EPMA summit 2014 under the auspices of the presidency of Italy in the EU: professional statements

Over the next 10–20 years, a pessimistic prognosis considers pandemic scenario for type 2 diabetes mellitus, neurodegenerative disorders and some types of cancer followed by the economic disaster of healthcare systems in a global scale. Well-recognised deficits of currently provided medical services result from the delayed ‘disease care’. Herewith EPMA releases the long-term strategies for the effective promotion of predictive, preventive and personalised medicine (PPPM) considered as the medicine of the future. Under the EPMA-umbrella, an international forum of currently 45 countries is actively contributing to the development and implementation of the innovative PPPM concepts. EPMA is open for collaboration with other leading European and global professional networks relevant for the effective promotion of PPPM in sciences and practical implementation.

Unpredictable, unpreventable and impersonal medicine: deficits of current healthcare Over the next 10-20 years, a pessimistic prognosis considers pandemic scenario for an increasing number of chronic diseases, such as type 2 diabetes mellitus, neurodegenerative disorders, some types of cardiovascular diseases and cancer followed by the economic disaster of healthcare systems in a global scale. Well-recognised deficits of current healthcare is the delayed 'disease care' with all negative consequences such as the low efficacy of medical services, decreased quality of the patient life, frequent hospitalisation and increasing economical and societal burden. 'We have the knowledge for disaster reduction, what we need is the action' [1].
PPPM-medicine of the future and evidence-based platform to advance healthcare Advanced healthcare promotes the paradigm change from delayed interventional to predictive medicine tailored to the person, from reactive to preventive medicine and from disease to wellness. Predictive, preventive and personalised medicine (PPPM) is the new integrative concept in healthcare sector that enables to predict individual predisposition before onset of the disease, to provide targeted preventive measures and create personalised treatment algorithms tailored to the person. Integrative approach by PPPM is considered as the medicine of the future. The cost-effective management of health promotion and disease care implements the innovation by PPPM in modernisation of medical services. Being at the forefront of the global efforts, the European Association for Predictive, Preventive and Personalised Medicine (EPMA, http://www.epmanet.eu/) promotes the integrative concept of PPPM amongst healthcare stakeholders, governmental institutions, educators, funding bodies, patient organisations and in the public domain [2]. Under the EPMA-umbrella, an international forum of currently 45 countries is actively contributing to the development and implementation of the innovative PPPM concepts (see Figure 1) worldwide. The main structures altogether create a consolidated scientific, technological and educational platform and elaborate the long-term strategies of the association, namely:

Long-term strategies of the European Association for Predictive, Preventive and Personalised Medicine
Prioritised medical fields listed and shortly described below have been approved as being of strategic interests of the association. The study was approved by the EPMA BOARD of Directors, Group of Associate editors responsible for individual sections, EPMA Institutional members and EPMA Industrial Advisory Board. Consequent realisation will be organised by the EPMA using following instruments: ➢ multilateral professional and international collaborations, ➢ excellent research activities, ➢ high-quality publications (The EPMA Journal, EPMA Book-Series and other instruments), ➢ scientific projects responding to the calls of the 'Horizon 2020' (and other appropriate national and international programmes), international meetings (EPMA Summits/World Congresses and other appropriate forums) [3], ➢ implementation of the evidence-based research achievements for an effective advancing of healthcare by innovative medical services (creation and qualification of PPPM centres of excellence), ➢ PPPM-related education for both professionals and general population, ➢ effective career promotion of young professionals creating a highly qualified professional elite for the realisation of PPPM objectives via new generations of experts in the EU and global scale.    The growing body of knowledge on nutrition requires the dissemination of well-elaborated information within the scientific and public domains. This section focuses on integrative medical approaches for individualised nutrition by means of predictive, preventive and personalised medicine. It aims to create professional opinions and to enhance and develop knowledge and skills taking into account evidence-based scientific achievements in the fields of epidemiology, healthy lifestyle, optimised nutrition, food science/technology/culture, medical ethics and cost-effective healthcare and environmental and affordable strategies. We welcome innovative approaches for nutrition in health and disease, which can then be used to build up expert recommendations and standardisation. Our goal is to produce an evidence-based consensus for sustainable guidelines in predictive medicine together with targeted prevention in healthy individuals, persons at-risk and stratified patient groups with manifest diseases and provide advice to stratified patient groups, institutions, food producers and marketing experts [23,24], also using the assessment and intervention tools of clinical nutrition and health psychology. Health and disease main determinants are genetic, environmental and behavioural, and each component is merged and interacts with the others. Environment is a still neglected topic in PPPM; nonetheless, geography, climate, anthropic modification, urban, rural and occupational, agriculture and fishing are all subsets that should be considered, along with societal issues and political and economical implication, for increasing the possibility of successful outcomes in health promotion. A greater attention is warranted within the comprehensive objectives of research, also in other field, with a perspective of predictive, preventive and personalised medicine. 12 With the increasingly complex relationship between basic research and clinical application, there is a pressing need to bridge the translational gap from bench to clinic using integrative methods. Topics should explore advances in pathophysiology, disease modelling, biomarker discovery and validation, novel diagnostics (including companion diagnostics) in personalised medicine which should help translate knowledge from studies at the bench side to care at the bed side. Clinical trials and public health studies generating data allow to develop new research hypotheses with a potential to unlock new mechanisms. New approaches in drug development, including data management, bioinformatics and systems biomedicine, allow to address the whole continuum of translation research in genomic medicine: from gene discovery to health application, to evidence-based guideline, to health practice and finally to health impact [28,29]. 14.Information and Communication Technologies (ICT) (responsible editors: Heinz U. Lemke, Germany, and Michael Legg, Australia) PPPM proposes innovative strategies towards an ICT-based holistic presentation of the individual patient and corresponding medical processes/ procedures. These strategies imply a redesign of healthcare activities within a given domain of medical discourse, such as cardiovascular, neurological, diabetic or oncologic disorders. ICT systems support provided by a medical information and model management system-like architecture, which includes a number of carefully selected diagnostic and therapeutic core functionalities, is the prerequisite for an effective PPPM. With a holistic presentation of a specific patient based on appropriate mathematical modelling methods, such as probabilistic relational models and process models as well as advanced ICT-enabling tools, the practice of medicine will be substantially transformed towards model-based medical evidence, providing transparency of clinical situations, processes and decisions for patient and physician. ICT approaches may result in profound and cost-effective modernisation of healthcare. The beneficiaries of these transforming methods and technologies will include patients, healthcare providers and society at large [30,31] The section is focused on predictive and prognostic laboratory tests considered as the robust platform for more precise diagnosis, targeted prevention and treatments tailored to the person. Current deficits in medical services such as delayed intervention, untargeted medication, overdosed patients and ineffective treatments require the role of laboratory shifted from the 'passive performing' to the 'active advising' one. Recommendations by the laboratory to assist clinical practice are highly desirable. This assistance ranges from advising on the necessity for additional tests to the dynamic analysis of the targets. Additional tests should be considered from the viewpoint of their reasonability, in order to reach an accurate and realistic health-related data interpretation for the individual. The analysis of dynamic changes of the target is essential to evaluate potential health impacts such as an individual predisposition to the disease and/or a predictive diagnosis before a clinical manifestation of symptoms. Laboratory value-added investigation and interpretation should be obligatory in creating an advanced functional relationship between laboratory medicine and clinicians together as the responsible decision-makers [36][37][38]. 18.Biobanking and Biopreservation (responsible editor: Judita Kinkorova, Czech Republic) Internationally valid biobanking is currently an ongoing process, facing major viability challenges which are in the focus of this section. As for individual types of biological material (tissue samples, blood samples, DNA, RNA, proteins, metabolites, etc.), unified/standardised instructions and legal approaches should be validated how samples may be collected, stored, retrieved, shared and tested. The analytical quality of collections, storage condition and donation of samples to a biobank require a strict control both at national and international levels. Disease-focused collections require acquired samples to be retrospectively valid for a development of novel biomarkers and novel drugs/treatments. For a disease-specific biobanking, patients should be stratified with immaculate record-keeping, to enable to draw conclusions on the new markers. The functional link to the reliable clinical data and interpretation is crucial for the utility of any biobank [36,39]. 19.Biomarkers (responsible editors: Suzanne Hagan, UK, and Byong Chul Yoo, South Korea) If biomarkers are discovered, are they applicable to diagnostics, treatment targets/monitoring or both? Is a biomarker defined on a molecular basis? Does one biomarker unambiguously define corresponding pathology? Does a new diagnostic approach apply to groups of risks and targeted prevention? Is a multi-level biomarker panel applicable/available to secure a precise diagnose and therapy targeting? This section is in a mission to respond to the above questions [40][41][42]. 20.Medical Chemistry (responsible editor: Jorge F. J. Coelho, Portugal) This section involves a multidisciplinary approach that ranges from the application of innovative active therapeutic medicines to advanced methods for controlled delivery. Particular attention is paid to outstanding developments involving structurebiological activity relationships in different areas of interest for this topic, such as: stem cells; rational drug design, new (co)polymers; creation of tailor-made drug delivery systems; incorporation of target molecules to the polymeric structures; encapsulation of approved drugs with the polymers; preparation and characterisation of nanoparticles for in vivo diagnostics and treatment; and evaluation and validation of new systems in vitro and in vivo studies [43][44][45][46]. 21.Design (responsible editors: Antony Kent, UK, and Guglielmo M. Trovato, Italy) The specific challenge for multidisciplinary communication is the design of media to facilitate effective interaction amongst professional groups in PPPM. These groups currently 'speak different languages' which reinforce each group's professional perspective and frequently underestimates the added value of the transfer of products between disciplines. The specific output of this designing activity is the so-called 'professional interactome' and the representation of complex networks of information.
The interactome represents the most optimal model of healthcare organisation designed specifically for the implementation of an effective interaction amongst professional groups in PPPM that creates the main focus of this section. Recognising the need for engagement and to enhance an patient's ease of access to, and usability of, services and products, the design principles of envisioning and empathy, ergonomics and prototyping will be applied to the conceptualisation and development of personalised services (service and experience design) and personal medical devices (product design). Since 'style in the life' is one of the most important factors affecting health status and its perception, particularly in youngsters, design in the wider sense of the concept and, namely, fashion's trends strongly influences media, health-related behaviours, body size, shape and appearance perception. For these reasons, multidimensional assessment and intervention aimed to favourable modifications of lifestyles should include the awareness that urban, home and work design, even clothing and fashion and related industries, can be addressed to the enhancement of PPPM intervention [47]. 22.Education (responsible editor: Ondrej Topolcan, Czech Republic) This section aims at creating new didactic and educational measures, including e-learning tools, conducting important information for all PPPM relevant professional groups (medical doctors, students, nurses, etc.), patients and their family members as well as individuals as risk and targeted groups in populations, introducing innovative concepts of PPPM and shifting the paradigm from delayed reactive care, to predictive and preventive medical care. It will distinctively draw on current multimedia design practices (see the above paragraph 21) to create attractive and motivational learning materials as well as communications targeted to key groups. The ultimate goal of this activity is to support the creation of a new generation of professionals in medicine who will be able to implement a holistic approach to patient care that recognises the complexity and individuality of any organism instead of treating the patient as a disaggregated 'pool of organs' [48,49]. 23.Business Models (responsible editor: Frank Heemskerk, Belgium) Poor economy of healthcare systems and delivery is in the focus of this section. Across Europe, there is a great diversity of systems, payment and reimbursement schemes. This imposes a highly fragmented market (market access is governed by various public and private organisations) which raises the efforts (seeking recognition, market authorisation and reimbursement in 28 different countries and respective bodies) and the costs (all different bureaucratic schemes) considerably. On the one hand, there is a need for policy dialogue to achieve some harmonisation in rules and delivery but also in access and reimbursement for patients European Society of Radiology (ESR, www.myesr. org); EPMA and ESR have proclaimed the long-term partnership and mutual support in effective promotion of common efforts in the predictive diagnostics, targeted preventive measures and personalised patient treatment in the European healthcare and in global scale. The development of professional synergies between EPMA and ESR are expected to lead to much progress in the PPPM generally and, in particular, strengthen the role of the issue-related European networks. Considering these clear strategic benefits, both EPMA and ESR decided to collaborate considering following items: creation of expert recommendations for advanced healthcare collaborative promotion of innovative medical fields and the philosophy of integrative medicine collaborative development of scientific projects dedicated to translational medicine and practical application of innovative technologies in routine medical practice networking of institutional members in Europe and worldwide mutual enrichment of the long-term strategies and outlook in PPPM by concepts development and regular publishing of position articles in both journals-The EPMA Journal and European Radiology mutual support of educational and training programmes by inviting experts and providing expertise related to diverse branches of PPPM creation of innovative didactic materials for PPPM-related educational and training programmes collaborative development of granting strategies and synergies in setup of innovative projects related to PPPM, e.g. in the European 'Horizon 2020' creation of specialised EPMA/ESR workshops at the regular EPMA World Congresses and ESR Congresses -Mutual support in publicity (website, public relation, etc.).
European Federation of Clinical Chemistry and Laboratory Medicine (EFLM, www.efcclm.org); EFLM provides European leadership in clinical chemistry and laboratory medicine. Both EPMA and EFLM consider the integrative approach by PPPM as the medicine of the future. In furtherance of their mutual interest in advancing the healthcare paradigm from reactive to predictive, preventive and personalised medicine and in laboratory medicine as the integrating element in PPPM, the two organisations recognise the added value of working together and initiate the establishment of the joint Working Group (WG). The strategic document about EPMA/EFLM professional synergies recently has been published in The EPMA Journal to define clear priorities of the collaboration [36].
European Society of Predictive Medicine (EUSPM, www.euspm.org); EPMA and EUSPM are joining the efforts for the predictive diagnostics, targeted preventive measures and personalised patient treatment in the European healthcare. Professional synergies are developed, and bilateral support is provided concerning all scientific, granting, publication, practical application and any other network-related activities.
European Depression Association (EDA, www.europeandepressionday.com); EDA is interested in professional collaboration with the EPMA focusing specifically on predictive diagnostics, targeted prevention and advanced person-centred approaches for the most optimal treatment of depression as the stratified patient cohort.
European, Middle-Eastern and African Society for Biopreservation and Biobanking (ESBB, www.esbb. org); Designed as being reliable for advanced healthcare services, biobanking considers the interests of all parties involved in the research and business. International biobanking is in a focus of both EPMA and ESBB creating the solutions to the below listed unmet needs, namely How can local and international barriers be broken down to unify international biopreservation technologies, sample collections and databases? Who carries the role to promote in the process of biobanking internationalisation? Who should cover the costs of the internationally accessible systems? Who is allowed to legally use these international biobanks once they are created? Who could be nominated as the end user of the data collected?
EPMA is open for collaboration with other leading European and global professional networks relevant for the effective promotion of PPPM.