I can say this with only a minor fear of being labeled a sycophant or worse, but Ruth is a model boss: knowledgeable, hard-working, and above all nurturing and empowering towards her employees.
A native New Zealander, Ruth graduated from Auckland University with a first class honors Masters degree in biochemistry and physiology. While doing her PhD she joined Adis, a major medical communications company, first as a medical writer, and then as publications manager for the journals Drugs, Pharmacoeconomics, CNS drugs, and Health Outcomes. She quickly developed close ties with the pharmaceutical industry clientele and moved into business development with Adis, writing strategic plans and developing innovative publication programmes.
In November 2000, Ruth founded Rx Communications. A consummate entrepreneur, she has overseen exponential growth in both staff and revenue for the company; she’s also a highly innovative thinker, having chosen, while most medical communications companies are located in metropolitan areas, to place Rx in a small market town in North Wales.
As she puts it: “We could be located anywhere as long as it has a good road to the airport and good broadband telecommunications.” The company numbers among its clients most of the major pharmaceutical firms… and has a global network of more than a hundred experienced freelance medical writers.
The Rx CEO says that her personal business philosophy is to deal with integrity and to bring love and passion to what you do; her best quality, she believes, is her ability to pick the right people. “I look for an openness to different ideas and a certain energy,” she says. But even though she takes a kindly and benevolent approach to her staff, she is a perfectionist; moreover, she loves a good argument so long as it’s dialectical and not diabolical.
Ruth has two young daughters, and says she wants to do more travel (are you serious, Ruth? You must have enough frequent flyer points to go to the moon); and to learn Welsh. Now there’s a worthy ambition: trust me, Mandarin is much easier.
Patti founded a website, www.healtheconomics.com, 16 years ago; and that made her one of the early adopters of the Internet. Today, she says, it’s the number one website for health economists globally… with some 10,000 visitors a month.
The website is an umbrella for her consulting services. She calls it a mega website for health outcomes and health economics resources, and works with several companies in the pharmaceutical industry, including Pfizer, Genentech, J& J and GSK, as well as with related consulting companies. The site also provides employment information.
Patti came to her present position following a stint as director of medical affairs and outcomes research for Alza, now a J&J company, where she ran the Phase IV clinical trials. Before earning a PhD in pharmacy administration with an emphasis on health economics at the University of the Sciences in Philadelphia she was a product manager at Sandoz (now Novartis) with particular responsibilities for that company’s heart, kidney, and liver transplant immunisation drug, Sandimmune.
Today, she says that this particular combination of experience and skills places her ideally to bridge the gap between clinical trials and marketing. Health economics affects so many different stakeholders, she believes, so the market has to tailor itself to each of them… recipients may be looking for different information and benefits depending on whether they are managed care organisations, hospitals, employers, or clinicians.
Of HOC, she says:”I like its conciseness, its breadth of issues and its targeted focus.”
And when she’s not running her health economics website and consultancy, Patti plays the guitar, and tries to cure what she calls ‘nature deficit disorder’ by providing children, including her twin eight-year-old boys, with a solid grounding in nature and environmental issues. In fact, she and her husband Steve Gustafson recently took an RV trip across the United States for 2 1/2 months. Part of the training she offers has to do with survival skills – surely an excellent capability for those in today’s healthcare jungle. As she puts it: “My dream is to be stranded on an island for a year, with only a pen-knife.”
On January 1st 2006, Dr Dennis Gross retired from Merck after 28 years; the following day, he took up his present position as Associate Dean, Masters Programs, in the College of Graduate Studies at Thomas Jefferson University.
At Merck, he had started out as a senior research pharmacologist working on the project team that discovered the angiotensin converting enzyme inhibitors Vasotec and Prinivil. Dr Gross went on to fill senior management positions in the company, directing research operations, and serving as director of programme resources and logistics. In that capacity, he was responsible for operations and financial oversight of Merck research labs in the UK, Japan, Canada, and Italy. He reckons that, all told, he flew a million and a half miles for Merck.
During that time, he fused a business career with an academic one… serving as an adjunct professor at Jefferson from 1977. No wonder Gross is a strong proponent of bringing ‘real world’ experience to the benefit of the 350 students in his masters programme in biomedical sciences. “It adds richness and diversity to the student experience,” he says, and helps to prepare those students for what he believes will be a very different future in pharmaceuticals.
Many of the professors in the department lecture on what they actually do for a living, he says, and he himself grafts onto his administrative duties a teaching schedule in pharmacology and toxicology. “I really enjoy interacting with the students,” he says, “and it really is a way of giving back some of what I learned in industry.” And those students themselves are pretty diverse – some just out of undergraduate studies; others with perhaps 10 years in the business world.
Off campus, Dennis Gross enjoys music and photography… and is a voracious reader who’s been collecting books – especially on the Middle East – for 40 years, prompted perhaps by the fact that his grandfather fought in Palestine in World War One and met the fabled Lawrence of Arabia.
Of HOC, he says: “The newsletter serves the useful purpose of exposing people in a succinct way to the issues of the day that affect them professionally.”
A factor that has confounded the issue of adherence or compliance for 40 years is the actual pharmaceutical and the disease being treated. Thirty years ago we had an education tape at Merck about this issue: Keeping the Hypertensive Patient in Compliance.
The biggest problem with hypertension and high cholesterol is simply these diseases are asymptomatic. The patient does not sense anything wrong. They are likely to think: “why should I continue to take a drug that makes me feel bad regardless of how much it costs, even if it is generic?”
The patient was probably feeling fine with their high cholesterol, osteoporosis or high blood pressure and now we prescribe them a drug that makes them feel worse and restricts their lifestyle.
For the drugs used to treat osteoporosis they cannot take the medication with food for at least 30–60 minutes; they can drink only water with the pill, and they cannot lie down and, by the way, the medication won’t really do anything for them for at least 9–10 months and we won’t really know what it is doing for them unless they fall and don’t break a hip.
Why should they continue to adhere to something with lots of side-effects and no visible positive outcome – getting heartburn every time they take their osteoporosis drug or postural hypotension from their high blood pressure medicine? Cleaner side-effect profiles may be the key to adherence – not price.
Entusiasmo. That’s a word that describes, in his native Italian, what Vittorio Maio brings to his work in health policy and outcomes research. “What makes me really happy,” he says, “is being able to see research theory translate into actual practice in the real world.”
Vittorio graduated from the University of Perugia and moved to the United States in 1999; there, he immediately joined Dr. David Nash’s Department of Health Policy at Thomas Jefferson Medical College, where he is a research assistant professor and director of the Fellowship programme in outcomes research.
But he has not lost touch with his professional and cultural roots. A few hours after our interview for this article, he was winging his way back to Italy – a trip he makes four or five times a year. In Bologna, he conducts population-based outcomes research with a unique healthcare database. The studies embrace differences in the use of health care services between men and women, the elderly, and children; they look at approaches to, say, cardiac care and how general practitioners might be persuaded to change their approaches to treatment and prescribing. They are even touching gently upon the idea of pay-for-performance among physicians.
Vittorio brings this international perspective to his professorial role at Jefferson. He finds that his students are particularly receptive to this… and he is not afraid of editorialising on the subject of American healthcare, which he describes as the most regressive system in the world. “We all pay the same,” he says. “People should pay according to their resources.”
In general, Vittorio’s particular research enthusiasm has to do with the elderly, with trying to change physician behaviour, and with pay-for-performance – linking quality to incentives. Beyond that, he says, non-adherence to drug regimens “is a huge interest.”
Asked about HOC, he is equally upbeat: “What you’re doing,” he says, “is an important way to connect health economists, researchers and decision-makers. It’s concrete, an easy read, and credible.”
US News and World Report calls him a patient safety guru; Modern Healthcare has repeatedly named him among the top 100 most powerful people in American healthcare; his curriculum vitae runs to more than 70 pages, of which one whole page is devoted to his multiple honours and awards.
Dr. David Nash is chairman of the Department of Health Policy at Jefferson Medical College, an integral unit of Jefferson Medical College and of Thomas Jefferson University Hospital, which was founded in 1825. The Department employs 42 people from an eclectic range of disciplines including pharmacy, public health, medicine, nursing, and administration.
Funding for the Department’s current range of 36 active projects comes from the pharmaceutical industry (40%); government (10%); and the remaining funding comes from a mix of both the private and public sectors. Among those projects are technology assessment; cost effective analyses;, diffusion of technology into medical practice; and policy pieces for differing audiences, including State government.
Specifically, the Department’s research team focuses on health services and outcomes projects in such areas as: clinical care quality measurement for hospital departments; productivity measurement associated with specific disease states; disease management outcomes measurement; senior health issues; and value-based healthcare purchasing for employers.
The Department produces numerous articles and research papers, as well as publishing four journals: American Journal of Medical quality; Disease Management; Biotechnology Healthcare; and Pharmacy and Therapeutics. David Nash serves as editor of all four.
There are several cutting edge policy issues currently attracting the Department’s interest. These include retail, in-store clinics; the US physician shortage, particularly in primary care; the growing issue of compliance with drug regimens; and the specifically US concerns over malpractice litigation, and the roughly 50 million Americans who are uninsured. So far as the issue of retail medicine is concerned, Nash is a strong proponent. What they offer, he says is access, convenience, and price transparency. In fact, he chairs something called the Take Care National Medical Advisory Board, a company in the retail medical business. (HOC will publish an article on these retail clinics in our October issue).
So far as the doctor shortage is concerned, Nash believes that while this is due to the usual suspects – overutilisation of services, an aging population and increasingly sophisticated technology – a more significant cause is what he calls the feminisation of medicine. More than half of the entering class of US medical schools are women … who tend to work fewer hours and have shorter careers.
The Department of Health Policy is appropriately involved in continuing education. It has a cadre of external Fellows and Senior Scholars, puts on a number of conferences each year, and operates ,jointly with Jefferson’s College of Graduate Studies, a Masters program in public health.
Having seen Dr Nash in action over several years, I can say that he also brings to his extraordinarily full professional life a talent for public speaking, and marketing … and for inspiring loyalty and enthusiasm among his staff.