Does stigma around depression stop sufferers seeking treatment?

by Amy Schofield 14. August 2017 09:33

 

 

From the darkness

A third of us suffer from depression, but does stigma stop many seeking help?

 

When Prince Harry confessed, with searing honesty, to the depression he developed in the years following the death of his mother, Princess Diana, people sat up and took notice. It opened up a new conversation about depression and mental health, but it also left many wondering why the stigma around the condition continues to exist. Sufferers still feel unable to share the truth about how they are feeling, with family, friends and employers, perhaps because of a lack of understanding around how serious clinical depression can be.

According to the mental health charity Mind, approximately 1 in 4 people in the UK will experience a mental health problem each year. Of these, 3.3 in 100 people are suffering from depression. Although depression is more common in women than men, rates of suicide among young men are rising, while rates of depression and anxiety among young people have increased by 70% over the past 25 years. The World Health Organisation says that, “if we don’t act urgently, by 2030 depression will be the leading illness globally”.

 

Cause and effect

Depression isn’t always caused by any single factor, but several triggers:

• Social – loneliness and isolation, losing your job, divorce, bereavement

• Psychological – a traumatic experience from childhood, family issues

• Physical – illnesses such as glandular fever, side effects of some medications

• Genetics – certain people may be genetically predisposed to depression.

 

Treatments for depression

 

Antidepressants

These medicines treat the symptoms of depression by acting on chemicals in the brain that lift mood. They include:

• Selective serotonin reuptake inhibitors (SSRIs) – the most widely prescribed, these include Fluoxetine (brand name Prozac), citalopram (Cipramil), paroxetine (Seroxat) and sertraline (Lustral).

• Serotonin-noradrenaline reuptake inhibitors (SNRIs) – similar to SSRIs, these include duloxetine (Cymbalta and Yentreve) and venlafaxine (Efexor).

• Noradrenaline and specific serotonergic antidepressants (NASSAs) – the most prescribed of these in the UK is mirtazapine (Zispin).

• Tricyclic antidepressants (TCAs) – older types of antidepressant, they may be prescribed to people who have failed to respond to other medications, or those with OCD or bipolar disorder. They include amitriptyline (Tryptizol), clomipramine (Anafranil) and imipramine (Tofranil).

 

Talking therapies

Used alone or in combination with antidepressants, talking therapies aim to help patients to recognise factors that might be causing their depression, and find ways to cope. They include counselling and cognitive behavioural therapy, and referrals are normally made by the patient’s GP, but waiting lists are long. Patients can also consult charities such as Sane for information on free or low–cost counselling, or pay for private therapists or counsellors. Go to sane.org.uk

 

Self–care

Joining self–help groups, where patients meet others in similar situations, can help people cope with their depression. Good self–care, including eating healthily, exercising and asking family and friends for support can aid recovery. 


Help is out there

No one should suffer in silence from depression, and there are many organisations which provide support, advice or empathy, without judgement or discrimination. 

Go to mind.org.uk; sane.org.uk; samaritans.org; justonelook.org; depressionuk.org; supportline.org.uk.

There are also a number of platforms which allow peer-to-peer interaction. Go to depressionalliance.org; turn2me.org; friendsinneed.co.uk; headstogether.org.uk.


Case study:

Georgina Lloyd

I have always been a high-achiever and put myself under continuous pressure to succeed. I have a fear of failure, due to the demands which I place on myself. I strive for perfection.

Academically, I did well at university before going on to become a lecturer. After a successful two years I gave up this career and applied to become a police officer. While waiting for intake, I spent time gaining further experience as a pharmaceutical representative.

Early in 2015, I went though IVF treatment and, unfortunately, things did not work out. Instead of my partner and I dealing with it, talking things through and grieving, we both ploughed ourselves into work. I became obsessive about exercise and began taking part in cycling events and triathlons as I knew I could do well and get a sense of achievement and self-worth. They were a distraction from the hurt and pain I was going through.

I didn’t want to drop the professional image. Yes, there were external pressures, but it was the internal pressure I put on myself which became my downfall. I did not want to show any sign of weakness, so I just hid how I was really feeling.

My relationship ended a week before Christmas 2015. I did not want to see or speak to anyone and spent Christmas on my own, as I didn’t want to face the world. It was a work colleague I had confided in that saved my life on Christmas Eve, as I had serious thoughts of ending it all.

In work, I still presented myself as ‘happy smiley George’. I did not want people to know how broken I was, but at the end of March 2016 I sought help from my doctor. Everything came out and I sobbed for 30 minutes. I remember arguing with the GP who told me not to go to work the following day. I wanted to as I didn't want to be seen as a failure or weak. It was midday when I finally said to my line manager that I had to leave. That was 15 months ago.

I have had fantastic support from my GP and workplace. I completed a 10-week mindfulness programme organised through work and some local courses on managing depression and stress through the NHS. Taking part in the BBC 1 documentary Mind over Marathon encouraged me to talk and forced me to be open with family and friends.

My puppy, Olly, has also been a saviour. He has been brilliant for me; I now have responsibilities and he keeps me grounded.

There is still a massive disparity with physical health. Thankfully, with all of the positive work being done to support mental health and with all of the well–known faces speaking out about their battles, the shift is happening, but there is still a long way to go.    

Follow Georgie’s story at depresseddetective.com and on Twitter @georgie_lloyd.

 

Case study:

Lisa Browning

My depression began in September 2009 when my daughter (22 months old at the time) was diagnosed with cerebral palsy just two days before I was due to have my son by C-section.

When my son was born I felt he was just in the way of me trying to learn about my daughter’s condition and how I could help her. I had no feelings for my son and just went through the motions. It was a terrible time.

I also blamed myself for my daughter’s disability, becoming very tearful, angry and panicky when I left the house. My husband urged me to see the doctor, but I was brought up thinking that antidepressants were addictive and that depression was not a ‘thing’.

In November 2009 I woke at 2am and went to buy a frozen turkey for Christmas and presents for the children. I had decided I should get in my car and drive off somewhere, but first needed to be sure the children would have a nice Christmas. I felt I was bad for them and they would be better off if I were not around. In the car park I sat there sobbing, then decided I needed help, so went home and woke my husband.

The next day I saw the doctor, who prescribed antidepressants. I felt better after a few months of these, combined with getting help for my daughter, and took them for the following two and a half years.

We emigrated to Australia, however, and I started slipping back into the dark hole and was unable to scramble out. We returned to the UK six months later and I fell pregnant with my third child. I could not take medication due to the pregnancy, but my depression seemed to level out. My GP advised walking and this really helped – I was worried about postnatal depression and was monitored, but everything seemed okay.

Six months later my stepfather was diagnosed with a terminal brain tumour and both my husband and I were made redundant. I was falling back into that hole and immediately sought help. I was put back onto the same medication I took in 2010 and have been taking this ever since. I still walk often and this lifts my mood.

I always advise anyone who has depression to seek medical advice from a GP and talk, talk, talk as much as possible to someone they trust.   

 

Case study:

Charlie Reid

I was diagnosed with depression towards the end of 2014.

It’s something that, deep down, myself and my family had known I’d been suffering with a lot longer, but I kept pushing it aside, telling everyone ‘I’m fine – there’s nothing wrong - I don’t need help’ until it eventually became too much for me to cope with and I struggled to deal with everyday life.

The decision to brave that first trip to the doctor was one of the scariest things I’ve ever had to do. I finally had to admit I wasn’t coping with my feelings and emotions and ask for help. I had to open myself up to a complete stranger and tell him things that I hadn’t told anyone before. I cried my heart out and I told him I didn’t know why I felt so upset or angry all the time and why I couldn’t bring myself to even get out of bed in the mornings.

I had nothing to worry about. My doctor was really easy to talk to and didn’t make me feel silly or attention seeking. He understood.

After talking for a while, we discussed different options of what we could do together to help improve my feelings/emotions and how to start dealing with the depression. This included finding the source of why I felt how I did (still a work in progress), counselling and medication.

I was first put on a daily medication to trial and was scheduled to return in a few weeks. The thought of taking medication worried me and I told him I didn’t want to become addicted or rely on it. He provided me with a non-addictive medication which I started taking the next day. He also told me that I could start counselling sessions and provided me with a number to call when I was ready to go ahead.

I’ve found ways to calm myself and help deal with my emotions – exercise is amazing – I can feel so low and then stick on a workout DVD and I feel so much better. I’ve also taken to adult colouring books and art therapy. Sitting quietly outside drawing and colouring is so therapeutic and really helps when I feel an attack coming on.

Having a doctor to talk to really did help, but I hope in future there are more professionals are available to discuss mental health with outside of a doctor’s surgery and provide a more varied range of ways to help deal with it, apart from just medication. Things are looking up and with the help of family and friends I’m learning to cope with my depression.

Case study:

Gemma Wood

I started suffering with depression from the age of 17, however through treatment, it may have suggested that my depression had become masked through other coping techniques since the age of 12.

The combination of school life and the secrets I carried at home was where my depression began. There were many family secrets that I had withheld from sharing, in fear of further consequences. This impacted my school experience, where I was badly bullied due to suffering with serve dyslexia. I was finally assessed for this aged eight (in the 80s it was not recognised as a learning disability). I was known as the ‘thick’ girl. My older sister was incredibly challenging in our household, and was in and out of psychiatric assessments. I had spent my youth trying to be everything BUT her, and opening up to my depression seemed impossible.

My parents put me into hospital at the age of 18, after they had begun to notice my complete withdrawal from life and massive weight loss. I was diagnosed with depression and an eating disorder.

Once I came to terms with the idea that I may have episodes of depression throughout my life, and that very stressful experiences can trigger this, I have found certain structures that help minimise the impacted my depression can have on my everyday life. I cannot and will not carry secrets again. I regularly engage in therapy to help keep a healthier and balanced lifestyle, I take antidepressants if and when needed. I keep being honest with the people who I need in my life.

You don’t have to suffer alone. Sharing this with a close friend, GP, or other professional doesn’t mean that it defines you. You are you, and something at this time is preventing you from being able to be all of that. Asking for help is a strength – even if it feels a weakness. There are people out there that can truly help you, so reach out.

(Pictured: Left - Georgina Lloyd, Right - Lisa Browning and family)

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Features

Overdrawn: What exactly is CEP and can pharma help?

by Alex Ledger 14. August 2017 09:29

 

 

We are all aware of the severe financial straits the health and care system currently finds itself in. According to figures from NHS Improvement the provider deficit for 2016/17 was £791m, and this is set to be repeated this year with the King’s Fund recently forecasting a near £500m provider overspend.

With no substantial new money on the horizon from Government, and all political attention focussed on Brexit, and the passing of the ‘Great Repeal Bill’, the NHS will continue to feel an ever-tightening squeeze on its resources. One such mechanism that has become more high profile over the last month is the new Capped Expenditure Process, or CEP.

CEP is another double-act intervention by NHS England and NHS Improvement. These are the bodies in England with responsibility for overseeing the commissioner and provider sectors and, importantly, the bodies which negotiate provider reimbursement via the tariff. It is the latest in a series of measures introduced by NHS central agencies to bring down spend in line with its budgetary allocations.

Simply put, CEP is a spending cap targeted at specific areas of the country deemed to be financially out of control. It is designed to contain high levels of spending, while bringing under its scope whole health economies, including both commissioners and providers in the region.

Earlier this year, CEP areas were asked to review their current financial plans and come back with bold proposals that would bring spending back in line with budget allocations. They were asked by NHS England and NHS Improvement to consider controversial interventions and ‘think the unthinkable’ over the nature of the care they deliver to reduce local spend.

It is reported that the original instruction to CEP areas stipulated that revised plans and proposals for cost-saving measures should not compromise patient safety and CEP plans should be consistent with the rights set out in the NHS Constitution, and protect patient choice.

The revised financial plans submitted in May 2017, through the CEP, were due to be reviewed by National Directors of NHS England and NHS Improvement. Details of the revised plans, however, are still not in the public domain, but it is likely that many of the areas have produced revised plans that come far closer to closing the financial gaps they face.

 

Backlash from the NHS

Trusts under the CEP programme have openly criticised the plans. NHS Providers, the body that represents the NHS provider sector, has stated that: “Trusts are concerned that these targets can only be realised in full by cutting or reconfiguring services in ways that are neither realistic nor reasonable.” It also added that, “Some of the proposals could challenge fundamental expectations shared by NHS staff and the public about what the health service is there to provide.”

As a result, according to the Health Service Journal, NHS Improvement has since agreed to nearly halve the savings targets sought through CEP from an initial target of £470m, down to required savings of £250m, although there remain significant concerns about the risks involved in delivering these.

The Guardian reported that Shadow Health Secretary Jonathan Ashworth MP has openly criticised CEP, by saying: “The capped expenditure process is in total chaos. The government are refusing to answer questions about it and Jeremy Hunt is trying to shirk responsibility for this scheme, which will see hundreds of millions of pounds cut from health budgets.”

 

Pharma to help meet the cap?

To date, dialogue between central NHS bodies and those areas under CEP measures have taken place largely behind closed doors. It is undoubtedly a missed opportunity that industry has not been approached to explore how it might contribute towards meeting these ambitious savings targets.

Industry already provides financial support to the cash-strapped NHS through a unique agreement in the PPRS whereby it underwrites growth in the country’s medicines bill over and above agreed limits. Many companies, however, are seeking to do more with the NHS and have offers specifically designed to help deliver returns.

There is a chance for pharma companies to help generate savings, whether in the cost of treatments or through system efficiencies, to support the achievement of financial targets in hard-hit areas, without compromising patient care.

NHS England’s new Commercial Unit is still being formed, but has started to move into second gear. It now needs to look outward and engage in new types of discussions with industry. There is a clear opportunity for the NHS to benefit from pharma’s ideas and partnerships.

Such collaborations would help generate headroom in specific health economies, so that some of the ‘unthinkable’ measures can remain ‘unthought’ and patients living in certain parts of the country will not receive a lower quality of care compared with others.   

 

Response time

Suggested measures include:

 

•          Reducing spend on non-urgent work

•          Reducing levels of planned elective care currently outsourced to non-NHS providers

•          Restricting access to services, with IVF specifically called out

•          Stopping funding for some low value treatments, and seeking to delay or avoid funding some treatments newly approved by NICE

•          Closing wards and operating theatres to reduce staff and operational costs, where it will not impact on emergency care services

•          Closing hospital sites

•          Selling property and surplus land.

 

 

Being watched

So far 14 areas have been listed where future financial plans are deemed unaffordable.

 

1. Bristol, South Gloucestershire & North Somerset

2. Cambridgeshire & Peterborough

3. Cheshire: Eastern, Vale Royal & South

4. Cornwall

5. Devon

6. Morecambe Bay

7. Northumberland

8. North Central London

9. North Lincolnshire

10. North West London

11. South East London

12. Staffordshire

13. Surrey & Sussex

14. Vale of York & Scarborough & Ryedale

 

 

Alex Ledger is Deputy Managing Director at Decideum – the views expressed here are entirely his own. Go to decideum.com

 


 

 

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Features

There's a long way to go for mental health parity

by J Pinching 5. August 2017 10:03

 

 

Head room

We have made considerable progress with mental health, but there’s a long way to go.

 

Mental illness and ‘Britishness’ have always been a toxic pairing. The combination of dark episodes, depression or anxiety, and a national identity built on a stiff-upper lip, has made our collective mental journey slow and difficult.

Mental illness still makes us uncomfortable, and it has only been through considerable force that we have brought it into sharp focus and, more importantly, stared it down; often in our own mirror. Consequently, in 2017, we are a little more comfortable with what we see and, indeed, what we hear.

In these passages, we confront our position on mental health and our experts ponder where we are in the great scheme of things. As a nation, have we really made progress and are we anywhere near reaching parity with physical conditions?

 

 

The Charity

Leila Reyburn, Mental Health Services Manager at Mind

Mental health has been neglected for decades; by government, by public services and by society as a whole. As a result, mental health services have suffered huge underinvestment by comparison to physical healthcare services. We see the impact of this in people who do not get the help they need, when they need it, and in the distinct lack of investment in the prevention of mental health problems.

In contrast, we have seen considerable change in public attitudes towards people with mental health problems over the last decade, with a 9.6% improvement (around 4.1m people) since our anti-stigma campaign, ‘Time to Change’, began in 2007.

Alongside efforts to decrease the stigma around mental health, initiatives like Mind’s ‘Find the Words’ campaign aimed to give people greater confidence in seeking support from their GP or primary healthcare provider. Now that stigma is starting to dissipate and more people are seeking help, it is vital that we have the funding and resources in place to cope with high demand.

We are also a year into the Five Year Forward View for Mental Health, a robust and clear plan to start improving mental health services, which comes with an additional £1bn investment in mental health services by the end of 2020-21.

We need to keep up the pressure to make sure these promises are fulfilled and that money reaches the frontline. The proof will ultimately be in the improved experiences of people accessing mental health services. Go to mind.org.uk

 

 

The Confederation

Sean Duggan, Mental Health Network Chief Executive, NHS Confederation

There has been huge progress in the way mental health is talked about and recognised, with campaigns such as ‘Heads Together’ having a positive impact on tackling stigma. With greater awareness of mental health, however, comes extra pressure on services, which are already stretched.

The Government has pledged to put mental health on a par with physical health, but this needs to be reflected in investment and the continued progress of the Five Year Forward View for Mental Health. Getting mental health services right will relieve pressure on other parts of the health system and we urge the Government to deliver on its promises and ensure mental health gets the equal status it deserves.

 

 

The Campaigner

Kenny Johnston, Founder of the CLASP Charity

Mental health has progressed positively in the last decade, though the road ahead is difficult if parity with physical conditions is ever going to be achieved.

Part of the problem is the general public’s failure to realise the normality and variety of mental health difficulties, which we all encounter in our daily lives. The lack of support towards someone with a mental health issue remains different compared to the reaction towards an individual with a broken arm, cancer or a heart attack. Sadly, we still live in a society with a need for visible proof of an illness, before there is an acknowledgement.

More people need to speak about their mental health experiences in order to engender normality, while empowering and inspiring others. The power of people speaking openly has been proved throughout history, assisting in ending negativity about different social aspects and illnesses, ending stigmas and formulating parity across different races, religions and sexual orientations.

A perfect example is cancer, which 40 years ago had a stigma due to the the low prospects of survival. Nowadays, there is early screening, effective medical treatment, support and information, while events such as ‘Race for Life’ enable unity.

Normalising mental health will build positivity, showing there is no need to fear it. The more people speak, the more we can achieve as individuals and as a society.

Mental health can find parity across society, institutions, employers and wider healthcare; but it needs to learn from cancer, the LGBT community and other social stigmas in order to achieve it. Go to claspcharity.com

 

The Columnist

David Thorne, Pf Magazine Columnist and former mental health nurse

Mental health has progressed since I was a nurse in the 80’s but, sadly, far too little. It remains characterised by dichotomies – patient rights versus public protection, excellence alongside abuse and empathy for celebrities, but fear of ‘that guy on the bus’.

The rhetoric is for mental health integration with mainstream healthcare, but psychiatrists and mental health nurses have helped to isolate themselves and their services through a sub-culture of lost confidence. Services are not designed for those most in need and the third sector is where positive practice invariably sits in addressing self-harm, substance misuse and crippling isolation.

 

The Psychiatrist

Andreas Papadopoulos, Consultant Psychiatrist at Avon and Wiltshire Mental Health Partnership NHS Trust

For years Government mandates have pushed for parity of esteem between mental and physical health. Although NHS England has urged local CCGs to increase their funding for Mental Health Trusts, almost half have seen theirs drop. Trusts continue to be paid through block contracts, which don’t reflect the increases in demand, making them endure funding cuts in a disproportionate way.

Mental health only receives 6% of the total UK health research funds and, as a result, many of the drugs used in the treatment of mental illness have not changed for the last 20 years. Patients with mental illness, therefore, continue to suffer inferior quality of life and fail to achieve functional recovery.

Mental illness is much more difficult to diagnose and treat compared to physical illness, due to a lack of treatments which actually cure, rather than simply treat mental illness. Add to that a reluctance among patients to seek help and you have a big problem.

Inpatient treatment is helpful, but very expensive, and the number of NHS inpatient beds has significantly shrunk, opening opportunities for independent providers to charge vast amounts . Community services that provide support to people at risk are invaluable, but to ensure success in the long-term an upfront investment is necessary.

In the meantime, inequality continues to widen, and for that to be corrected a political and societal change is needed which allows people to achieve their potential.

 

The Patient

Ian Cartwright, Diagnosed with depression 27 years ago

My journey into depression, like so many other people these days, was due to excessive stress at work.

I worked in the outdoor event hire industry for many years, climbing through the ranks and eventually becoming a general manager. Stress for me was about seeking to be perfect, to be productive and not let anyone down. I became and still am a workaholic.

For me, depression also has a physical element. During one meltdown, I slept all day and all night for weeks, with very little energy. My GP’s diagnosis was depression. Men don’t generally admit to it, but my road to recovery began when I eventually said: “I suffer from depression”.

The diagnosis in 1990 paved the way for life as a Methodist Minister. During my seventeen years in the ministry I had three major breakdowns and the last one, in 2016, lead to my early retirement.

Depression is like existing in a desert; a dry, dark, lonely, uncomfortable and debilitating experience. I did, however, discover many healing and refreshing streams of healing in my personal desert.

This included help from my tremendous GP, taking medication and the use of talking therapy, because it is vital to be open about mental health. The NHS is wonderful, but I had to wait a long time for treatment and it finished early due to lack of funding.

Fortunately, I have had incredible help from a range of other sources. A local mental health charity introduced me to compassion focused therapy, which has been amazing. My family and friends are also very supportive, encouraging me to go for walks, while volunteering at York Council for Voluntary Services has kept me active. If you are experiencing mental health problems, there is amazing help out there.

It’s great to be feeling better, but it’s been a long journey back. Ian’s book ‘Healing Streams in the Desert’ is available at imagineprojects.co.uk

 

The Professionals

Deborah Carpenter, Psychotherapist, Nightingale Hospital

“The problem with mental health is that it’s not solely about funding, it’s about understanding what patient needs are and being able to provide necessary care on a consistent basis.”

 

Megan Johnstone, Mental Health Nurse at an East London Foundation Trust

“It is not being given parity. If somebody has diabetes, they receive treatment almost instantly. In contrast, someone with depression could be waiting six months. There are constant cuts – our assertive outreach team is being discontinued and one of our rehab wards is being shut.”

 

 

 

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Features

Funding flows in the NHS: Parliament to frontline

by Amy Schofield 31. July 2017 09:22

 

For full content, watch this webinar On Demand at parallellearning.co.uk

 

Following the money

 

Webinar report

The fourth Parallel Learning webinar focused on understanding the NHS England ‘money trail’. 

Chaired by Michael Sobanja and with expert insight from speaker Julie Wood, Chief Executive of NHS Clinical Commissioners (NHSCC), this webinar sought to deliver an appreciation of how financial allocations are made in the NHS. It also concentrated on awareness of funding flows, identifying how key decisions are made and how spending arrangements might change in the future.

 

How is the money spent?

With the help of a flowchart created by The King’s Fund covering the 2016-17 figures, Julie opened by explaining how the money flows to and through the NHS once Parliament has voted on how much it intends to allocate to the health service. Parliament voted to invest just over £120bn in 2016-17, and this flowed down into the Department of Health (DoH), which decided how to allocate the resource to the organisations that play a role in influencing the spend on health, including NHS England and regional teams, regulators and Health Education England, and Public Health England. Julie then covered how that money flows from commissioner to provider – acute care, mental health, community services, and primary care, including GP practices and community pharmacy.

 

Risks and opportunities

Julie went on to talk about the opportunities and risks posed by the shifting NHS landscape – pointing out that: “Nothing stands still in the NHS”. She said that the development of Sustainability and Transformation Partnerships (STPs) means that commissioners and providers are being asked to work much more closely together in terms of commissioning and delivering care.

“It’s the politicians’ job to determine how much the NHS is allocated and what it expects for that allocation, and it’s NHS England and its commissioners’ job to make the very best of the NHS pound,” concluded Julie. “You can only spend the same NHS pound once, therefore it’s really important that we spend it on the right thing, so that we get the best return on that investment.”

 

The death of commissioning?

In the Q&A session, Michael Sobanja asked if STPs and the move towards integration, “Really mark the end for CCGs and commissioning?” Julie responded that it doesn’t mark the end of either, and that the activities we currently enjoy as part of a commissioning process are the very same activities that any healthcare system has to go through.

“It has to decide on priorities, it has to decide what to do about those priorities, it has to plan healthcare, it has to understand the healthcare needs of its population,” Julie explained. “Commissioning is here to stay. We might change the language, the lexicon, but we still have to have a commissioning focus.”

 

Working together

Julie pointed out that in the last couple of years commissioners have been working much more collaboratively together: “How they work together to transact their commissioning activities is where I think we will start to see, and are seeing, differences. What’s really good for STPs is that for the first time in a long time we’re having commissioners and providers getting around the same table.”

She added: “If there is much greater ownership of the same pound that you can only spend once, it will free up the opportunities to start thinking differently.”

 

Under pressure

Michael cited a recent report by The Health Foundation, in which the charity identified three ‘unavoidable financial challenges’ that need to be tackled by the incoming government if it is to maintain healthcare and social care services. Any shortfall will inevitably result in downward pressure on budgets, including on drugs budgets, he said.

“With its current level of resource, the NHS cannot do all that it is expected to do,” agreed Julie. “There is no doubt that the NHS is under significant pressure. This gets us into the territory of difficult choices. We have to make sure we’re doing things as efficiently as possible.”

When a delegate posed the question, “Does greater integration mean the end of differential pricing for pharma?” Julie referred to the development of Regional Medicines Optimisation Committees, saying that a national system of medicines optimisation across the country could help to ensure delivery of the right care and outcome: “Pricing of drugs is part of that, as well as how we reduce variation in spend and take–up of medications.”

 

Delegate feedback

“Really excellent. I certainly learnt a great deal.” Simon Reese, Regional Business
Manager, Apodi.   

 

Go to parallellearning.co.uk

 

Julie Wood’s NHS career spans 30 years, focused on service development and innovation in primary care and commissioning, with the last 16 years at Director or Chief Executive positions within health authorities and primary care trusts across the UK.

 

 

 

 

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Features

Could breast milk cure cancer?

by Amy Schofield 24. July 2017 09:47

 

 

 

Don’t believe the hype: health headlines dissected

 

THE STORY

As if it wasn’t already successful enough when it comes to growing small humans, breast milk is, apparently, the gift that just keeps on giving, with the discovery of a compound contained within it that could kill cancer cells. Nicknamed HAMLET (Human Alpha-lactalbumin Made LEthal to Tumour cells) by the Swedish researchers from the University of Lund who discovered it, could the compound represent the start of a more targeted approach to destroying cancer cells and offer an alternative to gruelling chemotherapy and radiotherapy treatments?

 

THE RESEARCH

HAMLET is a complex between alpha-lactalbumin (a-lactalbumin, the primary protein component of human milk), and oleic acid, which kills tumour cells, sparing healthy ones. It was found by accident, while Swedish Immunology Professor Catharina Svanborg was conducting antibiotics research with novel antimicrobial agents.

The team needed human cells and bacteria on which to experiment with agents contained within the milk, and decided to use human tumour cells. “To our amazement,” Prof. Svanborg told The Daily Mail, “When we added this compound of milk, the tumour cells died.”

Once inside the stomach, the protein targets the mitochondria and the cell nucleus of cancer cells, avoiding the cells’ outer defences and killing the cell, without destroying surrounding healthy cells.

“The results identify HAMLET as a membrane-perturbing agonist that triggers lethal ion fluxes in tumour cells”, said Prof. Svanborg. In other words, it gets through the cancer cells’ defensive membranes and triggers a process which causes the cells to weaken and die, in what she calls a “totally serendipitous discovery”.

 

THE RESULTS

In human trials, HAMLET has shown therapeutic efficacy in three cancer models; colon cancer, bladder cancer and a human glioblastoma xenograft model. “In each of these cases, we observed positive and interesting effects,” said Prof. Svanborg. Patients with superficial bladder cancer received injections of HAMLET into the bladder on five consecutive days preceding surgery. Within just two hours, large numbers of dead tumour cells were passed
in the patients’ urine.

 

THE DEAL

According to Prof. Svanborg’s team’s report on the research: “Early in vitro experiments showed that HAMLET has broad anti-tumour activity with a high degree of tumour selectivity”.

Results from the research also suggest that HAMLET could help bowel and cervical cancer patients, and a further trial is planned.

 

The press said: 

“Swedish scientists find breast milk is ‘cancer cure’” Daily Mail Online

“Breast milk compound ‘may help cure cancer’” Independent.co.uk

“Breast milk kills cancers claim scientists” Telegraph.co.uk   

 

 

 

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Features

Marketing Focus: the shift from treatment to prevention

by J Pinching 18. July 2017 11:04

 

 

Read part one of Setting the scene in the June edition of Pf Magazine here.

 

PART TWO: Setting the scene

Dr Graham Leask and Stewart Adkins return to address the shift from treatment to prevention and take a look at pharma’s future.

 

Shift from treatment to prevention

The change from treatment to prevention would represent a previously unimaginable societal shift over the next five to 10 years. Traditionally pharma makes money from selling treatments. To change the mindset of the industry, and its payers, from one of selling treatments to preserving wellness, will not be easy. To monetise the preservation of wellness means using the actuarial knowledge from population healthcare data to carve out populations and assume responsibility for their care in exchange for a per capita fee.

Customers within this population would then have to be regularly screened and encouraged, or even forced, to take significant responsibility for their own health. In exchange for not smoking, exercising regularly, eating healthily and staying within weight, a customer would expect to be treated for any acute or chronic condition that still arose. Individual companies may struggle to accept patients with co-morbidities since they may not be able to price the risk.

Nevertheless, there may be conditions, such as asthma, where companies could price the risk and prevent downstream co-morbidities by active monitoring and treatment. This was attempted 20 to 30 years ago by so-called disease management programmes, but perhaps availability of data and modern analytics makes this feasible today.

 

Rise of ‘social prescribing’

In the long-term, if the pharmaceutical industry finds a way of monetising the preservation of wellness, social prescribing must be a necessary part of that model.

Early intervention with lifestyle changes, for example, physical fitness, weight loss, healthy eating and smoking cessation, which are sustainable, will have huge downstream benefits for society as a whole, translating into a massively reduced prevalence of chronic diseases like type 2 diabetes, heart disease, strokes and COPD/asthma. These behavioural changes, although superficially obvious to all, may be very difficult to implement, however, and could easily take a generation or more.

Herein lies the barrier to change, since upfront investment in clinician time (cognitive therapy takes a lot longer than the prescribing of an SSRI and is considerably more expensive), gym memberships, diet clubs and e-cigarettes will be huge, whereas the clinical benefits and accrued cost savings will follow many years afterwards. This is certainly not a threat to the pharmaceutical industry unless it incorrectly prices the risks in a disease management programme.

It is far more likely that big pharma will need to partner with government and health authorities to implement change, while allowing life assurance and pension funds to design long-term funding schemes with a pay off at the back end.

If this is to work in a social healthcare model, such as we have in the UK, we will need a wholesale shift in the healthcare narrative, backed up by a ‘carrot and stick’ approach that rewards those that take responsibility for their own healthcare, while subtly penalising those that do not or will not. Whether society as a whole will consider this unfair remains to be seen; but perhaps expecting society to pay for its citizens to eat, drink and smoke itself to death is not fair either.

One cannot expect pharma to navigate such difficult waters without huge support from politicians and civic society. At the moment there are straws in the wind, but few signs of a definite direction of travel. In the meantime, social prescribing will be limited by short-term budgetary constraints and likely to be restricted to isolated pockets of far-sighted health authorities in a few pilot studies.

 

Death of a salesman?

The mantra, that the traditional role of the pharma salesperson will soon become obsolete, was first suggested in the 1990s when PBMs were introduced in the US and, similarly , during ‘Thatcher’s NHS Reforms’, and neither was correct. In reality doctors are individuals – some only respond to ‘face-to-face’ discussion, others may prefer digital, but few doctors see no representatives at all. To influence a committee requires active networking. Even when a strong guideline is in place, patients and doctors require choices. For example, UK practices using inhaled steroids for asthma stock, on average, seven products. In theory at least, these are interchangeable. 

 

The healthcare landscape of the future

Most markets as they mature become more concentrated as power passes to the distributor and products become commoditised. To some extent this has occurred with the UK primary care market, yet companies still make considerable money from branded generics and ‘me-too’ products. If we assume that a guideline is in place restricting the range and a ‘use the cheapest first’ policy pertains, then such concentration will continue, and the ‘pan-continental wholesalers’ will drive supply.

It is likely that companies will embrace a more blended approach to promotion that perhaps mirrors how healthcare intervention is being guided by the internet and use of sophisticated computerisation.

 

 

 

 

 

 

 

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Features

Biosimilars are here and they mean business

by J Pinching 18. July 2017 09:50

 

 

Fair imitation

 

They say that ‘imitation is the sincerest form of flattery’, and in the last decade this belief has been reflected increasingly in life-saving pharmaceuticals. Throughout the retail sector, it has been going on for years – items of clothing masquerade as high-end brands, but at a fraction of the cost.

In the altogether different pharma industry, imitation is becoming the catalyst for a vibrant sub-sector marketplace. Above all, it represents a new hope for patients who are, understandably, keen to access previously unavailable treatments.

We ask our experts from across pharma, healthcare and specific disease area organisations about the impact of the biosimilar revolution and, critically, where it goes from here.

 

Replica medicines: Same or similar

A biosimilar starts its journey to market when the patent on a medicinal product is due to be lifted. After the expiry, the ‘parent’ company no longer has the legal right to exclusively manufacture the product in question, allowing competitors to enter their versions at a reduced unit cost. New biological products have different names, but are almost identical to the originals. Pivotally, for patients, biosimilars should produce the same or similar clinical results.

The biosimilars market has significant potential across the board; for ‘big pharma’ it is a chance to quickly bolster portfolios and, for small to medium enterprises, it represents the opportunity to innovate without the burden of relentless R&D. Like many new concepts biosimilars have gone through a period of suspicion, snobbery and cynicism, but their refusal to go away suggests an exciting frontier, which can be widely appreciated, by manufacturers and patients. Contention only lingers due to the fear that some companies may sacrifice future R&D for quick biosimilar gains.

 

A new age

Tim de Gavre is Sandoz UK Country Head

 

Biosimilars have made significant progress over the last 18 months. We’ve seen the launch of monoclonal antibodies and very large proteins, and significant uptake of biosimilars. If you look at the biosimilar of Infliximab, for example, uptake is greater than 70%.

That has been driven by very positive engagement between the NHS, NICE and industry, working to increase the profile of biosimilars, helping to educate and increase usage in an appropriate way.

One of the forums is the Biosimilars National Programme Board, chaired by Keith Ridge (Chief Pharmaceutical Officer), with representatives from patient groups, industry associations, the MHRA and the NHS. This is where a lot of the initiatives have been discussed and a new publication ‘What is a Biosimilar’ has emerged from it.

There are still a lot of HCPs who, when you say ‘biosimilars’, will still give you a blank look, so there is much to do. Patients need to have confidence in these medicines and feel comfortable that when they switch, the same benefits will be experienced as the originator. Furthermore, the switch process also refocusses trusts on patients that haven’t been assessed for years.

There is a continual flow of new products coming into the market, but if the NHS wants to afford the next generation of innovation, it needs biosimilars. Also, some companies have become very comfortable with products that haven’t experienced competition for decades. When their portfolio comes under threat from a biosimilar it forces them to innovate.

Sandoz has been doing some work with the NHS around the cancer vanguard. The collaboration across three institutions – UCL Hospital, The Christie and The Royal Marsden – will ensure that when the biosimilar comes, they are ready.

 

 

Patients rewarded

Ailsa Bosworth is founder and CEO, National Rheumatoid Arthritis Society

 

Biosimilars have revolutionised treatment for approximately 20% of the 690,000 people in the UK living with the severest form of rheumatoid arthritis (RA).

Clinical trial results suggest that the four biosimilars available to RA patients show similar efficacy to the originator product.

It is essential that patients and physicians work together in agreeing when, and if, it is appropriate to switch from an originator to a biosimilar. As the word suggests, it is not a 100% replica of the original drug, so some patients with complex diseases may not respond as well as they do to their existing medication.

It’s important to note that this market is tightly regulated, and all products are strictly assessed for their quality, safety and efficacy. Once on the market, products are closely monitored, so patients should not worry about the quality and safety of biosimilars.

The benefits to the NHS of using less expensive medications will be very noticeable if those savings can be reinvested into rheumatology services across the country – helping to provide an improved service for those battling this autoimmune disease.

Ideally, we’d like to see the savings going towards more specialist nursing posts, improving access to physiotherapy, podiatry, psychological support and occupational therapy services, as well as improved patient education support.

 

 

Push for precedence

Steve Wilkinson is Chair, British Oncology Pharmacy Association (BOPA)

 

Clinical opinion on biosimilars in UK oncology and haematology has changed in recent years from concern to growing acceptance.

Clinicians now understand that biosimilars do not always have to repeat the phase II/III clinical trials, while the regulatory process shows new products to be therapeutically equivalent, allowing biosimilars to be used for the full range of licensed indications.

Strong leadership from the NHS and NICE has been key to this shift in opinion. Indeed, NHS England, as commissioners of cancer medicines in England, is incentivising hospitals to rapidly adopt biosimilars as part of its Commissioning for Quality and Innovation programme.

This push is due to the financial benefit of using biosimilars. NHS budgets for cancer medicines are fixed, and the Cancer Drugs Fund (CDF) no longer offers a safety net, so there is a clear opportunity to safeguard NHS budgets. In addition, they can ensure new cancer medicines are affordable, helping patients and clinicians, and benefitting pharma.

BOPA promotes oncology pharmacists to manage the successful introduction of biosimilars, and believes products should be used for all commissioned indications, provided there are pharmacovigilance protections, e.g. branded prescribing. The organisation does, however, acknowledge there are challenges to introducing biosimilars, such as adapting chemotherapy prescribing systems.

Meanwhile, the next few years will see the emergence of a trastuzumab biosimilar, which is also administered intravenously. This does, however, raise questions about patients on Herceptin SC, which many hospitals adopted due to saving benefits. It’s likely that commissioners will initially focus on intravenous solutions, but further ahead, bevacizumab – widely used under the CDF, but since removed – could be revived, particularly if more cost-effective biosimilars become available.

Steve writes in his capacity as BOPA Chair. Views expressed are his and do not represent the NHS England position.

 

 

Healthy competition

Tina Healy is Director of Immunology, Global Data

 

Biologic therapies are driving market growth across immunology and oncology indications. GlobalData estimates that the biologics market from both therapy areas reached over $150B in 2016 across the seven major pharmaceutical markets – US, France, Germany, Italy, Spain, UK, and Japan. This colossal market size serves as a key driver for biosimilar developers to tap into.

Access to existing biologic medicines remains a challenge, due to high cost, while barriers for biosimilars include physician unfamiliarity, physician scepticism, the availability of other novel therapies and the lack of real-world evidence, thereby fuelling patient fears.

Focussing on the EU, the European Medicines Agency (EMA) has approved 28 biosimilars to date, of which nearly 70% are used to treat immunology, oncology or oncology-related diseases. With rising healthcare costs across the EU, and with biosimilars offering discounts of 10–30% off the prices of originator products, several biosimilars are expected to be granted approval by the EMA in 2017 and beyond.

Even a modest discount in price, compared to the originator, will provide huge savings to the national health services of EU countries. Pressure from national health authorities to prescribe biosimilars and affordable alternatives, as part of cost-saving measures in cost-conscious markets such as the UK, will thus influence biosimilar usage.

In the highly competitive biologics market, however, it remains to be seen whether innovator companies will reduce the prices of their brands or employ other strategies
to stave off biosimilar competition.

 

 

Change is coming

Warwick Smith is Director General, British Biosimilars Association (BBA)

 

The crucial impact of biosimilar medicines cannot be ignored or underestimated by patients or payors alike.

Biological medicines are dominating global lists of the best-selling prescription drugs. Very successful treatments for rheumatoid arthritis and autoimmune diseases have led the way, while other disease areas, such as oncology, are coming to the fore.

With UK healthcare budgets stretched by ageing populations, affordability is key to widening patient access. Additionally, as biological medicines play a more significant role in providing life-saving and life-enhancing treatments, greater uptake of biosimilar medicines is critical.

To date some clinicians and patients have been more cautious about the trend, although there have been areas of clear success. As experience increases, so will understanding around switching to biosimilars.

NHS England has done an excellent job in bringing together all stakeholders – NICE, industry groups, patient groups, doctors and nurses – to understand why biosimilar medicines should be routinely adopted, and why switching from the originator is a perfectly natural thing to do. Indeed, NHS England has issued guidance for commissioners which suggests that clinicians should consider moving patients from the originator to a biosimilar when it is less costly.

The BBA – along with other industry partners - is also driving several initiatives. These have included working with NHS staff to develop authoritative information about biosimilars, as well as organising educational events.

 This collaboration between stakeholders is very important and we have seen the most effective uptake in the UK when commissioners and medical professionals work together. One well-documented example of this is Southampton, where the trust is able to save £60,000-£80,000 per month, while also investing in additional nurse and pharmacist support.

 

 

 

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Features

After General Election chaos what now for pharma?

by Alex Ledger 17. July 2017 10:13

 

Wheat from the chaff

Where does the General Election leave the pharmaceutical industry?

As we all know, the result of the General Election means that no single party has an absolute majority. What initially seemed a sure thing for Theresa May unravelled into an epic political miscalculation that has left her leadership position in ruins and her Brexit negotiating hand seriously weakened.

At the time of writing, it is uncertain as to how long she will be able to fend off her critics and retain her position. Meanwhile, the nature of her working relationship with the Democratic Unionist Party (DUP) of Northern Ireland has the potential to be very disruptive.

 

Scrutiny in Parliament

After striking a workable arrangement with the DUP, which seems likely at this time, her ability to pass new legislation in the form she had outlined in the Conservative manifesto has been greatly diminished. Her Government will face intensified scrutiny at every stage, always with the risk that her detractors both inside and outside her own party will unseat her through a vote of no confidence.

With an increased number of seats, Labour will have more power to undermine government plans and an increased ability to scrutinise the Prime Minister, including through an emboldened Corbyn and a greater representation of Labour MPs on Select Committees.

The House of Lords will gain an expanded role in questioning Government legislation. Under the Salisbury Convention, the upper chamber does not oppose policies outlined in a governing party’s election manifesto. Without a majority government in place, the House of Lords faces no such restrictions and will feel it has a greater role to play in holding the legislative agenda to account.

A weaker government may also mean that civil servants, including Simon Stevens, and city mayors, will wield more influence over legislation and the policy agenda. These new factors will have major implications on May’s ability to progress politically controversial policies, including her ‘hard Brexit’ plans.

Meanwhile, the DUP will be handed a degree of political power in Westminster that they could never have foreseen, and it is likely that they will attempt to capitalise on this during the future passing of legislation. This will almost certainly include stipulations on an increase to public monies flowing to Northern Ireland and commitments to retain a ‘frictionless’ border with the Republic of Ireland post-Brexit.

Make no mistake, a change of Prime Minister in the near-term is not out of the question, nor is the prospect of another election within the coming year.

 

The NHS & the Life Science Industrial Strategy

With a minority government and only a loose arrangement with the DUP, the Conservatives face difficulties progressing their political agenda, particularly with regards to Brexit and other contentious issues. In terms of NHS funding and the Life Sciences Industrial Strategy, all parties align on the need to address funding pressures, but are divergent on levels of required finances, methods for raising revenue and solutions to long-term challenges like social care.

In general, the DUP are seeking increased funding for Northern Ireland, particularly around infrastructure, skills and education, as well as their health service. In the run up to the election, Labour committed to injecting the most money into the NHS, with £30bn over five years and an additional £8bn to social care.

The Lib Dems committed to allocate £6bn per year to the NHS and social care services combined, while the Conservatives pledged to increase current NHS spending by a minimum of £8bn over the next five years, while also proposing ways to increase social care funding. A settlement for the NHS, including social care, will be a divisive issue for the new government to tackle. Expect front page headlines and potential rebellions within the Conservative party.

There is likely to be less of a challenge in the life science sector. Both the Conservatives and Labour committed to investing 3% of GDP into UK R&D. Similarly, the Lib Dems pledged to protect the science budget, with an aim to double innovation and research spending across the economy.

In addition, both Labour and the Lib Dems want the UK to continue having access to EU-funded projects, such as Horizon 2020, post-Brexit. The Conservatives have committed to implement the recommendations of the Accelerated Access Review, making sure patients get new treatments faster.

Similarly, during the Election, Labour committed to ensure all NHS patients get “fast access to the most effective new drugs and treatments”. Regardless, Brexit will consume the majority of focus and political resource.

  

Brexit means…

Theresa May has indicated that her Brexit plans will continue unchanged, including timelines for the start of negotiations, although overall progress might falter in the face of stronger opposition in the House of Commons.

With a minority government, Theresa May will govern without a formal majority. This creates an almost impossible situation for her in relation to Brexit. Presuming May is able to successfully negotiate an exit from Europe and a positive deal with the rest of the European Union, she has committed to putting any final settlement before the House of Commons.

Without a majority vote, or even a consensus within her own party, the Prime Minister may find it highly challenging to secure the required number of votes to make this a reality. ‘Remain’ politicians, if they haven’t already, will leverage the Election results to maximum effect in order to frustrate the Brexit process at every stage,
if not attempt to reverse it completely.

It is clear that Theresa May’s intention is to rebuff potential leadership contenders within her party, and stay on for the duration of the Brexit negotiating process. Her position is only strengthened  because there is no clear successor that would be palatable either to the party or electorate.

Moreover, were someone to take over the role, they would arrive without any political mandate at all, bringing the threat of another General Election and even less negotiating time. There seems general acceptance among Tories, and even the general public, that this situation is not desirable.


Alex Ledger is Deputy Managing Director at Decideum – the views expressed here are entirely his own. Go to decideum.com

 

 


 

 

 

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Features

Two stories about one of the UK’s most common cancers

by Amy Schofield 11. July 2017 10:40

 

 

Two stories

Pancreatic cancer is one of the UK’s most common cancers, but survival rates are low.

 

Pancreatic cancer is the 10th most common cancer in the UK, with around 9600 people diagnosed each year. The disease has the lowest survival rate of all the 21 most common cancers, with just 5% of people in the UK living for five years or more after diagnosis. Shockingly, survival rates have remained largely unchanged for the last 40 years.

Early diagnosis is key to improving survival rates. Currently, 80% of people are diagnosed once the disease is at an advanced stage, when surgery –the one treatment which can save lives – isn’t an option. Just 8% of patients actually have surgery. 

A late diagnosis will often occur because pancreatic cancer doesn’t usually cause many specific symptoms in the early stages, and symptoms can be quite vague. When pancreatic cancer is inoperable, treatments such as chemotherapy are used to slow down the growth of the cancer and relieve symptoms.

What risk does pancreatic cancer pose and what hope is there for patients? Pancreatic Cancer UK gives us the facts, while two incredible stories speak of courage and the unpredictability of life. 

 

Treatments

Currently the standard first line chemotherapy option for pancreatic cancer patients is gemcitabine, which has been proved to extend survival by an average of seven months.

FOLFIRINOX is also routinely used to treat advanced pancreatic cancer, which can extend survival by 11 months, compared to seven months for gemcitabine alone. This treatment, however, is associated with more severe side effects, meaning the treatment is only suitable for a very small proportion of patients.

FOLFOX is most commonly used by clinicians as a second line treatment for advanced disease.

 

Pancreatic Cancer UK provides personalised support and information via the Pancreatic Cancer UK Support Line. Freephone 0808 801 0707 or email nurse@pancreaticcancer.org.uk

For more information about pancreatic cancer or Pancreatic Cancer UK, please visit pancreaticcancer.org.uk/support and follow @PancreaticCanUK.

 

Case study: 

John William Street 

as told by his daughter, Melanie Hamer

 

My Dad was always healthy. He was a quiet, thoughtful man and he’d do anything for anybody. A draughtsman by trade, he was also a keen artist – though he played it down – and was always interested in his grandchildren’s lives, and in our business. He never complained about anything, and he was never ill.

But in the spring of 2015, Dad started getting tummy troubles, then in May, he started feeling an uncomfortable twinge under his shoulder blade, and he lost a little bit of weight. The doctor thought he might have gallstones, so sent him for tests.

Pancreatic cancer had been mentioned in passing, but the possibility of gallstones was the focus. While we waited for the test results, the tummy troubles persisted, and his urine was darker. The twinge under his shoulder blade was still there too, and he was developing back pain. But he never complained and only took some paracetamol when it was really needed.

On the 27th of June 2015, Dad’s eyes went slightly yellow – he was going to the GP for his test results on the Tuesday. I said to my Mum to take Dad to A&E if he wasn't well before then, and he went to A&E on Monday the 29th of June, even though he disliked the fuss. There, he was diagnosed with pancreatic cancer.

On 2nd July, they told him that it was advanced and aggressive and had spread to his liver, gall bladder, stomach, and bowel. When symptoms show with pancreatic cancer it is very often too late for treatment and this was the case for Dad. We asked how long Dad had left. “Six to eight weeks,” the doctor replied. It was too late, they told us. There’s nothing to be done. We were all horrified and shocked. We had no time to come to terms with Dad being ill, let alone how little time we had left with him.

I looked at the consultant and asked him what he would do, if it was his father. “I’d take my Dad home,” he said. People say that the world stops when you get bad news. Mine did. I can still remember how I felt, looking at Dad.

My dignified Dad stood up and shook the doctor’s hand after he had received the news that he was going to die. He was such a proud and dignified man; he would have worn a tie in his hospital bed had Mum taken one in for him. It was heart-breaking.

We brought Dad home. He got everything in order, which included buying a new car for Mum, so she could get around. The palliative care nurses visited him, and though part of me wanted to keep him at home, so we could look after him there, he told us he wanted to go into the hospice. My sister, Mum and I sat vigil with him, 24/7, and he was never alone. We lost Dad a week after he went into the hospice, on the 26th of August 2015. He was 77.

It was such a shock, it was so quick, just eight weeks from diagnosis.

Pancreatic cancer can be a devastating disease. Understanding symptoms and signs could potentially lead to early diagnosis, which may lead to a more positive outcome.

 

 

Case study: 

James Dadge

 

I’d been feeling ill for some time, and had been relatively active, but I’d put on weight after our second boy was born. In September 2013 I weighed 24 stone. Hitting 40, I got a personal trainer, and lost nine stone.

Over Christmas 2014, my diet lapsed, and the weight went back on. Then at the start of 2015 my metabolism changed. I was pooing seven times a day. I was so tired. At night I’d fall asleep at 7.30. Previously I’d be up at 5am and off to work.

As 2015 progressed my bowel habits got worse, and despite being back to my bad eating habits I was still losing 2lb a week.

Blood tests showed high blood sugars; I was borderline diabetic. My GP sent me for a colonoscopy – nothing to be seen. The colorectal surgeon said I either had irritable bowel syndrome or ulcerative colitis.

One night in August 2015, on a family holiday, my stomach felt like it was going to explode. The doctor said my blood sugars were through the roof and I was jaundiced.

I was referred again and a different colorectal surgeon spotted something on my ampulla, a mass, but “nothing nasty”. I was to have a minor operation to put a stent, which would clear the way so my pancreas could start working properly again.

I was ready to go down, and the consultant came in. “There’s no easy way to say this…you’ve got cancer.” Me? No, it cannot be me. I’m never ill. Cancer was not part of the plan. It was 9 September 2015, and I was 42. My partner Andrea came right away.

They sent me to the brilliant Christie hospital. I had a neuroendocrine tumour, with the primary in the pancreas. A big one, which had to shrink and peel away from major blood vessels, so they could operate. I started chemo the next week.

The oncologist gave me a prognosis. I had the chemo. It was still too risky to operate and they tried another chemo drug. I returned to work, ran the Manchester 10km for charity with mates. The surgeon said that he could operate, though he hadn’t done it before, and it was a major procedure.

I made a will, wrote letters to Andrea, my sons Ben and Dan, said goodbye to work. I made specific arrangements about songs and poems for my funeral. I got fit.

When I came round from the operation, the surgeon told me that they got it all out, and the tests confirmed it. I’m still under surveillance, but I’m not in pain like I was.

Cancer grabs you, but it can never take you. What is constant is hope, that is the only thing which will keep you going, for there will be dark days. You will find hope all around. Live for the moment right now; after all everything is terminal, it’s just how you make use of your time before reaching the terminus.

Read James’s full story at here.  

 

 

 

 

 

 

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Features

Pharma marketing: UK vs US

by Amy Schofield 10. July 2017 10:26

 

 

Marketing medicines is a totally different ball game on each side of the pond.

The US is the only country, apart from New Zealand, which allows pharmaceutical companies to advertise direct to consumers (aka DTC advertising). The ability to advertise in this way is not permitted within the UK’s regulatory framework. The ban on DTC advertising in the UK is based on the premise that physicians, not companies, are best placed to decide on which medicines should be prescribed to a patient. But is DTC advertising all good news for pharma’s bottom line and bad news for the patient, and how would UK consumers react if DTC advertising was allowed here?

 

Trust issues

According to ZS Principal Chris Morgan, the negative PR surrounding some aspects of pharma, combined with people’s general dislike of advertising and the issue of timing, mean that even if DTC advertising was permitted in the UK, it might not be welcomed.

“The only advertising people like is that which is surprising, or funny, and pharma advertising is so heavily regulated that it is rarely ever those things,” Morgan explains. “In the US, people accept DTC advertising. The whole healthcare provision system accepts that it’s been there forever, but in the UK, it hasn’t. The transition would probably be a difficult one.”

Despite being accepted across the Atlantic, it appears that some US consumers aren’t fans of DTC advertising and perceptions of the pharma industry do it no favours. For example, a Harris Poll study* from January 2017 found that just 9% of US consumers believe that pharmaceutical and biotechnology companies put patients over profits.

In addition, a 2016 Harvard study** found that 57% of consumers would support removing DTC adverts from television. Hensley Evans, Head of Patient and Consumer Marketing,
 ZS Associates, says: “This isn’t surprising, given that more than one third of them also said they believe that drug advertising increases the prices they pay.”

 

Doctor view

People in the US and the UK have a different mindset when it comes to how they perceive the authority of their physicians, and what they can ask of them. According to Morgan, people in the UK have traditionally been more deferential to doctors than their US counterparts, and though this is changing with the advent of the informed patient, there are other factors at play. “In the US, the relationship is different,” he says. “In the UK, people are more sensitive to budgets, prescribing guidelines and care pathways, so you can ask your doctor for something, but it doesn’t necessarily mean you’ll get it.”

Does DTC advertising in the US threaten the position of the physician in the patient’s eyes? “I think the intention of the DTC ban in the UK is to preserve the authority of the physician as the one who determines the best course of action for the patient,” says Evans.

In the US, the American Medical Association (AMA) also wants to ban DTC advertising. Board Chair-elect Dr Patrice Harris thinks that DTC advertising ‘inflates demand for new and more expensive drugs, even when they may not be appropriate’, and leads to ‘increased demand for more expensive drugs’. 

“Based on the AMA’s position on DTC in the US, it’s likely that it is consistent with the wishes of many, if not the majority, of physicians,” reflects Evans.

 

Positive spin

Does the US’s direct approach empower patients or put them at risk? According to Evans, it is the former: “It empowers patients by providing both disease education, often prompting them to seek more timely medical advice and support, and information about treatment options.”

Evans proposes that DTC advertising actually drives broader awareness of diseases that might otherwise go undiagnosed or untreated, which leads consumers to discuss conditions that they are concerned about with their healthcare professionals, which in turn leads to earlier diagnosis and treatment.

She also reasons that advertising direct to consumers also improves medicines adherence to advertised brands, which can slow the progression of disease and improve patient outcomes. “Studies have demonstrated that advertisements help encourage patients to continue taking their medication,” says Evans.

Of course, pharma has a vested interest in driving brand awareness among consumers who have been diagnosed with a condition, but this could ultimately benefit the patient. “There are many physicians who believe that the availability of disease and treatment information has resulted in a more educated and empowered consumer, who is more easily able to take appropriate actions to manage their health conditions. DTC allows pharma to directly communicate to consumers who have requested such information.”

Morgan also believes that there are ways in which DTC advertising in the UK could benefit patients: “One of the positive aspects,  if the funding behind it was appropriate, would be helping patient groups and manufacturers to get accurate information out there, because there’s an awful lot of misinformation.” 

*theharrispoll.com   **harvard.edu

 

The promotion and advertising of medicinal products in the UK is governed by advertising laws and the Human Medicines Regulation 2012, which is enforced by the Medicines and Healthcare Products regulatory Agency. In practice, pharma operates under self-regulation in relation to the promotion of medicines according to the ABPI’s Code of Practice for the Promotion of Prescription-Only Medicines, which is administered by the Prescription Medicines Code of Practice Authority (PMCPA).

 

 

 

 

 

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