So today, I had the privileged of hearing John Daly, CEO of the Grattan Institute, and Simon McKeon, Chair of the Strategic Review of Health and Medical Research – Better Health through Research speak at two different events about the current and future state of the Australian healthcare landscape. Without going into the specific details they spoke about, the key points I picked up were that burgeoning healthcare costs were likely to worsen over the next 10 years, and that at a higher level, health and medical research really should be embedded into healthcare service delivery.
This got me thinking – how do we use the fruits of innovation to combat healthcare expenditure increases? How do we, as a nation, use our limited health and medical research (HMR) resources (funding, people) to get better value for what we invest in tackling the big health issues today, and for tomorrow? There had been some discussion following Simon McKeon’s presentation at NICTA’s Big Picture event about the septic nature of the innovation culture in Australia, but the question remained open as to how the innovation cultural gap could be dealt with.
Following on from these presentations I had a chat with @MVEG001, and found myself discussing how Australian investors were averse to very high-risk investments, how the nature of the available capital and investment remits for different investors influenced their pre-seed/very early investment behaviour in the life sciences sector, and what would make particular healthcare solutions attractive for investment.
The light bulb moment struck when I started to think more about my own experiences being an inventor and to an extent, innovator in our research team, and how we’d built a life science investment package that had significant momentum to not only pull in grants, but to attract and engage life science investors down the rocky commercialisation pathway. Especially in the post-GFC economic climate.
So the title question: What does the ideal entrepreneurial-minded health and medical research scientist look like? I’m not entirely sure just yet, but I know at least this:
- They need to understand their entire research ecosystem, and have a clear view of the problems they’re aiming to address
- They need to know what the real “needs” are by understanding all stakeholder needs
So I’m not talking about ideas-driven research (though that’s still highly important), I’m talking about needs-driven research that address more immediate problems, within a shorter time frame, that gets attention from Government because it means more incremental costs savings. Research that interests patient support groups because possible interventions may alleviate the more immediate burdens for chronic conditions that don’t have near-future cures.
To develop a HMR scientist with such entrepreneurial attributes, the entire training pathway of an undergraduate through to an early-career researcher needs to change. Our expectations of what a young, entrepreneurial HMR scientist is going to be quite different from the academic scientists we previously trained and currently train in this country. We must embrace this new type of scientist, and it will be harder for some to do than others.
Let’s break the aforementioned points down a bit more:
They need to understand their entire research ecosystem, and have a clear view of the problems they’re aiming to address
Gaining a global view of where one plans to spend their research career in is important, as good risk management practice allows one to see where barriers to success lie. If you plan on developing some new intervention, but it’s not as good as another one that costs half as much, why bother? Esp. if it takes you 8 years to develop it, only to find that it’s not easily transferable to a patient, or costs too much, or doesn’t meet health technology assessment criteria for reimbursement. If you don’t know these risks and issues right at the beginning, you could easily go down a research pathway that doesn’t confer tangible benefits to the patient. But how do you know what patient’s want from potential interventions? What benefits to patients want? How do you know if Government is going to pay this intervention? Is there a return on investment for potential investors and other funders? Will healthcare practitioners adopt this intervention? Who else is in this space of research/invention/innovation that competes with you? Which vested interest group will be upset with the introduction of this intervention? Well, you need to find out – it leads me to my next point.
They need to know what the real “needs” are by understanding all stakeholder needs
Understanding what the needs are for everyone in the healthcare delivery supply chain for a particular disease indication is utterly crucial. Yes, you may have a fantastic intervention, but if it costs 10x as much as the next-best intervention that delivers 2x the benefit, it’s unlikely that you’ll get any attention from any health technology assessment/reimbursement body. If patients get treated but are not satisfied with the outcomes, it might not be adopted by healthcare practitioners. So understanding the needs of ALL stakeholders gives you better insight on how to direct your research efforts and precious resources into research that really hits the mark for everyone. A by-product of doing this due dilligence for yourself is that it increases your attractiveness for further investment (financial, personnel, or other).
So what sort of training changes do we need to make?
- Teach entrepreneurship concepts about needs innovation, and demonstrate the power of innovative thinking at the undergrad and post-grad level, and highlight the importance of entrepreneurship in the healthcare sector. Expose them to the tools of innovation. I’ve blogged about this before here and here.
- Second (verb) early career researchers to wherever they need to be to immerse in a relevant environment BEFORE they start writing grants/applying for funding. Get them to spend a year visiting clinics, working with patient support groups and spending time at government departments so they truly understand the needs of all major stakeholders. Get them to learn about how other people that have gone down this pathway have been unsuccessful, so they don’t repeat these mistakes. Teach them why the interventions they develop have to meet certain economic criteria.
- From there, guide them to leverage these experiences as inspiration for high-impact, innovative research. With better insight, they are better equipped to see future problems and barriers to successful implementation, such as designing clinical trials with health economic measures built in, or developing healthcare technologies with designs that can accommodate regulatory requirements in future. Basically, knowing today what they will need tomorrow to carry the intervention right through the translation pathway to the patient with minimal hinderance.
Ticking the boxes of all the stakeholders by identifying them early on will make their research truly have the treatment and economic impact that’s desired, while keeping everyone in the healthcare delivery supply chain happy.
But for any of this to work, we, as players within the HMR sector, need to start accepting that this type of entrepreneurial-minded HMR scientist is desirable within our sector. Collectively, we need to communicate this to every young researcher coming out of our science/biomedical science courses. Our senior scientists must actively promote this type of next-generation HMR investigator, not as an after-thought, but as a responsibility to the next generation – I’d even go as far as saying that it should be to the same level of encouragement that a supervisor would go to to teach a student a new technical skill.
Why is this all so important? Well, it’s all about building a sell-able research and solution package that has sufficient momentum to reach the patient, on its own merit, where all stakeholders come away better off. If the solution is well thought-out and demonstrated in a small but important way (i.e., the “killer innovation experiment”), its path to adoption is going to be much easier and face less barriers. Building this “momentum” isn’t easy, but I believe it can be done.
My travels over the last 2 years have seen me go to Federal Parliament, listen to the problems faced by early-career researchers, learn and hear about the Australian biotech/medtech industry requirements, and learn about the basics of what investors are looking for. And in summary, this is what I’m hearing (but please correct me if I’m wrong, and feel free to add to the stakeholder list in the comments):
Patients: “Listen to me, so you can fix me more effectively.”
Federal government/Treasury: “Tell us what to do to solve the problem of rising healthcare expenditure.”
HMR scientists: “Fund my work because it’s important, and give me a stable career while you’re at it.”
Investors: “Give mind-blowing investment opportunities, because this isn’t Silicon Valley where capital is easier to obtain – my cash needs to support all the fledgling companies in my portfolio.”
Reimbursement bodies: “Give me something that is better for the same price/better for the relative increase in cost/delivers the same effectiveness for less, and have the data to prove it.”
But you know what? Up till now, I haven’t heard anyone articulate what an ideal solution looks like, because stakeholders in all the different groups don’t truly understand all the needs and problems of each other. So what I’m proposing is a model that closes this gap, and tries to address the needs of all stakeholders. Sure, I haven’t had a chance to validate what this “model” scientist looks like, but as a nation, we need to more stringently define what they’re going to look like, so we at least have an idea about what we’re working towards. Once that’s agreed upon, then we can have the conversation about how we get there.
I’ve blogged about entrepreneurship in medical research in the past, but I hope this post better articulates the benefits entrepreneurial-minded HMR scientists would confer to Australians, and people of all nations globally.
Thoughts, comments and feedback welcome. Post in the comments section or find me on Twitter @ayftan.