Healthcare and Wellbeing PR

The media has reported that the National Institute for Health and Clinical Excellence (NICE) is to lose its power to recommend against the use of new medicines on the NHS. Following the reports, the Department of Health has confirmed that in future NICE will give advice on which drugs are effective, but will not decide whether patients should be given treatments their doctor recommends.

Lord Howe, Parliamentary Under Secretary of State at the Department of Health, said: “NICE is recognised as an international leader in the evaluation of drugs and health technologies, and it will continue to have an important advisory role, including in assessing the incremental therapeutic benefits of new medicines. However, as we implement our plans for value-based drug pricing, its role will increasingly focus on authoritative advice to clinicians on how to deliver the most effective treatments, and on the development of quality standards.”

The change in NICE’s role may improve access to drugs which doctors believe will extend or improve the quality of their patients’ lives, but critics have warned that there could also be a return to the ‘postcode lottery’, with patients in certain areas being refused treatments that are available to those in other areas. The changes also raise a number of questions, particularly around the new system of value-based pricing and what this really means for patients, the NHS and industry. It also raises questions about the implications for the pharmaceutical industry in terms of sales and marketing, and whether the “authoritative advice” for clinicians will in fact continue to influence decisions in the same way as existing NICE guidance.

Whatever the answers to these important questions, the highly complex and emotive debate about the changing role of NICE looks set to run and run.

Reports today regarding the ‘creation’ of prostate cancer in the lab by a team at the University of California to boost research and understanding is yet another great example of how stem cells can help refine the way we treat disease.   How long will it be before stem cell research and genetic determination of cancer becomes standard practice in helping people to achieve a healthier future?   Probably when we are able to better educate society that there is more to making people better than simply giving them a pill and sending them home.  This is a new era of understanding where disease comes from, how it affects individuals based on their genetics and how we can be targeted in therapeutic intervention.   This is exciting for our future…and we should celebrate it!

The moves of an industry giant to make its library of compounds available external scientists seeking cures for tropical diseases today, is one of those landmark moments that shouldn’t just pass us by.

Those who can look forward and see a future for leading sector players as partners in public health in parallel with meeting their commercial commitments are taking a bold step and are certain to reap the rewards.  After all, the world is getting smaller, warming up and tropical diseases closer to all of us (remember past scares about malaria in the Thames valley).  People should be able to look forward to a healthier future…

I was very fortunate to attend a meeting last night hosted by The Health Club from the London Business School, which included a very formidable panel from across all areas of the healthcare world. The theme of the conference was ‘Challenging the status quo’ and the headline speaker was none other than Andrew Witty, CEO of GlaxoSmithKline.

First off, this man is a truly phenomenal orator. He stood before an audience of some 270 business leaders and spoke without props, notes or slides for a full 25 minutes. Clearly drawn by the theme of the conference, he talked about how he’d gone about changing the culture and practice of the world’s second largest pharma company, since becoming CEO in 2008 by focusing on innovation, development and reputation.

He has revolutionised innovation in the R&D process by developing Development Performance Units across the world. Rather than having separate ‘divisions’ of research across the world that are split by scientific discipline, he insists that project teams are all co-located in the belief that truly serendipitous discoveries can only happen when people with different skills are drawn together in the same place. The project teams also have to pitch their ideas to a group of experts before they can begin their work and interestingly, these experts are drawn from both within and without GSK so the pitch process can truly ‘load the dice’ in the favour of success; very much like biotech start-ups.

The change that he has brought to the business is probably only as wide-ranging as it is since he is the CEO and has the real power to change the business from the top down with little resistance. His goal to provide an industry-wide patent pool for the use of generic companies in LDCs, along with pricing drugs at cost, is well-documented but it will be interesting to see just how far he’ll go to challenge the status quo in the developed world to really enhance the company’s reputation; not least that of the industry.

On his twitter page, the physician and writer, Ben Goldacre, claims that his BMJ article last week exposes some of the ‘crimes’ that the pharmaceutical industry has committed by maintaing the practice of conducting their own clinical trials. He believes that a genuine conflict of interest exists and cites ”difficulties in getting clear information about the number of suicide attempts in industry trials of SSRI antidepressants or the number of heart attacks in patients on rofecoxib.”

Although this is largely defensible behaviour, it would be intersting to see whether Mr Witty’s drive to take subjectivity out of the pharma industry and drive a real difference in the developing world – because he can – will also lead to a change in the way clinical trials are conducted and evaluated. One of the other speakers last night, Sir William Castell, proposed that drugs should not be ‘priced’ until they have been evaluated on the market for three years, versus only having to show a statistical significance in a clinical trial of only 4,000 patients-or-so.

With the cost of drug development running into hundreds of millions of dollars, however, it’s unlikely that any pharma company will want to cede this type of control to a third party, but that’s not to say there may not be a better way, which could appease Dr Goldacre and disruptively enhance the reputation of a globally relevant industry.

We can probably all identify with having so many things to do, either at home or at work, that sometimes we feel completely swamped with the jobs that need to get done. I remember having this conversation with my boss around four years ago when I’d started in a new role with my company while moving house as a consequence. He kept piling all sorts of extra-curricular tasks onto my already brimming to-do list and when I asked him where I was supposed to begin, he told me to ‘prioritise my priorities’. I must have looked incredulous because he went on to explain that even priorities can be ordered and tackled in a methodical way and that no problem is too great.

Today, the BBC ran a story entitled “Doctors must stop pushing drugs at depressed people” and the bottom line is that, according to Dr Jennifer Wild, a clinical psychologist from King’s College London, doctors are not following the National Institute for Health and Clinical Excellence (NICE) guidelines that recommend using Cognitive Behavioural Therapy (CBT) as well as antidepressant drug therapy. Dr Wild, in an interview with the Today programme, said that data existed to show that CBT was equally as effective as antidepressant therapy.

Right.

Well even if you believe that, which I struggle to without assessing all the data, then good luck encouraging time-poor GPs to diagnose depression at first presentation, arrange CBT with a third party provider, deal with treatment follow-up only to then reassess those patients for whom CBT doesn’t work before determining what further intervention is required! Back in the 1990s, I worked with GPs througout the UK every day for over seven years and over that time witnessed them becoming increasingly frustrated with red tape and paperwork as ‘fund-holding’ gripped the NHS. Back then, GPs complained to me that they had less than seven minutes with each patient in their busy surgeries and I can’t believe that with the recent introduction of PCTs, the time they have with patients today has got any longer.

So in the last two weeks the very same NICE, which has decided that we should pay for both antidepressant drugs and CBT for the six million depressed people in the UK without really knowing which will work, has also determined that just a few thousand cancer victims can’t have the treatments Nexavar and Avastin. These two drugs have been shown to extend life by upto two years, so just who is determining the treatments that should and shouldn’t be paid for when it comes to treating the nation’s sick and isn’t it about time they prioritised their priorities?

Driving back from a family event earlier this-evening, I took the gamble of continuing my 70 mile journey home despite the car warning me that I only had just over 70 miles left to run before I ran out of fuel. There was no shortage of places to stop and refuel on the way back, I simply decided to ignore the car’s multiple warnings and considered that, in general, I knew best and would take the chance. Finally reaching the petrol station near home, I felt a little flushed with victory that – mercifully – I had been right to take the gamble, despite the car reporting towards the end of journey that I had, in fact, zero more miles left to run until almost certain disaster and a good helping of embarrassment.

How similarly I often consider my health.

Watching some of the BBC Children In Need show with my daughter on Friday evening, I was moved by the story of two young girls who lost their father to a brain tumour earlier this year. My ten year-old daughter was even more upset by the story and, as she said goodnight, told me that she hoped she wouldn’t have to go through the same kind of trauma. Without thinking, I told her not to worry because I didn’t have cancer and she wasn’t to worry about it and go to sleep. I said that, of course, because that is what a father is supposed to say if he wants to avoid a lot of tears, but as I walked downstairs from her bedroom I began to really hope that I was right…

A few short months ago, many of us were defending our National Health Service from attack by some groups within America who considered such ‘healthcare for all’ would be a bad thing for their country. I didn’t get involved in the debate but considered that both sides had a point. The one that is of most relevance is how do you know when you are reaching the real ‘zero more miles left to run’ point? As a male in my mid-to-late thirties, I am beginning to run the risk of all sorts of conditions and, if I lived in the US, I’d most likely have an annual screening test to catch many of them early. Indeed, this month is ‘Movember’ and thousands of men will be growing a moustache, or ‘mo’, to raise money for The Prostate Cancer Charity, hoping to beat last year’s figure of £2.4M. There is no screening for prostate cancer in the UK, unlike PSA testing in the US, despite it still being the most common form of cancer diagnosed in men in the UK.

I haven’t seen a doctor (as a patient, that is!) for over four years and not because of ignorance or the fact that men tend to visit a doctor about a third as often as women, but because generally I feel fine, have no need to and – most importantly – nobody has asked me to. Perhaps that isn’t the right way to think, however, it could be that rather than the risky games like the one I played with my car this-evening, I should consider my own health more seriously and be encouraged to take a more responsible attitude to my wellbeing. That, for what it’s worth, is something I think we can rightly learn from our cousins across the pond and something I believe the NHS should urgently address if we are expecting it to be the custodian of the nation’s health for the next 60 years.

Having just returned from the American Heart Association (AHA) congress in Orlando, Florida I’ve been reflecting on what were the hot topics. One that particularly stuck in my mind was an abstract presentation of a study funded by Nintendo, which assessed the health benefits of playing Nintendo’s Wii active games – Wii Sports and Wii Fit Plus.

12 healthy, normal weight men and women ages 25 to 44 were engaged in all the activities available in the game packages. They played the games inside an airtight room equipped with sensors that recorded the level of carbon dioxide in the air. The researchers estimated the participants energy expenditure as measured by MET (a unit that measures the energy cost of an activity).

Most of the activities (67%) were classified as strictly light intensity (less than 3 METs), but the activities with the highest energy expenditure included the single-arm stand resistance (5.6 METs), the basic running (5 METs) and the hula-hoop (4.0 METs). The researchers noted that 30 minutes of these activities per day would meet the AHA’s recommended guidelines on moderate intensity physical activity.

What I’m most interested to see is how Nintendo will utilise these results once the study is fully published. It certainly provides them with an excellent PR opportunity.

A two-day public meeting was held by the FDA this week to understand if the agency should regulate how drug and medical devices promote on the internet. Approximately 800 people attended the meeting with representatives from the healthcare and pharmaceutical industry, online media and services firms including Google, and patient groups, although in smaller numbers than expected.

In this day and age we know that the internet is a great source of information and it clearly plays a large role for patients wanting to know more about a particular condition, medication and/ or treatment. We also all know that there is a lot of inaccurate and incorrect information on the web, which can be misleading, confusing and potential dangerous for patients.

The pharmaceutical industry globally has been very reluctant to embrace social media and digital tools, not because they don’t want to, but because they are nervous of getting on the wrong side of their local regulatory body. The industry is already so strictly regulated and there are no guidelines that clearly define what is acceptable and what isn’t online. Which is why this meeting was so important – it was the first step in this process and welcomed by all parties. By allowing the pharmaceutical industry to have a presence online it will also allow them to address and correct any misleading information about their products.

So, how on earth can such a thing be regulated. Well one suggestion is to introduce an FDA internet logo. The presence of this logo would assure the reader that the site has been approved by the agency. That suggestion was put forward by the group Pharmaceutical Research and Manufacturers of America (PhRMA).

Another discussion point was who should be responsible for monitoring and correcting misleading or unbalanced information appearing on sites like Wikipedia and blogs.

Essentially all parties are pushing the FDA on guidance on how products should be handled online, now it’s up to the FAD to decide on the next steps.

The use of digital tools and social media in healthcare is still somewhat of a grey area, particularly in the world of pharmaceuticals. So we’ll be keeping our eyes glued to the FDA’s public hearing on promotion of FDA-regulated medical products using the internet and social media tools http://www.fda.gov/AboutFDA/CentersOffices/CDER/ucm184250.htm. For an inside peak preview check this out http://www.doseofdigital.com/2009/11/sneak-preview-fda-social-media-hearing-testimony/. We will be blogging on the outcomes of this meeting and hope to see similar steps happening in Europe soon.

Welcome to the first Healthcare and Wellbeing PR post! The team in the Healthcare and Wellbeing department at Hill and Knowlton, London always have a lot to say and what better place to say it then on our very own blog. If you’d like to find out more about what we do, why not check us out on http://www.hillandknowlton.co.uk/what/your-sector/healthcare-wellbeing.  

We’re passionate about the world of healthcare and will be blogging on news, events and our views on PR campaigns developed in the field. We look forward to sharing with you more about our work and our thoughts on the industry moving forward.