First DiGA registrations: Is this the future of medicine?

The race is open, DiGA can be set in motion. More precisely, it is possible to go through the formal application process in order to obtain funding from the health system. Or, in very neat terms: providers of digital health applications (DiGA) can submit an application to the Federal Office for Drugs and Medical Devices (BfArM) for inclusion in the DiGA directory. The first 15 DiGA have been submitted, the overview can be found here (German) and is updated continuously.

At a time when the professionalism of statistical evaluation of studies is discussed and discredited in tabloid headlines, a disclaimer in advance: Of course, the first 15 submissions do not allow a comprehensive and differentiated picture of digital medicine to be drawn. But a first impression is allowed.

What do we see in this DiGA series? Applications on the subject of nutrition, digestion, diabetes. Apps on mental health and stress. Migraine apps, sleep training and mobility analysis. One deals with data communication between doctor and patient. And then there is ADA. Obviously, this technology is the closest thing to the future of medicine in Germany in 2020. This is good news; in the sense of: After all. However, anyone who expected the establishment of DiGA to give a boost to the future of digital medicine does not need a new app, but simply more patience.

What is the categorical difference here? If you have sleeping or intestinal problems, you are sure to find help with the right app. That’s good. The future of digital medicine – and what is meant here is: the true potential of data – will only become visible where the diagnosis has not yet been made. Data takes anamnesis processes to a completely new level. This is where the power of digital medicine lies, in the networking, linking, processing and interpretation of large quantities of the most varied data. ADA can do this. And Scitim certainly contributes to this. End of this list.

It may be that the very applications that were already fully developed and now only want to tap into an additional stream of revenue are in the front row here. It may also be that these very concrete applications are simply faster and easier to develop. Thirdly, they are undoubtedly capable of generating benefits. But when we ask about the future of medicine, we are still waiting for something that is as much – or even more? – The future is as ADA.

Devastating Result of the 2020 EPatient Survey

The EPatient Survey is an at least reasonably representative online study on the state of digital health in Germany and, above all, on the use of digital health services by patients. In other words: customers. That is positive, we can learn something from that. Alexander Schachinger and his team have just presented the 2020 results. Learning: It is a tragedy.

A highlight: The use of online consultation hours with doctors has tripled. Sounds good. The percentage of patients who used the online consultation hour has increased from 0.7% to 2%. So the trivial realization must be: The online consultation does not take place. It is a chimera. The fact that the survey period included the beginning of the corona pandemic only reinforces this interpretation.

The head of the study sees a “large increase” here. The digital entrepreneur and co-founder of the Spitzenverband Digitale Gesundheitsversorgung, Diana Heinrichs, commented on today’s digital press conference: “The result is devastating”.

Julia Hagen from the Federal Ministry of Health reported from workshops with doctors on health tips and their use in consultation and treatment. A formative impression: the doctors were mostly in a positive mood, but feared overtime. The interested observer asks himself: Yes, what else? The example of Amazon and its uncompromising simplicity of operation, which was also quoted in the press conference, is the result of extraordinarily hard work. The EPatient Survey says: “People want simple and useful health apps, but there is currently no relevant use for them, at least not for the apps that the legislator has on the screen.“ One commernt: One must urge the pharmaceutical assistants to address the customers actively on health related apps. Whether we could at least overtake the educational system in terms of digitalisation, the moderator of the press conference asked. The choice of goals also says something about one’s own ambitions.

So what is most saddening here? The findings that have basically only underpinned an unpleasant premonition with new data – or the reaction to it? Please make your own decision.

Transhumanism in times of Corona

The futurologist in me wavers over a message from Zoltan Istvan this morning. Zoltan is one of the most prominent transhumanists in the US and beyond. He pushes the issue forward in terms of content and also knows how to generate the necessary publicity, right up to his own presidential candidacy. At the same time, he is simply a very nice guy who would not easily cause a stir in any pedestrian zone in the world.

On LinkedIn this morning, he makes the following statement:

Those who have supported the corona lockdown in recent weeks bear indirect responsibility for shrinking budgets in medical research outside the field of virology. Therefore: Those who have already reached a certain age today may simply be too late for the necessary breakthrough in the considerable extension of human life. This is the view of transhumanism.

Anyone who likes it may dismiss it as theatrical thunder. But Zoltan has at least one point here: Do we strike the right balance between maximum short-term action and the courage to think big, long-term and visionary? Nobody can want people to become seriously ill because we have not developed a vaccine against the current corona virus quickly enough. But do we want to prolong human life significantly later than we might otherwise have done? However immediate the interactions will be in the end, the call for courage and vision in times of action is necessary.

Corona: Not a lie, … but a trap

Never before has healthcare been so fast. From a local viral infection in China to a multi-billion dollar pan-European donor conference in just a few months. We could almost believe that the future of medicine is being decided in the international competition for the first vaccine against corona. The Corona App will help us to digitize health care. And the ethics committee is dealing with the compulsory vaccination. Everyone is already happy, or at least busy. And trapped.

Systems tend to be self-preserving. This basic truth from the systemic consultation will prove true in the coming months using the example of Corona. The system has set up a simple but tempting trap for us. It follows a simple dramaturgy:

  • We were able to develop, test and produce a vaccine in a very short time. This proves the efficiency of our health system, Research Department.
  • We were able to ensure at all times that sufficient free capacity was available in intensive care medicine. This proves the efficiency of our health system, Department of Stationary Medicine.
  • We now have a health care app, with/without… (please insert any tech company). This proves how flexible and capable of development our health system is, department “Something with Computers”.

The subtext is clear: Everything’s fine. Please do not touch anything. Just keep funding the same.

To counter the cheap counter-attack with the necessary: Whoever has such a well-developed and well-funded health care network in his everyday life can easily stay cool even in pandemics. Of course. But we would fall into the trap mentioned above if we were to conclude that everything is already in order. As if all we had to do was pay a little better for nursing care and there it was, the prototype of a sustainable health system. It is not.

The real digitalisation of the healthcare industry is still in full swing. It goes way beyond fighting a single Corona family virus. Health is ripe for disruption. This will be a place not to think about Corona in the weeks ahead. Health is bigger.

Beyond Meat: Today the future starts with the discounters

The shelves of the big discounters are usually not the first address when it comes to the future of healthcare. Today it’s different, since today “Beyond Meat” is on the refrigerated shelves at Lidl. A milestone in food retailing. But more than that: with consumer products such as “Beyond Meat”, a new era also begins for healthcare. The door to individualized medical food is open.

It is remarkable that Wiesenhof CEO Peter Wesjohann has secured the exclusive distribution rights for Beyond Meat in Germany. Wiesenhof thus joins the ranks of companies such as Rügenwalder. Actually classics of the meat industry, they rely on the constantly growing group that prefers vegetarian and vegan products. I discussed this development with both of them a few weeks ago at an event on the future of nutrition in Oldenburg’s Münsterland. In beautiful harmony both emphasized that they assume a stable growth of the vegetarian and vegan segments. Rügenwalder now accounts for 30% of group sales here.

Medical Food

With the actually inconspicuous packaging from Beyond Meat, there is a new idea in the refrigerated shelf. It appears to be a prognosis that is by no means daring: customers will take this idea home with them and it will solidify. The idea is: food will be made for me. The technologies currently under discussion for alternative protein sources lead directly to on-demand options. Exactly the same technology and supply chain can be used to produce meat substitutes on the spot. On order. According to my taste requirements. And, more importantly, based on my health data. In the first step, my “Beyond Meat” is tailored to my allergies and intolerances. In the second step, it compensates for nutrient deficiencies measured in real time. The step to order medical food couldn’t be smaller.

By the way, the introduction of “Beyond Meat” is also a picture book case for exponential growth. Whoever restricts it to the “burger for veggies” market in the long run will overlook the actual potential: individual meat-like products, made to order. The focus is not on the 10% vegetarians, the focus is on all those people who want to increase their well-being through nutrition, namely: all of them.

Mystery doctor’s letter

The report is two weeks old, it has what it takes to become a scandal and yet it goes unheard: a large number of general practitioners spend up to an hour a day reading medical letters, especially from clinics. And they don’t understand them. A study conducted by the University of Düsseldorf has shown this very clearly. The Ärztezeitung has reported on this. Nobody should be able to say that he did not know. And yet: Nothing.

Incomprehensible abbreviations, superfluous information, no structure, real gaps. The doctor’s letter in its current form is obviously not a suitable instrument for doctor-to-doctor communication. There are clear legal obligations for reliable discharge management. Author and reader of the letter also both studied, even the same subject. Nevertheless the quality of the communication is so miserable that the physician letter is more than a source of error: It is obviously a mistake warranty.

And yet I am again meeting players in the healthcare sector for whom the scan of a handwritten doctor’s letter is already a step in the direction of digitization. Most recently at a high-ranking conference in Berlin in April 2019. Spoiler alarm: It’s not. The study by the University of Düsseldorf clearly shows how low the fruits of the digitisation of the health system actually hang. 12,000 symptoms are classified. They must be recorded and documented, and one or more of the 10,000 diseases described must be deduced. What is an ongoing overload for the human brain mutates into a finger exercise in digital communication. Every computer science student in the first semester will program a communication logic that reliably processes and transports this information. Just as a warm up in the morning.

Did we ever think that a letter was the right medium to share complex medical data? We are not yet talking about the legitimate requirement of patients to receive their own medical data and its clinical interpretation first and foremost themselves – and in an understandable form. Anyone who has a serious interest in increasingly digitalised medicine for the benefit of people will start tomorrow.

Three questions – three answers: Dr. Stefan Knupfer, Board of Directors at AOK Plus

The 2b AHEAD expert network in dialogue. Health experts regularly raise relevant questions on the future of health. Other experts from our network comment on this – and in turn ask new questions that will go to new experts. In this way, an inspiring dialogue grows and we will continue to expand it.

Focus today: Dr. Stefan Knupfer from AOK Plus

The expert questions today go to Dr. Stefan Knupfer, Deputy Chairman of the Board of AOK Plus for Saxony and Thuringia, based in Dresden. In 2006, Dr. Knupfer was appointed as an authorised representative of the Management Board. With the merger to form AOK PLUS, he assumed the role of Managing Director of the Market Division. Since 2011, he has worked as Managing Director of the Finance/Controlling unit and authorized representative of the Executive Board.

The future of the principle of solidarity in an ageing society

Peter Ohnemus, DacadooPeter Ohnemus, founder and CEO of Dacadoo: How can the principle of solidarity be financed in a world where we live to be 85 years old on average and where 30% of the German population will soon be 65+?

Dr. Stefan Knupfer, AOK Plus

Dr. Stefan Knupfer, Deputy Chairman of AOK Plus: The logic underlying the solidarity principle to this day is based on the assumption that an ageing society must also be a sicker society. I think this approach is obsolete.

Isn’t it rather the case that older people stay healthy longer and age healthier? Isn’t it also the case that ageing people today have better and cheaper therapies available than a few years ago?

The main burden of health expenditure in a person’s life lies in the last three years of life and is significantly higher for chronically ill people than for those who are not chronically ill. So is it not much more sensible to focus on the prevention of chronic diseases at this point? I think that the digital transformation offers numerous opportunities here, the potential of which is currently far from being sufficiently exploited.

The fact is that both medical progress and, in particular, digitalization are progressing at a rapid pace. This is accompanied by numerous opportunities that have not yet been exploited, or only insufficiently exploited, to make health care more efficient and different, without losing sight of the well-being of the individual in an ageing society.

In addition, the social and economic system in Germany is currently essentially based on private property, whereby a redistribution principle or the approach of a Sharing Economy has so far had little effect. As a result of demographic change and increasing tendencies towards individualisation, the solidarity principle of statutory health insurance schemes is getting into difficulties. In the future, this will pave the political way for a citizens’ insurance to provide basic services or a new financing of the solidarity principle through tax subsidies, e.g. from a financial transaction tax.

In the future, distributive justice will have to play a greater role. Health will become a public good. Particular challenges lie in the equitable distribution of health resources and in equitable access to health prevention and care for all people, regardless of their origin or income. Rationalisation through digitisation alone will not be enough to compensate for cost pressures from medical progress and demographic change, making the question of alternative system logic unavoidable.

In a sharing economy based on distributive justice, everyone has equal access to medical-technical innovations. Trends such as increasing “medical tourism” in the sense of cross-border use of medical services and the increasing willingness to share data also necessitate a fundamental rethink. In my view, Big Data can be a new “currency” and replace obsolete causality arguments. In times of digital transformation, an idea of solidarity extended by the data division dimension will continue to express the will of people to stand up for each other in the future.

Experimental medicine for terminally ill patients

Liz Parrish, BiovivaLiz Parrish, Gründerin und CEO von Bioviva: Do you believe that terminally ill patients should have access to experimental medicine? Please explain.

Dr. Stefan Knupfer, AOK PlusDr. Stefan Knupfer, stellvertrender Vorsitzender der AOK Plus: In my opinion, experimental medicine represents the basis of all therapeutic interventions, as it lays the foundation for further clinical trials with proof-of-principles experiments.

Experimental medicine makes it possible to understand human diseases, so as their origin, their pathogenesis and their effects on the organism in general and to develop new effictive therapies of various kinds from this understanding. Experimental medicine usually means basic research – of course with the aim to improve practical therapeutic action at the bedside.

However, until the findings of experimental medicine are actually available at the bedside, often a lot of time passes – time that a terminally ill person may no longer have. Such a terminally ill human being, fully aware of and fully aware of his situation, and freely to choosing to do so should, in my view, have access to experimental medicine – that is, to medical interventions that are not yet fully ecidence-based for health care.

The key point, however, is that terminally ill people are often no longer able to make such a decision of full consciousness and full willpower themselves. Here I see an ethical fundamental question of our society that urgently needs an open discourse: how do we deal with the advanced medical options we now have to artificially keep people alive? May trusted people speak for terminally ill relatives, ie act in their (presumed) will when it comes to choosing experimental medicine as a last resort or even providing a terminally ill relative for further basic research?

So far, there is no social consensus, no “modus operandi”, which is carried by all people. In this respect, a generalized answer to the question of access to experimental medicine for terminally ill people, which can only be answered individually, is currently not possible.

The doctor as “health pastor”

Frieder Hänisch, LimbachgruppeFrieder Hänisch, Business Development, Limbach Gruppe: Is the essential role of the physician in the future still the “health pastor”, who brings about the therapy decision and has a competence advantage over technical services (e.g. ADA-App), or is he only needed as a legal entity for liability issues in the health care system?

Dr. Stefan Knupfer, AOK PlusDr. Stefan Knupfer, stellvertrender Vorsitzender der AOK Plus: To start with, a counter question: Is the doctor really a “health pastor” today? Is he not rather a quite rational “health status surveyor” and a therapist of often only symptoms, but not of systemic and dynamic states – because illness and health are not static entities?

The so-called “talking medicine”, which places high demands on the social skills of the physician, has in recent decades actually stepped more and more into the background of medical activity. However, I believe that this trend will again develop in the direction of a return to what we call “pastoral” competences. Social competences, a high degree of empathy and the ability to advise and perhaps even coach other people will play a decisive role in the role of the physician in the future.

Similarly, physicians will be required to have a much greater understanding of digital applications in the future, because they will support the work of physicians on patients to a much greater extent in the future. The role of the physician will be between the physician as “Life Scientist” and the physician as “Mental Scientist”.

The information asymmetry between doctor and patient is decreasing more and more, which means that mature and well-informed patients will expect the best possible offers from a doctor for their respective health situation in the future.

Disappointment CES – the future of healthcare is out this year

Many colorful pictures, perfectly suitable for photo galleries on almost every news website. The CES in Las Vegas is a grateful media event. For years there has been no listing of gadgets and news without a “Health” section. But where is the promised future this year? The column often remains empty. Disappointment CES.

The BBC refers to Pillo, a likeable pill dispenser assistant for the home. But it’s already several years old. Otherwise BBC names technology for pain therapy, the effectiveness of which it directly denies.

Withings presents a device for – Attention! – measurement of blood pressure. The in-house communication department promises results on a clinical level. This is certainly practical, as is often the case with Withings, the design is pleasingly appealing and Withings received the CES Innovation Award for it. This in itself says a lot about the innovative power that this year’s CES will bring to the healthcare sector. Blood pressure! Next to it are smart watches. Genuine innovations. But I don’t want to do withings bashing. The company has successfully left the stopover at Nokia’s health unit behind. After all, they do show something.

The Stuttgarter Zeitung reads “CES in Las Vegas – Completely new perspectives in medicine” – but that was last year. This year, the topic is drowning behind autonomous vehicles, larger televisions and powerful mobile phones. There’s no question that none of the three is being played on for the first time, neither in Las Vegas nor elsewhere. Where is the impetus for the future of healthcare? Anyone who had expected the impetus to change the often cumbersome healthcare system from innovations on the consumer side (the author counts himself among them) can only hold true: Disappointment CES for the healthcare industry.

Three questions – three answers: Frieder Hänisch, Limbach Gruppe

The 2b AHEAD expert network in dialogue. Health experts regularly raise relevant questions on the future of health. Other experts from our network comment on this – and in turn ask new questions that will go to new experts. In this way, an inspiring dialogue grows and we will continue to expand it.

Focus today: Frieder Hänisch from the Limbach Gruppe

The expert questions today go to Frieder Hänisch, Project Manager Business Development at the Limbach Gruppe based in Heidelberg.  The Limbach Gruppe was founded as an association of independent laboratories and is the largest owner-managed laboratory group in Germany.

Asymmetry of knowledge

Peter Ohnemus, DacadooPeter Ohnemus, founder and CEO of Dacadoo: DNA testing is becoming more powerful and cheaper. How will we manage this asymmetry between customers and health insurers in the future? The customer can know everything about his clinical picture and the health insurance companies simply have to pay “blindly”?

Frieder Hänisch, LimbachgruppeFrieder Hänisch, Business Development, Limbach Gruppe: There are two scenarios in which genome sequencing is used in a way that can be experienced by the individual: Diagnostic sequencing based on a case of illness or sequencing on behalf of a customer for self-payers.

In the case of a disease, genome sequencing is indicated in a selection of disease patterns for therapy decisions. In Companion Diagnostic, the most effective drug is selected on the basis of the individual genome. Prominent examples are oncological diseases such as breast cancer. Here, medicine has learned that the drugs originally developed are ineffective in some patients because the mechanism of action of the drug cannot interact with the cell receptors. In 2017, however, there were only 14 disease entities for which such a procedure can be used meaningfully.

In my view, there is no asymmetry in this scenario. Both the patient and the health insurance company have a high degree of interest in the fast, target-oriented and thus also most cost-effective therapy.

In the case of a healthy payer, the knowledge of the genome information has to be considered from both sides: A) the information is available to the health insurance company but not to the contributor, and in the opposite case B) the genomic information is available to the contributor but not to the health insurance company.

A) The health insurance company corresponds to an insurance company in its business model. It therefore always has an interest in knowing individual disease risks and their probabilities of occurrence in order to control the business model via the contribution rates. In extreme cases, this means measuring premiums on the basis of the individual genome. As long as society does not block it by ethical norms and legislation, the procedure described is likely to be followed in the future.

It should be mentioned restrictively that the genome only permits statements about the probability of occurrence for a selection of diseases. In my view, knowledge about the Internet browser history of a health insurance fund member is much more meaningful for the formation of risk models than genetic information.

B) The current commercial offers for genome sequencing such as “23andMe” (genome sequencing service for 99 USD, as of November 2018) or MyHeritage present themselves more as lifestyle products for enthusiasts and genealogists. In essence, there is another question at the forefront: Does a psychological factor come into play when private genome analysis provides a probability of illness for serious illnesses that can only occur in the middle phase of life? Huntington’s disease, for example, does not break out until around the age of 40. Knowing a predisposition can lead to an enormous increase in psychological stress. The right of knowledge contrasts with the right to conscious ignorance.

I would not speak of a “blind payment” by the health insurance companies. A payment is made in case of illness, not in case of the probability of a future illness. Furthermore, on average 80% of the individual health costs are incurred at the end of life due to intensive medical care (about the last two years of life). From this fact out I consider the information advantage of an individual by knowledge of its hereditary information negligible for the health system.

Personalization vs. data protection

Arkadiusz Miernik, Universität FreiburgArkadius Miernik, Professor at the University of Freiburg: How will the further development of data-based, personalised treatment approaches be possible if data protection requirements become increasingly strict?

Frieder Hänisch, LimbachgruppeFrieder Hänisch, Business Development, Limbach Group: Thank you very much for this very up-to-date and important question. It is also a complex question.

Even today, without personalized treatment approaches, pharmaceutical research faces the great challenge of identifying the ideal patient population and including it in the later phases of clinical trials. Since the statistical effect strength of the new treatment approach must exceed that of the treatment previously used, the choice of study group per se is becoming increasingly difficult. The fundamental hurdle is therefore the study design and only much later data protection.

Data protection becomes relevant if the largest possible data pools are to be created over a longer period of time and then evaluated. In other words, all studies that use a big data approach. On the scientific side, I’m a little sceptical about the use of Big Data. More data does not necessarily mean better data. For me, the most important question here is the minimum data set that is required to answer the question.

I see the use of new technologies such as blockchain technology as a promising solution. It offers the possibility of a validated and complete documentation of the used data (smart contracts). This technology makes it possible, for example, to link the personal data of study participants with a token. Each use of the data in the sense of an analysis should generate a traceable transaction. The data owner thus has the option of controlling the use of his data and retaining decision-making authority similar to copyright. A little further thought can also result in new payment models for the use of personal health data. The study participant deposits the data anonymously and, in the event of a request for use from a study, can release the transaction, if necessary even for a usage fee.

Unfortunately, as far as I know there is no implementation of this technology yet, so this thought experiment has yet to prove itself in reality.

Interaction of the physical and the mental

Florina Speth, 2b AHEADFlorina Speth, Senior Researcher, 2b AHEAD ThinkTank: The interplay of our mental and physical state is often still ignored in the Western medical world. How will this develop in the future?

Frieder Hänisch, LimbachgruppeFrieder Hänisch, Business Development, Limbach Gruppe: In contrast to physical diseases, which are described and understood very well in molecular terms, mental diseases are predominantly phenotypically characterized. Similar symptoms are interpreted as similar diseases. Since the symptoms and intervals of the disease phases are very broad in the area of mental diseases, this basic assumption may lead to a misleading classification of disease patterns. It would be better to classify according to the molecular profile. As an analogy, the reclassification of bacteria based on findings from genome analysis should be mentioned here.

Furthermore, the diagnosis of mental diseases is essentially dependent on standardized questionnaires, in which the patients’ self-awareness contributes to the diagnosis and is also based on the psychologist’s subjective experience. Although biomarkers for diagnosis are in research, they have not yet gained market acceptance.

However, the further development of this field of science is clearly recognizable and the standard work on the classification of mental diseases “Diagnostic and Statistical Guide to Mental Disorders” (DSM-V) increasingly refers to the basic molecular events.

Neurodegenerative diseases – such as Alzheimer’s dementia – are diseases of old age. Life expectancy worldwide rose from 50 years in 1960 to over 65 years in 2010. This increase by 15 years has unmasked these clinical pictures. They have always been there, but their symptoms were hardly relevant because other diseases had already led to death.

These orthodox medical examples show a developing understanding for the mental impairments also in the western world. With reference to your initial question, I cannot name any good reasons in Western medicine for this strong physical focus. In Asia this connection of body and soul is, in my opinion, also based on the religious world view. In Japan every object is attributed a soul, which is a completely different basic understanding than our western division into organic/animated and inorganic substances.

3 Questions – 3 Answers: Bioviva

A new format starts here on the blog: The 2b AHEAD expert network in dialogue. Health experts regularly raise relevant questions on the future of health. Other experts from our network comment on this – and in turn ask new questions that will go to new experts. In this way, an inspiring dialogue grows and we will continue to expand it. Would you like to become a part of it? Just send me a short mail or comment here.

In the focus today: Liz Parish and Avi Roy from Bioviva

The expert questions today go to Liz Parrish, founder and CEO of Bioviva, and Avi Roy, CTO of Bioviva. Bioviva is one of the pioneers of telomerase – or to describe the result: Bioviva is working to prolong human life by intervening in the genetic code. Significantly prolonging it. Bioviva’s research focuses on the ageing processes of individual cells. Parrish, Roy & Team are among the most important drivers of the longevity movement.

Success-based medicine

Peter Ohnemus, DacadooPeter Ohnemus, Founder and CEO of dacadoo: With digital health, the proof of positive outcomes of drugs can be fully documented. When do we want to start designing a 100% outcome-based healthcare system?


Liz Parrish, BiovivaLiz Parrish, Founder and CEO of Bioviva: We do not have any evidence to support the claim the ‘digital health’ can absolutely prove positive (or negative) outcomes for drug trials. Most molecular and physiological biomarkers are hard to measure digitally without having an advanced molecular pathology lab. But regardless, your question regarding the outcome-based healthcare system is a valid one. Currently, in the UK the National Institute for Health and Care Excellence (NICE) balances the choices of medicines available to patients based on a multifactorial assessment of cost-effectiveness, opportunity costs associated with decisions, and the impact of treatment option on quality-adjusted life years (QALY). QALY’s and disability-adjusted life years (DALY) are the main outcome-based method to test the efficacy of a treatment in a healthcare system. Although flawed this is currently considered the gold standard by health economists and politicians. In conclusion, all countries that can afford to have a functioning health care system try to assess the efficacy of treatments based on outcomes, but the biomedical science community need to provide them with better biomarkers than QALY and DALY’s.

Who do we trust?

Arkadiusz Miernik, Universität Freiburg Professor Arkadiusz Miernik, Freiburg University:  Should we trust the big pharmaceutical companies or rather biohackers in the future?



Liz Parrish 2, BiovivaLiz Parrish: We think that it is foolish to blindly trust any organisation or system. At BioViva we really like the Russian proverb, which was used by President Ronald Reagan on many occasions, “Trust but verify.” To elaborate, we are building a standardized bioinformatics testing platform which will test the efficacy of anti-ageing treatments regardless of them being produced by big pharmaceutical companies, or small biotech startups, or indeed biohackers.

Consequences for the immune system

Florina Speth, 2b AHEADFlorina Speth, Senior Researcher, 2b AHEAD ThinkTank: How does our immune system react when we continuously and permanently prevent diseases?

Avi Roy, BiovivaAvi Roy, CTO, Bioviva: Dr Speth, I am not quite sure that I understand your question, but I’ll try to answer it. In biogerontological research, and at bioviva we are trying to rejuvenate the human body and its organs and tissues at a cellular level. Our research and therapeutics target the hallmarks of cellular ageing which includes genomic instability, telomere attrition, epigenetic alteration, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication.  these processes happen in every cell type in the human body. when we think about treating a disease we are not necessarily thinking about cardiovascular disease or dementia instead we are targeting these fundamental cellular processes that go awry overtime. Therefore immune system cells will be beneficially affected by these anti-ageing treatments and would produce favourable outcomes. We imagine a future where we can rejuvenate long live cells, kill cells that are senescent or cancerous, and create new functional cells from stem cells.