10 thoughts from 5 great healthcare minds – Becker’s Hospital Review

5 important people gave their thoughts about our current healthcare system in this Becker’s Hospital Review article:

– Jonathan Bush, founder and CEO of athenahealth (Watertown, Mass.)

– Malcolm Gladwell, journalist and best-selling author

– Chuck Lauer, former publisher of Modern Healthcare, and author, public speaker and career coach

– Nancy Schlichting, CEO of Henry Ford Health System (Detroit)

– John Halamka, MD, CIO of Beth Israel Deaconess Medical Center (Boston)

My favorite thoughts in a nutshell:

– On healthcare’s sustainability: new infrastructure is essential. Obsolete systems are a burden and a brake when it comes to innovation and efficiency.

– On changing the practice of medicine: doctors will have to consider the patient as a whole and spend time taking care of all the aspects of his/her health.

– On high-price medicine: prices should be linked with the innovation the product brings to the patient and the other stakeholders including the health system.

– On sharing healthcare data: data sharing with the goal of improving the life of each patient by learning and analytics could be a game-changer in the next future.

All these quotes could inspire leadership styles and help us create, implement and deliver better care for the patients in need.

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Failure to publish the results of all clinical trials is skewing medical science – The Economist

Truth

A recent article published in The Economist highlights the fact that more than half of all the clinical trials are never published.

In any situation, if we only know half of the truth, distorsions ocurr and could lead to inappropriate and harmful decisions. A US law was passed in 2007 to encourage pharmaceutical companies to register them on a website and give follow-up on the results.

But this is not always precisely executed. After the legal maximum of a year was up, the percentage of clinical trials which had had their results published:

– 17% of those paid for by industry;

– 8% of those sponsored by the National Institutes of Health;

– 6% of those paid for by other government agencies/academic institutions.

The quantity of missing trials is huge and hiding poor results is not what we expect from scientists.

It has to change as hidden or missing data could lead to the use of inappropriate drugs in some patients. There is hope: the website Alltrials (launched by Ben Goldacre) and the charity behind this initiative are leading the movement toward more transparency. The charity “Sense About Science is working on an index, to be published later this year, that will rate pharma firms according to the extent of their commitment to publish all trials”.

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Therapeutic Financing Rounds in 2015: Gene Therapy Outpaces Antibodies in Early Stage Investment

Great stats and insights on financing rounds up to now

Next Phase Newsletter

By Michael Quigley, Director of Research, LSN

mike-2

It is no secret that 2015 has been a highly active year for deal-making in the life science space.  However, what is often overlooked is exactly where in the space those deals are taking place. Life Science Nation’s financing rounds database contains detailed information on over 250 of these rounds that have taken place since January 1 of 2015. We track this data from a variety of sources however as many companies and investors chose not to disclose this information this should be viewed as a sample of the entire data set of financings. With this article will highlight what our data tells us about the rounds that have taken place thus far in 2015 for therapeutics companies around the globe.

The first cut worth examining is the types of technologies that received funding.

f1 Figure 1 | Source: LSN Financing Rounds Dataset |…

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The Venture Funding Boom In Biotech – Life Sci VC

One of my favorite blogs recently posted an excellent article on the funding boom currently taking place in the biotech sector.

I think that this article really deserves a read. Why? Because it goes deeper into the fundamentals of the industry destroying some myths about the figures, very often misunderstood by the crowd.

According to Bruce Booth, despite the gigantic amounts invested in the sector:

– it is not always VC funding;

– it is not equally distributed;

– it is not linked to an increasing number of biotech companies getting financed;

– it is not leading to an increase in the the number of new companies created.

Moreover, after this analysis, the author wonders about the current situation (overfunding?) and what would happen in the next few months when investors would switch to other sectors… Another crucial question also emerges: will the number and quality of new ventures be sufficient to refresh the current ecosystem?

 

Additional material:

Venture Capital Investing Exceeds $17 Billion For The First Time Since Q4 2000 – PWC – July 2015

Torrid pace of VC investing in H1 sets a new biotech record – FierceBiotech – July 2015

Biotech Investing Hits An All-Time High–But Is It A Bubble? – Forbes – July 2015

Biotech: The Forgotten Bubble – Barrons – July 2015

Should The Biotech Bubble Be Feared? – Bloomberg – June 2015

 

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Why Are We Failing To Fund Mental Health Research?

Insightful post on the reasons of mental health underfunding.

Snackable Science

Everyone is affected by mental illness in some capacity, either directly or through those that we know. Around a quarter of the population experience a mental health condition each year and this high prevalence has considerable repercussions, both socially and economically. Indeed, many would be surprised to hear that on top of obvious human suffering, mental illness is estimated to cost the UK an eye-watering £105 billion a year once healthcare expenses and lost productivity have been taken into account.

With mental illness disrupting the lives of so many and harming the economy to such an extent, I was genuinely surprised to hear of the funding gap that exists in mental health research. Compared to other diseases that place a similar burden on society, publicly funded research into mental health is disproportionately low. Cancer research provides some of the strongest evidence of this effect, receiving around 20% of total UK research expenditure, almost four times more than the amount invested…

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With Big Data & Digital Health – New Collaborations are Emerging in the Pharma Industry – PWC

TeamWork

A newly published report by PWC reveals novel collaboration models for improved value of medicines

“Driven by empowered consumers and connected technology, the New Health Economy is shifting business incentives from volume to value with a focus on health outcomes beyond the clinic.”

Big data together with EHR (electronic health records) and wearables drive patient empowerment. Today, more and more, people have their say in treatment choices. Actually, health benefits and prices are crucial criteria for decision, especially as patients face today higher out-of-pocket expenses than ever before. We all well know that expensive treatments are financially disastrous for patients as mentioned in one of my previous posts.

Currently, increased focus is put on drug cost effectiveness as we switch progressively from a fee-for-service to an outcome-based world. Every treatment should be precisely calculated in order to be sure that it is optimized for all stakeholders from all points of view. In this context, already last year, PWC highlighted the beginning of a new system: the New Health Economy, where outcomes and quality are rewarded (instead of volume). It is the continuum of what has been started by Michael E. Porter several years ago.

All these changes have essential meanings. Therefore business models need to adapt to current trends: digital is unavoidable; purchaser perspective is necessary; patients need to become partners; regulatory changes have to be anticipated.

Adapting business models is fantastic but not sufficient. Novel collaborations are needed to optimize them for long-term success. All the stakeholders have to be integrated and blended by the biopharma companies: government agencies, insurers (payers as a whole), new entrants, consumers. Beyond collaborations, a consensus on the value of new medicines should be agreed on. Additionally, consumer and patient health information should be leveraged to improved personalization and precision of treatments.

In one word, several changes will flow the industry and challenges will pave the way to success. But it will become much more exciting to develop drugs in this context than ever before!

Report: PWC-21st-century-pharmaceutical-collaboration-July2015

 

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Partnering with patients in the development and lifecycle of medicines – TIRS

Infusion

A wave of new articles on patient-centric drug development flooded the news during the last weeks

It is not a new concept. A task force was started back in 2003 by ISPOR on this topic and several thinkers proposed this vision even before.

One of the more comprehensive article on this topic is the Call for Action written by several experts in the field both in the industry and academia as well as people coming from patient associations, together for the development of a master framework for systematic patient involvement.

Several stakeholders are committed to the success of a specific medicine: researchers, developers, industrials, regulators, insurers, doctors,… but very often they all forget about the main and the most important among them: the patient. He or she is the one taking the drug, benefiting from care or even cure in some cases but also suffering from side effects.

At each stage of development, involving and engaging the patient will bring advantages (pages 8 and 9 of the article gave great figures about them):

– Early research: better prioritization, improved resource allocation, clinical trial protocols reflecting patient needs, superior recruitment rates.

– At launch and beyond: more appropriate benefit-risk assessment, focus on drugs of value to patients, improved treatment adherence.

A part from e-patients blogs, dedicated societies emerge in order to make coordination effort toward common goals like the Society for Participatory Medicine: “Participatory Medicine is a model of cooperative health care that seeks to achieve active involvement by patients, professionals, caregivers, and others across the continuum of care on all issues related to an individual’s health. Participatory medicine is an ethical approach to care that also holds promise to improve outcomes, reduce medical errors, increase patient satisfaction and improve the cost of care.”

In conclusion: “It is essential that all stakeholders participate to drive adoption and implementation of the Framework and to ensure that patients and their needs are Embedded at the heart of medicines development and lifecycle management.”

 

You probably remember the fascinating talk given by e-patient Dave in 2011 during TEDxMaastricht. Dave deBronkart said as an introduction that patients need to be much more involved in order to drive better healthcare as well as superior patient outcomes. The future is now!

 

Additional material

What’s Next for Patient-Focused Drug Development? FDA Announces Final PFDD Meetings, and BIO Recommends Broader Use of the Benefit-Risk Framework – 2015

Partnering with patients in the development and lifecycle of medicine – 2015 – Therapeutic Innovation & Regulatory Science

Integrating the patient perspective in the assessment of benefits and risks of medicines – ISPOR 2014 Workshop

Finding the patient in the drug development process – F. Lewis-Hall (Pfizer) – ISPOR 2013

Toward Patient-Centered Drug Development in Oncology – 2013 – NEJM

 

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Can Finance Cure Cancer? Andrew W. Lo Talk at the University of Geneva – June 29th 2015

I had the chance to attend this refreshing talk about what finance could do to help drug development. My summary of the talk is shown below.

CanFinanceCureCancerAWLGenevaJune2015

 

Memorial Sloan Kettering Cancer Center Interactive Drug Calculator – What will it bring?

DrugPrices

A lot of buzz has been around these days about an initiative launched by a well-know cancer center. We take a step back and think about the rationale and the benefits.

The Memorial Sloan Kettering Cancer Center launched an interactive cancer drug calculator comparing the cost of several cancer drugs with a “fair” price based on factors such as the benefits (extended life expectancy for example) and the issues (like the side effects, development costs,…). The calculated price and the official list price do not match in many cases.

The concept

The rationale

Several doctors, especially oncologists, complained and are still angry about the escalating costs of cancer drugs in the US. It is not rare to see price tags around USD 100’000 per patient per year of treatment. It is clearly unsustainable for the whole system and could be a huge issue for patients as they are required to pay a portion of the cost. See more in one of my past blog posts.

The project leader, Dr. Peter Bach, said: “Prices for many new cancer drugs don’t reflect their value to doctors and patients. Right now, manufacturers have total price control, and total control of prices has led to irrational pricing behaviors.” This situation is not easy to manage.

With the Abacus Tool, we can see the official list price and the “abacus” price, that will be determined by different factors chosen by the user.

The benefits

This tool reflects the implementation of value-based pricing, discovered by M. E. Porter. More on this concept by following this link.

As said earlier by Daniel Goldstein, “currently cancer drug prices are not linked to the benefit they provide. They’re priced on what the market can bear, which is an unsustainable system.”

Patricia Danzon agrees and states that “assigning a monetary value to an additional year of life and discounting a drug’s toxicity should be key components of any pricing system.”

Each user will find a different price depending on the value of each factor he/she decides to select. It is a real personalizable tool for each individual confronted to cancer and its financial burden.

Conclusion

Paying for a specific value is true in any industry apart from the pharmaceutical area. Value-based pricing should be put in place to bring benefits to patients as well as to guarantee the reimbursement of life-saving treatments to each person without destabilizing the health system budget. The ASCO initiative is also working on a conceptual framework to assess the value of cancer drugs (see below).

The value-based pricing for drugs will work its way and it is definitely worth it for all the stakeholders!

Additional resources

‘Financial toxicity’ looms as cancer combinations proliferate – Nature Biotechnology (subscription required) – 2015

How Much Should Cancer Drugs Cost? – 2015 – WSJ

Another initiative by ASCO: American Society of Clinical Oncology Statement: A Conceptual Framework to Assess the Value of Cancer Treatment Options – 2015 – Journal of Clinical Oncology

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Scientists want to make sure medical breakthroughs aren’t just for white men

Precision medicine could reduce the gender gap in clinical trials and genetic databases. This will lead to better care and improved outcomes for women and minorities.

The Rise of the Empowered Health Care Consumer – Deloitte Dbriefs Health Sciences Series

Deloitte-Debrief-EmpoweredConsumer-June2015

An excellent webcast took place yesterday.

The key points are above on the MindMap I did. The presentation is available here: Deloitte_Dbriefs_Empowered_Healthcare_Consumer_Jun2015

The main take-home message: companies really should include the new health care consumer as a stakeholder. The patient has now more power than ever. He/she is more informed, more connected, more commited but also more demanding.

2015 Design of the Year – Human Organ on Microchip – Financial Times

Innovation

Accelerating the path to market for drugs is the dream of many scientists. Reality is closer than you think…

A Financial Times article (subscription required) highlights this breathtaking innovation that could revolutionize the life sciences world.

“These new organs on chips will enable scientists and researchers to mimic responses to drugs and treatments in human tissue without recourse to animal or human testing”.

It will enable researchers and pharmaceutical companies to spend less time and money in animal models as well as in human clinical trials. It will also accelerate the development and allow patients to be provided with the needed drugs sooner than ever before.

Human organ on a microchip has won the 2015 Design Museum’s Design of the Year contest. Thought and developed by a cross-disciplinary team of researchers led by D. Ingber and D. Dongeun Huh at Harvard University’s Wyss Institute, this chip is able to mimick several different types of organs. By using it, it will also be possible to see whether a patient would respond or not to treatments. Personalized medicine will be more precise and more targeted. Additionally, multiple chips can be connected to play the role of the human body.

Have a overview of the technology in their 2-minute video presentation:

 

Go deeper into this amazing technology and its potential application with the TEDx Boston talk by Geraldine Hamilton:

 

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Doctor On Demand Pulls In $50 Million To Continue Expansion Of Its Virtual Doctor Visit Platform

Telemedicine is on the rise. It could be extremely useful for remote areas as well as disabled people unable to visit the GP office. Availability 24/7 is also reassuring for chronic disease patients.
This is clearly one of the main trend in the healthcare industry.

Medtronic – The Digital Pancreas – The Future of Diabetes Management? – Fierce Medical Devices

pancreas

A truly interesting article of the transformation of Medtronic Diabetes business

2015 could be a year to remember as the start of a new era in improved diabetes management thank to digital tools.

Diabetes management at Medtronic & deals history

It started several years ago but back in May 2001, a transforming event took place: Medtronic bought Minimed as well as an affiliated company for USD 3.8 billion. Looking only at Minimed, Medtronic paid USD 3.28 billion for USD 400 million in sales (8.2x 2001 sales). Despite its price, quoted as high by some investors and analysts at that time, the deal rationale was pretty compelling as it allowed Medtronic to enter the diabetes management arena. MiniMed offered a beachhead into the field of technological management of diabetes, one of the fastest-growing chronic diseases in the world and one that affects an estimated several millions of people. The devices produced by MiniMed help patients manage their insulin needs and monitor glucose levels.

Since 2001, several deals and partnerships paved the way up to where Medtronic is today. After having a look at my deals database, I can say that some of them clearly stand out:

November 2004: agreement with Novo Nordisk on prefilled insulin cartridges;

– August 2007: co-promotion & co-marketing with Lifescan and Bayer of blood glucose meters (in USA together with Lifescan and outside USA with Bayer extended in 2011). These devices had wireless data transmission to insulin pums;

May 2009: strategic marketing collaboration with Eli Lilly on patient education and disease management;

June 2009: acquisition of PreciSense, a medical device company developing CGM (continuous glucose monitoring) technology. A step forward for “closed loop” systems dedicated to insulin delivery;

January 2013: research collaboration with GI Dynamics on EndoBarrier;

August 2013: acquisition of Cardiocom, a developer and provider of integrated telehealth and patient services for the management of chronic diseases;

June 2014: global strategic alliance with Sanofi, aimed at improving patient experience and outcomes for people with diabetes around the world. The priority is the development of drug-device combinations and delivery of care management services to improve adherence as well as simplify insulin treatment.

Medtronic has built its Diabetes franchise over the last several years and is still fully committed to be the leader in this field. This pledge could lead to the achievement of the digital pancreas, a fully autonomous device (closed loop system) monitoring blood glucose continuously and adjusting insulin doses as perfectly as the biological pancreas without human interaction. Some researchers already have prototypes, studies are ongoing, universities and hospitals are teaming up. The field is really at its boiling point!

Deals and partnerships in 2015

In this FierceMedicalDevices article, we can see Medtronic advancing its franchise by investing with determination and dedication in new technologies.

Many partnerships have been signed in 2015: Diabeter (a diabetes clinic and research center dedicated to providing comprehensive and individualized care for children and young adults with diabetes), DreaMed (artificial pancreas technology for integration into future Medtronic insulin pumps). Beyond healthcare companies, Medtronic is also expanding its network into consumer electronics with Samsung (integration of mobile and wearable devices to improve disease management with an Android mobile app) and diabetes data with a startup called Glooko. It also partnered with IBM Watson Health for next-generation disease management solutions.

All these deals are clearly accelerating innovation at Medtronic but in a patient-centric fashion as in every deal we can see the benefits for them and the management of their disease. What could be the next step? A deal with Apple in order to nearly fully cover all the mobile OS in the world.

For my conclusion I will quote Medtronic CFO, Gary Ellis: “We’re focused on transforming our diabetes group from a market-leading pump and sensor company into a holistic diabetes management company focused on making a real difference in outcomes and costs,” summed up Medtronic CFO Gary Ellis on the most recent quarterly conference call.

 

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