Accelerating access to medicine – the opportunities of personalised medicine and the challenges to overcome
Blog post: BRC Chief Operating Officer Dr Nick McNally and BRC Communications Officer Madeleine Stewart round up conclusions from the Accelerating Access to Personalised Medicine symposium...
The development of personalised medicine has the potential to transform the way scientists approach disease. Owing to the development of novel technologies such as genetic sequencing and improved imaging, medical interventions can now increasingly be tailored to the individual, enabling health systems to more explicitly identify people with specific sub-types of disease and deploy more focused treatment strategies for patients.
Yet, despite the advancements in technological tools available to medical science there remains public concern that medical innovation is not yet delivering benefit to patients quickly enough. The UK government’s 2016 Accelerated Access Review is one manifestation of this growing concern. The Review articulates how accessing innovation in the NHS has become increasingly challenging, creating frustration for clinicians and patients who often have to wait for life-saving treatments; and for innovators who must navigate multiple processes before their products can be used.
The acceleration of access to personalised medicine was the theme of a symposium hosted last month at UCL. Chaired by Sir John Tooke and coordinated by the Centre for the Advancement of Sustainable Medical Innovation (CASMI), in collaboration with the BRC, the UCL Personalised Medicine Domain and the Oxford University Health Care Values Partnership, the symposium used 3 important areas of biomedical innovation – treatments for neurodegenerative diseases, cellular and gene therapies and precision imaging - to set the scene for lively discussion and debate. But what was different about this symposium was that the discussion was provoked by an explicit focus not on the opportunities and challenges specifically of the clinical science but on the ethical, economic and behavioural challenges that might impede (and therefore must be overcome to improve) access to these promising new medical approaches.
Professor Steve Morris, Professor of Health Economics at UCL, posed questions about how society will pay for precision medicines that whilst holding the potential to transform an individual’s life might cost society hundreds of thousands of pounds. Wider economic issues were considered by Professor Morten Ravn (UCL Professor of Economics) questioned the economic consequences, for example, in investment in innovation and affordability to healthcare systems, of a shift from the era of one-size fits all blockbuster drugs (low cost, high volume) to small volume, highly precise and targeted medicines, Current mechanisms of measuring value and cost effectiveness of medicines are unlikely to be suitable in a new era of precision medicine. There are clearly implications here for a new social compact on how we fund and deliver healthcare innovation. And how do we accurately value a prevention versus a cure in the new era of personalised medicine?
Professor Jonathan Montgomery, (UCL Professor of Healthcare Law and Ethics, presented important ethical challenges that will need to be overcome if the potential of personalised medicine to quicken access to medical innovation is to be realised. The question of how healthcare organisations and society as a whole will handle the patient who is not eligible for the precision targeted therapy will need careful consideration. Will precision medicine widen health inequalities? And how do we facilitate informed choice around precision medicine? Wide public acceptance of personalised medicine will only come when barriers to understanding the terminology around, for example, genomics medicine have been breached.
The symposium discussions also emphasised the importance of human behaviour in determining how innovation is accessed. Three levels of influence were discussed: individual, organisational and societal. Key to this is an appreciation that public and patients may have different views and imperatives when it comes to access to healthcare. The public are often sceptical about pharmaceuticals and perceptions can shift markedly in response to ‘bad news’ stories in the press. In parallel with scientific developments that enable biomedical precision we need behavioural sciences that help us to understand the psychosocial factors influencing engagement and inform effective for communicating personalised medicine enable informed choice. As Professor Rob Horne, UCL Professor of Behavioural Medicine put it, this is about ‘putting the person into personalised medicine’. How do we incentivise patients to adherence to preventive treatments when the benefits may only be realised in the distant future?
Despite the significant challenges that lay ahead in the pursuit of ever faster access to personalised medicines there was a refreshing air of optimism and confidence amongst panellists, presenters and other participants at the symposium – a belief that personalised medicine will be able to live up to its potential. Initiatives such as the UK’s 100,000 Genomes Project are, for example, indicative of the government- level support for the integration of genomic and personalised medicine into the day-to-day delivery of healthcare. Government investment in research infrastructure such as the NIHR Biomedical Research Centres is also testament to a commitment to bring about faster, more effective translation of medical science, including personalised medicines, into patient benefit.
An appreciation amongst such national projects and infrastructure, of the role that innovation science (understanding and optimising the process of innovation and adoption) can play alongside biomedical science in realising the potential of personalised medicine will be critical to the success.