Today, the chances of healthy ageing are better than ever. Nonetheless, severe illnesses such as dementia, Parkinson’s disease, cardiovascular diseases, certain types of depression as well as cancer still occur as people grow older. Many of those aged over 60 today are chronically ill or suffer from various illnesses. German health research is faced with tremendous challenges. For this reason, the German government is increasing its support for researchers whose work will provide a better quality of life in advanced age.
Our life expectancy has significantly increased over the past decades. We owe this in part to the great progress in health research. Today, one in two men will live to reach at least 80 years of age; one in two women will even celebrate her 85th birthday. But with this positive development comes the underlying risk of certain illnesses occurring more often. The number of people who are suffering from cancer, cardiovascular, metabolic, infectious, lung or neurodegenerative diseases is increasing significantly. There is also pressure to act due to the emergence and rapid global spreading of new pathogens and the formation of multi-resistant germs.
The example of neurodegenerative diseases demonstrates the consequences of an ageing society very clearly. According to the Deutsche Alzheimer Gesellschaft (German Alzheimer’s Society), there are 1.4 million patients suffering from dementia living in Germany today. Every year, almost 300,000 new cases are added. According to estimates, the number of patients suffering from Alzheimer’s will increase to about three million by 2050. In addition to the burdens imposed on the patients and their relatives, this also poses new challenges for our health system. In order to create better preconditions for researching the major widespread diseases, the Federal Ministry of Education and Research (BMBF) has established the German Centres for Health Research (DZG). These are: the German Center for Neurodegenerative Diseases (DZNE), the German Center for Diabetes Research (DZD), the German Centre for Cardiovascular Research (DZHK), the German Center for Infection Research (DZIF,), the German Center for Lung Research (DZL) and the German Consortium for Translational Cancer Research (DKTK). The objective is to quickly transfer research results to clinical practice: people are to benefit immediately from research. The best minds are working together across Germany independently of institute and disciplinary boundaries. The Federal Ministry of Research will provide more than 750 million euros for these centres by 2015.
Both research into the causes of diseases and the development of new diagnostic and therapy options are time-consuming and costly processes that demand long-term commitment, not only from the researchers, but also from a research funding organisation such as the BMBF. When it comes to neurodegenerative illnesses, the BMBF’s long-term research funding and institutionalisation through the German Center for Neurodegenerative Diseases (DZNE) have contributed to attaining a better understanding of the underlying disease mechanisms, ascertaining risk factors and developing methods for more precise and earlier diagnosis. Nevertheless, dementia is still not curable. Our growing understanding of basic illness mechanisms creates the conditions for medicine that is tailored to the genetic make-up, environmental influences and lifestyle habits of individual people or specific population groups. Besides seeking a better understanding of illness mechanisms, this approach, which is known as individualised medicine, focuses in particular on targeted prevention, diagnosis and treatment. With the action plan “Individualized medicine”, which was introduced in 2013, and the associated funding measures, the BMBF wants to contribute to improving knowledge on individual factors in the development of diseases and treatment options. The development of targeted treatment approaches in oncology has already made considerable progress. A drug therapy is often used in cancer treatment. But the effectiveness of such a therapy varies greatly from patient to patient. The majority of patients suffer severe side effects from chemotherapy. The cancer-causing changes in the patient’s genetic make-up as well as tumour resistances are crucial for the effectiveness of the drug treatment. Two leading-edge clusters funded by the BMBF, “m4 – Personalized Medicine” and “Ci3 – Cluster for Individualized ImmuneIntervention”, are developing new treatment processes that are optimally effective for the individual patient and thus provoke as little side effects as possible.
The problem of ineffective medicine unfortunately affects a large number of illnesses. Depending on the disease, even the best medication only works for 30 to 70 per cent of sufferers. In future, systemic medicine should help to solve this problem. Improved examination methods and the use of large volumes of data collected in the process in models are expected to lead to a significant increase in the data basis for diagnosis and therapy decisions in the near future. There are already approaches towards deriving therapy decisions from complex mathematical models of biological systems which integrate different datasets.
However it is often precisely the progress that is needed to resolve the pressing issues of health research that raises diverse social, legal and ethical issues. On the one hand, a better understanding of the genetic causes of diseases can help to treat patients in a more targeted way. On the other hand, a number of new issues arise from this development. What demands can society make on the individual regarding health care if an increased risk of disease exists? Does the knowledge of a risk oblige every individual to behave in a way that is specially tailored to his or her health? Who should have access to data regarding an individual’s disease risk?
Such aspects have to be identified and discussed as early as possible in order to be able to make extensive use of the potential provided by the insights obtained from health research for improving patient care. It must also be analysed at an early stage which normative or regulative framework ensures that new possibilities are dealt with responsibly. To support this process, the BMBF is funding so-called ELSA research in addition to its research funding in the area of modern life sciences. The acronym “ELSA” stands for an autonomous branch of research which deals with the ethical, legal and social aspects of modern life sciences
Hardly any research field has developed as rapidly in recent years as life sciences. Many diseases that were untreatable some years ago are today not nearly as daunting as they once were. The BMBF’s ongoing research funding has contributed to this. However, there are still great challenges ahead that we must face in the coming years, especially with regard to the demographic development.
Thomas Rachel, member of the Bundestag (German parliament), has been parliamentary state secretary to the Federal Minister of Education and Research since November 2005. He has been a member of the German parliament since 1994. Before his appointment as parliamentary state secretary, he was spokesman for education and research policy of the CDU/CSU parliamentary group as well as CDU/CSU spokesman in the commission of enquiry on “Ethics and Law in Modern Medicine” He has been federal chairman of the CDU/CSU Protestant Working Group (EAK) since 2003.