Pharma Strategy Blog

When a month just isn't enough

Sadly my mother passed away while I was in transit back to the UK after a 2 year battle with heart disease.  In the end, she went peacefully in her sleep after a sudden clot on Saturday, something we are all very thankful for.  It is better to go with grace and dignity than be in pain for days and weeks or months on end.  She was in very good hands and couldn't have been in better care since she was on my sister in law's critical cardiac ward and they would have done they very best to make her as comfortable as possible.  My mum's worst fear was always becoming so incapacitated that she was rendered helpless, after a previous heart attack reduced her physical abilities somewhat. She was never really the same after that, but was able to function as best as she could while maintaining her independence.

My eldest niece went to visit her Grandma in hospital on Monday and was shocked at how frail and thin she looked.  The youngest chose not to go, preferring to remember her as she was.  I respect both of their decisions; I didn't have either choice as I was regretably late back again and she passed away in peace while I was in transit.  At times like these, I am just grateful my mother didn't suffer and to be scooped up by my brother's family so my feet remain on the ground with a relatively clear head.  We come from a family, my brother and I, that is relatively undemonstrative and unemotional.  Excess anything would be frowned upon, no matter the circumstances.

This led to an interesting and informative discussion last night with my sister in law, a devoted and dedicated cardiac nurse.  She does a phenomenal job; I don't know how she finds the strength to deal with death and dying patients every week.  We talked about the differences in the US and UK healthcare systems and how NICE impacts the access to new treatments.  We both agreed that a single unified national decision and formulary is much fairer than the post code lottery that exists at the moment, where someone in Cardiff can get access to newer, better, treatments than someone in say, Hull simply because their primary care trust has a different formulary.  The inequities of that system seem unfair at worse and silly at best; the UK is one country not always united in consensus.  Different healthcare trusts will take the NICE decision and implement them differently depending on their budget decisions and constraints.

How does this affect the US?  Well, firstly this sort of healtheconomic analysis is inevitably coming across the pond, so manufacturers had better get used to the idea that different cancer drugs may be restricted in the future.  After all, my mother's illness and peaceful passing made me realise that let's say she had lung cancer instead of congestive heart failure.  Would an extra few weeks or a month had made any difference?  No. It only prolongs the pain and agony for all around if the diagnosis is clear. 

There is no cure for advanced cancer, data is measured in increments of survival, usually by a matter or a few weeks or months.  But at what cost?  Is spending $50,000 for an extra month of life really the best we can do?

It is my hope for the future that as we learn more about the science and biology of disease, we will develop better, more targeted combinations that shut off the critical aberrant activity that leads to cancer, thereby leading to significantly longer progression times than we have now.  After all, the success of Gleevec has lead to patients life expectations improving from 3-4 years to a much more robust 10 years plus.  That's a huge improvement, not a couple of weeks.  We must not forget, however, that personal responsibility to one's health and fitness should play a much larger part than it does in many cases. 

How should we help further better patient education and, more importantly, action for change? 

There will be no blog updates this week

Due to an urgent and critical family emergency, this blog will not be updated this week while my time and attention is focused elsewhere on loved ones.

Many thanks for everyone's patience.

Normal service will hopefully be resumed sooner rather than later.

Social Bookmarking finally comes to serious cancer journals?

I was checking out a paper today in Molecular Cancer Therapeutics and was rather surprised, nay astounded, to see a prominent link to social bookmarking (see graphic).

Wow!

Guess what the options were on clicking the link? 

• Delicious
• Digg
• Connotea
• CiteULike
• Complore

Complore?  What the hell is that?  Oh, a site for Indians studying for their MBA entrance exams for qual and quant analysis, it seems.  Eeek, what is that doing in a cancer journal?

No StumbleUpon, Mendeley, Zotero, Diigo? 

It seems a bit of an arbitrary list but hey, we technology friendly scientists should be pleased to see any bookmarking I suppose, but still. The only one I personally use in their list is Delicious but increasingly prefer Zotero and Diigo for social bookmarking. 

Ah well, I look forward to seeing a Share This widget, then you can choose your sharing options more freely.

Are these appearing in mainstream journals in other therapy areas?

If so, that's a good reason as any to have some fireworks on July 4th ;)

Posted via email from sallychurch's posterous

Where do patients and consumers go for online medical information?

This was an interesting question a client asked me recently.  The answer wasn't entirely surprising judging from the May Hitwise data below:

Source: Hitwise, May 2009


The Hitwise data featured is based on U.S. market share of visits as defined by the IAB, which is the percentage of online traffic to the domain or category, from the Hitwise sample of 10 million U.S. Internet users.  Hitwise measures more than 1 million unique websites on a daily basis, including sub-domains of larger websites.  Hitwise categorizes websites into industries on the basis of subject matter and content, as well as market orientation and competitive context.  The market share of visits percentage does not include traffic for all sub-domains of certain websites that could be reported on separately.

Let's look at the trends behind the data.  WebMD has been around a long time and has built up and earned a reputation for high quality medical information on a variety of topics.  It also manages a nice mix between information from health care professionals, sponsored topics and homely down to earth information on very complex issues, including glioblastoma.  I have used this tumour as a baseline for comparing the top three sites in what kind of output they generate:



The Mayo Clinic is probably one of the top hospital sites for offering quality and timely information about health related topics, although we can perhaps forgive them for some of their more sensational press release headlines recently, which would be more suitable for a tabloid than a venerable institution.  Sadly though, their information on various cancers, including glioblastoma, is rather sketchy at times as this search showed.  It is rather surprising considering they are a nationally recognised cancer centre:





RighHealth is a new up and coming player in this field.  They also have the Kosmix search tool as their engine driving the data mining, which is extremely useful for contextual medical searches.  Rather than have tens of pages about brain cancer, for example, RightHealth organise the information into several categories, making it much easier to decide exactly what you are looking for at a glance, like this:




You can also scroll down and gather plenty of other information about topics relating to brain cancer news and blogs.  However, the disadvantage of this site is the weird juxtaposition of totally unrelated diseases appearing in your search.  In this case, I'm not sure what crohn's disease and ulcerative colitis has to do with brain cancer and glioblastoma?  In the past, I have seen information on prostate cancer pop up in a side box while searching for information on breast cancer.  That's rather disconcerting and a doesn't inspire confidence in the search results at all; ideally you want relevant, up to date information on just the words you are searching for, not some sponsored deal that vaguely relates to health matters rather than say, autos or insurance.  This is something RightHealth need to fix or at least understand their medicine a little better or it will be a bitter pill for the patient to swallow.

I was a little surprised not to see About.com appear in the list considering it's principal focus is on providing simple and easy to understand information for patients.  Perhaps they could do with a web2.0 makeover though because on checking the site the information was rather turgid and poorly presented from a user experience perspective:



A little known secret is that you can find more detailed and relevant information about clinical trials, news, up to the minute conference summaries on medical topics via WebMD's sister site, Medscape.  It's free to register and sign in but gives you much more detailed and interesting intelligence on which to make an informed decision.  I should disclose that I have written and interviewed key opinion leaders on various cancer related topics, but was using the site independently for some time before that. 
Overall, it's a mixed bag for medical searches and easy to see why WebMD dominates this space. 

Happy July 4th weekend!

Image by Stuck in Customs via Flickr

Well, perhaps not if you're British ;).  Oh the irony!

While everyone else here in the US is out celebrating, I'll be working and catching up on the backlog so it will be nice to be free for new projects due to start next week.

Is there ROI with social media?

Trying out shiny new things is always a balancing act but corny though it sounds, fortune often does favour the brave.

Check out this thoughtful but fun blog post from Thinking Pharma, the new kids on the block....

Posted via email from sallychurch's posterous

Normal people vs. scientists

Love this one... from xkcd:

So true ;-)

Posted via email from sallychurch's posterous

Pfizer discontinues Sutent in colorectal cancer

That was the lead headline screaming from my intelligence database this morning, from several sources.  On checking the Pfizer website, to verify the information, I found the following in a terse press release:

"Pfizer Inc announced today the discontinuation of the SUN 1122 Phase 3 trial that evaluated Sutent^® (sunitinib malate) plus FOLFIRI (irinotecan plus infusional 5-fluorouracil and leucovorin) versus FOLFIRI alone for the first-line treatment of metastatic colorectal cancer (CRC).  The independent Data Monitoring Committee (DMC) found that the addition of sunitinib to the chemotherapy regimen FOLFIRI would be unable to demonstrate a statistically significant improvement in the primary endpoint of progression-free survival (PFS) compared to FOLFIRI alone, in this study.  No new safety issues were identified."

It would therefore seem that small molecule TKI's are not the way to go with this disease given that Novartis' vatalanib also failed in phase III trials of a similar nature.  Genentech's Avastin acts differently, targeting the outside of the receptor as a monoclonal antibody.

For Pfizer, this represents another major setback with Sutent after the recent failure in breast cancer studies.  Prior to that, the company terminated two other compounds in phase III development, namely, esreboxetine for fibromyalgia and PD 332,334 for generalized anxiety disorder (GAD) so 2009 is not turning out to be a stellar year for them.

Chasing blockbusters is clearly not all it is cracked up to be. 

Contrast Pfizer's experiences with Novartis approach by following the science rather than the money in a Business Week article.  Ilaris, an IL-1 inhibitor, has just been approved by the FDA for a rare autoimmune condition known as Muckle Wells disease.  This development follows a similar strategy to that taken by the company with the development of Gleevec, ie focusing on the biology of the disease and finding a targeted drug aimed at the critical mutation.  The result?  Over 90% of children and adults suffering from the immune disorders that the drug was designed to treat experienced rapid, sustained remissions.

Related articles by Zemanta

• Pfizer discontinues Sutent in breast cancer (pharmastrategyblog.com)

The Cluetrain Manifesto ten years on

In many ways, things are probably going a lot faster than many of us realise in the digital age as blogging and RSS aggregation gives way to lifestreaming and real time information...

  
Download now or listen on posterous

Memo.m4a (3087 KB)

Sent from my iPhone

Posted via email from sallychurch's posterous

The complexity of cell signalling pathways in oncology

If we take a look at the IGF-1R pathway shown in the diagram, we can appreciate the sheer size and complexity of tyrosine kinase blocking downstream of the receptor. 

One of the more recent trends that is showing up in clinical trials is to combine an mTOR inhibitor such as everolimus or temsirolimus, with an IGF-1R inhibitor such as NVP-AEW541 (Novartis) or IMC-A12 (ImClone), in solid tumours such as GIST and or liquid tumours such as lymphomas.  The benefits of this strategy may outway the potential downsides, given the ubiquity of IGFR expression.

Another, similar, approach is to combine the mTOR with an EGFR or HER-2 inhibitor.

It remains to be seen whether receptor and downstreaming blocking will add any improvement in efficacy without introducing significant side effects, but intuitively, the approach makes sense and may even lead to a delay in disease progression or the development of resistance.  Indeed, it is possible that patients may respond to different therapies, leading to the identification of new biomarkers for determining a more personalised approach to the treatment of cancer.

Time will tell.

Posted via email from sallychurch's posterous

links for 2009-06-30

• Health Savings Accounts: Much Ado About Nothing | BNET Healthcare Blog | BNET
  Overall, AHIP says that 6.1 million people had HSA-eligible high-deductible plans in January 2008, and about a quarter of them bought those policies in the individual market, where workers without employer-based coverage seek insurance. But if only half of those people have HSAs, and the rest just bought high-deductible policies because they couldn’t afford anything else, CDHPs are having a relatively small impact on the 47 million uninsured.
  (tags: healthcare cost benefits savings HSA)
• Cancer Therapies: How Much Is Life Worth? The $440 Billion Question
  The authors illustrate cost-benefit relationships for several cancer drugs, including cetuximab for treatment of non-small cell lung cancer, touted as "practice changing" and new standards of care by professional societies, including the American Society of Clinical Oncology. They ask, "Is an additional 1.7 months [the additional overall survival for colorectal cancer patients treated with cetuximab] a benefit regardless of costs and side effects?"
  (tags: healthcare cost oncology drugs survival health economics benefit)
• CQ Politics | Is Preventive Care a Cost Saver?
  "The reason preventive care doesn’t save money is simple. To prevent a single stroke, for example, doctors must treat thousands of people who have high blood pressure and therefore are at risk of stroke. The same goes for use of cholesterol-lowering statin drugs, which can prevent heart attacks."
  (tags: prevention healthcare cost epidemiology risk)

A (very) short Podcastlet

We're all busy these days with so much information that it can be overwhelming.
 
Here's a one minute audio I just tried on my iPhone, take a quick moment to listen and tell us what you think of the amazing things you can do with modern technology....

  
Download now or listen on posterous

Memo.m4a (2955 KB)

Sent from my iPhone

Posted via email from sallychurch's posterous

The evils of audio translation and it's relation to Pharma

Image via CrunchBase

One of the big challenges with the Web2.0 world is as more services provide audio through YouTube and other tools, the ability to transcribe and translate into the written word has yet to catch up with reality.  We've all experienced the vagaries of Google Translate on websites, but what about audio files? 

A while back, I enthusiastically tried out some apps available on my iPhone with the idea of testing them out for authenticity and accuracy for business purposes.  These included ReQall and Jott.  Now, even bearing in mind I have a British, not American accent, it was a bit of a surprise to be reading a translated shopping list and finding I needed an item hilariously called "break your knees" and other such gibberish.  Sadly, I was at the checkout before realising that it actually meant 'frozen garden peas'!

It was therefore with great amusement that I read an interesting article in the New York Times this morning about Google Voice.  Here is one such snippet:

"Sunday schnitzels cripples"?  Yikes, I'm glad my accent isn't the only one that gets mangled by the computer algorithms!!  

A few years ago, we used to send CD's of physician interviews off for medical translation and of course, they would come back with some absolute gems and pearls, necessitating having to listen to the whole thing again to tune up the quirks and strangulated medical terminology.  After a while, we began to think maybe it was easier to do it ourselves, at least it would be accurate, if time consuming.

Having just signed up for Google Voice, it will be interesting to see how good the service really is, but raising ones hopes too much is probably not a good idea after reading the hilarity of the examples in the Times article.

How many of us have started to get those small Flip video cameras for posting content to the audio web via YouTube, Qik, UStream, Viddler, Vimeo etc?  At $200 a pop for a point and shoot, the costs are now so low that a major barrier has been removed for the masses to take advantage of new technology without needing a Ph.D to figure out the weighty and complicated manuals.

Recently, Fred Wilson of A VC described how the API could be used to get a written translation of a half hour long interview from a YouTube video.  Most of us can scan text and mine it for key points relevant to us much more quickly than listening to an audio presentation without written cues.

Many of us listen to Pharma and Biotechnology analyst presentations regularly, but again, these are time consuming and there is many a time when I would rather download the presentation and a transcript for easy offline review while on a train or plane than having to sit through a live or recorded webcast for an hour at an inconvenient time, and of course, you don't where or when the relevant items of interest will pop up, forcing you to sit through the whole thing to get a small nugget of intelligence that might actually be valuable.

Still, in the Pharma world, imagine if you could accurately translate audio from the web, which included patient sentiments about brands, diseases or even companies?  That would be very powerful indeed, especially with significant growth in online communication expected to come from video over the next few years.  Being able to analyse the ideas expressed in the aggregate would be a really useful tool for social media monitoring.

Watch this space for further developments in the near future.

Quiet reflection is sometimes a good thing...

These pictures were taken from a basic point and shoot camera on a business trip to Milan, Italy.  

Away from the hurly burly of life and meetings, it is sometimes good to find time to reflect and recharge the batteries.  The trip allowed me space to be absorbed in new scenery, sights and sounds and yet, all the while, my brain was subconsciously creating new ideas.  Some were captured in my trusty moleskine, others live on in the photos, since they trigger the memories of the moment.  

These creative thoughts have since formed the backbone of some new company projects we are rolling out and also working with various partners on.

When was the last time you allowed time for reflection and renewal?  What do things do you to stimulate creativity?

See and download the full gallery on posterous

Posted via email from sallychurch's posterous

links for 2009-06-26

• Knowledge Architecture for the 21st Century: The Napa Group Model for Sustainability
  A description of inter-and intra-generational sustainability, based on the "Napa Tetrahedron," of a general model for sustainability usable in many situations and by many groups to provide a tool for communities to define the elements they value and need to work together toward common goals.
  (tags: KM Napa Tetrathedron Models Communities Sustainability)