COMMENTARY

Healthcare 2018: Changes Coming to an Office Near You

Hansa Bhargava, MD

Disclosures

January 25, 2018

Hello. I'm Dr Hansa Bhargava. As we at Medscape and WebMD look forward to healthcare in 2018, we would like to call attention to some 2017 medical news that may well have an effect on you and your patients in the coming year.

Biotechnology Trends

First, there were several key developments on the biotech front. In December, the US Food and Drug Administration (FDA) gave approval for the use of ingestible digital trackers embedded in aripiprazole pills as a way to monitor medication use. Contact with stomach fluids activates the sensor, which transmits information to a small patch worn by the patient, which then relays data to a mobile device.

The implications are far-reaching. Similar ingestible technology is being eyed for its potential to monitor proper doses and the frequency of opioid use, a practice which could help track potential overuse.[1]

In the same vein, biointegrated technology in patches could be used to measure vital signs as well as muscle movement. Such technology already has been incorporated into clothes, such as infant socks, which can monitor heart rate and O2 saturation in newborns. The device, evaluated in a study[2] involving over 45,000 infants, has the potential to not only alert caregivers to potential life-threatening events, but to also provide insight into vital-sign variability in healthy infants.

In addition to monitoring, another potential cutting-edge application for patches is the treatment of peanut allergies. Patches that deliver small amounts of peanut protein through the skin are now in phase 2 clinical trials.[3] In trials of epicutaneous immunotherapy, just under half of the study patients were able to tolerate an oral protein challenge or at least a 10-fold increase in consumed dose of the peanut protein from baseline to 1 year.

Patches are also being considered as a delivery mechanism for flu vaccines. Disposable microneedle patches use 100 solid, dissolvable needles to release encapsulated drug or vaccine.[4]

Gene Therapy

After decades of research on potential treatments for countless genetic diseases, gene therapy boasted a success in 2017.

Last year, the FDA voted unanimously to endorse gene therapy for treatment of inherited retinal dystrophy. Injecting genetically modified viruses into the retinas of patients led to improved sight in 90% of those treated.

And the gene therapy adeno-associated virus serotype 9 (AVSX 101) is being hailed as a possible breakthrough for treating spinal muscular atrophy.[5] In its first clinical trial, infants injected with this treatment had dramatically improved survival at age 20 months as well as improved motor skills.

Grafting genetically corrected skin onto open wounds of patients with epidermolysis bullosa led to significantly improved wound healing.[6]

After almost 30 years of research, each of these potential successes is a breakthrough. Genetic therapies for other diseases are not far behind.

Healthcare Delivery

The changes are not just clinical; they're also in the delivery of healthcare. Telehealth services for diagnosis, treatment, and education are more widely used, and states are now recognizing the need to regulate use. In 2017, every state but Connecticut and Massachusetts made substantive changes to better define regulations affecting telehealth services.[7,8]

There are two potentially concerning issues from the federal government. Congress's continuing failure to extend the Children Health Insurance Program puts an estimated 9 million children from low-income families at risk.

We also have uncertainty about the repercussions of the tax bill's elimination of the Affordable Care Act mandate. We will have to see if this change results in an increase in insurance premiums, potentially leaving many Americans uncovered and a domino effect on hospital systems and our very own practices.

Each of these key developments may make a difference for you in 2018.

For Medscape and WebMD, I'm Dr Hansa Bhargava.

Follow Hansa Bhargava on Twitter.

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