A sublime strategy for holistic diagnoses

Interview by Daniela Zimmermann

Professor Erich Reinhardt (below), President and CEO of Siemens Medical Solutions and member of the Board of Management of Siemens AG, discusses the company's current and future strategies.

Photo: A sublime strategy for holistic diagnoses

Prof. Reinhardt: We defined our strategy in the late 1990s; we are currently implementing it, step by step. The strategic orientation is based around the development of products, software and services that help our customers to improve the quality of their healthcare services whilst lowering their costs. We see two big opportunities here: innovations in various medical technologies for diagnosis and therapy, and the optimisation of processes in healthcare systems with the help of information technology. Broadly speaking, this is our strategy. To achieve progress, we will continue to implement it over the next five years.

Why was the strategy developed in the late 1990s?
At that time we undertook an extensive analysis of healthcare requirements, and discovered stable, global trends: The population is growing and becoming increasingly older; awareness of health issues is growing, and the requirement for healthcare services is on the increase. In addition, there is great awareness of the need to increase efficiency and lower costs. Our strategy is based on that.

Are you trying to shift responsibility for healthcare over to the ‘end users’, so they must undertake these issues themselves?
I don’t like the term ‘shift’. But I do approve of a healthcare system in which every individual becomes more responsible for his or her own health. Despite all current discussions, I don’t actually believe that the system is too expensive for the individual. It all boils down to the question of where to invest one’s money. The Germans spend an annual 170 billion euros on cars; spending on statutory medical insurance is around 140 billion euros annually - half of this covered by employers. So it really depends on how, and for what, you can motivate people to spend their money.

Like not going on a holiday and investing the money in one’s health instead?
ER: A holiday is not a good example. It is all about the overall attitude towards the importance of health for each individual. How much is somebody prepared to spend if he receives certain services in return? Anyway, we assume that most people – although probably not all of them – will be prepared to spend on healthcare issues which are of particular relevance to them.

What gives you reason for hope?
Demand for, and interest in, healthcare services among the general public is increasing, worldwide. The question is whether we can service this demand within healthcare systems. Do we have the relevant products? My answer is yes! Moreover, health also will become important from an economic point. It is already one of the most important economic factors. You could almost say that, if you want to boost the economy, you must stimulate the healthcare system - and it may not actually be the right approach to simply look at costs. It is just as important to improve quality, to make what’s on offer more attractive, whilst at the same time offering services at the best possible costs. As yet, opportunities to lower costs through increases in efficiency have by no means been exhausted.

What effect does this philosophy have on individual products? What do they offer that they didn’t offer before?
I’ve already mentioned this strategy briefly: Increasing quality, lowering costs. So, with new products, the questions we need to ask ourselves are: What can I do to diagnose illnesses earlier and How do I obtain the specific information required for this? This is important for diagnosis, so that a clearly defined therapy can be developed that works quicker, is more efficient and therefore saves costs, apart from the fact that it will be far more convenient for patients. With regards to therapy, what we need to ask ourselves is how we can monitor the effects of therapy to make sure that, if the desired treatment effect is not achieved, we can change treatment procedures at an early stage. There is a lot of potential here, because healing can be monitored in the long term, and an individually customised monitoring programme can be initiated for risk cases. So, quality in all areas, from early detection and diagnosis, treatment and care needs to be increased through innovations.

Molecular imaging plays a decisive role here.
Yes. Currently a lot is happening in this area, for example in biomarkers. Another important subject is the question of whether biomarkers could be developed to diagnose Alzheimer’s. Amyloid plaques are important here. We are currently testing an FDDNP marker that can be used in two different ways: for early detection and as a product for the pharmaceutical industry. For the latter, there are already intensive studies to establish where and how different drugs actually work. Based on the hypothesis that amyloid plaques are relevant, a researcher can then monitor whether a drug is having the desired effect with the help of these markers.

There are further starting points for molecular medicine in terms of the early detection of diseases: It will become possible to carry out a risk analysis at a very early stage in someone’s life by looking at an individual’s genetic structure and its effects on the development of individual diseases. This, combined with a look at someone’s family history, should give us a good idea of how much a person is, for example, at risk of developing cancer. At a later stage in that life, we would then look at what type of preventive medical check-ups are to be recommended.

Yes, it is a risky area, which is why individual patients must be allowed to choose whether they want to undergo these examinations or not.

What happens when medical insurers actually order you to have these check-ups?
This would not be my approach. However, insurers may actually decide to no longer cover treatment for certain illnesses if the at-risk individuals refuse to accept preventive measures that have been proved beneficial for their individual circumstances. Or, put another way, is it right to expect the community to cover treatment if at-risk individuals refuse effective preventive procedures? However,  these are issues for society. It is not up to the medical industry to determine the right way forward, although we do play an active role in these discussions. We have to achieve a consensus here, along with detailed and comprehensive information for the public.
Let’s return to the medical advantages inherent in the early detection of diseases. Take cancer for example: People known to be at risk can already be screened – at low cost – with certain blood tests. We only have to look for certain proteins associated with certain types of tumours. If we find these proteins we can use the relevant imaging procedures, such as PET, to determine from where these proteins have come. If this is done during the early stage of the cancer developing, chances of a cure are the highest – which, of course, is what we’re interested in! However, this must be done on a reliable scientific basis. At the moment there is still a lot of uncertainty around these issues.

Siemens has been on a bit of a ‘shopping spree’ recently, purchasing DPC, CTI and Bayer Diagnostics. What do ‘traditional’ Siemens people think about dealing with biologists, pharmacists and laboratory people?
If you look at our strategy, as I’ve explained, using molecular medicine as an example, it is important to have in-vitro diagnostics in your portfolio. It isn’t enough just to produce body images; you also need to analyse blood and other body fluids to obtain a diagnosis. The potential for synergy here is enormous. That’s why we acquired DPC and Bayer Diagnostics. These companies cover in-vitro diagnostics, which has now expanded our portfolio. We always say that it is important for our strategy to service areas of prevention, early diagnosis, diagnosis, therapy and care. Those are our fields of activity. So, from a strategic aspect, to make progress, we are looking at what we must do with this chain, this continuum of care.

Now we are no longer limited to the product side, but also cover the chemical side - and we are definitely on new ground here, although we made a first step on to that ground when we acquired CTI last year. When you run PET systems, the contrast media and biomarkers are of great interest – and CTI has a biomarker development project that looks into the diagnosis of various diseases, such as Alzheimer’s, which is also a chemical issue. So, again we have synergies here. However, this is still new ground for us, which certainly needs to be handled with care and attention. Our involvement in molecular medicine is exciting, because we are linking processes that others have not yet connected. We are very optimistic in this.

It must be exciting to draw together these very different cultures and encourage chemists, biologists, engineers, MRI and CT specialists to exchange ideas.
Yes. But we have already had a little practice, and have discovered there are interesting ways of bringing together two different worlds with the same objective. There is definitely a lot of interest and curiosity on both sides.

How do you view developments in CT and MR-PET?
From my point of view, the biggest potential lies in computer-assisted diagnostic procedures linked to evaluation programmes that view images and screen them for - and point towards - suspicious areas. This knowledge-driven medicine will play an important role. We have been investing in this for a few years, because we want to support radiologists and enable them to view and read images as quickly and efficiently as possible. Computer-assisted evaluation programmes can compare images, develop correlations and to use databases to achieve objective results. Generally speaking, this means that information and knowledge processing is becoming more important, and research in this area will intensify.

Regarding MR-PET: What I can say is that there is a lot of scientific interest in this project. We know how the technology works and are currently building prototypes. We are doing the right thing with this, and are confident that our work will soon bear fruit.

17.11.2006

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