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The Official News & Technical Journal Of The International Society For Pharmacoeconomics And Outcomes Research
Incoming Presidential Address

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.

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