Medical progress is no substitute for lifestyle modification

• For five years, the Polpharma Scientific Foundation has been organizing regular Scientific Debates, which are an important place for meetings and exchange of knowledge for both patients and doctors. It is a space where the latest achievements in medicine meet the practice and needs of everyday health care.
• You can now watch one of the recorded debates on the Foundation's website. The main topic of the debate was: "What's new in medicine in 2024?"
• Two more debates will be posted on the website in September and October.

- From my point of view, the most important scientific event of 2024 was the awarding of the Nobel Prize in Physiology and Medicine to Victor Ambros and Gary Ruvkun for the discovery of the function of microRNA . This is a breakthrough moment, the culmination of many years of research conducted since 1993 - said Dr. Katarzyna Rolle from the Institute of Bioorganic Chemistry of the Polish Academy of Sciences in Poznań.

MicroRNAs are regulatory molecules that have the potential to change gene expression . The expert presented a graphic illustration of how this works in practice. She compared the cellular structure to an organization in which DNA acts as a director, mRNA is a manager transmitting orders, and proteins are a team of workers performing specific functions. MicroRNA, on the other hand, acts as a managing director who corrects actions depending on changing conditions, such as stress or disease. By influencing the expression of specific proteins, they are indicators of changes in environmental conditions and pathological states, which is crucial, for example, in neurological diseases, diabetes and cancer.

According to Dr. Rolle, the importance of microRNAs lies primarily in their diagnostic potential . They can enable precise and early diagnosis of diseases that have previously been difficult to detect, such as pancreatic cancer, non-small cell lung cancer, and tumors of the nervous system.

Prof. Jarosław Reguła from the National Institute of Oncology and CMKP, chairman of the Scientific Council of the Polpharma Foundation, admitted that nothing worthy of the Nobel Prize had happened in gastroenterology, but he emphasized one important achievement from last year – the possibility of predicting the occurrence of non-specific inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis, about two years in advance . He notes that in Poland about 100 thousand people suffer from them, and these diseases require expensive treatment, including biological treatment.

- By predicting the onset of the disease earlier, among others on the basis of microRNA, but also other laboratory markers, preventive measures can be taken. This reduces the risk of sudden and acute attacks of the disease, which may even lead to the need to remove the intestine - the expert emphasized.

The method is not widely used in gastroenterology at the moment, but studies confirm its effectiveness in predicting nonspecific inflammatory bowel diseases. It will certainly become more common in some time. Especially since there are already standardized methods for determining microRNA in body fluids, blood, saliva and cerebrospinal fluid.

In turn, in cardiology, one of the greatest achievements were systemic changes, indicating the directions of development of cardiology. - The most important event was the publication of four new guidelines of the European Society of Cardiology . They concerned arterial hypertension, atrial fibrillation, chronic coronary syndromes and peripheral artery disease. These are the most common pathologies in the area of ​​circulatory system diseases - assessed Prof. Aleksander Prejbisz from the National Institute of Cardiology, member of the Scientific Council of the Polpharma Foundation.

These guidelines emphasize the importance of prevention as the foundation of effective treatment. Even if the patient receives modern treatment, such as stent implantation or atrial fibrillation ablation, without proper prevention there is no effective, long-term therapy. The professor noted that despite the availability of modern interventions, statistical data in Poland does not show a decrease in the number of deaths from modifiable causes . This means that prevention is still insufficient.

- At the same time, in addition to the fact that we have very good drugs for hypertension, an increasingly broad panel of lipid drugs, antihyperglycemic drugs, the next stage of the revolution is the pharmacological treatment of obesity. Currently, we have two very effective drugs on the market, and there are another 20-30 molecules in research - he emphasized.

However, in his opinion, without changing lifestyle, real improvement in public health will not be achieved: - Only if we start modifying lifestyle, taking medications regularly, watching what we eat, what level of physical activity we have, paying attention to certain elements, only then can we talk about prevention of circulatory system diseases. Medical progress will not replace lifestyle modification.

In this context, he considered the activities carried out as part of the National Cardiovascular Diseases Program to be a significant step. A few days ago, the My Health program was launched. As part of the project, tests are being performed, and if irregularities are detected, further actions are taken. A new survey, the so-called "ten for the heart", is also to be made available soon, and will be available in the My IKP system.

The expert emphasized that only through a comprehensive approach is it possible to effectively reduce expenses for expensive treatment and reduce the number of avoidable deaths: - In Poland, expenditure on prevention has so far been a hundred times lower than in many other European Union countries . Meanwhile, the same risk factors are responsible for both heart disease and cancer.

Professor Jarosław Reguła confirmed that when it comes to oncological prevention, we are still far behind, just like the rest of the world, where prevention is spent on a fraction of a percent compared to all costs. A positive example are the Scandinavian countries, which adopted a memorandum that in 2030 half of health care expenditures would be allocated to treatment, half to prevention.

The problem, however, is that preventive programs in Poland do not bring the expected results . - We all repeat the slogan that prevention is better than cure, but few of us use these preventive programs - noted Dr. Rolle.

This is confirmed by the observations of Prof. Reguła, especially in the context of colon cancer: - There is indeed a problem with the reporting or acceptability of screening tests as preventive measures.

In his opinion, the biggest oversight of the Polish healthcare system is the lack of emphasis on the quality of medical services, control of this quality, marking of quality measures and monitoring subsequent stages of preventive actions: - Perhaps our decision-makers think that if something is available, people will be wise enough to use it themselves. This does not happen .

An example of this is endoscopic examinations, in which Poland already has a well-developed quality measure – the so-called ADR (adenoma detection rate). This is an indicator that assesses the effectiveness of the endoscopist in detecting polyps, and its level is directly related to the risk of missing cancer after the examination. The professor cited Dutch studies, which showed that the quality of colonoscopy performance measured by the ADR indicator had a greater impact on the effectiveness of prevention than compliance with medical recommendations.

Experts unanimously agreed that from the perspective of technologies used in medicine, the most important things are happening in the area of ​​artificial intelligence development. The huge potential of AI is noticeable in the development of pharmacology.

- Artificial intelligence is very useful in finding new applications for existing drugs. Last year, about 17 thousand such applications were discovered, even in very rare diseases - indicated Jowita Michalska, CEO of Digital University and ambassador of Digital EU.

In the area of ​​prevention, she emphasized the importance of wearable technologies in the hospital-at-home model, i.e. the use of devices that monitor health parameters in real time. These increasingly precise sensors are approaching laboratory standards in quality.

Artificial intelligence is also used in diagnostics. It is proving to be extremely effective in detecting various types of anomalies, which increases recognition and facilitates making the right diagnosis.

As the expert emphasized, we currently have access to about 21 thousand different tools using generative artificial intelligence, which are based on large language models . However, in order to fully use the potential of these technologies, investments in the education of doctors are necessary, and such programs are already being implemented.

What convinces users are easy-to-implement improvements that can bring benefits in the short term, the so-called “low-hanging fruit.” An example is the reduction of administrative burdens, when time-consuming bureaucratic work can be successfully performed by AI. The expert gave an example of one of the projects:

- After three months of introducing specialist training for specific business areas and providing a secure tool in a given organization, work efficiency improved between 20-40 percent, depending on the type of work. This is something that happens very quickly, is inexpensive and is extremely quickly scalable.

The measure of the success of using AI can be the Nobel Prizes awarded to specialists in this field, and the breakthrough year was 2024. Geoffrey Hinton received it for groundbreaking achievements in deep learning, and Demis Hassabis for the AlphaFold project, revolutionizing drug design.

At the same time, new technologies may also carry risks, for example in the form of the risk of hallucinations, i.e. the creation of false information.

- Hallucination is the greatest sin currently existing in the field of artificial intelligence . It is indeed advisable to be extremely cautious in everyday use, for example in scientific works, even in creating bibliographies. In parallel, much more precise tools are being created, capable of presenting reliable data and analyses - admitted Dr. Rolle.

All these technological changes mean that ChatGPT, like Uncle Google, is becoming a new, home source of medical advice. The problem is how to educate patients so that they do not self-medicate irresponsibly, but at the same time know how to use the available tools wisely.

- The answer to most of these questions is education, how to recognize the threats and possibilities of technology from the first grade of primary school. We have already trained 250 thousand children in Poland and 4500 teachers, cooperating with almost 3000 schools - said Jowita Michalska.

Because – as she argued – consciously used AI tools can be helpful in the area of ​​maintaining well-being. The “longevity” trend is becoming increasingly fashionable. Soon we will enter the era of “AI agents”, i.e. personalized, autonomous advisors who will manage our health. Technology companies are already offering such tools. The difference between chat and an agent is that the agent does not require constant asking questions – it works in the background, processes data, planning based on a set goal. In the near future, everyone will be able to have their own personal, digital health carer who, after entering data, e.g. test results, will prepare a diagnosis.

The clinician community looks at new technologies with hope, but also has a number of concerns.

- In the GPT chat or in the search engine, the patient will read a lot of unverified information. The question is, who will he trust now? The search engine, the assistant, or the doctor he comes to? Why, despite the growth of technology, do we have a growing number of people who do not get vaccinated? This is a problem. We need to consider where and how this technology should be used - said Prof. Prejbisz.

He reminded us that we are dealing with growing anti-vaccination and anti-statin movements. Although statins are cheap and effectively prolong life, many patients avoid them, generating higher costs of treating complications.

Prof. Prejbisz noted that these movements are based on conspiracy theories: - At a time when more and more technology is introduced, when people understand the world around them less and less, conspiracy theories will become more and more common, because they explain reality to them in a simple way. The need for education applies not only to children, but also to the elderly.

Dr. Rolle also pointed out certain threats of new technologies, emphasizing that effective treatment is not possible without the participation of a doctor: - We are perhaps able to make a diagnosis by entering appropriate information into the chat. However, there is the issue of awareness of what we are doing, how we are doing it and trusting the doctor. I think that the outbreak of all anti-initiatives is unfortunately due to the decrease in trust in the medical community.

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