Words by Louise Rogers
In the 1985 blockbuster, 17-year-old Californian teenager Marty McFly is accidently sent back to 1955 in the time machine his friend Dr. Emmett Brown (Doc) has made from a DeLorean sports car. As their time-travelling adventures begin to unravel, the pair must work together to prevent irreparable damage to the year 1985 and beyond so they can travel back to the future they left behind. Travel forward to 2019 and the healthcare industry is calling for its own Flux Capacitor (the core component that enabled the DeLorean to time travel); many pharma professionals have of late made reference to 16th century Chinese medicine, where doctors were paid to keep their village healthy and not incentivised by the coming of sickness – it seems they understood that prevention is better than cure. The task at present? To go back in time to this preventative model to fashion a better future for healthcare.
“The reality of today is while we keep adding value to our products, the only way for our price is for it to go down”, voices Kris Sterkens, Chairman, Janssen, EMEA, at eyeforpharma Barcelona. “Our breakthrough medicines are not getting reimbursed, and when they do it’s with significant delays running into years. Even the land of free pricing is coming to an end”, he continues, referring to the drug-price Senate hearing that took place at Capitol Hill in February. The verdict? The current business model is broken, and even though it may still work in pharma’s favour by increasing profits year-on-year, “if all the other stakeholders don’t believe it’s working then we have to take that perception as reality.”
Sterkens accentuates his point of pharma’s constraint with the German phrase ‘eisenbahnscheinbewegung’ – the pseudo sensation of moving forward on a train, when in reality you are only seeing the train next to you making headway. “That is the risk we face as an industry if we do not change. We will be left in the station, while the tech companies and whoever else take healthcare to the next level.” Pharma and tech’s future venture together is no newly laid track; their alliance has a constant presence in industry conversations, with the realisation that if pharma do not find a way to fully integrate tech into their ecosystems, they will unquestionably be priced-out.
This is the direction technology is heading in; it’s essentially a GPS for your health
“So, what does the future business model look like?”, Sterkens asks. “A few things come to mind. We need to start moving earlier in the treatment before disease symptoms show. We may even get to a place where we can predict, before the disease manifests.” He brings forward the idea of a circular economy model: pharma’s own version of Spotify or Netflix, where instead of paying for a product we would all pay a flat fee for a service. “Another idea could be to have a pre-agreed outcomes-based model for indication: the longer patients stay on the medications, the lower the price. Outcomes-based medicine, value-based healthcare, pharma and technology working together – that is the future and our opportunities will be unparalleled. But to make this happen, we have to create alignment with our stakeholders.”
“It’s not just a technology issue”, voices Brent Saunders, Chairman, President, CEO, Allergan. “It’s also a will issue”, broaching the subject that the biggest fight we face today in healthcare is actually the one against our own nature. He gives the example of heart disease: “99% of cases can be solved preventatively with diet, exercise, and statins. The truth? We don’t like to exercise, we like to eat, and no-one wants to take a pill every day.” Although not untrue, this statement only scratches the surface of the web of human behaviour.
A better understanding of behavioural intervention to treat, intervene in, and prevent disease has been acknowledged in recent years. We know that the one-size-fits-all medicine approach does not even closely fit all, and out of the factory comes personalised medicines. The same holds true for behavioural interventions – not all techniques work for everyone. Representing behaviour science in managing and preventing disease at eyeforpharma is Jennifer Turgiss, VP, Behaviour Science & Analytics, Johnson & Johnson Health and Wellness Solutions. “In behaviour science and digital healthcare, the reason that so many patients get left behind is because of this one-size-approach.” Using AI and machine learning, Turgiss’ team build digital programs to tackle behaviour change, which can adapt and deliver different solutions based on the individuals engaging with them.
“This is the direction technology is heading in; it’s essentially a GPS for your health”, explains Turgiss. “The user has a journey and is heading in a certain direction. Maybe the journey is to quit smoking or to manage stress levels. Along the way, instead of taking a left, you take a right, so then the system will need to readjust to the changed course and will need to figure out a way to get you back on track relative to where your starting point was.” Turgiss echoes Sterkens and highlights how the challenges that face the industry with tackling prevention lie with the current business model. “Until we can figure out how to fund prevention projects, it will just remain a good idea that is never fully executed.”
Slowly but surely, individuals are warming to the idea of prevention models. The 2016 Kendrick Consulting research shows that 63% of consumers in the top 20 markets want disease prevention programmes in place. A year later, PwC report that 85% of US consumers would be willing to pay in advance for disease treatment. “Where do patients go for care and prevention? They go to the consumer and wellness industries”, voices Bharat Tewarie, EVP, Chief Marketing Officer, UCB. “The Global Wellness Institute estimate their market to be a staggering $4.2 trillion with a growing rate of 6.4%. So there is a market, but it’s happening outside pharma.”
Your comfort zone is not where you need to be, because the magic happens somewhere else
The term ‘immorbidity’, coined in 2013 by Jaap Goudsmit, Senior Advisor Prevention, Janssen, is defined as ‘spelling out a life free from disease’. The novelty of the word itself is matched only by that of its concept – the idea that it could be possible to live in a disease-free utopia. Sterkens addresses the room: “For those of you who think staying in the current business model is the safest thing to do, I have to tell you it’s probably the riskiest. Your comfort zone is not where you need to be, because the magic happens somewhere else.”
There is a moment in Back to the Future when McFly realises he can’t get back to 1985 using plutonium, which is what the DeLorean runs on. Rather than attempting to build a new time machine, we see McFly and Doc generate the necessary 1.2 jigowatts from a bolt of lightning. Innovation doesn’t always mean creating something new; sometimes the best path to innovation comes from existing ideas and concepts, much like our journey back to 16th century China to seize the model of prevention and take us one step closer to a world free from disease.