A glance back to Pharma Integrates, London 2022 – part iii

Run by Life Science Integrates, Pharma Integrates was in its 11th year in 2022. It was a unique event, at which leaders from across the pharmaceutical pipeline addressed the needs of the industry, shared their own insights, and tackled debates on the crucial topics that influence the future of patient outcomes.

With pharmaphorum in attendance, the day continued from the fireside chat with Tamsin Berry, head of policy and partnerships at AreteiaTx and partner at Population Health Partners, and Lord David Prior, deputy chairman UK and global senior advisor for Lazard. Next up was a panel: ‘Rise of the Centenarians’.

Moderated by Lord James O’Shaughnessy, senior partner at Newmarket Strategy, panellists included: Tina Woods, founder and CEO at Collider Health; Nick Stephens, executive chairman at The RSA Group; Samantha Benham-Hermetz, director of policy and public affairs at Alzheimer’s Research UK; Giovanna Mallucci, founding principal investigator at Altos Lab; and Aaron Weaver, co-head of venture creation at Apeiron Investment Group.

Human lifespan as health span

Lord O’Shaughnessy opened with a comparison of Lord David Prior’s pessimism with his own optimism: “We are going to live forever, [but] not quite forever,” he said. “[With] the rise of the centenarians, with the potential to extend a human life and healthy human life at that, [we] need to think of the consequences in the science of longevity.”

Nick Stephens began: “I’ll try and give a bigger picture. It starts with this week, the global population passing eight billion. This has been driven primarily by prevention and sanitation, but human lifespan hasn’t increased immensely. So, we need to focus on health span.”

He continued: “We have a demographic bulge coming down the tracks at us very fact indeed. In Japan, it’s already there. We have a group of people living unhealthy lives from 70 to 90 years old. Behind that bulge of unhealthy people is an ever-decreasing number of productive people, people who can pay for that care. So, we need new models.”

Stephens reiterated that the focus should be on health span, not lifespan: “I’d like to be a hundred and healthy and productive and active and engaged. I’ll need fixing, as my behaviour is not good. How do we do that? The model in life sciences is one of invention, theory checking, and scaling, and we have great scientists all around the world exploring these.”

He went on: “The reimbursement model isn’t going to work either. [It] has to be a cost at a fraction of the cost at which medicines are presented today. How do we consumerise? How do we bridge the value of death between a great scientific idea, a potential therapeutic, and an industry? It requires enormously higher risk and venture investment. Where will the money come from? From people who have longer viewpoints than politicians of venture partners: we’re talking about nation states, pension funds.”

An ageing population and dementia

Giovanna Mallucci spoke next: “Two things struck me: the global population is eight billion or more, and the world is ageing. We’re getting to 70 and beyond. Over 70, you have a one in three chance of dementia: over 80, it’s a one in two chance. [And] as the population ages, we’re in trouble.”

She continued: “In 2022, we don’t have any meaningful treatments to slow down dementia, but optimistically I’m a science and a neurologist; I’ve been seeing dementia patients for 25 years. In my training, what […] hasn’t changed is neurodegenerative prospects. If we move away from the concept of cure, you can cure pneumonia – you can’t cure dementia. The killer, though, with dementia is institutionalisation. It costs society, as well. You can slow dementia: healthy brain, healthy body. There are lots of ways we can change risk and progression. A lot of drug discovery, though, is for those people who don’t want to change their behaviour.”

Lord O’Shaughnessy asked what Mallucci meant by ‘institutionalisation’.

“Where you can’t look after yourself,” she replied. “The real impact on society and the morale of health systems […] We need to change our lifestyle trajectory right now.”

Lord O’Shaughnessy compared Mallucci’s point to Lord Prior’s earlier mention of having a health system set up to treat sick people and prevent people from getting sick.

Ageing: the psychology and behavioural aspects

Picking up on this, Tina Woods said: “There needs to be a paradigm, a systemic shift. I spent years working in pharma and biotech, working with critical stakeholders – the burning platform has been around for a while: [we] have to reduce demand. We are living very unhealthy lives. The US has the most advanced healthcare system in the world – that’s ridiculous, that’s a burning platform that needs to change.”

She continued: “The discrepancy between the wealthiest and the poorest citizens has to change. It is about money. We have the most unbelievable, exponential developments taking place. AI drug discovery? That’s already disrupting the pharma model […] Change the incentives. [There is] huge potential in pension funds, new freedoms coming up for investment in higher risk innovation areas: these are the sorts of things I think about.”

Woods further explained: “We know the biology of ageing, its hallmarks: the cure for dementia will come from understanding the trajectory far earlier. [We] need to shift the whole way we think of health – 80% of determinants of health have nothing to do with the health service. The psychology of ageing, the behavioural aspects of ageing: it’s no wonder those who go into institutions deteriorate. Who wants to live when you have a crap life and you’ve lost the people that you love around you? People need to be nurtured and thrive.”

Lord O’Shaughnessy highlighted the trend of discussions veering to the need for a behaviour change and found it interesting that drugs and health services were seeming to be put into the context of a whole life lived.

Samantha Benham-Hermetz added: “Talking about a whole life lived, when I walked in, I saw a portrait of the Queen. Talk about a whole life lived: surrounded by her dogs, her family, her horses. Two days before she died, she was still fully functioning. She had a different life to most people [though].”

She carried on: “Start from the beginning: [there are] two mountains to climb and a bridge between them. How do we drive investment? Mountain one. Then, pharma is also doing research in clinical trials, but the missing bridge is translational science. We’ve been lobbying for that bridge. Using AI, [there are] new fishing expeditions to see the proteins and understand how they can identify new targets in future.”

Specifying her pursuant topic of discourse, Benham-Hermetz continued: “Every day, people come when already experiencing symptoms – [they] get lost, can’t concentrate, ask [the] same questions over and over again. The changes in the brain are happening 15 to 20 years before that. The Eden Initiative – early detection of neurodegeneration – [uses] blood-based biomarkers. [Take] Ronald Reagan: there were changes to his speech patterns seven years before. We’re looking at changes in the brain, the risks. Part of the challenge in diagnosis is a pen and paper test, drawing a clock backwards: in 2022, that seems quite amateur. In top-class neuro centres, [there are] amyloid PET scans, CSFs, but [these are] costly and invasive.”

Obesity: drugs versus healthy diet and exercise

At this point, Lord O’Shaughnessy asked the panel what the comparison was between behavioural changes versus a pill, noting obesity prevention programmes were using a new class of drugs that “seem to be incredibly effective in controlling weight by controlling appetites”.

Mallucci replied: “It’s all druggable. People say, ‘when are we going to get the drugs?’ They already exist: they’re called exercise, calorie restriction […] People being people, [however,] they want a shortcut, they want a statin.”

Stephens made a comparison: “We’ve evolved for too many […] rewards. For example, the contraceptive pill. Will you stop teenagers having sex? No, so you have an intervention. For a small number, they will choose abstinence, but a larger section of the population needs pharmacological help or intervention.”

Woods, however, disagreed: “Would you do that for an eight-year-old child? Their family can only afford junk food, [they] have been raised on junk food. For some, a pill is a perfect solution, but obesity is a complicated condition. A root-and-branch review is needed. Many policies in obesity management have failed. [The] nanny state approach is a mistake. Management of obesity is complex and linked to [the] food industry: how do we change investment away from industries that harm health? [We’re] living in a world where convenience is king.”

The panellists detoured into a reminiscence of the ‘trite example’ of Halloween, how these days “kids roam the streets with carrier bags of sweets”, whereas, when they’d been children, they were little bags and they were “happier and thinner”.

Benham-Hermetz noted: “[Lord] David Prior said it best: we don’t have the research on intervention. We know hypertension in midlife contributes to dementia, but are people getting access to blood pressure testing in midlife? Part of the difficulty is the long-term view […] One pharma company has four medicines that might be of benefit, but [it] won’t conduct phase 3 because [it’s] too expensive.”

Diversity, informal care costs, and interconnected health

One audience member stated: “[It is] detrimental to simplify approaches to long-term health conditions: eat less doesn’t work. Approximately five million people are dieting every day. If it was that simple, there wouldn’t be the prevalence. [The] 658 policies put forward for obesity focus on individual change – this doesn’t work. Pharma intervention is beneficial, but needs to be combined with AI and tech advances for personality factors: change the rhetoric.”

Before the panel could respond, another audience member urged that the “economies of scale seen thrown into cancer with relatively quick return on investment need to be applied to neurodegenerative disease” as well. A third question revolved around diversity.

On this and the previous point, Benham-Hermetz replied: “South Asian populations are at higher risk [of] diabetes, but come forward later due to society stigma. Social and cultural issues need to be overcome at the same time. On reimbursement, I had the fortune (or misfortune) to be part of NICE methods review back in 2020 [and saw] the lack of willingness to incorporate informal care costs. So much of the informal care is delivered for a long time by families.”

Stephens added: We are all going to die. If we can delay everyone’s death by one day, it’s 130,000 lives. It’s a global priority we share, but haven’t joined up […] We have to understand the biology: change regulations to Ancient China, with wellness, not illness, as focus.”

Benham-Hermetz concluded: “Dementia rarely travels alone – that’s the catchphrase.”