PHARMA FUTURE: Is Pharma Geared Up for the Future?

There was a man named Vasculo D’mage who lived life like there was no tomorrow. So
much the better, since Vasculo did not have too many tomorrows. His king-sized lifestyle
caused Vasculo to develop high blood pressure. After bouts of dizziness and headaches,
Vasculo was hauled off by his wife, to a doctor who pronounced him a hypertensive and
prescribed medicines that Vasculo had to take for the rest of his life. The thought scared and
depressed him and like any scared man Vasculo made his way straight to the bar to
contemplate. And he contemplated long and hard – with whisky and red meat. All this led to
nothing much apart from accommodating copious quantities of cholesterol into his blood.
The fat-thickened blood raced through his arteries (vasculature) and over many years,
eroded them causing – you guessed it – vascular damage! Slowly but surely, Vasculo D’Mage
ate up his tomorrows and finally succumbed to a massive heart attack one morning leaving
behind a grieving and helpless wife.

This is how things would end up for most people who suffer from chronic diseases like
heart disease, diabetes etc. One of the reasons is that these diseases are asymptomatic – or
simply - without symptoms. People who suffer from these diseases do so silently – not
because they are resilient, but because they feel nothing unusual. This makes them pay less
attention to their doctors’ advice, ignore taking medicines on time or in the recommended
doses and not heed advice on lifestyle modification. This, in turn, leads to aggravated illness
and often premature death.

A fact that the pharmaceutical industry - and others who profit from all things healthcare –
take solace in, is that as long as people fall ill, everyone makes money! Sad but true. Yet.

Yet, what if? What if the sun rises on a day when technology overpowers such things that are
taken-for-granted and makes them obsolete? And such a day shall come. The ‘Pharma
Future’.
Today, a challenge for pharmaceutical companies is to ensure that patients suffering from
chronic disease listen to their doctors’ advice on taking medicine and other precautions. This
would, along with improving the health of patients, also increase the duration of patients on
the medicines manufactured by these companies. While it seems unethical, it isn’t if its done
with the patients’ best interests in mind. Non-compliance leading to worsening illness or
even premature death is clinically proven. While doctors know this, they are often helpless
given the sheer number of patients they manage in the limited time they have.

Often, pharmaceutical companies step into this sphere to assist doctors to manage their
patients better. As long as product promotion programs are not disguised as compliance
programs – this is a good thing, since most people need constant reminders about taking
medication and following medical advice. Now this is what we already know. The ‘taken-for-
granted’ part here is that as long as people fall ill, all things healthcare make money. The
doctors, the hospitals and the pharmaceutical companies.

What if this wasn’t to be in the future. Who knows what technology is already evolving?
Technology (nascent or otherwise) that has the potential to disrupt health and healthcare
delivery!

What if Vasculo D’Mage lived in the future? Vasculo’s doctor would then diagnose him as
suffering from high blood pressure. On a hunch he would run Vasculo’s DNA through a
routine genome test mapped with the biometrics captured in his unique identity number and
find out that he has a high familial (genetic) risk of developing coronary artery disease and
diabetes. A software program in the doctor’s computer would rapidly calculate the time it
would take for Vasculo’s blood vessels to be damaged, accumulate lumps of cholesterol,
cause this lump to obstruct blood flow to his heart or brain and lead to a heart attack or
stroke.

In short, technology would accurately predict the hour of Vasculo’s death! The doctor would
also determine the chances of Vasculo listening to his health improvement advice through a
simple, user-friendly probability model. The computer would calculate that the chances of
adhering to medical advice for Vasculo’s personality types is very less. This would provide
invaluable information to the doctor to decide the exact course of treatment that he would
adopt for Vasculo. Since the doctor would personalize his advice to suit Vasculo – and not
simply dole out routine advice and prescription – Vasculo (and his wife) would listen with
rapt attention and even ask a few questions. All of this in under 30 minutes!

Next, the doctor would give Vasculo just one pill to swallow. This one pill, which is actually
an implant created through nano-engineering, would possess the capability to deliver
medication for chronic diseases (high blood pressure and diabetes that Vasculo suffers/will
suffer in the future) at the required doses. This implant would last Vasculo till the end of his
life injecting medicine straight into receptor sites providing superior efficacy and eliminating
chances of side-effects and drug-drug interactions. This targeted delivery would also
optimize the quantity of medicine while maximizing therapeutic efficacy. This would mean
that Vasculo would need very little medicine in each dose to keep him healthy therefore
allowing him to use the drug implant longer. Nano-engineering would also develop methods
of regenerating the drug inside his body for use therefore not requiring him to refill the
implant in his entire life. Micro-sensors in the ‘drug-bot’ would analyze Vasculo’s biologics
and send back reports on his health status to his doctor at stipulated frequency. This would
allow Vasculo to carry on with his life even while he remains under constant medication and
medical supervision!

If all this sounds like science fiction to you, then imagine the chaos it can instill into the
business models of healthcare providers. A patient will have to buy a medicine only once! He
will not be required to come to hospitals more than once in his whole life! How would
hospitals, doctors and pharmaceutical companies continue to make money?!

Is the healthcare delivery model geared up for this future? How can pharma play a role to
shape the future of healthcare delivery?

A few decades ago most medicines had to be consumed twice or thrice a day to create
therapeutic efficacy inside the patient’s body. The creation of extended release (XL) or
modified release (MR) systems made it possible for the same medicine to be consumed only
once a day and yet produce the required therapeutic effect. Open source drug delivery
(OSDD) research will soon create Life Time Release Systems (LTRS) thus allowing
once-in-a-lifetime implants as embedded in Vasculo’s body. This would signal the death of
conventional drug therapies over the next 25-40 years as costs fall for LTRS making the
technology affordable to a majority of health consumers.

This change in modality of healthcare delivery and the nature in which health and healthcare
is consumed in the future will also undoubtedly require doctors and hospitals to develop
different capabilities focusing on building better services and service models since patients
will not have to visit hospitals as regularly as used to. Therefore, while consumption of
products will reduce, opportunities will abound in the services sector. Healthcare will have to
develop a consumer service model like the white consumer goods industry beginning with
the equivalent of annual maintenance contracts (AMCs) to home delivery of healthcare
services such as diagnostics, reports, consultations and medicines.

The pharmaceutical industry currently positions itself as one of the stakeholders in the
healthcare value chain. Being a common thread that runs through the chain, the importance
of the industry will increase multifold. The life and health of people such as Vasculo D’Mage
is set to change for the better with the developments that the future holds. These
developments will create scores of opportunities for all stakeholders, especially the
pharmaceutical industry. How large a role the industry wants to carve out for itself depends
on how well it reads the future of healthcare. The question to ask is how well is the industry
geared up for the future? The pharma future.

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SALIL S. KALLIANPUR
I am just another guy caught in the quagmire of pharmaceutical marketing,
trying to get my two cents across through my blog and this newsletter. I
haven't worked outside the pharmaceutical industry and outside the sales &
marketing function. I sincerely hope that there will be people from other
industries and domains who will deem it fit to share their views and rich
experiences. Last but not least, I am no John Mack, so do forgive the
limitations in views expressed! It is my sincere hope that this newsletter helps
each of us understand how our work in healthcare marketing intersects with
life, in general, and helps us to become better human beings.