Hunt hangs on for health and social care future

by Vicky Whitehead 23. April 2018 09:59


Accountability in Health and Social Care, and the incredible unsinkable Health Secretary


Earlier this year, Jeremy Hunt somehow survived another Cabinet reshuffle. His ability to stay in post is becoming such an in-joke that even the infamously humourless Theresa May made light of it. The beleaguered PM quipped that even under a Corbyn Government “Jeremy Hunt would still be Health secretary, obviously”.

Hunt was declared ‘unsinkable’ and ‘unsackable’ by the press because he didn’t just survive the reshuffle, he even managed to gain an extra element to his job title, becoming Minister of State for Social Care.

The fact that social care has always technically been within the Department of Health’s portfolio is neither here nor there. What’s worth pointing out, however, is how little this extra title means, because social care has, in reality, been the day-to-day responsibility of local government since 2013.

This is because in 2013 the Health and Social Care Act restructured the NHS, giving away much of the Department of Health’s responsibility to NHS England, Clinical Commissioning Groups (CCGs) and local government.



April showers: Local elections and local commissioning


Next month, local elections will take place across England. Research suggests that only one third of registered voters will turn out, because they don’t think it will affect their lives. For local health and social care policy the elections will have complex repercussions.

Local authorities control a myriad of services. In addition to social care they are responsible for public health. This means they run sexual health services, mental health services, drug and alcohol services and the NHS health check, to name but a few. And these services interact constantly with the wider NHS albatross.

It is impossible to predict what the impact of local elections will be, because so much depends on the individual councillors and officers chosen in each vastly different locality. But it is a very simple fact that local elections can, and do, change health and social care services.



One direction or a change of direction?


One impact that is a little more clear cut is that Labour are likely to make large gains across England. This will likely cause tension between Labour controlled local agendas
and national Conservative-led plans.

There has already been one recent tense showdown between the head of the Local Government Association, Lord Porter, and Simon Stevens, Chief Executive of NHS England.

Local government were threatened with a loss of budget control, after there were national deteriorations in ‘bed blocking’ – transfer of care – rates. This effectively meant that patients were occupying hospital beds due to a lack of suitable care elsewhere.

Simon Stevens declared it was clear that the current approach of the local government ‘wasn’t working’. This caused Lord Porter to produce data showing the delays were largely the fault of the NHS, and that local authorities had actually seen marked improvements in their transfer rates.

Whatever else the outcome of the elections, if Labour secures their hold across local government these organisational conflicts may be inflamed further.



Accountability in Healthcare


As mentioned, the 2013 Health and Social Care Act devolved much of the Department’s day-to-day power over the NHS. They were left holding the purse strings, but that was about it.

In fact, if you write to the Department of Health these days – about almost any issue you care to mention – you will probably receive a stock response that the issue you are interested in does not fall under their responsibility.

NHS England and CCGs are expert bodies, but they are not elected officials and they are less accountable to the public than the Department of Health was.

With a Health Minister who seemingly cannot be fired, and distant bodies like CCGs and NHS England commissioning the majority of services, it is worth remembering the voice that local elections can give the general public in all areas of healthcare.   


Vicky Whitehead is Business Partner at Ogilvy Healthworld Market Access. Go to





Tackling antimicrobial resistance: What’s new?

by Amy Schofield 8. April 2018 09:53


1. 1. Supercharge me


Researchers at the University of Queensland (UQ) in Australia have ‘supercharged’ an old antibiotic using a technique that could potentially lead to the revitalisation of other antibiotics. Dr Mark Blaskovich and Professor Matt Cooper from UQ's Institute for Molecular Bioscience modified the old drug, vancomycin, in a bid to combat the rise of vancomycin-resistant bacteria. The team modified the antibiotic’s membrane-binding properties to selectively bind to bacterial membranes rather than those of human cells, creating a series of supercharged vancomycin derivatives. The supercharged drug has the potential to treat deadly superbugs including MRSA.


2. Sleeper cell


Research from the University of Exeter has discovered a novel way to identify so-called ‘sleeper cells’, which are likely to survive antibiotics. Biophysicist Dr Stefano Pagliara and team used a miniaturised device to isolate and study single bacteria over time, and found that after they dosed bacteria with ampicillin, the majority of the 1.3% of cells that survived were live, but non-growing. Those cells that appear to be dormant and resemble the cells killed by the antibiotics in fact have the ability to ‘wake up’ and lead to reinfection even after a prolonged period of time.


3. Chicken sinner


Research from the Food Standards Agency (FSA) has shown that chickens for sale in Britain’s supermarkets are harbouring record levels of superbugs resistant to some of the strongest antibiotics. The FSA tested a large sample of fresh whole chickens from retailers, reporting ‘significantly higher proportions’ in instances of campylobacter found to be resistant to ciprofloxacin, the antibiotic usually used to treat it, compared to a previous survey 10 years ago.


4. The fall


A report from the Netherlands-based Access to Medicine Foundation shows that the number of new antibiotics in development has fallen significantly since 2000. The report, presented at the World Economic Forum in Davos, called on drug companies to do more to tackle the threat of AMR. The Foundation assessed 30 drugmakers worldwide. GSK and Johnson & Johnson emerged as leading the way in endeavours to combat AMR. Foundation head Jayasree Iyer said: “Pharmaceutical companies have a critical contribution to make to the effort to tackle superbugs.”


5. Added incentive


A research project managed by AstraZeneca and the University of Geneva has concluded that a market entry reward of $1 billion per antibiotic globally could significantly increase the number of new antibiotics arriving on the market in the next three decades. DRIVE-AB (Driving Re-investment in research and development for antibiotics and advocating their responsible use) had the task of developing and costing new economic models to promote antibiotic innovation and the sustainable use of novel antibiotics. The consortium assessed more than 30 incentives and determined that a market entry reward, in addition to unit sales for qualifying antibiotics, would create a more attractive market for investment in antibiotic research and development.







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Heart-stopping poison - key to a male contraceptive?

by Amy Schofield 3. April 2018 09:37


Could a heart-stopping poison hold the key to a male contraceptive pill?


Don’t believe the hype: health headlines dissected





Since the birth control pill was invented in the Sixties, women have had many options for family planning using oral contraceptives. Despite many years of research, men still only have two options – condoms or vasectomy. A new study on rats, however, has shown potential for a male pill derived from a plant extract, ouabain, traditionally used by African hunters and warriors in arrows to stop the hearts of their prey. Is this the bolt from the blue that could point to a contraception revolution?




Previous research has shown that ouabain, made by two types of African plants, and produced in small amounts in mammals’ bodies (probably to help control blood pressure), curtails fertility in men. But due to the risk of heart damage, ouabain on its own wouldn’t make a viable male contraceptive.

Ouabain works by interrupting the movement of calcium and sodium ions through a membrane protein (Na,K-ATPase) made up of protein subunits and found in cell membranes. One type of subunit, ?4, found solely in sperm cells, is a protein recognised as being essential to fertility in male mice. Ouabain powerfully binds to ?4, and also less tightly to other Na,K-ATPase subunits.

Researchers from the University of Minnesota and University of Kansas set out to design ouabain analogues that would be more likely to bind to the ?4 protein in sperm than the subunits in heart tissue, potentially creating a heart-safe male contraceptive pill.




The team created a derivative that was capable of targeting ?4 sperm cells in rats and binding to them, restricting the cells’ ability to swim and reach an egg to fertilise.




The researchers say that the contraceptive effect of the compound should be reversible because ?4 can only be found on mature sperm cells, so those cells produced after treatment with the ouabain derivative is stopped should remain unaffected. Ouabain may offer men a birth control pill option with fewer side effects than hormonal options.

The study authors said: ‘Our results are promising because our candidate molecule, unlike ouabain, is nontoxic in rats. Our modification is a big step forward in the process of developing a nonhormonal male birth control pill. But there’s a lot left to do before men can buy this contraceptive at the pharmacy.’

Future studies will now focus on proving that a reduction in sperm movement translates into a drop in egg fertilisation in animals. ‘If things continue as planned, we hope to get to human clinical trials within five years,’ they concluded.


What the press said:

‘The future of male birth control: A 2000 year old poison?’

‘This arrow poison may make male birth control a reality’ the

‘Heart-stopping arrow poison could be the key to male birth control’    





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What is being done in the fight against ovarian cancer?

by Amy Schofield 26. March 2018 14:18


March is Ovarian Cancer Awareness Month. Early detection of this devastating disease is essential. What’s being done?


Ovarian cancer kills 11 women every day in the UK and survival rates in the UK are amongst the worst in Europe. The outlook for women with ovarian cancer can be bleak. There have been very few new treatments approved for ovarian cancer in the last two decades; meanwhile, public and charitable funding for new research has dropped by one third (34%) in the past five years, according to figures from the NCRI (National Cancer Research Institute). 

Statistics show that when a woman is diagnosed at the earliest stage of ovarian cancer, her chance of surviving for five years or more is over 90%, therefore, early diagnosis and investment in research is vital to ensure that survival rates improve.


On target to beat ovarian cancer

Target Ovarian Cancer is the UK’s leading ovarian cancer charity. Its medical research programme funds ovarian cancer research across the UK. 

“Some of our current projects centre around finding new diagnostic biomarkers for ovarian cancer, DNA damage and repair in ovarian cancer; and finding novel treatments for rare types of ovarian cancer,” Rebecca Rennison, Director of Public Affairs and Services at Target Ovarian Cancer, says. “Target Ovarian Cancer has launched a new three-year campaign – TAKE OVAR – that aims to accelerate change and transform the futures of more than 25,000 women in the UK who are living with ovarian cancer – and thousands more who are yet to be diagnosed.”


Limited options

Treatment options at any stage of ovarian cancer are limited, and ovarian cancer research lags behind research into other cancers, Rennison says: “The majority of women with ovarian cancer diagnosed today will receive by and large the same treatments patients were being prescribed 20 years ago, with a few exceptions.”

On 8 February, NICE invited Tesaro to submit a proposal for including the PARP inhibitor niraparib (Zejula®) in the Cancer Drugs Fund, for treating some types of recurrent ovarian cancer. Previously licensed for use in the UK by the European Medicines Agency, it can be used to treat women who have platinum-sensitive recurrent ovarian cancer. The drug works by slowing the progress of ovarian cancer by stopping DNA in cancer cells from repairing, promoting cell death.

PARP inhibitors could previously only be used to treat women who have a mutation in the BRCA1 or BRCA2 gene, however niraparib can be used whether or not women have a mutation in their BRCA1 or BRCA2 gene.

“The NICE funding recommendation for niraparib marked an important step forward in the availability of ovarian cancer drugs in the UK,” says Rennison. “While a handful of new drugs such as bevacizumab (Avastin®) and olaparib (Lynparza®) have become available in the past few years, these are only available to a small number of women with ovarian cancer. This was something Target Ovarian Cancer stressed when presenting evidence at the NICE inquiry on the future of niraparib, and we will follow its progress through the fast-track Cancer Drugs Fund.” At the time of going to press, the draft guidance was still open for consultation.  

Other ovarian cancer drug developments in the pipeline include further PARP inhibitors such as rucaparib (Rubraca®), and immunotherapy treatment avelumab (Bavencio®). 




Symptoms of ovarian cancer are frequent and persistent, and usually occur more than 12 times every month. They include:



  • Pelvic or abdominal pain
  • Increased abdominal size/persistent bloating
  • Difficulty eating/feeling full quickly
  • Needing to wee more urgently or more often



Other symptoms can include unexpected weight loss, change in bowel habits, and extreme fatigue. Any post-menopausal bleeding should always be investigated by a GP. 

Women who regularly experience any of these symptoms – that are not normal for them – should visit their GP.




Personal story:

Sally Ryan, 45, was diagnosed withan aggressive form of ovarian cancer while pregnant with her first child.


In November 1998 I was 26-years-old, had graduated from university, and was just married. I’d noticed that there was an unusual lump on the lower right side of my abdomen, but put it down to too much partying. Then I fell pregnant in early December. The routine doctor’s appointment was anything less than routine. I was told I was six months pregnant, or at least there was the possibility that I was carrying twins. Over the following weeks I was sent for a scan. No baby’s heartbeat could be found. Instead there was a large cyst obscuring the view of everything. 

I went back to the doctor and was immediately referred to the hospital. It was Christmas Eve. I asked what was happening and they said they were going to remove the cyst. I told them I was pregnant and they told me I would lose the baby. I asked if there were other options and was told that I could come back at 13 weeks’ gestation and have the cyst removed then as the baby would be more reliant on my placenta than my hormones. 

At 13 weeks pregnant I was back at the hospital. The cyst was large and I looked heavily pregnant. The cyst was over 28cm in length, over a kilogram in weight, and difficult to take out. As it was being removed it burst. However, the baby was intact, and all seemed well. After three days in hospital the specialist came over to see me. He informed me he had removed most of my right ovary while removing the cyst. He told me the cyst had been cancerous. He told me it was ovarian cancer. He left.

I went home and spent the weekend wondering what the rest of my life would look like and how long it would be. I tracked him down at his private practice and went there on the Monday. I asked for clarification and he told me the skin of the cyst was cancerous and that it had touched many parts of my internal organs. He told me that the rest of my right ovary and fallopian tube would have to be removed after the baby was born to limit the possible spreading of the cancer. He said that I was the second person to have this particularly aggressive form of ovarian cancer and that the other patient had recently died. 

I was lucky. The cancer didn’t spread, and I didn’t need any further treatment after the removal of my ovary and fallopian tube. Ovarian cancer is frightening. It’s quiet, and had I not been pregnant I wouldn’t have followed up on that small lump until it was possibly too late. That was 19 years ago. My son is now an apprentice carpenter and I have two other children. I’m going back to regular checkups this year as cancer continues to be a presence in my family.    




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Tracking progress of the Rare Disease Strategy

by Claudia Rubin 19. March 2018 09:18





February’s magazine focused on rare diseases, but how can implementation plans for the Rare Disease Strategy be properly monitored?


The Rare Disease Strategy implementation plans for England were jointly published by the Department of Health and Social Care (DHSC) and NHS England. Four years after the Strategy was announced, this is welcome news for the 3.5 million people in the UK who suffer from a rare disease and the countless other people who take an interest in their welfare.


One advantage of publishing these plans so long after the strategy, and for that matter, after the plans of the Devolved Nations, is that simply making it to publication was a cause of some celebration, and presumably relief. The plans do contribute to the greater level of transparency that DHSC and NHSE seek in this sector and demonstrate a commitment to maintaining improvement in the support, care and services that rare disease patients receive.

In an unprecedented move, the 51 commitments have been divided up between NHSE and DHSC, which makes deciphering the nuances of the proposals that little bit harder, and holding someone accountable for the deliverables trickier.


Official oversight is provided by the Rare Diseases Advisory Group (RDAG) which makes recommendations to NHS England on developing and implementing the strategy; and also by the Rare Disease Policy Board (RDPB), a UK-wide committee, managed by DHSC, with responsibility for facilitating the coordination of policy development and meeting the commitments set out in the strategy.


As DHSC puts it: ‘The role of the RDPB is to monitor what is being implemented in respect of the strategy and the role of RDAG is to make recommendations to NHS England on how the Strategy is implemented.’

Considering the potential conflict of interest of the RDPB, given that its membership is comprised of people from the organisations tasked with delivering the Strategy, one must question how effective this oversight and accountability can be. It is certainly crying out for a robust political role, for example, from the Health Select Committee or another cross party group to ensure progress is monitored and shortfalls are exposed.


Among the highlights of the DHSC’s commitments are;


•          The Rare Disease Policy Forum and a new digital platform for the Forum.

•          A new annual conference by the UK Rare Diseases Policy Board

•          The establishment of a task and finish group to improve the ‘diagnostic  odyssey’ of rare diseases patients. 

•          An emphasis on the importance and potential of genomics.



Agreed targets: NHS England’s three main objectives


1. Facilitating earlier diagnosis


NHS England will implement wider genomic testing and additional genetic tests. It also plans to work with GP and nurse groups to increase awareness and improve knowledge of rare diseases.

On DHSC’s part, there is a welcome focus on the so-called ‘diagnostic odyssey’, with the aim of ‘understanding in detail the diagnostic pathway’ as the ‘first step in finding ways to improve diagnosis and subsequent early intervention'. Last year a diagnostic odyssey task and finish group was established to identify and describe the diagnostic journey of three disease case studies. It will report its initial findings later in 2018.



2. Improving care coordination


NHS England is to develop ‘rare disease inserts’, a set of criteria to sit alongside service specifications that will enable patients to hold providers to account for their care. It will insist for example that everyone has an assigned care coordinator. The intention of these inserts, and the related idea of ‘alert cards’ seem positive, and perhaps patient groups should suggest they are best placed to lead this project, ensuring they have the most useful information and that the most uncommon rare diseases are not forgotten.



3. Promoting research


 Though lacking information, the development and implementation of Rare Disease Collaborative Networks (RDCNs) could realise sizeable benefits for patients and the NHS. Anything that can be done to further direct the groundbreaking research from the 100,000 Genomes Project directly into frontline services and care will be of value.



Magic numbers...


The plans take steps for progress evaluation, with a set of measures, through regular stakeholder meetings and reporting to the RDPB. Critics have noted, however, that measures hold no specifics on appropriate standards or targets.

On care coordination, the measure against which NHSE claims it can be held accountable, in terms of delivering recommendations 8, 27, 33 ,47 and 51 of the strategy, are the number of rare disease collaborative networks endorsed and the number of rare disease collaborative centres endorsed.


But what number counts as good? There is no detail here or standard to reach for, which may not encourage much ambition.


Then there is the elephant in the room – is there any new money attached to these plans? Well yes, some. We know that the 100,000 Genomes Project is funded, then there is the £20 million Genomics Education Programme, and specialised services continue to receive a healthy share of the overall NHS budget, but none of these represent new money for new commitments. Significantly the number of conditions screened for at birth would most certainly make a big difference to rare disease diagnosis – but with no new money for the national screening programme, how many new conditions will pass the committee’s current criteria for screening cost effectiveness?


In this brave new world of innovation – stem cell treatments, multiple indication therapies and advanced technologies for complex diseases - the assessment system that evaluates costs and benefits of treatments available on the NHS is absolutely crucial. The only measure that NHS England is holding itself to account for delivering is whether a process is published. The current one, still intentionally referred to as ‘interim’ by Sir Andrew Dillon, is not yet fit for purpose and many of us are keen to help improve it quickly.


A progress report on the UK Strategy for Rare Disease is due and while we all want credit to be given where it is due, we will also be eagerly looking for some robust analysis of the milestones needed to meet the strategy’s ambition.


Claudia is a Director at Decideum. Go to









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Are young people excited by a career in industry?

by Amy Schofield 14. March 2018 11:52



Breakthroughs, tech and innovation are abundant, but are young people excited by a career in industry?


Ask children what they want to do with the rest of their lives and you'll get a range of responses, such as “train driver”, “YouTuber” or “Ronaldo”. How often will you get the answer, “I want to work in the pharmaceutical industry”? But it’s a career with a clear career framework and opportunities to use myriad skills in numerous roles. It also provides the support to succeed and the chance to make a real difference to patients’ lives. What’s not to love? Are young people seeing the potential in taking the pharma path, or is it a struggle to attract the best young talent to the industry? We ask our experts.



Joanna Paish

Recruitment Manager at Apodi Ltd

An acknowledged skills shortage in young people with science qualifications led to a new Sector Deal for Life Sciences being announced by the Government late last year. The perception of top pharmaceutical companies is improving year-on-year according to the 2017 Reputation Institute Report, however, opportunities in pharma are not always well known by young people, despite the industry offering competitive packages and excellent career prospects.

At Apodi we think it is great to hear about new initiatives within the industry that provide graduate programmes, apprenticeships, internships and other training initiatives that will facilitate opportunities to enter the industry in the future.



Caroline Wilcher

Director of Recruitment and Talent Aquisition at Ashfield, part of UDG Healthcare plc

When I graduated 25 years ago, I knew I wanted to be a pharma rep.

At the time, my tutors were mystified as to why I would want a career in sales and tried to push me into R&D, which at that time was a very viable option where many companies were investing heavily. Nevertheless, I was determined to follow my own path.

Now, R&D roles are few and far between, but sales roles still have a negative stigma within the academic world. Sadly, there is still very little awareness of the incredible career paths that this route can offer.

In my opinion, the industry needs to work harder to communicate effectively with universities and spot future talent – we need to build relationships and support their requirements.

We spend a lot of time liaising with employability managers and graduates across the country and have our very own graduate ambassadors attending workshops and seminars.

Combining a passion for science with great influencing skills and business acumen isn’t easy – but for the right kind of person, I couldn’t recommend a career in pharma sales more.



Michele White

HR Director UK & Ireland, UCB

Our applicant rates demonstrate that a career in pharma is an attractive prospect to those currently in education. Many individuals, however, do not appear to have a ‘target’ pharma company in mind when starting their search, or an awareness of the breadth of organisations operating in this sector.

Some graduates and postgraduates joining UCB from university or an academic role said they were attracted by the opportunity to impact drug-discovery and make a difference to the lives of patients.  In the pharmaceutical industry, they interact with colleagues responsible for discovering, developing, testing and launching drugs.

We would like to continue attracting high-quality candidates and make them aware of the wide variety of long-term career opportunities available to them. In particular, we need to attract medics, geneticists and those with skills and qualifications in chemistry, translational biology, early pipeline development and bioinformatics.



Andrew Croydon

Head of Education and Academic Liaison, ABPI

The ABPI is always encouraging more young people to consider a career in an industry, pushing back the boundaries of science. We provide interactive materials aimed at young people and their career advisors, take part in outreach programmes and support specific careers events such as university Bioscience Careers Days.

Our industry has a lot to offer, but we know there are major skills gaps that need to be addressed if the UK is to be ready to research and develop the medicines and vaccines of the future.

In our most recent skills report, we identified gaps in areas such as maths, bioinformatics, statistics, data and informatics, computational skills and translational medicine or clinical pharmacology. All these areas need addressing for the industry to thrive.

We know that young people are showing an interest, however, and are actively pursuing a career in the pharmaceutical industry. University careers advisors tell us that young people are expressing an interest in regulatory affairs, promotion of medicines and, overwhelmingly, R&D roles.

When we surveyed our member companies, they told us that apprenticeships are increasing in popularity as a career entry route, but these aren’t the only solution to bridging the skills gap.

If our industry is to recruit the talented individuals we need, we must get even better at demonstrating the globally competitive benefits of working in the industry, the diversity of roles and continually evolving career paths, while explaining how potential employees will be at the cutting-edge of science, helping create the next generation of medicines for patients around the world.



Getting into pharma

Words by Rachel Cresswell, Sales and Marketing Manager, PharmaJobs


Pharmaceutical companies in the UK currently employ around 73,000 people and this number continues to grow. But with fierce competition among graduates, where’s the best place to start?


1. Why do you want to join the industry?

Why do you want to join pharma, and what is it that you enjoy the most? Graduate roles cover a range of functions, from medical sales to marketing and human resources, so be sure of exactly what you want before telling the company why you can do it.


2. Do you have a related degree?

For many roles, you’ll need a Life Sciences degree, with some requiring specific qualifications such as a PhD. For commercial roles, employers may accept a degree from a different discipline, as long as you can demonstrate the required skills and characteristics. 


3. What work experience do you have?

Having relevant work experience is a great way to stand out from other candidates. Some of the largest pharma companies offer internship schemes, ranging from three months to a year. Alternatively, you can try applying to local hospitals or universities to find out about opportunities. 


Discover available graduate roles at 






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To succeed companies must change their tired sales strategies

by J Pinching 5. March 2018 15:29

Words by Stewart Adkins


Paying lip service to modern sales and marketing isn’t enough, new techniques must be taken seriously and applied.


With the advent of Key Account Management and now digital channels of marketing, it is more important than ever for promotional resources to be analysed and quantified as appropriate.

Even if the assumption were true, that traditional levels of promotional spending were justified by subsequent sales and profits growth that can no longer be an acceptable justification for a promotional budget tweaked from previous years.

Every Commercial Director must start with a zero budget and justify each and every spending item in terms of its impact on sales and its contribution to profit. To do that requires a full understanding of how promotional components interact with every other component. Can you write on a single sheet of paper how your marketing strategy works and then test that strategy?


Testing sales and marketing strategies

Modern methods of data analysis, developed at Cranfield and Aston Universities, have been peer-reviewed and tested in the field, time and again. At least five of the Top 10 pharma companies have used this analysis somewhere within their organisation, as have many medium-sized companies.

These methods are based in theory, but have enormous practical applications and can use a company’s own data, from its CRM system for example, to boost sales and decrease promotional spending, much of which is wasted.

Methods based on regression analysis are unhelpful, as they make too many unsupported assumptions about the relationships between input variables and sales output. Given that only five of the Top 10 pharma companies have outperformed the S&P 500 since Jan 2000 there is a good case to argue that continuing underperformers will face calls for a break up sale – like GSK – to a third party or drastic reorganisation, such as has occurred with Sanofi. Sometimes all three outcomes seem to be on the cards at the same time, damaging employee morale within and shareholder support from without.



Don’t forget the promotional spend

Remember, the doom-mongers’ concerns about reduced returns on R&D use traditional promotional spending levels within the numerator of their ROI calculation. Typically, they will be assuming 25-30% of sales is spent on promotional activities.

A reduction of that spend by five percentage points could almost double returns on R&D. Indeed, Deloitte’s latest research calculates that the top pharma companies have an aggregate return on R&D of just 4.2%. Such a reduction in spending, with no loss of sales momentum, is entirely feasible with modern methods of data analysis and subsequent implementation of conclusions.

The big puzzle today is why so many commercial organisations have sales effectiveness teams and so few have adopted modern statistical tools. The solution to this conundrum may lie in the power of the affiliate, seeing the strength of their commercial organisation as a proxy for their own power and influence.

The application of modern data analysis to CRM and other promotional data could free the country manager from having to make enforced and sometimes arbitrary budgetary cuts. It could also provide the decision-making tools to make rational resource allocations that boost sales and reduce waste.

If used regularly as part of a promotional resource audit – perhaps every promotional cycle – not only should sales and margins rise, but the reduction in strategic drift should make the boom and bust of commercial organisations a less frequent occurrence.


Reality check

For several reasons the pharmaceutical industry is under pressure to deliver better sales and profits growth, and better shareholder returns.

The commercial model that evolved during the supremacy of primary care products, and which served the industry well enough for 20 years, has been slashed and remodelled, supposedly to fit a focus on secondary care.

Despite some reduction in promotional resource overall what remains is a legacy mindset that still considers 25-30% of sales being spent on sales and marketing as appropriate. This is not surprising if budgets are simply tinkered versions of the previous year.

Return to zero budgeting and a thorough analysis of each and every component of promotional spend would be an excellent start. Removal of waste and a focus on activities that actually work would be even better. This would drive sales growth, improve margins and show reasonable returns even on today’s crop of new product offerings.

Such rigorous analysis using modern statistical methodologies might be anathema to affiliate managers, yet the results would become quickly apparent in better commercial key performance indicators. When aggregated they would show up as above expected growth.

Surely an approach that can relieve some of the pressure on beleaguered industry managers, but also begin to reverse the share price underperformance that causes so much soul-searching, must be worth considering.   


Stewart Adkins was a Pharmaceutical Analyst at Lehman Brothers for 23 years and is now a Director of Pharmaforensic Limited. Go to





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Can eating your greens prevent dementia?

by Amy Schofield 26. February 2018 09:52


Don’t believe the hype: health headlines dissected




Research appears to show that eating one or two servings of leafy green vegetables per day could slow the memory decline associated with ageing. The newspapers greeted the study with headlines suggesting that eating your greens could actually stave off dementia. So, does eating a salad a day really keep the doctor away?



Researchers at Rush University Medical Center in Chicago, led by study author Martha Clare Morris, aimed to increase the understanding of biological mechanisms underlying the association between nutrients in green leafy vegetables and cognitive decline.

The primary nutrients and bioactives in greens such as spinach, rocket and kale include vitamin K, lutein, nitrate, folate and kaempferol.

The participants were divided into five equal groups based on how often they ate leafy green vegetables.

For those who ate the most, the rate of decline in scores on thinking and memory tests was slower by 0.05 standardised units per year than the rate for those who ate the least leafy greens – an equivalent difference to being 11 years younger.



This was a prospective study of 960 participants of the Memory and Aging Project. Participants aged 58–99 years – without an existing dementia diagnosis – completed a food frequency questionnaire and had less than two cognitive assessments over a mean period of 4.7 years.

The study results, published in the online issue of Neurology, appeared to show a link between consumption of leafy greens and a slowing of cognitive decline.

The researchers concluded: ‘Consumption of approximately one serving per day of green leafy vegetables and foods rich in phylloquinone, lutein, nitrate, folate, α-Tocopherol, and kaempferol may help to slow cognitive decline with aging.’



The study does build on the body of research that shows a healthy diet could slow memory loss, and proves a fragile link between eating leafy green vegetables and a reduction in cognitive decline and memory loss.

As dementia itself wasn’t measured in the study, at this stage it can’t be concluded that the diet could prevent dementia. In addition, some participants were followed-up for the relatively short period of two years, and it can take longer for memory loss and dementia to develop.

Morris herself pointed out that the study merely showed an association. Dr James Pickett, Head of Research at Alzheimer’s Society, agreed, but added: “What’s good for the heart is good for the head. A healthy diet rich in essential nutrients, combined with regular exercise and avoiding smoking, can help to reduce your risk of developing dementia.”


What the press said:

“A salad a day keeps dementia away, researchers say”

“Eating salad could help stave off dementia, new research reveals”

“A salad a day keeps brains 11 YEARS younger” Mail Online.   



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How can pharma navigate the complex marketing landscape?

by J Pinching 21. February 2018 11:15

Words by Stewart Adkins


The first chapter of pharma’s commercial evolution takes us from the insatiable sales-drive of the 1980s to the present, highly complex marketing landscape.


It is easy to forget that our competitive industry still has 80-90% gross margins and, as a consequence, its traditional commercial model is driven by sales growth, rather than worrying about costs.

Under most circumstances, incremental sales drive incremental profit. Within the affiliates this is obvious, and country managers have often resisted attempts by corporate counterparts to take a centralised approach to sales and marketing, claiming their country’s commercial ecosystem is unique and not amenable to meddling.

Of course, the modern pharma company will also have to conduct market access, medical education and phase IV studies within its affiliates, but the reality is that most affiliate activity is focused on sales. For large pharma companies the sales and marketing budget usually beats R&D budgets by 1.7 times, and this is becoming increasingly difficult to justify.


Rise of primary care dominance

Throughout the 1980s and 90s the focus on sales-driven growth led to the evolution of some very different ways of working within primary care, from co-promotion and co-marketing with embedded local players, to the ‘petal’ system of multiple salesforces detailing overlapping product ranges.

The purpose of these techniques, together with employment of contract sales teams, was a sort of ‘shock and awe’ strategy which swamped the physician with frequent visits about particular products. The competitive response was usually swift and commensurate, resulting in a commercial arms race between players within a hotly contested therapeutic area.

This was known as the ‘share of voice’ model, and when applied to large primary care categories, it drove top line growth so successfully that governments and institutional payers were forced to find a response to escalating drug bills around the world.


Backlash from health technology

This response varied from country to country, but has taken two main forms; the Health Technology Assessment response and the consolidated payer response. Throughout the 1990s and 2000s, in the UK (NICE), much of Europe, Australia and parts of Asia, there has been systematic developing of a process that assesses whether a product represents value for society.

Much of the health economics work is shared among countries, and pricing comparisons made between the same product in different countries are routine. The benchmarks for the monetary value of a healthy human being are the subject of debate, but are necessary to make budgetary choices in a system without unlimited resources.

The consolidated payer model, operating in the US through pharmacy benefit managers such as Express Scripts, relies on large payers exerting pressure on manufacturers for rebates, with some undifferentiated product portfolios having to rebate as much as 50% of their gross price.

The impact of health technology assessments can be seen today, manifesting itself in pricing pressure, therapeutic substitution, a diminution of decision-making by physicians and a conscious shift towards products with a confirmed medical need. A decline in R&D productivity, however, has not made this process easy.


Dead end: Primary care hits a wall

Many commentators blame the decline in R&D productivity for the steep fall in product approvals through the 2000s but, in reality, there have been several forces at work.

The rise in genomics, together with high-speed screening techniques, led to a belief that chemical libraries could be screened against unprecedented targets and that optimised drug candidates would flood through the discovery phase into phase I trials.

The sharp product rise in the early clinical phases then came to a shuddering halt during phase II ‘proof of concept’ studies, when large numbers of clinical failures unveiled the reality – there is no short cut to understanding disease biology.

As research cul de sacs were explored, a squeeze on primary care products began in the form of price pressure from above and greater safety demands from below. As a consequence, and aided by the rise in technology, a rapid increase in the proportion of newly-approved, biological in origin drugs commenced.

Monoclonal antibodies, vaccines, enzyme replacement therapy and other therapeutic peptides, aided by insatiable demand for insulin, developed strong sales and completely changed the nature of commercial interfacing with physicians.


Biologicals change the commercial dynamic

The pressure on primary care products, together with the impact of the patent cliff in 2012/13, have combined to drive sales of primary care products into stagnation. Much of industry downsizing, particularly within commercial operations, has been in response to this.

Perhaps most merger and acquisition activity within pharma also has its origins in this relentless pressure on primary care sales and the need to reload the pipeline quickly with biologicals and specialties.

The success of biologicals and other specialties, such as oral cancer drugs, in terms of both approval and sales, has required the industry to change its commercial emphasis. The huge traditional focus on primary care or family doctors has changed to specialists, and their support workers within a secondary care or hospital environment.

The increased complexity of the specialty sell, sometimes involving multiple decision-makers, formulary approval, health economic arguments, companion diagnostics and performance-related reimbursement, has required a much smaller, but more skilled group of people to interface with the healthcare network.

Many companies have yet to find the necessary mix of skills within their workforce and are still working under the old assumptions that spending on promotional activities can remain as high as it used to be under traditional models. They do so at their peril. Check out Part 2in the next issue, as promotional resources and modern data come under intense scrutiny…   


Stewart Adkins was a Pharmaceutical Analyst at Lehman Brothers for 23 years and is now a Director of Pharmaforensic Limited. Go to





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Mark Samuels' mission to accelerate access to medicine

by J Pinching 20. February 2018 13:26


Mark Samuels is on a mission to get medicines to patients and start dynamic friendships.


There’s a lot of talk in this business about ‘putting the patient first’, but my guest today backs it up by repeatedly putting his neck on the line, to prove he’s doing just that. Chief Business and Strategy Officer at Medicines Discovery Catapult, Mark Samuels, doesn’t like a simple existence and prefers climbing seemingly insurmountable obstacles – metaphorically and literally. Let’s find out why.


What is the brilliantly-named Medicines Discovery Catapult?


The purpose of the Catapult is to support the life sciences sector and, in particular, small to medium-sized enterprises (SMEs) at the early stage of research. Many of these will be biotech companies, diagnostic companies or spin-outs from university. People throw the word ‘exciting’ about a lot in healthcare, but this really is. From a blank sheet of paper, we are now rapidly building and delivering the Catapult’s programmes of work.


In what ways can you help these guys?


We’ve got some very rare scientific kit which, if you were a small company with a highly promising molecule, you wouldn’t otherwise have access to. For instance, we’ve got the UK’s only solid state nuclear magnetic resonance facility, which is vital for drug target validation. Furthermore, we’ve got a vast breadth of expertise, and often this know-how is as important as lab capabilities. By the end of this year, we aim to have over 100 staff, made up of world-class people with commercial, scientific and informatics experience. They don’t just talk about it, they’ve done it for real.


What other ways are there of supercharging the med pathway?


We’re driving collaborations, which combine capabilities from all the different organisations involved. Drug discovery in the UK can seem very fragmented – lots of brilliant teaching hospitals, universities and patient charities doing great work, but it isn’t always obvious to an SME how to bring them together. 


What do patient charities bring to the mix?


Many of them are huge powerhouses in their own right, and they know precisely what a patient needs. This is an area where drug discovery can be strengthened, because eventually people in industry will need to submit patient reported outcomes, so it’s better to trigger that process from the start.


How do you get people who are protective of their discoveries to share information?


I pioneered some of the most complex collaborations in clinical research, when I led the establishment of the Government’s translational research collaborations. These are very large-scale consortia, each involving up to 36 different universities and NHS Trusts, working as one team with industry. So, you can imagine the challenges involved in getting all of them to work together. 


What great things happen when they break bread?


Those partnerships have been running for years now and been responsible for many successful projects, including a trial of the first new drug in 50 years for chronic cough and the world’s largest clinical trial for preventing rheumatoid arthritis. I instigated the ongoing HIV collaboration between Oxford, Cambridge and London biomedical research centres, which is currently undertaking a first in-human trial for a cure. Even against all odds, collaboration can happen as a force for good.


In the vast healthcare landscape, where does the Catapult sit among NICE, the NHS and so on?


As a broker and neutral convener. We’re funded by Innovate UK and, therefore, not-for-profit and here to benefit the UK. I probably have an unusual breadth of insight into UK life sciences; for example, I represented the UK’s diagnostic industry in co-chairing the establishment of NICE’s programme to evaluate diagnostics. I also know what the industry’s position on submissions is, from my time on the strategy board of the NHS’ research arm. At the Catapult, we’ve certainly got a wide range of perspectives we can bring together.


Did you always plan for a career in life sciences?


I studied molecular biology for my first degree, then went to work for Unilever and spent many years in fast-moving consumer goods in the UK, Holland and France. I had a great time and at one point in my career, worked on marketing for Star Wars – a dream job!


That’s an usual career path, Mark. 


I definitely come from a different background – I was a serious mountaineer in my 20s and 30s, and took six months off to climb the Alps and Andes. I was on a mountain called Aconcagua, when I ran out of money and realised it was time to get a job. It was sheer serendipity that, while I was there, I bumped into another couple of climbers who happened to be recruitment consultants for the life sciences sector.

On top of a mountain? Come on, Mark, I wasn’t born yesterday! It’s absolutely true. They introduced me to Roche, and that’s how I came into the industry in 2001. I started in a marketing role and eventually become head of business development for Roche’s diagnostics division. After a decade, I left Roche for a role in Government, where I set up the National Institute for Health Research’s Office for Clinical Research Infrastructure, driving collaboration in the research centres it funded. It was such a big task that many of my respected colleagues told me not to take the job.


How did it pan out?


It had all the challenges of a start-up. At the beginning, we had four members of staff and were operating out of a coffee shop, and yet we were representing the Government, so had all the bureaucracy that comes with that. Within five minutes of starting, Pfizer had announced it was closing Sandwich – but I actually enjoy difficult situations, and things soon improved. We started forming a lot of allies very quickly and built partnerships with many of the foremost scientific leaders in the country. When I started in 2009-10, £30m was coming in through industry investment, and by 2014-15 it was up to £130m.


What are your major ambitions for the Catapult in the future?


Patient-centred collaborations, and starting with the patient need. After all, we are all patients, and we all need this to work.


What record would you choose for the soundtrack of your life?


God is a DJ.


Naturally. It’s your last supper, what are you having?


Pizza and wine, please.


Coming up! Goodbye, Mark.


Bye John.   


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