How pharma can support patients: Dr Imtiaz Ahmed

Jacky Law interviews consultant neurologist Dr Imtiaz Ahmed about the problems faced by patients with Parkinson's disease and multiple sclerosis.

Dr Imtiaz Ahmed kicks off a series of interviews with Doctors.net.uk members to discuss how pharma companies can better support patients.

What NHS neurological doctors and patients want is more hands-on help to ensure people know how to take their medications safely and appropriately.

Interview summary

JL: Can you describe the biggest challenges in your therapeutic area in terms of how pharma companies might be able to help?

IA: I work as a consultant neurologist in a district general hospital in east England providing outpatient services and dealing with inpatient referrals. The challenges I face are almost entirely to do with the treatments. In multiple sclerosis (MS), for example, we have a huge range of medications. There used to be only two or three but now there are six or seven with more coming out all the time. These are complex products and it is very difficult for us to give all the information that patients need in a half-hour clinical slot. What they want to know is fairly straightforward: what the drug does, why it is useful, the studies that have been done to back this up. But multiple sclerosis is a serious condition and ideally this information should be given by a trained nurse who can listen to their concerns and answer personal questions. It is not enough to simply give people an iPad presentation or a website address for more information.

"In multiple sclerosis (MS), for example, we have a huge range of medications. There used to be only two or three but now there are six or seven..."

Similarly, with Parkinson's disease, there are multiple drugs that can be prescribed and in some cases (around four in 100), patients will develop a serious side-effect called impulse control disorder. To identify it they all need to be closely followed up to find out how they are taking the drug and how they are responding.

JL: What can pharma companies do?

AI: What we really need are more nurses. In Parkinson's the problem is more about ensuring patients don't develop the side-effects in impulse control that are common to all the dopamine agonists. If patients suddenly start gambling, for example, or developing symptoms of hyper-sexuality, they are unlikely to tell you. But it is important these side-effects are highlighted. A nurse is well placed to follow up patients, ideally once every two months, and feedback to us how they are tolerating their treatment. Another side-effect is becoming obsessed or intensely fascinated with meaningless movements or activities such as collecting, arranging or taking apart objects. One patient brought in 250 pairs of shoes the other day.

JL: What are the pressures with MS?

AI: It is not just about delivering information but being there to listen to patients. When they are diagnosed with either Parkinson's or MS they are in shock and need to be listened to. It is very helpful to be able to make an appointment to see a specialised nurse who knows all about the condition and can explain what is happening and why it is important to take the medication. The ideal would be for pharma companies to club together to share the cost of nurses because it is important for patients to get an independent perspective of the drugs on the market. It doesn't have to be a qualified nurse; anyone trained in the condition could do this work and it would take a lot of pressure off the doctors.

JL: Apart from contributing to the cost of independent nurses, what else can pharma companies do?

AI: Once I have decided what drug a patient should be on, the company could send someone trained in the disease, a nurse or medical science liaison, to help ensure the patients understand what they are taking and why. We need manpower because patients need someone to talk to.

"We need manpower because patients need someone to talk to."

JL: Do any companies stand out in terms of their efforts to support patients?

AI: Genus Pharmaceuticals is the company that produces APO-go (apomorphine). This is a dopamine agonist that must be given by injection and before the drug is administered the patient must be tested. The company sends an apomorphine nurse whenever the drug is prescribed to set up the trial and teach the patient how to continue with the treatment.

In multiple sclerosis, Biogen has a particularly good liaison team, which tests patients for a particular infection before they are given their drug. The team liaises with the MS nurse, they provide information and support on how to deal with the disease and also provide a central phone number that doctors, nurses and patients can use.

JL: What kind of joint working projects with the NHS would you like to see pharma companies getting involved in?

AI: Ways to fund more independent nurses.

JL: Apart from more funding for neurological nurses, what is the biggest single thing you would like to see pharma doing to make your job easier?

AI: Better education for doctors about new medications. Of course, we can read about these things in the medical journals and on sites like Doctors.net.uk, but I would like to see more educational meetings where several companies talk about their products and there is discussion with doctors about how they work in particular patients and circumstances.

These meetings should be dominated by discussion not flip charts so we can learn from the experience of other doctors. I really think doctors and pharma should be working much more closely together. Pharma companies bring products to market but we need more help at the points of delivery, in the training about the products, in monitoring they are used safely and in helping patients understand why they need to be taken on a regular basis.

 About the interviewee:

This article was coordinated by Doctors.net.uk, the UK's largest professional network of doctors. Available to UK-registered doctors in primary and secondary care, Doctors.net.uk is an effective digital channel and a trusted source of medical education, research and communication. It is used by approximately 40,000 doctors every day.

Closing thought: Who should pay for more NHS nurses?