Your precision public health questions answered! A conversation with Dr Michelle Griffin
Your precision public health questions answered! A conversation with Dr Michelle Griffin14 December 2022 | 8min
Recently, Healthcare Transformers in collaboration with Lab Insights hosted an engaging panel discussion on the emerging trend of precision public health (PPH). Three expert speakers took us on a deep dive into how cutting-edge precision medicine tools to more specifically target treatments can be applied to public health. Their insights sparked such interest in our audience that we had more questions than they could answer live!
We had the pleasure of catching up with one of the panelists, Dr Michelle Griffin, clinician, strategist, and advisor with over 20 years of experience in healthcare, to get her answers and opinions on the most pressing questions asked.
In case you missed the live event, take a look at our summary article: Precision medicine and public health – making health more preventative and proactive across populations.
How to make a change
HT: What is your opinion or guidance on PPH implementation for communities, academia, and clinical practice? Is it possible to make a shift toward precision medicine in public health when a “one size fits all” approach is still predominant on an individual level?
Michelle Griffin: There is a wide gap to bridge from where we are currently, which is very much a one size fits all approach, to personalized medicine. However, I think healthcare professionals, scientists, patients, consumers, and industry all recognize a universal gain from moving to personalized medicine on an individual and population level.
In the start-up space, venture capital firms with a health focus or health portfolio are seeking personalized and even hyper-personalized (where patient n=1) medicine opportunities, so there is an industry push that drives research and innovation, which will hopefully soon become more commonplace and even expected.
Industry can provide a financial accelerant to this area by taking the first steps in investing in infrastructure and people – often in partnership with clinicians and academia – to deliver the first successes. These can then be scaled up for different disease cohorts and populations.
HT: What would be your thoughts on how we create policy frameworks that make PPH a reality by supporting data collection and sharing while respecting privacy and data security issues?
Michelle Griffin: Understandably, there are high levels of hesitancy when starting the development of anything new in healthcare. This is usually due to not knowing how to get started, or not being sure what has to be done – or more often both. Equally, there is significant wastage when different teams, companies, and government agencies look to introduce something, but they start the process from the beginning – rather than studying and learning from what has been done before and adopting good practices.
Policy frameworks are useful to outline the areas that need to be considered. They should provide links to relevant and helpful agencies such as the Information Commissioner’s Office which uphold information rights specifically in regard to data governance in the UK, for example. Where possible, case studies of good practice and/or learnings from planning and implementation should also be included.
Privacy and data sharing is an exciting area that is often seen as massive barrier. But it is worth taking time to understand the individual country and agency processes and laws that sit behind the policies and practices. In my experience at Public Health England, working on the national registration services for cancer and rare diseases, there were many opportunities around data sharing – some successful and some not!
In short, my advice is to have a clear idea of what you want to achieve, but be prepared to compromise and look for innovative solutions – such as the use of aggregate data and simulated datasets. In addition, it is essential to build relationships, keep communicating and understand that these negotiations may take a long time.
Precision public health on a global scale
HT: How can lower-income countries make this important shift to targeted therapy and precision medicine? Especially, if there is such a big gap to fill when it comes to technology, knowledge, expertise, training, and access to the right instruments.
Michelle Griffin: There are many practical obstacles and challenges that need to be overcome for any country to shift their healthcare setup to one that’s focused on targeted therapy and precision medicine. This is more difficult for lower-income countries. However, in my experience, having a vision and a will to do something different can achieve this.
When I worked at WHO on the Zika virus outbreak, it was a global concern involving many countries affected in different ways. Much of South America experienced an epidemic, it affected countries with different healthcare systems and environments, but there was a united effort to work collectively to pool resources, intelligence, and infrastructure, forged by each country wanting to know and commit to what they needed to achieve. Once people are on board, then it becomes less about politics and more about practicalities and solutions.
Another example is the COVID-19 pandemic. There have been major learnings about how collaboration is possible and the benefits of speeding up R&D and regulation, as well as reducing costs by working together across private/public sectors, governments and countries.
HT: Beyond what has been shared during the panel discussion, have you seen additional examples of PPH initiatives in different countries that others could learn and take inspiration from?
Michelle Griffin: We now have access to unprecedented quantities and types of data, and so there are many examples of where PPH has been implemented. Tracking outbreaks of infectious diseases, for example, involves the review of big data combined with predictive analytics to be more targeted. This is regularly done by many countries to track the flu season locally and globally in relation to vaccine preparation. And, more recently with regard to the COVID-19 pandemic, the various genetic variants, symptomatology, management, and outcomes could be tracked using the same methodologies.
HT: As the healthcare industry shifts toward digital and decentralized health, are UK healthcare institutions, governments, and reimbursement systems adapting fast enough to keep up?
Michelle Griffin: It is very exciting to see the growing trend of decentralized trials and healthcare, and a move to more digital health with monitoring and provision of ‘health at home’. Like most, if not all, healthcare systems globally, the UK’s NHS and wider healthcare ecosystem are under pressure and are working hard to deal with the current challenges regarding increasing burden (through an aging population and an increase in the complexity of conditions) and decreasing financial resources.
Consequently, the NHS struggles to keep up with and adapt to the change in medical technology and digital health. But it recognizes the need and potential benefits to patients, staff, and the healthcare system. Therefore, the next 3-5 years are crucial in helping with the integration into current workflows and systems.
The commercial opportunities of precision public health
HT: With your experience from both the public and private sectors, and as an advisor to startups and life science companies today, do you see potential commercial opportunities in the area of PPH?
Michelle Griffin: Definitely. There is a need to help us understand more about the data we are collecting and aid the implementation of our learnings to improve health outcomes for individuals and populations. This will drive commercial opportunities.
For example, many large companies in industries such as pharma and medtech are moving away from in-house R&D and acquiring knowledge, expertise, and intellectual property through mergers and acquisitions. This provides an opportunity for smaller companies and startups to progress their ideas and innovations with the help of these larger firms. Many companies, for example, support collaborative accelerator programs to encourage innovation such as the Illumina Accelerator and Startup Creasphere programs.
Implementing precision public health
HT: When launching a PPH initiative, does mentioning industry involvement increase or decrease participant trust in your opinion?
Michelle Griffin: In my experience, mentioning industry involvement can be off-putting and may decrease participant trust. However, that is due to the way in which industry involvement is typically discussed – in an unclear, confusing, jargon-heavy manner.
When industry involvement is comprehensive and transparent to participants – explaining the role of industry, their access to participants and their data, their regulation and governance, etc – then it’s usually well received and, in fact, often welcomed.
HT: When it comes to the transition from reactive to proactive healthcare, Should we be encouraging patients to start taking preventative steps more often and earlier in life?
Michelle Griffin: I believe there is an urgent need to move away from a reactive healthcare model to a proactive one that’s built upon prevention. There is an argument for collecting data starting from pregnancy and using this data from early in life to inform healthcare and the management of diseases. At a population level, this could potentially help predict and plan what healthcare is needed.
But this is only one view of the situation. Irrespective of the difficulty and challenges of this proposed approach, we must consider what we want to achieve, why, and who will benefit. Of course, there are so many considerations and obstacles, but the biggest would be public acceptance and participation.
For example, it’s common knowledge that smoking causes lung cancer, and contributes to many other cancers and diseases that are the leading causes of death in the western world. Yet people still smoke! So, there is a long way to go before people widely accept, agree with, and participate in preventative medicine. Did you miss the event ‘Precision medicine and public health – A perfect fit?’
Watch the free full recording here.
Michelle Griffin, MD has nearly 20 years of experience in healthcare across the NHS and Public Health England in the UK and the World Health Organisation. She is a clinical doctor specializing in obstetrics and gynecology and now specializes in women's health, especially in health tech. She has been the Gynecology Lead for the National Cancer Registration Service and Lead for the National Rare Disease Registration Service, both of which are linked to Genomics England and personalized healthcare. She now works as an independent health expert and strategy advisor in women's health tech, specializing in women's health.