|
Chris L. Pashos PhD, 2008-2009 ISPOR President and Vice Pres & Executive Director of HERQuLES,
Abt Bio-Pharma Solutions, Inc., Lexington, MA, USA
 Communication is critical. Cooperation can
lead to some very positive outcomes.
Collaboration can yield some unexpected
benefits as well as risks. So last Saturday flying
into Pierson International Airport, I joined forces
with my colleague, Svetlana Danovitch, and then
a leader of another organization, Bill Marder. Bill
is the leader of what had been Medstat, now part
of Thomson, the global Toronto-based global
health care information company. Because we
are here for ISPOR, he wanted to get up to speed
on health and health care in Canada as soon as
he could. So as we were being driven into town,
Bill started to engage the taxi driver. At first he
thought he needed to act like a Canadian so he
started to administer the Health Utilities Index,
the HUI
The HUI is one of Canada's great contributions to
our field. It is a leading measure of patient outcomes
and you should know that it was developed
by Professors George Torrance, David
Feeney, and William Furlong. Dr. Torrance in particular
is a giant in our field, at least figuratively,
and is with us today. A longstanding contributor
to ISPOR, Dr. Torrance is the first person to conduct
research and teach at McMaster University
in pharmacoeconomics and outcomes research.
Indeed in 2006 he received from the ISPOR
Avedis Donebedian Outcomes Research Lifetime
Achievement Award, a true scholar, entrepreneur,
and global citizen. So thank you very much
George. So the HUI was administered and we
identified where our taxi driver fit within a continuum
of 972,000 unique health states. We continued
to think about Canada's contributions to
our field of pharmacoeconomics and outcomes
research, after all the focus of this conference is
enhancing, expanding outcomes research one
country at a time. And for this country or for this
time for this conference we certainly wanted to
think a little bit about Canada.
So let's take a look at some of the organizations
who are making important contributions to pharmacoeconomics
to outcomes research in
Canada. Front and center is a Canadian agency
for drugs and technologies in health. CADTH is a
national body that provides Canada's federal,
provincial, and territorial health care decision
makers with credible impartial advice and evidence-
based information about the effectiveness
and efficiency of drugs and other health technologies.
There are so many other organizations,
governmental, academic, commercial, that have
us moving one organization at a time. On the
slide you can see but some of those within
Canada, many within Ontario, but across from
British Columbia through the provinces, Quebec,
Ontario and onto into the Atlantic provinces.
Thank you to all these organizations born and
raised in Canada that are helping to move our
field forward, not just one country at a time but
are also sharing their ideas worldwide just as
Professor Adrian Levy characterized Sir William
Osler yesterday at the opening plenary session,
in this case pharmacoeconomics
is
not just local, it's not just provincial, not just
national, it's international. And certainly Diana
mentioned the growth, the breadth of our organization,
4,100 individuals across 96 countries.
Anyway, the taxi driver; getting back to him.
Achmed said some things seem to be out of kilter.
He noted recently that an elderly man had
just died in an emergency room waiting to be
seen in and triaged. That was the headline a few
weeks before. He also noted another person who
had died in an in-hospital episode after the surgeons
had operated on the one leg that was okay
while leaving untreated the diseased leg. I'm not
saying those to be funny but just to say that this
individual had noted the headlines in the newspapers
and those were uppermost in mind. That
said, he proceeded to describe health and health
care in Canada at least from his perspective.
People tended to wait for their care. Sometimes
they waited a long time but eventually they tended
to get the most important basics of care and
he and his family, he and his friends were happy
about that. His perspective was that Ontario in
each of the provinces did a great job promoting
health and wellness given constrained economic
resources. Not exactly his words but that was
the message he gave us. Given this wonderful
model, perhaps we should hold more of our
meetings here in Canada. It was interesting to
note that our taxi driver focused not on the sensational
headlines but on the common everyday
experience with which he and his family and
friends were most familiar. Perhaps as Professor
Levy alluded to yesterday, he was just being a
polite Canadian.
The stories and more specifically the headlines
that each of us read these days indicate that there
are ample examples of inappropriate behavior
among those of us engaged in clinical research
and the development of, and commercialization,
and even regulatory oversight of pharmaceuticals,
biologics, and medical devices. That
includes the clinical community. That includes
the policymaking community. Even on occasion
there's misconduct among the students among
us. No one of us, no one group of us is immune
from these types of stories. As health care practitioners, decision makers,
researchers, these headlines and stories can be
disappointing. They can be frustrating. You've
certainly noticed that. Headlines such as the FDA
is overwhelmed and not protecting the people
from injurious products. In the United Kingdom,
Fleet Street tabloids, NICE is not nice. NICE is
nasty. Even in JAMA, the headline for an editorial
is, For-Profit Entities Impugn Medicine. How
should we respond? Just this past week it was
enlightening to read quotes from three leaders of
the world's pharmaceutical industry. Richard
Clark from Merck, “I can't blame the media.
There is a trust deficit we have to fix. We have to
become more transparent about spending, about
relationships with docs.” Move to Pfizer and its
chief executive officer, Jeff Kindler, “It's important
for the industry to communicate with integrity and
to do everything it can to ensure the integrity of
the data and the science.” And finally, across to
the United Kingdom and Andrew Witty,
GlaxoSmithKline, “Drug makers need to listen
more and talk more particularly with drug buyers
about the true value of new medicines and with
government. Pharma and regulators are like two
ships missing in the night.” In these statements,
these global industry leaders are noting how
important it is for us to be rigorous in our
research, transparent in our methods, open in our
communications, and as importantly ethical in
our behavior.
Many years ago I worked with Professor Roger
Porter at Harvard University. Professor Porter
was an important economics and policy advisor
to several presidents beginning with President
Ford in the mid-1970s. Based on lessons he had
learned, he shared with us examples of his many
years within the West Wing of the White House.
He repeatedly emphasized to his colleagues, to
his students, one important point. This point
focused on personal behavior in any position of
leadership or follower-ship, whether in government,
in academia, or in industry. He said, if you
don't think your actions will look good on the front
page of the New York Times, or if you don't want
to see those actions highlighted on the front page
of the New York Times, don't do those things. Let
me suggest that we individually and collectively
as a society and collectively as parts of important
organizations around the world, that we be mindful
of this admonition. We are more than what we
do. We are more than modelers. We are more
than patient registry folks. We are more than
pharmacoeconomic specialists and outcome
researchers. We are as well how we do what we
do. ISPOR members, you, its members, have
worked diligently on ISPOR's Task Forces. We
saw all those great stories yesterday from ISPOR
Founding Executive Director Marilyn Dix Smith
and ISPOR President Diana Brixner. We've developed
good research practices, practice guidelines
to move our field forward. Guidelines have
been or are being developed and shared on the
ISPOR website on so many aspects of our work,
modeling, retrospective databases, patientreported
outcomes, but there's one example of
these guidelines that has now been developed
twice, the original and then the revision. It's not
focused on methods. It's the ISPOR Code of
Ethics. That is how we should do what we do in
terms of design and research practices, in terms
of sponsorship, in terms of publication and dissemination,
in terms of relationships with each
other and with external constituencies as well as
the role of ISPOR.
The main objective of the code is to help the science,
pharmacoeconomics and outcomes
research avoid or otherwise deal with the credibility
challenges that we see day in and day out in
the media. The newly revised Code of Ethics was
developed with input of all of the ISPOR membership
with a leadership provided by a cross-section
of ISPOR members from here in Canada, UK,
the US, and from New Zealand. These included
four professors, two pharmacists, two industry
officials, one commercial researcher. When this
important task force was created, we did not
leave out or exclude individuals because of their
place of employment. Indeed we would have
welcomed more individuals to participate.
Indeed if anything, ISPOR is unique in its attempts
to reach out to other groups or constituencies in
what we do, either as practitioners who do the
type of research that we do or complementary to
it, as clinicians and policymakers and other users
of that research, as students who will succeed us
as research practitioners or users, and even as
patients or other societal groups who are affected
by the research and its interpretation. As
ISPOR members indeed as participants in health
care practice, research, policy communities, etc.
please become familiar with the ISPOR Code
of Ethics.
When I first formulated a vision statement of what
I perceived as the vision for our society, I thought
about SR-squared and Three-C. Scientific Rigor,
Societal Relevance. We must always work to
promote the scientific rigor and validity of our
research while remembering that the value of our
work will increase when we present it in ways
that effectively meet the needs of typically skeptical
audiences. So as a result the Three-C,
Collaboration, Collegiality, Communication. You
might ask why, what does it matter what we do or
how we do what we do. All you have to do is see
the very front page of yesterday's Globe and Mail,
Canada's national newspaper, reproduced on
their website. The headline, With Neonatal
Resources Stretched Thin, More and More High-
Risk Infants are Sent South to Find a Bed.
Frustrated Doctors Demand a National Birthing
Plan. Then it laid out a variety of numbers, average
cost per day for something, average cost per
day in Canada, average cost in the U.S., average
length of stay, etc. This was a health economics
story on the front page of Canada's national
newspaper. Does what we do matter?
Absolutely. Our societies depend on us from the
very youngest to the very oldest. Students,
please take note. All of us should take note.
What we do matters, one country at a time, one
individual at a time. You have my commitment
that I will work building on the fine example set by
the leaders of ISPOR over these past 13 years to
continually work with all of you to improve our
methods, to improve our rigor, as well as our
communications and collaboration with other key
constituencies and to keep our ethical obligations
uppermost in mind.
In this regard, I'm very pleased to be accompanied
by a talented and very worthy Board of
Directors that you voted upon. Let me take this
moment to introduce the incoming board to you
and provide even more complete introduction on
our new directors. First, our immediate-Past
President is of course our current President,
Diana Brixner PhD, Professor at the University of
Utah. Our first new member of the board is
President-elect and ISPOR President for 2009-
2010, Dr. Michael Barry PhD, MD, BSc. Dr. Barry
is a clinician at St. James Hospital, runs clinics in
cardiovascular and internal medicine. He's a senior
lecturer at the University of Dublin, Trinity
College, and Head of the National Center for
Pharmacoeconomics in Ireland. Four Board
members who are continuing include the ISPOR
Treasurer, Dr. Karen Rascati PhD, RPh, of the
University of Texas, Dr. Lou Garrison PhD, of the University of Washington, and Dr. Richard Willke
PhD, at Pfizer in New York City, and Dr. Marilyn
Dix Smith RPh, PhD, Founding Executive Director,
ISPOR.
Other than Dr. Barry, we have now five new directors.
Typically we add three new each year but
again with the growth that we've seen we've
increased the size of the board by two. So the
five new members aside from our incoming
President-elect are Penny Mohr, Director of the
Division of Research and Health Plans and Drugs
at the Centers for Medicare and Medicaid
Services. Among her many duties is her service
on the CMS Council for Technology and
Innovation. Next is Paul Kind. He has a wide
ranging, multidisciplinary background research
career focusing on the development and application
of health status measures for use in clinical
and economic evaluations. Until this year he was
Professor of Health Economics at the University
of York. Dr. Zeba Khan PhD, RPh, trained as a
pharmacist. She is Head of U.S. Pricing, Price
Strategy and Policy at Novartis Pharmaceuticals.
Don Husereau, previously a community pharmacist,
currently Director of the Health Technology
Assessment Development Group at the Canadian
Agency for Drugs and Technologies in Health. As
well as Dr. Shanlian Hu MD, MSc, a medical doctor
and health economist, Dr. Hu is a Professor of
Health Economics, Director of the Training Center
for Health Management, and Director of the
Pharmacoeconomics Research and Evaluation
Center at the School of Public Health at Fudan
University in Shanghai. I welcome this opportunity
to work with and for you to advance ISPOR
and further the understanding, the practice, and
the importance of pharmacoeconomics and outcomes
research around the world. I invite you,
indeed I encourage you to become active in
ISPOR, even more active than you already are.
Regardless of our employment, regardless of our
geographic home, regardless of any factors that
may divide us, we truly are in this all together.
Look at your career, look at your service to our
field as indeed one that matters. Not only should
we look at moving forward pharmacoeconomics
and outcomes research one country at a time but
we as individuals should move our field forward
one person at a time just as did Canada's Sir
William Osler, just as did Canada's Dr. George
Torrance, just as do so many of you from around
the world. What contributions will you make?
Thank you very much. |
