Leadership and Teams - your role as a leader

As CEO you have 360 degree responsibility for the success of your company. It's a lonely role - why do it alone. Read my latest presentation on the selection, forming and shaping of a team for high performance. E mail for the pdf presentation - using the latest of published work from Teresa Amabile and Steven Radcliffe amongst others. Melanie@Think10.eu

Preparing the way for genomic medicine at MCRC

Genomic medicine will change the way we see patients and what we need to know about them to treat them. We will have to know something about their genetics and if they have a tumour we will want to know something about the tumour's genetic profile. It is the changes that are within the tumour DNA that are meaningful and which will give us information about how responsive the tumour will be to cancer medicines and what the tumour will do in response to that medicine - will it die or will it further mutate to evade the effects of treatment?
The big issue is where and how will we receive this level of analysis about our disease? Currently our generalist hospitals are not equipped with the people, skills or equipment to make this happen.
I visited the Christie Hospital in Manchester - a dedicated cancer centre with a huge catchment area of new patients each year. Alongside the Christie Hospital, Cancer Research UK has a thriving cancer research institute, The Paterson Institute, which does research of the highest calibre and most impressively with the delivery of future medicines in mind. The University of Manchester is adjacent to the Christie/Paterson site and provides critical access to technologies from their faculties. Working together, those in the Christie Hospital, at the University and in the Paterson Institute (collectively forming the Manchester Cancer Research Centre, MCRC) are trying to identify rapid ways to assess the patient's status and that of their disease. The scientists and clinicians hope that from nothing more than a blood sample they will gain significant information to guide treatment. More drugs coming through company pipelines will be associated with diagnostic and prognostic tests to make treatment more effective and ultimately more affordable (as they will be used when they can be most effective to reduce the disease burden and not when they cannot work). A magnificant building of the Christie Hospital, jointly funded with CRUK, will provide a PhaseI/II unit to ensure UK cancer patients are given access to the newest drugs on trial.
Why does this set up in Manchester excite me? Because it is dedicated to one therapeutic area - Cancer. All the stakeholders can point to the goal of curing cancer and helping their patients. This common interest and integrated skill set between academia and the clinic and NHS has to be how we design the future of our healthcare systems - specialist centres with the ability to use molecular analytical techniques, whole body imaging technology and sophisticated medicines is where there is hope that today's drug R&D research will be sufficiently understood to be used to best effect for us all when we are patients. Well done to CRUK, University of Manchester, the Christie NHS hospital for supporting this integration and collaboration and to Nic Jones who as well as running the Paterson Institute, heads up the MCRC.

TED MED 2009 continued................

Marc Hodosh says TED MED is "about celebrating scientists and engineers and people who solve problems"... indeed there are extraordinary people at TED MED who have solved many many problems.
Below are a few representative synopses of key themes from the conference.....

Collaboration


A chord was struck by John Abele - co-founder of Boston Scientific who described the lack of collaboration in medicine - he says the word is over-used and in the medical dictionary there is no such word. John has bought the KingBridge centre and turned it into the

Kingbridge Collaboration Institute
Building Collaborative Cultures and Leaders

OK....... - this is interesting for pharmaceutical companies. Are we amongst those who use the word and don't actually practise?

Cancer

There was a good degree of outrage by a notable cancer patient, Laura Ziskin and specialist doctors like David Agus (Professor of Medicine at the Unversity of Southern California) that we are not winning the war on cancer because we are not capitalising on what is available. David has founded Oncology.com and Navigenics. David has figures that say the death rate is the same today as it was 30 years ago. He wants to see the integration of the informatics and genetic information that can be gleaned today into the practise of medicine...NOW. Laura has founded Stand Up To Cancer which raised $100mUS and distributes this money to researchers with tough timelines for delivery according to the collective wisdom of the dream team of cancer specialists 'Blue Ribbon Committee'. The objective is to bring products to patients in 3 years!! There are smaller grants available for young inventors also. Bart Kamen (CMO from Case
Western Reserve University in Cleveland, Ohio) advocates treating the "whole patient" who has cancer and is an advocate of chronic regimes of therapy. We saw the power of driving behavioural change for young patients to ensure compliance on longer term therapies ie. following ALL (typically striking young teenagers who strive to get back to normal living and who risk relapse with poor complicance). Video games are showing great promise to influence behaviour - preventing relapse in half of the usual 20% of patients who relapse. David Ornish - frequently on US television talks about the proven impact on our gene expression profile of healthy living and eating - supporting our ability to influence our state of health directly with our lifestyle.

The future target for cancer treatment is the cancer stem cell - this is a growing agreed strategy and Keith Black of Mount Sinai Hospital where he is a brain surgeon is an advocate of cancer vaccination. He says that cancer stem cells are immunogenic and spend much energy in strategies to evade immune surveillance. His clinical work and interest is in the interplay between the immune system and medicine, for example how to work with chemotherapy and vaccination in unison. He said that Viagra has been shown to improve penetration of chemotherapy to the brain. He describes microwave technology also to minimise invasive surgery and showed remarkable tumour regression in a patient with this technique of both the primary treated tumour and a further tumour adjacent to the treated site which he attributes potentially to stimulated immune surveillance.

Continuing the theme of Non-invasive surgical procedures

Rick Satava, a US Army Medical Advisor described and showed pictures of the first full apendectomy, non-invasively performed through the mouth. Rick is acclaimed through his work with the Army to have great insights into future technology and it's impact on medicine. He is an advocate of simulation and believes that simulation systems of the human body should be more advanced today than they are - he interesting and challengingly says that the pharmaceutical and healthcare industry is the only major producer now that does not have a simulation of its target (the human body). Rick is an awesome mine of information and a challenging disrupter of the status quo. He also talked about a femtosecond lasar that can remove perform single gene manipulations and how we can now put animals into suspended animation for up to 6 hours - in which time they cannot die as they are technically not alive in this state by our criteria. They can be brought out of this state and are fine. Scary stuff and as he so correctly describes each advance brings moral and ethical questions and ultimately decisions.

We are what we eat

You have to view the wonderful pictures of Peter Menzel and his wife Faith D'Alusio following their round the world trip to photograph families and their food. Peter describes how they will try all diets but amongst the most concerning and stomach churning was beef from the high intensive farming practices of Texas. We are not progressing but regressing....

A key theme is to eat naturally, non-processed foods and to stop eating when you are 80% full and let the food enter your body and give the right signals. The growing obesity epidemic in the world and in particular it the US is a cataclismic disaster for healthcare and future generations' well being.

Behaviour change towards integrative medicine

TED MED 2009 vision....The future will involve and integrated healthcare system. One with empowered patients, who are in possession of their own data, accessed by their mobile phone. They will take care of their life style and choose to look after themselves and monitor their health. When in need of treatement they will choose their physicians and their doctors will be part of a team who are intent on treating the whole person, not just their cancer, but their mind and whole body.

This was the vision expounded by so many speakers and attendees. However Ezekiel Emanuel, brother of the Chief of Staff to President Obama's administration, is skeptical. Cautious and even, perhaps "silenced" on the topic of healthcare reform, it was evident that today's reality of getting heathcare to the masses is not a vision facilitated and supported by future technology and a mass of empowered and educated people who will act responsibly. For me this was a disconnect between the TED MEDsters and the reality and complexity faced by today's leaders. TED MEDsters are self selected, relatively wealthy, educated people and the enjoy visionary worlds. The are not wrong about the possible future but have some way to go before the future is a reality and the technology must keep coming in order to make it accessible to the the world at large.

'Business model malpractise'

Finally I need to mention Jason Hwang, Executive Director of Innosight Institute in San Francisco. He used the term "Business Model Malpractise". It is an a challenge to the way we think and is applicable to the pharmaceutical industry as it is to the whole healthcare system. He said that barriers we are experiencing today (as illustrated by the disconnect of the vision and the potential described in the previous paragraph) is because we are trying to fit new disruptive technologies into old business models. An example is that we feel we should have all our healthcare delivery eminating from one place - the hospital - this is not necessary or even desirable in the future yet we persist in building new large hospitals - when perhaps small local community clinics will be better. This is really food for thought for all business executives across possibly all industries at this time - but never more so than for those involved in healthcare and, I would argue, pharmaceuticals.

I have to stop there because you need to be at the next TED MED to get the full breadth and depth of insights and challenge. You can always ring me or write and ask for more........ Thanks for reading this far.

A First evening at TED MED 27/10/09

At TED in San Diego. Johnson and Johnson are the major sponsors - well done J&J, you're looking at the world differently! TED MED's founder, Richard Saul Wurman opened with Marc Hodosh. Richard likes to makes things simple and understandable - to demystify. This makes things accessible to everyone - he is an amazing man.

Let's move to regenerative medicine and stem cell breakthroughs. Daniel Kraft a physician at the Stanford Institute for stem cell biology and regenerative medicine told us the following..........The cutting edge of surgery and regenerative medicine is to build blood vessels, heart valves, bladders and skin - described as relatively simple now - we know how to do it, and are doing it!!! More complex organs such as the liver have more cell types and are highly vascularised structures. Surgeons would rather we receive such organs made predominantly of our own cells.

Imagine this Anthony Atala, Director of the Wake Forest Institute for Regenrative Medicine... told us ...take one liver, remove the liver cells to leave a vascular bed and regrow the new host's liver using their own cells around this vasculature. This hasn't been done in man of course, and it still leaves the issue of a foreign tissue vascular bed, but it's amazingly close to pushing organ development and regeneration to another level. These same amazing scientists are working on regenerative capacity of salamander limbs and are asking what stands in the way of humans regenerating their limbs - scar tissue is the answer - so skin science is leading the way here to provide an artificial living layer that prevent the body from scaring and keeps it on the healing and regeneration pathway.

So may highlights and insights but one more thought - Geo-medicine. Our geographical history has a huge impact on our health yet it is unrecorded - what was in the environment where we were growing up, were students and where we have spent our adult lives? Actually so much information is now available about those environments - it's just we don't tie the data into our medical history. There are some intent on changing this - Bill Davenhall, Global marketing manager of Health and Human Service Solutions, ESRI is onto this!! He thinks it will help determine our risk and thus avoid unexpected events like his heart attack without warning nor apparent risk. He also looks to the changing healthcare service contribution of our high street stores like CVS and Walgreen.

www.TEDMED.com

Inforsense and idbs link up on Translational Research

Inforsense and idbs held a Translational Research Symposium yesterday morning at the Dali Museum on the south bank in London. They are impressive with the same aims as Microsoft, to provide supporting integrated databases for all healthcare systems, with one user interface. Their advantage is that they really understand the pharma industry and work with academic and medical teams outside industry.
This creative team are looking at the problem differently - to put in place a means to draw from data in multiple environments and be able to interogate it through one interface. They understand the issues that lie between research based data and medically derived data - we all know this interface must be made seamless so that we can use research based technology in the clinic. This will enable more responsive clinical trials and should reduce unit cost and irrelevant activities. Amongst the speakers were those who understand the change required in clinical research and who speak eloquently about the defining features of a good biomarker that will support changes in clinical protocol design. A good day, Inforsense and idbs - thank you. go to this website to find out more...
http://www.idbs.com/InforSenseSuite/TranslationalResearchSolution/
Speakers on 22nd Oct were:
Professor Simon Lovestone, Institute of Psychiatry, King's College, London
Professor Richard Begent, Cancer research UK Targeting and Imaging group, Dept of Oncology, UCL Cancer Institute, London
Dr Andrew Chadwick and Tom Parke from Tessella
Dr Anita Grigoriadis, Breakthrough Breast cancer translational research at Guys
Jonathan Sheldon, Director, technology Solutions, Inforsense.
Idbs Chairman and CEO , Neil Kipling hosted the event.

Steve Lohr supporting the case for the changing pharma model

The Future of Healthcare Technology Summit

This two day summit in Boston's MIT Faculty Club showed a future world where complexity will be unravelled and presented to us as an aid to our jobs. Whether an emergency room medic, or a drug discovery scientist, information technology will be available to inform our decision making in real time, not removing our discretion but guiding us to the possibilities and most likely scenarios we face.
Robots that influence us to take care of ourselves, help us diet and motivate those in need of support to help themselves with their medications. Headsets that inform about the most likely condition of a trauma patient as the medic inputs vital signs and responds to questions - guiding the clinician to perform the most likely to be useful and informative tests rather than waste money on cautionary but uninformative ones. Programmes to integrate social, environmental and medical influences on our lives to predict disease propensity and to change behaviour to avoid disease onset and Microsoft's new methodology to compute huge volumes of input data, regardless of source that can be interogated to provide us with key connections between key points of reference (genetic sequence, proteins, medicines, side effects - you name it!).