Medical Meets Machine

Pharma needs to be at the intersection between technological innovation and medical insight



In his book The Tipping Point, Malcolm Gladwell writes about that magic moment when “an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire”.

Those in the know say that the use of technology in medicine is currently at that tipping point. With the potential to fundamentally change the practice of medicine over the next decade, this will also transform how pharmaceutical companies interact with and support healthcare professionals.

Healthcare is currently “low-resolution”, says Professor Iain Buchan, newly-appointed Director of Healthcare Research for Microsoft in the UK and Professor of Public Health Informatics at Manchester University.

We know a lot about patients when things go wrong, when they come into the clinic and details are taken, we get a snapshot in time. At higher resolution, the view extends across the patient journey, tapping into the rhythms of life. A very important rhythm is medication behaviour, about which  very little is truly known.”

He says that in a more connected and predictive world, we will look at therapeutics within the context of biology, behaviors and environments. “We are on the verge of a really interesting journey for clinical therapeutics and patient experience, which will allow us to have high definition healthcare. This will treat the patient journey and not just the stops along the way.”

For example, stratification will become ever more accurate with advancing biological knowledge leading to more precise care when coupled with technological advances, such as AI and personalization. Buchan explains that complex models of patients and as much as individual behaviours when it comes to treating an illness.

With such pervasive technology, transparency will come to the fore. “Today, if I go to my GP or look online for treatment options, it is hard to see how uncertain those options are. It may be that current evidence can’t determine whether treatment A or B is best for me. In this equipoise situation, the most transparent answer from the doctor, or the algorithm I consult before making the appointment, is: Don’t know: Would you like to enter a study to discover the best treatment in this situation, helping patients like you? The very nature of the consultation needs to change, and the right AI could underpin this evolution.” admits Buchan.

He continues by explaining that this connectivity will expose the “invisible” individual pharmacology of each patient, including the timing of medicines, and the “meta-medication” of lifestyle factors such as diet, alcohol, physical activity and sleep patterns.

“This will lead to a more purposeful connection between physician and patient. We are moving towards a world where personal health data and algorithms provide a view of the road ahead for your health, whereas old-style medical records were more of a rear-view mirror of healthcare,” forecasts Buchan.

“If patients donate data to be learnt from, healthcare systems have a duty to harness those data for better therapeutic understanding and development. Separate systems for post-marketing surveillance, clinical trials and prescribing quality management, etc. are wasteful – they need to merge into ‘bigger brains’ at the core of health systems.”

It’s clear this goes much deeper than the average patient support program. These algorithms will become an inherent part of any new therapy, meaning the success of a drug will not simply be down to the molecule, he asserts. “It is wasteful to support medication adherence in diabetes, for example, without using the same patient contacts to influence diet and physical activity.” These algorithm-drug combinations could potentially show up different subgroups of people who need a different type of therapy, so the boundaries between drug development and discovery may blur.

Unsurprisingly, this type of intelligent medicine means the physician’s role will change irrevocably, with a collaborative effort needed across tech, pharma and medicine. “As patients get more insights into what is happening in the body from recent medications and behaviors, feedback loops are created, which could lead to better outcomes. However, this kind of disruptive observation will also pose challenges in trial design for researchers and regulators.”

Physicians and patients will interact differently, and across all channels, says Buchan. “Trust is central. Trust not only in preserving patient privacy but also in making fullest use of personal data for the healthcare choices that can and should be computed.”

All this heralds a dramatic change in how pharma communicates with key stakeholders – patients, healthcare professionals, and regulators.

 


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