Physics, fads and forecasting: A different perspective on the future of healthcare

• A famous philosopher once asked a friend why people believed the sun revolved around the earth. She replied: "Because it looks that way." He then asked: "So how would it look if it looked as if the earth went round the sun?"

The story makes an interesting point: we sometimes rely on perceptions that contradict what we know to be true because the reality, from our perspective, seems counterintuitive. Who doesn't still talk about the sun rising in the east? (I know I do).

Coming back to earth, it’s also an instructive lens on the public debate about the role of off-patent medicines in healthcare, both today and in the future.

It’s common knowledge that generic and biosimilar medicines represent about 80% by volume of prescription medicines used worldwide – at a fraction of the total cost. And there’s no dispute about the fact that some of the most critical medicines in everyday use, from antibiotics through to ICU therapies, are almost entirely generic.

Who really calls the shots?

Still, if you follow the daily political discussions about healthcare, you could be forgiven for thinking the off-patent sector is just a minor star in the healthcare galaxy, circulating round the massive planet of ‘innovative’ branded medicines.

There are, of course, many good reasons for this, from the news value of innovation through to the sheer monetary clout of the branded industry. But that’s also a question of perspective: from where most people sit, it just looks as if patent-protected medicines matter more.

It’s a trend I have actually seen increasing in recent years, despite the renewed focus on essential medicines following the pandemic, as well as more recent disruptions to global supply chains.

Indeed, if you ask a group of healthcare experts to look a few decades into the future and predict what will change, the answers are likely to be largely focused on trends such as artificial intelligence and personalized medicine – and how they will shape the growth of the branded medicines sector.

However, there’s a key point that gets overlooked here: branded medicines have always been the ‘pipeline’ for the off-patent sector of the future. We see that today with the increasing uptake of biosimilar medicines: there are well over 100 reference biologics set to lose IP protection by end 2032 in Europe alone. My vision is that, a few decades from now, biosimilars of every medically relevant biologic known today will be broadly available to patients at more affordable prices.

Growing appetite for weight loss

And that’s just the beginning. We are already seeing the massive global appetite (pun fully intended!) for GLP-1 ‘weight loss’ medicines, and companies including Sandoz are already on track to make more affordable versions available to patients as soon as possible.

Expect the same with the next generation of branded medicines, particularly the rapidly advancing class of tailored cell and gene therapies, including oligonucleotides. The science may change, but the basic dynamic does not: patents reward innovation for a limited period, patents expire, competition enters the market and drives patient access.

As for AI, the likely benefits for production economics and quality control are clear. And that’s without mentioning the potential for AI to promote preventive care and improve supply and demand forecasting.

The key question for me is more practical: how do we get there from here? Much will depend on the political will to recognize the key role of off-patent medicines in addressing current challenges: from an ageing population, through complex and diverse financing models, to shortages of essential medicines and rising health inequalities.

Make the most of what we have

Off-patent medicines, with their large volumes and lower price points, serve as the perfect ‘pilot’ for new policy models (particularly across larger economic groups such as the European Union).

To take a concrete example: where better to start with the introduction of overdue changes such as digital leafleting, which can help resolve shortages in one country by more readily enabling imports from another? Let’s make the most of what we have, then use the results to smooth the introduction of what’s still to come (innovative and disruptive technologies and therapies).

Off-patent medicines can also serve as a blueprint to drive the much-heralded focus on preventive care. Patients need to be encouraged to take their health into their own hands, and policies need to drive this.

Take antibiotics, the backbone of modern medicine. Growing bacterial resistance (AMR) is driven largely by misuse, compounded by lack of access to the right medicines when they are really needed.

Focused implementation of modern diagnostic tools (think ‘bedside self-diagnostics’) is key to solving the first issue. And a market framework that focuses on the value of medicines, not just their price, is the only sustainable solution to the second.

Contrary to what most people think, science typically advances in small, but concrete, steps. Healthcare policy – and the assumptions that drive it – needs to do the same.