Author: Matt Wheeler

Keeping the ship afloat: Boldly changing course to avoid ‘sunken’ costs

by Matt Wheeler |

Reasoned decision-making is a vital skill in all walks of life. In a vacuum, this means examining all the options and rationally picking the best course of action. But, in the real-world, there are factors that might cloud judgement or introduce bias, and it’s important to keep a look out for these. One such tendency is known as the ‘sunken cost fallacy’.

Oxford Languages define the sunken cost fallacy as “the phenomenon whereby a person is reluctant to abandon a strategy or course of action because they have invested heavily in it, even when it is clear that abandonment would be more beneficial.” This theory could relate to any number of steps within healthcare. Ideally, it should not inform decision making, but, in reality, the human nature is susceptible to it.

It’s often quoted that only 10% of drug development projects make it all the way from Phase I to approval. The other 90% of ‘failures’ may fall at many different hurdles, for instance due to a lack of efficacy, an unacceptable safety profile, or acknowledgement of likely lack of commercial interest. Significant resources, both financial and time expended, will have already been invested in development when these warning signs appear, but clearly the rational (and ethical) decision is not to pursue these drugs further, regardless of ‘sunken cost’.

When it comes to clinical decision making, there are ways in which, in theory, sunken cost fallacy could impact decision making. If a healthcare provider has started a patient on an expensive therapy, but it becomes apparent that it is not working, might they be susceptible to continuing the treatment, rather than switching to something less expensive? Or would a doctor be less willing to entertain an alternative diagnosis if they had already spent considerable time on the original investigations that have led to a potentially incorrect conclusion? A cross-sectional, in-person survey of 36 medical residents, conducted by Bornstein et al in 1999, found that their evaluation of treatment decisions “reflected good reasoning, in that they were not influenced by the amount of time and/or money that had already been invested in treating a patient.” Interestingly, these skills were not shown to extrapolate to the evaluation of non-medical situations by the same people.

What of pharmaceutical marketing? Perhaps a pharma giant has invested millions of pounds over a number of years in cultivating a presence at an international congress, every year constructing the same eye-catching booth and updating their panels with the latest data for their brand (and serving great coffee…). They’ve formed great relationships with the organisers, and are well into preparation for the 2023 event in Melbourne. Unfortunately, COVID-19 Upsilon (sorry) means that whilst the congress will go ahead, no HCPs will be able to travel into Australia from any of the key target markets for the brand. Should they continue to invest in the event, or cut their losses?

Perhaps this all sounds a bit far-fetched – we all like to think we are (at least largely) rational in our decision-making. But the lesson seems a good one: investment in a project or idea should not preclude abandonment, if it is the right thing to do, whether this applies to healthcare professionals, pharmaceutical companies, or in fact within healthcare communications; hard though those conversations with clients might be. Not much use in updating the reference access dates and re-approving that beautifully designed, cutting-edge website that nobody has visited since 2018, after all; far better to expand the range of targeted, data-driven emails that have demonstrably increased market share and sales… This is not to dissuade investment or creativity, by any stretch – just to point it in the right direction boldly, and to have the bravery to change course when necessary.

Seeing the wood for the trees: Patients are the real story

by Matt Wheeler |

As a medical writer, it’s easy to get caught up in the nuts and bolts. Accuracy, readability and a clear, concise story (usually revolving around scientific data) are paramount. Of course, the understanding that the patient is at the core of the whole narrative, its reason for being, is never lost; but if you’re reviewing a 90-slide PowerPoint consisting of Kaplan-Meier curves, forest plots and adverse event tables, in reality, at least in my own experience, sometimes it’s hard to see the wood for the trees.

A few years ago I gave a ‘Lunch and Learn’ presentation titled ‘Powerful Patients’ to colleagues. I wanted to talk about people who had been through extraordinarily difficult experiences with their medical conditions, but had also achieved incredible things as patient advocates and role models.

There are two in particular that I still think of often, not necessarily because I’ve been involved in working with a medicine for their particular condition, but due to their achievements and zest for life. If you’ve worked with me before, you can probably guess who they are! Their incredible resolve has kept me going on tough days when that reference pack just isn’t coming together…

I hope that you find their stories as inspiring as I do.

Claire Wineland

Claire was born with cystic fibrosis in Austin, Texas in 1997. A few days after her 13th birthday, after a routine surgery, she developed septicaemia leading to full lung failure. Given only a 1% chance of survival, she emerged from a medically-induced coma after 16 days.

She would stay in the hospital for three months, during which time she decided to found ‘Claire’s Place Foundation’ to provide support to children and families affected by cystic fibrosis.

Claire would go on to be a prominent voice in the cystic fibrosis community, doing a number of Ted Talks – this one when she was just 14!

She was also part of my personal favourite healthcare communications campaign, Breathless Choir (winner of the Grand Prix in Pharma prize at the Lions Health awards in 2016).

Sadly, following a double lung transplant in 2018, Claire passed away due to complications at the age of 21. Her legacy continues to live on through her foundation. Shortly afterwards she was the subject of a documentary film that is also on YouTube, a tribute to a young person wise beyond their years, who undoubtedly had an enormous amount more to give.

Deborah James

Deborah was diagnosed with Stage IV bowel cancer in 2016, at the age of 35. I first heard of her as a member of the You, Me and the Big C podcast on the BBC, originally with herself, Lauren Mahon and Rachael Bland (who sadly passed away in 2018), discussing their lives with cancer and exploring many issues such as mental health, fertility and chemotherapy. Their informal and welcoming style has given a real community feel for people living with cancer, and the podcast continues to this day.

Deborah has been through an absolute litany of treatments and procedures, as anyone who follows her popular Instagram account, @bowelbabe, will know. She writes for a number of national newspapers and fundraises alongside major UK cancer charities, and has a best selling book, ‘F*** You Cancer’, a self-help guide to living your best life with cancer.

She has also been instrumental in helping bring new treatments to patients in the UK, acting as a case study for NICE submission as part of a clinical trial.

Her resolve and persistence in the face of adversity, still determined to help others, is amazing.

Hope is a powerful theme in healthcare communications, and both of these inspiring people have been determined to tell its story. That shared ideal only reinforces our job as creators to make sure that patients are always the focus of our work, weaving a narrative around the backbone of data to form a whole.

Are the COVID-19 mRNA vaccines the culmination of a journey, or just a stepping stone?

by Matt Wheeler |

At the time of writing, at the end of November 2021, COVID-19 continues to dominate the headlines, and everyone’s lives. The vaccine booster program continues apace in the UK, with urgency growing following the discovery of a concerning new variant, Omicron. The coming weeks will determine how much of a roadblock this new heavily mutated version of the virus is likely to be.

It’s not always easy to say whether the pandemic era (so far) has gone by in a flash, or felt like forever – it’s realistically a personal feeling determined by all sorts of factors. However, what is indisputable is the unprecedented speed of the development and roll-out of the COVID-19 vaccines.

It’s probably pretty safe to say that most people had never heard of messenger RNA (mRNA) before Pfizer/BioNTech and Moderna were thrust into the limelight in 2020 – in essence, it is genetic material that tells the body how to make proteins. There seems to be a misconception amongst some that this vaccine technology is brand new and developed at breakneck pace; however, mRNA vaccines have a storied history of development.

The question is – is this moment the triumphant culmination of the mRNA story (spoiler: almost certainly not) or an important milestone on the way to further innovation?

First, let’s take a brief look back at the history of mRNA vaccines. The path to success was not direct; for many years, mRNA was considered unsuitable for use as a drug or vaccine, due to its instability and cost. It was discovered in the 1960s, and, in 1978, fatty membrane structures called liposomes were used to transport mRNA into mouse and human cells, to deliver genetic material into cells and induce protein expression – the basis of the technique that would later see code for the COVID ‘spike protein’ delivered via vaccine to spark an immune response.

Investment and scientific innovation by hundreds of researchers in the decades since, including chemically modified RNA and fine-tuning of the liposome delivery system, led to the approvals of the mRNA vaccines currently forming the backbone of the global response to COVID-19.

mRNA vaccines have a number of potential benefits, including the possibility of rapid development and progress into clinical trials, and the capability of adapting to new strains (this may soon be tested by the afore-mentioned Omicron variant – vaccine manufacturers are already claiming that new vaccines might be ready in 100 days if it proves to be resistant to the current jabs).

There is certainly growing confidence that mRNA vaccines could have far-reaching applications in other infectious diseases; not just combating other respiratory viruses, such as influenza, but also malaria (an mRNA vaccine candidate is currently being tested at Oxford’s Jenner Vaccine institute) and HIV – described as being in a ‘fifth decade of a global pandemic’.

Over twenty mRNA-based immunotherapies have entered clinical trials for cancers, with some promising results in solid tumour treatments. Most cancer vaccines are therapeutic rather than prophylactic (with the exception of those for virus-induced malignancies, such as HPV). They must efficiently express tumour antigens and elevate immunity. Early results have demonstrated the potential of mRNA vaccines in treatment of advanced melanoma.

Earlier this month, promising early stage results were reported for an mRNA-based therapeutic for heart failure – patients undergoing coronary artery bypass surgery had an mRNA-encoding vascular endothelial growth factor (VEGF-A) injected into the heart muscle, which is hoped to stimulate the repair and regeneration of the heart. Whilst more research is needed, there is potential for improving patient outcomes for heart failure, a chronic disease where half of patients die within five years of diagnosis.

It’s possible that mRNA technology could be refined still further. Self-amplifying mRNA vaccines encode a ‘replicase’ that enables amplification of the original strand of RNA in the cell, with the aim of much higher protein expression at lower doses. The path to mRNA vaccines has drawn on the work of hundreds of scientists and researchers over many decades. Their perseverance has already changed the course of a global pandemic, saving many lives – but it seems inevitable that there is far, far more to come. With technology that can be adapted at such pace, and with a perhaps unprecedented level of public scrutiny, clear and effective communication about mRNA vaccines and therapies will be vital.

Measuring the science of hope in healthcare

by Matt Wheeler |

Anyone who has become a little introspective over the last 18 months can be excused. Many of us have suddenly found ourselves confined to our homes for extended periods, with reduced social interactions and facing down a pandemic with an uncertain timeline ahead. Last year, hope was something to hang on to, but optimism was perhaps harder to find.

“… hope may be understood as… attentional focus on the possibility that the future will be good, characteristically in the face of difficulty. Optimism, on the other hand… expectations that the future will be good (which may be with or without reasons)”1

Fortunately, with vaccines available and, hopefully, more effective therapeutics on the horizon, the outlook is brighter.

But what of hope in other areas of healthcare?

In medical communications, the concept and/or messaging of ‘giving hope to patients’ is a familiar (and noble) one. Relying on clinical data alone is rarely a path to effectively telling the story of a new drug or treatment’s merits: but everyone in the healthcare and pharmaceutical industry is driven to improve the lives of patients.

Deborah James (broadcaster, author and member of the excellent ‘You, Me and the Big C’ podcast team) often talks about ‘hope and options’ sustaining her as she lives with stage IV bowel cancer.2,3 Hope can assist patients through the trajectory of illness, from initial diagnosis, through treatment and follow-up.4

Hope as a concept, and ‘staying positive’, are common discussion points in clinical care.1

Charles Snyder, an American psychologist specialising in positive psychology, developed a ‘Hope Theory’. This suggests that there are two inter-related components of hope:1

  • Pathway thinking (Way power)
    • Considering strategies to reach a goal or goals
    • Hopeful people tend to create many pathways to get around possible obstacles
  • Agency thinking (Willpower)
    • Being motivated, and feeling able to begin and progress towards goals

There are a variety of methods available to assess hope; the most widely used measure is the Adult Hope Scale, designed to assess hope as a stable characteristic of a person, rather than a fleeting psychological state (you can view the scale here:,5

Several studies have shown a connection between having a high level of hope and health-promoting behaviours, such as not smoking, regular exercise and health diet. Since these behaviours have been associated with improved outcomes in diseases such as cancer, it is possible that hope itself could ultimately be a predictor of a patient’s journey and outcomes.1

Various interventions, including teaching of cognitive coping techniques, PRISM (Promoting Resilience in Stress Management) and meaning-centred group psychotherapy have all demonstrated increased hopefulness in patients with cancer.1

Organisations such as ‘Life’s Door’ aim to empower hope, meaning and quality of life throughout illness, aging, and at the end of life – with a vision of including hope in the physician’s tool box as an essential medical intervention.6

We are all familiar with ‘hope’ as a concept – but we might not think of it as an aspect that can have a measurable impact on outcomes for patients, or we might believe that it is an innate characteristic that cannot be changed by external forces. Hope enhancement techniques could be an important tool as part of a holistic treatment plan, and may form an important part of patient support programs. My hope is that we continue to explore the possibilities, bringing hope and optimism to the forefront of healthcare.

  1. Long KNG, et al. Global Epidemiology 2020;2:100018. Available at: [Accessed September 2021].
  2. The Sun. ‘Options and Hope’: I’ve found new fire after 13th operation and want to make the most of every day. Available at: [Accessed September 2021].
  3. F*** You Cancer: How to face the big C, live your life and still be yourself. Deborah James. Published by Vermilion. 2018.
  4. Corn BW, et al. Lancet Oncol 2020;21:e452–59.
  5. The Trait Hope Scale. Available at: [Accessed September 2021].
  6. Life’s Door – Who We Are. Available at: [Accessed September 2021].

Leading the way or leaping into the unknown? UK to press ahead with COVID-19 challenge trial

by Matt Wheeler |

In mid-February, it was confirmed that a selection of up to 90 young, healthy volunteers, unlikely to develop serious illness, would be deliberately infected with COVID-19 in a UK study1. This will be the world’s first study of this type for COVID-19, and has been under consideration since the pandemic began.

The UK has ostensibly done nothing by halves during the last year – hit overwhelmingly hard by cases, pressure on the National Health Service, and, tragically, lost lives, it is now seemingly the poster child for rapid vaccination roll-out. As of February 20th 2021, almost 17 million2 people have received the first dose of a coronavirus vaccine in the United Kingdom.

The UK government appears determined to remain at the forefront; this challenge study has already received £33.6 million3 in investment.

In the first stage – known as the virus characterisation study4 – researchers will investigate the required viral load to cause infection in this group (using the ‘original’ strain that has been circulating in the UK since March 2020). Following this, a small number of volunteers will be given vaccine candidates proven safe in clinical trials, and then exposed to COVID-19, with the aim of identifying the most effective vaccines and accelerating their development.

The history of challenge trials

The first challenge trial is perhaps the best known5, as a staple of school biology syllabuses. In 1796, Edward Jenner created the earliest version of a smallpox vaccine by taking a sample from a cowpox sore and putting it into the skin of his gardener’s eight-year-old son. He then deliberately exposed the child to smallpox, but he did not become infected. Not likely that this would be ethically acceptable today!

Jenner went on to test the method in over 6,000 people – and 200 years later, smallpox vaccines allowed for the eradication of the disease in the global population.

During the 20th and 21st centuries, challenge trials have been conducted in influenza, cholera and malaria, among others. They have also been under consideration for the Zika virus that emerged as a major health crisis in Brazil and other South American and Caribbean countries in 2015.

Why conduct challenge trials?

Challenge trials are not a required element of every vaccination development program. However, there are a number of factors that may make conducting such a study desirable for a specific disease6:

  • Animal models are imprecise in reflecting human disease caused by the infection
  • The disease has an acute onset, and can be readily and objectively detected
  • There are existing effective treatments that can be administered at an appropriate time to prevent significant illness, and prevent risk of death
  • There is a significant time imperative to develop understanding of the disease and vaccines/treatments for it – clearly the case with COVID-19

Ethical considerations

There will inevitably be questions as to the requirement for such trials for COVID-19:

  • Why would anybody agree to be deliberately infected with a virus that, as yet, has no effective rescue therapy?
  • Do we need to take the risks when we now have a number of approved vaccines being rolled out?
  • Whilst young people may be at the lowest risk of serious illness and death, some people suffer with debilitating symptoms for many months (‘long-COVID’), which may not be reversible
  • Considering the current lack of full understanding of COVID-19, how does this challenge trial sit with the medical principle of ‘do no harm’?
  • If a participant becomes seriously ill, will significant damage be done to public trust in science at a critical time, when vaccine hesitancy is already prevalent in some communities?

Human challenge trials are not new, and hold promise in building our knowledge of COVID-19. However, the ethical implications are many, and must be carefully considered.


Searching for the ‘silver lining’

by Matt Wheeler |

2020 will not, for the vast majority, be looked back on as a good year.

At the time of writing in mid-November, over 50 million cases of COVID-19 have been confirmed globally, with more than 1 million deaths. These are stark figures, the signature of a virus that has torn across the planet, and is still rife in many communities.

However, there is finally (seemingly) light at the end of the tunnel. Phase III vaccine results are beginning to emerge, with levels of efficacy exceeding even the most optimistic predictions when development began. Submission to regulatory authorities is imminent, and there is hope that the mammoth task of roll-out may even begin before the end of the year. Perhaps by mid-2021, life may look more ‘normal’.

It is human nature to look for the silver lining in situations, no matter how bleak. The question is, can there be any ‘silver lining’ to a scenario like this one? There is certainly no equivalence to be drawn in terms of good and bad outcomes, no disputing the horrendous toll that the disease has taken. But is there anything we can learn? Any scraps of positivity that may be useful for humanity ‘post-COVID’?

Public health awareness

  • Hygiene has never been more important. The concept of keeping your hands clean to minimise the risk of catching bugs is not new, but is now at the forefront of minds
  • This renewed focus also extends to educating children. WHO has partnered with Peppa Pig to launch the ‘Wash Wash Wash Your Hands’ singalong video, which, thanks to my niece, is now indelibly burnt onto my brain – although, that’s the whole point…


Collaboration and altruism in the pharmaceutical industry

  • In the search for a vaccine, big pharma companies have joined forces, including partnerships between Pfizer and BioNTech, and GSK and Sanofi respectively, accelerating the development process and giving hope of more than one viable product being made available
  • More broadly, companies are using knowledge gained from decades of experience with similar viruses to pilot treatments, donating compounds formerly tested on other viral pathogens such as Ebola and HIV, and exploring technologies for upscaling production of any successful vaccine candidate

Family time

We all hope that pharmaceutical innovation and public health policy are able to control the pandemic as quickly as possible. In the meantime, perhaps we can take some solace in the human capacity to adapt, and, ultimately, overcome.