New models of care
Rising cost of pharmaceutical research
The Melbourne gathering of HealthXL
The event was held at the Murcock Children’s Research Institute, set in the Royal Children’s Hospital, Flemington Road Melbourne.
HealthXL is an international organisation. Their aim is to resolve the most pressing healthcare problems through collaboration.
Four main themes were covered on this day:
- New models of care
- Keeping people out of hospitals
- Effective use of patient generated data
- Consumer empowerment and precision medicine and genomics
The impact that community health standards have on future generations was an overarching theme. As a lot of ground was covered and many unique speakers contributed, this topic is split into a number of blog posts.
This post is the first in a series of four.
“HealthXL started at frustration over the length of time it was taking, between agreeing for the need to fix a problem, to actually solving it – seventeen years on average”
Martin Kelly CEO and co founder of HealthXL
An international platform
Their aim is to enable researchers, companies, clinical staff and payers to engage in productive conversation.
They are currently putting companies through a verification process, so they can be recommended to their members with confidence.
HealthXL is also building a new app, that will allow the user to search their database for suitable companies.
Digital Health – success & failures
Lisa Suennen spoke with James Dromey.
Lisa first studied journalism during a Communications Degree from the University of California. She then worked in the business world, Venture Capital and technology. Finally she moved to health care.
Lisa is currently Senior Managing Director at GE Ventures. She publishes articles in the Venture Valkyrie blog. She is the founder of C-Sweetener, a not for profit aimed at helping women to benefit from mentorship, in order to reach their full potential. Lisa also teaches health care venture capital at Berkeley University.
Lise can see the difference between Silicon Valley startup illusions and a sustainable business.
‘Raising (venture capital) money doesn’t mean doing social good, it just means you are good at sales.’
She questions the rationale for six to ten billion dollars being poured into digital tech startups every year.
‘Exit valuation is poor, the Return on Investment is not there.’
Lisa believes that in the next five years many tech startups will crash.
She points out that ninety five percent of the dollars in health care actually flows through through services. In time she believes investors will move into supporting these people-based services.
Lisa doesn’t use any health apps herself.
According to Lisa the TV series Silicon Valley is a an accurate portrayal of the American tech scene. There are:
- No women
- The men are all nerds
- Startups have poor planning and
- Too much easy money is being thrown around.
Keeping people out of hospital
Dr Sharon Goldfeld is a pediatrician and Deputy Director Royal Children’s Hospital and Murdoch Childrens’ Research institute. She is interested in the population of children and pointed out that there are big inequalities across populations.
‘If you want to improve overall health outcomes you need to improve children’s health – social, physical, emotional.’
She referred to a report by researchers at the Murdoch Children’s Research Institute that highlighted the importance the first 1,000 days has on a child’s development and health.
Key factors for different rates of childhood development included an overuse of antibiotics and caesarian births that reduce the beneficial bacteria flora in the gut and chronic stress caused by domestic violence, poverty and poor nutrition.
Bruce Thomas is Managing Director and founder of the Arcady Group. He advises organizations on ways to improve their global health programs and is a recognized leader in the field of medication adherence.
His company works with Gates Foundation to explore new models of care for TB patients in areas where disease rates are high but medication compliance rates are low.
TB one of the top 10 causes of death worldwide. In 2016, 10.4 million people fell ill with TB, and 1.7 million died from the disease. Over 95% of cases and deaths are in developing countries.
Poor drug compliance
Medication adherence health startups
One of the biggest problems with TB treatment is poor adherence with the drugs. Causes include:
- The lengthy time to complete treatments, six months or more
- Changing regimens. Most treatments have an initial high intensity phase requiring four medications a day, followed by a continuation phase of two medications a day
- The large number of tables required to be taken every day,
- The doses vary for each patient, based on their body weight
- A lack of access to regular health monitoring and follow up support and
- Language barriers between rural people and city based health care workers
The vast majority of TB cases can be cured when medicines are provided and taken properly. However, failure to complete the full course of treatment occurs in 25% of cases or higher. This results are relapse, death and the spread of antibiotic resistant TB strains.
‘Smart’ drug packs can increase compliance rates, but are prohibitively expensive.
It’s important to get TB treatment right. In 2016, an estimated 1 million children became ill with TB, and 250 000 children died from the disease.
Low cost tech-based solutions
99dots an ultra low cost and innovative approach to medication compliance. Each anti-TB blister pack is wrapped in a pack that includes hidden phone numbers. The numbers are visible only when the drug pack has been opened. After taking daily medication, the patients make a free call to the hidden phone number. This gives off site health care works a clear idea of who is taking the drugs and who is not.
Patients also receive a series of daily reminders (via SMS and automated calls). If drug doses are missed, health care providers get in touch by phone.
The Arcady Group is also working with WisePill, an electronic pillbox designed to monitor patient adherence and to provide instant feedback via phone and internet technology.
The panel included Matiu Bush from Bolton Clarke and Caroline Hynes from OneView Healthcare.
Some of their points:
- Social issues affect medical compliance and treatment outcomes
- Highly educated nurses who try to follow neat clinical pathways struggle relating to poorer, low-skilled families
- Doctors in rapid turnover clinics struggle to engage properly with patients
- One solution trialled was to give patients different coloured pieces of paper before they saw the Doctor for their next script. The colour paper they handed the Doctor depended on whether they were taking their medications or not
Effective solutions can be low-cost and easy to implement
“Reforms will also include cutting the red tape at the FDA: there are over 4,000 drugs awaiting approval, and we especially want to speed the approval of life-saving medications.”
Medication adherence health startups
Gossip and politics
A rep from one of the pharma companies pointed out that it now costs over 2 billion USA to bring just one drug to market. This cost has doubled over the past ten years.
The causes? Growing health bureaucracy and excessive regulation.
The result? Fewer new drugs to treat disease are being produced.
According to the rep, to develop a new drug is not financially viable, unless you have a huge company. There are now only ten major pharma companies in the world. Reduced competition means less experimentation and innovation.
On April 2017 Trump nominated a new FDA commissioner Scott Gottlieb to try and reduce costs and delays.
Gottlieb, is a Doctor, a cancer survivor, a venture capitalist who has campaigned against red tape and excessive bureaucracy at the FDA, which he believes is depriving patients of life saving treatments.
The rep claimed that to run a pharmaceutical company is not financially viable any more. Most drugs developed don’t make it through stage 1, 2, 3 and stage 4 clinical trials.
This will impact on the availability of news drugs coming to market in the future. It’s in the interest of the future generation to get health costs down and get innovation to the patient’s bedside sooner.
So in summary we need to:
- Stop throwing money at trendy technology that has a narrow audience and instead, focus on community services with a huge audience
- Find practical and low cost ways to ensure that medications are taken correctly
- Put innovative products in the hands of Doctors and Patients as quickly as possible
The next post will be on precision Medicine & Genomics.
@ Wikihospitals March 2018