Everybody talks about it, all we hear about in the talks is about personalised medicine, but what we want to do is actually embed personalised medicine into healthcare systems. So this is a political initiative to actually look and see what are the enablers and the barriers for personalised medicine to actually become part of our healthcare as we deliver to our patients around Europe.
Wouldn’t people say we already have personalised medicine?
If we look at the systems, yes, there are some examples - imatinib mesylate in chronic myeloid leukaemia, for example. But if we look at the national level and in different European countries it’s actually difficult for certain countries to gain access to some of these medicines and also we don’t have a proper system that allows us really to look at national level at really having it as part of the system. So we talk a lot about personalised medicine, what we’re trying to say is we actually really need to act on that, fulfil the promise and at a European level have a structure that really allows us to embed it into our healthcare system.
What goes wrong to make treatment not personalised after a diagnosis?
One of the problems is that the whole system isn’t joined up. So obviously you may have a situation where, for example, a new drug has been developed that targets a particular abnormality. However, that also needs a companion diagnostic that will actually allow you to identify or stratify the patients who will benefit from that. We have different systems in relation to reimbursement in Europe so sometimes you can actually have the drug but the companion diagnostic won’t be reimbursed so what we’re trying to do is say, really we need a different way of doing things. The personalised medicine is probably not exactly the same as the delivery of clinical medicine as we’ve practised it so far so there are special approaches, separate structures that we need, really, to maximise the benefit.
Is your intention to have these services the same in every country?
I think we should be looking at an aspiration to do that so that actually, as citizens of Europe that we should all have access to new technology, we all should have access to innovation. It shouldn’t matter, it shouldn’t be a postcode lottery of where you live says whether or not you get access to innovation. So certainly very much our principle would be in relation to that of trying to provide an optimum approach across Europe.
How will you do this?
One of things that’s very important in this is making people work together. So one of the things that the European Alliance for personalised medicine, who I’m representing here today at EHA, is really to look at how can we make people talk together, how can the policy makers talk to the scientists, talk to the clinicians, talk to the drug companies? So provide an actual forum for everybody to work together because everybody in principle thinks that personalised medicine is a good thing but it’s the practice of actually getting it across the line so that it becomes part of a healthcare system. The patients are the most important part and I’m very sorry for leaving that out because I actually work a lot in patient advocacy myself. They are actually key to the process and one of the things we’ve started to do is have regular patient advocacy fora where the patient can really be part of this process and drive this process.
Who will be putting this into action?
What we feel is that bringing together the different stakeholders in relation to the drug companies, the scientists and the clinicians but working together, and that can be in pan-European studies, also working with the commission, for example, in relation to enabling some of these processes that we’re talking about, key that the patient actually is able to be empowered so that they can actually say, ‘This is what we want,’ and we can then help to actually bring that across the line.
The driving seat - who will be in the driving seat?
We would say that the European Alliance of Personalised Medicine is playing a key role as an enabler so as an over-arching bringing everybody together to drive this forward.
A Europe-wide body is going to do the controlling?
Well, it’s going to do the enabling, OK? So controlling is a strong word, I think enabling because, obviously, at national level we want people to actually drive that but it’s in providing structures that will allow people to bring that forward.
What might prevent this from happening?
Regulatory affairs is one issue. So obviously different countries have different regulations, we need to look at that, and we really need to talk and engage early. I think one of the problems at the moment is that there hasn’t been a conversation as it’s happening early in the process and then you come across the barriers and the problems and it’s very difficult to get over them when you’re actually a long way down the process. So if we can have a much earlier engagement and actually talk to the healthcare pairs, also look at it in relation to making economic sense; looking at how it will impact socially and economically as well and deliver better societal impacts as well as health impacts.
Isn’t this about healthcare systems and the services doctors would like to use?
Yes, certainly there is that that it’s very important that we do have that but healthcare is not a luxury, healthcare is a right of the European citizen and a part of that is innovation. We should be encouraging innovation because not only can it deliver for the health of the nation it can also deliver for the wealth and give economic benefit as well.
Won’t this be too expensive?
If you look, for example, in the French system, France is a very good model in personalised cancer medicine, for example, and they actually made the health economic argument beforehand. So they actually looked in relation to what is the cost if you give everybody, every patient, the same treatment, the same chemotherapy for a particular form of cancer, even though a lot of those patients won’t respond based on their molecular subtype. So what they said is, let’s look at how much that costs, so to give everybody an EGFR inhibitor rather than giving the people who actually will only benefit from it because of their molecular type. And what they did was they said the cost to set up 28 laboratories in France was far less than the cost to actually treat patients unnecessarily and also potentially having side effects that they would not benefit from.
Is it a pipedream to have something like the French model in a place like Romania?
I agree. I’m actually speaking in Romania next week at the European Cancer Patient Coalition Conference and I think we need to look at tailoring things to different countries. I think we need to sort out a lot of issues in relation to access but I think an aspiration in terms of trying to deliver the best quality for our European patients is what we should be aspiring to.
What can be done to reassure countries of the cost?
You need to open the dialogue, that’s the important thing. The dialogue to look at the discussion, to look at a national level and very much also to look at it as not going into a country and trying to be empirical in terms of what should happen but actually talking, listening, seeing what works best in different countries. That’s why I’m saying the model needs to be different and also probably needs to be flexible. We are all Europeans but we all have individuality as well and that’s also reflected in our health systems.
What would you say to doctors about all of this?
It can be a barrier and certainly it’s something that we’re going to have to look at. That’s why we believe talking is the most important thing so actually talking to people and listening.
Might tensions in Europe be a barrier?
We encourage them; we say, ‘We want you to be part of the process.’ We certainly want to look at it not only in the context of treatment but also, for example, in the context of early diagnosis because, for example, if we can have better early diagnosis we know we can have better outcomes for cancer patients. So it should be an engagement, not just with oncologists but with GPs, with the whole continuum of the health care system to allow us to do this.
