Simulations are all pervasive in modern technology, especially in the realms of aeronautics, nuclear power, movies, animations and computer games. From simulated VR (Virtual Reality) worlds in 3D allowing an unprecedented experience of realism – even more accentuated whilst wearing 3D goggles and motion-capture equipment – to modest extensions of visualization technology used to help represent data or imagery in order to allow ease of interpretation.
Visualization and simulation are very similar and the boundaries often blur when you consider systems such as Tableau or computer renderings of medical images to guide investigations or treatments. One striking example of the latter is the “Vein Viewer”, which allows users to clearly view blood vessels under the skin in real-time whilst drawing blood or injecting a vein with a near infra-red light projected image. Simulations allow for users to interact with them, something that pure visualizations don’t normally offer.
Thanks to the huge multi-billion-dollar gaming market, the price of VR simulation systems and the sophistication behind such tools are now far more affordable than ever before and the chances of utilizing these technologies in healthcare are really high. There already exist many VR platforms being used in the training of health professionals (Virtual Patients and Cases, for example) and in assisting the care process throughout the care life cycle.
The obvious advantage of “in silico” (within a computer) systems is that real patients do not have to endure the fallout of mistakes made by untrained medical personnel, as everything occurs in a simulated world. This also means that the user can experiment with different approaches in order to learn about why certain methods are better than others by actually witnessing the end results, no matter how detrimental the outcome might have been in real life as all the consequences are contained within a virtual environment.
Simulations bring learning to life – which can increase engagement. Not only beneficial to clinicians, but also the patient population helping them to understand and engage with their conditions.
Another important use of simulation is in the pharmaceutical industry but in silico systems are not yet widespread here – certainly of the 4 mainly big pharma/med devices companies I personally had the chance to visit during a 10-day boot camp on learning how to evaluate MedTech in Sweden – only 1 of them had any actual knowledge and plans of developing such systems alongside their traditional “in vitro” activities.
One highly sophisticated virtual system still under development that would have ground-breaking impact, opening the doors to precision, personalized medicine in a big way, is the “Virtual Physiological Human” system. Started in 2007 under the EuroPhysiome Project, a group of experts described the VPH as a complete collection of all the physiological, chemical, biological, etc. systems from a microscopic level to the macroscopic level in humans.
Though this has yet to be realized in a complete form, it is precisely this kind of technological infrastructure that would ease in silico clinical trials (ISCT) and drug development, potentially decreasing the costs and uncertainty of developing drugs in this high risk industry.
Under the traditional clinical trials process of development, pharma-companies can spend anything up to $1bn, 14 years with a 50% failure rate in developing just one drug. The risk and costs to failure are steep – and even early phase success does not guarantee patient safety or benefits in the even longer term.
At the moment clinical trials go through several phases, each of which increases costs and risks to patients. ISCT would speed up the process – especially of the early and last phases – if aligned with VPH systems which could check for viable target substances (likely to be turned into beneficial medicines) and predict ADEs (Adverse Drug Events) by virtually combining drug products with particular patient populations who have their physiology mapped within a VPH and genomic profiles system.
UK pharma-companies have especially got to get on the ISCT band-wagon, with some industry professionals worried about losing their leverage in the EU market which may see some changes in respect to “harmonizing” clinical trials from 2018. This may effectively restrict access to some beneficial clinical trials to UK patients, if the Brexit fallout jars with this EU “harmonization” process.