Future Shlock

One of the major disconnects in the pharma industry, for a variety of reasons (historical, regulatory, organizational) is  the one between product development and the marketing which follows. Products have always been developed mostly tailored to functional specs, with the needs and convenience of patients who end up taking the medicines a secondary, or marginal, factor (beyond a basic, obvious level). Indeed, such product-related elements such as formulation, vessel and packaging design are purely functional – syringe, self-inject pen, pill, gel-cap etc. etc. Marketing these products has mostly been conducted post-hoc, based on a finalized set of characteristics, which the market itself had little effect on, aside from the initial basic medical need.

Or, should I say, that was the way things have always been.

A widely used phrase in healthcare is the “consumerization of patients”. Indeed, they/we are seen as becoming much a more prominent factor in recent years, expecting more of our doctors but also more from the medical products that we (and our health insurance) are paying for.

Thus, the evolution of medicines from the conventional products we’ve always known into more sophisticated consumer products is set to change the way pharma companies develop and market their products and, of course, the way patients consume them . In order to meet the increasing expectations patients have of their drugs, based on patients’ increasing power and voice, medicines will be designed to be more friendly to patients, more useful, more comfortable, even more interactive where possible. All this, despite restrictive regulations and the very slow pace at which the legal framework surrounding the industry moves. With R&D naturally not dealing closely with non-medical patient needs, the natural move will be to interface marketing and product development.

Adding user-friendliness and the will to meet expanding patient needs will touch a variety of fields which are central to the industry’s business, including packaging, formulation, medical monitoring, patient adherence to name but a few. For patients, the solutions offered should touch upon all phases of the treatment journey, from the product received at the pharmacy, to routine usage, to re-ordering and result monitoring.

Some examples for possible different capabilities are:

• More convenient packaging for patients with motor issues; waste disposal and collection services for used syringes.
• Extended use of environmentally-friendly materials.
• Integrating medical follow up and result assessment with medicine taking: pills and/or syringes which measure and indicate the patients’ condition (e.g. blood or other internal parameters) upon injecting /digesting.
• Pillboxes which calculate the number of pills taken out and automatically remind the patient of the dosing regime, or syringes which include RFID broadcasters to indicate via computer-linked receivers to the doctor when patients have self-injected.

Manufacturing these medicines, making them more appealing to consumers not only for their health benefit proposition, but also on associated extra added-value as part of the empowered patient’s self-disease management, will require not only new skills and innovative ideas from product development people, but, equally as important, a linking of market knowledge prevalent in marketing & sales departments with the product development and design capabilities which exist in R&D departments.

This, of course, will require much closer work between these two important segments of pharma companies – the relationship between which has historically been non-existent, weak, or even one of mutual suspicion. Different staff profiles, a different work cultures and routine, a completely different “language” have all contributed to this internal gap. However, if companies want to really meet their customers needs, if they want to innovate, grow and succeed, making these two meet will be crucial.

During the last several long train/plane trips which I’ve taken over the past year or so I’ve bought and read the printed edition of Wired.

Now, Wired is one of the best known geek-zines (leg-en-dary), and I’ve been reading it for over a decade. However, when I contrast my experience when reading it these days with that of reading it ten years ago, it feels to me that the current publications just do not stand up to the same standard.

I’ve found I had this feeling after going through several issues.  It used to be, in the “good old days” that I couldn’t put the magazine down – the vast majority of articles and items were interesting, profound, visionary, exciting (see this article as a good example of what you could find), or any combination of the above. These days I just find it very…well..flat, uninteresting, mundane.

I’ve thought whether this is simply me, whether my interests have changed and the mag has stayed more or less the same? No, I don’t think what I look for has changed. It seems to be some editorial decision, though I’m flummoxed as to why would someone “dumb it down” – more varied offers for more “reader segments”? New readership with new, different, interests?

Please, can someone enlighten me as to what’s happened, am I alone in finding the new editions so bland, and/or where I can find a magazine which captures the spirit which Wired used to capture and carry so well?

When considering all that is written about the singularity, in print and online (including by yours truly), it is useful to step back and consider things from a different, less involved, standpoint.

What we have here is basically an idea. A belief. One which may be based on observed trends, but is nevertheless a projection made regarding the future. A future which for many is seen as exciting, fascinating, or even as offering salvation from the sufferings and limitations of humanity.

In these respects and others, the belief in the singularity is a semi-religious one. “In a few decades we will reach a point in which humanity will evolve/ merge with machines/ disappear/ be free of its mortal coil/ be redeemed/ saved/ connect to the infinity of information”. We have a prophet who writes books on the subject, speaks widely about the fantastic future he foresees and is quoted in pretty much every article about the subject.  We have droves of believers of all different backgrounds who are convinced that this future is certain and that they should do everything in their power to bring it to existence.

We even have blind, unquestioning, easily manipulatable faith, the worst aspect of traditional religions, in which people stop, or never start, doubting anything they are told. This despite the generally higher intelligence and educational background and wider scope and interests which many of the “believers” hold.

So as with all religions, blind faith is bad. Always question your beliefs, always doubt what you read about the future. It may be…no, it almost certainly will be, different than the one you envisage. Try to make up your own mind based upon real data. Many people may be speaking their minds and confidently foreseeing and prophesyzing what the future will be like. Don’t take their word for it – you read, you decide.

A few thoughts on post-human society, one which will emerge after the singularity (if we make it that far).

First of all, a definition of Singularity for you laymen (and women) by one of those who coined the phrase, Vernor Vinge, taken from this interview:

“My version is that in the near-historical future, it seems very likely that we will be able to create beings that are smarter than humans in every way we think of humans being smart and creative. This sort of technical advance is qualitatively different from other technical advances, and it qualifies for the name “singularity” in that the world afterwards is intrinsically unknowable to people on our side of the singularity.”

The interesting question for tonight is: where might religion, that ever-present blind belief in a creator/s and all the associated paraphernalia which has gathered round this idea over the centuries, fit in in such a world? Would it still be relevant and necessary for post-human beings, or would the radical changes which define this new civilization render religious belief obsolete?

Assuming you’re interested, there’s an easy way to answer this question: “how the heck could we know – that’s the nature of a singularity!”. This is a fair answer, scientifically speaking, however it’s not much fun and would not allow me to free-wheel in pontification. So allow me to venture forth.

Much regarding the answer to this question depends on the definition you use for the term “religion”:  is it a general fear of god – an “awe before the divine”? Perhaps it can be classified as a search for the ultimate truth, a source for guidance regarding the “right” way to live our lives: “a push…toward some sort of ultimacy and transcendence that will provide norms and power for the rest of life”? Or a more generic classification of any and every belief in a single or multiple god(s): “a general term used… to designate all concepts concerning the belief in god(s) and goddess(es) as well as other spiritual beings or transcendental ultimate concerns”?

The definition will naturally determine the answer, with the more traditional, restricted view of deities as omnipotent beings which respond to prayer/sacrifice/meditation less likely to persist than the wider view of “the search for ultimate truth” . However, the basic question is: will post-humans still need a god or supernatural beliefs to explain the unknown or that which they cannot answer (the meaning of life and all that), or will this be coolly categorized as “not yet known”? The latter is  an attitude much more in line with the scientific rationale of attempting to explain nature using observation and experimentation, while retaining doubt towards every theory until it is proven.

Two elements may factor in the answer to this: a. what post-human society consists of  (an evolution of machine intelligence – true AI gone exponential, or the joining of human and machine followed by this rapid increase in intelligence), and b. (in both cases) what are the rules according to which this society will be founded and operate upon?

In a “rise of intelligent machines” scenario, programming could play a vital role. As some would say that the search for the meaning of life goes hand in hand with self-consciousness, the emergence of real AI would bring this intelligence to question the meaning of its existence – with the associated questioning of the nature of its creator(s) (in this case humans) figuring heavily, at least in the early phases. Seeing beyond its human parents would quickly bring the question to where they came from, leading to deeper philosophical and metaphysical questions – and perhaps coming nearer to religious ideas.

The “human integration” scenario, which is in my eyes a much more optimistic one for humanity’s future (unless you take the hardcore and somewhat morbid “we evolve or become irrelevant and that’s the way things should be” view), incorporates the human view of religion into post-humanity. Surely a more interesting concept to think about. A post-human society would include in its core make-up some measure remaining from the vast heterogeneity which characterizes present-day humanity (reasonably assuming that some groups – religious? – will opt out of combining with machines), with religious beliefs being only one small aspect of this variety in thought. Of course, Atheism would also be an important and relevant viewpoint. How would such different beliefs be mirrored into the thoughts (I use this word very loosely as the thinking of a multi-conscious being is very different from that of a single entity) of a collective?

A good analogy which can perhaps help us take a glimpse into what such collective thought would be like is the coming together of many single-celled  organisms to form a multicellular structure. Consider for a moment that you are comprised of billions of cells, each with its own copy of your DNA and its cellular structure. However, the function of your body is part automatic and part led by your conscious thought – the product of billions of neurons firing in patterns in your brain. Thus, while many different cells with different functions and some degree of ‘autonomy’ exist, there is an overriding consciousness which can determine the path the whole organism takes. The analogy seems to dictate a central decision-making “body” which will breathe a set of beliefs, ideals and mundane instructions to the super-organism. It can be suggested that since such a central body will determine these central tenets, the “Body” of organized  religion will become redundant and disappear, with only the central, philosophical ideas such as the search for the meaning of life and the nature of creation remaining. Which is (or should be) of course, the central point of religion anyway

This entire subject is, of course, a matter to be discussed and debated. My opinion is limited to myself, and I’m sure many would argue with my limited conclusions here, and even with the rationale underlying them. Nevertheless, it makes for a very interesting thought experiment, one which I will pursue further within this blog.

Many who are unfamiliar with the pharmaceutical market see it as a homogeneous grouping of huge companies entrenched in pursuing a traditional, little-changing business model. This may have been correct for several decades, in which healthcare costs were manageable and little changed in the market itself. However, this industry, like all others, is forced to change with the times, and these years are seeing significant shifts. These relate both to the market itself and to the nature of the products which the companies are offering to patients. They have already altered the way pharma companies conduct the entire scope of their business, from R&D to sales and marketing, and will continue to do so in the coming years.

On the R&D side, the well-known slope of dwindling blockbusters and increasing research and development costs have forced companies to seek new revenue stream sources, from new product classes such as biologic drugs (treatments based on molecules synthesized using organisms and not chemical reactions) and stem cells, through partnering with other companies to achieve at least some cash inflow, to scouring the academic and small and medium enterprise (SME) field in search of promising novel therapeutic developments. In most cases, several of the above strategies are employed simultaneously. I will examine the future of pharma R&D in an upcoming post.

While these trends in R&D strategy are quite well known and have been written of extensively, the changes occurring in the way pharma companies market and sell their products, their relationship with the wide range of stakeholders in the healthcare market, and above all the very nature of what they as an industry offer to society looks set to change. This aspect of the changing pharma market has so far not received sufficient attention.

The focus of this change revolves around the pharma industry being pushed by healthcare market conditions to add more and more value to their products, beyond the intrinsic benefit which each drug represents. Companies are thus being pushed to compete not only on their products’ safety, efficacy and cost-effectiveness, but  also on what value they can add to their two key customer groups – patients and physicians.

In contrast with the changing R&D field and resultant product map, these changes are not dramatic – no government will one day announce that pharma companies must offer comprehensive support and information services on top of their products (indeed, many will balk at the idea) – however subtle shifts brought about by a number of factors are pushing towards this outcome. Even within the industry itself many are unaware of the magnitude of these changes and the necessary alterations in the way pharma companies do business.

The aforementioned factors are:

1. Increasing pressures on healthcare budgets which bring about increasing governmental pressure on drug prices
2. Overloaded doctors with time for little beyond minimal consultations and an inability to remain up-to-date in fields containing an ever-expanding amount of scientific data
3. Increasingly empowered patients looking for healthcare ‘experiences’ and comprehensive health solutions, with some willing to pay extra for such service package

These factors result in companies  being ever more pushed to offer to both doctors and patients solutions built around and on top of their drug products. A natural development in this respect is the companies becoming directly involved in Medication Therapy Management (MTM) and lifestyle packages built for patients using their products. The added value which companies can bring to MTM and similar programs stems from their deep understanding of diseases and the drugs used to treat them; their “deep pockets”; their wide ranging and close contact with large numbers of physicians, in particular prominent ones; and finally their ability to effectively interface with a large number of healthcare system stakeholders, bridging ones which do not normally touch eachother, such as pharmacists, specialists, payers and government.

Particular programs and initiatives by pharmaceutical companies which are included in such services are,  among others:

1. Patient support programs: use of nurses, call centers, remote telemedicine and other means to give the patients much more information, support and  assistance than their doctor can, to confidently take their medicine as prescribed and achieve their medical goals set.
2. Solutions for doctors: trainings regarding improving communication and patient management techniques, software solutions to facilitate improved clinic efficiency, making it easier for doctors to keep up to date with rapidly evolving fields.
3. Tailoring together with payers enhanced treatment packages with tiered pricing levels, including a range of informational, technique-related sessions and tools or those which pertain to related aspects of the drug or disease in questions. For example, for multiple sclerosis patients pharma companies may be drawn to help with information sessions on the disease and it’s treatment, seminars on advances in research, and, importantly, augmented nurse services to support patients with drug taking and related issues.

In many ways, the pharma industry is in a similar situation to companies in the numerous other business areas which have been forced to pile solutions and services on top of products. However, a significant difference is that in the pharma business strong regulation exists to keep the companies separated (to varying degrees) from their customers. This will mean that, in some countries, the expenditure, creativity and changes that may be necessary for companies to survive will be substantial and may put a significant strain on these companies’ viability.

In almost all cases, pharma companies will be forced to undergo the same changes experienced by companies in other fields when faced with such shifts. They will be required to develop internally, or outsource, competencies they have never had to have or make use of before, such as management of IT tools, healthcare support services, specialized training and much more.

The need for these services, coming from the healthcare stakeholders which pharma companies interface with, means that the companies and the parties they work with will be pushed further and further towards eachother, not being able any more to continues working in a mostly isolated fashion.  Those who will be most open and able to collaborate on win-win projects will emerge the big winners, and those who remain focusing on their products alone will slowly degenerate with the changing of the market and the tightening of healthcare budgets.

Sources:

1. Byron G. Auguste, Eric P. Harmon, and Vivek Pandit:  The right service strategies for product companies
2. Glen Allmendinger and Ralph Lombreglia: Four Strategies for Smart Services