CMS on how life sciences advancements are improving patient care

When the UK Life Sciences Champion Sir John Bell recently highlighted the need to create new industries within life sciences, Carina Healy immediately saw the potential for Scotland.

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Sir John, speaking at the Medicines and Healthcare Products Regulatory Agency, identified genomics, digital health and early diagnosis as three areas where the UK could develop new industries and remain a world leader in life sciences.

Healy, a partner and life sciences specialist with international legal firm CMS, says: “These areas play into what we do well in Scotland and present very big opportunities.” Healy goes on to explain these new industries and the potential they hold for Scotland.

Genomics – using genotyping to inform how patients are treated – is closely linked to precision or stratified medicine, where Scotland is already excelling.

Precision medicine allows doctors to tailor treatments to each patient’s specific needs, which can save lives, avoid unpleasant side-effects caused by unsuitable treatments and save the NHS money.

Scotland has great expertise in this area, with world-class academic research and cutting-edge companies developing new treatments to benefit the NHS. This is backed by innovative initiatives such as the Stratified Medicine Scotland Innovation Centre based at the Queen Elizabeth University Hospital (QEUH) in Glasgow, which brings together specialists from across academia, industry and the NHS.

One challenge facing this new industry is how to use the wealth of genetic data now available to inform medical treatment. Although genetic testing is getting increasingly more affordable, further research is needed to link that genetic data to specific diseases and treatment options.

As Healy explains: “The technology is there, but it doesn’t tell you much – yet. However, in areas like breast cancer, the use of the BRCA and HER-2 biomarkers is well-established and gives a clear indication of whether a certain class of patient is at risk or will respond to a specific drug like Herceptin.”

Healy says that, in the hospital of the future, an individual’s genetic profile is likely to be available in the same way as access to, for example, an individual’s blood type. She says: “We’re still quite far away, but we’ve decoded the genome and can do it cost-effectively. With further research we will be able to know how to make best use of this data to deliver more effective health care for individual patients.”

A UK government science and innovation audit of precision medicine in Scotland this year, led by the University of Glasgow, highlighted the significant assets Scotland has in this field and their potential. It suggested the effective use of electronic health records could drive collaboration and help turn academic research and innovation into better clinical practice.

Healy says the university’s bid for a Strength in Places grant to create a “Living Laboratory” for precision medicine at QEUH is an excellent example of how Scotland can bridge the gap between genomics research and patient benefit.

Digital health, which uses software, mobile apps and digital technology for health purposes, is an area where Healy thinks Scotland has work to do – but has all the key skills in place to make real progress.

“We have real strength in informatics, data science and AI in our academic research institutions,” she says. “Although we need to integrate those sectors better with life sciences and healthcare. The potential is there to build real capacity and deliver tangible patient benefits.

“In terms of digital health, this means making healthcare more efficient through use of digital technology, and improving the patient-facing offering.”

Scotland has great assets in the IT sector generally, from “Silicon Glen” to the burgeoning technology scene in Edinburgh. The capital is set to receive further investment in technology infrastructure as part of the £1.3 billion Edinburgh City Region Deal, which will focus on data-driven innovation and help boost Scotland’s existing capabilities.

The key to realising Scotland’s potential in the new digital health industry will be in linking the country’s digital expertise with its life sciences expertise to create new solutions. Work to link Scotland’s technology and life sciences industries has already begun. Exscientia, a company founded in Dundee, has been at the forefront of using digital technology to improve the drug discovery process, resulting in several collaborations this year with big-name drugs companies.

Further collaboration between the two industries will be supported by Glasgow’s Industrial Centre for Artificial Intelligence Research in Digital Diagnostics – iCAIRD – which involves 15 partners from across academia, industry and the NHS.

Healy stresses that although collaboration between private companies and the NHS has huge potential benefits, these collaborations must be structured correctly. It is especially important to address ethical and legal issues in accessing and managing patients’ data.

The collaboration between Google’s DeepMind and London’s Royal Free Hospital, which involved the transfer of personal data of 1.6 million patients, was an example of a collaboration that was not structured correctly and was found to be in breach of data protection laws. Healy says: “This erodes public trust in these types of initiatives, despite the very obvious benefits in healthcare treatment that can be generated.”

Despite this setback, DeepMind’s Streams app is now in use at the Royal Free Hospital and has been shown to enable consultants to treat acute kidney injury faster, potentially saving the NHS on average £2,000 per patient and saving consultants up to two hours per day.

“The great advantage for Scotland is that we have one NHS. We can access data sources more easily and we can pool it more effectively,” says Healy. “However, practices can vary across different hospitals and trusts, and clear central guidance would be helpful to ensure data is used both ethically and effectively.

“There are also issues around data quality as it is, of course, collected for clinical purposes, not for research or for training artificial intelligence systems.

“The ultimate goal is to pool data for patient benefit, and to structure collaborations between private companies and the NHS carefully so personal data is managed appropriately.”

There are also potential societal and political issues around ensuring all patients can benefit from digital health initiatives, for example in areas like GP surgery triage. Systems such as Babylon and DrDoctor allow patients remote access to GP services, but often benefit specific groups rather than the whole population.

“Younger, more IT-literate patients who have a specific issue but are generally healthier tend to use systems like this, while older, less IT-savvy patients with chronic conditions still go to GP surgeries,” says Healy. “So GP surgeries are left with patients who need more care and time, but the funding per patient is the same. The digital health gap between different generations will close over time, but it is still quite wide now.”

Overall, Healy notes, the message is that digital health offers huge opportunities in Scotland:

“We need to encourage more health tech businesses to work with the NHS in Scotland and get more entrepreneurs looking at this area. There are big opportunities for new entrants.”

In the third new life sciences industry, early diagnostics, Healy also sees “a huge area of unmet need and opportunity” in Scotland. She cites image recognition AI, where, for example, training an artificial intelligence system using large numbers of CT scans can mean tumours are spotted more quickly and accurately than using a surgeon’s eye, leading to earlier diagnosis, which in turn means more successful treatment for patients and potential savings for the NHS.

Scottish-based companies, including Canon Medical Research Europe, are exploring how technology such as AI can help with early diagnosis. Canon’s research, supported by the Scottish Funding Council, is looking for innovative ways to diagnose and measure mesothelioma tumours, which are particularly difficult to measure and treat.

Collaborations between Scottish companies and the NHS which capitalise on the organisation’s pool of health data will be a big boost to research and development of early diagnostics, particularly with the help of AI.

Although Healy recognises the challenges in collaborating on such projects, she is positive about the future: “It can still be hard to break down NHS silos and work through its contracting processes. However, Scotland’s strength is underpinned by excellent collaboration between the NHS, academia and industry. You can see it working in projects like iCAIRD and the QEUH’s Clinical Innovation Zone.”

Healy sees this as a good reason for Scotland to be positive about its life sciences industry and its opportunity to make the most of Sir John’s three new industries – genomics, digital health and early diagnostics. “It all comes back to that strong, deep collaboration. We need to build on that and keep selling Scotland’s strengths to a wider global marketplace.

“Our academic base is really strong, we have one NHS with very good electronic health records and the ability of industry to collaborate across different academic and NHS bodies to deliver positive patient outcomes.”

Find out more at CMS.