“EARLY ONE MORNING Jonathan, twelve years old, wakes up and finds that his stomach hurts — hurts badly. But he has no temperature and is not nauseous; he’s just in a lot of pain. His mother, Marianne, is not alarmed at first, only irritated that she can’t go to work. She lets Jonathan stay home from school, assuming that all will be well come evening. But the pain persists. By evening, she thinks perhaps seeing the doctor is a good idea; by early morning, after a night of sitting by Jonathan’s bed, listening to him moan, going to emergency has become a necessity. After an interminable wait in the emergency room, Jonathan is finally examined by a doctor. The doctor gently prods and probes Jonathan’s abdomen and then starts to look worried. He orders a CT scan. Marianne, who is now very apprehensive, asks, “What’s wrong?” The doctor is noncommittal: “Let’s wait for the scan”. But bad news follows. There is a mass in Jonathan’s stomach, the size of a golf ball. At this point, Marianne is having trouble holding herself together, and she calls her husband, Bill, who immediately races to the hospital. He feels sick at heart — the dreaded “cancer” word has not been spoken yet, but it is in the air.
The news gets worse. Jonathan is admitted to hospital, a biopsy is performed, cancer is diagnosed, and surgery followed by chemotherapy is advised. Jonathan’s life is at stake. The surgery is as successful as it can be, but it is very rare that a surgeon can remove all of this type of cancer. Hence the chemotherapy, to try to kill any remaining cancer cells.
Jonathan reacts well to the first dose of chemotherapy. He feels tired but does not get sick. Bill and Marianne allow themselves to dream: maybe Jonathan will get through this, and life will become a little more normal again. But following the second dose, Jonathan becomes short of breath after walking only a few steps. Back to the emergency: this time, the doctor calls a cardiologist, who tests Jonathan’s heart using an echocardiograph. The cardiologist returns, grim faced. “Your son has heart failure,” he informs Marianne and Bill. It turns out that Jonathan is highly sensitive to one of the drugs in the chemotherapy used to treat him. The drug, doxorubicin, causes heart problems in some patients, but the doctors have no way of knowing which patients are going to be affected.
In the space of a month, Jonathan has been transformed from a normal twelve-year-old to an invalid undergoing cancer treatment who also needs a heart transplant. How did this happen? And why was Jonathan treated with a drug that caused his heart to fail?”
This is an excerpt of Pieter Cullis’ book “The Personlized Medicine Revolution“. – I highly recommend you to read it if you haven’t done so yet.
Hopefully, you are as fortunate as I am and haven’t experienced anything similar yourself or lived through with any your loved ones. Unfortunately, this is the sad reality for many people and families today. This is why I was so excited to learn more about personalized medicine and how Pharma is working on evolutionary treatment methods.
I can’t offer a happy ending to this particular story but the good news is that thanks to smart Researchers and Pharma, there is hope to have better treatment options for patients like Jonathan or yourself one day. This is why I am so glad to work with Pharma-IT, as you really get to see how the technology is helping improving peoples lives. Which brings me to my goal of this blog post.
The main goal is to describe some of Salesforce’s investments in its Industry Solution, Health Cloud. I am an advocate for the Health Cloud and even though I am currently working with Salesforce, I will try to leave out any biases and only focus on its capabilities and value add for Pharma. I will also address some of the unique challenges that personalized medicine brings to Pharma, how smart technology is helping to address these, and more importantly improve Patient Experience and -Outcomes.
Disclaimer: Even though I am currently working with Salesforce, this is an unofficial post and reflects my personal opinions and publicly available information.
What is Personalized medicine
Personalized medicine, also known as precision medicine, is a rapidly growing field that tailors medical treatment to a patient’s individual needs. It addresses the Patients genetic code or composition of molecules by analyzing blood samples for example. This approach uses advanced technology and data analytics to improve patient outcomes, reduce longterm healthcare costs, and enhance the effectiveness of treatments. However, the implementation of personalized medicine requires significant technical support, managing the logistics across the entire supply chain in Pharma. This is where it’s great to see how modern technology in research like AWS can help to achieve faster discovery results utilizing big data and AI and how CRM technology like Salesforce Health Cloud can help improving the overall patient experience and outcomes.
Why Personalized Medicine is such a big topic and what do I get as a (future) Patient
- The 4th highest cause of death in North America is a bad reaction to a drug or a drug regimen ~100.000 death per year1
- It’s estimated that 90% of adverse drug reactions are not reported, so the dangers of taking prescription drugs might be higher2
- Approximately 75 percent of drugs for cancer treatment do not help the patient they are prescribed for.
- More than 70 percent of the drugs for Alzheimer’s do not work on the patient they are prescribed for.
- Nearly 60 percent of drugs for incontinence are of little use to the patient they are prescribed for3
Does that mean current treatments and drug aren’t safe or effective? Of course not. It’s amazing how far medicine and Pharma came and contributed to a doubled life expectancy since 1900.4 What it does mean though, is that even medicine that is very successful today, like statins that treat high cholesterol and reduce the risk of a heart attack by 54% and risk of a stroke by 48%, it’s produced for the “average” population.5
This a challenge, as not all of us fall into the cluster of the “average” population. Some people metabolize statins too quickly: their bodies break down the medication before it gets a chance to work, and their cholesterol levels stay high, so they are still at increased risk of a heart attack or stroke. Others metabolize the drug too slowly, and it lingers in their systems, lowering cholesterol levels but also causing all sorts of uncomfortable, often painful, side effects. Worst case, this can result in kidney failure.6
Personalized Medicine sounds promising, why do we still have mass produced drugs?
Personalized medicine isn’t suitable for every disease, but certainly for some more complex diseases like Cancer, Parkinson or Alzheimer. While there are several technical and operational challenges with personlaized medicine, I have tried to highlight some of them here. As usual for newer discoveries, pricing, the missing infrastructure and efficiency in processes like drug discovery are some of the macro-level challenges that will probably take some time until they get “resolved” or more affordable and profitable for Pharma and Payers. There are however, other more operational and short-term challenges listed below and this is where technology partners are needed for Pharma:
- The high cost of implementing and maintaining personalized medicine technology and infrastructure is a major challenge.
- Integrating personalized medicine into existing healthcare systems can require significant changes to infrastructure, interoperability, workflows, and processes.
- Workflows and processes are often maintained in siloed systems, lack of -interoperability, flexible scheduling, and -scalable supply chain visibility will affect the patient experience and increase costs
Fortunately these challenges are being addressed by smart technology already. As mentioned at the beginning, I want to focus on how Salesforce’s Industry Solution, the Health Cloud is planning to support Pharma in providing an excellent Patient Experience /-Outcome, help them to coordinate the complex logistics and ensuring smooth processes among all of the stakeholders like Patients, Manufacturers, Payers and HCPs. All of this is highly relevant for personalized medicine.
What does Salesforce Health Cloud do:
I had written a post on Health Cloud in general in the past already, in case you want to learn about it’s overall capabilities (link below).
For this post, I want to keep it short: It’s Salesforce’s investment into the Healthcare & Life Sciences (HLS) Industry and comes with built custom features designed specifically for pharmaceutical, provider, payer, and medical device companies. With the patient relationship always top-of-mind, it connects data from legacy systems and electronic health records (EHR), providing a complete view of the patient and other stakeholders.
What does that mean for Personalized Medicine
For personalized medicine, I am glad that Salesforce has added specific capabilities, under the term “Advanced therapy”, ensuring that typical personalized medicine workflows are offered out of the box. Advanced therapy is a subset of personalized medicine, which uses genetic or other biomarker information to make treatment decisions about individual patients to ensure they receive the appropriate dosage and drug, tailored to them based on their genetic makeup. The process is complex and typically involves a combination of healthcare providers, therapy specialists, nurses, manufacturers, and care coordinators. These advanced therapies are often one-time treatments that are potentially curative.
How will Salesforce’s Advanced Therapy Management help
Personalized medicine requires smooth workflows and process integration across provider and pharmaceutical industries. Health Cloud’s Advanced Therapy Management solution offers slot management and capacity configuration capabilities, so that admins can configure availability of resources at their assigned territories, and create and publish slots accordingly. Advanced Therapy Management’s Multi-Step Scheduling brings together data about different sites, resources, and appointment slots in one place.
For users of Health Cloud, Advanced Therapy Management helps pharmaceutical companies conduct complex therapies like cell and gene therapy with ease. Treatment center coordinators can schedule appointments for procedure steps like apheresis, manufacturing, and infusion at one go. Service territory relationships streamline search results by defining relationships between affiliated sites where consecutive therapy steps are performed. Salesforce Scheduler’s existing objects support effective slot management by helping users configure service resources, assets, and their availabilities at designated locations.7
This is great to see as it helps Pharma to manage the Patient Journey from Screening, through Blood Collection, Apheresis, Manufacturing and Injections.
And here is a demo by colleagues who have done a great job to show the end to end journey:
Demo – Health Cloud Advanced Therapy Management
Summary
In conclusion, personalized medicine offers significant benefits but also presents challenges that require technical support. I am really looking forward on how personalized medicine is going to impact Patient wellbeing in the next 3-5 years and am happy to work with companies where I can witness that technology is shaping outcomes to the better. I hope this post gave you a first impression on what role Salesforce is going to play in this area and I am very curious to see what’s next. In the meantine, I will be working on more posts like this summarizing where I believe technology can help the Pharmaceutical Industry. Next, I will be working on some concepts for value based outcomes which is likely as important as the Personlized Medicine revolution as Pharma needs smart contracting with Payers focusing on Patient Outcomes, as this will make it more affordable and focus on what’s truly important, the wellbeing of the Patient.
Would love to hear from you
What do you think of personalized medicine and how do you feel about Tech’s current offerings in that space? I would love to hear from you.
Demen
Sources:
1 – Cullis, Pieter – The Personalized Medicine Revolution / Jason Lazarou, Bruce H. Pomeranz, and Paul N. Corey, “Incidence of Adverse Drug Reactions in Hospitalized Patients,” Journal of the American Medical Association 279, no. 15 (April 15, 1998): 1200.
2 – Cullis, Pieter – The Personalized Medicine Revolution / Lorna Hazell and Saad A.W. Shakir, “Under-Reporting of Adverse Drug Reactions: A Systematic Review,” Drug Safety: An International Journal of Medical Toxicology and Drug Experience 29, no. 5 ( January 2006): 385–96.
3 – Cullis, Pieter – The Personalized Medicine Revolution
4 – https://ourworldindata.org/life-expectancy, 3rd April 2023
5 – Cullis, Pieter – The Personalized Medicine Revolution / Cleveland Clinic, “Health and Prevention: Statin Medications and Heart Disease,” Cleveland Clinic, http://my.clevelandclinic.org/heart/prevention/risk-factors/cholesterol/statin-medications-heart-disease.aspx.
6 – Cullis, Pieter – The Personalized Medicine Revolution
7 – https://developer.salesforce.com/docs/atlas.en-us.health_cloud_object_reference.meta/health_cloud_object_reference/hc_advanced_therapy_management_data_model.htm, 3rd April 2023
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