In a new white paper, Vodafone – supported by Bernard Vrijens, Professor in public health at the University of Liege, Belgium – claims that new connected solutions based around the Internet of Things (IoT) will help people to follow their medical treatment programmes more closely. This latest development could improve millions of lives and save billions of dollars.
The World Health Organisation has said that adherence – the action of complying with a medical treatment regime – for long term conditions such as hypertension, cancer and HIV stands at only around 50%, meaning half of patients do not follow their doctor’s instructions. As a result, patients’ chances of recovery and relief are reduced. Better approaches to adherence have been estimated to bring 50% of the non-adherent population onside1.
Bringing together smart devices, connectivity and the cloud, the Internet of Things (IoT) can lead to more effective healthcare, according to the white paper. It will encourage patients to follow their treatment programme more accurately by providing them with individualised information on their therapy. By encouraging them to continue with their full course of treatment, this approach could potentially save up to an estimated $290 billion in otherwise avoidable medical spending, in the US alone each year[i].
The data-driven and IoT enabled adherence management outlined in the white paper would offer benefits to patients, clinicians, medical device companies and those that pay for the provision of medical services. It could lead to more independence for patients, better treatment, more effective drug development and ultimately lower healthcare costs.
University of Liege Professor of public health Bernard Vrijens said, “Healthcare providers currently monitor four main vital signs: body temperature, pulse rate, respiration rate and blood pressure. The IoT means they’ll soon be able to accurately measure a fifth – adherence. I believe that that the importance of connectivity in the both medical devices and in patient engagement cannot be under estimated. This is a pivotal moment on the road to more individualised healthcare.”
Vodafone IoT Director Erik Brenneis added, “This is a great example of how the internet of things has the potential to help people live healthier lives and access more effective medical treatment. We hope that the vision and creativity of people like Professor Vrijens will quickly become a reality with the IoT. We believe that we are on the threshold of a significant change in the way chronic diseases are managed.”
(Source: Vodafone)
Gail Adinamis is an accomplished executive with over 35 years of comprehensive phase I-IV clinical trials experience, including over 12 years of global clinical trials management at Abbott Laboratories and Astellas Pharma US. She founded the business model for centrally managed in-home and alternate site services for clinical trials in 1992 and subsequently established these operations for three national home infusion companies and served as president of those wholly-owned subsidiaries. She subsequently founded and was President and CEO of an independent ambulant care service company for clinical trials prior to establishing GlobalCare Clinical Trials in 2010. Miss Adinamis has been recognized for two consecutive years by INC 500/5000 as being among the leaders of the top 5000 fastest growing private companies in the United States and received merit-based awards for CEO of the Year. She is active in many business and industry associations and recently participated in the Clinical Trial Transformation Initiative, a work group comprised of FDA and industry experts to assess the legal and regulatory implications of initiatives to streamline the clinical trial process. Here she tells Finance Monthly more about her company and her work.
You have been in leadership roles at a number of companies over the years – what would you say have been your top accomplishments to date?
The thing that I am most proud of is creating a new service model to streamline the clinical trials process and gaining global industry acceptance of the model – a model that is making a difference not only for the patients participating in the trials, but for those patients who will follow and hopefully benefit from the research.
It’s also very fulfilling to know that I’ve created a global company that currently operates in over 60 countries, and to be leading and successfully motivating a global team of professionals that effectively work together and enjoy coming to work every day.
How would you evaluate your role at GlobalCare and its impact over the last year or so?
My role is to provide the vision, leadership, strategic planning and oversight for GlobalCare Clinical Trials. I am surrounded by talented team members in various capacities. Together we have successfully more than doubled our revenue over last year and built a robust pipeline of business, based primarily on repeat business and word-of-mouth marketing.
What are your plans for the company for the rest of 2017 and beyond?
We are continuing to grow organically at a pace to ensure our quality. We will expand our footprint around the globe based on client requests and will add systems and technologies to create further efficiencies in our logistics.
What would be your top three tips for other CEOs?
· Be fearless – if you believe in what you do, go for it.
· Take time to hire the right people, don’t hire out of desperation.
· Don’t waste energy looking back at things you can’t change – spend it positively going forward.
What is the best advice you can give to other companies?
Communicate, communicate, communicate. Speak early and often to clients, vendors and employees. Be sure to thank those who provided opportunities or did a good job that contributed to your success. A personal call or conversation has much more impact than an email or text message.
Doing a good job for a client is the best marketing tool we have. We spend very little on sales and marketing and focus our attention on providing high customer satisfaction.
Website: http://globalcarect.com/
Kicking off May’s Game Changers section is a CEO that we’ve had the privilege of interviewing before – Mike Moran MBE from Proton Partners International. Mike has over 30 years of experience in strategic leadership, planning and programme delivery in the defence and healthcare sector both in the UK and abroad. He’s held various executive positions in defence and healthcare and is the Former Chairman of the Chamber of Commerce & Learning & Skills Council in Hereford and Worcestershire.
Proton Partners International Ltd is a company in the vanguard of advancing proton beam therapy in the UK, Formed by UK-based and international cancer and healthcare specialists, the company is set to build up to five proton beam therapy cancer treatment centres across the UK within the next four years. The construction of Proton Partners International’s first three centres in Newport (South Wales), Northumberland and Reading is currently underway, and a fourth UK centre, scheduled to be built in Liverpool, is in the planning phase with Liverpool City Council. At each centre, Proton Partners International aims to be able to treat 500 patients annually and, in addition to proton beam therapy, will offer imaging, chemotherapy, radiotherapy, immunotherapy and a range of supportive care services including survivorship and recovery. Here, Mike tells us about Proton Partners International’s current projects and plans for the future.
What has been happening with Proton Partners International since we last spoke in October? What have been the major achievements/challenges that the company has been faced with in the past six months?
Proton Partners International has seen a lot of exciting developments since October 2016. We have since announced that, in addition to our centres in Newport and Northumberland, we will also be opening cancer centres in Reading and Liverpool Earlier this year, we announced that our centres will be called The Rutherford Cancer Centres. The name reflects the renowned scientist Ernest Rutherford’s contribution in identifying and naming the proton in 1911.
We have recently opened the doors to our first cancer centre in Newport, The Rutherford Cancer Centre, South Wales, for conventional treatments, such as radiotherapy, chemotherapy, immunotherapy and imaging. The proton beam therapy machine has just been delivered on site, which is the first high energy proton machine to be on UK soil. The treatment will be available at our South Wales centre next year.
Proton Partners International also announced that we are going to undertake a major genomics research centre at the Life Sciences Accelerator building in Liverpool (the building is the first part of a ‘health campus’ that is set to surround the £335m new Royal Liverpool Hospital). We will work with the University of Liverpool’s Physics Department on a genomics programme to collate, analyse and distribute data from our treatment centres. In addition to the research centre, we have recently announced a two-year collaborative research project with The University of Liverpool to develop a new measurement system, known as a 3D Water Phantom, which will further improve the accuracy of proton beam therapy treatment. The new system will use pixelated silicon detectors, first developed at CERN, the European Organisation for Nuclear Research. Improved accuracy will lead to better modelling and calibration of treatment beams, which will offer more advanced treatment for patients. It will also allow for more accurate clinical research and development to be undertaken.
We have also strengthened our executive team. The company has appointed Lis Neil as Chief Operating Officer, formerly Operations Director of diagnostic and specialist services at Nuffield Health, and Dr Ian Barwick as Chief Scientific Officer, formerly Chief Operating Officer at the Life Sciences Hub Wales. With 25 years of senior healthcare experience, Lis Neil will be responsible for daily operations, such as commissioning new facilities and ensuring the quality, efficiency and safety of services offered by Proton Partners International. As Chief Scientific Officer, Dr Ian Barwick will play an integral role in driving patient-led research to ensure Proton Partners makes a valuable contribution to the future of cancer treatment.
On the awards side, since October 2016, Proton Partners International has won three awards from Acquisition International, including Best UK SME Lending Transaction Award, Most Promising New Business 2016, and 2016 Deal of the Year.
How do you ensure that Proton Partners International is at the forefront of any emerging developments?
The appointment of Dr Ian Barwick punctuates our commitment to innovation in cancer research and thought leadership. We have recently created a subsidiary Company, Rutherford Innovations Ltd, which will allow us to contribute more positively on the research effort without disrupting cancer services.
We also intend to be at the forefront of innovation in planning and treatments. The radiotherapy suite includes Elekta’s state of the art Versa HD linear accelerator (Linac) fitted with a range of electron and Xray treatment beams (including high-doserate), as well as cone-beam CT and 6D online patient positioning, Volumetric Modulated Arc Therapy (VMAT), Image Guided Radiotherapy (IGRT), Deep Inspiration Breath-Hold (DIBH) and patient surface monitoring techniques to ensure even greater treatment accuracy. The patient surface monitoring has been installed across all of our modalities, which we believe is the first in the UK and one of the world’s earliest adopters.
For planning purposes we have installed computerised tomography (CT), MRI and the world’s first, digital PET-CT systems. Alongside this is Philips Pinnacle treatment planning system (TPS) and Elekta’s MOSAIQ Oncology Information System (OIS). Both these software solutions are installed on centralized servers so they can be used across all our sites.
In respect of chemotherapy, the latest treatment regimens will be offered either intravenously (into the blood stream) or orally via tablet form.
The adoption of proton beam therapy, using the latest IBA Proteus®ONE compact single-room proton beam therapy solution, demonstrates that we are prepared to bring the best and latest treatment to the UK. The Proteus®ONE delivers proton beam therapy using the latest pencil beam scanning technology that allows the dose to be delivered to the exact shape of the target area (tumour).
2017 is expected to see the opening of Proton Partners International’s first two cancer centres, in Newport and Northumberland – could you provide an update on their statuses? What have been the key challenges that the company has been faced with thus far, in relation the two cancer centres?
The Rutherford Cancer Centre, South Wales, has recently opened to receive referrals for conventional cancer treatments and we will soon be in a position to start treating patients with these conventional therapies.
The treatment part of the proton beam therapy machine, known as the gantry, arrived on site in Newport in April. Proton Partners International will be using the Proteus®ONE compact gantry at all of its centres. The cyclotron was delivered in May. This is the first Proteus®ONE machine in the UK. After full installation has taken place, we will be in a position to fire the first proton this year and following the clinical commissioning process, we will be able to treat patients with proton beam therapy in early 2018.
The centre in Northumberland, which will be known as The Rutherford Cancer Centre, North East, and the centre in Reading, which will be known as The Rutherford Cancer Centre, Thames Valley are both currently under construction. Our fourth centre, The Rutherford Cancer Centre, North West has been submitted for planning permission.
We have a number of challenges which we do not see as insurmountable, but nevertheless require careful consideration, planning and mitigation. We have construction and build challenges which, once mitigated will significantly reduce lead-time for future builds.
We are also installing technical equipment with very complex mechanical and engineering requirements in a timeframe never achieved anywhere in the world. In addition to managing several new market entries at one time, we are also bringing new innovative treatments to the UK healthcare market.
The most significant challenge that we will face over the next decade however, is keeping up with the demand for proton beam therapy. As the clinical evidence reads out, there will be more patient demand which will require the development of more operational centres. Proton Partners International will be at the forefront of the growth.
What further projects lie on the horizon? What excites you about the rest of 2017 and beyond?
We have just begun the installation process of the cyclotron at The Rutherford Cancer Centre, South Wales, which is really exciting as this is the part of the machine that actually fires the beam. I like to think of it as the heart of the proton beam therapy machine. Once this goes through the formal installation process, we hope to fire the first high-energy proton beam in the UK (not on a patient) by the end of 2017.
As part of our Thought Leader features, this month Finance Monthly had the privilege to interview José R. Sánchez, the President and CEO of Chicago-based Norwegian American Hospital (“NAH”), a 200-bed safety net hospital. Here he sheds some light on his role to create and meet the vision of Norwegian American Hospital, recent changes in the American healthcare system and how he balances between the need for profitability and the needs of the hospital’s patients.
Tell us a bit about your career path prior to joining Norwegian American Hospital? What brought you to your current position?
I began my career in the healthcare field in the city of New York back in 1979, working in various hospitals until 2010. I joined the New York City Health and Hospitals Corporation in 1996 as head of one of the public healthcare hospitals. I was promoted to Senior Vice President of the largest healthcare network in the public healthcare system and was also CEO of Lincoln Hospital. My responsibility was to lead the business operations and integration of the network, which was comprised of three acute care hospitals (two of them were level-one trauma centers), and 24 clinics in East Harlem, Central Harlem, and the South Bronx in New York City. In 2010 NAH was in search of an executive CEO to turn around the failing hospital that was just about to close, as a result of poor financial performance, low quality, a poor reputation, declining volumes and a lack of an infrastructure to support the hospital’s growth.
How has your role impacted the hospital in the past 6 years?
In 2010 I outlined a vision for the recovery of the hospital and restored financial stability, quality improvement, physician engagement, community engagement and investment in technology to improve electronic medical records. Since that time, the hospital has been able to close in the black for the last 5 years. Our quality has improved significantly and we have been awarded and recognized nationally for our quality journey and accomplishments. We have grown every business line and we have improved and aligned with the vision of the organization and the integrity of the overall community, as well as full implementation of electronic medical records. Currently every service we offer is online.
What were the goals that you arrived with back in 2010? 6 years later, would you say that you have managed to achieve them?
We have been able to achieve the original outlined vision of 2010 and surpassed and excelled in each one of those areas. Today, Norwegian American Hospital is considered at the top of the safety net hospitals across the state in financial status, quality metrics and operational efficiency.
What are Norwegian American’s ethics towards its patients?
NAH is fully dedicated to improving the health status of every resident in the Humboldt Park Community on the West side of the city of Chicago. Patients are put at the centre of our universe and we always aim at providing the best care possible through identifying evidence-based best practices. Decisions are made on what is best for our patients and resources allocation is focused on community needs.
How have you managed to balance between the need for profitability and the needs of your patients?
As a not-for-profit organization, it is a pretty difficult balance between profitability and patient needs. It is clear that our mission to provide care to every patient, regardless of ability to pay, needs to be balanced within the existing hospital resources. Safety net hospitals in the State of Illinois depend primarily on Medicaid patients and State subsidies. To balance the budget that will be required to provide the care that is needed for patients in poor communities. To frame the question, there are 40 safety net hospitals in the State and they comprise 19% of all hospitals. Those hospitals collectively provide $375 million in community benefit and also provide approximately 40% of services to individuals with substance abuse and mental illness. Part of our effort to balance profitability and patient need is to take a very strong advocacy role to ensure services are delivered to those patients in our community. We at NAH treat patients with the worst health conditions in the State, requiring significant resources. Our objective is to ensure the greatest operational efficiency to meet patient needs.
Could you tell us a bit about any recent changes in the American healthcare system, both in terms of regulation and funding? How have they impacted NAH?
Back in 2010, the Affordable Care Act was passed as legislature in this country, as a landmark legislation to reform the traditional healthcare delivery system in the United States. The objective was to expand coverage to all Americans and to reduce cost and improve quality. During the last 7 years of implementation of the Affordable Care Act, we have seen a significant positive trend in coverage, where more than 20 million Americans have been able to secure health care coverage. In addition, the objective of reducing cost has never been obtained as a result of many individuals who entered the market with insurance coverage, who presented conditions worse than predicted. Therefore, the cost of healthcare in our country has increased. For example, premiums of health coverage have continued to escalate. As a result, the high utilizer of services has increased and insurance plans have passed on the cost to consumers through higher premiums and higher deductibles for services. The impact of the Affordable Care Act has created a positive impact for NAH since its implementation. Before the legislation, our self-pay, no pay percentage of patients was about 15%. Today we are somewhere between 5 and 7%. Therefore, it has improved our bottom line.
What would you say differentiates Norwegian American from other healthcare providers?
NAH has been able to transform to the expectations of market trends in operational efficiency, technology implementation, cost reduction and quality improvement.
What lies ahead of you and NAH?
It is totally unpredictable what lies ahead for safety net hospitals and any other healthcare system in the United States at this time. We know that the current President outlined a health plan called the American Healthcare Act to repeal and replace the Affordable Care Act. Although that proposed legislation was rejected by the House of Representatives, the future of healthcare is still unpredictable. The Secretary of Health of the United States has tremendous authority and influence to change and modify policies that will have an impact on healthcare for the rest of the country. Any changes at the federal level would have impact in our State and therefore, at NAH we know that our on-going goal is to continue to reduce cost across the board. It is difficult to reduce cost when a significant number of hospitals in the country are operating in a deficit and in very small margins. Norwegian is one of these institutions operating in very small margins and any negative impact will have devastating results in the operations of the hospital.
Endoceutics is a private pharmaceutical company operating in the field of women’s health and hormone-sensitive cancer prevention and treatment. Founded by Dr Fernand Labrie, who previously discovered and developed medical castration with GnRH agonists and combined androgen blockade, the first treatment shown to prolong life in prostate cancer, the firm is the world leader in the mechanism of action of sex steroids.
After retirement at Laval University at the age of 69 years, Dr Labrie decided to devote his full time efforts to Endoceutics, which he founded in order to apply to clinical medicine the discoveries of his team, concentrating on the novel science of intracrinology which his team discovered.
The business of Endoceutics goes from fundamental discovery to clinical research, manufacturing and commercialisation, thus representing a complete pharmaceutical company. The idea behind this strategy is to always look for clinical applications using the best technology and never be afraid of changes which are the key to improved medicine.
Following approval of IntrarosaTM by the FDA in November 2016 for the treatment of dyspareunia, a predominant symptom of vulvovaginal atrophy due to menopause, Endoceutics focuses on developing non estrogen-based therapies for sexual dysfunction and the other symptoms of menopause, including hot flushes, osteoporosis and muscle loss. Hormonal therapies for breast, uterine and prostate cancer, male hypogonadism as well as endometriosis are also under development. Here Dr Labrie, one of the most accomplished researchers in the international scientific community, discusses the implications of this innovative new treatment for women’s health.
Career path
After obtaining his MD and PhD (endocrinology) degrees with Honours at Laval University, Quebec City, Canada, Fernand Labrie pursued his postdoctoral training at the University of Cambridge, UK, first in the Laboratory of Professor Asher Korner, a leader in molecular biology of steroid action and then, in the Laboratory of Molecular Biology with Professor Frederick Sanger, twice Nobel laureate in medicine for the first amino acid sequencing of a protein (insulin, 1958) and then first nucleotide sequencing of a DNA (1980). Professor Labrie then isolated the first mammalian messenger RNA (rabbit hemoglobin) and could achieve its partial nucleotide sequencing.
Upon returning at Laval University in 1969, he founded the first Laboratory of Molecular Endocrinology that became one of the most important research groups in endocrinology in the world with a total personnel of up to 350 people including 32 senior scientists. Between 1982 and 2008, he has been scientific director of the CHUL (Centre Hospitalier de l’Université Laval) Research Center (1200 employees) and, at a time, the largest medical research Institute in Canada. From 1990 to 2002, Professor Labrie has been head of the Department of Anatomy and Physiology at the Faculty of Medicine, Laval University, while, between 1992 and 1995, he was president of the Fonds de la Recherche en Santé du Québec, the granting agency for health research in the province of Quebec.
A major contribution of Professor Labrie to clinical medicine has been the discovery and development of medical castration with GnRH (Gonadotropin-Releasing Hormone) agonists which replaced surgical castration worldwide. This achievement was soon followed by the discovery and development of Combined Androgen Blockade (CAB), the first treatment shown to prolong life in prostate cancer. Medical castration with GnRH agonists and combined androgen blockade have become the standard hormonal therapy of prostate cancer worldwide. This has been the first combination of drugs approved by Health Authorities, namely by Health Canada in 1984 and by the US FDA in 1989. This discovery is at the basis of the recent successfully pharmaceutical development of enzalutamide and abiraterone acetate to achieve blockade of the action and formation, respectively, of the androgens made locally in the prostate in castration-resistant prostate cancer.
Afterwards, Professor Labrie discovered that a large proportion of androgens and estrogens in women (100% after menopause) and men are made in peripheral tissues from the inactive precursor dehydroepiandrosterone (DHEA) by the mechanisms of intracrinology. DHEA is transformed locally and intracellularly into small amounts of androgens and estrogens according to the local needs without biologically significant release of the active sex steroids in the circulation, thus avoiding potentially negative systemic effects. Professor Labrie and his group also discovered and developed the most potent and specific antiestrogen, namely acolbifene, a compound having exclusively estrogen blocking activity in the human breast and uterus.
Major Achievements
Professor Labrie's research findings are described in more than 1330 scientific publications and have been cited more than 50,000 times. Dr Labrie is the most cited Canadian scientist among all disciplines in the international literature. He received the King Faisal International Prize in medicine and numerous other awards, including the Friesen Award of the Canadian Society of Clinical Investigation, the Hoffenberg International Medal Award of the Society for Endocrinology of the United Kingdom in 2013 and is Doctor Honoris Causa at the Universities of Caen and Athens. The Dr Fernand Labrie Fellowships of the Canadian Society of Endocrinology and Metabolism are awarded annually in his honour. In addition, starting in 2014, an annual Fernand Labrie Fellowship is awarded by the Laval University Research Center in Molecular Endocrinology, Oncology and Human Genomics.
In addition to the discovery of medical castration and of the now standard treatment of prostate cancer, which continue to help millions of men worldwide, there are 32 million women in the United States alone who could benefit from IntrarosaTM, his newly discovered and developed treatment of vulvovaginal atrophy approved in November 2016 by the FDA. IntrarosaTM is a non-estrogenic treatment for vulvovaginal atrophy. This treatment uses Prasterone (DHEA), a compound without intrinsic estrogenic or androgenic activity which is transformed intracellularly into androgens and estrogens only in the cells and vaginal layers physiologically in need of these sex steroids. This innovative treatment provides a replacement for the local deficiency in sex steroids with no significant increase in circulating estrogens or androgens and consequently, no effect in the other tissues.
In addition, positive effects are observed on the four domains of sexual dysfunction, namely desire, arousal, orgasm and pleasure, an effect secondary to local androgen formation and not found with estrogens. These observations are under further evaluation by Endoceutics.
Community involvement
Fernand Labrie has been president of Innovatech Quebec, a highly reknown investor organization of the Quebec City area, and is now Chairman of the Board of Quebec International, the body responsible for economic strategy in the Quebec City area, a city having the highest level of employment in Canada.
Fernand Labrie has been director of research at the Laval University Hospital Research Centre from 1972 to 2006, one of the largest research organizations in Canada with 1200 members.
Endoceutics’ priorities towards its clients
Looking into the future, Dr Labrie believes that the female health market will be dominated by a focus on creating novel treatments for all aspects of menopause based upon intracrinology or the normal physiology of sex steroids, a discovery of Endoceutics. In order to keep ahead of this emerging development, Endoceutics will be seeking to explore more clinical applications using the best technology largely developed within the company, taking as example steroid assays using mass spectrometry, now the gold standard in the industry. Change in the therapeutic field is central to improving the lives of women across the globe, and as such, Endoceutics will continue to embrace this strategy as the company seeks to be the leader of innovation in the pharmaceutical market.
Vision for Endoceutics in the near future
Endoceutics’ overall aim is to offer to all women around the world the benefits of an efficacious and safe treatment of all the problems of menopause, which include hot flushes, vaginal dryness, sexual dysfunction, loss of bone, loss of muscle as well as memory and cognition loss. The company has a very strong desire to move science forward for a better life of their fellow citizens, and this will remain Endoceutics’ ongoing goal.
For more information, please email fernand.labrie@endoceutics.com
