Lateral thinking on diagnostics can help tackle antibiotic resistance

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(Originally published on Health Service Journal Blog, 18th Nov 2014, available here)

New diagnostic technologies can help improve patient outcomes, support changes to our habits and improve surveillance systems to tackle antibiotic resistance, writes Anna Williams

The rising use for antibiotics was linked with the growing prevalence of antimicrobial resistance in a Public Health England report, published last month. To most health professionals this is not groundbreaking news. Nevertheless, our understanding of the development mechanisms of resistance pales in comparison to the magnitude of the problem it presents.

Thankfully, this year there has been much very vocal activity about antimicrobial resistance, such as the publicity surrounding the Longitude Prize. Projects such as these should make us all re-examine our own relationship with antibiotics and look at what can be done to help slow resistance. There is no “magic bullet” for this problem but more can be done to help both from a technical and a social perspective.

Today marks the launch of the Longitude Prize, so it is fitting that we should open the competition for entries on the same occasion as European countries come together for Antibiotics Awareness Day. There is no better time to spread the message about prudent use of antibiotics and reflect on the global problem of antibiotic resistance.

Focus on the future

The Longitude Prize 2014 is a competition with a £10m fund to tackle antibiotic resistance.

I work as a researcher in the team developing the prize at Nesta. We are asking people from across the globe to come up with a point of care diagnostic to detect and understand infections to enable the prescription of the right antibiotics at the right time.

We hope entrants produce new and innovative diagnostics that will ultimately help to slow the rate of antimicrobial resistance and enable us to safeguard antibiotics for the future.

Tools and tests are one way to help us slow resistance by providing healthcare professionals with information to help make accurate clinical decisions. They can help definitively rule in or out bacterial infection, directly informing the decision to prescribe antibiotics.

However, there remains a technical challenge in developing a diagnostic that is rapid and sufficiently accurate to inform antibiotic prescriptions at the point of care, as well as being cost effective.The diagnostics the Longitude Prize seeks to develop may also go one step further by providing all of the necessary information to identify an effective antibiotic or combination of antibiotics.

This would allow clinicians to use a targeted, narrow spectrum of antibiotics that perhaps they wouldn’t normally use on the first occasion, thereby minimising the use of broad spectrum antibiotics. There are some exciting diagnostics out there already – for example, Spectromics is in the patent application stage for its urinary tract infection diagnostic. The test monitors phenotypic change that occurs between a urine sample and different candidate antibiotics to provide guidance on the most effective treatment. Up to 70 per cent of urinary tract infections are resistant, so Spectromics and other innovators in the field have the potential to inform accurate diagnosis and treatment, thereby improving care for a large proportion of patients.

Swelling numbers

Inflammation can be an indicator for bacterial infection and there are several tests that have been developed to detect biomarkers for inflammation. There are a variety of blood based tests for procalcitonin levels that are able to detect sepsis in patients. A recent systematic review of these tests showed that they may be effective in informing the initiation and termination of antibiotic treatment for respiratory infection, reducing overall exposure to antibiotics. This is encouraging news.

However, the relative benefits of inflammatory tests such as procalcitonin and C-reactive protein are widely debated, so there is a need for further research into their use in primary care settings. There has been innovation in the range of tests for bacterial infection, but they generally are unable to fully demonstrate cost effectiveness, accuracy and usability in comparison with the best available alternatives. The Longitude Prize is pushing innovators to address such inadequacies and calling for a more ambitious test than anything currently available.

Surveillance tactics

Better surveillance techniques to collate data on bacterial resistance will help us better understand its spread and underlying mechanisms. The more we understand the situation facing us, the better we can deal with the issue head on. Surveillance is needed in all environments where resistance can occur and diagnostics can act as a tool for collecting information.

At a national level, hospitals are best equipped to carry out surveillance. However, more and more care is being delivered in the community by multiple organisations providing more than one services and this may lead to difficulty in implementing standards for surveillance. Explicit infection control policies need to be developed by each organisation responsible for the care of individuals, which are specific to the settings of care. This should include all care settings, from hospitals to homes, community transport and day centres.

The standardised collection of data through diagnostic devices presents a simple way to increase surveillance in these settings. The 2011 chief medical officer’s annual report asserts that NHS England is well placed to collect, collate, analyse and disseminate information from surveillance. The UK needs to develop methods to ensure consistency and standardisation of data collection, but we also need to understand how this data will be used, so we collect the most useful information.

The European Centre for Disease Prevention and Control sets a good model for best practice in data collection, evaluation and dissemination. Such models should be considered when action is taken to federate and connect databases from health and social care in the UK.

The chief medical officer has also called for interoperability standards for health information systems, so emerging surveillance technologies can easily be integrated. This interoperability will also provide vital flexibility when actions are taken to globally integrate surveillance efforts.

Human nature

Human behaviour plays a big role in tackling resistance. The British public demonstrated their support for tackling the issue of antibiotic resistance by voting that this should be the focus of the Longitude Prize. In a new survey – published today for the prize – 78 per cent of respondents expressed concern about the issue of antibiotic resistance. However, it is interesting that public concern may not always translate into responsible behaviour, because nearly a quarter of respondents admitted to not completing a course of antibiotics prescribed to them.

Our own actions can contribute to resistance. Whether a doctor has prescribed antibiotics when not necessary or whether a patient has decided not to finish a course, all rests with the individual’s responsibility. Every time we expose bacteria unnecessarily to antibiotics, we create an environment that is favourable to the development of resistance. In another survey for the Longitude Prize, 28 per cent of British GPs prescribe antibiotics “several times a week”, even when they’re not sure they’re medically necessary.

Nearly all (90 per cent) say they feel pressure from patients to prescribe: 70 per cent do so because they’re not sure whether the patient has a viral or bacterial infection, and 24 per cent say it’s because they lack easy to use diagnostic tools. New diagnostic technologies can help improve patient outcomes, support changes to our habits and improve surveillance systems to tackle antibiotic resistance.

As well as technology to combat resistance there must be local, national and global action to innovate within healthcare systems to make effective use of existing tools and resources to tackle the problem. We hope diagnostics will play a key role in making this journey easier.

Anna Williams is a Researcher at Nesta

Longitude Prize: Incentivising MedTech to deliver solutions

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Originally published on MedTech Views Blog 19th June 2014, available here.

The £10 million pound Longitude Prize forms another route to funding vital medical and healthcare research, from antimicrobial resistance, to paralysis and dementia.

 

MedTech is transforming the world in which we live; we are healthier and more able than ever before. However, there are still a number of fundamental challenges that we face both locally and globally. The launch of the Longitude Prize 2014, with it’s £10 million prize fund, is seeking solutions to some of these fundamental scientific challenges. Antibiotic resistance, paralysis and dementia are on the shortlist of issues that could reap a £10m research windfall. The MedTech community has a vital and integral role to play, harnessing its power to innovate and accelerate towards the winning solutions!

The British public is being asked to cast the deciding vote to choose which challenge the Longitude Prize 2014 should focus on. Three out of a total of six challenges have implications for medicine and healthcare, that’s half the shortlisted challenges. This not only reflects the global importance of improving healthcare, but it also highlights the importance of MedTech as discipline. From dementia to antimicrobial resistance and paralysis, these challenges are diverse and require lateral thinking, which we so often see in the entrepreneurial MedTech community. Nesta, with the support of the Technology Strategy Board has developed the prize and the Longitude Committee identified these six challenges with careful consideration to ensure a science prize might be the most appropriate mechanism to stimulate innovation and collaboration that might otherwise not occur.

Antibiotics

The preservation of antibiotics and the production of novel alternatives is vital to our future survival. Many existing antimicrobials are becoming less effective, as bacterial colonies are developing resistant to treatment, while the inappropriate use and misuse of these medicines is causing an acceleration of the numbers of reported cases of resistance globally. The pipeline for the development of new antibiotics is at an all time low and initiatives to implement behavioural and education programmes are in their infancy. Most policy proposals to tackle antimicrobial resistance put forward two main points for action: Action to conserve the antimicrobials that we already have, and action to accelerate solutions in diagnosis and drug development.

For the first time, antimicrobial resistance topped the agenda at the G8 meeting of science ministers last year. While solutions have been proposed to incentivise and accelerate solutions in drug development with initiatives such as, Advanced Market Agreements (AMAs) and Product Development Partnerships (PDPs), challenge prizes still have an important role to play. The Chief Medical Officer for England, Dame Sally Davies has highlighted the need to encourage a range of incentives to address the currently stagnated pipeline, primarily she proposes the use of PDPs, AMAs and Science Prizes as well as changes in patent agreements, to extend the patent period from twenty years to, say, twenty-five years.

Antibiotics underpin all modern medicine. It is vital that health professionals can make increasingly accurate prescriptions, reducing the number of broad-spectrum antibiotics used. There are several interesting MedTech and biomedical research groups already working in this area. For example, RAPP-ID are working on point-of-care test platforms for infectious diseases. But as Rangarajan Sampath mentioned in his blog yesterday, current culture based techniques are often inaccurate for bacterial diagnosis and we require innovation to improve patient care. The Longitude Prize for antibiotics will incentivise this much needed innovation, competitors will be asked to develop a cheap, rapid and extremely accurate point of care test that can enable practitioners to diagnose a bacterial infection in a variety of health care settings.

Paralysis

Paralysis can be devastating, and affects people with a range of medical conditions from stroke to nerve damage. Although some types of paralysis can be improved through intense rehabilitation, there is no effective treatment to restore the function of the nervous system. To the outside world, this limited mobility is the main symptom of paralysis. In reality, numerous secondary conditions dramatically affect the day to day life of those with paralysis. These secondary symptoms often include loss of normal bladder and bowel function, sexual function, low blood pressure, the formation of blood clots, pneumonia, neuropathic pain, spasticity and muscle spasms.

Given the multiple causes of paralysis, for example, stroke, spinal cord injury, and multiple sclerosis, a total cure for paralysis is distant goal for medical science. In the meantime, there is an extraordinary opportunity to develop incremental solutions that restore freedom to those who have been paralysed. Therefore the paralysis prize seeks solutions that could restore movement to individuals with any form of paralysis, in an easy light and useable form. The innovation must also address the secondary symptoms of paralysis.

The beauty of this prize is that there is scope for new forms of collaborations within the MedTech industry. For example, Neuroprosthetics is an area of research that has seen significant progress in the past decade, some treatments focus on replacement strategies by recording the electrical signals of neurons in the brain and translating them into the movement of devices such as robotic arms. Regenerative medicine has also made a lot of progress towards finding a cure for paralysis, but solutions are still in an early phase. Developments in robotics, bioengineering, and artificial intelligence have led to innovative technological solutions that offer support to people with paralysis. The emergence of assistive devices such as powered exoskeletons like REX, are an amazing feat of engineering, however all of the current fields of research need future refinement and could benefit from future collaboration in order to win the prize.

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Picture: REX in action

Dementia

It is estimated that 135 million people worldwide will have dementia by 2050.

In order to solve the problems posed by dementia, we need a cure, condition-altering treatment or a robust preventative intervention. New treatments, for instance anti-tau drugs, are currently being developed and could potentially improve cognitive functioning, but it could be many years before they are approved for clinical use, if at all. As with all chronic conditions, care plays a critical role in the management of dementia. This care will usually take the form of emotional, cognitive, and physical support from paid carers, but also from close family members, and friends.

Studies suggest that telecare systems and home automation have great potential to reduce the cost of chronic conditions where management is key. The largest barrier to success of the systems that currently exist is that they are not well suited to the nature
of dementia; for instance, they will often require interacting with new, unfamiliar devices or change established patterns of behavior in order to acquire meaningful information, things which many dementia sufferers would find difficult. However, there are a range of novel technologies that are in development, from simple location devices and fall sensors, to more complex ambient sensor systems such as the ambient kitchen developed by Newcastle University. Although stand-alone technologies exist, the prize for Dementia will focus on the development of assistive technologies that deliver an exceptional level of care, while rewarding innovation that provides an integrated home system of ambient technologies that support people with dementia to live independently in their own homes for longer.

Many of these issues are already being worked on by experts in a diverse range of science and technology disciplines related to medicine and healthcare. Three other non-medical challenge areas are also available to vote on: water, food and flight.Prizes open up new opportunities and we are throwing down the gauntlet to the MedTech community to provide new innovation. In Autumn 2014, we open the challenge to innovators across the world to solve the public’s chosen problem.

Find out more and vote for your chosen challenge here: http://www.longitudeprize.org/

Watch the BBC horizon documentary about the Longitude prize here: http://www.bbc.co.uk/iplayer/episode/b044mkxt/horizon-the-10-million-challenge

Twitter: @Longitude_prize

Facebook: https://www.facebook.com/longitudeprize