Covid-19 Pushes Pharma To Walk The Talk of ‘Patient-Centricity’

Echoing many other industries, such as, Fast-Moving Consumer Goods (FMCG), pharmaceutical industry leaders, as well, have been talking about putting their customer at the center stage of strategic decision-making processes. In other businesses this grand intent is generally expressed as, ‘customer oriented’ or ‘customer-focused’, or ‘customer-driven’, besides several other similar expressions.

However, in the pharma industry this popular expression is widely talked about as ‘patient-centricity.’ Nonetheless, it is also generally believed that pharma leaders, weren’t hugely inclined to ‘walk this talk’ – until Covid-19 pandemic struck the world – very hard. In this article, I shall delve into this area, focusing on several aspects of it. Let me begin with, what COVID-19 has taught about pharma’s ‘patient-centricity’ efforts.

What COVID-19 has taught about pharma’s patient-centricity efforts:

A recent study, titled, ‘What COVID-19 has taught us about pharma’s patient centricity efforts,’ published by ZS on July 05, 2020, unravels some interesting findings in this area. Some of those points are as follows:

  • ZS’ mid-2019 ‘Patient Centricity Industry Study’ had found nearly universal agreement about the importance and significance of being patient-centric.
  • But the investment for the same did not match the intent, creating an “optimism gap” where senior leaders think more progress than middle the management.
  • At that time, while 73 percent of participants agreed that ‘patient centricity’ is fundamental to their organization, only 16 percent said they understood their individual role in the organization’s ‘patient centricity’ initiatives.
  • Whereas, during the past few months as the industry responds to Covid-19 pandemic, ‘pharma has demonstrated that it can quickly mobilize to surround and support patients, making the workforce focus on the patient priorities.
  • Over the past three months, organizations were found to look at new ways to engage with patients. For example, patient panels to continually check in and monitor the impact on the patient experience, connecting with patient advocacy groups – to get a pulse on critical needs and leveraging the field force to hear from physicians where their patients need the most help.
  • These companies are also investing now to understand the impact of Coronavirus on the patient and partner with others in the ecosystem.

Some interesting industry initiatives during Covid-19 pandemic:

This  ZS study noted, several pharma companies are showing great flexibility and creativity in tapping into their combined expertise and skills to support patients and the healthcare community, in a time of need. Some of the interesting examples cited in the paper include:

  • Pfizer rolled out a five-point plan, including an R&D SWAT team to support vaccine development.
  • Lilly, Merck and others banded together to help employees with relevant skills, volunteer on the front lines of treatment
  • Several other pharma companies have also joined with the Bill and Melinda Gates Foundation to share data.

I hasten to add, according to this study, some industry leaders did agree that COVID-19 has proven that it’s possible to actually be more patient centric in business operations for better outcomes. However, many pharma players would still need to ‘walk this talk’ and put in hard work with adequate resources in getting there – the study noted.

Could ‘patient-centric pathway lead to post Covid-19 business recovery?

Just lip service on ‘patient-centricity’, as witnessed earlier, is unlikely cut any ice in the new normal, as people start living with the new Coronavirus, in everyday life. Making this more touted, but less practiced concept work on ground in pharma, is expected to be one of the effective pathways for early business recovery, as we move on.

The McKinsey article of May 12, 2020, titled ‘Pharma operations: The path to recovery and the next normal’ has also flagged this issue, alongside a few more. Similar to the findings of the above ZS study, this paper also noted that ‘leaders of operations in the pharmaceutical industry have been historically slow to respond to changing times. Interestingly, during COVID-19 pandemic, many of those leaders were found highly responsive to the new demand of time. They ‘rallied to enable the supply of key medicines across borders, manage workforce safety, and handle evolving government restrictions, while beginning to prepare for new vaccines and therapeutics, it noted.

More importantly, several companies have now put in place crisis-response command centers. These hubs play critical roles to appropriately manage and bring stability in an otherwise unstable time. From this experience, in my view, ‘patient-centricity’ could be an effective pathway to follow for post Covid-19 business recovery. Having said that, let me try to tighten some loose knots of understanding in this specific area, as below. To start with, let us together recapitulate a brief background of evolution of ‘patient-centricity’ concept in the drug industry.

“No decision about me, without me”:

Not so long ago, the National Health Service (NHS) of U.K realized that every patient should be as actively involved in making decisions about their health and health care as they wish to be. Accordingly, in 2012 it released the White Paper - ‘Equity and Excellence: Liberating the NHS,’ setting out the U.K Government’s vision of an NHS that puts patients and the public first, where “no decision about me, without me” is the norm.

The concept of ‘patient centricity’ in the pharma industry is believed to have grown from the above concept. The core idea of the concept, as defined in a BMJ article is, “Putting the patient first in an open and sustained engagement of the patient to respectfully and compassionately achieve the best experience and outcome for that person and their family”.

The authors envisage, effective implementation of the same would provide an opportunity for drug companies to adopt and use its core facets as reference points for patient engagement, throughout a product life cycle. In tandem, this also flags an important point: Why the concept of ‘patient-centricity’ is mostly talked so ‘passionately’ by almost all drug companies, while very few of them seem keen to ‘walk the talk?’

The key barriers to achieving ‘patient-centricity’:

The key puzzle on ‘Patient centricity: everyone wants it; not everyone gets it’, was well-deliberated by Reuters Events (Pharma), published on December 14, 2024. It pointed out – as an aim ‘patient-centricity’ is all too often overlooked, despite the fact that even several top pharma companies often express their desire to be patient centric organizations; such as:

  • “Inspired by patients, driven by science” (UCB);
  • “Science and patients…the heart of everything we do” (AstraZeneca);
  • “A global integrated healthcare leader focused on patients’ needs” (Sanofi).

Analyzing the overall reasons for the same, the paper articulated: ‘Difficulties in communication with patients, skepticism about their input, and unwillingness to relinquish control are some of the barriers to achieving patient centricity.’ Interestingly, this situation remains generally unchanged even today.

Conclusion:

Meanwhile, as recorded in the morning of September 06, 2020, total Coronavirus cases in India have reached a staggering figure of 4,113,811 with 70,679 deaths, despite every effort taken by the Government. As PTI reported on September 05, 2020: At the current pace, India will overtake Brazil early next week to become the country that has seen the second highest number of cases.’ With this perspective, let us now look at the concept of ‘patient-centricity’ for better treatment outcomes.

As deliberated earlier, just as providing affordable care for all – making ‘patent-centricity’ the centerpiece of the core business strategy for pharma, had remained akin to chasing the ‘Holy Grail’. This happened, despite last so many years one could easily spot inclusion ‘patient-centricity’ even in the corporate vision and mission statements of many drug companies.

As it appears today, the term ‘patient centricity’ remained another cliche, till Covid-19 disrupted the status quo of the old normal? But, will it last long? Only another robust study in the future, I reckon, will be able to confirm it. However, this would mostly depend on whether patients continue sending signals of: “No decision about me, without me,” for better health outcomes.

It’s not a terribly disputed fact, either that various stringent norms in the Covid lockdown period, have prompted many health care consumers switching from their good old health care practices, to the digital or online mode to meet with similar needs. Consequently, they are now becoming more digitally empowered than ever before. In this situation, leveraging AI with expert help, would help implement ‘patient-centricity’ more productively to meet challenges of the new normal.

If done with precision, it would help move even beyond ‘patient-centricity’ in the new normal, with better disease prevention or management and ‘connected healthcare,’ leading to better quality of lives for many. Thus, Covid-19 pandemic – pushing pharma to ‘Walk the Talk’ of ‘patient-centricity,’ if lasts long, could usher in a fundamental change in the health care space. It has demonstrated its huge potential during the ongoing pandemic to ensure patient-friendly, high quality, affordable and universal health care value delivery – for patients’ sake.

By: Tapan J. Ray   

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

Cancer Cure: Inching Towards The ‘Holy Grail’?

In a Press Conference on August 20, 2015, the 39th President of the United States, now 90-year-old  Jimmy Carter, revealed (video) that during a liver surgery earlier this month the doctors diagnosed that he has cancer. The type of cancer that he is suffering from is called melanoma, which has already spread to his liver and brain. Medical jargon would term it as deadly metastatic cancer.

Though the surgeons have removed the liver tumor, and well-targeted radiation treatment for four other small tumors in his brain has already been initiated, the original site of the melanoma, the lethal skin cancer, has reportedly not been found, as yet.

Mr. Carter’s medical treatment has started with an infusion of a new class of drug that uses the human immune system to fight cancer cells. The drug has been reported to work not only in advanced metastatic cancer, but also in the old age of patients. The former American President appears optimistic about the treatment outcomes with this new therapy, ‘placing his fate in the hands of God’, though initially he thought that he had just weeks to live.

I shall deliberate in this article, in an easy to understand language, though briefly, the promises offered by two latest options for cancer cure. One of these two, has just become available to patients and the other one, after an initial jaw-dropping success, is undergoing further tests in a renowned research laboratory of the United States.

Two novel pathways for cancer treatment:

Until recently, surgery, radiation and chemotherapy used to be the three common options for cancer treatment. One breakthrough option has just been launched and more in the offing.

In search of a cure for cancer, pathbreaking outcomes of medical research, especially in the following two areas, are significant:

A. Immunotherapy: It is a revolutionary approach to cancer treatment. The first of this novel class of drugs has just come to the market, with which Mr.Jimmy Carter is now reportedly being treated.

B. Re-programming cancer cells back to normal: Success has just been achieved in laboratory studies with this technique. It holds a strong promise to cure cancer, universally.

A. Immunotherapy:

On June 1, 2015, in an article titled, ‘Cure for terminal cancer’ found in game-changing drugs, “The Telegraph” – well-regarded international news daily, reported on anti-cancer immunotherapy drugs, as follows:

“Terminally ill cancer patients have been ‘effectively cured’ by a game-changing new class of drugs. In one trial, more than half of patients who had just months to live saw deadly tumors shrink or completely disappear.”

“In recent days, the results of trials of a number of treatments which harness the body’s immune system have been announced at the American Society of Clinical Oncology’s annual conference in Chicago. They show promise in the fight against skin cancer and lung disease.”

As we know, most of the cancers are deadly. All these grow and spread, as they manage to hide from the immune system, disguising the life-threatening danger. Thus, medical research scientists pondered that the human immune system could play a critical role in the fight against cancer and even cure, by harnessing its ability to fight the deadly disease, effectively and decisively.

To achieve this goal, this class of new cancer drugs work by allowing the body to recognize and attack cancer as any other harmful invader to the body. It effectively blocks a cellular pathway that hinders the ability of the human immune system to attack cancer cells.

At present, to treat different types of cancer, more number of immunotherapy drugs are undergoing clinical investigations.

Brilliant treatment outcomes, but not universal:

It has been reported, about one third of patients taking immunotherapy for the treatment of cancer experienced positive results. Those who responded to this therapy, showed immediate effect with their tumors shrinking or vanishing in a matter of weeks. As a result, the patients who had no more than weeks or months to live, just as former US President Jimmy Carter, have gone into remission for years and continuing with their normal lives.

It has also been reported, otherwise such patients could expect to live just nine months, if given standard treatment of cancer. Researchers said, they were hopeful that half of the patients responded to immunotherapy would end up “living disease-free”.

These drugs are expensive, costing roughly US$150,000 per year, which is a part of a different debate altogether.

Not a ‘magic bullet’:

Besides its high cost and outstanding quality of results, it is worth noting that immunotherapy is not a ‘magic bullet’ for all types of patients and in all cancer. It, therefore, throws a challenge for the oncologists to understand, why immunotherapy benefits only to some cancer patients, and who are those patients?

Moreover, there is a possibility of immunotherapy sending immune system of some patients to overdrive, precipitating auto-immune disorder that may attack also the healthy cells.

Thus, immunotherapy is not the ‘Holy Grail’ for the treatment of cancer, neither it is nowhere near a perfect drug for the treatment of all types of cancers in all patients.

Two key findings:

In this regard, two key findings of the researchers on immunotherapy are as follows:

  • Roughly around 15 to 20 percent of patients could experience shrinkage or remission of cancer
  • Half of the patients who responded found it lasting for at least six months

Thus, immunotherapy can at best be a cure for only some terminally ill cancer patients, mostly for some time, but not for all.

“In the hands of God”:

All these factors on immunotherapy probably would help us to understand, why an erudite person like Mr. Jimmy Carter said, though optimistic about the new treatment, he is placing his fate ‘in the hands of God’.

B. Re-programming cancer cells back to normal

The question, therefore, comes up now, if immunotherapy is not the ‘Holy Grail’ for cancer treatment that the research scientists have been intensively searching for, is there anything else coming up for cancer cure?

It appears so. A totally different approach to re-program the cancer cells back to normal has very recently been reported by Mayo Clinic’s Florida Campus in the United States. With this, cancer researchers’ dream of making the tumor cells morphing back to normal cells, they once were, would probably come true.

The research findings, published in Nature Cell Biology on August 24, 2015, represents ‘an unexpected new biology that provides the code, the software for turning off cancer,’ said the senior investigator of this study.

In the normal process, cells in the human body divide constantly to replace themselves and stop dividing when they have replicated sufficiently. However, unlike the normal cells, cancer cells do not stop dividing, they go out of control, leading to huge cell reproduction and tumor growth.

For the ultimate cure of cancer, scientists at Mayo Clinic have now reportedly succeeded in reversing the process responsible for the normal cells from replicating too quickly.

Possible cure now within sight?

This could ultimately lead to a newer class of breakthrough treatment that would be able to reverse cancerous growth in the human body, possibly curing cancer, without the need of surgery, chemotherapy, radiation or even immunotherapy.

Scientists at the Mayo Clinic have said that their initial experiments in some aggressive types of cancer are quite encouraging. They have successfully done this in very aggressive human cell lines from breast and bladder cancer.

Towards the ‘Holy Grail’:

In pursuit of finding a cancer cure, research scientists have been making commendable progress, over a period of time.

In the last few years, spectacular breakthroughs in treatment of cancer have been possible from the increasing genetic and biological understanding of the researchers, especially in ascertaining exact defects in the DNA code of human genes that cause cancer.

Ability to sequencing human genome has offered a key tool to the researchers to compare the DNA codes of cancerous and normal cells and identify the differences.

From within the 20,000 human genes, around 500 cancer genes have been reportedly discovered and are being catalogued. Clear understanding of what happens precisely when the cells divide uncontrollably and cancer spreads in different parts of the patients’ body, is taking place with commendable progress of various research initiatives in this area.

Based on the current knowledge on human genome, a number of new drugs have been and are being developed to target the cancer-causing genes with great accuracy. Such types of drugs are called ‘personalized medicines’, as these act on specific gene abnormality of patients related to certain types of cancer. Sophisticated laboratory tests facilitate treatment with ‘personalized medicines’. These are more effective with lesser side-effects, as compared to generally used anti-cancer drugs, prescribed to all cancer patients.

However, the question keeps lingering, ‘Is the Holy Grail for cancer cure has now come within sight?’

Conclusion:

Medical scientists continue to take rapid strides towards better and more effective treatment for cancer, if not cure, with fewer side-effects.

Claims for long remissions with immunotherapy, are being reported for some patients with even metastatic cancer and also in old age, just like former President of America – Mr. Jimmy Carter.

The success achieved by the scientists of ‘Mayo Clinic’ in re-programming rogue cancer cells back to normal, is stunning.

Being successful in this effort, the researchers have compared cancer with a complex software program of life. When it goes out of control, ‘instead of the code for normal cells, a code for making abnormal cells is executed’. This new study signals a strong possibility of bringing the cancer cells back to normal.

Medical experts keep their fingers crossed. Although, some of them do apprehend that there may never be a single ‘Magic Bullet’ to cure all types of cancer in all patients. This is mainly because cancer involves a large number of different disease areas, such as, breast, lung, bowel, prostate, blood and so on.

But hope refuses to fade out, as science continues to keep unravelling spectacular breakthroughs in this direction, at a fairly brisk pace. All these researches may be cancer types or patient types specifics, but the progress is taking place in the right direction.

Even in the ‘Mayo Clinic study’, scientists have been, so far, successful in re-programming the breast and bladder cancer cells back to normal, though they believe that this success sends a strong signal of an “early and somewhat universal event in cancer.”

Immunotherapy is undoubtedly a path breaking step that ensures cure in some types of cancer and in some categories of patients. However, if re-programming the cancer cells back to normal, eventually becomes an ‘universal event’ in the treatment of this generally frightening disease, no doubt, the medical science is now slowly but surely inching towards the ‘Holy Grail’ for cancer cure…at long last.

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.