Business


continuous monitoring and patient reminders, the compliance challenge remains unchecked, especial- ly in poorer economies. l Diabetes: In 2014, it was estimated that 422 mil- lion people worldwide were living with diabetes (a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation)30. This was approximately one in 11 of the world’s adult population and the figure is expected to rise to around 642 million people by 204031. l Asthma: The incidence of asthma (in 2017 approximately 8% of the UK population was asth- matic32 with a similar percentage estimated in the USA33) remains significant. Environmental pollu- tion and continued use of fossil fuels in emerging economies had not reduced sufficiently and the occurrence of asthma, particularly in the young, continued to rise throughout the 2020s.


Outside of the HONDA conditions, several other issues are worthy of note:


l Cancer: In 2018, cancer was the second leading cause of mortality globally, responsible for an esti- mated 9.6 million deaths34. The economic impact of cancer was significant, it remains so and is increasing. The total annual economic cost of can- cer in 2010 was estimated at approximately $1.16 trillion. By 2030, the number of global cancer deaths has increased by 45% with about 70% of those deaths occurring in low and middle income economies. lMental health: Mental health issues have contin- ued to dominate, in particular depression, anxiety, schizophrenia, bipolar disorder35 and the demen- tias. These conditions have driven huge increases in cost pressures on social care across the world. The current cost of Alzheimer’s alone is estimated to be around $2 trillion annually36. However, the use of digital technologies (eg in-dwelling biosensors, monitoring, diagnostics, therapeutics, robotics, the implementation of social care initiatives, such as the intelligent home) has helped to deliver signifi- cant, cost-effective support for patients37. No affordable and widely-effective new therapies for dementia had been approved and released by 2029. (Note: Since 1998, ~100 drugs had been tested but by 2019 only four had been authorised for use.) l Anti-microbial resistance: The predictions of AMR causing a meltdown in routine medical pro- cedures was narrowly averted by using break- throughs in phage therapy38 and anti-bacterial monoclonal antibodies39. The challenging eco- nomic issues that had prevented the pharmaceuti- cal industry from diverting resources into AMR


46


were overcome during a global summit in the mid- 2020s when a new reward structure was imple- mented giving substantial tax advantages to com- panies that brought anti-microbial molecules to the market. New challenges continue to emerge, how- ever, as people live longer. Managing and curing pathologies related to ageing has become the next unconquered field40,41.


Innovative technology The last decade has also seen numerous technolog- ical advances which have profoundly transformed the pharmaceutical and healthcare industries:


l AI and ML: AI has long been seen as integral to the healthcare industry. By 2018, more than a third of healthcare providers had made investments into healthcare AI and medical-predictive analytics, preparing for the next generation of automated healthcare. In its 2019 AI Predictions42, PwC asserted that AI “…could contribute up to $15.7 trillion to the global economy by 2030”, a predic- tion which has proven relatively astute in hind- sight. For example, in pathology the extensive use of


whole-slide imaging aligned with pattern recogni- tion methods based on deep learning and incorpo- rating clinical, radiologic and genomic data allowed highly-sophisticated, rapid and accurate diagnosis and prognosis43. Elsewhere, the genomes of patients were avail-


able to AI/ML-based prescribing systems allowing physicians to deliver low-risk, highly-effective stratified medicine prescriptions. Furthermore, big data analytics and Machine


Learning algorithms were widely deployed to anal- yse large scale data of Electronic Medical Records (EMR), automatically learning how physicians treated patients in real-world settings. When newly-written prescriptions deviated from the spectrum of typical treatment patterns, they were flagged as a potential error prompting the physi- cians to double check. Such technologies reduced the burden of adverse events and medically- induced deaths which was estimated by a Johns Hopkins study to be the third-largest cause of death in the US44. l The role of the physician: By the mid-2020s, it was clear that the role of the physician was chang- ing, becoming more like a technician, patient/carer educator and counsellor, while high-powered, RWD-driven AI/ML-based systems performed the differential diagnoses and provided treatment sug- gestions. Robotics were supporting many areas of care, especially for the aged45. The Japanese


Drug Discovery World Fall 2019


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