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PERSPECTIVES


Novartis’ Dr. Ameet Nathwani explains the role of digital in patient outcomes

Dr. Ameet Nathwani, global head of medical affairs at Novartis Pharma AG discusses the profound role of digital in delivering better patient outcomes.

What has drawn you to work in the healthcare industry, specifically in pharmaceuticals?

I trained as a cardiologist and cardiovascular doctor. While I loved my time helping patients, I was often frustrated as an individual doctor knowing I would never be able to create new concepts or medicines with the limited availability of funding and technology in institutes at that time. I quickly recognized where my heart (pardon the pun) lay, and while collaborating on a project with a pharmaceutical company, I was offered a position.

Since then, my focus on creating breakthrough medicines in the cardiovascular area has never waned. It has been the single strongest motivation for every role I have had and, I hope, will continue to have.

I am still in awe at the unrivalled opportunities available in the pharmaceutical industry to change medicine and save lives on a global scale. This, however, comes with high expectations. There is a delicate balance to the integrity and ethics of advancing health care, while allowing a commercial enterprise to benefit from the value it has created by changing the lives of patients.

What is the most inspiring program or medicine you have helped bring to the patients that need them? What has the impact been?

My area of passion has always been heart failure. When I was still in training, I was inspired by a lecture debating the unmet needs in heart failure, given by Professor Henry Dargie, who I admired deeply.

That lecture had such a profound impact on me that I’ve made the search for novel interventions for heart failure a priority. I was very fortunate to work with Professor Dargie, among many others, on the concept of developing beta-blockers in heart failure, which were already being used in hypertension and angina.

This was a quite a radical concept in the 1990’s when beta-blockers were contra-indicated for use in heart failure. There were many examples where attempts at using these types of agents had led to poor outcomes. So when the concept re-emerged with better agents that could counterbalance some of the deleterious effects, I was very fortunate to be able to work with the top thought leaders in the disease.

By using careful clinical design of dosing and well-constructed outcome trials, we were able to bring Carvedilol (Coreg) to the US and Europe for chronic heart failure. I remember being stunned when we saw an unexpected mortality benefit. Seeing a previously contra-indicated drug—able to save the lives in a disease with a mortality rate greater than most cancers—get approved was a very emotional and inspirational time.

How do you see the role of digital evolving over the next three years in helping bringing life-saving or life-enhancing medicines and treatments to market? What 2-3 areas will have the most impact?

Aside from the advancement in understanding disease pathways, I think the use of digital technologies will have the next most profound impact on research and medical care. We are in a time when many diseases in some advanced clinics across the world are managed virtually by their physicians. For example: video calls with parallel home monitoring with telemetric information, ECG’s, biomarkers at home with data uploaded into the network, pre-set alert levels to allow real-time decision making, movement monitoring in patients with neurologic disease using movement sensors, and the list goes on.

Doing clinical trials in the traditional ways no longer makes sense. The empiric manner in which we recruit patients, identify their diseases, and then have them routinely come to scheduled hospital or clinic visits is inefficient, expensive and may not reflect the ability to shape how the disease could be managed in the future.

I see digital as a means to monitor therapeutic responses more readily or at home. We recently licensed the glucose sensing contact lens from Google, but that is really just the start of what’s possible. Digital can help leverage ‘predictalytics’, large data sets, and individualized responses on multiple parameters to determine the risk of ‘an event’.

I don’t think there is any area of what we do today which will not undergo a radical change. Digital is making the patients’ lives easier—improving adherence (e.g., micro-chips on pills) and increasing specificity, such as digitally targeted medicines (programmable nano-particles targeted to disease area). Digital is also making physicians’ lives easier (e.g., Google glass with superimposed anatomical MRI data while operating).

The newly coined term ‘Digiceutical’ is not a transient fad! The bigger question is how can the industry stay ahead of the curve to the usual 10+ year product life cycle, and be agile enough to leverage this as a key advantage.

There is a lot of talk about digital’s role in causing healthcare to become more like a “consumer” business. How will pharmaceutical companies have to change their business models to address this?

Companies should start by integrating digital enthusiasts into every team since digital cuts across each specialty, function or domain. Next, our business and development teams need to live and breathe these technologies and spend time contemplating the possibilities and changing how they work, including embracing technologies.

Second, the business model needs to embrace a digital roadmap as a core part of the development plan and business plan. This could entail all elements of the life-cycle including digital technology integration in the trials, creation of state of the art analytic databases during phase III, virtual trial set ups, testing multiple novel wearable devices in the trials, undertaking continued evidence generation after trials or registration through interfaces with electronic medical records, and so forth.

Additionally, the ability to customize will be essential to allowing local businesses to adapt to the local circumstances/preferences, and may allow negotiating better market access for drugs by offering complementary digital solutions and monitoring risk to improve outcomes. I can see drugs in the future being ‘registered’ with some sort of digital suite of solutions for patients and physicians.

Digital enables unprecedented collaboration – what are some potentially unexpected collaborations we might see in the future?

We must be alert to the fact that many prominent technology companies are focusing on health care. The likes of Samsung and Google have health care front-and-center of their strategy and they have the capability and vision to create disruptive solutions for health care.

There are many other start-up companies where digital innovations are positively changing patient outcomes and pathways. I see pharmaceutical companies needing to look very carefully at the pipelines of tech companies to identify where we can create differentiated ways to co-combine drug therapy and technology to fundamentally tackle a disease—not just biologically, but along the entire healthcare system in which the disease is managed.

As for unexpected collaborations, I am not sure anything can truly be counted as being unexpected.

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