News from Nowhere 71 Oct. 25th 2018

Cell and Gene Therapies: The Goldrush continues

News from Nowhere was pleased to receive from ReportLinker a review of the business opportunities in one of the mushrooming areas within the biopharmaceutical industry, Cell and Gene Therapies. Both of these therapy types are expected to play a pivotal role in the future growth of the biopharmaceutical industry. ReportLinker is a technology company that simplifies how analysts and decision makers get industry data for their business (ReportLinker.com). Here are some snippets.

 The market for T-cell immunotherapy is projected to grow at an annualized rate of over 80% during the time period 2018-2030 although around 60% of this market is likely to be driven by CAR-T therapies (anti-cancer therapies based on modified immune system cells) even up to 2030. According to a recent research by Roots Analysis, the field has witnessed a tremendous growth in the interest of stakeholders, with over 200 instances of collaborations between industry and academics, and has seen over $8 billion invested by strategic investors in this domain.

The overall market for gene therapies is expected to witness significant growth in opportunities in the coming decade, with close to 300 product candidates currently undergoing development for a diverse range of clinical disorders. About $9.5 billion worth of capital has been invested in the last five years to support R&D in gene therapies and over 34,000 patents related to gene therapies have been filed in last five years alone.

There is a lot of money entering this therapy industry, and product costs for the NHS will be high.

Faith in Science

A new survey from Novartis, Amgen and Banner Alzheimer’s Institute, along with Alzheimer’s Disease International, shows that 91% of people from around the world believe medical research will result in a treatment for dementia. The study also showed that 60% of those adults believe a cure will be developed in their lifetime. That may be because of wishful thinking – dementia is a frightening problem – or lack of awareness of the failure of the last twenty years’ worth of research efforts to produce a disease-modifying drug. This is ‘promissory medicine’ – lots of new chemicals show promise, but none get beyond the trial stage because they don’t work, or even do harm. The message to the public is: “Keep on Giving”.

NHS cutbacks hit the private sector

The commercial medical firm Spire Healthcare has announced a 20% profit reduction in the first half of this year, mostly attributable to “unprecedented depth and speed of decline” in NHS admissions. It looks as if waiting list pressures in the NHS have not yet built up enough to encourage Trusts to buy elective surgery from the commercial sector. Spire is one of Britain’s largest private healthcare providers, operating 39 hospitals and 11 clinics with around 8,400 full-time staff. It works with NHS referrals as well as self-paying customers and private medical insurance patients.

Source: National Health Executive Online Private health giant Spire reveals 20% profit hit after NHS funding cutbacks 19/9/18

Lessons from Babylon

Babylon’s GP at Hand practice teaches us so much about the NHS. Would any of us have predicted that a primarily on-line service would draw 30,000 Londoners away from their current GP? There we have a measure of the public’s discontent with practices that push demand away and downplay convenience.

What a lot of myths Babylon has generated!  GP at Hand is not cherry picking in the sense of picking out the profitable patients. Since Babylon gets paid less for the needs and wants it serves – primarily episodic concerns among younger people with no long term conditions – it is difficult to see how these patients can be profitable, unless Babylon somehow reduces their demand.

Anyway, Babylon didn’t choose the restrictions on who could enrol with it, they were chosen by NHS England, as follows:

  • Women who are or may be pregnant (If you are pregnant, NHS England advises that you register with a GP practice close to where you live) 
  • Adults with a safeguarding need 
  • People living with complex mental health conditions 
  • People with complex physical, psychological and social needs 
  • People living with dementia 
  • Older people with conditions related to frailty 
  • People requiring end of life care 
  • Parents of children who are on the ‘Child at risk’ protection register 
  • People with learning difficulties 
  • People with drug dependence 

Of course the practices deserted by this patient group will lose money, but surely they cannot be paid for work they do not do? The warning that some general practices will be ‘destabilised’ needs to be taken seriously, but it is fundamentally a complaint about competition. Although many GPs are independent contractors to the NHS (with the tax advantages this brings), they are not innovative businesses, in fact they behave like NHS employees. Dr Richard Vautrey, Chair of the GP Committee of the British Medical Association, says it clearly: “….many practices, if not most practices, already offer telephone consultations. What they haven’t got is the IT kit to be able to offer smart phone consultations, or Skype-phone computer consultations, any many would like to be able to do that, if the technology was provided to them”(our emphasis).

This is all standard innovation curve behaviour, and we have seen it before. Innovators get ahead of the management regime, the problems become clear, the regulators over-react, eventually everyone corrects, money gets thrown at the problem, the system goes mainstream and the cycle begins again. We will not improve the NHS if we make up spurious reasons to reject innovation. The right approach is to work out whether the innovation benefits the public. So far NHSE has done a good job in reining in GP at Hand’s expansionist urges whilst watching its performance in London, and the CQC has been forthright. Babylon, known for its aggressive approach, has challenged 4 CCG’s decisions and taken legal action against the CQC over a negative report. This won’t make them many friends, and NfN moles don’t rate their chances, but at least they will have done their disruptive duty.

 

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