PHARMA MARKETING:
UK vs US July 2017 PHARMAFI E LD.CO.U K
2017 Perception, Motivation and Satisfaction Survey Have you ever stopped for a moment to consider what it is that really motivates you? Perhaps you’re striving to build a successful long-term career, or to ensure you and your family are secure? Or are you simply motivated by the prospect of an increased salary, a better car, or your next promotion? Or is it – as I suspect – a far more subtle and eclectic mix – one that includes a host of different, but important factors that must combine in an optimal way for you to feel really valued and full of purpose?
If you ever find yourself asking any of the above and wanting greater insight on you, your company, or your peers, now is the time to find out! Simply take part in the 2017 Perception, Motivation and Satisfaction Survey to get the answers you’re seeking! Need a company-wide view? Call George Newall on 0781 000 6472 or Hazel Lodge on 01462 476119 for more details.
And now consider this – does your relationship with your manager and benefits package really stack up? Or is it the cause of some degree of dissatisfaction?
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YOUR SAY PFPEOPLE .CO.UK
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George Newall – Managing Director, Catalyst Project Management Ltd.
WELCOME
EDITOR
John Pinching john@pharmafield.co.uk A S S I S TA N T E D I T O R
Amy Schofield amy@pharmafield.co.uk ART DIRECTOR
Emma Warfield emma@pharmafield.co.uk COMMERCIAL DIRECTOR
Hazel Lodge hazel@pharmafield.co.uk SALES & MARKETING MANAGER
Rachel Cresswell rachel@pharmafield.co.uk FINANCIAL CONTROLLER
Fiona Beard finance@e4h.co.uk P f AWA R D S
Melanie Hamer melanie@e4h.co.uk PUBLISHER
Karl Hamer karl@e4h.co.uk pharmafield.co.uk e4h.co.uk @pharmafield @pharmajobsuk HEAD OFFICE
Spirella Building Bridge Road Letchworth Garden City Hertfordshire SG6 4ET United Kingdom Cover illustration by Alex Buccheri alexbuccheri.com The content of and information contained in this magazine are the opinions of the contributors and/or the authors of such content and/or information. Events4Healthcare accepts no responsibility or liability for any loss, cost, claim or expense arising from any reliance on such content or information. Users should independently verify such content or information before relying on it. The Publisher (Events4Healthcare) and its Directors shall not be responsible for any errors, omissions or inaccuracies within the publication, or within other sources that are referred to within the magazine. The Publisher provides the features and advertisements on an ‘as is’ basis, without warranties of any kind, either express or implied, including but not limited to implied warranties of merchantability or fi tness for a particular purpose, other than those warranties that are implied by and capable of exclusion, restriction, or modification under the laws applicable to this agreement.
I
Letter from the Editor
n Britain, we have a long and proud history of doing things our way. Even in the aftermath of a strange and unpredictable General Election, the results proved beyond any doubt that we are a population that does things differently. Much of this edition is about how exactly that manifests itself. Our cover story, for example, focusses on the myriad differences between how our innovative UK pharma industry is regulated, and the system adopted across the pond, in the razzmatazz of the USA. Our biosimilars piece tells an emerging story of replica medicines in the UK; how initial suspicion has lifted, replaced by acceptance, cautious excitement and a groundswell of hope for millions of patients (who don’t care which company makes their medicines). Meanwhile, in a very moving therapy area item, two highly personal pancreatic cancer stories speak of the unpredictability of disease, the fragility of the human condition and, ultimately, of courage. We’ve also got a compelling interview with ABPI President, Lisa Anson, and an intriguing Coffee Break with a matron who has paced the corridors for over 30 years. In addition, our wonderful cornucopia of columnists carefully dissect, ponder and reflect on what happens next for the NHS, healthcare politics and pharmacy in today’s Britain. Regulars such as ‘Movers and Shakers’ and ‘Don’t Believe the Hype’ complete a formidable team sheet. No one can deny, it’s been a difficult few months for everyone in Britain but, as evidenced in this magazine, we are not without some pretty impressive virtues. Keep making a difference,
No copying, distribution, adaptation, extraction, reutilisation or other exploitation (whether in electronic or other format and whether for commercial or non-commercial purposes) may take place except with the express permission of the Publisher and the copyright owner (if other than the Publisher). The information contained in this magazine and/or any accompanying brochure is intended for sales and marketing professionals within the healthcare industry, and not the medical profession or the general public.
Pf Magazine is published monthly. For a free U.K. subscription visit pharmafield.co.uk/subscribe.
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M AG A ZI N E | J U LY 2017 | 1
CONTENTS
03 08 10 11 12 16 18 20 22 26 29 30 32 34
MAGAZINE
July
N E WS
Bringing you this month’s essential headlines C OV E R S TO RY
Differences between UK and US pharma marketing
READER’S VOICE:
OPINION
“I was really impressed with how the June edition of Pf Magazine tackled diabetes. We have a family member that was diagnosed with type 1 only 18 months ago, so I absorbed the feature with interest. I was shocked about the parity of care – we have been lucky and received excellent care, but this should be the case for everyone. It was also very interesting to read the case study and learn about two devices that could make our lives simpler. We are currently researching both. As your article stated, with 3.6 million people diagnosed with diabetes, this is a subject that isn’t going away, so thank you for highlighting it.” Amanda Done, sent via email
Could commerce be the saviour of the NHS? F E AT U R E
Breast milk could obliterate cancer cells POLITICS
Digging up the chaotic political landscape MARKETING
Treatment to prevention in marketing terms E D U C AT I O N
Latest webinar follows NHS funding flows OPINION
The challenges of modern hospital pharmacy F E AT U R E
Biosimilars are transforming medicine access
HAVE YOUR SAY: Is mental illness being given parity with physical conditions? As a nation are we better at talking about depression? What are the best healthcare apps on the market? We’ll be covering these issues in the next Pf Magazine – want to contribute? GET IN TOUCH: hello@pharmafield.co.uk
F E AT U R E
Pancreatic cancer is brought into focus
@pharmafield
@pharmajobsuk
Pf Magazine
P H A R M ATA L E N T
What does it take to win a Pf Award? OPINION
Taboo of menopause at work taken to task M OV E R S & S H A K E R S
Who’s moved on and who’s moved up
BE IN THE KNOW. To request a FREE print subscription for your workplace, or to sign up to our weekly newsletters for the essential headlines, Jobs of the Week, Pharmatalent and thought-provoking features, visit pharmafield.co.uk/subscribe This issue and all past issues of Pf Magazine can be viewed online at issuu.com/pfmagazine
P H A R M ATA L E N T
Interview with new ABPI president, Lisa Anson
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P f N E WS : B R IN G IN G YOU TH I S M O NTH ' S E SS ENTI A L H E A D LIN E S
MED PRICING .
Hiker’s HITCH
T YPE 2 DIABETES
Key partnership
The European Commission (EC) has launched a formal investigation into alleged price hiking by Aspen Pharmacare. Aspen is reportedly facing a fine of £220m for ‘hiking prices’, after the company raised the costs of five cancer drugs. It is the first time the EC has investigated a drug company for alleged excessive pricing and it follows an investigation by The Times which showed that “Aspen had aggressively pursued price rises across Europe after buying the rights to the five cancer drugs from the British company GlaxoSmithKline”.
Dr Richard Torbett, Executive Director, ABPI, said: “The ABPI has repeatedly said that it does not in any way support or condone it. Thankfully, these examples are rare, and we are fully supportive of recent legislation that will allow the UK Government to tackle excessive profiteering and close a loophole that has allowed large price hikes.” Aspen, which is also appealing against a €5m fine imposed by Italian competition authorities last year for raising prices on other drugs, has not commented on the investigation.
E
li Lilly and KeyBioscience AG have signed a collaboration focused on the development of Dual Amylin Calcitonin Receptor Agonists (DACRAs), a potential new class of treatments for metabolic disorders such as type 2 diabetes. The partnership includes access to the DACRA platform, involving multiple molecules; notably, KBP-042, KBP-089 and KBP-056. KeyBioscience has initiated Phase II development with KBP-042, while other assets in the collaboration range from Phase I to pre-clinical. Under the terms of the agreement, Lilly will receive worldwide rights to develop and commercialise the molecules. In exchange, KeyBioscience will receive an initial payment of $55 million and is eligible for additional milestones, as well as future royalty payments. The dual activation of calcitonin and amylin receptors is thought to improve insulin sensitivity, suppress food intake, reduce fat deposition, improve blood glucose levels and cause weight reduction. Morten Karsdal, Chairman of the board, KeyBioscience AG, said: “The dual activation of the calcitonin and amylin receptors is exciting research in the diabetes space.”
M AG A ZI N E | J U LY 2017 | 3
SMART OPTION
T EC H N O LO GY
Abbott has unveiled CE Mark and the first use of the new Confirm Rx™ Insertable Cardiac Monitor (ICM); the world’s first smartphone compatible ICM that will help physicians to identify difficult-to-detect cardiac arrhythmias, including atrial fibrillation. Since CE Mark’s approval, implants have occurred in 10 countries across Europe. The device continuously monitors a patient’s heart rhythm and transmits information via the myMerlin™ mobile app, allowing physicians to follow their patients remotely and diagnose arrhythmias. The device incorporates wireless technology, which allows the ICM to communicate directly with the app. The new interactive app, available in over 35 languages, replaces passive transmitters and empowers patients to participate in their own care. Dr Mark Carlson, Chief Medical Officer of Abbott’s cardiac arrhythmias and neuromodulation businesses, said: “The technology has been designed with robust data privacy and security measures to ensure peace of mind for both patients and providers.”
C
ancer Research UK-funded scientists are to harness the Zika virus and test whether it can destroy brain tumour cells, potentially leading to new treatments for glioblastoma, a cancer that is particularly difficult to treat. The research, using tumour cells in the laboratory and in mice, will see if the Zika virus can target and destroy cancer cells. Each year in England around 2300 people are diagnosed with glioblastoma. Fewer than 5% of patients survive the disease for five years or more. Existing treatments are limited by their ability to cross the bloodbrain barrier, and doses must be kept low to avoid damage to healthy tissue. The Zika virus, however, can cross the blood-brain barrier, and could target cancer cells, sparing normal adult brain tissue. Contracting the Zika virus in pregnancy causes severe disability in babies by attacking stem cells in the developing brain, but in adults with fully-developed brains, the virus only causes mild flu-like symptoms.
Dr Harry Bulstrode, lead researcher, who has received a Cancer Research UK Pioneer Award to carry out the research, said: “If we can learn lessons from Zika’s ability to cross the blood-brain barrier and target brain stem cells selectively, we could be holding the key to future treatments.” Pf View: Taking something that is inherently bad and turning it into a positive is a remarkable piece of fearless innovation. It will also provide optimism for people with a notoriously ruthless form of cancer.
ZIK A VIRUS
UNLIKELY HERO
Quick doses Phase III results of G S K’s mepolizumab in patients with severe chronic obstructive pulmonary disease have shown a reduction in exacerbations. • N OVO N O R D I S K are partnering LY F E B U L B on a project to support international patient entrepreneurs who develop innovative diabetes management ideas.
B I A L and E I S A I announce that the EMA has approved Zebinix ® for use as a once-daily monotherapy to treat adults with partial-onset epilepsy. • R O C H E announces clinical data showing effectiveness of new Perjeta-based regimen in preventing recurrence of HER2–positive early breast cancer.
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TH E G E N E R A L M E D I C A L CO U N C I L has unveiled new standards to boost the flexibility of doctors’ postgraduate training across the UK. • Committee for Medicinal Products for Human Use of the E U R O P E A N M E D I C I N E S AG E N CY recommends marketing authorisation for hyperkalaemia therapy, Veltassa®.
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. ARTIFICIAL . .INTELLIGENCE.
MND OVER MATTER
T
he Sheffield Institute for Translational Neuroscience (SITraN), part of the University of Sheffield, has announced that its research into a drug candidate discovered by British artificial intelligence firm BenevolentAI has delivered positive results. The study, led by Dr. Richard Mead and Dr. Laura Ferraiuolo, has assessed the efficacy of the drug candidate known as Amyotrophic Lateral Sclerosis (ALS). SITraN found there are significant and reproducible indications which suggest that the drug prevents the death of motor neurones in patient cell models,
and delayed the onset of the disease in the gold standard model of ALS. ALS is a progressive neurodegenerative disease that causes muscle weakness, paralysis and, ultimately, respiratory failure. Life expectancy following diagnosis is currently two to five years. There are only two FDA approved drugs available to patients. Riluzole was approved in 1995, and more recently, Edaravone became an option. SITraN is now moving to the next phase of research, assessing the suitability and potential for clinical development.
EPILEPSY
Weed works According to research, cannabis derivative cannabidiol (CBD) cuts the frequency of seizures in children with Dravet syndrome – a severe form of epilepsy. CBD is a compound within the cannabis plant that doesn’t contain the psychoactive properties which induce the high usually associated with cannabis. The study included Epidiolex, a liquid pharmaceutical formulation of CBD, which has not been approved by the US Food and Drug Administration. 120 children and young people with Dravet Syndrome, between the ages of two and 18 years, were randomised across 23 sites in the US and Europe. They received either CBD 20 mg/kg or a placebo added to their existing treatment, over a 14-week period. CBD cut the frequency of seizures by 39%, while seizures stopped completely in three study participants. The placebo group showed a 13% reduction in seizures from around 15 per month to 14. Lead investigator Professor Orrin Devinsky, of NYU Langone Medical Centre in the US, said: “Cannabidiol should not be viewed as a panacea for epilepsy, but for patients with especially severe forms these results provide hope that we may soon have another treatment option.” Pf View: Once again this highlights the seemingly endless medicinal properties of cannabis and sooner or later these products will get through. The substance comes with baggage, but fortunately science is unconcerned by its history as a recreational drug.
CLINICAL TRIALS
Winning CheckMate
B
ristol-Myers Squibb has announced efficacy and safety data from CheckMate -204, the first Phase II study evaluating the cancer immunotherapy combination of nivolumab® plus ipilimumab®, in adult patients with advanced melanoma that has spread to the brain. In the study, 60% of patients treated with combination therapy achieved intracranial clinical (IC) benefit. The combination therapy also demonstrated that over one-fifth (21%) of patients achieved a complete IC response – meaning there was no detectable sign of the cancer in their brain remaining. Additionally, the data showed that 33% of patients achieved partial responses (significant tumour reduction) and 5% experienced stable disease (no progression in tumour growth). This data was presented at the American Society of Clinical Oncology (ASCO) Annual Meeting 2017. Professor John Wagstaff, Professor of Medical Oncology, College of Medicine, Swansea University, said: “The data is really promising and shows the potential using immunotherapy can have in wiping out tumours.” In 2014, around 15,400 people were diagnosed in the UK and approximately 2400 people died from the disease.
M AG A ZI N E | J U LY 2017 | 5
I N N OVAT I O N
Cell mates
H I V.
Collaboration between the pharmaceutical industry, patients and health regulators will be a ‘game changer’ in delivering exciting new cell and gene therapies to treat conditions like cancer and vision loss, according to Dr Magda Papadaki, the ABPI’s Head of Manufacturing Innovation. In a review article – ‘Adaptation through Collaboration: Developing Novel Platforms to Advance the Delivery of Advanced Therapies to Patients’ – published in Frontiers in Medicine, Dr Papadaki sets out the first step in the development, approval and adoption of these innovative medicines. Despite the emergence of new cell and gene therapies, patients still face delays in accessing these new treatments. Dr Papadaki argues that a shift is needed towards continual, long-term monitoring of medicine benefits and risks rather than the current assessments made on limited evidence. If this fails to happen, patients may miss out or face significant delays. She said: “By looking at the growing number of public-private partnerships and open innovation projects, this review attempts to define the new business and organisational standards needed to ensure patients get new innovative treatments faster.”
PROTEIN SHAKE UP
Pf View: It is a wise move by the ABPI to challenge industry, the NHS and patients to take collaborations to another level. The last five years have witnessed successful partnerships, but it must become the new norm and patients must be part of that equation.
HIV
POSITIVE STEPS
The Global Meningococcal Initiative (GMI) has recommended that people who are HIV–positive should be vaccinated against meningococcal disease (MD). The recommendation by GMI, an international group of expert scientists, doctors and public health officials,
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S
cientists at The Scripps Research Institute (TSRI) have used previously discovered structures of a protein on HIV’s surface, called the envelope glycoprotein, to design a mimic of subtype C, responsible for the majority of infections. The new immunogen is part of a growing library of TSRI-designed immunogens that could one day be combined in a vaccine to combat many strains of HIV. The research, published in the journal Immunity, was led by TSRI Professor Ian Wilson, Hanson Professor of Structural Biology and Chair of the Department of Integrative Structural and Computational Biology, and TSRI Professor of Immunology, Richard Wyatt, who also serves as Director of Viral Immunology for the International AIDS Vaccine Initiative (IAVI) Neutralizing Antibody Center at TSRI. The new study was published alongside a second study, led by scientists at the Karolinska Institute in Stockholm, which showed that the vaccine candidate can elicit neutralising antibodies in non-human primates. Prof. Wilson said: “All of this research is going toward finding combinations of immunogens to aid in protecting people against HIV infection.”
is based on recent studies showing an increased risk of MD in individuals who are HIV positive. Results of surveillance data analysis from 2003–2007 in patients of all ages in South Africa showed that HIV was associated with a higher incidence of MD and higher rates of death from MD. Other recent studies found a 13-fold and 10-fold greater risk of MD for those with HIV. Patients in studies were receiving antiretroviral
therapy for HIV and a good standard of healthcare. Vinny Smith, co-author of the paper and Chief Executive of Meningitis Research Foundation said, “We welcome the GMI’s recommendation to vaccinate people living with HIV to help save lives. It is also vital that high-risk groups are particularly aware of symptoms so they can act quickly and get medical help as soon as meningococcal disease is suspected.” This global recommendation was published in Journal of Infection.
E X P E R T A N A LYS I S
P f N E WS : B R IN G IN G YOU TH I S M O NTH ' S E SS ENTI A L H E A D LIN E S
N E WS FO CUS Looking at a notable story in sharp focus
Real world data to provide insights on expected breast cancer treatment outcomes
N
ovartis and IBM Watson Health have announced their collaboration to find ways to improve standards of care for patients suffering from breast cancer. The companies will collaborate on developing a cognitive solution that uses real world data and advanced analytical techniques to provide insights on the expected outcomes of breast cancer treatment options. IBM Watson Health will contribute its skills in data analytics and machine learning to determine combinations and sequences that may lead to the best patient outcomes, while Novartis will contribute its breast cancer expertise. Watson is the first commercially available cognitive computing technology able to analyse high volumes of data, understand complex questions, and propose evidence-based answers. Bruno Strigini, Chief Executive Officer of Novartis Oncology, said: “We will use real-world breast cancer data and cognitive computing to identify solutions that may help physicians better understand which therapy may be best for which patients.”
L AW R I E J O N E S Managing Director, 42group Artificial Intelligence (AI) systems like IBM Watson have the power to transform pharma. IBM Watson itself is an incredibly sophisticated system that can be used in many applications to process data quickly, efficiently, and – most importantly – intuitively, providing actionable insights for researchers. As an agency, we worked with Alder Hey Hospital and the Hartree Centre to support the implementation of IBM Watson at Alder Hey Hospital in Liverpool. The power of the system is in processing raw data in an intelligent and insightful way. The insights it develops can be used to tailor the patient experience, ultimately improving the service and potentially patient outcomes. It’s a similar principle that’s being used in the Novartis/IBM partnership. The interesting challenge for pharma is in finding areas where AI can have a real and productive benefit. In most cases, the data processing power of AI is used to analyse the masses of scientific data available. Pharma has historically been quick to adopt new methods and technologies, and AI will be no different. Currently, these systems are being adopted incrementally, alongside existing processes. It’s playing a supportive role at the moment, but in the future, it could take a leading role. Pharma will need to form new relationships with tech companies like Google and IBM. The balance of power could shift, with each side bringing their own expertise to the party. It’s too early to say what impact this could have on the pharma hegemony, but it’s an interesting time. Go to 42group.co.uk PAU L I N E K E NT Managing Director, Satellite PR We are moving away from the traditional model of healthcare to one in which professionals and patients work in partnership. Real world evidence (RWE) is a step towards this, and there is increasing evidence that outcomes for many diseases, including cancer, are improved by the level of insight RWE provides. Understanding which therapy works best is dependent on a number of factors, such as lifestyle, and the more we can bring these factors together, the better. This is an exciting development and one which could influence clinical practice guidelines. Knowledge flows from increased access to relevant information and hence informed choices. Go to satellitepr.com
M AG A ZI N E | J U LY 2017 | 7
PHARMA MARKETING:
UK vs US
Marketing medicines is a totally different ball game on each side of the pond. WORDS BY
8 | PH A R M A FI EL D.CO.U K
Amy Schofield |
I L L U S T R AT I O N B Y
Alex Buccheri
COVER STORY
T
he US is the only country, apart from New Zealand, which allows pharmaceutical companies to advertise direct to consumers (aka DTC advertising). The ability to advertise in this way is not permitted within the UK’s regulatory framework. The ban on DTC advertising in the UK is based on the premise that physicians, not companies, are best placed to decide on which medicines should be prescribed to a patient. But is DTC advertising all good news for pharma’s bottom line and bad news for the patient, and how would UK consumers react if DTC advertising was allowed here?
TRU S T I S S U E S
D O C TO R V I E W
According to ZS Principal Chris Morgan, the negative PR surrounding some aspects of pharma, combined with people’s general dislike of advertising and the issue of timing, mean that even if DTC advertising was permitted in the UK, it might not be welcomed. “The only advertising people like is that which is surprising, or funny, and pharma advertising is so heavily regulated that it is rarely ever those things,” Morgan explains. “In the US, people accept DTC advertising. The whole healthcare provision system accepts that it’s been there forever, but in the UK, it hasn’t. The transition would probably be a difficult one.” Despite being accepted across the Atlantic, it appears that some US consumers aren’t fans of DTC advertising and perceptions of the pharma industry do it no favours. For example, a Harris Poll study * from January 2017 found that just 9% of US consumers believe that pharmaceutical and biotechnology companies put patients over profits. In addition, a 2016 Harvard study ** found that 57% of consumers would support removing DTC adverts from television. Hensley Evans, Head of Patient and Consumer Marketing, ZS Associates, says: “This isn’t surprising, given that more than one third of them also said they believe that drug advertising increases the prices they pay.”
People in the US and the UK have a different mindset when it comes to how they perceive the authority of their physicians, and what they can ask of them. According to Morgan, people in the UK have traditionally been more deferential to doctors than their US counterparts, and though this is changing with the advent of the informed patient, there are other factors at play. “In the US, the relationship is different,” he says. “In the UK, people are more sensitive to budgets, prescribing guidelines and care pathways, so you can ask your doctor for something, but it doesn’t necessarily mean you’ll get it.” Does DTC advertising in the US threaten the position of the physician in the patient’s eyes? “I think the intention of the DTC ban in the UK is to preserve the authority of the physician as the one who determines the best course of action for the patient,” says Evans. In the US, the American Medical Association (AMA) also wants to ban DTC advertising. Board Chair-elect Dr Patrice Harris thinks that DTC advertising ‘inflates demand for new and more expensive drugs, even when they may not be appropriate’, and leads to ‘increased demand for more expensive drugs’. “Based on the AMA’s position on DTC in the US, it’s likely that it is consistent with the wishes of many, if not the majority, of physicians,” reflects Evans.
P OS ITI V E S PI N Does the US’s direct approach empower patients or put them at risk? According to Evans, it is the former: “It empowers patients by providing both disease education, often prompting them to seek more timely medical advice and support, and information about treatment options.” Evans proposes that DTC advertising actually drives broader awareness of diseases that might otherwise go undiagnosed or untreated, which leads consumers to discuss conditions that they are concerned about with their healthcare professionals, which in turn leads to earlier diagnosis and treatment. She also reasons that advertising direct to consumers also improves medicines adherence to advertised brands, which can slow the progression of disease and improve patient outcomes. “Studies have demonstrated that advertisements help encourage patients to continue taking their medication,” says Evans. Of course, pharma has a vested interest in driving brand awareness among consumers who have been diagnosed with a condition, but this could ultimately benefit the patient. “There are many physicians who believe that the availability of disease and treatment information has resulted in a more educated and empowered consumer, who is more easily able to take appropriate actions to manage their health conditions. DTC allows pharma to directly communicate to consumers who have requested such information.” Morgan also believes that there are ways in which DTC advertising in the UK could benefit patients: “One of the positive aspects, if the funding behind it was appropriate, would be helping patient groups and manufacturers to get accurate information out there, because there’s an awful lot of misinformation.” *theharrispoll.com **harvard.edu
THE PROMOTION AND ADVERTISING of medicinal products in the UK is governed by advertising laws and the Human Medicines Regulation 2012, which is enforced by the Medicines and Healthcare Products regulatory Agency. In practice, pharma operates under self-regulation in relation to the promotion of medicines according to the ABPI’s Code of Practice for the Promotion of Prescription-Only Medicines, which is administered by the “The intention of the DTC Prescription Medicines ban in the UK is to preserve Code of Practice the authority of the physician Authority (PMCPA).
In 2015 the
US DRUG INDUSTRY SPENT
$5.2 BILLION
ON DIRECT-TO-CONSUMER
MARKETING,
UP 60% FROM FOUR YEARS EARLIER. Source: Statnews.com
as the one who determines the best course of action”
M AG A ZI N E | J U LY 2017 | 9
OPINION
W
GET CARTER The Carter Review – submitted by Lord Carter to the DH – made recommendations to hospitals about being more transparent, making procedures consistent and working closely with neighbouring NHS trusts. His review revealed unwarranted variation in running costs, sickness absence, infection rates and prices paid for supplies.
arning: In the light of the General Election result, expect major change to the structure and ways of working across the NHS in England. And whatever you do, don’t construct your team’s territories on the basis of 44 STPs. There is one trend that hasn’t been altered by the result, and one which has major implications for pharma – the rise of ‘arm’s-length’ companies owned by NHS Foundation Trusts. This is so fresh from the kitchen, it doesn’t have a name, so let’s call them ALAMOs – ‘arm’s-length and managed organisations’. It also reflects the last somewhat desperate stand. This is happening because acute hospital trusts lose money treating patients. The payment-by-results prices do not cover the cost of care for most tariffs, especially those for unplanned care. If you don’t believe me, then ask yourself why almost every acute trust ended the year overspent. Interestingly, those that underspent tend to own companies that provide commercial synergies. Northumbria Healthcare, my local Foundation Trust (FT), is one of the country’s largest fleet car operators and supplies payroll services
Remember the ALAMO! David ponders the collision of healthcare services and commerce.
WORDS BY
David Thorne
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“This is so fresh from the kitchen, it doesn’t have a name, so let’s call them ‘arm’s-length managed organisations’”. to multiple companies. I believe it was the most profitable FT in England last year, as commercial activity enabled them to subsidise their clinical work. A small FT, 10 miles from me, has an ALAMO called QE Facilities, which is growing so quickly I can see it having a larger turnover than its host’s clinical income within five years. Those two aren’t the only examples, but it is significant that their North-East labour market and estates costs have helped them develop such a model. It’s a bit like the situation at Manchester United – there used to be a football club, but now it is a seller of replica shirts that every so often hosts football matches. Indeed, it even buys players for their impact on shortterm sales, rather than playing ability. So, what does this mean for you? Well, imagine if procurement decisions for a hospital in, say, Dorset or Sussex are managed from Gateshead. Now include tender management, stoma care procurement, infection control, pathology super labs, regional imaging hubs, private IVF, wound care product selection, training, home delivery of medicines, locums, clinical guideline development, tattoo removal, homecare, prescribing protocols and formulary management. The key factors here are consolidation, working at scale, Carter Review principles and opportunities from regional cost variations – all behind the NHS brand logo. Do you know which trusts are working like this and which trusts are their clients? What impact does this have for your products? What are the opportunities here for pharma to offer business-to-business models? Surely it is a chance for pharma companies to back up the oft-repeated claim that they are ‘healthcare providers, not just makers of pills and lotions’. If this is more than throw away jargon, seize the day and prove it with ALAMOs. David Thorne is Chair, Washington Community Healthcare and Non-Executive Director, City and Vale GP Alliance. Go to blueriverconsulting.co.uk
F E AT U R E WORDS BY
Amy Schofield
Could breast milk cure cancer? Don’t believe the hype: health headlines dissected TH E S TO RY As if it wasn’t already successful enough when it comes to growing small humans, breast milk is, apparently, the gift that just keeps on giving, with the discovery of a compound contained within it that could kill cancer cells. Nicknamed HAMLET (Human Alpha-lactalbumin Made LEthal to Tumour cells) by the Swedish researchers from the University of Lund who discovered it, could the compound represent the start of a more targeted approach to destroying cancer cells and offer an alternative to gruelling chemotherapy and radiotherapy treatments?
TH E R E S E A RC H HAMLET is a complex between alphalactalbumin (a-lactalbumin, the primary protein component of human milk), and oleic acid, which kills tumour cells, sparing healthy ones. It was found by accident, while Swedish Immunology Professor Catharina Svanborg was conducting antibiotics research with novel antimicrobial agents. The team needed human cells and bacteria on which to experiment with agents contained within the milk, and decided to use human tumour cells. “To our amazement,” Prof. Svanborg told The Daily Mail, “When we added this compound of milk, the tumour cells died.” Once inside the stomach, the protein targets the mitochondria and the cell nucleus of cancer cells, avoiding the cells’ outer defences and killing the cell, without destroying surrounding healthy cells. “The results identify HAMLET as a membrane-perturbing agonist that triggers lethal ion fluxes in tumour cells”, said Prof. Svanborg. In other words, it gets through the cancer cells’ defensive membranes and
triggers a process which causes the cells to weaken and die, in what she calls a “totally serendipitous discovery”.
MILKING IT
TH E R E S U LT S In human trials, HAMLET has shown therapeutic efficacy in three cancer models; colon cancer, bladder cancer and a human glioblastoma xenograft model. “In each of these cases, we observed positive and interesting effects,” said Prof. Svanborg. Patients with superficial bladder cancer received injections of HAMLET into the bladder on five consecutive days preceding surgery. Within just two hours, large numbers of dead tumour cells were passed in the patients’ urine.
TH E D E A L According to Prof. Svanborg’s team’s report on the research: “Early in vitro experiments showed that HAMLET has broad anti-tumour activity with a high degree of tumour selectivity”. Results from the research also suggest that HAMLET could help bowel and cervical cancer patients, and a further trial is planned.
TH E PR E S S SA I D : “Swedish scientists find breast milk is ‘cancer cure’” Daily Mail Online; “Breast milk compound ‘may help cure cancer’” Independent.co.uk; “Breast milk kills cancers claim scientists” Telegraph.co.uk
BREAST MILK
200 contains more than
constituents including WATER, PROTEINS, ESSENTIAL FATTY ACIDS, CARBOHYDRATES (LACTOSE), MINERALS,
VITAMINS & TRACE ELEMENTS
It protects against
INFECTIONS and boosts the
IMMUNE SYSTEM
1000 CALORIES
On average, it takes
A DAY TO PRODUCE BREAST MILK
M AG A ZI N E | J U LY 2017 | 1 1
WHEAT from the CHAFF
Where does the General Election leave the pharmaceutical industry?
A
s we all know, the result of the General Election means that no single party has an absolute majority. What initially seemed a sure thing for Theresa May unravelled into an epic political miscalculation that has left her leadership position in ruins and her Brexit negotiating hand seriously weakened. At the time of writing, it is uncertain as to how long she will be able to fend off her critics and retain her position. Meanwhile, the nature of her working relationship with the Democratic Unionist Party (DUP) of Northern Ireland has the potential to be very disruptive.
W
WORDS BY
Alex Ledger
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THE NHS & THE LIFE SCIENCE INDUSTRIAL STRATEGY
ith a minority government and only a loose arrangement with the DUP, the Conservatives face difficulties progressing their political agenda, particularly with regards to Brexit and other contentious issues. In terms of NHS funding and the Life Sciences Industrial Strategy, all parties align on the need to address funding pressures, but are divergent on levels of required finances, methods for raising revenue and solutions to long-term challenges like social care. In general, the DUP are seeking increased funding for Northern Ireland, particularly around infrastructure, skills and education, as well as their health service. In the run up to the election, Labour committed to injecting the most money into the NHS, with £30bn over five years and an additional £8bn to social care. The Lib Dems committed to allocate £6bn per year to the NHS and social care services combined, while the Conservatives pledged to increase current NHS spending by a minimum of £8bn over the next five years, while also proposing ways to increase social care funding.
POLITICS
“A weaker government may also mean that civil servants, including Simon Stevens, will wield more influence over legislation”
S C RUTI NY I N PA R LIA M E NT After striking a workable arrangement with the DUP, which seems likely at this time, her ability to pass new legislation in the form she had outlined in the Conservative manifesto has been greatly diminished. Her Government will face intensified scrutiny at every stage, always with the risk that her detractors both inside and outside her own party will unseat her through a vote of no confidence. With an increased number of seats, Labour will have more power to undermine government plans and an increased ability to scrutinise the Prime Minister, including through an emboldened Corbyn and a greater representation of Labour MPs on Select Committees. The House of Lords will gain an expanded role in questioning Government legislation. Under the Salisbury Convention, the upper chamber does not oppose policies outlined in a governing party’s election manifesto. Without a majority government in place, the House of Lords faces no such restrictions and will feel it has a greater role to play in holding the legislative agenda to account. A weaker government may also mean that civil servants, including Simon Stevens, and city mayors, will wield more influence over legislation and the policy agenda. These new factors will have major implications on May’s ability to progress politically controversial policies, including her ‘hard Brexit’ plans. Meanwhile, the DUP will be handed a degree of political power in Westminster that they could never have foreseen, and it is likely that they will attempt to capitalise on this during the future passing of legislation. This will almost certainly include stipulations on an increase to public monies flowing to Northern Ireland and commitments to retain a ‘frictionless’ border with the Republic of Ireland post-Brexit. Make no mistake, a change of Prime Minister in the near-term is not out of the question, nor is the prospect of another election within the coming year.
A settlement for the NHS, including social care, will be a divisive issue for the new government to tackle. Expect front page headlines and potential rebellions within the Conservative party. There is likely to be less of a challenge in the life science sector. Both the Conservatives and Labour committed to investing 3% of GDP into UK R&D. Similarly, the Lib Dems pledged to protect the science budget, with an aim to double innovation and research spending across the economy. In addition, both Labour and the Lib Dems want the UK to continue having access to EU-funded projects, such as Horizon 2020, post-Brexit. The Conservatives have committed to implement the recommendations of the Accelerated Access Review, making sure patients get new treatments faster. Similarly, during the Election, Labour committed to ensure all NHS patients get “fast access to the most effective new drugs and treatments”. Regardless, Brexit will consume the majority of focus and political resource.
BREXIT MEANS…
T
heresa May has indicated that her Brexit plans will continue unchanged, including timelines for the start of negotiations, although overall progress might falter in the face of stronger opposition in the House of Commons. With a minority government, Theresa May will govern without a formal majority. This creates an almost impossible situation for her in relation to Brexit. Presuming May is able to successfully negotiate an exit from Europe and a positive deal with the rest of the European Union, she has committed to putting any final settlement before the House of Commons. Without a majority vote, or even a consensus within her own party, the Prime Minister may find it highly challenging to secure the required number of votes to make this a reality. ‘Remain’ politicians, if they haven’t already, will leverage the Election results to maximum effect in order to frustrate the Brexit process at every stage, if not attempt to reverse it completely. It is clear that Theresa May’s intention is to rebuff potential leadership contenders within her party, and stay on for the duration of the Brexit negotiating process. Her position is only strengthened because there is no clear successor that would be palatable either to the party or electorate. Moreover, were someone to take over the role, they would arrive without any political mandate at all, bringing the threat of another General Election and even less negotiating time. There seems general acceptance among Tories, and even the general public, that this situation is not desirable. Alex Ledger is Deputy Managing Director at Decideum – the views expressed here are entirely his own. Go to decideum.com
M AG A ZI N E | J U LY 2017 | 13
MATRON of HONOUR Valerie Walker has been putting the ‘care’ into ‘healthcare’ for over three decades. INTERVIEW BY
C
aring for people in forgotten or alienated sections of society presents significant challenges. For my subject, it has been the challenge of a lifetime. Join me as I share coffee and a biscuit with Valerie Walker, whose very job title suggests a fervent desire to keep calm and carry on. Hi Valerie. What is a Matron? I’m nothing like the characters portrayed by Hattie Jacques in the Carry On films. I am responsible for the running and delivery of quality nursing care at a sixty-bed care home for ex-servicemen and women. The role is somewhat different to the caricature of a matron in an NHS hospital, walking round with a clipboard. When did you realise you wanted a career in healthcare? When I was young, I enjoyed looking after my Nana, who had multiple sclerosis. I realised I wanted to be a nurse and applied to Guy’s Hospital, in the days when you had to interviewed with a parent. I got accepted, and moved to London on my own. It was a big thing in those days – no one visited for three years. What happened next? In 1986, after completing my training, which included several years of experience on the wards, I went to work at the ‘Home for Incurables’, in Putney.
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John Pinching
Wow, that’s a sensitive name. My Nana was living there, and I visited her while I was a student nurse. I thought it had enormous potential, but a few weeks after starting work I thought, “what have I done?”. As time went on, however, it became clear that I could make a difference. What was it like working at such a specialised institution? When I first started, patients accepted that they had an incurable disease, but hoped it could be improved. The residents typically had MS, Parkinson’s or motor neurone disease – all the progressive neurological conditions I was passionate about. In wider society, I thought they were treated like third class citizens. In my Nana’s case, we had to catheterise her and look after all her physical needs, but it didn’t affect her mentally. What challenges stood out? I progressed into a management of incontinence role – 350 people lived there, 300 of whom were incontinent; it wasn’t the sexy end of nursing. I took the National Board course at the Institute of Urology, under the tutorage of Julian Shah (a notable incontinence expert), and he convinced me there was a lot more we could do at the home. The first thing I did was get rid of the carpets. Incontinence and carpets are a recipe for disaster.
The name of the place seems barely believable. It took us until the 1990s to change it, first to ‘The Royal Hospital and Home, Putney’, which was terrible, because people didn’t know what it was for, and finally, ‘The Royal Hospital for Neurodisability’. By that time, we’d opened an Acquired Brain Injury unit, Huntingdon’s unit and a day hospital. From being a sleepy institution, we had moved into modern health service delivery. It ended up being a place with a great atmosphere. What was your next move? I joined The Queen Alexandra Hospital in 2001, after my husband’s job took him to Worthing. I had called about a matron job, and the new CEO John Paxman, cousin of Jeremy, said, “Well, are you interested or not?” How very ‘Paxman-esque’. Yes. When I visited the place I thought, “I could do so much here”. What did the job involve? Setting up a social programme for the residents. I wanted it to be far more progressive, so I started transferring everything I had learnt at Putney. As a nurse, I’ve always passionately believed that patients should be treated as if they were your own mother or father, and that is what I teach my nurses now.
COFFEE BRE AK
What is the set up at The Queen Alexandra? There is an age range of between 31 and 98, and some residents are entirely dependent on us; 41 have suffered strokes and some are paid for by the NHS to be rehabilitated. We also take ex-service women and relations of ex-service personnel. If you have empty beds, you must show public benefit.
“I have developed a multidisciplinary approach, which includes a physio department, an occupational therapy department, speech therapists and dietitians”
What are the specific needs of ex-servicepeople? I have nursed people who couldn’t talk about being prisoners of war and had become very insular. One resident didn’t open up until the last days of his life and I was the only person he would talk to. He’d known me for 10 years and had psychological problems about what he did in the forces – presumably killing people. At the end, I sat with him and held his hand. It wasn’t because I was a matron or a woman; we just connected. What have been your proudest achievements there? I have developed a multi-disciplinary approach to support nursing and healthcare, which includes a physio department, an occupational therapy department, speech therapists and dietitians. I’ve got all the integrated services, so you don’t have to wait four months to be treated, like in most nursing homes. What is your relationship with pharma? It has a vital place within the conditions I work. It’s just a shame we can’t always get the drugs we want, because it is controlled by price. I have to fight my corner and say, “We’ve done the research and used the drug, but we need a different treatment, and this is why". I’ve been working with the same GPs for a while now, and if they hear that, ‘Matron wants to speak with them’, it’s because I have a question about a drug. Gone are the days when, on the NHS, you could get anything you wanted signed off. What record would you choose for the soundtrack of your life? ‘I’m in the Mood for Dancing’, by The Nolan Sisters. Naturally. It’s your last supper, what are you having? Pink tuna, covered in sesame seeds, with a lovely salad. Superb choice! Goodbye Valerie. Bye John.
M AG A ZI N E | J U LY 2017 | 15
PART T WO:
SETTING the SCENE Dr Graham Leask and Stewart Adkins return to address the shift from treatment to prevention and take a look at pharma’s future.
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S H I F T FRO M TR E ATM E NT TO PR E V E NTI O N The change from treatment to prevention would represent a previously unimaginable societal shift over the next five to 10 years. Traditionally pharma makes money from selling treatments. To change the mindset of the industry, and its payers, from one of selling treatments to preserving wellness, will not be easy. To monetise the preservation of wellness means using the actuarial knowledge from population healthcare data to carve out populations and assume responsibility for their care in exchange for a per capita fee. Customers within this population would then have to be regularly screened and encouraged, or even forced, to take significant responsibility for their own health. In exchange for not smoking, exercising regularly, eating healthily and staying within weight, a customer would expect to be treated for any acute or chronic condition that still arose. Individual companies may struggle to accept patients with co-morbidities since they may not be able to price the risk. Nevertheless, there may be conditions, such as asthma, where companies could price the risk and prevent downstream co-morbidities by active monitoring and treatment. This was attempted 20 to 30 years ago by so-called disease management programmes, but perhaps availability of data and modern analytics makes this feasible today.
MARKETING
R I S E O F ‘ S O C IA L PR E S C R I B I N G’ In the long-term, if the pharmaceutical industry finds a way of monetising the preservation of wellness, social prescribing must be a necessary part of that model. Early intervention with lifestyle changes, for example, physical fitness, weight loss, healthy eating and smoking cessation, which are sustainable, will have huge downstream benefits for society as a whole, translating into a massively reduced prevalence of chronic diseases like type 2 diabetes, heart disease, strokes and COPD/asthma. These behavioural changes, although superficially obvious to all, may be very difficult to implement, however, and could easily take a generation or more. Herein lies the barrier to change, since upfront investment in clinician time (cognitive therapy takes a lot longer than the prescribing of an SSRI and is considerably more expensive), gym memberships, diet clubs and e-cigarettes will be huge, whereas the clinical benefits and accrued cost savings will follow many years afterwards. This is certainly not a threat to the pharmaceutical industry unless it incorrectly prices the risks in a disease management programme. It is far more likely that big pharma will need to partner with government and health authorities to implement change, while allowing life assurance and pension funds to design long-term funding schemes with a pay off at the back end. If this is to work in a social healthcare model, such as we have in the UK, we will need a wholesale shift in the healthcare narrative, backed up by a ‘carrot and stick’ approach that rewards those that take responsibility for their own healthcare, while subtly penalising those that do not or will not. Whether society as a whole will consider this unfair remains to be seen; but perhaps expecting society to pay for its citizens to eat, drink and smoke itself to death is not fair either. One cannot expect pharma to navigate such difficult waters without huge support from politicians and civic society. At the moment there are straws in the wind, but few signs of a definite direction of travel. In the meantime, social prescribing will be limited by shortterm budgetary constraints and likely to be restricted to isolated pockets of far-sighted health authorities in a few pilot studies.
“To change the ‘mindset’ of the industry, and its payers, from one of selling treatments to preserving wellness, will not be easy” D E ATH O F A SA LE S MA N? The mantra, that the traditional role of the pharma salesperson will soon become obsolete, was first suggested in the 1990s when PBMs were introduced in the US and, similarly , during ‘Thatcher’s NHS Reforms’, and neither was correct. In reality doctors are individuals – some only respond to ‘face-to-face’ discussion, others may prefer digital, but few doctors see no representatives at all. To influence a committee requires active networking. Even when a strong guideline is in place, patients and doctors require choices. For example, UK practices using inhaled steroids for asthma stock, on average, seven products. In theory at least, these are interchangeable.
TH E H E A LTH C A R E L A N D S C A PE O F TH E FUTU R E Most markets as they mature become more concentrated as power passes to the distributor and products become commoditised. To some extent this has occurred with the UK primary care market, yet companies still make considerable money from branded generics and ‘me-too’ products. If we assume that a guideline is in place restricting the range and a ‘use the cheapest first’ policy pertains, then such concentration will continue, and the ‘pancontinental wholesalers’ will drive supply. It is likely that companies will embrace a more blended approach to promotion that perhaps mirrors how healthcare intervention is being guided by the internet and use of sophisticated computerisation.
Read part one of Setting the scene in the June edition of Pf Magazine, available online at issuu.com/pfmagazine
Stewart Adkins was a Pharmaceutical Analyst at Lehman Brothers for 23 years and now writes independently.
Dr Graham Leask worked in industry for over 20 years and now works with Warwick University as a writer and researcher on pharma strategy.
M AG A ZI N E | J U LY 2017 | 17
E VENTS & CONFERENCES
WEBINAR REPORT:
Following the money: Funding flows in the NHS, from Parliament to the frontline
£
The fourth Parallel Learning webinar focused on understanding the NHS England ‘money trail’. WORDS BY
Amy Schofield
£
C
haired by Michael Sobanja and with expert insight from speaker Julie Wood, Chief Executive of NHS Clinical Commissioners (NHSCC), this webinar sought to deliver an appreciation of how financial allocations are made in the NHS. It also concentrated on awareness of funding flows, identifying how key decisions are made and how spending arrangements might change in the future.
H OW I S TH E M O N E Y S PE NT ?
JULIE WOOD Julie Wood’s NHS career spans 30 years, focused on service development and innovation in primary care and commissioning, with the last 16 years at Director or Chief Executive positions within health authorities and primary care trusts across the UK.
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With the help of a flowchart created by The King’s Fund covering the 2016-17 figures, Julie opened by explaining how the money flows to and through the NHS once Parliament has voted on how much it intends to allocate to the health service. Parliament voted to invest just over £120bn in 2016-17, and this flowed down into the Department of Health (DoH), which decided how to allocate the resource to the organisations that play a role in influencing the spend on health, including NHS England and regional teams, regulators and Health Education England, and Public Health England. Julie then covered how that money flows from commissioner to provider – acute care, mental health, community services, and primary care, including GP practices and community pharmacy.
R I S K S A N D O PP O RTU N ITI E S Julie went on to talk about the opportunities and risks posed by the shifting NHS landscape – pointing out that: “Nothing stands still in the NHS”. She said that the development of Sustainability and Transformation Partnerships (STPs) means that commissioners and providers are being asked to work much more closely together in terms of commissioning and delivering care. “It’s the politicians’ job to determine how much the NHS is allocated and what it expects for that allocation, and it’s NHS England and its commissioners’ job to make the very best of the NHS pound,” concluded Julie. “You can only spend the same NHS pound once, therefore it’s really important that we spend it on the right thing, so that we get the best return on that investment.”
TH E D E ATH O F CO M M I S S I O N I N G? In the Q&A session, Michael Sobanja asked if STPs and the move towards integration, “Really mark the end for CCGs and commissioning?” Julie responded that it doesn’t mark the end of either, and that the activities we currently enjoy as part of a commissioning process are the very same activities that any healthcare system has to go through. “It has to decide on priorities, it has to decide what to do about those priorities, it has to plan healthcare, it has to understand the healthcare needs of its population,” Julie explained. “Commissioning is here to stay. We might change the language, the lexicon, but we still have to have a commissioning focus.”
WO R K I N G TO G E TH E R Julie pointed out that in the last couple of years commissioners have been working much more collaboratively together: “How they work together to transact their commissioning activities is where I think we will start to see, and are seeing, differences. What’s really good for STPs is that for the first time in a long time we’re having commissioners and providers getting around the same table.” She added: “If there is much greater ownership of the same pound that you can only spend once, it will free up the opportunities to start thinking differently.”
For full content, watch this webinar On Demand at parallellearning.co.uk
U N D E R PR E S S U R E Michael cited a recent report by The Health Foundation, in which the charity identified three ‘unavoidable financial challenges’ that need to be tackled by the incoming government if it is to maintain healthcare and social care services. Any shortfall will inevitably result in downward pressure on budgets, including on drugs budgets, he said. “With its current level of resource, the NHS cannot do all that it is expected to do,” agreed Julie. “There is no doubt that the NHS is under significant pressure. This gets us into the territory of difficult choices. We have to make sure we’re doing things as efficiently as possible.” When a delegate posed the question, “Does greater integration mean the end of differential pricing for pharma?” Julie referred to the development of Regional Medicines Optimisation Committees, saying that a national system of medicines optimisation across the country could help to ensure delivery of the right care and outcome: “Pricing of drugs is part of that, as well as how we reduce variation in spend and take–up of medications.”
D E LE G ATE FE E D BAC K “Really excellent. I certainly learnt a great deal.” Simon Reese, Regional Business Manager, Apodi. Go to parallellearning.co.uk
FUND TIMES
100% of our delegates said
KNOWLEDGE
of NHS FUNDING
11 S E P T E M B E R 2 0 1 7
New models of primary care provision What have we learned from previous and current reforms? Join Dr James Kingsland OBE as he reviews lessons learned from past primary care models.
Live Q&A with Dr James Kingsland OBE & Michael Sobanja
ADVANCE YOUR THINKING The traditional division of primary care, hospitals and patient community services has become a barrier to coordinated patient care, and general practice is facing higher demand and pressures than ever before.
In this next webinar from Parallel Learning, Dr James Kingsland OBE reviews previous and current reforms – what can we learn from them? What does the future of primary care look like?
Book your place now: Expert speaker James Kingsland and Chair, Michael Sobanja, discuss the impact of new models of primary care on pharma. Pf Magazine readers can claim an extra 20% discount with code Pf Mag20.
IN THEIR DAY-TO-DAY ROLE WAS
IMPORTANT £
parallelle arning.co.uk M AG A ZI N E | J U LY 2017 | 19
OPINION
Altered STATES
More in demand than ever, hospital pharmacists are having to adapt to a changing environment. in primary care. We are also seeing a greater number of complex patients with more than one long-term condition, challenges in social care and increased strain on bed occupancy. This puts pressure on pharmacy services to ensure patients are discharged quickly, while also managing those on multiple medicines.
WORDS BY
Deborah Evans
W
ith all the focus on community pharmacy within the profession, it’s important to reflect on some of the significant challenges faced by my hospital pharmacist colleagues. I’ve been involved in hospital pharmacy several times throughout my career, starting with my pre-registration placement, over 30 years ago, at Addenbrooke’s, and when working as a business unit director for GSK. To understand how much hospital pharmacy is changing to support patients and the NHS, I had a chat with fellow Royal Pharmaceutical Society board member, Aamer Safdar, Principal Pharmacist Lead for Education and Development, Guy’s and St Thomas’ NHS Foundation Trust. Aamer, what are the biggest challenges that hospital pharmacy faces? There are funding challenges across the whole NHS. We’re seeing greater strain on hospitals, with more patients attending A&E for problems that could have been managed outside the hospital setting, largely due to significant pressure
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With so much pressure on the NHS, what are the key drivers for the hospital pharmacy service? They include the Five Year Forward View, the General Practice Forward View and the Lord Carter review of hospital pharmacy services. One key area of work is to identify variations in medicines spend across hospitals through the utilisation of NHS Benchmarking. This process has identified attainable savings, such as using biosimilars to lower costs. When I worked in hospital pharmacy, we worked alone, but this is changing. How important is inter-professional working? We work much more closely with our professional colleagues. Extending integration of pharmacists into clinical teams allows us to share our expertise among fellow clinicians within the hospital, and outside, in primary and social care. Knowledge transfer between pharmacists, whatever sector they work in, is critical as most patient care in relation to medicines is provided outside hospital. What will enable hospital pharmacy to fulfil its ambitions? The Lord Carter review intends to review the skill mix of pharmacy staff, while recognising pharmacists as medicines experts, and who should be in attendance on ward rounds and in clinics.
Pharmacists should make independent clinical decisions about medicines use, and be able to prescribe and de-prescribe medicines. I believe we will see much more focus on reducing the number of medicines patients are on, especially when they are not of clear benefit. How can pharmacists improve adherence? Wherever pharmacists work, they must focus on ensuring patients take and use their medicines appropriately. Education, including independent prescribing and the ability to work in and across teams will be key to success. I also think digital interoperability of systems within hospitals and across care pathways is critical. We need shared access of patient health records so that we can ensure better clinical information flows between clinicians.
“Industry has a vital role to play in relation to medicines in the NHS and hospital pharmacy, where meds are often initiated on wards”. What does the industry need to be thinking about to support hospital pharmacy? The pharmaceutical industry has a vital role to play in relation to medicines in the NHS and hospital pharmacy, where medicines are often initiated on the wards or in specialist clinics. This should include value-based pricing of new, complex medicines and relationships between commissioners of high-cost medicines nationally, regionally and locally. In addition, the industry should be providing clinical information and support to hospital pharmacists so they can identify the position for these medicines in a therapeutic plan. Ongoing information and support to hospital pharmacists remains vital in order for pharmacists to have the most up-to-date evidence on which to base their clinical decisions and recommendations. Deborah Evans is Managing Director of Pharmacy Complete, Board Member of Royal Pharmaceutical Society England and practices in a pharmacy within a GP practice. Go to pharmacycomplete.org or email deborah@pharmacycomplete.org
“We’re seeing greater strain on hospitals, with more patients attending A&E for problems that could have been managed outside the hospital setting”.
COUNTER ACTION It seems that many of the challenges faced by my hospital-based professional colleagues are very familiar to those faced in community pharmacy – reductions in funding, increased demand on services, managing patients with multiple complex diseases and adding more clinical value, with a view to benefitting patients and the NHS. Getting the digital connectivity right, supporting pharmacists’ ongoing development towards prescribing and ensuring the availability of excellent information on medicines will all be key. Pharma is in a strong position to help facilitate the dialogue between pharmacists across sectors, linking community, hospital, GP practice and primary care pharmacists. Such activity has got to be beneficial to the NHS and patients. I’m absolutely convinced there is an important and continuing role for industry to support the profession, whatever sector they work in.
M AG A ZI N E | J U LY 2017 | 2 1
Fair imitation 2 2 | PH A R M A FI EL D.CO.U K
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hey say that ‘imitation is the sincerest form of flattery’, and in the last decade this belief has been reflected increasingly in life-saving pharmaceuticals. Throughout the retail sector, it has been going on for years – items of clothing masquerade as high-end brands, but at a fraction of the cost. In the altogether different pharma industry, imitation is becoming the catalyst for a vibrant sub-sector marketplace. Above all, it represents a new hope for patients who are, understandably, keen to access previously unavailable treatments. We ask our experts from across pharma, healthcare and specific disease area organisations about the impact of the biosimilar revolution and, critically, where it goes from here.
F E AT U R E
Biosimilars are destined to create an exciting marketplace, but not without controversy. WORDS BY
A NEW AG E
John Pinching
Tim de Gavre is Sandoz UK Country Head
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REPLICA MEDICINES: SAME OR SIMIL AR A biosimilar starts its journey to market when the patent on a medicinal product is due to be lifted. After the expiry, the ‘parent’ company no longer has the legal right to exclusively manufacture the product in question, allowing competitors to enter their versions at a reduced unit cost. New biological products have different names, but are almost identical to the originals. Pivotally, for patients, biosimilars should produce the same or similar clinical results. The biosimilars market has significant potential across the board; for ‘big pharma’ it is a chance to quickly bolster portfolios and, for small to medium enterprises, it represents the opportunity to innovate without the burden of relentless R&D. Like many new concepts biosimilars have gone through a period of suspicion, snobbery and cynicism, but their refusal to go away suggests an exciting frontier, which can be widely appreciated, by manufacturers and patients. Contention only lingers due to the fear that some companies may sacrifice future R&D for quick biosimilar gains.
iosimilars have made significant progress over the last 18 months. We’ve seen the launch of monoclonal antibodies and very large proteins, and significant uptake of biosimilars. If you look at the biosimilar of Infliximab, for example, uptake is greater than 70%. That has been driven by very positive engagement between the NHS, NICE and industry, working to increase the profile of biosimilars, helping to educate and increase usage in an appropriate way. One of the forums is the Biosimilars National Programme Board, chaired by Keith Ridge (Chief Pharmaceutical Officer), with representatives from patient groups, industry associations, the MHRA and the NHS. This is where a lot of the initiatives have been discussed and a new publication ‘What is a Biosimilar’ has emerged from it.
“If the NHS wants to afford the next generation of innovation, it needs biosimilars” There are still a lot of HCPs who, when you say ‘biosimilars’, will still give you a blank look, so there is much to do. Patients need to have confidence in these medicines and feel comfortable that when they switch, the same benefits will be experienced as the originator. Furthermore, the switch process also refocusses trusts on patients that haven’t been assessed for years. There is a continual flow of new products coming into the market, but if the NHS wants to afford the next generation of innovation, it needs biosimilars. Also, some companies have become very comfortable with products that haven’t experienced competition for decades. When their portfolio comes under threat from a biosimilar it forces them to innovate. Sandoz has been doing some work with the NHS around the cancer vanguard. The collaboration across three institutions – UCL Hospital, The Christie and The Royal Marsden – will ensure that when the biosimilar comes, they are ready.
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iosimilars have revolutionised treatment for approximately 20% of the 690,000 people in the UK living with the severest form of rheumatoid arthritis (RA). Clinical trial results suggest that the four biosimilars available to RA patients show similar efficacy to the originator product. It is essential that patients and physicians work together in agreeing when, and if, it is appropriate to switch from an originator to a biosimilar. As the word suggests, it is not a 100% replica of the original drug, so some patients with complex diseases may not respond as well as they do to their existing medication. It’s important to note that this market is tightly regulated, and all products are strictly assessed for their quality, safety and efficacy. Once on the market, products are closely monitored, so patients should not worry about the quality and safety of biosimilars.
PATI E NTS RE WARD E D Ailsa Bosworth is founder and CEO, National Rheumatoid Arthritis Society
PUS H FO R PRECE D E N CE Steve Wilkinson is Chair, British Oncology Pharmacy Association (BOPA)
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linical opinion on biosimilars in UK oncology and haematology has changed in recent years from concern to growing acceptance. Clinicians now understand that biosimilars do not always have to repeat the phase II/III clinical trials, while the regulatory process shows new products to be therapeutically equivalent, allowing biosimilars to be used for the full range of licensed indications. Strong leadership from the NHS and NICE has been key to this shift in opinion. Indeed, NHS England, as commissioners of cancer medicines in England, is
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incentivising hospitals to rapidly adopt biosimilars as part of its Commissioning for Quality and Innovation programme. This push is due to the financial benefit of using biosimilars. NHS budgets for cancer medicines are fixed, and the Cancer Drugs Fund (CDF) no longer offers a safety net, so there is a clear opportunity to safeguard NHS budgets. In addition, they can ensure new cancer medicines are affordable, helping patients and clinicians, and benefitting pharma. BOPA promotes oncology pharmacists to manage the successful introduction of biosimilars, and believes products
“It is essential that patients and physicians work together in agreeing when to switch from an originator to a biosimilar” The benefits to the NHS of using less expensive medications will be very noticeable if those savings can be reinvested into rheumatology services across the country – helping to provide an improved service for those battling this autoimmune disease. Ideally, we’d like to see the savings going towards more specialist nursing posts, improving access to physiotherapy, podiatry, psychological support and occupational therapy services, as well as improved patient education support.
should be used for all commissioned indications, provided there are pharmacovigilance protections, e.g. branded prescribing. The organisation does, however, acknowledge there are challenges to introducing biosimilars, such as adapting chemotherapy prescribing systems. Meanwhile, the next few years will see the emergence of a trastuzumab biosimilar, which is also administered intravenously. This does, however, raise questions about patients on Herceptin SC, which many hospitals adopted due to saving benefits. It’s likely that commissioners will initially focus on intravenous solutions, but further ahead, bevacizumab – widely used under the CDF, but since removed – could be revived, particularly if more cost-effective biosimilars become available. Steve writes in his capacity as BOPA Chair. Views expressed are his and do not represent the NHS England position.
F E AT U R E
H E ALTHY CO M PE TITI O N
CHAN G E I S CO M I N G
Tina Healy is Director of Immunology, Global Data
T
B
iologic therapies are driving market growth across immunology and oncology indications. GlobalData estimates that the biologics market from both therapy areas reached over $150B in 2016 across the seven major pharmaceutical markets – US, France, Germany, Italy, Spain, UK, and Japan. This colossal market size serves as a key driver for biosimilar developers to tap into. Access to existing biologic medicines remains a challenge, due to high cost, while barriers for biosimilars include physician unfamiliarity, physician scepticism, the availability of other novel therapies and the lack of real-world evidence, thereby fuelling patient fears. Focussing on the EU, the European Medicines Agency (EMA) has approved 28 biosimilars to date, of which nearly 70% are used to treat immunology, oncology or oncology-related diseases. With rising healthcare costs across the EU, and with biosimilars offering discounts of 10–30% off the prices of originator products, several biosimilars are expected to be granted approval by the EMA in 2017 and beyond. Even a modest discount in price, compared to the originator, will provide huge savings to the national health services of EU countries. Pressure from national health authorities to prescribe biosimilars and affordable alternatives, as part of cost-saving measures in cost-conscious markets such as the UK, will thus influence biosimilar usage. In the highly competitive biologics market, however, it remains to be seen whether innovator companies will reduce the prices of their brands or employ other strategies to stave off biosimilar competition.
Warwick Smith is Director General, British Biosimilars Association (BBA) he crucial impact of biosimilar medicines cannot be ignored or underestimated by patients or payors alike. Biological medicines are dominating global lists of the best-selling prescription drugs. Very successful treatments for rheumatoid arthritis and autoimmune diseases have led the way, while other disease areas, such as oncology, are coming to the fore. With UK healthcare budgets stretched by ageing populations, affordability is key to widening patient access. Additionally, as biological medicines play a more significant role in providing life-saving and lifeenhancing treatments, greater uptake of biosimilar medicines is critical. To date some clinicians and patients have been more cautious about the trend, although there have been areas of clear success. As experience increases, so will understanding around switching to biosimilars. NHS England has done an excellent job in bringing together all stakeholders – NICE, industry groups, patient groups, doctors and nurses – to understand why biosimilar medicines should be routinely adopted, and why switching from the originator is a perfectly natural thing to do. Indeed, NHS England has issued guidance for commissioners which suggests that clinicians should consider moving patients from the originator to a biosimilar when it is less costly. The BBA – along with other industry partners - is also driving several initiatives. These have included working with NHS staff to develop authoritative information about biosimilars, as well as organising educational events.
“The competition biosimilars bring will create savings, allowing stretched budgets to be spent more efficiently” This collaboration between stakeholders is very important and we have seen the most effective uptake in the UK when commissioners and medical professionals work together. One well-documented example of this is Southampton, where the trust is able to save £60,000-£80,000 per month, while also investing in additional nurse and pharmacist support.
M AG A ZI N E | J U LY 2017 | 2 5
SYMPTOMS of PANCREATIC
Two stories Pancreatic cancer is one of the UK’s most common cancers, but survival rates are low.
P
ancreatic cancer is the 10th most common cancer in the UK, with around 9600 people diagnosed each year. The disease has the lowest survival rate of all the 21 most common cancers, with just 5% of people in the UK living for five years or more after diagnosis. Shockingly, survival rates have remained largely unchanged for the last 40 years. Early diagnosis is key to improving survival rates. Currently, 80% of people are diagnosed once the disease is at an advanced stage, when surgery –the one treatment which can save lives – isn’t an option. Just 8% of patients actually have surgery. A late diagnosis will often occur because pancreatic cancer doesn’t usually cause many specific symptoms in the early stages, and symptoms can be quite vague. When pancreatic cancer is inoperable, treatments such as chemotherapy are used to slow down the growth of the cancer and relieve symptoms. What risk does pancreatic cancer pose and what hope is there for patients? Pancreatic Cancer UK gives us the facts, while two incredible stories speak of courage and the unpredictability of life. TR E ATM E NT S Currently the standard first line chemotherapy option for pancreatic cancer patients is gemcitabine, which has been proved to extend survival by an average of seven months. FOLFIRINOX is also routinely used to treat advanced pancreatic cancer, which can extend survival by 11 months, compared to seven months for gemcitabine alone. This treatment, however, is associated with more severe side effects, meaning the treatment is only suitable for a very small proportion of patients. FOLFOX is most commonly used by clinicians as a second line treatment for advanced disease. Pancreatic Cancer UK provides personalised support and information via the Pancreatic Cancer UK Support Line. Freephone 0808 801 0707 or email nurse@pancreaticcancer.org.uk For more information about pancreatic cancer or Pancreatic Cancer UK, please visit pancreaticcancer.org.uk/support and follow @PancreaticCanUK.
2 6 | PH A R M A FI EL D.CO.U K
CANCER THE SYMPTOMS OF PANCREATIC CANCER CAN BE QUITE VAGUE AND MAY COME AND GO TO BEGIN WITH.
Common symptoms include TUMMY & BACK PAIN,
UNEXPLAINED WEIGHT LOSS & INDIGESTION Other symptoms may include:
CHANGES
TO BOWEL HABITS
– INCLUDING PALE, SMELLY POO THAT MAY FLOAT, DIARRHOEA OR CONSTIPATION
JAUNDICE
(YELLOW SKIN OR EYES & ITCHING)
FEELING & BEING SICK
Recently diagnosed
DIABETES • PANCREATIC CANCER RESEARCH HAS HISTORICALLY BEEN UNDERFUNDED. THE DISEASE ATTRACTS JUST 1.4% OF THE UK CANCER RESEARCH BUDGET PER YEAR, DESPITE 1% OF PATIENTS LIVING FOR 10 YEARS OR MORE AFTER DIAGNOSIS. • BY 2026, PANCREATIC CANCER WILL BE THE FOURTH BIGGEST CANCER KILLER IN THE UK, UNLESS RESEARCH FUNDING IN DRAMATICALLY INCREASED. • PANCREATIC CANCER SYMPTOMS ARE OFTEN VAGUE AND IT IS IMPORTANT TO REMEMBER THAT SYMPTOMS WILL MOST LIKELY BE CAUSED BY MORE COMMON THINGS SUCH AS INDIGESTION OR HEARTBURN.
F E AT U R E
C A S E S T U DY:
J O H N WI LLIAM STRE E T A S TO L D BY H I S DAU G HTE R , MELANIE HAMER
“We had no time to come to terms with Dad being ill”
M
y Dad was always healthy. He was a quiet, thoughtful man and he’d do anything for anybody. A draughtsman by trade, he was also a keen artist – though he played it down – and was always interested in his grandchildren’s lives, and in our business. He never complained about anything, and he was never ill. But in the spring of 2015, Dad started getting tummy troubles, then in May, he started feeling an uncomfortable twinge under his shoulder blade, and he lost a little bit of weight. The doctor thought he might have gallstones, so sent him for tests. Pancreatic cancer had been mentioned in passing, but the possibility of gallstones was the focus. While we waited for the test results, the tummy troubles persisted, and his urine was darker. The twinge under his shoulder blade was still there too, and he was developing back pain. But he never complained and only took some paracetamol when it was really needed.
On the 27th of June 2015, Dad’s eyes went slightly yellow – he was going to the GP for his test results on the Tuesday. I said to my Mum to take Dad to A&E if he wasn't well before then, and he went to A&E on Monday the 29th of June, even though he disliked the fuss. There, he was diagnosed with pancreatic cancer. On 2nd July, they told him that it was advanced and aggressive and had spread to his liver, gall bladder, stomach, and bowel. When symptoms show with pancreatic cancer it is very often too late for treatment and this was the case for Dad. We asked how long Dad had left. “Six to eight weeks,” the doctor replied. It was too late, they told us. There’s nothing to be done. We were all horrified and shocked. We had no time to come to terms with Dad being ill, let alone how little time we had left with him. I looked at the consultant and asked him what he would do, if it was his father. “I’d take my Dad home,” he said. People say that the world stops when you get bad news. Mine did. I can still remember how I felt, looking at Dad. My dignified Dad stood up and shook the doctor’s hand after he had received the news that he was going to die. He was such a proud and dignified man; he would have worn a tie in his hospital bed had Mum taken one in for him. It was heart-breaking. We brought Dad home. He got everything in order, which included buying a new car for Mum, so she could get around. The palliative care nurses visited him, and though part of me wanted to keep him at home, so we could look after him there, he told us he wanted to go into the hospice. My sister, Mum and I sat vigil with him, 24/7, and he was never alone. We lost Dad a week after he went into the hospice, on the 26th of August 2015. He was 77. It was such a shock, it was so quick, just eight weeks from diagnosis. Pancreatic cancer can be a devastating disease. Understanding symptoms and signs could potentially lead to early diagnosis, which may lead to a more positive outcome.
M AG A ZI N E | J U LY 2017 | 2 7
F E AT U R E
C A S E S T U DY:
JAM E S DAD G E
I
Pancreatic Cancer UK is supporting those affected by the disease, investing in ground breaking research, lobbying for greater recognition of pancreatic cancer and being a voice for everyone involved in the fight. pancreaticcancer.org.uk
2 8 | PH A R M A FI EL D.CO.U K
’d been feeling ill for some time, and had been relatively active, but I’d put on weight after our second boy was born. In September 2013 I weighed 24 stone. Hitting 40, I got a personal trainer, and lost nine stone. Over Christmas 2014, my diet lapsed, and the weight went back on. Then at the start of 2015 my metabolism changed. I was pooing seven times a day. I was so tired. At night I’d fall asleep at 7.30. Previously I’d be up at 5am and off to work. As 2015 progressed my bowel habits got worse, and despite being back to my bad eating habits I was still losing 2lb a week. Blood tests showed high blood sugars; I was borderline diabetic. My GP sent me for a colonoscopy – nothing to be seen. The colorectal surgeon said I either had irritable bowel syndrome or ulcerative colitis. One night in August 2015, on a family holiday, my stomach felt like it was going to explode. The doctor said my blood sugars were through the roof and I was jaundiced. I was referred again and a different colorectal surgeon spotted something on my ampulla, a mass, but “nothing nasty”.
I was to have a minor operation to put a stent, which would clear the way so my pancreas could start working properly again. I was ready to go down, and the consultant came in. “There’s no easy way to say this…you’ve got cancer.” Me? No, it cannot be me. I’m never ill. Cancer was not part of the plan. It was 9 September 2015, and I was 42. My partner Andrea came right away. They sent me to the brilliant Christie hospital. I had a neuroendocrine tumour, with the primary in the pancreas. A big one, which had to shrink and peel away from major blood vessels, so they could operate. I started chemo the next week. The oncologist gave me a prognosis. I had the chemo. It was still too risky to operate and they tried another chemo drug. I returned to work, ran the Manchester 10km for charity with mates. The surgeon said that he could operate, though he hadn’t done it before, and it was a major procedure. I made a will, wrote letters to Andrea, my sons Ben and Dan, said goodbye to work. I made specific arrangements about songs and poems for my funeral. I got fit. When I came round from the operation, the surgeon told me that they got it all out, and the tests confirmed it. I’m still under surveillance, but I’m not in pain like I was. Cancer grabs you, but it can never take you. What is constant is hope, that is the only thing which will keep you going, for there will be dark days. You will find hope all around. Live for the moment right now; after all everything is terminal, it’s just how you make use of your time before reaching the terminus. Read James’s full story at Pharmafield.co.uk
P H A R M ATA L E N T
What does a
WINNER look like?
We ask past winners and judges of the Pf Awards what it takes to win a Regional Manager Award WORDS BY
J
John Pinching
ust what does it take to be the best? Winning a Pf Award is the ultimate accolade for individuals working in the pharmaceutical sales industry who want to test themselves against their peers and demonstrate how they perform under pressure. Since 2001 the awards have become widely recognised as the definitive achievement for representatives operating in the areas of sales and medtech. Winning a Pf Award represents a major career highlight and Pf Award winners go on to scale ever greater heights in our highly–competitive industry. This year, we’re introducing two entirely new Pf Award categories – The Best Newcomer Award and The Cross Functional Team Award – bringing the total number of categories up to 15. Entries open in September. Go to Pfawards.co.uk and take your first step to finding out what it really means to be a winner, just like Bayer’s Penny Shaddick, winner of the 2015 Team Manager (now Regional Manager) Award.
JUDGE
WINNER
Roger Hostler
Penny Shaddick
Regular Pf Awards judge
2015 Team Manager Award
CHALLENGE
P R E PA R AT I O N
Entering the Regional Manager Award is a challenge because you’re being judged by people who are vastly experienced and very knowledgeable. You have to do several things very well, while testing yourself against other talented people in the industry.
There is a set of values at Bayer that we strive to meet. While doing a good job and enjoying our work is vital to success, the Bayer LIFE values drive us to be better. You need to have a convincing track record of performance, do things to the best of your ability and improve the lives of patients.
U N D E R S TA N D
ASSESSMENT
You have to appreciate the difference between management and leadership. The roleplay section highlights this very well, so you need to be confident in understanding how different people need to be managed differently. If you’re not confident, you’re not going make it through the Pf Awards.
On Assessment Day you will be challenged and have to dig as deep as possible to deliver your skills. My advice would be to stay calm, be positive and remember that you are there because you are good enough. Show what you are capable of, and remember, everyone is in the same position as you. Thankfully, the judges do make you feel at ease.
WINNING
WINNING
Key to winning in this category is the ability to think on your feet, judge a situation and react accordingly. The Pf Awards are an excellent barometer for self-assessment against industry standards and I think they are particularly important for up and coming professionals.
It isn’t very often in your career that you are given the chance to glean feedback from experts, which will help you reinforce your strengths and highlight areas you can work on. If you build on the experience as part of your development it can give you a great platform and added exposure.
FUTURE
After winning the award, my profile within Bayer grew and I was viewed as someone who was serious about my professional development – it demonstrated that I was prepared to go out of my comfort zone to challenge myself. I have had two internal role changes since the Pf Awards and am now Head of Healthcare Partnerships in the Patient Access Department – my dream job.
CAREER
To get nominated is difficult, but winning an award is an amazing achievement. It can really boost a career. Winners need to understand that it isn’t the culmination of something, but the beginning of something else. They must take the energy of winning an award and transfer it back into the workplace.
H AV E YO U G O T W H AT I T TA K E S ? V I S I T P FAWA R D S . C O . U K T O F I N D O U T M O R E M AG A ZI N E | J U LY 2017 | 2 9
OPINION
“Research has shown that the more women reported experiencing menopause-related symptoms, the less engaged they felt at work”
WORKING
CONDITIONS
80% of women experience menopause symptoms ALCOHOL, SPICY FOOD AND
CAFFEINE CAN CAUSE
HOT FLUSHES during the menopause
WOMEN PRODUCE
3 TIMES MORE TESTOSTERONE THAN
oestrogen during menopause
HRT can be taken using gel, tablets or patches
WOMEN LOSE BONE TISSUE
more rapidly than men
WORDS BY
T
Dr Louise R Newson
he menopause is a subject that is often considered a taboo, and its effect on the mental, emotional and cognitive well-being of menopausal women, their colleagues, friends and partners is seldom talked about. Many women associate the menopause with hot flushes and night sweats, however, the symptoms of reduced self-confidence, low self-esteem, irritability, fatigue, anxiety and depression often affect women, particularly at work. Research has shown that the more women reported experiencing menopause-related symptoms, the less engaged they felt at work, and the more inclined they were to quit. I see numerous women in my clinic who tell me they have reduced their working hours, changed roles or even given up work all together as they had been making mistakes, struggled with learning tasks or generally felt too tired.
Menopause for thought Ending taboos about a condition society is reluctant to face.
I am constantly astonished at how little women and men know about symptoms of the menopause and the associated health risks, including increased risk of cardiovascular disease and osteoporosis. There are currently around 3.5 million women aged between 50 and 65 years in employment across the UK, and women represent nearly half of the entire labour force. This should mean that the menopause is as important as any other occupational health issue. It is likely that early diagnosis, education and adjustments can act as a preventative measure for menopause-related sickness. Furthermore, when the menopause is managed correctly, not only can it reduce absenteeism, it enables women to talk about their concerns with colleagues. Increasingly, organisations are looking at health and wellbeing strategies in the workplace as there is an established link between health and performance in the workplace. It is recommended that employers support menopausal women as part of an holistic approach to employee health, such as suitable adjustments to the physical and psychosocial work environment and the provision of training to line managers. It is vitally important that women are properly educated about treatment options for the menopause, including hormone replacement therapy (HRT). This choice is the most effective treatment for the control of symptoms and has been shown to improve the function of women at work. In spite of the many myths connected with it, for the majority of women under the age of 60, the benefits of HRT outweigh any risks. In conclusion, for women to feel comfortable with the challenges of the menopause at work, society itself must shift away from old fashioned perspectives. Dr Louise R Newson is a GP and runs a private menopause clinic at Parkway Hospital, Solihull. Go to menopausedoctor.co.uk
READER’S V
3 0 | PH A R M A FI EL D.CO.U K
f ie
HA
EY OU
ld
VOICE R S AY @ph ar
ma
Does your employer recognise the menopause as a condition? HAVE YOUR SAY @pharmafield
P H A R M ATA L E N T
Career high fives Caroline Wilcher, Recruitment Director at Ashfield, offers quick tips for career progression.
1.
H I T YO U R TA R G E T S
It sounds obvious, but this is a target-driven industry – you’ve got to deliver.
2.
OWN YOU R DEVELOPMENT
A good employer will support you, but be proactive; put yourself forward, shadow those above you and take time to find out what the next step really involves.
3.
MAKE THE MOST OF YOU R CURRENT ROLE
Don’t run before you can walk. How can you get more from your role before you look to move on?
4.
5.
FIND THE R I G H T M AT C H
You’re ambitious, but is your employer? What’s their development programme like? How do they treat employees? Are they heading in the right direction?
T H I N K L AT E R A L LY
Sometimes you have to move sideways to move forwards – be open-minded.
Ashfield, part of UDG Healthcare, have been experts in recruitment for more than 20 years, sourcing and developing the highest quality individuals at all levels for their clients. Caroline heads up an experienced recruitment team who are all APBI qualified and have a deep understanding of their clients’ needs.
M AG A ZI N E | J U LY 2017 | 3 1
P H A R M ATA L E N T
MOVERS & SHAKERS
STUART RAETZMAN
TRACY DOWLING
Nestlé has appointed Stuart Raetzman as CEO of Nestlé Skin Health. Stuart is a healthcare professional with over 25 years’ experience. He previously held senior executive positions with several healthcare companies and has worked across many healthcare areas, including pharmaceuticals.
Tracy Dowling has been appointed as the new Chief Executive of Cambridgeshire and Peterborough NHS Foundation Trust. Tracy joins the community care and mental health provider from the Cambridgeshire and Peterborough Clinical Commissioning Group, where she is Chief Officer.
SARATHA RAJESWARAN
The Association of the British Pharmaceutical Industry (ABPI) has appointed Saratha Rajeswaran as the new Executive Director of Government Affairs and Devolved Nations. Prior to joining the ABPI, Saratha worked as Associate Director of Public Affairs at Edelman.
IN BRIEF GW Pharmaceuticals has announced the appointment of VOLKER KNAPPERTZ as Chief Medical Officer and PROFESSOR BEN WHALLEY as Head of Discovery Research. Quotient Clinical has appointed AZHAR KALIM as Chief Commercial Officer.
WHO’S GOING WHERE AND WHY THEY’RE GOING THERE. WORDS BY
Rachel Cresswell
3 2 | PH A R M A FI EL D.CO.U K
DERICA RICE is to retire as the
Chief Financial Officer of Lilly. Southern Health NHS Foundation Trust has appointed LYNNE HUNT as chairwoman.
Pf GR ADUATE OF THE MONTH Here we feature an outstanding graduate who is making their mark in the industry. NAME: Rebecca Reeve COMPANY: QuintilesIMS ROLE: Trainee Clinical Research Associate – Graduate programme UNIVERSITY DEGREE: BSc Pharmacology (Industrial) REBECCA SAYS: “I initially became interested in clinical research during my study at the university and I realised I wanted to pursue a career as a CRA while working in Phase I development during my placement year. At QuintilesIMS, I have found an exciting career that gives me the opportunity to work across a diverse range of therapeutic areas in a fastpaced, challenging and dynamic environment.”
KNOW A RISING STAR WHO DESERVES A MENTION? RACHEL@PHARMAFIELD.CO.UK
LOUISE FAIRBURN
Louise Fairburn has joined The Cormis Partnership as a new Partner. She previously worked at AstraZeneca as Vice President, Global Commercial Academy. Louise said: “I made the decision to join Cormis to work alongside a talented team and be part of their mission to deliver exceptional capability interventions that transform performance through people.”
NAZNEEN RAHMAN
AstraZeneca has announced the appointment of Professor Nazneen Rahman as a Non-Executive Director of AstraZeneca. On appointment, Professor Rahman also becomes a member of the Science Committee.
SHABBIR MOSTAFA
Recipharm has appointed Shabbir Mostafa as Director, Business Management UK & Ireland. Shabbir said: “Recipharm is highly regarded as a significant force in the pharmaceutical sector – it’s an exciting time to join the team.”
M AG A ZI N E | J U LY 2017 | 3 3
P H A R M ATA L E N T
New ABPI President Lisa Anson discusses her career, the challenges industry faces and why there are so many reasons to be optimistic about pharma. INTERVIEW BY
John Pinching
What are the challenges facing industry? We are at a critical juncture. There are a few vital items on the ABPI agenda that I am keen to have at the forefront of our minds. Firstly, the wide area around reputation and, secondly, the issue of getting UK-based patients access to new medicines. In addition, we need to ensure that life sciences continue to thrive in the UK. To achieve those priorities, we must work closely as an industry – a sense of unity is something I am passionate about bringing. Are you still optimistic about industry despite the political uncertainty? There are a number of uncertainties, but Britain still has exciting innovation and an impressive medicines portfolio. The General Election, Brexit and the industrial strategy are all opportunities to open up dialogue about a future in which the Government, NHS and industry can all prosper. How do you intend to make the most of the relationship between the ABPI and its members? The ABPI is designed to represent the interests of its members, but different companies will always have different points of view about different issues. The ABPI isn’t going to be able to agree with all of them, but it is vital to have a balance of member representation and ensure issues are well discussed and explored. When we reach a position, as an industry or as a board, we must get behind it on the key points and join together to make a difference. What is your opinion on NICE and the work it is carrying out? I have a lot of respect for NICE and work very collaboratively with them. It is important that medicines are appropriately valued, however, and there are many aspects of NICE that could be updated – which I think they are open to. Some of the real challenges are political, such as the appropriate threshold against which medicines are assessed. The current marker was set in 1999, at NICE’s inception, and has never changed. In real terms that’s a 42% devaluation of medicines in this country. What have been the biggest changes in industry during the last 10 years? The accelerated development of new medicines has been critical. We have seen drug development occurring in three or four years, as opposed to 15. The speed of innovation, personalised healthcare, development of highly-targeted medicines and a better understanding of patient profiles are altering the landscape. This has changed the way physicians think and how
3 4 | PH A R M A FI EL D.CO.U K
pharmaceutical companies market, while also impacting on pricing and how patients get access to new medicines. Challenges around reimbursement have become more acute and, due to the breadth of what is available, public pressure on healthcare funding has become a growing issue. A few years ago, buzz terms like transparency and joint working were doing the rounds – are they now a reality? There has been a huge amount of work carried out by the industry on transparency and partnerships. The general direction of travel has been positive and when you see partnerships on the ground, within the NHS, there are some spectacular examples of effective joint working where pharma, the NHS and, above all, patients have benefitted. There are also examples where industry and the NHS hardly speak to each other, so we have keep demonstrating what can be achieved when we get it right. Ultimately, partnering and delivering services together engenders trust. How can we improve our external reputation? As an industry, we have to be better at explaining that we are well-regulated and have a system which ensures all our activities are appropriate. It’s something we should be incredibly proud of. I also feel strongly that we have a very important purpose to help patents. We’re not perfect, but the more people there are that understand our industry, the more positive they will be towards us. It is a journey and one that involves more open communication with healthcare professionals and patient groups. Was it always your desire to have a career in pharma? I always had a fascination with science and that certainly existed in
“It’s an exciting and continually changing industry, and one that isn’t afraid to take risks.”
my teenage years. I still find it incredible that every one of us, every day, undertakes innumerable biological processes that even our brains cannot understand. It is this curiosity that drove me to a science degree and continues to drive me today. What has made your career so rewarding? Seeing medicines getting to patients, and the difference these products make to so many lives, has given me the most satisfaction. It is an exciting, challenging and continually changing industry, and one that isn’t afraid to take risks. You get all of that built into a career in pharma, and it was the realisation of that scope and scale which has led me to where I am now. As I take on the role of President, I see our industry as a real force for positive change. I always remind myself that out of the WHO’s top 100 drugs in the world, 99 have emerged from commercial pharma companies. What is your advice to anyone thinking of a career in pharma? If you have a passion for the possibilities of science and medicines, or if you love a commercial or business environment, there are incredible opportunities at every level of pharma, even if you don’t have a scientific background. There are exciting prospects in both science and business, at a local and global level – that’s what makes this industry unique. Go to abpi.org.uk
YOUR SUCCESS IS OUR GOAL • Market access • Drive sales • Reduce costs Call us on 0370 541 8717 or visit www.forte.uk.com for more information on how Forte Pharma can help you succeed.
For all your practice requirements
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M AG A ZI N E | J U LY 2017 | 3 5
O N YOU R R A DA R
BAC K T WE ET THE WORD ON CYBER STREET S O M E T H I N G TO S AY ? @Pharmafield
SGLT-2 inhibitors
King's Health Partners @kingshealth
M A D E BY: AstraZeneca. Following June Pf ’s feature focussing on diabetes, AstraZeneca has shared the primary results from CVD-REAL. The study, on type-2 diabetes patients who have been prescribed an SGLT-2, assessed data from 300,000 patients across six countries, and found the new treatment reduced hospitalisation by approximately half, compared to other drugs.
We’re using wearable technology to halt #diabetes #DiabetesWeek #NHSresearch The BMJ @bmj_latest
Long term aircraft noise is linked to incidence of high blood pressure #BMJresearchnews BBC Health News @bbchealth
GP recruitment: More junior doctors choosing Wales Pancreatic Cancer UK @PancreaticCanUK 75% of people
in the UK cannot name a single symptom of pancreatic cancer. How many are you aware of?
R E S E A R C H R E S U LT S of the M O N T H
AOB
EU Medicines Agency @EMA_News
14 applications for new #biosimilars were received in 2016 – the highest number in a year so far Louise Newson @mymenopausedr
The menopause is an occupational health issue. Employers should have responsibility for their staff. @WMAWP #EMAS2017 EFPIA @EFPIA
Oschmann @merckgroup collaborative industry approach would speed development of new meds via conglomerate recruitment to trials #EFPIA2017 Pf Magazine @Pharmafield
Is #mentalhealth finally being given parity? If you work in mental health, let us know what you think for an upcoming edition of Pf Magazine RotherhamNHSLibrary @RotherhamNHSLib Can search engine
data save lives from pancreatic cancer? #BigData
3 6 | PH A R M A FI EL D.CO.U K
NOT TO BE SNEEZED APP
GELLED WELL
As if hay fever sufferers don’t have enough to deal with, the news of a ‘super pollen’ epidemic this summer threatens to pile on the misery. But fear not – Dr Paul Carson, a leading allergy expert, and his son David, have developed the UK’s first HayFeverRelief 3D app. This ‘mobile allergy clinic’ equips hay fever sufferers with personalised advice on the type of treatment you should be taking. hayfever-relief.com
A topical gel using ‘transdermal technology’ is set to benefit patients with erectile dysfunction (ED) who are unable to take PDE5s, such as Viagra and Cialis. Developed by Futura Medical, the gel is a topical ED treatment applied directly to the penis, containing the active ingredient glyceryl trinitrate. It relaxes the muscles and dilates the penile arteries, leading to a natural erection. futuramedical.com
X-RAY VISION An augmented reality (AR) headset, which enables surgeons to see through the patient’s body to assist and guide complicated surgery, has been developed by design and development firm Cambridge Consultants. Using Microsoft’s HoloLens headset, the highly intuitive AR surgical system arms surgeons with ‘X-ray vision’, making it possible to see inside a patient in a real time, 3D interactive perspective, while operating through minimally invasive openings.
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