Living in the Gaps: What the XLH Patient Journey Tells Us About Rare Disease Care in the UK

X-linked hypophosphataemia isn't a condition most people have heard of. It's a rare inherited disorder of phosphate regulation that causes progressive bone and muscle problems throughout life — and for many patients, the adult years are when the cumulative toll really hits.

medintel conducted a qualitative study involving UK physicians across endocrinology, rheumatology, metabolic bone disease, and nephrology to map out what the patient pathway actually looks like. The picture that emerges is one of localised improvisation, variable quality, and a treatment landscape that too often leaves patients treading water.

Getting to a Diagnosis

For most adults with XLH, the road to diagnosis starts with something non-specific — persistent pain, fatigue, a fracture — and a GP who may or may not connect the dots. Around 90% of patients are diagnosed in childhood and transition into adult services; for the remaining 10% or so, the adult diagnosis tends to come in their twenties, though it can be much later. In childhood, misdiagnosis is common: rickets, growing pains, poor nutrition. In adults, the differential is broader — ankylosing spondylitis, rheumatoid arthritis, fibromyalgia, vitamin D deficiency all get in the way. Low phosphate, physicians stressed, is the key diagnostic signal that unlocks everything else.

Diagnostic access is not uniform. Genetics testing — useful for confirming PHEX mutations and cascade family screening — is not available at every District General Hospital. FGF23 levels aren't tested everywhere. The physicians who work at regional specialist centres had notably more confidence in their diagnostic toolkit and referral pathways than those based at DGHs, who reported working with fewer resources and less joined-up multi-disciplinary support.

A Pathway Built on Local Luck

There is no single national blueprint for managing adult XLH. Which specialty takes the lead — endocrinology or rheumatology — appears to depend largely on who happens to work at a given hospital and what their clinical interests are. As one metabolic bone specialist put it bluntly: it's historical. Where an interested endocrinologist built up a cohort, endocrinology runs it. Where a rheumatologist did, rheumatology does.

Multi-Disciplinary Teams, where they exist, are described as inconsistent and ad-hoc. In specialist regional centres, a dedicated specialist nurse often acts as a care coordinator for patients with rare genetic bone disorders — a role that makes a meaningful difference to continuity. But outside those centres, that role simply doesn't exist. The concept of "expert centres" is itself murky: physicians had differing views on what designates one, with references to ERN Endo, ERN Bone, and approved rare disease sites. A loose network of centres — Sheffield, Leeds, the Royal Free, Cambridge, Oxford and others — is understood to carry disproportionate expertise, but formal designation remains unclear.

Transition from paediatric to adult care follows NICE guidelines in principle, though these weren't front of mind for at least half the physicians. In practice, the transition typically spans six to nine months between ages 16 and 18, ranging from a simple referral letter to joint clinics involving both adult and paediatric teams. Physicians at specialist centres were generally more confident in the process. Most considered their own local approach adequate, even where they acknowledged wider systemic shortcomings.

The Treatment Problem

The most consistent frustration in the study is conventional therapy — oral phosphate supplements and active vitamin D. Most adult patients remain on it, not because it works well, but because burosumab, despite being licensed, was not accessible to these physicians' patients at the time of the study. The side-effect profile of conventional treatment is significant: GI intolerance, the risk of nephrocalcinosis if over-treated, and compliance problems driven by high pill burden and unpleasant taste. Physicians estimated around 70% of patients experience some side effects. The result is a slow, demoralising attrition of patient engagement.

Patient disengagement is a recognised feature of the landscape. When treatment isn't helping, appointments feel pointless. Patients — particularly adolescents navigating university, new jobs, changing geography — disengage. NHS trusts typically operate a "two strikes" discharge policy: miss two appointments, get sent back to primary care. Those who disengage tend to return to the system eventually, but usually via orthopaedics, pain management, or A&E, rather than through planned care.

What This Means

The physicians in this study weren't sounding alarms about catastrophic care failures. Most felt their patients were broadly managed adequately — "they don't get lost in the system" was a phrase that recurred. But adequacy is a low bar. The structural inequality between specialist centres and DGHs, the absence of consistent MDT provision, the dependence on individual clinician interest, and the limitations of conventional therapy all point to a system that delivers satisfactory care despite itself, rather than by design. For a rare disease population that lives with progressive, lifelong symptoms, that distinction matters.

About the Research

This research was sponsored by a donor and the results were designated for public circulation.

medintel is a specialist medical market research consultancy. For more information, contact intel@medintel.co.uk.

medintel conducts larger-scale quantitative and qualitative research across healthcare professional populations. If you're interested in more on rare disease research, please get in touch.

IVL challengers face a challenge: 90% physicians plan to stick with Shockwave

Recent acquisitions suggest the peripheral IVL space is moving from a one-player market to a four-way race* within the next 18 months. But latest survey data from medintel suggests ~90% physicians plan to stay on Shockwave, despite new devices from large players becoming available.

The data

medintel surveyed 311 vascular surgeons and interventional radiologists across the US and EU in Q1 2026 — independent, non-commissioned research via the Mr Doctor Network panel.

Adoption is already high. 80% of vascular surgeons and interventional radiologists already use IVL. At the time of survey, Shockwave was the only commercially approved platform in routine peripheral use. We asked IVL users how they expected to adapt their practice as new systems entered the market (n=249). 92% planned to continue primarily with Shockwave. Bolt Medical — now Boston Scientific Seismiq — had 4% pilot intent. AVS had 2%. FastWave under 1%.

"The 92% figure tells you everything about why challengers need a Stryker or Boston Scientific behind them," says Kilian Toal, Partner at medintel. "You don't move procedural share at that level of entrenchment through clinical evidence alone."

Among the 20% not currently using IVL (n=62), 39% cited limited lab or hospital availability as the primary barrier and 26% cited cost and reimbursement. Only 16% saw no outcome advantage over alternatives. A further 13% indicated their patient caseload simply doesn't require it: a reminder that non-use isn't always a conversion opportunity.

The demand is there. The bottleneck is structural — and new 2026 CMS peripheral IVL add-on codes, effective January 1, directly address part of it.

One finding rarely captured in public commentary: 59% of physicians surveyed also use IVL in aortic and iliac procedures for endograft delivery and sealing in EVAR not just in peripheral.

These findings are consistent with our September 2025 survey of 162 vascular surgeons and IRs across the US and EU, in which 33% named IVL as the PAD technology they were most excited about over the next three years — more than double the interest in absorbable stents, atherectomy, or drug-eluting technologies.

A note on scope — and what comes next

Both surveys were limited to vascular surgeons and interventional radiologists. This was a deliberate methodological choice, but it carries an important implication: in the US, interventional cardiologists perform a significant volume of peripheral vascular work, and in markets like Germany, angiologists contribute meaningfully to peripheral IVL practice. Neither group is captured here. Our peripheral adoption figures are therefore likely to understate true market penetration rather than overstate it.

This gap is something we intend to address. medintel is planning a dedicated IVL survey in the interventional cardiology space — covering both peripheral practice and coronary use — in the coming months.

On coronary IVL

This research covers peripheral and aortic practice only. The coronary space is a separate, large market moving fast — Abbott completed TECTONIC enrollment in April 2026, FRACTURE data is due in 2H 2026, and EuroPCR 2026 this month includes a dedicated late-breaking session featuring ICARE (IVL vs rotational atherectomy at 12 months) and FRACTURE interim data. It is also worth noting that ShortCUT and VICTORY (TCT 2025) showed cutting balloons and super-high-pressure NCBs to be non-inferior to Shockwave on minimal stent area in moderate calcification — prompting some ACC commentary repositioning IVL as a tool for genuinely recalcitrant calcium rather than a default. medintel will cover coronary IVL separately.

ENDS.

NOTES:

* Shockwave grew 18.5% year on year in Q1 2026 to $305 million and is launching fifth-generation coronary and peripheral catheters this year. Boston Scientific Seismiq is in US limited market release with FRACTURE coronary trial data expected in 2H 2026. Stryker expects the AVS deal to close in Q2 2026 with potential Pulse IVL FDA clearance before year-end. FastWave is preparing to start its Artero peripheral pivotal trial. The peripheral IVL space is moving from a one-player market to a four-way race within 12 to 18 months.

---

January 2026 survey: n=311 vascular surgeons and interventional radiologists, US and EU. September 2025 survey: n=162, same specialties and geographies. Both independent and non-commissioned, conducted via the Mr Doctor Network panel. Peripheral and aortic practice only. Interventional cardiologists not included.

For the underlying data: intel@medintel.co.uk

UK Psychiatrists Open To New Anti-Psychotic Treatments

A qualitative study with UK psychiatrists reveals the messaging challenges — and opportunities — facing market entry for an anti-psychotic

Schizophrenia is one of psychiatry's oldest challenges, yet the drug landscape has barely moved in 30 years. Clozapine arrived in the early 1990s, and since then? Incremental tweaks. Small wonder the psychiatrists we spoke to are both frustrated and — crucially — genuinely open to something new.

medintel conducted research with psychiatrists across the UK, representing early intervention, community, acute, and forensic settings. The focus: how are they treating schizophrenia today, where do they get their information, and where would a new anti-psychotic be positioned?

The treatment picture: holistic first, medication second

Ask a psychiatrist how they treat schizophrenia and the first word you'll hear is holistic. The bio-psycho-social model isn't just a phrase — it's a governing philosophy. Medication is essential, but it's part of a wider programme of social rehabilitation, community support, and long-term patient engagement.

What this means for a new anti-psychotic: it cannot be positioned as a standalone solution. Any drug that looks like a silver bullet will be viewed with scepticism. The opportunity is to position a new anti-psychotic as a catalyst — something that gives patients enough stability to participate meaningfully in the social recovery that psychiatrists already believe in.

Negative symptoms: acknowledged, but not prioritised

There's a real unmet need in negative symptom management — psychiatrists know it, and they're frustrated by it. But here's the catch: negative symptoms consistently lose the triage battle to positive ones. Hallucinations and acute psychosis demand immediate attention; apathy and social withdrawal emerge later, and are often masked by depression or managed through social rather than pharmacological means.

The messaging implication is significant. "Treats negative symptoms" as a standalone claim won't move the needle. A new anti-psychotic needs to connect benefit to real-world outcomes that psychiatrists care about — particularly substance misuse and relapse prevention, which are daily clinical headaches across all settings.

Receptivity is there for new treatments

The core competitive challenge isn't awareness — it's differentiation. If a new anti-psychotic’s efficacy for positive symptoms is comparable to established treatments, physicians need a compelling clinical reason to advocate for formulary inclusion and tolerate the prescribing risk. The side-effect profile and negative symptom story are the levers, but they need sharper data and real-world case evidence to land convincingly.

How to reach them

The channel picture is straightforward: conferences, peer-reviewed journals, and local professional meetings dominate. What's striking is how few reps are visiting psychiatrists — and how many said they'd actually welcome it. There's an open door here that isn't being walked through. Sales rep detailing, combined with sponsored educational events (positioned around clinical issues like substance misuse rather than obviously branded), could gain real traction.

The bottom line

A new anti-psychotic has opportunity in the treatment pathway — most likely as a second-line option in early intervention and community settings. But it needs to earn its place on formularies, and that means giving psychiatrists the clinical ammunition to make the case internally. Strong comparative data, relevant case studies, and a narrative that ties the drug to the social outcomes psychiatrists actually care about. That's the brief.

Based on qualitative research with UK NHS psychiatrists.

About the Research

medintel is a specialist medical market research consultancy. For more information, contact intel@medintel.co.uk.

medintel conducts large scale quantitative and qualitative research across broad healthcare professional populations. If you're interested in more on rare disease research, please get in touch.

The Paclitaxel Paradox: Physicians Hold Steady Despite SWEDEPAD Setbacks

Despite trials failing to support the impact of paclitaxel-coated balloons and stents on key peripheral arterial disease endpoints, almost half of physicians do not intend to change their use patterns for paclitaxel-coated devices.

In a medintel survey of 304 physicians, 45% of vascular surgeons and interventional radiologists stated that they did not intend to change their paclitaxel-coated device practice. While 21% did indicate they would shift to sirolimus or everolimus devices, the majority seem unmoved by recent evidence.

This comes in the face of two key trials, SWEDEPAD 1 and SWEDEPAD 2, which demonstrated  that paclitaxel coated devices were not associated with reduced risk of amputation or improved quality of life compared to uncoated devices in patients with chronic limb-threatening ischemia and intermittent claudication. Taken together, these findings led to principle investigators to recommend careful risk-benefit analysis when considering such devices.   

The majority of physicians do not expect their paclitaxel device usage to change, despite recent clinical trial data . Surveyed in Q4 2025.

Paclitaxel technologies are no stranger to controversy in the PAD space, heralded for reducing rates of restenosis and target lesion revascularization one minute and the next, implicated in increasing mortality. The ups and downs this technology has faced in terms of clinical evidence may explain physician hesitancy to reject it on the basis of the most recent findings.  

More critically, physicians appear to be waiting for a clearly superior alternative before moving away from their workhorse paclitaxel. A further line of inquiry by medintel revealed that the most influential factor driving new device utilization was demonstrated improved patient-centered outcomes, followed by a reduction in repeat procedures. This suggests that the bar for displacement isn’t reliant on cost, improved pricing structures or better training, but rather demonstratable superiority.

When considering an alternative to paclitaxel, physicians want improved patient-center outcomes and durable reductions in repeat procedures. Surveyed in Q4 2025.

This physician reluctance creates a complex market dynamic where negative evidence doesn’t immediately translate into market erosion, but where the door remains open for drug-coated technologies that can deliver on patency.

ENDS.

About the Research

Methodology Note: This analysis is based on a survey of 304 (US and EU interventional radiologists, vascular surgeons) conducted in October 2025. This survey represents a focused snapshot of perspectives rather than a comprehensive market study.

medintel is a specialist medical market research consultancy. For more information, contact intel@medintel.co.uk.

medintel conducts larger-scale quantitative and qualitative research across broader physician populations. If you're interested in more extensive PAD market research or other custom studies, please get in touch.

Intravascular Lithotripsy Holds Promise 2:1 Versus Absorbable Stents In PAD

FOR IMMEDIATE RELEASE.

Vascular surgeons and interventional radiologists, show twice the level of enthusiasm for the opportunities offered by Intravascular Lithotripsy (IVL) than the next technology believed to show most promise, absorbable stents, in offering innovation in Peripheral Arterial Disease (PAD) treatment over the next three years.

medintel surveyed 162 physicians (interventional radiologists, vascular surgeons) from across the EU and US, and 31% of physicians named IVL as the technology they're most excited about over the next three years.

This represents more than double the interest in the next category, absorbable stents/biodegradable scaffolds at 15%. Similar differences were seen with only 14% of physicians excited about the possibilities for atherectomy and the same for drug eluting technology at 13%.

Technology physicians are most excited about the potential of in PAD. Surveyed in September 2025.

Intravascular Lithotripsy technology is rapidly transforming the treatment landscape for Peripheral Arterial Disease, with significant growth opportunities forecast. Tibial vessels are highlighted as the highest potential growth area for IVL technology as new, lower-profile devices with longer balloons enter the market.

IVL has revolutionised calcium management in vascular procedures. Physicians report IVL is dramatically reducing the need for stenting in femoral-popliteal treatments while improving safety profiles compared to traditional atherectomy.

‘IVL has transformed calcium management over the last few years,’ notes Kilian Toal, Director at medintel. ‘The ease of use, short learning curve, and applicability across most vessels mean it is rapidly becoming the first choice for many physicians in preparation for severe calcific disease.’

IVL is viewed by physicians as especially beneficial when treating diabetic and end-stage renal disease patients, populations projected to grow significantly in coming years.

While Shockwave Medical currently dominates the IVL market, competitive devices from companies including Bolt Medical (recently acquired by Boston Scientific), Abbott (through CSI acquisition), Amplitude Vascular Systems (AVS) and FastWave Medical are in development or early clinical trials.

Market competition is expected to intensify as reimbursement policies catch up with clinical practice and the growing evidence base continues to demonstrate IVL's effectiveness.

ENDS.

About the Research

Methodology Note: This analysis is based on a survey of 162 (US and EU interventional radiologists, vascular surgeons) conducted in September 2025. This survey represents a focused snapshot of early adopter perspectives rather than a comprehensive market study.

medintel is a specialist medical market research consultancy. For more information, contact intel@medintel.co.uk.

medintel has the capability to conduct larger-scale quantitative and qualitative research across broader physician populations. If you're interested in more extensive RDN market research or custom studies, please get in touch.

Renal Denervation Market Poised for Mainstream Adoption by 2030, New Physician Survey Reveals

FOR IMMEDIATE RELEASE

75% of practicing interventional cardiologists predict procedure will become standard hypertension treatment despite current limited adoption

[October 31st 2025] - A new market research study by medintel reveals that renal denervation (RDN) is experiencing a remarkable resurgence, with three-quarters of interventional cardiologists practicing the procedure predicting the procedure will become mainstream hypertension treatment by 2030.

The survey of 123 interventional cardiologists across the United States and Europe found that while only 37% currently perform RDN procedures, 75% of those with hands-on experience believe the technology will achieve widespread adoption within five years.

"After nearly a decade in the wilderness following early clinical setbacks, renal denervation is back with rigorous evidence and renewed industry commitment," said Kilian Toal, Partner, at medintel. "The physician confidence we're seeing represents a fundamental shift in how the medical community views this technology."

Ends.

Background Notes:

Market Revival Built on Solid Foundation

The RDN market has transformed dramatically since its early boom-and-bust cycle. Initial enthusiasm in the 2010s led to major acquisitions, including Medtronic's $800 million purchase of Ardian. However, the field went quiet after Medtronic's pivotal Symplicity HTN-3 trial failed in 2014.

The current revival is anchored by FDA approvals in November 2023 for both ReCor Medical's Paradise ultrasound system and Medtronic's Symplicity Spyral radiofrequency system—the first renal denervation devices approved in the United States. Boston Scientific's recent $540 million acquisition of SoniVie signals renewed industry investment.

Technology and Patient Selection Trends Emerge

This research survey on renal denervation practices revealed clear preferences among practicing physicians:

• 80% prefer radiofrequency-based systems over ultrasound technology

• 68% identify resistant hypertension patients (on ≥3 medications) as the ideal candidates

• US and European adoption rates are remarkably similar at 36% and 39% respectively

Barriers Remain But Solutions in Sight

Despite optimism, physicians identified key obstacles to broader adoption of renal denervation:

• Access and reimbursement coverage (55% of respondents)

• Patient identification and responder selection (52%)

• Cost and hospital economics (48%)

• Lack of long-term clinical evidence (43%)

Regional differences emerged, with US physicians more concerned about long-term evidence and economics, while European colleagues focused on patient selection and awareness.

Looking Ahead

The study suggests RDN's path to mainstream status depends on addressing systemic challenges around reimbursement, patient selection tools, and long-term evidence. A pending Medicare national coverage decision could serve as a pivotal catalyst for broader US adoption.

About the Research

Methodology Note: This analysis is based on a survey of 123 (US n=67 and EU n=56) interventional cardiologists conducted in August 2025. This survey represents a focused snapshot of early adopter perspectives rather than a comprehensive market study.

medintel is a specialist medical market research consultancy. For more information, contact intel@medintel.co.uk.

medintel has the capability to conduct larger-scale quantitative and qualitative research across broader physician populations. If you're interested in more extensive RDN market research or custom studies, please get in touch.

KOLs on Vascular Access Challenges in 2025

Leading EU and US vascular access specialists this month discussed critical developments in the field. Two topics of debate were the recent withdrawal of endoAVF devices and the need for the development protocols on high-flow fistula management.

Medtronic Withdraws Ellipsis EndoAVF Device

In a surprising development, Medtronic has withdrawn its Ellipsis endovascular arteriovenous fistula (endoAVF) device from the market. Despite positive clinical outcomes and strong patient preference due to cosmetic advantages and fewer complications, adoption challenges and cost barriers appear to have influenced this decision. Experts noted the device faced reimbursement hurdles in several markets despite commanding 85-90% of the global percutaneous fistula market. Despite the withdrawal, there is optimism about the future of endoAVFs with new technologies like the VENOS 2 study. The VENOS 2 study involves a new device that simplifies the procedure and shows early promise. Experts highlighted the need for a second-generation device to reduce the number of procedures required for fistula maturation.

High-Flow Fistulas Present Unaddressed Challenges

Experts interviewed identified high-flow fistulas as a significant yet under-recognised clinical challenge, particularly in post-transplant patients. With flows reaching two to three litres—effectively tripling cardiac output—these fistulas can cause considerable cardiovascular strain. Despite this, systematic follow-up and management algorithms remain lacking. Discussions emphasised the importance of monitoring and potentially intervening in high flow fistulas to prevent complications. Experts believed there is a need for more rigorous follow-up and research to develop strategies for managing high flow fistulas.

ENDS

Robotic Surgery After 30 Years Still Faces Adoption Challenges

Robotic surgery, now entering its third decade of clinical use, has revolutionised minimally invasive procedures across multiple specialties but medintel finds it still continues to face adoption hurdles.

Expanding Surgical Applications

Originally pioneered in urology, robotic platforms received FDA approval for gynecological applications in 2005. Applications have since expanded to ENT, cardiothoracic, general, and colorectal surgery. In gynecology, use has evolved from hysterectomies to pelvic floor repairs, myomectomies, and complex endometriosis cases.

‘Technology enhances skill, it does not replace it’

Robotic systems enhance surgical capabilities through improved precision, visibility, and ergonomics, but complement rather than replace expertise. Earlier complications stemmed primarily from inadequate surgical experience rather than technological limitations.

‘These platforms are sophisticated tools requiring proper training and sound surgical judgment’ explains a surgical director to medintel. ‘They enable minimally invasive approaches for complex cases but remain dependent on the surgeon's skill.’

Economic Realities Affect Implementation

Clinical evidence indicates robotic surgery can shorten hospital stays while reducing complications and readmission rates. However, realising these benefits requires sufficient platforms to serve surgical teams—a significant challenge in resource-constrained environments.

The pandemic has increased waiting times for non-urgent procedures, particularly in specialties like endometriosis surgery, driving more patients toward private care where robotics are more accessible.

Future Innovations

Recent advances include single-port systems for complex cases, though these await regulatory approval for gynecological applications. While AI is emerging in surgical training environments, autonomous robotic surgery remains distant due to the subjective nature of surgical decision-making.

The primary barrier to wider adoption remains economic, as more affordable systems with comparable quality are needed for full integration into healthcare systems worldwide.

ENDS

AI's Role In Research: Linear Connections Not Lateral

medintel continues to test the possibilities of the latest AI platforms, and utilise how AI with phenomenal analytical results while safeguarding data privacy and maintaining standards in accuracy and validity.

The massive boost to productivity, and speed of turnaround of immediate topline findings is a significant benefit as well as the ability to interrogate data to pursue lines of enquiry.

However, the one-sided nature of the enquiry means it needs to be treated carefully and can easily result in false positives.

The lack of the ability for the researcher to see the whole picture in the data and see fresh perspectives can be a challenge. Researchers need to know the data to see the wider picture. In addition detailed storytelling still needs to be very much guided. AI serves as a powerful collaborative tool rather than a replacement for human expertise: for the time being anyway!

AI as Research Assistant, Not Replacement

‘The most successful researchers view AI as an extension of their capabilities, not a substitute for their expertise,’ was noted on a recent forum of qualitative researchers.

AI Does Not Think Laterally: It Is Built On Linear Connections

AI is built on a series of yes, no, yes, no linear connections. It is not intuitively designed to think laterally. When humans think laterally, they make creative leaps between concepts, draw unexpected connections, and approach problems from unconventional angles. This often involves intuition, emotional context, and life experiences.

AI systems can simulate aspects of lateral thinking by making connections between seemingly unrelated concepts in training data; generate multiple approaches to solving problems and identify patterns across different domains.

However, AI lateral thinking doesn’t have genuine intuition or emotional context that often drives human creativity. AI connections are based on statistical patterns in training data rather than lived experience. As Claude AI describes:

‘I don't have the embodied understanding that humans develop through physical interaction with the world.’

Freeing Researchers for Higher-Value Work

This limitation aside, AI technology excels at handling repetitive tasks including transcript processing, pattern recognition, and response clustering. This efficiency creates more space for researchers to focus on deeper analysis and meaningful connections.

Recognising Critical Limitations

There are significant limitations in current AI capabilities, particularly regarding emotional intelligence and cultural context and the one directional nature of the enquiry. AI outputs accepted without critical evaluation, especially under deadline pressure are a concern.

Strategic Implementation Critical

The most effective AI integration occurs when technology is used as a reflective partner that helps identify bias and validate conclusions rather than generating independent insights. This approach creates what one participant called "an inexhaustible thought partner" that enhances rather than replaces human expertise.

A Collaborative Future

Like with most professions, AI is firmly part of the future of research, and as it evolves it may well lead to a shrinking workforce. AI certainly has the potential to mean greater volume of research done by fewer humans, but the human touch to guide the interrogation and pitch the narrative appropriate to the audience will likely remain.

ENDS

KOLs On PAD Innovations And Challenges In 2025

medintel interviewed leading vascular specialists to discuss advances in Peripheral Arterial Disease (PAD) treatments to understand key innovations.

Bioresorbable Scaffolds Show Promise Below the Knee

Following the successful LIFE BTK trial, bioresorbable scaffolds have emerged as potential game-changers for below-knee interventions. This technology addresses both mechanical and biological factors affecting vessel patency. While experts expressed enthusiasm about devices like Abbott's Esprit™ BTK System scaffold, they cautioned about efficacy in longer lesions and suggested potential future applications beyond below-knee territories.

Limus-Based Therapies Gain Momentum

Development of sirolimus-coated balloons has accelerated, particularly for below-knee applications where paclitaxel devices have shown limited efficacy. The SIRONA trial demonstrated non-inferiority of sirolimus versus paclitaxel above the knee at one year. Specialists noted limus-coated devices show reduced distal embolization issues, though technical challenges in drug delivery remain.

Evidence Gap in Vessel Preparation Techniques

Despite widespread use of vessel preparation methods including specialty balloons, lithotripsy, and atherectomy, experts highlighted the lack of robust evidence demonstrating improved outcomes. High-cost devices require stronger proof of clinical benefit, with successful strategies likely needing combination with definitive treatments rather than functioning independently.

ENDS

Challenges of Ethnographic Research on Continuous Glucose Monitoring

A recent ethnographic project on Continuous Glucose Monitoring use among Type 1 Diabetes Patients in the US and Germany made use reflect on the following project management issues:

Recruitment and Selection Barriers

Finding representative participants for ethnographic research on continuous glucose monitoring (CGM) devices presented significant challenges in a recent study in US and Germany. In the US, the fragmented healthcare system creates access disparities, making it difficult to recruit across socioeconomic boundaries. Many lower-income patients lack access to advanced CGM technologies, potentially biasing research toward more affluent participants. In Germany, despite universal healthcare, we found recruitment often requires navigating multiple clinical gatekeepers and regional health authorities, extending timelines and adding administrative complexity.

Cultural Differences in Health Technology Perception

American and German patients approach health technology differently, complicating comparative analysis. US patients often view CGMs through a consumer technology lens, focusing on features and convenience. German patients typically prioritize precision, reliability, and data privacy, reflecting broader cultural attitudes toward healthcare and technology. These differences influence how patients interact with devices and their willingness to share experiences, requiring researchers to adapt their methodological approaches for each context.

Data Privacy and Regulatory Compliance

Germany's strict data protection laws under GDPR created additional hurdles for collecting observational data about CGM use in natural settings. Requirements around explicit consent for each data collection point posed a challenge for ethnographic work. The US presents different challenges with HIPAA compliance and varied state-level privacy regulations, particularly when research crosses insurance and provider boundaries.

Technology Ecosystem Variations

The surrounding technology ecosystem significantly impacts CGM usage patterns. US patients typically use a wider range of connected apps and digital platforms to manage their diabetes, while German users often rely more heavily on their primary healthcare provider's recommended systems. We had to account for these different ecosystems when analysing how patients integrate CGMs into their daily diabetes management routines.

Longitudinal Engagement Challenges

Maintaining consistent participation proved a challenge both countries. In the US, high patient mobility and insurance changes caused challenges. German participants may exhibit greater stability but often show more reluctance toward continuous remote monitoring aspects of research, particularly when it involves sharing data outside their immediate healthcare environment.

Market Engagement Model

Introduction

Our engagement approaches are tailored to each client's unique needs, ranging from value-proposition workshops to executive education, team coaching, and project consulting.

Below is our structured seven-phase model that guides successful market engagements.

Phase 1: Situation Analysis

This initial phase evaluates current market positioning, identifying existing value propositions and delivery systems. We assess how effectively these deliver value to customers and shareholders, and examine vulnerabilities against market trends and disruptions.

Phase 2: Common Language and Customer Mindset

We establish a shared customer-centric framework for your team. This provides essential tools to understand customer needs while building organisational buy-in for the reinvention process.

Phase 3: Research Preparation

We synthesize current knowledge about unmet customer needs in target segments. Role-playing exercises help formulate initial hypotheses about promising opportunities, preparing teams for field research.

Phase 4: Customer Field Research

We study actual customers whose lives we aim to improve, identifying problems they may not recognize themselves. This typically involves 10-15 in-depth interviews per market opportunity, professionally facilitated to capture maximum insights.

Phase 5: Value Architecture

Using research insights, we develop improved customer scenarios with superior value propositions and delivery systems. These define the ideal future state that solves customer problems in innovative ways, specifying experiences and price points that motivate customers to choose your solutions.

Phase 6: Concept Testing

We create narrative descriptions of new scenarios to test with customers. Team members revisit selected customers to validate these concepts, confirming their potential success or identifying necessary revisions.

Phase 7: Finalization and Launch

We evaluate, refine, and implement the most promising value propositions. This includes developing business cases and estimating market potential.

Maximising Impact Through Strategic Market Research

The Critical Role of Research in Healthcare Innovation

In today's competitive healthcare landscape, the difference between products is increasingly marginal, making effective research essential before product introduction. Well-designed research ensures new healthcare products are not only clinically efficacious but also effective and acceptable in real-world settings. Understanding end-users and the healthcare-commercial ecosystem is crucial for maximizing impact and return on investment across all development stages.

Integrating Research Throughout the Product Lifecycle

Social and behavioral research should operate alongside product development as a critical component of the process. These techniques help answer market-critical questions about current behaviors, unmet needs, evaluation criteria, system challenges, and innovation opportunities. Appropriate research supports decision-making at all lifecycle stages—from early concept development through launch and post-market monitoring—significantly reducing risk at decision-making milestones.

Key Research Approaches for Different Development Phases

Different research methodologies serve specific phases of product development. Early-stage research focuses on needs assessment and concept testing. Mid-stage development benefits from product refinement studies and human-centered design approaches. Launch-phase research emphasizes message testing and market forecasting, while post-launch efforts concentrate on tracking studies and further refinement opportunities.

Essential Market Research Principles

Six critical principles emerge from successful market research: (1) Innovation should be continuous rather than seeing products as "finished"; (2) Comprehensive market understanding requires including all stakeholders and avoiding assumptions; (3) Testing should examine context and ideas surrounding the product, not just the product itself; (4) Research should strengthen products, not merely evaluate them; (5) Rigorous forecasting is essential for appropriate planning; (6) Ongoing tracking sustains success even after launch.

Effective Implementation Strategies

For maximum benefit, research should be incorporated from the earliest stages—even before concept development. Professional research partners help ensure appropriate design and execution. The actionability of findings depends on employing correct methodologies and ensuring outcomes inform organizational planning. This approach optimizes public health interventions by developing strong understanding of all relevant stakeholders from end-users to product developers, commercial groups, and government entities.

Qualitative Research Techniques: Understanding Patient Quality of Life

We recently completed an in-depth study with diabetes patients, and wanted to reflect on some of the projective techniques the team used to elicit information.

Visual Exploration Methods

Image-Based Expression: We asked diabetes patients to create collages representing their daily experiences with the condition. This helped us uncover emotional dimensions that standard questionnaires might miss. When patients selected images showing isolation during mealtimes or anxiety in social settings, they revealed quality of life challenges they hadn't articulated in direct questioning. Their explanations of these visual choices provided rich insights into lived experiences.

Archetype Analysis: Presenting Archetypes to patients revealed how they viewed themselves at different stages of their diabetes journey. This technique helped us understand the psychological evolution from diagnosis through adaptation. Many initially identified with a Victim archetype but transitioned to Hero or Caregiver as they mastered self-management.

Disease Experience Personification

Character Development: Having patients describe diabetes as a person in their lives uncovered profound emotional relationships with the condition. This metaphorical approach helped us identify that many long-term patients personified their diabetes as an "unwelcome roommate" they had learned to accommodate rather than a "mortal enemy" to be fought.

Contextual Scenarios: Scenario exercises like "hosting a dinner party while managing diabetes" illuminated social challenges that significantly impacted quality of life. These discussions helped us identify previously unrecognized barriers to treatment adherence in social contexts.

Interactive Exploration

Recognition Activities: Device and medication identification exercises sparked productive discussions about treatment experiences. This approach helped us understand how physical interactions with management tools affected emotional wellbeing and treatment satisfaction.

Classification Exercises: Having patients sort aspects of diabetes management into categories revealed that continuous glucose monitoring caused less life disruption than previously assumed, while dietary restrictions created more significant quality of life burdens than clinicians typically recognized.

Narrative Techniques

Creative Writing: Patient-written letters to newly diagnosed individuals helped us identify emotional milestones in the adaptation process that healthcare providers often overlooked when developing support programs.

Situational Storytelling: Patient narratives about navigating healthcare systems uncovered systematic barriers to optimal care that directly impacted quality of life, particularly around appointment scheduling and medication access.

Supplementary Methods

Association Mapping: Placing care elements in concentric circles helped us visualize which aspects of diabetes management created the greatest burden, revealing that administrative tasks often caused more distress than medical procedures.

These techniques provided deeper insights into diabetes patients' lived experiences beyond clinical measures, fundamentally reshaping our understanding of quality of life factors in diabetes management.