The UK’s first GP consortia have been launched in Cambridgeshire.

The two consortia will have control of all commissioning in their areas and have access to a budget of around £215 million. However, the PCT will still have to approve spending decisions until the Government changes the current legislation.

The Hunts Health Consortia is made up of 10 practices, while the Borderline Commissioning Consortia will make funding decisions for four practices.

The progress of the consortia will be assessed after twelve months and the PCT plans to form four more during this time.

NHS Cambridgeshire Chief Executive Dr Paul Zollinger-Read commented: “Our aim is to improve patient experience, services and outcomes at the same time as using resources more efficiently. We hope that more GP consortia in Cambridgeshire will be in a position to ‘go live’ in the near future.”

GlaxoSmithKline has been forced to abandon trials of its genital herpes vaccine, after it was found not to prevent the disease.

This is big pharma’s third product disappointment in the last few days, after prostate cancer therapies manufactured by Pfizer and AZ also failed to meet their primary endpoints.

Further investigation into the product, Simplirix (Herpes Simplex Vaccine), was decided against after the results of an eight-year phase III trial, conducted with the US National Institute of Allergy and Infectious Diseases (NIAID), showed the vaccine failed to prevent genital herpes.

Gary Dubin, Vice President and Director, Late Clinical Development at GlaxoSmithKline Biologicals said: “We would like to express our gratitude towards our partner NIAID for their proactive collaboration and substantial contribution in the program and the volunteers for their participation in the study.”

In the rapidly changing NHS Richard Gray, Commercial Director, Cegedim Dendrite UK, explains how technology should be used as an essential component to successful Customer Relationship Management.

For pharmaceutical companies, the ability to share local knowledge and best practice in a timely and effective way will be key to long term success in the new NHS. Customer Relationship Management (CRM) has always been viewed as the solution, but may not have always delivered on its promise under the old pharma selling model. However, as pharmaceutical companies embrace market access and the need to truly share information across different areas of the business, CRM will be key to tracking interactions across every part of the organisation and managing the complexities of stakeholders’ relationships.
The vast majority of pharmaceutical companies may have made the shift to a Key Account Management (KAM) structure in order to respond to the needs of a payer-led health service; but just what support is in place to ensure that a KAM model is effective?
Over the next 12 to 18 months, the NHS is set to experience massive structural change, from the disbanding of Strategic Health Authorities (SHAs) to the creation of GP commissioning bodies. Keeping pace with this change, the new stakeholders, and the way in which the pharmaceutical company is interacting with these individuals – and their network of contacts and opinion leaders – will be essential.
These new bodies will be under huge pressure to drive down costs and deliver efficiencies, all within a totally new way of working, offering pharmaceutical companies clear opportunities to share best practice, shape service provision and build strong, supportive relationships.
It is therefore essential to have an effective mechanism for sharing information across the pharmaceutical company, to leverage insight gleaned during interactions to ensure the specific needs are understood and met according to the overall strategy.

Enabling key account management
But for today’s new generation of KAMs just how is this complex market access requirement to be delivered? How can a KAM ensure activities, from providing health service stakeholders with information within a defined timescale to implementing a strategic messaging campaign, are carried out on time and to the required standard? Does a KAM know that a key target has contacted the call centre for information? Can a KAM track not only which key stakeholders have received a direct marketing email, but which have responded and whether there is any overlap between these individuals – from committee membership to the use of shared GP commissioning services?
In this increasingly complex health service, pharmaceutical companies should not be concerned simply with one to one relationships but also with the extended relationships. Interactions with a stakeholder’s colleague or co-member of a committee can be extremely relevant to the overall pharmaceutical messaging.
So, can CRM solutions really support market access strategies? Can they reach across organisational boundaries to provide access to information across the business from sales reps to medical liaison, call centre to research and development? And, can they really support the needs of the new pharmaceutical KAM?

The extended CRM model
The CRM model for pharmaceutical companies is very different to the way the majority of organisations use this technology. At the most basic level, most non-pharma or fast moving consumer goods companies will use CRM to track interactions from initial customer introduction through to sale. The performance metrics are clear and easily understood.
For pharmaceutical companies however, the complex networks of influences and the multiple ways the organisation will engage with the extended network of stakeholders make such simple performance calculations impossible. Whilst in the past, under the traditional rep/detailing approach, traditional coverage and frequency of visit metrics would have sufficed; with the move to KAM and focused market access strategies that encompass diverse elements of the company, the needs have changed.
Today, pharmaceutical companies require a very different set of metrics that include the quality of the interaction, whether activities are part of a coordinated strategy and the timeliness of information provision. In addition, to the ability to support these diverse metrics intuitively, the CRM system needs also to reflect the unique nature of pharmaceutical data.
Whilst most organisations in other industries will populate their own CRM databases with information from customers and prospective interactions, pharmaceutical companies have a far more complex network of stakeholder contacts to track and understand. Therefore, the role of a CRM vendor changes in this arena; and an ability to provide up-to-date, accurate information that reflects the fast changing nature of the NHS, the new stakeholders in medicines management and GP commissioning groups, as well as pharmaceutical relevant CRM software, is essential.

Customer insight
It is only with this depth of information and the ability to support pharmaceutical specific metrics that a company can put in place a CRM strategy that supports effective market access. Key to achieving this model is the decision from day one to ensure every relevant department and individual has access to the system and, more importantly, also believes and values the benefits the good use that CRM brings – from sales and contact centre to medical affairs. Just providing KAMs with access is not going to suffice; if the customer is to be truly at the heart of the organisation, every part of the business must have access to all interactions.
Of course with this depth of complex, overlapping information, it is essential to ensure each individual understands the data, both how it relates to a specific role or function and its relevance to the overall market access campaign.  CRM systems must be able to display the information intuitively, providing a 360 degree customer view with simple links to relevant interactions such as meetings, face-to-face calls, emails, direct mail and call centre requests.
Within this framework, the KAM can build up virtual organisations and key accounts; which could be a person, a health centre or other NHS body, or just a virtual organisation built from a number of different stakeholders. Providing a KAM with the ability to create the key account, with an action plan and SWOT analysis, is key to supporting this huge transition and achieving really effective relationship management.
Add in real-time mobile access and everyone now has access to all requirements exactly when they need them. KAMs can track project plans, chase up actions and measure performance within a single, trusted, cross-organisational system.
A good CRM system cannot turn a rep into a successful KAM overnight. But without the ability to track the quality of interactions, the timeliness of actions and the relevance of the extended relationship, KAMs will have little chance of implementing successful market access strategies or delivering the local knowledge required to build strong relationships across the new NHS.

Richard Gray is the Commercial Director of Cegedim Dendrite UK.  Founded in 1969, Cegedim is a global technology and services company specialising in the healthcare field.  Further details are found online at www.cegedimdendrite.com. Mr Gray is a regular contributor for Pf; his last article was published in the August issue.

Since the White Paper’s release in July, there have been numerous discussions on its impact on pharma. Jean-Francois Delas, analyses the proposed reforms and how they’ll affect the industry.

Over recent years the UK has pioneered the evolution towards payer-driven healthcare. This has created significant business shifts in both primary and secondary care, provoking a fundamental rethink of pharmaceutical commercial operating and governance models.
Now, with its White Paper, Equity and Excellence: Liberating the NHS, the Government has signalled yet another revolution in the way healthcare is organised and delivered. Although the intent and underlying principles of the NHS reform set out in the White Paper may be laudable, the reality is likely to present major challenges both to healthcare professionals and to the pharmaceutical industry, with a high risk that the ‘new’ commercial models currently being developed and implemented will no longer be fit for purpose.
In response to an evolving healthcare environment involving larger numbers of stakeholders operating at a range of different levels, pharmaceutical companies in the UK have taken the lead in restructuring commercial operations to recognise the increasing influence of payers and patients in addition to traditional healthcare providers such as GPs. Most companies are introducing multi-layered account management structures to handle interactions with these different stakeholder groups, comprising of:

• National management responsible for relationships with the NHS and related bodies
• Regional organisation responsible for relationships with Strategic Health Authorities
• ‘Field forces’ responsible for relationships with Primary Care Trusts and practices.

With the increased focus on payers and other decision-makers, the perceived need for the role of the traditional GP-focused sales representative has diminished in recent years; and perhaps the most visible impact of pharmaceutical companies’ commercial restructuring activities has been the near-unilateral reduction in sales force headcount.

The new health service
The latest healthcare reform set out in the White Paper promises to further change the way care is funded, commissioned and delivered, and is being heralded as the biggest shake-up of the NHS since its creation in 1948.

Funding of care: The White Paper reinforces the commitment to value-based treatments – already exemplified by the move away from the PPRS scheme towards Value Based Pricing by 2014 – with the Government setting out the vision for the NHS to be held accountable for clinically credible and evidence-based outcomes measures. In addition to its current role as HTA, NICE will assume responsibility for the implementation of some 150 quality standards over the next five years which will directly determine healthcare payments. An independent NHS Commissioning Board will be set up to review progress in achieving health outcomes, and allocate NHS resources accordingly.
A new NHS outcomes framework will set out a batch of targets focusing on clinically relevant benefits, to include treatment safety and effectiveness and patient experience. The framework is expected to be in place later this year, ready for implementation from April 2011.

Commissioning of care: In perhaps the most highly-publicised departure from the current system, GPs will be at the core of commissioning with an estimated 300-500 consortia drawn from some 35,000 GPs assuming commissioning responsibility from the existing ten SHAs and 152 PCTs, which will ultimately be abolished. The roll-out of these consortia will be progressive, with shadow entities (to PCTs) established in 2011/12 before full transfer of responsibilities from April 2013. Although GP practices have previously had some responsibility in commissioning services through Practice Based Commissioning, this new responsibility – overseen by the NHS Commissioning Board – represents a key and major change. 
At the local level, healthcare professionals and providers will be given more autonomy, albeit within the guidance provided by a commissioning outcomes framework – derived from the overarching NHS outcomes framework – and will have greater accountability for the results they deliver. On this basis, consortia and providers will have to agree on local priorities. NICE quality standards will be reflected in commissioning contracts and financial incentives, while the NHS commission board will calculate practice-level budgets and allocate these directly to consortia.
Following initial progress with payment by results, the NHS Commissioning Board will refine and accelerate the development of best-practice tariffs – starting in 2011/12. In parallel, a more comprehensive payment for performance schemes is being developed, in which payments will be conditional on achieving quality goals. The longer-term vision and ambition is the move to personal budgets which put patients in greater control of their own health. Pilots will be encouraged in discrete regions, although a more general roll-out is not expected in the immediate future.
Delivery of care: More than ever before, providers will be accountable for delivery of care. Payment will be made on the basis of performance, with Patient Reported Outcomes becoming a key measure and focus. Within the next three years, each NHS Trust will become – or be a part of – a foundation trust, with associated freedom and autonomy under the joint supervision of two independent regulators, Monitor and the Care Quality Commission. The Department of Health will also extend the scope and value of the Commissioning for Quality and Innovation payment framework to support local quality improvement goals. A similar model will be introduced in primary care with the establishment of a single contractual and funding model.
Patients will be given increasing choice in deciding their own care, including treatments and selection of providers. This will be supported by increasing amounts of information on safety, effectiveness and experience, and enabled by allowing individuals to exercise greater control over their health records.

What now for pharma?
To accommodate the future market environment brought about by the proposed NHS reform, two main changes are expected to impact pharmaceutical commercial operations:

1. The nature of the conversation: an acceleration towards value-based discussion
Demonstrating the economic value of treatment is rapidly becoming the common denominator for discussions with various stakeholder groups, and economic considerations are likely to become even more critical for securing market access:
The Value Based Pricing scheme will lay out the foundations looking at a broader definition of value across the whole patient care continuum including post-care and societal costs
The new NHS Commissioning Board is independent of political influence with various financial incentives to make the whole system more productive and effective
GPs consortia will have the freedom to commission with local contracts, funding and incentives designed to reward achievements against targets
There are opportunities for a higher degree of involvement of the private sector to support consortia and delivery of care, reinforcing the focus on financially sound provision of services.

2. The structure of the conversation: devolution of decision-making to the front-line
Compared to the current regional focus for the implementation of national guidelines via SHAs and PCTs, decision-making will now reside with GPs at the point of interactions with customers. In some ways this represents a return to the ‘old model’ with GPs enjoying greater freedom of prescribing decision-making. As well as assuming the responsibility for planning and commissioning of care, GPs consortia will also be expected to be involved in activities such as prioritisation of care, service (re)design and recommendation/evaluation of providers and outcomes.
These two key changes will have direct implications on the commercial operations for pharmaceutical companies. Some will be minor and a natural continuation or acceleration of current initiatives; some are likely to be more fundamental and structural.

Capabilities: In an article published earlier this year, Kinapse discussed the list of future commercial capabilities required by the pharmaceutical industry to accommodate the evolving healthcare environment. These included customer-facing capabilities – such as account management, lobbying, contracting, clinical education, KOL management and patient engagement; and enabling capabilities – including Health Economics Outcomes Research (HEOR) and epidemiology.
Indeed, these capabilities are perhaps even more relevant to sustain the new nature of the conversation as described above, and as such, their implementation should become an even greater priority. However, in order to support the new structure of the conversation, it is critical that the specific mix and content of these capabilities is tailored to address the requirements of the particular set of stakeholders identified in the NHS White Paper.
The mapping of these capabilities to commercial roles within the organisation is also likely to change as the customer landscape continues to evolve. For example, in order to be able to interact effectively with new GPs consortia, ‘field forces’ are likely to need greater training in technical disciplines such as HEOR and epidemiology.

Structure and size: This is perhaps where the proposed NHS reform will have the greatest impact. The proposal to phase out SHAs and devolve planning and commissioning power to an estimated 300-500 GPs consortia will require a comprehensive review of both the structure and the size of pharmaceutical companies’ current regional and field operations. In some cases there will be minimal impact. For instance, regional directors currently responsible for maintaining relationships with SHAs will see their roles slightly modified as they transition to interacting with groups of consortia and the overseeing NHS Commissioning Board. However, in other cases the impact will be more far reaching, with the biggest changes likely to involve field operations – which typically comprise of account managers currently responsible for relationships with PCTs, and representatives currently responsible for relationships with GPs. In order to achieve good coverage of each GP consortium as an independent and autonomous commissioning entity, there is likely to be a requirement for an increase in the size of field operations, primarily in the number of account managers. Although this may imply a welcome reversal of the downsizing trend seen over recent years it is likely to represent a significant challenge for companies to implement, since the skill sets of account managers and representatives are substantially different and there is a relatively limited available talent pool of the former. Faced with limited opportunities to recruit experienced account managers, companies might have to review internal career development tracks. For example, training representatives in the necessary account management skills to perform these roles. However, because of the different skill sets required, this process is likely to be highly time consuming at best, and in many cases may not be possible at all.

The way forward
Although implementation of the full scope of changes set out in the NHS White Paper will span the next few years, the Government is proposing rapid action in the near term – the first changes are proposed to commence later this year with a view to being operational by the beginning of the next fiscal year. In this context it is imperative that pharmaceutical companies begin to consider immediately if and how they need to adapt. A three-stage process is recommended:

Landscape analysis – detailed review of the future NHS
Companies must undertake a detailed review of the likely future stakeholder landscape to determine specifically how care will be funded, commissioned and delivered. The key decision-makers and influencers at each stage must be identified and used to define future commercial requirements.
Organisations will also need to understand the detailed timeframe of the proposed changes to the UK healthcare environment and be aware of key milestones and their implications. This understanding should form the basis of change plans that allow phased implementation of relevant components of the commercial models in response to specific trigger points in the evolving healthcare environment.

Commercial capabilities implications – competencies and roles
The landscape analysis and understanding of future commercial requirements should be utilised to inform an audit of commercial abilities that profiles the requisite capabilities against those which currently exist in order to identify those which need reinforcing/development and those which need to be acquired. Capabilities will be specific to the interaction with particular stakeholder groups.
Requisite capabilities should then be mapped against roles in order to determine which will house the new capabilities. This stage is likely to present opportunities for changes to existing role descriptions and/or for new roles to be created.

Commercial organisation adaptation – structure and size
The final stage of the process is to shape new capabilities and roles into an organisational model and to define the appropriate structure and size. Sizing will ultimately be dictated by workload considerations, based on the number of customers, their relative importance and the degree of planned activities.
In summary, it is clear that the NHS reform set out in the recent White Paper will bring disruption to current pharmaceutical commercial models that are themselves in their infancy. Good and early analysis and planning around the proposed changes and their operational and organisational implications is critical for proactive and effective management of what promises to be a radical shake-up of healthcare provision in the UK.

Jean-Francois Delas is Vice President at Kinapse Ltd. and leads the Marketing & Sales Consulting Practice. Kinapse provide consulting and outsourcing services to the life sciences industries across the world. To download the Kinapse White Paper: New commercial realities, please visit www.kinapse.com.

The proposed White Paper reforms offer pharma companies the perfect opportunity to evolve and introduce new commercial strategies. Calling upon his own experiences, Adam Knights explains how the role of Key Account Managers can help pharma change the record.

I had a smile like the Joker from Batman when I first read the White Paper. It is not every day that Government agenda falls in line with your business strategy but on July 12th that’s exactly what happened to us at 15 Healthcare. Since we started the company in 2009, my fellow directors and I have championed one fundamental maxim to enable success: the only way to manage NHS customers is by deploying key account management strategies that ensure company personnel are in front of the right person at the right time in order to broker business to business deals.
The White Paper is not so easy for the pharmaceutical industry though. How much time, effort and money has the industry spent dealing with medicine management mandarins; whose agenda has been about limiting effective branded medicine on the basis of cost? This customer cohort will likely dissipate from PCTs to compete for roles within emerging GP consortia. The question is, as customers move around amidst organisational upheaval, where should the industry focus its efforts? Who will the market access team deal with in the future? Where exactly will decisions be made? Whilst the White Paper heralds radical reform and change for the NHS, will the industry be prepared to embark upon such disruption in order to align more effectively with its customers?

A new era
The NHS has undergone many changes over the years. However the White Papers signals perhaps the most radical in the last 25-years. Whilst we await further details we know that GP consortia will form and will most likely become home to a number of functions hitherto provided by PCTs. Pharma will need to react and adapt to interact with these emerging customer groups. Imagine a consortium of 150,000 patients with the power to commission services, procure medicines and manage prescribing without any interference from a PCT? The idea of calling on individual GPs with a ‘sales aid’ and the ‘latest campaign’ will become redundant.
The industry talks a lot about Key Account Management yet most companies only tinker at the edges. Sending someone on a two-day KAM course and giving them a new title will not give them the commercial/clinical nous they will need in the new world. New skills, competencies and frameworks will have to be drawn up to deal with a variety of customers ranging from commissioning leads to finance directors. That doesn’t mean just retraining the sales force, it means every aspect of the business needs to understand the new world.
Medical departments will have to find ways to support these functions and resist becoming totally risk averse. Key Account Management is about telling your teams what they can instead of what they cannot do.
Internal training and development teams will need to raise their game too. No more cuddly marshmallow attendance courses with everyone ‘loving’ the trainer at the end. My guess is the new level of training will come externally initially until the bar is raised internally. I have seen lots of courses running that don’t resemble anything like the environment the sales force are facing. Keep it real and accept it will be painful for some.

Working together
For me the next phase of Key Account Management is alignment - both external and internal. Let's assume that your sales force has become an effective group of account managers. Now ask yourself the question: are we aligned? Does every department understand the overall strategy? Does the strategy allow a bottom up process and, most importantly, is the strategy aligned with that of the NHS (See Figure 1).
Culture and processes is the single biggest challenge, companies that manage this well excel. Those who don’t struggle to succeed with any organisational change.
Businesses can assess their commercial effectiveness through alignment. Not being aligned costs money. Some simple and effective measures will increase productivity. I have heard mutterings from some individuals that the White Paper will allow them to go back to the old way of working and coverage and frequency models will come back into vogue. Please do not be so naive to think that this will accelerate your organisation to success. Teams comprising of capable account managers will gain ground with customers as GP commissioners seek to secure value-based clinical and commercial deals.

The case for Key Account Managers
The KAM approach works provided the individuals in role are fit for purpose. How should companies assess capability, skills and competencies? Some of the competencies 15 Healthcare look for include:

Commercial acumen: can this person deliver on a commercial deal and, more importantly, can they recognise one when it is staring them in the face.
Strategic planning: is the account plan strategic? Does it align with the local NHS? Does the account manager fully understand the business planning process?
Compelling argumentation: when challenged by a customer can the account manager deal with the issue there and then without having to refer simple questions to a medical department?
Autonomy: people used to autonomy thrive in a KAM environment. With autonomy comes responsibility however, it also means making some mistakes – you cannot build a first class account team without making errors, its normal!
Sales focused: all these competencies are fine but useless unless you can deliver on sales. Professional account managers like to be held responsible for sales.

Are account teams working the same locality successful? In my experience, no. This is because the key to KAM is to deploy an individual who becomes the centre of every activity in a specific geography. This person ideally should be accountable for the profitability of the business and report at a board level. Other support functions like medical liaison and marketing should satellite this individual and be deployed as an appropriate resource when needed.
Many companies fail to resist the temptation to establish a team of account managers on the same territory and then add insult to injury by introducing a RBM to manage them. Where is the accountability in this model? By default it is the RBM. By adding a regional boss to the mix you immediately create a further management tier that clouds effective ‘line of sight’ on the business. I was an RBM at one point in my career and, in all honesty, I got in the way. I was so concerned with delivering inputs for the senior management team that the real business did not receive the time or exposure it needed and, as a consequence, did not grow. The RBM is one of the toughest roles in the industry. Managing the business, appeasing senior management and keeping a team happy whilst getting a knife in your back every 10-minutes is no fun. It is a role that many aspire to and often regret within six months of being appointed.
The question that has to be asked by all companies is clear: amidst so many changes affecting our customer organisations, and where a move towards advanced account management seems a logical progression, are RBMs really needed? If the RBM is that capable – and many are – at business skills, coaching, mentoring, leadership and selling, why not make the RBM the Key Account Manager? After all, there is no written rule that states all sales models have to conform to traditional norms.

Adam Knights is Managing Director of 15 Healthcare – a leading healthcare broker between the NHS and pharma through holistic and strategic key account management. Adam joined the pharmaceutical industry in 1998 after a successful career in the armed forces. He applied military strategy and tactics early on to develop an account model that challenged traditional thinking and planning. He went on to pilot successfully the regional account director (RAD) in Takeda before becoming the first RAD in the UK and then sales director for the RAD team.

UNISON, the UK’s largest public service union, has started legal action against the Secretary of State for Health as part of a campaign to save the NHS.

The union claims that the Government’s refusal to consult the public on the proposals in its White Paper, Equity and Excellence: Liberating the NHS, is unlawful and “lip service of the worst kind”.

The day after the White Paper was published, NHS Chief Executive Sir David Nicholson told all NHS chief executives to start implementing the proposals “immediately”. UNISON wrote to Sir David arguing that no steps should be taken until the public have had the opportunity to consider them.

The plans include handing £80 million to GPs to commission care and abolishing Strategic Health Authorities and PCTs.

Sir David agreed that no changes should be made until after the consultation period, but added that the consultation only covers to how the proposal should be implemented, not whether it should be implemented at all.

Karen Jennings, UNISON Head of Health, said: “I find it incredible that the NHS Chief Executive would say he believes there is no legal duty on the Secretary of State to consult on the merits of the proposals in the White Paper.

“The White Paper contains sweeping changes to the NHS and how it should be run. The NHS Constitution enshrines the principle that the public, staff and unions have an absolute right to be consulted. The Department of Health’s refusal to recognise this clear and important legal duty leaves us no option but to issue legal proceedings as a matter of urgency.”

The Government has rejected the accusations and says that it will defend against the legal action. A spokesperson said: “The Government has already launched public consultations on specific elements of the White Paper, and further documents will be published this year.”

UNISON has said that this legal action is the start of its campaign to prevent such large-scale changes to the NHS. In a statement it said: “This must be supported by health workers and public sector workers across the country. The true message of what is happening must be exposed to the public so they can hold this Government to account for its broken promises, and to stop the decimation of the NHS.”

Roche’s cancer drug Herceptin (trastuzumab) will soon be available to treat NHS patients with gastric cancer, after NICE reversed its previous negative recommendation.

The Institute has recommended the drug for patients with metastatic gastric cancer who have high levels of human epidermal growth factor receptor 2 (HER2), a protein found on the surface of some cancer cells.

Despite originally rejecting Herceptin in this patient population, NICE reconsidered its guidance based on a new analysis provided by Roche which focused on patients with the highest levels of HER2.

Herceptin use will be restricted to the treatment of people who have not received prior treatment for their metastatic disease and whose tumours express high levels of HER2, and in combination with cisplatin and capecitabine or 5-fluorouracil, for

Andrew Dillon, Chief Executive of NICE said: “The Committee discussed this new information and concluded that trastuzumab was cost-effective in this patient group. The Committee also agreed that trastuzumab for this group of patients fitted the criteria for consideration for appraising a life-extending, end-of-life treatment.”

©Roche

Pfizer has discontinued late-stage trials into Sutent (sunitinib malate) for prostate cancer, after no improvement in survival was shown.

This is the second time in a few weeks that Pfizer has halted trials of the drug, which was proven to be ineffective in treating lung cancer in August.

The indication under investigation was in men with advanced castration-resistant prostate cancer (CRPC) that had progressed despite treatment with chemotherapy, in combination with prednisone.

An independent Data Monitoring Committee (DMC) found that the addition of Sutent was unlikely to improve overall survival when compared to prednisone alone.

AZ has also been forced to abandon trials into a potential treatment for metastatic CRPC, zibotentan, due to an unsuccessful study. However, trials into the drug in other CRPC settings will continue.

Dr. Mace Rothenberg, Senior Vice President of Clinical Development and Medical Affairs, Pfizer Oncology Business Unit, said: “There is a great need for better therapies for prostate cancer and we are committed to working with basic scientists and clinical researchers to identify more effective treatments for this disease.”

Sutent is currently used in various indications in gastrointestinal stromal tumor (GIST) and advanced/metastatic renal cell carcinoma (RCC). Pfizer is also investigating the drug for the adjuvant treatment of renal cell carcinoma in a Phase 3 trial.

Tamiflu (oseltamivir) may have protected patients from developing pneumonia during the 2009 swine flu pandemic, a study of cases in China has demonstrated.

The research, published on bmj.com, shows that treatment with Tamiflu was also associated with a shorter duration of fever and viral RNA shedding.

Researchers reviewed the medical records of 1,291 patients in China with laboratory confirmed mild H1N1 infection during the 2009 pandemic. Three quarters (76%) were treated with Tamiflu from a median of the third day of symptoms.

Out of the 920 patients who had a chest x-ray, a minority (12%) had abnormal findings consistent with pneumonia and Tamiflu was identified as a significant protective factor.

However, the authors stress that these findings should be interpreted with caution, due to “the retrospective design of this work and the fact that not all patients underwent a chest x-ray”.

They call for continued investigation into the effectiveness of antiviral treatment “to allow for improvement both in clinical treatment and public health guidance”.

By Sarah Setterfield, Personal Marketing Expert

Leaving a message on voicemail or an answer phone

Sometimes when I get back to my office there can be as many as ten messages for me.  I press the play button and stand listening with a pen in hand and pad at the ready.  Some messages are so quick that I have absolutely no chance to getting their name let alone their phone number.  Others are so detailed that they take up lots of time.
The purpose of leaving a message is because you need some action, whether it is a call back, confirmation of something or simply to pass on some information.  To have positive associations to your name when you leave a message, I would recommend following these guidelines:

1. Make sure the first piece of information you give is your name
2. Leave a concise message, state clearly up front the major reason for the call and then back up with any 'fill-in' information that is necessary to the call
3. Speak slower than you normally would
4. Try to restrict your message to 15 - 20 seconds
5. At the end of the message, repeat your name and leave your telephone number

It's amazing how much better you can make someone's day by being considerate.  It's also a good impact winner for you!

Texting

At first, we scoffed at this "short message service," famously known as SMS. This new fad of text messaging was too impersonal, too informal, too slow, and not long after, too popular to ignore any longer. What was once a quick way to pass on short messages has now become a preferred method of communication for many.

· Does every text message require a response?

· Are we then obliged to enter into a text conversation?

· When we do respond, is it proper to continue until the conversation is officially ended?

· If I get busy and just don't answer at some point, am I being rude?

There is very little protocol on the etiquette of texting, but I like to think that any conversation should have a greeting, some useful stuff in between, and a "goodbye" at the end.
I don't like all the abbreviations and text speak because I find it hard to read quickly.  I like punctuation and capital letters because that way it shows respect to me from the sender.  I do hate it when a text conversation suddenly ends because I wonder what happened!
Whatever your form of communication it is a representation of you and what you stand for.  Think of the person you are texting and put yourself in their shoes, how do they communicate and how would they like to receive a text.

Better still, why not call them!

Sarah Setterfield is the creator and owner of Impact For Success and one of the most experienced consultants in Personal Marketing in the UK today.

Contact the author

Tel:  01908 375371

Web: www.impact4success.com