Latest / Lab to Lives / The Emperor’s Naked And The Trial’s Still On w/ Dr. Grant Coren

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The Emperor’s Naked And The Trial’s Still On w/ Dr. Grant Coren · Lab to Lives

• 0:00
  SPEAKER_03: Welcome to another episode of Lab2 Lives.
• 0:03
  SPEAKER_03: Today we are joined by Dr.
• 0:05
  SPEAKER_03: Grant Koren.
• 0:06
  SPEAKER_03: Very excited to have you with us.
• 0:08
  SPEAKER_03: And I'm not gonna let him speak just yet.
• 0:10
  SPEAKER_03: I'm just gonna hog the microphone for a little bit and explain how I encountered Grant.
• 0:15
  SPEAKER_03: So I'm quite the avid LinkedIn user, and a lot of LinkedIn is quite boring to be frank, especially with the dawn of AI.
• 0:24
  SPEAKER_03: It's as though the post gets worse and worse the more AI is used.
• 0:27
  SPEAKER_03: But I encountered a post about the role of CROs in the pharmaceutical industry by Grant.
• 0:33
  SPEAKER_03: I read both the post and the article behind the post and just couldn't wait to get to know more about this dynamic.
• 0:40
  SPEAKER_03: So I code-emailed Grant and said, You're super interesting, let's talk more.
• 0:44
  SPEAKER_03: And we have.
• 0:45
  SPEAKER_03: And now we're here recording a podcast episode together.
• 0:48
  SPEAKER_03: It's one of those stories where LinkedIn brings people together.
• 0:52
  SPEAKER_03: Interesting people.
• 0:53
  SPEAKER_03: So that's why we have Grant with us.
• 0:55
  SPEAKER_03: And you will also know more about what exactly makes Grant interesting when we get to his actual introduction.
• 1:01
  SPEAKER_03: But before we get to that, I am going to do a round of check-in questions, both from Grant, but also with my two co-hosts, Alex and Dimitri.
• 1:10
  SPEAKER_03: I would like to know whether in the past week you have either actively tried to engage more with human beings or tried to avoid engagement with human beings.
• 1:21
  SPEAKER_03: And I'll give an example for myself.
• 1:23
  SPEAKER_03: I have actively avoided engaging with human beings by shopping for clothes online for my daughter because the thought of going to an actual shop and having her spend time in a dressing room at the shop seemed daunting.
• 1:36
  SPEAKER_03: So I prefer sending packages back and forth until we hit a size that actually fits her instead of going to a shop and engaging with a shopkeeper.
• 1:44
  SPEAKER_03: So I'm team avoiding contact with human beings at least this week.
• 1:47
  SPEAKER_01: And probably also avoiding.
• 1:49
  SPEAKER_01: I don't think I've been to a shop for about five years.
• 1:53
  SPEAKER_01: But my avoidance is because it's been replaced by animals, because I'm fortunate that I have a neighbour who has pet sheep who have had multiple lambs, and therefore I am bottle feeding four baby lambs twice a day.
• 2:10
  SPEAKER_01: That's cool.
• 2:11
  SPEAKER_01: So I'm doing that instead of talking to people.
• 2:13
  SPEAKER_01: Yeah, that's a great substitute for people.
• 2:16
  SPEAKER_01: It's very cathartic.
• 2:18
  SPEAKER_01: It's a very zen moment having baby lambs literally jumping all over you and climbing all over you to get to the bottle.
• 2:24
  SPEAKER_01: It's very sweet.
• 2:26
  SPEAKER_04: Not very nice.
• 2:27
  SPEAKER_04: I've been kind of avoiding people a little bit as well, but only because I was away in Italy and I do not speak Italian.
• 2:34
  SPEAKER_04: And so it's quite difficult then.
• 2:36
  SPEAKER_04: You sort of find yourself because of the language barrier kind of disconnecting a little bit.
• 2:40
  SPEAKER_04: Me and my wife were talking about it because we are both British but live in Denmark, and there's always that language barrier.
• 2:46
  SPEAKER_04: We went on holiday last year to Scotland, and it was the most relaxing time because for the first time in a few years, spending a long time in a culture that we knew the language of and understood really well.
• 2:56
  SPEAKER_04: So yeah, that was why for me over the last week I've been a bit more avoidant than usual.
• 3:01
  SPEAKER_00: For me, I think I was quite engaging with people last week.
• 3:04
  SPEAKER_00: I can't really come up with like a specific example.
• 3:06
  SPEAKER_00: It's just generally I've been very much in a spring mode, and I really wanted to just talk more and engage more with different people around me.
• 3:14
  SPEAKER_00: So that was quite a fun week for me, but nothing specifically pops up in my head.
• 3:18
  SPEAKER_03: It's funny how it oscillates sometimes.
• 3:19
  SPEAKER_03: Well, I am now going to take us to the introduction round.
• 3:23
  SPEAKER_03: And on this show, we attempt to place ourselves in the five value streams of a pharmaceutical company or the pharmaceutical industry in general.
• 3:32
  SPEAKER_03: We have the innovation stream where we develop drugs, the treatments, or the thing that makes people better or diagnoses them.
• 3:39
  SPEAKER_03: We have the manufacturing or production stream where we figure out how to make it for the masses, the compliance stream, where we ensure that it is safe and actually works as we intend it to work.
• 3:49
  SPEAKER_03: And then we have the commercial stream where we attempt to market it and make a profit from it.
• 3:55
  SPEAKER_03: And then we have the corporate stream where we build an organization that can support the product promise.
• 4:00
  SPEAKER_03: And I'm going to now ask each one of you to place yourselves on where, at least lately, you have been on these five value streams in a pharmaceutical company.
• 4:09
  SPEAKER_03: And Grant, I would like to start with you and maybe also give you a little bit more time to give us some background on the journey you've had across these value streams.
• 4:17
  SPEAKER_03: Sure.
• 4:19
  SPEAKER_01: I don't really fit into any of the streams because I work across all of them.
• 4:23
  SPEAKER_01: So I think you knew this was an unfair question to ask.
• 4:27
  SPEAKER_01: Just very briefly, my background is a degree in genetics, a PhD in cancer research and molecular biologists.
• 4:34
  SPEAKER_01: And I moved from academic research into clinical research because I was more interested in clinical research and not a very good molecular biologist, truth be known.
• 4:43
  SPEAKER_01: And fell into recruitment and had spent the last 32 years in recruitment working with organization across all of these five.
• 4:51
  SPEAKER_01: So I dip in and out of all five at various times.
• 4:55
  SPEAKER_01: The majority of my work is probably more drug development focused and post-drug development, but I still do as much discovery work as I can because it allows me to pretend I'm still a scientist.
• 5:08
  SPEAKER_01: So it's pretty much across all five.
• 5:10
  SPEAKER_01: I don't really sit in just one group.
• 5:13
  SPEAKER_03: Makes sense.
• 5:13
  SPEAKER_03: Well, today I'm going to place myself in the corporate stream, the one that's all about building a company that can actually support the development of a drug.
• 5:23
  SPEAKER_03: Because the last two weeks of my focus has been very much on organizational design and building.
• 5:28
  SPEAKER_03: So it feels like more of my focus recently has been on how do we make sure that things run less so on the actual development of the drugs?
• 5:37
  SPEAKER_04: Yeah, I'm back in corporate world a little bit with clients right now.
• 5:40
  SPEAKER_04: But actually, yeah, what I'm working on mostly is more of the compliance stream.
• 5:45
  SPEAKER_04: How, in particular, for certain drug products, how people are getting them approved.
• 5:49
  SPEAKER_04: I mean, it's a lot about endpoints and novel endpoints.
• 5:51
  SPEAKER_04: That's been my focus.
• 5:52
  SPEAKER_04: Well, and clinical evidence as well, right?
• 5:54
  SPEAKER_04: What's the clinical evidence level needed around this endpoint to be able to use it for getting a drug approved?
• 6:01
  SPEAKER_04: And that's one of these big important side issues that isn't necessarily about the drug itself, but is still crucial if you want to get your drug onto market and approved and that kind of thing.
• 6:10
  SPEAKER_04: So that's where I've been over the past couple of weeks.
• 6:13
  SPEAKER_00: For me, as before, I'm very much in the innovation stream working on making the innovation faster, smoother, give better outcomes, reuse the data instead of just stashing them somewhere and never touching again.
• 6:26
  SPEAKER_00: So definitely very much on the innovation part.
• 6:28
  SPEAKER_00: And I think maybe it's worth clarifying for our listeners also, Brent, you mentioned recruitment.
• 6:33
  SPEAKER_00: And in this context, we're talking about clinical child recruitment and not people recruitment, are we?
• 6:38
  SPEAKER_00: Like ATR.
• 6:39
  SPEAKER_01: No my recruitment background is people recruitment across different organizations.
• 6:45
  SPEAKER_01: Ironically, I've worked with an awful lot of site management businesses helping them with their patient recruitment, but mine is very much recruiting people for organizations across the entire sector.
• 6:57
  SPEAKER_03: Good clarification there.
• 6:58
  SPEAKER_04: A lot of recruitment going on.
• 7:01
  SPEAKER_04: Well it also highlights one of the interesting things about this space is that very normal everyday words take on a new meaning.
• 7:07
  SPEAKER_04: Recruitment in a clinical trial concept is different from recruitment in just the general way that everyone understands it.
• 7:13
  SPEAKER_01: Yeah, you can't do anything in this industry without it having a word attached to it.
• 7:17
  SPEAKER_04: Yeah.
• 7:18
  SPEAKER_04: To be fair, I prefer the words to the acronyms.
• 7:20
  SPEAKER_04: The acronyms are what really kill me.
• 7:22
  SPEAKER_01: Yeah, I think it's one of those things where creating a separate language, and many industries do this, allows people to feel a little bit more important than they necessarily are because nobody else understands.
• 7:32
  SPEAKER_03: Yeah.
• 7:32
  SPEAKER_03: It's just the analphabet soup.
• 7:34
  SPEAKER_03: We're like knee deep and just letters.
• 7:36
  SPEAKER_03: You pull one out and something gets attached to it, and probably it means something somewhere.
• 7:40
  SPEAKER_04: It's interesting for understandability of this process, and I know this might not be a topic for today, but I mean sometimes some emails that I receive, it it's like a code, they're completely inscrutable.
• 7:49
  SPEAKER_04: And so actually, if you're an everyday person trying to understand how this healthcare development system works, it's it's kind of impossible.
• 7:56
  SPEAKER_04: There's a there's a real transparency challenge there, I think.
• 7:59
  SPEAKER_04: But uh maybe that's a topic for a future episode.
• 8:02
  SPEAKER_01: I think the problem starts earlier than that, actually.
• 8:04
  SPEAKER_01: I mean, if you ever read scientific publications, nobody can understand those unless they're a scientist in that field.
• 8:10
  SPEAKER_01: And science should be written for people to understand to increase awareness across the general population.
• 8:18
  SPEAKER_01: But if you try and do that in a scientific publication, they just throw it back at you.
• 8:22
  SPEAKER_03: I was uh looking up for other purposes what the rules are for when you make a drug advertisement in the US or in New Zealand, you know they have this sequence afterwards where they list all the side effects and please talk to a doctor first and stuff.
• 8:37
  SPEAKER_03: Yeah, the bit that's twice as fast as everyone else, yeah.
• 8:40
  SPEAKER_03: Yes, yeah.
• 8:40
  SPEAKER_03: I was trying to research what do they actually say?
• 8:43
  SPEAKER_03: And I found out that the FDA actually states that it has to be understandable to the common man and may not be obscured by fast speech or visual or audio aids.
• 8:55
  SPEAKER_03: And I was like, like to explain that sequence, you would need like 10 minutes of the ad itself.
• 9:00
  SPEAKER_04: Well, and it's also the speed of that is just about understandable, but it's borderline, right?
• 9:05
  SPEAKER_04: It's this point where there's a a letter of the regulation, which is fine, but sometimes pushing right up to the border of that still doesn't really embody the spirit of what's trying to be done, which is to make sure people understand what's going on and the side effects and have informed consent around their treatment.
• 9:21
  SPEAKER_04: Understandable is very subjective.
• 9:23
  SPEAKER_01: Yeah, it it depends on your background.
• 9:25
  SPEAKER_01: Exactly.
• 9:26
  SPEAKER_01: And really what they should say is this is just so nobody sues us.
• 9:30
  SPEAKER_03: But this actually leads nicely into the topic that I do want us to focus on today.
• 9:35
  SPEAKER_03: This came out of our initial conversation grant when we're kind of spitballing what our common interests are.
• 9:40
  SPEAKER_03: And we spoke about whether a pharma really values patience over profit.
• 9:45
  SPEAKER_03: We all say that we value patience.
• 9:48
  SPEAKER_03: It's in all of our mission statements, it's one of our values.
• 9:52
  SPEAKER_03: I would bet for all pharma companies if patients are up there value-wise.
• 9:56
  SPEAKER_03: But when we do such tricks, such as speeding up the actual explanation of what this drug does when our explanations in the packaging are written in a language that is impossible to understand, do we really value I vote profit?
• 10:11
  SPEAKER_03: Done! Find a podcast.
• 10:12
  SPEAKER_03: All right, let's go.
• 10:17
  SPEAKER_01: Yeah, I mean, it's as we chatted that very briefly the other week.
• 10:20
  SPEAKER_01: It's such a can of worms because there are so many areas that feed into this.
• 10:25
  SPEAKER_01: And increasingly, you know, there is a debate about whether or not that is putting patients first, whether that's how trials are run, how drugs are developed, which areas are targeted, what is or isn't targeted.
• 10:38
  SPEAKER_01: And, you know, my concern is that increasingly we're not doing the best that we could be for patients.
• 10:45
  SPEAKER_01: It's almost like this whole scenario many, many decades ago, of the everlasting light bulb.
• 10:51
  SPEAKER_01: We have the capability to have an everlasting light bulb, but it's just not in anybody's interest to produce it apart from the end user.
• 10:58
  SPEAKER_01: Well, the end user in this case is patients.
• 11:00
  SPEAKER_03: Wait, wait, we have an everlasting light bulb?
• 11:02
  SPEAKER_03: Did I miss this?
• 11:03
  SPEAKER_04: But you don't know the story?
• 11:04
  SPEAKER_04: No?
• 11:05
  SPEAKER_04: Granted, it sounds like you need to explain the everlasting light bulb a bit more.
• 11:08
  SPEAKER_01: There is the potential to produce an everlasting light bulb, but the patent was effectively bought by light bulb manufacturers who don't want you to have an everlasting light bulb.
• 11:18
  SPEAKER_04: Gosh darn it.
• 11:19
  SPEAKER_01: I know it's this it's this planned obsolescence point as well, right?
• 11:22
  SPEAKER_01: I don't know if that is a myth or whether there really is a patent, but it's around not producing the best quality product that you could in any sphere of life because they want you to replace it.
• 11:35
  SPEAKER_01: I mean, when I was a kid, white goods lasted 25 years.
• 11:40
  SPEAKER_01: Well, white goods now, if they last 10 years, you're doing well.
• 11:43
  SPEAKER_01: So I think that we can always do better, and I think that in our industry we can do a lot better if we really wanted to focus on patients.
• 11:51
  SPEAKER_00: What do you think are the light bulbs of our industry, Grant?
• 11:54
  SPEAKER_00: Like, what do you think are like the things that in our industry kind of have the same energy as the light bulb problem?
• 11:59
  SPEAKER_01: Firstly, we have fundamentally for many years focused on treatment rather than cure.
• 12:05
  SPEAKER_01: You know, why would you cure a disease if you can sell medication for it for somebody's lifetime?
• 12:12
  SPEAKER_01: So I think that is a fundamental thought process that needs to shift.
• 12:16
  SPEAKER_01: But I think also we do a lot of things, you know, clinical trials are nowhere near as diverse as they should be, and therefore we are not doing the best that we can for as diverse a patient population as we should.
• 12:28
  SPEAKER_01: I think drugs are cost prohibitive in many instances for many people in the world, and the regulatory process still doesn't allow drugs to be registered across different countries without different requirements.
• 12:42
  SPEAKER_01: So the same drug can be accessible to one part of the population and not another.
• 12:48
  SPEAKER_01: Not good reasons, I would hasten to say, rather than for good reasons.
• 12:52
  SPEAKER_01: So I think there's an awful lot that we can do, Demetrian, and a lot we could and should do better.
• 12:57
  SPEAKER_01: But I think it's at every single level.
• 12:59
  SPEAKER_01: I mean, I I think that the pharmaceutical industry as an industry remains a relatively easy industry to make money.
• 13:07
  SPEAKER_01: Okay.
• 13:07
  SPEAKER_01: Easy, you said.
• 13:09
  SPEAKER_01: Relative to other industries.
• 13:10
  SPEAKER_00: Isn't I I thought it's like, you know, you need to spend billions and billions to develop a drug and then hire a lot of PhDs and everything.
• 13:17
  SPEAKER_00: How that can be easy.
• 13:18
  SPEAKER_01: You don't see many pharmaceutical industries not making an annual profit.
• 13:22
  SPEAKER_03: I think that there is a distribution of risk in the industry.
• 13:25
  SPEAKER_03: Like the bigger the pharma company is, the less risk it has of not making a profit.
• 13:31
  SPEAKER_03: But in fact, all the risk of failure we kind of outsource to the biotechs who invest in novel treatments and actually bear the risk of not knowing whether this is going to work or not.
• 13:42
  SPEAKER_03: And then if it works, then they are acquired by the large pharmaceutical companies.
• 13:47
  SPEAKER_03: And if it fails, well then they just uh die and that whole product and the capability of developing it just dissolves and probably distributes into other biotechs at some point.
• 13:57
  SPEAKER_01: Yeah, we have a very clear and defined outsourcing model for clinical trials for the CRO industry.
• 14:04
  SPEAKER_01: But I think what you've said is very pertinent because it is almost like unofficially now pharma have outsourced a lot of the early discovery and target identification to biotech.
• 14:17
  SPEAKER_01: And that's unhealthy.
• 14:18
  SPEAKER_01: We need both.
• 14:19
  SPEAKER_04: The risk point's an interesting one because I think it's also a useful explanation of some of the dynamics going on and why they're they're a bit more difficult to shift, because it's not like someone's sat at the top saying, Oh, well, we don't want this curative treatment, but we want this one that addresses the symptoms but not the causes.
• 14:38
  SPEAKER_04: But it's not like that.
• 14:39
  SPEAKER_04: It's more these series of micro decisions, right?
• 14:42
  SPEAKER_04: That are in every single case adopting the lower risk or the lowest risk forwards.
• 14:47
  SPEAKER_04: And it's the accumulation of those micro low risk decisions that then result in, hey, this new wonderful biological cell and gene therapy is great, but we're not going to develop it or sell it, we're going to use this symptomatic treatment instead.
• 15:01
  SPEAKER_04: But is that how you folks all perceive things, or how does that look to you?
• 15:06
  SPEAKER_01: I think it is about risk.
• 15:07
  SPEAKER_01: I would agree.
• 15:08
  SPEAKER_01: I don't think there is any sort of Machiavellian figure in the industry saying, no, we don't care about patients, but I think it's about risk.
• 15:15
  SPEAKER_01: I think that the level of risk that pharma takes has continually got less and less and less and less.
• 15:23
  SPEAKER_01: And I think that's around strategic decisions, but I think also on an individual level, I think there are people now who are terrified to make a decision.
• 15:31
  SPEAKER_01: They don't want that responsibility.
• 15:34
  SPEAKER_03: And this kind of leads me to the people part in pharma.
• 15:37
  SPEAKER_03: And Grant, you have helped recruit people across the entire value chain.
• 15:41
  SPEAKER_03: And I assume also for both big pharma and smaller biotic.
• 15:46
  SPEAKER_03: I am curious: like, is there a stark difference between the kind of person who gravitates towards a big pharma company and a smaller biotic?
• 15:54
  SPEAKER_01: Yeah, definitely.
• 15:55
  SPEAKER_01: They're very, very different as clients.
• 15:58
  SPEAKER_01: One is fun and delightful, and the other is less fun and less delightful.
• 16:03
  SPEAKER_01: But it's around people's appetite for risk and decision making, and I guess the level of commitment that they want to make to an organization.
• 16:14
  SPEAKER_01: In Pharma, you have a very defined role.
• 16:18
  SPEAKER_01: You can see where you're going to be on day one, and you can probably see where you're going to be on year three, five, ten.
• 16:26
  SPEAKER_01: You know, there's a defined path, and you're often discouraged from looking outside of the parameters of your precise role.
• 16:34
  SPEAKER_01: And if you continue to do that, you can, after 25 years, be the world's leading authority on something so niche that actually nobody else cares about it.
• 16:46
  SPEAKER_01: But you don't know that, obviously.
• 16:48
  SPEAKER_01: Whereas in biotech, you are gonna have to wear many hats, you are gonna have to pick things up that aren't your responsibility because nobody else is there to do it, and you're gonna have to make decisions, and you're gonna have to make quick decisions.
• 17:04
  SPEAKER_01: And people are attracted to one or the other.
• 17:07
  SPEAKER_01: In the same way that people are attracted to working in big pharma or in the service sector.
• 17:12
  SPEAKER_01: Very different animals, very different people.
• 17:15
  SPEAKER_01: Now, the biggest challenge, I think, would be that we need to really try and get people to move between these different environments because that would improve everything for everybody.
• 17:25
  SPEAKER_01: But there is a resistance to doing that.
• 17:28
  SPEAKER_01: People that go into pharma and move into biotech tend not to go back.
• 17:32
  SPEAKER_00: Why do you think it would improve?
• 17:33
  SPEAKER_00: Is it because like people would cross-pollinate each other ideas, have like different attitudes to the same project and bring like sort of diversity in a sense of ambition?
• 17:41
  SPEAKER_01: I think that if you look at the different environments, especially pharma, people are still doing things the same way they were 30 years ago.
• 17:49
  SPEAKER_01: Because I mentioned earlier, it was 10 years out of date then.
• 17:52
  SPEAKER_01: If you had people come from biotech or from the service sector into big pharma, they would look at things differently, dress things differently, bring new solutions, and actually just challenge the way things are done.
• 18:05
  SPEAKER_01: And that is, you know, for me, the biggest sort of not talked about topic.
• 18:10
  SPEAKER_01: People do things the same way just because it's always been done that way.
• 18:14
  SPEAKER_01: Well, what if when that was initiated, it wasn't very efficient?
• 18:18
  SPEAKER_01: Nobody challenges that.
• 18:20
  SPEAKER_01: And I think that if you are in that system already, you just accept it and tolerate it, you don't challenge it.
• 18:27
  SPEAKER_01: But if you come into it, you can challenge it.
• 18:29
  SPEAKER_01: I'm never ever afraid to sit in front of a client and say, I'm really sorry, but can you explain that to me again like I'm six years old?
• 18:37
  SPEAKER_01: Because sometimes it doesn't make sense.
• 18:39
  SPEAKER_04: No, there's all of these embedded ways of working and things.
• 18:42
  SPEAKER_04: And like you say, they might not necessarily be the best way of doing things.
• 18:45
  SPEAKER_04: Or the environment's changed as well, right?
• 18:47
  SPEAKER_04: That's the the other big thing in in pharma is that it used to be that you could rely on hitting a few blockbusters that get you billions over many years, and that's your nice income.
• 18:57
  SPEAKER_04: But that's much less the case, also.
• 18:59
  SPEAKER_04: It's also that the big farmers need this new influx of different ways of doing things.
• 19:04
  SPEAKER_01: Or just redefining the word blockbuster to keep their shareholders happy.
• 19:08
  SPEAKER_01: Well, yeah, also.
• 19:09
  SPEAKER_01: That's the other way of doing it, right?
• 19:10
  SPEAKER_01: Yeah.
• 19:11
  SPEAKER_01: The world has changed dramatically, and the industry needs to learn how to adapt and embrace the changes that would benefit the industry.
• 19:21
  SPEAKER_03: For me, this is a topic pretty close to home because some of the challenges that I am facing in the organization that I'm a part of is once you scale, like you become essentially a different beast.
• 19:33
  SPEAKER_03: And both in the way that you do need more stability, so you can't be changing everything all the time because you have more people who need to also change if you change something, but also you attract people who are less willing to change, and hence you become more entrenched than you were before.
• 19:49
  SPEAKER_03: So I I am curious about this dynamic of risk aversion and where it actually comes from.
• 19:55
  SPEAKER_03: Does that come first or is that a result of the people and decisions that you have?
• 19:59
  SPEAKER_04: Actually, there's uh some organizational theory stuff about all of this.
• 20:03
  SPEAKER_04: And I can't remember who did the diagram, but this five-stage diagram of how organizations develop.
• 20:09
  SPEAKER_04: And you start off as this small, nimble startup, and then as you go through these stages, you become more process-oriented.
• 20:16
  SPEAKER_04: You're going from trying to discover something to try and repeat something.
• 20:19
  SPEAKER_04: So you become more rigid, more static, bigger, and that's when it you get more fixed in your ways and it's more difficult in general.
• 20:27
  SPEAKER_04: And one of the challenges actually on the organizational design kind of things is picking your organizational structure to best do what you're trying to achieve through each of those stages.
• 20:36
  SPEAKER_01: I think also it is harder once you become larger to drive change and to be an inverted commas nimble.
• 20:44
  SPEAKER_01: But I think a lot of it also comes from the attitude of the leadership.
• 20:49
  SPEAKER_01: I think that historically we used to see people in industry who were seen as in inverted commas maverick CEOs.
• 20:57
  SPEAKER_01: And the reality was that they were CEOs that still wanted to have a biotech type feel in a pharma company.
• 21:04
  SPEAKER_01: And I think that if you're a true leader that wants to drive change, you have to empower people to make decisions, you have to encourage people to make decisions, and you have to create an environment where it is okay to make a decision that ultimately proves to be wrong.
• 21:22
  SPEAKER_01: A lot of the lack of decision making is fear of the consequences of making a decision that is ultimately wrong.
• 21:30
  SPEAKER_01: My simplistic view has always been it is better to make a decision that is ultimately wrong than not make a decision at all.
• 21:38
  SPEAKER_01: Make quick decisions.
• 21:39
  SPEAKER_01: If it's going to fail, fail quickly and address it.
• 21:43
  SPEAKER_01: But just not making a decision doesn't achieve anything.
• 21:47
  SPEAKER_00: Not making a decision is also a decision.
• 21:49
  SPEAKER_00: It's a decision not to make a decision, right?
• 21:51
  SPEAKER_00: And it's very interesting what you guys are talking about.
• 21:53
  SPEAKER_00: I think it's very curious because for me it sounds right, and that's something I also resonate with, is that there is this sort of two types of employment.
• 22:00
  SPEAKER_00: Right, what you said, Graham, there is the biotechs who attract people who seek more, I'd say, agency as you described it, people who are willing to take risk and responsibility in exchange for higher reward.
• 22:10
  SPEAKER_00: And then there's a bigger pharma which attracts more stability-seeking people.
• 22:14
  SPEAKER_00: And I think for me it's an interesting topic also, because one of the things is that as I work in IT, one of the mechanisms you can do to kind of build stability and reliability without losing flexibility is the IT systems.
• 22:28
  SPEAKER_00: And that's why I think they were so like booming in the last 20-30 years, because fundamentally they allow more people to connect, more data to integrate.
• 22:34
  SPEAKER_00: So as you grow bigger, you can still keep the same flexibility without submitting to chaos.
• 22:39
  SPEAKER_00: But another thing I thought about, and it's very interesting, the stability risk attitude, because you kind of mentioned it, right?
• 22:45
  SPEAKER_00: That basically people who seek stability go on big pharma and it's a self-selecting process.
• 22:49
  SPEAKER_00: And the people who seek ambition go into the small biotechs, and it becomes a self-fulfilling prophecy and self-selecting process as well, right?
• 22:56
  SPEAKER_00: And it almost feels like the market adapted to it in a way of saying, okay, we in a big company can't really, really innovate, but we now need to because all the low-hanging fruits have already been picked up.
• 23:08
  SPEAKER_00: So we're gonna outsource risk, as we talked in the beginning of this podcast, to the smaller startups and let them take the risks and do the flexible, risky moves because they know how to.
• 23:18
  SPEAKER_00: And then it almost doesn't sound too bad because if you're the ambitious, probably younger person with a lot of vision, how to change the world, you have a place where you can go and you meet your peers who are just as ambitious and as energetic and as seeking change.
• 23:31
  SPEAKER_00: Then every one of you enjoys working because if you are a lone, agentic, energetic person working in a big pharma company, you would probably want to quit your job like after two weeks.
• 23:40
  SPEAKER_00: So it almost feels like a good thing.
• 23:42
  SPEAKER_00: I guess that's one of the things I hear from you, and I'm curious what you think.
• 23:45
  SPEAKER_00: And another one, I'm just gonna jump into it because we kind of touched on that.
• 23:49
  SPEAKER_00: I'm curious what do you, Grant, think, and all of you actually think.
• 23:52
  SPEAKER_00: Is it like an individual people intentions or is it the system first?
• 23:56
  SPEAKER_00: What I mean by that is it is it specific leaders who make decisions for their political interests, for their safety interests, that end up driving all these problems in a big pharma?
• 24:07
  SPEAKER_00: Or is it more like just systemic effect that once you're big enough, no matter if it's pharma or tech or insurance or banking or whatever, you just kind of the market is such that you need to acquire stability and rigidity, or else you won't last long.
• 24:22
  SPEAKER_00: And it's kind of the system first, the systems we build, and kind of make a selection of comp this rigid companies that survive, and then they have to stay rigid, otherwise they don't survive.
• 24:32
  SPEAKER_00: And that's why the decisions are made by individuals.
• 24:35
  SPEAKER_00: Like in a sense that maybe a CEO of a big pharma company wants innovation, but if he does it, then his company died, kind of that attitude.
• 24:42
  SPEAKER_00: Do you think that's a real risk?
• 24:43
  SPEAKER_01: I think it I think it is a systemic problem.
• 24:45
  SPEAKER_01: And I think to your point a minute ago, that I think the gap between farmer and biotech that may have once sat here has done this.
• 24:53
  SPEAKER_01: So I think they've become more different in terms of cultures and environments.
• 24:58
  SPEAKER_01: But I still think that it would be better to have people moving between the two rather than remaining just in one of those because biotechs are failing for the wrong reasons at the moment.
• 25:11
  SPEAKER_01: Biotechs are failing because of the lack of investment, not because of the lack of good products or good platforms or good ideas or good molecules.
• 25:20
  SPEAKER_01: They're failing for reasons of finance rather than science.
• 25:25
  SPEAKER_01: That needs to change.
• 25:27
  SPEAKER_01: I think one of the ways that we miss an opportunity is, as we discussed earlier, big pharma have effectively outsourced risk to biotech, and then they go and acquire the biotechs.
• 25:40
  SPEAKER_01: I think at this juncture we have an opportunity because they could allow these biotechs to continue to perform within the pharma company as a dynamic environment.
• 25:52
  SPEAKER_01: All too often what happens is they buy this biotech and then they take away all of the things that made that biotech very successful by trying to make them like themselves.
• 26:06
  SPEAKER_03: This is where we had a guest on the show who suggested that Big Pharma is in fact a VC fund.
• 26:13
  SPEAKER_03: But you're absolutely right, Grant.
• 26:15
  SPEAKER_03: Instead of just investing in biotechs and letting them be and letting them succeed on their own merits, we try to, we're like the Borg.
• 26:22
  SPEAKER_03: We try to merge them into ourselves and let them become like us.
• 26:25
  SPEAKER_03: And this is actually detrimental because then we lose the advantages that the biotechs had in the first place.
• 26:30
  SPEAKER_01: You're then back to the cynical perspective of saying actually they were never interested in the biotech company in the first place, they just wanted their pipeline.
• 26:39
  SPEAKER_03: And even more sinister, not necessarily even the pipeline, maybe killing off the potential competition to whatever is happening in the big pharma's pipeline.
• 26:47
  SPEAKER_01: Actually, the everlasting light bulb.
• 26:49
  SPEAKER_01: Yeah.
• 26:49
  SPEAKER_01: I often wonder what it would be like if Big Pharma, let's say, acquired 10 biotechs and gave them 50 million a year and said, we're just going to check in with you once a year, and we're going to leave you to do your own thing.
• 27:03
  SPEAKER_01: Be an interesting and expensive model.
• 27:05
  SPEAKER_04: I mean, just to complete the circle on that risk point, it's interesting.
• 27:08
  SPEAKER_04: Because another talk I was listening to the other day, because one of the other big topics is in Europe in general.
• 27:14
  SPEAKER_04: Why do we lag, say, the US in terms of having big, not just pharma, but big technology companies?
• 27:19
  SPEAKER_04: And the reason for that is exactly your point there, Grant, which is it's not that we have a lack of ideas, it's not that we have a lack of startup companies, but there is this stage of investment in the say 100 million to low billions level that isn't available typically in the EU, but it is in the US.
• 27:37
  SPEAKER_04: And that's made the big difference in terms of the, particularly in the technology sector, why the US is leading Europe so much, which wasn't the case 10 years ago.
• 27:44
  SPEAKER_04: And I think it's similar here.
• 27:45
  SPEAKER_04: There isn't that level of investment available for these biotechs.
• 27:49
  SPEAKER_04: Because this model of just give them some money and check in every now and again is an investment model.
• 27:54
  SPEAKER_04: But it doesn't exist really for those biotechs.
• 27:56
  SPEAKER_04: So their only route is this acquisition route through pharma.
• 28:00
  SPEAKER_04: And the reason that those investment levels don't exist again is risk.
• 28:04
  SPEAKER_04: But risk at the institutional investor, our pension funds level.
• 28:08
  SPEAKER_04: So I think that also loops back to the risk.
• 28:11
  SPEAKER_01: Yeah, I do think that culturally there is greater appetite where investment is concerned for risk in the US than there is in Europe.
• 28:21
  SPEAKER_01: I think, and this is going to sound horribly simplified, and I don't mean it quite to this extent, but I think sometimes in the US, investment decisions are based on the level of enthusiasm.
• 28:33
  SPEAKER_01: Everybody's really excited about something, everybody's passionate about something, and it happens.
• 28:38
  SPEAKER_01: And sometimes that's a really good thing, and sometimes it's not a good thing.
• 28:41
  SPEAKER_01: In Europe, that doesn't happen in the same way because you've always got somebody there saying, yeah, but what if?
• 28:48
  SPEAKER_01: And then somebody else say, Well, what if this then happens?
• 28:50
  SPEAKER_01: Or what if that?
• 28:51
  SPEAKER_01: There's a very much more cautious approach.
• 28:54
  SPEAKER_01: And the enthusiasm model in the US means that some things get funded that are nuts, that should never get funded.
• 29:02
  SPEAKER_01: But also things get funded that should be funded, but we in Europe would probably not fund because we're too risk-averse.
• 29:10
  SPEAKER_01: And it's a difficult balance to get right.
• 29:13
  SPEAKER_03: I do wonder how this caution happens in big pharma.
• 29:16
  SPEAKER_03: How do executives end up being so jaded with risk?
• 29:20
  SPEAKER_03: I think a part of it is also that most uh big pharma companies, well, it's probably not true that most, a lot of them at least, are publicly traded.
• 29:27
  SPEAKER_03: And there is a pressure to make a certain amount of profit, and the CEOs and the top management are measured on how much profit they produce for their shareholders.
• 29:37
  SPEAKER_03: And I do think that kind of skews their incentives.
• 29:40
  SPEAKER_03: Whereas smaller biotechs, everyone knows that it's gonna be another decade before they turn a profit.
• 29:45
  SPEAKER_03: So they face less pressure in that regard.
• 29:48
  SPEAKER_01: It's also the market.
• 29:49
  SPEAKER_01: I don't think you're wrong, but that is the ultimate evidence that shareholders that matter and not patients.
• 29:56
  SPEAKER_00: How can we quantize patients?
• 29:58
  SPEAKER_00: The problem with the money is that it's very easy to measure and everybody does it.
• 30:02
  SPEAKER_00: And if you look at like American law, you have what's called fiduciary duty, where you like as a CEO, you must generate revenue.
• 30:08
  SPEAKER_00: And the question is like, what could we do as an industry, regulators?
• 30:11
  SPEAKER_00: I don't know who, where does the pressure come from to make sure that we put patients and how do we quantize patients good and how do we even define what's patients good?
• 30:19
  SPEAKER_00: I'm curious what your idea is about that.
• 30:21
  SPEAKER_03: Wait, wait, Grant, maybe this is where the cure should come in.
• 30:24
  SPEAKER_03: You get more funding if you actually cure something.
• 30:27
  SPEAKER_01: It is definitely easier to quantify the financial side and the profitability.
• 30:34
  SPEAKER_01: But actually, with all the data that we have, quantifying the impact on patients is not difficult anymore.
• 30:42
  SPEAKER_01: You know, we have so much patient data now.
• 30:45
  SPEAKER_01: I mean, arguably, of 100% of the data that we have, we probably only use 5%.
• 30:51
  SPEAKER_01: Why we're collecting the other 95%, I'm not really quite sure.
• 30:55
  SPEAKER_01: But, you know, that's how the industry seems to prefer to operate.
• 30:58
  SPEAKER_01: But you can measure the impact on patients.
• 31:01
  SPEAKER_01: Sure, you probably can't do it on a quarterly basis in the same way that you can financials, but on a longer term, you can.
• 31:09
  SPEAKER_00: I think it's pretty interesting because you mentioned it in the beginning when we were still warming up with you, Gran, that you feel like the clinical trials in that sense, and collecting data, I guess, and also using them, is using a 30-year-old practice.
• 31:20
  SPEAKER_00: And you mentioned it again now that we already have data here, we just don't use them to quantify patients' impact.
• 31:26
  SPEAKER_00: Can you think of like a couple maybe examples or like ideas you have in that domain that you can share?
• 31:30
  SPEAKER_01: I think within clinical trials, there is a desperate desire to incorporate technology and to incorporate novel solutions, but nobody's really, again, willing to take the risk.
• 31:43
  SPEAKER_01: What we're seeing with AI is a classic example.
• 31:46
  SPEAKER_01: Pharmaceutical companies are spending billions of dollars that they are investing in AI.
• 31:52
  SPEAKER_01: Well, most of their employees are going to spend the next 20 years resisting incorporating it because they don't like change.
• 32:00
  SPEAKER_01: So you're spending billions, but it's not really being used in the way that it could be.
• 32:05
  SPEAKER_01: And actually, I would argue that some companies are spending billions of dollars on AI without even really knowing what they want it for.
• 32:12
  SPEAKER_01: But it's shiny and it's sexy, so they have to have it.
• 32:15
  SPEAKER_04: Is there an element here of which voices are able to shout loudest?
• 32:20
  SPEAKER_04: In the sense of, we do have all of this patient data and we do have all of this financial data.
• 32:24
  SPEAKER_04: And it seems that maybe the difference is the direct connection of that data into the company.
• 32:29
  SPEAKER_04: I'm sure CEOs, if they're not meeting their financial targets, hear a lot from the shareholder direction that sort of drive their decision making, but not so much from the patient direction, even though there is the same maybe quantity of information.
• 32:43
  SPEAKER_04: And I think it's perhaps the same with the AI side.
• 32:45
  SPEAKER_04: It's the big new thing.
• 32:46
  SPEAKER_04: There's this pressure from those with influence to incorporate it, but maybe that doesn't necessarily match yet the extent to which there's that demand further down the organization.
• 32:57
  SPEAKER_04: Is that what you see, Grant?
• 32:59
  SPEAKER_01: Yeah, I think it's very hard to generalize, but in its broadest sense, this is an industry that resists change and technology.
• 33:07
  SPEAKER_01: You know, when you look at very, very, very simple things like moving trial monitoring to technology systems, that took years.
• 33:17
  SPEAKER_01: You know, the technology was there years before the industry moved away from paper CRS.
• 33:23
  SPEAKER_01: That's crazy.
• 33:24
  SPEAKER_01: And we continue to do that.
• 33:26
  SPEAKER_01: And it's very, very, very easy for people to hide behind regulatory controls.
• 33:31
  SPEAKER_01: We can't adopt this because the FDA won't like it or the FDA won't support it.
• 33:36
  SPEAKER_01: Rather than, could we talk to the FDA and see how we can work this into what we're doing?
• 33:42
  SPEAKER_01: It's easier to hide behind that sort of no, we can't do it approach.
• 33:46
  SPEAKER_01: And I know it's hard to compare like with like, but go to other industries and you look at the level of robotics or the level of automation or the IT systems that they have, they're a long way ahead of what we're doing.
• 33:59
  SPEAKER_03: I think this is also the place where it gets a little bit personal, and we're back to which people do we have in our companies?
• 34:06
  SPEAKER_03: Like the rollout of a new way of collecting data for a clinical trial.
• 34:09
  SPEAKER_03: Ultimately, in a pharmaceutical company, that is one person who kind of has to stand their ground and say, no, we are doing this.
• 34:17
  SPEAKER_03: I'm putting my ethos on the line.
• 34:20
  SPEAKER_03: I'm using political capital to say that we are going to do this, and if we shall fail, everyone will know that I'm the one who wanted this and I'm going to take that risk.
• 34:28
  SPEAKER_03: And I think because we also recruit cautious people to pharmaceutical companies, we get less of that.
• 34:34
  SPEAKER_03: We get fewer people who are willing to stand on the soapbox and say, I endorse this move, even given the risk.
• 34:40
  SPEAKER_01: And that's why I sort of shared with you that I'm in a very fortunate position, that I'm my own boss.
• 34:45
  SPEAKER_01: I'm in the last decade of my career, probably, and my posts, I will freely admit, are the ramblings of an idiot.
• 34:53
  SPEAKER_01: But I'm very comfortable saying, guys, the Emperor's naked.
• 34:57
  SPEAKER_01: Why are we pretending otherwise?
• 34:59
  SPEAKER_01: A lot of the people that I speak to as a consequence of those posts are saying, It's so nice that somebody says that.
• 35:06
  SPEAKER_01: Because I can't or I won't.
• 35:08
  SPEAKER_01: But we all know it, but we don't have a voice.
• 35:10
  SPEAKER_04: I think there's a very interesting point in there as well, which is I'm inclined to give people who tend towards corporate work a bit more.
• 35:18
  SPEAKER_04: I don't think it's necessarily as deterministic as we've said on the call so far, because actually a lot of these people, when you talk to them outside of their work concept, will say things like, No, we know it needs to change, you know, it's a big problem.
• 35:30
  SPEAKER_04: But when you put them back in the organization, suddenly there's this reluctance.
• 35:34
  SPEAKER_04: And this point about hiding behind regulation, I think, is also a symptom of that, which is there's something about the organization's and the psychological safety, maybe that the individual feels to make a decision that may not work out or push for something that takes otherwise very smart and people who want to make a difference and puts them in this tight little box, then they feel they can't do anything, and then you end up in the situation of yeah, no decisions being made, but the car's still running, right?
• 35:59
  SPEAKER_04: So you don't go left or right, you just drive into the wall.
• 36:02
  SPEAKER_01: I 100% agree with you, Alex.
• 36:04
  SPEAKER_01: And that was why to Dimitri's question earlier, I said I felt it was systemic.
• 36:09
  SPEAKER_01: Because I'm very, very comfortable publicly stating that pharma companies have many, many brilliant people who really want to shift this paradigm, who really want to drive molecules to patients and really make a difference, and they are hugely passionate about it, and they're just brilliant, some of these people, and there's many of them, but the system does not allow them to really reflect that on a day-to-day basis.
• 36:40
  SPEAKER_00: I'm very curious because I think that like it's kind of only money pressure and stakeholder pressure, like you Alex phrased it, that they get much more asked about mining performance.
• 36:48
  SPEAKER_00: And one of the current trends we have this AI boom, and everybody needs AI and everybody wants AI, and every single shoe needs to have an AI.
• 36:55
  SPEAKER_00: And I think my question here: do you think it's like an opportunity for real change for pharma companies who want to, in a sense that today, like two years ago, buying in from people that we need a tech project to rework the way we collect data and stuff was like impossible as we discussed.
• 37:09
  SPEAKER_00: It was a single champion, like Ivana proposed.
• 37:12
  SPEAKER_00: But today, all the stakeholders come to the next board meeting, like, where's our AI project?
• 37:16
  SPEAKER_00: Are we in a race?
• 37:17
  SPEAKER_00: What's our AI?
• 37:18
  SPEAKER_00: Why am I not pouring billions in the new AI models?
• 37:20
  SPEAKER_00: And do you think it's like an opportunity for companies who want to change?
• 37:23
  SPEAKER_00: Because suddenly AI seems like a sexy trend that does generate money and the same pressure that already existed here before for not changing can now turn the winds and be like, oh no, no, no, we want all these technical things.
• 37:36
  SPEAKER_00: Or do you think they're just innately unable to change anymore?
• 37:40
  SPEAKER_01: I think that there is the potential for it to drive change.
• 37:44
  SPEAKER_01: Do I think it will?
• 37:45
  SPEAKER_01: Yeah.
• 37:46
  SPEAKER_04: Yeah.
• 37:47
  SPEAKER_04: The natural question that arises from that then is what needs to change to fix this?
• 37:51
  SPEAKER_04: What can we change?
• 37:52
  SPEAKER_04: What levers can we pull to improve this?
• 37:54
  SPEAKER_03: This is from my perspective, what can an individual do in this system?
• 37:59
  SPEAKER_03: Because at least if we can get each individual to do their best, that is one way to contribute to system changes.
• 38:05
  SPEAKER_03: And a lot of these specific issues are also the need for better leadership in our organizations.
• 38:11
  SPEAKER_03: So I'm just trying to push that angle, but also personally, because that is essentially what I can do, is just take more risks, use more political capital, and hope to survive.
• 38:19
  SPEAKER_03: But that doesn't address the systemic issues.
• 38:21
  SPEAKER_03: That is like on a very micro level.
• 38:23
  SPEAKER_00: And in honesty, it feels like shooting yourself in the foot, to be honest, because there is a reason why people are safe and risk-averse in pharma, and that's because if you are not, then eventually you are out of the game.
• 38:34
  SPEAKER_00: Which means that the more you push for changes, the more risks you take personally, right?
• 38:37
  SPEAKER_00: So to me, what you're saying sounds like it's more like you need a union of farm workers, but not in the sense of working for the better employment terms, but for a better pharma.
• 38:47
  SPEAKER_00: And also to answer your question, what can an individual do?
• 38:49
  SPEAKER_00: Well, today an individual can go to small biotech, quit pharma, go work in small biotech and realize themselves there.
• 38:54
  SPEAKER_01: And that is effectively what often happens.
• 38:57
  SPEAKER_01: I think you've touched on a key point, which is leadership.
• 38:59
  SPEAKER_01: Most of the people that I've ever encountered across my career who have had the ability to make decisions or who have really put their head above the parapet and tried to do things differently have done so because they have a direct boss who supports them and has their back.
• 39:16
  SPEAKER_01: And therefore, that allows them to feel much more comfortable making a decision that may not be the safe option.
• 39:23
  SPEAKER_01: And it's from having those leaders that support people, encourage people, and when it gets difficult, we'll have that person's corner, not blame.
• 39:33
  SPEAKER_03: I like the idea of the union.
• 39:35
  SPEAKER_03: The union of workers in pharmaceutical companies and biotechs who take like Socratic oath, but whatever that means for a pharmaceutical employee, I shall put patients over profit or my own ego standing in the company in every decision that I make.
• 39:52
  SPEAKER_03: I shall put my political capital on the line if it can improve the health of the patients that we're trying to serve something along those lines.
• 39:59
  SPEAKER_01: My cynical perspective says an awful lot of people in the industry would absolutely sign up for that.
• 40:06
  SPEAKER_01: Yeah.
• 40:06
  SPEAKER_01: But nothing would change.
• 40:07
  SPEAKER_01: Yeah.
• 40:08
  SPEAKER_01: I think theoretically, the industry is absolutely full of people that want to put patients first.
• 40:14
  SPEAKER_00: Can I ask on this question, actually?
• 40:15
  SPEAKER_00: I'm very interested on your opinion, Grant, because coming from a tech background, right, I have a tech perspective.
• 40:20
  SPEAKER_00: In tech, we often saw that basically what happens is that eventually when the things become too imbalanced and too weird, incumbents lose and then newcomers come in.
• 40:29
  SPEAKER_00: And I'm just gonna bring an example of like, say, IBM.
• 40:31
  SPEAKER_00: IBM was the center of computers in like 1970s, 1960s, and then everything was revolutionized.
• 40:38
  SPEAKER_00: And like today, modern pharma companies, they were big enough to survive and they still exist.
• 40:42
  SPEAKER_00: And now they're apparently having some sort of a renaissance for themselves after 30, 40 years of being in a void.
• 40:48
  SPEAKER_00: But in principle, what happened is that we didn't talk about IBM in 2000s, 2000s then.
• 40:53
  SPEAKER_00: Everybody was talking about Microsoft and Google and Feng later and whatever it's called today.
• 40:59
  SPEAKER_00: So my question here, like the moment when the tension gets too much and the pharma becomes too disconnected from patients' rights, maybe the solution is not in changing the pharma, but in just some new growing biotechs who will not be acquired because they will have a profitable model, who will not get acquired by big pharma, they will keep growing, and then eventually they will become the new pharma that brings all these values, that brings all these new ways of thinking and ways of functioning that promote patients first.
• 41:26
  SPEAKER_00: Could that happen, you think?
• 41:27
  SPEAKER_00: Like, is this a really right way to try, as Ivana suggested, to change existing companies from the inside, or is the better way just to go and find new companies who will eventually take over the leaders?
• 41:36
  SPEAKER_00: Because if the market is so imbalanced that there's so many problems and how we do handle things, it should be possible to disrupt it, to do the creative destruction.
• 41:43
  SPEAKER_01: I mean, firstly, I need to decide whether I'm offended by your use of IBM on the basis that I'm the only person on this call old enough to remember IBM when they were in their heyday.
• 41:55
  SPEAKER_01: But I but I think you make a good point.
• 41:57
  SPEAKER_01: I mean, you could make the same point about Nokia with mobile phones.
• 42:00
  SPEAKER_01: And I do think it's a good idea.
• 42:02
  SPEAKER_01: I think it makes absolute sense, but the evidence would indicate that it won't happen because even these biotechs that have got past that stage of being a biotech and becoming more like a small biopharmaceutical company, they still get acquired at some point.
• 42:21
  SPEAKER_04: I think that's maybe the challenge.
• 42:23
  SPEAKER_04: I mean, to link it back to our earlier conversation, I mean, the vast majority of companies in this space reach market for acquisition.
• 42:29
  SPEAKER_04: There's very few IPOs.
• 42:30
  SPEAKER_04: Because the money isn't there again at this hundred million to several billion level to carry companies through.
• 42:36
  SPEAKER_04: So in that situation, where do the disruptive companies come from?
• 42:41
  SPEAKER_04: Because actually the only route to market then becomes the already established players who then assimilate rather than allow companies to keep their own.
• 42:50
  SPEAKER_00: Like a Borg, like Johanna said.
• 42:52
  SPEAKER_04: Yeah, no, exactly.
• 42:53
  SPEAKER_04: So every everything becomes borgified, but there isn't an alternative route unless we have these sources of funding that can support companies of this scale through to become independent actors.
• 43:03
  SPEAKER_01: You need investors who are prepared to buck the trend and do something different.
• 43:10
  SPEAKER_01: But and again, based on past experience and looking at different models, those investors invest because they want a return on their investment.
• 43:20
  SPEAKER_01: And at some point, along comes big pharma with an offer that they find impossible to resist.
• 43:27
  SPEAKER_01: You need to be very, very, very determined to resist those approaches and 100% committed to patience over return on investment.
• 43:38
  SPEAKER_01: In which case, are you an investor?
• 43:40
  SPEAKER_00: It feels to me like you're saying that basically pharma beats any investor.
• 43:44
  SPEAKER_00: And what happens there is that not only you need to be able to resist, but the best strategy is actually being a little bit disinteresting to pharma because then they won't come to you and then you have to stick with other investors and you will actually have to build.
• 43:56
  SPEAKER_00: Like I know a company from a past where it's basically I asked the CO.
• 44:00
  SPEAKER_00: Like, what is your guys' plan for the exit?
• 44:02
  SPEAKER_00: And like, what are you gonna do?
• 44:03
  SPEAKER_00: You want to like acquisition, or what is that?
• 44:04
  SPEAKER_00: Like they were working in a very specific market, and he basically said, in a normal market, yes, we just grow a bit and then we sell to a bigger company, and everybody helps it after.
• 44:13
  SPEAKER_00: However, the market is just not there for us, nobody will buy us, and therefore we will have to make ourselves profitable because we have no other choice.
• 44:20
  SPEAKER_04: The thing that comes up out of this for me then, and sorry if this is blaspheming, it raises the question: is there then a role for the states in trying to resolve this problem?
• 44:29
  SPEAKER_04: Because actually, the more we analyze this, the more that it sounds to me is that this is an example of a market that's ceased to operate effectively.
• 44:39
  SPEAKER_04: And I think even in the most libertarian, uh classical economic libertarian mindsets, that's generally the area at which they say, well, that is the moment at which data expected courage to intervene to fix the market.
• 44:54
  SPEAKER_03: I think that's an interesting perspective because the alternative of creating new companies is taking the big pharmaceutical companies that we have and splitting them into smaller chunks because they have perhaps become too big and too all-powerful.
• 45:07
  SPEAKER_03: And we have seen examples of companies splitting, like Abbott spinning out ABBO like more than a decade ago now, and both companies, I believe, did better after the split than they were doing together.
• 45:19
  SPEAKER_03: So perhaps a similar model based on the monopoly idea could be used towards more large pharmaceutical companies.
• 45:26
  SPEAKER_01: But that is where we were 35, 40 years ago.
• 45:30
  SPEAKER_01: There were 500 pharmaceutical companies for 100 today.
• 45:35
  SPEAKER_01: That's been eroded over time.
• 45:38
  SPEAKER_01: And even if you did that on a mass scale, the same cycle would continue.
• 45:44
  SPEAKER_01: I think pharma companies are divesting parts of their businesses that they no longer feel is core.
• 45:50
  SPEAKER_01: So, whereas we went through a period where pharma companies really wanted a prescription medicine and an OTC medicine group, they're now focusing much more on one or the other.
• 46:01
  SPEAKER_01: And some of this can also be resolved if patent length was extended.
• 46:05
  SPEAKER_01: I think we haven't really talked about that today, but I think companies are investing an awful lot bringing mollusks to the market that may only have 10 years worth of patent shelf life left.
• 46:15
  SPEAKER_01: To me, that feels wrong.
• 46:16
  SPEAKER_03: Ooh, that's an interesting perspective.
• 46:18
  SPEAKER_04: I diverge that perspective in a way.
• 46:21
  SPEAKER_04: For me, it matters who the actor is there.
• 46:23
  SPEAKER_04: Decade of development into this thing, trying to go independently to market and launch it and sell it.
• 46:28
  SPEAKER_04: Then yeah, I think there's a real case for in that situation, the patent life being longer, to give those companies a better chance to survive.
• 46:35
  SPEAKER_04: If it's an established large farmer player who've simply waited for all of that work to be done and then bought it and sort of a percenter just marketed it, then I'm I'm less sympathetic to it.
• 46:46
  SPEAKER_04: But that's just a personal feeling, right?
• 46:48
  SPEAKER_01: I kind of get that, and I think that does resonate.
• 46:51
  SPEAKER_01: That makes sense to me as well.
• 46:53
  SPEAKER_01: But if you follow that model through, what would happen was the pharma companies wouldn't acquire the biotechs until they've got the 25-year patent.
• 47:02
  SPEAKER_01: You're just moving it further down that life cycle.
• 47:06
  SPEAKER_01: But fundamentally, I don't disagree with you.
• 47:08
  SPEAKER_01: I think that biotechs should be looked at in a different way.
• 47:12
  SPEAKER_01: But there are practical issues.
• 47:14
  SPEAKER_03: I wonder if there's also like a different incentive model in general that speaking to the regulation angle, right now the company that holds the IP to a drug are the ones who essentially make the biggest profit.
• 47:26
  SPEAKER_03: What if we imagine that the IP was allocated to each entity that contributes to the manufacturing or bringing about of the drug?
• 47:37
  SPEAKER_03: Then the profits would move or be more evenly distributed across different players in the industry.
• 47:42
  SPEAKER_03: Then even your clinical CRO would get some cuts of the profits of the drug and not just the parent company.
• 47:49
  SPEAKER_03: That would also significantly redistribute the generation of wealth.
• 47:53
  SPEAKER_03: It's like modern-day communism.
• 47:56
  SPEAKER_01: I think to the point that was made earlier about state involvement, there's a reason why China has become a very, very powerful player in this space.
• 48:06
  SPEAKER_01: And it's not entirely through entrepreneurialism.
• 48:09
  SPEAKER_01: Not that I can even say that word clearly.
• 48:11
  SPEAKER_01: They have been involved and they have invested, and it's making a difference.
• 48:16
  SPEAKER_01: Whether that would happen in a Western society is a different question because right now every government gains enormous benefit tax-wise from the pharmaceutical industry.
• 48:27
  SPEAKER_01: And would they really want to go from no longer gaining that tax and at the same time having to invest millions themselves?
• 48:34
  SPEAKER_01: I don't think it's as easily workable as it should be.
• 48:37
  SPEAKER_04: I think China's the interesting example here because, I mean, just not in pharmaceuticals, they've been doing very well in sort of the green technology transition in terms of having companies driving that and also electric vehicles.
• 48:50
  SPEAKER_04: And that's really because they adopted and invested in an industrial strategy around key areas, around those key areas specifically.
• 49:00
  SPEAKER_04: An industrial strategy has been a bit of an affimor, like in Europe in the US recently, because it's what you do in a very globalized, neoliberal, market-based society, right?
• 49:09
  SPEAKER_04: It's it's no, you leave it up to the market.
• 49:11
  SPEAKER_04: The state's rubbish at this, it can't do anything effective, and so just leave it to the wisdom of industry.
• 49:17
  SPEAKER_04: But I think what China's experience has done has shown that actually that's not necessarily always the case.
• 49:22
  SPEAKER_04: Having an industrial strategy can be useful and strong and even benefit the organization.
• 49:27
  SPEAKER_04: I mean, uh, China's future looks much better, benefit the country, even China's future looks much better now that they're becoming so dominant in these in these key industries.
• 49:35
  SPEAKER_04: Yeah, maybe something like that for pharma is useful in the sense that it supports the aims of the pharmaceutical industry, but also countries with big pharmaceutical sectors that are more competitive and better able to sell their products worldwide.
• 49:50
  SPEAKER_01: There's a lot of what China have done over the last 15, 20 years that you have to stand back and say that makes a lot of sense and that's very impressive.
• 49:59
  SPEAKER_01: The problem is we can't compare like with like because they have controls over areas that we have no controls.
• 50:06
  SPEAKER_01: They have a workforce base that cost a tenth of what we're charging.
• 50:11
  SPEAKER_01: But also, I'm old enough to remember when a lot of the nationalised industries in the UK were privatized.
• 50:18
  SPEAKER_01: And they were privatized because most of them didn't work very well.
• 50:22
  SPEAKER_01: Now, did they work better or worse than they do today?
• 50:26
  SPEAKER_01: Different people have a different view on that, and there are many things that people would like to see nationalized again.
• 50:31
  SPEAKER_01: But no, no one solution is the answer.
• 50:34
  SPEAKER_01: You need nationalized and privatized to work together in the same way that you need pharma and biotech to work together, in the way that you need sponsors and CROs to work together in a way that is much more of an aligned partnership than it is today.
• 50:53
  SPEAKER_01: And I think there are just too many aspects where it's an either-or choice where that should not even be a consideration.
• 51:00
  SPEAKER_03: That's a great point.
• 51:02
  SPEAKER_03: I love how we really moved into like the big structural questions in our industry.
• 51:06
  SPEAKER_03: This is phenomenal.
• 51:08
  SPEAKER_01: Isn't it amaz it's amazing that we've we've just said everything we need to say about what China have done in the last 20 years in two minutes?
• 51:15
  SPEAKER_04: There we go.
• 51:16
  SPEAKER_04: Embarrassingly, what we also have done along the way is lose track of the patients.
• 51:20
  SPEAKER_04: So uh maybe we're also falling into the same trap.
• 51:22
  SPEAKER_01: I don't think we really have, because I think all of these things that we talk about and we're chatting about are changes that ultimately need to happen if we are going to realign with patients.
• 51:33
  SPEAKER_03: I love the irony though, with that uh in the podcast episode about patients.
• 51:38
  SPEAKER_03: We kind of lost the patients.
• 51:39
  SPEAKER_04: Yeah, but I think a lot of it is about incentives.
• 51:41
  SPEAKER_04: What incentives are in the system to deliver for patients?
• 51:44
  SPEAKER_04: I mean, that's always a gradient, a scale from one side to the other, but maybe we're too far on one side of that, the industry's too far on one side of that right now to effectively deliver for patients in the ways that are needed.
• 51:57
  SPEAKER_04: I mean, the other thing that we haven't touched on, for example, is that it's not that there aren't curative therapies out there, right?
• 52:03
  SPEAKER_04: There's a lot of cell and gene therapy stuff coming through.
• 52:06
  SPEAKER_04: But the approach that's taken to those cell and gene therapies is, well, we know this will be curative and we know it's going to save healthcare systems a lot over the extended lifetime of the patient.
• 52:16
  SPEAKER_04: So let's charge a million dollars of treatment, two million dollars of treatment.
• 52:19
  SPEAKER_04: And whereas that makes sense from an economic point of view, is that patient-oriented?
• 52:24
  SPEAKER_04: Even though you are absolutely changing those patients' lives and, you know, curing them essentially in a lot of cases.
• 52:30
  SPEAKER_01: We still have, even though, as we discussed earlier, the world of blockbusters no longer really exists, we still have a payment model that is predicated on blockbusters.
• 52:42
  SPEAKER_01: Yes.
• 52:43
  SPEAKER_01: We don't have a payment model based on that million-pound gene therapy that is going to make a difference to one patient.
• 52:50
  SPEAKER_01: And that has to change.
• 52:52
  SPEAKER_01: Because otherwise, we're effectively wasting our time developing selling gene therapy solutions to any disease if nobody's going to pay for it.
• 53:01
  SPEAKER_01: And so the whole model has to shift to adopt that because it is the way forward and it is the ultimate in personalized medicines.
• 53:08
  SPEAKER_04: Well, I'd say that's an interesting test for the industry, I think, in terms of what we've been talking about around adapting to the near future.
• 53:16
  SPEAKER_04: Because a lot of cell and gene therapy leaders now, and I think was it Tever Pharmaceutical that announced that they were backing out recently, not because the treatment doesn't work and they can't make a lot of money from it, but that the manufacturing process becomes so individualized essentially that they're really struggling to incorporate that into their organization and manufacturing stream.
• 53:39
  SPEAKER_04: Maybe that's another area where we need to get a grip on this issue and actually solve it.
• 53:42
  SPEAKER_04: I mean, not to call out Teba specifically there.
• 53:44
  SPEAKER_04: I think there's other other brands are available.
• 53:46
  SPEAKER_04: Yeah, other brands are available.
• 53:48
  SPEAKER_04: Let's let's maybe see it.
• 53:49
  SPEAKER_04: Yeah.
• 53:49
  SPEAKER_01: I think you're right.
• 53:50
  SPEAKER_01: I think there are some very big questions that are being asked and are being discussed and debated, but I don't think we have the answers to them yet.
• 53:58
  SPEAKER_01: For instance, you know, to your point, that is maybe an area where there could be a partnership between private and public.
• 54:06
  SPEAKER_01: Could the state step in and provide manufacturing capability?
• 54:11
  SPEAKER_01: Because ultimately, if you charge, I don't know, a million pounds for a treatment for a patient that is going to cure them, you may well be saving that health system 25 million pounds over the life of that patient.
• 54:23
  SPEAKER_01: Well, that's a very, very strong argument for doing it.
• 54:26
  SPEAKER_01: But it is something that we need to think about in a very different way to manufacturing 10 million pills a day.
• 54:33
  SPEAKER_03: It is an interesting conversation to have what can this state and states, especially in Europe, do to help nudge the industry towards a different kind of model?
• 54:44
  SPEAKER_03: Capitalism might not be the most ideal model for getting most health to most people.
• 54:50
  SPEAKER_03: Perhaps there is something in rearranging who sponsors what if the ultimate benefit is health of citizens.
• 54:58
  SPEAKER_01: Isn't capitalism and entrepreneurialism the way that the European states promote this?
• 55:05
  SPEAKER_01: Yes, it is.
• 55:26
  SPEAKER_03: I would agree.
• 55:26
  SPEAKER_03: We're nowhere near actually seeing that happening.
• 55:29
  SPEAKER_01: I think the challenge is, and it's very easy to forget.
• 55:31
  SPEAKER_01: I'm horribly cynical, and I will admit that, but I think it's very easy to forget that all of these pharma companies who may well be putting shareholders before patients are full of people that have the drive and the passion and the desire that we all have.
• 55:47
  SPEAKER_04: Yes.
• 55:47
  SPEAKER_04: Yeah.
• 55:47
  SPEAKER_04: Well, and I think this is it.
• 55:48
  SPEAKER_04: It's how how do we unlock that capability better?
• 55:51
  SPEAKER_04: I think it's very easy in these conversations to sound very critical.
• 55:56
  SPEAKER_04: And it's important to balance that in terms of particularly around the individuals, right?
• 56:01
  SPEAKER_04: Because there's so many people that are in this with all the best intentions trying to do the best that they want.
• 56:05
  SPEAKER_04: And it's how do we better bring that out in the system that we have?
• 56:08
  SPEAKER_01: I don't want to tarnish individuals with the brush of corporate pharma.
• 56:14
  SPEAKER_01: I think that's very unfair.
• 56:15
  SPEAKER_01: I think for some people it's perfectly fair, but for a lot of people, it's very unfair.
• 56:20
  SPEAKER_01: So, how do we get those individuals to have the, I don't know if it's the bravery or the platform or the environment to feel comfortable having that voice and pushing the patient agenda more publicly, more openly, more aggressively, more frequently in their day-to-day world.
• 56:41
  SPEAKER_04: Because it's easy for us to do.
• 56:43
  SPEAKER_04: The only thing I'd add to that is change management theory, right?
• 56:45
  SPEAKER_04: Best is bottom up and top down.
• 56:47
  SPEAKER_04: So how do we empower people from the bottom up, but also from the top down, help organizations see this patient orientation as more in their interests and balance out some of the other drivers and priorities that they have.
• 57:00
  SPEAKER_03: I will take us now to the last segment of the show.
• 57:05
  SPEAKER_03: We've lost one of our call members.
• 57:08
  SPEAKER_03: We didn't only lose sight of the patients, we also lost a whole person.
• 57:14
  SPEAKER_03: So it's just gonna be uh Alex, you and Grant in the game show round of this episode.
• 57:21
  SPEAKER_03: And I have chosen a cynical topic for us, despite us kind of navigating out of our cynicism.
• 57:28
  SPEAKER_03: I was straight back in.
• 57:29
  SPEAKER_03: Yeah, amazing.
• 57:30
  SPEAKER_03: Thanks for that.
• 57:31
  SPEAKER_03: So today's quiz is going to be focused on how much the individual company made on one of their drugs.
• 57:39
  SPEAKER_03: Well, so I'm going to ask you four questions with four different products and four different companies, and I'm going to have you guess how much that company made on that drug in 2024.
• 57:52
  SPEAKER_01: With or without the use of Google.
• 57:54
  SPEAKER_03: You will have to Google fast for this.
• 57:56
  SPEAKER_03: Yeah.
• 57:57
  SPEAKER_03: If you do it discreetly, I shall.
• 57:59
  SPEAKER_01: This sounds absolutely horrific.
• 58:01
  SPEAKER_03: Good.
• 58:01
  SPEAKER_03: We shall get right into it.
• 58:03
  SPEAKER_03: So, Alex and Grant, how much did Merck make on Key Truder in 2024?
• 58:10
  SPEAKER_03: And I will just give you a hint that this is 46% of Merck's total revenue in 2024 and that a Keytruder is a cancer treatment.
• 58:18
  SPEAKER_03: Did they make$10 billion?
• 58:20
  SPEAKER_03: Did they make$20 billion?
• 58:22
  SPEAKER_03: Or did they make$30 billion?
• 58:24
  SPEAKER_01: I'm gonna go$30.
• 58:25
  SPEAKER_03: I'll guess$20.
• 58:26
  SPEAKER_03: It is, in fact,$30 billion.
• 58:29
  SPEAKER_03: Go grant.
• 58:30
  SPEAKER_01: Okay, let's stop now.
• 58:31
  SPEAKER_01: I'm winning.
• 58:32
  SPEAKER_01: Stop.
• 58:33
  SPEAKER_03: Alright.
• 58:33
  SPEAKER_03: Then let's continue.
• 58:35
  SPEAKER_03: Next big blockbuster drug.
• 58:37
  SPEAKER_03: How much did Nobonordisk make on Azempic in 2024?
• 58:41
  SPEAKER_03: This is weight loss drug.
• 58:43
  SPEAKER_03: Was it$10 billion?
• 58:45
  SPEAKER_03: Was it$20 billion?
• 58:46
  SPEAKER_03: Or was it$30 billion?
• 58:49
  SPEAKER_04: I think 2024.
• 58:52
  SPEAKER_04: No, they were kind of still meeting their expectations in 2024.
• 58:54
  SPEAKER_04: It's 2025 they started to struggle.
• 58:56
  SPEAKER_04: Oh, I'll go 30.
• 58:57
  SPEAKER_04: Let's go big.
• 58:57
  SPEAKER_04: Go big or go home.
• 58:58
  SPEAKER_04: We're in Denmark, let's support Novo.
• 59:01
  SPEAKER_01: I'll go 20 because just agreeing is pointless.
• 59:05
  SPEAKER_04: It undermines the quiz format somewhat, yeah.
• 59:08
  SPEAKER_01: Which we could do because she's making us be cynical even though we've tried to move away from the synonym.
• 59:13
  SPEAKER_01: Yeah, yeah, yeah.
• 59:13
  SPEAKER_01: Exactly.
• 59:14
  SPEAKER_01: We could boycott.
• 59:16
  SPEAKER_03: You you you can, but grant, in fact, you win again.
• 59:19
  SPEAKER_03: It is 20 billion.
• 59:21
  SPEAKER_01: I admit to winning by default there.
• 59:24
  SPEAKER_03: Let's move on then.
• 59:25
  SPEAKER_03: Let's talk about how much Sanofi made on DuPixent in 2024, and this is an immunology drug.
• 59:34
  SPEAKER_03: And your choices are 10 billion, 15 billion, or 20 billion.
• 59:39
  SPEAKER_04: I'm gonna go for 15 billion purely on the basis that it's the first time that number has come up.
• 59:45
  SPEAKER_01: I'm gonna have 15 billion for as well.
• 59:48
  SPEAKER_01: Well, then I can't lose.
• 59:51
  SPEAKER_03: Well, my quiz-making skills are too obvious in this case.
• 59:55
  SPEAKER_03: It is in fact 15 billion.
• 59:57
  SPEAKER_01: It did seem very odd that the options suddenly changed.
• 1:00:00
  SPEAKER_04: It's also very unfair that, because that's me and Grant winning through the path of taking the lowest risk, which is everything that we've been railing against this whole episode.
• 1:00:08
  SPEAKER_04: So we're winners, but we're hypocritical winners.
• 1:00:10
  SPEAKER_04: Okay.
• 1:00:10
  SPEAKER_01: He never said I wasn't a hypocrite.
• 1:00:12
  SPEAKER_04: No, exactly.
• 1:00:13
  SPEAKER_03: Last one.
• 1:00:14
  SPEAKER_03: Okay.
• 1:00:15
  SPEAKER_03: How much did EV make on Skyrizy in 2024, which is also an immunology drug and their new flagship drug after Humira?
• 1:00:26
  SPEAKER_03: Did they make 10 billion, 15 billion?
• 1:00:29
  SPEAKER_03: There it was again.
• 1:00:30
  SPEAKER_03: Or 20 billion.
• 1:00:31
  SPEAKER_01: 20.
• 1:00:32
  SPEAKER_04: Yeah, I'm gonna stick to our principles.
• 1:00:34
  SPEAKER_04: I'm gonna take the risk.
• 1:00:35
  SPEAKER_04: I'm gonna make the hard decision.
• 1:00:36
  SPEAKER_04: I'm gonna say 20 billion as well.
• 1:00:38
  SPEAKER_03: Well, this was a trick question.
• 1:00:39
  SPEAKER_03: And actually, when I was researching this, I was surprised.
• 1:00:42
  SPEAKER_03: The correct answer is 10 billion.
• 1:00:45
  SPEAKER_04: So that's taken that's that's a real hit to my psychological safety.
• 1:00:49
  SPEAKER_04: I'm gonna be much more in my box for the remainder of the podcast episodes.
• 1:00:53
  SPEAKER_01: I'm not gonna take a risk for the rest of 2026 now.
• 1:00:59
  SPEAKER_03: There was the risk enactment.
• 1:01:03
  SPEAKER_03: Yeah.
• 1:01:03
  SPEAKER_03: All right.
• 1:01:04
  SPEAKER_03: Well, thank you for playing.
• 1:01:05
  SPEAKER_03: And I don't know whether to uh take the feedback of making the answers less obvious or not.
• 1:01:10
  SPEAKER_03: This was fun.
• 1:01:11
  SPEAKER_01: I will freely admit that at least two of those questions were absolute guesses.
• 1:01:16
  SPEAKER_01: Whereas two of them were educated guesses.
• 1:01:19
  SPEAKER_03: Great.
• 1:01:20
  SPEAKER_03: Well, I would like us to round off before we end the show.
• 1:01:23
  SPEAKER_03: And my question to you for rounding off is what was the most interesting part of this conversation for you?
• 1:01:30
  SPEAKER_03: And perhaps something that gave you an idea or something you might be mulling over the rest of the day.
• 1:01:35
  SPEAKER_01: For me, the most interesting part is that I think we are all aligned in our desire to drive change, to talk about change and to promote change, and that there is a systemic problem within pharma, but at the same time, we've all acknowledged and appreciate the fact that that's not true at an individual level, and there are many, many people in pharma who do really want to focus on patients more than anything else.
• 1:02:03
  SPEAKER_04: I think for me, where we ended up in the conversation, right?
• 1:02:07
  SPEAKER_04: We start on a conversation about how do we deliver better for patients, and then we talk about end up talking about EU industrial policy or like thereof or you know, and everything in between.
• 1:02:18
  SPEAKER_04: And I think it highlights that this is a really complicated, interconnected, and fawny issue, which is why it's it's hard because it's hard.
• 1:02:25
  SPEAKER_04: And actually, there isn't a simple switch at any individual level of influence that we can simply turn.
• 1:02:31
  SPEAKER_04: We've got to be trying to do a lot of stuff at all of these different levels to really make the difference.
• 1:02:37
  SPEAKER_04: And yeah, that became a lot clearer to me today.
• 1:02:40
  SPEAKER_01: I think the whole topic of state involvement in one kind or another is is very thought-provoking.
• 1:02:46
  SPEAKER_01: Because that's really as dramatic change as well, actually, it's more dramatic change that I could even have imagined we'd talk about today.
• 1:02:53
  SPEAKER_04: Oh no, good.
• 1:02:54
  SPEAKER_04: Well, I'm glad we managed to.
• 1:02:55
  SPEAKER_04: I positively surprised you there.
• 1:02:56
  SPEAKER_04: I think it's also more of a general topic with a lot of other things going on in the world, right?
• 1:03:00
  SPEAKER_04: I've a lot of countries are more thinking about how they make the best of the industries that they have.
• 1:03:06
  SPEAKER_04: So I think it's also a topic it's not just us, right?
• 1:03:09
  SPEAKER_04: It's a topic that's coming up more generally.
• 1:03:12
  SPEAKER_01: Yeah.
• 1:03:12
  SPEAKER_01: It's a difficult time to be having those conversations because I think that there are many, many sectors and many countries who are much more in, if you like, survival mode than change mode.
• 1:03:23
  SPEAKER_03: My takeaway, but also maybe frustration that will stay with me for a while, is that when it comes to changing the pharmaceutical industry, I really try to make it like small.
• 1:03:33
  SPEAKER_03: But I believe in this conversation we once again discovered that it is not small.
• 1:03:37
  SPEAKER_03: It is big, it's systemic, and to make actual change happen, we need to change some very big things in our society.
• 1:03:42
  SPEAKER_03: And I I find that like both true but also frustrating.
• 1:03:46
  SPEAKER_03: Because it's so much harder to actually do something about.
• 1:03:49
  SPEAKER_01: It is frustrating, and the level of frustration is proportionate to how much we care.
• 1:03:55
  SPEAKER_01: Yeah.
• 1:03:55
  SPEAKER_04: Yes.
• 1:03:56
  SPEAKER_04: I'd like to comment on uh Dimitri's dignified silence.
• 1:03:59
  SPEAKER_04: I think that's also a lesson for us all in what he took away from the call as well.
• 1:04:04
  SPEAKER_04: Well done, Dimitri.
• 1:04:07
  SPEAKER_04: No, no, no.
• 1:04:08
  SPEAKER_04: I I think the uh connection and technology problems He will be back.
• 1:04:13
  SPEAKER_04: Well, this is it.
• 1:04:14
  SPEAKER_04: Maybe this is the other change is that we've got the time to talk about it, so we're not doing it.
• 1:04:18
  SPEAKER_04: So we should probably all get our heads down and uh and make some difference.
• 1:04:21
  SPEAKER_03: That's next up.
• 1:04:22
  SPEAKER_03: Well, Rant, Alex, Dimitri, thank you so much for joining me for this conversation.
• 1:04:27
  SPEAKER_01: Pleasure.
• 1:04:28
  SPEAKER_01: I've very much enjoyed it.
• 1:04:30
  SPEAKER_01: It's been a pleasure and look forward to seeing you both soon.
• 1:04:32
  SPEAKER_03: Absolutely.
• 1:04:33
  SPEAKER_01: Thanks, Grant.
• 1:04:34
  SPEAKER_01: Take care.
• 1:04:34
  SPEAKER_01: Bye bye.