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Article: How were the teenies? Reflecting on global healthcare and market research over the last decade

Rachel Howard, December 2019

Back in 2010, I presented my perspective on what the 2010s might look like for healthcare market research and business intelligence at the BHBIA Winter Seminar. As we round out the decade, I thought it would be timely to revisit my predictions and consider which of them actually came to fruition over the last decade, which did not, and why.

Global healthMy first reaction, looking back over my (already horrifyingly dated looking) PowerPoint slides, was to cringe at the nickname I’d assigned to the coming years – “the teenies”. Much like “the noughties” before them, that never caught on. Fortunately, from that point on, the rest of my predictions proved a little more prescient – “on the right track, but a little wide of the mark” is how one of my colleagues summarised them. 

The changing industry context

Ten years ago, pharma was facing a patent cliff, with falling levels of R&D productivity, and ‘blockbuster’ drugs facing the impending threat of generic competition with a wave of patent expiries on the horizon – Seretide, Lipitor and Symbicort among them. Biosimilar entrants were also expected, threatening to take share away from biologic drugs such as Enbrel (etanercept) and Humira (adalimumab), which represented some of the greatest pharmacological advances of the previous decade. It was an uncertain time for the industry, before the dramatic advances we’ve since seen in immuno-oncology, direct acting antivirals in hepatitis C and cell and gene therapies to name a few.

Over the last decade the focus of drug development has shifted away from mass market large molecule drugs for chronic conditions to often high cost drugs designed for niche patient populations: personalised medicine and advanced technologies to treat rare and ultra-rare diseases. As a result, payer scrutiny on drug pricing has continued to amplify, with a key focus of the last ten years being finding ways to contain costs and manage the budget impact of innovation. A well-defined market access strategy has therefore become of paramount importance for pharmaceutical companies – merely meeting clinical trial endpoints is no longer sufficient to guarantee commercial success. With regulators increasingly prepared to grant marketing authorisation to new entrants based on short-term, limited randomised controlled trial (RCT) data, real-world data has also become an important tool to validate patient outcomes in settings outside of clinical trials and provide justification for pricing decisions. However best practices to standardise the collection, analysis and transformation of real-world data into real-world evidence, avoiding biases and data quality issues, have yet to be fully established or implemented.   

In parallel, the concept of patient centricity has evolved from a vague soundbite in company mission statements to an essential pillar of clinical development, as patients have become increasingly empowered in decisions about their healthcare. Integrating the patient perspective and engaging them as partners much earlier in the process is becoming ever more critical for successful drug commercialisation; manufacturers can no longer afford to rely on clinician input alone when determining suitable endpoints. This is reflected in the high volume of patient research we now conduct.

While I mentioned payers and patients in passing in my presentation, I failed to predict how much more important both stakeholder types would become in healthcare market research over the last decade, relative to physicians, as a result of these changes. But looking back, this shift is one of the most dramatic I have witnessed in my career.

Digitalisation of healthcare

The first theme I considered was digitalisation of healthcare, boldly stating "while an apple a day used to keep the doctor away, in the 2010s, Apple will be the way patients interact with their doctors while they work, rest and play". 

At least Apple is still a dominant player in the smartphone market, meaning my reference hasn’t been rendered obsolete, but my hypothesis that as computer-literate baby boomers became the ‘poly pill generation’, their surgery of the future would “relocate into cyberspace” feels rather over the top. Brick-and-mortar facilities still dominate the landscape of healthcare provision, and that doesn’t look likely to change anytime soon. However, it is certainly true that we have witnessed considerable advances in telemedicine, and remote consultations are very much a reality. 

Implementation hasn’t been all smooth sailing – interoperability of health data sources such as electronic medical records remains a challenge, and legacy systems are getting in the way of a truly digitally connected, cloud-based healthcare system – but we have come a long way in terms of making healthcare services mobile, from diagnostic devices to patient support programmes. 

Here I considered the challenge of patient adherence – suggesting that sponsored pill reminders will pop up on patients’ screens and alert them to the location of their medication in an attempt to ensure they take their medicine at the correct times. The last decade has seen a proliferation of platforms designed to help with this, but a notable area that has exploded in popularity is behavioural science, and the use of “nudges” rooted in understanding of human behaviour in order to influence health interventions. Incentive-based adherence apps are one such example. Another notable innovative development in the area of adherence tracking is Abilify MyCite, a pill developed by Otsuka that includes an ingestible sensor, allowing patients and their healthcare providers to monitor adherence data via a mobile app. 

I talked about how the associated exponential increase in healthcare information (in real time, all of the time) would call for more intelligent data mining to make sense of it. I anticipated new technology with the ability to sift through ‘zettabytes’ and ‘yottabytes’ of data in order to validate everything that happens, as it happens. We’re not fully there yet, and I for one still think in megabytes and gigabytes, but big data analytics has definitely been a key area in which the industry has had to upskill over the last decade. In particular, the recent contributions of artificial intelligence and machine learning to medicine cannot be overstated, and look set to have a lasting impact on healthcare going forward.

I went on to suggest that every organ in our bodies would be given an IP address linked to our phone, which would automatically alert the emergency services as soon as it stops functioning. I might have been getting slightly carried away there, but the Internet of Medical Things (IoMT) is now a well-established concept in healthcare that isn’t a million miles away from this, with connected medical devices allowing objective reporting of biometric activity. 

Impact of technology on market research methodologies

My next prediction was that as patients started increasingly connecting to their healthcare professionals via smartphones, we market researchers would be too – and I explored various ways that technology might shape the ways in which we gather business intelligence.

One of my more hyper futuristic-sounding suggestions in this realm was respondents using their phones to access holographic virtual moderators, from the comfort of their own sitting room, as our clients stream the interview live through the moderator’s ‘eyes’. While not exactly our standard research methodology in 2020, mobile and digital methodologies have become ubiquitous and get us ever closer to accessing the decision-making moment in real time. More specifically, over the past couple of years we have been piloting both virtual reality and augmented reality as cutting-edge tools for conducting more immersive and engaging research.  

I had high hopes for biometric methodologies, including a suite of neurosensing applications that could simultaneously monitor respondents’ reactions to the communications they come across, collecting brainwaves, emotions and eye movements. All of which would instantaneously feed back suggestions about how designs can be refined and improved. Eye tracking has been around in market research for longer than a decade now, and occasional chatter about other methodologies “rooted in neuroscience” continues, but I am yet to be fully convinced of their added value in the healthcare market research setting. Due to their inability to provide the ‘why’, in my mind they haven’t (yet) come close to challenging tried-and-tested qualitative techniques in delivering actionable insights. However, we are successfully using facial analysis software as a complimentary tool to add insights to traditional research methods, and are increasingly using this approach to add another dimension to communications testing.

How pharma might tap in to these new technologies

I forecast how ‘cookies’ and ‘spyware’ (fairly novel-sounding concepts back in 2010) would stalk new generations of healthcare stakeholders as they browsed from one internet application to the next, presenting them with personalised and targeted communications. I was ominously close to the mark with this one, albeit not quite predicting the specific tools that we as market researchers might have at our disposal to track what people are saying on the internet using social media listening. 

I vaguely alluded to the new challenges that would arise due to the ethical implications of these ever more invasive and intrusive technologies, and the need for regulations and pharmacovigilance to keep up. However, I wasn’t quite prepared for the added complication of GDPR on our processing of respondents’ personal data, and I definitely underestimated just how much more compliance there would be associated with every stage of running a project.

Retrospectively, my most questionable, Armageddon-like prediction was that by the end of this decade, as a result of all of this information pollution, people would become exhausted, alienated and disillusioned, turning off their phones to escape information overload and forcing pharma companies to find new ways to connect with their customers. Instead, people are doing the opposite, and are more connected than ever before, with multichannel marketing now a well-established practice.

Reflections on my predictions

Overall, some hits and some misses, but I won’t be too hard on myself for those – reflecting on how my predictions held up to reality was a surprisingly revealing exercise. There’s a tendency to get caught up in our day-to-day work and lose sight of the larger-scale backdrop of changes that become clearer when we take a step back, but challenging the more outlandish past predictions can help prime us to prepare for what might come next and remind ourselves how far we have come and benchmark how far we still have to go. 

I concluded my 2010 presentation by saying: our challenge in the next decade will be to stay up-to-date by understanding how technology can help us, and widening our capabilities, without losing our core research and analytical skills.  I feel that this sentiment continues to hold true today for those of us working in healthcare business intelligence. The pace of technology shows no sense of slowing down, and while staying competitive depends on our ability to leverage new digital tools and techniques effectively, our collective human, and not artificial, intelligence, is still very much needed to piece together the meaning behind the data these can provide in order to deliver informed strategic recommendations. 

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