PKB at the Financial Times Global Pharmaceutical and Biotechnology Conference 2015

In November, the Financial Times held a Global Pharmaceutical and Biotechnology conference in London to discuss with the life sciences industry and their partners the new approaches, models and challenges in bringing innovations to the changing healthcare landscape. The conference that spanned two days covered topics from ethics to market access to patient and doctor engagement. Patients Know Best (Dr. Mohammad Al-Ubaydli) was invited in particular to take part in the conversation on the innovations surrounding patient and doctor engagement along with executives of AbbVie (Pascale Richetta, VP of operations, Western Europe and Canada), GlaxoSmithKline (Murray Stewart, CMO) and Sanofi (Pascale Witz, Executive VP, Global Divisions and Strategic Dev). The blog below contains the recording and important themes from this panel discussion.

  1. Patients are becoming more involved in their own care.

All of the pharmaceutical executives and PKB agree that patients are increasingly involved in their own care. This evolution is happening for several reasons. One, because as healthcare is becoming more complex and physicians are becoming more specialized, patients naturally know more about their own health. Two, consumer devices are giving patients access to biometrics which are allowing patients to interpret their own health. From the pharmaceutical perspective, healthcare is moving more towards chronic health management in the community which means that in addition to improving current physician education and relationships with pharmaceutical companies, they are also increasing patient involvement in the R&D process and education.

  1. Pharmaceutical companies are bringing innovation and improvements through partnerships with companies like PKB and Google.  

With increasingly complex protocols and a focus on patient centered care, patients, physicians, pharmaceutical companies and their partners (network of care) are rethinking ways to improve current processes. For instance, GSK is bringing and educating patients in the research and design process early on so that clinical trials can be defined around patient reported outcomes instead of the historical disease endpoints based on regulatory guidelines. Further, all three pharmaceutical companies in that panel have announced nontraditional partnerships to bring innovation and improvement to scale. Sanofi is partnering with Google; GSK is partnering with McLaren; AbbVie is partnering with Philips. PKB, a new entrance to the healthcare industry, too, is partnering with Janssen, a pharmaceutical company, and Perinatal institute, a nonprofit organization.

  1. Patient advocacy is increasing.

Patient advocacy is driving orphan diseases treatment and research but pharmaceutical companies are recognizing that patient advocacy is a vital part of their process for all diseases. AbbVie is increasing patient immersion and GSK is involving patients at all levels of their process. However, it is technology that is allowing patients to discover and aggregate at scale.

  1. Physician engagement have and will continue to play a vital role.

Because physicians have the closest relationship to patients, they are an important part of the conversation. Pharmaceutical companies are not only educating them and developing technologies that complement their workflows but they are also changing the way how they converse with physicians. PKB recognized that physicians were crucial from the start and convinced them that it is in their interest to reorganize the system and put the patient in the center.


[Transcript]

All right. Now I have to remember to ask our polling question right up front so we get some audience engagement here. So can we have the polling question please. So over the next five years how involved do you believe patients will become in their own care? Number one. Patients will become actively– highly actively involved advocates. Patients will have a fair level of involvement. Patients will be slow to adopt a more involved position. And no change from today.

00:00:41.340 –> 00:00:42.820

Responses are coming in. Give it just another second or two here. Can we make 150? We’re slowing down. Last chances to respond.

00:01:04.110 –> 00:01:04.610

Let’s go ahead and show the results. Patients will become highly involved advocates, 43%. 41%, patients will have a fair level of involvement. So we seem to be getting a pretty good consensus from the audience that patients are– involvement is increasing dramatically.

We’ve heard about this. I think Jean Christophe set this up very well this morning and we heard from Natalie [INAUDIBLE] at the center.

We have been hearing that a lot for a long period of time and I guess the question that I always ask around this one, are we finally reaching that point where patient engagement, patient involvement, patient advocacy, is finally becoming real? And why don’t we just go right down the row and get some result–those thoughts on that.

00:01:51.600 –> 00:01:52.100

Sure. So, there’s a few things required. Patient advocacy to come about and they’re all coming together at similar times. The first one is on the ground de facto as healthcare becomes more complicated, it’s being handled by specializations, especially more and more about less and less of the patient.

So de facto, the patient becomes the one who is the only party that turn up to all the appointments. They’re the ones who tell the different specialists what the other specialist’s had done to them. You’re also getting biometric technology. So you’re getting consumer devices and consumer prices and consumer usability coming into play so consumers are getting used to actually looking at their own data.

You’re getting analytics in place, where if you had the right structured data you have analytics both for the consumer and for the professional to understand what that data means. You have explanations that a friend named Dr. Google is the most used source for understanding–and it’s pretty good.

And so the final missing piece is a place to compute– to have that data that you wish to compute. So you need the health care system to let go of the data it has locked up inside institutions. What did your physician say when they saw you? What did the lab test come back with? What did the pathologist decide? Once those data points are in the hands of the consumer then you layer that with– they’re the only ones with the time and the interest and the availability to look at the data.

They’ve got the tools to interpret it. They’ve got the tools to understand it. All of that’s come into play at the same time. So I think they’re definitely coming up to be advocates.

00:03:23.655 –> 00:03:24.655

Pascale, your thoughts.

00:03:24.655 –> 00:03:29.070

Well I would agree and I think there’s been a big evolution and I think Jean Christophe touched on it earlier on. Our industry at some point was probably more as a professional focus than a patient focus, but I think placing the patient at the center is really I think our model which drives a complete change of the way we are working. And I think recently we engaged at Abbvie in a European [INAUDIBLE] group,multi-disciplinary engaging patient under the lead of Mary Harney who is a former Minister of Health in Ireland.

And in fact, when you look at what are the big strategy axis, we should work on you’ve got probably prevention and early intervention. If you don’t take a patient seriously you will not get it, right? The empowerment of the citizen beyond the patient, same topic, and even reorganizing the care delivery because we are moving to a chronic condition dominant world. And we know that our health care system is not fit for purpose, it’s a little bit the rotary phone versus the smartphone, right. And I would argue still the rotary phone age and if you think of the smartphone, you need to engage all together to really make the changes needed.

So the hospital is a fantastic example. It was designed for acute care, still it’s a dominant pillar of our healthcare system, but it’s chronic condition now, which needs another care delivery. So yes I think the patients are there along the side of health care professional and other stakeholders. I would say sort of togetherness moment that we are living.

Very good.

00:05:17.204 –> 00:05:17.941

Murray.

00:05:18.440 –> 00:05:18.939

One, I think we’re getting there. In GSKs medical vision is an organization that’s is recognized and trusted for the quality of our science. Keeping patients well being at the heart of what we do. The reason we put recognition and trust, is that’s the platform. I think people will really not appreciate what we do for patients until they recognize and trust what pharmaceuticals are about.

So I was a diabetes consultant looking after lots of patients. And I joined industry. My mom didn’t know why I was joining industry, and my patients didn’t know why I was joining industry. They thought I was going to be talking and selling drugs. They didn’t understand what pharmaceuticals do. And I think we’ve got to educate people about what physicians and pharmaceutical does. There are lots of jobs for physicians. There’s jobs in safety, jobs in drug development, in medical affairs, all working towards developing medicines that will make a difference to patients’ lives. And I don’t think the public are aware of that.

So how do we get them aware of what we do in the pharmaceutical industry? we’ve got to bring them in and show them. One of the most successful days we’ve had recently is when we brought patients in and took them through the R&D process. Taught them about phase one. Taught them what happens in phase 2, how we interact with the regular authorities.

They were really excited, and what we’re trying to do in our projects is get the patients involved in our projects so they understand the process and therefore can help in contributing.

So as well as great recognition and communication, I think if we’re going to be successful in getting our medicines to the patients we’ve got to get patients and doctors to trust the pharmaceutical company. So two ways for pushing trust is on transparency. I think we’ve got to be transparent about our data. We’ve got to be transparent about our clinical trials. We’re doing quite a lot in publishing our clinical trials. Patient level data is the next thing. We’ve got a data share program where many pharmaceutical companies are joining so that people can come in and ask questions of the raw data, but I think patient’s still don’t understand, and I heard about that, they know a little bit about trials, but most people don’t really understand the scientific language.

So the stage in the evolution of transparency is doing lay summaries, translating the science into language that everyone can understand.

The other thing about trust and transparency is our relationship with doctors. Here in the UK the BMJ have always said, oh well some of the doctors are in the pharmaceutical products, how can we trust doctors who had been paid to speak about products?

They’re only speaking about products because there’s a relationship about sales. There’s a misperception there, there’s a conflict of interest. To try and separate that what we’ve done at GSK is said, well we’re not going to pay primary care physicians, physician’s to speak of about our products anymore.

We know our products, we’ll be the ones talking about them. So to me if we really want to get on and make a difference to patients, we’ve got to get the pharmaceutical organization recognized for what we’re doing in terms of developing medicines, and get the world to start trusting the pharmaceuticals. Our motives are about getting medicines to patients.

00:08:43.025 –> 00:08:44.000

Pascale your thoughts.

00:08:45.071 –> 00:08:45.570

Very good. Well, first of all, let me tell you that it’s a delight coming from Paris, being here today, speaking about the patients. There’s a lot going on and we have heard a lot of the key things this morning already. I think that there was one thing that has really changed and that is driving this change is that the needs of the patient have really changed nowadays.

One, because of the evolution, the aging population, the fact that people live longer with more chronic diseases means that we have a large population that is actually dealing with their chronic diseases, sometimes for decades. And they want to know, they want to understand what they can do for themselves.

We all have relatives or ourselves have to deal with that. In prior to that the technology changes have actually enabled two main things.

One, the knowledge. It was talked earlier about. People understand a lot more and they want to understand what’s happening to them and they’re challenging the physicians. They’re challenging the health care professionals. They want to understand what is true about them and this is where, what is true for all the clinical trials, I can tell you personally I know how we build most of our clinical trials. The diversity is not necessarily there and I never can prevent myself from thinking, well does it really apply to thin woman rather than the big guys that are going through these clinical trials.

And the second thing, and the technology has enabled is this change in terms of the– I will call it the quantified self. All this measuring sensors, all the technology has enabled people to actually measure and trying to understand a lot better what is happening to them.

So I think this is really driving a completely different engagement from the patient themselves.

Now in parallel, and actually I completely agree with you, and I– my mom never told me anything about joining the pharmaceutical industry, but actually I’ve not been in what we call the pure pharmaceutical industry for that long. And one thing that struck me was that actually while everybody in our industry thinks about the patient, we tend to think about the patient’s safety, the toxicity, where we really want to do no harm, which is really important. But we forget a little bit the patient as a person. The patient as a consumer, the patient as an individual. And when you see what people do in understanding what is driving behaviors, consumer behaviors in all the different other industries, why don’t we really use that?

When we know that actually adherence is the biggest driver of the outcomes. Specifically in diabetes as you mentioned. I mean we know that half of the patients are actually dropping from their treatment within the first year. We know that half of the patients who are actually treating themselves are not at goal. And if you can find a way to design solutions that better fit their patients, their lives, you have a better chance to increase the adherence.

So that’s the path that we have taken. Some of the things have been now done in the industry, but we hire the first chief patient officer whose role was really to drive everybody in the company to think about the patient as a consumer. To think about what is really important to the consumer, and how you bring that back, and how you translate that into outputs.

So how do you bring that into the development of your solutions. The solutions being the drug, but it can also be technology, software, services, that you actually package together with your medicine so that you can really help the patients. And that’s particularly true in diabetes. Where we have built this integrated care initiative. I mean Sanofi has been the leader in driving an integrated care approach that is actually developing the solutions that will make a difference to the patients. Now the other thing that I would say is that to make it real, to make it something where the industry can make a difference, we need to embed it into the operations of what we do. It cannot be just an initiative that we run somewhere, and that makes us feel good, or that allows us to communicate.

It needs to be something that changes the way we work within the company, the way we work with other party, and the way we work with all the different stakeholders of the industry.

So I think this is really what is going to change the way we interact with the patients.

00:13:27.497 –> 00:13:30.080

Well I think you’re all hitting a very interesting point here and Jean Christophe hit it a little bit this morning as well.

As we move from more the acute world to the chronic world we get into very complex care management protocols and diabetes care being a very interesting one.

It requires drugs, but it requires devices, it requires integration, of a lot of different services, it’s a collaborative model. I guess the question that I ask there would be, the big pharma companies are you guys the conveners of that, or is it the new entrants like Mohammad with his kind of model that’s driving a lot of that?

And how do you transform?

00:14:14.260 –> 00:14:16.010

And maybe I’ll start–

Murray, why don’t I start with you on that one. So I think having looked after diabetes patients that it is complicated, and people say to me, well what’s the main treatment?

And the main treatment is diet and exercise. And that is about education and communication, but what I also enjoyed about looking after diabetes patients is the multi-disciplinary team. So you needed chiropodists, ophthalmologist’s, you needed everyone to be part of the care of the patient. And the best way to look at that is to look at the patient very holistically, and get them involved.

So the other thing when you’re looking after patients what is– it’s their disease. And sometimes as a physician you’re tempted to be directive and we know– if we’ve got families, we know it’s very difficult to get our children to do things.

Patient’s are the same. You can’t tell someone what to do. It’s no good just saying to someone, lose weight. It’s not that they don’t know that’s good, but they need the tools to enable them to do that. I think it’s about education, empowerment, and that means working together.

And I think we need to work together, physicians, patients, the pharmaceutical industry, thinking about education. So it’s a multi-factorial, but a multi-disciplinary approach for the patient.

00:15:39.500 –> 00:15:40.830

Pascale, what do you think?

00:15:40.830 –> 00:15:42.830

Well I think there’s a lot of education needed. I think it’s not only about the disease we treated. We are all expert in different disease. It’s about also the way we build the system and the efficiency of the system I want to comment on that. And we have, through various pilots, because we trust a lot into the pilot approach and the sort of bottom up power of making– driving the change. You can work on small things. I will take an example in terms of patient no-show, which is about patient behavior.

In Ireland where you’ve got a big shortage of physicians, patient no-show is a loss of productivity, if you wish, of the system. And by setting up with different department what has been called appointment angels, which are nurse’s assistant who are reaching out to the patient and by doing such give education, they are checking whether the paperwork is done, whether the lab tests are ready, whether the imaging is ready, and of course that the patient is coming.

To make sure that the first visit at the hospital, the patient show off, and this visit is as efficient as possible for both the patient and the physician. And guess what?

By only doing that, which is not about money, right. It’s about getting well organized. You can drop off in some department the drop off by 30% the no-show of the patient. By doing that they’re freed– if you take 100 appointments they’ve freed 27 slots of appointments, and if you turn it into money at the scale of one year, it was the equivalent of one more consultant.

So the gain in efficiency of the system was much better and then you can get into each of the specific therapy areas. So I think we should not neglect how much [INAUDIBLE] good by working and engaging together we can do to the system and getting more efficient.

00:17:49.330 –> 00:17:51.630

Mohammad you have a slightly different model, and it might be worth just two minutes on what your business does, but then I’d be interested in your reaction to what you’re hearing here.

00:17:59.400 –> 00:17:59.900

Sure.

00:17:59.900 –> 00:18:02.280

So we have a patient control medical record system. So that means a medical record like the physician has in the hospital or the physician’s office, but the patient controls who gets access to the data. And we did that in the beginning just because I’m a patient myselfand I just wanted to be the one who gets to decide what to look at the data, but what you know is most patients, the first thing they want when they get that control is, they get all their doctors to have full access to the record. They were hoping this was happening anyway. When they find it wasn’t, they just want all the doctors to talk to each other. And so that solves the legal issues around data sharing, and then that solves the productivity issues around lack of data sharing. And then that leads to safety improvements, because of productivity and data sharing issues.

So it’s a fantastic win-win for everyone in the system, and we started off instead of small pilots tertiary centers where you have people with rare diseases with extreme problems of data sharing across wide geographic areas and they’re expensive and complex patients. Places like Great Ormond Street Hospital in the UK. Then it went to local hospitals for diabetes, inflammatory bowel disease, common conditions.

And now we’ve got one region in the UK already wherefore 2.3 million people, all the records are being stored in one area under the control of the patient and as the patient goes across 170 different providers in that area, they ask the patient, I see you have a record in Patient’s Know Best, can I look at it? If they say yes, they can. If they say no, they can’t, unless there’s a patient’s unconscious or having something for their sake they have to intervene. And they also say, well this record, do you want to take over it? Do you want to login, look at the information and control who gets access?

And that’s the first stage of the patient being empowered to not just look at their health, but to understand and manage their own health. So we’re talking about the multidisciplinary team. The user interface is full of propaganda that’s basically around the patient as part of the team. They are a provider of care themselves. I mean diabetes for example, the diabetes– the patient with diabetes in the community has more data and delivers more medication than their physician can in the once every six months appointment. So they are the provider of care. So it’s all about using the patient to solve the information sharing issues, but also that builds up their capacity.

Now to your question about pharma versus tech, versus– I want to just tell you a story because it’s one of the stories that I got– got me obsessed with this problem back in 2007. So I spoke to a physician in Vanderbilt Medical Center and I was writing a book about data sharing and he said, a patient had come in with chest pain.

And he thought it might be aortic dissection. So he sent them for a CT scan, and radiology report comes back, the first line says no evidence of dissection, so the physician was busy, he moves towards other reports. But that month they were trying out patients having access to their reports, so the patient emails the physician and he says, what’s a thyroid?

And the physician said, why are you asking about the thyroid? He says well the last line in the report says, there’s shadow in the thyroid, so what’s a thyroid? And instantly the physician realizes what the radiologist was trying to warn him about, which is an incidental finding of thyroid cancer. So they sent him for biopsy, sure enough it was thyroid cancer, but fortunately it was caught early and the patient’s fine. But basically from that point onwards the physician changes from I’ll do this as a nice thing for the patient and I’ll even look at the data to actually sitting down with every patient and says, it is impossible for me to know everything about all of my patients. I need you, the patient, to do your part.

You have to look at the information as well. You have to double check. You have to understand your health as well as me. You can’t just rely on me. So it’s really the beginning of a participatory, collaborative relationship that includes the patient rather than just informs the patient.

So as we work with pharma, they understand that. A lot of pharma companies fund this technology along with the providers and the patient’s, because what they recognize is that the final outcome, the improvement in the outcome for their patient, which is what lets them negotiate with their payers and set the price for their product, it’s all about a network of care that includes the patient. The problem that they and much of the health care system faces that the regulators still exist in allocation of blame.

So they need to find at every part of the system who did what, or didn’t do what, and could they be blamed for doing something? And that regulation model does not scale to networks of care. So although many of the pharma companies and the providers and the patient groups that innovating on the ground by just getting on they’re doing and funding and carrying out the networks of care, the one request regulators across territories is to recognize that, and to recognize the other regulators like the aviation industry are all about systems and networks, as opposed to allocation of blame, are much safer and have better outcomes when they recognize and embrace that approach. And that’s basically what’s happening in healthcare today.

00:23:07.200 –> 00:23:07.741

Interesting. Yeah Murray.

00:23:09.280 –> 00:23:10.760

Can I pick up at the point about the regulators, because I think they are an important piece of the jigsaw in terms of getting people involved. And one thing that the patients are pushing for is the patient reported outcomes. So there’s very much that the patient say, well what’s important to me, isn’t in respiratory and FEV1. It’s that I’m breathless. And a lot of the regulatory– so pharma’s do a lot of trials based on regulatory guidelines, rather than what the patient wants the clinical trial to do.

So I think we’re getting there where we say, actually what’s important to the patient isn’t an end point like FEV1 it’s breathlessness, and we should be designing trials to show that people are less breathless, of less exacerbation, but the regular authorities need to be part of that dialogue with the patients, with the pharmaceutical industry, so we can start looking at relevant end points to the patient rather than historical disease endpoints.

We’re moving there, but it’s taking time.

00:24:09.720 –> 00:24:12.370

Pascale you hit on that too, so–

00:24:12.370 –> 00:24:15.160

Yes, actually I was about to talk about how we leverage the– at Sanofi we leverage the technology and how– I personally strongly believe in the convergence of biology and technology to make a difference in the patient’s lives.

So Sanofi, as I mentioned earlier, had really built this integrated care approach several years ago, and in diabetes I would say the Gen 0 is to have a good device that allows us to have an easy injection obviously. But we learned a lot on what we did and we also saw the evolution of technology.

A couple years ago we decided to go into blood glucose monitoring, because diabetes is so much linked to the measure of your glucose, but as we went into it we realized that nobody can be an expert in old field. And more and more we need to be in a world where we leverage everybody’s expertise and we drive a very collaborative approach of the different stakeholders. So it is both on the level of the payers, but also on the level of the other technology players, and one example is the partnership we announced Sanofi with Google at the end of August. And the reason or the rationale behind this innovative approach was that we have an expertise in medical and clinical management of diabetes.

We know our patients well, we know how you need to manage the patients however, we saw in Google a partner who could bring us miniaturization expertise, data analytics, data sharing, data storage capabilities, that actually somebody mentioned the amount of data type that you have to deal with, and how you can actually extract the signal from the noise can make a huge difference to the patient. One key European leader recently was telling us that’s one of the challenges he has is that the patients come with a log book. They have their number is written by hand and we all know that can drive a lot of errors. Then if the patient has logbook with him, they’re not sure you can trust the data you have in there. Then the nurse can focus on the one outlier where the doctor says, well I don’t really care about that one outlier. What I care about is this regular pattern of having a high at a certain point of the day and what can I do about it? How can I personalize the treatment, so that I will make a difference to the patient. So actually this partnership has the ambition to bring a different approach to how we can treat diabetes.

We got a lot of– actually I got a lot of questions about what do you want to do exactly?

Well what was really innovative to see we believe that actually it’s only by bringing different type of competencies together that we can help solve problems.

And we don’t know exactly what it is going to be, but we know we are going to– we are dedicating brains that  will work together looking at the same problem from different angles.

We also know however, that this is not going to make a big difference if you cannot bring with us all the stakeholders, the payers, whether their health systems in Europe or the private payers in the US, but so that all those investments in finding a way to improve the outcomes also gets recognized and incentivized.

I think it’s interesting thinking about who you partner with. So I think we do need to– for the benefit of the patients we do need to have an open mind of what we can learn from different industries, different parts of society. So it’s fascinating what you’ve done with Google.

00:27:54.600 –> 00:27:57.770

In GSK what we’ve done is a partnership with McLaren. And some would say, well partnering with McLaren, are you interested in fast cars? I’m not, but what we know McLaren do very well is they really monitor their drivers. So they monitor their heart, rates all the movements they’re doing. And we’re starting to adopt some of that technology in our clinical trials. So for arthritis we’re looking at some of the technology they’ve used in monitoring movement in McLaren’s drivers, with movement in our clinical trials, because obviously one of the things that patient’s surely are concerned about with something rheumatoid arthritis is their stiff in the morning, they can’t move. So how do you measure their movement? Well, we’re using some of the technology that McLaren have done in our clinical trials. They can then show benefit to the patients by showing real changes in their ability to move. So I think thinking why partnering with different groups will all add to the benefit of the patients. And I think there’s– So really what you’re saying is we’re partnering with McLaren I guess we’re [INAUDIBLE] But it’s true I think the partnership is a big element also of the change, driving the change.

00:29:07.110 –> 00:29:10.590

We have had the pleasure to work with Philips for example and we learned from them how good they are in doing patient flow, patient journey to develop and improve their device by bit and pieces, and I think this is something that the device industry has been probably leading at the forefront of the pharma industry and we’re getting into it now with the patient immersion really understanding from the patient’s standpoint. We’ve heard a lot about that partnering and collaboration need and I think it’s an interesting observation.

We’ve heard it a couple of times over the last day or so that the clinical trial is only a small piece, trusting the efficacy of the drug, but there’s behavioral, there are other indications, there are a whole lot of other things that go into that.

00:29:50.700 –> 00:29:53.170

Mohammad do you see– do you see partnering as important from your perspective as well? Are you looking at pharma companies to partner with your business?

00:29:58.231 –> 00:29:58.730

We do so. We already have partnership with Johnson. So this year they rolled out a system to 80 different sites across their full drug portfolio. We’re basically encryption nuts, so we’re obsessed with moving data security between wherever it exists and wherever the patient wants it. And for everything else around delivering the solution to the patient.

It’s all about partnerships. So whether that’s pharma companies that roll that out for clinical care, or use it within their research purposes, or the Perinatal Institute in the UK which accounts for 50% of deliveries in England.They’re rolling out across all their hospitals. All medical records companies all telecoms companies in different countries, basically in every touch point of the patient, the consumer, there is some benefit for that vertical for that geography of using the patient data technology with everything else that the patient needs.

And so partnerships is really about delivering something useful and delivering it scale.

00:31:00.910 –> 00:31:02.700

Very interesting. So I had a conversation a couple of weeks ago with a young woman who was suffering from an orphan disease. And we were talking about patient empowerment and she said, if you don’t actually get it. In the orphan disease world we’re actually all about patient advocacy, and we had 43% of our respondents here said, this is moving to advocacy.

And her comment was, I don’t want to just be empowered, I actually want to drive the system. Do you see patients becoming that engaged? Where they’re really to the point where they’re actually driving what you do, and helping you set direction?

Pascale I’m going to start with you.

00:31:38.950 –> 00:31:43.130

Well I think the reaction I have listening to you, I think that’s certainly true in orphan disease. When you deal with diabetes however, you very often deal with under-served populations. So people who are not as much into these type of networks. However, what I’ve seen actually in the last few years is a change in perspective from the physicians recognizing that actually for chronic diseases unless the patient is engaged in managing their disease, you don’t get to the same outcome. And I think that’s a big change, because, I think you were mentioning that before the doctors was pretty much telling them– telling the patient’s what to do and now the patients are pushing back.

I think we have even gone beyond that at a stage where I’ve heard numerous physicians telling me on diabetes, on long term disease, on cardiovascular thing well, but I’d rather have the patient not do the optimal treatment, but be sure that he’s going to follow the treatment, rather than just continuing to insist on absolutely taking the appropriate treatment. Specifically when you deal with diseases where the issue is not the disease itself, it’s not– it’s a silent disease, it’s not painful, you don’t really die from disease, you die from the complication of diseases. So it’s so important that you can actually make a difference at this stage. The last point I would say on diabetes specifically I am impressed by how people look at what has been done on oncology or Alzheimer’s with this massive advocacy, and diabetes feels a little bit behind in terms of how people realize that actually this is a disease.

It’s not just people who have eaten too much and we have to deal with the guilt of the patient, and that is also very important in how you can move the needle for this type of patients.

00:33:33.940 –> 00:33:34.890

Interesting.

00:33:34.890 –> 00:33:37.830

I think patient advocacy groups play a vital role and I think they’re teaching us a lot about how we development medicines. To your point, I think we should be involved in all stages development.

What we often find out is, and I think historically we would get the patients involved far too late in the process, in phase three we’d maybe say, oh we’re developing a medication for diabetes, what do you think of the medication? We need some patients and– but they should be involved right in the start of the clinical trial, because maybe the clinical trial was answering the wrong questions. So it start of processes– if you’re developing a drug, you should have a vision of what the medicine.

So we have a medicine vision group where the scientists think about the target and what we’re doing, and we want to incorporate patient’s right at the early stages. Someone said, well what do they know about phase one?

No, they need to be there, because by the time they’re involved historically, it’s too late to change anything. So I think the patient should be involved right at the start to the vision in phase one clinical trials considering what the endpoints are, changing them.

So when we set up protocols, protocols are the key thing for the scientists to get right.

We used to say, well we want to make sure they’re global. Well one question we now ask at a protocol view forum, has a patient been involved in designing the clinical trial? So I think we need patients from the beginning, right the way through. So you’re starting to build that informally then to all your trial processes? Formally part of the protocol.

00:34:59.305 –> 00:34:59.846

Interesting. Pascale.

00:35:01.550 –> 00:35:04.280

To build on that, I think we need to involve them early on. I fully agree. I think to the point of Pascale, you need also to take into account the patient, while not advocate right, or so well educated that they have reached the stage of advocates.

So having this patient immersion also to really understand the data, the life of the patient is another aspect where you can really find insight, which will help you for better design of the trials or to address the side of the drug.

Because I think what we’re talking here is going beyond the drug needs of the patients.

00:35:38.260 –> 00:35:40.150

Mohammad, with your group, they own their records, there they’re empowered, are they moving to advocacy?

00:35:43.910 –> 00:35:44.410

Yes. I mean– so I once read a history of people’s understanding of bees. It’s only in the 18th century that European languages changed, talking about the King Bee to the Queen Bee, because before then you couldn’t conceive of a female bee running the whole hive. Obviously it had to be a male that was in control. But the thing is, all that changed was our understanding of who was in control. It was a queen bee. Just took us a while to understand.

So what we find on the ground is for decades patients have already been in control. We may not have recognize that, but they have been. I mean, take diabetes, just the example of, if you don’t take your medication it doesn’t matter what the physician said or prescribed, they have exercised their control by not taking the medication and changing the exercise, or doing– changing their diet. So if you recognize they’re actually going to have to– they’re in control, and you have to work with them and for them, that changes things.

Now what has changed in the last 10 years is that technology allows discovery, and aggregation of demand at a scale previously unimaginable. So it is possible for patients in orphan group drugs– orphan groups to find each other, to find the latest research, to find the understanding of that research. And then it is possible for them to aggregate their demand, whether it’s initially crowdfunding, which then leverages foundations, which then leverages government funding. But they can work together to scale that was not possible before.

If you look at, there’s tiny percentage numbers, and you think that you always have to go through top down institutions. And so again, as we understand that, and we embrace it, then you– you unleash tremendously useful powers in the healthcare system.

Let’s throw it open to the audience and– oh I see a hand right here. That was quick. A burning question. Do we a– have a mic? Right up here.

00:37:48.650 –> 00:37:51.025

In the title of this panel where you speak of building relationships with doctors, and I was surprised to see in Mr. [? Tellier’s ?] presentation that when he spoke of collaboration between stakeholders the doctors are missing. Now, I guess it’s not a secret for anyone that with those organizations which are pushing personalized medicine,

00:38:16.110 –> 00:38:18.670

I don’t know if we should call it the stumbling block or the main difficulty is with the doctors actually adopting the system. So we’re not hearing much from building relationships with the doctors in a practice, which is really, really changing. We’re hearing a lot about the patients, but I’d be curious to hear you about what you do and you may be touched upon it Murray a little bit, to change the mindset and bring the doctors into the game of digitalization and so on so forth.

00:38:53.545 –> 00:38:54.395

Yeah. Go ahead take that.

00:38:56.370 –> 00:38:59.780

Well if I got it right from Jean Christophe presentation, the doctors was there, but the point was to place the patient at the center of the system. To be purposeful, if I can say, but the doctors are there. I guess maybe we didn’t mention it–

00:39:11.765 –> 00:39:12.306

[INAUDIBLE].

00:39:17.930 –> 00:39:21.340

I thought they were, but I think the doctors is there. Obviously I guess as an historical partner maybe we are discussing a lot of patient, because that’s probably the most radical shift, but obviously the doctors is at the center, is the one having the primary relationship with the patient. And to your point they’re also macro changes which I think are ahead of us, which is really the shortage of physician. I alluded to an island in Canada at, the shortage is a such that we need also to probably support the physician to refocus on where they can bring more value and back to the efficiency of the system to be frank.

I think the physician should be at the core of all serious condition. In countries like Canada, for example, where the shortage is so, so acute, you see in fact, delegation to other health care professional right. Nurses, pharmacists, who are getting into simple prescribing, simple health checks. So I think the aging that you’re alluding to, with an increased demographic of age patient, and the shortage of physicians, means that the roles of each health care professional has to evolve dramatically to be frank, including probably the technology which will help. In my example of a island, subsequent to the appointment angel, the physicians were recording the [? Vizsnap ?] application, which is the ability to record the simple video. They were recording [? Vizsnap ?] to the patient to explain, but will be the flow of the visit the next day. To be again, more efficient so I think the physician will get into all this digital world also to gain efficiency, because there will be less and, less and then we’ll have to have a high level of productivity.

00:41:16.880 –> 00:41:17.380

Murray

00:41:17.380 –> 00:41:19.700

I think there’s two solid cases– our links with physicians. So there’s one transaction where working with physicians in terms of payment, and I think we need to be transparent about that.

So if we’re working with physicians and in research, or they’re helping with advisory boards, I think with FP and the Sunshine Act, it should be very clear what that transaction is, and transparent to physicians, the public. So if you’re an ad board this is your payment for the vial you’re giving.

So that’s one relationship. But generally most physicians, when they look at the pharmaceutical, want to know about how does the drug work? What safety? And historically pharmaceutical companies used to go and do talks to doctors about our products. I think in the digital age now, doctors in the evenings, just want to click on something and find out the information. So what I think a lot of companies are now doing are allowing access to their sites, or– so we’re doing a lot of, you log onto our site if you want to know about a product you can go and see a video. We want to communicate wide of the physicians. So we’re doing more webinar based communications. So people from their computers at home can say, well I’d like to know about that, oh there’s a webinar meeting where we can hear about the products. If sales people are out visiting general practitioners and the practitioner says, well I want to understand the science more. We’ve done a pilot called click-to-chat where the salesperson can say to the physician, oh you want a bit more detail? Well I can put you in touch with our physicians in the company. And the salesperson leaves an iPad with a doctor, the doctor can then call a GSK physician, and have a scientific debate about our products. So I think moving to the digital age with physicians is doing things on their timetable, rather than the pharma’s timetable. So I think we’re moving from historical old fashioned talks about products to what do the physicians in the community want. They want information digitally. They want to be able to log on and find out about our products.

So I think there will be more forms of communication using digital means like webinars, videos, information online.

00:43:34.600 –> 00:43:35.780

Pascale.

00:43:35.780 –> 00:43:36.280

Yes. It’s a very important point actually, because we can only drive major changes if the physicians are on board. And the analogy I would drive when we think about leveraging data analytics and how data can support is there was always a phase of resistance thinking medicines is an art or a science and I have my added value of being able to read all these parameters.

I would make the analogy with the digital revolution in radiology, because I remember I had worked in the radiology field back then and I remember at the beginning in the computer aided diagnostics was hard to convince doctors, because they had the feeling that’s– well, I was reading my films. I was seeing everything. Until they realized that the technology and the software were allowing them to go directly to where you needed to see where there was a problem, flagging it. It does not replace it. It allows you to go much faster to the problem points. And I think this is really what technology will help us do, but we can only do it if we have the physicians embarking on it. And I think here it’s a mixture of generation, but also people who wanted to see it.

I would say on average, the younger generation is more prone to adopt it, but I have seen physicians from the older generation being actually the strongest advocate into it. So it has nothing to do with age, but it has to do with seeing the value, and I think one of our role– and that’s where at Sanofi we do that with some of our work with the doctors, is to see with them, and really develop the idea of where technology can help them gain time, be more precise, and make a difference for the patients. But it is something that is absolutely critical to how we are going to make a difference.

00:45:28.320 –> 00:45:31.010

Mohammad, let me get your perspective on this one.

00:45:31.010 –> 00:45:34.810

So when we started in 2008 Google Health and Microsoft HealthVault had been going for one year already, and what we noticed was the– about 1% of patients would get really excited. They’d spend three hours typing the data in, and they go to their physician and say, look what I’ve done, and the physician says, I don’t care.

I’m not going to use this thing with you, and that patient would never again engage. So what we did in the beginning was make sure that we focused on the physician’s and educating them, because they will get the remaining 99%.

So we basically built on three individually mad ideas. So one is the patient’s be in control. Two, the physician should be grateful that the patient is in control, and three the physicians be so grateful they’re going to pay to put the patient in control. And you don’t do that by just saying you should do it. You do it by convincing them and making sure they understand that it’s in their interest, safety, operationally, financially, to reorient the health care system around the patient.

So the first key is all we did was work with the physicians and then they work with the patients directly.

So we’re rapidly running down the clock here, but I think we can take one more question. How about right over there. Thank you.

00:46:41.560 –> 00:46:43.860

My name’s [? Melanie ?] [? Senior ?] with Informa and Nature. Thank you for the panel. I had a two pronged question about this notion of patient centricity, and I’m– I’d like the panel to talk a little bit about how you’re trying to operationalize patient centricity.

I mean, it’s so huge and difficult and each patient’s an individual, but how do you– are you, and how are you attempting to sort of develop processes and systems that can make patient centricity more systematic and make sure each discovery group brings in the patient at the early stage as you were describing Murray, et cetera. And then my second prong of my question is, is the business model behind all this? Are you having to sort of generate ROIs or is it enough for all the senior– the CEOs and senior management, they just know that you need to drive better outcomes.

00:47:36.290 –> 00:47:39.380

That’s the world we live in so throw the money at all these experiments and gosh it’s got to make business sense one day. Interesting question. Pascale why don’t you start.

00:47:45.940 –> 00:47:48.750

So I mentioned the operationalization of patient centricity. I think this is critical if you really want to make a difference. So the way we did that at Sanofi is when I mentioned that we have a chief patient officer, but the team of the chief patient officer is actually embedded into the project and the brand team from the beginning, to think about how you are going to embed the learnings that– I mean other part of the team are bringing from the patient’s as consumer. So that’s from the very beginning you’re thinking about how the treatment is going to be used, and what is going to make a difference. Now to your question about return on investment. Well, this is where the operationalization is so important, and this is why we have taken this approach at Sanofi to really embed it into the brand team, because you can make the same argument about marketing, but you do it because this is the way to design and develop products whether it is medicine, solutions, offerings, that will make a difference and that are going to be embedded.

Now it’s not something that is a coming from the top down and it’s an initiative again that looks well. It is really embedded in the project team, and for me this is the condition for it to be delivering, because then this is the same team that is measured on the success of the product and what you have done. I mean it’s simply I think you can– if you just talk it won’t happen. So you need to all layers of the organizations bought in, and you do need to formalize it. So with the protocol it’s a specific question that’s documented. Unless you actually go to a process and operationalize it and monitor it, it won’t happen.

Well at AbbVie we’ve got patient engagement and care team. They’re fully embedded into element disciplinary team, because we believe that it should be part of the mission of any employee at AbbVie and the way we do it is really to go through a patient immersion, patient journey design with the patients, which since we are doing that I’ve highlighted that we gain insight that we didn’t used to get before. And we as much as we can targeting to address the needs that we get from the inside. So I guess we are sort of in transition with the need of this patient engagement and care team with really driving and helping all discipline to embrace fully this really focus on the patient needs.

And back to the earlier question I think that the physician as all the stakeholders, are part of it, and we can see the tipping point where really one of the other stakeholders can make a difference to the patient or the carer, depending on the condition life.

00:50:41.520 –> 00:50:44.052

Mohammad I’m going to leave you with the last word here.

00:50:44.052 –> 00:50:46.510

So what you’re asking, what the first part of the question was about mass customization, really personalizing around the particular patient. So we do that by every team that we on board, we get them to do their protocols in the system, personal care plans, library, and so on, and then for themselves as an institution, but then the patient has multiple teams attached to them. Because they have diabetes and asthma for example. So every patient has a unique combination of teams and ends up with a unique set of care plans designed for their particular situation. And then in terms of ROI, obviously for the clinical team there’s an Roi around saving money or making money by delivering better patient care, but the pharma companies that we work with they ought to have an ROI from market access, they get to engage with their customers and their pay is a lot more or around initial term. And in the long term they do real world evidence. ROI again based on getting access to data for research purposes, that determines the business case.

Great.

So I’m afraid we’re going to have to leave it there.

Panel thank you for a very interesting discussion. We’re going to be on a networking break here from now (until 11)05, but again thank you very much panel.

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