The Pharmafocus Interview: David Gillen
pharmafile | February 3, 2009 | Feature | Research and Development | Pfizer, UK, medicines access
David Gillen says he is a born optimist. But Pfizer UK’s medical director says this positive outlook doesn’t blind him to the industry’s problems, the biggest of which, to his mind, is its reputation.
“The relationship the industry has with the NHS and academic medicine is frankly a very strange – and inappropriate – relationship. One based on mistrust and misunderstanding.”
He relates almost every question – be it about NICE or pricing – back to this relationship. Gillen is particularly focused on the question because he is working with his fellow medics in a special Royal College of Physicians (RCP) working party aimed at improving the relationship between doctors and the industry.
“The most common misconception is that it’s all about profits and not about patients. But the people I work with are probably individually the most ethically minded and ethically driven that I know.”
He says the poor reputation is partly due to the aggressive media in the UK, that doesn’t necessarily understand the industry.
Gillen says a recent Pfizer campaign to warn men about the dangers of buying counterfeit Viagra online was treated with great cynicism by some, due to the industry’s reputation as profit seeking.
“People ask, ‘this is all about patents and money, isn’t it?’ But that’s not the case; it’s not all about money. Clearly it is partly about protecting the business, but most of all it’s protecting the patients. If patients go online and buy counterfeit medicines, God knows what they’re taking.”
But he says pharma must take some responsibility for the mistrust: “I think in the UK we do a lot of good things for patients, the NHS, and the UK economy. But we just don’t get our message across very well.”
Tackling cynicism
He reflects how the same mistrust of industry has damaged the UK in terms of innovation and investment, and made it less attractive as a market compared to other countries.
He thinks slow adoption of innovation is partly due to the way doctors are taught, and partly due to the cynical side of the British psyche. “Anything new, we are slightly sceptical of it. UK physicians have always been sceptical about new drugs.”
He argues that this can then mean a lack of investment – global companies looking to carry out clinical research no longer consider the UK as a good base due to poor performance in clinical trials, which has happened as a result of poor joint-working. “The NHS and the UK haven’t got a great record in the delivery of clinical trials over the last few years. The processes are too slow, the recruitment reliability of patients is not good enough, and probably the attitude of investigators towards commercial trials is not as good as it is in other countries.”
But as an optimist, Gillen says this can and will change. In fact, he believes it has already begun to improve over the last 18 months, even if just in small patches across the country. He praises the “real commitment” from the government to help improve the environment for clinical trials, which he says is making progress. But he refuses to talk too long about government, and believes the issues of partnership between NHS and industry go deeper than party politics.
“We’re not getting enough science in schools, we’re not getting enough good scientists coming out of schools into industry. There is not enough transference between academics and industry. It’s a problem.”
Gillen is fascinated by the innovation of industry and would choose to practice medicine and come to industry if he had his time again. But he is also sorry so many young doctors regard a transition into pharma as “crossing the Rubicon”, and says it is another manifestation of the poor association between industry and the health service.
Pharma-doctor relationships
Gillen has decided to back up his words with action, and for the last year he has been involved in the Royal College of Physicians (RCP) working party.
The group is made up of RCP members and representatives from the UK pharmaceutical industry, who have met regularly over the past 12 months to examine the relationships between the two sides.
They have looked at any political, economic, commercial, organisational, professional and public barriers to creating the ideal relationship. The group says the overwhelming principle underpinning the initiative is to improve patient care, and a report written by Lancet editor and the working party’s chairman Richard Horton due in February will reveal their conclusions.
Gillen says the initiative will be a landmark, and clearly believes it could make a difference.
“It’s about trying to reconstruct this relationship which has got to a place where it shouldn’t be, and needs to get into a position where we put the patient at the centre. We can do that better.”
His belief that it can be achieved is based on the fact that academic/industry links are fundamental to discovering new drugs, and have been since the beginning of modern drug discovery.
“If you look at Alexander Fleming with penicillin, and most of the major breakthroughs in medicine, the discovery occurs in the academic sector, then the innovation and bringing it to market came through industry.”
But he admits an area in which pharma has gone wrong over the past few years is transparency.
“We’ve got a long way to go, but we’re making strides. We’ve got to go further in terms of our disclosure about clinical studies. We also need to think about disclosing our payments to opinion leaders.”
The US operations of Pfizer and rivals GSK both announced plans to declare such payments in 2008, and now companies in the UK and Europe may follow suit.
Gillen predicts change must come in how pharma companies fund continuing medical education. “It seems to me that we put money in and we get criticised for it. So something there has got to change.”
Gillen says people from the US and Europe have already taken an interest in the project, leading him to believe it could have an impact on a global level.
“We [the UK] are not a big player in the world, but we do have a lot of influence. We punch above our weight. If you look at where evidence-based medicine started, it started in Oxford with Archie Cochrane. If you look at where this reputational change can start, it can start here, and we can maybe help change the industry’s reputation around the world.”
Sutent: The UK against Europe
Sutent gained its European license for treatment of renal cell carcinoma in 2006. It is now commonly prescribed in nearly every country in Western Europe but it has yet to gain NICE approval for standard use on the NHS.
Gillen says, “I feel like the poor man of Europe when I go to medical meetings representing Pfizer in the UK, even with my Pfizer colleagues in Europe. They all say: ‘why can’t you use this medicine? Why doesn’t the NHS allow it?’”
Clinicians who treat these patients see Sutent as a big step forward. It’s seen by most countries in Europe as that as well, and used as such; yet in this country it’s not.”
Sutent and its rivals in the renal cell carcinoma field (Bayer’s Nexavar, Wyeth’s Torisel, and Roche’s Avastin) were rejected on grounds of cost-effectiveness in August. Even though it shows clinical improvement in many patients, most of those receiving the drug have had to pay for it themselves or make a case for ‘exceptional circumstance’.
But Gillen believes the drug may now be approved in NICE’s new ‘end of life’ QALY which makes it easier for cancer treatments to gain approval. “We have the reappraisal in January, and maybe that is fortunate timing considering NICE’s new approach.”
“The drug is designed for a finite population of patients with a limited potential improvement in mortality, so it seems to fit the criteria for that more flexible approach. He adds, “I think it is appropriate for a country of the size and with the prosperity of the UK.”
Biography: Dr David Gillen qualified in medicine from St Mary’s hospital in 1992, where during his undergraduate medical training he completed a BSc in physiology and clinical pharmacology.
He retained this interest in pharmaceutical medicine during his postgraduate training in medicine, cardiology and general practice. After working in the health service for about eight years, in cardiovascular posts in hospital medicine and in general practice, he joined Pfizer Global Research and Development in Sandwich in 1998.
At Pfizer, David has worked in R&D and medical affairs for the UK, and for global operations in New York for four years. He rejoined Pfizer UK in April 2007 having spent two years at Wyeth UK as medical director from 2005.
He currently leads a team of approximately 200 colleagues in a diverse medical department, which includes functions such as medical affairs, clinical research, drug safety, regulatory and medical information.
He is active in the UK clinical research community and serves on sub-committees of the ABPI, NICE and UK Clinical Research Collaboration.
He is currently is a member of the Royal College of Physicians working party looking at the relationship between industry, academic medicine and the NHS.
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