#Trump: Total reyekri nan US politik medikal?

With the news that Donald Trump has won a stunning victory to become the 45th President of the United States in January 2017, those working in personalised medicine and healthcare in general on both sides of the Atlantic will be watching carefully, ekri Ewopeyen Alliance for Personalize Medsin Direktè (EAPM) Egzekitif Denis Horgan.

In 2010, current President Barack Obama launched the Affordable Care Act (dubbed Obamacare). Later he ushered in the Precision Medicine Initiative (PMI), the latter in his 2015 State of the Union address. Therefore, it was surely a little surprising that health care for the nation’s more-than 300 million citizens was barely touched upon in the three feisty debates leading up to this week’s election.

Now that the results are known, supporters of Obamacare will be rueing America’s vote. Losing candidate Hillary Clinton had pledged: “As president, I'll defend the Affordable Care Act, build on its successes, and go even further to reduce costs. My plan will crack down on drug companies charging excessive prices, slow the growth of out-of-pocket costs, and provide a new credit to those facing high health expenses.”  However, ultimate victor Trump had previously spoken of “much-needed free-market reforms to the health-care industry”.

He had added: “But none of these positive reforms can be accomplished without an Obamacare repeal. On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.”

It is fair to say that at least some of the population agreed with him, as the effects of the Affordable Care Act have been far from perfect in the minds of many citizens.  Yet it is reasonable to assume that most Americans did not vote with health care at the front of their minds during this election.

So how will the new, very powerful set up (Trump has The White House, the Senate and the House of Representatives) deal with the health concerns of a nation of 320 million potential patients? Because health care was woefully unrepresented in the two campaigns, does the upcoming administration actually know what its people want and need?

And what now for PMI? At the heart of Obama’s initiative was the creation of a pool of people, both healthy and sick, both men and women, both old and young, who are being studied to expand knowledge of how genetic variants affect health and disease.

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What is clear is that much of the US populace wanted a change from the ‘old guard’. The public were obviously searching for an alternative candidate whom they felt could support them and their own issues. The fact that half of the country felt that the eventual winner cannot properly represent them highlights the faults in what is essentially a two-party system - a lack of choice in progressive candidates.  There are parallels between some reasons for America’s decision and the often slow integration of progressive new treatments, with personalised medicine at its heart, into healthcare systems worldwide.

It appears that key swing states were won due to those citizens who felt overlooked by the establishment shouting loudest. Partly, and despite having a massive party machine, the Democrats failed to adequately communicate with the man and woman in the street.

This is often mirrored when doctors fail to communicate properly with their patients, and fail to take into account their lifestyles, needs and opinions.

Trust was also an issue. Neither side trusted the other or, at the very least were cautious. There is often an undercurrent of that when more knowledgable patients worry about doctors not really in-teracting with them, as well as the problems of less time available with their overworked GPs and the attendant risks of misdiagnosis.

Democrats, and much of Western opinion, will tell you that under Obama the party achieved a lot in eight years. But can Trump build upon these achievements or will he simply set about dismantling them, while building a metaphorical wall (as opposed to the real one he has been talking about) between what healthcare needs and what will actually be provided?  Trump is a businessman, and clearly understands that sustainability in any sphere requires in-vestment, in people as well as infrastructure, and that a healthy nation is a wealthy nation. The right leadership here is vitally important and the president-elect must show it when his time comes.

Continued investment in health care in the US is of paramount importance, as it is here in Europe, although Trump hints that this will come from those ‘free-market reforms’, rather than from any central coffers.

Meanwhile, the election identified silos even within the media (as it did during and post-Brexit, in fact) and, to make another comparison, there are similar issues in health care.  One of the prime barriers to integrating personalised medicine into health-care systems is ‘silo thinking’. There is a desperate need for key players in all arenas to come out of their boxes and co-operate within their own disciplines and, crucially, beyond.

The Brussels-based EAPM is a multi-stakeholder organization that brings together a range of stakeholders including patients, healthcare professionals, researchers, academics and policymakers among others and aims to ensure the right treatment for the right patient at the right time.

The Alliance believes that Trump needs to bring all of America together after what has arguably been the most divisive US election ever (in fact, it mirrors the aforementioned referendum in the UK on Brexit when it comes to dividing an entire nation, with more shock, hatred and anger than even the worst pessimists expected).

As in the health-care arena in the European Union, which is fragmented in key areas, causing huge inequalities in access to the best medicines and treatments for citizens, the incoming Trump administration will need to find a balanced representation of views involving all stakeholders.  Again, as in Europe, access varies from household to household, often involving geographical lo-cation (availability of clinical trails, for example) and the wealth or lack thereof of the patient.

There needs to be a balanced, fine-tuned healthcare eco-system to ensure that America is doing its best for citizens during these times of rapidly escalating health-care costs.  Realistically, it would have been a tough challenge for any new resident of The White House, as it was for Obama, but that challenge will now fall at the feet of one Donald John Trump, a 60-year-old businessman from New York, who has never before held public office.

America, and Europe, awaits the 45th President’s health-care policies…

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