Cell and gene therapy are raising new ethical questions in clinical research and practice. “It will probably be the case that breast cancer, which now affects both wealthy people and poor people, will increasingly be a disease of poor people because wealthy people were able to get rid of the mutation from their families,” suggests Robert Klitzman, Professor of Psychiatry at the Columbia University College of Physicians and Surgeons and Director of the University’s Bioethics Masters and Certificate Programs. “Is this the kind of world we want, where wealthy people can afford to have better genes?”
“Peoples’ data is valuable. We know that researchers want it. And people should be rewarded for sharing it,” suggests Dawn Barry, President and Co-founder of the public benefit corporation LunaPBC. In 2018, LunaPBC launched LunaDNA, a genomic medical research database owned by its community: LunaDNA members share in the platform’s value through ownership shares exchanged for their health data.
As Johnson & Johnson Chief Medical Officer, DIA 2019 Co-Chair Dr. Joanne Waldstreicher is responsible for the company’s collaborations in ethical science, technology, and R&D policies, including those related to clinical trial transparency and compassionate access. “When you ask people why they’re participating in a clinical trial, a big part of it is to benefit themselves, they might have a condition or a disease where they’re looking for a new treatment option,” she explains. “But a very large part of their motivation is to contribute to medical knowledge that will advance or help care for a future patient.”
The emerging digital healthcare landscape is already becoming quite visible around the world, especially in Japan. But what is the true impact of digital technology on clinical research, drug development, and healthcare? “Imaging data plus AI is one of the best combinations,” explains Dr. Kazuhiro Kanmuri, Founder and Chief Executive Officer of Inter-Professional, Inc. Dr. Kanmuri served on the Program Committee for the June 2019 DIA Japan Cutting Edge Series Workshop #1.
Conversations about disparate healthcare access often address therapies approved for market, but how can we ensure equity in the clinical R&D processes that generate these therapies? “There’s not a ‘one size fits all’ approach to overcoming all the barriers to recruiting diverse participants in clinical trials, and there may be specific considerations for various populations you’re intending to recruit,” explains CAPT Richardae Araojo, Associate Commissioner for Minority Health, and Director of the Office of Minority Health and Health Equity. “A plan to address inclusion should be developed early on; it should not be an afterthought, and it begins and ends with the patient in mind.” CAPT Araojo will help lead the Clinical Trial Diversity session at DIA 2019.
“Digitization is something that is happening to everything that we do. It’s being called the fourth industrial revolution,” explains Dr. Robert Califf, former FDA Commissioner and Vice Chancellor for Health Data Science at Duke Health. “And if we do it right, it will actually free up clinicians to spend more time directly with people and, when they become patients, with sick people, which is what we really want.”
Do changes in clinical research, driven by emerging technology, change what we mean by “evidence”? “It’s not necessarily ‘trials versus real world evidence’–that is not particularly helpful because either type of evidence, either type of data, has its place and is complementary,” explains Mr. Michael Seewald, WorldWide Head of the Center of Excellence for Real World Evidence, Novartis Pharma, and member of DIA’s Future of Evidence Workshop program committee. “The exciting development is in developing data sources over a timeframe of decades that at some point will revolutionize healthcare in a respective therapy area.”
“One critical area when you look at healthcare systems is the issue of optimizing clinical and operational effectiveness,” suggests Professor John Lim, founding Executive Director of the Duke-National University of Singapore Centre of Regulatory Excellence (CoRE). “This is an area where research in AI is developing to really inform and aid decision making by not only physicians but also then operational decisions by healthcare providers.” Professor Lim is also Chairman of the Singapore Clinical Research Institute and National Health Innovation Center.
“China joining ICH is a magnificent milestone for the pharmaceutical industry in China,” explains Dr. Jingsong Wang, Chairman and Chief Executive Officer of Harbour Biomed. “We can see clearly more and more local pharmaceutical companies adopting the international standards to have a more innovative portfolio to face the competition from their global partners or counterparts.” Dr. Wang serves on the Steering Committee for our DIA China 2019 Annual Meeting in Beijing.
Should prescription drug or device advertisements include their price? “I don’t know how patients will perceive that because they won’t really know the difference between what they may or may not end up paying,” suggests Micheline Awad, Director, Regulatory Affairs, Advertising & Promotion, Neurocrine Biosciences, Inc. “We really haven’t studied in any systematic way the impact on the patient or on drug use or on being more transparent about drug prices,” explains Wayne Pines, President, Regulatory Services & Healthcare, APCO Worldwide, Inc. Micheline and Wayne served on DIA's Advertising & Promotion Regulatory Affairs 2019 program committee.