The great devolution? Examining the future of healthcare spending

by Amy Schofield 14. March 2017 09:39


The first Parallel Learning webinar examines the future of healthcare spending


Featuring a live Q&A between experts and key opinion leaders, the first ‘Parallel Learning’ webinar hosted delegates from the pharma and healthcare industries. They convened to discuss the future of healthcare spending, prompted by the example of Greater Manchester (GM) – the first English region to gain control of health spending.

Chair Michael Sobanja opened by explaining how this “immense” devolution project took us back to a deal struck in Manchester, during February 2015. It involved 10 boroughs, 12 CCGs, and 15 NHS Trusts – with a budget of around £6bn. George Osborne had referred to it as “part of his Northern Powerhouse project”, while Andy Burnham – Shadow Health Secretary at the time, said that it had the potential to create a “two–tier NHS”.

Michael asked, “Is it ambitious rhetoric, or a real opportunity to improve health?”

Speaker Peter Rowe – Deputy Chairman of East Lancashire NHS Trust –shared an insightful presentation on how the Greater Manchester Strategic Partnership has gone from signing the devolution deal, in February 2015, to taking charge of health and social care spending in April 2016. “There is a lot of trust between the people here, and the bureaucracy that supports it is slick and efficient. The speed at which decisions are being taken and implemented is quite astonishing. Things are moving very rapidly,” said Peter.

The webinar also explored what is happening on the ground in Manchester, how it will affect pharma’s customer relationships at a local level and how this will affect the establishment of similar organisations elsewhere.

“We’re seeing a real potential shift in political power, so that central Government will have much less influence over what actually happens on the ground,” explained Peter. “Local politicians, together with local health leaders, will be held to account by their populations through the ballot box and local elections.”


What now for pharma?

Peter set about explaining how Greater Manchester is intending to engage with pharma companies. During the live Q&A, he explained how the GM devo team, the ABPI, EMIG and various other bodies in the pharma industry, have signed a ‘Memorandum of Understanding’, which will answer many questions that industry has.

“This is probably the place in England where medicines optimisation has the best chance of success,” Peter explained. “Potentially GM could really be the test bed for things that you’ve wanted to do for years, which is to improve the value of your medicines, and prove the case that innovative use of medicines can make a difference to health outputs in the real world.”

In answer to a question regarding the Carter Review plans that will affect pharmacy, and whether they are on target, Peter said: “In the next few weeks, pharma colleagues should be able to see what is proposed in GM and the rest of the country. We shall see the manifestation of Lord Carter’s proposal in hospitals across the whole of the UK, not just in GM.”

On the issue of medicines optimisation, Peter referred to how there may have been too much focus on the use of low cost drugs: “There will be a sincere approach whereby it is seen that an innovative new medicine or an existing medicine, which might cost more, can genuinely change the way that either the healthcare system works, or whether the patient can be returned to work, or can have a quality of life that will reduce their demand on social services.”


Eyes on the future?

Who is accountable if GM “goes wrong?” asked another delegate. “GM want to set their own performance standards and it is likely that you will see a real shift in where accountability really lies,” replied Peter.

When asked by another delegate whether devolution can be applied everywhere, Michael Sobanja cited the possible effect of Brexit in slowing progress: “I don’t think devolution is going to go very quickly, or as quickly as we might have thought, had Cameron and Osborne still been around. Devolution has to have willing and competent partners.”

Is it likely that the model emerging in GM will form the basis for future sustainability and transformation plans (STPs)? “The truth is, it’s a big experiment,” said Peter. “The government, Department of Health and everybody else will watch it very closely. There will be many parts of it that will be used to inform STPs and the way they work.”

Peter said that speaking at the first webinar had been “a new experience, and very enjoyable. The presentation flowed well and the interaction with the Chairman and audience during questions was effective and positive.” He also praised the concept behind Parallel Learning: “It’s a great way to share information and to interact with busy people.”  

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Alex Ledger discusses what the loss of the EMA means

by Alex Ledger 14. March 2017 09:19


Joy division?


Will the loss of the European Medicines Agency (EMA) result in slower drug access for UK patients? It will according to Sir Alasdair Breckenridge – former chair of the The Medicines and Healthcare products Regulatory Agency (MHRA) – and it might do more than that.

Several countries are vying to give a home to Europe’s medicines licensing agency. Barcelona, Milan, Lyon, Dublin, Amsterdam, Stockholm and Budapest have all apparently submitted their interest. All offer sensible prospects, however, the stakes are high. An EMA staff survey, recently reported in the FT, has been presented to the agency’s governing board, which showed that about 50% of employees would leave in the event of relocation to an undesirable city.

Even losing a fraction of this number would dramatically restrict the EMA’s work programme, slowing down the rate of evaluations and, ultimately, approvals. All European patients would suffer.

The EMA relocated to large headquarters in London’s Canary Wharf two years ago. In those modern facilities, 890 medics, scientists and bureaucrats determine the licensing and monitoring decisions for medicines throughout the European Union. Additionally, the agency coordinates 36,000 national regulators and scientists each year, from across the continent, who approve the safety and efficacy of drugs.

To accompany this, a specialist regulatory industry has blossomed in and around London, supporting companies through the EMA’s processes. Relocation of the agency means the potential loss of highly-skilled professionals who will, inevitably, take their skills, taxes and expense budgets elsewhere.

Naturally, concern has also been raised in Parliament. During Prime Minister’s Questions SNP MP Philippa Whitford – member of the health select committee – raised a probing question, inquiring as to the Government’s plans to tackle the departure of the EMA. Theresa May’s retort was devoid of detail other than to say it was ‘looking into the matter’.

Jeremy Corbyn’s shadow health secretary, Jonathan Ashworth MP, has publicly stated that he has written to Jeremy Hunt, characterising the Government's handling as “reckless”, carrying with it a “damaging loss of jobs and wealth”.

Securing a good deal for medicines regulation is fast becoming a high-profile feature of the proposed Brexit negotiations. Any agreement will need to reassure industry that the UK will not represent a substantial hurdle to secure access. Achieving this is a tough demand.

An option to avoid disruption and cost would be an agreement for the UK to continue participating in the EMA and its regulatory system. There is precedent for this. Norway, Iceland and some smaller European countries are members and subject to its rulings. To achieve this, however, those countries had agreed to be members of the single market and, as part of this, accepted core EU principles such as free movement of people, goods, capital and services. There is no appetite within the Government to entertain such a ‘soft’ Brexit.

Another suggestion would be to automatically adopt post-Brexit EMA rulings by uniting the MHRA and NICE to make them a more appealing prospect to industry. A single, integrated agency responsible for an end-to-end value assessment of new technologies could speed up regulatory decisions and reimbursement. This would be a positive development.

Nevertheless, both bodies have prominent independent reputations – both domestically and internationally – and will be keen to protect their respective territories. NICE operates an international consulting arm, and the MHRA uses its expertise to conduct reviews on behalf of the EMA – it currently approves about 25% of all medicines in the EU.

To duplicate the EMA’s work would entail a substantial uplift in resource and cost. It is hard to see how Government would finance this without passing some cost onto industry. MHRA already charges and NICE has proposed new fees for its own assessments. These latter reforms have sensibly been paused for the time being, in light of Brexit, and will await publication of the Government’s industrial strategy in the coming months.

Somewhere the risks of European departure for the future of the life sciences sector are being listened to, but worryingly there remains little convincing detail about proposed solutions.   


EMA in numbers

Licenses medicines in 28 EU states

Equates to 25% of the world’s total drug market

Serves a combined population of 500 million people

The UK on its own is about 3% of the global market.


New order

Should Breckenridge’s views cause concern – would the impact of Brexit create a two-tier regulatory system in the UK? EMA as the major market, and the MHRA – or a succeeding body – as the second. If so, pharma could be deterred from launching in the UK early, particularly if it came with additional costs.

Theresa May’s government has suggested that much of EU regulation is readily adoptable and can be quickly ‘copy and pasted’ into UK law. Industry figures have been quick to endorse this, suggesting that a system of mutual recognition with the EMA might offer a workable solution. Some legislative experts, however, have been more sceptical.
There are suggestions that, because a sizeable proportion of EU regulation is considered to refer directly to European institutions or other EU legislation, it cannot be easily transferred.

The EMA – an agency subject to the European court system – has been clearly marked out as not featuring in the Government’s post-Brexit plans. Indeed, it was the judgements of this court which fuelled much of ‘Team Leave’s’ messages in the run up to the referendum. One of their core arguments was the cutting of the overly constrictive regulatory order to ensure the UK was not subject to decisions from the European Court of Justice after Brexit. It would be an Olympic effort to row back on that one.


Alex Ledger is Deputy Managing Director at Decideum - the views expressed are entirely his own. Go to



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A tour of fame, fortune and philanthropy

by Amy Schofield 13. March 2017 13:26


Gotta have faith

Following George Michael’s untimely death, stories of his generous donations to charitable causes surfaced. Which other celebrities have shared their good fortune?

Read the cover story in the March issue of Pf Magazine here.

George Michael

When George Michael died on Christmas Day, we were left with an incredible legacy of music and, of course, ‘Last Christmas’ echoing tragically in our ears. But then, in the following days, anecdotes of extraordinary and highly secretive generosity began to emerge. These weren’t ‘careless whispers’, but real stories about real people. In typically classy style, George had not only donated millions to countless charities throughout his life, but had also covertly helped strangers in ways that brought fresh tears to eyes already bleary with sadness.


Here’s how George brightened lives beyond his dulcet tones:

The Terence Higgins Trust: The former Wham star lost his partner, Anselmo Feleppa, to AIDS in 1993, and for many years donated experiences and gifts to the charity, enabling it to raise funds and help support people living with HIV. He also donated the royalties from ‘Don’t Let the Sun Go Down On Me’, his 1991 duet with Elton John. Head of Major Gifts and Special Events at the organisation, Jane Barron, said: “His donations contributed to a vision of a world where people living with HIV live healthy lives, free from prejudice and discrimination.”

Sport Relief: George pledged thousands to David Walliams, when the comic swam the English Channel in 2006. After George died, the comedian tweeted: “There are lots of stories about #GeorgeMichael’s legendary generosity emerging today. When I swam the Channel he gave @sportrelief £50,000.”

Childline: Childline founder, Dame Esther Rantzen, revealed how George generously gifted the royalties from his 1996 hit ‘Jesus to a Child’ to the charity, which amounted to just a portion of the millions he donated. Childline recently unveiled plans to hold a star-studded performance in 2017, honouring George’s generosity, and coinciding with the charity’s 30th anniversary. Esther Rantzen said: “George helped us reach out to hundreds of thousands of children through his generosity.”

Personal donations

Pointless presenter Richard Osman told the story of how – when he was working on Noel Edmond’s Deal or No Deal – a contestant told them she needed £15,000 for IVF treatment. “George Michael secretly phoned the next day and gave her the £15k,” Richard recalled.

Played a free Christmas concert in honour of the nurses who cared for his dying mother

Sent 1000 free concert tickets to hospital workers who treated him for pneumonia

Set up a trust which gave grants to support the rights of disabled children & adults


Camp sight: Alan Carr

Chat show host and comedian Alan Carr spreads not only laughter, but also goodwill to many charitable causes. Last year Carr became a patron of Neuroblastoma UK, which supports research to find new, more effective and kinder treatments for children diagnosed with this aggressive childhood cancer. He also supports children’s charity Variety, providing his trademark irreverent humour to their events, while also playing a significant role in raising the charity’s profile in important funding bids.


Money spinner: James Corden

The big-hearted TV, film and Broadway star, who began his rise to fame with Gavin and Stacey and can currently be seen hosting The Late Late Show, in the US, has never shied away from sharing his good fortune. The long-time host of the BRIT Awards once gave his £50,000 presenting fee to Comic Relief and – along with other celebrities – provided the sound of himself breathing over a backing track for a music video created by the Cystic Fibrosis Trust. It would also be fitting to remember Corden’s unforgettable Comic Relief appearance, as his Gavin and Stacey creation, Smithy, in a beat-up Volvo, singing along to George Michael, accompanied by the man himself.
The skit was the precursor to the now world-famous ‘Carpool Karaoke’ segment on Corden’s show and yet another reminder that George Michael was not just an incredible singer,
but a quite remarkable human being.


Mind craft: Ruby Wax

Self-confessed ‘poster girl for mental illness’ Ruby Wax is a advocate for mental health, having suffered from crippling depression for many years. As an ambassador for mental health charity, Mind, she has been vocal about her history of depression. Ruby's one-woman stage show, Losing It, toured mental health hospitals for free. She also created the ‘Black Dog Tribe’, working with the charity SANE to create a safe community for people suffering from depression in which they could share experiences.


Potter gold: JK Rowling

JK Rowling’s legendary charitable nature once led to her being knocked off the Forbes World's Billionaires list. Rowling has donated millions to a number of causes through her charitable trust, ‘Volant’, which supports causes such as the Catie Hoch Foundation, Children with AIDS, Dyslexia Action, the Make A Child Smile Appeal and the Multiple Sclerosis Society. The creator of the Harry Potter books, who used to write in an Edinburgh café with her baby daughter, to escape her poverty, once said: “You have a moral responsibility when you’ve been given far more than you need, to do wise things with it and give intelligently.”


Elton John

In response to watching many friends – including Freddie Mercury – suffer and die from HIV/AIDS, George Michael’s dear pal Elton John set up the Elton John Aids Foundation (EJAF) in the US, in 1992, and the UK in 1993. The organisation has grown into one of the largest, most respected and dynamic charities in the field. Elton ceaselessly champions the cause through leveraging his fame to raise awareness and funds – holding post-Grammy and Oscar parties as fundraisers, and opening his home to legions of celebrities every year for the famed ‘White Tie and Tiara’ ball. In 2016, the EJAF offered to finance HIV testing in the London borough of Lambeth, which is the UK local authority with the highest rate of HIV. He also gives large amounts of his personal fortune to charity.

READY FOR LOVE: the Elton John Foundation in numbers

£122 million raised

1049 projects supported

Seventh largest philanthropic funder of HIV


Net worth: Cristiano Ronaldo

He may be better known for his ball skills and giant ego, but footballer Ronaldo has a considerable heart too. He’s always been onside when it comes to sharing his estimated £120 million fortune with those less fortunate than himself. Notable examples include paying for experimental drugs for nine-year-old Real Madrid fan, Nuhazet Guillen, who was suffering from cancer of the spine. Meanwhile, he also responded to a plea from the parents of a 10-month-old baby boy, Erik Ortiz Cruz, who needed a life-saving brain operation. They asked him to donate a football shirt and boots to an auction, in order to raise funds for the £50,000 operation. Ronaldo paid for the operation and the further treatment.


Sweet dreams: Annie Lennox

Since amassing a fortune with 80s chart-busters Eurythmics, and later as a solo artist, singing superstar Annie Lennox has changed lives with her ceaseless altruism. When she heard Nelson Mandela describe the HIV/AIDS pandemic in Africa as a ‘genocide’, she became an activist for the cause. She went on to found the Annie Lennox Foundation and was honoured with the British Red Cross’ Services to Humanity Award in 2008. She is most well-known for her tireless work to raise awareness of the deadly impact of HIV/AIDS in Africa. In 2007, she created the SING campaign, which raises global awareness about the impact of HIV on women and children, in particular in South Africa, Malawi and the UK. She has also been appointed UNAIDS Goodwill Ambassador.


The key of life: Alicia Keys

Singer-songwriter Alicia Keys is an ambassador for Keep A Child Alive – a charity which provides life-saving anti-retroviral treatment to children and their families with HIV/AIDS in Africa and the developing world. She regularly visits Africa to speak with children who have lost their parents to AIDS and has also played at the New Jersey Live Earth, the Philadelphia Live 8 concerts and in events held for the victims of Hurricane Katrina.


Accounts office: Ricky Gervais

Ricky Gervais is a passionate supporter of animal rights, as well as giving generously to cancer charity Macmillan Cancer Support – raising around £1million for the charity by donating the profits from a series of warm-up shows. He likes a laugh and famously donated £1000 to Great Ormond Street Hospital after daring Gary Lineker – in a tweet – to use the football cliché, ‘it was a game of two halves’, during Match of the Day coverage of a quarter-final clash between the Czech Republic and Portugal. Lineker sportingly obliged. He is also an avid supporter of many other causes, including the Teenage Cancer Trust, Prostate Cancer UK and the Roy Castle Lung Cancer Foundation, as well as Comic Relief, for which he filmed a spoof African appeal for ‘Red Nose Day’ and brought back The Office legend David Brent, who was seen strumming a guitar to Brent’s protest song, Equality Street.   




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How are HCPs shaping the future of pharma?

by John Pinching 24. February 2017 10:25



Some would view a healthcare professional (HCP) taking a job with a pharmaceutical company as akin to an impressionable Jedi being seduced by the dark side of the force. Many more don’t even know that doctors, nurses and a plethora of other medical people even operate within industry.

In reality, HCPs are just as qualified, just as diligent and just as sworn to the ol’ Hippocratic oath as their NHS counterparts. Two HCPs working at two of the biggest pharma companies now reveal how they navigate the private sector terrain, while keeping patients in sharp relief.


Shaantanu Donde, Pfizer


The role

I am the Regional Medical Therapeutic Area Lead for the Europe Region. I provide medical support toward driving established drugs, while also launching newer variants into the market. The role entails coordination with national and global colleagues, and collaboration with business, safety and regulatory personnel. I also develop responses to medical queries received from HCPs and provide training to medical and business colleagues on products and therapy areas.


Sound advice

We provide strategic inputs regarding the effectiveness and safety of the products. This helps them reach larger and relevant populations through customer insights. As experts in the therapy area, we also give advice based on the unmet needs of disease areas and share competitive intelligence based on recent scientific data and literature.


Industry strength

I have continued to work in the industry as it offers a very conducive environment where your thoughts are valued and your innovation can influence the development of future strategies.


Patient focus

We do not generally get an opportunity to directly work with patients, but we can play a critical role in shaping their health by ensuring that our medicines are effective and safe. We can drive many patient awareness programs by developing appropriate content, but have to be sensitive about not influencing their decisions to adopt our products.


Changing lives

We can touch lives of our patients by addressing their needs through contributing to the development of new medicines and improving disease awareness. We also strive to help HCPs who have direct communication with patients, while ensuring the continued safety of drugs, and releasing safety alerts when adverse events occur in marketed products.


Reward system

Satisfaction comes from influencing patients’ health through working on so many good quality drugs. Getting an opportunity to engage with great HCPs, who have immense respect for the company and are willing to lend their expertise for better patient outcomes, is a really gratifying experience.


Public image

Though there is more visibility about the physicians working in the industry, I do not believe the general public are cognisant of this fact.


Achieving balance

It is very possible to stay unbiased. You have to stay focussed on patient health, without compromising your integrity, and there are checks to ensure you don’t promote your products inappropriately. The interactions with HCPs are critical and you must ensure that accurate information – based on scientific evidence – is shared appropriately.

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Duncan Gould, Merck


The role

I am a senior medical adviser working in the field of type 2 diabetes. I am principally involved in UK medical affairs, which entails the medical management of a launched product. I advise and interact with colleagues from commercial, legal and health outcomes, as well as NHS clinicians and other public officials. I have held numerous posts in medical affairs and clinical development over the years in several companies and therapeutic areas.


Sound advice

I advise on all medical aspects, to support accurate and balanced information about licensed diabetic medicines, as per the ABPI Code of practice. I also advise internally about data and other information on the company’s and competitors’ products.


Industry strength

In the past I have been an NHS GP and an anaesthetist, however, around 25 years ago decided that I would have a more fruitful and exciting career in the pharmaceutical industry. Had I remained as a GP in the NHS, I would now be very disillusioned and looking for early retirement. I do still see patients, as I have a weekly private practice session in London.


Patient focus

As I still see patients, I can understand that working solely for industry can blinker views and lead one down a tunnelled path. One is at risk of not seeing the big picture and being lost in the minutiae of data.


Changing lives

Given that new drugs coming to the market must demonstrate benefit – both from an efficacy, but also a health economic argument – it is clear that in working with such medicines you are making a difference to health. As a medical adviser you can also help educate stakeholders on the benefits of those medicines.


Reward system

Reward comes from addressing real unmet need with high-science medicine. I really enjoy cutting-edge innovation and thinking. For example, I was involved with a company that brought a new class of cancer treatment to the market and this has really revolutionised the way that some cancers are now treated.


Public image

The public are not aware of us. Historically, and to this day, pharma is seen as a suspicious industry by the media, and this misconception has been passed on to the public. Although it has not changed in several decades, HCPs within the NHS now hold greater respect for pharmaceutical physicians than they once did.


Achieving balance

It is possible to be completely unbiased and it is very important that one is. The medical role, and that of others, is to put the patient at the heart of all decisions. I have only ever experienced this philosophy with the companies I have worked for. Being biased is wrong and will be found out.

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Denise Nolson, 46, on remaining positive while dealing with illness

by John Pinching 10. February 2017 12:26



A series of interviews in which patients share their experiences - in their own words


Please tell us about your condition

My name is Denise Nolson. I’m 46, happily single and two years ago, I was diagnosed with rheumatoid disease (RD). Three months later I had to sign off sick from work, due to daily pain and fatigue, and - although I'd love to return to employment - at present I consider myself medically retired. I've since been diagnosed with fibromyalgia, ME and Sjögren's syndrome, all of which are commonly linked with RD.


What treatment or therapy do you use?

I'm on biologic medication for my RD, plus several other daily medications including anti-depressants, pain relief, factor V Leiden, and treatments for IBS and hypertension. Alongside these I have found holistic practices helpful, such as conscious breathing, meditation and chanting, as well as an electric under-blanket, heating pads, Voltaren gel and compression gloves.


What impact has it made on your life?

This could be a book! In chronological order, I have experienced constant pain, fatigue, losing my job and my house, homelessness, major anxiety attacks and worsening depression. In addition, I’ve become physically disabled, required crutches to walk, a mobility scooter, raised toilet seat, shower chair, bed rails and grab bars outside my front door. The situation has been further compounded by not being able to wash or dress myself on some days, sleeping for up to 18 hours and, conversely, having to endure bouts of insomnia.


Is adherence - sticking with your treatment regime - a challenge?

Not at all, it's a pain, but manageable on most days. I set the alarm for morning tablets, eye drops and mouth spray, and take a lax powder drink an hour later. The alarm sounds again in the evening for tablets, night eye gel and another lax powder drink. Then there’s a further alarm every two weeks for a biologic injection. I also self-manage pain, using paracetamol, tramadol and hydrocodone. It would be a real struggle to manage around working, or a family, but living alone means my life can be very simple. It's become a necessity.


What side effects, if any, do you have to manage?

Headaches, dry skin, eyes and mouth and bowel pain.


Are you getting enough information about what medicine you take?

Yes, but mainly because I self-educate. Shortly after diagnosis I started sharing my story through my blog - Singlerheum - and the online RD community has proved to be an amazing support network, which I'm proud to be a part of.


Are you looking for an improved treatment?

I'm looking for a cure! But in the meantime, an effective treatment would be great. I'm on my fifth RD med with no improvement so far.


Do you think that the pharma industry listens to you?

Honestly? I don't think they care, although I'd love to be proved wrong. A lack of thought given to containers alone causes millions of patients to experience further hardship. As both an active patient and advocate with RD I've never been asked any questions by the pharma industry. I have, however, signed up for a new med packaging trial next year, so we'll see.


How would you like to see communication with drug manufacturers improve?

I don't think there is any communication. In the UK, you are prescribed a med and you take it - that’s it. You have no say in terms of the brand, manufacturer and packaging. I'd love to see customer service advice lines, plain English on information leaflets and drug manufacturers with patient-friendly social media platforms that encourage open and unsolicited communication.


Are you feeling positive about the future?

Yes. Despite worsening mobility and physical health - and thanks in no small part to a fabulous GP and some great private therapy - I'm working on being grateful for the good in my life and also achieving peace. Acceptance of my multiple conditions has certainly gone a long way towards that. I have the support and love of friends and family, as well as the online RD community, and that keeps me moving!


For advice and support go to

Find out more about Denise story at 


‘The Patient Voice’ interviews are a collaboration between Pf Magazine and talkhealth.

talkhealth is one of the leading online health communities in the UK, providing free information and support to those with chronic health conditions; whilst collaborating with pharmaceutical and healthcare companies, charities and medical professionals to develop sustainable health programmes and solutions.



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Drug-resistant bacteria is threatening global health

by Amy Schofield 10. February 2017 09:09


Apocalypse Now: The advance of drug-resistant bacteria threatens global health – what’s being done to protect us?

Imagine a world where simple surgeries carry the risk of death. Where common infectious diseases – which previously posed no threat – could kill you, and where giving birth becomes life-threatening.

Before the invention of antibiotics, this was the perilous existence of our ancestors. We could, however, be returning to those dark ages, as the overuse of antibiotics brings with it the very real worldwide scourge of antimicrobial resistance (AMR).

“The threat is very serious,” said microbiologist Dr Jessica Blair PhD, of the Institute of Microbiology and Infection at the University of Birmingham. “Multi–drug resistant infections currently kill 700,000 people annually and this figure is rising every year. If this rise continues at current rates then it is predicted that by 2050 there will be 10 million deaths every year due to multi-drug resistant infections.”

The lack of novel drugs in development to replace those we can no longer use, due to resistance, means that Chief Medical Officer for England Professor Dame Sally Davies’ warning of an “antibiotic apocalypse” was no exaggeration.

“The use of antimicrobials underpins modern medicine,” added Dr Blair. “Without action now many simple infections will once again become untreatable.”

AMR threatens the effective prevention and treatment of a continually expanding range of infections caused by microorganisms such as bacteria, parasites, viruses and fungi.

AMR occurs when these microorganisms alter after being exposed to antimicrobial drugs including antibiotics, antifungals, antivirals and antimalarials. Sometimes referred to as ‘superbugs’, microorganisms that develop AMR are rendering antimicrobial medicines ineffective, meaning that infections persist, increasing the risk of an infection – with nothing to fight it. New resistance mechanisms are now emerging all the time and spreading across the world, threatening global public health.



AMR is compromising the fight against diseases including tuberculosis (TB), HIV and malaria and – without antibiotics that work – the successful outcomes of minor and major surgery, and cancer chemotherapy will be seriously compromised.

Figures from the World Health Organisation (WHO) show that 480,000 people develop multi-drug resistant TB each year. According to Dame Sally’s foreword to a report on AMR, from Lord Jim O’Neill and the Institute and Faculty of Actuaries, 50,000 people are dying every year in Europe and the US from infections that antibiotics have simply lost the power to treat. She warned that the death toll could increase worldwide and that our ever-increasing life spans may end up falling.

“The projected figures are much more worrying. It is quite possible – and perhaps even likely – that the recent era of material mortality improvements will give way to many years of material mortality worsening,” Dame Sally warned.

One study concluded that 70% of bacteria around the world have already developed resistance to antibiotics, including colistin, which is described as the last resort of antibiotics, due to its side effects.

It’s not just the over–use and misuse of antibiotics by humans which has contributed to the crisis; the growth of factory farming is linked with the development of AMR bacteria. Indeed, two-thirds of antibiotic consumption in the EU occurs in animal farming.

The human – as well as the economic cost – of AMR is massive, and until new medicines are developed, it can only grow. But there are exciting new developments afoot, giving hope to a world currently under considerable threat.


Antibiotic Guardian campaign

The Antibiotic Guardian campaign from Public Health England is asking the public, students, educators, farmers, the veterinary and medical communities and professional organisations to choose ‘one simple pledge’ about how they will make better use of antibiotics to slow resistance. Go to


Action Stations

In September 2016, 193 countries signed a landmark UN Declaration agreeing to combat AMR. Signed at the United Nations General Assembly in New York, the agreement followed a worldwide campaign led by Dame Sally and Health Secretary Jeremy Hunt to highlight the threat posed by resistance to antibiotics.

The nations duly committed to tackling drug-resistant infections as a priority, and agreed to develop surveillance and regulatory systems on the use and sales of antimicrobial medicines for humans and animals, encourage innovative ways to develop new antibiotics and improve rapid diagnostics. They will also carry out awareness-raising activities to educate healthcare professionals and the public on how to prevent drug resistant infections.

At the time, Dame Sally said: “We need governments, the pharmaceutical industry, health professionals and the agricultural sector to follow through on their commitments to save modern medicine.” The UN Secretary General is to report back on progress within two years.

Meanwhile, Dr Blair is spearheading a national campaign – Antibiotic Action. It is a public awareness initiative of the British Society for Antimicrobial Chemotherapy (BSAC) and works to inform everyone about drug resistance – including members of the public, scientists, HCPs and politicians.

“We need to make people aware of the issue of antibiotic resistance and try to help people understand the threat,” said Dr Blair. “The main messages are to urge everyone to use existing antibiotics wisely and promote the importance of infection prevention and control.” Go to


Discoveries in 2016

1. The European Commission (EC) granted marketing authorisation for AstraZeneca’s new combination antibiotic Zavicefta (ceftazidime-avibactam), developed for the treatment of patients with serious gram-negative bacterial infections, which require hospitalisation.

2. Scientists at Germany’s University of Tubingen discovered that people with the bug Staphylococcus lugdunensis (S. lugdunensis), present in their nostrils, were less likely to also have Staphylococcus aureus (S.auresus), including the superbug strain MRSA. Researchers identified the single gene that contained the instructions for building a new antibiotic which could treat superbug infections and named it lugdunin. Tests on mice showed that it could treat MRSA, as well as Enterococcus infections.

3. Life scientists at UCLA discovered that combinations of three different antibiotics from a group of 14 drugs can often overcome bacteria’s resistance to antibiotics, even if they are ineffective on their own or when combined with one other.

4. Symcel partnered with Colzyx to test 25 different new collagen VI derived anti-microbial peptides, analysing their capability to kill bacterial growth in different ways.


Wake up call

The ‘golden era’ of antibiotics research and development – when new medicines were being discovered – is toast. The old model, where pharma companies developed a new drug, then sold as much as possible of it, is no longer working, as old medicines lose their ability to fight infection. New products, therefore, must be used sparingly to avoid a repeat.

In his report, Lord O’Neill proposed a new way of repaying pharma companies for new antimicrobial medicines, through a ‘market entry reward’ payment of around $1.3bn (£890m) to the company that develops an effective new antibiotic for an ‘unmet need’.

Dr Jessica Blair is currently undertaking research to gain an understanding of the mechanisms of drug resistance in gram-negative bacteria. “By understanding the mechanisms we are better placed to target them with new drugs,” she said.

Dr Blair’s research involves efflux pumps – molecular pumps in the membrane of bacterial cells. “Efflux pumps are able to pump the antibiotic molecules straight back out of the cells allowing bacteria to survive the antibiotic treatment,” she explained. “Through this research we hope to be able to develop inhibitor molecules against these pumps that could be administered with existing antibiotics to restore sensitivity to these drugs.”

Dr Bjorn Herpers, clinical microbiologist at the Regional Public Health Laboratory in Haarlem in the Netherlands, said: “As all traditional antibiotics have eventually led to resistance, developing ‘new’ antibiotics of the traditional type isn’t the answer.”

The use of endolysins presents another new strategy. These are special enzymes that cleave the bacterial cell wall – a mechanism with no risk of generating resistance. “This resolves the doctor’s dilemma of not wanting to withhold a potential beneficial treatment to an individual patient, but having to be restrictive with antibiotics because of the risk of resistance induction,” added Dr Herpers.

Together with the Technical University of Zurich and the Dutch biotech company Micreos, he has successfully tested Staphefekt, the first endolysin available to the public for use against the bacteria Staphylococcus aureus, including the resistant type MRSA.

In further developments, Dame Sally Davies launched a new initiative at the London School of Hygiene and Tropical Medicine (LSHTM), in December 2016, to address the challenge of AMR. Giving the keynote speech at the launch of the School’s new Antimicrobial Resistance Centre, Dame Sally said: “We have a duty of solidarity to sort this, we cannot step back and watch it happen – we have to work out how to make a difference.”

The exciting research and development currently underway – along with action at local, national and international level – presents new hope that this potential global disaster can be averted.   



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Pharma & NHS: Solving the puzzle together

by Amy Schofield 2. February 2017 10:06



How is industry working with the NHS to deliver the best possible outcomes for patients?

Cross-sector joint working initiatives are witnessing the NHS deliver better outcomes for patients, by drawing on the extensive knowledge and expertise of the pharma industry.

Joint working ensures that patients receive optimal care and support to help them maximise the benefits of their treatment.

The Association of the British Pharmaceutical Industry (ABPI) produced a toolkit in 2012, when the concept was in its infancy. ‘Joint Working – A quick start reference guide for NHS and pharmaceutical industry partners’ describes these inter-sector partnerships as: ‘Situations where, for the benefit of patients, NHS and industry, organisations pool skills, experience and/or resources for the joint development and implementation of patient-centred projects and share a commitment to successful delivery.’

In delivering all that it promises in its ‘Five Year Forward View’, the NHS faces many challenges, including intense financial pressures and an unrelenting drive to improve quality and productivity.

Kopano Mukelabai, National Programmes Manager, Roche UK, said that the chance to work together exists despite – or perhaps because of – the challenges facing the health service: “There is real opportunity for this country to be a global leader in healthcare, even at these times when NHS finances are under severe strain.”

As a result of these difficulties, NHS organisations are increasingly calling on external expertise to supplement existing skills and resources, helping them rise to the challenges they face. This is where pharma enters the equation.


Two hearts

The pharmaceutical industry not only develops and supplies medicines that improve patients’ lives, it also brings business and financial expertise and a vast knowledge of therapy areas – essential for joint working initiatives with the NHS.

The Department of Health and the ABPI – along with pharmaceutical companies and other key industry bodies – are actively promoting joint working initiatives.

Harriet Lewis, NHS Engagement Partner (North) and Medicines Optimisation Lead at the ABPI, explained: “The pharmaceutical industry is wholly committed to working in partnership with NHS providers and commissioners to improve outcomes for patients, both nationally and regionally.”

The ABPI has four regional expert networks that focus on partnership working to support the NHS in delivering efficient and transformational services and care for patients. They provide opportunities for collaborations that focus on delivering benefits for patients, ranging from addressing pathway challenges, reducing unwarranted variation in care across regions and service arrangements to improve patient access to innovative treatments.

The Greater Manchester Diabetes Partnership – a collaboration between the NHS, ABPI, and a number of pharmaceutical companies – was set up in February 2016 to explore ways to enhance diabetes care. 

“By establishing a more integrated approach to patient care across Greater Manchester, with support from providers, commissioners, and third-sector stakeholders, the Partnership is working to improve patient outcomes and reduce unwarranted variation across the area,” reflected Harriet.

Collaborative working presents its own challenges, however. “When initiating joint projects between the NHS and industry, they often require more than one company to be involved,” added Harriet. “There can, therefore, be delays and barriers, as each side negotiates its responsibilities and roles to ensure a fair division of work among all involved. We believe, however, that by helping to sustain the NHS for the future, by working side-by-side with healthcare professionals and fully understanding the needs of patients, we can work together to improve the long–term care for patients.”


Seeds of change

Department of Health guidance encourages NHS organisations and their staff to consider opportunities for joint working with the pharmaceutical industry, where benefits to patient care and the difference it can make to their health are clearly beneficial.

In 2008, the Department of Health produced, ‘Best practice guidance for joint working between the NHS and the pharmaceutical industry’. It was designed to encourage NHS organisations and staff to consider joint working as a realistic option, and to advise NHS staff of their main responsibilities when considering such partnerships with the pharma industry.

After the publication of the ABPI’s initial toolkit, it released ‘Joint working with the pharmaceutical industry, guide and case studies’, in 2013. This publication shared seven steps to setting up joint projects, as well as providing evidence of successful partnership initiatives.


For the common good

Pharma has enthusiastically embraced working in partnership with the NHS, and vice versa. Across industry, projects that support innovation and high-quality patient care have been successfully completed and many more are ongoing, with the common goal of better patient outcomes providing the driving force behind them.

Roche’s Kopano Mukelabai sums up the approach of industry to partnering with the NHS: “Our ultimate goal is to transform the lives of thousands of people in the UK, and beyond, living with devastating conditions. Central to this is our promise to do all we can to ensure patients can access the medicines and tests that we are proud to have worked so hard to develop, while at the same time recognising that – for the NHS to remain sustainable – we all need to work together to ensure that every opportunity to capture value is maximised across the whole pathway.”   


5 NHS/Pharma High Fives 


1. Giant leaps: GSK

Joint working projects completed in 2014-2015 included NHS Lanarkshire and GSK working jointly to improve the management of chronic obstructive pulmonary disease (COPD) across North and South Lanarkshire Community Health Partnership Boundaries. Meanwhile, Epilepsy Scotland, Union Chimique Belge Pharma and GSK UK worked jointly to evaluate and subsequently improve the services for epilepsy patients in Dumfries and Galloway Health Board.


2. Support group: MSD

The company says that ‘some of its greatest achievements have come about through collaborative effort’. These include working with NHS North Lancashire, Ely Lilly,
Novo Nordisk and Pfizer on the Primary Care Diabetes Facilitator Project to increase management of diabetes in primary care. It also has a partnership with the London Sexual Health Programme (NHS England, London) and Bayer HealthCare on ‘Improving Choices in Contraception through Training’.


3. Street wise: AstraZeneca 

The company says that it is ‘committed to ensuring that AstraZeneca’s business is aligned with NHS priorities and supports delivery of excellent patient care’. It has duly undertaken over 30 joint working projects since 2009. These include collaborating with Stockport CCG to improve asthma and COPD care and reduce unplanned admissions and unwarranted variation.


4. Breathe easy: Teva UK

Involved in a number of joint working projects with the NHS across the country, Teva has helped with ‘Improving Asthma Outcomes’ in Ashford Clinical Commissioning Group, via a Medicines Use Review (MUR) support programme. This included inhaler technique training, MUR training and reducing asthma hospital admissions across NHS Bristol.


5. Roche solid: Roche

Over the last three years Roche has worked with over 25 NHS organisations on more than 28 projects. These include supporting initiatives to remodel cancer pharmacy services, helping to build whole system integrated care platforms in the South of England and alongside The Christie, in the new setting of a devolved health economy.






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Can you really worry yourself sick?

by Amy Schofield 26. January 2017 09:15



Don’t believe the hype: health headlines dissected



Do you constantly worry that a mysterious nagging pain could be the thing that kills you? Does the receptionist in your local GP surgery recognise you by your voice when you call for an appointment? According to new research, hypochondria – agonising that something is wrong, when the evidence suggests otherwise – really could be ruining your health. Also known as the ‘worried well’, people who constantly stress out about phantom illnesses are more likely to develop heart disease than those who are confident that they remain in rude health.



Researchers at the University of Bergen in Norway examined health data from more than 7000 people born in Norway in the 1950s. The anxiety levels of participants were measured using a standard questionnaire, while their heart health was tracked using national data on hospital treatment for heart conditions. The purpose of the study wasn’t to establish whether anxiety over health caused heart disease later in life but, rather, if there was a correlation between the two. The study was published in the BMJ Open.



The researchers found that during the 10–year follow-up period, twice the number of people who scored highly on the anxiety tests went on to develop heart disease (6.1%), compared to those who weren’t anxious about their health (3%), even when other risk factors – such as diet and smoking – were taken into account. Once the results were adjusted for risk factors, analysis showed that those with health anxiety at the start of the study were found to be 73% more likely to develop heart disease than those who weren’t. Curiously, the effect was also found to be more evident in men than women.



Although the results of the study showed that there was a link between health anxiety and heart disease, the researchers could not establish exactly why. This was because those with anxiety were likely to have other mental health issues, which could also contribute to coronary heart disease. The study authors said: “This finding corroborates and extends the understanding of anxiety in various forms as a risk factor for heart disease.” So, although health anxiety wasn’t found to be the single cause of heart disease, you clearly can worry yourself sick.


What the press said:

‘”Worried well” make themselves sick’ The Telegraph; ‘Hypochondriacs more likely to develop heart disease, study finds’ The Independent; ‘Why it’s no surprise that hypochondriacs get more heart disease’   


I told you I was ill

Hypochondriac comes from the Greek word hypokhondria, which literally means ‘under the cartilage (of the breastbone)’

Famous hypochondriacs include Charles Darwin, Florence Nightingale and Andy Warhol

After a performance of his play, ‘The Hypochondriac’, Molière passed out on stage and died a few days later




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Knowing me, knowing you: Meet the MSLs

by John Pinching 20. January 2017 10:13


In the ranks of pharma and the NHS there are people that speak the same language


In the curious ‘no man’s land’ that exists between industry and the NHS, Medical Scientific Liaisons (MSLs) break bread with healthcare professionals; conversing in a common vernacular, and maybe sharing the odd science-based joke.

This is a language that only they understand. Indeed, increasingly, industry views MSLs as the key to engendering trust and delivering on the promise of transparency.

No longer simply a loyal foot soldier – the MSL is leading the charge. A few pioneering pharma companies are instigating this remarkable rise – harnessing a passion for science and utilising an ability to communicate vital messages about life-changing products.

Motivated only by medical research, exciting therapy development and making a difference, MSLs are, perhaps, the future of pharma itself.



MSL in profile


Camila Marotta, Chugai Pharma UK

The role

As part of the Medical Affairs team, MSLs are the bridge between the pharmaceutical company and healthcare professionals – facilitating the exchange of unbiased medical and scientific information. We work throughout a product’s lifecycle, and pre-licence activities can include advanced budgetary notification to payors, medical educational meetings and advisory boards. We can also assist in formulary applications and investigator’s initiated trials. The primary objective of the MSL is to establish and sustain peer-to-peer relationships with therapy area experts at major hospitals and
academic institutions.


The difference

At Chugai Pharma UK we all have the patients’ interests at heart and are regularly reminded of why we do what we do. We believe that continual innovation, investment in research and partnerships, are the key drivers in targeting difficult-to-treat conditions and improving quality of life. As MSLs, we are at the forefront of sharing the clinical trial data, ensuring that clinicians have the information they need in order to make the right prescribing decision.


The reward

Medical educational meetings are one of the most rewarding parts of the role. I truly enjoy presenting and engaging on a relevant disease area and providing up-to-date information and support. We are currently working on delivering a series of meetings in the area of cancer cachexia, which is a very challenging and mostly undiagnosed condition.


The change

The pharmaceutical market is changing to accommodate the increase in personalised medicine, immunotherapy and fluctuating NHS budgets. There is great competition in the biopharma industry and, consequently, we need to be working in compliant collaboration with our internal partners, and to
the highest of standards.


The future

My personal ambition is to keep developing as an MSL – there’s always room to learn and develop. Aiming to be the best I can be at my job means that I’ll be delivering an improved service to my customers. I’m looking forward to being part of my first product launch as an MSL next year. Chugai Pharma UK has an exciting pipeline and 2017 promises to be a memorable year for all of us.

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Steve Patmore, Janssen

The role

At Janssen UK, the MSL function represents the medical department of the company. As an MSL, I interact peer-to-peer with healthcare professionals; supporting education and facilitating the exchange of up-to-date scientific knowledge on new and current Janssen products, ensuring the best outcomes for patients.


The difference

As an MSL, I have a deep-seated responsibility to healthcare professionals, and the patients who come under their care. By ensuring that we build strong, ethical relationships with clinicians and provide the highest quality of education and service, we are in the best position to make a positive difference to the lives of patients. We support initiatives such as investigator-initiated studies and real world evidence data collection, and this research has the potential to enhance how treatments work, improve clinical decision making and, ultimately, transform patient care.


The reward

Peer-to-peer conversations with clinicians are really fulfilling – taking time to engage with them and understand their interests and thinking. The quality of these interactions – together with the information and education provided by Janssen – has resulted in increased engagement and a strong belief among clinicians in the value we offer. Being able to further support the clinicians I work with in their ongoing education, or within their appraisals, is also very rewarding.


The change

The MSL role is changing – expectation is no longer just on data delivery. I have become more heavily involved in projects which gather insights from internal and external partners, enhancing the quality of interactions with healthcare professionals. By recognising our strengths and demonstrating that we are willing to listen, the role develops in line with the needs of people we serve. From a clinician’s perspective, I believe they are looking for more from pharma companies – they value the clinical conversations that go beyond mere translation of data, and are interested in the evaluation of real world evidence and health outcomes.


The future

As the lead on customer feedback projects within Janssen diabetes, I am looking forward to evaluating responses. This will be the first time we have had the opportunity to know what our customers think and this supports us in realising our aspiration of being the best. In terms of my own education I am looking to completing a virtual diabetes course at the University of Copenhagen. My other interest is in ‘critical thinking’ and I’ll be looking to develop this in 2017.

Go to





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Patients please: The ‘missing link’ between industry and healthcare

by John Pinching 17. January 2017 09:03



The ‘missing link’ between industry and healthcare provision has arrived (and they mean business).

Not so long ago your GP was the all-seeing, all-knowing, god-like figure, with your healthcare record in their filing cabinet. Patients would live for decades with a condition they knew nothing whatsoever about – their life and, indeed, death had been obediently handed over to the healthcare profession.

A lack of input from patients – the very people for whom pharma and the NHS exist – has, over several decades, created a power vacuum and it has taken an entire digital revolution for ‘the patient’ to occupy that void.

Recognising that there has been cultural shift, a few buzz terms – designed to create solidarity between industry and the patient community – have emerged, such as ‘patient centricity’ and, the utterly vacuous, ‘focussing on the end user’. This was well-meaning enough, but, until relatively recently, patient presence at healthcare-driven events has been practically non-existent and, for those patients willing to provide personal data and assist with research, experiences have been mixed.

Meanwhile, the online patient voice has grown in decibels – to the extent that it can no longer be ignored. The rise has developed through shared experience, support networks and, above all, challenging the medical profession. This, in turn, has seeped offline and into society – the patient has come in from the cold.

People want to know about their condition, people want to manage their illnesses and they want better therapies and apps to enable them to do it. The patient voice is here and it’s getting much louder.


Here’s to you, Nick Robinson

The BBC’s former Political Editor, Nick Robinson – a self-confessed workaholic – was diagnosed with a rare form of lung cancer in 2015.

At the ABPI’s Patient’s First conference he appeared as the de facto ‘celebrity patient’ and was brilliantly candid about his experiences. “It’s been a curious public journey”, he confessed. “And, yes, being in the public eye, you do get more attention and support.”

He was brutally honest about the reality of illness and the fragility of life itself. “You’re not in control, your body is – but we can control how we react. We head straight for the internet, and it’s almost always alarming. Shut the page!”

Nick went on to talk about how it wasn’t death that worried him, but the fear that someone might know something that they weren’t telling him. He said that he was far happier when he discovered that the doctor didn’t know the outcome. When he realised that Nick was fine with that, the doctor was “much more open about uncertainty.”

He urged us, as patients, to use our voices. After a wretched first stage of chemo, Nick told the nurse it had been dreadful, and was given a different cocktail next time.

He also set himself a personal goal – to return to his television duties on election night. “That was my Mount Everest,” he said. And return he did.

“You can never put patients first enough,” he concluded.

Nick Robinson has recovered and currently hosts Radio 4’s Today programme.



Top talk

Memorable quotes from the ABPI’s inaugural Patients First conference


“Once you’ve invited us to the party, don’t exclude us, and talk to us in a language we understand.”

 Jane Taylor, Chair of Patient Insight Group, Arthritis Research UK


“Patient research must be in the community – empower people by explaining research outcomes.” 

Dr Doug Brown, Director of Research and Development, Alzheimer’s Society


“Patient data is at the core of innovation; experience of living with a condition shapes new treatments.”

Nicola Blackwood MP, Parliamentary Under Secretary of State for Public Health and Innovation


“Research must be demystified. Take away the white coat and test tubes, and change the language.” 

Angela King, Patient Advocacy Lead, Novartis


“Conditions affect society – not just one person. It’s about changing mindsets and improving quality of life.” 

Keith Wilson, Patient Research Ambassador


“Before starting chemo, I was told you could travel on the tube afterwards – you can’t! Patients are the experts.” 

Professor Trisha Greenhalgh, Professor of Primary Care Health Services, University of Oxford



View from the expert

Over the last few years, the patient voice has become more confident, more educated and more important. The digital revolution has led to increased access to information, and a brave new world of healthcare has emerged.

Discussion forums, Twitter, Facebook, Instagram and many others provide patients with a platform to openly discuss health concerns, research their condition and share thoughts about their day-to-day lives. This has resulted in the growth of more engaged patients – and those providing healthcare have had to listen to what they’re saying.

The increasing volume of the patient voice has also coincided with the squeeze on NHS services. Four years ago the Department of Health published ‘Liberating the NHS: No Decision About Me Without Me’. It specifically targeted healthcare professionals, with the aim of providing patients with better choices and more control over their health.

Drawing on years of running product trials, and cohort patient trackers through talkhealth, feedback suggests that if patients are informed and feel more in control, commitment to their healthcare routine is higher, with better compliance.

Some 17 years ago, my own GP – who I think was ahead of his time – admitted he had run out of treatment ideas and acknowledged that I knew more about my daughter’s condition than he did! This experience repeats itself across health forums, as those battling with health issues become 'professional patients'.

In his book, The Patient Will See You Now, Eric Topol said: “We’ve learned in general that doctors don’t like smart patients. But this sort of attitude will do little to hold back a new generation of increasingly smarter patients and more supportive and smarter doctors.”

With rapid advances in technology it will be fascinating to witness the further progress of patient empowerment over the next decade.  


Deborah Wyatt is Founding Director of talkhealth Partnership Ltd. Go to





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