The Chronicle of Healthcare Marketing - September 30, 2018 by Chronicle

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TECH TRENDS WORTH WATCHING: Our list of the top technological developments that are going to change healthcare • 4 EDUCATING CONSUMERS: Denmark’s Cancer Society targets Danes headed to sunny destinations • 8

MY TURN: 25 per cent of Canadian seniors are taking 10 or more medications per day • 14

$7.95 · September 30, 2018 · Covering Canadian and Global Pharmaceutical Economics · www.pharmacongress.info

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Global coalition against HIV and AIDS

Bonny Prince Harry (right) and Elton John (below) launched the MenStar Coalition in July at the International AIDS Conference in Amsterdam. Funded by a number of foundations and supporters including Johnson & Johnson and Gilead, the Coalition will invest $1.2 billion to engage men in new and innovative ways to break the cycle of HIV transmission. The first project is to launch an HIV self-testing campaign aimed at young men in Kenya. A Richmond, BC company, bioLytical Laboratories, has developed a one minute INSTI HIV Self Test.

n Blockchain’s promise is that it may overcome the trust issues plaguing research, medical records, and more

By Kyra White,

Preparing for the inevitable Black Sky

n Lessons learned as Hurricane Maria disrupts Big Pharma production in Puerto Rico

OF THE CHRONICLE OF HEALTHCARE MARKETING

HURRICANE MARIA STRUCK the US territory of Puerto Rico in late Sept. 2017, there were concerns about the potential disruption of pharmaceutical and medical device manufacturing on the archipelago, and its impact on international stocks of medical supplies. There are more than 80 pharmaceutical and medical device manufacturing plants based in Puerto Rico, includLouissant ing Amgen, Abbott, AstraZeneca, Baxter, Bristol-Myers Squibb, GlaxoSmithKline, Lilly, Medtronic, Novartis and Procter & Gamble. In discussions with professionals on the scene, T HE C HRONICLE OF HEALTHCARE MARKETING has learned that development and execution of preHEN

paredness plans across sectors allowed for minimal to no interruption in supply of medical products to patients, and protected the safety and security of medical company personnel across the islands. But these same observers say Hurricane Maria should serve as a learning experience to further improve preparedness for future severe weather events and other emergencies. IDENTIFYING DEPENDENCIES

Hurricane Maria was considered a ‘Black Sky Event’—a situation where there was complete or almost complete loss of critical infrastructure, said Nicolette Louissant, executive director of Healthcare Ready, in an interview with THE CHRONICLE. Healthcare Ready is a US-based nonprofit organization, set up shortly after Hurricane Katrina in 2005. The organization focuses on questions of preparedness and response to disasters and seeks to act as a central link between private sector healthcare, the healthcare industry and supply chain, and public health and emer-

of THE CHRONICLE OF

HEALTHCARE MARKETING

We a t h e r p a t t e r n s

By John Evans,

Will blockchain revolutionize the pharma industry? Te c h n o l o g y

gency management agencies. “Being able to plan for an event like [Maria] is really a matter of thinking about what the key dependencies are for parts of medical manufacturing operations and how best to mitigate problems and create plans, and to bring in infrastructure to allow operations to sustain at some level until those critical dependencies are restored,” said Louissant. Shortly after Maria damaged Puerto Rico, Dr. Scott Gottlieb, the commissioner of the US Food and Drug Administration (FDA) told the House Energy and Commerce Committee’s subcommittee on Health that there were approximately 40 medications the FDA was concerned might be in short supply, according to The New York Times (Oct. 4, 2017). Turn to Hurricane Maria page 6à

N A FIELD WHERE EXPERT STATUS IS

granted after one year in the industry and three years can turn you into a dinosaur, blockchain is set to revolutionize the way pharma thinks about longstanding healthcare challenges and data management. That was one of the conclusions at the Blockchain in Healthcare conference in Toronto this past June. The conference, attended by early blockchain adopters, software developers, blockchain enthusiasts, policy makers, medical professionals, and industry leaders, addressed the question of how blockchain might transform the healthcare industry. Blockchain is a digital, decentralized, public ledger that tracks transactions in a chronological and secure fashion. A blockchain begins with a new transaction being put into a block, and each block is connected to the one before and after it. Transactions are then blocked together creating an irreversible chain—a blockchain. TRANSACTION VERIFICATION

Cryptocurrency, like Bitcoin, is one example of a system powered by a blockchain solution. The platform has all the necessary elements in a transaction-driven industry—it is distributive and is simultaneously permissive and secure. Blockchain is used to verify transactions of goods and services eliminating the need for a third party, such as a bank. Using a blockchain creates a permanent record of the transaction that cannot be changed, and its authenticity

Turn to Blockchain page 10à

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TOP TEN SIM PLE OFFICE SUPPLIES THAT CHAN GED THE WORLD. PAPER

Said to be one of the Four Great Inventions of China, the pulp and papermaking process dates back to the 2nd century B.C.

WHITEOUT RUBBER BANDS

Once known as “mistake out”, this correction catalyst came from the desk of Dallas secretary Bette Nesmith in 1951.

It was a stretch, but in 1845 Stephen Perry made the rubber band a reality.

STAPLES THE “BULLDOG” CLIP

Housed in one of the more exciting desk ornaments, these little bits of metal always deliver when you’re in a bind.

First trademarked by the UK’s Setten IXL Limited in 1944; torsion, elasticity and friction become one with this fastener.

S:15"

THE LEAD PENCIL In 1795, N.J. Conte blended ground graphite with clay and tossed it in an oven. This was what separated him from the competition.

THE PUSH PIN With $112.60 and an idea, Edwin Moore presented the pushpin to the world in 1900, later forming the Moore Push Pin Company.

THE RULER THE ERASER The eraser, or “rubber”, took on many forms before inventor Charles Goodyear discovered vulcanization in 1839, giving us the eraser we know today.

From the Indus Valley Civilization in 1500 B.C. to Anton Ullrich in 1851, the ruler has been the measure of many great things worldwide.

SCISSORS “Don’t run with scissors” could be heard echoing across Ancient Egypt around 1500 B.C.

Strategic Partnerships • Innovative Approaches • Impactful Tactics • Consumer Initiatives • Educational Programs • Engaging Events James Cran 416 926 2126 • www.antibodycommunications.com

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NOCs of Note: August 2018

Significant TTP approvals of Rxs for human use

Non-nucleoside reverse transcriptase inhibitor 08–13 Rilpivirine hydrochloride (Edurant, Janssen Inc.) Comments: Safety update to Edurant PM with regard to pregnancey and post-partum, oral tablet, 25 MG/TAB

PCSK9 (proprotein convertase subtilisin kexin type 9 08–10 Evolocumab (Repatha, Amgen Canada Inc.) Comments: Extension of an indication: primary hyperlipdemia (including heretozygous familial hypercholesterolemia), subcutaneous, 140 MG/ML, 140 MG/SYR Pyridone 08–09 Pirfenidone (Esbriet, Hoffmann La Roche) Comments: Updates to product monograph, package insert, bottle and carton labels, oral capsule, 267 MG/CAP, 267 MG/TAB, 801 MG/TAB

B:16.5"

T:16"

S:15"

Antihemorrhagic 08–02 Emicizumab (Hemlibra, Hoffmann La Roche) Comments: New drug submission, subcutaneous, 30 MG/ML, 150 MG/ML, 105

Turn to NOCs page 12à

NUVO PHARMACEUTICALS of CIPHER PHARMACEUTICALS of Mississauga, Up Here Mississauga, Ont. paid US$110 milOnt. got Health Canada’s okey-doke for dalbaWhat’s happening in drug marketing vancin (Xydalba), Tx for acute bacterial skin lion to acquire Aralez Pharmaceuticals, also of and skin structure infections (ABSSSI) in adults. Mississauga. Aralez’s Canadian specialty-pharmaceutical business, forThe Rx came through the acquisition of the Canadian portfolio of merly known as Tribute Pharmaceuticals, includes migraine Rxs Cardiome Pharma earlier this year. Says Cipher kingpin Robert Cambia and Suvexx, antihistamine Blexten, and Canadian rights to Tessarolo: “The approval of Xydalba bolsters our Canadian commerheadlice Tx Resultz. According to Nuvo numero uno Jesse Ledger: cial business, adding a near-term line of revenue, provides diversifica“Nuvo will be preserving the jobs of [more than forty] Canadiantion to our portfolio and reinforces our commitment to bring new based employees and we will ensure that patients and healthcare pracand innovative medicines to Canadian patients.” titioners across Canada continue to receive access to and support in relation to important medicines like Blexten and Cambia.” Health Canada says a second impurity has been found in valsartan manufactured by ZHEJIANG HUAHAI PHARMACEUTICALS, a ChinaMERCK CANADA got Health Canada thumbs up for ivermectin based CMO. The agency found N-nitrosodiethylamine (NDEA) in Turn to Up Here page 13à (Stromectol) as Tx of two tropical parasitic infections, intestinal products, after discovering strongyloidiasis, a roundworm, and onchocerciasis, known as river blindness. Says Merck prexy Anna Van Acker: “We recognize that Stromectol is globally considered the standard-of-care with over twenty years of real-world experience and that there is an unmet medical need in Canada.” She says the approval “reinforces our ongoing commitment of improving the lives of Canadian patients.”

Montreal’s SERVIER CANADA got a green light from Ottawa for ibritumomab tiuxetan (Zevalin), a Ca radiopharmaceutical combining ibritumomab tiuxetan with radiotherapy (Yttrium-90.) The product is approved for patients with relapsed or refractory low-grade or follicular, CD20 positive, B-cell non-Hodgkin's lymphoma (NHL), including patients with rituximab-refractory follicular non-Hodgkin’s lymphoma. Approximately 8,300 patients were diagnosed with NHL in 2017. Says Servier supremo Frederic Fasano: “Oncology is a priority for Servier Canada which is aligned with the company global strategy. Servier is fully committed to discovering and providing Canadian cancer patients with innovative treatment options.” The company markets Onscapar for acute lymphoblastic leukemia and Onivyde for metastatic adenocarcinoma of the pancreas. >> Servier previously announced the acquisition of Shire’s oncology business at a price tag of US$2.4 billion. Pursuant to the deal, Servier will establish a direct commercial presence in the USA.

Professional Pearls

Shifting perspective: Whether it is how pharmaceutical companies perceive which markets they are in, or how the impact of the industry is perceived, the perspective from which a question is asked can change the value of the answer received. At the 2017 National Pharmaceutical Congress, two speakers spoke on how shifting perspectives can increase the recognition of business value and help identify markets.

Re-inventing the pharma industry 4 key notes

John Haslam, gee-em, Horizon Pharma Our contributions to Canadian healthcare seem to be undervalued. We need to take a unified stand to change the narrative on our industry. We must create an industry-wide awareness plan that all can support and sustain. It must be backed by true industry trade-offs that contribute to publicly identified priorities. Seek to understand how our customers see us. Payors and patients feel that their system in Canada is working well. They believe that it is leading edge. What they want is for us to create solutions to help enhance the system, instead of pointing out the problems with the system. Utilize social media and patient groups to tap into a growing consumer-driven market. As an industry, we have been effective so far in using new digital platforms, but we can do a better job of finding new ways to insert ourselves înto the conversation. Become a more significant player in the ecosystem. For example, we could create a venture capital fund for Canadian innovation.

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September 30, 2018 · 3

Healthcare, Inc.

The Chronicle of Healthcare Marketing

The underutilized Canadian pediatric market 4 key points

Robin Hunter, gee-em, Mallincrodt Recognize that pediatrics is an under-supported market. Seventy per cent of medications prescribed to children in Canada are off-label. Find active partners for pediatric trials. CHU Sainte-Justine in Montreal and KidsCAN Trials, a national organization representing 17 children’s hospitals, are both looking for industry partners. Focus on your best bets. The research groups I mentioned may first look at products that already have pediatric indications in other countries. With projects such as OHIP+, provincial health plans may be reimbursing more pediatric prescriptions. It may be worth advocating for the 100 to 300 most necessary pediatric medications among the thousands of medications in the formularies. Recognize that you and your company may already be in the pediatric space. There is a great deal of research ongoing into genetics in pediatrics. If you have genetic therapies in your pipeline, you are in pediatric medicine even if you do not think you are.

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4 · September 30, 2018

Special Report

The Chronicle of Healthcare Marketing

Tech trends

that are changing healthcare

ECHNOLOGICAL DEVEL-

opments, particularly digital innovations, are transforming the role that pharmaceutical companies play in healthcare. Pharmaceutical firms are no longer just dispensers of medication, they are now playing a larger role in providing a diverse range of patient-care services.

“While pharmaceutical companies have been largely insulated from digital transformation, we believe that is changing rapidly. Patients expect healthcare to catch up with the rest of their digital lives and soon, connectivity will be built directly into medicines,” said Chris Hogg, Chief Commercial Officer at Propeller Health in Madison, Wis., in an email interview with THE CHRONICLE OF HEALTHCARE MARKETING. Propeller Health is a digital therapeutics company and developer of Propeller, a sensor that patients with asthma and chronic obstructive pulmonary disease This SPECIAL REPORT was written by Assistant Editor Bianca Quijano, with files from Editorial Intern Kyra White.

(COPD) can attach to their inhalers. The sensor is linked to a smartphone app to help patients and care teams manage triggers and monitor medicine intake. Hogg According to Hogg, pharma companies will play a major role in marketing these products to physicians. He says incorporating digital medicines will benefit industry by providing brand differentiation in a crowded marketplace. Recent technological advancements also empower patients with a better understanding of their symptoms, which can lead to increased medication adherence and brand loyalty. Aside from mobile apps, digital measures can provide additional outpatient support for customers, helping them become more proactive in their treatment plans. “When pharmacies and pharmaceutical companies offer more specialized services to their patients, this tends to build a greater rapport. Often this is a way that these pharmacies [and ccompanies] further tailor a person’s therapy and therefore build greater relationships with them,” said Bryce Wong, gee-em at RxOME Pharmacogenomics Canada Inc.,

in Vancouver. RxOME is the developer of the myDNA pharmacogenomic athome testing kit, which patients can order at their Wong local pharmacies. Using the DNA test, patients can have a better understanding of how they will react to certain medications. Aside from creating more opportunities for personalized medicine, digital technologies will also streamline drug development and research processes. For example, blockchain decentralized ledger technologies allow patient records to be stored in singular and encrypted places. Primarily, blockchain benefits patients because they will be able to know exactly who has access to their records. In addition, blockchain developers like Coral Health offer incentives for patients to make their health records available in databases that pharmaceutical companies can then use for potential recruitment to drug trials. “It is very difficult to find patients that are in the scope of a drug trial . . . You see mass media marketing to try to find people which is essentially like a needle in a

haystack—advertising on buses and subways. Our system will allow pharma companies to be able to mine and automize metadata within the ecosystem that allows them to identify patients who appear to fall within the scope of a drug trial that they are looking to fill,” said Jeremy Mullin, vee-pee of corporate development at Coral Health in Vancouver. Ultimately, technological advances are modifying the form and function of pharmaceutical treatments. These are some of the latest innovations that are bringing change.

STRAIGHT TO-HOME DELIVERY

Companies like MedExpress are offering drone-delivery options for their patients. The service may be ideal for remote areas. Those in favour of this alternative delivery method also say that it can reduce the embarassment that some people may feel when purchasing certain medications. In select cities in the US, Amazon also offers same-day deliveries of Turn to Tech trends page 10à

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September 30, 2018 · 5

The Chronicle of Healthcare Marketing

10 minutes with Gamze Yüceland of Takeda CEO interview

n New Takeda gee-em talks about the importance of critical investment in R&D in Canada

amze Yüceland has been appointed as the new general manager of Takeda Pharmaceutical Inc.’s Canadian operations in Oakville, Ont. With a 21-year-long career, Yüceland has held several senior sales and marketing positions in the pharmaceutical industry. She was most recently the general manager of Takeda in Turkey. Her direction was instrumental in launching and fostering the growth of the company in that region. With a presence in more than 70 countries and regions, as well as employing 30,000 people worldwide Takeda is among the

Yüceland

top 15 largest global pharmaceutical companies. Takeda is also one of the fastest growing pharmaceutical companies in Canada with 140 employees across the country. The company is investing in Canadian research and has contributed to more than $20 million towards partnerships and investments. Yüceland spoke with THE CHRONICLE’S Bianca Quijano about Takeda Canada’s next steps and her approach to leadership.

How is the Canadian market different from the Turkish and Japanese markets? Turkey’s emerging pharmaceutical market offers opportunities in various areas. One of the key differences between the Turkish and Canadian markets is that Canada is quite developed with a solid healthcare infrastructure, and significant and diverse healthcare expertise and capabilities. Is Canada a good place to do research and development (R&D)? Research and development (R&D) is a major focus for Takeda. We spend a significant amount of our total investment on R&D—approximately 20 per cent of global sales. Canada offers a dynamic environment for R&D and we are committed to supporting ongling clinical research. Over the past five years, Takeda Canada has dedicated approxiately $20 million to various R&D projects.

How does R&D in Canada ultimately support patients? Patients are our priority and their well-being is our purpose. Investing in research in Canada gives Canadian patients the chance to participate in clinical trials. Our priority with our treatments that are approved by Health Canada is to ensure that

patients across the country have equal access to the treaments they need as quickly as possible. We take a holistic, patient-centred approach and also look at ways to provide an extra level of care. For example, our inflammatory bowel disease (IBD) treatment is given by intravenous infusion and our patient support program offers

patients everything they need, from booking appointments at the infusion clinc closest to them to providing patients with information about the treatment. What are some therapies that Takeda has in the pipeline for the Canadian market?

Right now, gastroenterology and oncology are the main therapeutic focuses for Canada. We are working toward expanding our presence in IBD and oncology through partnerships and new product launches. For example, we recently launched a treatment for adults Turn to Yüceland page 8à

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Hurricane Maria tests resilience of pharma based in Puerto Rico Access to needed materials in the territory was challenging. A press release from Amgen on Oct. 25, 2017 noted that their manufacturing and packaging plants on the islands were fully operational, but at the time there were limited supplies of medicalgrade oxygen and nitrogen, a limitation they were in the process of overcoming. Amgenâ&#x20AC;&#x2122;s plant in

Puerto Rico manufactures Humira (adalimumab), the worldâ&#x20AC;&#x2122;s top selling drug, by revenue. In a Jan. 4, 2018 press release, the FDA announced that the Puerto Rican manufacturers of the medications on its initial list of concern had been reconnected to the municipal power grid. Many of those companies reported to the FDA that their production was increasing,

and the risk of future shortages of medications was on the decrease. â&#x20AC;&#x153;The measures taken by a lot of our partners were really focused around thinking about electricity dependency, road access, and plans for [human resources],â&#x20AC;? said Louissant. â&#x20AC;&#x153;They had generators, they had contracts for diesel fuel. All of those things were already in place and tested on a routine basis.â&#x20AC;?

Photo by Kris Grogan

continued from page 1

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Medical manufacturers in the territory had also established systems to check on the safety of employees and their families, she said. Louissant said that it must be ensured that plans are in place to make sure all staffâ&#x20AC;&#x201D; both those involved in operations and also those involved in facility maintenanceâ&#x20AC;&#x201D;are secure in the event of an emergency. This not only plays a significant role in overall response, it supports business operations and the business continuity after a disruptive event. Some of the manufacturing sites, such as Amgenâ&#x20AC;&#x2122;s, had prepared with on-site wells and water reservoirs to buffer against interruption of municipal water supplies. These emergency measures had been tested and practised on a regular basis, so all systems were known to be in working order and all personnel were familiar with the steps involved, Louissant said. â&#x20AC;&#x153;A plan is only as good as your ability to test it and revise it.â&#x20AC;? However, it will always be a challenge to plan for an event on the scale of Maria, Louissant said. â&#x20AC;&#x153;There will always be pieces of our preparedness that are just not as strong as we might have hoped that they are. It is simply because it is very difficult to plan for that level of catastrophe.â&#x20AC;?

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Two areas of particular challenge, she noted, were communications and long periods of time separated from outside electrical power. â&#x20AC;&#x153;While satellite phones were there, satellite phones can be unreliable at times. Many of our colleagues say that on a cloudy day you cannot get a call out,â&#x20AC;? Louissant said. â&#x20AC;&#x153;I think a lot of the manufacturers and others are looking at improving and thinking through how to have better communications in the absence of power and telecom [infrastructure]â&#x20AC;&#x201D;how will we able to get information across the island,

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September 30, 2018 Âˇ 7

Photo by U.S. Customs and Border Protection

The Chronicle of Healthcare Marketing

and also off of the island?â&#x20AC;? Also, the diesel generators were needed for longer, more sustained periods than had been anticipated, she said. â&#x20AC;&#x153;The idea of generator maintenance has really been incorporated as a bigger focus moving forward,â&#x20AC;? Louissant said. â&#x20AC;&#x153;It sounds like a small thing, but if we are seeing more events where we are going to see more mass power outages, thinking about how we deal with energy resilience is incredibly important. Something as simple as thinking about the plan for how to maintain generators so that they can operate for weeks and monthsâ&#x20AC;&#x201D;which they are not intended to doâ&#x20AC;&#x201D;becomes very important.â&#x20AC;? Another lesson learned from Hurricane Maria and its impact on medical manufacturers is the importance of partnerships, Louissant said. She said that even for large organizations or entire sectors, there will always be capabilities held by partners that can make the difference between effective and ineffective response to an emergency. â&#x20AC;&#x153;These are the types of things that I think are really being focused on now in terms of how to improve plans and preparations.â&#x20AC;?

â&#x20AC;&#x153;Right now we are looking at Puerto Rico, and we are talking about the impact to those islands,â&#x20AC;? she said. â&#x20AC;&#x153;The reality is that we are still in a recovery phase in Puerto Rico

and the US Virgin Islands, while we are preparing for the next hurricane season.â&#x20AC;? Climate change could lead to more frequent, and more severe situations, as well. â&#x20AC;&#x153;I think there has been a general recognition that extreme weather events are going to be a bigger concern moving forward,â&#x20AC;? Louissant said. She said that industry partners of Healthcare Ready have been developing mit-

igation strategies for climate change-driven challenges over the last 15 years. In Canada, the Centre for Excellence in Emergency Preparedness (CEEP), is an Ontario-based non-profit organization with the mandate of improving healthcare preparedness. The organization maintains a library of resources for emergency planners on their website at www.ceep.ca.

ARE BUILT-IN REDUNDANCIES ADEQUATE FOR THESE STORMS?

Redundancies were also very important to the minimization of disruptions of the flow of products to consumers. In its release, Amgen noted the importance of their redundant fill and finish facility in Ireland and their partnerships with contract manufacturers in the US and in Europe that could provide additional manufacturing capacity when it was needed. Baxter noted in a press release on Oct. 12, 2017 that they had received regulatory discretion from the FDA to import some products from their facilities in Australia and Ireland to the US market. â&#x20AC;&#x153;Being able to have redundancy allows for a plan to not hinge on a single element,â&#x20AC;? said Louissant. â&#x20AC;&#x153;For us as an emergency response organization and all our partners, redundancy is a very important piece of how we plan. Being aware of the points in a plan where we are not redundant, and recognizing those are points of weaker resilience.â&#x20AC;? Disaster preparedness must be an ongoing consideration, said Louissant. It is not enough to develop a plan on the heels of a disruptive event and expect that will prepare an organization for the next event.

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8 · September 30, 2018

The Chronicle of Healthcare Marketing

Danes take unique approach to sun education Government agencies

n Typical white-collar Dane receives 40 per cent of annual UV exposure in a single week of holiday in the sun

By John Evans,

of THE CHRONICLE OF HEALTHCARE MARKETING

HERE OTHER APPROACHES

have failed, a new tactic from a Danish agency appears to have produced results in the education of Danes regarding the dangers of sun exposure. The Danish Cancer Society has been running annual campaigns in the country to raise sun safety awareness, said Thomas Koefoed, speaking at the 4th

International Conference on UV & Skin Cancer Prevention in Toronto. The Society’s data, however, was showing that they needed to do more to reach Danes, many of whom have a tradition of taking vacations in other countries where there is greater ultraviolet (UV) exposure. “In Denmark we have the fifth highest incidence of melanoma in the world. In Australia it is maybe natural [because of the quantity of UV rays], but in Denmark we really do not have the conditions to get melanoma,” said Koefoed. SUN SAFETY AWARENESS

Koefoed was the campaign manager on the new strategy, an advertising campaign that was called “Help a Dane.” The goal of the program was to raise awareness of sun safety in Danes in part by targeting the local populations in the five main countries where Danes traditionally vacationed. The typical white-collar Dane receives 40 per cent of their annual UV exposure in a single week of sun-destination vacation, Koefoed said, and 32 per cent of Danes aged 15 to 64 years of age reported they had been sunburned on a sun-destination vacation in 2015. The Help a Dane program was built on an understanding of some relevant aspects of Danish culture. “One of them is that most Danes would actually like to do as the locals do when they are on vacation,” Koefoed said. “They want to follow the old locals and find a quaint restaurant on a side street, and boast about it when they come home.” Danes also are proud of their country and people and want to know how they are thought of internationally. They do not want to be perceived as foolish, he said. “And also there is a bit of Danish humour in there as well. Danes love to tease each other and be teased.”

In the wintertime, when Danes were more likely to be travelling on sun-destination vacations, the ‘appeal’ portion of the campaign was initiated. Danish television and radio personality Mikael Bertelsen delivered a straight-faced request for assistance to the local population of each of the targeted countries—Spain, France, Greece, Italy and Thailand—in their native language. Bertelsen requested that helpful locals identify vacationing Danes who were not taking adequate precautions—a gallery of badly sunburned Danes in their underwear serving as an example (see photo)—and ensuring they were seeking shade, wearing a sun hat, and using sunblock. Locals also were given the option of signing up online to become ‘ambassadors’ to the Danish visitors. “The strategy was to create these five videos and launch them in the respective countries, and do some international PR, and then cross our fingers and hope that the story would return to Denmark,” said Koefoed. CAMPAIGN WAS HIGH PROFILE

There was also an associated poster campaign in Danish and select international airports. A follow-up television campaign was then broadcast in Denmark the following summer, with footage of international ambassadors identifying Danes

on their beaches and explaining how they were helping the tourists. “It really worked,” said Koefoed. “When we did our evaluation we asked 1,500 Danes aged 25 to 55 who had been on a sunny vaca-

the campaign, and almost 12,000 locals signed up to be ambassadors. There were only 34 local stories in Denmark, however. “We are launching Help a Dane 3.0 this summer,” said Koefoed. That version will also

“When you get the ball rolling, you have to do something immediately, and make sure the Danes experience the magnitude [of response] the campaign really had.” Other revisions will include clearer directions for those who

Sample graphic from the Help a Dane campaign

tion in the summer of 2017. And 51 per cent knew the campaign, 42 per cent said they knew more about sun protection, 63 per cent were reminded to use sun protection on their vacation, and 42 per cent talked to their friends or relatives about the campaign.” All told, there were 319 international press stories about

use affectionate humour to reach Danes, but will be revised based on lessons learned from the earlier campaign, he said. “The idea of launching in the wintertime and then doing something again in the summer, the gap was too big. The world had forgotten about the campaign a little bit.”

sign up to become local ambassadors so there is a better understanding of how to actually help Danes. “We were so in love with the project that we made so much content that we really could not get it out,” said Koefoed, noting the new campaign will focus on impact over volume of content.

Yüceland of Takeda: ‘I’ve always tried to do more, learn different things’ —continued from page 5

with ALK+ metastatic non-small cell lung cancer (NSCLC) who have progressed on or are intolerant to an ALK inhibitor (crizotinib) to address an unmet need for patients with advanced disease. This is an important new advance that offers hope for patients facing the uncertainty of disease progression and the potentially devastating impact of brain metastases. What are some of the major lessons that you learned in your position as general manager of Takeda Turkey that you are able to apply here in Canada? My leadership style is not the norm, yet it has helped my achieve my goals particularly when I led the team in Turkey. I strongly believe in an inclusive approach and that means working with all members of the team in a collaborative way. I listen to my team and hear what our customers and stakeholders have to say as well, and make decisions with everyone’s best interest in mind. I am continuing that inclusive approach in Canada. That kind of approach of inclusivity, is that something you developed

through the years, in your various leadership roles? In the 20 plus years I have been working in the industry, I have acquired different skills from some excellent role models. I feel priviledged to have worked with some very strong leaders and I picked up some tips along the way. I learned that more people feel they are part of the decision-making process, the more they are invested. At Takeda Canada, we want our employees to feel like their contribution is meaningful. Success is a team effort; I am surrounded by a great team and I want to draw on their collective experiences, because having different perspectives brings creative solutions.

Takeda professes to have a strong set of core values. How does “Takedaism” influence your work? I have been in different places with Takeda in the world and the core values is something that unites all our divisions. I am very proud to say that our values drive the way we operate as a company and are the foundation of our decisions. “Patient Trust, Reputation, and Business,” we live by those four words. Patients are the primary consideration in

•

• • •

everything that we do. We build trust in our relationships with each other and the stakeholders. we work with. Our reputation is so important to us, and we work hard to uphold it and particularly proud of the reputation we have in the industry and among patients. Finally, we have had the same values for 237 years and that says everything about who we are as a company. .

On a more personal level, what are some of the things you did early on in your career that helped you get to where you are now? I am a very open person and have never restricted myself to a title. I’ve always tried to do more, learn different things, and have never been opposed to rolling up my sleeves to get a job done. This is something that has stuck with me throughout me career.

What has been your impression of Canada so far? I am ecstatic to be here. This wonderfully large country with all of its distinctiveness is impressive. I love the diversity and the people are so warm and welcoming. What’s not to like?

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Corporate thinking

Ross Glover, gee-em at Taiho Pharma Canada n The second in an ongoing series profiling exceptional leaders in the pharma community

OR MOST INDUSTRY LEADERS,

creating a culture of excellence involves managing and adjusting an existing team. But for Ross Glover, General Manager of Taiho Pharma Canada, it represented a unique opportunity: create a high performance culture from the ground up. Glover, who became “employee number one” in Feb. 2017, remembers those early days as intense. “We received a priority review from Health Canada in week three, so it was busy.” With no infrastructure and no timeline plan, it was truly a start-up, but they had a key advantage. “We had a very strong parent company in Japan and strong partners in the US.” T h e Japanese “parents” were particGlover ularly supportive. “They looked at the Canadian piece with open minds, considering product, people, place with a fresh perspective, and they were, and are, very interested to learn about Canada, our systems, etc. They’ve been totally collaborative and eager to learn,” he says. DIFFERENT VIEW OF SALES

But what about creating a culture from square one? For Glover, it meant building a new age pharma company based on a solid business plan, of course, but also with key principles, transparency, commitment, collaboration and passion. “These were the qualities we wanted to see in the people we hired. By asking specific questions during the interview processes, we could find people who had these, and also had a passion for startups. Certain people love that challenge,” he adds. Sales Director Craig Smith was one of these special hires, and he noticed the difference. “Ross tasked us with looking at the sales force from the point of view of the customer, rather than from the usual corporate perspective. It’s a perspective I’ve always had but it was refreshing to have it reinforced and supported.” As well, Glover engaged the services of the Thrive Partnership Group to execute a 360 culture leadership feedback review for Smith, who wanted a clearer picture of his role as leader of the sales team. Smith explains the process and result: “I’ve spent my career working to stop poor culture from invading the sales teams I have lead. The 360 helps to make sure the things you are trying to promote are actually happening. It tells you if you’re on the right road

and going forward, not backwards.” For Glover, the result of carefully assembling a culture from the ground up, has had profound and

positive results. “Now, we have a lot of commonality among us. There are core values that we share. We include everyone when we talk about culture and celebrate

This is the second in a series where THE CHRONICLE OF HEALTHCARE MARKETING profiles on exceptional culture leader in the Pharmaceutical industry. The series was developed by Rob Seguin and Christine Woodley from The Thrive Partnership Group in conjunction with THE CHRONICLE. In this issue, they speak with Taiho Pharma Canada’s gee-em Ross Glover.

our success and work on our issues together,” he explains. But measuring culture is an ongoing thing, and Glover and Smith both realize the need for continual monitoring. “It’s never too late to use the measuring exercises to find out everyone’s level of engagement. There are lots of changes in our

industry, drug laws, pricing issues, and we must make big decision but keep the culture on track as we do it.” So, while Ross Glover may have created Taiho Canada’s culture from the ground up, he is making sure the foundation is strong for future growth and engagement.

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Tech trends that will be changing the delivery of healthcare services continued from page 4

therapies that can be sent to people’s homes or workplaces, saving patients from the added task of picking up their prescriptions at the pharmacy.

‘AROUND THE PILL’ PACKAGES

These are digital health apps, devices, or services that can be prescribed along with a medication as part of a health package. The Propeller by Propeller Health, mentioned previously in this article, is one example. Propeller allows patients with asthma and COPD to monitor their own disease. Daiichi Sankyo also offers a wearable monitoring device and smartphone app that accompanies the use of their blood thinner. Takeda Pharmaceuticals offers an outpatient service called YOURVANTAGE along with their medications for ulcerative colitis and multiple myeloma.

DIGICEUTICALS

Primarily, digiceuticals are pills or therapies that have a digital component built into their composition. Digiceuticals were designed to help increase medication adherence. Abilify MyCite, a medication prescribed for schizophrenia, depression, and bipolar disorder, has a sensor built into the pill that tracks if patients have ingested it.

BLOCKCHAIN

Blockchain solutions improve the way health records are maintained. Timestamped tracking of changes, by design, ensure that records are up to date. They also identify any attempts at t a m p e r i n g. Contract research organizations may find demand for their services shrinking as this technology is more widely adopted.

“People are employing blockchain solutions already and it is simply just going to accelerate significantly,” said Mullin of Coral Health. “Several large entities in the US, like United Healthcare and Quest Diagnost-ics—the biggest lab entities and the biggest payers—have already collaborated and launched a blockchain pilot for doctor credentialling.”

Like blockchain, AI (artificial intelligence) can improve clinical trials when used to find the right patients from a number of data sources. AI can also be employed to predict the timing and location of disease outbreaks. A company called Artificial Intellig ence in Medical Epidemics (AIME) developed a Dengue Outbreak Prediction platform that currently supplies the Malaysian government and regional governments in Brazil and the Philippines with insights to manage and prevent disease upsurges. By analyzing dengue statistics and variables (i.e., weather, socioeconomic factors), their platform takes one minute or less to create a map of dengue cases in a particular year.

RISE OF HUMAN MICROBIOME/‘BACTERIAL’ THERAPIES

More products and medications that feature bacteria as a primary ingredient are in the pipeline. The US company AO Biome sells live probiotics (in the form of mists, shampoos, and moisturizers) designed to restore the human skin’s natural microbiome, which may have been stripped of its diversity due to modern-day practices such as regular bathing. The company is currently developing an intranasal spray for seasonal allergic rhinitis that is also composed of bacteria.

Blockchain angles in healthcare analysed by conference presenters —continued from page 1

can be verified by the entire community of blockchain users rather than a single centralized authority. A PHARMA PERSPECTIVE

The healthcare industry is in desperate need of a system to solve the issue of lack of trust between multiple involved parties, inefficient intermediaries, and the need for enhanced security, explained Dr. Dennis Porto. Dr. Porto is a dermatologist, early cryptocurrency adopter, and blockchain investor who studied management and healthcare at Harvard University in Cambridge, Mass. He discussed multiple use cases involving the previously listed criteria for blockchain in healthcare including electronic health records, population research, supply chain, global health, provider credentialing, clinical trials,

PHARMACOGENOMICS

By definition, pharmacogenomics is the study of variability in response to a drug due to an individual’s genetic code. Mentioned earlier in the article, companies like myDNA claim to help doctors and patients select the most appropriate treatment based on their genetic test kits. With some therapies, genomic testing is already recommended before prescription (i.e., warfarin, a medication used as an anticoagulant). “It is important that pharmacogenomic information be delivered to patients through a healthcare provider like a pharmacist, in order for that type of information to actually impact a patient’s care,” said Wong of RxOME Pharmacogenomics Canada Inc.

VIRTUAL REALITY PAIN KILLERS

Researchers at Cedars-Sinai Medical Center in Los Angeles reduced pain in over 300

“It is important that pharmacogenomic information be delivered to patients through a healthcare provider like a pharmacist, in order for that type of information to

actually impact a patient’s care” —Bryce Wong, RxOME Pharmacogenomics Canada

and genomics. “The advantage of supply chain tracking on a blockchain is that various stakeholders who may not trust each other, [for example] competitors or even just enterprises at different points in the supply chain, can transparently monitor and interact with any given pharmaceutical’s supply chain ledger,” Dr. Porto said in a follow-up email interview with THE CHRONICLE OF HEALTHCARE MARKETING. “This will be transformative for pharmaceutical companies.” Dr. Porto explained that both the pharmaceutical companies and public have much to gain from a Dr. Porto blockchain system. “Pharmaceutical companies would benefit by the efficiencies of automated workflows based on smart contracts, whereas the public would benefit from transparency around clinical trial data

hospitalized patients through virtual reality (VR) therapy. In the study, patients wore VR goggles to watch calming footage like helicopter rides over scenic portions of Iceland. Par ticipants reported a 24 per cent drop in pain scores due to the treatment. This may lead, in the future, to VR pharmacies that prescribe VR treatment to patients.

3D PRINTED MEDICATIONS

The way medications are manufactured is also changing. The US FDA just approved a 3D printed epilepsy drug called Spritam, which dissolves faster than average oral therapies. In the future, drugs may be printed out at the pharmacy on an as-needed basis.

‘GREEN’ PHARMACY IN RESPONSE TO CLIMATE CHANGE

The harmful impact of medicines on the environment has been well-documented (i.e., feminisation of male fish from exposure to contraceptive components). Organizations like the Association of the British Pharmaceutical Industry have now launched a tool to calculate the carbon footprint of pharmaceutical products. The EU has, for the first time, listed three pharmaceuticals—diclofenac, 17-aethinylestradiol, 17-ß-estradiol—in legislation as substances on a “watch list.” Furthermore, pharmaceutical companies have prioritized reduction of their emissions as official corporate goals (for example, Biogen reports that the company has maintained carbon neutrality since the end of 2014).

to prevent data manipulation,” he said. Smart contracts are arrangements that upon fulfillment of certain conditions can be executed automatically. This could revolutionize the supply chain and the complex paperwork associated with the transport of documents and physical assets such as medication or other pharmaceutical related products, he said.

ADDING UP THE COSTS

“The thing about disruption is we have to acknowledge that we have spent and spent and spent over the last 25 years against the golden grail of IT, innovation, and changing healthcare,” said Timothy Stephens, head honcho of Ballparkco.io, a company building digitally distributive ledgers, at the conference. “Here we sit 25 years later and we have created massive overhead. The challenge is to switch from the overhead model where there has been no stopping of that spend.” Stephans noted that despite spending so much on healthcare, many Turn to next pageà

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Blockchain: One more complicated piece to solve a complicated problem continued from page 10

people still do not have access to proper or appropriate services. A blockchain solution with a large field of data would allow the government and the pharmaceutical industry, for example, to use analytics to see where savings could be optimized and fixed amounts be distributed for a more logical and efficient usage of resources. FROM THE PUBLIC PERSPECTIVE

Imagine a world where individuals had a healthcare passport. Patients owned their healthcare data and were able to control the parameters by which people could access their information. Imagine a world where clinical trials and pharmaceutical companies have the opportunity to approach an individual based on their unique data set for trials, medical, or healthcare information. Those are just some of the opportunities discussed by Katie Robinette, founder and head honcho of Sponsor Finder, a digital health app, at the conference. Robinette discussed the concept of putting the ownership of health records back in the hands of patients. She sees it as an opportunity to de-antiquate the healthcare system that from an administration perspective is completely fragmented. Wearables, Fitbits, and Apple watches are examples of health devices currently tracking patient data. These tools serve as an opportunity to amass multiple sources of information for the healthcare industry to better treat individual patients as well as populations of like individuals. FROM THE TECH SIDE

Chinmay Patel, main man of BlockX Labs, a product and software development company, said during the conference that, “blockchain is literally five per cent of the [healthcare] solution, there is still regular development [of solutions] . . . blockchain is just one more complicated piece you have to use in order to solve a complicated problem, which is trust.” Patel discussed the issue of standardization, a notion almost impossible to achieve on a national or international scale, but something blockchain, if legislation is properly implemented, will help solve. Patel refers to blockchain as being better utilized for tracking transactions and artificial intelligence training modules, rather than large data files. At this point blockchain does not have the capabilities to store massive data files and is inherently inefficient based on the need to continuously update the ledger, he explained. Aside from storage and

transaction processing, another major issue is that data can also be “copy-pasted,” explained Patel. Software developers are still trying to solve the problems of data security and the debate between limited versus unlimited access to different parties involved in data sharing.

WHAT ABOUT LEGAL?

From a legal perspective Laila

Paszti, an attorney at GTC Law Group, PC, in Toronto also spoke at the conference. She discussed the regulatory framework as a driver of blockchain rather than a roadblock. Blockchain offers a solution to ensure that compliance and regulatory standards are met by utilizing the solutions’ ability to manage big data, she explained. It can be an invaluable asset to

the pharmaceutical and healthcare industry. “Right now healthcare is at a time where it is right for disruption, seeing that we have not had a mass of data [like this before] . . . we have data from healthcare providers, data from sensors, and we have an opportunity to amass data from different silos. Blockchain gives us a way to bring these silos together,” said Paszti.

“Companies that try to avoid the inevitability of blockchain may awake one day to find that their business model has been disrupted by savvy competitors or start-ups,” Dr. Porto added in the interview with THE CHRONICLE OF HEALTHCARE MARKETING. “I recommend that established companies take blockchain seriously.”

Social networking and healthcare

Manage that digitally overwhelmed feeling, and stay sane in the process

EMAIL HAS BECOME A STANDARD COMMODITY in modern day life—just like death and taxes. Little did Ray Tomlinson, the man credited with “inventing” email in 1972, know that over 3.7 billion people would be using email and sending billions of messages daily. This accounts for nearly 54 per cent of the world’s population. The rise of email has to do with our shared belief that it is less time consuming, more reliable, and more efficient than face-to-face meetings or phone calls. It also allows for asynchronous communication that facilitates collaboration with individuals irrespective of geography. Moreover, it enables the sharing of more information with more diverse sources when compared to the traditional single-channel meetings and memos (remember those?). Ultimately email was seen as the ultimate saviour in connecting more people more of the time. We, of course, know better now.

The email paradox Alas, the “not-so-nice” side to email has, unfortunately, reared its ugly head. We continuously hear the cries of “overload” when we think about our inboxes that never seem to go away. Today, it is literally impossible to get emails down to “zero”. And even if you do, it is a moment of celebration that can last for not more than a second before torrents of new messages start pouring in. Email overload is directly correlated with the number of emails received, the length of messages received, and the time that is required to process and respond. The immediacy of receiving has also caused pressure for people to respond quickly. It is also the culprit for generating many of the unanticipated tasks in our calendars. Email causes the innumerable number of interruptions we experience daily, leaving us feeling out of control when it comes to managing our time. Finally, email forces us to switch tasks continuously as well as challenges us to enact different roles simultaneously. We, in effect, lose our sense of focus and flow when in the midst of email. Flow, according to Mihály Csíkszentmihályi, who coined the term in 1975, is a mental state when one is fully immersed in a thought or action that is both energizing and focusing. It is in these times when we can lose our sense of time and space. Human beings have a limited capacity to receive, interpret, assimilate, and apply information. When our limits are exceeded, our cognitive performance declines. This can be seen at slower speeds or the inability to make decisions, prioritize, or organize information, thoughts, and processes. This is the “email paradox”. On the one hand, email has facilitated widespread information distribution and reduced information delays. On the other hand, it can overwhelm our processing capabilities and reduce our personal effectiveness. This can lead to feelings of stress, inefficiency, demotivation, and confusion.

The financial impact of email Email volume is dependent on many factors including job characteristics and organizational culture. An average employee will receive slightly more than twice the number of messages they send. With our ability to send “one to many”, the marginal cost per message experienced by senders is dramatically reduced when compared to traditional tools like “snail mail”. So, senders enjoy a disproportionate share of the email benefits while email receivers bear the brunt of the proverbial costs. For example, a typical employee will receive upwards of 350 email messages per week (70 messages per workday) while an execu-

tive will receive upwards of 300 messages a day. On average, onethird of messages received daily are considered unnecessary and can be quickly deleted. The other necessary messages will require anywhere from two to five minutes to process, since they need to be read and responded to with attention to proper word choices, correct spelling and grammar, and the correct recipient list. This all takes time. In fact, the average employee will spend approx 2.9 hours/day on email while an executive can spend more than 10.8 hours. In addition to the time and energy involved in reading and responding to another’s information request, recipients also tend to interrupt their own work to continuously monitor incoming emails to satisfy senders’ expectations of a timely reply. Studies have shown that an employee will take 24 minutes, on average, to get back into the groove of their work after checking email. They will also check email at least 50 times per day and use instant messaging, on average, 77 times during the same time period. These numbers rise steadily as we incorporate the “internet of things” into everything we do. The average worker will lose at least six hours per week to email interruptions and two hours per week to processing unnecessary email. That is a total productivity loss of eight hours per week, on email alone. That totals 392 hours per year, per employee. For an organization with 50,000 employees, this can translate to an approximate loss of $1B in productive employee time. Email and its effects on cognitive performance In addition to corporate financial losses, other employee productivity parameters are also affected. The average employee, while distracted by email, exhibit twice the degradation in IQ scores during the task execution. This is the same IQ scores achieved by an individual who has just smoked marijuana. The use of IQ scores has been used historically by psychologists when comparing performance in distracted versus nondistracted states. They refer to the degradation in focal task performance as “dual-task interference” when an individual tries to perform a second task simultaneously. In the tech-driven world in which we live and the increased pressure to “empty our inboxes”, we are forever multi-tasking. The evidence is checking email during meetings or texting while driving. It starts in the morning when checking our social feeds while feeding our dog or going to the bathroom. We kid ourselves into believing that doing multiple tasks at the same time somehow increases our productivity. The sad reality is that studies completely disprove this belief. It has been noted that “high media multi-taskers” who frequently engage in five or more simultaneous information streams score poorly on standard judgment, recall and reaction times when compared to “low media multitaskers”. Other studies of “task switching” and “interruptions” both show similar results. The scary thing, however, is that multitaskers and task switchers usually feel “more confident” about their performance than those engaging with less divergent efforts. Unfortunately, decision-makers who are bombarded with more information feel more confident about their decision making than those with access to less information. Sadly, the “information rich” people usually end up making worse decisions. Natalie Yeadon is Managing Director, IMPETUS Healthcare. Impetus is an Online

Customer Advisory Board expert, offering comprehensive B2B Online Customer Advisory Board solutions. Impetus helps drive brand direction and strategies through the retrieval of timely insights with customer executives and key opinion leaders through a series of project managed online touchpoints. To learn more about using the Impetus InSite platform for your next advisory board, contact Natalie at nyeadon@impetushealthcare.com or call 416–992–8557.

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The Chronicle of Healthcare Marketing Comments: New indication, oral capsule, 140 MG/CAP

NOCs of Note: August 2018

Significant TPP approvals of Rxs for human use —continued from page 3

Hoffmann La Roche) Comments: Labelling updates, subcutaneous, 1400 MG/11.7ML, 1600 MG/13.4ML

MG/0.7ML, 60 MG/0.4ML

Monoclonal antibody 08–01 Erenumab (Aimovig, Novartis) Comments: Labelling updates, subcutaneous, 70 MG/ML

Antidote 07–30 Idarucizumab (Praxbind, Boehringer Ingelheim (Canada) Comments: Labelling updates, intravenous, 50 MG/ML Antineoplastic 07–27 Rituximab (Rituxan SC,

Tyrosine kinase inhibitor 07–27 Nilotinib (Tasigna, Novartis) Comments: Update to the product monograph, oral capsule, 150 MG/CAP, 200 MG/CAP

Protein kinase inhibitor 07–26 Brigatinib (Alunbrig, Takeda)

Comments: New active substance, oral, 30 MG/TAB, 90 MG/TAB, 180 MG/TAB

Biologic response modifier 07–24 Adalimumab (Humira, AbbVie) Comments: Product monograph update, subcutaneous, 40 MG/0.8ML, 10 MG/0.1ML, 20 MG/0.2ML, 40 MG/0.4ML, 40 MG/SYR, 80 MG/SYR, 80 MG/0.8ML

Protein kinase inhibitor 07–24 Ibrutinib (Imbruvica, Janssen)

Interleukin-5 inhibitor 07/08 Mepolizumab for injection (Nucala, GlaxoSmithKline) Comment: New indication: Eosinophilic granulomatosis with polyangiitis. Nucala (mepolizumab for injection) is indicated as an add-on to corticosteroids for the treatment of adult patients with eosinophilic granulomatosis with polyangiitis (EGPA), powder for solution, 144 MG/VIAL

Dopamine receptor agonist 07–17 Cabergoline (Dostinex, Pfizer Canada) Comments: alternate primary container closure system, oral tablet, 0.5 MG/TAB

Antidiabetic agent 07–17 Insulin degludec (Tresiba, Novo Nordisk Canada) Comments: New indication: Tresiba is also indicated for the treatment of pediatric patients (>two years old) with type 1 diabestes melitus,subcutaneous, 100 UNIT/ML, 200 UNIT/ML

Glucocorticosteroid 06-14 Budesonide (Rhinocort Turbuhaler, AstraZeneca Canada) Comments: Updates to product monograph, package inserts and labels, inhalation, 100 MCG/ACT

Antifungal agent 06-12 Fluconazole (Diflucan, Pfizer Canada) Comments: To update the product monograph with pharmacokinetic information, 50 MG/TAB, 100 MG/TAB (oral tablet); 2 MG/ML (intravenous); 50 MG/5ML (powder for suspension) Protein kinase inhibitor 06-11 Alectinib (Alecensaro, Hoffmann La Roche) Comments: New indication, oral capsule, 150 MG/CAP

Phosphodiesterase-4 (PDE-4) inhibitor 06-07 Crisaborole (Eucrisa, Pfizer Canada) Comments: New active substance, topical ointment, 2.0% Molecular targeted therapy Ceritinib (Zykadia, Novartis) Comments: New indication, oral capsule, 150 MG/CAP

Immunosuppressant 06-01 Cyclosporine (Restasis Multidose, Allergan) Comments: New drug submission, ophthalmic emulsion, 0.05%

Customer Service

Support Programs

Technology Solutions

Contact Centre Triage & Information

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Database Development & Management

Medical Info Support

Pharmacy & Fulfillment

Sampling Tools/ AE Training

Patient Counseling & Follow up

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Reporting & Analytics

...we make an IMPACT on PATIENT CARE Contact Marcel A. Gervais: mgervais@HealthConnect.ca 1-800-748-8020 www.HealthConnect.ca

Making a difference in people’s lives by connecting them with health and wellness solutions

Antipsychotic agent 05-04 Risperidone (Risperdal, Janssen) Comments: Addition of safety statements to Part III to align with Part I and to remove discontinuation of all strengths of Risperdal M-tab (0.5, 1,2,3 and 4 MG) from product monograph. Updates to package inserts, oral, 0.25 MG/TAB, 0.5 MG/TAB, 1 MG/TAB, 2 MG/TAB, 3 MG/TAB, 4 MG/TAB; oral solution, 1 MG/ML. M-Tabs (orally disintegrating): 0.5 MG/TAB, 1 MG/TAB, 2 MG/TAB, 3 MG/TAB, 4 MG/TAB JAK inhibitor 08-17 Baracitinib (Olumiant, Eli Lilly Canada) Comments: New active substance, oral disintegrating tablet, 2 MG/TAB

Epidermal Growth Factor Receptor (EGFR) tyrosine kinase inhibitor 07–10 Osimertinib mesylate (Tagrisso, AstraZeneca Canada) Comments: New indication, oral tablet, 40 MG/TAB, 80 MG/TAB Glycemic control 07–06 Insulin glargine/lixisenatide (Soliqua, Sanofi-Aventis) Comments: New drug submission, subcutaneous, insulin glargine 100 UNIT/ML/lixisenatide 33 MCG/ML

Antiandrogen 07–03 Apalutamide (Erleada, Janssen) Comments: New drug submission, oral, 60 MG/TAB

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Prescription medication: More isn’t necessarily better, according to two commentators from evidencenetwork.ca —continued from page 14

cians are recognizing that they can do better. Canadian clinicians are starting the conversation with patients and clients that more medications don’t lead to better health, and that unnecessary medications can be harmful. The Choosing Wisely Canada campaign works with national clinician societies to develop evidence-based lists of medications and treatments clinicians should question. By thinking twice before prescribing, and talking with patients about the harms and risks of medications, clinicians are starting to tackle overuse of prescription medications. INFORMATION SYSTEMS DESCRIBED AS FRAGMENTED

Choosing Wisely Canada is also working with regional healthcare providers and clinician organizations to share evidence-based strategies to help clinicians think twice, offer alternatives and have conversations about when that medication may cause more harm than good. The campaign also offers tools to patients to ask questions and start the conversation with clinicians about when more is not always better. But more needs to be done. Clinicians need to be able to work within healthcare systems that offer them a fuller picture of what medications patients are taking. Fragmented and poorly designed information systems can make that difficult. Payment models that incentivize quick clinical interactions can make it challenging to get a detailed medication history and to have a conversation with seniors about how many drugs they take, how often and to properly explain the risks and benefits. Increasing clinicians, patients and the public’s awareness about the problem of overuse of prescription medications is just a beginning.

Karen Born, PhD is Knowledge Translation Lead of Choosing Wisely Canada and an assistant professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto. Dr. Wendy Levinson is the chair of Choosing Wisely Canada, an expert adviser withEvidenceNetwork.ca and a professor of Medicine at the University of Toronto. EvidenceNetwork.ca is located at the University of Winnipeg. © 2018 Distributed by Troy Media.

N-nitrosodimethylamine (NDMA) earlier this summer. Ottawa has recalled all Rxs containing valsartan made by the supplier, noting that both NDEA and NDMA are classified as probable human carcinogens. HealthCan is investigating, with the EUMA, US FDA, and other global regulators.

—continued from page 3

VALEO PHARMA of Kirkland, Que. inked a pact

with Besins Healthcare of Monoco for micronised natural progesterone (Utrogestan) in Canada. It is indicated for luteal phase support during in-vitro fertilization (IVF) cycles. Says Valeo boss Steve Saviuk: “We are excited to add this... to our Specialty Pharmaceutical portfolio and offer a new choice in a growing area of concern forrevised_Layout Canadian families.” New Custom Ad 1 14-08-19 2:29 PM

Up Here

What’s happening in the world of drug

PROMIS NEUROSCIENCES of Toronto tapped James Kupiec, MD as chief medical officer, a new position. He will oversee the company’s clinical trials of PMN310 for Tx of Alzheimer’s disease (AD.) Said ProMIS padrone Eugene Williams: “Jim’s expertise and experience as an accomplished leader of clinical development programs in Alzheimer’s disease and other neurodegenerative disorders will be a great source of strength for ProMIS. He will not only provide outstanding clinical trial leadership but will also play a significant role in interaction with regulatory authorities, key neuroscience opinion leaders and potential pharmaceutical partners.”

Page 1

Dr. Kupiec was vee-pee, of the neuroscience marketing research unit of Pfizer.

SUNOVION PHARMACEUTICALS of Mississauga, Ont. says Health Canada approved an SNDS to expand the indication for its antiepileptic drug eslicarbazepine (Aptiom) to include use as an adjunctive Tx for partial-onset seizures (POS) in adolescents and children above six years of age who are not satisfactorily controlled with conventional Tx. Aptiom is QD monotherapy and adjunctive Tx for POS in adults with epilepsy. Says Sunovion sachem David Frawley: “This approval strengthens our commitment to advancing therapies for people living with neurological conditions like epilepsy.”

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14 · September 30, 2018

The Chronicle of Healthcare Marketing

When the finger-pointing goes too far

APOTEX FOUNDER AND HIS WIFE, INVESTIgators remain flummoxed and media commentary grows ever more speculative concerning the disturbing circumstances around the deaths. By “speculative,” we mean “absent of facts and really stupid.” Published reports suggest that Barry and Honey Sherman were likely the targets of assassination, and several online discussions insist that the party most likely culpable was Barry Sherman’s long-time commercial adversary, Big Pharma. (Spoiler alert: Evidence to support this notion doesn’t exist.) Lack of certitude has never been an obstacle to Frank Magazine, the Ottawa-based fortnightly, which examines the matter and arrives at the conclusion that the pharma industry was behind the homicide (see https://goo.gl/Mvf4E6.) There is no surprise that a spokesperson for Innovative Medicines Canada—the industry association that speaks for Notorious B.I.G. (Pharma)—has failed to quash this scurrilous accusation. The group has shown itself to be adept at expressing nuanced positions on patent protection, reimbursement issues, and the economic need for scientific discovery, but denying the instigation of a presumed rub-out may be just slightly beyond their tactical capabilities. And so the assertion remains out there, a stain on every rule-governed, if not to say timorous, life sciences executive everywhere. We’re sorry, but Frank’s theory is instantly dismissible. For one thing, it’s impossible to imagine that a typical drugbiz manager would routinely lose weeks of sleep in fear of not complying with a provision of the Pharmaceutical Advertising Advisory Board code—but the same individual would think nothing of disregarding the instruction in Exodus 20:13 about taking the life of a business rival. Anyone who has ever shared an Uber ride with a pharma manager or director (and argued about splitting the fare) will exclude such a possibility. It’s not the way the real world turns, as opposed to the world of bad television drama. Pe r h a p s if an assigned September 30, 2018 • www.pharmacongress.info team of manPUBLISHER agement conMitchell Shannon sultants had produced a EDITORIAL DIRECTOR MANAGER, OPERATIONS report recomR. Allan Ryan Cathy Dusome mending a ASSOCIATE EDITOR SALES & MARKETING John Evans Peggy Ahearn certain course ASSISTANT EDITOR Christine Wytowych of action, the Bianca Quijano COMPTROLLER EDITORIAL INTERN Rose Arciero Kyra White INE MONTHS AFTER THE PASSING OF THE

Published four times annually by the proprietor, Chronicle Information Resources Ltd., from offices at 555 Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3 Canada. Telephone: 416.916.2476; Fax 416.352.6199. E-mail: health@chronicle.org Contents © Chronicle Information Resources Ltd., 2018, except where noted. All rights reserved worldwide. The Publisher prohibits reproduction in any form, including print, broadcast, and electronic, without written permission. Printed in Canada. Subscriptions: $59.95 per year in Canada, $74.95 per year in all other countries. Combined rate including Chronicle MONDAY and Chronicle MIDWEEK newsletters: $240 per year in Canada, $360 per year in all other countries. Single copies: $7.95 per issue (plus 13% HST). Canada Post Canadian Publications Mail Sales Product Agreement Number 40016917. Please forward all correspondence on circulation matters to: Circulation Manager, The Chronicle of Healthcare Marketing, 555 Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3 Canada. E-mail: circulation@chronicle.ca ISSN 1209-0654 THE CHRONICLE OF HEALTHCARE MARKETING welcomes contributions from readers. In particular, we’d like to know what’s going on at your company, or organization, and you are especially welcome to keep us informed about new developments, new appointments, and new practices at your shop. If you’re submitting an article, opinion piece, press release, or letter to the editor for consideration, please bear in mind that we select material for publication from a large volume of submitted material, and that we may not be able to publish your submission in a specific issue (or at all) due to space constraints and other considerations. Our policies are: All material submitted to THE CHRONICLE becomes the property of Chronicle Information Resources Ltd., and is subject to the company’s usual editorial procedures; We will not consider for publication any material that has been simultaneously sent to other publications; Only original material or information will be considered; Payment at our established freelance rates will be offered upon publication for feature articles and for the following departments: What Lies Ahead: Original articles of approximately 500 to 700 words dealing with trends that shape the healthcare industry; and My Turn: Opinion pieces of approximately 500 to 700 words, offering original commentary on issues facing the healthcare industry. Please refer inquiries to: Editor, The Chronicle of Healthcare Marketing, 555 Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3 Canada. Fax 416.352.6199, E-mail: health@chronicle.org

suggestion might get a hearing. But the consulting firm’s customary service is to promulgate best practices among industry peers—so that Company A is always in the position of waiting for Company B to be the first to prove the effectiveness of any new technique. The resulting stasis has long served to frustrate the more ambitious and assertive manager—but, in compensation, it provides a balance against introducing questionable concepts into an operating plan. You might think that contract-killing, regarded as both unlawful and ethically indefensible, surely must not count among those standard best practices. Much as the cryptic and lurid dénouement of the Shermans was bound to become the object of public fascination, it is revealing that some find it plausible that the pharma industry is capable of having played any role at all in the affair. How do these far-fetched notions even emerge? Certainly, the pharma sector’s reputation does not help. In the August 2018 survey of Business and Industry Sector Ratings, recently conducted in the USA by the Gallup polling group, Big Pharma is seen as once again as being up to no good. This perception has become as ritualized as hissing the guest villain during Columbo re-runs. The data confirms Americans don’t care much for lawyers, the oil and gas industry, or private healthcare operators. But they reserve their purest loathing for just two groups: the pharma industry, and the U.S. federal government. Together, these two institutions form the very bottom of the reputational pit. (See https://goo.gl/Jd8RGk.) It is nonetheless a remarkable leap, from having the public perceive you as untrustworthy, to being presumed capable of committing corporately premeditated homicide. Yes, it’s ridiculous; yes, it’s discouraging—and, certainly, the situation illustrates once again how the pharma sector’s intractable image problem frequently manages to get in the way of advancing the humanitarian causes we champion.

Preparing for disruption: This time it’s for real?

THIS EDITION OF THE CHRONICLE forecasts the emerging impact of technology on healthcare (see page 4). There is a certain yawn-factor built into these exercises in predicting the future, no doubt because this publication has been banging on about that topic since 1996. Nonetheless, it’s no special challenge to see that there are certain lines converging on the horizon—demographic, economic, technological, societal—and that the traditional organizational diagrams that depict how our businesses are conducted need to be rethought and re-drawn. Many initiatives that might qualify as potentially disruptive to the life sciences orthodoxy are underway, and several of interest are discussed in this issue. How best to prepare? The only advice we can offer once you’ve climbed aboard that (self-driving) vehicle might be to strap yourself in and hang on tight. The ride won’t be smooth, but it’s bound to be thrilling. Opinions expressed are solely the editorial judgment of this publication, and do not represent any other views. Rebuttals and comments are invited. Write to: health@chronicle.org

My Turn Prescription medications: More isn’t always better By Karen Born and Wendy Levinson, Special to THE CHRONICLE

HEALTHCARE MARKETING

y thinking twice before prescribing and talking with patients about the risks of medications, clinicians are tackling overuse. Canadians are living longer than ever and we are also taking more medications than ever. And this can make us sicker, not healthier. A report released recently by the Canadian Institute for Health Information found that one in four seniors in Canada take 10 or more medications. That’s a total of 1.6 million seniors in Canada who are at significant risk of being harmed by the very thing that’s supposed to help them. For example, benzodiazepines are a medical term for sleeping pills commonly prescribed to seniors who experience trouble sleeping or anxiety. These powerful drugs were designed for short-term use. Unfortunately, many seniors end up feeling dependent on these drugs for sleep and stay on them for the long term, sometimes indefinitely. These medications can lead to increased drowsiness, falls and possible fractures, and even car accidents. Antipsychotics are another powerful medication intended for short-term use in seniors that Canadians over 65 are taking for longer durations than necessary. Antipsychotics are sometimes prescribed during a challenging life event like a hospitalization or a move to long-term care. But long-term use can change a senior’s behaviour and personality, and puts them at higher risk for drug interactions and side effects. Individually, these drugs pose risk to seniors, especially when taken long term. The danger multiplies when multiple drugs are taken concurrently, increasing the potential for drug interactions and side effects. Unnecessary medications are not just harmful to seniors, but harmful to all Canadians. POTENTIAL SOLUTIONS TO RAMPANT OPIOID USE

The opioid epidemic is a powerful illustration of the harms that potentially unnecessary medications can cause individuals and communities. A recently published article by Ontario researchers found that powerful opioids are being prescribed for longer than necessary and at higher doses for Ontarians. Opioids are addictive and harmful medications when used inappropriately and when not needed. The data on the amount of unnecessary prescription medications Canadians use, and the many harms associated with this, are staggering. But there are solutions to this complex problem. Many of the solutions lie within the medical profession itself. After all, it’s mainly physicians who prescribe medications and their clinical colleagues such as nurses and pharmacists who dispense and monitor medication use. Increasingly, Canadian cliniTurn to More prescriptions, page 13à

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David Renwick

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