of deep machine learning algorithm development; otherwise, the cost will be too high. To get access to all the necessary data, building partnerships with healthcare providers worldwide will be more important than ever.
   
   Siemens Healthineers not only offers a broad portfolio of in-vivo and in-vitro diagnostics equipment, we have also built a system to bring it all together. The Siemens Healthineers Digital Ecosystem was designed to integrate and interconnect healthcare data from imaging, in-vitro diagnostics, and medical documentation. This data is generated in one of the healthcare industry’s largest installed bases. With this Digital Ecosystem, we want to reach healthcare providers faster with our innovative services and applications.
    
5. What new products or innovative technology did Siemens Healthineers showcase at Arab Health and MEDLAB 2018 exhibitions?
   
   At Arab Health 2018, we showcased our latest innovations in radiology. For example, our latest mammography system Mammomat Revelation with unique 50 degree 3D HD Breast Tomosynthesis provides the highest depth resolution in tomosynthesis, and thus delivers excellent quality 3D images. Now biopsies can also be performed leveraging this wide tomosynthesis angle.
   
   Another example is the new high-end 3 Tesla MRI scanner Magnetom Vida. It is the first scanner equipped with BioMatrix, a brand-new, innovative scanner technology that addresses inherent anatomical and physiological differences among individual patients, as well as variability among users.
   
   Our Business Line CT range at Arab Health this year included the latest high-end single-source system Somatom Edge Plus and its innovative FAST (fully assisting scanner technologies) Integrated Workflow with the FAST 3D Camera. Using artificial intelligence and deep learning technology, the camera automatically facilitates precise and consistent isocentric positioning of patients.
   
   We also presented nexaris Therapy Suite, a system to better integrate multi-modal imaging in surgery and interventional radiology. It provides support for precise diagnostics, intraoperative real-time imaging and direct check-up of results.
   
   And, at MEDLAB, we prepared selected presentations of our in-vitro portfolio to show our customers our comprehensive capabilities in diagnostics. Highlights included the Atellica Solution – world’s first IVD analysers with a patented, bi-directional magnetic sample transport that is 10 times faster than conventional conveyors. Our new epoc blood gas analyser makes us the only company to enable customised testing offerings based on individual facility needs to help improve process efficiency —whether that is handheld testing, benchtop solutions or central lab applications.
    
6. What was unique or new about the products Siemens Healthineers presented at Arab Health this year?
   With increasing volumes and complexity of data from different sources and across a range of disciplines, artificial intelligence is the key to make medical technology smarter, image data and lab result analysis faster, and examinations more accurate. Now, we are starting to implement artificial intelligence more and more in our systems like Somatom Edge Plus and its FAST 3D Camera
    
7. As a company closely associated with Arab Health for the past several years, how would you evaluate the impact of the event on the healthcare industry in the MENA region?
   
   Arab Health is a key tradeshow for Siemens Healthineers not only in the Middle East and Africa region but also globally. It serves as a great platform for us to exhibit our innovations and meet key decision makers, thought-leaders and industry experts.
    
8. What, according to you, are the real benefits and opportunities available to healthcare and trade professionals to attend Arab Health?
   
   The CME-accredited conferences that run alongside the exhibition are highly-valued by healthcare professionals – continuing medical education is an important topic and a core area of focus also for Siemens Healthineers. Other than that, visitors benefit from attending the exhibition which has grown substantially over the years and presents a range of equipment and services together with the very latest innovations.

In the Spotlight
Dr Bernd Ohnesorge, President Central Europe, Middle East & Africa at Siemens Healthineers, had previously served for four years as head of the Magnetic Resonance Business Unit. Dedicated to the advancement of medical technologies, he previously held several leading positions at Siemens including the position of the head of the X-Ray Imaging Products Business Unit in 2010 and 2011 as well as the leadership position of Siemens Healthcare in China and North-East Asia from 2006 to 2010.
He joined Siemens after the completion of his master’s degree in data communication and digital signal processing at the University of Erlangen in 1994. While serving in several R&D and management positions within the Computed Tomography Business Unit between 1994 and 2006, he finished his PhD thesis on methods for cardiac CT imaging in June 2002 at the Institute of Clinical Radiology of the Ludwig-Maximilian-University in Munich, Germany.

In line with the UAE Vision 2021, which aims to achieve a world-class healthcare system, the 43rd Arab Health Exhibition & Congress welcomed more than 4,200 of the most innovative healthcare companies and 103,000 attendees from 150+ countries to its home at the Dubai World Trade Centre from 29 January – 1 February 2018. With the demand for healthcare products and services continuing to increase within the region, Arab Health has once again proved its credentials as a must-visit exhibition for anyone associated with the industry - not only in the Middle East, but also across the globe.

Arab Health 2018, organised by Informa Life Science Exhibitions, was officially opened by His Highness Sheikh Hamdan bin Rashid Al Maktoum, the Deputy Ruler of Dubai and the Minister of Finance and Industry of the United Arab Emirates, who toured the exhibition along with local and regional dignitaries.

During his tour, HH Sheikh Hamdan inaugurated the Dubai Health Authority (DHA) online media channel known as Sahaa Wa Saada (Health and Happiness). Speaking during the inauguration, His Excellency Humaid Al Qutami, Chairman of the Board and Director-General of the DHA, said: “In line with the vision of our leaders and in line with the Dubai Health Strategy 2016-2021, we are keen to develop initiatives that promote healthy lifestyle and wellbeing. Prevention and healthy lifestyle is an important pillar of the DHA strategy and the launch of this online media channel stems from our goal to promote a healthy environment through community engagement.”

There are Deals to be Done

As expected, the exhibition floor at Arab Health was buzzing with excitement as many of the world’s leading healthcare companies showcased groundbreaking technologies and innovative solutions designed to improve patient experience and clinical outcomes across the region. A number of regional ‘firsts’ were announced, and millions of dollars of contracts were negotiated and signed during the four-day industry showcase.

One example was GE Healthcare’s announcement that it would deliver advanced diagnostic technology to fully equip the radiology department of King’s College Hospital London in the UAE, which is set to open in Q1 2019.

“The future of healthcare is fast, simple and about affordable solutions that drive tangible outcomes for patients and providers alike,” said David Mezher, General Manager- Middle East, GE Healthcare. “GE Healthcare has an established heritage of equipping the leading public and private sector hospitals in the region with the advanced technology physicians need to be able to focus on what matters most: delivering high quality care to their patients.”

Another announcement came from RAK Hospital in Ras Al Khaimah, UAE, as they launched a revolutionary stem cell therapy for the treatment of arthritis and other joint related issues. RAK Hospital’s Bone and Joint Centre will be led by world-renowned knee regenerative and reconstruction specialist Dr William Andrew Hodge.

Meanwhile, Royal Philips was at Arab Health to showcase its broad portfolio of smart digital platforms and intelligent solutions to help address the region’s biggest healthcare challenges. Some of the technologies on show included Azurion, Philips’ new-generation image guided therapy platform, MR Prodiva - the new MR Prodiva 1.5T provides enhanced clinical performance, workflow and patient experience. Philips also unveiled new solutions to drastically reduce exam times and elevate neuro-oncology.

The UK’s largest specialist heart and lung centre, the Royal Brompton & Harefield Hospitals Specialist Care, demonstrated two live surgeries on their stand at Arab Health -the Ozaki procedure for reconstruction of diseased aortic value function and the VATS lobectomy to treat large tumours of the lung. Both surgeries were performed in response to growing Middle East health concerns surrounding heart and lung disease. Each procedure highlighted how innovative techniques can have life-changing benefits for those living in the region.

Siemens Healthineers was at Arab Health to present a new range of diagnostic imaging and therapy solutions, the latest innovations use Artificial Intelligence (AI) and 3D camera technology to expand precision medicine and improve patient experience, reducing unwanted variations and repeat procedures. The innovations launched at Arab Health 2018 included the Cios Spin, an intra-operative 3D imaging device set to reduce revision surgery; the Mammomat Revelation, a premium mammography system featuring 3D HD Breast Biopsy, providing automated breast density measurements and improving patient access to functional breast imaging; and nexaris Therapy Suites, a solution to better integrate multi-modal imaging in surgery and interventional radiology.

All Eyes on Personal Health Tech

Manufacturers and providers of personalised healthcare products and services showcased pioneering technologies in the first-ever Personal Healthcare Technology Zone at Arab Health. The 800sqm Zone featured smart watches, health monitors, telemedicine technologies, and mobile device accessories.

One of the technologies on show was the Yirdoc intelligent mesh nebuliser from Qingdao Future Medical Technology Ltd in China. The mesh nebuliser is the third generation of technological innovation and comes with OOT-technology. It has one-button operation and uses intelligent technology to maximise the effect of the medication and offers adjustable nebulisation rate via the smartphone or tablet app.

According to Yuheng Feng, leader of the Global Market Unit at Yirdoc, “Traditional medical treatments for respiratory diseases come with a lot of problems including the possibility of cross infection in a hospital setting or the distress caused to children due to the noise from a traditional nebuliser. We have committed ourselves to providing a reliable, intelligent and portable home solution for the treatment of respiratory diseases.”

As part of the Personal Healthcare Technology Zone, the recently introduced Product Demo Zone also featured the latest ‘Smart’ healthcare products, from a healthcare concierge app which helps you connect to pharmacies and doctors, to the first smartphone electrocardiograph that enables remote reporting, to glucose monitoring devices.

A key exhibitor at the Product Demo Zone, Richard Thomas, Managing Director of Activinsights commented: “Arab Health is the perfect platform to showcase our latest innovative products, such as the Activinsights Band, which delivers efficient diagnostic solutions for healthcare providers and patients alike. Wearables and smart technologies are truly transforming the healthcare market, enabling higher quality and more efficient solutions.”
 
The 3D Medical Printing Zone returned to Arab Health for a second year in partnership with the Dubai Health Authority, displaying the most innovative technologies that are revolutionising the healthcare sector and the limitless clinical applications of 3D printing.

Beyond Borders

With global healthcare technology and service providers competing to deliver high quality, cost-efficient and smart healthcare, the international community was keen to put their best foot forward in terms of their national capabilities and expertise. This year, Arab Health hosted 40 national pavilions packed with innovative medical technology solutions aimed at impressing the stakeholders in the Middle East region.

Finland had a stronger than ever presence with more than 35 companies showcasing the latest innovations in Finnish healthcare services and technologies. One of the key highlights was the Adesante’s Clinical Operation Simulator (SurgeryVision™) - a virtual reality solution for surgery planning.

According to Teppo Lainio, Senior Advisor, QMS, SurgeryVision, and co-exhibitor at Business Finland stand: "This was our first time at Arab Health and it is the premiere of SurgeryVision to the world and the first place outside of Finland. We have gained a very good reputation here and have got an exceeding amount of leads from this area including UAE, Saudi Arabia and even further away from India and Pakistan. It is an extremely good exhibition and has proved to be useful for us. We are very happy and look forward to coming back next year."

Meanwhile, the focus for Healthcare UK at Arab Health 2018 was on prevention, quality and innovation - with outstanding applications in the field of digital healthcare. As Healthcare UK managing director Deborah Kobewka explained: “We have an excellent presence at Arab Health, as we have done for many years. Our objective is to profile the very best of British healthcare - both our public sector capabilities which are encapsulated by the NHS, as well as the private sector. This year, we have brought with us four innovative private sector companies that are all showcasing the very best of digital capabilities in the UK.”

Other national pavilions with a strong presence at Arab Health included the Italian pavilion with 127 exhibiting companies. The French pavilion took up 1,300 sqm of exhibition space and showcased medical expertise in a wide variety of areas from 130 French companies. From across the Atlantic Ocean, 30 Brazilian companies gathered at Arab Health to highlight innovations in healthcare technology solutions.

Getting Hands-On with Training

For the second year, Arab Health hosted the popular Hands-On Training (HoT) concept – real-time training modules that were delivered on the exhibition floor. With a number of unique programmes, participants were able to train on the advanced techniques with the latest state-of-the-art equipment across different modalities such as aesthetic and conservative dentistry, OR risk management, ultrasound, endoscopy, and many more.

Ansell, an Australian company that manufactures protection solutions, hosted a number of HoT sessions including on the hazards of glove powder. This education module examined the risks associated with powdered glove use to both healthcare providers and patients, as well as strategies to prevent exposure to glove powder.

Meanwhile, American medical technology firm Becton, Dickinson and Company (BD) hosted a medication management module that covered topics such as inventory optimisation in central pharmacy, outpatient smart pharmacy solutions and automating supply management in procedural areas.

Education the Arab Health Way

More than 8,000 delegates from across the globe participated in the Arab Health Congress that offered 19 business, leadership and Continuing Medical Education (CME) conferences aimed to bridge the gap in medical knowledge. Attendees had the chance to learn from leading experts in the field to hear about the most prominent topics in the region, including public health, family medicine and obesity, bringing the latest issues and developments in the industry to the forefront.

Speaking as part of the Paediatrics Conference, a popular speciality with this year’s attendees, Dr Rabi Hanna, a specialist in pediatric haematology, oncology, and blood and bone marrow transplantation at Cleveland Clinic in the US, shared his insights into a series of clinical breakthroughs that will revolutionise treatment of genetic blood disorders and increase the life expectancy of children diagnosed with sickle cell disease and thalassemia.

Dr Hanna said significant changes in treatment are likely in the next five to ten years, including advances in bone marrow transplant techniques, gene therapies, and improved medications. “In the past few years there have been big steps forward in haplo-transplants, using family members that are only half-matched, particularly a mum or dad with 50 percent of the child’s genes. That will give more children the chance of a cure, replacing bone marrow that is defective with new bone marrow that is healthy.”

With lifestyle diseases and chronic illnesses such as cardiovascular diseases, diabetes and arthritis becoming more prevalent in the region, speakers at the first Family Medicine Conference highlighted current approaches to diagnosis and management, as well as the latest preventive measures. The congress also welcomed its first Obesity Conference – a timely and relevant forum for clinicians in the region where prevalence of the disease has reached epidemic proportions.

The Show Goes on!

Since its launch at Arab Health 2017, Informa’s global medical directory – Omnia - has had over four million page views, more than 200,000 plus viewers, +7000 members and an estimated 30,000 products uploaded on its portal www.omnia360.com. Breaking all geographic boundaries and time zones for all of Informa’s Life Sciences events across the globe, year-round access to the portal enables visitors to source information on companies exhibiting at Informa Life Sciences’ shows as well as interact with and explore products beyond the show floor, whenever and wherever it is needed.

This year promises to bring in even more exciting possibilities for growth for all Omnia members and visitors. “In 2018, we will bring all of Informa’s Life Sciences events under the Omnia 360 umbrella - this includes 12 global trade shows,” said Joseph Chackola, Publications Director, Informa Life Sciences, Dubai, UAE. “In addition, several new platform features are being developed and deployed to guarantee business leads for each and every single member on Omnia. The goal is to enhance the whole exhibition experience - whether it is for the exhibitor, manufacturer or healthcare provider.”

Occupational health relates to the impact health has on work and work has on health. Its objective is to prevent or reduce occupational health diseases developing such as asthma, hand-arm vibration and noise induced hearing loss. Sometimes the employee brings these conditions into work and sometimes they can be made worse or contributed to by the working environment. In all cases, the employer has a responsibility to manage occupational health issues and often will use the services of an occupational health provider to assist them. Clearly as staff are a key business asset and essential to good productivity and profitability, they need protecting.

Staff can be put at risk from workplace exposures in a number of ways: through excessive noise that might affect their hearing or extreme stress that might affect their ability to carry out their responsibilities. Excessive chemicals in the environment is another potential hazard if absorbed through the skin or breathed in. These dangers can lead to conditions such as respiratory disease, eye and skin irritation, muscle and nerve damage and even cancer.

Team work pays
The role of an occupational health team is to keep staff in the best of health – physically and mentally. In addition, it will do the appropriate risk assessments to lessen the chances of ill health in the workplace. If any risks remain, control measures will need to be put in place, part of which may be an occupational health surveillance programme.

An occupational health provider should be selected by the employer on the basis of being able to work with their risk assessment, work with the staff identified as being at risk and being able to set a programme and make appointments with those at risk before getting back to the employer with a comprehensive health action plan.

More access to care needed
About 45% of the world’s population and 58% of the population over 10 years old belong to the global work force. A recent WHO study revealed that unhealthy working conditions contribute to at least 1.6% of the ‘burden of disease’ in the WHO European region. The major occupational risks associated with this burden are injuries (40%), noise (22%), carcinogens (18%), airborne particulate matter (17%) and ergonomic hazards (3%).

The WHO created a global strategy for occupational health in 1994 which called for all countries to show a “progressive development of occupational health services with the ultimate objective of covering all workers with such services irrespective of the sector of economy, size of company, occupation, mode of employment, or nature of self-employment.”

It added that many individuals spend one-third of their adult life in hazardous working environments and that approximately 120 million occupational accidents with 200,000 fatalities are estimated to occur annually. Furthermore the costs involved in theses health hazards amount to several per cent of some countries GDP. However, just 5-10% of workers in developing countries and 20-50% of workers in industrialised countries have access to occupational health services. The need is particularly critical in developing and newly industrialised countries where around eight out of ten of the world’s workers live.

Where we are now globally
There are numerous challenges facing occupational health provision around the world today. These appear to be linked with new information technology and automation, new chemical substances, health hazards associated with new biotechnologies, an ageing working population plus the special problems of groups such as the chronically ill, the handicapped, migrants and the unemployed.

To frack or not to frack
In the United States (US) for example, issues affecting workers cut across several industry sectors. In an article in the US journal Occupational Medicine, John Howard of the National Institute for Occupational Safety and Health pointed out some of the issues that needed addressing. Firstly the development of ‘fracking’, the process to increase the energy output in the US, has brought with it new risks to the workforce involved in drilling and other activities in extracting oil and gas up to the point of shipment.

The rise of the robots
Meanwhile, job automation and robotics, where jobs formerly done by human workers are now done by machines, continues to disrupt the labour market in a number of key sectors. Robotic workers are also working alongside human workers and there have already been headlines about workers injured or killed by robots such as the employee at a Volkswagen assembly line whose chest was crushed after a robot gripped and pressed him up against a metal plate in June 2015 in Germany. Occupational safety and health professionals will need to take a proactive approach, said Howard, to the risk profile of occupational robotics.

Brexit warning
In a recent article in Personnel Today, it was argued that Brexit could impact on occupational health and safety in the UK in two distinct areas. There is the potential knock-on effect for health and wellbeing spending should there be a downturn in the economy. Secondly there is the possibility of health and safety legislation being amended or watered down. Lucy Kenyon, communications director for the Association of Occupational Health Nurse Practitioners said there is a counter-argument to this in that in a recession or downturn, you need your skilled, experienced employees to be at work, fully fit and healthy even more.

On your bike!
In the UAE it has been suggested that sedentary desk jobs can contribute to physical inactivity and that stress in the workplace can result in lack of sleep and a poor diet and more needs to be done to tackle this. Dr Michael Bitzer, the chief executive officer at national health insurance company Daman said in an article in The National newspaper recently that encouraging a healthier lifestyle is key. He insisted that when organisations adopt a health-oriented strategy that prioritises the wellbeing of staff, it immediately impacts the employee-management relationship in a good way and can lead to increased loyalty. He suggested initiatives such as having weekly runs at a park or encouraging colleagues to get together for brisk walk or bike ride.

Future challenges
In their paper ‘Creating a Future for Occupational Health’, academics from the University of Washington suggested that changes in the workplace and the resulting job insecurity change the nature of risk to a large fraction of the workforce. The paper states: “Workforce demographics are changing, and economic disparities among working groups are growing. Globalization exacerbates the 'race to the bottom' for cheap labour, poor regulatory oversight, and limited labour rights. Largely, as a result of these phenomena, the historical distinction between work and non-work exposures has become largely artificial and less useful in understanding risks and developing effective public health intervention models.”

It added that additional changes related to climate change, governmental and regulatory limitations and inadequate surveillance systems can challenge and frustrate occupational health progress while new biomedical and information technologies expand the opportunities for understanding and intervening to improve worker health.

Better training and research
The University of Washington paper concluded that occupational health training, professional practice, and research should evolve towards “a more holistic, public health-oriented model of worker health. This will require engagement with a wide network of stakeholders. Research and training portfolios need to be broadened to better align with the current realities of work and health and to prepare practitioners for the changing array of occupational health challenges.”

The WHO said that with the rapid changes in modern working life such as the demands of learning new skills, adapting to new types of work, the pressures of higher productivity, work quality and time pressure, there are growing psychological and stress issues among the workforce. More attention and resources should be given to these matters within occupational health, which can ultimately play an important role in ensuring that productivity, quality, motivation and work satisfaction are maintained at a high level.

Governments’ key role
In response to this, the WHO has set out ten priority objectives for the development of occupational health at national and international levels. These include strengthening international and national policies for health at work and developing the necessary tools; developing healthy work practices and promoting health at work; establishing registration and data systems; using effective transmission of data and raising public awareness through public information.

The organisation says that the objectives reflect the importance of primary prevention and encourage countries with guidance and support from the WHO to establish their own national policies and programmes with the necessary infrastructure and resources for occupational health. The role of government in this will be crucial in order to set the standards for controlling risks at work and ensuring that compliance with such standards are adhered to. The principal players at the workplace level though are the employers and workers who should work closely together to ensure health and safety at work.

Last year Nature published an Outlook collection of viewpoints surrounding the progress and promise of precision oncology. The Perspective piece that particularly caught my attention was on “The precision-oncology illusion” authored by Vinay Prasad, assessing the success of genome sequencing programs and trials pairing individual patients with a targeted therapy matched to mutations and disease specificities. Whether one agrees or not with the arguments provided, one thing is true: we still have a long road to travel if we are to deliver on the promise and potential of precision medicine. That said, I believe that we have every reason to be optimistic.

Thanks to several major advances in genomic technologies, including the widespread implementation of gene panels to diagnose the molecular culprits of solid and haematological cancers, the advent of non-invasive liquid biopsies, and steady progress in precisely targeting drug therapies against individual patient tumours, we have made much progress in thwarting this hideous disease.

While these developments must be applauded, we need to get smarter and move faster. The two major challenges that continue to hamper our efforts in more precisely treating cancer are reversing cancer drug resistance and counteracting tumour cell spread factors.

Importantly, we are witnessing the extension of novel therapies – immune-based approaches in particular – to more tumour types, furthering our insights into the cancer genome and epigenome towards better tracking, detecting and treating disease, fine-tuning and tailoring cancer medicines matched to newly classified subtypes, and identifying new avenues for molecularly targeted therapy against metastatic disease. 

At preclinical level, our translational efforts are marking important progress in empowering predictive cancer science towards the next generation of precise anti-cancer therapies. By developing and pioneering increasingly “intelligent” humanised cancer models, including patient-derived tumour xenografts (PDXs) as avatars for patient response to therapy as well as organoids as in vitro models of disease, we continue to discover the driving factors that influence tumour growth, more accurately predict cancer progression and response to certain treatments.

Continued focus aimed at advancing today´s array of modelling systems will help us to increasingly deliver the predictive data required to reliably inform the clinical development of innovative agents and evidence reproducibility before moving to the clinic – avoiding costly duplication as well as wasted opportunity in our collective quest to get the right treatment to the right patient, on time and at the right time.

In order to address the immense complexity and heterogeneity underlying cancer, innovative drug combinations will need to be developed in order to improve outcomes for our patients. In terms of combinatorial targeted therapy and the which, for whom, and for what, the possibilities are endless when considering which to move forward. As we up the tempo in accelerating and potentiating truly transformative therapies, we must continue to uncover the genetic basis of tumour-specific vulnerabilities, and base our clinical studies on strong scientific rationale. Future clinical trial design must be based on robust scientific hypothesis coupled with the co-development of biomarkers to facilitate patient selection – the empirical; trial and error approach to trial design is no longer acceptable or affordable.

To move us closer to the holy grail of personalised medicine in oncology, it´s not only a matter of driving the necessary scientific breakthroughs from bench, bedside and back; it´s also about access to and affordability of novel cancer treatments.

According to a recent study, in 2015 there were an estimated 17.5 million cancer cases globally and 8.7 million deaths. Furthermore, cancer burden is on the rise at an alarming rate, owing to a growing and ageing global population as well as risk factors including smoking, obesity and dietary patterns. As an example, estimates suggest that cancer incidence is expected to increase more in the GCC region than in any other region across the globe over the next 20 years. Considering the widely-documented issue of cancer medicines carrying disproportionate price tags – the major contributing factor to unacceptable disparities in access to current therapies, and the daunting prospect that one in two people will develop cancer at some point in their lives, healthcare systems are already buckling under the burden, with some at breaking point.

Global oncology costs soared to 107 billion US dollars in 2015, representing an increase of 11.5% over 2014. According to the alarming estimation, these costs are set to reach 150 billion US dollars by the year 2020. In the last five years, costs of cancer medicines increased by 72% over 2010 in the US, and by 50% in countries other than the US. Coping with escalating healthcare costs now and beyond is a problem faced by all countries and, if we don´t collectively work together to prepare and suitably plan for the future, the outcomes for countless cancer patients, now and in the future, will be catastrophic.

The key now will be to work together to prioritise and better guide informed decision making when it comes to the fair pricing and access to approved therapies. The shaping of oncopolicy towards facilitating equitable access to optimal, affordable care for patients quite literally begins ´at home´. Decision makers will need to balance efficacy and reimbursement of anti-cancer therapies with regional socio-economic realities. In this respect, major professional societies and organisations will play an essential role in road mapping these necessary directions.

To name but one, the European Society for Medical Oncology (ESMO), for which I am truly honoured to currently serve as President-Elect, represents an essential partner in this process. ESMO´s Cancer Medicines Working Group with its especially appointed expert task forces, Policy Committee and Regional Committees are working hard, in concert, to better guide policy makers, regulators, reimbursing bodies and pharma companies to increase cancer therapeutic access of both innovative drugs and essential drugs.

We all consequently need to take a hard look at current policies and priority setting on a region-per-region basis. Without this essential overhaul, today’s advances in predictive cancer science, treatment and care, as well as prevention strategies, cannot possibly hope to benefit an increasing number of our patients, across borders, now and in the future.

Some difficult choices will have to be made in terms of selecting which therapy, for whom, based on clearly demonstrated benefits across patient populations. A multi-stakeholder review of cost settings and the suitably adjusted pricing of cancer therapies to enable equitable access to the most effective therapies, is also as important as investing in the cancer research itself.

Only in unison, by engaging the entire oncology ecosystem and considering the views and the perspectives of all stakeholders in oncology, including patients and families, researchers, payers, regulators, the policymakers, and industry, will we be able to pursue our dedicated efforts aimed at solving cancer sooner for as many patients as possible.

With more than 3 million new cases and 1.7 million deaths each year, cancer is the most important cause of death and morbidity in Europe after cardiovascular diseases. How can we ensure that patients have access to the best possible treatment and care? How can care for cancer patients be improved across Europe? These are the many questions and key focuses for the European CanCer Organisation (ECCO), established in 1981 to unite all healthcare professionals in oncology with the aim to improve health outcomes for all patients.

As a federation of European Associations, ECCO needs to bridge together different professional traditions and cultures like those of surgeons, radiologists, medical oncologists, pathologists, pharmacists, researchers, nurses, psychologists etc. It connects the European cancer community by leveraging knowledge, promoting education and building awareness. ECCO also plays an important role in engaging with policymakers at European and national levels to promote the interests of cancer patients, research, as well all other members of the oncocommunity.

ECCO was founded with a vision is to improve outcomes for all cancer patients in Europe through multidisciplinarity. There is not one golden standard; recommendations can lead the way to improve each healthcare system which vary largely across the WHO-Europe region by providing a toolbox for change.

Quality Cancer Care

Our research greatly reflects the debate on quality cancer care: what are the elements required to deliver high quality cancer care for all patients in Europe? For selected tumour types, ECCO has produced ‘Essential Requirements for Quality Cancer Care’ (ERQCCs). These are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific tumour type.

These provide oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high-quality care throughout the patient journey.
How do we contribute to cancer research? Apart from the organisation of several congresses for our members, ECCO is a founding member of the Alliance of Biomedical Research in Europe, which represents a unique initiative of leading European medical societies that together include more than 400,000 researchers and health professionals. It is also a longstanding partner of the Joint Research Centre, which provides the European Union with scientific knowledge when formulating policies and legislation. In this role, ECCO made important contributions to the development of European Guidelines for Breast Cancer Screening and Diagnosis - the European Breast Guidelines.

Lastly, ECCO also sets its own focus on cancer research, by providing feedback to the European Commission to its consultation on the Advisory group report for the Horizon 2020 Societal Challenge on health, demographic change and well-being. Horizon 2020 is the biggest EU Research and Innovation programme ever with nearly €80 billion of funding available over seven years (2014 to 2020) – in addition to the private investment that this money will attract. It promises more breakthroughs, discoveries and world-firsts by taking great ideas from the lab to the market.

In addition to this, we have set new priorities for policy and advocacy, uniting our members in fresh positions in respect to, not only quality cancer care, but also access to innovation, integration of care, as well as emerging oncology workforce issues. Where there is a grand debate concerning the future of cancer care, ECCO intends to help its members be present, articulate, and advocate for the interest of best quality patient care and outcomes.

Cancer research and beyond

ECCO tries to bridge the world of fellow researchers, healthcare providers in oncology and the broader public on burning topics in oncology. Our latest paper sets out that access to innovation is about more than pharmaceuticals alone. It challenges our own professions to identify potential areas of inefficient or outdated practice and treatment. It also brings the use of real world data to the heart of the access debate. These and more act as an example of how ECCO would like to bring about awareness and change into cancer research and beyond.

The ECCO 2018 European Cancer Summit takes place in Vienna, Austria on 7-9th September 2018. It aims at taking the congress to a higher level, namely to a summit where worldwide leaders from the cancer healthcare, patient advocacy and stakeholder communities come together in a unique multidisciplinary forum. The idea is to complete the summit with the agreement of consensus statements by leaders in cancer policy, which will shape oncopolicy in healthcare systems across Europe.

To connect science with real life, outcome research forms a decisive part, i.e., using real-world data to observe how new treatments and diagnostic modalities have performed in cancer care delivery. Health economics of cancer care is another decisive topic, which is highly connected with outcome research and cannot be surpassed in any oncology debate today. Lastly, ECCO aims to focus on the patient voice to determine an agreed vision for guiding and supporting patients through diagnosis, treatment and follow-up in a world facing an ageing population, increasing survivorship and a technological revolution in e-health resources.

ECCO’s vision is to inspire a movement in the oncology community, which will change policies and clinical practice across Europe. Access to innovation is a goal which is high on the agenda in Europe.
 Innovation in cancer care is certainly more than the scientific progress in immuno-oncology and personalised medicine. In oncology, cancer care has seen remarkable developments in such areas as:

• The speed and accuracy of diagnostic procedures;
• The effectiveness of surgery, radiation therapy; 
• The power of information technology; and,
• The development of multidisciplinary, specialist-led approaches to care.

From a European perspective, the European Commission sees cancer research and cancer control still as an important topic, though health policy overall does not seem to be high on the priority list of the current Commission.  However, we are delighted that a new EU ‘Joint Action’, following CanCon and aiming to implement the CanCon European Guide on Quality Improvement in Comprehensive Cancer Control, will start in 2018.

Educational Awareness
The EU’s research programme, Horizon 2020, has also set aside substantive resources for cancer research. This reflects the demographic changes and the increase of cancer incidences, but also the growing success in treating cancer, which provides strong motivation among politicians to invest in cancer research. However, the more research advances, the more it becomes apparent how many gaps there are still to close before science is anywhere near mastering cancer. Though there is the firm belief among researchers that cancer will be curable, there needs to be more research into the varieties of cancer we discover. The perception and understanding of cancer has become much more differentiated and will have to become even more so to help advance with therapies delivering best health outcomes.

ECCO has longstanding relationships with the American Society of Clinical Oncology (ASCO) and with the Japan Society of Clinical Oncology (JSCO) including via joint sessions at each other’s congresses.

Established in 1999, ECCO has been co-organising the Methods in Clinical Cancer Research (MCCR) Workshop, which is an educational programme that introduces junior clinical oncologists in any oncology subspecialty to the principles of good clinical trial design. The workshop is the product of co-operation between ECCO, the American Association for Cancer Research (AACR), European Organisation for Research and Treatment of Cancer (EORTC) and the European Society for Medical Oncology (ESMO). The junior clinical oncologists not only come from all specialities, but also from all over the world, which makes the workshop an international and inspiring event.

Beyond this, ECCO also strives to cooperate more on a policy level. For example, the question of protocols for clinical trials, clinical trial data and ethical questions are of international relevance and therefore, a joint approach is highly desirable.

ECCO is also involved as a contributing member of the Union for International Cancer Control (UICC) and aims at being an active partner internationally wherever there is common ground for the development of policy, for example via the World Cancer Declaration.

Given the dimensions addressed above, the growing importance of cancer research, the global co-operation needs, ECCO’s role of fostering multidisciplinary throughout the European region, but not stopping at this, is the right way forward.

Integration of health data

One important task is to deal correctly with health data. There is the need to compile data, evaluate it and use it in the best of patients’ interest. The means of our age, electronic tools and systems seem to offer endless opportunities if the society manages to harness digital health in an ethical and legally correct manner. All health stakeholders, healthcare professionals, patients and others have a duty to help maintain the political will among governments and health systems to adopt the approaches that can truly unleash the power of data for better healthcare.

Another challenge that remains today is the integration of health data generated in one component of healthcare delivery into the wider healthcare IT system, so that in terms of providing good patient care, a more seamless record can be shared across all three fields of primary, secondary and social care. For cancer research, the need to collect data as well to share results from clinical trials, independent as to whether they are positive, negative or inclusive, is decisive. Despite the establishment of Cancer Registries and European Reference Networks, it is still challenging within Europe. However, there are still many steps ahead before the challenge of data is managed appropriately in cancer research.

On 2nd October, the 2017 Nobel prize in Physiology or Medicine was awarded jointly to Jeffrey C. Hall, Michael Rosbash and Michael W. Young for their work in the “discovery of molecular mechanisms controlling the circadian rhythm”. Circadian rhythm is basically the cyclic rhythm driven by the internal biological clock which anticipates the 24-hour cycle of day and night that may explain physiology and behaviours of organisms. The amount of biomedical information and codified data they used to arrive at their discoveries is immense. In this article, I am going to explain how Big Data specifically can be utilised in advancing cancer care. And to do so, I am going to shed lights on two dimensions: the cancer biology dimension (the pure science), and the oncology dimension (the clinical side).

Almost everyone in health informatics industry has used the term “Big Data” in their discussions, scope documents, visions, investments, articles and so on, in which it would mean different things based on what and how we use it and interact with it. It should not, however, be vague or unexplained, but rather explorable and redefinable.

In today’s world and as of April 2017, almost 3.8 billion internet users exist, producing massive volume of data that is variant, come from different sources and with different speeds. This comprises the 4 V’s of Big Data (Volume, Variety, Velocity and Veracity), that was first identified by a business model in Harvard Business School, trying to define a layout to revolutionise managing the tremendous amount of data created every day.

In the healthcare automation world, it is now more pressing that implementation of any electronic health records (EHR) would be driven by a value-based mindset. I would also add a fifth “V” to the Big Data Four V’s; the Value, which identify the “what is in it for me” that analysis of these data would create as in new opportunity, measure or even new product line to sell.

Hospitals and clients are now more demanding to get their return on investments (ROI) when implementing new digital tools. Pressures from end users are also higher to embracing new changes brought on by EHR implementations. These include clinicians (physicians, nurses, pharmacists, radiologists, lab technologists and others).

The amount of data being reported and collected using EHR tools coming from oncology clinics and other oncology settings are huge, especially systems that come with end-to-end data reporting tools, like the business intelligence from Cerner.

I do believe these data are very important as it meets the 4 V’s of Big Data elements including the huge amount generated every day, its ease to standardise and normalise its variety, and its integrity and trustworthiness. Most important is its added value that is anticipated to improve quality of evidence-based cancer care.

Scientists (biologist and pharmacologists) are also using big data in proposing new theories for causes of cancers, discovering new therapy lines, developing new modalities of treatments, or even developing current standing theories, treatments and modalities. Thus, the need rise for the power of big data analysis and high-performance computing. My humble experience while studying at Harvard Medical School in a global education CBT program showed me how scientists are using massive data in their labs aiming only to replicate snapshots of the tumour’s genetic makeup, trying to understand more about a responsible gene and its role in certain cell malformation. The more data snapshots obtained, the clearer the picture becomes of how a cancer cell evolves. Laboratories and the pharmaceutical industry collaborate very closely to work on analysng the data coming from thousands of scientists and DNA sequencers from universities, private laboratories, pharmaceutical corporates and others, that are guided toward countless directions of scientific thoughts, theories and questions.

Second Dimension: The Clinical Oncology

On the other side and clinically, data in the oncology world are also big and it is growing faster than ever before. Demand is also increasing to provide more information for providers, patients, payors, investors and regulators. The key word is on reducing costs, while maintaining safe, efficient and high quality of care. Regulators and organisations such as ASCO (The American Society of Clinical Oncology) for example, has been working since 2015 on producing a platform called “CancerLinQ”, a big data platform that aims to improve cancer care for patients. This was driven by the movement towards personalised cancer treatment, an evolving approach to cancer treatment.

By collecting and analysing data from all patient encounters, CancerLinQ  aims to help clinicians deliver the highest possible quality of care for their patients.

Big Data related to cancer care are big, and the amount of information gained on both sides (clinical and research) are massive. Interoperability will maximise benefits when people who produce these data and those who are analysing them from both sources begin to normalise, standardise and quickly analyse these data in the same speed it is produced, while appreciating the obstacles and commonalities as well.

Suzie Tinaglia watched as her son Sam, 18, chose which T-shirts from his favourite Chicago sports teams to pack for college. Going away to school was a milestone she didn’t expect the oldest of her three children to reach.

“Our family went through 12 years of living through cancer,” Suzie said. “With each diagnosis and recurrence, we stopped everything. We never knew what was around the corner.”

Thanks to CAR T-cell therapy, a revolutionary new treatment for advanced blood cancers in children and adults, Sam’s future looks bright. He was one of the first 100 children in America to participate in clinical trials of the gene cell therapy, a revolutionary new blood cancer treatment approved by the U.S. Food and Drug Administration in late August. The University of Chicago Medicine’s Comer Children’s Hospital is among the first sites in the U.S. to offer the treatment, which works by using modified versions of a patient’s own blood cells to target and destroy cancer cells.

Sam was diagnosed with B-cell acute lymphoblastic leukemia (ALL) in 2003 at age 5. Doctors believed the standard treatment – three years of outpatient chemotherapy – would be effective in putting the leukemia into remission.  For most children with ALL, this first line therapy is successful.

But Sam was among the 20 percent of children with ALL who relapse after initial treatment. When he was close to the five-year mark of being in remission, leukemia cells were found in his bone marrow. His Comer Children’s medical team, led by John M. Cunningham, MD, began a more aggressive approach to treating the disease. In the years that followed, more rounds of chemotherapy and a bone marrow transplant brought short remissions, but failed to eliminate the cancer. When the cancer came back again, it was in his central nervous system.

“At that point, we were sure we had reached the end,” Suzie said. “We thought the cancer was never going to go away.”

Supercharging Sam's Blood Cells

But then Cunningham told the Tinaglia family that Sam was eligible for a CAR T-cell therapy clinical trial at Children’s Hospital of Philadelphia (CHOP). “He called it a groundbreaking procedure, that had shown incredible success rates in kids like Sam, who had recurrent leukemia,” Suzie said. CAR, or chimeric antigen receptor, T-cell therapy is a type of cancer immunotherapy that involves genetically engineering a patient’s disease-fighting T-cells, rewiring them to seek out, recognise and attack cancer cells. Scientists refer to CAR T as a “living drug”.

“CAR T-cell therapy is filling a gap in the goal we have of curing every child with acute lymphoblastic leukemia,” Cunningham said. “We've been looking for a treatment like this for more than 30 years.”

Cunningham referred Sam to CHOP and the Tinaglias arrived in Philadelphia – anxious but hopeful — in the fall of 2015.  

Sam’s T-cells were collected through apheresis, a non-invasive process (similar to donating blood). In a laboratory, scientists modified the cells, supercharging them to seek out a protein found on leukemia cells. After the CAR T-cells multiplied into the millions, they were returned to Sam’s blood stream where they began fighting the cancer. 

Soon after the infusion, Sam experienced some of the serious side effects associated with the treatment. Cytokine-release syndrome (CRS) brought on high fevers, fluctuating blood pressure, temporary memory loss and seizures. Also known as a cytokine storm, CRS is the result of T-cell activation, so it was a positive sign that the attacker T-cells were performing.

“We went into it expecting that something like this could happen,” Suzie said, “but we also knew it meant the treatment was working. And we needed this treatment to work.” Following a week’s stay in a paediatric intensive care unit, Sam recovered.  

“Nothing difficult came after the storm,” he said. “Once it was over, I was done with cancer treatment. No more chemotherapy. No more medications. The CAR T-cells really did the job. They’ve been working ever since.  

“I’m obviously very happy, because my cancer, hopefully, is gone forever. It’s amazing.”

A 'W' for Sam

Sam’s love of sports, especially the Cubs, helped him endure the cancer relapses and treatments throughout his childhood. In October 2016, as he marked his one-year anniversary of CAR T treatment, the Cubs won the World Series. His family celebrated both unexpected victories.

“We never thought we’d get to this point,” said Suzie. “CAR T-cell therapy was the exact treatment he needed. We are so thankful it worked out.”

About 8 million people around the world die of cancer each year – one patient every four seconds. At any given time, several times that many patients are ill with cancer and require care. At present, more than 1 in every 3 people in developed countries will have some form of cancer in their lifetime. In almost all countries, the incidence of cancer is also increasing significantly. While overall cancer incidence in the developing world remains lower than it is in the developed world, it is rising more rapidly. By 2030, cancer incidence is estimated to have risen by 65 percent in developed countries, by 80 percent in middle-income countries and to have doubled in the world’s poorest countries.

Despite these statistics, significant progress has been made in treating certain cancers primarily through our ability to diagnose early. For example, US survival rates in prostate cancer have improved by almost 1.5x in the last 40 years. In other, relatively higher survival tumor types, such as breast and colorectal, we are seeing more moderate gains in survival. And in tumour types that are difficult to diagnose early on such as non-small cell lung cancer and pancreatic cancer, 5-year survival rates remain within the high single-digit to low double-digit percent range (8-18%).

The remaining need to discover more effective medicines has driven continued investment in oncology. Looking at the pipeline over the last 20 years, we can see that there has been an explosion of clinical activity in oncology. Since 1996, the number of oncology molecules has quadrupled. In the last eight years alone it has nearly doubled. This has made oncology the largest therapeutic area, accounting for 30% of the overall pharmaceutical industry pipeline molecules and 40% of clinical trials, twice the size of the next therapeutic area of anti-infectives. Going forward, we expect this trend to continue. In fact, looking just at the last two years, the rate at which compounds are being investigated shows another step-up in growth, likely being driven by the opportunities of immuno-oncology, sharper stratification of patient populations and new ways to conduct development more efficiently. 

Looking broadly across the industry, we see the following 5 major forces at play that will likely shape the future of oncology:

1. Smaller patient populations either due to a focus on niche tumours or narrower stratification of subpopulations in more common tumour types
2. Shorter product life cycles, reduced by almost fivefold since the 1990s because of a more competitive landscape and faster innovation cycles
3. Increase in combination therapies driven primarily by immuno-oncology increasing the need for and complexity of partnerships across manufacturers 
4. Advent of novel technologies to address a broader set of indications and offering greater promise of personalised therapies
5. Significant shift in value across healthcare, partly driven and informed by big data, which in turn will enable more innovative access models

Smaller patient populations
Current trends in product pipelines indicate that lower-incidence tumours will account for nearly 50 percent of revenues by 2020. This reflects a shift in focus away from high-incidence tumours (for example, lung, colorectal, breast and prostate) to niche tumours with greater unmet medical needs. Target patient populations are narrowed further by more sophisticated stratification strategies. Nearly half of current Phase III trials conducted by the top 10 oncology companies include a companion diagnostic. Ninety percent of biomarkers are used for patient stratification. PD-L1 expression, a putative marker for PD-1/PD-L1 inhibitors, is an exception and is mainly used for retrospective analysis due to a lack of consensus around the assays and the analysis. The move towards narrower indications has important implications for both market access and the go-to-market model for manufacturer with an increased emphasis on patient finding. 
It will also generate more active debate about the sequencing of indications within development programmes, given smaller populations are often addressed only later in a product life cycle (cf. also paediatrics).

Shorter product life cycles
Innovation is a key driver in oncology. Over the last 15 years, novel drugs have generated more value in oncology than in any other therapeutic area. However, research and development is concentrated on a minority of potential targets, thereby increasing competitive intensity. Based on our own analyses, 80 percent of the pipeline activity of the top 10 oncology companies is focused on 37 percent of all the targets being explored. In addition, 80 percent of compounds in development have at least one competitor in the pipeline. 

This intense competition has shortened product life cycles. While Avastin, Gleevec and Herceptin enjoyed long periods of exclusivity, MEK, PD-1/PD-L1 and PARP inhibitors offer a good indication of how competitive drug development has become. An important potential implication for regulators is to manage a faster pace of innovation while upholding satisfactory approval standards. Pharmaceutical companies will require agile development capabilities and flawless product launches. They will increasingly need to adapt their go-to-market models to different product archetypes and to head-to-head situations in the same line in order to adequately inform physicians about trade-offs between alternative therapies. The neck-to-neck development of nivolumab and pembrolizumab is a good example of the speed and organisational commitment required for development organisations and commercial execution in the market (e.g., NSCLC 2L).

Increase in combination therapies
Immunotherapies have turbocharged combination opportunities. In the 10 most common tumour types, approximately 40 percent of ongoing PD-1/PD-L1 studies involve combinations. Currently, there are over 900 combination studies with PD-(L)1 inhibitors in the clinical pipeline alone. Despite recent setbacks to improve progression free survival (PFS) in a number of indications, an improvement of overall survival (OS) is still in the cards. We believe the trend towards combination therapies is likely to continue and will include more complex combinations such as triplets going forward. With this, PD-1/PD-L1 therapies will likely increasingly become interchangeable backbones, and partner therapies will eventually drive the next wave of value creation.

The increased use of combination regimens will increase both the complexity of therapy as well as administration of partnerships across manufacturers. For example, barring continued safety challenges, PD-(L)1-based combinations will rapidly increase in the market both in combination with other immune-oncology therapies as well as targeted, or in some cases chemotherapeutic agents. This trend will inevitably increase the complexity of clinical development and regulatory strategies to demonstrate contribution of parts. It will also affect day-to-day commercial operations of pharmaceutical players who need to define which of the combination partner companies fields pharmacovigilance alerts, medical information requests and disseminates what information about the combination regimen via their sales force and medical science liaisons. Lastly, manufacturers will need to find formulas on how to manage multiple combination partnerships and adequately share value for each one.
Patients and physicians will benefit from increased choices and hope for efficacious medicine combinations. However, these benefits tend to come with some degree of tolerability compromise and potential associated care requirements, boosting cost for oncology care even further in the respective healthcare systems.

New wave of technologies
A wave of innovation is moving through the industry pipeline. In the late pharmaceutical industry pipeline, this is most pronounced for monoclonal antibody derivatives, such as antibody-drug conjugates and bispecific antibodies, as well as of course CAR T-cells with the recent approval of Kymriah and Yescarta. Earlier in the pipeline, additional advances in cell therapy and nucleic acid-based therapies are prominent. The move towards personalised therapies with advances in diagnostics like liquid biopsy enables a more nuanced understanding of disease state and treatment response.
In 2011, Douglas Hanahan and Robert Weinberg published an update to their seminal article “The Hallmarks of Cancer,” which has been cited more than 20,000 times. This paper provided a framework to organise and think about cancer therapies in terms of the specific characteristics of cancers that they address. In the same spirit, we can think of innovation in terms of hallmarks of cancer technology and group innovation into diagnostic technologies and therapeutic technologies. Diagnostic technologies range from digital pathology and imaging to personalised biopsies. Therapeutic technologies range from nucleic acid-based approaches (including vaccines) and cell therapies to classic approaches based on small and large molecules, their derivatives and radiation. Innovation that will affect cancer care in years to come is underway across the entire wheel of technology hallmarks. 

Significant shifts in value 
Payors and professional associations are increasingly focused on oncology, given the increasing cost of oncology care delivery. Both US payors and health systems outside the US are experimenting with different care models. Payors are graduating from multiple small experiments to preferred models driven by value. For example, the UK National Health Service and Singapore are exploring indication-based approaches that drive cost reallocation to interventions with the greatest benefit in outcomes.

From a system’s perspective, and based on our own analysis, more than $100 billion of value in the healthcare system is estimated to shift along specific pathways, resulting in a higher standard of living, better quality of care, more efficacious treatments and improved access. The bulk of the benefits are achieved through better screening and care delivery, resulting in longer cancer-free lifespan and lower end-of-life cost. On a system level, new drugs and better regimens are expected to deliver more modest benefits in terms of value, but they also require a relatively minor increase in healthcare system costs. 

Patients, on the other hand, are already experiencing a step-change in cost, especially with immune-oncology-based combination regimens, e.g., in melanoma. Multiple myeloma is another indication in which costs will continue to increase significantly, given novel therapy entries and triple combination use. In prostate cancer, novel hormonal therapies are moving into earlier stages such as M1 and thus extending treatment duration with more costly alternatives as compared to chemotherapy. The aspect of “financial toxicity” will thus gain in significance as systems focus on drug budgets. Alternative payment models as well as considerations of oncology per-patient cost across the patient pathway from prevention to end-of-life care will thus help address potential constraints on the patient care side as well as optimise the allocation of spend across the pathway to improve overall outcome within the same cost envelope.

Big data will be a key enabler of this shift in value. However, to harness the full power of data, better data standards for higher interoperability and broader data sharing frameworks need to be in place. Initiatives like TRANSFoRm show initial proof for concepts that might also be applicable to oncology, but will need to be pursued with increased focus, rigour and speed.

Where we go from here
Taking a step back, it feels the field of oncology has rarely been in such a promising space. First, there is a wealth of opportunities to operationally execute better on the things being done today. For example, increased patient and physician awareness, improved physician incentives, better patient experiences and support can improve clinical trial recruitment and participation. More integrative data standards building on the multiple systems that already exist today and broader sharing will enable this. Second, novel approaches to conduct clinical trials are already taking hold with regulators supporting accelerated approval pathways, increasing numbers of surrogate endpoints and master protocols. And thirdly, with the impact of immune-oncology and novel therapeutic advances, there is a continued positive outlook that which will make the largest difference in the end -— more effective medicines for cancer patients.