Dr Elizabeth Fairley, COO and co-founder of social intelligence company Talking Medicines, explains how technology has shaped the drug landscape and why actually listening to patients might be the breakthrough the industry needs.
There are more drugs on the market today than ever before and the drug pipeline is massively more accelerated than it was ten years ago. How can the industry make sure that the drugs are reallydoing what they’re supposed to? How do we get it right? Not just once but five times: the right patient, the right drug, the right time, the right dose and the right route.
We are seeing immense advances in the way in which drugs are developed, in particular the availability of real world data and health information for researchers. In recent years technological advances are bringing the patient to the centre of healthcare in a way that hasn’t been possibly at the scale that the drug industry requires it.
There is much more recognition of how a drug can work within a particular setting and how it might actually perform for a patient. Technology and the advances of trying to understand how they work within patient environments, or in the body of a patient has been huge.
Digital health brings together digital technologies with health, healthcare and care programs, living and society to enhance the efficiency of healthcare delivery to make medicine much more personalised and precise.
Suddenly, we’re able to get beyond diagnosis and disease management with digital healthcare. We’re now capturing online conversations, digital care programmes and the utilisation of digital apps for health care, fitness and mental well-being. And more than that, we’re now able to make sense of the vast amount of data that is at our fingertips.
Without technology, drug development processes would be considerably slower and less efficient. In the past, it was more set on the biochemistry. Now, with the advances of chemical libraries, sequencing of the human genome, medicinal chemistry to optimise affinity, efficacy and stability, targeted therapeutics can deliver innovative new medicines that improve health and quality of life.
Patients are now being involved earlier in the drug discovery cycle too. Active patient participation in clinical trials has many benefits such as offering more information on the latest treatments and technologies and being able to access new drugs and treatments.
The traditional development lifecycle is just so long for research and development. The point where some clinical trials get into difficulty is that transition between a medicine that has been tested in a lab environment and testing on a real cohort of people. This has always been a challenge; however, technology has enabled the sector to be able to optimise these phases and speed up the process.
Technology has definitely given us more of an idea about the genetic makeup of individuals. This combined with the greater willingness to share information cross sector has ended up in the development of some seriously revolutionary medicines.
Biologics are a really good example of this. They’re more in line to treat the patient in the hope to cause less side effects and adverse reactions to drugs that the patient is taking. This shift to injectable technology has bolstered efficacy and performance. The advantage of this is that less of the drug needs to administered to provide benefit to the patient. There are also better dosing options, you can start patients on a lower dose and increase incrementally, fine tuning the drug delivery.
While the industry has always had blue sky thinkers (because innovation is what drives pharma), it could be said that the sector has been slow to embrace technology. Given this new patient-centric movement, the industry has realised that that is one of the best ways that they can get maximum information.
There has been a growing realisation that pharmaceutical companies must change if they are going to enable and harness technology even more successfully.
There has been a recognition that digital expertise must be brought in and that there must be digital working alongside robust science. In the scientific world it’s all about measurement and it’s the same in the digital world. Bringing the two together is what really accelerates it.
By bringing in the patient into the journey a lot sooner than just in the clinical stage of drug discovery, huge advances can continue to be made. There’s a slight reservation about actually talking to the patient. The apprehension is understandable as there are huge barriers to be overcome from a regulatory and compliance standpoint.
It’s curious but the voice of the people taking the drugs – the actual patients – hasn’t been as loud as it should have been. That’s despite extensive evidence that listening to patients and learning about their experiences can dramatically improve drug development, delivery, and accessibility, as well as patient support.
What we’re finding first hand is that the technology can identify barriers to access and opportunities for growth, and provide enhanced support for optimized health outcomes. We’re now able to assemble information about patient experiences with existing drugs which wouldn’t have been possible without technology.
In the work we’re doing, we can now gather patient voices from a number of different sources and cleanse and structure the information in a meaningful way. Conversational data can be derived from social media sites and forums where people discuss their experiences with diseases and medicines. This can be blended with information with data gathered directly from people using our connected devices as well as through patient surveys.
With data blended from so many different sources, we’re now starting to hear new things that are valuable to the industry. By getting close to people and learning in detail about the experiences they are having with the medicines they are taking we can be of assistance to patients with regard to managing their diseases. And we’re able to act as a translator, interpreting between the different language spoken by patients and medics, an approach which assists in diagnostics as well as disease management.
it is important that patients are listened to, especially as they are being brought in to more of the decision process across diagnosis and the management of their conditions and treatment. It is vital that the patient is kept safe to drive the better health outcomes.
By better understanding the patient experience – how individuals feel when taking their medicines in the real world – we will see many advantages such as improved drug efficacy and safety outside the clinical setting as well as accelerated trial times.
And this has had a significant impact across all aspects of digital health – health, care, living and society.
There can be scepticism about this kind of data from patients ‘in the wild’ . There can be a belief that as it’s so unstructured, how could you possibly pull any meaning from it? But we’re seeing huge shift in people using technology to actively monitor their own personal health and wellbeing. And with this, individuals are becoming more educated, playing a greater role in disease diagnosis and treatment. And one thing for sure, people tend to know how they’re feeling.
People are being much more vocal. Perhaps they’re experiencing feelings, symptoms for weeks and they’re trying to persist with a drug they’ve had prescribed. Maybe they’re struggling with taking a drug which isn’t seeming to show any benefit, and they start to seek out who can answer their questions. There’s a different wave that’s coming through where people are just much more plugged in, speaking more vocally and looking for others to share experiences with or to learn. It’s not all done by opening and shutting a textbook.
Technology can be a double edged sword though and one of the greatest challenges for drug development is keeping public trust in doctors, that they are very much best placed to advise patients. People can find information pretty quickly about a disease online, that goes for anyone not just health experts.
Patients will go online and use the available information to try and self-diagnose. They might try and buy a few drugs that might do all sorts of things. And that’s hugely dangerous. We have got to embrace new technologies and bring them in to drive better care and better outcomes as a whole. People self-diagnosing and self-treating is not where we want to be going.
But the benefits of technology in drug development far outweigh the problems. For people who are sick, the drive to discover and develop new drugs is paramount. That’s especially pressing where there is unmet medical need – where there is no or little knowledge for diagnosis, prevention or treatment.
The pharmaceutical industry is opening up to spending more time and resource understanding if a drug can be approved across multiple therapeutic areas. Especially about what, how and why people are taking medication to manage their conditions.
Understanding similarities between conditions, behaviours that people are experiencing has value.
This is really important and valuable for the optimisation of approved treatments as well as speeding up development by understanding how patients are experiencing a drug that is similar to the one that you’re developing, really helps on medicine advancement and production.
Using technology to get a co-med view is really important too. There’s a huge opportunity for combined drug that could be even more effective, to help to manage disease.
One interesting drug development is an “anti – aging” drug. In studies of more than 900 people this drug and others like it reinforced aging immune systems and cut risk for respiratory diseases. A version of the drug could win FDA approval in 2021, saving the lives of 1M people each year that have suffered from winter colds, flu, pneumonia and other respiratory tract infections. This would be a phenomenal breakthrough that definitely would not have been feasible let alone considered 5 or 10 years ago. Then there’s the work being done to develop COVID-19 vaccines. The speed at which vaccines have been manufactured and the early stage efficacies we are seeing for these drugs is absolutely phenomenal and incredibly impressive.
Since the emergence of the COVID-19 pandemic, Talking Medicines has seen a higher level of engagement, with people increasingly concerned about existing health conditions. We have also been purposefully listening to the discussion about the pandemic and conducting surveys to determine how it is perceived and the impacts it is having over time.
In one respect, the pandemic is bringing two different worlds together — those of COVID-19 vaccine developers and the people who need the vaccine. Opinions about the pharmaceutical industry are slowly changing as people are gaining a greater understanding of the complexity of therapy and vaccine development and the truth about the cost and time such efforts entail. We are also seeing a greater recognition of the positive impacts that medicines have on people’s lives. Pharmaceutical companies tend to engage with patients through what market research, healthcare professionals and patient organisations tell them. What’s been missing is the ability to work directly with patients, and the mutual benefits this relationship brings to both sides of the table.
The COVID-19 pandemic has changed attitudes to the use of technology in drug development in the best possible way. From a public perspective, people have realised that technology is our best shot at realising fast and effective treatment solutions which we all so desperately want and need.
From a governmental and industry standpoint – we have seen huge advancements in COVID-19 treatments from the technical collaborations that have occurred amongst a multitude of pharmaceutical companies and government bodies. We now know sharing of data and information can propel drug discovery and development.
Without a shadow of doubt, the pandemic has been a moment of reflection for the industry. They have realised it is unnecessary to have hundreds of field based sales operatives and will move towards a new small and agile sales force.
Furthermore, we expect marketing to become more patient centric, as companies will need to demonstrate that their brand adds value to patients. Pharma will need to offer a package of products and health services that the market not only wants and needs but is willing to pay a premium for. The pharma industry will no longer be rewarded for incremental innovation, me-too products and selling the most pills.
Generally, there is still a lot of work that needs to be done. The industry is embracing its patient centric label, however they need to learn how to collect patient information ethically and how best to use it to improve outcomes.
Dr Elizabeth Fairley is COO and co-founder of Talking Medicines. The company uses AI to provide a systematic way of measuring patient sentiment towards medicines, helping pharma deliver a greater return on investment for marketing, and better health outcomes for patients. For over a decade, Dr Fairley has worked with pharma partners (from early stage start-up to big pharma) to understand their needs to present potential partnership and investment opportunities.
