GHP June 2015

June 2015

www.ghp-magazine.com

Is There Such a Thing as ‘Healthcare 4.0’?

Stem Cells Might Expand Window

for Treating Stroke A recent study in STEM CELLS Translational Medicine could open the door to a new therapy to potentially expand the current window of time for treating patients after they have experienced a stroke (five times beyond that of a clot-busting drug) and significantly improves their chance of recovery.

Surgical Robots Market Worth $20 Billion by 2021

30 Minutes to Save a Life

– Doc Uses Social Network to Diagnose Fatal Condition

Also in This Month’s Issue: Poll: Many Americans Know Someone Who Has Abused Prescription Painkillers and Suffered Major Harmful Effects...

editor’s note

this month’s features

inside this issue

Welcome to the latest issue of Global Health & Pharma Magazine.

04 News

This month, we look at whether UAE looks likely to reach its ambitious healthcare goals by 2021 and we take a closer look at a scientifically accurate 3d model that accelerates device testing and research for the treatment of heart disease.

14 Takling the ‘Weekday Effect’

We speak to Dan Somers of Warwick Analytics about how far data-driven operations and Predictive Analytics in the healthcare industry has come, and find out from Oliver Harris, Managing Partner at Montreux Capital Management, why the UK healthcare industry is poised for a wave of M&A. There’s a report on the future of the surgical robots industry and why it is set to be worth an eyewatering $20 billion by 2021 and an exciting look at how stem cells could open the door for faster, more effective treatments for patients who have experienced a stroke.

Not only this but Nick Simpson, CEO of MSI Group, talks to us about tackling the’ weekend effect’ and we hear about how a popular US-based social network helped a doctor save the life of a 14-year-old boy.

Plus we have all the usual news and comment from around the global healthcare and pharmaceutical industries.

We hope you enjoy the issue.

Mark Toon, Editor

10 UK Private Healthcare Sector Poised for Wave of M&A

Stem Cells Might Expand Window for Treating Stroke

A recent study in stem cells could open the door to a new therapy to potentially expand the current window of time for treating patients after they have experienced a stroke.

Page 26

18 Merck Serono Takes Leading Role in Fertility Technologies 20 30 Minutes to Save a Life: Doc Uses Social Network to Diagnose Fatal Condition 22 Interoperability among Connected Medical Devices Can Potentially Transform Healthcare 24 SurgiQuest’s AirSeal® System Receives FDA 510(k) Clearance for Transanal Endoscopic Surgery 28 Dassault Systèmes Announces Commercial Availability of its First Simulated Human Heart

Surgical Robots Market Worth $20 Billion by 2021

Research report says surgical robot device markets anticipated to reach $20 billion by 2021 as next generation devices, systems, and instruments are introduced to manage surgery through small ports in the body.

Page 36

“Despite its size and potential, the UK specialist care sector is highly fragmented, in which the top 10 providers control more than 15% of the market and in excess of 81% of assets lie outside of the top 16 operators.”

Oliver Harris, Managing Partner, Montreux Capital Management, p10

30 Is There Such a Thing as

‘Healthcare 4.0’?

34 In New Cardiac Surgery Study NephroCheck® Kidney Biomarkers Rise to the Occasion 38 Poll: Many Americans Know Someone Who Has Abused Prescription Painkillers and Suffered Major Harmful Effects 40 Can UAE Reach Ambitious 2021 Health Goals?

42 Johns Hopkins Bloomberg School of Public Health to Lead $17 Million Canadian Project 44 Ongoing Challenges in Identifying and Tackling Food Fraud Are Vital to Safeguarding Public Health

Global Health & Pharma, 39A Birmingham Road, Blakedown, Worcestershire, DY10 3JW Tel: +44 (0) 1234 567 890 | Email: info@ghp-magazine.com | Web: www.ghp-magazine.com

news

Abcodia Secures Funding of £5.25 Million ($8m) to Launch the ROCA® Test for the Early Detection of Ovarian Cancer • Two new investors, Cambridge Innovative Capital and Scottish Equity Partners join existing investors Albion Ventures and UCLB • The investment enables the launch of the ROCA® test in US and UK in 2015, as well as the establishment of a US presence Abcodia has announced that it has raised £5.25 million funding from existing and new investors to bring the world’s most sensitive and specific ovarian cancer screening test, ROCA® to market.

of evidence for CIC’s investment. We are excited to support this groundbreaking test and bring it to the market so women around the world can feel empowered with more knowledge and more options.”

The financing was co-led by Cambridge Innovation Capital (CIC) and Scottish Equity Partners (SEP), who join existing investors Albion Ventures and UCL Business. Dr Robert Tansley, from CIC and Jan Rutherford, from SEP have been appointed to Abcodia’s Board.

The ROCA® test’s proven performance was reaffirmed in a study from the UKCTOCS trial at UCL, published in the Journal of Clinical Oncology1, 2 this month.

The publication showed the ROCA® test could detect ovarian cancer more accurately than existing methods and before symptoms occur.

Dr Julie Barnes, Abcodia’s CEO, welcomed the funding and commented: “The funding will allow Abcodia to launch the ROCA® test in the UK this summer and US markets later in 2015. This is the first cancer screening test that we are bringing to market and we are excited about its proven high performance. We feel passionately that the ROCA® test will make a real difference in the lives of women at risk of developing this aggressive form of cancer. The funding will help build operations and commercial teams in the UK and establish our US presence while continuing to grow our product pipeline focused on improving early cancer diagnosis.”

Jan Rutherford, partner at SEP, said: “Abcodia is one of the most exciting businesses involved in the early detection of cancer. Its novel data driven approach, underpinned by its unique biobank and its strategic partnership with Cancer Research UK, has the potential to materially enhance the way biomarkers are developed, allowing earlier disease diagnosis and improved patient outcomes. We are delighted to invest in such an innovative company and look forward to the launch of the ROCA test, initially through a number of private clinics in the UK this summer.”

Dr Robert Tansley, Investment Director at CIC, said: “The major unmet need in early detection of ovarian cancer and the unprecedented clinical validation behind the ROCA® test provided a compelling body

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news

Medical Staffing Agency Responds to 7-Day NHS Pledge In his first major speech since the General Election, David Cameron outlined plans to create a “truly seven-day NHS” by extending GP opening hours. Specialist healthcare recruitment agency, MSI Group, supports these proposals but warns that staff shortages will challenge the viability of this proposal.

Commenting on the Government’s outline plans, Nick Simpson, CEO of MSI Group said; “As an organisation which is on the front line of recruitment into the NHS, we understand the direct correlation between timely access to healthcare professionals and patient safety.

On this basis, we welcome proposals to extend the availability to access to GPs. However, it is perhaps needless to say, that an increase in availability of front line services will exacerbate existing GP and Nurse Practitioner shortages.”

“It’s no secret that the NHS is already struggling to recruit enough GPs and other health professionals.

Indeed, the Royal College of General Practitioners (RCGP) has estimated a fourfold increase in unfilled posts since 2010. According to analysis by health think-tank The King’s Fund, this shortage can be attributed to fewer GP training posts being filled, coupled with more family doctors choosing to take early retirement.”

“It’s encouraging to see that the RCGP, in conjunction with NHS England, has set out a 10-point plan which addresses the need to pipeline future talent.

However, until better workforce planning strategies are in place, the success of a truly seven-day NHS rests on the short term availability of locum doctors and agency nurses. There are simply not enough GPs to fill current permanent positions and extending opening hours will only stretch available resources.

Without the use of agency staff, the health service would fall over. Cameron’s proposals will only compound the need for flexible staffing solutions to maintain quality front line services.”

Appointments Gail S. Page Appointed as Executive Chairperson Of NX Prenatal Inc. NX Prenatal Inc., a privately held women’s healthcare molecular diagnostic company have announced that Gail S. Page has joined their Board of Directors and will serve as Executive Chair person. Ms. Page will be working with NX Prenatal to guide the commercial development of blood-based tests to support improved pregnancy outcomes.

“NX Prenatal has shown that its non-invasive technology can be used to identify biomarkers early in pregnancy that correlate with known adverse outcomes, such as spontaneous preterm birth,” noted Ms. Page. “This is a well-defined unmet medical need and developing blood based tests in this area will bring a much needed solution to physicians and patients alike. I look forward to working with the NX Prenatal team to develop a comprehensive strategy that addresses this market opportunity which is clearly aligned with the current vision of physicians and payers to address early detection as opposed to treating costly outcomes downstream.”

“We are very excited to have Gail’s depth and breadth of experience in the diagnostics field,” said Brian D. Brohman, NX Prenatal’s Chief Executive Officer. “Gail has been involved in the commercialisation of a number of women’s health diagnostic tests and will add great insight, passion and experience to our team, as we seek to launch breakthrough products than can significantly impact the health of mothers and their new-borns, and help manage one of the industry’s most costly outcomes in preterm birth.”

Ms. Page served as the President, CEO and Director of Vermillion, Inc. from 2006 through 2012. Under her leadership, Vermillion successfully raised over $100M in funding, as it developed and commercially launched the first proteomic IVDMIA FDA cleared blood test to help diagnose ovarian cancer. Prior to Vermillion, Ms. Page served on the executive management teams of Laboratory Corporation of America and Luminex.

Frederic Legrand - COMEO / Shutterstock.com

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news

Revolutionary Sterillo Rolled out in All CEF Branches New hand dryer, the Sterillo is the first in the UK to eradicate bad smells in public washrooms. Infections that spread in public washrooms including Salmonella, E-Coli, MRSA and Hepatitis A, will also be destroyed. The new Sterillo, kills the bacteria, mould and viruses that contaminate, spread disease and cause odours in public washrooms. The Sterillo is already in great demand and being rolled out via CEF, the UK’s leading electrical wholesale network. It will be available in all 400 branches of CEF across the UK and Ireland.

The traditional electrical wholesale market is worth around £5 billion per annum and CEF’s UK branch network is a £0.5 billion business. Whilst CEF is a traditional electrical wholesale business it embraces the multi-channel world and new technologies like the Sterillo to ensure it can provide customers with the very best and most innovative products.

Jeremy Saunders, General Manager at CEF says: “CEF are delighted to be a partner in this exciting new product launch, the Sterillo hand dryer represents a truly excellent development in the washroom product sector and the benefits to both the end client and users are really significant. We are very much looking forward to taking the product to market and informing and updating our customers of its benefits. The Sterillo is now available from our network of 400 branches and online.”

Typically, 40% of an average public washroom is contaminated by bacteria and viruses with one of the most affected areas being the wash basin and taps where we ‘clean’ our hands.

Until now, it has been virtually impossible to avoid self-contamination in a public washroom. Cleaning the air and all exposed surfaces is the only solution. By achieving this, the Sterillo reduces staff absenteeism, cleaning costs for employers and also helps to prevent epidemics such as norovirus in schools, hospitals and businesses.

Steve Levy, Inventor of the Sterillo says: “Regardless of how someone dries their hands, as soon as they touch any of the washroom surfaces or the door handle to exit the washroom they are almost certainly re-contaminating themselves. The only solution in public washrooms is to sanitise the entire environment by cleaning all the air and all the surfaces. We are delighted to offer a solution and to enter this partnership with CEF. We look forward to bringing The Sterillo to businesses and communities across the country.”

Washroom conditions can quickly spiral out of control, one bacteria can multiply to 8 million in 8 hours. Many Brits believe they are germ dodgers but in current conditions this isn’t manageable, the only solution for washroom hygiene is to sanitise the environment the air and all of the surfaces.

For more information visit the Sterillo website www.sterillo.com

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news

ClinicAll Equips an 81-Bed Clinic

Appointments Kineticos Expands Biopharmaceutical Practice Leadership Team with Two Senior Executive Appointments Kineticos, a specialised management consulting firm serving the life sciences industry have recently announced the expansion of their Biopharmaceutical practice leadership team with the additions of Dee Parson Grange, Senior Vice President, and Mark Osterman, Senior Vice President. Both executives will report to James Forte, Managing Director of the Biopharmaceutical practice at Kineticos.

Dee Parson Grange joins Kineticos as a seasoned executive with more than 25 years of experience achieving strategic and operational business goals for both large pharmaceutical and private biotech companies. Prior to Kineticos, Ms. Parson Grange served in various cross-functional leadership roles at Bayer Pharmaceutical, Bayer Biologic Products (now part of Grifols), and Biolex Therapeutics. In addition, she has provided consulting services to global biopharmaceutical companies targeting rare diseases, biosimilars, biobetters, and novel therapeutic proteins. She holds a BS in Biology from Graceland University and a global executive MBA from the Fuqua School of Business at Duke University.

Another clinic is taking a groundbreaking step towards the digital hospital of the future. In connection with extensive modernization measures, the Grupo Policlínico Quirurgico in Palma de Majorca is equipping its clinic with state-of-the-art technology. It stands to reason that the Group decided to install the innovative ClinicAll System, thereby achieving two goals at the same time. In addition to standard infotainment services for patients, ClinicAll also offers significant advantages that are crucial to future-proofing hospitals. In addition to standard patient infotainment services, i.e. optimizing processes and cutting costs by means of intelligent digital networks.

Thanks to ClinicAll, the Majorcan hospital will be able to incorporate digital medical records into the system, allowing the medical staff to access patient data directly from the patient’s bedside terminal. Thus, internal procedures can be synchronized and controlled more efficiently while optimizing medical care, treatment and support. The Grupo Policlínico Quirurgico is so enthusiastic about the ClinicAll System that it immediately concluded an operator agreement with a 10-year term.

About 81 beds will be equipped with state-of-the-art mobile and stationary ClinicAll bedside terminals. As the renovation of the clinic continues until December 2015, the installation is expected to be completed by spring 2016. In the near future, patients will therefore be able to enjoy comprehensive communication and infotainment services, including IPTV, Internet via a full web browser, video on demand (VoD), VoIP telephony and access to current news, weather forecasts, online games, clinic information and much more. Thanks to the incorporation of the HIS patient health record that will be implemented as soon as the first installation phase is completed, the medical staff will also benefit promptly from the efficiency of the state-of-the-art ClinicAll solution.

ghp June 2015 | 7

Mark Osterman also has over 25 years of experience in the biopharmaceutical industry. He started his career with 11 years at GlaxoSmithKline with roles of increasing responsibility in sales, clinical, and marketing before moving to Johnson & Johnson. At J&J, he was Vice President of the Johnson & Johnson Development Corporation and launched their stem cell internal venture. He also was responsible for the cardiovascular, pulmonary, metabolic, and mimetibody therapeutic areas in the Global Biologic Strategic Marketing group before being recruited to Discovery Labs. Mr. Osterman was Senior Vice President and responsible for commercial operations and business development at Discovery Labs before serving as Vice President of Global Marketing at Solstice Neurosciences. Immediately prior to joining Kineticos, he founded the Osterman Strategy Group, a boutique management consulting firm, where he worked with large and emerging biopharmaceutical companies as well as medical device companies to help solve their most challenging business issues. Mr. Osterman earned a dual BA in Business Management and Economics from North Carolina State University.

“Dee and Mark add extensive cross-functional experience to the practice along with an impressive track record of bringing new biopharmaceutical products to market across various therapeutic areas and geographies,” stated Mr. Forte. “Their expertise adds depth to our existing consulting capabilities and credibility to our practice as an increasing number of biopharma clients depend on our team to guide their path to market,” he continued.

news

Oncology Institute at European Medical Centre in Moscow Opens PET Diagnostics and High-Accuracy Radiotherapy Departments Group of Companies European Medical Centre (GEMC, www.emcmos. ru/en) became the first private clinic in Russia to open a Positron Emission Tomography (PET-CT) Department with its own production of pharmaceuticals, and a Radiation Cancer Therapy Department featuring two linear accelerators.

GEMC has thus created an unprecedented Institute of Oncology among private clinics in Russia, implementing a comprehensive oncologic protocol – from screening and high-accuracy diagnostics (MRI, PET/ CT, pathomorphology, immunohistochemistry, genetic testing) to chemotherapy and radiotherapy, da Vinci robot-assisted surgery, provision of psychological support for patients and their families, palliative care and pain treatment.

“The project received over ten favourable decisions and permits on security from regulatory bodies and expert organizations. All facilities are equipped with modern radiometric and radiation-monitoring equipment certified in Russia according to national and international standards,” – stated Leonid Shayman, GEMC Board Member responsible for the creation of the PET-CT and the Radiation Therapy Departments.

“The main advantage of the equipment is its ability to apply more intense radiation exposure in less time, greatly increasing the effectiveness of treatment, while reducing the length and number of sessions.

The department provides round-the-clock emergency radiotherapy for oncologic emergencies, and radiation treatment of cancer in children over three,” – added Shayman.

The PET-CT and Radiotherapy Centre is located at the multifunctional GEMC hospital on Shchepkin street 35 in Moscow. The total amount invested is 1.35 billion rubles. The annual capacity of PET-CT Diagnostics Centre is 6,000 patients, of the radiation therapy department – 25,000 patients.

The extended quality control laboratory, equipped with the most modern equipment, is operational. A research technique on sentinel lymph node for breast cancer and melanoma is applied. An expansion of radiopharmaceutical production choline and tyrosine applied in oncourology and neurosurgery is planned in autumn 2015.

The Department of Radiotherapy is equipped with TrueBeam and Trilogy linear accelerators by Varian (USA). Treatment is performed by highly-skilled professionals trained in radiation therapy in leading clinics in Israel and the USA Leading world experts participated in the project, including: Professor Eyal Mishani, Head, Cyclotron Radiochemistry Unit, Hadassah University Hospital (Israel); Professor Pablo Ros, Head, Department of Radiology, University Clinic of Ohio (USA); Professor Gustav von Schulthess, Chairman of Nuclear Medicine Clinic at University Hospital, Zurich (Switzerland), among other renowned specialists.

The opening of the PET-CT Diagnostics and Radiotherapy Departments represents the final stage in forming a system of full cycle medical treatment of oncologic patients at GEMC – clinics with a 25-year-old history of practice in line with international standards.

The GEMC Oncology Institute combines several specialized clinics and diagnostic units led by highly-qualified professionals, including clinics of oncology and hematology, neurosurgery, gynecological oncology, urogynecology, and the centre for breast cancer treatment.

The Department of Radionuclide Diagnostics is equipped with PET-CT and CT systems Philips Gemini (USA) and the single-photon emission computed tomography (SPECT) system Philips Brightview XCT (USA). The department features a cyclotron by IBA that produces its own PET-CT radiopharmaceuticals.

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industry insight

UK Private Healthcare Sector Poised for Wave of M&A

By Oliver Harris, Managing Partner, Montreux Capital Management A commonality of any large, developed market is the hegemony of its largest participants. Grocery sales in the UK are dominated by the ‘big four’ supermarkets that, in the 12 weeks ending 4th January 2015, had a combined market share of over 74%. The publically owned ‘big oil’ super majors, big tobacco and telcos are similarly structured.

The conglomeration visible in these sectors came about during intense periods of M&A, in which smaller players were absorbed and larger entities brought together. This consolidation sought to combine companies with synergistic components and create efficiencies.

The mere prospect of a publically traded company being taken over drives share prices up on the expectation of higher revenues based on the increased efficiency. Royal Dutch Shell’s acquisition of BG Group is a clear example of this. Precedent shows us such deals are incredibly lucrative for principals and spark a flurry of amalgamation within a sector.

UK care sector overlooked in M&A wave Identifying a market where such event driven value creation can be found is a sensible investment strategy. However, most markets of significant scale are largely consolidated and will remain so until regulatory ‘trust busting’ or significant macroeconomic pressures engender change. One area noticeably overlooked by investors, until recently, is the UK specialist care market. US, European, Middle Eastern, Asian and UK investors are beginning to recognise the sector’s strong long term fundamentals as well as the scope for M&A driven returns.

Specialist care is the provision of support for those with learning disabilities, mental health needs and acquired brain injuries. It is a market of considerable size and growth prospects – with the latest Laing & Buisson figures estimating the total market to be worth in the region of £7bn. Laing & Buisson anticipates the market will appreciate at a rate of about 1% per annum, due to population growth and better diagnosis of mental illnesses. The market is supported by strong, inflation protected fee yields charged for care, paid for

by Local Authorities.

Despite its size and potential, the UK specialist care sector is highly fragmented, in which the top 10 providers control more than 15% of the market and in excess of 81% of assets lie outside of the top 16

operators. This presents a huge opportunity for larger participants to purchase some of the many smaller care groups at low P/E multiples, lean out process and bolt on existing platforms and resources. Such actions will fashion earnings growth through cost savings and increase the scope for revenue creation.

Transactional activity in the space shows smaller assets are currently being bought at 6x earnings by larger assets trading at 10x, some as much as 13x earnings. It is easy to see how this process is lucrative for investors.

Transactional activity has accelerated over the last year, driven primarily by private equity and REIT buyers. When looking at the size of the market, current M&A activity and the scope for further deals, we believe the investment opportunity will peak within two to three years before the market’s largest participants have captured the majority of the market. The main reason this has not already happened is that healthcare provision in the UK is a staunchly regulated space, with high fiscal and care driven barriers to entry. However, there are ways for investors to participate.

Private equity, REITs and open-ended funds – such as the Montreux Healthcare Fund – have gained traction in the institutional market and are ideally poised to fuel M&A activity in private healthcare. The investment rewards for such vehicles could be considerable. Montreux Capital Management, for example, recently acquired The Regard Partnership and ACH Care Homes, measurably improving the companies’ earnings with ACH’s run rate EBITDA moving from £4.49m to £5.46m and its investment increasing 99.1% in ten months.

Irrefutable demographic drivers of care The UK care market is a compelling investment case underpinned by irrefutable demographic trends. The world is rapidly ageing. Currently, one in six of the UK population is aged 65 and older – a figure projected to reach one in four by 2050 and representing a total increase of 5 million people. The number of those aged 85 and over is set to almost quadruple within the same period.

The UK’s ageing population reflects an international phenomena: in part a consequence of the global age structure, with the large baby boom generation inevitably approaching retirement, and in part due to rising

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industry insight longevity. Whereas a man or woman born in the UK in 1981 had a life expectancy of 84 or 89 years respectively, a child born in 2030 might expect to live until 95 years. These factors are exacerbated by declining birth rates over the last four decades.

The irrefutable demographic trend is particularly relevant for the UK health and specialist care sector, as expenditure on healthcare tends to rise exponentially with age. Government actuaries predict the number of people living in residential care, for example, will almost triple by 2050.

There is a far greater risk of chronic health problems in older age, and this has significant implications for a country with an ageing population. In the UK the number of older people unable to live independently – whether due to limited mobility, frailty, or other mental and physical health impediments – is forecast to quadruple by 2050. Most require some form of long-term care.

The demand for local care is set to rise even among those suffering from chronic mental and physical conditions unrelated to age. At present, only 8% of families get health and care services from their local social services. This figure will soar as the population ages and unpaid caretakers such as parents or relatives are increasingly unable to provide support.

Many of the 29,000 adults with a learning disability, for instance, live with elderly carers who are too old or too frail to continue in their caring role.

By 2030, the number of adults over 70 years of age using social care services for their disabilities will more than double. Local authorities have planned alternative housing in only one in four of these cases, though they have a duty of care for all individuals with recognized conditions. In the 2010-11 year, authorities spent £260 million on direct payments for adults with learning disabilities, which represents an annual increase of 40% per year from 2005-06 after taking inflation into account. Equally, sales of disabled equipment in the UK have increased by 92.6% over the last 10 years. Evidently, demand for care is currently far outstripping supply.

Care homes offer high and sustainable income Healthcare has always been an attractive alternative form of investment. It is a defensive sector immune from short-termism: the provision of healthcare is not impacted by market forces and the payers for such services are not subject to fluctuating market sentiment.

The sweet spot for investing in care is with the operating companies, which are both the providers of care and owners of the real estate. The leading operators are creating profit levels in the region of 25%-28% for care provision, with gross fees being linked to RPI. In addition, the requirements to provide the capital and have the appropriate specialist regulatory experience have created high barriers to entry in the sector. This supports such high return levels.

Such a solid level of return helps to provide a high and inflation proofed income stream for investors, which is currently producing a running yield in the region of 7%-8%. In the current low interest rate environment, high and predictable income levels are a rare commodity. It is especially favourable when compared to

other alternative assets, the majority of which produce no income at all.

The valuation of care homes is driven by the net fees generated by each bed, rather than property market dynamics, thus insulating returns from a property market, bond market or stock market correction. However, there remains a real estate value underpin to any portfolio, which acts as embedded risk support.

Consequently, the return stream from the care home sector looks very different to any equity, bond or alternative asset and more closely resembles an inflation-linked, high yielding liability – such as a pension or endowment.

The M&A ‘window of opportunity’ is closing The global financial crisis created a paradigm shift in the perception of risk. The unprecedented collapse of most traditional asset classes prompted investors to look further afield for truly alternative forms of investment, immune from the short term impact of market movements. Additionally, the subsequent low interest rate environment of today has also resulted in a major quest for income – driving the prices of many yielding assets well above fair value.

The private healthcare sector will continue to grow unabated on the back of these inherent fundamentals, however, the ‘window of opportunity’ for M&A driven value uplifts will be largely over in two to three years as the larger participants attain greater market share.

Oliver Harris biography: Oliver Harris is a director of Montreux Capital Management. A finance graduate of the University of Surrey, Oliver has had an extensive career working for some of the world’s most respected financial institutions as well as following several successful entrepreneurial pursuits. He previously worked in the City for the investment advisory wing of a large investment bank before leaving to become a partner in a successful healthcare group. After that was sold in 2007, he moved to Switzerland to work for a private wealth manager. These roles have brought him into contact with some of the most important luminaries and companies within the financial, property and healthcare sectors.

Montreux Capital Management: Founded in 2010, Montreux Capital Management is a Swiss investment firm specialising in boutique, alternative funds.

With a global institutional client base, investors benefit from a specialist fund range which bears low correlation to the wider market, managed by our experienced partners.

Introducing funds to some of the world’s most respected global institutions and other well-informed, professional investors, Montreux understands the importance of a disciplined and sustainable approach in the investment process. By focusing on specialist asset classes and strategies, Montreux Funds aim to consistently generate returns regardless of movements in Equities, Bonds and the wider property markets.

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Oliver Harris, Managing Partner and Founder of Montreux Capital Management

ghp June 2015 | 13

industry insight

Tackling the

Weekday Effect

By Nick Simpson, CEO of MSI Group

The ‘weekday effect’ has been the topic of much concern and deliberation within the health service since the British Medical Journal reported that patients who have planned surgery near the end of a week or at weekends are at greater risk of dying than those operated on at the start of the week. Indeed, the statistically significant increase in mortality rates is nothing less than shocking; patients who have their operation on a Friday or Saturday are respectively 44% and 82% more likely to die within the next 30 days, than those having surgery on a Monday.

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With this in mind, Government initiatives to improve access to GPs outside of normal opening hours with the help of a £50m GP Access Fund, as outlined last year, will, in theory, prove to be an advantageous public health measure. Building on these proposals, in his first major speech since the General Election, David Cameron outlined plans to create a “truly seven-day NHS” by extending GP opening hours. Cameron’s pledge to increase the availability of access to GPs is, on the surface, a very welcome proposition. However, in reality, any increase in patient access to front line services is likely to exacerbate existing GP and Nurse Practitioner shortages.

According to analysis by health think-tank, The King’s Fund, this shortage can be attributed to more family doctors choosing to take early retirement coupled with fewer GP training posts being filled. Indeed, the Royal College of General Practitioners (RCGP) has estimated a fourfold increase in unfilled posts since 2010 – one in three GP training posts are now empty.

Furthermore, the RCGP has warned that more than 500 practices are under threat of closure, because so many doctors are close to retirement age, with too few younger medics stepping in to replace them. New figures from the UK’s medical deaneries show that more than 1,000 GP training posts are currently vacant.

As an organisation which is on the front line of recruitment into the NHS, we understand the direct correlation between timely access to healthcare professionals and patient safety. Although plans for seven-day GP opening are still far from fruition, we at MSI Group have already witnessed an increase in demand for locum GPs who can offer ‘wrap-around’ services during evenings and weekends, both in-person and remotely through urgent care centres, walk-in centres and the 111 service.

In 2013, just 20 per cent of medical students chose to work in general practice on completion of their foundation training. The Government has set a target for 50 per cent to do so by 2016, which would mean recruiting 3,250 GP trainees a year in England. That deadline has already been pushed back a year, after poor take-up rates in 2014.

Extending access to GP appointments from five to seven days would effectively mean a 40 per cent increase in demand for talent to plug this gap. And there is simply not an adequate supply of doctors to meet this demand on a permanent basis. An ageing population, retirement cliffs and insufficient talent pipelining have all contributed to an acute shortage of permanent healthcare professionals. While it is imperative that these issues are addressed long-term, we cannot escape the fact that agency nurses and locum doctors provide a valuable service that, for the imminent future, the NHS simply cannot do without. And this acute need for the skills of contract staff to maintain frontline services will increase proportionally in line with service availability.

It’s no secret that the NHS is already struggling to recruit enough GPs and other health professionals.

Reasons as to why fewer young professionals are choosing a career in general practice remain a topic of debate. However, GPs are now carrying out 370 million appointments a year, 70 million more than five years ago, so workload may be an issue. According to a ComRes survey of 1,004 GPs in January 2015, 27 per cent of respondents surmised that medical students were shunning this option because of volume of consultations, 19 per cent cited working hours and nine per cent attributed pay to the fall in recruitment.

While the use of agency staff within the health service has been met with controversy in the media, it’s important to consider the reasoning behind the use of contractors. Dr David Rosser, medical director of University Hospitals Birmingham, one of England’s biggest trusts, recently went on record to say; “The NHS doesn’t have the number of doctors it needs.

The shortage is real. We aren’t training enough doctors in this country, and so we are dependent on foreign-trained doctors. Doctors in more and more branches of medicine report shortages, especially in specialities such as A&E, where it’s tough work.”

Meanwhile, an investigation by the Guardian newspaper found that the NHS hired up to 3,000 foreign-trained doctors from at least 27 different countries last year to plug staff shortages. This research is backed by overall figures from the General Medical Council which show that the number of foreign-trained doctors on its register rose by 2,957 between 31 December 2013 and 6 January 2015. Those trained outside of the UK make up two-fifths – 39.4% – of the 7,500 year-on-year increase in the overall number of doctors. Foreign-trained doctors now represent over a third (36.6%) of doctors on the register, a figure that rises to 41.2% among specialist doctors.

Aside from qualified doctors, it is also worth noting that the service is suffering from a shortage of UK trained nursing professionals which will also have an impact on seven-day access. A recent survey by Health Education England found that 83 per cent of English NHS Trusts reported that they are experiencing qualified nursing workforce supply shortages. And with nurse practitioners now taking a more active role in the delivery of GP services, this additional talent gap must not be overlooked. Furthermore, the Royal College of Nursing’s chief executive, Peter Carter, has

ghp June 2015 | 15

industry insight warned that nurses employed directly by a trust would resist any changes to payments they receive for working outside office hours. Speaking to the Independent newspaper, Carter said: “The membership is quite clear: unsocial hours, weekend working, Christmas Day and bank holidays – they get a very modest higher level of remuneration. Any attack on that and I do fear it would result in industrial action.”

So what’s the solution to staffing the extra services proposed? We certainly need a long-term plan. It’s encouraging to see that the RCGP, in conjunction with NHS England, has set out a 10-point plan which addresses the need to pipeline future talent. Similarly, Health Education England (HEE) has outlined “robust training and recruitment plans” that will lead to more permanent doctors, nurses and paramedics in the NHS. Furthermore, GPs will be encouraged to delay or come back from retirement under a new £10m scheme attempting to boost the numbers of family doctors.

However, until better workforce planning strategies are in place, the viability of a truly seven-day NHS rests on the short term availability of locum doctors and agency nurse practitioners. There are simply not enough GPs to fill current permanent positions and extending opening hours will only stretch available resources even further. Without the use of agency staff, the health service would fall over. Cameron’s proposals will only compound the need for flexible staffing solutions to maintain quality front line services.

The NHS is going through times of unprecedented change. A series of bold Government initiatives designed to integrate the health and social care sectors – as outlined in the NHS Five Year Forward View – look set to invariably transform the core structures of local authorities across the UK. And these changes will, hopefully, ease blockages at the back door within acute settings. Greater access to GPs also has the potential to simultaneously relieve pressure at the front door as GPs become gatekeepers to stretched accident and emergency departments. If executed strategically, the health service could find itself operating more efficiently, effectively easing some of the pressures it is currently facing.

In order to realise this new vision for care, NHS trusts must look at all available sources of talent to build new structures which are fit for purpose. Of course, the future of the NHS depends on a fresh approach to workforce planning, however, in the interim, the truth is we must rely on contractors. Agency and locum professionals, who are subject to the same stringent criteria that permanent staff must adhere to, are our first line of defence against reduced care quality and patient safety issues. To put it simply, the success of a seven-day NHS hinges on the availability of contractors.

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Merck, a leading company for innovative and top-quality hightech products in healthcare, life science and performance materials, has announced the global collaboration agreement with the fertility technologies expert Genea Biomedx, an Australian company, dedicated to advancing fertility science and helping couples create families.

Merck Serono Takes Leading Role in Fertility Technologies

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industry insight With this partnership, Merck Serono, the biopharmaceutical business of Merck, and global market leader in drugs for Assisted Reproductive Treatment (ART), receives global marketing and commercialization rights to Genea Biomedx’s product portfolio. This comprises the innovative Gavi, Geri and Gems product lines which are expected to receive CE mark in Europe shortly, as well as a joint development pipeline.

Gavi will be the world’s first fully automated vitrification instrument, focusing on lab processes with the aim of reducing potential errors and increasing efficiency in cryopreservation of embryos and in the future for oocytes (eggs). Geri is a benchtop incubator fitted with a time-lapse camera to capture images of embryos as they develop and individually controlled incubation chambers per patient to minimize disruptive events to the early-stage embryo. Gems is the latest generation of Genea’s culture media allowing for high quality embryo cultivation.

The collaboration is part of the company’s strategy to provide the best fertility solutions to its customers to increase success rates. With the global rights to these three product lines and future developments, Merck Serono is expanding its market position, offering key potentially outcome improving technologies to support standardization, automation and objectivity. To further strengthen this position, Merck Serono will closely collaborate with Genea Biomedx to jointly develop other innovative technology products and services, and have formed a development hub to pave the way for further improvements for the patient.

“As a pioneer in reproductive health, we are continuously seeking to extend our product portfolio to bring innovative science and services to the fertility community,” explained Belén Garijo, Member of the Executive Board of Merck and CEO Healthcare.

“There is significant need for improved technologies in fertility treatment, since the majority of issues in ART are beyond drug therapy. The key priority of our Fertility Technologies unit at Merck Serono is to advance our fertility portfolio beyond drugs and to enable innovation in technologies and services.

Entering a global partnership with Genea will allow Merck to introduce innovative technologies in the ART market, further aiming to improve outcomes throughout the in vitro fertilization process. Merck Serono is dedicated to help patients realize their dream of creating a family.”

“Advancing the science of fertility treatment to improve outcomes and success rates for patients worldwide is Genea’s mission and we are excited that our agreement with Merck helps us continue to bring that aim to fruition,” said Tomas Stojanov CEO of Genea. “The launch of the three products, Gems, Gavi and Geri, is just the beginning of a unique collaboration between our two companies which will deliver innovative, high-technology products and thinking to fertility clinics around the world.”

The collaboration showcases both companies’ commitment to improve fertility treatment. Both Merck Serono and Genea Biomedx have a strong heritage in fertility treatment and will build on this expertise to invent and develop innovative fertility technologies. The collaboration is effective from May 1, 2015. Financial details of the agreement are not being disclosed.

Genea Biomedx Genea Biomedx creates and manufactures practical, accessible and precise fertility technologies that help standardise and automate fertility treatment. Its unique relationship with Genea Fertility means that Genea Biomedx is a manufacturer that truly understands the customers’ perspective. As a result Genea Biomedx has developed the world’s first automated vitrification instrument, and has other projects well advanced in the product pipeline.

Gavi, Geri and Gems Gavi - will be the world’s first automated vitrification instrument; Vitrification is a process used in IVF to preserve human egg cells (oocytes) or embryos by cooling them to deep sub-zero degrees. Approaching the process in an innovative way, Gavi uses an automated, standardized protocol aiming to provide consistent results in blastocyst vitrification.

Geri - a benchtop incubator with individually controlled incubation chambers per patient to minimize disruptive events to the early-stage embryo. It also incorporates a time-lapse camera to capture images of embryos as they develop.

Gems - the latest generation of Genea’s culture media for embryo cultivation.

Merck Serono Merck Serono is the biopharmaceutical business of Merck. With headquarters in Darmstadt, Germany, Merck Serono offers leading brands in 150 countries to help patients with cancer, multiple sclerosis, infertility, endocrine and metabolic disorders as well as cardiovascular diseases. In the United States and Canada, EMD Serono operates as a separately incorporated subsidiary of Merck Serono.

Merck Serono discovers, develops, manufactures and markets prescription medicines of both chemical and biological origin in specialist indications. We have an enduring commitment to deliver novel therapies in our core focus areas of neurology, oncology, immuno-oncology and immunology.

All Merck Press Releases are distributed by e-mail at the same time they become available on the Merck Website. Please go to http://www.merckgroup.com/ subscribe to register online, change your selection or discontinue this service.

Merck is a leading company for innovative and top-quality high-tech products in healthcare, life science and performance materials. The company has six businesses - Merck Serono, Consumer Health, Allergopharma, Biosimilars, Merck Millipore and Performance Materials - and generated sales of around € 11.3 billion in 2014. Around 39,000 Merck employees work in 66 countries to improve the quality of life for patients, to foster the success of customers and to help meet global challenges. Merck is the world’s oldest pharmaceutical and chemical company - since 1668, the company has stood for innovation, business success and responsible entrepreneurship. Holding an approximately 70% interest, the founding family remains the majority owner of the company to this day. Merck, Darmstadt, Germany, holds the global rights to the Merck name and brand.

The only exceptions are Canada and the United States, where the company operates as EMD Serono, EMD Millipore and EMD Performance Materials.

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education

30 Minutes to Save a Life: Doc Uses Social Network to Diagnose Fatal Condition

Just three weeks ago a doctor on SERMO, the top growing global social network of more than 340,000 doctors, saved a boy’s life through medical crowdsourcing. This disruptive new healthcare phenomenon enables doctors to pool their collective wisdom online to solve tough patient cases and save lives.

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training, education & skills When a 14 year-old boy visited the physician’s office with a persistent cough, the primary care physician ran all the standard tests – yet everything came back normal. When the boy returned for a follow-up, he reported feeling better after coughing up a strange looking “branch-like” mass, which his mother brought with him to show the doctor.

Before sending the unusual specimen to the lab, the doctor snapped a picture and posted it on SERMO to crowdsource insights from colleagues and specialists. He also created a poll listing multiple diagnoses.

Within 30 minutes, the first doctor responded to the community post and poll and over the next two days, 231 doctors from the US and UK weighed in with 16 possible diagnoses for the coughed-up branch.

Within a few hours, one cardiologist nailed it: Fontan-Associated Plastic Bronchitis, an extremely rare respiratory condition associated with previous heart surgeries that few primary care doctors will ever encounter.

“While pulmonary may help, he needs to see cardiology urgently for plastic bronchitis following Fontan surgeries…please give them a call and ask whoever is on call for the weekend when they can see him (or have him admitted)” – Cardiologist A paediatrician with pulmonology and respiratory expertise confirmed this observation: “I agree that this is very concerning for plastic bronchitis. We see this very frequently in our hospital especially in patients with congenital heart disease…I agree with [the first to diagnose plastic bronchitis] that he should be seen by cardiology ASAP.” Another doctor linked to a related post in which a child, who went undiagnosed with the same condition, died: “[I had] a little 3 year old patient of mine who died from this recently. Mother had shown her doctors a cast she had coughed up while in the hospital for respiratory symptoms post Fontan, but sent her home without recognizing the diagnosis. She died a few days later.”

Without waiting for results to come back from the lab, the child’s primary care physician referred the patient to cardiology. In just two days, the cardiologists treated the boy and saved his life.

As medicine becomes increasingly specialised, and with 13,000 known medical conditions, no individual doctor can diagnose all conditions across all specialties based on their personal training and knowledge alone.

In a recent international SERMO poll conducted in the UK, US, France, Spain, Italy and Germany, the majority of doctors (up to 87 percent) stated that at least 20 percent of patient cases fell in the medical “grey zone,” where doctors believe they would benefit from input from a broader range of doctors. Rare conditions like the one the boy presented with, are particularly challenging. According to the UK Strategy on Rare Diseases, there are between 5000 and 8000 rare conditions, which collectively affect up to 3 million people in the UK.

es from peers around the country and soon around the world within 1.5 hours and solve cases within 24 hours.

“Many treatable conditions go mis- or undiagnosed for years not for a lack of science, but simply because doctors traditionally do not have quick access to a network of specialists who can quickly recognize potential red flags of challenging conditions,” said Dr. Richard Armstrong a SERMO member and general surgeon.

“Medical crowdsourcing has the power to change that, giving doctors around the world free access to the best collective medical expertise at the tip of their fingertips.”

“Medical crowdsourcing fills a huge void in healthcare today and is transforming the way doctors practice everyday medicine,” said Dr. Easton Jackson, a SERMO member and the physician who treated the patient. “Now, in real-time, doctors can access hundreds of years of combined medical education at the push of a button to get faster – sometimes life-saving – diagnoses.”

Medical crowdsourcing works particularly well on SERMO versus other social networks because of the very large number of doctors on the site and the fact that all members are verified physicians.

Anonymity on SERMO is also a key aspect to doctors acting quickly and weighing in on tough cases. In a doctor-only environment, anonymity is the hallmark of SERMO and what makes it unique compared to other identified doctor networks. It is essential that doctors feel that they are safe to voice their opinions and to seek and give clinical input from their peers without fear of repercussions.

“Having the ability to access insights from my colleagues safely and securely – in a closed, doctors-only environment that also maintains patient privacy – is critical and certainly played a central role in making the diagnosis in time and saving this young child’s life,” said Dr. Jackson.

About SERMO SERMO is the United States’ top ranked social network for fully verified, licensed physicians. In April 2015 SERMO opened its doors to doctors in the UK. SERMO is the place for doctors to talk about real world medicine. Founded in 2005, SERMO’s mission is to unite physicians and provide them with a safe, private, and trusted platform for free and open discussions. SERMO is a virtual doctors’ ‘lounge’ where doctors candidly share their true feelings about their profession and lives. With over 305,000 verified US physicians from 93 specialties, representing 40 percent of the American physician community and 38,000 UK physicians representing 16 percent of the UK physician community, SERMO harnesses the collective wisdom of doctors, enabling medical crowdsourcing, knowledge sharing and thus the advancement of medicine.

On SERMO, doctors regularly benefit from the power of medical crowdsourcing to address the “grey zone.”

Over the course of 2014, doctors posted 3,500 challenging patient cases on the social network, which were viewed a total of 700,000 times and received 50,000 comments. On SERMO, most doctors receive respons-

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products

Interoperability among Connected

Medical Devices Can Potentially

Transform Healthcare Connected health infrastructure is emerging as a binding agent for diverse devices and workflows, aiding diagnosis, monitoring and prevention in the healthcare industry. For such an infrastructure to be efficient, stakeholders must first ensure that interoperability and connectivity standards are in place.

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New analysis from Frost & Sullivan, Healthcare and Medical Device Connectivity and Interoperability, finds that the adoption of connected healthcare infrastructure is not uniform across the world. This is primarily due to the lack of a holistic digital healthcare strategy that focuses on integrated care models.

“More than 50 percent of healthcare providers do not have a healthcare IT roadmap, although they acknowledge the role of digital health in enhancing healthcare efficiency,” said Frost & Sullivan Healthcare Research Analyst Shruthi Parakkal. “Consequently, even the existing interoperability standards such as HL7, DICOM and Direct Project are not being utilized optimally by many providers.”

Furthermore, hospitals are often required to update processes and workflows through expensive upgrades and reviews of codes and software. This process becomes more complicated in the absence of vendors that can guarantee connectivity between devices from various manufacturers.

“Hospitals/healthcare providers have an urgent requirement for connected devices and health IT solutions not only to manage healthcare data, but also to qualify ‘Meaningful Use’ requirements and be eligible for electronic health record incentives,” noted Parakkal. “Therefore, manufacturers of vendor-agnostic and open medical connectivity solutions are in demand, as they facilitate the integration of devices from different original equipment manufacturers.”

Alliances and gateways that harness interoperability and enable information sharing between devices and health IT solutions from different vendors will go a long way in augmenting connectivity. Meanwhile, technology advances in WiFi, Bluetooth, and radio frequency identification are also stoking market advancement.

Finally, the intensifying focus on healthcare interoperability in Food and Drug Administration (FDA) guidelines is expected to add thrust to the development of the market for healthcare and medical device interoperability and connectivity.

Healthcare and Medical Device Connectivity and Interoperability is part of the Connected Health Growth Partnership Service program. Frost & Sullivan’s related studies include: Seeing into the Future: New Opportunities on the Horizon for Smart Eyewear; Care Coordination Software—US Overview and Outlook, 2014–2020; Vital Signs - Review of the 2015 ECR: Latest Advances in Medical Imaging Clinical Decision Support; Big Data Opportunities in the US Medical Imaging Market. All studies included in subscriptions provide detailed market opportunities and industry trends evaluated following extensive interviews with market participants.

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products

SurgiQuest’s ® AirSeal System

Receives FDA 510(k) Clearance for Transanal Endoscopic Surgery SurgiQuest, Inc, a leading provider of innovative access technologies for minimally invasive surgery (MIS), has announced that its AirSeal® System recently received 510(k) Clearance from the FDA for Transanal Endoscopic Surgery (TES).

To date, the growth of transanal endoscopic surgery has been limited due to the technological constraints of conventional insufflation technology which is unable to provide a consistent, smoke-free working space. Because the AirSeal System ensures stable insufflation of the rectum and provides continuous smoke evacuation, surgeons can now perform TES with increased confidence, thus enabling faster adoption and proliferation within the global colorectal community. The category of transanal endoscopic surgery includes both transanal minimally invasive surgery (TAMIS) and transanal total mesorectal excision (TaTME), a surgical technique that has been shown to significantly improve patient outcomes in colorectal cancer procedures.

“The AirSeal Platform is a key factor in performing an ideal TaTME procedure,” said Dr. Joep Knol, a colorectal surgeon in Belgium and the first to use the AirSeal System in a transanal surgical approach. “By achieving a stable pneumorectum and providing optimal smoke evacuation, a meticulous dissection is possible.”

Hospitals, NHS Trust, in the United Kingdom. “It has enabled us to perform our TaTME procedures in a safe and more effective way.”

About SurgiQuest SurgiQuest, Inc. is a privately held venture-backed company, founded in May 2006. The Company develops, manufactures and markets innovative access technologies for minimally invasive surgery.

SurgiQuest’s patented AirSeal Access System both optimizes the endoscopic environment and provides unparalleled stability in the operative during MIS. Unlike conventional insufflation and trocar systems, the Company’s breakthrough integrated platform ensures stable pneumoperitoneum, continuously evacuates smoke and plume when energized medical devices such as electro-cautery, laser or ultrasound are used, and provides valve-free access to the operative cavity during robotic, laparoscopic and other endoscopic surgical procedures. AirSeal®, AnchorPort®, Low Impact® Laparoscopy, and SurgiQuest® are registered trademarks of SurgiQuest, Inc. All rights reserved. Additional information about SurgiQuest products can be found at www.surgiquest.com.

“The AirSeal System has had a significant impact on our ability to perform both TAMIS and TaTME procedures,” stated Matthew Albert, MD, who is the Program Director of the Colorectal Fellowship at Florida Hospital in Orlando, FL and an American pioneer in transanal endoscopic surgery.

“From the first time I used it clinically, I knew this technology would elevate our surgical capabilities, improve patient outcomes, and help reduce procedure time and costs.”

“Using AirSeal is essential to establish a clear and stable operative field,” said Roel Hompes, MD, a leading colorectal surgeon at Oxford University

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innovation

Stem Cells

Could Expand Window for Treating Stroke A recent study in STEM CELLS Translational Medicine could open the door to a new therapy to potentially expand the current window of time for treating patients after they have experienced a stroke (five times beyond that of a clot-busting drug) and significantly improves their chance of recovery.

Each year nearly 800,000 people in the United States suffer a stroke. Most of these – nearly 87 percent – are ischemic strokes caused by blood flow to the brain being blocked usually by a clot. Without oxygen the brain cells begin to die and death or permanent disability can result. Currently the only FDA-approved treatment for strokes is tissue plasminogen activator (tPA) a drug that works by dissolving the clot and restoring blood flow. Unfortunately to be effective tPA must be administered within about five hours of the stroke and many victims don’t get to the hospital in time to receive it.

Another downside is the drug can exacerbate leakage of the blood-brain barrier (which separates the brain from the circulatory system) and increase the chance for abnormal bleeding. This has left medical researchers searching for something that offers a wider treatment timeframe without negative side effects.

Among the more promising of these is stem cell transplantation using neural stem cells derived from pluripotent stem cells (iPSC-NSCs) reprogrammed from the patient’s own cells. These cells appear to possess multiple therapeutic benefits including replacing the damaged brain cells and fighting inflammation.

In the study researchers from Tulane University (New Orleans LA) conducted studies testing the effectiveness of iPSCs during the early stages of an ischemic stroke. Lead investigator Jean-Pyo Lee Ph.D. of Tulane’s Centre for Stem Cell Research and Regenerative Medicine and Department of Neurology explained “A good deal of stroke injury results from reperfusion – when the blood flow is restored after the stroke. If left unchecked reperfusion can cause an irreversible second opening of the blood-brain barrier within 24 to 72 hours after the first stroke occurs.”

“It is this second episode that contributes significantly to cell death” she said. “The goal of our study was to find a way to limit early-stage blood-brain barrier injuries an outcome that would protect against the second phase of stroke damage.”

Using mice as their test model 24 hours after stroke the researchers transplanted iPSC-NSCs into the animals’ ipsilesional hippocampus a natural niche of NSCs in the brain. In another 24 hours (48 hours after stroke) the stem cells had migrated to the stroke lesion and quickly improved the animals’ neurological function. Recovery of behavioural function persisted throughout the month-long monitoring period the team reported.

“The rapid therapeutic activity is not due to cell replacement but to a bystander effect that elicits reduced inflammation and blood-brain barrier damage” Dr. Lee said. “The results have clinical implications by indicating a much extended treatment window (24 hours as opposed to the maximum five hours for tPA). Plus there is the potential for a synergistic effect by combining transplanted hiPSC-NSCs with tPA to reduce a stroke’s adverse effects.”

“This is an interesting study that points to the potential of induced pluripotent stem cells to improve neurological function after a stroke,” said Anthony Atala M.D. Editor-in-Chief of STEM CELLS Translational Medicine and director of the Wake Forest Institute for Regenerative Medicine.

“Results in mice showed significant improvement in sensorimotor balance and motor function two to eight days after injury which was maintained during the one-month study period.”

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innovation

Dassault SystèMes Announces Commercial Availability of Its First Simulated Human Heart Scientifically accurate 3d model accelerates device testing and research for treatment of heart disease.

Dassault Systèmes, the 3DEXPERIENCE Company, world leader in 3D design software, 3D Digital Mock Up and Product Lifecycle Management (PLM) solutions, has announced during its SIMULIA Community Conference that the first heart model from its “Living Heart Project” will be commercially available on May 29, 2015.

Powered by Dassault Systèmes’ 3DEXPERIENCE platform’s realistic simulation applications, the commercial, high-fidelity scientifically validated 3D simulator of a four-chamber human heart is the first product of its kind. With this model, device manufacturers, researchers, and medical professionals will be able to perform virtual tests and visualize the heart’s response in ways that are not possible with traditional physical testing.

The “Living Heart” model as delivered represents a baseline healthy heart, which can be used to study congenital defects or heart disease by modifying the shape and tissue properties in an easy-to-use software editor. In addition, medical devices can be inserted into the simulator to study their influence on cardiac function, validate their efficacy, and predict reliability under a range of operating conditions.

For example, coronary stents can be evaluated for optimal type, size, and placement location to achieve the best performance.

“I had been aware of advances in simulation technology, but prior to the ‘Living Heart Project’ I was unaware that it could address the types of challenges I have as a practicing cardiologist and medical educator,” said Robert Schwengel, MD, FACC and Clinical Assistant Professor of Medicine, Alpert Medical School, Brown University. “Having spent time with their 3D experiences, I believe a product like this could be very powerful in helping to educate my patients, students of medicine, and current medical professionals, as well as lead to improved diagnostic capabilities and the personalization of medical therapeutics.”

Announced in 2014, the “Living Heart Project” leverages crowdsourcing of its 45 current members to build its models while protecting the intellectual property of each member. Members include regulatory

science focused organizations such as the Food and Drug Administration (FDA) and the Medical Device Innovation Consortium (MDIC), as well as technology providers, cardiologists, medical device manufacturers and hospitals such as St. Jude Medical and Mayo Clinic. This unique crowdsourcing approach has enabled the heart model to be independently tested and included in peer-reviewed scientific journals by project members, and helped Dassault Systèmes deliver the first iteration of the project’s commercial product on an accelerated schedule. This achievement demonstrates the effectiveness of the project’s approach and reaffirms the opportunity for simulation to address meaningful challenges in cardiovascular disease.

“The availability of the first commercial, physics-based simulated heart marks a significant milestone for digital medical tools that will advance cardiovascular science and directly impact the quality of life of patients,” said Scott Berkey, CEO, SIMULIA, Dassault Systèmes. “The ‘Living Heart Project’ is proof that our technology can potentially change the course of therapies through simulation of the human body. We will continue to collaborate with the biomedical community and our partners to provide technology and applications that will enhance the experience for heart patients everywhere.”

The “Living Heart” model includes well-defined anatomic details of the heart as well as proximal vasculature, such as the aortic arch, pulmonary artery, and superior vena cava (SVC). The dynamic response of the heart model is governed by realistic electrical, structural, and fluid (blood) flow physics.

In addition to the general availability of the heart simulator, the members of the “Living Heart Project” have collectively identified the highest priority cardiovascular applications for it and associated technological advancements which will help shape the functionality of future versions of the simulator.

To learn more about the “Living Heart Project” please visit: http://www.3ds.com/heart.

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industry insight

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innovation

Is There Such a Thing as

‘Healthcare 4.0’?

Dan Somers of Warwick Analytics (www.warwickanalytics.com) talks to GHP about how far data-driven operations and Predictive Analytics in the healthcare industry has come: when it can help, when it can’t and what is the true state-of-the-art in terms of new developments in data science.

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The healthcare industry in its widest sense is hugely complex: human beings are complex, conditions and their treatment are complex and the R&D and manufacture of treatments also hugely complex. The opportunity for improved insight across the industry is strong.

In an ideal world we would like to be making better decisions, quickly, based on all the factors affecting that decision. Imagine if we could remove subjectivity and the necessity to make decisions under the pressures of time and making sure it’s the surest and safest option.

But could we be close to a Healthcare 4.0 where we can benefit from the same efficiencies and accuracy that is already widespread in the likes of Industry 4.0?

Well, the various buzzwords of ‘Big data’ and ‘Internet of Things’ have given a lot of attention … perhaps hype … for predictive analytics as a core use case and new possibilities.

Predictive analytics can be applied throughout the healthcare cycle in areas such as: speeding up research trials; simulation of care quality; accelerated time to market for new therapies; market access and resource allocation for new therapies; high risk patients for ACO (accountable care organisation) and hospitals; the reduction of hospital readmissions; changing behaviour for healthier lifestyles; patient experience; and financial performance.

There is software that can correlate symptoms and set probability assessments in real time, and they can do this in a way that is faster than a human observer.

Other software can combine data about the physics, physiology, and genetics of the human body with information about materials used in medical devices such as pacemakers to anticipate how they will perform over time.

The idea is to predict potential failures and weaknesses in processes and equipment so they can be fixed before affecting patients and efficiencies. By having such accurate and timely insight, decisions can also be made quicker with almost guaranteed outcomes.

But what has stopped us maximising these opportunities to date?

Firstly it comes down to culture. There are many within the healthcare industry who have spent years learning their skill and craft. Many believe that an algorithm is no match to diagnosing a patient and in some cases they are, as at the time of writing, correct. Yet two different doctors can and will provide two different opinions, and variability (particularly where there are complexities or comorbidities) causes healthcare pathways to be diffused and deviate.

Secondly, it comes down to the quality of the data.

Hospitals are renowned for their disparate data silos and often the data is unstructured too i.e. in text format and itself not organised. Despite the push towards electronic health records, paper records still exist in many cases. And this has prevented the majority of existing predictive analytics models from working effectively.

Even when data are electronic and accessible, nearly all predictive analytics algorithms require a clean dataset and indeed a hypothesis – explicit or implicit – i.e. a known signal to look for. Some of these (decision trees and neural networks) can use machine learning to be trained but the data are rarely clean and by the time you have a statistically significant sample of issues you really have a much bigger problem. Mostly the problem is that issues look like one-offs. So trying to find an ‘unknown unknown’ signal without generating lot of false positives is much more of a challenging problem.

The motivation for the majority of these analyses and more is consistent: Improving patient care while avoiding financial and reimbursement penalties for hospitals.

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innovation The problem is basically one of ‘data-rich, information-poor’. The current methods involve data scientists spending weeks and sometimes months focusing on a specific repeatable issue and building the perfect model. Apart from this, can anything else be done?

The answer is yes. There are technologies emerging into the mainstream from a highly scientific background that can either automate or greatly assist with the joining, cleaning and transformation of disparate and unstructured data and some that have predictive analytics algorithms that can work with dirty and incomplete data. There are different ways to resolve the same problem and different strengths and weaknesses of each.

The technologies at the company I represent, Warwick Analytics, is one of the potential new approaches to address this. The approach it takes is two technologies combined: The first technology is known as ‘automated information retrieval’ (or AIR) and this is an automated approach and exhaustive pattern mining and pruning.

Significantly it does not clean data in case it strips out a signal in the future. It does have a downside in that it requires access to significant distributed computing power (whether on premise or cloud) but if this is available it can be extremely useful as it makes no assumptions and can work with text including typos and industry-specific terms. The output is to structure and classify the data.

The second technology is the home-grown, non-statistical, predictive analytics algorithm called RCASE (“Root Cause Analysis Solver Engine”) which was built to deal with dirty and/or incomplete data. The combination of both technologies in an iterative workflow means that all of the data can be fed in and the system will mine the historian for signals to explain/predict the clusters it has generated from AIR of seemingly unrelated incidents. One of the key benefits is that the alarm thresholds are explicitly predicted in terms of the amount of false positives and negatives and therefore signals can only be retrieved that are tolerable or valuable.

The predictive analytics solution is known as SigmaGuardian and is being used at many healthcare establishments.

The Site Operational Excellence Lead commented: “The pharmaceutical industry is highly regulated and we have to verify and document everything we do. So finding and validating the root causes which drove yield improvements was a key advancement and we are very pleased with the analysis that SigmaGuardian provided.

“We did not expect the results to be as good as they were, particularly with limited data we provided. Also the speed of calculation and the ease of interpreting the results was impressive too.”

In terms of healthcare provision, there is another use case in hospitals for predictive analytics: University Hospitals Coventry and Warwick NHS Trust (UHCW) also used SigmaGuardian to improve its treatment for stroke metrics (especially the then 80:90 stroke target) and also deliver sustainable savings of over £400,000 per annum in costs of running the stroke department.

UHCW were falling behind on their 80:90 stroke target and also experiencing sub-optimal outcomes, budget challenges, incomplete data and an unclear action plan.

Patient flows were monitored and analysed using the software. Matching these against a hospital system-map and patient data, the software identified the bottlenecks of the hospital system, enabling UHCW to prioritise and reallocate resources to the appropriate points in the system.

Without significant new investment, UHCW was able to rapidly improve the outcomes for stroke victims while also producing significant savings in costs of running the stroke unit. Within less than a year, the hospital was achieving well over the NICE quality standard for stroke units and is one of the best performing hospitals in the UK. So there are many opportunities for improvement in care quality, production quality and yield. Yes, we are challenged with data but there are still predictive analytics out there which can work.

Visit www.warwickanalytics.com for more information.

For example it was recently implemented at a major pharmaceutical company to reduce impurity levels in the production of a haemorrhoid treatment. They wanted to identify where the underlying reasons for the impurity formation lay.

Although the initial dataset was small and contained some inaccuracies, SigmaGuardian was able to employ its Information Retrieval technology to extract as much information from the data as possible, including logical inferences and derivative variables. From the first iteration, its ‘non-statistical’ predictive algorithm was able to generate and validate some strong signals without any hypotheses. Some of the results were expected and some were a surprise to the team. This led to a second iteration with more data. Warwick Analytics generated root causes to explain the factors which predicted both high yields as well as low yields. A Design of Experiments (“DoE”) was created from the results to validate the results. These concurred with the findings from SigmaGuardian and the relevant process changes could be implemented.

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innovation

In New Cardiac Surgery Study

NephroCheck

®

Kidney Biomarkers Rise to the Occasion An intervention known as remote ischemic preconditioning (RIPC) significantly reduced the occurrence of acute kidney injury (AKI) in cardiac surgery patients and confirmed that post-operative elevations of two kidney biomarkers act as an alarm for risk of AKI, according to a study published online today in the Journal of the American Medical Association.

Investigators in the study used Astute Medical, Inc.’s NephroCheck® Test to obtain measurements of the two biomarkers, tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP-7). In addition to confirming that post-operative elevations of the biomarkers indicate risk for AKI, results of the study suggest that such testing could someday play a role in the optimization of preventative therapies for AKI. AKI is one of the top ten hospital in-patient complications most likely to affect mortality, length of stay and cost.[1] Because no therapy exists for AKI, clinicians must focus on prevention and early risk assessment.[2] “Suddenly, we have opened several new doors in the field of AKI, which has not previously seen a breakthrough of this calibre,” said Dr. John Kellum of the University of Pittsburgh, who co-authored the publication. “To validate a new treatment is exciting enough, but equally intriguing is the performance of two biomarkers, which may be useful in gauging the efficacy of treatment.”

The 240-patient multicentre randomized double-blind clinical trial, conducted in Germany, was performed on high-risk patients[3] undergoing cardiopulmonary bypass, an exposure linked to risk of developing AKI.2 By temporarily stopping blood flow into the arm, RIPC triggered a biomarker-based alarm mechanism sending the kidney into a defensive mode.

Investigators reported that patients with elevated post-surgical cell cycle arrest biomarker levels, as measured by the NephroCheck® Test, had a significantly increased rate of AKI compared to patients with lower biomarker levels.

“Lack of a clearly defined mechanism for AKI and the inability to deliver therapy in an effective manner to the right patients have hindered many previous attempts to prevent AKI,” said Kellum. “Based on what we’ve learned so far, TIMP-2 and IGFBP-7 could prove useful in future studies evaluating RIPC and other potential therapies.”

“These results show once again in a multicentre trial that elevations of the NephroCheck® Test cell cycle arrest biomarkers, TIMP-2 and IGFBP-7, herald high risk of an imminent AKI when measured in settings where the kidney might be stressed from exposure to significant hazards that can cause AKI, such as after cardiac surgery,” said Paul McPherson, Astute Medical chief scientific officer.

Dr. Kellum is an inventor of the biomarker technology that is covered under a patent application filed by the University of Pittsburgh, WESTFALISCHE WILHELMS-UNIVERSITAT MUNSTER, and Astute Medical. He has received grant support and consulting fees from Astute Medical, Inc.

Investigators found that in patients receiving RIPC the occurrence of AKI decreased (from 52.5 percent to 37.5 percent; p = 0.02), as did the use of renal replacement therapy (from 15.8 percent to 5.8 percent; p = 0.01) and the duration of intensive care stay (from 4 to 3 days; p = 0.04). Furthermore, the incidence of moderate to severe AKI fell by 50 percent compared to the control group (from 25.8 percent to 12.5 percent; p = 0.02).

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About Astute Medical, Inc. Selected to the 2014 Fierce 15 by Fierce Medical Devices, Astute Medical is dedicated to improving the diagnosis of high-risk medical conditions and diseases through the identification and validation of protein biomarkers that can serve as the basis for novel diagnostic tests.

The Company’s focus is community- and hospital-acquired acute conditions that require rapid diagnosis and risk assessment. Astute Medical’s current areas of interest include abdominal pain, acute coronary syndromes, cerebrovascular injury, kidney injury and sepsis.

Astute Medical is a founding partner of 0by25, a human rights initiative aimed at eliminating preventable and treatable deaths from AKI worldwide by 2025.

Astute Medical’s NephroCheck® Test is currently available in the United States and Europe. The test received 510(k)-clearance through the FDA’s de novo classification process in September of 2014. In the United States the NephroCheck® Test is the only test that has received regulatory clearance as an aid in the assessment of risk for moderate or severe AKI. The test was CE-marked in 2012. For information regarding trademarks and other intellectual property applicable to this product, including international trademarks, please see astutemedical.com/about/intellectual-property. PN0465 Rev A 2015/05/28

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innovation

Surgical Robots Market Worth $20 Billion by 2021 The Surgical Robots Market Shares, Strategies and Forecasts, Worldwide, 2015 to 2021 research report says surgical robot device markets at $3.2 billion in 2014 are anticipated to reach $20 billion by 2021 as next generation devices, systems, and instruments are introduced to manage surgery through small ports in the body instead of large open wounds.

This 2015 surgical robots market research says robots bring new automated processes to all segments and worldwide surgical robot markets are poised to achieve significant growth as next generation systems provide a way to improve traditional open surgery and decrease the number of ports needed for minimally invasive surgery. Intuitive Surgical has market leadership position, advanced technology, an impressive installed base and a well-trained group of surgeons able to manage the robots.

Mazor Robotics, Medrobotics, Medtronic, NLT Spine, NuVasive, Otto Bock HealthCare, RTI Biologics / Pioneer Surgical Technology, Precision Spine, Restoration Robotics, SI-BONE 503, Spinal Elements, Spineart, SpineGuard, Spine Frontier, , Spineology, Spine Smith Partners, Spine Surgical Innovations, Spine View, Spine Wave, Stryker / MAKO Surgical, Think Surgical, Titan Medical, TranS1, UC Berkeley, Varian Medical Systems., Vecna Robotics, Victrex plc / Invibio, Vycor, Wenzel Spine, X-spine and Zyga Technology.

Other leading competitors will emerge in the surgical robots market and the group of several surgical robotic companies will collectively have enough marketing dollars and enough marketing clout to drive replacement of all open surgery. Robotic surgery is positioned to become the standard of care. The leading robotic surgical companies are poised to grow through acquisition, purchasing smaller companies that have developed as specialized product and gained FDA approval. A surgical robot recurring revenue model business model is essentially large one time purchase for a system complimented by replaceable or disposable instruments that cumulatively market a much larger and ongoing market. Vendors make money from the one time sale of a system and recurring revenue from sale of devices used in every operation.

The Accuray radiation systems that address the oncology market are perhaps the most exciting technology ever offered to any market. Because the systems are able to control the dose of radiation Amount of activity in the market, many companies, FDA approvals, way for existing vendors to improve footprint in market.

The automated process revolution in surgery and communications is being implemented via robots. Robots automation of systems is providing significant improvement in the accuracy of surgery and the repeatability of process. Existing open surgery can be replaced in large part by robotic minimally invasive surgery (MIS) during the forecast period. Minimally invasive robotic surgery, new robotic radiation treatment, and emerging robotic surgical approaches complement existing surgery techniques. Soon, all surgery will be undertaken with at least come aspects of robotic surgery replacing or complementing open surgery.

Initially, a vendor sells and installs the surgical system into new customer accounts. Once systems are sold into customer accounts, the vendor generates recurring revenue as our customers use the system to perform surgery. To do surgeries, the customers need to buy and consume instruments and accessory products. Vendors also generate recurring revenue from system service. The ability to deliver such an accurate dose of radiation means that the cancer can be eradicated in patients before the patient is administered a lethal dose of radiation. This represents a cure for cancer once it gets working according to the promise of the systems now in place.

Companies mentioned in this research include Intuitive Surgical, Accuray, Stryker / Mako, Hansen Medical, Medrobotics, Freehand 2010, Accel Spine, Accuray, Aesynt / Health Robotics, Alliance Spine, Alphatec Spine, Amedica, Apollo Spine, Ascendx Spine, AVRA Surgical, Back 2 Basics Spine, Captiva Spine, Centinel Spine, Corindus, Elekta AB, Freehand, Globus Medical, Hansen Medical, Healthcare Robotics Lab, Intuitive Surgical, Johnson and Johnson / DePuy Synthes, K2M, Lanx / EBI Holdings / BioMet /, LDR, Life Spine,

The aging US population has supported demand, since the occurrence of health issues that require medical devices is higher in the elderly population.

Buoyed by strong demand and sales, industry profit margins have increased considerably during the past five years. Hospitals are adopting robotic surgical devices to improve their outcomes numbers. Hospitals are measured on outcomes, robots for surgery, when used by a trained physician are improving outcomes significantly. Hundreds of universities worldwide have research programs in robotics and many are awarding degrees in robotics. These “roboticists� are increasingly being hired by Global 2000 organizations to link mobile robots (mobile computers) into existing IT systems. Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. Surgeons no longer have to stand throughout the surgery and do not tire as quickly. Hand tremors are filtered out by the robot’s computer software. The surgical robot can continuously be used by rotating surgery teams.

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public health

Poll:

Many Americans Know Someone Who Has Abused Prescription Painkillers and Suffered Major Harmful Effects A national poll by The Boston Globe and Harvard T.H. Chan School of Public Health has shown that, in an era when concern about drug abuse has been very high, more U.S. adults are concerned about prescription painkiller abuse than about heroin.

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While more than half (51%) of Americans believe that the abuse of strong prescription painkillers, such as OxyContin, Vicodin, and Percocet, is an extremely or very serious problem in their state, 45% say the same of heroin. Nearly four in ten (39%) believe that the problem of prescription painkiller abuse has gotten worse over the last five years, while an almost equal proportion (38%) believe the problem has stayed about the same.

Many Americans report knowing someone who has abused prescription painkillers Nearly four in 10 (39%) say they have known someone during the past five years who has abused prescription painkillers. Of those who have known someone who has had this problem, a majority say it has had a major harmful effect on the user’s family life (67%), work life (58%), and health (55%). In addition, 21% say that the person’s abuse of prescription painkillers led to their death.

“For much of the public, the issue of prescription painkiller abuse is not just a remote concern; it’s a problem they see in their personal lives,” said Robert J. Blendon, Richard L. Menschel Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health.

Those who have known someone who has abused prescription painkillers hold different views about the problem than those who have not. They are significantly more likely to think abuse of prescription painkillers is an extremely or very serious problem in their state (64% vs. 43%) and that the problem has gotten worse over the past five years (56% vs. 28%).

In addition, they are more likely to believe that prescription painkiller abuse makes a person more likely to use heroin or other illegal drugs (59% vs. 45%).

Americans’ views about the causes of prescription painkiller abuse Americans see multiple causes of prescription painkiller abuse. More than half (55%) believe the ease of buying prescription painkillers illegally is a major cause of the problem in their state. Nearly half (45%) believe that the ease of getting prescription painkillers from people who have saved some from an old prescription or that doctors prescribing painkillers too often or in doses larger than necessary are also major causes.

“We know that the prescription drug and heroin epidemic requires a comprehensive response,” said Michael Botticelli, Director of National Drug Control Policy. “That’s why the Obama Administration’s 2011 Prescription Drug Abuse Prevention Plan focused on provider education on pain and substance use disorders, prescription drug monitoring systems, safe drug disposal, and smart-on-crime enforcement. We are also working with Federal, State and local partners to increase access to effective treatment, while reducing overdoses and other consequences of this epidemic.”

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Results of the poll indicate one discrepancy between public opinion and support for policy action. While 45% of U.S. adults say that painkillers being overprescribed is a major cause of painkiller abuse, less than three in ten (29%) believe that current state and federal regulations make prescription painkillers too easy for people to get.

Public opinion divided on what government action should be taken No clear consensus emerges when it comes to expanding access to treatment for addiction to prescription painkillers or heroin. About half (48%) believe that their state government should require health insurers to provide more extensive coverage for treatment programs for people addicted to prescription painkillers or heroin, even if it adds to the cost of premiums for insured people. But an almost equal proportion (46%) oppose expanding treatment coverage by insurers beyond current requirements.

When asked whether they believe there is a long-lasting, effective treatment for prescription painkiller addiction, 45% of U.S. adults believe there is such a treatment, while the rest are split between saying that they don’t know (27%) and not believing that there is such a treatment (28%).

Some states permit adults to buy a medicine called naloxone or Narcan, which reverses the effect of a prescription painkiller or heroin overdose in progress, from retail pharmacies. Other states restrict adults’ ability to buy the drug because they think it might encourage use of illegal drugs. Americans are divided on whether or not adults should be allowed to buy naloxone at retail pharmacies, with 42% in favour and 47% opposed.

public health

Can UAE Reach Ambitious 2021 Health Goals?

A new Economist Intelligence Unit report, commissioned by Abu Dhabi investment company Waha Capital, evaluates the current quality of healthcare in the United Arab Emirates and identifies key challenges to be overcome to reach the government’s 2021 goals.

The United Arab Emirates government is seeking a world class health system within six years, as goals laid out in the Vision 2021 Agenda. This report finds that the UAE health sector has undergone far-reaching change over the last decade, from mandatory insurance to management outsourcing and regulatory reform. Today’s report looks ahead to the key milestones that need to be reached to attain the country’s goals.

Staffing and skills have been on an upward curve since 2007, but more is needed to meet 2021 targets, including a steep increase of 50% in the number of doctors from 2012 levels. Expatriates will be a major contributor to this expanded workforce but remain transient, which reduces the embedding of relevant skills and sensitivities.

“While the UAE is attracting health workers from many countries, additional incentives could encourage longer duration, which brings greater continuity of care,” says Adam Green, editor of the report.

Government and health providers may wish to explore financial compensation to reward length of service, as well as perks such as speed of immigration processes and the possibility of full ownership of a medical practice. While the UAE scores well on liveability indicators, such initiatives could help it ascend the global league tables as an expatriate destination for healthcare professionals.

harmonisation. Differing protocols and standards across each Emirate makes it harder for companies to attain scale. Relocating staff is difficult due to differing licensing processes, for example.

Finally, the report finds that data on health service quality is steadily improving - helping patients make informed choices about treatment. Providers are increasingly accredited to international standards, and the government is requiring more data reporting on metrics such as waiting times and readmissions.

After years of scant information, which led many patients to seek treatment abroad because of their lack of faith in domestic services, the UAE (especially Dubai and Abu Dhabi) is now collecting more information than ever before. The publication of comprehensive patient service quality data will for the first time provide an objective rather than anecdotal picture of the region’s service quality.

“With plans to collect and publish more of this critical data over 2015 and 2016, patients will be able to make informed decisions about local treatment, and government and insurance companies can use such data as leverage in remuneration policies, pricing and licensing,” says Adam Green.

The report also explores the growing role played by the private sector in health delivery.

Management outsourcing of public hospitals, and the creation of ‘free zones’, has attracted several regional and international health companies. To support investment further, policy makers could consider regulatory

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public health

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Johns Hopkins Bloomberg School

of Public Health to Lead $17 Million Canadian Project

The program will help the nation evaluate the impact of its global maternal and child health programs.

The Johns Hopkins Bloomberg School of Public Health’s Institute for International Programs will lead a five-year, $17-million program to help the Canadian government measure the impact of its maternal and child health programming around the world.

The program is part of the Canadian government’s initiative to improve accountability for maternal and child health investments. Canada’s Department of Foreign Affairs, Trade and Development announced the project as part of its broader commitment to ensure that maternal, newborn and child health remains a global priority beyond 2015.

In collaboration with the Canadian Network for Maternal, Newborn and Child Health, the Bloomberg School will develop a set of tools that will help the government collect better and more complete data about its global health programs. This information, in turn, will help policymakers make better decisions about where and how to invest funds to save the lives of vulnerable women and children across the world.

“By collecting better data, we can save more lives,” says Jennifer Bryce, EdD, a senior scientist in the Bloomberg School’s Department of International Health and the head of the new project. “If we know which programs work best, we can replicate and expand them to reach more women and children. This is an exciting opportunity to be a part of.”

In addition to developing the tools and validating their application in low-income country settings, the School’s Institute for International Programs will provide capacity building and support to Canadian organizations that plan and implement global maternal and child health programs. The Institute for International Programs will also provide technical assistance for the development and management of a Canadian-based data repository.

“Building on Prime Minister [Stephen] Harper’s dedicated leadership as co-chair of the United Nations Commission on Information and Accountability for Women’s and Children’s Health, the Canadian government is proud to partner with Johns Hopkins University to help ensure that investments to improve the health of mothers, newborns and children have the greatest impact,” said the Honourable Christian Paradis, Minister of International Development and La Francophonie. “Improving accountability for results in maternal, newborn and child health is a signature element of Canada’s top development priority to improve the health and save the lives of the world’s mothers and children.

Canada will continue to work towards accelerating global progress in this area and make certain the issue remains central to the post-2015 agenda.”

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public health

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Ongoing Challenges

in Identifying and Tackling

Food Fraud Are Vital to Safeguarding Public Health

The new food labelling legislation introduced in the UK in December 2014 has generated much discussion in the media and has not been understood or supported in certain sectors of the food industry, yet it provides a needed boost to the efforts to ensure responsible management of food products throughout the entire supply chain to avert risk of illness or even death for those who have food allergies.

Food fraud is committed when food is deliberately placed on the market for financial gain with the intention of deceiving the consumer. The two main types of food fraud are sale of food unfit and potentially harmful and deliberate mislabelling of food, such as products substituted with a cheaper alternative. Food fraud may also involve sale of meat from animals that have been stolen or illegally slaughtered, as well as wild game animals like deer that may have been poached.

The fish industry illustrates the international nature of the issue. In the US, a Boston Globe study undertaken in 2011-2 suggests that as much as half of fish purchased in US restaurants is incorrectly labelled. This type of fish fraud generally consists of a restaurant or market claiming to sell one type of fish, but actually delivering another cheaper fish to the customer. For example, red snapper is often replaced with tilapia. Studies in various parts of the US found up to 55% of fish purchased and DNA tested had been mislabelled by the seller.

Fish fraud is often intentional to increase profits. Other reasons are poor translations which are common with imported fish, and certain species with than one name resulting in mislabelling. Fish names are also sometimes changed for marketing reasons: the toothfish perhaps understandably became more popular after an American fish seller in 1977 started calling it Chilean sea bass.

One type of fraud that has raised real concern in this country is the substitution of ground almond for ground peanut, a cheaper alternative. This has been suspected in the supply chain of some takeaway restaurants and can pose a serious threat to food allergic consumers.

The new regulations make it the responsibility of food vendors to find out what’s in the ingredients they use to provide accurate information to their customers, but substitutions or translation issues in the supply chain can make this a real challenge. In June, RSPH will be launching a campaign to raise awareness of the need for food retailers to be more thorough in presenting the right information to help keep customers safe.

The responsible management of food allergens by the food industry is an ever present challenge and some measures are bound to be unpopular with certain sectors in the industry. However, the responsibility cannot lie in an unbalanced way with the consumer when the stakes are potentially so high. The constant vigilance needed to protect consumers from food fraud plays a vital role too in maintaining the honesty of supply chain management and food provision. In addition to the legal measures available, a sustainable approach needs to emphasise increasing awareness and upskilling staff through high quality training programmes.

RSPH, through its projects, events and qualifications, continues to be committed to the high standards needed to support efforts to protect the health of the general population.

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