ETHICS
what evidence would be required. This could also lead to more novel ways of funding research, which would come from joint research funding brought about by the NHS and industry working more closely together. This could take the form of limited marketing authorisation being granted to industry at specified NHS trial centres that would then pay to use the product, while helping to produce the required evidence. Mr Goldberg explained his
Mr Andrew Goldberg.
idea in more depth: “If 15 years worth of evidence, for example, is required to produce meaningful data for a hip replacement product, 10 NHS centres could be chosen to run a trial. Limited marketing authorisation would then be given to the product manufacturer to allow it to sell the product to the chosen centres. It is far more cost-effective for the company to be able to sell 10,000 products to 10 centres, than to sell 10,000 products to 200 centres, which is what happens today. Aside from bringing down the cost of sales, this would enable a rich source of meaningful data to be collected and would also ensure that patients were not being exposed to thousands of clinicians’ learning curves.”
‘Mr Goldberg proposed an interesting potential new way forward which could benefit all the stakeholders involved in the process ofbringing a new product to market.’
Mr Goldberg argued his case further. “This process aligns agendas – the company is not the sole funder of the product trial – because the NHS, in purchasing the product, is co-investing in the testing phase.” He continued: “This also produces more incentive for industry to run the most appropriate trials to demonstrate that the product has a legacy and, at an agreed point, the project would move into the post-market surveillance phase and appropriate measures could be put in place so that longer-term complications or issues could be identified and addressed.” The Joint Registries that exist in the UK already put us at the forefront of an information revolution in
medicine, but there are many thousands of implants that are not currently subject to such rigorous audit and in many cases, we do not want to compare just technology against technology but rather more technology against a non-invasive or non-operative alternative. Mr Goldberg did admit
that introducing such a radically different approach to product introduction would be a complex thing
to initiate. “If handed to civil servants, it would fail miserably,” he said. “It would need to be tackled at a senior political level to turn it into reality.” Finally, Mr Goldberg concluded his
presentation by pointing out that most innovation in the NHS is not actually related to the use of new technology, but is more often about services. “Most innovation in the NHS comes about as a result of changing the way that things are done,” he said. “I believe that we could make a far greater contribution to improvements in patient care by focusing on process change, rather than thinking up more and more ‘innovative’ devices.”
Reduction in budgets need not lead to a reduction of your demands.
Quality, Function and Design of the highest standard combined with the latest technology for more than 80 years.
MARCH 2012
THE CLINICAL SERVICES JOURNAL
27
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