Health technologies promising longer life often solve secondary problems
Activity monitors and blood tests offered by private companies give a false sense of security to people dreaming of a longer life. Instead, more attention should be paid to healthy eating and taking part in screening. Entrepreneurs interested in developing new health technologies should focus on ensuring evidence-based practices, said Taavi Tillmann, Associate Professor of Public Health at the University of Tartu, in a presentation at Startup Day in January.
Last year, the medical journal The Lancet published a study on the biggest risk factors that shorten people's lives in every country in the world. In the EU, the top three risk factors are high blood pressure, dietary risks and tobacco. Low physical activity is only 13th.
“Unhealthy diet is ten times more deadly than lack of exercise,” said Tillmann. When it comes to health monitors of all kinds, one can wear completely useless gadgets and still talk about how much they help because their early adopters tend to lead healthier-than-average lifestyles anyway. Therefore, the results obtained are very different from those of the average person, and the benchmarks do not reflect reality. According to Tillmann, one of the key issues that requires innovation in health is how to reach people who are too busy with their day-to-day problems and get them to use health-supporting technologies.
Disease prevention
From the perspective of the future of health care, the biggest win lies in disease prevention, which is where the development of health technologies should focus. At the same time, prevention is one of the most complex fields in medicine according to Tillmann, especially when a person feels well and has no symptoms. “If you break a leg, you are willing to go through all sorts of procedures to get it fixed. However, only half of people who do not have any symptoms show up when invited to a cancer screening, and only 10–20% of people with high blood pressure and high cholesterol take the necessary medication. This is one of the most complex underlying problems that public health and preventive medicine are trying to solve,” Tillmann added.
The researcher praised companies and organisations developing services to collect samples at home for cervical cancer screening, for example. In Estonia, the Estonian Gynaecologists’ Society, the Estonian Institute for Health Development and the Estonian Health Insurance Fund have been promoting the wider use of this option. “This is a fantastic example of innovation that does not require fancy blood tests or electronic gadgets yet indeed increases the screening participation rate and saves lives,” said Tillmann.
For instance, the introduction of self-collection kits for cervical cancer screening has increased the participation rate among Estonian women by nearly 10%. Moreover, data show that the share of those who opt for self-collection is the highest in counties with the lowest screening coverage.
A factor predicting disease may not affect prevention
According to Tillmann, determining causality is another complicated topic related to disease prevention. “If two factors are statistically linked, we should not blindly believe that one causes the other. Otherwise, the result will be bad science that is useless, biased, misleading or just plain wrong. Several indicators that are easy to measure and change may predict disease but may have no effect in preventing it,” he said. For example, some companies advertise that anyone can buy genetic tests, blood tests for prostate cancer or blood tests to find out the causes of fatigue without a doctor's visit. Tillmann believes this is mostly a waste of patient’s time and money.
Therefore, on the one hand, it is important to check whether new health technologies are backed up by research-based evidence and not simply by the feedback of a few enthusiastic users on the manufacturer's website. On the other hand, companies need to invest in clinical trials, especially randomised controlled trials. “The results obtained in this way will convince state health insurance funds who decide which services will be available to all. As consumers, we can be sure that the service is of high quality, and the company providing the service can have assured market demand for decades,” said Tillmann.
Evidence-based solutions born in Estonia
According to Tillmann, there are several good examples of health technology developers in Estonia who place great emphasis on clinical trials and evidence-based development. One example is Better Medicine OÜ, a Tartu-based company that was the first in the world to launch a CE-marked AI solution to help diagnose kidney cancer. It succeeded thanks to well-planned and well-executed clinical trials designed by excellent doctors from Tartu University Hospital and researchers from the University of Tartu.
In the past, a similar path has been successfully followed by Dermtest OÜ, whose digital tool facilitates the detection of melanomas and the treatment of other skin problems. The clinical trials needed for the development were published in 2023 in cooperation with Estonian doctors and researchers. Thanks to this, the service is available throughout Estonia, and the company has expanded into the German market.
Another commendable example is Migrevention OÜ, the creator of the digital headache clinic and mobile app, whose service is based on a clinical trial and which was co-founded by senior teaching physician Mark Braschinsky, the best-known Estonian neurologist specialising in headaches.
A warning lesson from the world of health-tech start-ups
In 2022, the health-tech start-up landscape was shaken by the news that the world's youngest billionaire, Elizabeth Holmes, had been convicted of fraud. In 2003, Holmes founded Theranos, a start-up company that promised to diagnose 200 diseases from a tiny blood sample. With a convincing story, she raised nearly a billion dollars, which all went up in smoke when the scheme was exposed.
How is it possible that nobody saw it through? There are a few lessons to learn. According to Tillmann, medicine and biochemistry are fields where decades of research are needed to reach a breakthrough. Therefore, before investing, it is important to check whether the team includes researchers who have proven themselves in the field and whether research findings supporting the promises have been published in high-quality peer-reviewed journals. Theranos lacked both experts and trustworthy publications to prove their claims.
Even though there are a large number of products and applications on the market that promise to prevent disease and prolong life, effectively addressing these issues is one of the most challenging tasks that no company can tackle without a team of experienced and educated medical experts, underlines Tillmann.
Read the article published in Geenius (in Estonian).
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28.02.2025
