Business
The pharma industry From a healthcare perspective, underfunding has been a chronic problem for the last decade in many of the more established economies; diseases that had been assumed to be under control had started to re-emerge – not least caused by the spread of misinformation about vaccines on social media9. The previously inexorable rise of healthcare
costs in relatively rich economies is now under con- trol. In the US, Medicare and Medicaid10 reim- bursements have been trimmed to align with aver- age OECD levels11. In Europe, the Beneluxa12 ini- tiative on pharmaceutical pricing, along with the ‘Valletta Declaration’13, has reduced expenditure on medicines. Alongside other pharmaceutical price control activities14 these measures have low- ered revenues for the Western-based biopharma- ceutical and life science industry, resulting in a decrease in R&D expenditure and a subsequent challenge to innovation. Consolidation in the industry continues thanks to technology giants swallowing some of the traditional research-based biopharma companies15. Outside of the West, Chinese pharmaceutical
companies have been significantly more successful and are now among the top tier global players16, having disrupted the status quo with high-quality, low-priced innovative healthcare solutions, includ- ing many traditional Chinese medicines (TCMs). This has driven an overall improvement in access to healthcare in China for the many and an expan- sion of healthcare markets. Today, patient empowerment is fully embedded
into the healthcare industry and the ability to com- pare treatments with outcomes is actively promot- ed. The prevention of disease has become an inter- governmental initiative with trillions of dollars being invested in fundamental research promising breakthroughs in many chronic, debilitating dis- eases17. The use of vast data resources is having a positive impact on discovery and the Real World Data feedback loop is an established part of research and development in health-related indus- try. This had led to a real increase in true cross- industry and within-industry pre-competitive col- laboration18-20.
Technology and healthcare By the early 2020s, technology such as AI-powered search allowed patients to arrive for appointments at their clinician’s office knowing more about their own morbidity than their doctor21. Soon, diagno- sis, treatment and prognosis were largely being determined by AI. Healthcare providers started experiencing a serious shortage of physicians due
Drug Discovery World Fall 2019
to talented students no longer viewing medicine as a quality career22. However, despite AI and Machine Learning
(ML) having success in some areas23 – not least where image analysis formed an important part of the diagnosis24 – progress in, and the widespread deployment of, automated diagnosis had failed to live up to its early expectations after lives had been lost due to algorithms making ‘stupid’ errors. By 2030, the ‘Quantum Advantage’, ie the
threshold where quantum computing applications could perform significant, useful tasks that classi- cal computing applications could not, had been achieved and some exciting progress has been made. Today, drug discovery has been transformed thanks to pharma companies using hybrid machines – high-performance classical computers tightly coupled with quantum computers – and advanced AI/ML algorithms. These hybrid machines have enabled ab initio drug design, cou- pled with advanced modelling to design innovative drugs of high specificity and low toxicity. The fun- damental requirement of AI/ML – ie access to suf- ficient data of sufficient quality – remains a signif- icant hurdle but has been overcome in part by the use of AI federated learning (FL) techniques25.
Population health trends From the early 2000s onwards, many predictions had been made about the increase in HONDAs (Hypertension, Obesity, Non-Compliance, Diabetes and Asthma). By 2030 these concerns had not materialised as extensively as had been expected, but nonetheless HONDAs were imposing a signifi- cant burden on world healthcare resources.
HONDAs l Hypertension: As predicted by the World Health Organisation (WHO)26, a significant percentage (35-45%) of the world population over the age of 25 continues to suffer from hypertension, particu- larly in less mature economies. l Obesity: Back in 2016, the WHO reported that approximately 39% of people over 18 years old were overweight with 13% of them being obese27. More than one in 20 cancer cases were caused by excess weight28. Obesity in 2030 remains a global health challenge with many more diet-associated disease states becoming symptomatic at younger ages. l Non-compliance: Depending on definitions, reported non-adherence rates in cancer patients ranges from 16% to 100%, illustrating a serious problem29. Although technology has enabled progress on this front with innovations such as
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