Showing posts with label pharmaceuticals. Show all posts
Showing posts with label pharmaceuticals. Show all posts

Friday, 23 June 2017

Bottom-Up Innovation

Branding Science’s approach to generating the new and improving on the old




I started Brand Garage as a fresh-out-of-Uni Research Executive, looking for a forum to voice my opinions on the wide range of approaches and methodologies in market research that I found can either be wildly progressive, or downright ancient.

This space would have to be absent of fear and ego. I wanted to avoid situations of someone more senior than me saying: “I’ve been in this business for years and trust me, that isn’t going to work.” Or “That’s how we’ve always done it, and it’s not a good idea to change.”

I’m a firm believer that ideas are not for shooting down, but for dissecting and re-assembling, until it is the idea that solves the problem. Or re-defines the problem for you, which can be equally useful.

Thankfully, the team at Branding Science gave me that forum, appreciating its potential for innovation, to the point where Brand Garage – our internal ‘think tank’ – is not only supported, but celebrated.

So, how do we ensure innovation in Brand Garage?

  • No-one above a certain senior level is permitted to attend these meetings (we range from grads to REs, SREs and RMs)
  •  We’re encouraged to argue, to challenge, to rip something apart
  • We are creatively agile - we achieve this through allowing ourselves to be iterative, constantly re-defining, readjusting and reflecting on our ideas
  • We don’t put pressure on outcomes. If we don’t end up creating an innovative solution, but come up with another question instead, then that is still a success in our minds
  • We will split the team into two smaller teams to explore different avenues of thought, rather than allow in-fighting to take over the innovation process

 (We’re also encouraged to go off site to meetings and order Pizza, which totally helps!)

As a result, Brand Garage has looked at:

  •          New ways to uncover emotional brand perceptions
  •          New ways to validly test TPPs
  •          New ways to trigger creativity internally during our analysis sessions

I’ve no doubt that this trust in the ‘people at the bottom of the pyramid, the young sparks, the people closest to customers, as the source of innovation’* is why Brand Garage has, and will continue to be successful in the future.

Email Branding Science at info@branding-science.com  to find out more about Brand Garage, or how our approach to innovation might be applied to your organisation! We look forward to hearing from you.
   
*quote taken from the TedTalk: How to manage for collective creativity, by Linda Hill 
(http://www.ted.com/talks/linda_hill_how_to_manage_for_collective_creativity/transcript?language=en)  

Written by Sofia Fionda, Research Manager at Branding Science

Thursday, 8 June 2017

Excuse me Doctor, I read this on the internet…?

I recently became aware of an article being shared across social media from a popular tabloid newspaper, informing readers that a bladder drug that is widely prescribed here in the UK increases a patient’s risk of developing dementia by more than fifty percent. In light of these risks, doctors recommend that it should no longer be used at all - information that was due to be presented at the European Association of Urology conference but was not yet publicly available.

Having studied Medical Sciences at undergraduate level and now working at Branding Science, naturally I was interested in where this information had come from. There was no reference made to the scientific evidence or research behind the claims made in the article, leaving readers (and especially those currently being prescribed this medication) unable to determine the accuracy or relevance of the statements made and consequently make a fully informed decision regarding any choices they may subsequently take regarding their treatment. Indeed on reading some of the comments it was clear that some readers were not in any way interested in the scientific rigour of the article and were taking the information presented at face value.  Some bladder patients were even saying that they were going to immediately stop taking their medication before even consulting with any relevant healthcare professional.


It is hardly surprising that the effect of what is seen on the internet can be dramatic, especially as patients can often feel overwhelmed by their health conditions and desperate to find a cure and feel better. 

So where do people go to try to find out what is best to do for their health?

Patients no longer rely solely on their doctors and nurses as their ‘primary and authoritative’ source of advice on their health.  Nowadays they will be influenced by many different factors. With the internet at the tip of our fingers, patients will commonly look online for more information about their condition, medications or symptoms.

As an industry, pharmaceutical companies have a responsibility to the patients taking their drugs and the doctors who prescribe them. We can use various aids to inform doctors (and patients) about the benefits and risks of a particular medicine (often supported by the intelligent use of market research), but there is little or no rigorous control over content is released by the media, or what information (positive and negative) may be shared by patient support groups and on online support forums, or, indeed what is gleaned by talking to trusted friends and family. 

But surely having a greater access to information is a good thing?

It can be, especially if it increases awareness of specific health issues or leads to a patient feeling better able to manage their health. Yet what happens if the ‘information’ is unhelpful, inaccurate, and delivered in a way that isn’t easily understandable or indeed relevant?

Look up “best treatment for cancer” online, and there are over 200 million websites for you to choose from. Alongside the up-to-date, evidence-based sites, there are also a large number of deeply unscientific sites promoting among other things “natural cures”, ‘specialised diets’, strange exercise programmes’ and even DIY cancer cure kits!


How do people navigate the web and filter through the vast array of sites to find those that are free from bias, authoritative and grounded in evidence? Are people looking at these information sources and able to decipher the medical terminology and jargon along with any detailed scientific information published online (as well as the information that isn’t factually correct) in order to be able to make an educated choice?

So what can we do?

The internet will never replace the profound human dimension of the doctor-patient relationship. Understanding how an illness affects a patient, and the importance of finding the right treatment for them, helps empower patients to better manage and feel in control of their health. Healthcare professionals need to identify reliable healthcare websites, give information to patients that is accurate, and build relationships that encourage open dialogue so that patients feel able to come to them with their concerns.

Here at Branding Science, we believe in patient centricity and care about getting it right for patients. Through our intelligent market research techniques and understanding of patient insights we help our clients to build a brand that truly addresses the needs of patients and fosters a relationship of open communication with healthcare professionals.

Email us at info@branding-science.com to find out more about how Branding Science can help you build a brand that understands and meets the needs of patients

Written by Linzie Reason, Marketing and Communications Executive at Branding Science 




Wednesday, 5 April 2017

Bad habits, take a hike!


How market research can get to the heart of a habit and help change customer behaviour

The dreaded habit. We all know what they are and we all have our own, and whilst some may be positive everyone will definitely be able to say which habit, or habits (!) they would like to eradicate.

But I have a secret for you: habits cannot be destroyed.

Don’t lose hope though. There are ways to alter those pesky habits that strike at the heart of your good intentions.

Science has shown that habits are stored in the brain, and as we now know, the brain can be re-programmed. Which means whilst they cannot be destroyed, changing a habit is possible.

Firstly, you have to understand a habit. In Charles Duhigg’s book ‘The Power of Habits’ he shows that habits have 3 core components:


In order to change a habit, Duhigg postulates, you have to identify the routine (that’s the behaviour, for example walking to the food point to steal a biscuit). Next, experiment with rewards to find out what’s driving the habit (are you going to the food point because you want to satiate your hunger?), and also isolate the cue (is it hunger pains you’re experiencing?).

Working with Brand Teams within Pharmaceutical companies, we often get asked to help our clients understand why their customers (Physicians, including GPs, specialists, pharmacists) prescribe a product over theirs, even though their drug has ‘better data’, and how they can change such behaviours.

What they’re essentially asking us is: How can we change our customers’ habits?

Well, that is where market research comes in.

We work with physicians, asking them to describe their prescribing practice (the routine), why they prescribe a particular product (the cue) and what outcome they are looking to achieve (the reward). We can do this by having in-depth conversations with physicians, either individually or in a group, or map these behaviours out through online surveys, looking at perceptions of drugs and patient numbers.

As a result, we provide our clients with direction on how to change prescribing behaviours, by giving physicians new cues and rewards that lead them to alter their original habits, helping our clients to position themselves as the brand of choice.

So as you can see, there is hope for you quitting sugar and eating healthy yet! You just need to work out how much you want those cookies, or if there is some other reason you are craving them, and how to break that routine!

Email us at info@branding-science.com to find out more about how Branding Science can help you understand and change your customers’ habits.

Wednesday, 19 August 2015

Lessons from Storytelling: Make your customer the Hero of your Brand’s story

Think for a second about your favourite character from a book you’ve read or a film you’ve watched. Or maybe that favourite character is from a television show, or even a podcast? What about this character makes them so great? Memorable? Is your character a hero or villain? What makes a character a hero or a villain for you?

A hero ventures forth from the world of common day into a region of supernatural wonder: fabulous forces are there encountered and a decisive victory is won: the hero comes back from this mysterious adventure with the power to bestow boons on his fellow man
-         Joseph Campbell, The Hero with a Thousand Faces

Is part of their appeal because you see yourself in them? Or rather, that you want to be them or have their experiences (and rewards, of course)? We all, on some level, would like to be the hero in an epic story, after all.

The main thing is here is that successful stories have compelling characters; without them, tales fall flat. So how are captivating characters created?

There’s a formula that writers like to follow in order to create compelling characters – be it heroes or villains – for their stories:

MC wants (External Goal) because (External Motivation) but (External Conflict).

Let’s look at this in a bit more detail: Characters, they say, have wants. These wants are governed by goals. Their goals come about because of motivation, but they always – and this is the crux of all the most memorable, most real characters – experience a conflict that prevents them from achieving their goals.

Now, I’m not asking that the pharmaceutical industry write the next New York Times Bestseller, or make a Hollywood blockbuster out of their brands.

But I believe there is something to this idea of making their customers the hero of their brand’s story, and not necessarily making the brand itself the hero.

It’s easy to walk into a physician’s office and tell them why a brand is the best product to treat their patients (typically this is done in the form of data). But does this truly impress physicians? Yes, it will, because they are medically trained to recognise superior products.

But what about when it is a crowded market space, where data for these products is similar and there isn’t much that can help to differentiate between them?

It might be suitable then to focus on your customer, rather than your product. The best way to do this? By making your customer the hero of your brand story. For example, taking the formula that authors like to use for their characters:

Physician wants to treat patients (Goal) because this is his job and it makes him feel happy (Motivation) but he doesn’t know which treatment is best (Conflict).

 By discussing your brand with your customer in this way, you are putting them at the centre of the story and helping them to fulfil their own needs but also be the hero for their patients.


Of course, this can be different depending on which culture you are in. For example, in the West heroes are typically individuals (e.g. Superman) whilst in the East they are often based on a collective’s triumphs. Knowing your market and your target customer is the key to any successful marketing strategy and one you must explore before you develop your brand story.

And again, who doesn’t wish to be a hero?


This article was written by Sofia Fionda Senior Research Executive at Branding Science

Tuesday, 21 July 2015

Live Storytelling: the impact #pharma can make in front of their customers

Trying to pinpoint when the first story was told would be impossible. Some of the most famous stories – Gilgamesh, Beowulf and even Aesop’s The Tortoise and the Hare - began life as fireside spoken tales.

It would be fair to assume that we started telling stories when we first devised language, but I guess that’s more about how stories were able to spread from one culture to another so prolifically – Homer’s Iliad was first told in Greece and it’s now been read on every corner of the globe. How’s that for impact?

Of course, written stories are very impactful in their own right. The bestselling book, according to Wikipedia, is the ‘The Bible’ – but even that began life through word of mouth.

Written stories cannot surpass the impact of live storytelling.

It’s why YouTube is so successful, and Ted Talks are watched by millions of people each year. There’s something powerful yet intimate about the presenter-audience relationship; relaying a story directly to others, watching their faces fly up in surprise, disgust, feeling the emotions of a tale.

The brain has a dedicated region – the Limbic system – to process emotion. What’s more, it has specific cells – mirror neurons – that are activated when another individual acts or shows emotion. These cannot be readily activated through reading a story; they are the brain’s response to viewing another human acting and mirroring their actions internally. All this in order to process information more efficiently.

Therefore, the impact of live storytelling can, in many cases, far surpass the effect of reading an article online, or, for example, a detail aid. Though the story has been carefully devised, structured and tested to fit physician’s expectations - even covering the emotional charge of treating a certain therapy area - it in no way negates the need for direct contact with your customers.

This makes the sales call – and most importantly the story you tell during this call – the best opportunity to convince your customers of your brand. So don’t forget this.

The question remains then: how will you come up with the killer story to tell your customers in that face-to-face situation? Well, the Branding Science Group specialise in helping you not only construct your story, but practice the execution. Get in touch with our team to find out more!!

This article was written by Sofia Fionda Senior Research Executive at Branding Science

Wednesday, 11 March 2015

More for patients


By now, you may have seen Adweek’s 2-minute video on Branding. Upon its release, the video immediately went viral, receiving over 130,000 views in 23 days.

What could be so compelling? The video speaks to one simple truth: the success of a brand hinges on the team’s ability to “see through the eyes, hearts, and minds of people.”

Watching the video got me thinking about pharma. During a recent project I interviewed a cancer patient named Jim, who spoke about the emotional roller coaster of his disease with complete vulnerability. 

When asked to describe his ideal treatment, Jim described Baymax from the Oscar-award winning animated film Big Hero 6. He said, “I want to feel like I have an arm being put around me, like I have someone who is helping to carry me through the pain and suffering.”

For those who haven’t seen Big Hero 6, Baymax is a healthcare providing robot who acts as a guardian and best friend to the movie’s main character Hiro. His comprehensive approach involves being in sync with patients physical AND emotional needs. He is the embodiment of patient-centric care, whose sole purpose in life is to care for people. Instantly activated by the sound of distress, Baymax only deactivates once his patient states “I am satisfied with my care.”

If Baymax is the gold standard for patient care, to what extent does pharma achieve this?

Every brand puts patient imagery front and center in their communications, but does that translate into a meaningful brand experience? How does pharma go beyond treatment and communication materials to truly address the needs of patients?

Living patient centricity is a challenge, but, in doing so, brands have the power to cut through the clutter and make all the difference – not just in the minds of patients, but for prescribers and payers as well.

A simple question must be answered.

Does your brand rise above to meet the needs of your customers?
·         What brand initiatives are you most proud of?
·         What has your brand done to change the treatment paradigm?
·         What added value does your brand provide to your customers?
·         What can your brand do to make Baymax a reality?
I believe in more for patients. Does your brand? Let’s get the conversation going. #moreforpatients


The author: Jess Soriano, part of the Branding Science San Francisco team 

Thursday, 3 April 2014


Brains, Brands and Sushi: Why Pharma need to focus on the emotive sell.

 
I read a startling statistic the other day that 95% of Brands launched actually fail.

Even more startling was the statistic that two thirds of drugs launched by the pharmaceutical industry fail to meet market impact expectations. Considering there are set to be 400 new drugs released in the next three years this is slightly worrying. Do the math. That’s around 266 potentially lifesaving drugs that will just fade into market obscurity…

So what on earth is going wrong?

Well, to answer that I guess we need to understand why those 5% of Brands that don’t fail, succeed.

It’s so easy to assume people will buy your product simply because you created it and it’s available.

It is also easy for the pharmaceutical industry to assume that customers will select their product for first line use because it happens to have the best clinical data out there. Wrong again. Let’s consider a scenario in the rheumatoid arthritis market where there is a clear market leader despite the fact that competitors also have comparable and in some cases, superior efficacy data. If we can’t explain a product’s use on rational reasons alone then there must be a less rational component.

And we often tell our pharmaceutical clients not to sell a product.

A product is functional. No-one loves toothpaste. They do, however, love Colgate because it promises to give them whiter teeth and fresher breath. And who wouldn’t want both of these things? This is the power of branding.

To understand why this love for Colgate over toothpaste is happening, let’s examine the brain. Because I don’t know if you are aware of this, but the brain controls everything we do. It’s the source of the majority of our behaviour and even though we are light years away from understanding exactly how it works, we have good enough technology at the moment to hazard a guess as to what might be going on.

You’re obviously objecting to my outlandish claim that you “love” Colgate.

But how outlandish is it really?

Using functional magnetic resonance imaging (fMRI) we can study the correlation between behaviour and increased activity in brain areas. By increased activity, I mean the assumption that more activity requires more energy therefore more oxygen is needed. It’s an indirect measure and requires extensive statistical analysis to make any sort of assumption. But for all intents and purposes, it’s a good place to start brain gazing.

So what’s happening when people view their favourite brands?

A study by Esch et al (2012) showed that the palladium (the part of the brain involved in emotional cognition) was positively correlated with viewing familiar brands. Translation: when we view brands we are familiar with, the emotional processing parts of our brain are activated. Moreover, when we view unfamiliar brands, the areas associated with linguistic encoding are comparably more active. Translation: whilst we use emotions to store and retrieve brand perceptions, we use our rational minds to evaluate novel brands.
 

What’s the relevance of this for the pharmaceutical industry?

Well, quite simply, customers are not solely evaluating brands on a rational basis. They aren’t weighing up the pros and cons every time they consider Colgate. The same way doctors aren’t weighing up the efficacy data every single time they prescribe treatments for an RA patient. Through positive experiences with the market leader they have developed a strong emotional attachment to the brand. So when it comes to writing a brand on that prescription letter, it is nearly always their favourite, and more importantly, it is rarely thought about.

What does storing brand perceptions in this way offer the individual?

There has long been a theory that brands might actually function as reward stimuli (Schaefer & Rotte, 2006). And when we do look at brand logos, studies have shown that brain activity increases in the essential component of the brain’s Reward Pathway: The striatum. It receives input from the Cerebral cortex and its outputs get fed into the basal ganglia system that is responsible for a variety of behaviours such as routine behaviours or ‘habits’ and cognition and emotions. Therefore, brand logos are enough to elicit a reward response that feeds into our perception of what we feel the brand offers us.

Furthermore, there is less activity in the brain areas associated with rational choice.

So if you are still with me after all this brain talk, then you’ll be starting to realise that perhaps there’s more to branding than simply conveying the overall benefits of a product.

And that engaging customers might be about more than just describing those benefits.

As our associate director, Anthony Rowbottom, likes to say: “If pharma tried to sell sushi they would describe it as cold, dead fish. That’s exactly what it is. But no-one is going to respond positively to that message.”


Pharma must stop thinking about their customers as cold, clinical doctors and stop selling their products as molecules and impersonal data. They need to appeal to the human in the white coat through the real life patient sat in their surgery opposite them, by describing how their product is providing a practical and emotional benefit for them both.

Think about this next time you are brushing your teeth…

This article was written by Sofia Fionda, Research Executive at Branding Science
To discuss this article follow us on twitter!
 
http://link.springer.com/article/10.1007/s11002-012-9176-3#page-1
http://www.upol.cz/fileadmin/user_upload/FF-katedry/kae/2007_Schaefer_Favorite_Brands_as_Cultural_Objects_Modulate_Reward_Circuit.pdf?origin=publicationDetail


 

 

Thursday, 27 March 2014


Accidental Blockbusters: Warfarin





“Of course, that’s how life is. A turn of events may seem very small at the time it’s happening, but you never really know, do you?” Tom Xavier

Warfarin is an anticoagulant currently prescribed to prevent blood clots. However it was originally introduced to the consumer world as a rat poison due to its haemorrhaging abilities.

In the early 1920’s a bizarre number of cattle in the US kept spontaneously bleeding profusely. Food sources in the area were scarce and so the cattle were being left to eat the damp, mouldy hay that was no good to anyone else. A Canadian vet twigged that the link between all of these haemorrhaging cattle was that they had consumed this unsuitable hay, and discovered that by removing the hay from the cattle’s diet, they returned to full health.

Thirty years later, the compound in the mouldy hay was finally characterised and was launched into the US market as a rat poison, proving an instant success. However a US soldier, unsuccessfully, tried to commit suicide by overdosing on this new toxin. Having been rushed to hospital, he was treated with vitamin K, the antidote, and made a full recovery, yet this started an investigation into the potential therapeutic use of the poison. And three years later, it was approved for use as an anticoagulant, with one of its first recipients being the US president at the time; Dwight D. Eisenhower.

One conspiracy theory, highlighting the dangers of warfarin and the complexity of its dosing regimen, suggests that Stalin was murdered using warfarin. As warfarin is tasteless and odourless, making it such a good rat poison, Stalin could have easily consumed it without knowing so, and he exhibited many of the symptoms commonly found in a warfarin overdose when he died.



This post was written by Graduate Research Exec Becky Geffen.
For more weird and wonderful pharamcetuical facts follow us on: @brandingscience


Thursday, 20 February 2014

So long as the fridge is full: a day in the life of a market researcher


If you work in the market research industry I’m sure you are already very familiar with the early morning starts, the delayed trains, cancelled flights, and stuffing your face on the move – not to mention the long hours spent holed up in a dark room, so oblivious to the outside that the apocalypse could happen and you would be none the wiser.

But for those of you who don’t work in market research and wonder what goes on behind the glass – no wild parties here, unfortunately – allow me to elaborate.

We conduct the majority of our research in a viewing facility. Think of those detective dramas, like CSI: New York, when they are interrogating a suspect and they are observing it from behind a huge one-way mirror. Our team, including clients, watch the research as it’s happening live.

Almost all respondents accept that they will be observed. Some even wave to our team behind the glass. And for our moderators, it’s quite daunting to conduct an interview with so many colleagues and clients present. But for the moderator, and I’d imagine the respondent too, after 5 minutes you forget about that fact entirely.

The viewing facility staff are almost always pleasant. They show you to your room. They point out where the limitless supply of snacks are (my favourite part of the induction) and the nicely stocked fridge (from water to wine), the air conditioning controls and the audio control. The essentials of fieldwork. Tea and coffee are offered and ALWAYS accepted. Overall, it’s like being shown around your hotel room.
 
If the travel was difficult, the first thing you want to do is collapse into a chair, with some facility chairs being more comfortable than others. You might be wondering why I mention this. Well, when you are expected to sit on a chair for fieldwork days from 10am to 10pm, the chair often becomes your best friend. And best friends should always be a comfort.

Our moderators have to be on the ball – you are there to take notes, but also to identify and interpret respondent insight, which takes a great deal of intellectual concentration. However, the most rewarding part of fieldwork can be the dialogue you have with your clients. You can debate their business objectives in the backroom after particularly insightful interviews and formulate a strategy alongside them. It’s an extremely productive way of working and we always encourage our clients come to central location days for this reason.

Setting up the interview room is all about asking where the respondent should sit so that the camera (we use to video them for analysis purposes) can capture them, and the size of the table in terms of how many respondents you are interviewing and the nature of the materials you are testing.

With room set up it’s all about the atmosphere you want to create between you and the respondent. You want them to feel sufficiently relaxed so that they are more willing to open up when asked questions. You want to be close enough to show them materials whilst not invading their personal space. And ultimately you want them to enjoy the experience.

And then there are the subtle touches you have to think about with regards to the topic of the discussion. If you are interviewing patients with diabetes it would not be prudent to have a big plate of biscuits etc. There are obviously many more examples.

Each respondent is different, of course. And the most exciting part is understanding how best to approach an interview based on their personality and engagement levels. No two interviews are ever the same, which is what makes the job both unpredictable and fascinating.
Sofia Fionda is a Research Executive in the Branding Science London office.

Monday, 3 February 2014

Bacteria: Good and Bad and how to tell them apart

“I love bacteria because they remind me of God,” said the professor. He was religious and the head of the department of microbiology and biotechnology in Tel-Aviv University, explaining how religion and science can thrive together. “Bacteria are everywhere, you cannot see them and they can do ANYTHING – just like God”, he exclaimed.

Indeed bacteria are everywhere and they are definitely in our bodies covering our skin and lining our intestines, giving us our distinctive smell, eating away our dead cells and share our food. They provide us with valuable source of vitamins that cannot be obtained otherwise and they protect us from infections of other microorganisms. Some of us call them ‘good bacteria’ to differentiate our helpful little friends from the dangerous disease causing microbes. Our ‘friendly bacteria’ are actually symbiotic and opportunistic at the same time. We are dependent on our flora as much as under its’ threat.
Try to remember when was the last time you were prescribed a course of antibiotics. How did you feel?

I have been on such a course only three weeks ago, augmentin it was, a generic brand, and in a way I was relieved the manufacturer was not one of our clients (so I did not have to fill an adverse event form). Nevertheless, I was unwell. The antibiotics killed the bacteria on the lining of my gut affecting digestion and making me uncomfortable (forgive me for not giving more detail). It is a well-known side-effect that made me ponder over a tub of yoghurt, why not try and make targeted antibiotics? Wouldn’t it be grand if you could target bacteria causing disease and spare whole body’s flora? If we could differentiate good bacteria from bad?

What are bacteriophages?
Bacteriophages are viruses that propagate by infecting bacteria, their hexapods land onto their prey (Figure 1) and inject their DNA into the bacteria, giving it orders to multiply bacteriophages until the bacteria bursts, the progeny moves on to the next bacteria and so on. Bacteriophages are specific to a bacteria strain which gives them a potential to be employed as targeted antibiotics.

It is intuitive that we could utilise the specific power of bacteriophages into treating specific infections, but for some reason the technology has not been taken by the western world.

Phage treatment has been approved and in use in Russia and Georgia since the 1920s. It actually had been in use before penicillin was even discovered in 1928. However, somehow the fear of viruses and the excitement over chemicals has led to antibiotics being developed and widely used, and now we are facing a possible crisis of multiple drug resistant strains of bacteria (MDR). Some call MDR risk ‘the perfect storm’, with only a handful of new antibiotics developed since the 1980s, we are not prepared for the next outbreak.

At the Eliava institute in Tbilisi, Georgia, infections are being treated with bacteriophages.  For example, a case of tonsillitis is treated by gargling a bacteriophage broth and the patient is cured in 6 hours, no antibiotics involved.  In the UK a seven day antibiotics course is the standard of care.

Figure 1 Bacteriophages T4 sitting on a bacteria injecting their DNA into it (electron microscopy image Science museum),
What are the difficulties in producing bacteriophage based antibiotics?
First of all safety, the use of an entity that self-replicates and have the ability to evolve is difficult to regulate as a fixed chemical entity or biologic. Bacteria are likely to develop resistance to bacteriophages. When such a resistance develops it is likely that the bacteriophages will mutate accordingly, but that may cause issues with produced batches and regulation in mass production.

Formulation issues - you can’t get bacteriophages through our digestive tract, how can we bring them to their target? Can bacteriophage be inhaled for treatment of tuberculosis?  

Another issue with bacteriophages is that they cause bacterial lysis that releases endotoxins. These are toxic to patient and may cause severe side effects such as fever. 

Bacteriophages can be genetically modified to not lyse their target bacteria so one virus would kill one bacteria without bursting its walls. The dead bacteria will then be cleared by the immune system, also such attenuated bacteriophage would be easier to regulate. Just like the use of attenuated viruses in vaccines.

The main reason is a general lack of interest in developing antibiotics because of low return on investment (until there is an outbreak).

Bacteriophages have been used in the western world, for the invention of the probably the most profitable drug ever made.

In the 1990s the phage display technology was invented and utilised by Cambridge Antibody Technologies (CAT) and BASF. The scientists at CAT engineered bacteriophages to express antibody segments and used the ability of bacteriophage bacteriophages to mutate to create many different antibodies, called a phage display library. This library was reacted against TNFα (Tumor Necrosis Factor), the best matching antibody was chosen, cloned and mass produced as a humanised monoclonal antibody. Manufacturing and marketing were given to Abbot, and the brand Humira was named.  Humira is widely used to treat psoriasis, ankylosing spondylitis (AS) rheumatoid arthritis (RA), ulcerative colitis and Crohn’s disease.

The next most likely development in modern medicine will have to be a targeted antibiotic, maybe a bacteriophage? What do you think?
Figure 2 bacterial culture killed by bacteriophages (Wikipedia). Bacteria –white. Hole formed by dead bacteria in the middle.

Dr Shai Senderovich is a Research Executive at Branding Science,
Any opinions in this article belong to the author and do not represent Branding-Science.
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Thursday, 24 October 2013

Something Wicked This Way Comes


In the February of 1692, two girls from Salem Village in the young American colonies began to suffer from strange fits that left them screaming, uttering strange sounds, contorting into strange positions, and with violent outbursts. A minister from a nearby town described their illness as “beyond the power of Epileptic Fits or natural disease to effect” and – assuming that only the supernatural could cause this illness - the Salem Village soon began the famous Salem Witch Trials.

Swept up by hysteria, everyone accused their neighbors, friends, and family of witchcraft. The town executed twenty people, nineteen by hanging and one by pressing to death when he failed to plead guilty. Five more of the accused died in prison.  The final trial took place in May 1693 and, with the defendants found not guilty, the case officially ended – at least judicially. The trials never died in the mind of the public, however, and for the decades and centuries that followed it obsessed the public with its plethora of unanswered questions.

The Crucible, by Arthur Miller, is based on the witch trials.

One of the main questions: what caused those girls to act so strangely and spark the craze of paranoia that led to so many deaths? Many theories have been put forward throughout the centuries, mostly based on the assumption that the girls faked their illness either to fuel family rivalries or as a cruel prank.

In 1976, Linnda R. Carporael proposed a new hypothesis: that the girls were suffering from poisoning by ergot-tainted rye. Their symptoms cited in the trials – convulsion, hallucination, crawling sensations in the skin, tingling in the fingers, headaches, vomiting, diarrhea, mania, psychosis, and delirium – match that of ergotism. Moreover, there was an abundance of rye in the area and, during those years, the right weather conditions for ergot to flourish. Although this theory has been subject to some academic debate, it is still one of the most widely accepted reasons behind the seventeenth century hysteria. 

Ergot is a group of fungus whose consumption causes a number of severe pathological syndromes in humans or other animals. As early as 1095, a special hospital was founded to treat the symptoms of ergotism. The condition gained the nickname “St. Anthony’s Fire” for the order of monks who founded the hospital and the burning sensation ergot poisoning causes in the limbs of the contaminated.
The effects of ergot have also been used deliberately in drugs. As Paul L. Schiff Jr. explains:
In 1582 a preparation of ergot that was employed in small doses by midwives to produce strong uterine contractions was described by Adam Lonicer in his Kreuterbuch. The use of ergot as an oxytocic in childbirth became very popular in France, Germany, and the United States. The first use of the drug in official medicine was described by the American physician John Stearns in 1808, when he reported on the uterine contractile actions of a preparation of ergot obtained from blackened granary rye as a remedy for “quickening childbirth.” However, shortly thereafter the number of stillborn neonates rose to a point that the Medical Society of New York initiated an investigation. As a result of this enquiry, it was recommended in 1824 that ergot only be used in the control of postpartum hemorrhage. Ergot was introduced into the first edition of the United States Pharmacopeia in 1820 and into the London Pharmacopeia in 1836.
In modern pharmaceuticals, ergot is used in medicines in the form of ergotamine. One example is Cafergot, a Novartis drug which is used to treat migraine headaches. Although cases are rare, the Novartis Consumer Information cites a risk of developing ergotism associated with the drug. Cafergot was discontinued in the UK in 2012. Ergoline alkaloids, originally isolated from ergot fungus, is also used in pharmaceuticals for the treatment of Parkinson’s disease, albeit usually in synthetic derivatives.
It is incredible to consider that we are now able to harness this poison - which has tortured humanity for millennia – for good. Yet the risk of poisoning still remains high, with several outbreaks of ergotism in the twentieth century. The risk of witchcraft accusations may be lower in this day and age, but with Halloween approaching… perhaps it’s best if you watch what you eat.
Sources
Paul L. Schiff, Jr. "Ergot and Its Alkaloids" in the American Journal of Pharmaceutical Education, October 15 2006. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1637017/
“Ergot” from Wikipedia. http://en.wikipedia.org/wiki/Ergot
“Ergotism” from Wikipedia. http://en.wikipedia.org/wiki/Ergotism
“Ergotamine” from Wikipedia. http://en.wikipedia.org/wiki/Ergotamine
“Salem Witch Trials” from Wikipedia. http://en.wikipedia.org/wiki/Salem_witch_trials
"Cafergot” from Drugs.com. http://www.drugs.com/pro/cafergot.html
“Cafergot: Consumer Information” from the Novartis Canadian Website http://www.novartis.ca/products/en/pharmaceuticals-c.shtml