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Paul Ormerod: What a good job Keynes didn’t believe in forecasti...: "Keynes is in many people’s minds at the moment, as uncertainty about the course of the economic recovery is high. In May 1933, at roughly t..."

Some Comments from the Third European Public Relations and Communications Summit

I recently attended the third European Public Relations and Communications Summit organized by the New York-based company Exl Pharma. This year there was a change in mood and direction compared with the first, the mood was urgent and the direction was towards building new kinds of partnerships with clinicians and patient groups. Corporate communicators are now much more than flag wavers in front of the juggernaut. They are managing a function vital to the survival of the company. Chief Executives know who they are.

So why this transformation? Pharma companies are in the process of changing their business models. The days of blockbusters are over, for them the phase of greater urgency was with the regulator in gaining initial market access. Instead the companies are having to relate much more directly to their funders: the patients. A new kind of pharma care pathway is now on the way to involving diagnostics, targeted personal therapies and outcome measurement. Companies have to take more responsibility for getting therapeutic results. Especially notable were the contributions at the Conference from Fiona Olivier, Strategic Business Communications Director at Abbott. And from James Read, Director of Public Affairs International at Gilead. Abbott are working to develop a new team approach to the culture change. Gilead has shown what can be achieved in getting improved results for patients from the new range of anti-viral therapies. The new model is being supported by key voices in the European Federation of the Pharmaceutical Industries and Associations led by Colin Mackay.

The new model gives the opportunity for a wider range of companies to develop special expertise. It’s more favourable to new entrants than the blockbuster model, those winner take all models that led to increased concentration in the industry. The new model gives smaller and medium sized companies the chance to build a new kind of relationship with patients.

Nick Bosanquet

Happiness Sceptic

Happiness Sceptic

I finally got something positive about the project to measure wellbeing. Much of this has so far rather left me cold. Clearly, there is more to life than the economy, and equally there are many measures of such things as life expectancy, quality of life, educational outcomes and so forth.

And some of the happiness gurus I find distinctly scary. When they tell me they know what makes me happy, I turn up my copy of 1984 (well worn it is too). When they say that all we need to know is a left hand variable (happiness) and the right hand variables which determine it (how often you go to the pub) I want to get away from regression analysis and reach for a gun so that I can shoot before I am shot as an undesirable who doesn’t know what is good for her.

But actually there is something in this. The something is the word ‘subjective’. A lot of subjective feelings are of course ephemeral, emotional and variable with the weather. But some of the ‘subjective’ analysis – how do you generally feel about life – has the capacity to enhance some of our objective analysis. We know that unemployment is a loss of output. We can measure the association with health problems. An association with views on life and its value adds a dimension to this understanding.

But I have not abandoned scepticism. First, I want to know how plausible I might find an allocation of public spending based on such judgements rather than the more normal ones. Moreover, if I discovered that unemployment was a greater scourge than previously thought, does this mean that we should pay people to continue to do jobs for which there is no economic justification?

Bridget Rosewell

Engaging Citizens

Engaging Citizens

I have just participated in a workshop organised by a EU Research Programme called ASSYST, which was focused on the role of ICT in developing policy for a green knowledge based society. I am often sceptical of titles such as this which seem to have every policy buzzword and which can become a substitute for thought. This was, however, an exception.

The most interesting phenomenon was how participants from two Italian regions, from Ile-de-Paris and from London (me) were all stressing the need for more open data access and for creating a more informed and participative dialogue with citizens.

Moreover, we were all positive about the potential for enhanced ICT access to revitalise democracy and help develop better, more focused and more effective public services.

Of course, our histories are not entirely shared and so the balance of views was not universal. Both Britain and France are more centralised than Italy, and in Britain the scope for deciding on local spending is decidedly limited. As ever, participants were shocked to discover that local authorities in the UK only dispose of 5% of budgets independently. This included some of the other Britons present, it should be said.

The group present included both regional policy makers and the academics from the research programme, who want to establish how to develop scientific descriptions of these interactions between citizen, policy and politics. How to model networks and their dynamics, as well as how connections might differ under wider use of internet communication were discussed.

The digital divide and the risk of disempowering those who cannot afford or do not want to try new methods of engagement were key risks, particularly if the sort of knowledge that begins to matter excludes the elderly whose value in some societies is precisely their broader knowledge. If it is the old who vote while the young engage differently, some of us were concerned about society tension.

Nonetheless, in spite of worries about these sorts of tensions, I came away more enthused about the fight to increase access to data, and more convinced that it is an important battle.

Bridget Rosewell

The New Economics of Cancer Care

The last four decades have seen a reduction of many diseases—but not of long term medical conditions—or of cancer. Between 1971 and 2008, the age standardized incidence of cancer has increased by around 24 per cent in males and 49 per cent in females. Cancer is rapidly becoming the leading UK cause of premature death under
70. Demand will be driven by population aging---75 per cent of new cancer cases are diagnosed in people over 60.
In The Economics of Cancer Care*, now available in paperback for the first time, Prof Nick Bosanquet of Imperial College, an economist and Chairman of Volterra Health and Dr Karol Sikora a leading clinician and former Director of the WHO Cancer Centre in Lyon set out how we could have a more effective cancer care through stages of a New Model :

• Prevention
• Screening and early diagnosis
• Ambulatory care
• Care programmes
• Palliative and end of life care

This model is international and requires co-ordinated action. Prevention is cost effective but does not reduce incidence in the short term: early detection can raise incidence as well as carrying a risk of false positives which will lead to treatment delays. Most cancer treatments can be organized on a day basis. And there is an urgent need for programmes to improve the quality of life of survivors. Lastly there is an international deficit in low cost effective end of life care.
The new model developed from research done by the authors on improving cancer services in The Czech Republic and Poland: and also for Hospital Trusts in the UK. The new UCLH cancer centre in London, where Nick contributed to the design, will have no in-patient beds and will aim at 10 days from referral to treatment. The new model offers a very positive and fundable way forward for cancer services for the future decade, where there will be a 100 per cent rise in demand and a 10 per cent rise in funding.

*N.Bosanquet and K.Sikora. The Economics of Cancer Care. Cambridge University Press paperback 2011.

Triumph of the City – Ed Glaeser

This new book celebrates how cities have made civilisation and fostered human endeavour. It is a readable and exciting book and I agree with many of its propositions. But what it has made me reflect on is the concepts of necessary and sufficient. In his book, Glaeser concentrates on the need for skilled citizens and education. He argues convincingly that this is essential for growth and city success. He is surely right.

But there are other necessities too. Not all of these come over clearly enough in my view, although they are certainly present. He writes about the rise of consumer cities, places where the ability to consume a desirable variety of goods and services makes them good places to be and thus generate the contacts which produce innovation and ideas.

In fact, cities started as consumer cities, places where the elite created the opportunity to make and consume luxury goods. What is fascinating is how long they took to create production cities, where this contact made it possible to have ideas and get them to function. The Roman Empire had very successful cities but couldn’t create the Industrial Revolution. This took considerable historical contingency – accidents perhaps in one reading – which came together to create the explosive growth which has reduced infant mortality, raised living standards and lengthened our lives.

Two elements are key to this contingency, communications and harnessing energy. Both are as essential as skills and education. Communications are both short and long range. Short range communication is about creating ideas and how to use them. Long range is about the ability to exploit these ideas and make them work. Small groups can get together and have all kinds of insight. Without longer range communication, nothing will happen. The internet and the world wide web have harnessed ideas in a wider and wider way, and follow on in the long road from printing, from the telegraph and telephone as well as physical communication as ways of communicating and expressing our ideas.

Glaeser tells how New York grew rich on pirating British novels – and indeed Rudyard Kipling complains about such piracy – this is precisely about harnessing ideas effectively.
Energy is the other pre-requisite. Tractors replaces horses in agriculture and transformed agricultural productivity, as indeed horses had done in medieval times. Electricity made elevators possible and the density of occupation in city centres which Glaeser extols. Fossil fuels have a productivity which nothing else has so far matched. All the education in the world will not help us when the lights go out.

The education and communication might help us create the new technologies which could replace such fuel, although we are still a distance from doing so. So we need three things – skills, communication and energy.

Ed Glaeser has focussed on the first of these. I suspect that this is partly because in the US they are still very rich in communications and energy infrastructures. However, in other countries the balance might be different. In the UK, the physical and energy infrastructure needs as much attention as the skills.

Do we want to throw money at reforms without results?

Volterra Consulting's new sister firm, Volterra Health, launched its first report today 'The Medical Arms Race, A New Global Perspective'. It sets out our main critique of common health policy reforms over the last thirty years and warns of the dual costs of running the 'Old Model' in parallel with attempts at the 'New'.

Volterra Health take a global view and show that while behavioural demand drivers of increasing health costs are important - and will become more so - there are basic structural problems preventing cost containment. Most developed countries suffer from an imperative to use the latest technologies and therapies - the so called 'medical arms race'. But some developing countries have shown that they can get better or comparable results for much, much less (see also McKinsey, 2010).

Professor Nick Bosanquet, Bridget Rosewell and Charlotte Alldritt argue that unless we halt this medical arms race and address underlying supply side issues, we'll continue to throw money at 'reforms' which only fail payors and patients. As Charlotte also argues in the Guardian today, healthcare is going to be the issue for 2011. Watch this space!