Pure Healthcare Strategy’s Post

Transcript

Hi, I'm Colin Chew and I'm a practicing ophthalmologist and a researcher. For example in the UK we have one of the lowest numbers of ophthalmologists per head of population in Europe and so and and besides just the ophthalmologist even in nursing staff, you know, why does support staff across the NHS. You know there's there's real labour shortages, you know massive shortages across across the sector. And so trying to work more efficiently with the staff that we have is, is a real priority and we are seeing this reflected in some of the developments. So several companies developing approaches for more sort of indwelling. Slow release devices for example for macular degeneration or almost patient at self administered approaches or drop administration. So I think that that that direction of travel does reflect the the wider appreciation for for the the it's not just your direct costs of the therapeutic but how you deliver it and monitor it across the healthcare setting. So I think one of the biggest challenges for ophthalmology at the moment is the sheer burden of of the numbers of patients that need help. We are probably joint the busiest outpatient specialty of of any, any medical specialty. Almost everyone at some point in their life will probably see an ophthalmologist and and so us finding better ways of improving flow, being more efficient and that will range from everything from as you say home monitoring through to innovations in terms of where a patient's. Can potentially not seeing a clinician straight away through to then employing machine learning and artificial intelligence to almost pre screen some of those images? Yes, so in in my area which is retina I suppose the biggest development this year has been the licensing of ferriss amab and for the treatment of neovascular age-related macular degeneration and also diabetic macular edema. So you may be aware that you know a lot of these patients to preserve vision and receive injections into their eyes and that's off often had to be on a very frequently frequent basis, so almost monthly and so you can imagine the the burden on the patients and also that the quality of life of needing monthly injections you know for. Years. And so what's really exciting about this, this, this new product is that they could extend the interval from probably the best we could hope for 6 to 8 weeks up to 16 weeks without significant detriment. So it was non inferior and and I think this reflects A wider trend and that there's now a focus on on improving delivery and quality of life and the burden of treatment and the healthcare costs because we've we've now sort of in many areas achieved. And the sort of visual preservation outcome, now it's all about trying to maintain that but reduce the the costs both to the patients and the health service. So my own interest across gene therapies, so I think there's been a lot of developments on that. We're seeing many more companies coming into the gene therapy space both viral and non viral and the eye is sort of perfectly suited for this being so compartmentalised. And obviously my interest in immunology and has been peaked, but there's increasing recognition in ocular gene therapy that immune responses are important. And and even though we've not been seeing overt inflammation, I think there's now a wider industry recognition that this is something we need to address. And I think that's helpful. It's a sort of maturation and across the industry and that means that we can start to really focus down and and and fix that. And then we're also seeing broadening of what gene therapy is being applied to beyond just the correction of genetic disorders as they were in the past through application to more complex diseases. So a lot of focus again on the treatment of neovascular AMD and beyond. So I think the advantage that we have is ophthalmologists is that the eye is almost through its design completely transparent. So we can look in and we have A and essentially observe deep tissues within the body and they contain blood vessels. So we can look at blood vessel health. So we can see the damage you know that's occurring through for example high cholesterol, diabetes, hypertension and beyond that most diseases that affect your entire body will affect your eye and so disease, autoimmune diseases. You know we can see you know that causing inflammation in the retina uh through to to almost you know any approach such as sickle cell disease. We can see a occluded blood vessels as we mentioned diabetes. We can see those changes and and know how they reflect your health overall and the rest of the body. And I think the other advantage that we have and I think where we hopefully will push this and obviously this is partly some of my research, I may be biased but we have better and better sort of platforms. For imaging the retina and we can get down to single cell resolution. So we could look at single nerve cell in in the retina dying potentially we could assess how well the photoreceptors so that the cells of the eye that detect light might be deteriorating in any given condition. And beyond that and we can look in and look at immune cells in the eye. And I think that will not only allow us to look at or devise better ways of studying you know eye health, but can be used to study fundamental biological. Processes in living patients, something that's really not as easy to do in in many other approaches to other organs and you can't really easily look in at your liver or looking at your heart directly, whereas we can, you know just almost take photographs of the back of the other simple scans non invasively and repeatedly across time. So I think we hopefully have a lot to offer in the ophthalmology field and and that's an area of growth that I hope will occur in the future. And not my expertise but the use of artificial intelligence machine learning being applied to big data across the healthcare field will will definitely expand. And I think the NHS if we handle it right particularly in terms of giving patients confidence that their data will be handled and protected correctly. I think the NHS really is a is a world leader just in terms of the fact that we share so much data and we require to many common using many common systems. So I think we'll see a lot of of of. Development and support going in that direction. And then in terms of I think a field called optogenetics, I think there's a lot of excitement there. So for patients that have and really very significant visual loss and there's a lot of exciting work emerging where you can again use different approaches to transfer light sensitive proteins into the remaining cells of the eye and restore a degree of vision. So I think that again is is a hugely exciting area and we'll see a lot more progress there and perhaps one of the benefits from. You know the pandemic has been the sort of enablement and use of you know sort of apps and much more interaction with with online, you know delivery of of healthcare. So you know virtual appointments, video calls, telephone calls certainly in our own service has been now employed much more widely and I think not necessarily you know with a lot of resistance. I think for many people where the issue or problem is is relatively minor, people are happy to save their time you know in access healthcare remotely. So I think we'll see. By continuing, I don't see that that changing. In our own service, we're using more and more of what we call one stop or imaging appointments. So for example, patients with retinal disease, they come in, they only see a technician and then they have all their scans and tests and then go home and then a doctor remotely reviews all their images and writes to them or telephones them afterwards. And that just means that patients aren't waiting in in in waiting rooms for a very long time and improves the efficiency for everyone. And certainly I think we'll see an expansion of those sort of approaches. And the delivery of care, so I guess our our equivalent at the moment is that we recommend most people get annually for an eye check at their local optician. And in fact a lot of patients that we see in our clinic are picked up from that sort of asymptomatic screening. But there is you know a push through devices for example you can put adapters onto an iPhone and take a picture of the back of your eyes. So I'm sure it's only going to be a matter of time before you know more elements come together. There are now contact lenses that can remotely monitor the pressure within your eye and directly link that to A to a a mobile phone. Device. And so I think there there is going to be, you know, continual progress on this front. I think people are becoming more familiar with you know, Smartware, you know, watches, you know, home monitoring using a whole range of devices and particularly, you know, as the younger generations come through, I think there's there's very little hesitation around that. So I'd say the, the big, uh, I think limitation that's becoming more clear is actually the computational power or the sort of infrastructure within many hospitals to deliver this, you know so and there there are many, you know, sort of competing software options. Many hospitals are creating their own in-house solutions. So there probably is a lot of inefficiency, but then it has to be tailored correctly to the end users. So often systems for example that might work well across a General Medical approach in a hospital. Often are not suited at all to the treatment of patients with with eye diseases in an eye clinic. And so I think that is really important but also just the the sort of existing infrastructure. So even you know the as we shift to to doing a lot of more of this through web portals on the cloud and having a good computer in the clinic that can rapidly access that is is is an issue. And so again you know more intelligent solutions are more efficient solutions to that I think will make a big difference. Obviously now the UK's involvement in Horizon Europe, you know, the massive ���95 billion funding program looks like it may not happen. So you know, science is really gonna stretch. Obviously, since Brexit, we're now having a lot of recruitment issues into science. And so for example, PhD students, we used to be able to take them from all across Europe and they were charged with tuition fees at the UK rate. Now they have to pay full, you know, overseas rates. So. So there's a few little things that give you a flavor of what's happening on the academic side. Maybe ultimately impacting translation, I think the, so the government I think announced they wanted to increase our GDP spend on R&D for about 1.7 to 2.4%. And I think a lot of that is meant to be sourced from industry interactions and collaborations. But it's not something that you can just create. You know it's an organic process where we're all you know, interpersonal creatures. And so I think you know trying to build those links are where the most successful relationships come out of and often by the time you get down to you know the nitty gritty. Quite a finesse product. A lot of academics have already pushed it in One Direction that may not necessarily then work for industry. And so again earlier communication, earlier interactions may may benefit as well as you know then you have many more ideas and once you build a relationship and trust you probably find that there are all these other projects ready to to to go but without someone to speak to you know then I think there's just never take off. There's also a I think a reticence amongst a lot of academics to necessarily pair up with a large partner straight off. And so we're seeing that balance between spinning it out yourself versus you know partnering up early. And I think that that that is an interesting conundrum. Many scientists don't necessarily have the expertise to run a business and and spin out company. And so unless they have the right support and then then a lot won't necessarily go down that route and long term it's it's hard to say which is a more successful. Approach I guess if you're focused just on delivering for the patients as quickly as possible, potentially partnering with a large established industry member is going to be quicker. But then I know as a scientist you are then more anxious about losing control to a degree of of the way that you know your product or your your medicine will will develop almost pairing with translational labs and an earlier phase having more of an established relationship because I think for a lot of researchers they just don't know when where who you know. They're even like a database of, you know, potential companies that haven't maintained an interest in areas that you can go to. Otherwise most people end up just relying on their university sort of departments who again, you know, often understaffed. So again that limits, you know, potential interactions, access. So all of those those aspects, you know, facilitated by industry could could be fruitful. Yeah, I think there's a big shift in in what's being done preclinically in academia versus industry now and I think there's been huge investment. On the pharmaceutical side, for many, many big players to do a lot of that fundamental early research, you know, in house. And actually there's been a lot of attraction for academics who have actually I know many people who are moving to industry because of these these new opportunities, potentially because there's a funding squeeze in in the academic sector. But also you know, there's almost some of the more exciting work is now shifting to to to industry.