Drug discovery and the NHS | Dr Annette Doherty

Thank you, Robert, and thank you very much for inviting me to be part of this panel discussion. I had a call with Robert about a week ago to make sure what he wanted was what I was going to deliver, and his last statement to me got me really concerned because he said, 'I want you to be provocative and challenging.' Now, it's a bit more difficult to be provocative and challenging as an industry representative than in the presentation we just heard from Julia, but I will do my best to raise some of the key areas that I think will contribute to a sustainable healthcare system in the UK and how the pharmaceutical industry can contribute. At GSK R&D, we are responsible for discovering innovative, valuable medicines that bring benefits to patients, the NHS, and society. GSK is a global company operating in over 150 countries; the UK is a very important investment country for us. In 2014, we invested almost a quarter of our R&D budget in the UK, so the subject of a sustainable healthcare system is of considerable importance. I speak not just for GSK but for trends across the industry. Robert asked me to talk about trends that will contribute to a sustainable healthcare system, so I will frame that around four big questions: what is the right biological target, what is the right molecule to intervene at that target, how quickly can we demonstrate proof of concept in early clinical trials, and how will we demonstrate value in the right patient population. Each of these areas is focused on improving target quality. Last year, we published a study showing that if we could increase the number of targets that had genetic phenotype support to 50%, we could improve clinical development success by up to 50% and reduce overall R&D costs by some 25%. To help improve target quality, we established a center for therapeutic target validation with EBI and the Sanger Institute to harness big data and genome sequencing, and the data will be shared openly. Five years ago, less than a third of our candidate molecules would even reach a first-in-human study; today, we have improved that to over 60% and are working to get to 90% plus probability of success once we nominate a candidate. We are investing in biomarkers and novel experimental medicine paradigms with the NHS and academia to get answers on whether we have selected the right target. As an old boss of mine often said, 'Get it right more often.' Then we will reduce attrition and costs. The fourth area is understanding the value proposition through real-world clinical studies, like the Salford Long study in COPD and asthma, which involved 80 GP surgeries, two major hospitals, and over 120 pharmacies to look at a medicine's effectiveness in a general population. This required a connected healthcare environment and training new NHS clinical staff. We are also seeing greater patient involvement in medicines development, which helps target real patient needs and can improve adherence. Another trend is investing in manufacturing technologies to transform how we manufacture and supply medicines, improving quality, reducing cost, and increasing access. Regarding precision medicine, we are moving beyond oncology into diseases like immunoinflammation, where we can characterize patients earlier through arthroscopy and TNF expression, and rare diseases where we know the genetic target and can potentially cure the disease. At GSK, we target medicines to patients most likely to respond, which increases access and reduces waste. In conclusion, collaboration between industry, academia, and the NHS is critical for a sustainable healthcare environment. Research is still not integral to NHS activity across the board, and if we improve that, it will benefit our healthcare system. Investing in the UK healthcare data infrastructure will maximize the potential of data to support research and patient care—the Salford Long study was made possible by the Northwest eHealth connected healthcare environment. For example, in NHS Scotland, we are identifying high-risk acute pancreatitis patients to enable earlier intervention by a GP. Innovation and research are absolutely critical to delivering transformational medicines of the future. Without a sustainable healthcare system and collectively working together in a more connected way, I don't think we will achieve the ambition we all have here in the UK. Thank you for your attention.