IQWiG Autumn Symposium
Current and controversial aspects in medicine and health politics are regular topics at the annual Autumn Symposium organised by the Institute for Quality and Efficiency in Health Care. The spectrum of speakers is usually as broad as the range of topics and includes epidemiologists and oncologists, as well as health economists and lawyers.
Presentations from previous "IQWiG Autumn Symposium" Events
Take Alzheimer's disease: Genetic testing can now be used to diagnose relatively reliably whether a person has hereditary Alzheimer’s disease and will thus develop the condition in the course of his or her life. Moreover, the presence of the disease, or more specifically, the abnormal protein deposits in the brain that are typical for Alzheimer's, can easily be detected by means of an amyloid PET scan. But what is the point of early detection if there is no effective treatment? Some say it helps those affected and their families to prepare for the future and make the corresponding decisions. But others argue that people may then have to live with the burdensome diagnosis for many years without really being able to do anything about the progression of the disease during that time.
Questions like these have been the focus of this year's IQWiG Autumn Symposium. IQWiG Director Jürgen Windeler notes: "The decisive factor is always which consequences arise from a diagnostic procedure and whether the patient is aware of them - before undergoing the respective procedure, of course. This applies just as much to prenatal diagnostics for identifying signs of malformations and disorders in the unborn child, to COVID-19 tests in the pandemic, and to the early detection of various types of cancer (which can in no way be generally equated with cancer prevention). At the IQWiG Autumn Symposium we would like to discuss the benefit and harm of medical diagnostics and also of screening programmes. What constitutes good medical diagnostics? When is less more? What about the right not to know? And what studies are actually needed to be able to assess the benefit of diagnostics?"
How much market can the healthcare system tolerate? How much can curing a disease, prolonging life or alleviating symptoms cost? How expensive can a new drug be? Where does Germany's aversion to health economic evaluations come from? And how can the patient perspective be incorporated into health economic evaluations? These questions are not new. But they arise all the more in times when prices that could overwhelm the financial capacity of the German healthcare system in the foreseeable future are being charged for certain treatments.
Health economic evaluations can provide information on whether the reimbursement of costs by the health insurance funds is appropriate and reasonable. "To date, however, we in the German healthcare system have shied away from the debate about how expensive a treatment may be in relation to the benefit it achieves," says IQWiG Director Jürgen Windeler at the IQWiG Autumn Symposium 2021. Why this is so, what a balancing of costs and benefits might look like, and how other countries are dealing with rapidly rising healthcare costs was discussed by participants in Cologne on 26 November.
Evidence-based surgery? Is that even possible? There is still the prejudice that everything in surgery is different, especially in comparison with drugs, that controlled studies are not necessary or not feasible. One reason for this may be that the framework for clinical research is different, also because regulatory authorities do not initially place high demands on high-quality research and therefore incentives to produce reliable clinical study results are lacking. However, as with medication, before surgery patients are just as interested in which surgical procedure is the most suitable for them: A or B or a conservative approach? Here, controlled studies and meta-analyses as traditional instruments of evidence-based medicine can generate the necessary answers.
Growing importance of robotics and artificial intelligence in the operating theatre
How has clinical-surgical research developed over the last 30 years and which research networks have been established? What is the infrastructure for the promotion of clinical studies in surgery? What are the methodological challenges facing those responsible for studies in the surgical disciplines? What are the facts and figures on the translation of evidence-based surgery into practice? Eleven experts answered these questions at the IQWiG Autumn Symposium on 29 and 30 November in Cologne and examined the topic from different angles. The focus was also on everyday surgical practice as well as on the legal framework under which clinical research takes place, especially in view of the increasing importance of support systems and artificial intelligence in the operating theatre. Do these technical innovations still offer room for evidence-based medicine?
As always, the IQWiG Autumn Symposium provided plenty of room for open questions, interdisciplinary discussions and networking.
Patients, doctors, media representatives and politicians: The communication of health-related evidence has several target groups that differ strongly in their previous knowledge, intentions and information needs. However, there are things in common, such as in communication psychology and sociology: The evidence communicated is often faced with internal resistance due to information overload, ingrained prejudice and competing influences – from marketing frames to fake news.
In contrast to such influences, many messages of evidence-based medicine are complex, counterintuitive, abstract and thus unemotional, that is, anything but catchy. These “sour fruits from the tree of knowledge” cannot be sweetened en passent, for instance by radically decreasing complexity or increasing emotionality – this would endanger their informative value.
On 23 and 24 of November 2018 in Cologne, 10 experts examined the topic from different perspectives in several (German-language) presentations: What are the basics, barriers and success factors of effective health communication? Which target groups do we communicate with and how? In this context, what are the specific conditions on the Internet? Are podcasts and storytelling suitable for evidence-based medicine? How does the rebuttal of myths and fake news work in the health field? How important are scientific findings in political processes, such as for legislation? How does scientific journalism convey complexity, and what is the relationship between emotion and evidence? What information (and in which format) and skills do doctors require for successful communication with patients? Does evidence-based health information in its current form fulfil the needs of people?
As always, the IQWiG Autumn Symposium provided lots of room for open questions, interdisciplinary discussions and networking.
As a matter of course, health care decisions are based on the results of clinical trials. Such evidence is also required when patients are to be provided with fair and appropriate information about the advantages and disadvantages of interventions.
However, tailored data are far from being available for every decision or every target group. Information pertaining to children, very elderly patients or patients with certain accompanying diseases, for instance, is lacking for many interventions. Or the data are obtained from clinical studies conducted outside of our cultural area. To what extent can their results support informed decisions here in Germany?
Can we extrapolate evidence in these situations without leaving the secure foundation of evidence-based medicine? If so, which methods should we use? Can we not say that extrapolation is even a necessary component of every scientific evaluation? Does it, on the other hand, encourage arbitrariness and undermine the efforts of evidence-based medicine? Where are the boundaries of transferability and how can they be drawn?
These are the questions addressed in this year’s IQWiG Autumn Symposium, also for current legislative reasons: The added benefit of drugs for children no longer has to be demonstrated with separate studies when a drug has already been approved for adults.
Is it better to have surgery or to wait? Can the dose of a drug be reduced? Does sharper imaging of tumours result in better health care? Taking a sober look at medical procedures and interventions will lead surprisingly fast to the insight that many highly relevant questions have not been answered.
At the same time, we have to recognize that studies that might be able to answer these questions fail to be conducted: be it that difficulties come up in the conceptual phase, be it that they fail at a later time point - because participation of physicians or clinics is poor or recruitment does not work out. Most studies that fail remain in the dark; only few are publicly discussed. However, the fact that important studies are not conducted is as interesting as the reasons that contribute to their failure or to their success. Because only on the basis of this information can the general framework for studies be changed in such a way that relevant questions can be answered.
At the Symposium, we are going to present both successful and failed study projects and take a look at their respective general framework.
Benefit assessments of medical interventions are conducted to answer the question: What is the benefit and possible harm of the intervention for patients? It has been repeatedly demanded to use not only the results from “artificial” randomized controlled trials to answer this question, but also data from the actual health care setting (real world).
This raises some obvious questions: What are the characteristics of these data and what specific contribution could they make to benefit assessments? What requirements would they have to meet to provide a basis for valid conclusions? Is it acceptable to accelerate drug approval on the basis of a weaker evidence base, referring to later real-world data? These were the main questions discussed at the IQWiG Autumn Symposium held on 27 and 28 November 2015.
On the occasion of IQWiG’s 10th anniversary, the Autumn Symposium held in Cologne on 28 and 29 November therefore took a look into the future: International and national experts from clinical practice, research, the health care system, politics and media provided answers from their particular perspectives. On the one hand, the Symposium covered the focus of evidence-based health care on patients, and on the other, the contributions IQWiG can make to meet the future challenges.
In the competing fields of patients' interests, legislation and research, the content of the term "quality of life" is interpreted differently, depending on the perspective. "Quality of life in health care: Do we know what we are doing?" – this is what we asked experts from research, medical practice and self-government, as well as patient representatives and other participants at the Autumn Symposium held in Cologne on 29 and 30 November 2013.
Current aspects in medicine and health care were discussed again in Cologne on 23rd and 24th November 2012. This year the speakers at the IQWiG Autumn Symposium posed two controversially discussed questions in health care: "Cancer: Is everything different?” and "Can less be more?”
Current and controversial aspects in medicine and health policy was discussed again in Cologne on 25-26 November 2011. This year the IQWiG Autumn Symposium, which has been taken place for the seventh time, was address the topics "Methodology: between regulations and arbitrariness” and "Personal responsibility”.
How can the benefits and harms of interventions in different medical areas be balanced against each other? How evidence-based can such a balancing be? How do the approaches to such a balancing of benefits and harms differ from the perspective of the German Drug Law on the one hand and that of the Social Code Book on the other? Which study data are required to be able to actually perform an informed balancing of benefits and harms? For example, how is the development of clinical practice guidelines affected if only part of the study data is available? What about data transparency in the field of medical devices? Leading health care researchers will discuss these and other questions at IQWiG's annual Autumn Symposium in Cologne on 19 and 20 November.
What value judgements are made in medical science? How many medical decisions are based on scientific proof, on proven knowledge? Can the pharmaceutical industry carry out objective research? Can we justify any rationing of health resources? What reforms are necessary to improve health care?
Leading health care experts from home and abroad met again at the IQWiG Autumn Symposium in Cologne on 28 and 29 November to discuss current and controversial aspects of medicine.
The first day focused on a key topic of the Institute: evaluating the benefit and harm of medical interventions. The topic for the second day of the symposium explored the requirements of and consequences for stakeholders in health care on the one hand, and insured citizens and patients on the other, as a result of the scientific knowledge obtained.
Can therapy outcomes be improved if patients are well informed? Which legal aspects need to be considered when informing patients? Why are many drugs so expensive? How are prices for medical services calculated and determined in other countries? Leading health care experts pursued these and other questions in Cologne on 23 and 24 November.
About 250 health care experts from Germany and abroad met in Cologne to discuss health care issues. What is the state of quality improvement in the pharmaceutical industry and quality control in medicine? Is the truth bearable? What are the benefits and harms of information for terminally ill patients?
In spring 2005, IQWiG decided to host its own symposium once a year in order to enable a direct exchange of ideas regarding new or controversial issues in evidence-based medicine and to involve a broader professional public in Germany. The results of the discussions will be incorporated in the IQWiG methods and will thus have an impact on how studies will be evaluated in the future. The first event of this type, the IQWiG Autumn Symposium 2005, was held on the 18th and 19th of November in Cologne.
Together with IQWiG employees, about 170 national and international health scientists discussed selected aspects of medicine. Epidemiologists and statisticians were represented as well as specialists from other medical fields. The presenters were largely members of IQWiG’s Scientific Advisory Board, who before the beginning of the symposium held a Board meeting in Cologne for the first time.
Meeting Programme (German Version)