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Luck Is A Skill: Written Medicine's Research Paradox 1

17/10/2016 14:05

One of the biggest differences between health tech and other tech is that health tech is always pressed for data to prove effectiveness. But where do you get data from if you are advocating for something that is actually novel? Does not one necessarily preclude the other?

Of course it make sense for healthcare providers and commissioners to ask for some evidence of effectiveness. In case you didn't know, evidence-based-medicine is a big thing, I mean a BIG thing. Not to mention that new drugs and some medical devices will not reach patients before they have amassed mountains of data. So people are used to seeing hard facts about health interventions.

But a small team of developers with start-up resources can't match the big Pharma machine. At best, we can show you how our innovation solves an existing problem and give you an idea of what to expect long term. What we can't do is give you research-level evidence that shows you how much impact an intervention has had on medical adherence compared to placebo in a randomised and blinded comparison with rigorous statistics, large sample sizes, p values and confidence intervals.

And even if we could, this would be looked at with some level of suspicion because the research was not performed independently. This happened to us when we applied for a research grant, the reviewers rightly pointed out that a director of Written Medicine, me, was also lead researcher and that this was cause for concern due to the conflict of interest. They also asked why we had not considered other interventions. I believe the answer to that is blindingly obvious...

So how do we do this? The commissioner won't buy without evidence and the grant bodies won't fund unless it is independent. Of course you could ask, "why don't you fund it yourselves?" And to that I answer: these research grants are costed between £20,000 and £200,000 if we don't pay ourselves for project management and underpay all service providers to operate the project. Just to help you benchmark it, a project manager's annual salary is in excess of £40,000. If we had that kind of money, we would be established and out of this chicken/egg scenario.

"So how did Written Medicine get out of it?!" I hear you ask. Well, I guess we were kind of lucky (note that I think luck is a skill):
First of all, we had been around for long enough.
Second, we had a Twitter presence which connected to the then President of the Royal Pharmaceutical Society, Mr Ash Soni. Ash is not just an all round nice guy but he works with people like us to stretch the boundaries of conventional care and improve lives. Sadly though, he is allergic to cats.
Third, Ash had connections with Grant provision bodies in Health Education England. Ash invited us to submit a simple and cheap research proposal.
And now we are in the middle of data collection for said project.

With any luck (remember this is a skill), this will help us to secure the attention of a few commissioners and NHS providers so we can continue the good work...

If any commissioner or healthcare provider is reading this, I would like to impart a couple of things to bear in mind:

  1. If the service seems like a good idea, give it a chance
  2. Please don't just ask for evidence, have a clear idea of which specific problem you want the intervention to solve
  3. Work with the startup to develop a simple, cheap evaluation that answers your specific question
  4. Pay the startup to run the trial, push for a discount, but pay for the trial

Doing this should allow you to justify buying the service outright with data from your own Trust/area that was cheap to collect. This minimises the risk for all, it helps you to onboard innovation, it helps the startup and (fingers crossed!) it improves patient care.

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