Will NHS Pharmacist’s give personalised medicine a chance?

One of the key reasons I’m so keen to see clinicians take the lead with mHealth is because there’s enough inprecision in evidence based medicine already and if they don’t lead Bad Pharma will increasingly run rings around them as it arms itself with patient data and relationships with payers.

If you’re uncertain about any of the key issues I’d thoroughly recommend you read Ben Goldacre’s best selling “Bad Pharma: How drug companies mislead Doctors and Harm patients“.

Regularly I seem to read about how organisations like the Royal College of General Practicioners and Royal College of Nursing are lending their credibility to Association of the British Pharmaceutical Industry documents that talk of the importance that Doctors aren’t “tempted to accept the negative myths about cooperating with industry… (because) working with (pharma) industry will not harm the objectivity of clinical decision making”:

…despite the strong evidence base that suggests “exposure to information provided directly by pharmaceutical companies” has led to “higher prescribing frequency, higher costs, or lower prescribing quality”.

Every now and then I hear of how you can “work with Big Pharma to make solutions” and I’ve seen my fair share of good examples but it’s not so obvious what this actually means when we’re talking about the relationship of payers and big pharma so I found this video from the excellent EyeforPharma Conference I spoke at earlier this year in Barcelona very interesting:

The NHS strategically, the main currency of value comes from the patient in the quality. So really it’s not asking the physician, it’s not asking the company, it’s saying to the patient here’s your validated score, now you’re using the drug what is your rating on your breathlessness? what is your rating on your asthma attack? So quality comes from the patient so that way no one, the argument isn’t with me and the pharma company, and what typically will happen is a drug company may say ‘we change, we transform the nature of the patients lives with this miracle cure’ but when you ask the patients ‘show us on your breathlessness questionnaire (SEE NOTE BELOW)” they say “well I’m feeling pretty rubbish on the placebo and I’m feeling pretty rubbish on the brand” so the truth is the disease is probably so bad it doesn’t matter whether the payer spends a fortune or keeps it cheap the patient will still feel rubbish and so there’s that element of ‘what’s the expectation of the drug’ firstly, is this really a miracle cure that transforms breathlessness into an athlete and it isn’t so there’s the expectation story. The other way value and I’ll give one case example of a small company with no market share completely transformed from their value story. In the rheumatology game with the monoclonals, expensive drugs, high cost drugs, thousand euro plus a month drugs, we have both Remicade® and Humira® were branded and the Consultants said these are the brands we want for our patients. Smaller company came by, 4th or 5th to market, not necessarily Gold Standard, UCB if anyone’s familiar, and they didn’t go to the consultants they didn’t go to the patients they came to the payer’s and said “What can we do for you? Our trial data is not much different, our evidence is you know the similar, the failure rate is the same, and we’re 4th to market we haven’t got the money to take all the Consultants to golf weekends and American Rheumatology, Orlando, Disney World, Okay?” so what the payers did is we don’t mind paying for drugs that work, it doesn’t matter which biologic you use in Rheumatology about 25% do well and the other 75% for one reason or other are not responders. It takes nearly 12 weeks to find the responders. UCB came to us and said ‘look, we give every patient 6 months free, you find the people it works in and you only pay for the people it works in’. [clicks fingers] Overnight.

Omar Ali, Formulary Development Pharmacist, Surrey & Sussex NHS Trust, in reply to the question “other than lower prices what measures of value would help you?“:

NOTE: by “breathlessness questionnaire” I take it (from the way Omar holds up a piece of card in front of him) that this is a paper based feedback form that is given to patients to complete.

Imagine being a patient suffering from a rheumatic disease being prescribed a drug that probably won’t work and then finding out that the decision to put you on it wasn’t made by your Consultant but because someone else charged with paying for your care had made a judgement call on the basis that a sales rep from a pharma brand had convinced them that their “trial data is not much different, our evidence is you know similar, the failure rate is the same” and offered it to the NHS on a only-pay-if-it-works style deal?

Imagine how you’d feel when you then Google UCB and find out it’s Union Chimique Belge and that while it’s not the size of Janssen or Abbott it’s far from being a small company – it’s a global pharmaceutical manufacturer with a history going back nearly 100 years with a market cap of €7.76 Billion.

I can’t also imagine it’s going to take the Abbott and Janssen reps a couple of heart beats to realise that instead of apparently taking all those Rhuematology Consultants to Disney Land they should be sending some more paper clips and pens over to the NHS Pharmacy buyers.

I wonder how Omar would react if he had arrived home from Barcelona and discovered all the windows on his home had all been changed because his neighbor had been getting his done by a small contractor who had promised to throw in a new set for being a neighbor – on a 6 month try before you buy deal of course!

*** *** UPDATE 28 July 2015 *** ***

The Telegraph: Lavish trips laid on by drugs firms to ‘sway’ NHS staff. Health service officials earn thousands organising and attending extravagant events where companies promote their products.

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