Wednesday, November 10, 2010

Health Advances Advances

I was privileged to be invited to the Health Advances panel last night on “Patient-Driven Healthcare: New Commercialization Strategies” at the Mandarin in Boston. As always, Mark, Skip and the crew put on a great event in a spectacular venue. The networking over wine and aps was so engaging that it was difficult to get people in the ballroom to hear
discuss this timely and important topic. They finally managed to herd us into our seats, and Skip Irving led a lively panel discussion.

There has been a lot of gum flapping about personalization for many years, but not a lot of solid progress. Yes, I’m aware of Herceptin et al., but Dx/Tx combos are still quite uncommon. I was initially a bit skeptical that this would be more of the same gum flapping, but was most intrigued by the part of the title after the colon: “New Commercialization Strategies.” The discussion thankfully turned out to have less to do with personalization, as the topic is commonly beaten to death, and more about the role of the patient in future healthcare.

In his opening comments, Jamie noted that Skip’s choice of words (“…patients at the table for these discussions”) reflected a misplaced focus, and should be turned around (“…patients allowing others at the table for these discussions”). I could hardly bite my tongue and wait for the Q & A.

I never did get the chance – the discussion ran significantly over, but everyone was enjoying it. Here’s my problem: with all due respect, I think Jamie is wrong.

I am reminded about a talk at an American Neurological Association meeting many years ago. In 1997, Allen Roses (who, by the way, completely disagrees with my prior snide comment about personalization) left Duke after leading the team that discovered the ApoE alterations associated with Alzheimer’s Disease to become SVP of Genetics Research and Pharmacogenetics at GlaxoSmithKline (where he remained until 2008 when he returned to Duke). Shortly after the announcement, he was giving a keynote lecture at the ANA meeting and started off by, well, not exactly ‘warming up’ the audience. Through a bit of a snarl and with a wagging finger, his opening lines went something like this: “I was stopped in the hall on the way here and a former ‘colleague’ asked me how it feels to be a whore, apparently referring to my recent move from an academic position to the crass, commercial GSK. Well let me tell you something. I am not a whore. Drug companies make drugs. Doctors don’t make drugs.”

I think Allen hit the nail on the head (although I may have said it a bit more politely). No party to this effort can take another for granted, but frankly, patients don’t make drugs, either. Yes, they have sometimes been seen as a tool to serve the purposes of a drug company in their commercial efforts, but there are also plenty of examples of true collaborations between a patient group and a drug company that served the needs of both parties. And yes, the patient groups are, will continue to be, and rightly should be an important part of the equation, but let’s not underestimate the need for a commercial partner in bringing a product to market.

Having said that, a system that delivers a product to the market only after investing $1B and 15 years of effort cannot sustain itself much longer. And what I was a bit disappointed about last night was that nobody cared to opine on that part after the colon. What are the new commercialization strategies? I have my own ideas, and have blogged about them before, but I would have really liked to have heard from the panel about their vision for the future of the drug development paradigm. Particularly on the heels of Fred Frank’s comment yesterday proclaiming the end of big biotech (I think he’s wrong, too).

The best comment of the evening? I’m not sure if everyone caught it, but Al made the provocative suggestion that we may soon see an outcomes-based reimbursement system. Could you imagine going to your healthcare providers and telling them that you’re only going to pay them if you get better?

Patient-driven healthcare is a good thing  …to a point. Years ago when I was at Athena Diagnostics, I led the team that launched the first test for neutralizing antibodies to β-IFN. At the time, the interferon therapies (Betaseron® and Avonex®) were the only options for patients with MS, and both were very expensive. Our assay identified patients in whom the neutralizing antibody titer was high enough that they were no longer deriving the benefit of the therapy (arguably the first personalized medicine test).

It was like selling ice cubes to Eskimos.

Athena Sales Rep: “Doc – use this test to see if your MS patients are responding to the drug.”

Neurologist: “Lemme get this straight. You think a patient with MS will allow me to stop the only hope they have for relief of their symptoms? Don’t let the door hit you on your way out.”

Now once the interferon alternative, Copaxone®, came on the market, it was a different story. But prior to that, no doctor would have stopped the therapy, no matter what the antibody titer. That would have been the correct decision, but it would never have been tolerated by patients.

All in all, a great event. It’s always better when there’s something to talk about. And that’s coming from someone who really knows how to flap gums.

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