Healthcare really should be all about patients, but in reality most of what we do is geared up to populations, not individuals. As a healthcare community, we don’t always challenge ourselves enough to take a really patient centric approach. This first became really apparent to me when I was in surgery, looking at how we look after patients after curative resection for breast cancer. Women have wildly varying expectations for follow up, yet we have struggled to adopt any more than a one size fits all approach. Any tailoring is related to disease characteristics, not women’s needs.
Can we do better?
Gearing up our approach to individuals is challenging. It is much easier for our healthcare systems to deliver standard approaches. But if we want to be more patient centric, the first step is to really understand what patients want and need.
As we make progress in difficult disease areas, such as oncology where I have spent my career, we can place significant pressures on systems with patients living longer, perhaps with more complex needs.
While the pharmaceutical industry is often seen as only providing medicines (let’s leave it at that, this is not the place to get into the thorny debate around access!), I feel it is incumbent upon us to also work with clinicians to assess the effects of those medicines on patients and systems and work to find solutions that help patients get the most out of their care. That can be very labour intensive, but more efficient systems not only benefit patients (which should be our primary concern) but can also make working conditions easier for clinicians (also good for patients) and help optimise outcomes from treatment.
This work doesn’t need to be costly or time consuming; using the correct methodology it can be achieved with quite small patient numbers, as we have done in renal cancer.
And in clinical research? Can we involve patients more?
We really have to, is the short answer.
In Parkinson’s disease, patients experience a multitude of symptoms and we assess some of those when we conduct trials in this area. But our assessments strive to be reproducible and comparable, and so are not always relevant to patients. But that makes it difficult for clinicians to decide on the ideal treatment for a patient based on their needs.
For example, what treatment do I give a lawyer or public speaker to ensure he can project his voice, something often lost in Parkinson’s? I don’t know, because voice projection isn’t an end point in trials so comparing treatments is impossible.
Not involving patients can even lead to companies wasting money creating solutions to problems that don’t exist.
The inhaled insulin product that my company developed is a great example. Significant research and development costs went into a medicine that was subsequently withdrawn from the market in 2007 due to lack of demand. This led to Pfizer taking an even more active approach to patient involvement. Our Chief Medical Officer, Freda Lewis-Hall, describes this as an ‘a-ha’ moment for her and it triggered a real change in approach in my organisation.
Working with patient groups to develop medicines
The next obvious step is to partner with patients and patient groups to develop our medicines. This is an area I will be discussing at this event with Baroness Morgan, the CEO of Breast Cancer Now (BCN). BCN's Catalyst programme, in which we are the first industry partner, will support studies in breast cancer which BCN and their supporters will have a key role in developing. I hope this brings more effective treatments, and more informative data, to patients more quickly.
One challenge, of course, is that patient groups don’t necessarily reach diverse population groups, and we all need to work really hard to ensure that we are reaching as wide a cross section of people as possible.
So what next?
We really need to push on and make true patient centricity a reality. The opportunities for all involved, not least patients, are too great to ignore. I haven’t got space to cover all the issues here, but this call to action from a number of companies and patient groups tells the story in even more detail and highlights how seriously we and other organisations are all taking these issues.
This ABPI-AMRC conference is a great start, but there will be real challenges in implementing some of the things we discuss and in ensuring widespread adoption across the NHS. But just because things are hard, doesn’t mean we shouldn’t try.
Dr David Montgomery, Medical Director of Pfizer Oncology UK, will be in conversation with Delyth Morgan, chief executive of Breast Cancer Now, at the Patients First conference hosted by AMRC and ABPI.