One of the most useful things I gathered, intelligence-wise, for a client project this week was from following some cancer patients stories via their their blogs. This is social media monitoring at is best.
Because they tell it as it really is, no strings attached…
What the treatment involves, the practicalities, the side effects, the tests, and everything else in between, including the weather and how the medications affect things like taste, for example.
I learned that the 3 infusions needed for their particular protocol took seven hours. Ouch! Imagine how tiring that would be for the patient and caregiver who was with them shepherding them around , the nursing staff monitoring it and everyone else involved?
As we go about our daily lives we forget how easy it is to take life for granted. This sort of real information keeps us human and our feet on the ground.
The rival product in development is a pill. You can pop it at home over breakfast while watching the morning news. Sometimes we forget that simpler is easier but not always better, though.
For short term treatments, remembering to take the pills is relatively easy but over the long term, compliance becomes a problem, either because you feel good and forget to take the pills or because chronic therapy can induce its own side effects and symptoms and perhaps you feel the need for a break from the relentless of it. After all, how many of us forget (or can't be bothered) to take antibiotics in the third week of a course, let along consider daily consumption for a more chronic condition?
Thus, I wasn't entirely surprised to see an article in the FT this week about the Novartis deal with Proteus, a company who focuses on compliance solutions:
"The company is testing technology that inserts a tiny microchip into each pill swallowed and sends a reminder to patients by text message if they fail to follow their doctors’ prescriptions."
Now, that may sound a little like Big Brother is watching you and the cynical might think that companies are more interested maintaining their profits by keeping refill prescriptions on schedule, but for some serious diseases it may also affect outcomes. In my experience, with acute conditions approximately 15-18% of patients forget to take all their pills, but this sadly rises to 25-35% with chronic therapy over time.
Another way companies can track the data from their own products is analyse the data from their Patient Assistance Programs (PAP). One time when I was working on the industry side as a marketer, we did this and were surprised to find that even with free drug, the compliance rate was about 25% for a cancer therapy taken chronically after about 18 months or so. We knew this would only get worse over time as patients feel better and think their cancer is in remission. That was a sobering thought because the risk of the cancer coming back is high unless the oncogenic clone was suppressed. It also underscores the importance of continuous patient and physician medical education; perhaps this is where patient programs through selective use of social media can be effective in reaching a wide audience. The message is never ever take anything for granted.
Think about the impact of chronic therapies for life threatening diseases like cancer, for example. As more companies are developing oral small molecule tyrosine kinase inhibitors (TKIs), so cancer moves from an acute condition to a chronic one. However, with TKIs their mechanism of action is based on constantly competing with ATP to suppress the oncogenic clone and keep the disease in check. This means that not taking the drug over time can lead to a return of the disease, new mutations and possibly even major relapse or patients becoming refractory or resistant to their therapy. That is the last thing an oncologist wants to see.
There are other ways to improve compliance, including Pharmacies tracking refills over time and phoning you with a friendly when you are overdue or chips in the bottle caps instead of the pills themselves. The loose pill bottles favoured in the US actually contribute the problem. Unless you get into an almost religious routine, it is easy to forget sometimes whether you took your daily dose or not and we haven't even considered the effect of patients deliberately self medicating less with to save money or because some side effects were bothering them. At least the weekly or monthly blister packs common in Europe make it easier to remind oneself to take the prescription on schedule more easily.
Ultimately, though, the goal with these tools is about helping to improve patient outcomes. This is a trend we are probably likely to be seeing more of in the future.