Biomedical Science vs. Health

Great article on NIH science.

http://articles.boston.com/2011-06-19/bostonglobe/29677537_1_nih-medical-research-health-care

I have been talking about this for over 15 years. I remember back at a FASEB meeting in Washington DC about 12 to 13 years ago when there were a three Senators and Congressman on a panel talking about the need to provide science that is of value to the public from the public's perspective. One person argued that grants are "independently reviewed". When questioned by the politician as to who is on the review boards, the person answered "a committee of our peers"! Case dismissed!!! Then while at the FDA during the '90s I would go to the occasional NIH internal meeting and mention how the NIH would be judged by the public based on the number of products that would make it to FDA review and approval. Not a popular stance.
This is long overdue. The article talks of the NIH director Francis Collins setting up an Institute for Translational Medicine. This is after NIH killed translational medicine over the last 20 years.

I am not saying that biomedical research is not of value but I am saying there needs to be a long hard look at the nature of the research which is what this article refers to. It's about time!

On standards in medicine

http://blogs.forbes.com/davidshaywitz/2011/06/21/standards-and-medical-practices-a-cautionary-prognosis-for-algorithm-based-care/?utm_source=alertsnewpost&utm_medium=email&utm_campaign=20110621

Very interesting article on algorithms in medicine. The first point is that the use of algorithms is a significant improvement than the existing practice of medicine. This leads to the main challenge in health care, and I believe it is because of the way medicine is practiced, i.e. the patient is kept out of the process, resulting in the patient perception that medicine is a science. Patients need to understand that medicine, unlike sciences like maths and chemistry and physics, is not a science, it is much more of an art. This leads to the concept that medicine is constantly evolving and improving which means the medicine of next year will be more concise than what is practiced this year. In other words, what is practiced today is not wrong at the time of practice, but patients can expect, just like consumers, that the next "version" will be improved. Algorithms will enhance this process.

And one more point, it is naive to think (again the perception that the industry tries to portray to patients) that each patient will receive a truly individualized management paradigm.

Just as I expected!

I was intrigued by the notice today that Nestle is buying the company Prometheus. This really is what I would be expecting from an intelligent company trying to make moves in creating a new industry.

It is ironic that about 4 years ago, while I was with Pfizer, I was asked by the Business Strategy group to be involved in a due diligence of a visiting company, Prometheus. I heard their presentation and was very enthusiastic on their strategy. I pushed Pfizer to invest but it was to no avail. Would have been a great return.
But this is very exciting news. The link is:

http://www.sfgate.com/cgi-bin/article.cgi?f=%2Fc%2Fa%2F2011%2F05%2F24%2FBUOV1JK5EI.DTL

This is a move for Nestle to enter health care. This is not necessarily the best move for establishing personalized nutrition. But it is clear that the Nestle strategy on personalized nutrition is unclear.

But it is very encouraging.

Australian Health Care Industry

I have been back in Australia for about 10 months now. Worked and networked with a lot of people from academic, government and private sector. It really isn't an industry rather a collection of companies and attempts at companies. There is a constant remark that tries to compare to the Israeli biotech/medtech community. No comparison. It really is a cultural thing!

Their is a lot of nice technologies here but there is a sense of trying to model on the US system. There is a genuine recognition that the Australian population is on a whole too small to make a financial success so the successful companies generally revolve around considerable accrual of frequent flyer miles!

It is unfortunate that this is the situation. It tends to inhibit the ability of obtaining an Australian "brand" in this space. The big three, CSL, Cochlear and ResMed are always referred to but this does not make an industry. There is no continuity and it consequently makes a hard sell of Australian biotech/medtech. Difficult situation.

Australia needs to develop its personality as a player in the global health care world.

More to follow on this in future blogs.

Back on line

It has been a turbulent few years for me. Moved from the pharmaceutical industry to the molecular diagnostics industry to the diagnostics industry and the Health IT industry. It taught me a lot. By "living" in these health care sectors, it made me realize and understand even more why the health care sector is broken. The business models for all these industries are out of synch with the payers, providers and patients. It is a product push approach working in a service industry! I left the US for personal reasons and moved back to Australia after 35 years. Australia is so much easier than the US and is financially in a better place. It is not as I remembered. There is more tension in the major cities but certainly far less than the US. The health system here is supposedly better as you hear that it is free. It is free if you are out of work! But for those employed it is a percentage of your income and then there are costs for services and products above this. Still trying to learn the system.

But I do consider Australia to be "the greatest clinical trial in the world"!

More on this, just wanted to get back on line.

The beginning

The healthcare system of today is dysfunctional. There are tens of millions of Americans uninsured. The variability in US healthcare is unacceptable. While on an average it may compare with Canada or European countries, the level is unacceptable considering the massive costs of healthcare and the rate at which it is increasing.
In addition, from a global perspective, in Third World countries, healthcare is at an atrocious level.
It is obvious that the system is not working both nationally in the US and internationally.
The healthcare industry is different from other industries. Generally, in the US, business opportunities are developed according to a "market pull" concept where the development and commercialization of a product is based on a customer need. In contrast, healthcare products are driven by the technology, often referred to as "technology push" . The rates of attrition of pharmaceutical agents is way higher than is considered acceptable for product development in other industries. The medical device industry also has higher levels of attrition. While the blame for this is usually put upon the high regulatory hurdles, it does not take into account the failure rate based upon factors such as lack of innovation and unsuccessful commercialization. This aspect of the healthcare industry is not often spoken of. This is why the age of the "blockbuster" pharmaceuticals cannot survive its present direction.
The problem begins and ends with the fact that there are no strategies in the healthcare industry. All marketed products are directed towards the physician. In addition, there is a strong impact of product reimbursement, payer formulairies, and prescribing practices by the doctors.
And with all of this, how often do you hear of the actual end user...............the patient..........the consumer?
This column will focus on my experiences with healthcare and the many factors that influence it. As someone who has worked in varoius aspects relating to healthcare for over 25 years, I have never had a problem getting out of bed and heading for work. The thought that my activities/actions can impact many lives is a great motivator. However, I have seen and continue to see tremendous waste, redundancies and actions that would not be tolerated in any other industry.