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Could a one-world clinical database be a reality?

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The Health Horizons Future Healthcare Forum, Guildhall, Cambridge, 2019. Picture: https://www.ianolsson.com
The Health Horizons Future Healthcare Forum, Guildhall, Cambridge, 2019. Picture: https://www.ianolsson.com

The recent Health Horizons conference had contributions from academics and researchers from across the world – and two of the suggestions were of potential global significance.

Rory O’Connor, chief medical officer of Pfizer Internal Medicine, suggested in an interview with the Cambridge Independent that as a result of the recent discovery of the microbiome, people will soon start to think of themselves as “colonies rather than individuals”.

And Joanne Hackett, chief commercial officer of Genomics England suggested that a “one world clinical trial” that pooled together all the medical information about every world citizen under one digital roof would significantly accelerate the healthcare outcomes for billions of people.

The Future Healthcare Forum took place at the Guildhall and the Corn Exchange at the end of June, drawing praise for its insights into innovation from attendees from around the world.

At the panel session on the second day - the Thursday morning - the topic of controlled vs uncontrolled trials was discussed by six panellists including Solange Corriol-Rohou, AstraZeneca senior director regulatory affairs & policy, Europe; Janet Valentine, director of Clinical Practice Research Datalink (CPRD) and Joanne Hackett, chief commercial officer of Genomics England. The discussion revolved around how to update methodology in testing process to enable a smooth transition to a more digitalised industry.

Health Horizons panel with Joanne Hackett, chief commercial officer for Genomics England, on the left. Picture: https://www.ianolsson.com
Health Horizons panel with Joanne Hackett, chief commercial officer for Genomics England, on the left. Picture: https://www.ianolsson.com

Panellist Tomasz Sablinski, co-founder and CEO of Transparency Life Sciences, said: “You cannot revolutionise clinical trials using the process of the last 50 years, you have to digitalise.”

Professor Hackett had a novel suggestion as to how this might best be expedited.

“Our dream is to have this one-world clinical trial,” she said. “Even though it perhaps would not be based in the UK, we’d be a part of it.”

A one-world clinical trial could significantly accelerate the development of knowledge in the age of data, facilitating faster drug testing and allowing world medicine to benefit from literally a global sample.

Half an hour later I put the idea to Rory O’Connor, the chief medical officer of Pfizer Internal Medicine and the first speaker of the day on the Thursday with a talk titled ‘Demonstrating Value - the necessary tension between controlled vs uncontrolled clinical trials’. But first I asked him about his own work.

“I’m the chief medical officer for Pfizer,” he said in an interview filmed by Health Horizons for future use. “I started my career at Pfizer in Sandwich [Kent] and moved across to New York several years ago.”

Pfizer is engaged in the Cambridge ecosystem.

“We have a significant group of colleagues in Cambridge,” Rory said, “and in fact our research worldwide has two headquarters - one is Cambridgeshire and one is Cambridge in Massachusetts, at Kendell Square. We moved a lot of colleagues here from Sandwich some years ago to take advantage of the cross-fertilisation of so many groups here.”

What sort of research is Pfizer focussing on?

“We don’t cover the full gamut of therapeutic areas but we have a significant interest in many of them, so oncology is very big for us, inflammation is also a large area for us, I’m particularly focussed on internal medicine which is cardio-vascular medicine and, increasingly, metabolic disorders, that’s something which is really concerning us because it’s a type of disease which affects very large numbers of the population, so has a very large impact on public health.”

Rory is also a big fan of the work being done on the microbiome.

“Yes I think this is a significant area for the future. We’re certainly not leading in that area and there’s a lot of different approaches to it, but I think this is such an exciting area and it may well be that we start to see ourselves as colonies rather than as individuals as we go forward.”

Rory O’Connor, chief medical officer of Pfizer Internal Medicine. Picture: https://www.ianolsson.com (13537680)
Rory O’Connor, chief medical officer of Pfizer Internal Medicine. Picture: https://www.ianolsson.com (13537680)

The digitilisation of healthcare is putting a lot of strain on legacy systems. Is it a frustrating process sometimes, as one of the members of the audience today suggested?

The NHS is actually well placed in that sense, particularly because of the identifier that patients carry, so you do have a fairly uniform provision of care in pretty much a single system with relatively little movement in and out of systems, which is a big issue in the US where you get a lot of churn of populations, but the frustration I think is very real, because we have probably the technical capability of recording all of the relevant information about an individual’s health, management and treatment, and recording the effects of the interventions whether that’s in medicine, or behavioural or a change in diet, and seeing what the result of that change in behaviour has been, so we can do on an individual basis: technically we have the ability to summate that and collect it and put it across very large populations. Why is it that we can’t do that? With the NHS - 50 million people - you can’t just say ‘How many people have this particular disease?’ and ‘How are they being treated?’ or ‘How many of them got better?’. And that is replicated across the world.

“So I think we’re looking more at social/political issues rather than technical issues in utilising the health information that we really technically have access to.

“What I would like to see is all health data being available so it could be interrogated as and when we have research questions. So each of us, every time we take a medicine or have any healthcare intervention, would form part of that future research project.”

That sounds like the “one world clinical trial” Professor Hackett spoke of?

“One world, yes. I hadn’t heard the phrase before but it’s a nice way of putting it. It’s probably nearly practically possible now if we felt that we really wanted to do it. The barriers are not technical, they’re social, political and behavioural. And I would say fundamentally, the behaviour I’m thinking of is an individual healthcare practitioner is asked to manage the patient, they’re not asked to contribute to research normally. Part of this aspirational world is the data they’re collecting is collected with accuracy and meticulousness on the part of that healthcare provider, that it can withstand an interrogation in terms of being research-quality data. We don’t currently ask that and if we don’t get that right we’ll just be analysing poor data sets which is not the best way forward.”

So is there a body or an organisation that could reliably host this data?

“I think that’s absolutely the central point. Who can we trust to reliably hold those data? That’s when I talk about the social and political barriers that we have here and I think that is the central one. A lot of people have been thinking about this, my only contribution would be it probably has to be ourselves as well, I think patients should have ownership of their data but not complete ownership of their data. Those data should also be available to larger public health concerns. How that is done, who is the effective custodian of those data? That’s a good question.”

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