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Interview with Les Levin (EXCITE International): dialogue is the key to make a difference in health outcomes

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Professor Les Levin, founder and executive director of EXCITE International was in the Netherlands to discuss further collaboration between EXCITE International and Health Innovation Netherlands (HI-NL).

Edited by Irene Kanter-Schlifke

EXCITE International is a global collaboration of key stakeholders -innovators/industry, regulators, payers, health systems, patients, scientists and end-users - working together in the premarket space to change the paradigm of health technology innovation and adoption. Les Levin is professor of Medicine at the University of Toronto and until recently, was senior consultant in Medical Oncology at the Princess Margaret Hospital. He was interviewed by HI-NL Operations Director Irene Kanter-Schlifke (IKS).

(IKS) What, in your experience, do innovators need most when developing their innovation?

(LL) “They need to know where they are aiming, the ecosystem in which the innovation will be functioning and the expectations of people and organizations that will ultimately make decisions regarding the development and adoption of the technology. They need to have an awareness beyond just the mechanics of the innovation, they need to have an awareness of the added value not to them as innovators, but to patients and health systems in particular. In this regard, they need to understand what alternatives are currently available and what is the value added of their innovation and vision – I think that’s the first priority - to conceptualize the context of the innovation.

The second thing they need is to listen. They need to develop the capacity to listen to those around them who might know more than they do. There can be a sense amongst innovators that what they have will cure people of any possible ailment in the world. That enthusiasm is great, but they do need to listen carefully to people who are experienced. And they need to build a team around them that represents the various aspects of what the innovation is about. 

Above all what they need is money. Unfortunately, without money, you don’t get far in the innovation game. And one of the great barriers is that no-one is prepared to invest at the front end of the technology lifecycle. People have the expectation of someone else taking the risk. So innovators need to have the awareness of what the risks are and what the expectation is of investors. You need to understand risk, before you take risk. If innovators don’t have that awareness of the risk at the front end, it’s extremely difficult to convince investors to invest.

(IKS) What would be your advice to young innovators?

(LL) “Listen. Seek the truth and listen; don’t be scared of truth. Because if you duck the real issues at the front-end, you pay the price at the back-end. It’s very easy to get into the innovation game, but very difficult to succeed. Be aware of where you are heading with the innovation and understand the expectations of regulators, payers, health systems, expert end-users and patients. If you fail, fail quickly.

(IKS) How can we stimulate the development of breakthrough innovations in the medtech-space? And who plays a role in this?

(LL) “By bringing health systems and end-users including patients together with innovators. Patients are terribly important. We have to realize that industry is part of the health system, they are not apart from the health system. Industry R&D is what is going to make a difference to health outcomes and efficiencies. Until very recently, it’s been a ‘them’ and ‘us’ relationship. Some even perceived industry as a threat to health systems, thinking that health systems can’t afford new innovations. In my experience the earlier industry engages with health systems, payers, experts and end-users, the more industry is likely to meet the needs of health systems and patient outcomes. That dialogue is important to bring the backend to the front end. There has to be that common purpose and trust to make it happen.

(IKS) And a final question: how can we achieve a better fit between all the new innovations and actual societal needs?

(LL) “Transparency. And significant, comprehensive engagement, not just with one person or one group of people. And this also needs to include end-users and patients. I think one of the best examples is development of protocols for clinical trials. Even now the outcomes of trials are mostly determined by experts who sit on clinical trial committees and very often these are experts working with methodologists. These outcomes are based on previous experiences where others have defined “legitimate” outcomes. But if you really want to know what outcome is important, just ask a patient and key decision makers!

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