Is COVID-19 the Catalyst We Needed for Positive Change?

John Whyte, MD, MPH; Murray Aitken; Bob Brisco


May 20, 2020

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  • The impact of reduced cancer diagnostic activity between March and June is estimated to be about 80,000 fewer diagnoses of cancer in the United States.

  • Clinical trials have clearly suffered a level of disruption, but participants and stakeholders have been moving quickly to change their clinical trial approaches while preserving the quality of data being gathered.

  • Innovative new approaches to conducting clinical trials are being developed, such as virtual approaches like e-consent and remote monitoring.

  • This is the ideal time for those in the health system to lean into the opportunity to take long-standing issues and see COVID-19 as a catalyst for positive change.

This transcript has been edited for clarity.

John Whyte, MD, MPH: Hello. I'm Dr John Whyte, chief medical officer at WebMD. In today's episode, we're going to take a deep dive into human data science, which allows us to look at trends that could have positive impacts on healthcare and patient outcomes. Murray Aitken from IQVIA and Bob Brisco from Internet Brands sat down with me to unpack it all.

Bob Brisco: Murray, I have a big question for you. Your company, IQVIA, has perhaps the most data and, therefore, insight on what's happening with health service delivery during this period. How concerned should we be about people putting off care right now?

Murray Aitken: I think we should be very concerned about that. We published some research a week or so ago looking at the reduction in cancer diagnostics—mammographies, colonoscopies, and so on.

And we did some modeling to estimate what that might result in in terms of fewer diagnoses of five different types of cancer. Assuming that we're in a 3-month period from the beginning of March to the beginning of June with reduced diagnostic activity, we estimated that 80,000 fewer diagnoses of cancer will result in that 3-month period.

Brisco: Wow.

Aitken: Now, whether that results in delays in initiation of treatment, whether that is caught up in the very near term, we're not sure. But that's a way of characterizing the magnitude of the impact that [COVID-19] is having.

Brisco: And is that part of the logic of the index, of, the longer this goes on post-June, the more the risk rises on these other treatments?

Aitken: Yes, absolutely. And that's also why, as we see the health system reopening, we need to understand how much of the increased activity is dealing with the backlog versus a new level service provision and interaction and engagement by patients with the health system.

I think it'll be somewhat challenging to actually understand how much is catch-up and how much is ongoing, particularly if you then overlay—coming into the fall—the prospect of the flu season coming on top of COVID and/or the impact of relaxing restrictions.

A lot of data are going to be conflated, which is why getting baselines established at a subnational level is so important, so that we can really look at the excess level or deficit of activity over the coming months.

Brisco: Murray, John and I want to ask you your perspective on change that could happen in the wake of COVID. I know you have been working on some of the things we should have been doing all along and spotlighting those. Can you tell us about those efforts?

Aitken: Yes. Those of us who have been in and around the health system for a while have a pretty long list of things that we scratch our heads about as to why they haven't changed already. And the typical answer is that there are entrenched positions and incentives, and there's a lack of a burning platform for change. Well, you know, the platform is clearly ablaze right now.

I think that makes this an ideal time for all of us in the health system and all of us interested in improving the performance of our health system to really lean into the opportunity that's there to take some of these long-standing issues and really seize the moment, see COVID-19 as a catalyst for positive change.

Brisco: Will you share a few of those topics?

Aitken: There's a long list. We've written up 10 of them on our website to start with. I think it sort of ranges. At one level, it's about telemedicine; it's an alternative way to engage with healthcare professionals. Its use has been relatively modest to date. It has increased a lot and changed a lot in the past few weeks, and it should be a part of the health system going forward.

It ranges from that to all the way to understanding more about the basics of human biology and disease, the natural history of disease. We need to understand epidemiology a lot better than we do.

I think COVID-19 has exposed a lot of the gaps in our understanding of relatively basic aspects of epidemiology. Zoonotic disease transmission, right? I mean, I think all of the essentially new infectious diseases are coming through zoonotic transmission.

That's not a new finding, right? It was being talked about around SARS and with HIV before that. But we've never really gotten our arms around coming to terms with what that means and what we need to do to better understand that.

It also includes things like the commercial model for vaccines, for curative medicines, for antibiotics. These things have been talked about for a long time. We still don't have an incentive model in place for those.

Now, with all the focus on COVID-19 and the urgency of discovering and developing new, effective, safe vaccines and therapeutics, it's time to take a proper look at some of those issues and move things forward.

So, again, it's a long list. My hope is that collectively, we seize the opportunity that's here. Obviously, we've got to deal with the crisis in front of us right now. But coming out of this, let's ensure that we see a wave of positive change, viewing COVID-19 as a catalyst for positive change for the longer term.

Brisco: Murray, for our Medscape audience, could you speak some more about clinical trials and what you're seeing, and what the impacts may or may not be?

Aitken: There has certainly been a level of disruption, but I have to say that it's very encouraging to see the extent to which all participants and stakeholders in clinical trials have already moved very quickly—with support of regulators—to maintain subjects in ongoing trials and to change the approaches by which those trials are being conducted while preserving the quality of the data being gathered.

And also, a movement for trial enrollment and initiation of new trials to continue as soon as possible, if not already, through adopting more virtual approaches and adapting the approach to the clinical trials.

I think it's clear that the life sciences sector remains as committed as ever to the programs of research that they have underway. And everyone, including IQVIA and the role that we play in conducting trials, is absolutely committed to ensuring that we maintain that program of R&D activity.

We've seen very, very few cancellations of programs. At the same time, the level of destruction and distraction is also quite clear. But I think, fundamentally, we're still very much on track.

Brisco: And do you think there will be learnings around new innovative approaches that will be a benefit coming out of this in terms of trial pacing?

Aitken: Yes, I do, like some of the virtual approaches to conducting the trial. For example, e-consent is something that we've been trying to promote as a more effective way to get patient consent and understanding of the trial.

That's something that has moved ahead very rapidly in the past couple of months. We hope that that will stay in place. I also think that this notion of remote monitoring of the patients—not necessarily requiring the patient to make their way physically into a doctor's office for something that could be done remotely—makes a big difference to subjects in clinical trials.

Whyte: Doing clinical trials in the home, delivering the intervention—that's new.

Aitken: Yes. And we've been talking about virtual trials for some time and actually implementing them, and learning a lot about how to implement them effectively.

COVID-19 has really turbocharged the interest and the effort and the learnings around that. We also have something we call risk-based monitoring of trials. That's been something we've been implementing for many years. But often there's resistance to fully adopting that. I think attitudes of sponsors have changed somewhat over the past couple of months with respect to applying a risk-based monitoring approach to clinical trials.

So, again, this is all positive news and positive outcomes that can come out of this shared experience we're all going through.

Brisco: On that theme, from the perspective of the pharmaceutical manufacturers, are there other learnings coming out beyond clinical trials? I don't know if it's copay program adoption, or are there other themes that you're seeing that you think will stay with us?

Aitken: The whole level of in-person interaction between the life sciences companies and healthcare professionals—that has, by definition, been subject to a significant amount of disruption.

So we've got a lot more e-detailing and education programs, virtual education programs, and so on. I don't think anyone thinks that's going to remain 100% virtual going forward, but the leading companies are definitely learning a lot from this experience. And there will be some significant rethinking about the balance between in-person and virtual interactions with healthcare professionals.

On the insurance side, it's still too early to say. We're not seeing much movement in terms of copay, coupon use, or shifts in coverage. But clearly, we're watching that, anticipating that there may be changes coming down the line.

Brisco: You mentioned the virtual reps and e-detailing and higher adoption of that. Do you think healthcare professionals themselves will be consuming that type of information differently than in the past?

Aitken: Well, we shouldn't underestimate the extent to which the healthcare professionals in their practices have also been significantly disrupted by the virus, and perhaps themselves rethinking their business model, their delivery model of care for patients.

To the extent that reimbursement has changed, certainly in regard to telemedicine visits, I think we'll see changed attitudes by the healthcare professionals with respect to their patients, but also certainly with respect to the way in which they receive and absorb information coming from life sciences companies. So, yes, absolutely. You know, it's a new day with respect to the engagement and interaction between the life sciences sector and healthcare professionals.

Whyte: I want to thank you both for joining me.

Brisco: Of course.

Aitken: Thanks.

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