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REVIEW
Treating An Aging Population — Innovative Dutch Solutions
Netherlands Foreign Investment Agency
Like Europe, Asia is facing a rapidly ageing population that is not reproducing itself. China, for example, makes up one-fifth of the world’s population with its 1.2 billion inhabitants and the infamous one child policy - causing dire population imbalance and an increasingly small workforce to support an increasingly large retiring population. Currently, China has about 137 million people aged above 65 years old and the number is expected to increase by another 100 million in just 12 years. By 2035, the median age of the Chinese would be the same as the current median age of the Japanese, jumping from 35 to 45.

Singapore and Hong Kong face similar problems although immigration laws are offsetting the negative impact by offering incentives to draw foreign talent. This, however, comes with its own set of problems like dissatisfaction and mistrust among the locals. Even Thailand, often thought of as a nation with a young population is expected to see a contraction of the workforce in as little as 10 years!

Economics of Ageing

Defined as a phenomenon where the median age of a nation rises due to declining birth rates and usually an accompanying rise in life expectancy, problems associated with an ageing population spreads far beyond just the immediate issues of human resources and the workforce, public finances and the economy, which alarmingly, seems to be what most countries are prioritizing as the main focus right now.

It is imperative that resources dedicated to the elderly be increased as well. The public welfare system, health care policies and all other issues pertaining to the health, welfare and social fabric of the nation have to be reviewed and amended to meet the evolving needs of the ageing population.

The most prevalent health conditions among people above the age of 65 years include coronary heart disease, stroke and cancer. The majority of the ageing population suffer from at least one of these conditions and they tend to overlap - dementia, depression, arthritis, osteoporosis and eye problems amongst many others.

The Dutch Approach

While there is no one solution that can be used across all countries, or even within countries, to tackle the issues of a greying population, the Dutch have built upon their experience in having to deal with the same situation for several decades. Even so, the problems of a greying population show no signs of slowing down for the Dutch either, expecting their over 65’s to increase from 15% in 2010 to 24% in 2040.

The Dutch life sciences industry is strong in the areas of human health (vaccines, therapeutics, medical devices and diagnostics), agriculture, food (dairy, functional foods, neutraceuticals), the environment (water sanitation) and fermentation.

“This prominence is due to the Netherlands’ productive R&D base and integrated approach to innovation,” says Ms Adeline Tan, Senior Project Manager, Netherlands Foreign Investment Agency (NFIA), based in Singapore. The main focus is on white biotechnology with applications in industrial production, and red biotechnology with applications in healthcare.

Dutch companies are leaders in this area. Through public-private partnerships, the private sector works closely with academia and the government on applied R&D. The country also boasts a national genomics program worth 500 million euros until 2012, 8 universities in biomedical sciences, 2 in agriculture and 1 in veterinary sciences. To facilitate valorization, the Life Sciences and Health (LSH) innovation program is investing 60 million Euros in some 100 projects over the next five years. The Dutch integrated approach to innovation connects programs among the renowned Top Institute Pharma, Centre for Translational Molecular Medicine and Biomedical Materials Programme.

Within the last 10-15 years, the Dutch life sciences sector, Ms Tan adds, has become one of the most research-intensive sectors with the potential to deliver innovative products, resulting in some of the recent breakthroughs that could alleviate medical issues prevalent among the greying population.

Treating Rheumatism with Electric Chip

Rheumatoid arthritis is a systemic auto-immune disease. Symmetrical inflammatory polyarthritis is the primary clinical manifestation and the arthritis usually begins in the small joints of the hands and the feet, before spreading later to the larger joints. The disease causes constant pain in joints and is a life-long condition with symptoms stemming from interactions between nervous and immune systems.

An estimated 40 million people in the United States have arthritis or other rheumatic conditions. By the year 2020, this number is expected to reach 59 million. Currently, about one percent of the world population suffers from rheumatoid arthritis and rheumatic diseases are the leading cause of disability among adults aged 65 and older.

Scientists in the Netherlands have found a way to treat rheumatism by implanting a chip into the neck of the patient. This breakthrough marks the first time in history where drugs are unnecessary in the treatment of rheumatism. The implanted chip delivers electric stimulation to the nervusvagus - the primary nerve responsible for regulation of heartbeat and breathing.

By implanting the chip, inflammation of joints can be inhibited. Joint inflammation is one of the most common side effects of rheumatoid arthritis. Electrical stimuli would be set to the vagus nerve in the neck for approximately one minute a day to reduce inflammation. Besides fewer complaints of pain and swelling in the joints, damage is slowed down.

At an international congress in Washington, the Academisch Medisch Centrum from Amsterdam announced that initial tests on 8 patients have delivered positive results. One patient’s progress was so good that he was deemed cured from the ailment entirely! Researchers were flooded with more than 1,000 requests from patients keen on participating when permission was first granted to carry out the tests in 2012. The results signify an important milestone in the treatment of rheumatoid arthritis despite having a test group limited to only 8 people.

The benefits of this new form of treatment can also be measured financially as the chip has an expected lifespan of approximately 10 years, as opposed to rheumatic drugs that are costly. Another advantage is that the implementation of pace-makers is a known technique, and as such, it can be applied quickly, as opposed to the lengthy clinical trials needed for developing drug treatments.

Better Vision with Enriched Eggs

Age-related Macular Degeneration (AMD) is an eye disorder that reduces vision drastically and can even lead to blindness. With a dark, blurred spot developing in the center of vision, the condition has a great impact on people’s well-being and there is as yet no treatment.

In Europe alone, 5.5 million people are diagnosed with AMD. Approximately 62 million additional people are at risk of developing AMD, or are in the early stages of the disease without even knowing it. The condition usually occurs from age 55 onwards, with almost 50% of people aged 65 and above suffering from this disease in a range from mild to very serious. Due to the progressive ageing of the population, the number of those affected will further increase.

A study conducted to investigate the impact of AMD on people suffering from the disease indicates that a mild form of AMD reduces the quality of life by 17%, which is comparable to the impact of angina pectoris. Quality of life in the final stage of AMD declines by 63%, which is comparable to a heart attack.

Maastricht University and biotech company, Newtricious, recipients of the prestigious Food Valley Award, successfully collaborated to develop a way to enrich eggs with carotenoids to help protect the elderly against the serious eye condition.

Carotenoids are not produced by the body and the dietary intake of carotenoids is low. They are naturally occurring in corn and leafy green vegetables like spinach. However, today, they are also an ingredient of a large variety of commercially available food supplements. Carotenoids are fat-soluble and as a result, bioavailability is low because of the low-fat environment in vegetables and food supplements.

The fatty composition of egg yolks allows for binding with the fat-soluble carotenoids, allowing for very efficient absorption in the human body. Eggs are also a source of lutein and zeaxanthin - with elevated intake, lutein and zeaxanthin been proven to increase the macular pigment in eyes.

The first trial in human volunteers was conducted in 2007 at the University Eye Clinic Maastricht after initial studies in the field of natural sources of lutein and zeaxanthin, enriched animal feeds and stability and consistency of carotenoid levels in hen eggs. In this pilot study, there were strong indications that the quantity of lutein in the eye increased in the test group that ate carotenoid-enriched eggs.

The ongoing project aims to make the enriched eggs commercially available to those at risk of developing AMD and to persons currently inflicted with the problem. In order to reach this group of consumers, a health claim would provide the strongest opportunity for communicating the added value of the enriched eggs – both Europe and the United States working towards legislative requirements for the claim.

Advanced Radiotherapy for Lung Cancer

Widespread use of advanced radiotherapy techniques in the Netherlands has resulted in improved survival among elderly lung cancer patients, according to major new research conducted by one of the country’s leading cancer centers. VU University Medical Center (VUMC) in Amsterdam, which has now treated more than a thousand patients for pulmonary tumors using stereotactic ablative radiotherapy (SABR) on treatment machines supplied by Varian Medical Systems.

According to Dr. Niels Haasbeek from VUMC’s department of radiation oncology, the greater use of advanced radiotherapy techniques have led to large improvements in survival for Dutch lung cancer patients over the age of 75, many of whom are too frail to undergo surgery. The patients in this age group who are fit enough for surgery also have the curative option of SABR as an alternative to surgery, he adds.

Lung cancer is the most common cause of cancer deaths worldwide yet improvements in overall survival have been minimal in recent decades. Using expertise gained by several years of advanced radiotherapy treatments for early-stage lung cancer patients, clinicians at VUMC embarked on a nationwide study to examine the impact of SABR on survival rates.

SABR, also sometimes referred to as stereotactic body radiotherapy or SBRT refers to a method of treating the tumor with a targeted high-energy radiation beam to damage tumor cell DNA and kill the cancer cell. It was first used in the Netherlands at VUMC in 2003. The university accessed the Dutch National Cancer Registry to examine survival data for three defined periods - the three-year period before it was introduced, the three-year period while it was becoming available at other Dutch centers, and the three years when it was available nationwide. The results showed a marked improvement in survival among the nearly 5,000 lung cancer patients aged over 75 who were treated over these nine years.

During the period covered by the retrospective study, advanced techniques such as SABR led to radiotherapy use for lung cancer patients increasing from 31 percent to nearly 38 percent and a corresponding increase in survival of nearly 10 months from 16.8 months to 26.1 months.  

Fostering Global Partnerships

A world leader in scientific research, the Netherlands with its R&D capabilities, combined with excellent logistics, infrastructure and the ability to meet the commercial and technological demands of our rapidly changing demographics. The country is able to achieve this through public-private collaborations both at the local and international level.

“These public private partnerships not only bring together top research groups in universities, knowledge institutes and academic medical centres with global companies, medium sized enterprises but high tech start-ups as well,” Ms Tan reiterates. The collective aim, she says is to improve therapies while giving a boost to life sciences research and development.

With the highest number of academic hospitals, companies and more than 100,000 people in jobs related to research and development in the life sciences industry, the Netherlands looks well set to make even more progressive strides in the field of human health, given the shift in global demographics and healthcare needs of specific population groups.

About the NFIA

The NFIA (Netherlands Foreign Investment Agency) is an operational unit of the Ministry of Economic Affairs. The NFIA helps and advises foreign companies on the establishment, rolling out and/or expansion of their international activities in the Netherlands. The NFIA was established more than 30 years ago, and has since then supported more than 2,800 companies from nearly 50 countries in the establishment or expansion of their international activities in the Netherlands. Besides its headquarters in The Hague, the NFIA has its own offices in the United Kingdom, Turkey, North America, Asia and the Middle East, as well as a representative office in Brazil. Additionally, the NFIA works together with Dutch embassies, consulates-general, and other organizations representing the Dutch government abroad, as well as with a broad network of domestic partners.

For more information on the innovative Dutch life sciences sector or investment opportunities in the Netherlands, contact Ms Adeline Tan, Senior Project Manager of the Netherlands Foreign Investment Agency (NFIA) at Tel: +65 6739 1137, email: tan@nfia-singapore.com or visit www.nfia-singapore.com

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