Plugging in to London’s Capital Markets and Support

The UK is at the forefront of life sciences innovation. Break through companies across the UK are creating cutting edge therapies, highly skilled jobs, and driving economic growth. But business and Government recognise that more still needs to be done to create stronger links between the life sciences and business community.

Large pharmaceutical companies, the likes of GlaxoSmithKline or AstraZeneca, may dominate the headlines and the attention of investors but the ground breaking work is often being done by growing and specialist firms. It is these companies that need our support if we are going to put the UK firmly on the global life sciences map.

The general pace of innovation taking place amongst these companies is astounding and we’re seeing biotech businesses look for funding. This is fuelling stock market listings and long-term investment in small and early stage biotech companies.

£2.4 billion was raised in IPO and follow on capital in the UK-listed life sciences sector in 2017, a 20 per cent increase compared to 2016. What’s more, funding was driven by companies returning to the market; over £2.1 billion was raised in follow on capital in 2017, a six fold increase compared to 2016.

Not only does this highlight long term investor appetite but London’s ability to finance life sciences’ company growth through access to  deep, liquid pools of multicurrency capital and blue chip investors with expert knowledge of the sector.

Another trend we’ve seen in 2017 is the public market’s ability to support innovation. Two specialist investment vehicles, US-based fund BioPharma Credit, a closed ended investment company focused on the life sciences industry, and Arix Bioscience, a firm focusing on generating value from health and life sciences, listed on the Main Market raising respectively $762 million and £100 million. BioPharma Credit became the first London listed fund to specialise in debt financing for the life sciences sector.

The float of Novacyt SA, a French diagnostics group, on AIM in November 2017, also highlighted the continued appetite for international life sciences companies to list in London. The firm is rapidly growing and aims to become leader in developing new products for the infectious disease and oncology testing markets.

Equity funding is the right sort of capital for these companies, be that angel investment, crowd-funding, venture capital, private equity or a stock market listing. We believe these firms should be spending as much as they can on Research & Development.

But the UK public markets are just one of the many ways in which London Stock Exchange Group supports fast growing life sciences firms.

ELITE, LSEG’s business support and capital raising programme for high growth private businesses, helps companies better prepare and structure for external investment. A number of UK and international life science firms have already joined the global ELITE community.

Oxford-based radiology firm, Adaptix, which provides low radiation & 3-D imagining, and Midlands-based, life-saving regenerative medicine company, Celixir, are just a few examples of British life sciences businesses at the cutting edge of healthcare innovation.

The excitement in life sciences is palpable across the UK. The building blocks are there and now we have the opportunity to capitalise on this progress. London Stock Exchange is committed through ELITE and its public markets, such as AIM, to foster the growth of home-grown and international life sciences businesses. Together with UK business and Government, we will ensure the UK retains its allure across the international life sciences community.

Written by  James Clark, Head of Tech & Life Sciences, London Stock Exchange

The One Nucleus blog is written by individuals and is not necessarily a reflection of the views held by One Nucleus.

 

 

 

 

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Posted in November 2011 | Leave a comment

Making Life Sciences Fashionable – What Can We Learn?

Kruger Crowne

Recently, I was fortunate to be invited to the Kruger Cowne Breakfast Club event held in London to hear two of their clients – Caroline Rush (CEO, British Fashion Council) and Millie Mackintosh (Entrepreneur, Designer, Model and Fitness & Health Ambassador) – discuss aspects of the fashion industry, supporting creative talent, entrepreneurship and business from their perspective. See some selected highlights at http://www.krugercowne.com/events/caroline-rush-millie-mackintosh/

Fashion may feel a long way from Life Sciences & Healthcare, but it was striking how so many of the challenges faced and advice given resonated with much of what I hear in our sector. The insight started during the networking beforehand in discussion with experts from a branding and PR company. We discussed the challenges of building trust with your target audience. Whether that audience is customers, stakeholders, investors, employees, colleagues or other depending on your specific company, how to engage and build trust in a technology-driven world is changing that engagement practice. Maybe our sector has much to learn from other industries in this regard as health technology and growing patient engagement are playing such a vital role in aspects such as early diagnosis, clinical trials and patient adherence. Interestingly, how to penetrate an industry sector such as Life Sciences, where terminology and a perceived desire to be closed to ‘outsiders’ was viewed as a challenge for those wishing to bring in new ideas and help.

As the main interview and audience Q&A of the Kruger Cowne Breakfast Club progressed, ably prompted by host Adrian Sington, the discussion revealed a number of common challenges (and similarities) across our two sectors. The increasing need to have multi-disciplinary teams to be able to create and position the value proposition to customers/investors is common to both. There was also discussion of the need to be relevant and in the moment, appreciating what is currently vexing and worrying the person you are pitching to at that particular time. Perhaps in Fashion, trends, technologies and customer needs move on faster than in our industry, although technology is changing our sector very rapidly.  Maybe staying timely and relevant is becoming increasingly important in aspects such as engaging patients, educators and investors.

One clear similarity in the Fashion and Life Science sectors is that talent is key. Creating new medicines is a very creative process and that, much like in Fashion, requires creative and innovative thinkers with the confidence to express their ideas. So where does that confidence come from and how can it be nurtured? The British Fashion Council takes a leading role for their sector by providing, awards and recognition to upcoming talent.  They have established the Fashion Trust to help entrepreneurs get started and address their business challenges, driving global platforms such as London Fashion Week to showcase designers and much more. There were also similarities in the skills arena. There was a feeling that our education system may be extremely well suited to developing new designers with the creativity skills and entrepreneurial drive required to start and grow new businesses. Success depends on many skills and functions such as machinists and pattern cutters to translate designs to products. Our education system may be less well suited to producing a deep labour pool in the production and manufacturing orientated roles which require different skills levels and aptitudes. These functions play no less an important role in translating a great idea into a great product than any other part of the process. If the UK is to grow the manufacturing and production side of the industry, scaling our businesses and driving economic growth it is important we enable an ambitious and entrepreneurial labour pool across all skills. This is not dissimilar to what I hear from our own sector. The Life Science Industrial Strategy seeks to address this issue through initiatives such as Cogent, increasing apprenticeship usage and investment in bio-manufacturing facilities with training. A desire to increase our innovation capacity. Another common challenge is how to capitalise on excellence in research and innovation to create jobs,  spreading the health and wealth benefits in regions neighbouring centres of research excellence yet not seeing economic benefit from those centres.

From an entrepreneur’s viewpoint, what were the key lessons?

Almost immediately it was set out that whilst the talent to design is essential in starting and growing your own business, an appreciation of what other parts of the business do is vital.. The founder needs to be aware of the importance of surrounding themselves with people with the complementary skills and competence required, so that they can focus on their value-adding role. An example given was how employment with an established company can provide exposure to, and hence appreciation of, the related administrative and support functions required to run a business. Such awareness being a big step on the way to a company founder assembling the right team to enable their success.

Enabling company founders to gain such awareness can be a challenge in our sector, especially where they focus on perfecting their scientific or technical skills. A small, focussed employer may not have the capacity to offer employees a rotation-style training programme where they spend time in other departments in order to understand the overall business. Such schemes are seen in larger employers, but less so in the small company space which accounts for a great deal of our industry. There is no compelling reason in my mind why universities are able to provide such an enlightening environment or should solely be charged with doing so. There are excellent examples of training in entrepreneurship and business skills, though that can only go so far perhaps. Work placements may be a scale-able and effective local solution whereby industry can play its full role too. I mention local since I feel there may well be a factor that some things happen best locally with central facilitation rather than control – the cluster effect! By helping students to gain awareness and insight of career possibilities (laboratory or business), organisations such as One Nucleus can make a useful contribution to developing a comprehensive talent pool for a cluster. Engaging our members in nurturing future talent in all roles is at the heart of a not-for-profit group such as ours.

We need to consider where the creative, and perhaps disruptive, ideas will come from.  At the Kruger Cowne Breakfast Club event, it was suggested that pathways need to be created for all. All sectors need to have a somewhat porous envelope that career builders can enter from multiple starting points, backgrounds and experiences. This is really about enabling true diversity in the sector. Access via multiple pathways, with guidance to those on their journey from established players, can avoid the industry sector being seen as too elitist to allow others in. A clear perception from the pre-session networking I mentioned above on this occasion. Elitism, real or perceived, increases the risk of a sector becoming less relevant, therefore not attracting the best talent. So I feel in our sector we must show due consideration to pathways – career pathways that attract, retain and enable the best talent and patient pathways that enable innovative solutions to be delivered with full engagement to improve outcomes.

So what do I feel I learned from the morning’s session? :

  • I saw many parallels across the Fashion and Life Sciences industries that reminded me of the common challenges we face in sustaining and building upon the successes to date
  • It also reminded me of what a highly creative and innovative powerhouse the United Kingdom is, in biomedical research, technology and design
  • An industry cannot be closed to new, sometimes disruptive ideas if it wishes to stay relevant and competitive
  • Access to capital at start-up and growth is key for all entrepreneurs

What I didn’t touch upon above was communication and engagement skills. Social media has changed society in terms of reaching customers, business partners, policy makers and talent. Maybe our industry starts from a difficult place to engage with non-specialists due to the complexity and terminology. Perhaps the Life Science industry has fewer good visual examples compared to Fashion when selling the product and engaging an audience.

The Fashion industry shows us however that creating excitement within your target audience, stimulating the conversation to get engagement and realising that people value the experience at least as much as the price when ‘buying’ are very effective. Our sector is increasingly enabling patient engagement by moving away from trade-trade dialogue to trade-patient dialogue. So we are adapting to a new landscape already. Our challenge is to expand that engagement to ensure we attract all the skills we need to grow our businesses, from high end science and business to technical, administrative and logistical support roles and those with the capital to join our sector on its journey to improving peoples’ lives. Creating the attraction not because it is seen as elitist, but because it is relevant, it makes a difference, is exciting and fashionable!

My thanks to Kruger Cowne and their clients for inviting me to the event and hearing their insights.

Written by Tony Jones PhD, CEO, One Nucleus

The One Nucleus blog is written by individuals and is not necessarily a reflection of the views held by One Nucleus.

Posted in November 2011 | Leave a comment

Artificial Intelligence and life sciences-the great coming?

The Prism Series “pop up event” Cancer research UK December 2017

Christmas comes but once a year. To most of us this is a really good thing as it costs so much. We look forward to all the festivities, parties and of course the consumption of too much food and drink. Part of the annual festivities is the annual Genesis Life Sciences conference held in London, pretty much on the same date every year. The conference which is the brainchild of Tony Jones and his team brings together all of the UK life science community to participate in discussions, exchange business cards and sometimes do fantastic deals. Tony has over the last few years come up with the idea of the Genesis Conference Fringe. Based on the Edinburgh festival but with less jokes, or maybe not, various ‘pop up’ events occur. These are at various venues all around London and on assorted topics appealing to most peoples Biotech tastes.

I had the pleasure this December to facilitate such a ‘pop up’ event on Artificial Intelligence and Life Sciences . The style of the event was that of a Prism Series, basically representing an open authentic discussion where the objective is engagement and community rather than the more traditional information transmission format (a dead duck!).

The event was held at the Cancer Research UK headquarters at the Angel Islington London. A really cool building with the sense of energy and purpose, an ideal setting to bring together people with interest and vision in what is artificial intelligence with in the arena of life sciences .

A really interesting and engaged group of individuals turned up. They looked good and even trudged their way through the sleet and snow to attend.Seeing life sciences from all sorts of perspectives from drug hunters to digital health, from IP lawyers to Ventures capitalists, they seemed a good bunch to get together.

The discussion was facilitated and ‘disrupted’ by myself and an interesting colleague Sanjeev Ahuja.  We have really different but complementary backgrounds My  perspective coming form many years in the Pharma world and Sanjeev from a deep Knowledge of Artificial intelligence .

The big question posed was is Artificial Intelligence just a buzz word for the moment. A catch all statement , the fantasy of science fiction or something turning up that will be so powerful our entire lives will change. Driverless  cars seem a reality ,is it possible  to  leave machines to discover novel therapeutics ie our lives in their hands! Humanity  seems to be putting both a monetary bet and almost a semi religious hope on computer power to solve the problems of an ever aging population and  new diseases. The Pharma industry rooted in  academic history relies on experimentation and hypothesis proposition using ‘wet work’ cells and tissues. Can algorithms and computers revolutionise this.

After a few hours of excited inclusive debate, covering aspects of  AI from literature mining, drug repurposing to  open innovation ,few big answers really emerged. The discussion and debate was the success of the event.

Will AI ever replace serendipity and human imagination. Some of the participants were hard on the old human . Humans can only deal with a couple of “vectors “at a time whereas computers can deal with many said one participant .The younger generation is more likely to trust the data ! Was another comment. Trust and value were clearly a key to people investing in the big bucks needed to set up artificial intelligence systems .How and at what part of the drug discovery sand development process could and should Artificial intelligence be  inserted.

-Healthcare is about treating mechanisms not diseases, phenomenological approaches to  treatment is over ! Maths and logic are the future

  • Data consistency and curation are central
  • -verification and validation to build trust is needed
  • AI is being used at various parts of the discovery process not to speed up the process but for decision making

Some real power statements were made

-Artificial intelligence is the last great technological advancement humans can make …….WOW

  • China is leading the strategic way ,pushing hard on this new technology
  • US and China are in front.
  • The uk has tremendous academic expertise but struggles to commercialize .Could the life science sector lead the way in capitalizing on AI
  • If we are a knowledge economy we must be in this !

The meeting finished with high energy, people were inspired there was  the promise to have another event and event build an AI interest community. Lots of chat resulted and a great cappuccino of course  . The greatest complement came from a participant  who said they did not expect to say so much! this is the sort of event people want.

A lovely time and great people …..

To the next ………

Written by Tony Sedgwick @thoughtdisruptor.com

The One Nucleus blog is written by individuals and is not necessarily a reflection of the views held by One Nucleus.

 

 

 

 

 

 

Posted in November 2011 | Leave a comment

Why Opt-In Matters When Applying Digital Success Tracking to Patient Care

This is a guest post for One Nucleus by Toby Beresford. Toby is the Founder and CEO of success tracking network Rise.global. Previously he has worked as a developer of web based disease management for patients, dermatology tele-referrals for GPs and was deputy chairman of the public health sub-committee for Wandsworth Council. His email address is toby@rise.global

At the recent PRISM Series Dave Snowden told the story of how he self-managed his recovery from Type 2 diabetes – he called it his hero’s journey. It’s a story he has told before in a blog post “Early Detection, Fast Recovery”. Critically, he caught the disease early, refused to countenance “palliative” care and instead took control over his cure, targeting key factors such as diet and exercise. After 7 months he was rewarded with an all-clear diagnosis, saving himself from early death and the NHS from another expensive chronic patient.

Dave “self-optimised” to cure himself. He tracked his progress over time on key metrics and little by little he continuously improved his health.

I’d like to pick up on a key phrase from Dave’s story “My GP was happy to support the process but critically did not propose it.” What Dave is saying here is that this was a path to health not prescribed by his physician – instead he chose it himself, and that path less travelled made all the difference.

When a journey is optional to take, there is no prize for completing it and you track your progress along the way. When self-optimisation using data is wrapped in a digital medium such as a website or app, this is known as “success tracking” and it is growing in popularity.

The biggest advocates of the success tracking model are of course the makers of digital “fitness” pedometers such as those made by FitBit and its competitors. Indeed, this is already big business – Meticulous Research expects the worldwide success tracking for health market to grow to £2.8bn by 2022. So far so good, with many clinicians trialling a similar approach with their patients.

toby beresford fitbit dashboard

(Photo: fitbit dashboard by Toby Beresford)

However, it is all too easy for clinicians to ignore the design principles behind phenomenal growth of the activity trackers and default to the old-school “carrot and stick” model of motivation. They may expect to have the same take up with digital trackers for their disease area but by getting the motivational design wrong they may be surprised by their failure.

Daniel Pink, in his book Drive: the surprising truth about what drives us, calls the carrot and stick model “Motivation 2.0”. “If-then rewards” he says, “often do more harm than good.” It’s the next evolution of behavioural design, Motivation 3.0 that really works in the long term. Only when we give patients “Autonomy, Mastery and Purpose” will they truly succeed on their own.

Knowingly, or unknowingly, Dave Snowden’s “hero’s journey” used a classic Motivation 3.0 approach. He chose to ignore the palliative route for care expected of him and opted-in to a curative route. He tracked his own diet and exercise until he made a full recovery.

So, how can we replicate this new motivational model within the confines of our existing healthcare system and leverage the scale and affordability of a digital approach?

One key area to look at is preventative medicine. My next door neighbour, currently a few months shy of her 80th birthday, has recently joined a weekly “prediabetes” group after local screening highlighted her as being at risk. As well as attending training, she now tracks her cholesterol, weight, diet and exercise on a weekly basis. While not using a digital approach today, there is much in diabetes prevention that could be delivered more effectively and cost efficiently using a success tracking app.

It is in this sort of elective care that clinicians can most benefit from applying success tracking principles. There will be a huge difference in compliance when someone “owns” their journey as we tend to behave differently when we are measuring ourselves than when someone else measures us. For one, we are a lot more interested in the results.

As a regular swimmer I know this to be true in my own life. I now use a SwimTag at my local pool. It comes in the form of a bracelet, picked up at reception and worn during my swim. Later that day I always check the email notification to see how many lengths I managed. Sometimes I’ll drill down into the data to see how fast I swam and the stroke details within each length.

toby beresford swimtag dashboard

(Photo: SwimTag dashboard by Toby Beresford)

So, when it comes to health and digital disease management, patients who opt-in to take care of themselves are much more likely to achieve their goals than those who comply out of duty or subservience to authority.

How can we encourage patients to opt-in though?

Persuading patients to opt-in is of course the million dollar question. Clinicians vary in charisma and patients vary in their attitude and ability to comply!

While traditional persuasion techniques (ensuring full understanding, knowing the opportunities and risks, hearing stories from others who have travelled the same route, encouraging social support etc) will all be applicable, I’d like to focus on what we can do when designing the digital tools themselves. The medium is part of the message after all.

So, what should the tool do?:

Allow fast and granular opt-in and opt-out

I’d expect any tool to allow me to choose my privacy level. Maybe I could choose to appear on a benchmark ranking of other patients but appear as anonymous, or I could stay “unranked” but still see how I am performing against the average. Or, if I choose I could opt out all together. Few patients may choose this, but giving them the option to is critical to achieving buy-in. This level of privacy control is fundamental and implementing a patient success tracking program without it risks failure.

Connect to online social identities

I am much more engaged by results, scores and ranks put alongside my real name with my photo. If I’m comparing with others on the same journey then I’d like to see their current photo and name too. Facebook now has 2bn users, love it or hate it, integration with Facebook is de rigueur.

Feedback stories not just results

Human beings engage with stories more than they do with raw numbers. Data storytelling is a growing discipline and its principles should be used in any program. Telling someone they’ve hit a personal best this week is much more engaging than simply giving them their results and expecting them to work it out themselves.

Allow the magic of social proof to do its work

I’ve never forgotten my Psychology lectures with Solomon Asch. He showed that we will change our mind, even to the extent of declaring something patently false to be true, when confronted with a group of peers believing it. Conformity is a huge driver of behaviour change.

Provide easy ways to share progress back into social media

In his journey out of diabetes, Dave Snowden also talks about the value of his journey being made public, the fact that others were tuning in kept him on task. Now while a public figure like Snowden has many thousands of followers, there is no reason why this shouldn’t be true for every patient within their own social group. Sharing a health journey on social media may sound scary to Baby Boomers and Generation X but for Millennials it is close to being the norm.

What are the risks?

As with any new approach there are plenty of risks. Certainly any kind of behavioural approach, if designed badly, can have unwanted side effects. People respond to tracking programs in ways not easy to foresee when you are designing them.

One risk to be especially aware of is “gaming the system”. By ensuring there is no cash incentive or reward you cut out most of this (the only person a cheat cheats is themselves) but it is difficult to wipe out entirely. You could see patients focusing on one metric to an extreme degree – such as starving themselves to get their score (and weight) down.

Other unintended side-effects I’ve seen are where people take short cuts to achieve a higher score, clubbing together in cabals to beat the system. With people so focused on winning the “game” they are oblivious to what’s going on around them, even to the extent of breaking the law.

These issues are easy to identify but sometimes hard to prevent. That’s why following a good methodology can really help, or better still, getting motivational design help from an experienced “gamification” designer.

What are the opportunities?

But despite the risks, the opportunity for success tracking programs within health remains significant. Patients effectively treating themselves is a gold standard for public health – the closer to the patient you treat the disease the more cost effective it is. A hospital bed is an expensive way to care.

Success tracking apps can scale up and offer ways for patients to self-care, saving us all money.

Better health tracking can improve public health too. If we can avoid the development of more people with chronic diseases like diabetes the better it will be for society as a whole.

Trailblazed by FitBit, digital success tracking is at the beginning of what it can achieve in public health. I’m looking forward to seeing more programs developed over the next years – let’s just make sure everyone remembers to keep them opt-in!

 

toby web   Written by Toby Beresford, Founder and CEO, Rise.global.

The One Nucleus blog is written by individuals and is not necessarily a reflection of the views held by One Nucleus.

 

Posted in August 2017 | Tagged , , , | Leave a comment

My Letter to you Dear Entrepreneur…..

Putting the c in Science – Commercialization, Community and Capital

by Sharon Vosmek

I am very much looking forward to my up and coming talk at the 2017 ON Helix conference. As an early stage investor, I especially enjoy opportunities to talk with and learn from life science innovators. You see, for me, science is quite personal.

My talk at the conference will focus on the three c’s of science: Commercialization, Community and Capital. This blog will give you a sample of what I look forward to discussing with the conference attendees. For me, these speaking opportunities keep me connected to innovation and markets – it is what I hear and learn, much more than what I have to say, that makes the travel and time worth every bit of it.

I recognize that you – dear entrepreneur – may not realize just how personal the decision to deploy capital can be for me, the early stage investor. Just as your entrepreneur’s passion connects you to your innovation, your customers’ needs, and your business, it is my passion that connects me to my investments and the innovations that each is driving to market.

My portfolio is made up of a combination of companies that make me feel like I am doing something meaningful with my money and contributing to something that has real value to society. This is especially true of my life science investments, many of which are seeking solutions for patients, doctors, and health care providers in previously underserved markets.

As an investor I have choices. I could invest in much safer things like public companies, real estate, or even shoes.  But my early stage, private company investing is personal. It is as much a statement of who I am as anything else I do.

Why should you the entrepreneur want to understand this? Because it is what makes us – you and I, dear entrepreneur – more alike than you might realize. And this alikeness, should you and I take the time to fully develop an understanding and appreciation of it, can be a powerful tool for your company and the opportunities you are pursuing.

We both want to change the world – for the better. We both want to be a part of something bigger than ourselves. And we both have a tolerance for the risk associated with these desires. These are all things that can create a solid foundation for our relationship – you as an entrepreneur and me as investor. And if we both commit to taking the time to listen to each other, before we commit to each other, these bonds can sustain us through the highs and lows of the startup journey. In my experience, if this foundation is strong, these aligned interests can even endure through the absolute failure of a business and carry us through together to your next innovation and my next investment.

Of equal importance is what makes us different. I have found that the most successful investor-entrepreneur relationships are also built on a clear understanding of what each can uniquely bring to the table. I chose you because of the unique opportunity that your innovation presents to me as it relates to my desire to change the world. I chose you because I believe in your innovation and I believe in you as the entrepreneur who will get it into the hands of the market. Equally, you, dear entrepreneur, should choose me for the opportunity I bring to your innovation.  Of course I bring the obvious capital. But if you choose me well, I can bring so much more.

I am surrounded by smart, experienced people who may just be your first or next customers, your trusted advisor, your next hire, your market analyst, your next investor. Once you learn how the innovation economy works, you will see that 6 degrees of separation is more like 2 or 3 in this slice of the economy and the possibilities of who I might be able to help you reach are limitless. This is my community and this is what I can bring to bear if, and only if, we have taken the time to listen to each other, articulate the full potential of your innovation in the market, and identify how together we can unleash the full power of this network.

You see, for life science entrepreneurs, it takes a unique combination of ability to commercialize, ability to engage a community, and an ability to raise capital that is aligned with your innovation.

As I said at the start of this post, I very much look forward to hearing the thoughts of the innovators at the ON Helix conference. I see the day as yet another opportunity for us to identify how we can together build greater understanding between entrepreneurs, investors, and markets so that the fruits of the lab can make it into the waiting hands of the patient.

Written by Sharon Vosmek, CEO, Astia

The One Nucleus blog is written by individuals and is not necessarily a reflection of the views held by One Nucleus.

 

 

 

Posted in November 2011 | Leave a comment

Digital Health, the Embassy, Russia and the Future

The Department for International Trade (DIT) is a specialised government body with the responsibility for promoting UK trade across the world and attracting inward investment. DIT initiated the 1st International Digital Health Conference in Moscow, April 2017.

A strong UK delegation of medical experts made their way to Moscow to attend a digital health conference, organised jointly by DIT Russia office and Moscow State University on 20-21 April.

What proved to be a great success started two years ago from an idea to bring UK digital technologies to Russian medicine. The idea was taken forward and developed into a niche industry event which attracted more than 200 healthcare professionals. This was also the flagship event of the UK-Russia Year of Science and Education 2017. “Health science is an area where the UK and Russia are working closely together despite political disagreements”, said Jonathan Brenton, Minister-Counsellor Prosperity at the British Embassy in Moscow, during the opening ceremony.

At the conference experts described how a digital approach can make medicine more effective. Dr. Ilan Lieberman, Clinical Director for Integration at the University Hospital of South Manchester (UHSM), shared his plans for the launch of high-tech medical devices. For example, a glucometer that measures glucose levels through the skin, without injections, and a mini-DNA sequencer integrated in a smartphone. These and other devices, according to Dr. Lieberman, will go into production in the UK in about three months. There are also developments in Russia: for example, electrocardiograms (ECG) using a smartphone and an app.

Data from such personal devices, along with other information about the patient, should be stored digitally. Ideally, the data storage system should be standardised throughout the country, but, as Gary Leeming, Director of Health Informatics at Greater Manchester Academic Health Science Network (GM AHSN), mentioned in his presentation, in Britain such a system is far from being standardised. “Five years ago, we started to create an integrated remote patient monitoring system. In the process it became clear that data on the treatment of patients is often disconnected, stored in different systems, while patients themselves are trying to remember what medical services they should receive in different situations. As a result, a project of a self-learning health system was born, involving the use of Datawell, a system of sharing information for use by clinicians, an innovative smart cities programme CityVerve and ground-breaking test beds such as the Salford Lung Studies.

In Russia, until recently, no unified system existed until the program for the implementation of the Unified Medical Information and Analytical System (UMIAS) was launched in 2011-2012. Despite the fact that the new system is not yet perfect, this is a big step forward.

If digital technologies are really capable of transforming health care in the same way as other spheres of our life, then what is needed for their full integration into medicine? Dr. Ilan Lieberman cited two different examples – Israel and the United States, where people participate in the financing of innovative projects through taxes and are generally ready to accept the risk for this. In Russia, there are a number of challenges, one of the biggest is that according to current legislation any medical assistance must be provided to the patient exclusively in person. To change the situation, a new law “on telemedicine” is being discussed in the State Duma (the lower House of Parliament), said Alexandra Orekhovych, lawyer at the Internet Initiatives Development Fund, who is also involved in the legislative process.

The problem of shortage of healthcare workers can also be solved by means of digital technologies, according to Brendan O’Brien, Consultant in Clinical Informatics of the Board of Health and Social Care of Northern Ireland. Historically, this part of the United Kingdom has a large number of hospitals but only 70,000 healthcare employees for a population of a 1.9 million. “Thanks to the introduction of the e-medicine strategy, we managed to provide the lion’s share of medical services remotely. There are already about 20 thousand online receptions per month, 90,000 prescriptions are being written out”, said Dr. O’Brien.

Liz Mear, Chief Executive of the Innovation Agency at Academic Health Science Network for the North West Coast, also reported that the work of the 15 branches of the Network was aimed at reducing health care costs through digital technologies. At the moment there are already 345 different software solutions to serve the purpose. However, according to Liz, the digital maturity of medical institutions in the UK is not high.

The second day of the conference was fully devoted to m-health technologies. Conference participants noted several major problems that impede development of the market. 2016 was a tough year for the sector. Developers have continued to produce new medical applications so that the total number of applications in the world reached almost 260,000. In the meantime, users were not in a hurry to install them on their smartphones. In 2016, the number of downloads of medical applications increased by 7 percent, although in 2014 and 2015 the growth was more than 35 percent annually. The reason is that consumers have begun to lose interest in medical applications.

About one third of mobile medical applications are now not designed for patients at all. Young and healthy users of technical innovations use mobile applications to count steps, calories, kilograms or pulse during training. But this information is not critical for them. “Of those who start using trackers – to count the number of steps – in two years only half continue to do this. For various reasons, they do not see any further benefits from this, “said Oleg Medvedev, Chair of Department of Pharmacology at the Faculty of Fundamental Medicine at the Moscow State University.

Experts are confident that m-health needs to be integrated into the healthcare system in Russia, provided that applications are of a high standard of quality, reliability and effectiveness and focused on solving the patient’s problems, said Pavel Vorobyov, Director of the Higher School of Therapists. Of course, payment for mobile applications via general medical insurance would mean a revolution in the Russian healthcare. Without the criteria of quality, reliability and effectiveness of m-health with reference to the evidence base, this simply cannot be done.

“A fast integration of medical and IT technologies sometimes leads to the emergence of products on the market which are not adapted to specific clinical problems, while the regulation mechanisms of this market are still not mature enough. There has to be a sufficient evidence base for the safety and effectiveness of digital health technologies to be used in both prevention and treatment of various diseases”, said Sergei Boytsov, Chief Specialist of the Russian Ministry of Health in the field of medical prophylaxis, director of the State Research Centre for Preventive Medicine.

Another question: If a patient decides to download a medical application, what shall he or she focus on? Experts are unanimous: in this case, the rating of medical applications with recommendations for patients will help. “One of the problems in Russia is that we do not have a common list of medical mobile applications. We do not have their ranking from the point of view of the doctor and from the patient’s point of view, “said Oleg Medvedev. Now, if a patient goes online and tries to find something, he can make a lot of mistakes. There should be an independent system for comparing and selecting such applications.”

One more problem. “Nowadays the Russian developers of mobile applications and devices first create a new technology, and then ask doctors to find where it can be applied,” said Oleg Medvedev. The results of such implementation are mixed. Is not this the source of a large number of “junk” developments? “For example, for several decades, a large number of Russian engineers have endlessly developed stimulants for biologically active points, which had no scientific basis,” said Medvedev. They have made a lot of such devices. The result of this activity was zero – a huge loss of time and deceived patients.” “A few years ago I was invited to the contest in Skolkovo, Russia’s largest science park, where I could not approve any development at all, e.g. devices for electronic acupuncture,” recalled Pavel Vorobyov. “We need to start, at the development stage, from what medical problem should be solved with the help of a mobile application or device,” according to Medvedev. We need to include all stakeholders in the process of planning – doctors, patient representatives, psychologists, service providers. And immediately we need to think about the quantitative measurement of the results of the introduction of our technologies.” The criteria for evaluating m-health, based on the evidence base, would serve as benchmarks for developers and would help cut off “garbage” applications even during planning. “It is possible to clarify the requirements for m-health through running several pilot projects,” said Boris Zingerman, Head of the Information Technology Department at the Haematology Research Centre of the Russian Ministry of Health. “For example, you can conduct pilots for such chronic diseases as arterial hypertension, diabetes, asthma and evaluate the result.”

The launch of the conference was marked by a reception at the British Ambassador’s residence in Moscow, where DIT Director John Lindfield said that he believed that the event was the start of a long and fruitful collaboration between the UK and Russia and eventually become a key event in the industry.

Written by Ekaterina Zhuravleva, Trade Adviser, Healthcare & Life Sciences, DiT.

The One Nucleus blog is written by individuals and is not necessarily a reflection of the views held by One Nucleus.

Posted in June 2017 | Tagged , | Leave a comment

Interdisciplinary Approaches to Uncovering Biological Computation

Biological computation is the information-processing that cells carry out to make the myriad of decisions required to grow and sustain life. Uncovering what this computation is, remains far from trivial – cells are infuriatingly complex, they are noisy, run multiple operations in parallel, and there’s a blurred line between what we might consider to be biological software and hardware. This motivates the need for interdisciplinary approaches to extract knowledge from data, and to formulate predictive, explanatory models of cellular decision-making that can be used in the future to guide experiments, and ultimately for the development of novel therapies in medicine.

The Biological Computation group at Microsoft Research focuses on developing theory, methods and software for understanding and programming information-processing in biology. Our research currently centres on three areas: Molecular Programming, Synthetic Biology and Stem Cell Biology. We tackle key questions in these fields through the development of mathematical models and domain-specific computational tools, first seeking to find the right level of abstraction to model the system under study, and second, by designing tools that allow us to extract knowledge from data that can be used to parametrise or constrain such models.

As one example, in collaboration with experimental researchers at both the Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, and the University of Padua, we are investigating the information-processing that governs growth and development. Together we are studying the pluripotent nature of embryonic stem cells. Pluripotency is the unique characteristic of these cells to differentiate into all cell types of the adult body – from skin cells, to gut cells, to blood cells, to brain cells. This potency marks them as a potentially invaluable tool for medicine. Even more remarkably perhaps, is the discovery that the pluripotent state can be induced from fate-specified cells using only a handful of factors, which could allow us to bypass the embryo altogether. This paints a picture of a sort-of stem cell utopia: imagine being able to generate patient-specific pools of cells for those suffering from heart disease, Alzheimer’s or Parkinson’s disease, or even insulin-producing cells for those with diabetes?

While embryonic stem cells hold significant promise for cell therapies and regenerative medicine, we still lack a fundamental understanding of the molecular processes that determine how differentiation proceeds, and what directs an embryonic stem cell towards a specific lineage. ‘Reprogramming’ cells back to the naïve state is also poorly understood, it and remains an inefficient process. The goal of our interdisciplinary collaboration has been to derive the biological program governing installation and maintenance of the pluripotent state. To this end, we’ve borrowed techniques from the field of formal verification, which are traditionally used in computer science to verify the correctness of computer programs, or check for bugs in software. The aim here, however, is to verify that a potential biological program is consistent with what is known experimentally by translating experimental observations into formal specifications that must be satisfied by the model.

Models that simply explain what is already known are limited in their usefulness. Certainly, reconciling a large number of experimental results into a single model is a significant step, allowing one to capture the present state of understanding in the field, and even resolve counterintuitive results. However, if your model can be used to predict some as-yet untested behaviour, which is subsequently found to hold experimentally, then you gain confidence in this current explanation of biological function and have learned something new biologically to boot. Beyond this, an often-overlooked benefit of modelling is when your model fails to predict some untested behaviour accurately. Incorrect predictions can be extremely informative in that they expose a flaw in the prevailing understanding of the system, forcing you to reconsider the assumptions that you have made. Ultimately, the approach is iterative, and models will be refined as they are constrained against new experimental data – to paraphrase George Box*, no model will ever be perfect, but some models will be useful.

Following this approach, we have developed models of the information-processing at work at the transcriptional level in embryonic stem cells. First, by encoding previous experimental results as ‘program specifications’ we sought to capture an understanding of pluripotency that accounted for changes in gene expression due to changes in the cell’s environment, and as the result of molecular perturbations. Importantly, we could generate then predictions of untested behaviour, that were subsequently supported by experimental tests, underscoring the usefulness of this modelling approach. More recently, we have sought to apply this understanding to explain how the pluripotent state is established during ‘reprogramming’ of somatic cells to the naïve state, which has also allowed us to predict accurately how to accelerate and enhance the efficiency of this process.

Ultimately the tools that we are designing as a group, such as those we have applied to better understand stem cell decision-making, will be combined into a platform for programming biology. Such a platform will enable users to uncover the biological computation that governs cellular decision-making, and then to use this understanding to reprogram, design and engineer biological behaviour.

Sara-Jane Dunn will be giving a Keynote Address at ON Helix 2017. Come and find out more about the work Microsoft is doing in the life science sector. More information can be found here.

*A 20th Century British statistician

Written by, Sara-Jane Dunn, Scientist, Microsoft.

The One Nucleus blog is written by individuals and is not necessarily a reflection of the views held by One Nucleus.

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Posted in May 2017 | Tagged , , , , | Leave a comment