The rapid pace of NHS reform means that the pharmaceutical industry needs new strategies for joint working to create and sustain commercial opportunities. Diana Vegh, NHS Partnership Manager at the ABPI, describes how the Association is working to develop a joined-up partnership strategy across the new NHS landscape.

The NHS has been going through one of the largest reorganisations since its inception – Sir David Nicholson famously describing it as “so big, you can see it from space” – and the implications for the pharmaceutical industry, particularly regarding the joint working agenda, are significant. So much so that the ABPI has established an NHS Partnerships Team, led by Kevin Blakemore, with one senior manager covering each of the four NHS England regional offices. The concept has been driven by Stephen Whitehead, our CEO, and was piloted several years ago as the ABPI Outreach Team – which made constructive inroads in the South-West, a challenging health economy to work in.

I am one of those regional managers, ex-NHS and industry, based in Devon, and covering a territory that stretches from Penzance to Margate. The population is 13.4 million, with a budget of £21.1 billion and 110 NHS organisations. There are 1,873 GP practices, 34 local authorities (with three unitaries), four clinical senates, five Academic Health Science Networks, seven Area Teams, three specialised commissioning hubs and 51 CCGs. And it’s a 14-hour return journey from one end to the other. Plus we’re a trade association, with limited resources. With such a large number of potential customers and new organisations, how do we make the best use of our time?

RIGS strike oil

Each of us has produced a regional business plan, aligned to member company priorities, broadly supporting our themes of value and partnership, and clustered around 11 core corporate objectives. These have all been discussed and agreed by our Board of Management, which is made up of member company executives. The most important objective for my team is improving the environment for access and uptake of innovative medicines. We’ve segmented our rapidly evolving customer base and developed stakeholder maps for engagement. But pivotal to helping us navigate this complex structure has been the establishment of our Regional Industry Groups or RIGs, one per region, which meet monthly. General managers of our member companies have nominated senior representatives to sit on these groups, and we are adding associates who will join us virtually, i.e. online, via WebEx and telephone conferencing.

My RIG is chaired by Lisa Rosewarne from MSD, and our deputy Chair is James Steed from Pfizer. We have agreed our Terms of Reference and work plan for 2013, with a series of five workstreams and virtual task and finish groups led by RIG members, focusing on industry-wide issues from medicines optimisation to the Formularies Good Practice Guide. We often have external speakers who may not meet with single companies but are happy to talk to a group – such as Steve Sparks from NICE, who manages the field-based Implementation Team, and who recently gave an excellent presentation at one of our meetings. We also connect our RIG to the national policy work we do, and communicate across the other ABPI teams.

We’ve had a number of ‘bids’ from the NHS and healthcare companies who are interested in working with the pharmaceutical that there is a need for external organisations to understand better what joint working truly means in terms of the ‘Moving Beyond Sponsorship’ work done by the ABPI and the Department of Health in 2010. Our key tool for this has been the Joint Working Guide, and in particular the sections on pages 7 and 8. One of our RIG workstreams is to use these guidelines to engage with potential partners in order to share constructive feedback and highlight examples of best practice that we are collecting from member companies.

We showcased this at a conference with the NHS Confederation in February this year, in London. We have a Memorandum of Understanding with the NHS Confederation and the ABHI to work on the Innovation, Health and Wealth agenda collectively; and this national policy work is essentially what we’re putting into practice in our regions.

Rules of engagement

In my day-to-day job and in my meetings with NHS stakeholders, I work to promote the whole pharmaceutical industry and a more mature working relationship with us. The majority of my discussions have been very positive, with a clear desire to move away from the old models of promotional metrics and explore a new way of working. Some CCGs, such as Torbay and South Devon, are striving to be ahead of the curve. Others are more conservative and prefer to agree a new policy on joint working first, and we’re trying to encourage the use of our toolkit and case studies.

But one thing I’m very clear to emphasise is that my team isn’t ‘the’ route into pharmaceutical companies. If an NHS organisation wishes to work directly with a company, of course it can. We are not competing with market access teams – we are enablers and facilitators – and the ABPI Code of Practice gives the NHS assurances about governance and conduct. But some organisations remain difficult to reach. I’m using good examples of joint working elsewhere in the NHS, or pragmatic discussions in other parts of the organisation, to overcome those barriers.

After all, partnership isn’t about pretending that everything’s fine and there aren’t any problems. But it is about moving to a place where you can agree to disagree, and solve your problems together even if you have differences. . e table above shows the framework I base my work on.

On the whole, projects seem to fall into three categories. The first category is disease specific projects, which often relate to long-term conditions such as COPD, diabetes or vascular health. Some of these can be quite broad, while others can be about specific service redesign projects in a particular health economy and relate to implementing new national guidance. The second category is projects that relate to an NHS priority, such as reducing inequalities, where industry expertise in social marketing and media has been put to excellent use. The final category, and the one expanding most rapidly, is where we have shared aims: improving patient safety, reducing medicines wastage, better adherence, realising the benefits of treatments – i.e. the medicines optimisation agenda.

Moving the goalposts

Those of you with a lot of experience may be reading this with a sceptical eye. Hasn’t this all been done before? Talked about before?

Yes. But this time, there are some key differences. The clinical voice is louder, and often in a leadership position. Attention is far more on quality than in the past, and the sanctions are greater. And while our austere financial climate is squeezing medicines spending, increasingly senior people are seeing that it is disingenuous to look at medicines solely as a cost pressure, and far more beneficial to see them as a means of improving health outcomes – on which the NHS is now being more tightly measured. New organisations also have a legal duty to innovate, which is now in primary legislation as part of the Health and Social Care Act. The new Academic Health Science Networks have been set up as companies, and though many focus on the earlier part of the medicines life cycle they will all be looking for new partnerships.

Pharmaceutical companies are also changing. We’ve gone from Share of Voice to Key Account Management, and the skills and competency mix of pharmaceutical field teams is very different from how it was a few years ago. When I’m out and about I’m meeting people with new roles, such as service development managers, NHS business managers and strategic account managers. And there have been a lot of redundancies in the NHS which have seen knowledge and skills move into the pharmaceutical industry. Today I had an email from a CCG asking me how they could second someone into an ABPI member company.

We are in a ‘perfect storm’ of policy, and the organisational turbulence we’ve all experienced is bringing some very forward-thinking and creative people into senior positions. Let’s make the most of that, and work together to get better outcomes for the populations that we live in and for the organisations that employ us.

Celgene’s Chairman and CEO Robert Hugin (pictured) has been appointed chairman of the Pharmaceutical Research and Manufacturers of America (PhRMA).

He succeeds Eli Lilly’s John Lechleiter and said his priorities for his 12-month term are to defend intellectual property and the incentives for new medicines.

John Castellani, PhRMA President and CEO, said the new chair will provide a “strong foundation for the millions of US jobs our industry creates and supports” through his policies.

Mr Hugin was appointed Celgene chair in 2011 having served as president since 2010 and chief operating officer since 2006.

“I look forward to working with our leadership team, the PhRMA staff, and our member companies to advocate for policies that support the advancement of medical innovation and that ensure access for patients to life-extending therapies,” Mr Hugin said. “Through our actions, we must ensure that continued medical innovation is part of the solution to healthcare costs and economic growth in the long term.”

Alongside Hugin’s appointment, the trade body also appointed Pfizer’s president and CEO Ian Read as the next chair and Merck and Co’s chief executive Kenneth Frazier as treasurer.

NICE has failed to recommend Pfizer’s Xalkori (crizotinib) for previously treated anaplastic-lymphoma-kinase-positive advanced non-small-cell lung cancer in new draft guidance.

An independent Appraisal Committee decided the drug did not meet NICE’s end-of-life treatment criteria so its cost exceeded the limit deemed cost-effective for NHS use.

Sir Andrew Dillon, NICE Chief Executive, said that although the clinical benefits of Xalkori had been recognised the high cost of the drug meant it could not be considered as a treatment option.

NICE usually recommends clinically effective treatments that cost up to at a maximum of up to £30,000 per quality adjusted life year (QALY) – the methodology current used to assess value.

If certain treatments meet the criteria to be considered under NICE’s supplementary advice for end-of-life treatments a higher cost per QALY may be accepted. The highest cost per QALY NICE has recommended has been around £50,000.

However, NICE’s Appraisal Committee concluded that the most plausible cost per QALY for Xalkori would be somewhere between £63,800 and £181,100 when compared with existing treatments and between £51,700 and £80,500 when compared with best supportive care.

“We have already recommended a number of treatments for the various stages of non-small-cell lung cancer,” said Sir Andrew Dillon. “However, although the independent committee that considered the evidence found crizotinib to be clinically effective treatment for ALK-positive non-small-cell lung cancer, even if the supplementary advice to the Committee for life-extending treatments had applied, crizotinib could not be considered a cost-effective use of NHS.”

NICE’s guidance is now open for consultation.

Vaccines are the most important breakthrough in modern medicine: the jewel in the crown of the pharma industry. What can the success of vaccines teach us about healthcare and the industry’s commercial model?

Out of the virus immunity comes.

Killing Joke’s lyric uses vaccines as a metaphor for the human ability to find a positive meaning in the darkest threat. The history of medicine has shown, time and again, that every disease holds the seeds of its own treatment – but to find the answer, you have to look deep inside the problem.

It has been said that no other health initiative, with the exception of clean drinking water, has done as much as vaccines to improve public health. Medical sales professionals love selling vaccines, for two reasons. Firstly, their potential to protect the young and the old against highly dangerous diseases is beyond reasonable doubt. Secondly, the sales model for vaccines is as dramatic as its medical impact: the supplier becomes responsible for securing the immunity of a population.

Yet, on the face of it, the public might wonder what the fuss is about. Vaccines are one-off medical treatments that protect against specific infections. Many are prophylactic: they don’t work if you have the disease. They are not 100% reliable, since pandemic infections have many competing strains. And they can have harmful side effects. So why should healthy people bother?

The answer lies in the list of deadly and disabling diseases that once cast a shadow over human life, but now are preventable: smallpox, polio, tuberculosis, measles, mumps, chickenpox, typhoid, cholera, bubonic plague, rabies, tetanus, diphtheria and pneumonia. For some viral infections, vaccines are the only effective treatment.

Vaccination programmes demand collaboration across disciplines and borders to protect populations and share medical innovations.  This collaboration model meets with scepticism on two sides: those who mistrust public health provision and those who mistrust the pharma industry. It’s not surprising, therefore, that vaccines meet with antagonistic campaigns and conspiracy theories from a coalition of unreason.

The body’s weapons

Vaccines are different from conventional medicines because they do not directly attack the disease: they provoke the body’s natural immune response against the disease, like a mock-invasion used as a military training exercise. A vaccine dose consists of dead or inactivated disease organisms, or biochemical agents derived from them. In designing a vaccine, scientists trade off risks and benefits.

The first vaccination was conducted by the rural English physician Edward Jenner in 1796. Hearing that local milkmaids who contracted a minor infection called cowpox never seemed to contract the deadly smallpox, he deliberately infected a farm lad with cowpox and then, when he had recovered, with smallpox. (Medical research ethics have improved somewhat since then.) The use of a live disease culture for immunisation is now called inoculation.

The first use of an artificial vaccine was conducted by Louis Pasteur in 1885, using a vaccine developed by his colleague Emile Roux by dessicating the spinal tissue of rabies-infected rabbits. Pasteur gave the vaccine to a boy who had been mauled by a rabid dog. He came to no harm.

Vaccines are still news, with global mobility and shifting demographics making the challenge of immunity more complex and urgent than before. In 2012, new vaccines were developed to treat meningitis, shingles, rotavirus (a cause of infant diarrhoea) and whooping cough. Vaccination against HPV, the cause of cervical cancer, is a new priority for health systems. The GAVI Alliance, dedicated to providing vaccination programmes for children in the developing world, has funding from the Bill & Melinda Gates Foundation and the support of many pharma companies.

A vaccine coalition

A leading company in the European vaccines field (and the only specialist firm) is Sanofi Pasteur MSD, a collaboration between two major pharma companies with a long history of investment in immunity. Sanofi Pasteur is founded on the work of the Pasteur Institute, while Merck’s Dr Maurice Hilleman developed vaccines for measles, mumps, hepatitis A and B, chickenpox, meningitis and pneumonia. The joint company protects half a billion European people against 20 major diseases.

Paul Hardiman, Communications Manager for Sanofi Pasteur MSD, told Pf about the company’s unique role in the European immunity landscape. There are three reasons for the collaboration, he explains: “It avoids a duplication of effort in the drive to develop new and innovative vaccines. It also allows a focus on the strengths and suitability of vaccines for different markets from both companies’ portfolios. This in turn gives flexibility and supports public health priorities.”

The two parent companies are both deeply involved in the global project of the GAVI Alliance. Both Sanofi Pasteur and MSD “use a policy of tiered pricing (linked to a country’s ability to pay) to enable access to vaccines in GAVI-eligible countries. This has included significantly reduced prices on vaccines against HPV and rotavirus and a pentavalent childhood vaccine against diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type B.”

In the UK, Sanofi Pasteur MSD plays a major role in public health immunisation programmes for children, young adults and elderly people. These “are secured through competitive national tenders, requiring the consistent and timely supply of large volumes of high-quality vaccines”. The company has dedicated vaccine representatives selling directly to pharmacies and GP practices.

“Every year, the Joint Committee on Vaccination and Immunisation (JCVI) carries out a horizon scanning exercise to identify all potential new vaccines expected from manufacturers that may have an impact on public health over the following five years.”

As public health in the UK shifts to local authority provision, vaccine suppliers need to be fully aware of the economics and logistics of immunity. Sanofi Pasteur MSD’s UK sales force are “vaccine experts, engaging with practice nurses and GPs to support them in the areas of vaccine supply, campaign organisation and communication, and the education of vaccinating HCPs.”

The company is now supplying Gardasil for a schools-based vaccination programme to protect teenage girls against HPV and hence against cervical cancer. It is also preparing to supply Zostavax for a national programme, starting later this year, to immunise senior citizens against shingles. In the future, the company hopes to target, cancers, allergies, addictions and diseases of the central nervous system.

Immunisation programmes deliver savings both in the short term (by reducing the need for acute treatment) and in the long term (by reducing disability and chronic illness). As the focus of healthcare shifts further into the community, vaccines are increasingly crucial weapons in the HCP’s armoury. Their value, the company maintains, can be expressed in both health and economic terms.

Diplomatic immunity

In February 2013, nine female health workers responsible for delivering polio vaccination programmes in the Kano province of Kenya were murdered by gunmen after a local preacher condemned the vaccine as a plot to cause infertility. Similar killings have happened in Pakistan. In the US, ideologues opposed to public health programmes have accused the Obama government of spreading disease in order to experiment on the public with dangerous biological agents. The internet has given these conspiracy theorists a large audience.

In the UK, a spurious panic was created around the MMR vaccine by Andrew Wakefield’s article in The Lancet in 1998, which claimed the vaccine was a cause of autism. As the BMJ has recently reported, the article was scientifically discredited within a year, and has since been exposed as an “elaborate fraud” based on research that never took place. However, Wakefield’s claims are still declared to be accurate by the Daily Mail and its bizarre columnist Melanie Phillips.

Why do vaccines inspire so much mistrust? The reasons are complex. Some people believe that harnessing the body’s immune response is ‘interfering’ with nature. Others maintain that public health programmes violate the responsibility of the individual to determine their own healthcare. Still others claim that immunisation programmes are a form of covert surveillance, or even of biological warfare.

Paul Hardiman argues that vaccination may be a victim of its own success: “Anti-vaccine sentiment is thought to arise when people no longer fear the disease for which they are being encouraged to accept vaccination. As vaccine coverage increases, serious disease starts to disappear along with people’s fear of the disease. As people lose sight of the threat, so anti-vaccine sentiment may replace the good reasons for vaccinating – raising concerns in people’s minds.”

Doctor and writer Ben Goldacre, whose book Bad Science is strongly critical of anti-vaccine conspiracy theories, argues that the industry is not blameless: “I think it’s fair to say that anti-vaccine conspiracy theories are a kind of poetic response to the obvious regulatory failure in medicine and in the pharmaceutical industry. People know that there is something a little bit wrong here.”

For example, he notes, the recent murders in Nigeria took place in the same province where Pfizer had run the Trovan antibiotic trial in 1996 – a trial whose controversial nature led to Pfizer paying the Nigerian government £75 million to settle out of court, and inspired John le Carré’s novel The Constant Gardener.

Goldacre comments: “There’s something interesting happening when a very destructive anti-vaccine conspiracy theory built around fear and anxiety that drug companies are behaving badly arises in the same very small province in northern Nigeria where Pfizer have been running a trial which many regard as unethical.”

We look back through the pages of Pf at what was happening in the pharma industry and the world five years and ten years ago.

March 2008

March 2008 was a turbulent month, with rioting in Tibet, bombing in Gaza, a Columbian raid on Ecuador, and the collapse of the Antarctic ice shelf. 

Arthur C. Clark, visionary author of 2001, died at the age of 90. The cinemas captured the mood of crisis, with a British SF film about a lethal virus sharing audiences with a satire on McCarthyism adapted from the work of Dr Seuss. New albums from Nick Cave, Bauhaus, Counting Crows and Nine Inch Nails underlined the disturbed mood, though Du†ffy’s Rockferry kept the UK public dancing around its increasingly empty handbags.

The lead article in the March Pf was ‘The changing face of sales’, an examination of the growing importance of networking and teamwork for medical sales professionals seeking to engage with the NHS. Sales has its own ‘open innovation’, and this article’s insights are still valid. Other articles looked at aspects of commissioning, compliance and coaching. In a new 

series, ‘Confessions of a medical representative’, our correspondent turned around a “lose-lose situation” with an honesty born of despair. A pro€file of Boehringer Ingelheim enticed the BI-curious by emphasising the company’s high levels of staff† retention and employee satisfaction.

The news section featured criticisms of the pharma industry – in particular, accusations of concealing evidence from clinical trials, promoting psychiatric drugs more widely than their e†ffectiveness justi€fied, and ‘evergreening’ (covertly blocking generic competition to brands). The ABPI declared the accusations unfounded. Some things never change.

March 2003

In March 2003, documents presented by the US government as proof that Iraq was developing a nuclear bomb were exposed as crude forgeries. None the less, the invasion began on schedule. Country rock band the Dixie Chicks told a London audience “We’re ashamed the President of the US is from Texas,” then went home to face a vicious backlash. Steps were taken worldwide to control the threat of SARS, a deadly form of pneumonia. Cinema audiences took comfort from the adventures of Piglet and the courage of a young Sikh woman leaving home to be

The March Pf examined the issue of flexible working, with new employment legislation helping companies and staff to tailor their contracts through job sharing, home working, flexitime and similar arrangements. Does that mean a better work-life balance or just a loss of job security? Managers at Pfizer, Abbott Laboratories and Alchemy discussed the flexible working arrangements they had introduced – all of which, in their experience, were full of win.come a footballer.

Other articles examined the skills needed for first-line sales management, explained how medical sales professionals can support GPs through the trauma of appraisal, and broke down the physician and nursing teams of a large hospital into manageable components for business engagement. A profile of Futures Resourcing explained its strategy of meeting the broad recruitment needs of clients and the long-term employment needs of candidates – from contract sales professionals to senior management – by functioning as a ‘total resourcing organisation’.

The news section featured Boehringer Ingelheim’s approval of a High Court judgement obliging parallel importers to respect product packaging and trademark rights. This was such good news, in fact, that Pf printed it twice: as industry news and again as product news. Other news stories included the new GP contract and the approval of Schering-Plough’s Remicade (infliximab) for treatment of two painful conditions, Crohn’s disease and ankylosing spondylitis, in the EU. These were covered once only, but with no less attention to detail.

Greek hospitals and pharmacies are running short of around 300 medicines because drug companies are refusing to supply them.

Hospitals failing to pay drug bills and parallel trading by wholesalers and pharmacists are the main reasons for supplies being withheld.

Major pharmaceutical companies that have admitted halting shipments of some products include Pfizer, Roche and Sanofi.

Medicines for arthritis, hepatitis C and hypertension, statins, antibiotics, anaesthetics, antipsychotics and antidepressants are all affected.

Dimitris Karageorgiou, Secretary General of the Panhellenic Pharmaceutical Association, said: “I would say supplies are down by 90%. The companies are ensuring that they come in dribs and drabs to avoid prosecution. Everyone is really frightened.

“The government is panic-stricken and the multinationals only think about themselves and the issue of parallel trade because wholesalers can legally sell them to other European nations at a higher price.”

According to the Greek government, more than 50 companies are holding back products or planning to do so. The Ministry of Health is intending to fine eight major drug companies, which have not been named.

There are reports of widespread panic and anger among patients who are going from one pharmacy to another with prescriptions. “We have reached a tragic point,” commented Karageorgiou.

With austerity tightening in Greece, the debts owed to pharma companies by hospitals and social insurance funds has reached €1.9bn (£1.6bn).

Pfizer has admitted withdrawing four medicines “because alternatives were available and because of the parallel trade situation”: leukaemia drugs Zavedos and Aracytin, the analgesic Neurontin and the epilepsy treatment Epanutin.

Roche said it was withholding supplies to Greek public hospitals, apart from “critical medicines” such as HIV drugs, but was still supplying pharmacies.

Sanofi claimed it was still supplying public hospitals with life-saving and unique products (for which no generic version or recommended alternative exists).

GSK, AstraZeneca, Novartis and Boehringer Ingelheim denied they had stopped supply of any products to Greece.

The pharmaceutical industry has urged the Greek government to set its drug prices in accordance with a eurozone standard. Greek drug prices are 20% lower than the next lowest in the EU, giving rise to widespread parallel trading.

Greek regulator the National Organisation for Medicines has banned the export of 60 medicines and is considering another 300. It will fine wholesalers and pharmacists who have broken the export ban.

We look back through the pages of Pf at what was happening in the pharma industry and the world five years and ten years ago.

February 2008

The Earth moved for thousands of UK pharma sales professionals in February 2008, but not on Valentine’s Day. The biggest earthquake in 25 years shook buildings at night, injuring a few people and scaring many. Kosovo’s declaration of independence led to political earthquakes in the Baltic region. And in the first tremor of the banking crisis, the UK government was forced to nationalise Northern Rock. In the cinemas, a woman with transplanted eyes saw the dead and gangsters ran but couldn’t hide in the grey streets of Bruges. Musically it was a month of soul, with a new Donna Summer album and Duffy’s happy handbag classic ‘Mercy’.

February’s Pf encouraged its readers to get to grips with the rapidly evolving NHS market, with articles on the new commissioning framework, practice-based commissioning and joint working. Industry insider Brad Abbey said the regulatory environment was throwing sales professionals to the “gladiators” of a hostile market. Professional development articles dealt with redundancies and job applications. Industry news included a parliamentary report encouraging the use of generic drugs; investigations into illegal patent protection by pharma companies; and the launch of a new class of HIV drug in the UK.

Pfizer used the February Pf to talk about its evolving field organisation, with new initiatives in account management giving the company increased traction with customers. VMC described the “strategic commercial and operational consultancy” it had developed to help pharma companies build the skills base they need. Star explained why its partnership with Nestlé Nutrition was the cream in the coffee of the latter’s UK sales operation. ACHiiVE discussed the industry’s learning and development needs in unstable
times.

February 2003

In February 2003, with the invasion of Iraq less than a month away, over a million people marched in London against it – the biggest demo in the UK’s history. Experts exposed the dossier of ‘critical’ intelligence information about Iraq issued by the UK government as a ragbag of material copied from old sources. The return of the past disturbed the month’s cinema, with films about a haunted videotape and a haunted planet. There were more ghosts in a song of forbidden love from Russian female pop duo t.A.T.u. that topped the UK singles charts.

The lead article in February’s Pf was a guide to getting into medical sales, with tips for newcomers and questions they should ask themselves – e.g. “Can I deal with the rejection from customers?” A feature on ‘shadowing’ explored the pros and cons of this complex approach to training. NHS articles discussed the new nurse and pharmacist prescribers and provided a guide to the corporate structure of the NHS. Our news section featured the “rampant epidemic” of drug counterfeiting, the worsening shortage of GPs in the UK, and the launch of the first approved treatment for acute stroke.

A new feature, ‘Appraisal Evidence’, offered readers 20 questions to test their knowledge of a professional area – in this case, the workings of PCTs. Repeated high scores in these tests could earn readers a Certificate of Achievement in CPD that they could present at a future appraisal.

Eli Lilly introduced its new ‘Business to Business’ team to support managed entry for drugs into the UK market by building commercial relationships with NHS organisations. Napp described itself as a “family owned pharmaceutical business” whose culture inspired loyalty while demanding expertise. Contract sales organisation In2Focus explained its goal of providing experienced, innovative professionals to pharmaceutical companies outsourcing their sales operation.

The Scottish Medicines Consortium (SMC) has accepted Eliquis (apixaban) for prevention of strokes in patients with atrial fibrillation (AF).

The drug, produced by Pfizer and Bristol-Myers Squibb (BMS), has also been provisionally recommended by NICE.

Its use in Scotland with AF patients over 40 is predicted to prevent nearly 1,000 strokes and over 300 deaths per year.

Following its EMA approval in November 2012, the SMC has accepted Eliquis for prevention of strokes in patients with non-valvular AF who have one or more risk factors (e.g. hypertension, diabetes).

Based on recent clinical trials, the SMC said Eliquis was superior to warfarin in preventing strokes and was associated with fewer major bleeds.

It also requires no monitoring and dosage adjustment, thus reducing the cost of treatment and avoiding the risks associated with poor monitoring.

AF affects over 60,000 people in Scotland over the age of 40. It causes a fivefold increase in stroke risk, resulting in 7% of all strokes. Strokes due to AF are more severe, and more likely to recur, than strokes with other causes.

Difficulties in setting the dosage of warfarin, the standard anticoagulant, mean that fewer than half of Scottish AF patients at high risk of stroke are receiving it.

Dr Derek Connelly, Consultant Cardiologist at the Royal Infirmary, Glasgow, said: “The SMC acceptance of apixaban is an important step forward for patients with atrial fibrillation in Scotland. The availability of a new treatment option that does not require [clotting time] monitoring may help decrease the impact atrial fibrillation has on the quality of life of patients, their families and carers.”

According to Amadou Diarra, BMS General Manager, UK and Ireland, the risk of stroke in patients with non-valvular AF is “a serious public health concern” that Eliquis can help to address.

NICE has provisionally recommended Eliquis in the same indication, with final guidance expected shortly.

The alliance between BMS and Pfizer to develop drugs against cardiovascular disease began in 2007.

The pharmaceutical industry’s reputation in the last twelve months has declined worldwide, a new survey has found.

Only a third of patient groups now believe that pharma has an ‘excellent’ or ‘good’ reputation, figures from PatientView’s independent 2012 annual review show. In 2011, 42% of respondents had the same opinion.

A global survey of some 600 international, national and regional patient groups showed that 66% of respondents felt the industry needed to do more to improve its corporate image and its relationship with patients.

Respondents were quizzed on their impression of 29 of the largest global pharmaceutical companies, including Pfizer, AstraZeneca, Boehringer Ingelheim and Roche.

Up to half of responses claimed that pharma had a ‘poor’ record in 2012 for its pricing policies. Nearly the same amount (48%) also claimed that the industry had a ‘poor’ record for being transparent over the last twelve months.

There was also a marked change in opinions of the way pharma manages adverse news about its products – down 29% compared to the 2011 results; of whether it has ethical marketing practices – a fall of 23% on the 2011 data; and of its relationship with the media – down 19% on last year’s results.

But the survey was not all bad news for pharma. As part of the study, respondents were asked to provide feedback on six key indicators that influence corporate reputation: patient-centeredness; patient information; patient safety; useful products; transparency; and integrity. Lundbeck topped the charts after it received the highest ranking overall and moved up three places on 2011’s chart – see below.

Gilead Sciences, which jumped from 10^th in 2011 to 2^nd last year, and Eli Lilly, which improved from 18^th to 9^th place, also had reason to celebrate.

John Pinching stands on the street corner of pharma-touched films, thumbing a lift from Jake Gyllenhaal, who takes him on a vomit-inducing tour of medicinal drugs and romance. The second outing concerns a parental dispute and the rediscovery of John’s lost love, Jodie Foster.

Love and other drugs (2010)

This ghastly film reunites the often sublime Gyllenhaal with the omni-naked (omnaked?) Anne Hathaway. The venture, however, is no Brokeback Mountain.

Central character Jamie (Gyllenhaal) is a ‘charismatic’ salesman who, according to this film, is completely irresistible to all women. After losing his job – having been predictably caught shagging the boss’s girlfriend – he embarks on a career as pharmaceutical drugs sales rep, supposedly with Pfizer.

In order to get in front of the right people he begins by seducing dim-witted surgery administrators – who happily part with confidential data – and sabotaging the displays of pharmaceutical rivals.

While attempting to schmooze with one doctor he encounters pseudo-intellectual Maggie (Hathaway) for the first time and, naturally enough, she exposes herself. This is her cue to remove clothing in every single sequence thereafter. The result is a hotchpotch of excruciatingly unerotic sex scenes during which the audience are bored or embarrassed, or both, into submission. Phony romantic bullshit follows, as the pair ‘discover’ something deeper than mere physical attraction.

Meanwhile, Jamie’s career as a pharma rep ascends in accordance with his libido. There is seemingly no member of mankind that won’t be convinced by his charm and the recital of active ingredients in pharmaceutical drugs.

The plot is as thin as a used prescription and the only pain relief is when the credits – and I use that term loosely – start rolling. This is a truly lamentable film and, if viewed, could lead to severe side effects, such as total disillusionment.

Pharma score: **** 

Disclaimer: This film is abysmal, the rating is purely based on pharma content.

Carnage (2011)

Roman Polanski’s intimate, claustrophobic and biting satire places a mirror in front of white, middle-class American parenting, and the results are at once amusing and unsettling.

The plot centres on an incident involving an argument between two eleven-year-old boys resulting in one brandishing a stick and the other losing a tooth. After this establishing playground scene, the action cuts to the victim’s ‘domestically blissful’ home, where his parents are in the midst of ‘polite’ negotiations with the parents of the perpetrator, as they attempt to compose a written statement to the school outlining what happened. Both sons remain absent throughout, leaving the adults to discuss the state of affairs ‘amicably’.

Although they complete the summary, it seems that they cannot quite agree on whether it was a violent assault, which left one boy ‘disfigured’, or merely a playground prank that resulted in a minor dental problem. Consequently, the dialogue becomes increasingly strained as both highly strung couples attempt to maintain their fragile composure.

As tempers become frayed, the short-comings of the parents become apparent. Unpublished ‘writer’ Penelope – exquisitely portrayed by the sublime Jodie Foster – is materialistic and hysterical. Her husband, Michael (John C. Reilly), is more concerned with whisky and cigars. Meanwhile, Kate Winslet takes her usual self-satisfaction to new heights as nervous Nancy, and the superb Christopher Waltz (Alan) is a selfish attorney obsessed by work-related events unfolding on his Blackberry.

Indeed, it is Alan that provides the intriguing pharma connection. His frequent cell phone conversations allude to bad publicity that the product ‘Antril’ is receiving, leaving him to manage the fallout. His concern is not helped by Michael who realises that his mother is on the aforementioned medication and starts to panic. Despite Alan’s reassurances Michael calls his mother and insists that she stops taking it.

Pharma score: ***