To be (briefly) on the front lines


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For many of us working in the life sciences and passionate about the biotechnology sector, our motivation often stems from the power of medicine to help people.  Somewhere on the career path, one may have thought about the doctor route. For me personally, the potential there ended in high-school with an aversion to blood and sensitivity to bearing bad news to patients.

However, during the final year of my PhD this year on financing global health, I had the opportunity to attend Oncology Summer School at the University Medical Centre at the University of Gronigen, in the Netherlands. The course brought together 36 medical students from six continents to attend a course on clinical and experimental oncology. I was the only student without prior clinical training, but I had experience in drug development and financing. I was very excited about this opportunity – and the course did not disappoint.

Every day that I walked through the doors of the university teaching hospital, I knew I was going to learn something new.  For my PhD, I had examined how an international organization like the Global Alliance for Vaccines and Immunizations (GAVI) can finance cervical cancer vaccines for populations in low-income countries, but did I know what a clinical indication of cervical cancer looked like? No. But by the end of the Day 2 of this course, I did. The course consisted of patient case presentations, ward rounds and lectures in the mornings and research briefings in the afternoons.

Although not advertised in the course description, my favourite part of the program was meeting the medical students from around the world and understanding the functions of different health systems. We each gave a poster presentation, and through listening and Q&A, I absorbed large amounts of local knowledge.  The majority of the course participants came from developing countries, and their most frequent comment of the Dutch hospital environment was, “Wow, this sure looks different from my teaching hospital back home.”  In a high-income country such as the Netherlands, the 16 million people are serviced by 400+ consultants in oncological care and 200+ consultants in palliative care and 10,000+ professionals in networks and working support groups[1].  In a low-income country such as Rwanda, its 11 million people received their first cancer centre of excellence in July 2012, with 24 beds.

The patient case studies each morning were very insightful, but tough – especially the day examining pediatric oncology (a 10 year-old boy telling us his neuroblastoma story was particularly hard) and the palliative care case study (told by the husband of a deceased patient).  As I sat there and listened to the specialist oncologists give lectures on differential diagnoses, clinical trials and alternatives of treatment, I felt a renewed sense of motivation. I always knew that the reason I worked in the life-sciences industry was because I could help people, but seeing the clinical trial patients in the hospital persevering, with the help of their oncologists, was truly inspiring.

A doctor may pick a therapy option from a list, but the work of bringing a particular drug to market comes through years of work by laboratory scientists, regulatory affairs and accountants who keep the cashflow in check during long cycles of drug discovery and development. When I raised the question in class if the doctors and other students in the room knew how much it cost to develop an oncology drug, many blank faces looked back. With changes in demographics and increasing burdens on health systems, I think young doctors in training can benefit from an introductory course on health economics. Similarly, I think policy makers and biotech executives can benefit from a consistent reminder of the true end user of their decisions and products.

In my lifetime, I may not be on the front lines of healthcare very often: I may never physically diagnose a patient, prescribe a course of therapy, or cure them. However, I hope through my work in the life-sciences sector, I can help facilitate innovations to progress from development to delivery – where oncologists all over the world can successfully use them.

Julia Fan Li

[1] Statistics derived from presentation by Comprehensive Cancer Centre Netherlands

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