That was the title of a panel discussion held during One Nucleus’ Life Science Leadership meeting at St Bartholomew’s Hospital in central London on 8 March this year supported by One Nucleus partners Cerba Research. It was, therefore, probably one of the last life sciences meetings to be held in the UK before we belatedly entered our coronavirus lockdown. Some delegates seemed rather nervous about mingling over the excellent buffet lunch, but there were few other signs of the tsunami of change that was about to engulf the industry. It was a fascinating meeting, packed with insights that will become even more relevant as we – hopefully, sooner rather than later – emerge into the post-pandemic world.
The panel was chaired by Steve Gardner, CEO of the Oxford-based biotech company PrecisionLife, whose plenary lecture on patient stratification in asthma and breast cancer had been one of the day’s highlights. He introduced a panel that reflected the theme of collaboration in its diversity: Jelena Polajeva of the NIHR Office for Clinical Research Infrastructure in London, Jane Theaker of Kinomica Ltd. In Alderley Edge, Cheshire; David Harland, Medical Head of Personalised Healthcare at Roche UK; and Rakesh Uppal, who directs Barts Life Sciences, the innovation arm of St Bartholomew’s and Queen Mary, University of London.
Gardner started by asking the panellists how they are collaborating to deliver precision medicine, and what barriers they encounter in doing so. Theaker began her answer with a succinct definition of precision medicine – getting the right drug to the right patient at the right time – and cited cost as the main barrier to collaboration in her small company. Harland described the tendency of big pharma to operate in silos and so miss making links between different technologies and different therapeutic areas. Uppal, a clinician in a large and diverse London NHS trust, brought up the vexed question of ethnicity: much omics research is biased towards Caucasian subjects, overlooking clinically important genetic diversity.
A series of questions to individual panellists followed. Gardner asked Theaker about opportunities for collaboration in the SME sector; Polajeva about funding opportunities; Harland about the role of the regulators, which are critical to the delivery of precision medicine, and Uppal about how novel precision therapies can be moved into clinical practice. Uppal brought up two points that were to recur from time to time during the discussion: cash, or the lack of it (particularly in the NHS) and the importance of data security and patient consent. ‘Collaboration’ includes collaboration with patients as well as within and between companies, the NHS and universities; Polajeva cited the NHRI’s group of volunteer ‘expert patients’ who attend conferences and meet innovators there.
Similar questions were raised when the discussion was opened up to questions from the floor. Theaker cited an estimated cost of $8K/patient for one multi-gene test panel, but Harland claimed that the cost of treating the ‘wrong’ patients with a blanket therapy could be higher still. Personalised therapies that are cost-effective in the US insurance-based system may be less so in the UK and EU countries with more socialised systems. Technical costs, however, are bound to fall; we have only had most omics technologies for a decade or two and there is still a lot of research ground to cover before effective omics-based precision medicines are made widely available.
Looking to the future, Polajeva claimed that the future would be digital, and was being funded: her own organisation, the NIHR, has just launched a £140M fund for AI in medicine. Precision medicine will be used to prevent as well as to cure disease and, interestingly, Harland predicted that pharma giants like Roche would increasingly collaborate with each other as well as with SMEs and academia.
But where are we now, less than three months from the meeting and well into the age of COVID-19? Omics based precision medicine is already being used to try to understand the enormous differentials in the severity of this disease, the causes of which must be partly genetic. And, in face of an unprecedented health crisis, the need for deeper collaboration is intense. Fortunately, many companies and consortia are already stepping up to the plate; the science is risky, but the potential rewards are immense.
Written by Dr Clare Sansom - Freelance Science Writer
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