Zooming In On Patient-Centricity
We train our lens on the industry's most talked up topic. How do you turn a slogan into substance?
If patient-centricity was a film, it would have a three-act structure. The principle characters have already been introduced, the nature of the quest has been laid out, but the forces bent on frustrating the mission still stand in the way of the victorious denouement.
Of course, life doesn’t follow such a neat formula, but with a career spanning 28 years, Bob Oliver, CEO of biopharmaceutical start-up V ClinBio and until April 2017 CEO of Otsuka, can fill in a few of the gaps.
Perception versus reality
The regulatory framework can stifle visionary thinking, but not in the conventional sense, says Oliver, pointing to a tendency to think “myopically” about perceived restrictions.
Patient-led initiatives would be more innovative and effective if people began thinking broadly and then adjusted to the regulations, as opposed to the other way around.
He cites Otsuka’s hugely successful antipsychotic drug, Abilify (aripiprazole). “An executive in Japan wanted to understand how schizophrenic patients think, and to understand what caused the barriers to their use of medication because the rate of compliance was very low. He lived with patients who suffered from the ailment for two months, and the insights that he gleaned helped design Abilify, which became at one point the top-selling medicine in the US and one of the top-selling medicines in the world.
“It has been said, that if you want to understand the behaviour of animals, don’t go to the zoo, go to the jungle,” says Oliver.
Oliver champions this level of intervention. “This goes beyond ethnography, which, for me, is what it means to understand the patient, to have empathy, compassion, and to walk in their shoes.”
Less is more
The design of the US healthcare system often stymies meaningful progress, says Oliver. “We've been conditioned to interface with too many intermediaries, and the US healthcare system is a case in point. There are two payers –the government and employers – but we deal with so many hurdles in-between that we often lose our focus on the reason why we exist.”
The structure may not budge, but people can. “We need to find new ways to interact with and develop programmes that better serve and improve the outcomes of the end-user – the patient. It will take vigilance and work because that is not how the system is designed; our system is essentially one of sick care and not wellness, but we need to focus on both. There are some integrated healthcare companies that do this to some extent but as an industry, we have got to shift our thinking.”
Reducing the number of stakeholders would also facilitate a more direct relationship between pharma and patients, he posits. A philosophy that should encourage pharma to rethink its reliance on the HCP. “Physicians are very compassionate but the person who has the disease has better insight than the person who treats the disease.”
Patient focussed initiatives are undermined at the point of access, says Oliver. There are shocking disparities when it comes to getting life-saving medicines to the patients that need them the most, he says.
“It begins in clinical trials. A representative sample of the population may be insufficient, depending on the disease, because the disease burden could be higher on certain groups than others. However, you should have a representative sample when it comes to gender, ethnicity, age and all the demographics that make up the disease and as close to proportionality as possible.”
Oliver delineates between invention and innovation, proposing that the latter is the key ingredient of lasting success. Rewriting the rulebook entirely is fanciful, whereas improving on the existing model has the potential to be transformative, he says, likening it to the meteoric rise of Apple.
“Steve Jobs transformed the world and the way we communicate and the way we interact by incrementally transforming devices that we use every day.” This approach will drive meaningful change in the patient space, asserts Oliver.
Oliver believes the increased focus on the patient has come organically out of the industry’s shift from a macro-market to a micro-market. “You now have lots of specialty and rare disease areas; 20 years ago, that was not attractive because everyone was focussed on mass-market drugs., This shift alone is causing the market to focus on smaller populations, which are getting more personalized. In some instances, the diseases are so rare, there are only hundreds of patients, which is causing a greater focus on the patient.”
The convergence of artificial intelligence, sophisticated diagnostics and greater access to information will continue to help the patient-centricity movement gather steam, says Oliver. Redoubling efforts to better integrate data systems, more e-prescribing, and the rise of regulatory bodies who insist on electronic medical records will continue to “push things further downstream” towards the patient, he says.
Bob Oliver will be weighing in on this topic at the eyeforpharma Philadelphia 2018 event between the 10th and 11th of April.
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