George Laszlo has a post on his blog on a report on the future of the biopharmaceutical industry by BT …. yes BT. So what is the report all about. To try and come up with an unbiased view, I actually didn’t read Laszlo’s post, but decided to read the report and voice any opinions.
First of all, the report is definitely an interesting read, and if you were wondering why BT would be interested in commissioning such a study, the reasons become obvious fairly early. BT is betting that telecommunication is going to play a major role in our electronic/digital healthcare futures, and they want to understand what their role might be. Secondly, there is a lot in the report, in that it is likely to give rise to follow up posts on a bunch of subjects. Here I want to do two things (a) provide a sense of the assumptions and conclusions in the report, and (b) continue with my experiments in using new ways to communicate thoughts and ideas. Lets see how it all works out.
The report is entitled Pharma Futurology. Joined up healthcare . As the name suggests, the report is definitely futuristic. Just to define the term (from the report)
Futurology – the study of the future – involves critical reasoning about the way things will develop based on observations of the present, while considering the path that development has taken to get to this point.
In this case, the future is 2016. Like many reports of this nature, this report also tends to overestimate the pace at which new technologies are making an impact on healthcare. The focus of the report is actually one that makes a lot of sense. Pharma is on trouble, for many reasons varying from a lack of public trust, a lack of pipelines and changes in the way healthcare is likely to be administered in the future. The core argument of the report is that the biopharma industry needs to change (something I believe most people will agree on) by becoming one part of the healthcare ecosystem, one driven by communication technologies and the increased digitization of patient information.
While I tend to agree with many of the premises, and even the solutions, there are some words of caution. In silico modeling and simulation will make a huge impact on bringing drugs to market faster some day, but that day is not a decade away. At least not at a level where a significant chunk of our drugs will be developed with biosimulation and other computational methods playing significant roles in reducing trial costs and safety testing. Too much has to change for that to happen, especially in a world where it still takes a decade to bring a drug to market.
I do believe that communication technologies, EMRs, PHRs, etc will start having an impact in this timespan. Not everywhere, but the use will be at a level that the average consumer will start feeling it. In a way there are two challenges here. While we will have a more educated patient population, one that hopefully will be better positioned to make decisions, we must not forget about the doctors. In an environment where patients will demand more participation in their treatment regimens, where sensors and diagnostics will help in improved decision making, physicians will need to redefine their roles. I still worry about what this role might be. The biggest fear is that patients, perhaps being marketed to directly, will “think” they have the answers, but will lack sufficient medical knowledge to come up with the right decisions. Call me quaint, but I still believe that the medical process needs to become a conversation between the patient and the physician about the best options, not one where the role of the doctor is just figuring out dosage and making sure that any diagnostics are being interpreted properly.
As expected, personalized medicine is prominent throughout the report. I have been on record as saying that the pharma industry has to think outside the blockbuster model. The report seems to agree with the idea that a portfolio of drugs treating the same disease for different subpopulations seems to be the inevitable way to go (perhaps slight different formulations or compounds). My only disagreement with that hypothesis is the timeline. I think true personalized treatment regimens are at least 20 years away from being the majority of drugs being released. However, during that time we will be able to refine our methods, and gain experience from understanding drug response and getting used to the idea that a drug that treats 30% of the population need not be a failure. The achievement will be to reduce the cost of developing targeted drugs to make the economics more attractive (it’s pointless spending the kind of money being spent on drugs today to end up with one that’s only going to work on a 3rd of the potential market).
Perhaps the most interesting idea in the entire report was that of outcomes-based payment. In other words, a drug that does not work will not be reimbursed. It’s something I haven’t thought about sufficiently to comment further, but hope to do so sometime in the future.
In the end, we are faced with the reality that healthcare will change. I do not necessarily buy into the idea of nationalized healthcare or a single payer system, but the ecosystem of healthcare, one where discovery, development, trials, treatment, and post-market intelligence are inexorably linked does not fit into the current payment model, nor do personalized medicine or targeted treatments. The take home message; that the pharma industry cannot afford to become isolated from this healthcare network also rings true.
I encourage everyone to read the report. If nothing else, it provides an insight into a future, a future that is almost certainly further away than 2016, but closer than some of us might realize. There are very interesting sections on implantable sensors, and sensors in clothing, etc, as well as discussions on data mining and semantic analysis. There are discussions around IP, open data, etc. There are also some amusing moments like the following
incentivising patients to remain on their schedule, e.g. with a free ringtone or a free game download for children
Somehow, I think that is not going to work.
There are a lot of interesting anecdotes and insets in the report. In the following video, I talk about a tele-care pilot in Liverpool, the “cloud”, big brother and why it brought targeted advertising to my mind.
Direct Link for RSS Readers
Future discussions around this report will focus on specific trends in tele-medicine, forecasting, and personalized medicine and patient participation.
Further reading:
The future of scientific computing
Microsoft 2020 report
IBM Healthcare 2015
IBM Pharma 2010 – Silicon reality
Technorati Tags: British Telecom, Pharma, Futurology, Trendspotting, Healthcare
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