This kind of personalisation is in great demand. Some hospitals are fitting custom-made 3D bone or joint implants, prosthetics and skin for burns victims. But medical travellers are also accessing surgeons who are using 3D models on which they plan extremely complex surgical procedures. Paediatric surgeons at SickKids in Canada, say 3D models have become vital in the planning of intricate operations on tiny organs for example. “As personalised medicine takes a stronger footing (in large thanks to the advancements in medical tech), procedures and treatments will be increasingly individualised,” asserted Jordan Mills, CEO of MirrorMe3D, a specialist 3D printing company. “You see this happening at a micro-level with 3D printing of medication to individualise dosage levels up what we’re doing, which is helping surgeons with individualised planning for an aesthetic outcome.” Mills’ company works with cosmetic surgeons and reconstruction specialists to create life-sized 3D models of patients’ noses and faces, using scans or photos that are manipulated according to changes requested from their surgeon. Surgeons use models to plan cosmetic procedures, but also in consultation with patients. “Doctors can obtain 3D models ahead of a virtual consult and use it to show the patient potential outcomes,” she said. “Many patients want to see a 3D model of themselves and some feel it helps them better understand what types of changes to expect post-operatively. This makes the model an incredibly important communication tool and often helps patients and surgeons with setting more realistic expectations.”
Another technology that travellers may not specifically travel for, but innovators say may improve their chances, is AI. The hope is that it will be able to diagnose prostate, ovarian, lung and bowel cancer at an early stage and can reduce deaths. Algorithms might detect pneumonia on a chest X-ray or identify a patient at risk of sepsis or acute kidney injury. They might automatically generate a discharge letter that would usually be time consuming to write.
Today, Moorfields Eye Hospital is using AI to analyse retinal scans, University College London hospitals is utilising it in radiotherapy planning, and Imperial College London in mammography scans. They are collaborating with DeepMind Health, owned by Google’s parent Alphabet, on these projects. AI is also being used by hospitals to help doctors make clinical decisions based on the best available information by keeping up with the enormous scientific papers, guidelines and other important information for them. IBM’s Watson for Health technology – specifically Watson for Oncology (WFO) scours the cloud for medical journal peer-reviewed studies, case studies, newest clinical guidelines from around the world and process them, recommending personalised evidence-based treatments. The system has been used by Bumrungrad International Hospital (BIH) in Thailand, Icon Group in Australia, Grupo Angeles Servicios de Salud in Mexico, Mãe de Deus in Brazil, Taipei Medical University in Taiwan, and three South Korean hospitals.
Nan Chen, Senior Director of R&D and Clinical Data at BIH, has championed the technology. “WFO is one example of the key technologies that will help clinicians harness the increasing amounts of data that is becoming available as both medicine and treatment become more personalised for each individual patient,” he said. “As we treat more than half a million from over 190 countries each year, these technologies are increasingly important to provide the level of care that our patients have come to expect.”
He added that doctors, sometimes in locations where there are no oncologists – such as BIH-owned hospital in Mongolia – could use clinical WFO decisions confidently. In fact, last year, researchers from BIH and IBM Watson compared decisions made by WFO with oncology specialists at BIH’s Horizon cancer centre and found 81 per cent agreement on retrospective cases (70 per cent for breast, 56 per cent for cervical, 90 per cent for colon, and 94 per cent for rectal cancer for example).
Some hospitals are fitting custom-made 3D bone or joint implants, prosthetics and skin for burns victims. But medical travellers are also accessing surgeons who are using 3D models on which they plan extremely complex surgical procedures
Critics say, however, more independently verified proof that WFO works is required, and less US-focused treatment recommendations. BIH did not respond to requests for comment, although researchers said discordance was largely attributable to BIH oncologists’ preferences, including favouring non-US guidelines for certain cancers, patient preferences, including toxicity, cost and logistic concerns. “Other reasons for non-concordance included recommended US treatment options not available in Thailand,” they said.
It seems that as innovative technologies race ahead, the rules and public debates on when or whether they are appropriate trail along behind, as does the independent medical evidence establishing whether they work. AI has come in for criticism when it’s at odds with data protection rules. Many monitoring apps have not been peer-reviewed or approved by medical bodies such as the US FDA. And, said Woodman, stem cell applications continue to be oversold to patients everywhere. NHS Choices, a UK science-based health information source, warns that not all overseas clinics providing proton beam therapy do so based on the best available evidence. “They heavily market their services to parents who are understandably desperate to get treatment for their children. Proton beam therapy can be very costly and it is not clear whether all children treated privately abroad are treated appropriately,” it said. Whether patients travel for appropriate services, therefore, will be up to how much good-quality information, rather than hype, is available. ■