It made me think whether the Health/Medical industry had the same level of awareness of the impact of social media and whether they saw any value in it. I recently saw a nice visual “infographic” posted by John Joyce on Mindmeister.com demonstrating the myriad of social networking and media sites out there. It’s mind boggling, so little wonder people and businesses struggle to grasp it all.

The following infographic posted on the Vincos Blog shows the uptake and impact of one of the relatively more well-known social networking sites called LinkedIn (a professional version of Facebook ). If LinkedIn was a country it would have a population about the size of the UK or more than 3 times the population of Australia and growing.

What was curious was that out of 17 industry sectors listed the medical sector ranks a pretty respectable fourth for the number of Linkedin users. Unfortunately this number doesn’t reflect my own experience, since many of the doctors I know have never even heard of LinkedIn much less bothered to register on it.

So we’re looking for the medical/health LinkedIn users not just in Australia but all over the world, make yourself known we’d love to hear how else you are using social media in your professional life and business. We’d love to feature some of the more innovative ways the use of social media might improve healthcare.

TRANSCRIPT

MT: Our Guest today is Toby Wilson Waterworth, he is the Co-Founder and CEO of Atlantic Healthcare, an international Specialist-led Pharmaceutical group based in the UK which currently has three phase III programmes targeting gastro-intestinal disorders.

Welcome Toby.

TWW: Thank you Dr Tan, it is very good to be with you.

MT: Toby, I’ve been looking over your background and you have a rather distinguished career in the healthcare sector in the UK and internationally.  So much so that you are the life sciences and healthcare expert for the British Government’s Global Entrepreneur Programme and a couple of years ago you were appointed as the Chair of the MIT Enterprise Forum in the UK.  What sparked your interest in health and what prompted you to start Atlantic Healthcare?

TWW: Well, it really extends from the fact that I come from a medical family; my father was a surgeon, my mother a nurse. I grew up with the medical journals spread across the breakfast table, being taken to the hospitals where my parents worked and a continual stream of visiting patients. I have always been passionate about innovation and improved outcomes for patients. When I found out that I was not sufficiently intelligent to become a doctor (I just could not do chemistry!), I did the next best thing and became an accountant. Atlantic Healthcare therefore became the obvious thing to do, to build a successful company providing innovative specialist treatments for difficult patients managed in the hospital environment.

MT: Well, there are lots of  large and small pharma companies around, what makes Atlantic Healthcare different?

TWW: The answer is we have some of the best people and it is important that they are also passionate about making a difference for these patients and working on very exciting products. Atlantic Healthcare is focused on targeting therapeutic products for specialist hospital indications where the cost of developing and commercialising products is relatively low and market protection can be obtained through orphan drug status and similar mechanisms. We are acquiring products and companies with existing or near term market revenues that complement the group’s overall plans, with which we can use the teams experience to accelerate access, scale quickly and add considerable value, for patients and investors alike. Importantly the members of the team have done this before.

MT: You mentioned Orphan Drug status, can you tell me more about that and why it’s important?

TWW: Orphan Drug status is important as it provides a faster, lower cost route to market for specialist drugs where there are lower numbers patients with poorly served or unmet medical needs. Because of their specialist needs, these patients are often treated in the hospital environment.
The legislation for the regulators to approve drugs for orphan drug status was set up a number of years ago, specifically to encourage the development new treatments for these patients. A company must apply to the regulator to be granted Orphan drug status and demonstrate the unmet need and that low numbers of patients suffering the condition, typically less than approximately 200,000. In granting approval, a company is permitted to undertake smaller (and therefore cheaper and quicker) clinical trials and no charge is made for application for marketing approval. In addition, in the United States, the Food and Drug Administration may grant a Fast Track status where they recognise a pressing need for the patient group, to accelerate approval and if necessary grant a lower “conditional approval”.

Confirming the need, Atlantic Healthcare has been granted Orphan Drug status for pouchitis for both the United States and Europe. Our treatment for pouchitis has also been granted Fast Track by the Food and Drug Administration.
We are also in the process of applying for Orphan Drug status for the treatment of pouchitis in Australia and for the same drug in another condition, for the treatment of left-sided colitis.

MT: So are there other companies that are using this model and if so what sort of success have they had?

TWW: The answer is yes and no.

Yes, there are other companies that have been successful in providing drugs for specialist patient treatments. Most of these companies developed in the US and then expanded overseas employing conventional growth and acquisition business model. With Orphan drug status being made available, this sector is growing very quickly and new companies are emerging in Europe also.

The best example is Boston, USA headquartered and NASDAQ listed Genzyme Corporation Inc, which generated sales of US$4.5 billion in 2009 from multiple products in this sector. However they are now getting so big, they need to find more conventional large pharmaceutical products to continue their growth. Incidentally, in moving in that direction they acquired exclusive rights to a near to marker medicine Mipomersen from Isis Pharmaceuticals – as we did for our inflammatory bowel disease programmes. Their product is the treatment for cholesterol, a much more mainstream patient population focus.

The “no” part to my answer is because whilst Atlantic’s team are very experienced and understand patients needs very well, we are using our knowledge to innovate and grow very differently, using an outsourced, capital efficient business model.

Most companies have difficulty scaling their operations internationally in a cost effective manner. I recruited the team because they have all had significant experience of working internationally and through out-sourcing. That means we can deliver new therapies and can scale our activities across international borders quickly and very cost effectively, by utilizing established infrastructures and processes of third party organisations we know.

When I was involved in building development company Alizyme, it was Europe’s first truly out-sourced business model company, applying it to product development. Now we are extending and applying the same business model principles to building an international company supplying specialist treatments.

MT:    As I mentioned in the introduction you currently have three phase III programmes targeting gastro-intestinal disorders of which you have touched on a pouchitis treatment.  Can you tell me a little more about the products, the problem they solve and why you have chosen this segment of the market?

TWW: The three phase III programmes are a new way of treating inflammation and are targeting inflammatory bowel disease, a growing area of specialist treatment driven by unsatisfactory existing treatments and the need for and use of new therapies.

Most patients with inflammatory bowel disease will require surgery at some time; in ulcerative colitis, this is likely to involve removal of the large intestine (colon) and the surgical creation of an artificial rectum known as a pouch, using the ileum.

Pouchitis is a common post-operative inflammatory complication of the pouch. There are around 200,000 pouchitis sufferers in the United States and Europe for which there is no approved treatment.

These programmes were a very exciting acquisition for us. They are based on a drug called alicaforsen, an antisense molecule that switches off the production of the protein ICAM-1 involved in inflammation.

The first two programmes are delivering alicaforsen as an enema to treat topically pouchitis and ulcerative colitis. The third programme delivers alicaforsen intravenously for the treatment of Crohn’s disease.

With our applications for Orphan Drug status having been granted, we are focusing on making available and supplying alicaforsen enema the treatment for pouchitis first. We plan to commence this in around six months time under the European Named Patient Supply regulations, prior to completing a (relatively) small phase III clinical trial and marketing authorisations. This allows early revenues to be reinvested back into the product for wider availability for patients, in the United States and elsewhere.
Then we will extend the areas of treatment using the same enema to other inflammatory bowel conditions, most notably ulcerative colitis.

MT: With any new drugs on the market most clinicians are concerned about safety and efficacy in the first instance.  Without going into too much detail, what sort of results have you had thus far and what sort of sampling sizes are we talking about?

TWW: Safety and efficacy is obviously our priority. A considerable depth of clinical data has been generated for these programmes.
Clinical trials have been undertaken in five phase II studies with alicaforsen enema for pouchitis and ulcerative colitis, involving 300 patients. The results showed the drug was safe, well tolerated, is demonstrating significant endoscopic healing and has a significant duration of response – the drug treatment course comprises a once a day delivery for six weeks. The duration of response extended to six months from cessation of treatment.
This offers a significant benefit to these patients and with the potential for clear and strong product differentiation
In addition we have data from trials involving the intravenous treatment of 900 Crohn’s patients, for which there were no adverse events related to alicaforsen. Clinical data has demonstrated this to be a very safe drug.

MT: I understand that the future of Atlantic Healthcare involves acquiring new products will they also be in the gastro-intestinal area?

TWW: We are not limited to the gastro-intestinal area. Atlantic Healthcare is addressing the needs of the hospital sector and medical conditions that are too specialist for large global pharmaceutical companies to profitably address, driven by unmet or poorly satisfied needs of the most difficult patients, who travel to be treated in hospital.
We are focused on providing products for these patients and building a pipeline of similar products that meet our criteria, that we intend to acquire, to build a significant international specialist pharmaceutical company.

MT: So where do you find these new products that fit your criteria?

TWW: Atlantic has a unique, experienced world class management team, board and advisors with a track record of identifying product opportunities that Atlantic can license or acquire for this sector.

We have deep roots internationally across the industry, into the major pharmaceutical companies for whom such products are too small to be focused on, and biotechnology companies whose products are not of licensing interest to the majors. And who do not have their own commercial capabilities.
We are therefore quite uniquely able to identify, quickly evaluate and access these products internationally, through our extensive industry networks.

MT: Why don’t these companies market those products themselves?

TWW: Atlantic realises the intrinsic value of non-core assets of major pharmaceutical groups, and of biotech companies that do not have their own marketing expertise and strategies.

We are focusing on products meeting our criteria that are either no longer core to the pharmaceutical companies concerned or they (the biotechnology companies) do not have the necessary skills or appetite to commercialise the products  themselves.

MT: OK, so to summarise, Atlantic Healthcare really focuses on developing drugs that have already overcome the very early and highly risky stages of their development that have demonstrated some success as far as positive phase 2 study findings or products that have already been approved and marketed but are no longer a priority to the big pharma companies but still have inherent value, this basically reduces the product risk.  Additionally due to things like having Orphan Drug Status which allows the drugs to be both protected and fast tracked through the next phases of development combined with the fact that these are niche products that command a better margin this works to significantly reduce  the commercial risk.  Is that right?

TWW: That’s correct

MT: That’s great, so changing tack a little, I’m told that Atlantic Healthcare is mainly targeting the North American and European hospital markets, so what is your interest in Australia?

TWW: Our main focus initially has been the hospital markets of Europe and the United States.  However Australia and New Zealand are very similar markets, hence the early license agreement we entered into with ASX listed Sigma Pharmaceuticals.

In building an international company, we have now established a bridge head in Australia for the Asian markets and appointed two directors there, Steve Hobbs and Michael Cradock.

Steve is well known in the pharmaceutical industry and was involved in building the Australian operations for the international pharmaceutical businesses Innovex and Quintiles. Michael, a Chartered Accountant from PricewaterhouseCoopers has a lot of experience with similar growth businesses, appropriate for our plans for the region.

MT: Who else is involved with Atlantic Healthcare?

TWW: I am very fortunate to have as my two chief lieutenants industry veterans Drs Huw Jones and Allan Cambridge who both have track records in the industry.
Huw has over twenty years commercial activity in pharmaceuticals and understands patient needs very well. He has supervised over fifteen product launches in half a dozen European countries and numerous product and company acquisitions and divestments. His roles have included CEO of Ardana plc, building the European operations of Elan Pharmaceuticals from a start-up into a 600 person $100 million turnover division, and UK marketing director for SmithKline Beecham Pharmaceuticals, now part of GlaxoSmithKline plc.

Allan has a similar background. He has held senior technical, production, commercial and management positions with particular expertise is managing growth, products and innovation in healthcare companies. Allan’s career has included being UK General Manager of Evans Medical Ltd, and a member of the team that purchased the company from Glaxo in 1986 and later sold it to Medeva. He was also involved in setting up Du Pont Merck in Europe, international business development for Wyeth Laboratories and with me building Alizyme plc before becoming CEO of AIM listed Lipoxen plc in 2002.

Backing us up is a fantastic team, including an internationally renowned board of directors and a medical advisory board comprising leading global experts in gastro-enterology and colorectal surgery.  My intention is always to have the best people work with me.

MT: So final question, where to from here for Atlantic Healthcare?

TWW: More of the same.

We have concluded our first agreement and acquired our first hospital specialist product which we are in the process of making available to patients, initially under the Named Patient Supply regulations.

We are now extending the international reach of Atlantic and aiming to complete the acquisition of further similar hospital prescribed products for poorly served or unmet patient needs.

This is a very exciting time for patients and Atlantic alike.

MT: OK, so if anyone is interested in more information on Atlantic Healthcare, your products or the opportunity to invest in the company, where should they go?

TWW: I would be very happy to share more information about Atlantic Healthcare with anyone who is interested.

We are in the process of undertaking a European/Australian investment to accelerate the supply of the treatments for needy patients, as I have outlined today. You can drop me a line (toby@atlantichc.com), or connect with my local Australian director Steve Hobbs (Steve.hobbs@atlantichc.com) or Michael Cradock (michael.cradock@atlantichc.com) who would be happy to discuss your interest with you.

Of course full details can be found on our website www.atlantichc.com

MT: Toby it’s been a pleasure talking to you and I wish you all the best for the future.

TWW: Marcus, I am delighted to have had the opportunity to talk to you and share our exciting plans for Atlantic Healthcare. It has been a pleasure also, thank you.

– Jonathan Zittrain, Harvard law professor and Internet expert

Just because something is new, popular and cool doesn’t make it useful nor benign. If you asked me as a “busy and serious professional person” about Twitter 12 months ago I would have told you it was clearly a frivolous outlet for procrastination and people with nothing else better to do with their time. Without wanting to sound overly critical or judgmental, inane tweets such as “I’m heading for the toilet” or “the cat just yawned” only adds fuel to this view. Used in this way, social media channels such as Twitter and Facebook are self-indulgent and not particularly useful to anyone.

I have come to discover that there are in fact many useful applications of Twitter and social media in general especially in healthcare and educational settings. These applications include but are not limited to community collaboration, service recovery, crisis communications, recruitment, education and real time news/announcements.

That’s on the plus side. However, on the negative side is the very real threat of not completely being in control of the message, breaches of patient confidentiality, bad word of mouth and loss of productivity.

A recent news article article on CNN (source) graphically illustrates how an employee’s “personal” social media use can still reflect vicariously on organisations they are affiliated with. If professional swimmers can supposedly bring the entire sport of swimming into disrepute by the posting of some racy photos on Facebook, imagine what photos of doctors drinking, grinning and brandishing guns as souvenir shots whilst on humanitarian aid missions can do to reputations and professional standings.

Ultimately, Social media channels are simply tools. Like all tools, in the right hands they can be used effectively and efficiently to achieve a desired outcome. In the wrong hands these tools can cause tremendous damage not only to the users but to those around them. This could express itself in catastrophic reputational loss leading to brand or career damage, law suits and negative commercial consequences.

Given how explosive and important social media is proving to be as a form of communication and marketing it behooves those who have dismissed it as a fad, to look at it again but much more carefully. Organisations need to consider drafting “Rules of Engagement” as far as how Social Media is to be used by employees in formal and informal settings.

- Max Planck
The Philosophy of Physics, 1936

Much has been said in the short time since the much-hyped launch of Apple’s new iPad. Most of the analysis from the Geek-aratti seems to suggest disappointment and underwhelmed comments such as “it’s nothing new” & “Apple has failed to deliver on the hype”. From jokes linking it’s name to feminine hygiene products to rants about it’s lack of features being an Apple-led planned obsolescence conspiracy.

Of all the criticisms, the one that perplexes me the most is the one claiming that because the iPad is purely an oversized iPod touch it has nothing new to offer.

However, in the healthcare setting, and no doubt numerous other settings also, those added inches make a significant difference. With a larger screen the ease of use and stylish user interface previously associated with the iPhone will pave the way to long awaited change in the use of such devices in healthcare settings. Previous iterations have failed for various reasons, including cost, weight and poor interoperability.

The indicative cost of the iPad at less than $1000 will address some cost issues. It’s typically Apple-elegant form and weight of less than a kilo should overcome the bulkiness and clunkiness objections.

Without question, iPad apps accompanying the myriad of iphone apps will quickly come out of the woodwork over the next 6-12 months. Many of these apps will no doubt service the healthcare sector.

Accompanying these predictions of software apps should also spawn a whole range of hardware modifications, new accessories and devices for the conduct of all manner of investigations, assessments and communications either plugged directly into the iPad or via bluetooth.

In view of the sorts of healthcare environments these devices will find themselves I certainly hope robust protective casings that can be easily sanitised will be developed as well as harnesses or adaptor kits that will allow easy portability, accessibility and use of both hands to type.

For change to occur and mass adoption to take place, timing is everything and with e-Health being on the forefront of many health reform agendas globally you can’t help but think the iPad (despite it’s flaws) is positioned perfectly to act as a timely change agent in an industry that has never fully embraced tablet technology before.

This final point is the most important reason why I believe the iPad is such an important development for the healthcare sector. It is this point which appears to be under-recognised or missing in most commentary I have seen thus far.

Tablet computing in healthcare will happen, it’s a matter of whether the iPad will be the device to herald in a new era of adoption of the technology or whether it will be another more fully featured device. One can only hope that Google’s undoubted response won’t be called the “Paddle One”.

- Star Trek Voyager

The advent of technology has created efficiencies and remarkable tools allowing us to diagnose and treat all manner of health problems like never before.

Human nature and the reductionist agenda of efficiency-driven health bureaucrats and capitalists will always look to automation to improve productivity, reduce errors and costs. So is there a place for doctors in the brave new world of technology driven health care?

If science fiction is any indication we will either be looked after in the future of healthcare by robots or computer-generated holograms.

If the role of doctors is merely to process informational inputs and communicating and executing algorithmic outputs then I suspect it is game over. In the early days of chess playing computers, Grand Masters boasted that computers would never defeat the best human opponents and for the best part of three decades they were proved correct. The first crack emerged however, in 1996 when IBM’s Deep Blue computer defeated the then reigning World Champion Garry Kasparov.

The “gestalt” or gut feel so highly prized by human physicians born out of the human brain’s incredible ability for pattern recognition is still a function of complex and numerous neural connections. So it is only a matter of time that the complex diagnostic algorithms and numerous evidenced-based guidelines associated with healthcare will be mastered by technology.

Our ability to execute treatments has already been met by robot-driven surgery and there has been much talk of nanotechnology bots being used for targeted therapy. So in light of all this, what then, if any, will be the role of human doctors?

I believe that the future of human doctors will be to act as the soft, user interface of technologically driven tools. You see the answer to our question lies not in the potential of the technology but rather the preferences of the patient. For the same reason people hate automated telephone systems when they have a problem or complaint there is still something comforting in dealing with another human being. In times when the medical odds are stacked against us we are looking for discretion and not rigid protocols. We want warmth, compassion, hope and optimism; qualities not currently widely associated with “technology” or at least not yet anyway!

At the end of the day human beings are a social species and in times of distress, dis-ease and dis-comfort no one wants to feel alone even if you have access to the best technology can offer.

The potential for many health innovations seem tremendous, yet why has there been such a reluctance and slowness to adopt them. The long awaited movie Avatar serves as a fitting metaphor for the health innovation agenda in many countries.

By all accounts Avatar’s director, James Cameron, had a vision of a cinematic masterpiece which by any standard was ambitious and risky. Making this project the more difficult was the missing technology and know-how to make it happen. It says a lot about the individuals involved in any long-term endeavour to stay the course in the face of uncertainty and adversity. Never more true is this of health innovation, which in the case of eHealth and biotechnology innovations involve significant capital investment and long development and validation times.

It takes vision, leadership and the willingness to commit to the process in the firm belief that something tremendous and worthwhile is being created. The question is whether some of these innovations are really worth the wait. Is the hype justified? Certainly for projects such as the movie Avatar the end result has been a triumph of the “unreasonable man”.

The conservatism in health care to embrace change and progress is well documented. It is almost as if progress happens inspite of the medical establishment. I believe the hammering of medical students and doctors in general to follow guidelines and well-worn algorithms under the guise of “evidence-based medicine” has its limitations when it comes to innovation. It never ceases to amaze me how we often choose the brightest and the best of the education system to enter medical schools around the world only to turn these bright minds into unthinking, uncreative automatons.

Of course no one wants a maverick clinician. However, once in awhile it is exactly these “maverick” clinicians that whilst taking fire from colleagues for years eventually discover a Nobel Prize winning breakthrough or continue to save lives when others have given up. Let’s not be naïve, not all “mavericks” are altruistic and misunderstood geniuses. However, not all of them are crackpots or dangerous rogues either. The question is how do we separate the “unreasonable man” from the “maverick”?

I believe the answer to this question in part lies in changing the culture. By encouraging all clinicians to undertake more teaching roles and engaging in research, creates a cultural norm of inquiry and valuing innovation. It is well known that groups lauded for their innovation, like Google and 3M, allow their employees time, resources and latitude to explore personal ideas. Why shouldn’t we do the same at the coalface of clinical medical practice?

Most clinicians are so bogged down in seeing the tsunami of patients and completing the ensuing paperwork that little time is devoted to reflection or creative pursuits. Building teaching and research into professional development is an ideal method of doing exactly this. I’m not talking about research in the esoteric, navel gazing sense as is sometimes associated with certain academia. I’m talking about formalised think-tanks of grassroots clinicians, within medicine and inter-professionally, grappling collectively with clinical conundrums, big picture challenges and having the latitude to explore potential solutions without being pilloried as misfits or worse still, criminals.

We need visionaries, we need leadership and we need courage to negotiate our way through this brave new world of health progress, never forgetting the centrality of the patient’s welfare in all that we do. However, let’s not ignore or forget the critically under-developed and under-appreciated resource of “unreasonable” people forming the “grassroots” of the healthcare industry. We will get more innovation and less angst if more was invested in nurturing this vastly untapped resource.

So it is with a mixed sense of trepidation and excitement that I embark on what I hope to be a journey of discovery. I must admit I love innovations, so hopefully this blog will not nearly be as soul destroying as first envisaged. I know there are others that share my passion for the novel and interesting so before too long I hope to enlist other contributors to this blog. Game on…