To Predict and to Intercept
The head of Janssen’s disease interception platform talks about progress – and babies.
Disease interception – as opposed to the treatment of disease when it is diagnosed – has the potential to do two major things: to make things a great deal cheaper for cash-strapped health authorities and to offer patients a far better quality of life.
In February 2015, Janssen launched its Disease Interception Accelerator (DIA), an ambitious platform which seeks to shift healthcare from diagnosis and treatment to prediction and pre-emption. In Janssen’s ideal world, the term ‘patient’ will become redundant, as intervening and stopping disease from progressing in healthy individuals becomes the norm.
This requires everyone involved to think very differently about people’s health. “We need to reiterate that this not going to be solved today,” insists DIA head Ben Wiegand. “But when did the iPhone come out? 2007? Now I can’t imagine the world without one, which is a significant change in less than ten years. It’s the same in healthcare: by 2025, there will be significant changes.”
This has not stopped people criticizing Janssen’s approach. “Our team is 100% focused on interception,” Wiegand says. “The one comment we’ve had from outside is more cynicism than anything else: ‘You are providing therapeutics for people who are sick and now you look to provide interventions to people who are healthy?’”
He brushes this off with good humour. “When we explain it, people see we are truly trying to do the right thing.” The pharma world is watching with interest and in the DIA’s first year or so, Wiegand reckons there have been two major highlights. The first is the progress made in its work on type 1 diabetes and the collaborations which have been put in place. The second is being able to expand to six ventures. “We’ve learned a lot about the science,” he says.
The DIA currently has six ventures on its books: type 1 diabetes; presbyopia/cataracts; perinatal depression; oral cavity and oropharyngeal cancer/cervical cancer; plus – the two most recently announced - gestational diabetes; and chronic obstructive pulmonary disorder (COPD).
The diversity of these therapy areas – from oncology to immunology - is instructive. There is an obvious strategic reason: several tie-in with the company’s existing core expertise. But Janssen does not want to be bogged down if one or more turns out to be a less fruitful area of discovery. Janssen also wants to work on projects which can swiftly demonstrate results rather than requiring, say, a 15-year study.
“That’s why we chose gestational diabetes – it’s time bound,” he continues. The disease affects pregnant women, usually developing by the third trimester, and these mothers are more likely to develop type 2 diabetes later in their lives. The disease can also affect the child during pregnancy and later in life. “We want to show success and to learn quickly,” he continues. “If the first trial doesn’t work, we don’t want to have to wait ten years for the next one.”
The idea of preventive health care rather than reactive disease care is very striking – in the UK, for example, the NHS is sometimes described (not just by its detractors) as a ‘National Sickness Service’ rather than a ‘National Health Service’. Wiegand is quick to defend authorities’ existing methods of treatment, saying: “We commend health authorities for their work today since it makes sense where the current toolbox exists”.
We can change the paradigm although it will still be hard. The second hire in our group was a behavioral psychologist: changing behaviors is not going to be easy but we’ve had a positive response from payers, providers and advocacy groups.
However, the development of genomics and of biomarker discovery tools which look, for instance, at low incidence of proteins, has given scientists the ability to predict things which were simply unknowable before. Still, getting the precise diagnostics right is one thing -ensuring that the work is effectively carried through on the ground is quite another.
“No-one wants to get sick,” he points out. “We can change the paradigm although it will still be hard. The second hire in our group was a behavioral psychologist: changing behaviors is not going to be easy but we’ve had a positive response from payers, providers and advocacy groups.” The latter is particularly important. “We are working with advocacy groups to make sure we are understanding patients and gaining their input,” he insists.
This being the case, could the DIA’s approach be applied to any therapy area, or are there limits? “You need three critical elements for disease interception to work,” Wiegand explains. “You must be able to identify a high-risk population, you must be able to monitor them, and you need to have a solution. So it’s relevant for the majority of diseases. There are some that today we simply don’t know enough about – but over time, I think most, if not all, will fit this scientific approach.”
Money is always an issue in health research, but by reaching out to other organizations, Wiegand believes this can be overcome. Janssen’s aim with the DIA is to try entrepreneurial, non-traditional, academic, pharma and biotech approaches. To take a couple of examples, it is working with privately-held immune-oncology company UbiVac to research a potential interception approach for oral cavity/oropharyngeal cancer, while in type 1 diabetes, it has partnered with Washington University School of Medicine and JDRF, the leading global funding organization in the field. “Collaborations are critical,” he insists. “And not just where we’re supporting research to be done: JDRF is investing – we can both win. We can create a tremendous amount of value. We want science-based solutions that work: we are excited about the responses we’ve been getting.”
We’re trying to identify the right people at the right stages. Our aim is to be very personalized and precise.
Wiegand is enthusiastic about the need for intervention in the DIA’s two latest projects. “Gestational diabetes is not just a risk for the mother,” he notes. “The unborn child has a 7-8 times higher risk of progressing to disease in their life.” Most diagnostics for the pregnant woman currently happen at 26 weeks, which means that by the time the data comes back it is too late to make a difference during their pregnancy. Janssen is working with the Agency for Science Technology and Research (A*STAR) in Singapore to find ways of identifying the start of metabolic dysfunction itself, which should open up new possibilities. “We’re trying to identify the right people at the right stages,” he goes on. “Our aim is to be very personalized and precise.”
COPD, meanwhile, is the third leading cause of death worldwide. The DIA and a team from Boston University are analyzing data from the Detection of Early Lung Cancer Among Military Personnel (DECAMP) consortium, a multidisciplinary translational research programme, to advance the development of targeted therapeutics. “It’s a unique opportunity to get ahead of the game,” Wiegand says. “We don’t have to start tracking people: the data exists.”
Need for collaboration
In conversation, Wiegand comes back several times to the importance of sharing information and expertise with others.“We are starting conversations with payers and providers, asking what data they will need,” he explains. “We’re not going to be able to do this ourselves: we need collaborations all around the world.”
This is why, in type 1 diabetes for example, the DIA has established relationships in Finland: the Nordic country has a higher incidence rate of the disease than the US, which means there may be lessons to be learned. “You have great researchers there,” says Wiegand. “There is a different healthcare system and a burning desire to get ahead of the disease, working globally.”
Part of the reason that there is so much interest in the DIA is the obvious possibility of financial savings in healthcare systems which are under intense financial pressure – but Wiegand is cautious. “Getting ahead of the disease offers the potential of reducing the cost burden, but there is a lot to figure out,” he explains. “We’re not saying these savings are available. Also, just as important is that everyone sees the idea of improved quality of life: the opportunity to live longer and healthier and that improvement leads to improved productivity. So there are indirect benefits but we are working to quantify those, pulling together those models".
Wiegand has been at J&J for 21 years, spending a large chunk of his time in the baby franchise. It is here that outsiders can glimpse a little of what makes him tick. “In the first 1,000 days of life, someone’s health trajectory is being set up for the future,” he begins. “By the time you are 30, 40, 50, a lot of those pathways have already been set up. So I was intrigued by the role played by the developing baby – it’s been a guiding light for me. All of us are made differently – but we can live the best we can.”
Research to reality
The DIA is a tight ship, with a headcount of ten or so, although that figure rather underplays the resources available: while the DIA is a discrete part of J&J, it still exists within the group’s ecosystem – and has received offers of help from staff who are keen to see what Wiegand and his team are doing. “We have well over 100 people in J&J who have heard about us and are helping us in some way – perhaps by giving 10% of their time as a clinical researcher,” he suggests. “But we ensure we are not distracting them from their day job - we have a business to run.”
Nonetheless, the work of the DIA is attracting interest precisely because of what it could represent. “It’s a long road,” Wiegand concludes. “Stakeholders have been very responsive. But this is not a research project. We believe we can make this a reality.”
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