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The Personalized Medicine Consortium of Luxembourg: Driving Innovation in

Healthcare for Luxembourg

Goal

Small is beautiful

• Luxembourg has the potential to be a world leader in testing and implementing new advances in personalized medicine into its health care system

• 5 hospitals, no medical school, 1 university

• Small, but excellent scientific community – very collegial and embraces partnerships

• Different Ministries work closely together on personalized medicine initiative

• Ministry of Health believes that research will improve health

• Introduction of new innovation involves only one level of government

• One of three most expensive healthcare systems in world

• September 2010 – agree to support a major coordinated initiative in personalized medicine focused on four priority research areas: – Cancer (lung, colon, and breast)

– Type 2 diabetes

– Parkinson’s disease

– Large population cohort

• Creation of Consortium to bring together all of the key stakeholders under one umbrella

• Goal: Establish Luxembourg as a leader in the adoption of new advances in personalized medicine

Evolution of Personalized Medicine Consortium (PMC)

Transition from Traditional Medicine to Personalized Medicine Will Require Radical Change

Hospital and

Pathology labs

Patient Doctor

Results

Diagnosis

Disease

Tissue

Examine

Treatment

Symptoms

Integrated

Information

Patient Doctor

Summary

Data

Tissue

Examine

Probable

Diagnoses

+

Recommended

Treatments

Molecular

Diagnostic lab

Best Treatment

Clinical

Data

Worldwide

Data

Informatics

Centre

eHealth

Record

1) How translate new knowledge into innovation?

Translational research and clinical trials do this step reasonably well

1) How transfer new innovation into a healthcare system?

Need new research process here – topic of Luxembourg Health Summit

Two Big Problems in Personalized Medicine

Problem: Introducing Innovation into Healthcare Often Fails

Discovery Research

Translational Research PMC

Healthcare System

Benefits for citizens of

Luxembourg

Very small

benefits

Research

Innovation

Successful research does not automatically lead to

successful innovation

• Patients/public – many effective interventions require behaviour change (smoking, diet, screening)

• Hard to change widely held beliefs – risk of vaccinations, genetically modified food, fluoridation of water, evolution

• Physicians – too many new guidelines for treatment; changes often may impact income; require new knowledge

• Hospitals – change requires radical redistribution of work

• Government – concern that radical change will cost too much and be too disruptive (making re-election difficult)

Barriers to Change

Missing Step in Innovation Process

Basic Discovery Research

Pilot Studies in Healthcare

System

Clinical Trials and Studies

Translational Research

Use in Healthcare

System

New Paradigm: Pilot studies followed by gradual introduction into the health care system

Discovery Research

Translational Research PMC

Healthcare System Benefits for all

citizens of Luxembourg

Small Pilot

Good benefit for few

Larger Pilot

Good benefit for

more

Proposed new approach for innovation in healthcare in Luxembourg

Healthcare System

Research Innovation

• Ten countries are working together to test health innovations in pilot studies in a real healthcare systems

• Develop process for introducing radical change into a healthcare system

• Test new approaches in pilot studies on groups with 5,000 to 1 million participants

• Jointly plan pilots to bring best practices to all countries

• Share successes and failures

• The PMC is working with the Ministry of Health to explore the possibility of joining this initiative

Maimonides Project – Introducing Innovation in Healthcare

Maimonides Strategy

Think Big • Luxembourg is leader in early

adoption of new advances in personalized healthcare

• Strive to:

– Prevent the preventable

– Cure the curable

– Manage chronic disease when necessary

Act Small

• Small projects that can be easily replicated anywhere

• Partner with the most innovative companies and research institutes

• Use best practices from other countries and share our experiences

(Big Dreams and Small Practical Projects)

May 2

• 40 Luxembourg opinion leaders will meet to discuss ways for Luxembourg to introduce innovation into its healthcare system. The goal will be to identify 3 or 4 projects that can be started this year.

Potential themes for projects:

• Healthcare Services

• Personalized Health

• Active Lifestyle for Health

• Diet and Stress Management

• Healthy and Aging Population

Luxembourg Health Summit

Questions and Comments

Organization of PMC

Cancer Diabetes

LNS

CRP-Santé CIEC

IBBL

LCSB

Parkinson’s Disease

Health Economics

Normal Cohort

PMC

Composition of PMC

• Leaders of each program in

personalized medicine

• Leaders from each major partner

• CIEC

• Health economics

• Laboratoire National de Santé

• IBBL accepts responsibility for the

administrative budget of PMC and

for coordination

• PMC meets monthly

• Decisions made by consensus

• Healthcare system not aligned with current health problems

• Most patients have chronic disease and system was created to meet acute needs

• Health system responds well to small innovations, e.g., new imaging technology, new laboratory tests

• System not ready for radical changes to align system with needs

Problems

• To make Luxembourg the healthiest country on earth

• To prevent diabetes

• To prevent heart disease

• To ensure the future health of your children and grandchildren

• To make Luxembourg’s health system efficient, innovative and user friendly

• To work closely with all groups striving to improve health

Opt-in:

• Smoking – largest risk factor for preventable disease - risks identified in 1938-1950; US Surgeon General warning in 1964; still have 15-40% of adult population smoking.

• Lumpectomy – never good data supporting radical mastectomy. When data confirming effectiveness of lumpectomy, still took 15 years to obtain wide-spread use.

• Overuse of antibiotics – described as problem over 30 years ago and still a problem

• Electronic Health Records

Solutions Difficult to Implement

Components of Personalized Medicine Initiative

1. Excellent, multidisciplinary research teams

a) focused on specific problems using systems biology

b) conduct the innovative research

c) coordinate the clinical testing of novel interventions.

2. Sophisticated technology platforms

a) collect high quality tissue and clinical data

b) high through-put technologies generate the large datasets

required by the teams.

3. State-of-the-art informatics

a) conduct informatics research

b) support the disease teams for data mining, data analysis and

model building.

• Tissue and data bank

• Technology hub

• Research

• Personalized Medicine Consortium (PMC)

IBBL – Integrated Concept

IBBL Vision: To be an international centre of

excellence in biobanking and to accelerate the

introduction of personalized healthcare for the benefit

of Luxembourg