Merck & Co. is no longer a drug company. Or at least that’s one of its top executives told the Innovations in Diabetes Summit in St. Louis Park, Minnesota Wednesday.
Now before you start shorting Merck stock, the company, a longtime stalwart of Big Pharma, is still very much in the business of making pharmaceuticals. It’s just that today’s Merck prefers to call itself a “healthcare company,” said Dr. S. Sethu Reddy, Merck’s director of medical affairs for diabetes and obesity.
The change is not merely cosmetic. For all of the innovations and new treatments on display at the summit, sponsored by LifeScience Alley, BioBusiness Alliance of Minnesota and MedCity News, there is a growing realization that technology won’t cure diabetes in the United States.
God knows we’re still trying, especially here in Minnesota. EnteroMedics Inc. in Roseville is developing a device that uses electricity to treat obesity, a leading cause of diabetes. Exsulin Corp. in Burnsville is testing a drug that can boost production of insulin-producing cells. Medtronic Inc. (NYSE: MDT) in Fridley is selling integrated diabetes pumps and sensors, a system it calls an artificial pancreas.
But an absolute technological solution now seems increasingly unlikely. Take the drug industry. Pharmaceutical companies have spent billions of dollars on the idea it can create the Holy Grail of drug therapy, a sort of magic pill that can cure chronic diseases like diabetes and Alzheimer’s. But like the real Holy Grail, does it even exist?
The results, so far, haven’t been promising. Diseases and their causes, it turns out, are much more complicated than we thought and may concern a host of factors interacting over the course of time. Which is why companies like Merck are shifting to a more holistic view of the disease, a strategy that focuses on treating the peripheral features of diabetes and Alzheimer’s instead of identifying one root cause.
“With great expectations comes great failures,” Dr. Reddy said. “The bloom is definitely off the rose. There is no such thing as the perfect drug.”
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Which is why Merck calls itself a healthcare company now. The (former) Pharma giant worked with the American Diabetes Association (ADA) to create “Journey for Control,” an online initiative designed to educate patients about diabetes. It also created Vrees, an iPhone application, to help patients understand the disease.
“We can’t just talk about drug development,” Dr. Reddy said. ‘We have to bring more value to the physician office and the patient.”
Drug companies are not the only ones who need to adjust.
Dr. Victor Montori, a professor of medicine at Mayo Clinic and the summit’s keynote address, says doctors must tailor treatments to fit the patient’s specific needs and lifestyles, not the other way around.
Patients often don’t comply with diabetes monitoring and treatment prescribed by doctors not because they are lazy or stubborn — they simply don’t have time, Dr. Montori said. For example, the ADA says a patient should spend 143 minutes a day managing their diabetes care, he said.
“That’s a part-time job!” Dr. Montori said.
Instead, a doctor should adopt the concept of “minimally disruptive medicine,” that while the patient may not comply with all of the doctor’s recommendations, he’ll at least establish some priorities. It’s up to doctor and patient to determine which treatments are realistic and medically acceptable, not an easy feat for physicians whose initial impulse is to prescribe more, not less treatment,” Dr. Montori said.
“Doctors have to learn to let go,” Dr. Montori said. “We don’t know how to stop treatments.”
Doctors also need to redefine what constitutes success, focusing on patient goals instead of disease goals, he said.
Instead of just emphasizing data like a patient’s cholesterol levels, Dr. Montori said, doctors should ask: Did the patient live longer? Did the treatments help the patient feel better? Did they help the patient to live independently without complications?
