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Why medical affairs has a role to play in climate, health and equity.


Now that the first week of the Health Systems Transformation Basecamp at the School of Systems Change has drawn to a close, it seems like a good moment to reflect on what systems change actually is, and why it is useful to life science businesses.

When I first started work at GSK, I sat next to one of the cool and trendy Marketing Directors who had a t-shirt with the slogan “Change Agent”. I remember thinking – “that’s awesome, to change something, I wonder if I could do that?” I imagined a pioneering maverick, a heroic character, that courageously went out there and made a real difference to the world.

What I did not appreciate was that we are all “change agents” - because changing things is a very natural part of life. It is part of growing up, forging relationships, learning and contributing to society through our work. We are living systems that are constantly changing ourselves and the world around us, either intentionally or unintentionally. The first question, then, is how we get more intentional about this unavoidable change. That’s where the practice of systems change can help.

“A system is a set of things—people, cells, molecules, or whatever—interconnected in such a way that they produce their own pattern of behaviour over time.”

Meadows 2009

Another way of looking at it is to recognise that almost every large pharmaceutical company has been through a huge raft of organisational changes in the last 12 to 24 months somewhere in the world. No matter how many strategic consultants we hire, the external environment is changing so fast that business models of today are no longer fit for tomorrow.

Systems change helps us to detect and prepare for these patterns of change that are coming our way, a little bit like weather forecasting. It helps us take the right actions at the right moment in time. This saves the business money in the long run, making sure it is resilient to cope with the storms that lie ahead.

“The purpose of a system is what it does. There is after all, no point in claiming that the purpose of a system is to do what it constantly fails to do.” 

Anthony Stafford Beer.

When a life science business is struggling – maybe pipelines have failed or employee retention is low, or sustainable business models seem impossible, or tenders and sales are being consistently lost - it is tempting to say that the system is “broken”. But one of the things we learn early on at Basecamp is that systems are not broken. They are perfectly designed to do the things that they are designed to do.

Rather than trying to fix what is broken, we begin to realise that something about the way the system is structured or organised, and something about its ultimate purpose and goal, needs to shift and change in order for the business to thrive and survive.

At this point we are almost certainly dealing with complexity - complex processes, complex relationships and complex structures. This is when the tools and processes of systems change can help us to diagnose and locate where in the complex system we need to intervene in order to shift the patterns of structures and relationships towards better outcomes.

In summary, systems change is the intentional practice and process of reshaping complex patterns and structures within businesses to anticipate and even dance with the external forces of change to improve outcomes.


­­­­­­­­­­­­­­­­­­­­­­­­­­This was a very short overview of systems change! If systems change is something you are curious about for you, your medical team or your purpose-driven business, please do get in touch for a conversation. I also encourage you to reach out to the School of Systems Change to find out more.

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Have you heard the popular and somewhat cliched quote “life is a journey, not a destination?” This is certainly true in my lived experience. The medical degree I got at the age of 23 felt like a significant high point in my life, but it was the experience of actually working as a doctor within the NHS that was far more valuable and rewarding.

Today was the first session along our 4 month journey into health systems transformation at the School for Systems Change and it got me thinking; how often do life science businesses prioritise the “journey” of the lived experience of employees, customers and communities over the “destination” of its financial bottom line? In an ideal system, these two things would go hand in hand.

A business needs to make a good return on its investment, but there are many other non-outcome related aspects of a business that hold value - from the continuous growth and development of its employees, to the space for creative sharing of ideas that spark unexpected innovations and the fostering of multi-cultural diverse communities. A healthy business also considers these process orientated dimensions, not just its measurable and reportable outcomes.

Lets take another relevant example from the life science sector – clinical trials. We usually design trials to evaluate the benefit of a medicine or vaccine on health related outcomes in a pre-specified population. The focus is predominantly on the health outcome - the data that will convince regulators, clinicians and patients that the medical innovation has a benefit that is worth the risk. We might look for ways to measure an outcome that is more “patient centric”, but it is still the outcome that matters most.

Yet something we have known for a very long time is that many people derive a benefit from being part of the process of a trial, even beyond the medication they receive – the so-called placebo effect. Participants have access to medical care that exceeds the usual standards and receive more intensive support when they have symptoms or concerns. Expanding access to trials to ensure diverse representation of populations in need therefore contributes to the broader healthcare shift to equitable models of health.  

On the other hand, the process of delivering the clinical trial could involve recruiting patients from very large geographical distances, especially if it’s a rare disease. The transport required to get them to clinic visits could generate greenhouse gas emissions that contribute to worsening climate change with negative impacts on public health. The process of the trial could then influence health negatively, a risk that might not be worth the benefit at population levels.

This type of complexity is what the practice, process and outcomes of systems change helps us to navigate. I look forward to sharing more as the week unfolds.

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My last two blog posts have been a bit philosophical and contemplative. I begin to challenge our existing health paradigms, and courageously untangle any mindsets or assumptions that hold us back. Reflecting in this way can help us get the diagnosis right so that we use our energy wisely, but it has to be balanced with simultaneous pragmatic actions. Otherwise there is a risk that we will not do anything or get anywhere.

So let’s get practical and think about “what” medical affairs can do to tackle climate, health and equity. In my white paper, which is over one year old now, I provide a framework that proposes action areas. As I have continued to engage with individuals and organisations through my work, I predict that 3 consensus action areas might be emerging.

The first is carbon foot printing of clinical trials. Although clinical trial regulations do not yet mandate measurement and reporting of carbon emissions associated with clinical trials, large companies that form part of the Sustainable Markets Initiative increasingly expect Contract Research Organisations to use measurement frameworks already developed. In addition, for companies active in clinical development, carbon emissions generated by clinical trials will be a significant contribution to overall carbon footprint and therefore difficult to ignore. Medical affairs are well placed to contextualise the benefits and risks of undertaking any given trial, taking into account the value of the data generated as well as possible downstream harms from environmental impacts.

The second is environmental factors and health equity. There are signals that companies are starting to explore environmental drivers of health equity to help shift the goal of health systems towards keeping people well rather than treating disease e.g. Novartis Foundation AI4HealthyCities. One such environmental driver is air pollution, typically affecting health in poorer urban community areas. Signals show that air pollution could be most effectively tackled through local community or city-level policy interventions. As ecosystem connectors and data generation engines, medical affairs can partner or convene a broad range of stakeholders and champion aligned data driven goals that improve health.

The third is to focus on the patient, by considering how climate change will affect people living with specific diseases.  This includes better understanding the information the general public are / will be seeking regarding the sustainability of medicines in the context of broader health care. Providing information on medicines sustainability is an inherently complex topic and forward thinking companies are already beginning to tackle this. Medical affairs are the guardians of patient centricity and will play a critical role.

Let me know if one or more of these resonates with you.

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