Trials with Maya Z

Maya Zlatanova, CEO of TrialHub (00:00)
Hello, everyone. This is Maya. It's a lovely Monday here when we're recording this conversation, enjoying the summertime, but most of all, enjoying that I finally managed to get to speak to you on my podcast, Annabel de Maria. Annabel is a very special guest for me and you'll see why, and especially

when we speak about my latest mini series around standard of care and the importance of standard of care for making clinical trials more efficient. Why? Because Annabel, she's the chief patient officer of Alira Health. And throughout the years, she's been involved in so many patient engagement projects, like so many of them. I have the privilege of knowing Annabel for quite some time now. I wish I knew her even before that.

But she told me so many different stories. Like one of it, have to say, I always remember, when I think about Annabel, I always remember about this story is the fact that she was a part of the launch of Viagra when she was part of Pfizer. So Annabel, please introduce yourself briefly to our audience, your background, and tell us a little bit more about yourself. And of course, once again, welcome Annabel.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (01:24)
Maya, thank you. I appreciate so much the invitation because I always have lovely conversations with you and today it's gonna be, I'm sure, another one. Basically myself, as you said, I'm the Chief Patient Officer at Alira I've spent almost 30 years now, which you say when you're a little bit old, right? But you see, if you've been able to spend 30 years in patient engagement, it's a lot.

And I started my career when I was 25 in the pharmaceutical industry. Since today, I've been in seven different pharmaceutical companies around the globe and working on very different type of profiles and drug profiles, basically.

So basically this is me now I am the chief patient officer at Alira and working on a very transversal function, securing that the voice of the patient is raised and it's heard throughout the whole life cycle management of a drug or a medical device.

Maya Zlatanova, CEO of TrialHub (02:21)
Yeah, thank you Annabel. And I want to mention something because that's, you mentioned your role at Alira Health, but I know one of the things I know, I don't know Alira so well, although I know it's quite innovative company with a mission. I've been following Alira Health's CEO for quite some time and I know that the company has quite a patient aligned mission, which is really amazing. But I know from

how much you're trying in your role to educate companies, why and how they can and they should speak with patients as early as possible. So I always admired this work. Annabel, we have a very, important need actually today, which is a conversation we started even when I actually invited you. You kind of asked me.

Hey, Maya, would you like to discuss the patient journey or the patient pathway or the standard of care? And you're actually raising a very good question. I even decided to run a poll on LinkedIn to see what people think. Tell me, from your experience, how do you see the difference between standard of care, patient pathway, and patient journey? Is there a difference and what is the difference?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (03:42)
Yeah, I think there's a difference and to me there's an important, more than a difference, there's an important nuance, which is the patient pathway to me, it's what it happens in real world. So all those gaps and barriers in the system that the patient is gonna pass through at each stage of his or her treatment. So there's gonna be a series of different steps and the patient is gonna pass through all those steps and that theoretically is the standard of care.

because many things may happen across this pathway, right? However, to me, the patient journey is like an extra layer that you may add on the top of this patient pathway, which is how does the patient experience the patient pathway, right? Meaning that there's gonna be an interpretation from the emotions of the patient on how is it this pathway, how painful it is or how delicate or how

or what are the insights that you can extract from this journey. And all that together gives you a picture that is much more complete than the pure patient pathway. So I may say that the pure patient pathway is more technical while the patient journey, it adds an extra emotional layer maybe. I hope I'm kind of explaining this well because I know it's not an easy task when you interview a patient

his or her pathway, they immediately bring you a bunch of details and nuances that are about their experience.

Maya Zlatanova, CEO of TrialHub (05:17)
Yeah, and that's absolutely critical because like with many things like we're so different each one of us So it's about our perspective and how do we experience something? So maybe something like for example with pain, know that pain is probably one of the most difficult end point to to measure because it's not about what you think it's Pain, but how do you experience that?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (05:42)
have a super experience with the pain thing. We wanted to check in one of our clinical studies, we wanted to check how patients were interpreting the validated questionnaire in pain. And the disease that we were working on,

pain induced chemotherapy. And when we asked patients about the validated skill was basically the first question was from one to five, how much pain do you have in the morning? And patients responded to us, I don't have pain. And we were like very surprised about you don't have pain. So what do you have? And they responded, well, we basically have like pins and needles or

Maya Zlatanova, CEO of TrialHub (06:22)
no.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (06:23)
numbness but we don't have pain and that was interesting because we may even give for granted that a validated scale called validated scaling pain

It's the right one to use. And it may happen that the patient is interpreting the word pain, which is the central word in a validated scale for pain. So as you said very well, each of us are very different. We interpret things differently, right? And that's why for me, the patient journey is about interpretations, emotions, understanding, insights, experiences.

Maya Zlatanova, CEO of TrialHub (06:57)
Yeah, you're absolutely right. Let's go back to the patient pathway in Annabelle. You actually mentioned in earlier conversations that one of the things that led you to go after this patient engagement career was exactly a project. think the Viagra one, you mentioned the Viagra one, that this opened your eyes and that actually

led you to start working in patient engagement and everything around patients. So how critical is to understand the patient pathway?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (07:33)
Well, you see in the case of Viagra, understanding the patient pathway or the patient journey, whatever we want to call it today, is as critical as you can fail completely at the time of commercialization if you haven't understood very well the patient journey at the time of clinical. So in an ideal world, I always used to say that everything should happen in clinical when it comes to patient engagement. Why? Because that is the time when everything is going to be set, including

HTA requirements or commercialization requirements. I'll give you the example of Viagra. When we start with the clinical development of Viagra, it happened absolute chance. We never expected to start developing Viagra on erectile dysfunction. We just did it because chance, patients living another trial were reporting very good signals of good erections, let me say. We never asked them about their emotions, their impressions,

Maya Zlatanova, CEO of TrialHub (08:25)
Yeah.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (08:32)
what they were feeling about the disease. We just gave it for granted that we had the super drug, the drug itself. Indeed, we didn't even ask for reimbursement. We just arrived into the market. We felt

I might even say a little bit arrogant in the sense that we felt we had the super drug and we could launch without reimbursement because everybody would be super keen to come and take the drug. What happened in real life is that no single patient showed up at the doctor's office. Why? Because they were so afraid about recognizing the disease. No one, no single man wanted to go themselves and be in front of the doctor and recognize, hey, doctor, I do have erectile dysfunction. Basically, this was it, but it took us three

Maya Zlatanova, CEO of TrialHub (08:54)
Yeah, I had to get

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (09:16)
years to understand. We had to go back, do a whole patient journey, right? We need to interview all those patients. We need to understand how they felt, why they didn't want to have a conversation with their doctors, and once we understood the whole journey.

We could fix it. Indeed, we fixed it with a very basic kind of activity, let me say, because we tried to understand who could be an ambassador around the globe that they could trust. And we finally understood that Pelé, the soccer player, the Brazilian soccer player, was a good ambassador for them. we just hired Pelé, we put him on the television. And Pelé was saying, if I had erectile dysfunction, I would talk to my doctor full stop. But we lost three years of sales while on the

Maya Zlatanova, CEO of TrialHub (09:46)
Yeah.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (10:00)
on the papers, everywhere. We all used to see those headlines about Viagra, the super drug. That was not true in the first three years. We didn't sell properly during the first three years. So ideally, patient passports should be fixed in clinical.

Maya Zlatanova, CEO of TrialHub (10:13)
How do you?

Yeah, I actually don't understand that. What do you mean saying like the patient pathway should be fixed in clinical? Can you elaborate on that?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (10:24)
Yeah, you're right. I was not clear enough because what I mean is that you should develop a patient journey in clinical by interviewing an important group of people, an important sample size. You should interview them, define what is the patient journey, understand what are the gaps in that journey, understand what are the pains in that journey, and also understand how you can fix those gaps and those pains. And for you to do that, you have the time of clinical for you to be ready at time of commercialization.

So in the case of Viagra, if we had known it in advance enough, we would have started preparing the market much more in advance of the launch and making people talking about their sexuality in a much easier way and also preparing doctors for those conversations that we never did.

Maya Zlatanova, CEO of TrialHub (11:08)
Mm. Yeah.

Yeah, I actually wonder. That's just an assumption. I may be totally wrong here. with Viagra, for example, for erectile dysfunction, there must have been a clinical trial precisely for that. Like how, when you say you failed the first three years, do you also consider the clinical trial itself? Or you mean the commercial side of things? Didn't you actually gather this nuance of like, not

willing to share with their doctors, even identifying the patient should be a signal that there's something wrong.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (11:51)
No, so, that's, that's the problem here that we didn't recognize the big problem until we were in the market already. So we were in commercialization process, meaning we just had 10 years for us to, to recover the, the, the investment. Right. And so if you just have 10 years and you lose 3 and also during that process, competitors were arriving in the market. That was an absolute disaster. And you may say, but viagra was sold tons and tons and millions and millions of dollars. Correct. But , viagra could.

have sold double and triple of those million dollars, right? Simply because we didn't recognize the problem until the second and the third year.

Maya Zlatanova, CEO of TrialHub (12:23)
Yeah.

Yeah. Do you recall how did you come up with this idea? We tried everything for years. Let's now go and speak with patients. Like how did you come up with this idea? And that's like many years ago. So what shifted your mind?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (12:46)
And so we came up with this idea asking patients again, because asking and asking, and you understand that they are all centralized.

Maya Zlatanova, CEO of TrialHub (12:56)
But even asking the patients, Annabel, sorry to interrupt you, but like, how did you even come up with the idea we need to go and speak with the patients? Because we've been speaking to doctors, nothing's selling basically. So let's go in as the patients.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (13:09)
That's a very good question, Maya, because at that time, we were talking about 29 years ago, no one was talking to patients. That's a very good question. But we were so desperate that we needed to say, OK, guys, we have to speak with patients because something is wrong and we don't know what it is. Of course, we were somehow...

in mentioning, I don't know, but in general, all of us were kind of very clear of what could have happened, but we needed to prove it. And for that, we needed to go back and speak to patients. And it was an immediate reaction from patients like, indeed, and now I'm talking about patients in Europe, because as you know, in the US, you can directly advertise drugs to patients. So drugs, I mean brands. So in the US, you can advertise Viagra on the television. But

Maya Zlatanova, CEO of TrialHub (13:54)
Mm.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (14:00)
So in the US, they weren't faster at speaking to patients because they were testing the advertisement. But in Europe, our culture is still a little bit old fashioned when it comes to talk about sexuality, and I mean 30 years ago, not now, right? We had to speak with them. There was no other option, no other.

Maya Zlatanova, CEO of TrialHub (14:14)
Yeah.

Hmm, very interesting. So you mentioned that like 20 plus years ago. What's the difference with today?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (14:29)
Thanks God we have advanced a lot because at least we speak with patients.

However, there's so much work to be done, Maya. We speak a lot with patients, just depending on some diseases where there are more need for speaking with patients, we don't do it for granted in every disease type. As an example, we speak with patients much more in rare diseases than in chronic conditions. Sometimes we speak with patients too late when we are already in the market where we should speak with patients prior to ideally even phase one for us to understand

very well their unmet needs and therefore develop clinical plans who were much more supporting those unmet needs. So yes we have advanced a lot but yes we still have a long journey to go.

Maya Zlatanova, CEO of TrialHub (15:17)
Yeah. Why Annabelle? Like what stops us from having, let's say the ideal world is every single clinical trial, every single patient project, launching projects, every single plan, let's say needs to go through some sort of a patient understanding. And I have a question to that as well, but I'll ask that a little bit later. So what stops us, if that's the ideal world, what stops us today 20 years later since we know...

that it's important what stops us today from doing that.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (15:49)
I used to hear a couple of good excuses. They are not good, but they are excuses. And one is compliance. So some companies are still saying that it is not compliant to speak with patients, which is not correct. You have to speak with patients in the right way and you have to do things properly. That doesn't mean that it's not compliant. And

You also hear this excuse that I personally, it makes me angry, which is the one about the return of the investment, right? Still some companies questioning what's the return of talking with patients. I really cannot understand how someone can even question that there is no return at speaking with patients. Speaking with patients has always a return. You cannot even imagine that every single time that you speak with a patient, you get an insight that is invaluable.

Maya Zlatanova, CEO of TrialHub (16:42)
So are these the top excuses for compliance and return on investment?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (16:49)
Those are the ones that I hear more often, right? Of course, there might also be some fear. And that's my personal opinion. Why? Because when you speak with patients, you may get your whole clinical trial questioned. And so you may not like to hear it. Some people does not ask because they don't want to hear the response, right?

Maya Zlatanova, CEO of TrialHub (16:55)
Mmm, okay.

Yeah, that's so true, the way. That's so true. I think I told you about this book some time ago. It's called The Mom's Test. It's actually a popular book among startups in the tech world. And it's basically you go and ask nobody else but your mom about your new idea only because your mom will support you. Come on, she's your mom. So you don't go to anyone else because you're

Well, my mom said it's a good idea. I'm going to go after my idea only to realize that eventually you end up speaking with like the market and then the market won't be your mom. so I understand this year. Like I've been in this situation, let's put it that way. Like about the return on investment. I have two questions actually. You mentioned something very interesting and you mentioned

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (17:52)
Right.

I three days.

Maya Zlatanova, CEO of TrialHub (18:08)
In the United States, you can do these commercials. You're just allowed to do these commercials and that's one way to also understand the patient. So that brings me to this question. What are the different ways for you to understand patients? Is it only speaking to them or what are the different ways to actually understand better the patient pathway, the patient journey, even today, like in our universe where we are way more connected.

Can you give us what are the different alternatives and variations to understand the patient?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (18:43)
So there are different techniques that you can use when speaking with patients. Most of them are market research, and I will now explain a little bit about this. And some of those are more about focus groups, which can also be considered market research for sure. But to me, they are more qualitative.

more reach in terms of insights. So when it comes to market research, you can do pure qualitative market research. So you interview patients one to one and you get a proper sample of patients around the globe. You interview them and then you get all the insights together and you from there, you can build a good patient journey. You can also do quantitative market research, but when you do quantitative market research, the patient also responds to the questions and therefore you put in front of the patient a questionnaire of

not more than 15 minutes and the patient is going to respond to However, the nuances of the experiences, emotions are more difficult to capture. There's another type of market research that I adore, which is the ethnographic studies. When you do ethnographic studies, you live with the patient.

Maya Zlatanova, CEO of TrialHub (19:41)
Mmm, yum.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (19:53)
By living with the patient, imagine how much insights you can get and you can so well understand what is it for that patient to live with that disease. There's another type of studies like Delphi, panels, et cetera, but basically those are the ones that we use the most. We also use a lot what we call patient advisory boards. You can call it patient advisory boards, you can call it focus groups, you can call it whatever you wish, but at the end in this type of technique, you put a group of six or seven patients together for them to

about one specific topic. It might be, as in example the endpoint of a trial or it might be checking the logistics of a protocol of a clinical trial.

It might be many things, the topics, right? But at the end of the day, they discuss and they put a solution in common, which is always very interesting. Sometimes it can be with patients and sometimes it's with patient representatives. So these are different type of angles here. You don't always need the angle of a patient or the angle of a patient representative. It might depend on the final goal of your project.

Maya Zlatanova, CEO of TrialHub (20:57)
What about the difference when and how do you balance because I think you need both but how do you balance work with patient advocates and like lay patients for example?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (21:12)
That's very good question.

The example that I wrote about the pain, wanted to check a scale, a validated scale, and we wanted to see if patients joining the trial would understand well the scale. So basically in this case, we needed to work with patients because what we were going to have in the trial are real lay patients, right? We are not going to have patient association representatives in the trial. And for that matter, we needed the opinion of the patients. But say that we want to check the end point of the trial. Patient

Maya Zlatanova, CEO of TrialHub (21:16)
Mm -hmm.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (21:44)
representatives, are very well aware, they are very savvy and they have a bunch of knowledge on what is it the endpoint of a trial and why and how it should be designed and what are the needs that at HTA level you're going to find later on in the process. Therefore, if you check a protocol or the endpoint of a trial with patient representatives, you may get a lot of additional suggestions that can enrich a lot the protocol itself.

Maya Zlatanova, CEO of TrialHub (22:10)
Okay, so that's a very interesting thing, like enriching the protocol. I know today is very trendy to discuss ways to quantify the patient burden looking and analyzing the protocols. I also know that the majority of companies that are trying to follow this approach are simply

It's not simple, but let's say that's what they do today. They kind of compare the burden that their protocol may be causing to patients with other protocols. shouldn't we actually Annabel, shouldn't we compare our protocol, like our protocol's burden with the burden that the patient pathways presenting to the patients?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (23:01)
Yes, I agree with you completely. We should compare it this way, but still we should be aware about the burden that we are bringing with that protocol. So, yeah, and you can compare it even with both if you wish. I think there's a case.

Maya Zlatanova, CEO of TrialHub (23:09)
Yeah, of course.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (23:17)
published the EMA. It's a case on Duchenne where caregivers were requested for gene therapy in this Caregivers were requested to bring those kids to the center of excellence one or two, if I remember well, one or two times a month So usually center of excellence in gene therapy, they may be like 400 kilometers from home. And that was not an option for those caregivers. That was too much burden even compared to the standard of care.

right? And so those burdens have to be checked. Yes or yes.

Maya Zlatanova, CEO of TrialHub (23:51)
Yeah, you're so right. Last week, I recorded another conversation around pediatric research. And I'm pretty sure you know Begonya And she has this amazing project where she's assessing the burden of because she works the language, yes, cross border, exactly cross border that basically there are only these few excelence centers.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (24:10)
cross border.

Maya Zlatanova, CEO of TrialHub (24:20)
It's not even excelence centers, like pediatric centers that are conducting these clinical trials for kids. But like she mentioned, there was like a whole episode on that. Sometimes doctors are working only with international families. I say families because usually it's not just the patient, but it's also their parents and so on and so forth. And that causes a huge mess. it's, you know, sometimes I'm...

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (24:40)
True.

Maya Zlatanova, CEO of TrialHub (24:47)
I'm questioning, we speak about a lot in clinical research, what is ethical, what's not ethical. One, for example, question is, is it ethical to conduct clinical trials on kids? That's like another story, but is it ethical to have one hospital in one country for a population of kids that spread throughout the whole continent? Like, is that ethical? Anyway, it's another big question.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (25:16)
We won't fix it. Exactly, we won't fix it. I know. What I made there to say is that it is not ethical to run a clinical trial without having a speaking with patients before starting the trial.

Maya Zlatanova, CEO of TrialHub (25:17)
Yeah, absolutely.

I agree. Yeah, I agree. 100%. I don't think it's ethical to start any project without speaking with the patients themselves. It's the same thing like you creating a product without speaking with the possible customer, not getting their feedback. But here, the stakes are much higher. We speak about their health, their comfort, their life. Anyway, Annabel, I have another question, which is again to do with the return on investment.

And it's kind of a two -sided question because on one side, let's say that there is an impact speaking with patients. But on the other side, there is a cost for speaking with patients. And I've never run such, I mean, I did run such projects, say, but in my case, we found a way to do it very cost efficient. But what's your experience? Is it that expensive to run such a project or is it lack of coordination?

so that you are able of doing this patient engagement early

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (26:30)
Wow, Maya, I love that you're raising this question because you compare the total cost of a clinical trial, right? Say, I

phase two, one small trial for a biotech, it could be even something around 10 million euros. So we are speaking about big, big numbers. How much is it to speak with a group of six or seven patients in an advisory board? Maximum price that we might be speaking about 30 K So compared to those 10 millions, how much is that? It's ridiculous. And I find it unacceptable that still someone is discussing about the price of speaking

with patients. Although when people speak about return of the investment, they go even beyond. They're just talking about how much does it cost to speak with patients. They talk about is this going to bring us a return, which there are some studies that are definitely explaining that by speaking with patients in phase two, you may accelerate six months time to regulatory and you may save half a million dollars.

Why? Basically because if you check the protocol with a group of patients you may avoid one amendment of the protocol which means you may avoid one resubmission of the protocol which is a delay in time and is an extra cost. So definitely speaking with patients pays off.

Maya Zlatanova, CEO of TrialHub (27:55)
Yeah, yeah, absolutely. I agree with you. And also, I wonder actually, where do you see the role of technology and understanding patients? And I will be more precise here. For example, you mentioned the commercials as one way to understand, to get signal.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (28:16)
Wait a minute. mentioned the commercial of, yeah, but we have to explain this well because I don't want to confuse the public here. So when you do a commercial, you test the commercial and then you test the commercial with patients and you may get some insights. That doesn't mean exactly that you're going to get the patient journey. You may get some insights from the commercial. Just to be clear, because I was concerned about the sentence that I gave here. I don't want to confuse anyone.

Maya Zlatanova, CEO of TrialHub (28:20)
Yep. Yeah.

Yeah, of course.

Got

That's why I asked you once again, Annabel, to make sure that it's clear. Still, it's good to have these things on top of your head because not every company, and let's say not every founding team of a private company, for example, has this type of mindset. So these things are essential to be able to even monitor. And you can do that not just with TV commercials. You can do that

Facebook advertisement and so on and so forth. It doesn't help you to understand the patient pathway and the perspective of the patients, but it does give you some signals that can then help you to point you in the right direction. I have another question. There was so many questions. I know we don't have much time, but I need to cover at least one more, one or two more. Is there a big difference between the patient pathway?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (29:08)
of exactly.

Yes.

Yep, sure.

Maya Zlatanova, CEO of TrialHub (29:33)
let's say the patient journey, is there a big difference between the patient journey from one country to the other? And how should you be basically, if let's say you've done a focus group with a few, let's say country, like patients from a few countries of the ones that you're gonna conduct your clinical trial, is that enough?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (30:03)
Again, Maya, I love your questions because they are so to the point and very clear. So yes, there is a difference, an important one when it comes to patient journey in the US or in Spain. For example, when it comes to oncology journey.

Maya Zlatanova, CEO of TrialHub (30:18)
Mm, yeah.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (30:21)
Spain has an amazing public system. So you're a patient in oncological process. You feel supported, accompanied, secure. Of course, you have some fears, but for sure, you have all those difficulties that you have to deal with, emotionally speaking. But you at least feel that the system is supporting you. Same journey for same type of patient in the US can be absolutely different. And that's why when

When we draw patient journeys, in general, we try every time we can, we try to draw patient journeys by country, if possible. And there are more similarities in Europe, for sure, but still there are differences between UK and Italy. And there are big differences between France and Sweden.

Maya Zlatanova, CEO of TrialHub (31:11)
Yeah. Yeah.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (31:13)
or Bulgaria, right? So therefore, the more you understand the patient journey in that country, the more you're going to support those gaps that need to be filled in. Basically, this is it.

Maya Zlatanova, CEO of TrialHub (31:21)
Yeah. And to what extent do reimbursement, like the reimbursement system affect the patient journey? Why is being reimbursed in the country and what is the patient journey?

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (31:34)
to do.

maybe it's the most important step here, right? Because we have seen even inside the same country, we have even seen regions giving access and other regions not giving access to the same treatment, or one region giving immediate access and the other region taking like 10 months to give access to the same treatment, which is so unacceptable. speaking about ethical that we were speaking in the past, I think that we could have another whole podcast about the ethical of the improvement and the

Maya Zlatanova, CEO of TrialHub (32:03)
Yeah. Yes. Let's say many challenges to discuss. I hope that with people like you, Annabel, we can get more comfortable in doing more patient engagement and get closer to this ideal world where there is no trial or no project involving patients, concerning patients without actually understanding them first. I'm actually very hopeful.

And I know that with time, both technology, but also our drive towards that, we'll make sure that we can achieve that. And if not with every clinical trial, at least every single project that is meaningful and has like some serious ambitions to change the patient journey, to change the healthcare system. Yes. Well.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (32:59)
really hope so. yeah.

Maya Zlatanova, CEO of TrialHub (33:00)
The good news is that we not only hope, but we also work towards that. with that, I really want to thank you for your work, for the fact that you're always open to share your stories. And for the example that you give

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (33:18)
Maya, same goes from here to me, to you. So sorry. You are amazing. And the fact that you're constantly, you know, helping on messaging about this important topic, is fantastic. So thank you so much for your effort, for your time. And for this podcast that I'm sure that is going to support many people like hearing new stuff, that is always welcome. Thank you so much.

Maya Zlatanova, CEO of TrialHub (33:21)
Awesome.

That's the idea. Thank you, Annabelle.

Annabel de Maria Bosch, Chief Patient Officer of Alira Health (33:46)
Thank you, Maya you have a good day.