The Astrazeneca award is given for an outstanding personal contribution to the pharmaceutical industry which has resulted in clear benefit to patients. This year's winner has a background in veterinary science and virology. He was chief science and technology officer at SmithKline Beecham before moving to a new consulting company, Health Technology Networks, in 2000.
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| George Poste: Gene therapy has been overhyped |
Dr George Poste (chief executive officer, Health Technology Networks) received
the Astrazeneca industrial achievement award 2000.
Research and development costs within the pharmaceutical industry continued
to escalate, Dr Poste said, but there was also enormous pressure on profit margins.
Price controls were increasing as were interventions by bodies such as the National
Institute for Clinical Excellence. The vital challenge for the industry was
to increase the predictability of drug candidate selection. Very few drugs actually
reached the market and the high failure rate had to be reduced. Molecular medicine
would have an enormous impact in this field, Dr Poste said. Until now biology
and medicine had been largely descriptive, but with modern genetics it was possible
to elucidate disease processes at a molecular level.
Large constellations of genes and how these were switched on and off could
now be studied. All the cells in the body had the same DNA. It was this switching
on and off which resulted in the many different cell types. Advances in genetics
had resulted in many new molecular targets for drug therapy.
The rise in resistance to antibiotics meant that molecular targets were also
being studied in microbes. However, even with a research and development cycle
of only 10 years, it would still be a number of years before the next wave of
antibiotics became available.
Dr Poste felt that gene therapy had suffered from excessive hype and lack of
realism. The impact of gene therapy on clinical medicine was likely to be minimal
in the coming years. Molecular diagnostics would be the most important field
in this decade.
Advances in molecular medicine had shown that it was no longer possible to
consider many diseases as uniform entities. Each had a range of subtypes and
each subtype was characterised by a distinct genetic alteration. These subtypes
were important because they were indicative of both the likely response to treatment
and progression of the disease. Molecular diagnostic tools were being used to
identify the disease subtypes. Such disease heterogeneity had recently been
demonstrated for certain acute leukaemias.
The identification of disease subtypes was likely to result in more market segmentation.
With many small market segments it might not be possible for the pharmaceutical
industry to recoup the costs of drug development. However, if treatment could
be targeted to patients with the genetic profile which correlated with drug
efficacy and safety, ineffective treatment and adverse drug reactions could
be avoided.
Dr Poste felt that safety would be a key driver moving forward our understanding
of individual variation in responsiveness to drugs. Adverse drug reactions and
the consequent morbidity and mortality were an enormous problem. At present,
drug therapy was routinely assessed for drug-drug interactions, but this would
move to drug-patient interactions. Other than sensitivity to antibiotics such
as penicillin, drug-patient interactions were not routinely addressed. Knowledge
of a patient's genetic information would indicate whether patient-drug interactions
might be problematic.
The answer to the questions of what was different between people who had a disease
and those who did not and why disease progression varied between individuals
was in their genes. At present, medicine was reactive with treatments only being
sought when symptoms arose. In the future, individual genetic risk profiling
could be used for disease prevention and preventative therapy. However, linking
clinical outcomes to genetic variation was an enormous task requiring both time
and resources. Work in this field also had significant ethical, legal and social
implications including privacy, discrimination, eugenics and racism.
The immense amount of data that was now available had reached a crisis point
which neither the industry nor academia could handle, Dr Poste went on. Linking
genetics to medicine would require vast information technology support. Effective
information exchange would be vital in future health care systems. The link
between health care and information technology was irrevocable and had implications
for all aspects of clinical practice.
Developments in information technology had already resulted in major changes
in the relationships between patients and health professionals. Dr Poste reported
that 40 per cent of people in the US now sent e-mail to their doctors and 22
per cent had articles from medical journals when they consulted a doctor. Clearly
the internet was altering patient-doctor interactions and consumers' expectations
of health services would increase. The next developments were likely to include
internet based health monitoring devices. Such devices would be used at home
to monitor compliance, lifestyle changes and other aspects of health.
The link between computing and medicine also had profound implications for medical
education. Education had to change, but medical schools were not moving to address
this.
Health mattered to everyone. People saw health as a right. They wanted treatment
and thought treatments could have no risk. Changes in both demographics and
the expectations of consumers meant that the economic problems of health care
could only get worse. Many ways would be needed to reduce the costs of health
care. Dr Poste felt that the public mood was moving to the view that making
money from ill health was unacceptable. The only area of profitability in health
care in the US was the pharmaceutical industry.
There was a unique convergence of forces currently shaping the evolution of
health care; global markets driving down drug prices, the rise of molecular
biology, rapid commercialisation and genesis of new competitors, and systems
coming together. The two issues stressed by Dr Poste were that molecular science
was making medicine mechanistic and that health care information technology
systems would be vital in harnessing the resultant massive data flows.