Given this specialization in and deep knowledge of CNS, how would you assess the Turkish medical systems’ ability to handle mental illness?
First of all, when we portrait the global burden of mental illnesses, today 700 million people worldwide are living with brain disease and only half of them are being treated. Those people unfortunately live up to 20 years less than others. We know that more than 70 percent of people with brain disease experience discrimination and 90 percent of all suicide victims also suffer from a brain disease.
Since Lundbeck was established in Turkey in 1999, we have worked to coordinate the stakeholders in mental health to best serve the patients in the country. As such, we have cooperated with the medical community to host educational events and perform various support functions to improve understanding of patients with mental illness, and how to best approach them and their treatment. We have achieved a lot since then, however awareness and sensitivity amongst the general public is still an issue, and there is a long way to go in terms of education and de-stigmatization.
A recent survey called IDEA covered seven countries including Turkey initially to reveal the impact of depression in the workplace and the subsequent personal and economic burden, a key area of focus for Lundbeck. The results showed that in Turkey, people generally are not comfortable discussing their depression at work, meaning that it is something to hide. This is a cause for presentism, where patients with depression go to work and do not take sick leave, but are not fully present and not able to meet mentally the demands of their job due mainly to cognitive impairment from their depression.
As an overall assessment and my recommendations for the future, I would say that although the medical community is well informed on CNS diseases and optimal treatment approaches, mental illness is still not understood as well as necessary by society at large. Second, there is still a need from the governmental side to dedicate more resources to treating mental illness, educating the public, and providing support mechanisms for patients. According to the World Health Organization reports, depressive disorders are projected to be the first leading cause of global burden of disease in 2030 followed by the ischemic heart disease as the second leading cause.
There is still much to do to enable that the brain diseases and other diseases are treated on an equal basis (mental and physical health parity), to ensure a national standard on mental health in workplace and to end stigma around depression.
Who are the key stakeholders for Lundbeck to engage with to help encourage cultural change and learning in this field?
We have worked with the national psychiatry and neurology associations from the very beginning. Globally, Lundbeck engages strongly with patient organizations and those efforts are quite well received by the patient groups. This year, a global survey which measures and ranks the corporate reputation of 37 pharmaceutical companies and is based on the evaluation and input from 1,150 patient organizations from 58 countries around the world has rated Lundbeck at the first place in the area of mental health. In Turkey, there are few active patient groups however, I see that the medical community is the key stakeholder advocating for patients and is our strongest partner in encouraging change and advancement in mental health awareness and treatment. In addition, we are in continuous contact with key governmental institutions to exchange opinion on the public policies and funds available for mental health patients who are seeking treatment.
Is mental health a priority for the government when it comes to facilitating market access?
The government is the key stakeholder when it comes to introducing new treatments to Turkey. Lundbeck has actually been one of the more successful companies in the last year or two in terms of bringing new products to Turkey, as we have had the opportunity to obtain marketing authorization for two innovative products in 2014. We are proud that we have launched a new product for the treatment of alcohol dependence, and we also have received the regulatory approval for a new antidepressant. When it comes to new product access, we view the government as a key partner to work with on mental health’s unmet needs to best serve the patients in the country. There is a National Mental Health Action Plan in place by the Ministry of Health and we continue to engage in discussions to bring in functional solutions to practices in the area of alcohol use disorders or unmet needs in depression.
How has the new molecule for the treatment of alcohol dependence been received so far in Turkey?
This drug has an important position for patients who have difficulty in accepting abstinence treatment or in maintaining their abstinence.
In alcohol dependence treatment, fewer than half of the individuals with the disorder ever get treated. Existing treatments has required total abstinence. There is still an unmet need in this area since there is only an estimated 60 percent chance for one or more years of abstinence for alcohol dependent patients. And, 40 to 75 percent of them are estimated to have a relapse within the first year.
In this challenging treatment area of alcohol dependence, this molecule is a useful and efficacious tool to meet the unmet needs in the area and to help patients at the outpatient settings. The acceptance in Turkey has been very well indeed and we are hopeful that this new treatment scheme may even help Turkey deliver the corresponding target of the World Health Organization, which is attaining at least 10 percent relative reduction in the harmful use of alcohol by 2025.
Which parts of your portfolio will be most important to meet the unmet medical needs in the coming years?
The alcohol dependence product is Lundbeck’s first new product introduction in Turkey in seven years, and it is very exciting to be bringing innovation to this treatment area again. The next step will be providing Lundbeck’s new antidepressant to treatment providers to help them battle with some specific, yet not widely investigated symptoms of depression.
Another key product in our pipeline is in Alzheimer’s, and currently Turkey is participating in the global clinical trial for this drug at six clinical study centers. We believe that all of these products will be important for the scientific partnership of Lundbeck Turkey with the key stakeholders in the central nervous system disorders.
Is Turkey seen as an attractive investment environment, and how can the government improve attractiveness?
The government and industry have constantly discussed bringing innovation to Turkey, yet there have been significant challenges especially in the area of pricing although the government has to be fairly recognized for designing some incentives in support of local manufacturing. Lundbeck is very proud to have taken action, and have transferred technology and brought innovative manufacturing activities to Turkey alongside our clinical research activities. With our local manufacturing partner Pharmavision, we have completed the technology transfer of the innovative antidepressant and we have obtained marketing authorization for this molecule as a locally manufactured product at the end of 2014. We have also been extremely satisfied with the quality of the neurology and psychiatry centers in Turkey when it comes to R&D cooperation, and we have identified a few as key centers for future global studies in this area.
After working for more than 20 years at Pfizer, Lilly, and GSK, what are your impressions of Lundbeck as a company, now that you have led the Turkish affiliate for two years?
It is different in the sense that this is the first specialized company that I have ever worked for. Lundbeck is celebrating its 100th anniversary globally and we call this dedication Progress in Mind, which not only covers the proud of our past century in drug discovery but also our future promise to broaden the acceptance of patients and their access to treatment and the society.
The clear difference to me is; when you work as part of a dedicated company in one area then you have the chance to develop a much greater level of understanding, and much deeper and more specific relationships with all stakeholders to take a more significant patient-centric approach.
I am grateful to my former companies, and greatly enjoyed all that I was able to do and learn with them, but honestly it is so fulfilling to be a part of a specialized company like Lundbeck in CNS.