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Welcome to Pharma Talk Radio. This podcast is focused on
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using digital technologies to enhance patient experience and better matched
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supply chain from the twenty twenty five pod Partnership Opportunities
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in Drug Delivery Conference. For more information on the POD conference, editorials, podcasts,
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or webcasts, please visit podconference dot com. Thank you and
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enjoy the podcast.
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My name is rab Koshik. I had Takeda's the device
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digital innovation team for the plasma dirived business. We have
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the molecule business, which is outside. So for plasma it's
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slightly different. It's we collect people's plasma and then we
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make medicines and we provide it back. It's very very
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large volumes and the protein that we handle has to
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be more sensitive, so slightly different, also large volumes. I'll
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quickly let my co hosts introduce themselves. Our moderator didn't
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make it, so we are all going to moderate and
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speak at the same time.
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Rebecca Forward. So I work for very Next. We are
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an innovative cro that does design and development, clinical pre
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clinical testing, and regulatory quality services, and I work closely
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with our drug delivery team, so working with a lot
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of pharmaceutical clients on developing drug delivery devices.
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I'm June Way, Innovation manager at Novo Nordisk, So I'm
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in charge of external partnership for device and digital device
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component and we are based in Cambridge and it's a
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small team and then we'll have a big device manufacturer
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team and also engineers sitting in Denmark. So yeah, we're
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doing our search and scout team for early device technology
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and also combination product technology in United States.
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Wonderful. So let me start with you, Rebecca. You work
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across clients to identify needs and digital plans. So are
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you seeing a concerted effort on drug delivery devices and
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connected care and some kind of ROI business case Because
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I always refer to diabetes as being the gold standard,
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but then for others, what's the kind of development you've
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seen over the last few years.
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Yeah, so we do see a lot of drug delivery
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devices going to digital platforms, and I think a lot
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of that plays into moving away from just adherents but
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into more of therapy management and preventive care as well.
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So instead of adherents being did we take our drug
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on time or did we take our drug at all,
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it's now moving to Okay, we've taken our drug, but
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how does that change my future outcomes? How does that
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feedback to possible changes in what we and how we're treating,
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and that information is being integrated back to the care
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team that ultimately then care and help change those outcomes
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for the patient. So we're seeing, i mean, the the
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digital trend in general with a lot of younger patients
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and a lot of early adopters into the digital space.
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People want to take proactive care of their of their
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health and therefore are really looking for what are those
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modalities where they can really own part of this care
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platform instead of really being more reactive or uh to
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to to the therapy itself. So we are seeing a
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lot of drug delivery clients looking for how do we
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integrate that digital platform?
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Wonderful? So a question for Junuai with the g LP
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market and the broader diabetes obesity system ecosystem, how do
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you see this different formats of wild syringes and devices,
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connected devices with all the patient journeys converging or do
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you see any converging or because Novol kind of has
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it all right, We've got bands, syringes, devices and connected care.
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So yeah, this is exciting kind of market right now.
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And also I think most of the people are aware
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of like GRP one and this is a blockbuster drug.
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I need it, yeah to do I can give you
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this count right, So yeah, So I think like it's
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interesting to maybe not just talk about digital technology or
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device or connected device. So if we jump out of
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the box, so we have I mean this drug device
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formats right now are not just like a technical upgrade
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or maybe life cycle management tools, and we can we
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can see these device strategies more like you know, product strategy.
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And for example, as you just mentioned, like we have
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seen a wide range of device options including like violences
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range autoinjectors and also potentially maybe connected device for GRP
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one and for obviously that these users, right, But it's
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interesting like how we digest these options. So for me,
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it's like each of these options provide a value for
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the patient around their patient journey. But it's really important
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for the pharmaceutical companies to sharpen their understanding of what
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exactly the patients require and the need and also the
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market evolving. For me, it's no longer like launching a
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product you know, on the market. It's more about launching
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the right product at the right time. So for example,
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the vire on the strange options. We can never imagine
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this could be launched like if you have autoinjector as
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a solution, right, but it's a strategy like a marketing
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of sales, like like kind of initiative. So to be
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as right now, we're also adapting a learning of like
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how to you know, launch multiple products on the market
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in the same region even so how to you know,
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differentiate this product and also maybe also learning how to
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do this direct to customer our direct to patient like service.
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Yeah, that's interesting that direct to customer, direct to patient.
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So on that patient interaction, Rebecca, you were mentioning therapy
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management and preventative care. But beyond adherence, what are some
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of the features that you feel are good engagement strategies?
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Because I make it like in a consumer world, what
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are the five apps you use? You use banking, or
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you use music, you use navigation because these apps actually
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help you to reduce your steps to not look up
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the map or not look up go to the bank.
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So in healthcare, what are some of those features that
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you feel are helpful and providing those reduction of steps
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or engagement.
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Yeah, I mean some of them are ones that obviously
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have some again change to your treatment paradigm. So something
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that actually will provide that feedback loop things like right
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now will have for again, you know, a big push
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on patient adherence has really been the trend, but be
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just general reminders that okay, it's time to take your medication.
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But now looking at further along the preventative care kind
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of therapy treatment is okay, what are the environmental factors
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or what are you traveling, what are some of the
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different things that might be happening, and getting that data
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that feeds that back into how do we then start
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giving triggers to now it's time to take your drug
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based on the fact that if it's let's say an
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allergy type medication or an asthma, based on the environmental
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factors outside or other aspects, that we'll just have that
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patient engage further because now they're actually getting treatment when
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they need its, versus on a time based aspect. Another
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one is there start to be some digital apps, Like
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you said again, they're useful. So for patients on let's say,
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with mental health concerns anxiety depression, there's therapeutic apps that
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are being recommended or prescribed alongside those drugs to help
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the patients with different ways of moderating kind of their
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disease state themselves, which again could then feedback into okay, now,
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how do we change the dose regime that they're on
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and or change the drugs that they're on, or provide
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some additional supplements. So we start to see some of
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those apps evolve, and again as people find those to
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be helpful and successful in their treatment pathway, they start
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to use those as a normal means.
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Yeah, wonderful. And from our side, I think I mentioned
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this to other people before, but we came up with
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an idea of voice enabled infusion app or we worked
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with Amazon. So it came to us like from cooking
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that if you can say, hey, I want to cook
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pasta or veryani, it can walk you through the steps
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of the recipe. So similarly, if you say I would
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like to infuse this drug, it could walk you through
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on video or audio. And and what we liked is
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that the patients actually appreciate that it's hands free. They
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don't have to fiddle with the app, and they can
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talk to it and it can talk back. So we've
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successfully managed to actually work with Amazon and come up
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with that. But that's another example of having an engagement
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from a different perspective. It's a simple thing that you
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already have in your life with Alexa or Google, which
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you can very quickly transport to health, just like Apple
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Health is doing with their watch. So more and more
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I hear that the consumerization of health care needs to
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be with the existing consumer products that are in the
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market rather than create new ones. There is a lot
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of app fatigue. I get a lot of pushback that
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patients are already drowning in their disease. They don't want
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to deal with an app. So you have to make
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it such that it starts being engaging or reduces their
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stress or strain. So like we have some other features
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like drink your water, polite nudges, take a walk, enter
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your symptoms through voice, what's your mood feeling like height, weight, body, etc.
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And other medications. You don't want multiple apps, but also
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you just want like the top five features rather than
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fifteen or twenty.
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Can I play off that?
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Ask you another question?
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How do you balance adding the advanced features with the
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need for simplicity for the older adults or patients with
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low digital literacy.
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Yeah, that's a good one. So the voice example is one,
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and then the other ones were making the signs and
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symbols on the apps more intuitive with colors, with large symbols,
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with the touchscreen, so basically imitating what works today with
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a lot of people who are I wouldn't say less
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digital literate, but don't want to get into the wording
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and the reading. So just like you used to design
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user interface is and charts and paper for how Dell
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used to come with a simple put this computer together
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with a picture diagram, you could pretty much apply that
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human factors and UI to app development. And I think
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if you approach it like that, a lot of people
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appreciate that it is more like a lego block rather
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than intricate set of directions.
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And I'll maybe give another example on similarly, like you're saying,
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there's a lot of app fatigue. But on top of that,
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we've done some development of a product drug delivery device
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that has an application, but the delivery device itself had
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some very very simple symbols and some feedback to the user. Basically,
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we took what is the critical pathway that they absolutely
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need to do XYZ to complete this therapy and the
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rest of it that could be provided a lot more
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information that would be helpful, let's say for the clinician,
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for the patient really more on that preventative of really
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understanding how is this working. All of that was fed
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onto the app because they had a lot more ability
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to we could we could mind data and actually provide
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more insight through the application. But the device itself gave
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the aspect of here are the quick, easy steps that
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you had to do to make sure that they did
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receive the drug therapy. And then again so that way
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at least if they didn't want to use the app,
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or they were unable to or it was too difficult,
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just based on based on who the patient was, they
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could still get the therapy. And so there's some aspects
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we have built into some of those digital applications that
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are what is minimal viable. Let's make sure that that
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can be done by anyone, very very simply. And then
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let's add those additional features that most patients may want
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and clinicians probably want as well, but let's keep that
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separate just to make sure that we can still ensure
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that the patient can forget the therapy regardless.
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Great thank you, June, you were many thing flexible to
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accommodate multiple telehealth partners, So some device design choices to
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help having a product being interoperable across disparate telehealth systems.
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What are some of your thoughts on that?
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So I saw like also just echo with Rebecca is
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like it's also interesting for us to think out, just
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like a double click of like what exactly the role
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of pharmaceutical companies should do in this digital health like component.
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So should we like you know, like work with these
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expertise like partners to you know, like a code generating
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an ecosystem, or should we you know, try to own
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everything we want to own? So that's also an interesting
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question where I think every single day like also depends
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on different drug projects, right But for what I'm learning
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right now, if we want to make a connective device
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for maybe GP one for like obviously dis use, we
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need to make sure the platforms or maybe the protocols
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should be more standard, so like a more like generic
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towards different telehealth equal like help telehealth company or maybe partners.
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So that's kind of the learning. We will maybe adapt
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in the future, but right now, so far, we don't
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have any connected device for GRP onie users. But we
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are monitoring the space and also we're monitoring the trend
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and if there will be a future, I think that's
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the time for us to really understanding from a data perspective,
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how to transfer data, how to like do the data integration,
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and also cloud based data storage, so to make sure
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like we can apply the same maybe software, metic, device,
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protical or algorithm to different like telehealth partners, right, and indeed,
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I think for obest and adapt this area, we can't
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have more options, so we're don't need to work alone
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by ourselves to make those apps we can right now,
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maybe a lot of people are aware of like they
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have so many like telehealth company working obesit online so
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we can also get prescription there, right, so you don't
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necessarily to go to your like phys to get the
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physical exam to get a prescription, so you can go there.
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But also they're also launching like the whole ecosystem of
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like how to prevent obviousity and also for the lifestyle intervention,
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so that's something for sure, like a novel or maybe
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other farmer companies who are not really maybe like capable
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to do that, right. So that's why I feel like
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my feeling is like it's good to kind of closely
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working with these companies and kind of like using our
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knowledge from clinical development, maybe from the drug like discovery perspective,
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right to educate them to make sure they have a
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properate like maybe advertisement on education towards the patients. But
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for sure, like on the digital component, I think we
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should rely on those partners and trust those partners to
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co deliver products together.
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Wonderful. And on the data, what is some of the
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data that you guys have experienced collecting and using realistically,
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Because somewhere I heard data is the new goal, but
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now there's so much its data is the new sand
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because there's so much of it, you have to dig
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in the data to find the gold. So like, what
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are some of your experiences of having extracted data, found
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some insight, applied it back. Because all that looks very
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good in theory, but you try to do it in reality,
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it's very difficult for us. Like rare disease, we only
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have hundreds of patients, so we don't know how much data.
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We don't have a lot. And then diabetes is the
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other extreme, which is lots of data. So any thoughts
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on that, Rebecca or one way.
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I can jump at first, so this is not really
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a drug delivery example specifically, but in the womb care industry,
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I did work with a device, a connected device that
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did a lot of that data was pushed back to
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the farmer or the company itself, and a lot of
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it was around tracking of kind of these were larger
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kind of rented pumps, so a lot of it had
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to do with the supply chain, and it was making
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sure that we know where those pumps are, what hospitals
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have they been deployed to, because eventually they were rent
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like I said, rented pumps, so eventually we wanted to
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get those back both for maintenance purposes but then also
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at the end of a contract and sure we get
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those back. So a lot of it was just tracking
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of where is our supply chain in the out there
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in the world. But also there was some patient aspects
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to that too, in that we did collect things like
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as the pumps running on the various different patients that
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were deatentified, are we getting a lot of alarms on
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this patient, or are we getting or are they having
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successful treatments? How long are they being treated for? So
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that information did come back. I will say this was
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this project specifically, it was quite a few years ago,
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and so a lot of that data. To your point,
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I'm not sure there was strong changes being made, but
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that fed more back to the R and D group
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of like how can we make improvements here for the future.
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There wasn't anything specifically changing that patience itself, but it
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does start to play into how do we how do
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we know what's out in the field, at least in
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a device perspective for things that we do want to
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do preventative maintenance on and things like that.
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Yeah, wonderful because earlier you used to go to survey
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and find these and call people, and so now there's
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this mechanism for getting the feedback anything from you.
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Yeah, from a supply chain perspective, right, So I'm trying
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to like talk about the topic. So I think it's
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more like about the market share focusing, so from a
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supply chain perspective. So it's no longer just maybe a
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prescription volume. Based on my understanding after I talk with
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my colleagues, I'm not expert here, but it seems like
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right now we are seeing a shift of the chind
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that is like monitored the maybe the real world behavior
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like data so for example, you can track like how
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patients switch between different formats. As I just discussed right,
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patient can switch from buy on STRINGE to out the
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injector and maybe they will switch back to monitor and
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we understand why. And second is like they may switch
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between different brands. Even so, so this is something interesting.
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We will collect the data and as we try to
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digest and then understanding and we should have the real
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time data collection. And the second component will be what
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promotes these healthcare providers to you know, like recommend one
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device over the other the other options. So we don't know.
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So then we are also seeing like there's something new
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data wing to collect and try to you know understand.
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So but overall I think these insights right now become
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kind of the core kind of like a strategy like
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thinking to to kind of shape our product design. Also
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the supply chain.
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Yeah yeah, fantastic. So last couple of questions one is
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like both launch patient engagement, like who should who should
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take responsibility the pharma, the device, the speciality, pharmacy, the
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channel partner, all of them and how or what do
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you think are the pros and cons of the governance
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structure of you know that patient engagement and continued you know,
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ongoing monitoring, measuring adherence compliants. Because there are so many
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people in the value chain, yeah.
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I can start. I think, just like anything else in
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medical devices, is to be a risk based approach. So
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if the drug is high risk, then the pharmaceutical company
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should absolutely own the patient information and sort of the
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overall supply chain or that overall value chain, just because
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they're both best suited for doing any safety reporting or
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kind of the clinical outcomes. If the drug itself is
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only successful, let's say through the modality of delivery, then
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perhaps the OEM or the device partner should really own
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that data and own that paradigm. There's other things too,
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where again, if it's more clinician based treatments, then perhaps
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the clinicians the most effective in that to own that
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patient data, own that feedback. And then there's gonna be
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cases too where you know, there's a little bit of both.
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It's going to be a risky drug and it's only
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delivered through a specific method, and you need the clinician involved,
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and therefore there's going to be some sort of a
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shared partnership through this. But just like anything else, it
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should start from what is that risk based approach and
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who has the biggest influence on the success for the
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patient or the outcome for the patient and really push
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that the ownership in their direction.
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Yeah, from my understanding, it's like a farmer should be
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responsible for patients. So that's all so, and everybody want
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to increase patients like experience, right, so ween to be
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responsible and feel the liability. So if we are, I mean,
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if we are not clear off of our responsibility, we
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shouldn't maybe not never step into that area.
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Okay, wonderful. And so one last or close to last
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question is what does the future look like for you
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or how do you think that digital device? I call
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it the three D drug device, digital the three D ecosystem.
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So how would you like it to be in the
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next three four years? Because it's been changing, but there
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is still a lot of challenges and adoption theeians compliants
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and understanding different levels. There are still some people who
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are quite not so sure about digital health and whether
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it is working or not. So are you guys bullish?
384
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And what is your view or vision for this to
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be in the next three to five years?
386
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So I think I would say I'm on the Polish
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side I think we should definitely be utilizing the digital
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aspects that we have to support patients. I mean, you
389
00:22:49.119 --> 00:22:52.160
look at other parts of the healthcare industry and obviously
390
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and the big buzzwords, right AI, machine learning, all of
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those aspects. You see that already being used in diagnostics
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mostly right, with a lot of imaging and processing of
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that imaging. But there's no reason we shouldn't be able
394
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to start to apply that in other areas too. And
395
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it's not I think the one thing I heard this
396
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at a couple conferences not too long ago, but I
397
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think there's always going to be that human in the
398
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loop aspect. So I don't think this is let's take
399
00:23:23.240 --> 00:23:26.720
away the clinicians. Let's you know, this is going to be. Yes,
400
00:23:26.799 --> 00:23:29.680
there's a little more straight to patient interactions, and I
401
00:23:29.759 --> 00:23:33.039
think that's helpful, But we're not getting rid of the clinicians.
402
00:23:33.079 --> 00:23:35.599
We're not getting rid of those caregivers. Those absolutely need
403
00:23:35.640 --> 00:23:38.160
to be part of it, but they can be armed
404
00:23:38.200 --> 00:23:40.920
with a lot better information to help make those decisions
405
00:23:41.000 --> 00:23:45.039
both faster which can improve outcomes, but also more reliably.
406
00:23:45.759 --> 00:23:49.920
And so that's where I think the we absolutely need
407
00:23:50.000 --> 00:23:52.920
to bring digital aspects into the pharmaceutical industry as well.
408
00:23:54.359 --> 00:23:57.599
For me, I'm also polish but also caut yourself, like
409
00:23:57.680 --> 00:24:00.599
the way we work on to solve the problem. So
410
00:24:01.480 --> 00:24:03.640
I mean for me, it's more like right now, like
411
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we all want to work in this exciting area, but
412
00:24:06.400 --> 00:24:09.200
also like what's the best way for farmer to work
413
00:24:09.279 --> 00:24:12.680
in this component? So for me, like a partnership like
414
00:24:12.759 --> 00:24:16.920
strategy is really really important and essential. Maybe. So then
415
00:24:17.920 --> 00:24:20.119
the final question I think most important question is like
416
00:24:20.519 --> 00:24:23.359
how to define or balance the costs and shares and
417
00:24:23.400 --> 00:24:26.720
the rental revenues? Right so who will take over the
418
00:24:26.799 --> 00:24:29.119
cost and who will get the revenue? For me, I
419
00:24:29.160 --> 00:24:30.960
think it's really important right now we need to have
420
00:24:31.079 --> 00:24:33.720
a clear like metrics right now to think about like
421
00:24:34.240 --> 00:24:37.359
how to take this share this kind of like costs
422
00:24:37.359 --> 00:24:40.200
and revenue shares. For me, I think couple like maybe
423
00:24:40.319 --> 00:24:43.119
thinking first is like maybe we need to check like
424
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the percentage increase of this therapy like persistence it can
425
00:24:48.079 --> 00:24:52.400
generate through this digital app and be like this telehealth system.
426
00:24:52.519 --> 00:24:52.640
Right.
427
00:24:53.119 --> 00:24:55.640
Second will be like the reduction of the set effects
428
00:24:55.640 --> 00:25:00.880
on the adverse events through the technology. Then the third
429
00:25:01.000 --> 00:25:04.440
one will be like how many like new patients acquisitions
430
00:25:04.960 --> 00:25:08.200
can collect or like like can collect maybe through these
431
00:25:08.319 --> 00:25:09.880
like partner channels.
432
00:25:09.960 --> 00:25:10.079
Right.
433
00:25:10.400 --> 00:25:12.599
So I think with this outcome like driven like a
434
00:25:12.720 --> 00:25:16.839
database on metrics, will really like have a clear structure
435
00:25:16.920 --> 00:25:21.240
for farmers to clearly justify the investment and also align
436
00:25:21.319 --> 00:25:23.720
with the partners in we're beginning to tell them like
437
00:25:23.839 --> 00:25:26.759
this is a co owner like co ownership, right, So
438
00:25:27.319 --> 00:25:30.519
that I think with the fundamental like alignment, then it's
439
00:25:30.559 --> 00:25:33.160
a good start to to kind of navigate this this
440
00:25:33.319 --> 00:25:33.880
kind of problem.
441
00:25:35.079 --> 00:25:38.200
Yeah, those are those are I'm very Polish as well,
442
00:25:38.359 --> 00:25:42.519
and I think if I compare, I always tell people
443
00:25:42.880 --> 00:25:44.880
that did you ever think there will be a driver
444
00:25:45.039 --> 00:25:48.960
less car? And it is happening already. There is way more.
445
00:25:49.200 --> 00:25:51.599
Even in Boston I heard I've not done it yet.
446
00:25:52.240 --> 00:25:54.279
I had not imagined it. So just like there can
447
00:25:54.319 --> 00:25:57.519
be a driver less car, there can be a lot
448
00:25:57.680 --> 00:26:02.200
more patient treatment. So like nowadays, you pick up your iPad,
449
00:26:02.319 --> 00:26:04.839
it says, oh, you usually read the Wall Street Journal,
450
00:26:04.880 --> 00:26:07.599
there's some AI happening there. Your watch is like, oh,
451
00:26:07.680 --> 00:26:09.799
it's your sleeping time, would you like me to set
452
00:26:09.839 --> 00:26:13.799
your alarm? So imagine a day that your watch or
453
00:26:13.880 --> 00:26:16.960
whatever says it's time to wake up, go for your walk,
454
00:26:17.160 --> 00:26:20.720
come back, drink your hot water, have a drug, take
455
00:26:20.799 --> 00:26:25.200
this dose. There is a CGM like monitoring device which
456
00:26:25.279 --> 00:26:28.279
is telling how you're doing, so it would vary the
457
00:26:28.359 --> 00:26:31.839
dose based on your requirement, and it would then also
458
00:26:32.440 --> 00:26:36.640
record your symptoms. It would keep like logging you like
459
00:26:36.759 --> 00:26:40.599
a digital companion fully and be seamless because it would
460
00:26:40.599 --> 00:26:44.480
talk to you or remind you, or I mean just
461
00:26:44.640 --> 00:26:47.200
be the digital companion And hopefully that can all then
462
00:26:47.240 --> 00:26:51.519
transcend back to become more what I understand about jen
463
00:26:51.599 --> 00:26:54.720
AI versus just like the AI and before that it
464
00:26:54.920 --> 00:26:57.799
was like you typed in FAQs and it used to
465
00:26:57.920 --> 00:27:01.839
answer from the database. How you type in any garbled stuff.
466
00:27:02.000 --> 00:27:05.079
It deciphers what you're trying to say, and it answers
467
00:27:05.160 --> 00:27:08.759
what you are actually looking for. So with Jenny, I
468
00:27:08.920 --> 00:27:12.319
hope that the treatment will get customized to every person
469
00:27:12.400 --> 00:27:15.440
and they will start feeling more that I need to
470
00:27:15.519 --> 00:27:18.079
rely on my digital companion because it is actually knowing
471
00:27:18.160 --> 00:27:21.559
me and my treatment, not just from a delivery, but
472
00:27:21.720 --> 00:27:24.920
from a reaction and how my body and my overall
473
00:27:25.039 --> 00:27:28.559
ecosystem is reacting back to it and giving the information
474
00:27:28.680 --> 00:27:32.799
back to my IT'CP nurses in the ecosystem, so I feel,
475
00:27:32.839 --> 00:27:35.359
of course there's a lot of talk of privacy and
476
00:27:35.440 --> 00:27:39.839
data privacy. I think privacy is long lost now, so
477
00:27:40.079 --> 00:27:44.119
we should just adopt the data and the digital companions
478
00:27:44.160 --> 00:27:47.599
for us to all have much better outcomes. When I
479
00:27:47.680 --> 00:27:49.880
started driving a car, there was no rear view camera,
480
00:27:50.039 --> 00:27:53.279
there was no navigation, there was gears, there was a
481
00:27:53.319 --> 00:27:56.559
lot more that I had to do. And the behavior
482
00:27:56.680 --> 00:27:58.599
change has happened because it's made it so much easier.
483
00:27:58.680 --> 00:28:03.440
There's navigation. My son was like, you travel the same route,
484
00:28:03.480 --> 00:28:06.519
but you still have the navigation on. It's for traffic
485
00:28:06.759 --> 00:28:10.200
because I want to make sure that. And similarly rear camera.
486
00:28:10.359 --> 00:28:13.240
I used to park and ding and dent my car,
487
00:28:13.319 --> 00:28:15.960
but now rear camera and so on and so forth.
488
00:28:16.079 --> 00:28:18.960
Right Tesla drivers they just like have the self drive.
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So the behavior change happens easily when it makes it
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easier for you because you really then adopt the digital
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or figital I call it physical and digital aspects which
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are making your life easier. So I will say, if
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those digital companions and products are making your life easier,
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your behavior change is guaranteed. But if it's going to
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be harder to adopt, it'll be this is just my view.
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Any others, I'll.
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Take two seconds. But I was going to say, it's
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something that is going to take time. To your point,
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it has to be a behavior change. But I think
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you made a point too of like you start to
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see a pattern of you wake up in the morning
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and you always read the Wolk Street Journal. Now it's
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starting to pop that up for you, right, So it's
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make it's anything that will make their lives easier, they
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will start to adopt to. But also watching those patterns
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of how people react to the drugs that they're on
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or whatever it may be, and adapting the digital.
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Solutions to that.
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Just final comment, I think like we will trust the
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partner again, So I mean I'm sure like a partner
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they are studying like human like behavior and those usability
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here and also urine a science even right, so for
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us as a farmer, we make we will make the
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best in class drugs and they will trust the partner
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to do the rest of the work.
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00:29:31.839 --> 00:29:34.240
We hope you enjoyed the podcast. For more information on
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00:29:34.279 --> 00:29:39.039
the pod Conference editorials, podcasts, or webcasts, please visit podconference
518
00:29:39.079 --> 00:29:40.839
dot com. Thanks for listening.
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Welcome to Pharma Talk Radio. This podcast is focused on
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using digital technologies to enhance patient experience and better matched
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00:00:08.439 --> 00:00:12.320
supply chain from the twenty twenty five pod Partnership Opportunities
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00:00:12.359 --> 00:00:17.160
in Drug Delivery Conference. For more information on the POD conference, editorials, podcasts,
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00:00:17.239 --> 00:00:21.039
or webcasts, please visit podconference dot com. Thank you and
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00:00:21.120 --> 00:00:22.079
enjoy the podcast.
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My name is rab Koshik. I had Takeda's the device
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digital innovation team for the plasma dirived business. We have
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the molecule business, which is outside. So for plasma it's
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slightly different. It's we collect people's plasma and then we
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make medicines and we provide it back. It's very very
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large volumes and the protein that we handle has to
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be more sensitive, so slightly different, also large volumes. I'll
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quickly let my co hosts introduce themselves. Our moderator didn't
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make it, so we are all going to moderate and
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speak at the same time.
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Rebecca Forward. So I work for very Next. We are
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an innovative cro that does design and development, clinical pre
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clinical testing, and regulatory quality services, and I work closely
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with our drug delivery team, so working with a lot
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of pharmaceutical clients on developing drug delivery devices.
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I'm June Way, Innovation manager at Novo Nordisk, So I'm
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in charge of external partnership for device and digital device
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component and we are based in Cambridge and it's a
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small team and then we'll have a big device manufacturer
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team and also engineers sitting in Denmark. So yeah, we're
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doing our search and scout team for early device technology
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and also combination product technology in United States.
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Wonderful. So let me start with you, Rebecca. You work
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across clients to identify needs and digital plans. So are
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you seeing a concerted effort on drug delivery devices and
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connected care and some kind of ROI business case Because
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I always refer to diabetes as being the gold standard,
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but then for others, what's the kind of development you've
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seen over the last few years.
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Yeah, so we do see a lot of drug delivery
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devices going to digital platforms, and I think a lot
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of that plays into moving away from just adherents but
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into more of therapy management and preventive care as well.
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So instead of adherents being did we take our drug
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on time or did we take our drug at all,
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it's now moving to Okay, we've taken our drug, but
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how does that change my future outcomes? How does that
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feedback to possible changes in what we and how we're treating,
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and that information is being integrated back to the care
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team that ultimately then care and help change those outcomes
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for the patient. So we're seeing, i mean, the the
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digital trend in general with a lot of younger patients
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and a lot of early adopters into the digital space.
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People want to take proactive care of their of their
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health and therefore are really looking for what are those
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modalities where they can really own part of this care
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platform instead of really being more reactive or uh to
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to to the therapy itself. So we are seeing a
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lot of drug delivery clients looking for how do we
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integrate that digital platform?
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Wonderful? So a question for Junuai with the g LP
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market and the broader diabetes obesity system ecosystem, how do
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you see this different formats of wild syringes and devices,
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connected devices with all the patient journeys converging or do
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you see any converging or because Novol kind of has
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it all right, We've got bands, syringes, devices and connected care.
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So yeah, this is exciting kind of market right now.
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And also I think most of the people are aware
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of like GRP one and this is a blockbuster drug.
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I need it, yeah to do I can give you
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this count right, So yeah, So I think like it's
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interesting to maybe not just talk about digital technology or
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device or connected device. So if we jump out of
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the box, so we have I mean this drug device
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formats right now are not just like a technical upgrade
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or maybe life cycle management tools, and we can we
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can see these device strategies more like you know, product strategy.
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And for example, as you just mentioned, like we have
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seen a wide range of device options including like violences
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range autoinjectors and also potentially maybe connected device for GRP
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one and for obviously that these users, right, But it's
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interesting like how we digest these options. So for me,
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it's like each of these options provide a value for
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the patient around their patient journey. But it's really important
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for the pharmaceutical companies to sharpen their understanding of what
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exactly the patients require and the need and also the
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market evolving. For me, it's no longer like launching a
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product you know, on the market. It's more about launching
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the right product at the right time. So for example,
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the vire on the strange options. We can never imagine
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this could be launched like if you have autoinjector as
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a solution, right, but it's a strategy like a marketing
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of sales, like like kind of initiative. So to be
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as right now, we're also adapting a learning of like
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how to you know, launch multiple products on the market
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in the same region even so how to you know,
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differentiate this product and also maybe also learning how to
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do this direct to customer our direct to patient like service.
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Yeah, that's interesting that direct to customer, direct to patient.
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So on that patient interaction, Rebecca, you were mentioning therapy
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management and preventative care. But beyond adherence, what are some
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of the features that you feel are good engagement strategies?
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Because I make it like in a consumer world, what
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are the five apps you use? You use banking, or
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you use music, you use navigation because these apps actually
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help you to reduce your steps to not look up
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the map or not look up go to the bank.
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So in healthcare, what are some of those features that
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you feel are helpful and providing those reduction of steps
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or engagement.
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Yeah, I mean some of them are ones that obviously
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have some again change to your treatment paradigm. So something
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that actually will provide that feedback loop things like right
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now will have for again, you know, a big push
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on patient adherence has really been the trend, but be
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just general reminders that okay, it's time to take your medication.
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But now looking at further along the preventative care kind
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of therapy treatment is okay, what are the environmental factors
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or what are you traveling, what are some of the
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different things that might be happening, and getting that data
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that feeds that back into how do we then start
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giving triggers to now it's time to take your drug
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based on the fact that if it's let's say an
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allergy type medication or an asthma, based on the environmental
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factors outside or other aspects, that we'll just have that
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patient engage further because now they're actually getting treatment when
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they need its, versus on a time based aspect. Another
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one is there start to be some digital apps, Like
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you said again, they're useful. So for patients on let's say,
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with mental health concerns anxiety depression, there's therapeutic apps that
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are being recommended or prescribed alongside those drugs to help
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the patients with different ways of moderating kind of their
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disease state themselves, which again could then feedback into okay, now,
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how do we change the dose regime that they're on
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and or change the drugs that they're on, or provide
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some additional supplements. So we start to see some of
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those apps evolve, and again as people find those to
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be helpful and successful in their treatment pathway, they start
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to use those as a normal means.
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Yeah, wonderful. And from our side, I think I mentioned
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this to other people before, but we came up with
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an idea of voice enabled infusion app or we worked
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with Amazon. So it came to us like from cooking
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that if you can say, hey, I want to cook
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pasta or veryani, it can walk you through the steps
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of the recipe. So similarly, if you say I would
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like to infuse this drug, it could walk you through
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on video or audio. And and what we liked is
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that the patients actually appreciate that it's hands free. They
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don't have to fiddle with the app, and they can
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talk to it and it can talk back. So we've
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successfully managed to actually work with Amazon and come up
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with that. But that's another example of having an engagement
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from a different perspective. It's a simple thing that you
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already have in your life with Alexa or Google, which
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you can very quickly transport to health, just like Apple
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Health is doing with their watch. So more and more
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I hear that the consumerization of health care needs to
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be with the existing consumer products that are in the
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market rather than create new ones. There is a lot
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of app fatigue. I get a lot of pushback that
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patients are already drowning in their disease. They don't want
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to deal with an app. So you have to make
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it such that it starts being engaging or reduces their
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stress or strain. So like we have some other features
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like drink your water, polite nudges, take a walk, enter
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your symptoms through voice, what's your mood feeling like height, weight, body, etc.
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And other medications. You don't want multiple apps, but also
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you just want like the top five features rather than
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fifteen or twenty.
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Can I play off that?
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Ask you another question?
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How do you balance adding the advanced features with the
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need for simplicity for the older adults or patients with
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low digital literacy.
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Yeah, that's a good one. So the voice example is one,
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and then the other ones were making the signs and
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symbols on the apps more intuitive with colors, with large symbols,
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with the touchscreen, so basically imitating what works today with
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a lot of people who are I wouldn't say less
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digital literate, but don't want to get into the wording
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and the reading. So just like you used to design
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user interface is and charts and paper for how Dell
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used to come with a simple put this computer together
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with a picture diagram, you could pretty much apply that
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human factors and UI to app development. And I think
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if you approach it like that, a lot of people
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appreciate that it is more like a lego block rather
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than intricate set of directions.
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And I'll maybe give another example on similarly, like you're saying,
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there's a lot of app fatigue. But on top of that,
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we've done some development of a product drug delivery device
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that has an application, but the delivery device itself had
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some very very simple symbols and some feedback to the user. Basically,
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we took what is the critical pathway that they absolutely
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need to do XYZ to complete this therapy and the
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rest of it that could be provided a lot more
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information that would be helpful, let's say for the clinician,
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for the patient really more on that preventative of really
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understanding how is this working. All of that was fed
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onto the app because they had a lot more ability
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to we could we could mind data and actually provide
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more insight through the application. But the device itself gave
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the aspect of here are the quick, easy steps that
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you had to do to make sure that they did
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receive the drug therapy. And then again so that way
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at least if they didn't want to use the app,
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or they were unable to or it was too difficult,
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just based on based on who the patient was, they
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could still get the therapy. And so there's some aspects
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we have built into some of those digital applications that
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are what is minimal viable. Let's make sure that that
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can be done by anyone, very very simply. And then
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let's add those additional features that most patients may want
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and clinicians probably want as well, but let's keep that
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separate just to make sure that we can still ensure
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that the patient can forget the therapy regardless.
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Great thank you, June, you were many thing flexible to
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accommodate multiple telehealth partners, So some device design choices to
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help having a product being interoperable across disparate telehealth systems.
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What are some of your thoughts on that?
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So I saw like also just echo with Rebecca is
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like it's also interesting for us to think out, just
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like a double click of like what exactly the role
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of pharmaceutical companies should do in this digital health like component.
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So should we like you know, like work with these
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expertise like partners to you know, like a code generating
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an ecosystem, or should we you know, try to own
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everything we want to own? So that's also an interesting
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question where I think every single day like also depends
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on different drug projects, right But for what I'm learning
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right now, if we want to make a connective device
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for maybe GP one for like obviously dis use, we
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need to make sure the platforms or maybe the protocols
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should be more standard, so like a more like generic
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towards different telehealth equal like help telehealth company or maybe partners.
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So that's kind of the learning. We will maybe adapt
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in the future, but right now, so far, we don't
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have any connected device for GRP onie users. But we
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are monitoring the space and also we're monitoring the trend
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and if there will be a future, I think that's
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the time for us to really understanding from a data perspective,
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how to transfer data, how to like do the data integration,
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and also cloud based data storage, so to make sure
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like we can apply the same maybe software, metic, device,
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protical or algorithm to different like telehealth partners, right, and indeed,
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I think for obest and adapt this area, we can't
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have more options, so we're don't need to work alone
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by ourselves to make those apps we can right now,
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maybe a lot of people are aware of like they
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have so many like telehealth company working obesit online so
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we can also get prescription there, right, so you don't
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necessarily to go to your like phys to get the
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physical exam to get a prescription, so you can go there.
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But also they're also launching like the whole ecosystem of
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like how to prevent obviousity and also for the lifestyle intervention,
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so that's something for sure, like a novel or maybe
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other farmer companies who are not really maybe like capable
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to do that, right. So that's why I feel like
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my feeling is like it's good to kind of closely
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working with these companies and kind of like using our
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knowledge from clinical development, maybe from the drug like discovery perspective,
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right to educate them to make sure they have a
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properate like maybe advertisement on education towards the patients. But
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for sure, like on the digital component, I think we
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should rely on those partners and trust those partners to
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co deliver products together.
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Wonderful. And on the data, what is some of the
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data that you guys have experienced collecting and using realistically,
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Because somewhere I heard data is the new goal, but
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now there's so much its data is the new sand
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because there's so much of it, you have to dig
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in the data to find the gold. So like, what
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are some of your experiences of having extracted data, found
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some insight, applied it back. Because all that looks very
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good in theory, but you try to do it in reality,
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it's very difficult for us. Like rare disease, we only
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have hundreds of patients, so we don't know how much data.
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We don't have a lot. And then diabetes is the
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other extreme, which is lots of data. So any thoughts
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on that, Rebecca or one way.
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I can jump at first, so this is not really
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a drug delivery example specifically, but in the womb care industry,
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I did work with a device, a connected device that
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did a lot of that data was pushed back to
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the farmer or the company itself, and a lot of
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it was around tracking of kind of these were larger
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kind of rented pumps, so a lot of it had
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to do with the supply chain, and it was making
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sure that we know where those pumps are, what hospitals
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have they been deployed to, because eventually they were rent
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like I said, rented pumps, so eventually we wanted to
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get those back both for maintenance purposes but then also
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at the end of a contract and sure we get
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those back. So a lot of it was just tracking
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of where is our supply chain in the out there
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in the world. But also there was some patient aspects
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to that too, in that we did collect things like
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as the pumps running on the various different patients that
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were deatentified, are we getting a lot of alarms on
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this patient, or are we getting or are they having
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successful treatments? How long are they being treated for? So
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that information did come back. I will say this was
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this project specifically, it was quite a few years ago,
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and so a lot of that data. To your point,
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I'm not sure there was strong changes being made, but
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that fed more back to the R and D group
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of like how can we make improvements here for the future.
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There wasn't anything specifically changing that patience itself, but it
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does start to play into how do we how do
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we know what's out in the field, at least in
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a device perspective for things that we do want to
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do preventative maintenance on and things like that.
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Yeah, wonderful because earlier you used to go to survey
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and find these and call people, and so now there's
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this mechanism for getting the feedback anything from you.
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Yeah, from a supply chain perspective, right, So I'm trying
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to like talk about the topic. So I think it's
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more like about the market share focusing, so from a
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supply chain perspective. So it's no longer just maybe a
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prescription volume. Based on my understanding after I talk with
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my colleagues, I'm not expert here, but it seems like
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right now we are seeing a shift of the chind
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that is like monitored the maybe the real world behavior
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like data so for example, you can track like how
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patients switch between different formats. As I just discussed right,
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patient can switch from buy on STRINGE to out the
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injector and maybe they will switch back to monitor and
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we understand why. And second is like they may switch
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between different brands. Even so, so this is something interesting.
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We will collect the data and as we try to
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digest and then understanding and we should have the real
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time data collection. And the second component will be what
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promotes these healthcare providers to you know, like recommend one
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device over the other the other options. So we don't know.
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So then we are also seeing like there's something new
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data wing to collect and try to you know understand.
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So but overall I think these insights right now become
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kind of the core kind of like a strategy like
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thinking to to kind of shape our product design. Also
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the supply chain.
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Yeah yeah, fantastic. So last couple of questions one is
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like both launch patient engagement, like who should who should
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take responsibility the pharma, the device, the speciality, pharmacy, the
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channel partner, all of them and how or what do
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you think are the pros and cons of the governance
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structure of you know that patient engagement and continued you know,
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ongoing monitoring, measuring adherence compliants. Because there are so many
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people in the value chain, yeah.
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I can start. I think, just like anything else in
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medical devices, is to be a risk based approach. So
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if the drug is high risk, then the pharmaceutical company
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should absolutely own the patient information and sort of the
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overall supply chain or that overall value chain, just because
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they're both best suited for doing any safety reporting or
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kind of the clinical outcomes. If the drug itself is
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only successful, let's say through the modality of delivery, then
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perhaps the OEM or the device partner should really own
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that data and own that paradigm. There's other things too,
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where again, if it's more clinician based treatments, then perhaps
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the clinicians the most effective in that to own that
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patient data, own that feedback. And then there's gonna be
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cases too where you know, there's a little bit of both.
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It's going to be a risky drug and it's only
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delivered through a specific method, and you need the clinician involved,
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and therefore there's going to be some sort of a
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shared partnership through this. But just like anything else, it
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should start from what is that risk based approach and
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who has the biggest influence on the success for the
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patient or the outcome for the patient and really push
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that the ownership in their direction.
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Yeah, from my understanding, it's like a farmer should be
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responsible for patients. So that's all so, and everybody want
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to increase patients like experience, right, so ween to be
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responsible and feel the liability. So if we are, I mean,
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if we are not clear off of our responsibility, we
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shouldn't maybe not never step into that area.
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Okay, wonderful. And so one last or close to last
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question is what does the future look like for you
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or how do you think that digital device? I call
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it the three D drug device, digital the three D ecosystem.
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So how would you like it to be in the
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next three four years? Because it's been changing, but there
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is still a lot of challenges and adoption theeians compliants
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and understanding different levels. There are still some people who
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are quite not so sure about digital health and whether
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it is working or not. So are you guys bullish?
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And what is your view or vision for this to
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be in the next three to five years?
386
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So I think I would say I'm on the Polish
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side I think we should definitely be utilizing the digital
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aspects that we have to support patients. I mean, you
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look at other parts of the healthcare industry and obviously
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and the big buzzwords, right AI, machine learning, all of
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those aspects. You see that already being used in diagnostics
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mostly right, with a lot of imaging and processing of
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that imaging. But there's no reason we shouldn't be able
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to start to apply that in other areas too. And
395
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it's not I think the one thing I heard this
396
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at a couple conferences not too long ago, but I
397
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think there's always going to be that human in the
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loop aspect. So I don't think this is let's take
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away the clinicians. Let's you know, this is going to be. Yes,
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there's a little more straight to patient interactions, and I
401
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think that's helpful, But we're not getting rid of the clinicians.
402
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We're not getting rid of those caregivers. Those absolutely need
403
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to be part of it, but they can be armed
404
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with a lot better information to help make those decisions
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both faster which can improve outcomes, but also more reliably.
406
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And so that's where I think the we absolutely need
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to bring digital aspects into the pharmaceutical industry as well.
408
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For me, I'm also polish but also caut yourself, like
409
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the way we work on to solve the problem. So
410
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I mean for me, it's more like right now, like
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we all want to work in this exciting area, but
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also like what's the best way for farmer to work
413
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in this component? So for me, like a partnership like
414
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strategy is really really important and essential. Maybe. So then
415
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the final question I think most important question is like
416
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how to define or balance the costs and shares and
417
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the rental revenues? Right so who will take over the
418
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cost and who will get the revenue? For me, I
419
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think it's really important right now we need to have
420
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a clear like metrics right now to think about like
421
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how to take this share this kind of like costs
422
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and revenue shares. For me, I think couple like maybe
423
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thinking first is like maybe we need to check like
424
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the percentage increase of this therapy like persistence it can
425
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generate through this digital app and be like this telehealth system.
426
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Right.
427
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Second will be like the reduction of the set effects
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on the adverse events through the technology. Then the third
429
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one will be like how many like new patients acquisitions
430
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can collect or like like can collect maybe through these
431
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like partner channels.
432
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Right.
433
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So I think with this outcome like driven like a
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database on metrics, will really like have a clear structure
435
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for farmers to clearly justify the investment and also align
436
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with the partners in we're beginning to tell them like
437
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this is a co owner like co ownership, right, So
438
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that I think with the fundamental like alignment, then it's
439
00:25:30.559 --> 00:25:33.160
a good start to to kind of navigate this this
440
00:25:33.319 --> 00:25:33.880
kind of problem.
441
00:25:35.079 --> 00:25:38.200
Yeah, those are those are I'm very Polish as well,
442
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and I think if I compare, I always tell people
443
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that did you ever think there will be a driver
444
00:25:45.039 --> 00:25:48.960
less car? And it is happening already. There is way more.
445
00:25:49.200 --> 00:25:51.599
Even in Boston I heard I've not done it yet.
446
00:25:52.240 --> 00:25:54.279
I had not imagined it. So just like there can
447
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be a driver less car, there can be a lot
448
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more patient treatment. So like nowadays, you pick up your iPad,
449
00:26:02.319 --> 00:26:04.839
it says, oh, you usually read the Wall Street Journal,
450
00:26:04.880 --> 00:26:07.599
there's some AI happening there. Your watch is like, oh,
451
00:26:07.680 --> 00:26:09.799
it's your sleeping time, would you like me to set
452
00:26:09.839 --> 00:26:13.799
your alarm? So imagine a day that your watch or
453
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whatever says it's time to wake up, go for your walk,
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come back, drink your hot water, have a drug, take
455
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this dose. There is a CGM like monitoring device which
456
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is telling how you're doing, so it would vary the
457
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dose based on your requirement, and it would then also
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record your symptoms. It would keep like logging you like
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a digital companion fully and be seamless because it would
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talk to you or remind you, or I mean just
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be the digital companion And hopefully that can all then
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transcend back to become more what I understand about jen
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AI versus just like the AI and before that it
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00:26:54.920 --> 00:26:57.799
was like you typed in FAQs and it used to
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answer from the database. How you type in any garbled stuff.
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00:27:02.000 --> 00:27:05.079
It deciphers what you're trying to say, and it answers
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what you are actually looking for. So with Jenny, I
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00:27:08.920 --> 00:27:12.319
hope that the treatment will get customized to every person
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and they will start feeling more that I need to
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00:27:15.519 --> 00:27:18.079
rely on my digital companion because it is actually knowing
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me and my treatment, not just from a delivery, but
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from a reaction and how my body and my overall
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00:27:25.039 --> 00:27:28.559
ecosystem is reacting back to it and giving the information
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back to my IT'CP nurses in the ecosystem, so I feel,
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of course there's a lot of talk of privacy and
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data privacy. I think privacy is long lost now, so
477
00:27:40.079 --> 00:27:44.119
we should just adopt the data and the digital companions
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00:27:44.160 --> 00:27:47.599
for us to all have much better outcomes. When I
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00:27:47.680 --> 00:27:49.880
started driving a car, there was no rear view camera,
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00:27:50.039 --> 00:27:53.279
there was no navigation, there was gears, there was a
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00:27:53.319 --> 00:27:56.559
lot more that I had to do. And the behavior
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00:27:56.680 --> 00:27:58.599
change has happened because it's made it so much easier.
483
00:27:58.680 --> 00:28:03.440
There's navigation. My son was like, you travel the same route,
484
00:28:03.480 --> 00:28:06.519
but you still have the navigation on. It's for traffic
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00:28:06.759 --> 00:28:10.200
because I want to make sure that. And similarly rear camera.
486
00:28:10.359 --> 00:28:13.240
I used to park and ding and dent my car,
487
00:28:13.319 --> 00:28:15.960
but now rear camera and so on and so forth.
488
00:28:16.079 --> 00:28:18.960
Right Tesla drivers they just like have the self drive.
489
00:28:19.079 --> 00:28:22.319
So the behavior change happens easily when it makes it
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00:28:22.519 --> 00:28:26.839
easier for you because you really then adopt the digital
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00:28:27.359 --> 00:28:31.759
or figital I call it physical and digital aspects which
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00:28:31.799 --> 00:28:35.359
are making your life easier. So I will say, if
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those digital companions and products are making your life easier,
494
00:28:39.400 --> 00:28:42.680
your behavior change is guaranteed. But if it's going to
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00:28:42.720 --> 00:28:45.599
be harder to adopt, it'll be this is just my view.
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Any others, I'll.
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00:28:48.000 --> 00:28:50.240
Take two seconds. But I was going to say, it's
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00:28:50.319 --> 00:28:52.359
something that is going to take time. To your point,
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00:28:52.640 --> 00:28:54.759
it has to be a behavior change. But I think
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00:28:54.759 --> 00:28:57.319
you made a point too of like you start to
501
00:28:57.319 --> 00:28:59.200
see a pattern of you wake up in the morning
502
00:28:59.240 --> 00:29:01.200
and you always read the Wolk Street Journal. Now it's
503
00:29:01.240 --> 00:29:03.440
starting to pop that up for you, right, So it's
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00:29:03.720 --> 00:29:05.799
make it's anything that will make their lives easier, they
505
00:29:05.839 --> 00:29:08.880
will start to adopt to. But also watching those patterns
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00:29:08.960 --> 00:29:11.480
of how people react to the drugs that they're on
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00:29:11.599 --> 00:29:13.960
or whatever it may be, and adapting the digital.
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00:29:13.720 --> 00:29:14.480
Solutions to that.
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00:29:15.839 --> 00:29:17.839
Just final comment, I think like we will trust the
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00:29:17.880 --> 00:29:20.519
partner again, So I mean I'm sure like a partner
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00:29:20.680 --> 00:29:23.440
they are studying like human like behavior and those usability
512
00:29:23.440 --> 00:29:26.240
here and also urine a science even right, so for
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us as a farmer, we make we will make the
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00:29:28.240 --> 00:29:30.519
best in class drugs and they will trust the partner
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to do the rest of the work.
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We hope you enjoyed the podcast. For more information on
517
00:29:34.279 --> 00:29:39.039
the pod Conference editorials, podcasts, or webcasts, please visit podconference
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00:29:39.079 --> 00:29:40.839
dot com. Thanks for listening.
